Birgitte Schantz Laursen

Sensitization in patients with painful knee osteoarthritis

&NA; Pain is the dominant symptom in osteoarthritis (OA) and sensitization may contribute to the pain severity. This study investigated the role of sensitization in patients with painful knee OA by measuring (1) pressure pain thresholds (PPTs); (2) spreading sensitization; (3) temporal summation to repeated pressure pain stimulation; (4) pain responses after intramuscular hypertonic saline; and (5) pressure pain modulation by heterotopic descending noxious inhibitory control (DNIC). Forty‐eight patients with different degrees of knee OA and twenty‐four age‐ and sex‐matched control subjects participated. The patients were separated into strong/severe (VAS ≥ 6) and mild/moderate pain (VAS < 6) groups. PPTs were measured from the peripatellar region, tibialis anterior (TA) and extensor carpi radialis longus muscles before, during and after DNIC. Temporal summation to pressure was measured at the most painful site in the peripatellar region and over TA. Patients with severely painful OA pain have significantly lower PPT than controls. For all locations (knee, leg, and arm) significantly negative correlations between VAS and PPT were found (more pain, more sensitization). OA patients showed a significant facilitation of temporal summation from both the knee and TA and had significantly less DNIC as compared with controls. No correlations were found between standard radiological findings and clinical/experimental pain parameters. However, patients with lesions in the lateral tibiofemoral knee compartment had higher pain ratings compared with those with intercondylar and medial lesions. This study highlights the importance of central sensitization as an important manifestation in knee OA.

Health related quality of life and quantitative pain measurement in females with chronic non-malignant pain

The aim of the present study was to assess, compare, and correlate the pain response to an experimental pain stimulus (hyperalgesia to pressure pain threshold (PPT) measured from different body sites), the pain intensity (VAS) of the habitual pain, and quality of life parameters (SF‐36) in groups of females with chronic non‐malignant pain syndromes. Forty female pain patients with fibromyalgia/whiplash (n = 10), endometriosis (n = 10), low back pain (n = 10), or rheumatoid arthritis (n = 10), as well as 41 age‐matched healthy female controls participated in the study.

A dialogue-based web application enhances personalized access to healthcare professionals – an intervention study

BackgroundIn today’s short stay hospital settings the contact time for patients is reduced. However, it seems to be more important for the patients that the healthcare professionals are easy to get in contact with during the whole course of treatment, and to have the opportunity to exchange information, as a basis for obtaining individualized information and support. Therefore, the aim was to explore the ability of a dialogue-based application to contribute to accessibility of the healthcare professionals and exchangeability of information.MethodAn application for online written and asynchronous contacts was developed, implemented in clinical practice, and evaluated. The qualitative effect of the online contact was explored using a Web-based survey comprised of open-ended questions.ResultsPatients valued the online contacts and experienced feelings of partnership in dialogue, in a flexible and calm environment, which supported their ability to be active partners and feelings of freedom and security.ConclusionThe online asynchronous written environment can contribute to accessibility and exchangeability, and add new possibilities for dialogues from which the patients can benefit. The individualized information obtained via online contact empowers the patients. The Internet-based contacts are a way to differentiate and expand the possibilities for contacts outside the few scheduled face-to-face hospital contacts.

Coping with clean intermittent catherization – experiences from a patient perspective

Background:  Poor bladder emptying is a well-known phenomenon in urology which increases the risk of urinary tract infection. Thus, it is important to insure effective bladder emptying for the patient. This may be performed by emptying the bladder intermittently by means of a disposable catheter. The method is called clean intermittent catheterization (CIC). The purpose of CIC is, apart from the scientific reasons, to give patients the opportunity to live the life they did prior to experiencing problems with bladder emptying. In our view, a large number of patients do not cope with their new life with CIC in spite of learning programmes and written guidance. Aim:  The aim of this study was to develop knowledge about how patients experience having to empty their bladder by using a disposable catheter for the rest of their lives. Knowledge nurses could be used to improve the quality of the procedure for CIC training. Furthermore this study also helps in investigating the strategies used by the patients used to master CIC in order to improve the organization of training in the future. Method:  The research design was qualitative and took a phenomenological hermeneutic approach. The data were based on interviews with eight patients using CIC. Results and conclusion:  The results suggested that need to perform CIC for the rest of one’s life resulted in a traumatic crisis which could be experienced to be more or less stressful. Situations were mastered employing strategies which could either be problem- or emotion-focused. These strategies aimed, respectively, at solving the problem or at reducing the unpleasant feelings connected with the situation.BACKGROUND Poor bladder emptying is a well-known phenomenon in urology which increases the risk of urinary tract infection. Thus, it is important to insure effective bladder emptying for the patient. This may be performed by emptying the bladder intermittently by means of a disposable catheter. The method is called clean intermittent catheterization (CIC). The purpose of CIC is, apart from the scientific reasons, to give patients the opportunity to live the life they did prior to experiencing problems with bladder emptying. In our view, a large number of patients do not cope with their new life with CIC in spite of learning programmes and written guidance. AIM The aim of this study was to develop knowledge about how patients experience having to empty their bladder by using a disposable catheter for the rest of their lives. Knowledge nurses could be used to improve the quality of the procedure for CIC training. Furthermore this study also helps in investigating the strategies used by the patients used to master CIC in order to improve the organization of training in the future. METHOD The research design was qualitative and took a phenomenological hermeneutic approach. The data were based on interviews with eight patients using CIC. RESULTS AND CONCLUSION The results suggested that need to perform CIC for the rest of ones life resulted in a traumatic crisis which could be experienced to be more or less stressful. Situations were mastered employing strategies which could either be problem- or emotion-focused. These strategies aimed, respectively, at solving the problem or at reducing the unpleasant feelings connected with the situation.

