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  • 1.
    Andersson, Ulrika
    et al.
    Lund Univ, Sweden; Lund Univ, Sweden.
    Nilsson, Peter M.
    Lund Univ, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg Ctr Person Centred Care GPCC, Sweden.
    Ekholm, Mikael
    Wetterhalsan Primary Hlth Care Ctr, Sweden; Danderyd Hosp, Sweden.
    Midlov, Patrik
    Lund Univ, Sweden.
    Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study2024In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
    Abstract [en]

    Objective To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures Association between self-reported BP and 10 self-report lifestyle-related variables. Results Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.

  • 2.
    Vestala, Hanna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Midlov, Patrik
    Lund Univ, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden.
    Eldh, Ann Catrine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients living with hypertension - a randomized controlled trial in primary care2024In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
    Abstract [en]

    ObjectiveTo estimate the effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only).DesignA parallel group, non-blinded, randomized controlled trial, conducted October 2018-February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support via mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement.Setting31 primary healthcare centers in Sweden.Subjects949 patients treated for hypertension.Main outcome measuresThe effects on preference-based patient participation, that is, the match between a patient's preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression.ResultsAt baseline, 43-51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for 'managing treatment myself' at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months.ConclusionThe interactive web-based support system via mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care. Although patient participation is essential when having a long-term condition, interventions optimizing individuals' engagement have not been fully identified.About half of the patients with hypertension in this study did not experience participation in the manner and extent they preferred.A web-based support system via mobile phone improved some aspects of patient participation in the short- but not long term.Strategies to better identify patients' preferences for patient participation are needed, to evaluate and improve the outcome of care.

  • 3.
    Andersson, Ulrika
    et al.
    Lund Univ, Sweden.
    Nilsson, Peter M.
    Lund Univ, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden.
    Hoffmann, Mikael
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Wennersten, Andre
    Lund Univ, Sweden; Skane Univ Hlth Care, Sweden.
    Midlov, Patrik
    Lund Univ, Sweden.
    Examining the impact of E-health management on hypertension2023In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 41, no 11, article id 1864Article in journal (Other academic)
  • 4.
    Andersson, Ulrika
    et al.
    Lund Univ, Sweden.
    Nilsson, Peter M.
    Lund Univ, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden.
    Hoffmann, Mikael
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Wennersten, Andre
    Lund Univ, Sweden; Skane Univ Healthcare, Sweden.
    Midloev, Patrik
    Lund Univ, Sweden.
    PERson-centredness in Hypertension management using Information Technology: a randomized controlled trial in primary care2023In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 41, no 2, p. 246-253Article in journal (Refereed)
    Abstract [en]

    Objectives:To increase the proportion of individuals with hypertension obtaining a blood pressure (BP) of less than 140/90 mmHg by improving the management of hypertension in daily life from a person-centred perspective.Methods:In this unblinded randomized controlled trial, we tested an interactive web-based self-management system for hypertension. A total of 949 patients with hypertension from 31 primary healthcare centres (PHCCs) in Sweden were randomized 1 : 1 to either the intervention or usual care group. The intervention included daily measurement - via the participants mobile phone - of BP and pulse and reports of well being, symptoms, lifestyle, medication intake and side effects for eight consecutive weeks. It also included reminders and optional motivational messages. The primary outcome was the proportion of participants obtaining BP of less than 140/90 mmHg at 8 weeks and 12 months. Significance was tested by Pearsons chi(2)-test.Results:A total of 862 patients completed the trial, 442 in the intervention group and 420 in the control group. The primary outcome (BP <140/90 mmHg) at 8 weeks was achieved by 48.8% in the intervention group and 39.9% in the control group (P = 0.006). At 12 months, 47.1% (intervention) and 41.0% (control group) had a BP less than 140/90 mmHg (P = 0.071).Conclusion:The proportion of participants with a controlled BP of less than 140/90 mmHg increased after using the interactive system for self-management of hypertension for 8 weeks compared with usual care. Although the trend continued, there was no significant difference after 12 months. The results indicate that the effect of the intervention is significant, but the long-term effect is uncertain.

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  • 5.
    Andersson, Ulrika
    et al.
    Lund Univ, Sweden.
    Nilsson, Peter M.
    Lund Univ, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden.
    Harris, Katie
    Univ New South Wales, Australia.
    Chalmers, John
    Univ New South Wales, Australia.
    Ekholm, Mikael
    Danderyd Hosp, Sweden.
    Midlov, Patrik
    Lund Univ, Sweden.
    Variability in home blood pressure and its association with renal function and pulse pressure in patients with treated hypertension in primary care2023In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527Article in journal (Refereed)
    Abstract [en]

    Blood pressure variability (BPV) represents a cardiovascular risk factor, regardless of mean level of blood pressure (BP). In this post-hoc analysis from the PERson-centredness in Hypertension management using Information Technology (PERHIT) study, we aimed to explore BPV in daily home measurements in hypertensive patients from primary care, to identify factors associated with high BPV and to investigate whether estimated glomerular filtration rate (eGFR) and pulse pressure, as markers of target organ damage (TOD), are associated with BPV. For eight consecutive weeks, 454 participants reported their daily BP and heart rate in their mobile phone, along with reports of lifestyle and hypertension-related factors. Systolic BP (SBP) values were used to calculate BPV with coefficient of variation (CV) as primary estimate. Background characteristics and self-reports were tested between fifths of CV in a linear regression model, adjusted for age and sex. Associations between BPV and eGFR and pulse pressure were tested with linear and logistic regression models. Higher home BPV was associated with higher age, BP, heart rate, and smoking. BPV was lower for participants with low alcohol consumption and treatment with calcium channel blockers. There was a significant association between BPV and pulse pressure (P = 0.015), and between BPV and eGFR (P = 0.049). Participants with high BPV reported more dizziness and palpitations. In conclusion, pulse pressure and eGFR were significantly associated with home BPV. Older age, high BP, heart rate, and smoking were associated with high BPV, but treatment with calcium channel blockers and low alcohol consumption was associated with low BPV. Trial registration: The study was registered with ClinicalTrials.gov [NCT03554382].

  • 6.
    Andersson, Ulrika
    et al.
    Lund Univ, Sweden.
    Bengtsson, Ulrika
    Univ Gothenburg, Sweden; Univ Gothenburg, Sweden.
    Ranerup, Agneta
    Univ Gothenburg, Sweden.
    Midlov, Patrik
    Lund Univ, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden.
    Patients and Professionals as Partners in Hypertension Care: Qualitative Substudy of a Randomized Controlled Trial Using an Interactive Web-Based System Via Mobile Phone2021In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 23, no 6, article id e26143Article in journal (Refereed)
    Abstract [en]

    Background: The use of technology has the potential to support the patients active participation regarding treatment of hypertension. This might lead to changes in the roles of the patient and health care professional and affect the partnership between them. Objective: The aim of this qualitative study was to explore the partnership between patients and health care professionals and the roles of patients and professionals in hypertension management when using an interactive web-based system for self-management of hypertension via the patients own mobile phone. Methods: Focus group interviews were conducted with 22 patients and 15 professionals participating in a randomized controlled trial in Sweden aimed at lowering blood pressure (BP) using an interactive web-based system via mobile phones. The interviews were audiorecorded and transcribed and analyzed using thematic analysis. Results: Three themes were identified: the technology, the patient, and the professional. The technology enabled documentation of BP treatment, mainly for sharing knowledge between the patient and the professional. The patients gained increased knowledge of BP values and their relation to daily activities and treatment. They were able to narrate about their BP treatment and take a greater responsibility, inspired by new insights and motivation for lifestyle changes. Based on the patients understanding of hypertension, professionals could use the system as an educational tool and some found new ways of communicating BP treatment with patients. Some reservations were raised about using the system, that it might be too time-consuming to function in clinical practice and that too much measuring could result in stress for the patient and an increased workload for the professionals. In addition, not all professionals and patients had adopted the instructions regarding the use of the system, resulting in less realization of its potential. Conclusions: The use of the system led to the patients taking on a more active role in their BP treatment, becoming more of an expert of their BP. When using the system as intended, the professionals experienced it as a useful resource for communication regarding BP and lifestyle. Patients and professionals described a consultation on more equal grounds. The use of technology in hypertension management can promote a constructive and person-centered partnership between patient and professional. However, implementation of a new way of working should bring benefits and not be considered a burden for the professionals. To establish a successful partnership, both the patient and the professional need to be motivated toward a new way of working.

