Bakgrund: KOL är den tredje vanligaste dödsorsaken världen över. Pulmonary rehabilitation är en vanlig del av behandlingen som fysioterapeuter ofta utgår ifrån vid rehabilitering för patienter som lider av KOL. Telerehabilitering är ett alternativ till pulmonary rehabilitation. Forskning som jämför effektiviteten av telerehabilitering hos patienter som lider av KOL är dock begränsad. På senare tid har det på grund av bland annat coronapandemin uppkommit ett ökat behov av att utvärdera hur effektiv telerehabilitering är jämfört med pulmonary rehabilitation eller obehandlad kontrollgrupp.  Syfte: Syftet med denna litteraturstudie var att systematiskt granska vetenskapliga artiklar vad gäller effekten av telerehabiltering på livskvalité samt, kondition och muskelstyrka hos patienter med KOL och att bedöma tillförlitligheten av artiklarnas sammanvägda resultat. Metod: Metoden som valdes var en litteraturstudie. Sökningen genomfördes i Pubmed och CINAHL. Kvalitén av åtta studier från sökningen granskades med PEDro och resultatets tillförlitlighet bedömdes med GRADEstud. Resultat: Kvalitén i de åtta studierna som inkluderades varierade mellan medelgod och hög. För utfallsmåttet livskvalité påvisades att telerehabilitering är lika effektivt som pulmonary rehabilitation och tillförlitligheten bedömdes som måttligt hög (+++). För utfallsmåttet fysisk kapacitet kunde man inte påvisa att telerehabilitering är lika effektivt som pulmonary rehabilitation där tillförlitligheten bedömdes som låg (++). Endast två studier hade med utfallsmåttet muskelstyrka vilket gjorde resultatet svårbedömt.  Konklusion: Telerehabilitering bedömdes vara lika effektivt som pulmonary rehabilitation avseende livskvalité men detsamma kunde inte påvisas för fysisk kapacitet. Mer forskning inom området behövs och framtida forskning bör försöka eftersträva mer likhet i interventionerna. / Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. Pulmonary rehabilitation is a common part of the treatment that is often used by physical therapists. Telerehabilitation is an alternative to traditional pulmonary rehabilitation, but it has a limited amount of research. Lately, partially because of the Covid-19 pandemic there has been an increased need to evaluate the effects of telerehabilitation.  Objective: The objective of this systematic review was to systematically review scientific studies regarding the effects of telerehabilitation on health-related quality of life, physical capacity and muscle strength among patients suffering from COPD. The aim of this study was also to assess the reliability of the combined results of the studies. Method: A systematic search was conducted in Pubmed and CINAHL. Eight studies were reviewed using PEDro and the reliability of the result was assessed using GRADEstud. Results: The quality of the studies varied between good and excellent. Telerehabilitation was deemed to be equally effective as pulmonary rehabilitation regarding the outcome health related quality of life and the reliability for the result was rated as moderately high (+++). The effectiveness of telerehabilitation for the outcome physical capacity proved not to be certain with a low (++) reliability. Only two studies included the outcome muscle strength which meant it could not be assessed.  Conclusion: Telerehabilitation was deemed to be equally effective as pulmonary rehabilitation for the outcome health related quality of life but not for the outcome physical capacity. More research on the subject is needed and future studies should aim to have the interventions be more similar.

No description available.

No description available.

No description available.

No description available.

No description available.

