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  • 10201.
    Wangchuk, Tshering
    University of Skövde, School of Informatics.
    Community-based Influence Maximization framework for Social Networks2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Maximizing Influence (IM) in social networks has a considerable role to play in the phenomenon of viral marketing, targeted advertisements and in promoting any campaigns. However, the Influence Maximization Problem is a very challenging research-problem due to it being NP-Hard and scaling with the social networks with millions of nodes and edges becomes very tough due to the computational complexities concerned with it. Recently, solving this problem through the use of community detection based methodology is becoming very popular since, it reduces the search space by dividing the network into smaller and more manageable groups called "communities." As part of the larger research work, we reiterate a framework which has been inspired by collection of different work done by Alfalahi et al. (2013) that we can implement to solve the IM problem and its limitation through community detection and fuzzy logic inspired approach. Since the work is still under development, for this project, we report on understanding the IM field through literature reviews and in communicating a design of IM framework as inspired by the previous works. We also present our version ofthe blueprint (Algorithm design) of the framework as a five step approach. For the purpose of this report, we implement and evaluated the step 1 and step 2 of the framework. Step 1 is about preprocessing the input network with a similarity measure, which according to previous study by Alfalahi et al. (2013a) aids the algorithms in detecting better community structure (clear and accurate distinction of the nodes into communities in networks). We test it to see if it holds true. Step 2 is about implementing the community detection in social network. We benchmarkthree candidate algorithms, chosen based on theirperformance, from the previous studies in community detection fieldand we report onwhich algorithm should we consider to use in the proposed framework through experimentationon the simulated data. We use Normalized Mutual Information (NMI) and Modularity (Q) as evaluation metrics to measure the accuracy of the community detected by the candidate algorithms. Our results show that similarity based preprocessing does not improve the community structure and thus may not be required in the framework. We also found out that Louvain should be the algorithm that use to detect communities in social networks since it outperforms both CNM and Infomap on Q and NMI

  • 10202.
    Wangler, Benkt
    et al.
    University of Skövde, School of Humanities and Informatics.
    Åhlfeldt, Rose-Mharie
    University of Skövde, School of Humanities and Informatics.
    Perjons, Erik
    Process Oriented Information Systems Architectures in Healthcare2003In: Health Informatics Journal, ISSN 1460-4582, Vol. 9, no 4, p. 253-265Article in journal (Refereed)
    Abstract [en]

    In order to create value for customers efficiently and to avoid unnecessary or redundant activity, organizations need IT support that interacts well with their business processes. In addition, healthcare organizations require transparent communication between the various actors and between IT systems. A new type of process oriented integration architecture has been developed using software devices known as process managers. These use simple graphical models to visualize business process integration and facilitate its management and monitoring. This article discusses the benefits and difficulties of introducing process manager technology into healthcare, based on a project to integrate IT systems over the patient process and across several organizations. Particular problems are caused by communication across organizational boundaries, e.g. due to security issues. However, the technology is able to manage and monitor processes and to make communication simpler and safer.

  • 10203.
    Warell, Annelie
    et al.
    University of Skövde, School of Technology and Society.
    Wising, Johanna
    University of Skövde, School of Technology and Society.
    Skapandet av narcissistiska karaktärer: En symbolisk interaktionistisk- samt kulturanalytisk tolkning av uppkomsten av narcissism2009Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie är att ge förståelse för de förklaringsmodeller som ges av informanter gällande sexualförbrytares tolknings- och beteendemönster analyserat utifrån ett symbolisk interaktionistiskt perspektiv och ett socialpsykologiskt samt kulturanalytiskt perspektiv på narcissism. Det som behandlas i studien är hur personal inom psykiatrin uppfattar att självet hos sexualförbrytare utvecklats samt hur detta beskrivs i de två dokument studien använder sig av och hur dessa utsagor kan tolkas utifrån ett symbolisk interaktionistiskt perspektiv på identitetsskapande. Vidare belyses hur sexualförbrytares tolknings- och beteendemönster kopplas till narcissism utifrån ett socialpsykologiskt och kulturanalytiskt perspektiv. Genomförandet av studien har skett med hjälp av triangulering i form av kvalitativa, semistrukturerade djupintervjuer med personal vid Skogomeanstalten samt analys utifrån två dokument (Hedin, Kuosmanen,Lindholm & Månsson, 2002; Kwarnmark & Tidefors Andersson, 1999) som behandlar sexualbrottsdömda vid Skogomeanstalten. Framkommit i studien har att primär- samt sekundärsocialisation är av stor vikt vid utvecklingen av narcissistiska karaktärsdrag samt att kulturella och sociala förhållanden påverkar formandet av just dessa karaktärsdrag. Studien har påvisat dessa narcissistiska karaktärsdrag hos vissa av de sexualförbrytare som undersökts.

  • 10204.
    Warenius, Linnéa
    et al.
    University of Skövde, School of Life Sciences.
    Pettersson, Karen O.
    Lund University, Lund, Sweden.
    Nissen, Eva
    University of Skövde, School of Life Sciences.
    Höjer, Bengt
    Dalarna University, Dalarna, Sweden.
    Chishimba, Petronella
    Kitwe School of Nursing, Kitwe, Zambia.
    Faxelid, Elisabeth
    Karolinska Institutet, Stockholm, Sweden.
    Vulnerability and sexual and reproductive health among Zambian secondary school students2007In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 9, no 5, p. 533-544Article in journal (Refereed)
    Abstract [en]

    The present study aimed to explore secondary school students' needs in relation to sexual and reproductive health in order to inform efforts to improve the quality of health services available to young people. The study involved data collection from 716 11-22-year-old students in four secondary schools in an urban area in Zambia. Students completed a questionnaire and were invited to write down any inquiries they had regarding sexuality and reproduction. Findings revealed that boys and girls lack adequate information about human reproduction and STIs, including HIV. To avoid misconceptions and myths, they also need clear information on contraceptives and masturbation. Responses indicate that young people would welcome guidance and support related to contraception, pregnancy, abortion and STIs/HIV, but also on love and relationships. Culture, religion and gender are important factors influencing sexuality and sexual abuse. These issues need to be taken into consideration when developing youth-friendly programmes for young people