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  • 7.
    Hoffmann, Mikael
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Peter M.
    Lund Univ, Sweden.
    Ahlner, Johan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Dahllof, Bjorn
    Univ Gothenburg, Sweden.
    Fredrikson, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences.
    Saljo, Roger
    Univ Gothenburg, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Do patients or their physicians more accurately assess long-term risk associated with hypertension? A population-based study2020In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 38, no 2, p. 166-175Article in journal (Refereed)
    Abstract [en]

    Objective: To compare the assessments of 10-year probability by patients and their physicians of cardiovascular complications of hypertension with actual outcomes. Design: Patients with uncomplicated hypertension treated with at least one antihypertensive drug at inclusion were followed for 10 years through mandatory national health registers. Setting: 55 primary health care centres, 11 hospital outpatient clinics in Sweden Patients: 848 patient, 212 physicians. Main outcome measures: Patients and physicians estimated the probability of hypertension-related complications with treatment (death, heart failure, acute myocardial infarction/AMI, and stroke) for each patient in 848 pairs. Estimates were compared with the clinical outcomes 10 years later using data from the Mortality Register and the National Patient Register. Results: Patients were significantly better (p < 0.001) than their physicians in estimating the average probability of heart failure compared with actual outcome data (14% vs. 24%, outcome 15%), AMI (16% vs. 26%, outcome 8%), and stroke (15% vs. 25%, outcome 11%). Patients were significantly worse (p < 0.001) at estimating the average probability of death (10% vs. 18%, actual outcome 20%). Neither the patients nor the physicians were able to distinguish reliably between low-risk and high-risk patients after adjustment for age and sex. Conclusions: Patients were better than their physicians in estimating the average probability of morbidity due to hypertension. Both the patients and their attending physicians had difficulty in estimating the individual patients risk of complications. The results support the use of evidence-based tools in consultations for assessing the risk of cardiovascular complications associated with hypertension.

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  • 8.
    Midlov, Patrik
    et al.
    Lund Univ, Sweden.
    Nilsson, Peter M.
    Lund Univ, Sweden.
    Bengtsson, Ulrika
    Univ Gothenburg, Sweden.
    Hoffmann, Mikael
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Wennersten, Andre
    Skane Univ Hlth Care, Sweden.
    Andersson, Ulrika
    Lund Univ, Sweden.
    Malmqvist, Ulf
    Skane Univ Hlth Care, Sweden.
    Steen Carlsson, Katarina
    Lund Univ, Sweden.
    Ranerup, Agneta
    Univ Gothenburg, Sweden.
    Kjellgren, Karin I.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden.
    PERson-centredness in hypertension management using information technology (PERHIT): a protocol for a randomised controlled trial in primary health care2020In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 29, no 3, p. 149-156Article in journal (Refereed)
    Abstract [en]

    Purpose: For primary health care (PHC), hypertension is the number one diagnosis for planned health care visits. The treatment of high blood pressure (BP) and its consequences constitutes a substantial economic burden. In spite of efficient antihypertensive medications, a low percentage of patients reach a well-controlled BP. The PERson-centredness in Hypertension management using Information Technology (PERHIT) Study is a multicentre randomised controlled trial. PERHIT is designed to evaluate the effect of supporting self-management on systolic blood pressure by the use of information technology in Swedish primary health care. Materials and Methods: After inclusion, 900 patients from 36 PHC centres are randomised to two groups. In the intervention group, patients are provided with a self-management support system including a home-BP monitor and further requested to perform self-reports and measure BP every evening for eight consecutive weeks. In the control group, patients receive treatment as usual. Results: The primary outcome will be the change in systolic blood pressure in patients with hypertension. In addition, person-centredness, daily life activities, awareness of risk and health care costs will also be evaluated. Conclusion: The results of this randomised controlled trial with assessment of blood pressure and same-day self-reports will provide patients a tool to understand the interplay between blood pressure and lifestyle applicable to primary health care. The self-management support system may be of importance for improved adherence to treatment and persistence to treatment recommendations.

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  • 9.
    Drott, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Fomichov, Victoria
    Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Starkhammar, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Kjellgren, Karin I.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Oxaliplatin-Induced Neurotoxic Side Effects and Their Impact on Daily Activities2019In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 42, no 6, p. E40-E48Article in journal (Refereed)
    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.

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  • 10.
    Hallberg, Inger
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden.
    Ranerup, Agneta
    Univ Gothenburg, Sweden.
    Bengtsson, Ulrika
    Univ Gothenburg, Sweden; Univ Gothenburg, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Univ Gothenburg, Sweden; Univ Gothenburg, Sweden.
    Experiences, expectations and challenges of an interactive mobile phone-based system to support self-management of hypertension: patients and professionals perspectives2018In: Patient Preference and Adherence, E-ISSN 1177-889X, Vol. 12, p. 467-476Article in journal (Refereed)
    Abstract [en]

    Background: A well-controlled blood pressure (BP) reduces cardiovascular complications. Patient participation in care using technology may improve the current situation of only 13.8% of adults diagnosed with hypertension worldwide having their BP under control. Objective: The objective of this study was to explore patients and professionals experiences of and expectations for an interactive mobile phone-based system to support self-management of hypertension. Methods: The self-management system consists of: 1) a mobile phone platform for self-reports, motivational messages and reminders; 2) a device for measuring BP and 3) graphical feedback of self-reports. Patients diagnosed with high BP (n=20) and their treating professionals (n=7) participated in semi-structured interviews, after 8 weeks use of the system in clinical practice. Data were analyzed thematically. Results: The self-reporting of BP, symptoms, medication use, medication side effects, lifestyle and well-being was perceived to offer insight into how daily life activities influenced BP and helped motivate a healthy lifestyle. Taking increased responsibility as a patient, by understanding factors affecting ones well-being, was reported as an enabling factor for a more effective care. Based on the experiences, some challenges were mentioned: for adoption of the system into clinical practice, professionals educational role should be extended and there should be a reorganization of care to fully benefit from technology. The patients and professionals gave examples of further improvements to the system, for example, related to the visualization of graphs from self-reports and an integration of the system into the general technical infrastructure. These challenges are important on the path to accomplishing adoption. Conclusion: The potential of a more autonomous, knowledgeable and active patient, through use of the interactive mobile system would improve outcomes of hypertension treatment, which has been desired for decades. Documentation and visualization of patients self-reports and the possibilities to communicate these with professionals may be a significant resource for person-centered care.

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  • 11.
    Drott, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Starkhammar, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Kjellgren, Karin I.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Neurotoxic Side Effects Early in the Oxaliplatin Treatment Period in Patients With Colorectal Cancer2018In: Oncology Nursing Forum, ISSN 0190-535X, E-ISSN 1538-0688, Vol. 45, no 6, p. 690-697Article in journal (Refereed)
    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.

