[Penicillin should be withdrawn from the list of drugs that district nurses are allowed to prescribe].
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Biomedical subjects
Publications and source records attributed to G Larsson.
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The aim of this study was to carry out a theoretically-based survey of elderly persons' perceptions of quality of care, in terms of their evaluations of actual care conditions, as well as the subjective importance they ascribe to these. The sample consisted of 428 elderly (> or = 60 years) persons, in four different care environments: a geriatric department (N = 51); persons receiving home nursing (N = 111); nursing homes (N = 111); and service homes (N = 154) in two Swedish cities. Data were collected by way of personal interviews, structured from the questionnaire, Quality from the Patients' Perspective (QPP). The QPP is theory-based and consists of 40 items covering 17 factors. Each item was evaluated in two ways by the respondent: assessment of perceived reality, and evaluation of subjective importance (Likert scales). The results show that personal characteristics, such as age, sex, and self-rated health, had a limited effect on reports of what were regarded as highly important care characteristics, as well as on ratings of actual care conditions. Psychological well-being was strongly related to perceived reality ratings: a favorable well-being covaried with favorable ratings and vice versa. Considerable differences were noted in both types of ratings when the four types of care environments were compared. On the subjective importance scales, persons living in service homes reported lower scores, particularly on the scales designed to measure the medical-technical competence of the caregivers. On the perceived reality scales, the participants in service homes and the geriatric department scored lower.(ABSTRACT TRUNCATED AT 250 WORDS)
The aim of the study was to evaluate the effects of an organizational change programme in a surgical department in Sweden (the introduction of modular nursing) on the nursing staff's perception of job satisfaction and quality of care, and to identify factors which promote or hinder this organizational change. Planning and implementation of the change programme took about 1 year and comprised structural changes and staff training. Assessments of job satisfaction and quality of care were made immediately before, and 1 year after, implementation of the change programme. Data were collected from the staff of two wards. Virtually no statistically significant changes were found when looking at the department as a whole. However, considerable differences were noted between the two wards, particularly in the following areas: relationships with colleagues, identification and commitment, and perceived quality of care. The quality of the interpersonal relationships, and the leadership of the wards' head nurses, appeared to be crucial determinants of the outcome.
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The enzyme dUTPase catalyses the hydrolysis of dUTP and maintains a low intracellular concentration of dUTP so that uracil cannot be incorporated into DNA. dUTPase from Escherichia coli is strictly specific for its dUTP substrate, the active site discriminating between nucleotides with respect to the sugar moiety as well as the pyrimidine base. Here we report the three-dimensional structure of E. coli dUTPase determined by X-ray crystallography at a resolution of 1.9 A. The enzyme is a symmetrical trimer, and of the 152 amino acid residues in the subunit, the first 136 are visible in the crystal structure. The tertiary structure resembles a jelly-roll fold and does not show the 'classical' nucleotide-binding domain. In the quaternary structure there is a complex interaction between the subunits that may be important in catalysis. This possibility is supported by the location of conserved elements in the sequence.
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The influence of a low-dose combined oral contraceptive (ethinyl estradiol 30 micrograms + desogestrel 0.15 mg) on menstrual blood loss (MBL) was evaluated in 20 healthy, young women. MBL prior to commencing oral contraception was 60.2 +/- 5.6 ml (range 22-116 ml), and decreased (p < 0.001) to 36.5 +/- 5.2 ml (range 7-80 ml) and 33.7 +/- 4.1 ml (range 5-70 ml) after 3 and 6 months' oral contraceptive medication, respectively. The reduction in MBL during oral contraception was most apparent during the first two days of menstruation. Five women had an MBL > 80 ml prior to commencing oral contraceptive medication. In all of these women, MBL during the 6th menstrual period after commencing oral contraception was < 80 ml. All the women included in this study had a normal blood hemoglobin concentration, hematocrit and erythrocyte indices and there were no significant changes in these variables during the course of the study. Serum ferritin concentration prior to commencing oral contraception was 44.2 +/- 9.0 micrograms/l and was largely unchanged after 6 months' oral contraception (39.7 +/- 6.3 micrograms/l). On admission to the study, two women had a serum ferritin < 10 micrograms/l, indicative of low iron stores. Both these women had an MBL > 80 ml at the baseline assessment. Serum ferritin concentration increased during oral contraceptive medication in both women (from 8.5 micrograms/l to 12.0 micrograms/l and from 5.4 micrograms/l to 6.8 micrograms/l, respectively). The duration of menstruation (p < 0.01) and the number of women suffering from dysmenorrhea (p < 0.05) was reduced during oral contraception.
