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  • 1.
    Bergh, Ingrid
    et al.
    University of Skövde, Department of Health Sciences. Department of Geriatric Medicine, Göteborg University, Vasa Hospital, Göteborg.
    Sjöström, Björn
    Department of Health Care Pedagogics, Göteborg University, Göteborg.
    Odén, Anders
    Department of Geriatric Medicine, Göteborg University, Vasa Hospital, Göteborg.
    Steen, Bertil
    Department of Geriatric Medicine, Göteborg University, Vasa Hospital, Göteborg.
    An application of pain rating scales in geriatric patients2000In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 12, no 5, p. 380-387Article in journal (Refereed)
    Abstract [en]

    This study examined the applicability of three different pain rating scales, the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS) and the Numeric Rating Scale (NRS), in geriatric patients. Data collection was performed in a geriatric clinic at a university hospital. A structured interview was conducted with 167 patients (mean age = 80.5 years). Patients rated their current experience of pain twice with a 5-minute pause in-between on the VAS, GRS and NRS, and were then asked if they experienced pain, ache or hurt (PAH) or other symptoms. The correlations were high and significant both between the ratings of the VAS, GRS and NRS (r = 0.78-0.92; p < 0.001) (alternative-forms reliability), and between the test and retesting (r = 0.75-r = 0.83; p < 0.001) (test-retest reliability). A logistic regression analysis showed that the probability to accomplish a rating on the pain scales decreased with advancing age of the patient, and this was especially marked for the VAS. The probability of agreement between the patients' ratings of pain and the verbal report of PAH tended to decrease with advancing age; this was especially so for the VAS. Patients who verbally denied PAH but reported pain on the scales rated it significant lower (p < 0.001) than those who verbally reported PAH and rated the pain as well. Eighteen percent of patients who denied pain but rated a pain experience verbally expressed suffering or distress. The study suggests that pain rating scales such as the VAS, GRS and NRS can be used to evaluate pain experience in geriatric patients. However, agreement between verbally expressed experience of PAH, and the rated experience of pain tended to decrease with advancing age. This indicates that the pain-evaluating process will be substantially improved by an additional penetration supported by a wide variety of expression of hurt, ache, pain, discomfort and distress.

  • 2.
    Bergh, Ingrid
    et al.
    University of Skövde, Department of Health Sciences. Department of Geriatric Medicine, Göteborg University.
    Sjöström, Björn
    University of Skövde, Department of Health Sciences.
    Odén, Anders
    Department of Geriatric Medicine, Göteborg University.
    Steen, Bertil
    Department of Geriatric Medicine, Göteborg University.
    Assessing pain and pain relief in geriatric patients with non-pathological fractures with different rating scales2001In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 13, no 5, p. 355-361Article in journal (Refereed)
    Abstract [en]

    Although pain is a frequent problem among elderly patients, they are often omitted in clinical trials and few studies have focused on assessing pain relief in this population. The aim of this study was to compare geriatric patients' verbally reported effect of analgesics with changes in pain experience rated with four different rating scales: the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS), the Numeric Rating Scale (NRS), and the Pain Relief Scale (PRS). Altogether 53 geriatric patients (mean=82 yrs) with non-pathological fractures in 4 geriatric units at a large university hospital were selected. In connection with the administration of analgesics, the patients were asked to "Mark the point that corresponds to your experience of pain just now at rest" on the VAS, GRS and NRS. This was repeated after 1.5-2 hours, and a direct question was asked about whether the analgesic medication given in connection with the initial assessment had had any pain-alleviation effect. Two comparisons were conducted with each patient. The results show that the probability of accomplishing a rating on the VAS, GRS, NRS, and PRS was lower with advancing age in these elderly fracture patients. The correlations between the ratings of the VAS, GRS and NRS were strong and significant (r=0.80-0.95; p<0.001) both at the initial assessments and at the re-assessments. However, the verbally reported effects of the analgesics were often directly opposite to the changes in rated pain. Therefore, application of the VAS, NRS, GRS and PRS for the purpose of assessing pain relief must be combined with supplementary questions that allow the patient to verbally describe possible experience of pain relief.