  • 10205.
    Warenius, Linnéa U.
    et al.
    Division of International Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Faxelid, Elisabeth A.
    Division of International Health, Department of Public Health Sciences, Karolinska Institute, Sweden.
    Chishimba, Petronella N.
    Kitwe School of Nursing, Kitwe, Zambia.
    Musandu, Joyce O.
    Department of Nursing Sciences, University of Nairobi, Nairobi, Kenya.
    Ong'any, Antony A.
    Department of Nursing Sciences, University of Nairobi, Kenya.
    Nissen, Eva B.-M.
    University of Skövde, School of Life Sciences.
    Nurse-Midwives' Attitudes towards Adolescent Sexual and Reproductive Health Needs in Kenya and Zambia2006In: Reproductive health matters, ISSN 0968-8080, E-ISSN 1460-9576, Vol. 14, no 27, p. 119-128Article in journal (Refereed)
    Abstract [en]

    Adolescent sexuality is a highly charged moral issue in Kenya and Zambia. Nurse-midwives are the core health care providers of adolescent sexual and reproductive health services but public health facilities are under-utilised by adolescents. The aim of this study was to investigate attitudes among Kenyan and Zambian nurse-midwives (n=820) toward adolescent sexual and reproductive health problems, in order to improve services for adolescents. Data were collected through a questionnaire. Findings revealed that nurse-midwives disapproved of adolescent sexual activity, including masturbation, contraceptive use and abortion, but also had a pragmatic attitude to handling these issues. Those with more education and those who had received continuing education on adolescent sexuality and reproduction showed a tendency towards more youth-friendly attitudes. We suggest that critical thinking around the cultural and moral dimensions of adolescent sexuality should be emphasised in undergraduate training and continuing education, to help nurse-midwives to deal more empathetically with the reality of adolescent sexuality. Those in nursing and other leadership positions could also play an important role in encouraging wider social discussion of these matters. This would create an environment that is more tolerant of adolescent sexuality and that recognises the beneficial public health effect for adolescents of greater access to youth-friendly sexual and reproductive health services.

  • 10206.
    Wark, Landon
    et al.
    Cell Biology, University of Manitoba, CancerCare Manitoba, Winnipeg, Canada / Department of Human Anatomy and Cell Sciences, University of Manitoba, Winnipeg, Canada.
    Klonisch, Thomas
    Department of Human Anatomy and Cell Sciences, University of Manitoba, Winnipeg, Canada / Medical Microbiology and Infectious Diseases, Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
    Awe, Julius
    University of Skövde, School of Health and Education. Cell Biology, University of Manitoba, CancerCare Manitoba, Winnipeg, Canada / Department of Clinical Genetics, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    LeClerc, Cecile
    Cell Biology, University of Manitoba, CancerCare Manitoba, Winnipeg, Canada.
    Dyck, Brandon
    Cell Biology, University of Manitoba, CancerCare Manitoba, Winnipeg, Canada.
    Quon, Harvey
    Department of Oncology, University of Calgary, Calgary, Alberta, Canada / CancerCare Manitoba, Winnipeg, Manitoba, Canada / Tom Baker Cancer Centre, Calgary, Alberta, Canada.
    Mai, Sabine
    Cell Biology, University of Manitoba, CancerCare Manitoba, Winnipeg, Canada / Department of Human Anatomy and Cell Sciences, University of Manitoba, Winnipeg, Canada / Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
    Dynamics of three-dimensional telomere profiles of circulating tumor cells in patients with high-risk prostate cancer who are undergoing androgen deprivation and radiation therapies2017In: Urologic Oncology, ISSN 1078-1439, E-ISSN 1873-2496, Vol. 35, no 3, p. 112.e1-112.e11Article in journal (Refereed)
    Abstract [en]

    Introduction: Accurate assessment and monitoring of the therapeutic efficacy of locally advanced prostate cancer remains a major clinical challenge. Contrary to prostate biopsies, circulating tumor cells (CTCs) are a cellular source repeatedly obtainable by blood sampling and could serve as a surrogate marker for treatment efficacy. In this study, we used size-based filtration to isolate and enumerate CTCs from the blood of 20 patients with high-risk (any one of cT3, Gleason 810, or prostate-specific antigen>20 ng/ml), nonmetastatic, and treatment-naive prostate cancer before and after androgen deprivation therapy (ADT) and radiation therapy (RT).

    Materials and methods: We performed 3D telomere-specific quantitative fluorescence in situ hybridization on isolated CTCs to determine 3D telomere profiles for each patient before and throughout the course of both ADT and RT.

    Results: Based on the distinct 3D telomere signatures of CTC before treatment, patients were divided into 3 groups. ADT and RT resulted in distinct changes in 3D telomere signatures of CTCs, which were unique for each of the 3 patient groups.

    Conclusion: The ability of 3D telomere analysis of CTCs to identify disease heterogeneity among a clinically homogeneous group of patients, which reveals differences in therapeutic responses, provides a new opportunity for better treatment monitoring and management of patients with high-risk prostate cancer. 

  • 10207.
    Warnskog, Louise
    et al.
    University of Skövde, School of Health and Education.
    Brännlund, Hanna
    University of Skövde, School of Health and Education.
    Kvinnors upplevelser av att leva med Endometrios: En litteraturbaserad studie2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Endometrios är en kronisk kvinnosjukdom där livmoderslemhinnan växer utanför livmodern. Detta resulterar i inre blödningar och bäckensmärta. Syfte: Att belysa kvinnors upplevelser av att leva med Endometrios. Metod: En litteraturbaserad studie baserad på analys av 12 vetenskapliga artiklar. Resultat: Det framkom två huvudteman, Endometrios den avfärdade sjukdomen samt Faktorer som påverkar livet för kvinnor som lever med Endometrios. Resultatet från detta examensarbete påvisar att Endometrios har stor inverkan på kvinnors liv och resulterar i lidande då diagnosen fördröjs. Sjuksköterskan har en viktig roll när det gäller att ge kvinnorna rätt vård. Diskussion: Det finns ett flertal olika miljö- och stressfaktorer som inverkar på kvinnors upplevelser av Endometrios. Flertalet av dessa skulle kunna förebyggas genom utbildning av vårdpersonal och information om Endometrios till allmänheten. Publiciteten skulle i stor utsträckning minska de drabbade kvinnornas lidande. Kliniska implikationer: Endometrios klassas i nuläget inte som en folkhälsosjukdom och har inget vårdprogram. Socialstyrelsen behöver utarbeta ett specifikt vårdprogram för sjukdomen. Vårdpersonalen kan då känna minskad osäkerhet kring Endometrios.

