Biomedical subjects

U Rosenqvist

Publications and source records attributed to U Rosenqvist.

At least 19 recordsLinked to original sources

PubMed2006

Being a young and inexperienced trainee anesthetist: a phenomenological study on tough working conditions.

BACKGROUND: Physicians at the beginning of their specialist education have been reported to be especially exposed to stress and difficult working conditions. Considerable worry has also been caused by reports about anaesthetists dying at a younger age than other specialists as well as by reports about higher than average suicide rates among anaesthetists. Maybe as a consequence, many young doctors are reluctant to choose anaesthesiology as their future specialty. The aim of this study was to investigate what difficulties trainee anaesthetists experience at work. METHODS: Nineteen trainee anaesthetists in six Swedish hospitals were interviewed. Phenomenological analysis of the interview text was performed. RESULTS: All trainees had experienced considerable, sometimes extreme demands at work. Most of them often felt insufficient and inadequate and had problems with the professional role. Support from consultants was sometimes lacking. Some trainees expressed deep feelings of loneliness and helplessness in difficult clinical situations. CONCLUSIONS: This study shows that trainee anaesthetists have to live up to high work demands, often with very little support. Because too much stress is an obstacle to professional learning, such working conditions are a hindrance to good specialist education. The first measure to be taken should be to ensure that all trainee anaesthetists always have easy access to senior cover.

Anesthesiology↗

PubMed2005

A two year family based behaviour treatment for obese children.

BACKGROUND: Childhood obesity has become a nutritional problem in China since the 1990s. AIMS: A family based behavioural treatment was developed and tested, to see if its use was feasible in China and to evaluate its impact on obese schoolchildren. METHODS: In a single school in Beijing, 33 obese children were randomly assigned to a treatment group and 35 to a control group. The treatment group participated in a family based behavioural treatment programme for two years. Height and weight were measured every six months for all participants. Blood pressure, cholesterol, and triglyceride levels were measured at baseline and after two years of programme implementation. RESULTS: Body mass index (BMI, kg/m2) was significantly reduced in the treatment group (from 26.6 (1.7) to 24.0 (0.9), 95% CI 2.06 to 3.18) but not in the control group (from 26.1 (1.5) to 26.0 (1.6)). Total cholesterol decreased 5.5% and triglycerides 9.7% in the treatment group. There was a significant correlation between change in BMI and change in triglycerides. There were no significant changes in plasma lipids in the controls. Blood pressure values also decreased significantly in the treatment, but not the control group. CONCLUSIONS: A family based behavioural intervention was feasible to use in treating obesity in schoolchildren in Beijing, China. After two years of implementation, it successfully decreased the degree of obesity, reduced levels of blood pressure, and decreased serum lipids in treatment; there were no significant changes among control children.

Adolescent↗

PubMed2004

Trainee anaesthetists understand their work in different ways: implications for specialist education.

BACKGROUND: Traditionally, programmes for specialist education in anaesthesia and intensive care have been based on lists of attributes such as skills and knowledge. However, modern research in the science of teaching has shown that competence development is linked to changes in the way professionals understand their work. The aim of this study was to define the different ways in which trainee anaesthetists understand their work. METHODS: Nineteen Swedish trainee anaesthetists were interviewed. The interviews sought the answers to three open-ended questions. (i). When do you feel you have been successful in your work? (ii). What is difficult or what hinders you in your work? (iii). What is the core of your anaesthesia work? Transcripts of the interviews were analysed by a phenomenographic approach, a research method aiming to determine the various ways a group of people understand a phenomenon. RESULTS: Six ways of understanding their work were defined: giving anaesthesia according to a standard plan; taking responsibility for the patient's vital functions; minimizing the patient's suffering and making them feel safe; giving service to specialist doctors to facilitate their care of patients; organizing and leading the operating theatre and team; and developing one's own competence, using the experience gained from every new patient for learning. CONCLUSIONS: Trainee anaesthetists understand their work in different ways. The trainee's understanding affects both his/her way of performing work tasks and how he/she develops new competences. A major task for teachers of anaesthesia is to create learning situations whereby trainees can focus on new aspects of their professional work and thus develop new ways of understanding it.