  • 3.
    Bergh, Ingrid
    et al.
    University of Skövde, Department of Health Sciences. Avdelningen för geriatrik, Göteborgs universitet.
    Sjöström, Björn
    University of Skövde, Department of Health Sciences.
    Steen, Bertil
    Avdelningen för geriatrik, Göteborgs universitet.
    Smärta hos äldre: Skattningsskalor – förekomst och verbala uttryck för smärta och smärtlindring2003In: Incitament: för en hälso- & sjukvård i förvandling, ISSN 1103-503X, Vol. 12, no 7, p. 642-644Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Smärta är inte en del av det normala åldrandet, men många äldre drabbas av sjukdomar som leder till smärta. Smärta är en subjektiv sensorisk och emotionell obehagsupplevelse med faktisk eller potentiell vävnadsskada. Varje person upplever smärta på sitt sätt och denna uppfattning får avgörande betydelse för hur hälso- och sjukvårdspersonal kan förhålla sig till människor med smärta.

    Utgångspunkten för denna avhandling var att studera smärtförekomst bland äldre och att evaluera användandet av smärtskalor. Våra resultat visar att skattningsskalor kan vara till hjälp.

    Artikeln baserad på Ingrid Berghs avhandling: Pain in the elderly - Rating scales, prevalence and verbal expression of pain relief

  • 4.
    Bergh, Ingrid
    et al.
    University of Skövde, Department of Health Sciences. Department of Geriatric Medicine, Göteborg University, Gothenburg.
    Steen, Gunilla
    Department of Geriatric Medicine, Göteborg University, Gothenburg.
    Waern, Magda
    Institute of Clinical Neuroscience, Section of Psychiatry, Göteborg University, Gothenburg.
    Johansson, Boo
    Department of Psychology, Göteborg University, Gothenburg.
    Odén, Anders
    Department of Geriatric Medicine, Göteborg University, Gothenburg.
    Sjöström, Björn
    University of Skövde, Department of Health Sciences. Department of Health Care Pedagogics, Göteborg University, Gothenburg.
    Steen, Bertil
    Department of Geriatric Medicine, Göteborg University, Gothenburg.
    Pain and its relation to cognitive function and depressive symptoms: A Swedish population study of 70-year-old men and women2003In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 26, no 4, p. 903-912Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the prevalence of pain and its characteristics, and to examine the association of pain with cognitive function and depressive symptoms, in a representative sample of 70-year-old men and women. Data were collected within the gerontological and geriatric population studies in Göteborg, Sweden (H-70). A sample of 124 men and 117 women living in the community took part in the study. A questionnaire was applied which included four different aspects of pain experience: prevalence, frequency of episodes of pain, duration and number of locations. In close connection to this, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. The prevalence of pain during the last 14 days was higher in women (79%; n = 91) than in men (53%; n = 65) (P<0.001). Women (68%; n = 78) also reported pain that had lasted for >6 months to a greater extent than men (38%; n = 46) (P<0.001). The frequency of episodes of pain was also higher among women, 64% (n = 74) reporting daily pain or pain several days during the last 14 days while 37% of the men (n = 45) did so (P<0.001). Women (33%, n = 38) also reported pain experience from ≥3 locations more often than men (11%; n = 13) (P<0.001). On the other hand, the association between depressive symptoms and pain experience was more evident in men than in women. Women were taking significantly more antidepressants compared to men (P<0.03). The results show that pain is common in 70-year-old people and especially in women. However, associations between depressive symptoms and the four aspects of pain experience were more pronounced among men. 

  • 5.
    Haljamäe, Ulla
    et al.
    Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
    Nyberg, Gudrun
    Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Sjöström, Björn
    University of Skövde, Department of Health Sciences. Institute of Health Care Pedagogics, Göteborg University, Sweden.
    Remaining experiences of living kidney donors more than 3 yr after early recipient graft loss2003In: Clinical Transplantation, ISSN 0902-0063, E-ISSN 1399-0012, Vol. 17, no 6, p. 503-510Article in journal (Refereed)
    Abstract [en]

