Bakgrund: Medelåldern för att drabbas av höftfraktur är 80 år och bakomliggande orsaker är falltendens och benskörhet. Majoriteten av dem som drabbas av höftfraktur är kvinnor. Att drabbas av höftfraktur kan innebära ett stort lidande, det är ofta en smärtsam upplevelse, både vid själva skadetillfället men även under vårdtiden. Syfte: Att beskriva patienters upplevelser av vården vid höftfraktur. Metod: Denna studie genomfördes som en litteraturöversikt, där databaserna Cinahl, Psycinfo, PubMed och Web of Science användes vid artikelsökningen. Resultat: Resultatet baserades på tio artiklar, av kvalitativ och kvantitativ design. Patienternas upplevelser av vården vid höftfraktur resulterade i tre kategorier: kommunikation och information, bemötande och trygghet samt smärta och smärtlindring. Patienterna ville vara delaktiga och få löpande information om vad som hände och vad som skulle ske gällande deras vård. Trygghet var en känsla som tillkom av beröring från vårdpersonalen och uppskattades då patienterna upplevde sig som utsatta. Smärtlindringen var viktig för att patienterna skulle känna välbefinnande och inte ha ont. Konklusion: Kommunikation är den röda tråden genom resultatets alla delar. Patienternas upplevelser av information, trygghet, bemötande, smärta och smärtlindring påverkas alla av hur väl kommunikationen mellan dem och vårdpersonalen har fungerat. Det är därför viktigt att sjuksköterskor försöker identifiera varje patients individuella förutsättningar och behov för att ha möjlighet att anpassa information, kommunikation och egenvård så att varje patients behov tillgodoses. / Background: The average age of suffering a hip fracture is 80 years, and the causes are falls tendency and osteoporosis. The majority of those who suffer from a hip fracture are female. To suffer a hip fracture could mean great suffering, it is often very painful, both at the time of the injury, but also during the hospital stay. Aim: To describe patients' experiences of care at hip fracture. Method: This study was conducted as a literature review, in which ten articles were included. The databases used in this study was Cinahl, Psycinfo, PubMed and Web of Science. Results: The results were based on ten articles, which were of qualitative and quantitative methods. The patients' experiences of care at hip fracture resulted in three categories: communication and information, treatment and safety and pain and pain relief. The patients wanted to be involved and receive ongoing information regarding their care. When patients experienced themselves as vulnerable the touch from the nursing staff created a sense of security. Pain relief was important for patients to feel the well-being and not have pain. Conclusion: Patients' experiences of information, security, treatment, pain and pain relief are all affected by communication. It is important for nurses to identify each patient's individual circumstances and needs in order to be able to adapt the information, communication and self-care to meet each patient's needs.

Bakgrund: Många patienter med psykisk sjukdom har en livsstil som genererar livsstilssjukdomar på grund av brister i egenvården. Detta genererar lidande och samhällskostnader men är något som kan förhindras. Sjuksköterskan har möjlighet att i en holistisk anda förbättra för patienten med hjälp av interventioner. Syfte: Syftet är att beskriva vilka hinder och möjligheter som påverkar patienter med allvarlig psykisk sjukdom till livsstilsförändringar. Metod: Detta är en litteraturstudie där författarna har sökt och granskat vetenskapliga artiklar i olika databaser. I materialet hittades olika teman som har sammanfattats i resultatet. Resultat: De stora hindrena för att förändra sin livsföring är den psykiatriska sjukdomen och den medicinering den kräver. Sjukdomen innebär ofta sociala problem, lågt självförtroende och ångest. Medicinering ger sedering och viktökning. Generellt upplevs gruppaktiviteter som positivt då det ger struktur åt aktiviteter och socialt stöd från andra patienter. Uppmuntran från andra patienter och från personalen är viktig, vars attityd kan vara avgörande. Genom interventioner går det att förändra parametrar som vikt, motionsgrad och kunskap om livsstils hos patienterna. Konklusion: Med ett holistiskt förhållningssätt där patientens alla livsdelar ses som viktiga går det förändra livsstilen för patienter med psykisk sjukdom så att den blir mer hälsosam. Förändringar kräver att hänsyn tas till sjukdomen och medicinering samt att patienten får mycket stöd i en intervention som är individanpassad, men gärna i grupp. / Background: Patients with severe mental illness often experience physical illness as a result of poor lifestyle choices and lack of self care acts. This generates suffering and costs for society. But it is preventable; nurses can work to improve the health of her patient by motivating the patient to participate in health intervention. Aim: To describe obstacles and potentials that affects patients with severe mental illness in health promoting lifestyle changes. Method: Literature review Result: The big obstacles in changing lifestyle are the psychiatric illness and the medication that it involves. Mental illness is often generating in social problems like anxiety and low self esteem. Medication results in weight gain. Group activities are generally viewed as positive and gives structure to daily life and social support. The interventions result in health gains considering weight, activity, knowledge and eating habits. Conclusion: With a holistic view, nurses can help changing the lifestyle of patients with severe mental illness. Group interventions are to be preferred. Interventions must be implemented in line with the illness cycles and the medication.