  • 12.
    Drott, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Vilhelmsson, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Experiences with a self-reported mobile phone-based system among patients with colorectal cancer: a qualitative study2016In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 4, no 2, p. 182-190, article id e66Article in journal (Refereed)
    Abstract [en]

    Background: In cancer care, mobile phone-based systems are becoming more widely used in the assessment, monitoring, and management of side effects.

    Objective: To explore the experiences of patients with colorectal cancer on using a mobile phone-based system for reporting neurotoxic side effects.

    Methods: Eleven patients were interviewed (ages 44-68 years). A semistructured interview guide was used to perform telephone interviews. The interviews were transcribed verbatim and analyzed with qualitative content analysis.

    Results: The patients' experiences of using a mobile phone-based system were identified and constructed as: “being involved,” “pacing oneself,” and “managing the questions.” “Being involved” refers to their individual feelings. Patients were participating in their own care by being observant of the side effects they were experiencing. They were aware that the answers they gave were monitored in real time and taken into account by health care professionals when planning further treatment. “Pacing oneself” describes how the patients can have an impact on the time and place they choose to answer the questions. Answering the questionnaire was easy, and despite the substantial number of questions, it was quickly completed. “Managing the questions” pointed out that the patients needed to be observant because of the construction of the questions. They could not routinely answer all the questions. Patients understood that side effects can vary during the cycles of treatment and need to be assessed repeatedly during treatment.

    Conclusions: This mobile phone-based system reinforced the patients’ feeling of involvement in their own care. The patients were comfortable with the technology and appreciated that the system was not time consuming.

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  • 13.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska Akademin, Göteborgs universitet; Centrum för personcentrerad vård (GPCC), Sahlgrenska Akademin, Göteborgs universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska Akademin, Göteborgs universitet; Centrum för personcentrerad vård (GPCC), Sahlgrenska Akademin, Göteborgs universitet.
    Hallberg, Inger
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska Akademin, Göteborgs universitet; Centrum för personcentrerad vård (GPCC), Sahlgrenska Akademin, Göteborgs universitet.
    Lindwall, Magnus
    Centrum för personcentrerad vård (GPCC), Sahlgrenska Akademin, Göteborgs universitet; Institutionen för kost- och idrottsvetenskap, Psykologiska institutionen, Göteborgs universitet.
    Taft, Charles
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska Akademin, Göteborgs universitet; Centrum för personcentrerad vård (GPCC), Sahlgrenska Akademin, Göteborgs universitet.
    Improved blood pressure control using an interactive mobile phone support system2016In: The Journal of Clinical Hypertension, ISSN 1524-6175, E-ISSN 1751-7176, Vol. 18, no 2, p. 101-108Article in journal (Refereed)
    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.

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  • 14.
    Hallberg, Inger
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ranerup, Agneta
    Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Applied IT, University of Gothenburg, Gothenburg, Sweden.
    Kjellgren, Karin I.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Supporting the self-management of hypertension: Patients' experiences of using a mobile phone-based system2016In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 30, no 2, p. 141-146Article in journal (Refereed)
    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.

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  • 15.
    Drott, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Starkhammar, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    The trajectory of neurotoxic side effects' impact on daily life: a qualitative study2016In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 8, p. 3455-3461Article in journal (Refereed)
    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.

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  • 16.
    Drevenhorn, Eva
    et al.
    Lund University, Sweden.
    Bengtson, Ann
    University of Gothenburg, Sweden.
    Nyberg, Per
    Lund University, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. University of Gothenburg, Sweden.
    Assessment of hypertensive patients self-care agency after counseling training of nurses2015In: 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)
    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.

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  • 17.
    Berglund, Helene
    et al.
    University of Gothenburg, Sweden; Swedish Institute Health Science, Sweden.
    Hasson, Henna
    Swedish Institute Health Science, Sweden; Karolinska Institute, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. University of Gothenburg, Sweden.
    Wilhelmson, Katarina
    Swedish Institute Health Science, Sweden; University of Gothenburg, Sweden.
    Effects of a continuum of care intervention on frail older persons life satisfaction: a randomized controlled study2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 7-8, p. 1079-1090Article in journal (Refereed)
    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.

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  • 18.
    Zetterqvist, Ann
    et al.
    University of Gothenburg, Sweden.
    Aronsson, Patrik
    University of Gothenburg, Sweden.
    Hägg, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Reis, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Tobin, Gunnar
    University of Gothenburg, Sweden.
    Booth, Shirley
    University of Gothenburg, Sweden; University of Witwatersrand, South Africa.
    On the pedagogy of pharmacological communication: a study of final semester health science students2015In: BMC Medical Education, E-ISSN 1472-6920, Vol. 15Article in journal (Refereed)
    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.

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  • 19.
    Berglund, Helene
    et al.
    Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Vårdalinstitutet, The Swedish Institute for Health Sciences, Lund, Sweden.
    Blomberg, Staffan
    Department of Social Work, Lund University, Lund, Sweden; Vårdalinstitutet, The Swedish Institute for Health Sciences, Lund, Sweden.
    Dunér, Anna
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden; Vårdalinstitutet, The Swedish Institute for Health Sciences, Lund, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Organizing integrated care for older persons: strategies in Sweden during the past decade2015In: Journal of Health Organization & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 29, no 1, p. 128-151Article in journal (Refereed)
    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.

  • 20.
    Aronsson, Patrik
    et al.
    Department Pharmacology, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Booth, Shirley
    Department Pedagogical, Curricular and Professional Studies, Faculty of Education, University of Gothenburg, Gothenburg, Sweden; School of Education, University of the Witwatersrand, Johannesburg, South Africa.
    Hägg, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Zetterqvist, Ann
    Department Pedagogical, Curricular and Professional Studies, Faculty of Education, University of Gothenburg, Gothenburg, Sweden.
    Tobin, Gunnar
    Department Pharmacology, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Reis, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    The understanding of core pharmacological concepts among health care students in their final semester2015In: BMC Medical Education, E-ISSN 1472-6920, Vol. 15, no 1, article id 235Article in journal (Refereed)
    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.

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  • 21.
    Drevenhorn, Eva
    et al.
    Lund University, Sweden.
    Bengtson, Ann
    University of Gothenburg, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. University of Gothenburg, Sweden.
    To be motivated or only comply - patients views of hypertension care after consultation training for nurses2015In: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 74, no 1, p. 28-36Article in journal (Refereed)
    Abstract [en]

    Objective: This paper reports on patients perspectives on the nurse management of hypertension following consultation training, elicited as part of a randomised controlled study. Method: Telephone interviews were conducted with 16 patients in an intervention group (IG) and eight patients in a control group (CG), 3 years after nurses consultation training in primary health care. By means of a 3-day course, nurses were educated in patient centredness, Motivational Interviewing, the Stages of Change model, guidelines for cardiovascular prevention, lifestyle changes and pharmacological treatment. In addition, they took part in video-recorded consultation training with simulated patients. A specially designed educational booklet was developed for patients in the IG. Results: Of the 16 patients in the IG, 13 reported that their views and former experiences were taken into account and all eight patients in the CG reported the same. Patients in the IG reported that the nurse listened and they had been guided and motivated to perform lifestyle changes. The booklet in the IG was reported to have been read several times, but a few patients did not remember receiving it. There were more informed thoughts about how to manage lifestyle in the IG. Patients in the CG were less detailed in their descriptions. Conclusion: Patients in both IG and CG reported to have made efforts to change lifestyle, and patients in the IG reported that they had been coached and motivated by their nurses to do so.