  • 10208.
    Warrén Stomberg, Margareta
    University of Skövde, School of Life Sciences. Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Guest at Hospice: Time for Consideration2009In: The American Journal of Hospice and Palliative Medicine, ISSN 1049-9091, Vol. 26, no 4, p. 277-280Article in journal (Refereed)
    Abstract [en]

    This study focuses on daily life situation of terminally ill guests residing at a hospice. In the study, interviews were conducted with 9 such guests. Data were analyzed using a method similar to content analysis. Categories emerged that were related to aspects regarding as external and internal essentials for the well-being of the individual at the hospice. These essentials were as follows: encouragement from the staff, the alleviation of pain, a pleasant and calm atmosphere at the hospice, the significance of visits from relatives, the regret of not being able to take care of oneself, and time to reconcile to one's life. These results not only show the need for close community with both family and staff but also the need for privacy to reflect on life.

  • 10209.
    Warrén Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences. The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Nilsson, Kerstin
    University of Skövde, School of Life Sciences. The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Nursing Students' Self-Graded Motivation to Complete their Programme of Study2010In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 4, p. 42-47Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore variation in nursing students’ motivation to complete their programme of study,  as  well  as  factors  relating  to  low  versus  high  motivation  and  students’  opinions  of  what  would  increase  their motivation to complete their programme of study. A study was carried out between April 2006 and December 2007. A total of 872 students registered in a 3-year nursing programme  randomly  participated  in  self-rating  their  motivation  score  once  each  semester.  Descriptive  statistics, statistical calculations and content analysis regarding open-ended questions were performed. Most of the students, 73%, rated their motivation as ≥6 on a 0-10 Likert scale; and 16% gave a rating of ≤4. The desire to become  a registered nurse (RN)  and having  a positive  attitude towards the  studies were  the main factors influencing high motivation to complete the programme of study. Having a negative attitude towards the studies was an explanation of decreased motivation. There was a significant decrease (p=0.001) in the motivation score with respect to number of semesters, and motivation increased with the student’s age (p=0.0119). Suggestions for increasing motivation given by those who rated their motivation as ≤4 mainly focused on improvements in didactics and study organisation.

  • 10210.
    Warrén Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Tronstad, Svein - Erik
    Skaraborgs Hosp Skövde, Dept Obstet & Gynecol, SE-54185 Skövde, Sweden.
    Hedberg, Karin
    Department of Health Employment, Hälsan och arbetslivet, Skövde, Sweden.
    Bengtsson, Jan
    University of Skövde, School of Life Sciences.
    Jonsson, Peter
    University of Skövde, School of Life Sciences.
    Johansen, Lars
    Skaraborgs Hosp Skövde, Dept Surg, SE-54185 Skövde, Sweden.
    Lindvall, Birgitta
    University of Skövde, School of Life Sciences.
    Work-related musculoskeletal disorders when performing laparoscopic surgery.2010In: Surgical laparoscopy, endoscopy & percutaneous techniques, ISSN 1530-4515, E-ISSN 1534-4908, Vol. 20, no 1, p. 49-53Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to survey the occurrence of musculoskeletal disorders in the population of gynecologists and general surgeons performing laparoscopic surgery.

    Methods: A questionnaire was distributed to 558 general surgeons and gynecologists and 378 were answered (68%). Descriptive data analysis and statistical calculations were performed.

    Results: One or more disturbing symptoms were common among laparoscopists. More than 70% of the laparoscopists had one or more symptom. Pain was the most common symptom followed by fatigue and stiffness. Lower back, neck, and shoulders were most frequently affected. Headache and visual discomfort were also reported. Longer workload over time and ageing resulted in significantly more disorders (P<0.01). Female physicians had significantly more disorders (P<0.01).

    Conclusions: This study revealed musculoskeletal disorders in a majority of laparoscopists. The laparoscopic technique often requires static and tiring work positions, sometimes extreme, which can explain musculoskeletal disorders among general surgeons and gynecologist.

  • 10211.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Observation vid anestesi ger viktig kunskap2006In: Vårdfacket, ISSN 0347-0911, Vol. 30, no 3, p. 55-56Article in journal (Other (popular science, discussion, etc.))
  • 10212.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Postoperativ smärta2005In: Incitament, ISSN 1103-503X, Vol. 14, no 2, p. 211-213Article in journal (Refereed)
    Abstract [en]

    Trots att det idag finns kraftfulla och skonfulla läkemedel, tekniker och kunskap som möjliggör smärtlindring, upplever omkring 50% av patienterna moderat till svår smärta efter operation. Akut smärta efter kirurgisk intervention kan utlösa ogynnsamma effekter. Det är med andra ord fortfarande angeläget att vidareutveckla den postoperativa smärthanteringen. Denna avhandling fokuserar på möjligheter att optimera smärthanteringen efter operation.

  • 10213.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Postoperative pain management: Nurse perspectives on acute pain services2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Postoperative pain management (POPM) has remained an area of concern despite major efforts to improve pain assessment and management by the introduction of specified guidelines, advanced techniques for pain alleviation, and education of staff members. Different nurse specialists are involved in the perioperative care of surgical patients. It is still not known to what extent the specific information noted by the nurses about the individual surgical patient at the different steps of the perioperative management is taken into consideration so that a potentially more optimal, individualised POPM as part of acute pain services (APS) can be provided.

    The aims of the present study were to assess if information of potential value for the POPM is noted by nurse anaesthetists involved in the perioperative management of surgical patients and to what extent such information could be of value for an individualised POPM of surgical patients and if nurse involvement is of importance for the adequacy and efficacy of POPM routines in a nurse-based, anaesthesiologist-supervised acute pain service (APS) model on surgical wards.