The study evaluated the effects of an organisational change programme on quality of care in a Swedish intensive care unit (ICU). The programme included: structural components e.g. converting assistant nurse positions to nurse positions; behavioural components e.g. improvements of report routines; and attitudinal components e.g. explication of what quality of care could mean in the ICU. Planning and implementation of the programme took about 1 year. Quality of care was studied on 40 patients 3 months before the intervention and on 40 patients 18 months after. An observation and question scheme was used for data collection. using Henderson's (1960) nursing model of patient's needs as point of departure. Statistically significant improvements of quality of care were noted on several observations at the postintervention assessment. Most of the improvements were noted on activities aimed at assisting the patient with basic physical needs such as breathing, nutrition, elimination, movement, sleep and rest, and avoiding dangers. No effects were noted on activities aimed at assisting the patient with psychological and spiritual needs. Discussing the results, the multimodal character of the intervention programme was believed to be a significant factor.
Alcoholism among women has increased during the last decades. Thus it is likely that an increasing number of pregnancies will involve risk of alcohol damage to the fetus. In this article, two antenatal programs are presented to identify pregnancies at risk. Adequate alcohol information seems to be sufficient for socially drinking women, whereas alcoholic women need extensive support to abstain from alcohol. The psychosocial support was not experienced as intrusive.
The purposes of this study were twofold. The first was to investigate if relaxation training conducted by nurses as an integral part of their caring activities affected breast cancer patients' experiences of radiotherapy sessions as well as their general wellbeing. Second was to evaluate a pedagogical model for large scale application of relaxation training as an integral part of caring. The sample consisted of 64 consecutive outpatients with breast cancer at a Swedish oncology clinic, receiving their first radiotherapy treatment course following surgery. Every second patient was assigned to an experimental group (n = 32, mean age: 59.5 years) and every other second patient was assigned to a control group (n = 32, mean age: 60.0 years). The programme resulted in the following general effects: fewer perceived daily hassles and a more cheerful overall mood state. The following treatment situation specific effects were noted: programme participants appraised the treatment sessions as successively more benign-positive and less threatening. They also reported more perceived muscular tensions during treatment sessions. Most goals concerning the routinization of the pedagogical model were reached.
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The aim of the study was to determine if using linen in hospital beds affects patients' well-being. An experimental group consisting of 52 patients (mean age: 64.4 years) at a medical ward used linen in the bottom sheet, the protective sheet, the pillow-case and the patient gown for 4 weeks. A control group consisting of 40 patients (mean age: 67.5 years) at the same ward was observed for 4 weeks using the conventional material (cotton, cotton/polyester). Marginal positive effects on patients' well-being were noted when linen was used. It was discussed that the relative importance of the bed material to patients' well-being may be low, compared to medical treatment, nursing, etc. Given the high cost of linen, about 15 times more than the conventional material, it was suggested that the health care system should refrain from large-scale use of linen in hospital beds.
The paper is theoretical, patient centred, and focuses on the two following questions: (1) In what way might a stress theoretical approach further our understanding of how helping can affect somatic and psychological processes in patients, and (2) in what way might stress theory offer action oriented guidelines for those who offer help? A stress model is outlined involving relationships between a patient's cognitive appraisal of a given care situation, his or her coping efforts, and emotional and physiological reactions. Several conditions, related to the patient and to the care giving situation, which might influence the patient's appraisal process are discussed. Possible short- and long-term effects of helping in the somatic and psychological domains are presented. Two examples of common care situations are analysed to show how stress theory may offer helpers an action oriented tool. The concept of participatory caring, implying not only patient involvement but actual power sharing between patients and health professionals, is discussed.
The ability of Cytobrush and Papaplast to collect endocervical cells in vaginal smears was tested in a prospective randomized comparative study including 107 women. Endocervical cells were found more often and in greater numbers with Cytobrush, also in women over 50 years of age. Papaplast missed endocervical cells twice as often as did Cytobrush. The use of the latter instrument meant that the number of repeat smears necessitated due to the absence of endocervical cells could be considerably reduced, with consequent improvement in the cost/benefit ratio.
Specimens for chlamydial culture, direct fluorescent antibody (DFA) test, two enzyme immunoassays (EIA) for antigen detection, and serum for chlamydial antibodies were collected from 256 infertile women. Specimens were taken from the tubes during tuboplasty and from the cervix and endometrium during laparoscopy or tuboplasty. Antibodies to Chlamydia trachomatis were found four times more often in patients with signs of prior pelvic inflammatory disease (PID) than in infertile women with normal pelvic findings. Only 48 (37%) of 131 patients with signs of prior PID had a history of PID. Ten or more C. trachomatis elementary bodies (EBs) per smear were found in 21 (8.2%) of 256 patients. Six patients had a positive culture or a positive antigen EIA test. All six had high numbers of EBs in the DFA test. We conclude that routine culture and EIA antigen tests detect only a minority of persistent chlamydia infections in this population, but subjective factors in the interpretation of DFA methods must be considered.
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