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  • 22.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien, Göteborg.
    Kjellgren, Karina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien, Göteborg.
    Hallberg, Inger
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien, Göteborg.
    Lindwall, Magnus
    Institutionen för kost- och idrottsvetenskap, Göteborgs Universitet.
    Taft, Charles
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg.
    Blood pressure decrease with a mobile phone-based system to support self-management2014Conference paper (Other academic)
  • 23.
    Berglund, Helene
    et al.
    Sahlgrenska Academy at the University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Dunér, Anna
    University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Blomberg, Staffan
    Lund University, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Care planning at home: a way to increase the influence of older people?2014Conference paper (Refereed)
  • 24.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg, Centrum för personcentrerad vård, Göteborgs universitet.
    Kasperowski, Dick
    Institutionen för filosofi, lingvistik och vetenskapsteori, Göteborgs Universitet.
    Ring, Lena
    Centrum för forsknings- och bioetik, Uppsala Universitet, Läkemedelsverket, Uppsala.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg, Centrum för personcentrerad vård, Göteborgs Universitet.
    Developing an interactive mobile phone self-report system for self-management of hypertension. Part 1: Patient and professional perspectives2014In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 23, no 5, p. 288-295Article in journal (Refereed)
    Abstract [en]

    Low adherence remains a struggle in hypertension management, despite improvement efforts. Presuming that increased patient participation is a possible approach, we collaborated with patients and healthcare professionals to design a self-report system to support self-management. The study aimed to explore and describe relevant aspects of hypertension and hypertension treatment, for use in the development of an interactive mobile phone self-report system. It further aimed to suggest which clinical measures, lifestyle measures, symptoms and side-effects of treatment would be meaningful to include in such a system. Five focus group interviews were performed with 15 patients and 12 healthcare professionals, and data was analysed using thematic analysis. Patients suggested trust, a good relationship with caregivers, and well-being as important aspects of hypertension self-management. Furthermore, they regarded blood pressure, dizziness, stress, headache and tiredness as important outcomes to include. Patients sought to understand interconnections between symptoms and variations in blood pressure, whilst healthcare professionals doubted patients’ ability to do so. Healthcare professionals emphasized accessibility, clear and consistent counselling, complication prevention and educational efforts. The study presents aspects of importance for follow-up to understand the interplay between blood pressure and daily life experiences for patients with hypertension.

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  • 25.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg, Centrum för personcentrerad vård, Göteborgs universitet.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg, Centrum för personcentrerad vård, Göteborgs universitet.
    Höfer, Stefan
    Innsbruck Medical University, Department of medical psychology, Innsbruck, Austria.
    Taft, Charles
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien Göteborg.
    Ring, Lena
    Centrum för forsknings- & bioetik, Uppsala Universitet, Läkemedelsverket, Uppsala.
    Developing an interactive mobile phone self-report system for self-management of hypertension. Part 2: Content validity and usability2014In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 23, no 5, p. 296-306Article in journal (Refereed)
    Abstract [en]

    Self-management support tools using technology may improve adherence to hypertension treatment. There is a need for user-friendly tools facilitating patients’ understanding of the interconnections between blood pressure, wellbeing and lifestyle. This study aimed to examine comprehension, comprehensiveness and relevance of items, and further to evaluate the usability and reliability of an interactive hypertension-specific mobile phone self-report system. Areas important in supporting self-management and candidate items were derived from five focus group interviews with patients and healthcare professionals (n = 27), supplemented by a literature review. Items and response formats were drafted to meet specifications for mobile phone administration and were integrated into a mobile phone data-capture system. Content validity and usability were assessed iteratively in four rounds of cognitive interviews with patients (n = 21) and healthcare professionals (n = 4). Reliability was examined using a test–retest. Focus group analyses yielded six areas covered by 16 items. The cognitive interviews showed satisfactory item comprehension, relevance and coverage; however, one item was added. The mobile phone self-report system was reliable and perceived easy to use. The mobile phone self-report system appears efficiently to capture information relevant in patients’ self-management of hypertension. Future studies need to evaluate the effectiveness of this tool in improving self-management of hypertension in clinical practice.

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  • 26.
    Drevenhorn, Eva
    et al.
    Institutionen för hälsovetenskaper, Lunds Universitet.
    Bengtson, Ann
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien, Göteborgs Universitet.
    Nyberg, Per
    Institutionen för hälsovetenskaper, Lunds Universitet.
    Kjellgren, Karin I.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademien, Göteborgs Universitet.
    Effects on hypertensive patients' satisfaction with information about their medication after nurses' consultation training2014In: Pragmatic and Observational Research, ISSN 1179-7266, Vol. 5, p. 35-41Article in journal (Refereed)
    Abstract [en]

    Background: There is a well-known problem in hypertension care with patients' adherence to treatment. Patients who score high in answering the instrument Satisfaction with Information about Medicine Scale are reported to have greater adherence to their medication.

    Aim: To explore how hypertensive patients' satisfaction with information about their medicines was affected by nurses' education in Motivational Interviewing.

    Material and methods: The Stages of Change model and Motivational Interviewing was the theoretical base for consultation training for nurses. Nineteen nurses attended 3 days of video-recorded consultation training with simulated patients. They were updated in hypertensive medication and were trained in motivating patients to improve their self-management as well as adherence to lifestyle changes and medication. The satisfaction with information instrument identifies patients' satisfaction with information about the action and usage of medication as well as potential problems with it. The instrument was used to assess how well the needs of individual patients for medicine information were met at baseline and 2 years after the training. The 19 trained nurses in the intervention group worked with 137 patients, and a control group of 16 nurses, who gave normal care, worked with 51 patients.

    Results: There was a difference between the intervention and control group in total score (P=0.028) 2 years after the intervention. Patients in the intervention group perceived higher satisfaction with the action and usage of their medication (P=0.001) and a lower degree of potential problems with their medication (P=0.001). Patients in the control group also perceived a lower degree of potential problems with their medication (P=0.028).

    Conclusion: We suggest that consultation training for nurses with the aim of motivating patients to be more self-directed in their self-care improves satisfaction with information about medication.

  • 27.
    Berglund, Helene
    et al.
    Sahlgrenska Academy at the University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Dunér, Anna
    (University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Organizing integrated care for older persons: strategies in Sweden2014Conference paper (Other academic)
  • 28.
    Hallberg, Inger
    et al.
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet, Centrum för personcentrerad vård, Sahlgrenska akademin, Göteborgs Universitet.
    Taft, Charles
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet, Centrum för personcentrerad vård, Sahlgrenska akademin, Göteborgs Universitet.
    Ranerup, Agneta
    Avdelningen för informatik, Göteborgs Universitet, Centrum för personcentrerad vård, Sahlgrenska akademin, Göteborgs Universitet.
    Bengtsson, Ulrika
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet, Centrum för personcentrerad vård, Sahlgrenska akademin, Göteborgs Universitet.
    Hoffman, Mikael
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Stiftelsen NEPI, Linköping .
    Höfer, Stefan
    Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria.
    Kasperowski, Dick
    Institutionen för filosofi, lingvistik och vetenskapsteori, Göteborgs Universitet.
    Mäkitalo, Åsa
    Institutionen för pedagogik, kommunikation och lärande, Göteborgs Universitet.
    Lundin, Mona
    Institutionen för pedagogik, kommunikation och lärande, Göteborgs Universitet.
    Ring, Lena
    Centrum för forsknings- och bioetik, Uppsala Universitet, Enheten för läkemedelsanvändning, Läkemedelsverket, Uppsala.
    Rosenqvist, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Kjellgren, Karin I
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet, Centrum för personcentrerad vård, Sahlgrenska akademin, Göteborgs Universitet.
    Phases in development of an interactive mobile phone-based system to support self-management of hypertension2014In: Integrated Blood Pressure Control, E-ISSN 1178-7104, Vol. 7, p. 19-28Article in journal (Refereed)
    Abstract [en]