Adult↗

PubMed2004

Diabetes control in Swedish community dwelling elderly: more often tight than poor.

OBJECTIVE: To determine glycaemic control in elderly patients with diabetes living in community dwelling. DESIGN: Descriptive, cross-sectional and open. Prospective with regard to blood glucose. SETTING: Community-dwelling in-patients. SUBJECTS: From a total number of 351 patients in seven Swedish centres of community dwelling we identified and recruited all 45 patients with diabetes receiving treatment with insulin, and/or oral medication. MAIN OUTCOME MEASURES: Blood glucose was measured fasting, 2 h after breakfast, in the evening and at night, for three consecutive days. RESULTS: Mean HbA1c was 5.9 +/- 1.1% (range 3.6-8.6%). The patients were split in three HbA1c-groups for analysis: lower- (3.6-5.3%), middle- (5.4-6.3%) and higher-tertile (6.4-8.6%). The groups where similar with regard to age, time in community dwelling, ability to eat and move around independently, but body mass index was lower in the lower tertile (P < 0.003 and P < 0.04, compared with middle- and higher-tertiles). We recorded 14 episodes with blood glucose </=4.0 mmol L-1 in eight patients. Blood glucose </=4.0 mmol L-1 was mostly recorded during night (n = 8) or in the morning (n = 3). CONCLUSIONS: Swedish patients with diabetes in community dwelling are over- rather than under-treated and have low HbA1c levels. Despite very regular eating habits and near total compliance with medication, hypoglycaemias are frequent and possibly linked to malnutrition.

Aged↗

PubMed2004

Physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system.

Seeks to identify physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system. Details a descriptive, qualitative study, with semi-structured individual interviews of 21 physicians in the Accident and Emergency Department of South Stockholm General Hospital. Identifies four descriptive categories for possibilities and obstacles. Concludes that gaining access to patient drug history enables physicians to carry out work in a professional way--a need the computerised prescription support system was not developed for and thus cannot fulfil. Alerts and producer-independent drug information are valuable in reducing workload. However, technical prerequisites form the base for a successful implementation. Time must be given to adapt to new ways of working.

Attitude of Health Personnel↗

PubMed2003

Can we bridge the gap between goals and practice through a common vision? A study of politicians and managers' understanding of the provisions of elderly care services.

The objective of this study was to identify and describe how local politicians and managers experience and understand problems and goals regarding the structures and processes involved in the care of the elderly. Qualitative methodology of a conceptual modelling workshop was used. Participants were health care politicians, local municipal politicians, and executive care managers. The main result was that all participants agreed on four key visions for the health care of the elderly: see the person, see the individual's resources, see the encounter, and see yourself. Other findings indicated that (a) care of older persons was governed by diverse interests, (b) the organisation lacked clear leadership and comprehensive goals, (c) the organisation was fragmented, and (d) there was a lack of skilled staff members to meet patient needs. Older persons were regarded as passive receivers of care or as objects that did not take an active part in health care decisions that affect them.

Aged↗

PubMed2003

Understanding cardiac follow-up services--a qualitative study of patients, healthcare professionals, and managers.

The study explores the experience and understanding of stakeholders involved in follow-up services after a cardiovascular event. A multimethod approach was used consisting of questionnaires, telephone surveys, and in-depth, face-to-face interviews. Five themes were identified: patients wished to be seen in their total context, patients should do as told; healthcare professionals perform check-ups and control cardiac risk factors; healthcare professionals are in charge of the care processes; and the structure and processes of the healthcare organization. Results indicate that healthcare professionals have considerable difficulty in understanding the patient's situation and to collaborate between different levels of care. Furthermore, the total healthcare organization lacked comprehensive and practical structures in the follow-up process, rehabilitation, and secondary preventive services.

Aftercare↗

PubMed2003

Professional artist, good Samaritan, servant and co-ordinator: four ways of understanding the anaesthetist's work.