    Semistructured interviews of nurse anaesthetists (n=40), questionnaire responses of staff members (n=375)/surgical patients (n=110) and assessment of medical records (n=135)/database data (n=222) were included for evaluation of factors of importance in the perioperative care and POPM of surgical patients. Descriptive statistics, non-parametric and parametric tests were used for the analysis of the data.

    It was found that nurse anaesthetists continuously monitor different stress evoked physiological signs induced by surgical interventions during general anaesthesia. Nurses considered the signs indicative of pain evoked stimuli and/or insufficient depth of anaesthesia. The intraoperative information of the response pattern and anaesthetic drug requirements of the individual patient noted by the nurse anaesthetist was considered at present not to be routinely taken into consideration but could be a successful strategy in an optimal multi-professional approach to postoperative pain management. The introduction of APS, using a nurse-based anaesthesiologist-supervised model, resulted in more adequate pain management routines, better patient satisfaction with information about POPM, and increased confidence in pain management among nurses on the surgical wards than was noted for the outcome data for the hospital not having introduced such an APS model. Database documentation of outcome measures of POPM for patients receiving postoperative epidural analgesia was found to provide valuable information about the adequacy of the POPM. The feedback of information from the anaesthesia services to the surgical ward nurses was found not to be efficient enough to make ward nurses properly aware of the importance of their own direct involvement in the documentation process of POPM and that such involvement could further optimise POPM outcome

  • 10214.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Postoperative pain management: Nurse perspectives on acute pain services2005In: Smärta, ISSN 1402-1048, Vol. 10, no 1, p. 5-6Article in journal (Other (popular science, discussion, etc.))
  • 10215.
    Warrén-Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Specialistsjuksköterskan viktig för nyopererades smärtlindring2005In: Perspektiv på högskolan i Skövde, ISSN 1653-8242, Vol. 1, no 2, p. 16-17Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Det är viktigt med kontinuerlig kommunikation mellan all personal som bedömer, behandlar och dokumenterar patientens smärta i samband med kirurgi. Här har specialistsjuksköterskan en viktig roll för att föra information om patienten vidare. Det visar en avhandling från Sahlgrenska akademin.

  • 10216.
    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.

  • 10217.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Haljamäe, Hengo
    Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Göteborg.
    Postoperative pain management: impact of quality assurance and audit documentation on clinical outcome2003In: Current Anaesthesia & Critical Care, ISSN 0953-7112, Vol. 14, no 5-6, p. 217-221Article in journal (Refereed)
    Abstract [en]

    Progress in postoperative clinical pain assessment and management is not only dependent on optimal choice of analgesic drugs and techniques but also of quality assurance of the clinical routines, i.e. the overall organization of the acute pain services. Proper revision of present routines on the basis of accepted quality assurance standards and practice guidelines on pain management is an essential part of improved postoperative pain management. The present survey reflects the impact of organizational revision of pain management routines on the audit of pain management and on the attitudes of staff members involved in the acute pain service. Monitoring and documentation of relevant audit variables are essential and such outcome variables should continuously be analysed and constitute a feedback channel between all staff members involved in the APS so that remaining problems can be identified and properly managed

  • 10218.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Lorentzen, Per
    Skaraborgs Hospital, Skövde, Sweden.
    Joelsson, Håkan
    Skaraborgs Hospital, Skövde, Sweden.
    Lindquist, Helene
    Skaraborgs Hospital, Skövde, Sweden.
    Haljamäe, Hengo
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Postoperative pain management on surgical wards: impact of database documentation of anesthesia organized services2003In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 4, no 4, p. 155-164Article in journal (Refereed)
    Abstract [en]

    Postoperative pain management (POPM) should be based on an organization exploiting existing expertise and documenting the outcome of the POPM in each individual patient. The aims of the present study were to evaluate the adequacy of database documentation of POPM of an anesthesia organized, nurse-based, anesthesiologist-supervised acute pain service (APS) on surgical wards and to assess to what extent the information obtained was continuously used to improve practice. From 2890 registered cases in the database (patient controlled analgesia, n = 1975; epidural analgesia [EDA], n = 915), a homogeneous two-year sample of documentation charts from use of EDA for POPM in connection with major, open, abdominal surgical procedures (n = 381) was chosen for detailed analysis. The data charts contained information on patient data, drug dosage, total amount of infused drug, duration of EDA treatment, occurrence of side effects, and patient’s level of satisfaction. The database information was easily accessible making assessment of relevant aspects of the routines, including associations between analgesic technique, patient related factors, and satisfaction with the services, immediately available. Only 58% of the data charts were properly completed and fed into the database but the clinical safety of the missing nondatabase documented sample was not found jeopardized. Although the database documentation routines were considered to fulfill basic requirements of data collection and monitoring of the appropriateness of POPM, they were not found to function optimally. The reason seemed to be inadequate feedback of information between the parties involved in the POPM services. The present study stresses the importance of establishing routines for adequate, continuous feedback of recorded audit data from the APS team to the surgical wards for the maintenance of a high level of compliance with accepted guidelines.

  • 10219.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Segerdahl, M.
    Karolinska Institutet.
    Rawal, N.
    Örebro University Hospital.
    Jakobsson, J.
    Karolinska Institutet.
    Brattwall, M.
    Sahlgrenska University Hospital, Gothenburg.
    Clinical Practice and Routines for Day Surgery in Sweden: Implications for Improvement in Nursing Interventions2008In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 23, no 5, p. 311-320Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to examine nursing practice in day surgery settings in Sweden. A questionnaire focusing on the routines of the day surgery process of patients in Sweden was administered. Based on these findings, appropriate nursing interventions are outlined and discussed. Day surgery routines were in accordance with general worldwide practice. The study revealed that nursing involvement was rare in the preoperative routine. In addition, the major part of the recovery process, including assessments of discharge eligibility and information about pain management, was managed by PACU nurses. The nurse follow-up revealed a number of subjective queries and symptoms that, in a seemingly easy way, could have been prevented by further perianesthesia/perioperative patient education. There is an obvious place for nursing interventions when the decision for day surgery is taken. These interventions should focus on providing the patient with information before surgery, preoperative patient health screening, and information/education at discharge. Furthermore, nursing interventions should include quality assurance, such as follow-up calls for the evaluation of care, as well as providing information and coaching for the patient at home.

