Eating difficulties, complications and nursing interventions during a period of three months after a stroke

AIM: The aim of this study was to describe eating difficulties and especially swallowing in patients with dysphagia, types of nursing intervention, and the development of complications over 3 months. The aim was also to explore common characteristics of eating difficulties that influenced the ability to finish meals. METHODS: Twenty-four consecutive patients admitted because of stroke and dysphagia were included. Nursing interventions, based on assessments, were individually designed. RESULTS: Three subgroups could be identified: those (n=9) who were unable to complete a meal, despite assisted feeding, because of reduced alertness/energy and impaired swallowing function; those (n=5) who could complete a meal, despite suffering from reduced alertness/energy; and those (n=10) who could complete meals with minor difficulties. Patients in the first two groups developed complications such as respiratory infections and/or malnutrition. There was a tendency towards that complications in the third group were less frequent and the hospital stay was significantly shorter than in the other groups. CONCLUSION: The level of alertness/energy in patients with dysphagia after stroke was important for the ability to eat and swallow and the development of complications over time, and thus of great importance for the interventions applied

Integrating the rational unified process and participatory design for development of socio-technical systems : A user participative approach

This study presents the MOPT-Systems Development Process, aimed at bridging the gap between ideality and reality. The process is based on an approach to systems development involving a formalised process for developing socio-technical systems. In specific, it integrates a modified Rational Unified Process (RUP) framework with a socio-technical system view and an extended participatory design (PD) perspective using PD techniques and social research methods. It is argued that the integrated approach, by combining the RUP formalisation, modeling tools and coverage of the entire development process, together with the parallel development of methodology, organisation, and personnel, will greatly enhance the chance of solid systems, grounded in the organisation and appreciated by its users. In this respect, the close cooperation with the end-users throughout the development process is supposed to contribute

Integrating the rational unified process and participatory design for development of socio-technical systems : A user participative approach

This study presents the MOPT-Systems Development Process, aimed at bridging the gap between ideality and reality. The process is based on an approach to systems development involving a formalised process for developing socio-technical systems. In specific, it integrates a modified Rational Unified Process (RUP) framework with a socio-technical system view and an extended participatory design (PD) perspective using PD techniques and social research methods. It is argued that the integrated approach, by combining the RUP formalisation, modeling tools and coverage of the entire development process, together with the parallel development of methodology, organisation, and personnel, will greatly enhance the chance of solid systems, grounded in the organisation and appreciated by its users. In this respect, the close cooperation with the end-users throughout the development process is supposed to contribute

Eating difficulties, need for assisted eating, nutritional status and pressure ulcers in patients admitted for stroke rehabilitation

The aim of this study was to describe the types and extent of eating difficulties, the need for assistance when eating, the nutritional status and pressure ulcers in consecutive patients (n = 162) admitted for stroke rehabilitation over a period of 1 year. Structured observations and assessments of eating, nutritional status (subjective global assessment of nutritional status), pressure ulcers and activities in daily living (Katz ADL-index) were performed by a nurse who also trained the staff to perform these assessments. Difficulties in eating were found in 80%, and 52.5% were unable to eat without assistance. Eating difficulties were: 'eats three-quarters or less of served food' (60%), difficulties in 'manipulating food on the plate' (56%), 'transportation of food to the mouth' (46%), 'sitting position' (29%), 'aberrant eating speed' (slow or forced) (26%), 'manipulating food in the mouth' (leakage, hoarding, chewing difficulties) (24%), 'swallowing difficulties' (18%), 'opening and/or closing the mouth' (16%), and 'alertness' (9%). Thirty-two percent were undernourished (49% of patients needing assisted eating and 13% of those not needing assistance, P < 0.0005). Among patients who were dependent in one or more functions according to the Katz ADL-index, 15% had pressure ulcers. The strongest eating variables for predicting nutritional status were 'alertness', 'swallowing difficulties', 'eats three-quarters or less of served food', and 'aberrant eating speed'. Nutritional status could in turn significantly predict pressure ulcers. Eating difficulties among patients with stroke are complex and the patient's situation before stroke adds to this complexity, especially among those dependent on assisted eating. As difficulties occur both among patients needing and not needing assisted eating, all patients with stroke admitted for rehabilitation need to be systematically assessed for eating difficulties and action needs to be taken to facilitate eating, especially as patients with eating difficulties risk becoming undernourished and in turn developing pressure ulcers

Eating difficulties, assisted eating and nutritional status in elderly (gt-or-equal, slanted65 years) patients in hospital rehabilitation.

