Experiences of unexplained chest pain and physical activity: A Meta- Ethnography

Aims and objectives The aim was to examine the experiences of physical activity in the patients with unexplained chest pain. Background Previous qualitative studies have compiled data on the physical activity experiences of people with unexplained chest pain. Nevertheless, no meta-synthesis exists on this topic to advance the theoretical development of future-related studies. Design A meta-ethnographic synthesis of qualitative studies was conducted. Original qualitative studies on the physical activity experiences of people with unexplained chest pain were identified and systematically synthesised using a meta-ethnographic approach. Methods Seven databases were searched for relevant full-text articles in English, Danish, Norwegian and Swedish. There were no limitations concerning year of publication. Articles were first screened against inclusion criteria for eligibility and then assessed for quality and analysed using Noblit and Hare's seven-step meta-ethnography process. The ENTREQ checklist for systematic reviews was used. Results Nine qualitative studies were included in the analysis. The physical activity experiences of people with unexplained chest pain illuminates the metaphor: “Physical activity means balancing uncertainty” with four themes: looking for possible explanations, feeling vulnerable, feeling uncertain of consequences and being physically active may mean becoming more capable. Conclusion For people with unexplained chest pain, being physically active meant moving toward being more capable. The participants felt vulnerable and physical activity helped in balancing uncertainty. A comprehensive model illustrates the antecedents and succedent for the physical activity experiences of individuals with unexplained chest pains.publishedVersio

Symptoms in women with Peripartum Cardiomyopathy: A mixed method study

Objective: Peripartum Cardiomyopathy is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth. The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with Peripartum Cardiomyopathy, leading to missed or delayed diagnosis. Women\u27s experiences of Peripartum Cardiomyopathy symptoms remain poorly studied. The aim of this study was to explore and descirbe women’s experiences of symptoms in Peripartum Cardiomyopathy. Design: A triangulation of methods with individual interviews and data from medical records. Setting: Mothers with Peripartum Cardiomyopathy diagnosis were recruited from Western Sweden as a part of research project. Participants: 19 women were interviewed and medical records were reviewed by authors. Data analysis: All interview transcripts were analysed using qualitative inductive content analysis to identify key themes. Results: The main theme, meaning of onset and occurrence of symptoms is captured in the metaphor: being caught in a spider web, comprising subthemes, invasion of the body by experienced symptoms and feeling of helplessness. Symptoms related to Peripartum Cardiomyopathy started for 17 women during pregnancy and in two post partum and time from symptoms to diagnosis varied between three and 190 days (median 40). The physical symptoms were:shortness of breath, excessive fatigue and swelling, bloatedness, nausea, palpitation, coughing, chest tightness, bodily pain, headache, fever, tremor, dizziness, syncope, restless and tingly body and reduced urine output. Emotionalsymptoms were: fear, anxiety, feelings of panic, and thoughts of impending death. Conclusions and implications for practice: Symptoms of Peripartum Cardiomyopathy were debilitating, exhausting and frightening for the women interviewed in this study. Health care professionals responsible for the antenatal care, especially midwives, need skills to identify initial symptoms of Peripartum Cardiomyopathy for early referral and treatment by a specialist. In order to give optimal care more research is needed to show how to improve midwives\u27 knowledge of Peripartum Cardiomyopathy

A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings

The purpose: of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+). Method: A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish. Results: In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation. Conclusion: Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context

Globalization: Migrant nurses' acculturation and their healthcare encounters as consumers of healthcare