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / To systematically review all studies examining HPV vaccination acceptability among immigrant and ethnic minority parents and eligible individuals for cervical cancer prevention in the Unites states. MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane database searches were conducted searching for English language, US‐based studies to examine immigrant and ethnic minority population’s acceptability of HPV vaccination. Thirteen of more than 3,098 potentially relevant articles were included in the final analysis. Results. Latinos were statistically more likely to accept vaccination for both their daughters and sons. Foreign‐born adult Latinas were more accepting of the vaccine than U.S.‐born Latinas after controlling for other variables. Overall African American and Asian American parents were less likely to accept HPV vaccination for their daughters than Hispanic and White parents. Of the African American parents who intended to vaccinate their children the majority were significantly non‐Baptist and had higher levels of education. The majority of Haitian immigrants intended to vaccinate daughters and the rest agreed that they would most likely have their daughters vaccinated if their daughters’ physicians recommended it. More research is needed, particularly in the context of health care provider HPV vaccination recommendation to immigrant and ethnic‐minority populations. Acceptance figures so far suggest that the vaccine is generally well received among Hispanic/Latin and Haitian immigrants, but details of ethnic variations among these groups and a qualitative understanding of lower rates of acceptability among African American and Asian American communities are still being awaited. Despite advances in cervical cancer screening rates in the US, cervical cancer remains disproportionately high among low‐income immigrant and minority women, making this subgroup particularly vulnerable to disparities in screening and its detection. The purpose of this study is to examine the qualitative aspects of institutional and community level interventions of Cervical Intraepithelial Neoplasia (CIN) within the immigrant and refugee populations and the use of HPV vaccination as a prevention method. Combinations of the following keywords/phrases will be used: CIN‐ Cervical Intraepithelial Neoplasia, Cervical diseases, Cervical dysplasia, Refugees, Pap smear, Cervical Cancer Screening, HPV‐ Human Papillomavirus, HPV vaccination, Ethnic minorities, Immigrants. Independent reviews of each article will be conducted to assess the study quality and confirm the accuracy, completeness, and consistency of the abstracted data.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Current stroke imaging protocol at Barrow Neurological Institute calls for a noncontrast computed tomography (NCCT), a computed tomography angiography (CTA), and a computed tomography perfusion (CTP) at the time of presentation to the emergency department (ED), and follow up imaging includes magnetic resonance diffusion weighted imaging (MR‐DWI). This information is used to determine the appropriateness and safety of tissue plasminogen activator (tPA) administration. Previous studies have shown the risk for post‐tPA hemorrhagic conversion rises significantly as the size of the infarct core increases. Thus, it is of great importance to have an accurate method of measuring core infarct size in patients presenting with acute ischemic stroke. The purpose of our study is to determine if CTP correctly identifies the infarct core and if post‐tPA hemorrhagic conversion is related to the size of the infarct core and/or the accuracy of CTP in identifying the infarct core. The ultimate goal is to improve patient outcomes by decreasing the morbidity and mortality associated with tPA administration. This study is a retrospective chart review of all patients who presented to the ED during a one year period with signs and symptoms of acute ischemic stroke who then subsequently received tPA. Imaging was also reviewed, including the NCCT, CTA, CTP, and MRDWI for each patient. In this study, MR‐DWI is used as the gold standard for determining the presence or absence of an infarct core. CTP and MR‐DWI are in agreement of the presence of an infarct core in 7 patients, or 10 percent of the time. Similarly, CTP and MR‐DWI are in agreement of the absence of an infarct core in 31 patients, or 44 percent of the time. In the other 32 patients, CTP and MR‐DWI are in disagreement. The percent correlation between CTP and MR‐DWI was found to be 24 percent with a p‐value < 0.05. As for post‐tPA hemorrhagic conversion, 12 percent of patients had hemorrhagic conversion, and when the hemorrhage rate was compared to the size of the infarct core, the odds of post‐tPA hemorrhagic conversion were 56 times higher in the group of patients with infarct cores larger than one‐third of a vascular territory than in patients with smaller infarct cores with a p‐value < 0.001. Although no significant correlation was found between the accuracy of CTP data and the rate of post‐tPA hemorrhagic conversion, patients with concordant CTP and MR data had a 46% lower likelihood of post‐tPA hemorrhagic conversion than did patients with contradictory CTP and MR‐DWI data. Conclusion: Because patients with infarct cores larger than one‐third of a vascular territory are 56 times more likely to hemorrhage than patients with smaller infarct cores and CTP is less accurate than MR‐DWI in identifying the infarct core in patients presenting with acute ischemic stroke, CTP studies should not be part of the acute stroke imaging protocol. Another imaging modality, such as MR‐DWI, may be preferential in the setting of acute ischemic stroke to identify the infarct core.