The experience of distress in relation to surgical treatment and care for breast cancer: An interview study

PURPOSE A diagnosis of breast cancer is a key turning point in a womans life that may lead to her experiencing severe and persistent distress and potentially presaging a psychiatric disorder, such as major depression. In Denmark an increased standardization of care and a short hospital stay policy minimize the time of medical and nursing surveillance. Consequently, there is the potential risk that distress goes unnoticed, and therefore, untreated. Therefore, the purpose of this study was to explore the experience of distress in Danish women taking part in surgical continuity of care for breast cancer. METHODS AND SAMPLE A phenomenological-hermeneutic approach inspired by the French philosopher Paul Ricoeur was conducted to explore the experience of distress in relation to surgical treatment and care for breast cancer. Semi-structured interviews were conducted with 12 women who recently had surgery for breast cancer at six departments of breast surgery in Denmark from May 2013 to November 2013. KEY RESULTS The understanding of the experience of distress in the period of surgical continuity of care for breast cancer is augmented and improved through a discussion related to four identified themes: A time of anxiety, loss of identities, being treated as a person and being part of a system, drawing on theory and other research findings. CONCLUSION Distress experienced by women in the period following diagnosis arises from multiple sources. Support and care must be based on the womans individual experience of distress.

Caring for Dinner in Hospital

Better organization may improve quality of care around meal serving in a hospital unit. Background: The organization of care regarding serving of food, monitoring and assisting patients with meals is a complex nursing task, however, to a low degree investigated. This study was done at request from the department multi professional nutrition team, as nutrition monitoring was difficult to achieve. Furthermore meal serving, especially regarding dinner, was found chaotic and unsatisfying. Aim: To explore practise and organization around meal serving regarding dinner and find reasons for poor monitoring of nutrition intake. Methods: Observations as well as patient and staff interviews and observation in a department of gastroenterology in 2010. Results: Ten patients, six nursing staff and four service staff members were interviewed. Observations weredone for nine hours during two days of dinner servings. A positive and helpful attitude was seen. How ever, lack of time, knowledge, lack of assignment of responsibility and many competing tasks interfered with the meal serving and elated tasks. Low priority was given to assisting patients with eating and to documentation of individual nutritional assessment and care. Poor monitoring of nutrition intake was seen, due to insufficient training of service staff and lack of communication of responsibility. Conclusion: A poor organisation of the overall work was found. The nurses had too many competing tasks. Lack of knowledge, documentation and acknowledgement of importance of own actions, was profound among the nursing-staff regarding nutritional care during dinner serving.

Long-term effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure

Background This study investigated the long-term effects of humidified high-flow nasal cannula (HFNC) in COPD patients with chronic hypoxemic respiratory failure treated with long-term oxygen therapy (LTOT). Patients and methods A total of 200 patients were randomized into usual care ± HFNC. At inclusion, acute exacerbation of COPD (AECOPD) and hospital admissions 1 year before inclusion, modified Medical Research Council (mMRC) score, St George’s Respiratory Questionnaire (SGRQ), forced expiratory volume in 1 second (FEV1), 6-minute walk test (6MWT) and arterial carbon dioxide (PaCO2) were recorded. Patients completed phone interviews at 1, 3 and 9 months assessing mMRC score and AECOPD since the last contact. At on-site visits (6 and 12 months), mMRC, number of AECOPD since last contact and SGRQ were registered and FEV1, FEV1%, PaCO2 and, at 12 months, 6MWT were reassessed. Hospital admissions during the study period were obtained from hospital records. Hours of the use of HFNC were retrieved from the high-flow device. Results The average daily use of HFNC was 6 hours/day. The HFNC group had a lower AECOPD rate (3.12 versus 4.95/patient/year, p<0.001). Modeled hospital admission rates were 0.79 versus 1.39/patient/year for 12- versus 1-month use of HFNC, respectively (p<0.001). The HFNC group had improved mMRC scores from 3 months onward (p<0.001) and improved SGRQ at 6 and 12 months (p=0.002, p=0.033) and PaCO2 (p=0.005) and 6MWT (p=0.005) at 12 months. There was no difference in all-cause mortality. Conclusion HFNC treatment reduced AECOPD, hospital admissions and symptoms in COPD patients with hypoxic failure.