From Wiley via Jisc Publications RouterHistory: received 2023-06-30, rev-recd 2023-09-25, accepted 2023-09-26, epub 2023-10-08Article version: VoRPublication status: PublishedTemitayo Odewusi - ORCID: 0000-0002-1746-6080 https://orcid.org/0000-0002-1746-6080Globally, one of every eight nurses is a migrant, but few studies have focused on the healthcare experiences of migrant nurses (MNs) as consumers or recipients of healthcare. We address this gap by examining MNs and their acculturation, barriers to healthcare access, and perceptions of healthcare encounters as consumers. For this mixed‐methods study, a convenience sample of MNs working in Europe and Israel was recruited. The quantitative component's methods included testing the reliability of scales contained within the questionnaire and using Hayes Process Model #4 to test for mediation. The qualitative component's methods included analyzing interviews with iterative inductive thematic analysis. Quantitative findings on MNs (n = 73) indicated that the association between acculturation and perception of the healthcare encounter, which MNs experienced as healthcare consumers, was mediated by barriers to healthcare access, even after adjusting for age and gender (p = 0.03). Qualitative interviews with MNs (n = 13) provided possible explanations for the quantitative findings. Even after working in the host country's healthcare system for several years, MNs reported difficulties with their healthcare encounters as healthcare consumers, not only due to their limited knowledge about the culture and healthcare resources but also due to the biased responses they received.pubpu

Instrumentation and control system architecture of ECRH SST1

The Electron Cyclotron Resonance Heating (ECRH) system is an important heating system for the reliable start-up of tokamak. The 42GHz and 82.6GHz Gyrotron based ECRH systems are used in tokomaks SST-1 and Aditya to carry out ECRH related experiments. The Gyrotrons are high power microwave tubes used as a source for ECRH systems. The Gyrotrons need to be handled with optimum care right from the installation to its Full parameter control operation. The Gyrotrons are associated with the subsystems like: High voltage power supplies (Beam voltage and anode voltage), dedicated crowbar system, magnet, filament and ion pump power supplies and cooling system. The other subsystems are transmission line, launcher and dummy load. A dedicated VME based data acquisition & control (DAC) system is developed to operate and control the Gyrotron and its associated sub system. For the safe operation of Gyrotron, two level interlocks with fail-safe logic are developed. Slow signals that are operated in scale of millisecond range are programmed through software and hardware interlock in scale of microsecond range are designed and developed indigenously. Water-cooling and the associated interlock are monitored and control by data logger with independent human machine interface

Patients with worsening chronic heart failure – Symptoms and aspects of care. A Descriptive and Interventional study

The aims of this thesis are to (1) explore the factors related to seeking care (Paper I), (2) describe the association between fatigue and selected symptoms (Paper II), (3) validate a method to detect the symptoms (Paper III) and (4) evaluate home care with respect to health-related quality of life (HRQL), medical safety, and cost-effectiveness in patients with worsening chronic heart failure (CHF) (Paper IV). All studies utilise data on patients with worsened CHF who sought care at the emergency department or heart failure clinic. Semi-structured interviews were performed (Paper I), and the questionnaires were administered in the form of interviews (Papers II – IV). Eligible patients (Paper IV) were randomised either to home care (HC) or conventional care (CC). Patients in the home care group were initially treated in the emergency department or in the ward and thereafter sent home. Follow-up took place the next day by a specialist nurse and thereafter every day or every other day for 5 -7 days, determined by patient’s health status. The Patients in the CC group were treated according to hospital treatment guidelines. The patients were followed up after 1, 4, 8 and 12 months in both groups. The patients reasons for seeking emergency attention were mainly because of symptoms they experienced (58%), followed by recommendations from either relatives or caregivers (42%). Reasons for not seeking care earlier were attribution of their symptoms to the external factors, uncertainty, old age, previous unpleasant experiences with health care, and hopelessness. Only 5% could relate their current symptoms to worsening CHF. Anxiety was associated with mental fatigue, whereas depression was associated with general fatigue, a decrease in activity and reduced motivation. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was valid, reliable and more responsive than the Short Form-36. Health care cost differed significantly between the HC and the CC group (p < 0.001 after initial intervention and p = 0.04 at the end of the study and p= 0.05 including costs from HF clinic visits, which occurred after termination of the intervention and during study period). The groups did not differ in HRQL or medical safety. The findings from this thesis suggest that, emotional distress may influence patients’ ability to identify symptoms and response for seeking care. KCCQ can be helpful in measuring symptoms in patients with CHF. HC evaluated in this study might play an important role in future care and treatment of patients with CHF. The important aspect is to identify crucial elements in individual needs and provide care accordingly. The significance of being cared for at home and factors influencing symptom reporting are discussed in this thesis