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Motor vehicle accidents involving pedestrians are some of the most common and lethal forms of injury for children in the United States. Among younger children, a common mechanism of action for severe trauma is when a vehicle runs over the child in a forward or backward motion at low speed resulting in a blunt crush injury. This typically occurs in non‐traffic settings including driveways, sidewalks, and roadways. Such incidents have been referred to in many different ways in the literature but for the purposes of this paper will be referred to as low speed vehicle run‐overs. This is a retrospective chart review carried out at Phoenix Children’s Hospital in affiliation with the University of Arizona College of Medicine‐Phoenix that categorizes and examines the injuries sustained by patients involved in low speed vehicle runovers occurring between December 2007 and August 2013. Fifty‐five pediatric patients were included with a median age of 24 months and 6 of these patients were fatally injured. Internal injuries were common overall and significantly more common in children ≤24months. Over half of the cohort sustained fractures, with a 24% incidence of skull fractures. All fatalities were the result of traumatic brain injury. Twenty percent of victims required operative intervention. It was concluded that the severity of these types of incidents varies from minimal to life threatening and best care requires close and thorough evaluation by the trauma and emergency department teams.

Bakgrund: Sjuksköterskorna har ansvar i att vårdandet uppfyller kraven på en god och säker vård där patienternas behov blir tillgodosedda. Forskningen visade att det finns många hinder på akutmottagningarna för att uppfylla dessa krav. Många faktorer kan påverka hur stort utrymme vårdandet ges på akutmottagningarna. Prioriteringar och förutsättningarna ger inte alltid sjuksköterskorna möjlighet att vårda patienterna i enlighet med forskning och vårdvetenskapligt perspektiv. Syfte: Syftet var att beskriva sjuksköterskors upplevelser av vårdandet på akutmottagningar Metod: En kvalitativ litteraturstudie baserad på vårdvetenskapliga artiklar Resultat: Två teman formulerades: Att utmanas i sitt vårdande med 3 subteman och att utmanas i sin profession med 2 subteman. Studien visar att sjuksköterskor arbetar under press, upplever otillräcklighet/frustration och ställs inför organisatoriska hinder. Kompetens och att vara patienters ombud framkommer även i studien som påverkande faktorer i vårdandet. Slutsats: Det föreligger många utmaningar i sjuksköterskornas arbetssituation på akutmottagningarna som kan utgöra hinder i vårdandet. Faktorer som tidsbrist, stress, likgiltighet och känslor av hopplöshet identifierades. / Background: Nurses´ have responsibility in caring to meet the requirements of good and safe caring, where patient needs are met. Research shows that there are many obstacles on emergency departments to fulfill those requirements. Many factors can influence how much space is given to the caring on emergency departments. Priorities and conditions does not always give the nurses opportunity to care for patients in accordance with research and care perspective. Aim: The aim was to describe nurses´ experiences of caring in emergency departments Method: A qualitative literature review based on nursing-care scientific research. Results: Two themes were formulated: To be challenged in their caring with 3 subthemes and to be challenge in their caring with 2 subthemes. The study shows that nurses work under pressure, experiencing insufficiency/frustration and faces organizational barriers. Competence and patient advocacy emerges also in the study as factors in caring. Conclusion: There are several challenges in nurses' working conditions in emergency departments that may pose obstacles in the caring. Factors as lack of time, stress, indifference and feelings of hopelessness was identified.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The rate of technology expansion is rapidly covering even the most remote parts of the globe and in the lowest resource settings. With globalization however, low and middle income areas are facing emerging health issues such as injuries and chronic medical conditions. With these illnesses, there are inevitable demands on emergency services. It has been thought that technology be utilized to augment emergency medical care in such settings where formal Emergency Medical Services. To aggregate and analyze the existing literature on the topic a systematic literature review was conducted. This study analyzed the existing literature on prehospital emergency care in settings in which no formal EMS services were utilized. Four databases were searched with inclusion and exclusion criteria, yielding 1782 results. The initial screening excluded all but 21 articles. Of the 21 articles in full review, 15 were included in the final review. Studies included in the final review were grouped into those reporting outcomes from five categories: Feasibility, Quality of Care, Response Time, Patient Outcomes, and Cost Effectiveness. Only one study was identified to be of high quality. There was a lack of studies with adequate statistical analysis to conduct statistical aggregation. Most studies however reported prehospital telemedicine in settings without EMS to be feasible, provide quality care, are be cost effective. However, the lack of statistical analysis makes it difficult to make conclusions. Also, several studies did show response time of a trained basic life support volunteer to be faster than EMS in many of the settings. But no positive health outcomes were observed in patients treated with projects utilizing technology in the prehospital setting. The prehospital emergency medicine setting is a young field of study that may have significant hurdles in application. The studies conducted have shown promise in the use of technology in prehospital settings without formal EMS services, but are not robust enough to make strong conclusions or recommendations that could be put into practice. Thus, more robust, statistically oriented research is imperative in the field so that we can fully explore the potential of technology in the prehospital setting, especially in low resource and rural settings without formal EMS services. With more robust studies, we can hope to integrate new technologies into practice and better serve the populations without adequate EMS coverage to provide more timely emergency care.