Improving visiting nurses’ post-hospital medication management: A participatory approach

Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to facilitate suggestions for changes in future practices.,Based on a previous study on visiting nurses’ post-hospital medication management, two workshops were conducted in a visiting nurse department in a Danish municipality.,The visiting nurses emphasised knowledge of patients’ basic needs and prioritised their performance of context-specific nursing assessments, with a preventive focus as a prerequisite for improved patient safety in post-hospital medication management.,The participatory approach can increase the acceptability and feasibility of changes regarding future practices and thereby reduce the gap between official documents and daily practice. Although the local development of suggestions for changes in practices does not provide general knowledge, a subsequent detailed description of the changes in practices can promote transferability to other healthcare settings after local adjustments are made.,Flexible home healthcare, with stable relationships enabling the continuous assessment of the patient’s needs and symptoms, along with subsequent adjustments being made in care and medical treatment, might enhance patient safety in post-hospital medication management.,This paper adds to the knowledge of the need for integrated care in medication management in patients’ homes. It argues for primary healthcare professionals as “experts in complexity” and suggests a reconsideration of the purchaser-provider division of care to patients with unstable health conditions and complex care needs during the first days following hospital discharge.

Development of a questionnaire encompassing indicators of distress: A tool for use with women in surgical continuity of care for breast cancer

PURPOSE Women with breast cancer often experience significant distress. Currently, there are no questionnaires aimed at identifying womens unique and possible changing indicators for distress in surgical continuity of care for breast cancer. We developed and tested three questionnaires specifically for this use. METHODS AND SAMPLE We first searched PubMed, CINAHL and PsycINFO to retrieve information on previously described indicators. Next, we conducted a focus group interview with 6 specialised nurses, who have extensive experience about consequences of breast cancer for women in surgical continuity of care. The questionnaire was tested on 18 women scheduled for breast cancer surgery. Subsequently, the women were debriefed to gain knowledge about comprehensibility, readability and relevance of items, and the time needed to complete the questionnaire. After adjustment, the questionnaires were field-tested concomitantly with a clinical study, which both consisted of a survey and an interview study. KEY RESULTS Three multi-item questionnaires were developed specific to different time points in surgical continuity of care. The questionnaires share a core of statements divided into seven sub-scales: emotional and physical situation, social condition, sexuality, body image, religion and organisational factors. Besides the core of statements, each questionnaire has different statements depending on the time point of surgical continuity of care when it was to be responded to. CONCLUSION The questionnaires contain comprehensive items that can identify indicators for distress in individual women taking part in surgical continuity of care. The items were understandable and the time used for filling in the questionnaires was reasonable.

A Smartphone App to Foster Power in the Everyday Management of Living With Schizophrenia: Qualitative Analysis of Young Adults’ Perspectives

Background Literature indicates that using smartphone technology is a feasible way of empowering young adults recently diagnosed with schizophrenia to manage everyday living with their illness. The perspective of young adults on this matter, however, is unexplored. Objective This study aimed at exploring how young adults recently diagnosed with schizophrenia used and perceived a smartphone app (MindFrame) as a tool to foster power in the everyday management of living with their illness. Methods Using participatory design thinking and methods, MindFrame was iteratively developed. MindFrame consists of a smartphone app that allows young adults to access resources to aid their self-management. The app is affiliated with a website to support collaboration with their health care providers (HCPs). From January to December 2016, community-dwelling young adults with a recent diagnosis of schizophrenia were invited to use MindFrame as part of their care. They customized the resources while assessing their health on a daily basis. Then, they were invited to evaluate the use and provide their perspective on the app. The evaluation was qualitative, and data were generated from in-depth interviews. Data were analyzed using a hermeneutical approach. Results A total of 98 individuals were eligible for the study (mean age 24.8, range 18-36). Of these, 27 used MindFrame and 13 participated in the evaluation. The analysis showed that to the young adults, MindFrame served to foster power in their everyday management of living with schizophrenia. When MindFrame was used with the HCPs consistently for more than a month, it could provide them with the power to keep up their medication, to keep a step ahead of their illness, and to get appropriate help based on their needs. This empowered them to stay on track with their illness, thus in control of it. It was also reported that MindFrame could fuel the fear of restraint and illness exacerbation, thereby disempowering some from feeling certain and secure. Conclusions The findings demonstrate that young adults diagnosed with schizophrenia are amenable to use a smartphone app to monitor their health, manage their medication, and stay alert of the early signs of illness exacerbation. This may empower them to stay on track with their illness, thus in control of it. This indicates the potential of smartphone-based care being capable of aiding this specific population to more confidently manage their new life situation. The potentially disempowering aspect of MindFrame accentuates a need for further research to understand the best uptake and the limitations of smartphone-based schizophrenia care of young adults.