Technological advances mean that medical education bodies can now teach doctors in training using sophisticated engineering systems. Clearly, it is important to establish the efficacy of such innovative educational methods. This study was undertaken primarily to determine whether or not an interactive computerised teaching programme could train medical students and junior house officers to impart effectively distressing information. Subjects were fifth year medical undergraduates at the University of Aberdeen during the 1997/98 academic year. Subjects were separated into two groups. One group had access to the teaching programme during their final undergraduate year, whilst the other did not. Subjects conducted simulated interviews toward the end of their fifth year at medical school and toward the end of their pre-registration year. All subjects were assessed on one of three cases. Subjects were assessed on the same case at both assessment points. All interviews were videotaped. Performances were scored independently by two raters. Subjects rated their own performances. Of 132 medical undergraduates, 94 (71%) conducted interviews toward the end of their fifth year. Of the 63 who could participate one year later, 45 (71%) conducted a second assessment interview. The interaction teaching programme did not improve subjects' ability to give bad news at either test point. Regarding subjects' ratings, at the undergraduate test point, the two significant differences favoured those subjects given access to the teaching programme. At the postgraduate assessment point, the four significant differences favoured those subjects not given access to the teaching programme. Analyses indicated that the skills of doctors in training could be reliably evaluated using three ten-minute interviews. Subjects were poor at evaluating their own communication skills. Those who gave bad news more frequently as junior house officers performed at a similar level to those who gave bad news less frequently. The implications for medical education are discussed.

Background: In Sweden about 19000 people fall victims of sudden death every year. This covers around 20% of all deaths. Relatives are those who are closest to the patient, regardless of the type of relationship. When a patient suddenly dies this affects the relatives and they can suffer from high risk of complicated grief reactions or crises. Being the nearest professional contact in these situations, the nurse has an important role in supporting and guiding the relatives. Aim: The aim of this literature review was to nominate the relatives' needs of support from the nurse when a loved person suddenly dies. Method: The literature review was based on seven articles with a quality approach. Results:The analysis resulted in four themes; "to be seen and confirmed", "information", "take farewell" and "follow-up ". To be able to give support both mentally and physically, it is important for the nurse to give proper attention to the relatives. The nurse supports according to individual circumstances, giving clear and concise information. With privacy, peace and quiet the nurse may create the conditions for a dignified farewell. Afterwards, when the shock phase subsides, many questions need to be answered and a follow-up meeting is important. Conclusion: As nurses we will meet with relatives of patients who have suddenly died. Our results are, however, useful in all types of care, not only in cases of sudden death. The nurse´s attention to the relatives is an important factor in health care. Knowledge about the benefits of taking care of relatives in a situation of sudden death is, currently insufficient. Knowledge of the reactions of relatives who are confronted with sudden death needs to be further explored and existing research needs to be conducted / implemented in health care.

<p>ABSTRACT</p><p><strong>Background:</strong> A diary often helps the critically ill patient better to understand her/his illness and fill gaps in memory regarding their experiences in the ICU. To date there appears to be a lack of research that specifically focuses on family members’ experiences of the use of a diary within the intensive care setting. <strong>Aim: </strong>The aim of the study was to explore how family members experienced a diary kept during their sick relative’s stay in the ICU. <strong>Methodology: </strong>A qualitative methodology and, in particular, a hermeneutic approach were deemed to be appropriate for the study. Eleven participants were interviewed relating to nine diaries. Collected data have been analysed using hermeneutic interpretation inspired by Gadamer. <strong>Findings:</strong> Family members experienced that the diary sustained strengthened and deepened the connection to their sick relative and confirmed the presence of family members at bedside. The diary worked as a forum for mutual exchange of information between nurses and family members which led to a feeling of being united with the nurses in understanding. This in turn created a sense of togetherness and the family members didn’t feel neglected. In addition the diary was experienced as an implied hope that the outcome of the ICU stay would be good<strong>, </strong>thereby lending strength to worried family members<strong>. Conclusion: </strong>The diary was experienced as a tool that enhanced family members’ wellbeing.</p>

Research has consistently shown schizophrenics to perform significantly poorer than normal controls on commonly used measures of neuropsychological functioning. Research on the neuropsychological functioning of first-degree relatives of schizophrenics who do not themselves have schizophrenia is comparatively sparse but suggests the likelihood of deficits in this group as well. A battery of standard neuropsychological tests was administered to three groups: first-degree relatives of schizophrenics who do not themselves have schizophrenia (FDR-SCZ), first-degree relatives of persons with major depression and bipolar disorder (FDR-MOOD), and normal controls (NC). The FDRSCZ group was not found to demonstrate significantly impaired performance relative to the other two groups on any of the hypothesized or exploratory analyses. These implications of these findings are discussed with reference to previous studies and future research.