  • 10220.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Haljamae, Hengo
    Routine intra-operative assessment of pain and/or depth of anaesthesia by nurse anaesthetists in clinical practice2001In: Journal of Clinical Nursing, ISSN 1365-2702, Vol. 19, no 4, p. 429-436Article in journal (Refereed)
    Abstract [en]

    • Patient safety and comfort during general anaesthesia and surgery are to a considerable extent dependent on the capability of anaesthesia personnel to interpret directly monitored as well as indirect clinical signs of pain and/or depth of anaesthesia.

    • The aim of the present study was to evaluate how nurse anaesthetists in their clinical routine work assess and interpret intra-operative responses evoked by pain stimuli and/or insufficient depth of anaesthesia.

    • A questionnaire was designed to assess the perceived relevance and validity of cardiovascular, respiratory, mucocutaneous, eye-associated, and muscular responses for routine assessment of intra-operative pain and/or insufficient depth of anaesthesia in patients undergoing surgery under general anaesthesia.

    • Data were obtained from 223 nurse anaesthetists working at nine different university anaesthesia departments in Sweden.

    • A number of significant indicators for pain and depth of anaesthesia could be identified for spontaneously breathing as well as for mechanically ventilated patients. No variable was considered entirely specific for either intra-operative pain or depth of anaesthesia. Changes in breathing rate/volume, central haemodynamics (BP, HR), lacrimation, and presence of moist and sticky skin were given higher score values as indicators of pain than as indicators of depth of anaesthesia. Occurrence of grimaces, attempted movements, and presence of non-centred pupils were variables considered more indicative of insufficient depth of anaesthesia than intra-operative pain.

    • In conclusion, it is obvious from the present data that indirect physiological signs of intra-operative pain and depth of anaesthesia are still considered of importance by Swedish anaesthesia nurses in the anaesthetic management of surgical patients.

  • 10221.
    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.

  • 10222.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences. University of Göteborg.
    Sjöström, Björn
    University of Skövde, School of Life Sciences.
    Haljamäe, Hengo
    Sahlgrenska University Hosptial, University of Göteborg.
    The role of the nurse anesthetist in the planning of postoperative pain management2003In: AANA Journal, ISSN 0094-6354, Vol. 71, no 3, p. 197-202Article in journal (Refereed)
    Abstract [en]

    Adequate pain relief after surgery is essential for avoiding pain-associated stress and patient comfort in the postoperative period. The Swedish nurse anesthetist has an important role in the intraoperative management of the surgical patient by assessing and moderating individual physiological response evoked by surgical stimuli during general anesthesia. The extent to which knowledge of specific individual response patterns are used to plan postoperative pain management is unknown. The aim of the present study was to assess the role of the nurse anesthetist in planning early postoperative pain management for surgical patients. Nurse anesthetists (N = 101) at 4 academic hospitals in Sweden responded to a questionnaire focusing, in addition to demographic data, on intraoperative routines for postoperative pain management, perceived clinical relevance of used routines, personal involvement (in addition to existing routines) in postoperative pain management, factors influencing pain alleviation requirements, and the potential role of the nurse anesthetist for improved postoperative pain management. We found that type of anesthesia and type of surgical procedure were both factors considered important for postoperative pain management. A majority of the participants believed that pain management approaches were not appropriately individualized to the patient.

  • 10223.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Wickström, Kerstin
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Joelsson, Håkan
    University of Skövde, School of Life Sciences. Skaraborgs Hospital, Skövde, Sweden.
    Sjöström, Björn
    University of Skövde, School of Life Sciences. Sahlgrenska University Hospital, Göteborg, Sweden.
    Haljamäe, Hengo
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Postoperative pain management on surgical wards: do quality assurance strategies result in long-term effects on staff member attitudes and clinical outcomes?2003In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 4, no 1, p. 11-22Article in journal (Refereed)
    Abstract [en]

    Postoperative pain management (POPM) remains suboptimal on surgical wards in many countries despite the availability of effective analgesics, new technologies for drug administration, and clinical practice guidelines for pain management. The aim of the present study was to assess remaining long-term effects on pain management routines, patient experiences, and staff member attitudes in surgical wards more than 3 years after introduction of a quality assurance program for POPM and compare the findings to those of an organization where a corresponding systematic, entire hospital, quality assurance program had not been completed. A descriptive and comparative design, based on survey data from both patients (N = 110) and staff members (N = 51) on urologic surgery wards, was used. Significant (p < .05 to p < .0002) overall relationships were observed for identified shortages in pain management routines (lack of preoperative information, inadequate preoperative discussions on pain management, wait for pain killer) and reported experience of pain, nausea, or vomiting in the postoperative period. The quality assurance program, anesthesia-based pain services using a nurse-based anesthesiologist-supervised model, resulted in more adequate pain management routines, better patient satisfaction with POPM, and increased confidence in pain management among nurses on the surgical wards. On the basis of the present study it may be concluded that more than 3 years after the introduction of a quality assurance program for POPM in surgical wards, the pain management routines, patient experiences, and staff member attitudes have remained markedly improved and in accordance with the aims of accepted clinical practice guidelines for surgical pain management.

  • 10224.
    Warrén-Stomberg, Margareta
    et al.
    University of Skövde, School of Life Sciences.
    Öhman, Ulla-Britt
    Surgical Department, Hospital of Falköping, Sweden.
    Patients undergoing total hip arthroplasty: a perioperative pain experience2006In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, no 4, p. 451-458Article in journal (Refereed)
    Abstract [en]

    Aim. The aim was to evaluate patient’s perioperative pain experience after total hip replacement and patients’ satisfaction with pain management.

    Background. Total hip arthroplasty is a common surgical procedure intended to reduce pain and return patients to better function. Realistic expectations about total hip arthroplasty is important for optimal postoperative recovery and the information must be adapted to fit the individual patient.

