Oral health is a complex issue associated with social and behavioral factors and general health. Therefore, this study aims to explore Swedish older adults’ perceptions of oral health and its ...influence on general health, based on the World Dental Federation's (FDI) definition and framework of oral health. The study adopted a descriptive qualitative design. Data were collected from semi-structured individual and focus group interviews with older adults (n = 23) and were analyzed with deductive direct content analysis. The study was evaluated using the COnsolidated criteria for REporting Qualitative research (COREQ) checklist. The older adults described the importance of good oral health in the physical, social, emotional, and mental aspects of their daily lives. The findings also indicate that older adults described oral health as multifaceted and agreed with the FDI's definition and framework of oral health. Therefore, the study findings might provide healthcare professionals with new knowledge and further insight into older adults’ perceptions of oral health and its influence on their well-being and general health.
Purpose
To describe patients initiating dimethyl fumarate (DMF) and measure persistence with DMF, discontinuation, and switching in treatment-naïve DMF patients and patients switching to DMF from ...other multiple sclerosis disease-modifying treatments (DMTs).
Methods
A population-based cohort study of all Stockholm County residents initiating DMF from 9 May 2014 until 31 May 2017. All data were derived from a regional database that collects individual-level data on healthcare and drug utilization of all residents. The study outcomes were persistence with DMF and DMF discontinuation and switching to other DMTs. Persistence was measured as the number of days until either DMF discontinuation (treatment gap ≥ 60 days) or switching to another DMT.
Results
The study included 400 patients (median follow-up = 2.5 years). The majority had previously been treated with other DMTs (61%). Throughout the follow-up period, 124 patients (31%) discontinued DMF and 114 patients (29%) switched treatment. Overall, 34% of patients initiating DMF stopped treatment within 1 year and only 43% of patients remained on DMF at 2 years from treatment initiation.
Conclusions
DMF had a rapid market uptake likely due to high expectations held by both patients and clinicians. However, persistence with DMF in routine clinical practice was found to be low.
Purpose
The aim was to prospectively map symptom clusters in patients with stage I–IIIa breast cancer during standard chemotherapy treatment in a randomised study.
Methods
Participants completed the ...Memorial Symptom Assessment Scale (MSAS) at baseline, day 12 after the first and third cycle of FEC 75 or FEC 100, and day 12 after the last cycle of Taxotere. Cut-off values for symptom scores, a mean value based on each individual reporting a symptom including occurrence, frequency, severity and distress for inclusion in analysis, were determined.
Results
The symptom burden cluster analysis was conducted in two steps and included symptoms with high frequency and high levels of distress. The factor analysis revealed three symptom clusters; physical, gastro (phys/gastro) and emotional, with core symptoms that remained stable over time. The most prevalent symptoms for the total sample during all cycles were as follows: lack of energy (range between 48 and 90%), feeling sad (48–79%), difficulty sleeping (54–78%), difficulty concentrating (53–74%), worrying (54–74%) and pain (29–67%).
Conclusion
In summary, we have prospectively established that symptom clusters remain stable over time with a basis of core symptoms. This knowledge will aid in the development of effective core symptom-focused interventions to minimise symptom burden for patients treated with chemotherapy for breast cancer.
Aims and objectives
To describe and explore older women's experiences of having had repeated urinary tract infections (UTIs).
Background
UTIs are one of the most common bacterial infections among ...older women. Approximately one‐third of very old women suffer from at least one UTI each year. Despite the high incidence of UTI, little is known about the impact of UTI on health and daily life in older women.
Design
A qualitative descriptive design.
Methods
A qualitative study using semi‐structured interviews was conducted with 20 Swedish women aged 67–96 years who suffered from repeated UTIs the preceding year. The data were analysed using qualitative content analysis.
Results
Two main themes were identified: being in a state of manageable suffering and depending on alleviation. Being in a state of manageable suffering was described in terms of experiencing physical and psychological health problems, struggling to deal with the illness and being restricted in daily life. Depending on alleviation was illustrated in terms of having access to relief but also receiving inadequate care.
Conclusions
This study demonstrated that UTIs are a serious health problem among older women that not only affects both physical and mental health but also has serious social consequences. The women in this study described the physical and psychological health problems, struggling to deal with the illness, being restricted in daily life, depending on access to relief and receiving inadequate care.