Reliability generalization (RG) is a method for meta-analysis of reliability coefficients to estimate average score reliability across studies, determine variation in reliability, and identify study-level moderator variables influencing score reliability. A total of 107 peer-reviewed RG studies published from 1998 to 2013 were systematically reviewed to characterize the meta-analytic methods employed and to evaluate quality of reporting practice against standards for transparency in meta-analysis reporting. Most commonly, RG studies meta-analyzed alpha coefficients, which were synthesized using an unweighted, fixed-effects model applied to untransformed coefficients. Moderator analyses most frequently included multiple regression and bivariate correlations employing a fixed-effects model on untransformed, unweighted coefficients. Based on a unit-weighted scoring system, mean reporting quality for RG studies was statistically less than that for a comparison study of 198 meta-analyses in the organizational sciences across 42 indicators; however, means were not statistically significantly different between the two studies when evaluating reporting quality on 18 indicators deemed essential to ethical reporting practice in meta-analyses. Since its inception a wide variety of statistical methods have been applied to RG, and meta-analysis of reliability coefficients has extended to fields outside of psychological measurement, such as medicine and business. A set of guidelines for conducting and reporting RG studies is provided.

Bakgrund: Kronisk hjärtsvikt är ett globalt växande tillstånd i hela världen. Sjuksköterskan har en betydande roll i att ge kunskap och att informera kring hur det är att leva med kronisk hjärtsvikt. Syfte: Att beskriva dagligt liv för patienter med kronisk hjärtsvikt, utifrån ett patientperspektiv.    Metod: En litteraturöversikt där 13 kvalitativa artiklar har inkluderats. Studien baseras på induktiv ansats. Resultat: Personer med hjärtsvikt upplever en förändrad livssituation efter att de har fått diagnosen kronisk hjärtsvikt. Resultatet redovisas i kategorierna: Begränsningar i vardagen, Påverkan av omgivningen och Mötet med vården. Slutsats: Resultatet visar att personer som lever med hjärtsvikt genomgår fysiologiska förändringar, men även känslomässiga, sociala och andliga förändringar. För att möta dessa personer behöver sjuksköterskan ha kunskap i att identifiera individens behov och därefter utforma omvårdnaden utefter den unika individen. / Background: Chronic heart failure is an common disease worldwide. The nurse has a significant role in providing knowledge and information about how to live with chronic heart failure. Aim: To describe daily life for patients with chronic heart failure, from a patient perspective.   Method: A literature review where thirteen qualitative articles were included. The study is based on inductive approach. Results: People with heart failure experience a changed life situation after they have been diagnosed with chronic heart failure. The results are reported in categories: Limitations in everyday life, Influence of the environment and Health Care services. Conclusion: The result shows that people living with heart failure undergo physiological changes, but also emotional, social and spiritual. In order to meet these people, the nurse needs knowledge in identifying the needs of the individual in order to design nursing according to the unique individual.

Good language skills are essential to academic success. Immigrant and refugee children who enter school without previous knowledge of the societal language are more prone to failure and need of special support. The aim of this study is to describe bilingual educational program used in preschool and primary school and to examine their outcomes related to language development, both for the home language (L1) as well as the school language (L2). 17 studies were identified through a systematic literature review. Results showed a predominance of the transitional bilingual education (TBE) and two-way immersion (TWI) models in bilingual education. Language related outcomes confirmed the finding from previous literature that bilingual education doesn't inhibit L2 acquisition. Also, confirming previous literature, advantages of bilingual programs over monolingual ones are proven hard to confirm. However, several methodological issues addressed by the previous meta-analysis seem to generally persist in the most recent literature. The results of this study reiterate the need for more high- quality study in the field. Moreover, future research should also include experimentation with different languages. Finally, this argues the interest to further study and implement bilingual education programs to better accommodate the need of children with a migration background.