Background: Suicide is a common cause of death and mental illness is the main reason why someone decides to end their life. Many family members are left in sorrow after these dramatic changes. Research shows that people who have lost a relative in suicide are more likely to become depressed. Objective: The purpose of this study was to describe how relatives experience losing a relative to suicide. Method: A literature-based study was used to investigate how relatives experience losing a relative to suicide. The results were analyzed by using a qualitative content analysis comprising five steps. The analysis resulted in three themes and eight subthemes. Results: The result showed that the initial response to the suicide is shock and confusion. They experienced a hard time understanding what have happened and needed support to cope. Society's stigmatization made it hard to move on. Finally they have to accept the unacceptable in order to continue their lives. Conclusion: The relatives got into a traumatic crisis when they first heard of the suicide. They experienced problems with their mental- and psychical health. They need a lot of support to find strategies for managing their grief. Nurses play a major role in helping them in their grief, giving them comfort and finding professional support. / Suicid är en vanlig dödsorsak i Sverige. Beskedet om att någon valt att ta sitt liv kommer ofta plötsligt och utan förvarning. Här lämnas en stor andel närstående såsom familj, vänner och kollegor som ofta är oförstående för vad som inträffat och oförmögna att hantera beskedet. Examensarbetet fokuserar på vad som händer med de som lämnas kvar efter att någon de älskat valt att ta sitt liv. Vid ett vanligt dödsfall så sker det ofta mer odramatisk och det kanske är förväntat att personen ska dö. När en anhörig begår en suicidhandling blir den drabbade närstående kvar med ilska, skuld och frågor som inte kan bevaras. Självmordet kan ske på dramatiska sätt som innebär en svårare sorgehantering för de som efterlämnas. Risken för att drabbas av psykisk ohälsa är större för de som upplevt ett trauma och för att förebygga ett lidande hos de närstående behöver sjukvården fånga upp dem och ge dem de verktyg de behöver för att bearbeta sin sorg. Examensarbetet baseras på 10 kvalitativa vetenskapliga artiklar, där författarna till studien plockat ut fynd i resultatet för att belysa studiens syfte som är att beskriva närståendes upplevelser av att förlorat en anhörig i suicid.  I resultatet framkommer det att de närstående går igenom en traumatisk kris, upplever stigmatisering från samhället och att det har ett stort behov av support. Genom denna studie kan sjuksköterskor få en större insikt för hur närstående upplever förlusten av en anhörig genom suicid och med hjälp av det lära sig mer om krishanteringen för att kunna bemöta den patientgruppen genom att ge tröst och lindra lidanden.

Introduction: Dento-alveolar anomalies associated with Orofacial clefts (OFCs) can present with a wide range of variation. This vast diversity makes it difficult to pinpoint their specific etiology. For instance, differentiating anomalies that arise as a consequence of the physical effects of the cleft itself or from the same biological processes that result on clefting, from those that likely occur as a sequela from the surgical repair is a challenge. One approach that can aid this differentiation is to study if first degree relatives of children with clefts whom themselves do not have an overt cleft but may carry genetic cleft risk, are more likely to present some of these anomalies. If so, the elevated risk on these seemingly unaffected relatives will indicate that the particular anomaly arises as a consequence of the molecular pathways that give rise to cleft risk rather than from the physical consequences of the cleft or the surgical repairs. Understanding the different etiological factors underlying dental anomalies within the cleft phenotypic spectrum is a fundamental step for prevention and better management of such anomalies. Amongst the most common dento-alveolar anomalies seen in children born with OFC are tooth size-arch length discrepancies and dento-alveolar shape irregularities, mostly studied in the maxillary arches. Such arch irregularities lead to moderate or severe malocclusions. It is not well known if unaffected family members (UFM) of children with clefts are also susceptible to such dento-alveolar shape irregularities and thus their etiology is not well understood. This study aims to characterize 3D variation in dento-alveolar shape as part of the cleft phenotypic spectrum in UFMs of individuals with OFCs compared to controls with no history of OFC. Methods: A total of 760 maxillary and 760 mandibular casts were digitally scanned using a NextEngine Laser scanner and digitized by two raters with 92 landmarks for maxilla and 94 landmarks for mandible, covering gingival margins and occlusal surfaces via Landmark Editor Software. A reliability of 88.15% was obtained for an interrater agreement error of less than 1mm for all landmarks obtained. 3D coordinates were extracted and registered using a Procrustes fit procedure. Procrustes residuals were analyzed via canonical variate analyses to capture differences in 3D shape between cases and controls. Of the 760 maxillary individuals attempted, 535 (Cases N=133, Controls=402) had all 92 landmarks and 688 (Cases=192, Controls496) had at least 40 landmarks in the canine to canine region. Of the 760 mandibular individuals attempted, 434 (Cases N=99, Controls=335) had all 94 landmarks and 611 (Cases=180, Controls=431) had at least 40landmarks in the canine to canine region. Thus analyses were done separately for each subsample. Results: Case-control differences were not significant (P=0.11) for overall maxillary dental arch shape. However, for the maxillary canine to canine dataset, significant differences were found (P=0.02 for raw Procrustes distance, P<0.0001 for Mahalanobis distance). Case-control differences were significant (P=0.02) for overall mandibular dental arch shape. Significant shape differences were also found for the mandibular canine to canine dataset (P=0.01 for raw Procrustes distance, P<0.0001 for Mahalanobis distance). In other words, there is better separation between cases and controls for the mandibular dataset compared to the maxillary dataset (P=0.11 for the maxillary full arch). Cases had maxillary and mandibular anterior dentitions that were overall retrusive, with anterior teeth that significantly tapered towards the incisal third with larger interproximal incisal embrasures and height to width rations that deviate from ideal ratios (i.e. width is ~70% of the height) due to an overall decrease in crown height. Also, incisal edges seem to flare outwards from the arch line when compared to controls. Moreover, case arch forms trend towards a “v” shape, resembling a Bonwill-Hawley arch shape compared to a “u” shape in the controls. Conclusions: Upper anterior, lower anterior and overall arch shape significantly differ between UFM of individuals with OFC and controls. The most significant differences were located in the maxillary and mandibular anterior dentitions, where cases were more retrusive overall with incisal edges that were tapered and flared, displaying large embrasures and tapered and flared, displayed large embrasures when compared to controls. The phenotypic differences identified in this study contribute to the understanding of the cleft phenotypic spectrum aiding future studies of cleft etiology and cleft risk prediction.