    Methods. A descriptive design was used comparing patients outcome data. Pitman’s test was used for statistical analyses. Adult patients (n ¼ 112) undergoing surgical hip replacement procedures answered a 17-item questionnaire on the fourth postoperative day. The questionnaire included given alternatives and visual analogue scales (0–100 mm) for the pain assessment.

    Result. The patients’ postoperative pain experience after hip replacement surgery was in average low, 33Æ1 mm on a 100 mm visual analogue scale. Patient’s pain experience was reported to be highest on the first postoperative day for most of the patients. The preoperative pain experience tends to be higher than the postoperative

    pain experience. Older patients reported less average pain level postoperatively. Satisfaction with pain management was high.

    Conclusion. The pain experience tends to be higher preoperatively than postoperatively. Patients who reported a higher pain experience postoperatively reported that their pain experience was significant higher than preoperative expected.

    Relevance to practice. It is important for the postoperative outcome measure that the patients have a realistic expectation of pain experiences after total hip arthroplasty. The nurse is one of the staff members responsible for information to the individual patient.

  • 10225.
    Warzecha, Tomasz
    et al.
    University of Agriculture, Kraków, Poland.
    Lundh, Dan
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre.
    Mandal, Abul
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre.
    Effect of Fusarium culmorum infection on survivability of a T-DNA tagged mutant of Arabidopsis thaliana harboring a mutation in the peptide transporter gene At5g460502011In: Biotechnologia: Journal of Biotechnology, Computational Biology and Bionanotechnology, ISSN 0860-7796, Vol. 92, no 1, p. 77-84Article in journal (Refereed)
    Abstract [en]

    Previously, we have reported a T-DNA tagged mutant (TAG_009) of Arabidopsis thaliana exhibiting a significant sensitivity to biotic stresses. We have also cloned and analyzed the tagged gene At5g46050. Based on bioinformatic and molecular characterization, we proposed that At5g46050 is involved in the transport of peptides participating in plant defense against biotic stresses. To provide further evidence for supporting our proposal, this time we exposed this mutant to Fusarium culmorum, a potential fungal pathogen. Besides TAG_009 line, in our investigations we included two SALK insertion mutants (SALK_003119 and SALK_145209), two wild-type ecotypes (WT_C24 and WT_Col-0) and an additional T-DNA tagged mutant (TAG_197-6) of A. thaliana. We have found that the highest degree of leaf damage was exhibited by TAG_009 line (damage score 4.37), whereas the lowest was observed in WT_Col-0 ecotype (damage score 3.43). The highest rate of mortality after eight weeks of inoculation with F. culmorum was also observed in TAG_009 line (85.24%), while the lowest was in WT_Col-0 line (37.22%). We have also found that plants of SALK_145209 line, despite being infected with Fusarium, produced the highest number of leaves (average 14.17 leaves per plant), whereas the lowest number of leaves was produced by plants of TAG_197-6 line ( average 9.5 leaves per plant). Statistical analyses showed that the differences between the T-DNA tagged line TAG_009 and WT_Col-0 were significant, whereas in comparison with wild-type control plants WT_C24, they were insignificant. Based on these results, we can conclude that the gene we have tagged by using T-DNA-mediated in vivo gene fusion is indeed involved in the plant defense against Fusarium infection.

  • 10226. Way, Andy
    et al.
    Gawronska, BarbaraUniversity of Skövde, School of Humanities and Informatics. University of Skövde, The Informatics Research Centre.
    the 11th International Conference on Theoretical and Mathematical Issues in Machine Translation2007Conference proceedings (editor) (Other (popular science, discussion, etc.))
  • 10227.
    Weber, Julia
    University of Skövde, School of Informatics.
    Relationen mellan ljud och text: Hur diegetiska ljud påverkar uppfattningen av en textbaserad berättelse2016Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Detta arbete undersöker hur diegetiska ljud påverkar uppfattningen av en textbaserad berättelse och om ljudet kommer att främja eller störa läsarens inlevelse. Baserat på teorier om audiovisuella medier har en skönlitterär text med ackompanjerande ljud skapats för att undersöka huruvida dessa teorier även kan appliceras på text. Försökspersoner har sedan fått läsa texten en gång med ljud och en gång utan för att avslutningsvis intervjuas och tillbes jämföra deras inlevelse i de olika versionerna.

    Undersökningen visade på att diegetiska ljud påverkade inlevelsen positivt och att texten blev mer levande, atmosfärisk, interaktiv och stämningsfull.

  • 10228.
    Wegefelt, Linda
    University of Skövde, School of Health and Education.
    Vuxnas uppfattning om att använda digitala verktyg inom området fysisk aktivitet2018Student thesis
    Abstract [en]

    Introduction: Access to support is essential to prevent physical inactivity which is a majorpublic health problem. Digital tools have the potential to increase activity levels and aninterest has been raised to investigate adults' perception of such use.Aim: The purpose is to describe adult people's perception of facilitators and barriers to digitaltools in the field of physical activity.Method: A systematic literature review with a base in qualitative research was conducted inPubMed, where 15 articles were analyzed in a descriptive synthesis.Results: The result indicates that people experience the opportunity for goal setting,competition and support in digital tools as promoting. Technical barriers and insufficientpersonal adaptation is obstructing for use.Discussion: Online communication and support means a relatively new way to receivesupport. Involving digital tools in the healthcare sector in the future can provide greatopportunities for individuals as well as healthcare providers to gain transparency and controlin their own health. From a public health perspective, focus on accessibility and personaladaptation becomes particularly significant.

