‘I was young, I wanted to return to sport, and re-ruptured my ACL’ – young active female patients’ voices on the experience of sustaining an ACL re-rupture, a qualitative study

publishedVersio

Language as a barrier to successful communication

Vi lever i tiden där stora folkvandringar är ett faktum och dessa har lett till att var och en av oss kommer i kontakt med människor från andra delar av världen. Den ”negativa” sidan av folkvandringar är att allt större andel av invånare i Sverige inte har svenska som modersmål. Språket har centralt betydelse under mötet mellan patienter och vårdpersonalen. Problem som kan uppstå vid språksvårigheter, är inte bara språkliga utan även kulturella eftersom kultur och språk går hand i hand. Syfte Syfte med denna uppsats var att beskriva och belysa hur livssituation för patienter som har serbokroatiska som modersmål och inte behärskar svenska språket påverkas. Särskilt ville jag belysa hur språksvårigheter påverkar kommunikationen då patienter gör besök inom vården. Metod Denna studie genomfördes som en intervjuundersökning. Sammanlagt intervjuades femton personer- sju kvinnor och åtta män. Informanternas svar har bearbetats genom kvalitativ innehållsanalys. Resultat Resultaten av studien visar att miljöombyte, kultur och språk påverkar informanternas välbefinnande. Språket i samband med kulturskiftandet är det största problemet när det gäller kommunikationssvårigheter. Kommunikationssvårigheter handlar i lika hög grad hos vårdpersonalen som inte har kunskaper i transkulturell omvårdnad så som hos patienter som inte kan svenska språket och besöker vården. För att kommunicera med patienter räcker inte att bara använda det språk som används inom området omvårdnad. Vårdpersonalen måste också förstå hur det språk som patienter använder inte bara inkluderar olika betydelser av ord utan även hur dessa betydelser färgas av ett annat kulturellt sätt att tänka

Total hip replacement in immigrants and Swedish patients. Evaluation of preoperative care, socioeconomic background, patient-reported outcomes and risk of reoperation

Total Hip Arthroplasty (THA) aims to reduce pain and improve mobility, function and quality of life in patients with osteoarthritis, when non-surgical treatment has failed. Despite good or excellent results in the majority of patients, some of them are dissatisfied. This variability in outcome is multifactorial. Preoperative information, hospital care and postoperative rehabilitation may be more demanding if the patient is not familiar with the domestic language, belongs to a cultural minority or lives in poor socioeconomic circumstances. This thesis aimed to investigate the influence of ethnicity and socioeconomic factors on the outcome after primary THA. Demographic information and data relating the surgical procedure, patient reported outcome collected preoperatively and one year after the operation and any subsequent revision/reoperation were retrieved from the Swedish Hip Arthroplasty Register. Cross-matching with data from the Patient Register and Statistics Sweden was performed to retrieve information about comorbidities, cohabiting, education, and country of birth. Interviews and a self-administered questionnaire on given preoperative information, pre- and postoperative pain and patient satisfaction including the DASS 21 score for mental health of patients were also used. The interviews were analyzed using content analysis according to Graneheim and Lundman. The patients were analyzed in four groups (born in Sweden, the Nordic countries, Europe and outside Europe including the Soviet Union) or two groups (born in or outside Sweden). Patients from both groups in the qualitative study, expressed concern about inadequate pre-operative information on implants used, pain relief, choice of anaesthesia, no or too short a time to put questions to the surgeon and an overall stressful clinical situation. All the immigrant groups had more negative interference relating to self-care (p≤ 0.02), some immigrant groups tended to have more problems with their usual activities (p≤ 0.05) and patients from Europe and outside Europe more frequently reported problems with anxiety/depression (p≤ 0.005). Patients born abroad showed an overall tendency to report more pain on the VAS than patients born in Sweden. One year after the operation the immigrant groups reported lower values in all EQ-5D dimensions. After adjustment for covariates including the preoperative baseline value most of these differences remained apart from pain/discomfort and regarding immigrants from the Nordic countries, anxiety/depression as well. One year after the operation pain according to the VAS had decreased substantially in all groups. The immigrant groups indicated however more pain than those born in Sweden both before and after adjustment for covariates (p<0.001). Patients born outside Sweden had generally a poorer mental health than those born in Sweden. The risk of revision and reoperation within a period of two years did not differ between immigrants and patients born in Sweden. The difficulties for the patients born outside Sweden may depend on cultural differences, communication problems and differences in indications. This patient group could benefit from improved pre-and postoperative information and other measures to facilitate and improve their rehabilitation

Emerg Infect Dis

Paenibacillus larvae causes American foulbrood in honey bees. We describe P. larvae bacteremia in 5 injection drug users who had self-injected honey-prepared methadone proven to contain P. larvae spores. That such preparations may be contaminated with spores of this organism is not well known among pharmacists, physicians, and addicts