This study describes frequencies and associations between eating difficulties, assisted eating and nutritional status in 520 elderly patients in hospital rehabilitation. Eating difficulties were observed during a meal and nutritional status was assessed with Subjective Global Assessment form. Eighty-two percent of patients had one or more eating difficulties, 36% had assisted eating and 46% malnutrition. Three components of eating were focused upon ingestion, deglutition, and energy (eating and intake). Deglutition and ingestion difficulties and low energy were associated with assisted eating, and low energy associated with malnutrition. Underestimation of low energy puts patients at risk of having or developing malnutrition

Effects on blood pressure in patients with refractory angina pectoris after enhanced external counterpulsation

Objective. Enhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to reduce the frequency and severity of angina pectoris. Little is known how EECP affects the blood pressure. Methods. 153 patients with refractory angina were treated with either EECP or retained on their pharmacological treatment (reference group). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate were measured pre- and post-treatment and at 12 months follow-up. Results. EECP treatment altered the blood pressure in patients with refractory angina pectoris. A decrease in the blood pressure was more common in the EECP group compared with the reference group. In the reference group, an increase in the blood pressure was more common. A correlation between a decrease in blood pressure after EECP treatment and a higher baseline MAP, SBP and DBP was seen. No such correlation was seen in the reference group. The blood pressure response did not persist at 12 months follow-up. Conclusion. EECP treatment affects the blood pressure in patients with refractory angina pectoris. The decreased blood pressure may be a result of an improved exercise capacity, an improved endothelial function and vasoreactivity in general

Psychological resilience and health‐related quality of life in 418 swedish women with primary breast cancer : Results from a prospective longitudinal study

Psychological resilience is considered a major protective psychological mechanism that enables a person to successfully handle significant adversities, e.g., a cancer diagnosis. Higher levels of resilience have been associated with higher levels of health‐related quality of life (HRQoL) in breast cancer (BC) patients, but research examining the longitudinal process of resilience is limited. The aim of this population‐based longitudinal study was to investigate resilience and HRQoL from diagnosis to one year later in 418 Swedish women with primary BC. Resilience was measured with the Connor–Davidson Resilience Scale 25, and HRQoL was measured with the Short Form Health Survey. The participants responded to questions regarding demographic and study‐specific varia-bles. Clinicopathological variables were collected from the Swedish National Quality Register for Breast Cancer. The mean score for resilience was 70.6 (standard deviation, SD = 13.0) at diagnosis and 68.9 (SD = 14.0) one year later, p < 0.001. The level of trust in the treatment and financial situation demonstrated the greatest association with the change in resilience levels. No oncological treatment modality was associated with a change in resilience levels. HRQoL decreased over time in the co-hort. Resilience was positively associated with HRQoL at one year post diagnosis, which demon-strates that resilience is an important factor in maintaining HRQoL

A new approach to state the areas of oxygen deficits in the Baltic Sea

Sediment and near bottom water oxygen data was evaluated to look for correspondence in anoxic conditions. The SGU and SMHI monitoring data showed high correlation, although the actual data tested proved to be few, coincidence in space was promising. The conclusion drawn from the evaluation is that anoxic postglacial sediments were generally overlaid by near bottom anoxic waters. Hence, it is suggested that the spatial distribution of postglacial clays in the sea-bottom surface can be used, together with near bottom waters oxygen data, to improve spatial distribution in mapping oxygen deficits.Time series of oxygen deficit volume and area was calculated from near bottom data from several sub basins in the southern and central Baltic Proper. In general, hypoxic and anoxic water conditions increased over time but perturbations of improved oxygen conditions linked to major inflow events occurs especially in the Bornholm, Eastern and Western Gotland Basins.The high spatial variability of the postglacial sediments in the Western Gotland Basin compared to other basins indicates that it is indeed sensitive to the area coverage of anoxic waters. In addition, the relatively weak stratification and high variability over time of oxygen deficit make this basin favourable for oxygen improvement engineering methods.In coastal waters several bays along the Östergötland and Småland archipelagos should be further evaluated before selected for ecological engineering methods to improve oxygen conditions

Psychological resilience and health-related quality of life in Swedish women with newly diagnosed breast cancer

Purpose: Psychological resilience appears to be an important influencing factor in various aspects of health-related quality of life (HRQoL) in a context of adversity, eg, being informed of a cancer diagnosis. The purpose was to investigate psychological resilience and HRQoL in Swedish women with newly diagnosed breast cancer in relation to demographic and clinicopathological characteristics. Methods: A population-based cross-sectional study was conducted including 517 women with breast cancer in the South Swedish Health Care Region. Participants were enrolled at the time of consultation for the diagnosis. Psychological resilience was assessed with the Connor-Davidson Resilience Scale 25 (CD-RISC25), and HRQoL was assessed with the Short Form Health Survey. The participants responded to questions regarding demographic variables. Clinicopathological data were collected from the Swedish National Quality Register for Breast Cancer. Results: The mean score for psychological resilience was 70.6, identifying 15% of included patients with a score lower than 58 (−1 standard deviation). The study cohort had significantly lower mean scores for several aspects of HRQoL compared with Swedish normative data. Regression analyses demonstrated that psychological resilience was significantly associated with all domains of HRQoL after adjustment for demographic and clinicopathological factors. Conclusion: Higher levels of psychological resilience were significantly related to higher levels of HRQoL in Swedish women with newly diagnosed breast cancer and no modifying factor was identified. The assessment of psychological resilience at the time of breast cancer diagnosis might allow for early identification of women in need of more intense psychosocial support. Future studies are needed to identify a clinically relevant threshold of the CD-RISC25