    Hypertension is a significant risk factor for heart disease and stroke worldwide. Effective treatment regimens exist; however, treatment adherence rates are poor (30%–50%). Improving self-management may be a way to increase adherence to treatment. The purpose of this paper is to describe the phases in the development and preliminary evaluation of an interactive mobile phone-based system aimed at supporting patients in self-managing their hypertension. A person-centered and participatory framework emphasizing patient involvement was used. An interdisciplinary group of researchers, patients with hypertension, and health care professionals who were specialized in hypertension care designed and developed a set of questions and motivational messages for use in an interactive mobile phone-based system. Guided by the US Food and Drug Administration framework for the development of patient-reported outcome measures, the development and evaluation process comprised three major development phases (1, defining; 2, adjusting; 3, confirming the conceptual framework and delivery system) and two evaluation and refinement phases (4, collecting, analyzing, interpreting data; 5, evaluating the self-management system in clinical practice). Evaluation of new mobile health systems in a structured manner is important to understand how various factors affect the development process from both a technical and human perspective. Forthcoming analyses will evaluate the effectiveness and utility of the mobile phone-based system in supporting the self-management of hypertension.

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  • 29.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Ring, Lena
    Uppsala universitet.
    Hallberg, Inger
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Development of a mobile phone self-report system for persons with hypertension: focus group interviews with patients and providers2013Conference paper (Other academic)
  • 30.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Ring, Lena
    Uppsala universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Hallberg, Inger
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Development of a mobile phone self-report system for persons with hypertension: focus group interviews with patients and providers2013Conference paper (Other academic)
    Abstract [en]

    Introduction: Hypertension is a risk factor for cardiovascular disease for which poor adherence to therapy becomes a substantial threat to health. Major efforts have been made to explore reasons for poor adherence but few successful interventions have been designed. There is a need for effective strategies designed to facilitate an increased understanding for the complexity of hypertension and treatment by strengthening of patient participation as well as patient empowerment. Purpose / Methods: The aim of this study was to explore and describe relevant aspects of hypertension and hypertension treatment, from the perspective of persons with hypertension and health care providers. Focus group interviews were performed with 15 persons with hypertension and 12 health care providers and analysed according to thematic analysis. Results: Persons with hypertension perceived trust, relationship to providers, well-being and prevention of complications as important aspects of hypertension care. Further they sought to understand the interplay between symptoms and variation of blood pressure. The providers emphasised accessibility, clear and consistent counselling, prevention of complications and educational efforts but doubted patients’ ability to be participating partners in care. Conclusion: The study presents aspects that persons with hypertension and health care providers deem important in hypertension management. Our finding provides input for future outcome measures, such as self-reports and may serve as a foundation for the development of a self-report system for persons with hypertension. They may further facilitate patient empowerment by increasing the understanding of hypertension and its’ treatment, from a person-centred perspective.

  • 31.
    Reis, Margareta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences.
    Aronsson, Patrik
    Sahlgrenska akademien, Göteborgs universitet.
    Booth, Shirley
    Göteborgs universitet.
    Hägg, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Pharmacology.
    Tobin, Gunnar
    Sahlgrenska akademien, Göteborgs universitet.
    Zetterqvist, Ann
    Göteborgs universitet.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Lättare för studenter att återge fakta än att dra egna slutsatser2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 48, p. 2156-2157Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Artikelförfattarna har genomfört en pedagogisk hypotesgenererande studie om de medicinska utbildningarna. Deras slutsats är att studenterna behöver bättre förutsättningar för att tillägna sig kunskaper, färdigheter och förhållningssätt i ämnen som anatomi, fysiologi och farmakologi.

  • 32.
    Berglund, Helene
    et al.
    University of Gothenburg, Sweden .
    Wilhelmson, Katarina
    Swedish Institute Health Science, Sweden .
    Blomberg, Staffan
    Swedish Institute Health Science, Sweden .
    Duner, Anna
    Swedish Institute Health Science, Sweden .
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. University of Gothenburg, Sweden .
    Hasson, Henna
    Swedish Institute Health Science, Sweden .
    Older people's views of quality of care: a randomised controlled study of continuum of care2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 19-20, p. 2934-2944Article in journal (Refereed)
    Abstract [en]

    Aims and objectives To analyse frail older peoples views of quality of care when receiving a comprehensive continuum of care intervention, compared with those of people receiving the usual care (control group). The intervention included early geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older peoples own homes. less thanbrgreater than less thanbrgreater thanBackground Prior studies indicate that tailored/individualised care planning conducted by a case manager/coordinator often led to greater satisfaction with care planning among older people. However, there is no obvious evidence of any effects of continuum of care interventions on older peoples views of quality of care. less thanbrgreater than less thanbrgreater thanDesign Randomised controlled study. less thanbrgreater than less thanbrgreater thanMethods Items based on a validated questionnaire were used in face-to-face interviews to assess older peoples views of quality of care at three, six and 12months after baseline. less thanbrgreater than less thanbrgreater thanResults Older people receiving a comprehensive continuum of care intervention perceived higher quality of care on items about care planning (p0005), compared with those receiving the usual care. In addition, they had increased knowledge of whom to contact about care/service, after three and 12months (pandlt;003). less thanbrgreater than less thanbrgreater thanConclusions The study gives evidence of the advantages of a combination of components such as organising care-planning meetings in older peoples own homes, case management and interprofessional teamwork. less thanbrgreater than less thanbrgreater thanRelevance to clinical practice The results have implications for policymakers, managers and professionals in the area of health and social care for older people to meet individual needs of frail older people.

  • 33.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Postoperative recovery from the perspective of day surgery patients: A phenomenographic study2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 12, p. 1630-1638Article in journal (Refereed)
    Abstract [en]

    Background: Today, many patients undergo surgical procedures in a day surgery setting. The shift from inpatient care to care at the patient’s own home following discharge places various demands on patients and their families during the recovery process. There is a need for knowledge of how the postoperative recovery process is perceived, as research indicates a lack of support for patients managing recovery at home.

    Objectives: To explore day surgery patients’ perceptions of postoperative recovery.

    Design: A qualitative design with a phenomenographic approach was used.

    Methods and settings: Semi-structured interviews with 31 patients undergoing an orthopaedic, general or urologic day surgical procedure were carried out face-to-face at the patients’ homes, 11-37 days post-discharge. Patients were recruited from two day surgery settings: one private unit and one unit associated with a local county hospital.

    Results: The patients perceived postoperative recovery as comprising internal and external prerequisites and implied changes in ordinary life with varying levels of support. The organization at the day surgery unit, with its advantages and disadvantages, was perceived as having an impact on the subsequent recovery trajectory. The results are demonstrated in three descriptive categories: ‘Conditions for recovery at home’, The rollback to ordinary life’ and ‘Being a cog in a flow of care’.

    Conclusions: Postoperative recovery following day surgery implies, from the patients’ perspective, a migration from being a recipient of care at the day surgery unit to playing an active role, with extensive responsibility at home. To manage self-care confidently, postdischarge patients require knowledge and understanding of what constitutes the normal range in recovery following their specific surgical procedure.