BACKGROUND: Evaluating clinical competence among anaesthetists has so far focused mostly on theoretical knowledge and practical skills. According to theory, however, the way anaesthetists understand their own work has also greatly influenced the development of professional competence. The aim of this study was to investigate how anaesthetists understand their work. METHODS: Nineteen Swedish anaesthetists were interviewed. The interviews were open and sought answers to three questions 1) When do you feel you have been successful in your work?; 2) What is difficult or what hinders you in your work?; and 3) What is the core of your professional anaesthesia work? Phenomenographic analysis was performed. RESULTS: Four ways of understanding the anesthesiologists' professional work were found: 1) Give anaesthesia and control the patient's vital functions; 2) Help the patient, alleviate his/her pain and anxiety; 3) Give service to the whole hospital to facilitate the work of other doctors and nurses, caring for severely ill patients; and 4) Organize and direct the operation ward to make the operations list run smoothly. CONCLUSIONS: This study shows that anaesthetists understand their work in qualitatively different ways, which can be assumed to affect their work actions and also the way their competence develops. This has implications for the education of anaesthetists; it is important to find ways of making anaesthetists in training consciously aware of the different ways their work can be understood, as this will give them better prerequisites for future competence development.

Adult↗

PubMed2003

Contradictions in elderly care: a descriptive study of politicians' and managers' understanding of elderly care.

The care of older people in Sweden has undergone several major reorganisations during the past decade. The healthcare organisation, governed by the county councils, previously had the responsibility of providing care services for elderly people. However, the local municipalities have taken over that duty since 1992. The obligation of the health services is now restricted solely to medical issues. The present study focused on the understanding that politicians and managers have about caring for older people. A section of Stockholm with a population of 320,000 inhabitants was studied. The authors hypothesised that differences in understanding might have an impact on the services of care which older people receive. Interviews were conducted with eight leading politicians and 12 managers responsible for elderly care services. The main focus of inquiry concerned the participants' understanding of caring for older people. The results indicate that politicians and managers in elderly care sometimes have divergent views on how the care should be developed and produced to best serve older people. Five themes of understanding elderly care services and eight contradictory statements among the respondents were identified. A follow-up group session with the respondents was conducted to discuss the results of the interviews. The different ways of understanding elderly care services showed a complex and fragmented organisation lacking clear goals, structures and leadership. However, the authors found a willingness among respondents to collaborate with one another, as well as indications of positive attitudes toward improving healthcare, domiciliary and nursing care of older people.

Aged↗

PubMed2001

A change of the physicians' understanding of the encounter parallels competence development.

Patients today complain that physicians do not listen. There is a need to improve the professional competence in the patient encounter. According to theory, competence is a result of how people perceive their work. Observation and reflection can improve the competence. The aim of this study was to investigate if physicians can develop a more patient-centred consultation style by an experienced-based specialist course and how such a development is related to the physicians understanding of the task. The physicians video recorded consultations and reflected on these. The video consultations were analysed with a time study and Pendleton et al.'s consultation schedule [Pendleton D, Schoefield T, Tate P, Havelock P. The consultation: an approach to learning and teaching. Oxford: Oxford University Press, 1984.]. Before-after questions were answered. The study indicates that seven out of 10 physicians participating in the course had developed a patient-centred attitude and acted according to it. The time study gave ambiguous results. This study implicates that it is possible to initiate competence development by influencing the understanding of the encounter.

Adult↗

PubMed2001

Field test of a group education program for type 2 diabetes: measures and predictors of success on individual and group levels.