ABSTRACT Background: A diary often helps the critically ill patient better to understand her/his illness and fill gaps in memory regarding their experiences in the ICU. To date there appears to be a lack of research that specifically focuses on family members’ experiences of the use of a diary within the intensive care setting. Aim: The aim of the study was to explore how family members experienced a diary kept during their sick relative’s stay in the ICU. Methodology: A qualitative methodology and, in particular, a hermeneutic approach were deemed to be appropriate for the study. Eleven participants were interviewed relating to nine diaries. Collected data have been analysed using hermeneutic interpretation inspired by Gadamer. Findings: Family members experienced that the diary sustained strengthened and deepened the connection to their sick relative and confirmed the presence of family members at bedside. The diary worked as a forum for mutual exchange of information between nurses and family members which led to a feeling of being united with the nurses in understanding. This in turn created a sense of togetherness and the family members didn’t feel neglected. In addition the diary was experienced as an implied hope that the outcome of the ICU stay would be good, thereby lending strength to worried family members. Conclusion: The diary was experienced as a tool that enhanced family members’ wellbeing.

Bakgrund: När en individ drabbas av Alzheimers, vilket orsakar minnessvårigheter påverkas även familjen då vardagen drastiskt förändras. För att öka de närståendes hälsa och bemöta dem på bästa sätt behövs en ökad förståelse om deras upplevelser.Syfte: Syftet med denna studie är att genom självbiografier belysa närståendes upplevelser av att leva med en person som har Alzheimers sjukdom i det dagliga livet.Metod: En litteraturstudie av självbiografier skrivna utav närstående till personer med Alzheimers.Resultat: I resultatet kunde vissa upplevelser urskiljas. Upplevelserna delades upp i olika kategorier. Huvudkategorier var Att börja förstå, Att förlora en livskamrat, Att leva med en person med Alzheimers, Att leva psykologiskt ensam.Diskussion: Många negativa upplevelser och likheter framkom i datamaterialet. Det som framkom i studien kan styrkas med tidigare studier. Huvudkategorin Att förlora en livskamrat visade sig vara framträdande hos de närstående.Implikationer för Omvårdnad: Sjuksköterskan kan genom en ökad förståelse för de närståendes negativa upplevelser ge stöd som kan bidra till mera positiva upplevelser. / Background: When an individual is diagnosed with Alzheimer's, which causes memory difficulties, this will also affect the family/relatives as everyday life drastically changes. To assure optimal approach of these relatives and to improve their health a greater understanding of their experiences is required.Aim: The aim of this review is to shed light upon relatives' experiences of everyday life living with an individual with Alzheimer's disease.Method: A literature review. Result: Analysis of autobiographies written by relatives of individuals with Alzheimer's revealed certain specific experiences. The experiences were categorized. Main categories were: Beginning to understand, To loose a life-partner, To live with an individual with Alzheimer's, To live alone psyhologically. Discussion: A lot of negative experiences and similarities appeared in the material. What emerged from the study is substantiated by previous studies. Main Categories To loose a life-partner was found to be prominent in the related. Implications for Nursing: Nurse can by a better understanding of the related negative experiences support that can contribute to more positive experiences.