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  • 34.
    Bengtsson, Ulrika
    et al.
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Hallberg, Inger
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Aspects of hypertension - a multi-perspective approach on the way towards adherence and self-management2012Conference paper (Other academic)
    Abstract [en]

    Hypertension is a long lasting condition for which a poor adherence to therapy becomes a substantial threat to the individual and public health. Major efforts have been made to explore reasons for poor adherence but few successful interventions have been designed. There is a need for effective strategies tailored for the unique needs of persons with hypertension. We set out to explore and describe relevant aspects of hypertension and hypertension treatment, from the perspective of persons with hypertension and health care providers. Focus group interviews were performed with 12 persons with hypertension and 15 health care providers and analysed according to thematic analysis. Persons with hypertension perceived trust, relationship to providers, well-being and prevention of complications as important aspects of hypertension care. Further they sought to understand the interplay between symptoms and variation of blood pressure. The providers emphasised accessibility, clear and consistent counselling, prevention of complications and educational efforts but doubted patients’ ability to be participating partners in care. The study presents aspects that persons with hypertension and health care providers deem important in hypertension self-management. Our findings provide input for future outcome measures and may increase the understanding of hypertension and treatment from a person-centred perspective.

  • 35.
    Berglund, Helene
    et al.
    Sahlgrenska Academy at the University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Duner, Anna
    University of Gothenburg, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Blomberg, Staffan
    Lund University, Sweden; Vårdalinstitutet, Swedish Institute for Health Sciences, Lund, Sweden.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Care planning at home: a way to increase the influence of older people?2012In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 12Article in journal (Refereed)
    Abstract [en]

    Introduction: Care-planning meetings represent a common method of needs assessment and decision-making practices in elderly care. Older peoples influence is an important and required aspect of these practices. This studys objective was to describe and analyse older peoples influence on care-planning meetings at home and in hospital. Methods: Ten care-planning meetings were audio-recorded in the older peoples homes and nine were recorded in hospital. The study is part of a project including a comprehensive continuum-of-care model. A qualitative content analysis was performed. Results: Care-planning meetings at home appeared to enable older peoples involvement in the discussions. Fewer people participated in the meetings at home and there was less parallel talking. Unrelated to the place of the care-planning meeting, the older people were able to influence concerns relating to the amount of care/service and the choice of provider. However, they were not able to influence the way the help should be provided or organised. Conclusion: Planning care at home indicated an increase in involvement on the part of the older people, but this does not appear to be enough to obtain any real influence. Our findings call for attention to be paid to older peoples opportunities to receive care and services according to their individual needs and their potential for influencing their day-to-day provision of care and service.

  • 36.
    Drevenhorn, Eva
    et al.
    Lund University, Sweden .
    Bengtson, Ann
    University of Gothenburg, Sweden .
    Nilsson, Peter M
    Lund University, Sweden .
    Nyberg, Per
    Lund University, Sweden .
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Consultation training of nurses for cardiovascular prevention - A randomized study of 2 years duration2012In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 21, no 5, p. 293-299Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to increase patients adherence to the treatment of hypertension through the consultation training of nurses. Thirty-three nurses were included in the study. In the intervention group (IG), 19 nurses took part in a 3-day residential training course on the Stages of Change model, Motivational Interviewing and guidelines for cardiovascular prevention, and recruited 153 patients. Sixteen nurses in the control group (CG) recruited 59 patients. A decrease in systolic and diastolic blood pressure and total cholesterol was noticed in both groups over the 2 years. Heart rate (p = 0.027), body mass index (p = 0.019), weight (p = 0.0001), waist (p = 0.041), low-density lipoprotein-cholesterol (p = 0.0001), the waist-hip ratio (p = 0.024), and perceived stress (p = 0.001) decreased to any great extent only in the IG. After 2 years, 52.6% of the patients in the IG (p = 0.13) reached the target of andlt;= 140/90 mmHg in blood pressure compared with 39.2% in the CG. For self-reported physical activity, there was a significant (p = 0.021) difference between the groups. The beneficial effects of the consultation training on patients weight parameters, physical activity, perceived stress and the proportion of patients who achieved blood pressure control emphasize consultation training and the use of behavioural models in motivating patients to adhere to treatment.

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  • 37.
    Magnusson, Maria B
    et al.
    University of Gothenburg, Sweden Primary Health Care Clin Angered, Sweden .
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Winkvist, Anna
    Sahlgrenska Academy, Sweden .
    Enabling overweight children to improve their food and exercise habits - school nurses counselling in multilingual settings2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 17-18, p. 2452-2460Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. The study aimed at analysing school nurses counselling of overweight and obese children in settings with many immigrants, focusing on content concerning food and physical activity and how this was communicated. Background. For people with a predisposition for overweight, the weight control process requires cognitive skills. School nurses counselling of overweight children has the potential to support this process by enabling personal resources in the children and their families. However, there is uncertainty among nurses about how to conduct supportive counselling. Design. An explorative design was used when collecting and analysing data. Method. Twenty-two counselling sessions between eight school nurses and 20 overweight children were audio-recorded and analysed using qualitative content analysis. Most of the participating schools represented areas with low socioeconomic status and a high proportion of immigrants and refugees. Results. Less adequate skills in enabling resources in the children and their parents were observed. Concurrently, school nurses provided inadequate explanations about food and physical activity. Topics related to general nutrition models were frequently communicated as general advice instead of individually tailored counselling. Counselling families with other languages and food cultures than the traditional Swedish created additional difficulties. Conclusions. Improved nutritional knowledge for nurses may enhance their skills in enabling childrens and families resources. School nurses should be provided with opportunities to cooperate with other professions in counteracting overweight. Relevance to clinical practice. Our findings demonstrate a relationship between content skills and person-centeredness in the counselling. This highlights the importance of inter-professional collaboration to ensure a high quality of lifestyle counselling. School health authorities should give high priority to facilitating school nurses evidence-based continuing education.

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  • 38.
    Brink, Eva
    et al.
    Inst. of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg; Centre for Person-Centred Care, University of Gothenburg; Dept of Nursing, Health and Culture, University West, Trollhättan.
    Alsén, Pia
    Dept of Nursing, Health and Culture, University West, Trollhättan.
    Herlitz, Johan
    School of Health Sciences, University of Borås; Inst. of Medicine, Sahlgrenska University Hospital, Gothenburg.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Cliffordson, Christina
    Dept of Nursing, Health and Culture, University West, Trollhättan.
    General self-efficiacy and health-related quality of life after myocardial infarction2012In: Psychology, Health & Medicine, ISSN 1354-8506, E-ISSN 1465-3966, Vol. 17, no 3, p. 346-355Article in journal (Refereed)
    Abstract [en]

    Fatigue after myocardial infarction (MI) has been found to be distressing. A person's self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.

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  • 39.
    Ranerup, Agneta
    et al.
    Institutionen för tillämpad informationsteknologi, Göteborgs Universitet.
    Hallberg, Inger
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Bengtsson, Ulrika
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Mastery and autonomy in medication with a mobile self-report system: a project in action2012In: Persuasive 2012: Design for Health and Safety, 2012Conference paper (Refereed)
    Abstract [en]

    The overall aim of this research program is to design and examine if a mobile phone-based self-report system can be used to a) mediate knowledge about hypertension b) improve adherence to antihypertensive treatment and c) increase patient participation and autonomy

  • 40.
    Hallberg, Inger
    et al.
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Bengtsson, Ulrika
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa & Centrum för personcentrerad vård (GPCC), Göteborgs Universitet.
    Patientmedverkan i behandling av högt blodtryck med hjälp av mobiltelefon2012Conference paper (Other academic)
  • 41.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Postoperative recovery and its association with health-related quality of life among day surgery patients2012In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 11, no 24Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first Postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe Postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between Postoperative recovery and healthrelated quality of life 30 days after discharge.

