Early avoidable 30-day post discharge readmission among patients diagnosed with chronic obstructive pulmonary disease (COPD) is associated with poor transition care processes. The purpose of this project was to analyze organizational system processes for admission and discharge transition care of patients diagnosed with COPD to identify key intervention strategies that could decrease the rate of 30-day post-discharge readmission by 1%. The project used the transitional care model as the framework to target specific care transition needs and create patient-centered, supportive, evidence-based relationships among the patient, the providers, the community, and the health care system to identify key intervention strategies for implementation. A retrospective chart review was conducted of transitional care management and care coordination practices of providers of patients diagnosed with COPD. Analysis of the data revealed that the local regional organization used a single, generic, computerized discharge planning and care transition process for patients diagnosed with COPD. As a result, missed opportunities to target a patient's specific care needs led to higher rates of readmission. The implications of the findings of this project for social change include identification of evidence-based recommendations and practices that could influence clinician practices and improve patient outcomes and the quality of health care delivery.

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The purpose of this article is to synthesize the evidence on advance care planning (ACP), determine what is applicable to the home health (HH) setting, and find where gaps in knowledge may exist. An integrative review methodology was chosen. Although there is ample literature on the topic of ACP, most research has been conducted in the acute care, outpatient, and general community settings. There is limited literature regarding ACP with patients living with chronic cardiovascular and pulmonary illnesses, who comprise the majority of the HH population. Some literature has been published regarding the interprofessional team's role in ACP in the HH setting. A gap in knowledge exists regarding ACP in HH, and recommendations for future research are provided.

Syftet med denna studie var att undersöka patienters upplevelser av att leva med KOL samt identifiera eventuella faktorer som underlättar det dagliga livet. För att göra detta genomfördes en litteraturstudie där artiklar analyserades efter Carnevalis (1999) Dagligt Liv ↔ Funktionellt Hälsotillstånd-modell. Patienter upplever svårigheter, krav, i det dagliga livet relaterat till hygien, måltids-situationer och sociala situationer. Patienterna får anpassa sin aktivitetsnivå till sitt aktuella hälsotillstånd. Underlättande faktorer, inre resurser sprungna ur patienter-na själv och yttre resurser, hjälper till att balansera upp kraven i det dagliga livet. Genom att ytterligare stärka patientens inre och yttre resurser anses livskvaliteten hos KOL-patienten förbättras genom att högre nivåer av balans uppnås. / The aim of this study was to explore patients’ experiences of living with COPD and to identify factors to facilitate daily life. To do this a literature review was performed where articles were analysed through Carnevali’s (1999) Daily Life ↔ Functional Health status-model. Patients’ experience difficulties, demands, in daily life related to hygiene, meal-related situations and social situa-tions. Patients need to adapt their level of activity to their current health status. Facilitating factors, inner resources from the patient him/herself and outer resources helps to balance the demands in daily life. Strengthening the patients’ inner and outer resources is believed to increase the COPD patients’ quality of life through higher levels of balance.