We performed field testing of a previously described group education program for type 2 diabetes. HbA(1c) levels at start, 6 and 12 months were collected and demographic factors examined to identify predictors of long-term glycemic control on individual and group levels. "Glycemic success" comprised of (1) achieving target values of HbA(1c) < or =6.5% and/or (2) decreasing HbA(1c) progressively, depending on initial values. Groups in the field test and previous pilot-study (N=105) decreased their mean HbA(1c) significantly after 6 months, implying that diabetes mass education led by pharmacists could be possible in the future. Target HbA(1c) < or =6.5% was seen in 51% at start and 63% after 12 months (P=0.023). Initial HbA(1c) and BMI were the most important success predictors; age, sex, duration, and civil status showed no effects. Overweight individuals relapsed after initially decreasing their HbA(1c), emphasizing the need for long-term support in weight management. Experienced loneliness affected outcomes, indicating interaction between diet self-care and social relations.

Adult↗

PubMed2001

Patient education--new trends in Sweden.

Patient education has a long history in Sweden and the field of diabetes care has been in the forefront of the development since the last 20 years. It is now well recognised that patients with chronic diseases must know how to handle their situation and that the long-term outcomes very much depend on how successful they are in their endeavour. More recently, patient education was also provided outside the medical services. Group education and a new role of the educator as a tutor and facilitator has emerged. Education is imparted more and more in the form of experiential learning.

Adaptation, Psychological↗

PubMed2001

Contradictions in the medical encounter: female sexual dysfunction in primary care contacts.

BACKGROUND: Over the past two decades, primary care physicians have been encouraged to participate in the management of sexual disturbances. Women with type 2 diabetes, often treated by GPs, are at high risk of experiencing sexual dysfunction. OBJECTIVE: Very few qualitative studies have described the impact of sexual dysfunction on the diabetic women experiencing it. Our aim was, therefore, to explore the effects, if any, of type 2 diabetes on "womanhood and intimacy" and investigate whether women wish to receive medical attention for their sexual disturbances. METHODS: We used a purposeful sample of middle-aged and older women (44-80 years) diagnosed with type 2 diabetes (n = 33). Methods triangulation was employed: focus group interviews were combined with observer data and a structured, anonymous questionnaire. We performed content analysis, with co-researcher control for systematic bias during the coding process. RESULTS: Personal characteristics, such as age, sex, experience and attitude of the doctor, the specialty considered to be appropriate (GP versus gynaecologist) and circumstances (time and privacy) in the primary care setting appeared to significantly influence women's willingness to discuss--if at all--sexual matters with physicians. CONCLUSION: GPs should aim to create an open atmosphere to encourage discussion of female sexual dysfunction in the consultation room. However, women with sexual problems might benefit more from peer help through patient or women's organizations. The role of GPs might therefore consist of supporting these services and identifying female sexual dysfunction in type 2 diabetes, a problem that middle-aged and older women have difficulty communicating.

Adult↗

PubMed2001

Walking for exercise - immediate effect on blood glucose levels in type 2 diabetes.

OBJECTIVE: To determine the immediate effect of walking on blood glucose levels in patients with type 2 diabetes. DESIGN: Participating patients walked for half an hour on one occasion and on another day they remained physically inactive for half an hour. Blood glucose was measured before and after walking and resting. SETTING: Krokom in the north of Sweden. PATIENTS: Thirty-nine persons with type 2 diabetes, aged 63 (SD 8.5). MAIN OUTCOME MEASURES: Difference of blood glucose levels before and after walking and resting respectively. RESULTS: Post-walk glycaemic levels were reduced by 2.2 mmol/l (SD 1.5). No significant reduction could be observed after a period of physical rest. CONCLUSION: Walking can be safely employed in groups or individually as an introduction to low-intensity exercise and as a demonstration of its blood glucose lowering effect in type 2 diabetes.

Aged↗

PubMed2000

Understanding the job in a new way--a basis for development of competence in diabetes care.

Patients complain that doctors and nurses do not listen, and therefore a need to develop the patient encounter is at hand. Phenomenological theory has opened new ways to develop professional competence. If the idea holds that we express our understanding about our work through our actions, a change in understanding might further develop professional competence. This idea offers a new way to develop competence in diabetes health care service. The aim of this study was to map health care professionals' understanding of the patient encounter before and after an educational intervention that focused the way the health care professional experienced the encounter, and to describe how their understanding changed. Two general practitioners and two diabetes nurses participated. They were interviewed before and after the intervention. The intervention comprised 4-5 sessions during which they together with a tutor reviewed their videotaped consultations with different persons with diabetes. The tutors' role was to make interventions that could alter the persons understanding of the diabetes consultation through questioning. The interviews were analysed using phenomenographic method. The results show that the professionals changed their ways of experiencing the encounter after the intervention. They started to question their way of working, focused the patient's learning process and became interested in how to stimulate it.