  • 10229.
    Wegman, Pia
    et al.
    Department of Clinical Medicine, School of Health and Medical Sciences, Örebro University, 701 85 Örebro, Sweden.
    Göthlin Eremo, Anna
    Department of Clinical Medicine, School of Health and Medical Sciences, Örebro University, 701 85 Örebro, Sweden.
    Lindlöf, Angelica
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre.
    Karlsson, Mats
    Department of Pathology, School of Health and Medical Sciences, Örebro University Hospital, 701 85 Örebro, Sweden.
    Stål, Olle
    Department of Clinical and Experimental Medicine/Oncology, Faculty of Health Sciences, Linköping University, 581 85 Linköping, Sweden.
    Wingren, Sten
    Department of Clinical Medicine, School of Health and Medical Sciences, Örebro University, 701 85 Örebro, Sweden.
    Expression of the forkhead transcription factor FOXL2 correlates with good prognosis in breast cancer patients treated with tamoxifen2011In: International Journal of Oncology, ISSN 1019-6439, Vol. 38, no 4, p. 1145-1151Article in journal (Refereed)
    Abstract [en]

    Aromatase is an important enzyme in the local synthesis of oestrogens and its expression has been shown to be increased in breast cancer through the activation of multiple promoters. However, the mechanisms behind this are not yet fully understood. A novel candidate in this context is the transcription factor forkhead box L2 (FOXL2), which has been recognised to be co-expressed with aromatase and transcriptionally active promoter II in developing goat and chicken ovaries. We propose that FOXL2 could be involved in the increased expression of aromatase in breast cancer. We examined FOXL2 and its relation to aromatase in 132 post-menopausal breast cancer patients by immunohistochemistry. Using in silico analysis, we further searched for FOXL2 binding-elements in the aromatase gene promoters. The results demonstrate that FOXL2 is expressed in breast cancer and influences clinical outcome with improved recurrence-free survival in cases with nuclear expression. In a multivariate Cox model, nuclear FOXL2 was a significant prognostic factor in ER-positive patients treated with tamoxifen (HR=0.18, 95% confidence interval (CI)=0.04-0.81, P=0.03). Tumours expressing nuclear FOXL2 were also more likely positive for stromal and/or cytoplasmic aromatase (P=0.03 and P=0.008, respectively). In silico analyses revealed binding elements of FOXL2 in promoters I.3, II and I.7 of the aromatase gene of which promoter I.7 was most significant. In conclusion, this is the first study to report that FOXL2 is expressed in breast cancer and correlates with aromatase as well as with clinical outcome. The results further strengthen a possible binding of FOXL2 to aromatase promoter I.7. Nevertheless, whether FOXL2 is a direct activator of aromatase requires further investigation.

  • 10230.
    Weidensten, Anna
    University of Skövde, Department of Computer Science.
    Människors förväntningar på arbetsbelysningen i hemmiljö: En studie för IKEA of Sweden2004Independent thesis Basic level (degree of Bachelor)Student thesis
    Abstract [sv]

    Det artificiella ljuset är något som idag ses som en självklarhet. Det är först när ett strömavbrott uppstår som betydelsen av ljuset blir riktigt påtaglig och visar hur hjälplösa människor blir utan det. En bra belysningsanordning, på exempelvis arbetsplatsen, är en förutsättning för att korrekt information från kontexten återges. Det här examensarbetet har undersökt vilka förväntningar och krav människor har på sin arbetsbelysning i hemmet. I samband med examensarbetet utfördes intervjuer för att få en bättre förståelse för hur individer tänker kring arbetsbelysning i hemmiljö.

    Det erhållna resultatet värderades sedan i relation till en konceptuell modell över hur ljuset kan påverka arbetsprestationen. Studien förväntades besvara vilken betydelse och funktion komponenterna förväntningar, kontext och humör har för arbetsbelysning i hemmiljösammanhang. Utifrån resultatet kan en slutsats dras om att Boyces arbetsprestationsmodell (2003) kan vara lämplig för att beskriva arbetsbelysningskontexten men att vissa modifieringar i modellen bör göras. Människor har olika förväntningar på arbetsbelysningen och det gäller främst designen, ljusstyrkan och ljusspridningen.

  • 10231.
    Weimann, Hanna
    et al.
    Lund Univ, Div Occupat & Environm Med, S-22185 Lund, Sweden.
    Björk, Jonas
    Lund Univ, Div Occupat & Environm Med, S-22185 Lund, Sweden.
    Rylander, Lars
    Lund Univ, Div Occupat & Environm Med, S-22185 Lund, Sweden.
    Bergman, Patrick
    Linnaeus Univ, Dept Sport Sci, Kalmar, Sweden.
    Eiben, Gabriele
    Univ Gothenburg, Dept Publ Hlth & Community Med, Gothenburg, Sweden.
    Neighborhood environment and physical activity among young children: A cross-sectional study from Sweden2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 3, p. 283-293Article in journal (Refereed)
    Abstract [en]

    Aims: The aims of this study were to investigate the association between the neighbourhood environment and physical activity among young children in a Scandinavian setting, and to assess the influences of seasonal variations, age, sex and parental education. Methods: Physical activity was assessed with an accelerometer and neighbourhood resources were estimated using geographic information systems for 205 Swedish children aged 4-11 years. Neighbourhood resources were generated as the sum of three neighbourhood attributes: (a) foot and bike paths, (b) non-restricted destinations and (c) recreational area, all within 300 m of each child's home. Physical activity was assessed as: (a) total volume of physical activity (i.e. counts per minute), (b) sedentary time and (c) moderate to vigorous physical activity (MVPA). The association between neighbourhood resources and physical activity was analysed using mixed linear models weighted by measurement time and adjusted for sex, age, season of activity measurement, type of housing and parental education. Results: Children were more physically active in areas with intermediate access to neighbourhood resources for physical activity compared to areas with worst access, while the difference between intermediate and best neighbourhood resource areas was less clear. The association between physical activity and neighbourhood resources was weaker than with seasonal variations but compatible in magnitude with sex, age, type of housing and parental education. Among specific neighbourhood attributes, the amount of foot and bike paths was associated with less sedentary time and more MVPA. Conclusions:This study provides some, not entirely consistent, evidence overall for an association between the neighbourhood environment and physical activity among young children in Scandinavia.

  • 10232.
    Weishaupt, Holger
    University of Skövde, School of Humanities and Informatics.
    Inference of gene regulatory networks for Mus musculus by incorporating network motifs from yeast.2007Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    In recent time particular interest has been drawn to the inference of gene regulatory networks from microarray gene expression data. But despite major improvements with data based methods, the network reconstruction from expression data alone still presents a computationally complex (NP-hard) problem. In this work it is incorporated additional information – regulatory motifs from yeast, when inferring a gene regulatory network for mouse genes. It was put forward the hypothesis that regulatory patterns analogous to these motifs are present in the set of mouse genes and can be identified by comparing yeast and mouse genes in terms of sequence similarity or Gene Ontology (The Gene Ontology Consortium 2000) annotations.