Bakgrund: Digitala kontaktvägar har fått en framträdande roll inom primärvården. Genom digitala kontaktvägar ska individen stå i centrum och öka förmågan att hantera sin sjukdom. Egenvårdsråd är högt prioriterade för patienter med kroniskt obstruktiv lungsjukdom och syftar till att minska symtom, förebygga exacerbationer, öka fysisk aktivitet, förhindra sjukdomsprogression och minskad dödlighet. Syftet: var att belysa vilka erfarenheter patienter med KOL har av egenvårdsråd genom en digitaliserad kontakt med vården. Utifrån litteraturöversiktens 14 kvalitativa artiklar framkom tre huvudkategorier: från fysiska till digitala kontaktvägar, erfarenheter av att möta distriktssköterskan på skärmen och digitala egenvårdsråd. Metod: Studien genomfördes som en systematisk litteraturstudie med induktiv ansats. Resultat: Digitala egenvårdsråd ansågs vara ett användbart komplement, inte som en ersättning till fysiska besök hos distriktssköterskan. Konklusion: Den samlade kunskapen från föreliggande studie kan ligga till grund för att distriktssköterskor och verksamhetschefer inom primärvården får en bättre förståelse kring hur egenvårdsråd uppfattas av patienterna, i takt med att deras kunskaper och upplevelser förändras med den digitala utvecklingen. Det vetenskapliga underlaget är begränsat och framtida forskning bör fokusera på en större enkätundersökning för att kunna dra slutsatser av hur digitala egenvårdsråd påverkar patienter med kroniskt obstruktiv lungsjukdom. / Backround: Digital contact path have gained a prominent role in primary care. Through digital contact path, the individual should be at the center of attention and increase the ability to manage their illness. Self-management is a high priority in COPD care and aims to reduce symptoms, prevent exacerbations, increase physical activity, prevent disease progression and reduce mortality. The aim: was to investigate COPD patients' experiences of self-management advice through digitally mediated care. Based on the literature review's 14 qualitative articles, three main categories emerged: from physical to digital contact paths, experiences of meeting the district nurse on the screen and digital self-management advice. Methods: The method used was a systematic literature review with an inductive approach. Results: Digital self-management advice was considered a useful supplement, but never a substitute for physical visits to the district nurse. Conclusion: The collected knowledge from the study could contribute to district nurses and operational managers within primary care gaining a better understanding of how patients perceive self-management advice, as their knowledge and experiences change with digital development. The scientific basis is limited, future research should focus on a larger survey to be able to draw conclusions about how digital self-management advice affects COPD patients.

Bakgrund Kronisk obstruktiv lungsjukdom är ett pågående folkhälsoproblem som främst drabbar personer som röker. Det finns även andra faktorer, som passiv rökning samt exponering för luftföroreningar, som kan öka risken att framskrida sjukdomen. Egenvård är mycket viktigt i detta tillstånd, eftersom det i nuläget inte finns något botemedel mot sjukdomen. Syfte Syftet är att belysa patienters upplevelse av att leva med kronisk obstruktiv lungsjukdom. Metod Litteraturöversikt som baserades på tio kvalitativa vetenskapliga artiklar från Cinahl och PubMed. Resultat Resultatet visade att KOL påverkar människor på olika sätt, både psykiskt och fysiskt. Patienterna kan uppleva trötthet och andnöd i vardagen. Sjukdomen kan orsaka känslor som skuld, skam och ensamhet, vilket har visat sig leda till isolering. Slutsats På grund av att KOL är en kronisk sjukdom som varar livet ut är det viktigt att behandlingen effektivt hanterar patientens symtom. Sjuksköterskans uppgift är att identifiera samt förstå patientens unika behov och skräddarsy behandlingen utifrån dennes behov. Sammantaget är vårdens kvalitet en nyckelfaktor som formar relationen mellan sjuksköterska och patient. / Background Chronic obstructive pulmonary disease is an ongoing public health issue primarily affecting individuals who smoke. There are other factors, such as passive smoking and exposure to air pollution, which can also increase the risk of developing the disease. Self-care is crucial in this condition as there is currently no cure for the disease. Aim The aim is to illuminate individuals’ experience of living with chronic obstructive pulmonary disease. Method A literature review based on ten qualitative studies from Cinahl and PubMed. Results The results showed that COPD affects people in various ways, both mentally and physically. Patients may experience fatigue and shortness of breath in their daily lives. The disease can trigger emotions such as guilt, shame, and loneliness, which has been found to lead to isolation. Conclusions Due to COPD being a chronic disease that lasts a lifetime, it is crucial for treatment to effectively manage the patient’s symptoms. The nurse’s responsibility is to identify and comprehend the patient’s unique needs and tailor the treatment accordingly. Overall, the quality of care is a key factor that shapes the relationship between the nurse and the patient.