Bakgrund: Antalet personer med demenssjukdom i Sverige beräknas uppgå till 150 000. Utav dessa vårdas 55 procent i hemmet av anhöriga. De anhörigas roll och funktion som vårdare i hemmet blir alltmer centralt, då vård och omsorg flyttas från det offentliga rummet till det privata. Att träda in i rollen som anhörigvårdare förändrar livssituationen avsevärt och allt planeras kring demenssjukdomens villkor. Syfte: Att sammanställa och belysa forskning som beskriver hur de anhöriga upplever sin situation av att vårda en anhörig som drabbats av en demenssjukdom. Metod: En litteraturöversikt där fem kvantitativa och sex kvalitativa artiklar analyserats. Resultat: Artikelanalysen resulterade i tre teman:  en ny livssituation, förändrad relation och känslomässigt påfrestande. I resultatet framkom att anhöriga rapporterade ohälsa. Diskussion: Anhöriga är en utsatt grupp, som behöver mycket stöd för att de ska orka axla rollen som anhörigvårdare. För att de ska kunna ge den demenssjuke god vård, krävs ett samarbete mellan den anhörige och vården. Kunskapen i studien är användbar för sjuksköterskan och kan användas som ett verktyg för ökad förståelse i mötet med den anhörige. / Background: The numbers of people with dementia in Sweden are estimates at 150 000. Out of these 55 percent cared for a relative at home. The role and function as a caregiver in home are becoming more centralized, when health care move from the public sphere to private enter the role of careers changing life situation considerably and everything is planned around the dementia illness. Aim: To collate and illustrate research that describes how the relative experiences their situation of caring for a relative with dementia. Method: A literature survey in which five quantitative and six qualitative articles were analyzed. Results: Article analysis resulted in three headings: a new life situation, changes in relationships and emotional trying. The results revealed that caregivers reported illness. Discussion: Relatives are a vulnerable group in need of much support to maintain the role as a caregiver. To be able to provide the best dementia care requires a coperation between caregivers and health care. Knowledge in the study is useful for the nurse and can be used as a tool for better understanding of the meeting with the relative.

SAMMANFATTNING Syftet med studien var att undersöka vilka behov av stöd anhöriga till myelompatienter upplever att de har under den polikliniska behandlingsperioden. En kvalitativ metod med deskriptiv design användes och studien utfördes med hjälp av semistrukturerade intervjuer. Nio anhöriga till myelompatienter urvaldes specifikt med tanke på ålder, kön, relation till patienten och hur länge denne varit sjuk. En innehållsanalys av intervjuerna gjordes och de viktigaste fynden i denna studie var att informanterna uttryckte behov av olika typer av information från olika kanaler och att de hade behov av att samtala med någon om sin situation. Efterfrågan på medicinsk information återkom vid olika tillfällen under intervjuerna och det ansågs väsentligt att få veta när förändringar ägde rum i sjukdom och behandling. Informanterna ville ha varierad mängd information, från detaljerad till mer översiktlig sådan och framställan skulle vara muntlig, skriftlig eller både ock. Informanterna angav familj och vänner som samtalspartner men kunde även tänka sig personal och anhöriga till andra patienter. Behov uttrycktes både för att föra samtal enskilt och i grupp, vid varierad tidpunkt. Samtal sågs också som en möjlighet att få uttrycka egna behov och dela andras erfarenheter. Slutsats: Resultatet kan uppmärksamma mottagningar på att de behov av information och samtal som anhöriga ger uttryck för skulle kunna bemötas på ett bättre sätt genom att, på ett tidigt stadium av patientens sjukdom, erbjuda olika former av stöd för att tillgodose dessa behov. / ABSTRACT The aim of the study was to investigate the needs of relatives of patients with myeloma feel that they have during treatment on an outpatient ward. A qualitative approach with a descriptive design was used and the study was performed by doing semi-structured interviews. Nine relatives of patients with myeloma were specifically chosen with regard to age, sex, relationship to the patient and how long he/she had been ill. A content analysis of the interviews were made and the most important findings of this study was that relatives expressed the need for various types of information from various channels and that they had a need to talk to someone about their situation. Demand for medical information returned at different times during the interviews, it was considered essential to know when changes occurred in the illness and treatment. Relatives wanted a varied amount of information, from detailed to more summary and request would be oral, written or both kinds. Relatives specified family and friends as a partner to talk to but could even conceive of staff and relatives to other patients. Need expressed both in order to have talks individually and in groups, at varied times. Talks also were seen as an opportunity to express their needs and share others ' experiences. Conclusion: The result can make outpatient wards to pay attention to the needs for information and talks that relatives expressed could be addressed more effectively by, at an early stage of a patient's illness, provide various forms of assistance to meet these needs.