The influence of cognitive status on outcome and walking ability after hemiarthroplasty for femoral neck fracture : a prospective cohort study

INTRODUCTION: Femoral neck fracture (FNF) is a devastating injury with serious medical and social consequences. One-third of these patients have some degree of impaired cognitive status. Despite this, a high proportion of hip fracture trials exclude patients with cognitive impairment (CI). We aimed to evaluate whether moderate to severe CI could predict walking ability, quality of life, functional outcome, reoperations and mortality in elderly patients with displaced FNF treated with hemiarthroplasty (HA). METHODS: This cohort study included a consecutive series of 188 patients treated with HA for a displaced FNF. Patients were assessed for estimated preoperative and 1 year postoperatively with regard to walking ability, cognitive status, quality of life with EQ-5D and hip function with Harris hip score. RESULTS: There were 188 patients who met the inclusion criteria. A total of 130 patients were in the control group, and 58 were in the CI group. At 1-year follow-up, 31 patients (24%) had died in the control group and 22 patients (38%) had died in the cognitive impaired group. This difference in reoperation and mortality rate was statistically significant (log-rank test, p = 0.016). The CI had a significantly higher incidence of being non-walker (28 vs. 4%, OR 9.2, p = 0.001). The EQ-5D was higher in the control group, while the Harris hip score was comparable in the two groups. CONCLUSIONS: Moderate to severe CI was associated with a high incidence of non-walking ability, worse quality of life, high mortality and re-operation rate after femoral neck fractures treated with HA

A Prospective Observational Cohort Study on Orthopaedic and Anaesthetic Registrars Performing Femoral Nerve Block on Patients with an Acute Hip Fracture

We investigated if a femoral nerve block (FNB) for patients with a proximal femoral fracture (PFF) and administered by an orthopaedic registrar (OR) instead of an anaesthesiology registrar (AR) lowers the lead time to block and reduces the total amount of rescue analgesics during the preoperative phase. 205 patients were included in a prospective observational cohort study. The main outcome variable was rescue analgesics as total intravenous morphine prior to surgery. All results were adjusted for confounding using age, sex, cognitive dysfunction, and ASA classification. The OR group (n=135) was over 2 hours faster in performing the block compared to the AR group (n=70) but was nonetheless correlated with an increased amount of rescue analgesics during the study, 2.4 mg morphine (95% CI 0.0–4.9) more compared to the AR group. We found no difference between the groups in the risk of adverse events. We conclude that, for patients with an acute PFF and with morphine consumption as end point, how soon from arrival to hospital the patients receive a FNB is of lesser importance than who is administering it. Based on our results we recommend that emergency hospitals should have routines for anaesthesiologists performing FNB on this frail patient group

Migrant general practitioners' experiences of using interpreters in health-care : a qualitative explorative study

BACKGROUND: According to the UNHCR, 250 million people currently live outside their country of birth. The growing multicultural population poses a major challenge to healthcare professionals who aim to provide individualized, holistic care, which respects the individual's autonomy. To ensure basic rights, healthcare interventions should be guided by the value of benefiting others; individuals should be treated honestly, equally, and impartially. OBJECTIVE: To investigate immigrant doctors' experiences of using interpreters in the Swedish health-care system. MATERIAL AND METHODS: Twenty-eight doctors, 12 men and 16 women from Bosnia and Herzegovina, Croatia, Macedonia and Serbia participated in four focus group interviews (FGI). The interviews were audio recorded, transcribed and analyzed using content analysis method. RESULTS: The best results in the present study were achieved in situations where a professional interpreter was involved. In some cases, the doctors were forced to use relatives or a colleague to interpret, which in many cases proved to be a mistake. The consequences of poor interpretation routines included payment by mistake, a patient paying an interpreter who refused to interpret, time spent waiting for another interpreter, as well as disturbances to the daily work schedule. Finding someone who could replace an interpreter who did not show up caused time shortage and increased stress. CONCLUSIONS: Improved routines and more effective cooperation between interpreting services and health-care centers are needed in order to ensure that using professional interpreters guarantees appropriate, high quality care. Improvements are needed to provide satisfactory health-care to people with limited language skills. In order to achieve this, better education of interpreters is needed, especially regarding cultural diversity and medical terminology. These improvements present complex challenges, deserving empirical and critical reflection in order to improve the work situation for doctors

Living with a recalled implant : a qualitative study of patients' experiences with ASR hip resurfacing arthroplasty