    METHODS: A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery recovery scale and the quality of recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate Postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between Postoperative recovery and health-related quality of life.

    RESULTS: Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower Postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).

    CONCLUSION: Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.

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  • 42.
    Magnusson, Maria B.
    et al.
    Sahlgrenska Akademien, Göteborgs Universitet.
    Sjöberg, Agneta
    Sahlgrenska Akademien, Göteborgs Universitet.
    Kjellgren, Karin I.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lissner, Lauren
    Sahlgrenska Akademien, Göteborgs Universitet.
    Childhood obesity and prevention in different socio-economic contexts2011In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 53, no 6, p. 402-407Article in journal (Refereed)
    Abstract [en]

    Objective

    To assess recent trends in obesity, health beliefs, and lifestyles in Swedish schoolchildren, with focus on socioeconomic disparities.

    Method

    The study was conducted in two areas with high and low socioeconomic status (SES). 340 11–12 year olds participated in three cross-sectional surveys assessing food-related behaviours, physical activity and health beliefs, together with anthropometric examinations. Comparisons were made before and after a community-based intervention (2003 versus 2008) within the low-SES school, and between the low and high-SES school (2008 only).

    Results

    In the low-SES school BMI z-score decreased over 5 years (0.80 vs 0.46) as did the percentage of children frequently consuming sweet drinks (43.5 vs 26.8%), statistically significant in girls only (p < 0.05). Children increasingly perceived benefits of healthy life-styles (37 vs 55%). In 2008, consumption of breakfast, vegetables, sweets and sweet drinks differed between schools, as did screen-time and physical activity, all in favour of the high SES-school where the obesity-prevalence was significantly lower (0.8 vs 6.7%).

    Conclusion

    Positive changes in diet and weight status were observed, especially in girls, within a low-income multi-ethnic community undergoing a health promotion intervention. Our results underscore the multifactorial etiology of childhood obesity and the importance of continuing tailored, gender-sensitive prevention efforts.

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  • 43.
    Ekman, Inger
    et al.
    University of Gothenburg.
    Swedberg, Karl
    University of Gothenburg.
    Taft, Charles
    University of Gothenburg.
    Lindseth, Anders
    University of Gothenburg.
    Norberg, Astrid
    University of Gothenburg.
    Brink, Eva
    University of Gothenburg.
    Carlsson, Jane
    University of Gothenburg.
    Dahlin-Ivanoff, Synneve
    University of Gothenburg.
    Johansson, Inga-Lill
    University of Gothenburg.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Liden, Eva
    University of Gothenburg.
    Ohlen, Joakim
    University of Gothenburg.
    Olsson, Lars-Eric
    University of Gothenburg.
    Rosen, Henrik
    University of Gothenburg.
    Rydmark, Martin
    University of Gothenburg.
    Stibrant Sunnerhagen, Katharina
    University of Gothenburg.
    Person-centered care - Ready for prime time2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 4, p. 248-251Article in journal (Refereed)
    Abstract [en]

    Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.

  • 44.
    Janson Fagring, A.
    et al.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Lappas, G.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Welin, C.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Manhem, K.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Rosengren, A.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Twenty-year trends in incidence and 1-year mortality in Swedish patients hospitalised with non-AMI chest pain. Data from 1987-2006 from the Swedish hospital and death registries2010In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 96, no 13, p. 1043-1049Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To study trends for 20 years in incidence and 1-year mortality in hospitalised patients who received a diagnosis of either angina or unexplained chest pain (UCP) in Sweden.

    DESIGN AND SETTING:

    Register study of all patients aged 25-84 years identified from the Swedish National Hospital Discharge Register who were hospitalised with a first-time diagnosis of UCP or angina pectoris during 1987 to 2006.

    PARTICIPANTS:

    A total of 378 454 patients, 235 855 with UCP and 142 599 with angina.

    MAIN OUTCOME MEASURES:

    1-Year mortality and standardised mortality ratios (SMRs).

    RESULTS:

    From the period 1987-1991 to 2002-2006, the observed 1-year mortality rate in men and women with UCP aged 25-74 years decreased from 2.19% to 1.45% and from 1.85% to 0.91%, respectively. SMRs decreased from 1.67 (95% CI 1.39 to 1.95) and 1.63 (1.27 to 2.00) to 1.09 (0.96 to 1.23) and 0.88 (0.75 to 1.00). Corresponding decreases in 1-year mortality for a discharge diagnosis of angina were from 6.50% to 2.49% in men and from 4.80% to 1.68% in women, with SMRs decreasing from 2.69 (2.33-3.05) and 2.59 (2.06-3.12) to 1.09 (0.93-1.25) and 1.05 (0.81-1.29), respectively. Similar changes occurred in patients aged 75-84 years. Only men with UCP aged 75-84 years still retained a slightly increased mortality (SMR 1.14 (1.01-1.28)).

    CONCLUSIONS:

    The prognosis of patients admitted with chest pain in which acute myocardial infarction has been ruled out has improved for the past 20 years, such that the 1-year mortality of these patients is now similar to that in the general population.

  • 45.
    Drevenhorn, E
    et al.
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet.
    Bengtson, A
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet.
    Kjellgren, Karin
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet.
    Evaluation of consultation training in hypertension care2009In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 8, no 5, p. 349-354Article in journal (Refereed)
    Abstract [en]

    Background: Nurses in hypertension care play an important role in minimising the risk factors for cardiovascular diseases, but this care can be improved.

    Aim: To evaluate the content of nurses' consultations with hypertensive patients before and after consultation training.

    Methods: Nineteen nurses from a randomised study of nurse-led hypertension clinics at health centres received three days of residential training in patient-centred counselling and cardiovascular prevention. To assess the result, two consultations with hypertensive patients in clinical practice before and after the training were audio-recorded. Content analysis was used for the analysis.

    Results: Diet and exercise were the most frequent topics in the consultations both before and after the training. Discussions about alcohol and the patient's responsibility for treatment increased after the training. The time spent talking about various issues, other health problems, history and appointment scheduling decreased in the consultations after the training.

    Conclusion: After the consultation training, the nurses succeeded in emphasising important issues for risk factor control to a greater extent.

  • 46.
    Magnusson, MB
    et al.
    Sahlgrenska Academy, University of Gothenburg, Sweden..
    Hulthén, L
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Misunderstandings in multilingual counselling settings involving school nurses and obese/overweight pupils2009In: Communication & Medicine: An Interdisciplinary Journal of Healthcare, Ethics and Society, ISSN 1612-1783, E-ISSN 1613-3625, Vol. 6, no 2, p. 153-164Article in journal (Refereed)
    Abstract [en]

    School nurses' counselling is pivotal in stemming the obesity epidemic. Barriers for good counselling such as nurses' misunderstandings and ambiguities when relating to overweight and obesity need to be addressed. In this study, we explored misunderstandings in school nurses' counselling of overweight pupils in multilingual settings, together with how school nurses talk about the condition. Counselling sessions involving eight nurses and 20 pupils (aged 8-16 years) were audio-recorded and analysed using theme-oriented discourse analysis. Statistical methods were used as a complement. The focal themes were misunderstandings and nurses' talk about overweight and obesity. Analytical themes were framing, footing and facework. Data analyses revealed three main origins of misunderstandings occurring in school nurses' counselling of obese and overweight pupils: (1) nurses' illusion that they know what advice the pupils need; (2) nurses' insensitivity to the pupils' and parents' concerns; and (3) lack of lingual understanding. School nurses' apparent difficulties to talk about overweight and obesity suggest a need to reflect on how to name these issues during counselling. School nurses' dominance and pupils'passivity were obvious. We suggest that counselling should be regarded as learning contexts and be subjected to possible quality assurance in the future.