For the past few decades, the popularity of graphene oxide (GO) nanomaterials (NMs) has increased exceedingly due to their biomedical applications in drug delivery of anti-cancer drugs. Their unique physicochemical properties such as high surface area and good surface chemistry with unbound surface functional groups (e.g. hydroxyl - OH, carboxyl /ketone C=O, epoxy/alkoxy C-O, aromatic group C=C, etc) which enable covalent bonding with organic molecules (e.g. RNA, DNA) make GO NMs as excellent candidates in drug delivery nanocarriers. Despite the overwhelming biomedical applications, there are concerns about their genotoxicity on human DNA. Published genotoxicity studies on GO NMs were performed using non-commercial GO with 2-3 layers of GO sheets, synthesized in various laboratories with the potential for inter-laboratory variabilities. However, what has not been studied before is the effects of the commercial GO (15-20 sheets; 4-10% edge-oxidized; 1 mg/mL) in vitro on DNA damage in human whole blood and peripheral blood lymphocytes (PBL) from real-life patients diagnosed with chronic pulmonary diseases [asthma, chronic obstructive pulmonary disease (COPD), and lung cancer], and genotoxic endpoints compared with those from healthy control individuals to determine whether there are any differences in GO sensitivity. Thus, in the present study, we had characterized GO NMs using Zetasizer Nano for Dynamic Light Scattering (DLS) and zeta potential (ZP) in the aqueous solution, and electron microscopy using the Scanning Electron Microscope (SEM) and Transmission Electron Microscope (TEM) in the dry state, respectively. Cytotoxicity studies were conducted on human PBL from healthy individuals and patients (asthma, COPD, and lung cancer) using the Methylthiazolyldiphenyl-tetrazolium bromide (MTT) and Neutral Red Uptake (NRU) assays, respectively. The genotoxicity (DNA damage) and cytogenetic effects (chromosome aberration parameters) induced by GO NMs on human whole blood from healthy individuals and patients were studied using the Alkaline Comet Assay and Cytokinesis-blocked Micronucleus (CBMN) assay, respectively. Our results showed concentration-dependent increases in cytotoxicity, genotoxicity, and chromosome aberrations, with blood samples from COPD and lung cancer patients being more sensitive to DNA damage insults compared with asthma patients and healthy control individuals. Furthermore, the relative gene and protein expressions of TP53, CDKN1A/p21, and BCL-2 relative to GAPDH on human PBL were studied using the Reverse Transcription Quantitative Polymerase Chain Reaction (RT-qPCR) and Western Blot techniques, respectively. Our results have shown altered gene and protein expression levels. Specifically, GO-induced cytotoxicity, genotoxicity, and micronuclei aberrations were associated with TP53 upregulation - a biomarker of DNA damage - in both patients and healthy individuals. These effects show that GO NMs have promising roles in drug delivery applications when formulated to deliver drug payload to COPD and cancer cells. However, the fact that cytotoxicity, genotoxicity, chromosome instability, and gene/protein expressions - biomarkers of cancer risk - were observed in healthy individuals are of concern to public health, especially in occupational exposures at micro levels at the workplace.