BackgroundTotal hip arthroplasty is the traditional treatment for osteoarthritis in the hip joint. Hip resurfacing arthroplasty, with metal on metal bearing, is a modern concept initially developed mainly for young active people. The metal-on-metal hip arthroplasty implant, Articular Surface Replacement (ASR), was implanted in approximately 93,000 patients before it was recalled in 2010 due to a high complication rate. This study aimed to evaluate patients' own experiences living with an implant that they knew had a high complication rate and had been recalled from the market.MethodsA total of 14 patients, still living with the implant, of a cohort of 34 patients were available for follow-up. Qualitative semi-structured interviews were conducted with 14 patients where a majority actively sought for metal-on-metal hip resurfacing arthroplasty (HRA), and subsequently underwent HRA with an ASR prosthesis between 11/21/2006 and 09/28/2009. The responses were analyzed using content analysis described by Graneheim and Lundman to compress text and identify categories and subcategories.ResultsThe results showed that most patients had already decided that they wanted a metal-on-metal HRA implant before meeting the surgeon. They expressed that the implant made it possible to live an active life. A majority did not think about the fact that they had a hip implant, because they lacked subjective pain. Most of the patients were positive about the annual exams at the hospital and wanted them to continue. None of them felt that their trust towards the healthcare system had changed after the implant recall. They expressed a belief that they would need new surgery sooner than they first thought.ConclusionsDespite all the attention when the ASR prosthesis was recalled, patients with ASR-HRA did not report themselves negatively affected by the recall in this group of patients where a majority had actively sought for an HRA procedure. The healthcare system has an obligation to continue the annual exams, even if the implant provider does not continue reimbursement

Migrant General Practitioners' Experiences of Using Interpreters in Health-care: a Qualitative Explorative Study

BACKGROUND: According to the UNHCR, 250 million people currently live outside their country of birth. The growing multicultural population poses a major challenge to healthcare professionals who aim to provide individualized, holistic care, which respects the individual’s autonomy. To ensure basic rights, healthcare interventions should be guided by the value of benefiting others; individuals should be treated honestly, equally, and impartially. OBJECTIVE: To investigate immigrant doctors’ experiences of using interpreters in the Swedish health-care system. MATERIAL AND METHODS: Twenty-eight doctors, 12 men and 16 women from Bosnia and Herzegovina, Croatia, Macedonia and Serbia participated in four focus group interviews (FGI). The interviews were audio recorded, transcribed and analyzed using content analysis method. RESULTS: The best results in the present study were achieved in situations where a professional interpreter was involved. In some cases, the doctors were forced to use relatives or a colleague to interpret, which in many cases proved to be a mistake. The consequences of poor interpretation routines included payment by mistake, a patient paying an interpreter who refused to interpret, time spent waiting for another interpreter, as well as disturbances to the daily work schedule. Finding someone who could replace an interpreter who did not show up caused time shortage and increased stress. CONCLUSIONS: Improved routines and more effective cooperation between interpreting services and health-care centers are needed in order to ensure that using professional interpreters guarantees appropriate, high quality care. Improvements are needed to provide satisfactory health-care to people with limited language skills. In order to achieve this, better education of interpreters is needed, especially regarding cultural diversity and medical terminology. These improvements present complex challenges, deserving empirical and critical reflection in order to improve the work situation for doctors

A cohort study comparing internal fixation for undisplaced versus hip arthroplasty for displaced femoral neck fracture in the elderly : a pilot study for a clinical trial

Introduction: The literature regarding undisplaced femoral neck fractures (FNF) is sparse. The aim of this prospective feasibility study is to compare the clinical outcome after undisplaced FNF treated with internal fixation (IF) and displaced FNF treated with hip arthroplasty. We hypothesized that hip arthroplasty would give a lower incidence of reoperations. Methods: A total of 235 patients were included with a median age of 84 years (range 65-99). A consecutive series of 65 patients with undisplaced FNF were treated with IF, and 170 patients with displaced FNF were treated with either a total hip arthroplasty or a hemiarthroplasty. Follow-up interviews were conducted at 1 year using the Harris Hip Score (HHS), WOMAC, and pain numeric rating scale (PNRS). The minimum follow-up time was 22 months. There was no difference in baseline data between the groups. Results: Nineteen (8%) hips required reoperation at least once at a mean of 6 months (range 0-35). The rate of reoperation was higher in the IF group compared to the hip arthroplasty group (13.8% vs. 5.9%, 95% CI 0.9-6.4). The overall 1-year and 2-year mortality was 28% and 40%, respectively, with no difference between the groups. The most common reasons for reoperations in the IF group were non-union and avascular necrosis, and 6 patients were treated with hip or excision arthroplasty. In the arthroplasty group, the most common indications were deep infection and dislocation. We did not find any differences between the groups in terms of HHS, WOMAC, and PNRS. Conclusions: In this feasibility study, we found no differences in patient-reported outcomes between the groups although IF required a higher rate of reoperations. Further randomized trials are needed to establish the optimal treatment of undisplaced FNF in the elderly. Trial registration: ClinicalTrial.org, NCT03392285. Retrospectively registered on 5 February 2018