Bakgrund En stor andel av äldre personer drabbas av demenssjukdom i Sverige. Sjukdomen ger ofta en känsla av att tappa sin identitet och upphov till beteendemässiga symtom som försämrar livskvalitet och skapar lidande. Med hjälp av olika omvårdnadsåtgärder kan dessa personer få hjälp att återskapa sin identitet, minska oro och ångest och därmed öka deras livskvalitet och välbefinnande. Syfte Att beskriva omvårdnadsåtgärder som främjar hälsorelaterad livskvalitet hos personer med demenssjukdom. Metod Studien genomfördes som en strukturerad litteraturstudie med inslag av den metodologi som används vid systematiska översikter. Databaserna som användes var CINAHL och PubMed, artiklarna som användes var publicerade mellan 2019 och 2024. Resultat I resultatet framkom att det viktigaste för att öka livskvaliteten för personer med demenssjukdom är individanpassat stöd och aktiviteterna. Involverar personer med demenssjukdom i sociala sammanhang, främjar delaktighet och skapa en trygg omgivning för att bidra till en bättre livskvalitet. Terapiformer som fysisk aktivitet, djurterapi och musikterapi har visat sig ha betydande positiva effekter på hälsa och välbefinnande hos personer med demenssjukdom. Slutsats De olika omvårdnadsåtgärderna som har en positiv effekt på livskvaliteten och välbefinnandet är exempelvis fysisk aktivitet, att vara ute i naturen, att bibehålla sociala relationer och känna en gemenskap, att lyssna på musik samt att vara i närheten av djur. / Background A large proportion of elderly individuals are affected by dementia in Sweden. The disease often leads to a sense of losing one's identity and gives rise to behavioral symptoms that deteriorate quality of life and cause suffering. Through various nursing interventions, these individuals can receive help to restore their identity, reduce agitation and anxiety, thereby increasing their quality of life and well-being. Aim To describe nursing interventions that promote health-related quality of life in people with dementia. Method The study was conducted as a structured literature review with elements of the methodology used in systematic reviews. The databases used were CINAHL and PubMed, and the articles used were published between 2019 and 2024. Results The results revealed that the most important factor in increasing the quality of life for people with dementia is individualized support and activities. Involving people with dementia in social settings promotes participation and creates a secure environment to contribute to a better quality of life. Therapies such as physical activity, animal-assisted therapy, and music therapy have been shown to have significant positive effects on the health and well-being of individuals with dementia. Conclusions The various nursing interventions that have a positive effect on quality of life and wellbeing include, for example, physical activity, being outdoors in nature, maintaining social relationships and a sense of community, listening to music, and being in the presence of animals.

This thesis describes patients in acute postoperative pain as well as patients with acute cancer-related pain in palliative care, and their experiences and perceptions of pain management in relation to HRQOL and the multidimensionality of pain. A combination of qualitative and quantitative methods was chosen. Data were collected using interviews and questionnaires; APS, SF:36 and a new developed questionnaire PC-PPQ measuring care related to pain management in palliative care. For assessing pain VAS and Pain-o-Meter were used. The study group consisted of 100 patients on their second postoperative day, and of 75 patients with cancer-related pain from two palliative care teams. The result showed that at the time of the interview 29 of the patients with postoperative pain reported a pain > 3 on VAS and 79 reported VAS > 3 as worst pain past 24 hours. The higher the intensity of pain the less satisfied the postoperative patients were with the nurses´ way of treating their pain. Thirty-three patients stated that they had received information regarding the importance of pain relief. Patients with postoperative pain as well as patients with cancer-related pain had been prescribed analgesics mostly a combination of Paracetamol, NSAID and opioid. Of the 75 patients with cancer-related pain and in palliative care 22 patients reported pain >3 on POM-VAS and 47 patients reported >3 on POM-VAS as worst pain past 24 hours. Twenty-eight patients reported an average pain > 3 on POM-VAS past 24 hours. Twenty-four patients used the words troublesome or tiring when describing their affective pain. Sensory pain was described as prickling or sore by 15 patients. The patients perceived their pain as “aching all over” and expressed a wish for pain relief as well as a fear for increased pain. HRQOL especially physical functioning decreased for patients with average pain > 3. Being cared for by a nurseled or a physician-led palliative care team indicated no statistically significant differences for patients´ HRQOL or pain intensities. The patients had experienced a statistically significant better care after being referred to a palliative care team, despite that pain control had not been optimized. Patients expressed a need for communication, planning and trust in order to improve pain management. Continuity of care and the opportunity to talk increase the patients feeling of security, as well as improved their perceived pain control. Structured ongoing discussion concerning pain management from an early stage of the disease or already preoperatively can provide an important intervention to meet the results of this thesis. Pain assessment covering the multidimensionality of pain, and pain treatment plans including both pharmacological and non-pharmacological treatment are further important interventions.