    Living kidney donor programs, based on willingness among family members and close relatives to donate, have made it possible to perform a satisfactory number of kidney transplantations. Early graft loss in the recipient may occur and it is not known if such an event will result mainly in acute, rather transient, emotional reactions or if long-lasting reactions may be evoked in the living kidney donor. The aim of the present study was to assess and describe the remaining experiences of donors (n = 10) more than 3 yr after early recipient graft loss or death of the recipient. A phenomenographic, interview-based research approach was used. Five different fields or domains were identified: (i) the decision to donate; (ii) the information provided; (iii) care received at the time of donation; (iv) responses at graft failure; and (v) concerns remaining at the time of the interview. All donors expressed that they had volunteered to donate and that no stress had been put on them. The information given prior to and in connection with the donation procedure was deemed insufficient but all donors were satisfied with the medical care provided in connection with the nephrectomy and in the immediate post-operative period. Graft failure was immediately accepted on the intellectual level by nine of 10 donors but still evoked emotional reactions and responses included a wish that continuing contact with the transplant staff had been provided. The present interview-based study shows that it is of importance that the donor is thoroughly informed about all donor as well as recipient-related factors including the potential risk of recipient graft failure. In case of graft failure, or the death of the recipient, the transplant unit staff members should offer contact for discussions of medical matters as well as for psychosocial support. In individual cases it may be necessary to maintain such a supportive contact channel for a prolonged period of time.

  • 6.
    Thundal, Kajsa-Lena
    University of Skövde, Department of Health Sciences.
    Spelar det någon roll för kvinnors alkoholkonsumtion vad de gör på sin fritid?2003In: Socialmedicinsk tidskrift, ISSN 0037-833X, Vol. 80, no 4, p. 333-339Article in journal (Other academic)
  • 7.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, Department of Health Sciences.
    Haljamäe, Hengo
    Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Göteborg.
    Acute pain services2003In: Current Anaesthesia and Critical Care, ISSN 0953-7112, E-ISSN 1532-2033, Vol. 14, no 5-6, p. 211-215Article in journal (Refereed)
    Abstract [en]

    An interdisciplinary acute pain service (APS) team seems the most attractive clinical organization model for postoperative pain management (POPM) to fulfil the intentions of pain management guidelines in practice. The specific knowledge of anaesthesiologists in the use of drugs and techniques for pain alleviation is of specific importance. Therefore, the anaesthetist is usually the team leader and works together with nurses in the postanaesthesia care unit (PACU), acute pain nurses (APN) and surgical ward nurses. A nurse-based anaesthesiologist supervised type of APS seems in several respects to be a suitable model for POPM in clinical practice.

  • 8.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, Department of Health Sciences.
    Sjöström, Björn
    University of Skövde, Department of Health Sciences. Göteborg University.
    Haljamäe, Hengo
    Sahlgrenska University Hospital, Göteborg.
    Assessing Pain Responses During General Anesthesia2001In: AANA Journal, ISSN 0094-6354, Vol. 69, no 3, p. 218-222Article in journal (Refereed)
    Abstract [en]

    Major technical and pharmacological achievements in recent years have greatly influenced the practice of anesthesia. Clinical signs related to the main aspects of anesthesia, i.e., hypnosis, analgesia, and muscular relaxation, are increasingly obtainable from variables supplied by the monitoring equipment. It is not known, however, to what extent more indirect, patient-associated clinical signs of pain/depth of anesthesia are still considered of importance and relied on in the intraoperative management of surgical patients. The aims of the present study were to assess what clinical signs, indirect as well as monitor-derived, are considered indicative of intraoperative pain or depth of anesthesia by nurse anesthetists during general anesthesia. In connection with anesthetic management of surgical patients, Swedish nurse anesthetists (N = 40) were interviewed about clinical signs that they routinely assessed and were asked if the observed signs were considered indicative mainly of intraoperative pain or depth of anesthesia. It was found that skin-associated responses (temperature, color, moisture/stickiness) were commonly considered to indicate intraoperative pain rather than depth of anesthesia. Respiratory movements, eye reactions, and circulatory responses were considered to be indicative of either pain or insufficient depth of anesthesia. The present data indicate that indirect physiological signs are still considered of major importance by anesthesia nurses during the anesthetic management of surgical patients.

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