Relevance to clinical practice
It is important to improve the knowledge about how UTI affects the health of older women. This knowledge may help nurses develop strategies to support these women. One important part in the supportive strategies is that nurses can educate these women in self‐care.
The aim of the study was to investigate whether urinary tract infection (UTI) in a representative sample of 85-, 90- and ≥95-year-old women is associated with delirium.
In 504 out of 643 women ...(78.4%) it was possible to evaluate UTI and delirium. Assessments such as the Organic Brain Syndrome (OBS) Scale, the Geriatric Depression Scale-15 (GDS-15) and the Mini-mental State Examination (MMSE) were performed during home visits. Delirium, dementia and depression were diagnosed according to the DSM-IV criteria. A diagnosed, symptomatic UTI with or without ongoing treatment, documented in medical records or detected in association with the assessments, was registered.
Eighty-seven of 504 women (17.2%), were diagnosed as having a UTI with or without ongoing treatment when they were assessed, and almost half of them (44.8%) were diagnosed to be delirious or having had episodes of delirium during the past month. One hundred and thirty-seven of the 504 women (27.2%) were delirious or had had episodes of delirium during the past month and 39 (28.5%) of them were diagnosed to have a UTI. In a multivariate logistic regression model, delirium was significantly associated with Alzheimer's disease (OR = 5.8), multi-infarct dementia (OR = 5.4), depression (OR = 3.1), heart failure (OR = 2.3) and urinary tract infection (OR = 1.9).
A large proportion of very old women with UTI suffered from delirium which might indicate that UTI is a common cause of delirium. There should be more focus on detecting, preventing and treating UTI to avoid unnecessary suffering among old women.
Payers and providers face challenges in enabling appropriate and sustainable access to new medicines. To help enable rational use of new medicines various policy options exist. In Sweden, horizon ...scanning, forecasting, value-based pricing and reimbursement, treatment recommendations, and assessment of drug utilization patterns and patient outcomes in routine clinical practice have been used to facilitate rational introduction of new medicines. Such activities, however, should be informed by research and be subject to continuous evaluation.This thesis aims to examine selected elements of the process for managed introduction of new medicines. Study I provides an evaluation of the Swedish Horizon Scanning System. Study II assesses the impact of treatment recommendations on the use of new medicines in the specialized care setting. Finally, studies III and IV explore the utility of healthcare databases in the assessment of real-world use and outcomes of two specialist medicines prioritized for managed introduction.Different types of data were used in these studies, including public assessment reports published by the European Medicines Agency, early assessment reports prepared by the Swedish Horizon Scanning System, national sales data on all inpatient and outpatient medicines, regional administrative healthcare services data, and national registers of Statistics Sweden and the National Board of Health and Welfare.The evaluation of the Swedish Horizon Scanning System demonstrates that all innovative medicines that had substantial economic impact were identified and assessed prior to their introduction. The assessment of the impact of treatment recommendations shows that both local and regional treatment recommendations were associated with changes in the use of new medicines. Both regional and national healthcare databases provide the opportunity to study the use and outcomes of new medicines in routine clinical practice.The findings indicate that healthcare decision makers can rely on the outputs of the Swedish Horizon Scanning System to keep informed of new medicines. Moreover, treatment recommendations appear to influence the uptake and utilization of new specialist medicines. Finally, even though the existing Swedish data sources provide unique research opportunities, the assessment of appropriate use and relevant outcomes of the growing number of new specialist medicines may still be impeded by a lack of fit-for-purpose data.
Purpose
The purpose of this study is to describe the utilization of disease-modifying treatments (DMTs) in relapsing-remitting multiple sclerosis (MS) and assess the impact of both the introduction ...of new drugs and treatment recommendations (local recommendation on rituximab use issued at the largest MS clinic in Stockholm and regional Drug and Therapeutics Committee (DTC) recommendation on how dimethyl fumarate should be used).
Methods
Interrupted time series analyses using monthly data on all MS patients treated with DMTs in the Stockholm County, Sweden, from January 2011 to December 2017.