Diabetes Mellitus↗

PubMed1999

[Intensified insulin treatment is cost-effective].

Both the Diabetes Control and Complications Trial (DCCT) in USA/Canada, and Stockholm Diabetes Intervention Study (SDIS) showed intensified insulin treatment and reduced glycaemia to prevent complications in patients with insulin-dependent (type I) diabetes mellitus. In the DCCT, the intensified treatment was considered cost-effective. In the SDIS, investigation of the direct increase in costs due to the intensified insulin treatment showed the saving in direct costs due to the reduction in photocoagulation requirements, and in the prevalence of renal insufficiency and of amputation, to correspond to 10 years' intensive insulin treatment. Thus, as intensified insulin treatment in type I diabetes reduces direct suffering at a low cost, it may be regarded as 'evidence-based' and mandatory.

Canada↗

PubMed1999

Study circles at the pharmacy--a new model for diabetes education in groups.

During the past years diabetes education has developed greatly. However, a survey of diabetes care in Sweden in 1995 showed that only 40% of the patients examined had acceptable HbAlc values. This underlines the need for an effective and low-cost patient education programme. In this study we tested the feasibility of a 1-year group education model for patients with type 2 diabetes at Swedish pharmacies. In the study circles, led by specially trained pharmacists, participants learned how to self-monitor glucose, to interpret the results and to act upon them. We conclude that study circles held at pharmacies are a feasible way of educating persons with type 2 diabetes. The group setting promoted learning through peer help and gave emotional support to participants. Metabolic control as measured by HbAlc improved significantly after 6 months, but reverted to baseline levels again at 12 months. The reason for this needs further investigation.

Aged↗

PubMed1999

Elevated plasma semicarbazide-sensitive amine oxidase (SSAO) activity in Type 2 diabetes mellitus complicated by retinopathy.

AIMS: To measure plasma semicarbazide-sensitive amine oxidase (SSAO) activities and detect retinopathy in Type 2 diabetes mellitus (DM). METHODS: Cross-sectional, population-based study of 65 diabetes patients (61 diagnosed from the age of 30 years) with or without retinopathy as determined by fundus photography in primary care. HbA1c was analysed by ion exchange chromatography on a Mono S for HbA1c column. SSAO activities were assayed radiometrically and formaldehyde-albumin adducts by ELISA in plasma samples from patients and 136 healthy controls. RESULTS: Subjects with diabetes had higher plasma SSAO activity, measured as nmol benzylamine x mlplasma(-11) x h(-1)(mean 20.6), than controls (mean 14.3), P<0.0001; 95% confidence interval (CI) for difference 4.9-7.7. SSAO activity was higher in patients with retinopathy (mean 23.2) than in those without (mean 18.9), P=0.012; 95% CI for difference 1.0-7.5, and related to the HbA1c value. No statistically significant relationship between diabetes duration and SSAO activity was found. With HbA1c values and insulin treatment entered into a multiple logistic regression model, SSAO activity no longer predicted retinopathy, P increasing from 0.025 to 0.17. SSAO activity and the presence of any retinopathy were unrelated to titres of antibodies against formaldehyde-treated human serum albumin. CONCLUSIONS: SSAO activity, earlier found to be elevated in Type 1 DM, is also elevated in Type 2 DM. The SSAO family of enzymes may be involved in the development of diabetic retinopathy, possibly by catalysing the formation of toxic metabolites. A potent and specific inhibitor of human SSAO might help prevent retinopathy in Type 1 and Type 2 DM.

Amine Oxidase (Copper-Containing)↗