  • 47.
    Journath, G.
    et al.
    Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Hellénius, M-L
    Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Manhem, K.
    Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Nilsson, P. M.
    Lund University, University Hospital, Malmö, Sweden.
    Association of physician's sex with risk factor control in treated hypertensive patients from Swedish primary healthcare2008In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 26, no 10, p. 2050-2056Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To study the association of physician's sex with blood pressure, lipid control, and cardiovascular risk factors in treated hypertensive men and women, stratified for the sex of their physician.

    METHODS:

    In a cross-sectional survey of hypertensive patients, 264 primary care physicians (PCPs), 187 men and 77 women from across Sweden, recruited 6537 treated hypertensive patients (48% men) during 2002-2005, consecutively collected from medical records and registered on a web-based form connected to a central database. Patients were included consecutively in the same order as they visited the healthcare centre.

    RESULTS:

    Hypertensive women more often reached target systolic/diastolic blood pressure levels (<140/90 mmHg) when treated by female PCPs than when they were treated by male PCPs (32 vs. 24%, P < 0.001). This difference remained when comparing female and male physicians' nondiabetic female patients. Both male and female patients had better control of total cholesterol and low-density lipoprotein cholesterol levels when treated by female PCPs than when treated by male PCPs (total cholesterol <5 mmol/l: women 30 vs. 24%, P < 0.001; men 42 vs. 34%, P < 0.001; low-density lipoprotein cholesterol <3 mmol/l: women 39 vs. 33%, P < 0.01; men 41 vs. 35%, P < 0.05). Female PCPs had a higher proportion of treated hypertensive patients with diabetes than did male PCPs but male PCPs had a higher prevalence of treated hypertensive men with microalbuminuria compared with female PCPs.

    CONCLUSION:

    Female physicians appeared more often to reach the treatment goal for blood pressure in female patients and cholesterol levels in all patients than did male physicians.

  • 48.
    Jansson Fagring, A.
    et al.
    IThe Sahlgrenska Academy, Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Rosengren, A.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Lissner, L.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Manhem, K.
    Sahlgrenska University Hospital/Mölndal, Göteborg, Sweden .
    Welin, C.
    Sahlgrenska University Hospital/Mölndal, Göteborg, Sweden .
    Depression, anxiety, stress, social interaction and health-related quality of life in men and women with unexplained chest pain2008In: BMC Public Health, E-ISSN 1471-2458, Vol. 8, p. 165-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Unexplained chest pain (UCP) is a common reason for emergency hospital admission and generates considerable health-care costs for society. Even though prior research indicates that psychological problems and impaired quality of life are common among UCP patients, there is lack of knowledge comparing UCP patients with a reference group from the general population. The aim of this study was to analyse differences between men and women with UCP and a reference group in terms of psychosocial factors as depression, anxiety, stress, social interaction and health-related quality of life (HRQOL).

    METHODS:

    A self-administered questionnaire about psychosocial factors was completed by 127 men and 104 women with acute UCP admitted consecutively to the Emergency Department (ED) or as in-patients on a medical ward. A reference group from the general population, 490 men and 579 women, participants in the INTERGENE study and free of clinical heart disease, were selected.

    RESULTS:

    The UCP patients were more likely to be immigrants, have a sedentary lifestyle, report stress at work and have symptoms of depression and trait-anxiety compared with the reference group. After adjustment for differences in age, smoking, hypertension and diabetes, these factors were still significantly more common among patients with UCP. In a stepwise multivariate model with mutual adjustment for psychosocial factors, being an immigrant was associated with a more than twofold risk in both sexes. Stress at work was associated with an almost fourfold increase in risk among men, whereas there was no independent impact for women. In contrast, depression only emerged as an independent risk factor in women. Trait-anxiety and a low level of social interaction were not independently associated with risk in either men or women. Patients with UCP were two to five times more likely to have low scores for HRQOL.

    CONCLUSION:

    Both men and women with UCP had higher depression scores than referents, but an independent association was only found in women. Among men, perceived stress at work emerged as the only psychosocial variable significantly associated with UCP

  • 49.
    Pandic, S.
    et al.
    The Sahlgrenska University Hospital, Östra, Gothenburg, Sweden.
    Ekman, I.
    The Sahlgrenska University Hospital, Östra, Gothenburg, Sweden.
    Nord, L.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Device-guided breathing exercises in the treatment of hypertension – perceptions and effects2008In: CVD Prevention and Control, ISSN 1875-4562, Vol. 3, no 3, p. 163-169Article in journal (Refereed)
    Abstract [en]

    Background

    Behavioural and non-pharmacological treatments of hypertension suggest that relaxation and stress management can lower blood pressure (BP). There have been several studies showing that breathing exercises using various behavioural approaches, such as yoga, relaxation, biofeedback and transcendental meditation benefit hypertensive patients by decreasing their BP.

    Methods

    A randomized controlled pilot study was conducted over a period of 16 weeks, including 31 patients in the intervention-group using Resperate. A control group of 22 patients only listened to music (CD) and used no other therapeutic device. The exercises were accomplished over 15 minutes, three times a week in both groups. Patients (n = 18) from both groups were interviewed about their perceptions of the treatment.

    Results

    After 16 weeks, the systolic blood pressure decreased −3.9 mmHg (p = 0.105) in the Resperate group and −16.8 mmHg (p = 0.000) in the CD group. The diastolic blood pressure decreased in the Resperate group −1.5 mmHg (p = 0.000) and in the CD group −4.1 mmHg (p = 0.000). The breathing frequency was lowered in the Resperate group −2.4/min (p = 0.000) and in the CD group −1.2/min (p = 0.232) after 16 weeks. There were no statistically significant differences between the groups. Patients generally were satisfied with the use of devices and seemed to perceive the treatment as a chance to influence their own health.

    Conclusions

    The use of device guided breathing exercises (Resperate) indicated an antihypertensive effect but only listening to relaxing music also decreased blood pressure.

  • 50.
    Kjellgren, Karin
    et al.
    The Sahlgrenska Academy, Göteborg University, Sweden.
    Hendry, G.
    University of Western Sydney, Australia.
    Hultberg, J
    University of Gothenburg, Sweden.
    Plos, K.
    University of Gothenburg, Sweden.
    Rydmark, M.
    University of Gothenburg, Sweden.
    Tobin, G.
    University of Gothenburg, Sweden.
    Säljö, R.
    University of Gothenburg, Sweden.
    Learning to learn and learning to teach - Introduction to studies in higher education2008In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 30, no 8, p. e239-e245Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    How students are introduced to their studies will affect the quality of learning. This project deals with tools for lifelong learning to increase students' awareness of learning how to learn. In parallel to an introductory course for students, a course for teachers was given with a focus on tutoring students.

    AIMS:

    To evaluate an interprofessional transition course for first-year health science students, the LearnAble project, and a teachers' course aiming to support students to be successful in their learning.

    METHOD:

    The project was followed up by a computer-based course evaluation, reflective journals, the Learning Process Questionnaire and the Approaches to Teaching Inventory. The questionnaires were distributed before and after the courses. Teachers (n = 31) and students (n = 270) in two courses from different health educations participated.

    RESULTS:

    Students' approaches to the course and to learning could be described as technical/reproductive, seeking for an identity or as reflective/transformative. The evaluation indicates that a deep approach to the studies among the students was related to higher age and female gender. Teachers with earlier pedagogical education supported students more in the attempts to question their own understanding.

    CONCLUSION:

    The most obvious result was the positive impact of being a tutor for a group of students in parallel to studying pedagogy.

     

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