Results
There were 4765 individuals diagnosed with MS residing in the Stockholm County from 2011 to 2017. Of these, 2934 (62%) were treated with an MS DMT. Since 2011, fingolimod, alemtuzumab, teriflunomide, dimethyl fumarate, peginterferon beta-1a, and daclizumab were introduced. Only fingolimod and dimethyl fumarate significantly impacted MS DMT utilization. In parallel, the use of rituximab off-label increased steadily, reaching 58% of all DMT-treated MS patients by the end of the study period. The local recommendation on rituximab was associated with an increase in rituximab use. The regional DTC recommendation on dimethyl fumarate was associated with a decrease in dimethyl fumarate use.
Conclusions
Three MS DMTs—fingolimod, dimethyl fumarate, and rituximab off-label—impacted MS DMT utilization in the Stockholm County. The associations between the treatment recommendations and the subsequent changes in MS DMT utilization indicate that such interventions can influence the uptake and utilization of new drugs used in the specialized care setting.
Objectives
The clinical benefits of use of secondary preventive pharmacotherapy in ischemic stroke/TIA have been previously demonstrated. A potential target for facilitating the use of recommended ...medications is primary care physicians. Therefore, we carried out an audit and feedback intervention aimed at primary care centers. The aim was to improve the use of secondary preventive stroke medications and diagnosis recording in ischemic stroke/TIA.
Materials and Methods
The intervention consisted of structured, healthcare database‐derived quality reports on secondary preventive medication use and diagnosis recording, sent in 2015 to half of the primary care centers in Stockholm County, with information specific to each primary care center. Medication dispensation (primary outcome) for statins, antihypertensives, antiplatelets, and anticoagulants, as well as diagnosis recording (secondary outcome), was compared between intervention centers and control centers in the 18 months following the intervention. Outcome data were derived from the healthcare databases of Stockholm County (VAL).
Results
Dispensation of medications to the 12 766 patients analyzed in the study was high. Over 77% of patients used antihypertensives and antithrombotics, and 65%‐68% used statins. After the intervention, no differences in medication dispensation were seen between the intervention and control centers, even after adjusting for potential confounders.
Conclusions
A simple audit and feedback intervention directed toward physicians in primary care did not improve medication dispensation to ischemic stroke/TIA patients 18 months later. Any future audit and feedback intervention aimed at improving adherence to guidelines for secondary prevention in primary care should consider multiple and continuous reminders, the graphical appeal, and widening the recipients to include patients.
Mental illness is a global health problem and encompasses many conditions with varying degrees of severity. Telephone contact is often the patient’s initial contact with the healthcare system. This ...study aimed to illuminate telenurses’ experiences of managing calls with patients affected by mental illness in primary healthcare. Semi-structured individual interviews were conducted with 11 telenurses and a qualitative content analysis was conducted. The COREQ checklist was used to ensure trustworthiness. The analysis revealed three themes, labelled as: ‘Finding a solution to solve and deal with circumstances’; ‘Being emotionally affected and re-evaluating the situation’; and ‘Using distracting approaches and creating space for reflection’. The results show that telenurses adopt different strategies to manage negative and positive situations. This requires telenurses to be adaptable with the patient affected by mental illness as well as within each call and the conditions within the healthcare organization to manage calls with patients affected by mental illness.
Abstract The aim of this study was to describe the prevalence of urinary tract infection (UTI) and associated factors among very old women. In a cross-sectional, population-based study in Sweden and ...Finland, 532 women were asked to participate and 395 (74.2%) were possible to evaluate for UTI. Data were collected from structured interviews and assessments made during home visits, from medical charts, caregivers and relatives. UTI diagnosis documented in medical records during the preceding 1 and 5 years was registered. About one-third (117/395, 29.6%) were diagnosed as having suffered from at least one UTI in the preceding year and 60% in the preceding 5 years. In a multivariate logistic regression model, UTI in the preceding year, was associated with vertebral fractures (odds ratio (OR) = 3.2; 95% confidence interval (95% CI) = 1.4–7.1), incontinence (OR = 2.8; 95% CI = 1.8–4.5), inflammatory rheumatic disease (OR = 2.8; 95% CI = 1.4–5.7) and multi-infarct dementia (OR = 2.4; 95% CI = 1.3–4.5). UTI is a major public health problem in very old women and were independently associated with vertebral fractures, urinary incontinence, inflammatory rheumatic disease and multi-infarct dementia which might indicate that UTI is not a harmless disease.
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