Bakgrund: Kronisk obstruktiv lungsjukdom är en folkhälsosjukdom som drabbar miljontals människor och är det tredje vanligaste dödsorsaken i världen. För att kunna bemöta patienterna som drabbas av sjukdom krävs stort ansvar av sjukvården och främst sjuksköterskor som har en betydande roll av att främja hälsa och minska symtomlidande. Patienter behöver kontinuerlig uppföljning och utbildning kring sjukdomen för att kunna få en förståelse av innebörden samt utveckla egenvårdsåtgärder. Syfte: Syftet var att belysa individens upplevelser av att leva med kronisk obstruktiv lungsjukdom. Metod: Litteraturöversikt som utgick från 13 kvalitativa originalartiklar. Resultat: I resultatet presenterades patientupplevelsen med hjälp av övergripande teman som: “fysiska utmaningar”, “psykologiska utmaningar hos patienter med KOL", “Självkänsla och Stigma”, “Acceptans och Hanteringsstrategier” samt “Förlust och begränsningar”.   Slutsats: Litteraturöversikten om kroniskt obstruktiv lungsjukdom (KOL) visar komplexa fysiska och psykologiska utmaningar. Fysiska hinder som trötthet och andnöd påverkar vardagslivet, medan psykologiska utmaningar som självkänsla och stigma kan leda till depression och social isolering. Vikten av socialt och psykologiskt stöd framhävs för att komplettera medicinsk vård och underlätta hanteringen av KOL:s påverkan på livskvaliteten. / Background: Chronic obstructive pulmonary disease is a public health ailment affecting millions of people and is the third leading cause of death worldwide. To effectively address patients affected by the disease, a significant responsibility falls on healthcare, particularly on nurses who play a crucial role in promoting health and alleviating symptoms. Patients require continuous monitoring and education about the disease to gain an understanding of its implications and develop self-care measures. Aim: The aim was to illustrate individuals' experiences of living with chronic obstructive pulmonary disease. Method: Literature review based on 13 qualitative original articles. Results: In the results, patient experiences were presented using overarching themes such as: “physical challenges”, “psychological challenges in COPD patients”, “Self-esteem and Stigma”, “Acceptance and Coping Strategies” and “Loss and Limitation”. Conclusions: The literature review on chronic obstructive pulmonary disease (COPD) highlights complex physical and psychological challenges. Physical barriers, such as fatigue and breathlessness, impact daily activities, while psychological challenges, including self-esteem and stigma, may lead to depression and social isolation. The importance of social and psychological support is emphasized to complement medical care and facilitate coping with the impact of COPD on quality of life.

Introduction: There is a growing interest in how technology can be used in order to provide efficient healthcare. Aim: The aim is to explore perceptions on the use of home telemonitoring in patients with COPD.                                                                                                                             Method: Semi-structured individual interviews were carried out with eight women and five men who were part of a larger project aiming to develop and evaluate a telemonitoring system. Participants were interviewed after having used the system for two to four months. Interview transcripts were analysed with qualitative content analysis. Results: The analysis resulted in the theme a transition towards increased control and security and the categories: facing enablers or barriers, increasing control over the disease, providing easy access to care and affecting technical confidence or concern. Participants expressed initial feelings of insecurity, both in practical aspects using the telemonitoring system as well as regarding their disease. The telemonitoring system could reinforce and confirm the participants´ feelings of their current state of health, and the practical management of the telemonitoring system became easier with time.     Conclusion: Telemonitoring can be a valuable complement to healthcare with the potential to contribute to equity in care. However, in order to improve further development and implementation of telemonitoring, several actions are needed such as improved patient education and the use of co-creation. Additional research is needed particularly in the design of user-friendly systems as well as tools to predict which patients are most likely to find the equipment useful as it may result in reduced costs and increased empowerment. / Introduktion: Intresset för hur teknologi kan användas för att erbjuda effektiv sjukvård ökar. Syfte: Syftet är att utforska KOL-patienters upplevelse av att använda ett webbaserat rapporteringssystem i hemmet. Metod: Semi-strukturerade individuella intervjuer med åtta kvinnor och fem män som deltog i ett större projekt med syfte att utveckla och utvärdera ett webbaserat rapporteringssystem. De intervjuades efter att ha använt systemet två till fyra månader. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i temat en övergång till ökad kontroll och trygghet samt kategorierna: möta möjligheter eller hinder, ökad kontroll över sjukdomen, skapar lättillgänglig vård samt påverkar teknisk självkänsla eller oro. Deltagarna uttryckte till en början osäkerhetskänslor, både vad gäller praktiska aspekter i användandet av rapporteringssystemet samt kring själva sjukdomen. Det webbaserade rapporteringssystemet kunde förstärka och bekräfta deltagarnas egna känsla av mående och det praktiska hanterandet av rapporteringssytemet blev lättare med tiden. Konklusion: Webbaserade rapporteringssystem kan vara ett värdefullt komplement till sjukvården med potential att bidra till jämlik vård. I syfte att förbättra fortsatt utveckling och implementering bör förbättrad patientinformation samt vikten av att ta med användarna i utformningen beaktas. Mer forskning behövs för att optimera användarvänlighet samt att identifiera de patienter som har bäst nytta av systemet då det kan ge hälsoekonomiska vinster och inte minst öka patienters delaktighet.