Background and aims: Heart failure (HF) is a life threatening condition and optimal handling is necessary to reduce risk of therapy failure. The aims of this thesis were: (Paper I) to examine whether BNP (B-type natriuretic peptide)-guided HF treatment improves morbidity and mortality when compared with HF therapy implemented by a treating physician at sites experienced in managing patients with HF according to guidelines; (Paper II) to investigate how to define a responder regarding optimal cut-off level of BNP to predict death, need for hospitalisation, and worsening HF and to determine the optimal time to apply the chosen cut-off value; (Paper III) to evaluate how Health-Related Quality of Life (HR-QoL) is influenced by natriuretic peptide guiding and to study how HR-QoL is affected in responders compared to non-responders; (Paper IV) to evaluate the impact of patient age on clinical outcomes, and to evaluate the impact of duration of the HF disease on outcomes and the impact of age and HF duration on BNP concentration. Methods: A randomized, parallel group, multi-centre study was undertaken on 279 patients with HF and who had experienced an episode of worsening HF with increased BNP concentration. The control group (n=132) was treated according to HF guidelines and in the BNP-guided group (n=147) the HF treatment algorithm goal was to reduce BNP concentration to < 150 ng/L in patients < 75 years and <300 ng/L in patients > 75 years (Paper I), and to define the optimal percentage decrease in BNP and at what point during the follow-up to apply the definition (Paper II). To compare the BNP-guided group with the conventional HF treated group (Paper I), and responders and non-responders (Paper II) regarding HR-QoL measured with Short Form 36 (SF-36) at study start and at study end (Paper III) and to evaluate if age or HF duration influenced the HF outcomes and the influence of BNP on age and HF duration (Paper IV). Results: The primary outcome (mortality, hospitalisation and worsening HF) was not improved by BNP-guided HF treatment compared to conventional HF treatment or in any of the secondary outcome variables (Paper I). Applying a BNP decrease of at least 40 percent in week 16 (compared to study start) and/or a BNP<300 ng/L demonstrated the best risk reduction for cardiovascular mortality, by 78 percent and 89 percent respectively for HF mortality (Paper II). The HR-QoL improved in four domains in the BNP-guided group and in the control group in six of eight domains; however there were no significant differences between the groups (Paper III). For responders the within group analysis showed improvement in four domains compared to the non-responders that improved in one domain; however there were no significant differences between the two groups. There were improvements in HR-QoL in all four groups (Paper III). Age did not influence outcome but HF duration did. HF duration was divided into three groups: HF duration less than 1 year (group 1), 1-5 years (group 2) and >5 years (group 3). A 1.65-fold increased risk could be demonstrated in those with HF duration of more than five years compared to patients with short HF duration. The BNP concentration was increased with increased age, and there was a better response regarding BNP decrease in NP-guiding in patients with short HF duration, independent of age (Paper IV). Conclusions: There were no significant differences between BNP-guided HF treatment group and the group with conventional HF treatment as regards mortality, hospitalisation or HR-QoL. The responders to HF treatment showed a significantly better outcome in mortality and hospitalisation compared to non-responders but no significant differences in HR-QoL. The duration of HF might be an important factor to consider in HF treatment by BNP-guiding in the future.

By examining barriers to care, health professionals can better understand what disparities exist between groups and who may be at greater risk for poor primary care. Researchers have highlighted the need for additional research that focuses on the extent of unmet needs for U.S. children with sickle cell disease (SCD). The purpose of this quantitative study was to compare the differences between parents who are in a SCD support group and those who are not. The theoretical framework of this study is based on the chronic care model and social support theory. A total of 128 parents of children with SCD completed the study survey. The sampling occurred by e-mail, phone, and face-to-face conversations. Selection criteria for potential participants in both groups were based on their children being diagnosed with SCD. Seventy-four participants (57.8%) were members of a SCD support group, and 54 participants (42.4%) were not members of a SCD support group. In this study, the independent variables were parents attending or not a SCD support group. The t test and MANCOVA was used to assessed the association between perceptions of barriers to care and support group status. However, statistical analysis showed no significant results. The null hypothesis was not rejected. Therefore, the positive social change implication is to further explore potential factors that may shape perceptions of barriers to care for those with SCD so that perceived barriers to care can be overcome.