    In order to examine this hypothesis, small permutations of genes with high similarity to such yeast gene regulatory motifs were first tested against simple data-driven regulatory networks by means of consistency with the expression data. And secondly, using the best scored interactions provided by these permutations it were then inferred networks for the whole set of mouse genes.

    The results showed that individual permutations of genes with a high similarity to a given yeast motif did not perform better than low scored motifs and that complete networks, which were inferred from regulatory interactions provided by permutations, did also neither show any noticeable improvement over the corresponding data-driven network nor a high consistency with the expression data at all.

    It was therefore found that the hypothesis failed, i.e. neither the use of sequence similarity nor searching for identical functional annotations between mouse and yeast genes allowed to identify sets of genes that showed a high consistency with the expression data or would have allowed for an improved gene regulatory network inference.

  • 10233.
    Weishaupt, Holger
    et al.
    Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.
    Johansson, Patrik
    Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.
    Sundström, Anders
    Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.
    Lubovac-Pilav, Zelmina
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Olsson, Björn
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Nelander, Sven
    Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.
    Swartling, Fredrik J.
    Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.
    Batch-normalization of cerebellar and medulloblastoma gene expression datasets utilizing empirically defined negative control genes2019In: Bioinformatics, ISSN 1367-4803, E-ISSN 1367-4811, Vol. 35, no 18, p. 3357-3364Article in journal (Refereed)
    Abstract [en]

    Motivation: Medulloblastoma (MB) is a brain cancer predominantly arising in children. Roughly 70% of patients are cured today, but survivors often suffer from severe sequelae. MB has been extensively studied by molecular profiling, but often in small and scattered cohorts. To improve cure rates and reduce treatment side effects, accurate integration of such data to increase analytical power will be important, if not essential.

    Results: We have integrated 23 transcription datasets, spanning 1350 MB and 291 normal brain samples. To remove batch effects, we combined the Removal of Unwanted Variation (RUV) method with a novel pipeline for determining empirical negative control genes and a panel of metrics to evaluate normalization performance. The documented approach enabled the removal of a majority of batch effects, producing a large-scale, integrative dataset of MB and cerebellar expression data. The proposed strategy will be broadly applicable for accurate integration of data and incorporation of normal reference samples for studies of various diseases. We hope that the integrated dataset will improve current research in the field of MB by allowing more large-scale gene expression analyses.

  • 10234.
    Welleby, Tommy
    University of Skövde, School of Humanities and Informatics.
    Exempelinlärda ANN som artificiella förare i bilspel2012Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Artificiella neurala nätverk (ANN) kan användas för att lära och efterlikna olika beteenden. I det här projektet används ANN för att kontrollera en bil i en simulatormiljö genom att lära upp nätverken med mänskliga exempel. Syftet med projektet är att ta reda på vilken kombination av parametrar det är som gör att en bil kan kontrolleras av ANN med ett bra resultat. Detta undersöks genom att skapa åtta olika artificiella förare som representerar olika kombinationer av parametrar och sedan jämföra förarnas beteende och resultat för att se vilken förare som klarar sig bäst. På så vis är det sedan möjligt att härleda vilken kombination av parametrar som är den bästa för att kontrollera en bil med ANN. Resultaten från experimenten visar att den bästa kombinationen av parametrar för att styra en artificiell bilförare med ANN är högnivåinput, högnivåoutput och en delad nätverksarkitektur. Framtida arbeten innefattar bland annat hybrider av kombinationer.

  • 10235.
    Wendel, Carina
    et al.
    University of Skövde, School of Life Sciences.
    Bodén, Emma
    University of Skövde, School of Life Sciences.
    Endometrios hos unga kvinnor: - upplevelser av skolhälsovården2011Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Endometrios,  en  sjukdom  med  symtom  som  smärtor  eller  blödningar  i  samband  med menstruation, börjar ofta i tonåren men diagnostiseras inte förrän flera år senare. Kvinnorna med denna diagnos beskriver ofta att de inte  fått förståelse för sina problem under tonåren. Sjukdomen kan innebära stora besvär  för den drabbade och följder på det fysiska, psykiska och sociala planet kan ses. Syftet var att studera hur unga kvinnor med endometriossymtom upplevde  skolsköterskans  stöd  under  högstadie-  och  gymnasietiden,  för  att  kunna  påverka deras livskvalitet. Via Svenska endometriosföreningens ungdomssektion i Sverige gjordes en kvantitativ   undersökning   med   kvalitativt   inslag.   Ett   frågeformulär   skickades   ut   till föreningens  59  medlemmar,  24  kvinnor  svarade.  Resultatet  visade  att  några  få  kvinnor  var nöjda med den hjälp de fått under skoltiden men de flesta kvinnorna uttryckte att de saknade kunskap,  stöd  och  förståelse  från  skolsköterskan  vilket  ibland  gav  ett  icke  tillfredsställande bemötande. Det framkom även i studien att förståelse och kunskaper saknades i vissa fall även hos  ungdomsmottagningar  och  läkare.  Tillgängligheten  av  skolsköterskan  på  de  olika skolorna  varierade.  Mer  resurser  bör  läggas  på  kunskaper  både  hos  skolsköterskor  och  de unga kvinnorna själva för att förbättra livskvaliteten hos de unga kvinnorna. 

  • 10236.
    Wendelholt, Erica
    University of Skövde, School of Humanities and Informatics.
    Evolutionary Psychology - Sex Differences in Spatial Abilities2008Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Sex differences in spatial ability, especially mental rotation, navigation and object-location memory are described in this essay. Biological differences in brain morphology, hormones and genes between men and women are presented as explanations for the sex differences. Another level of explanations offered are evolutionary, hence the most influential evolutionary psychological theories are summarized and evaluated. These theories are Gaulin’s and Fitzgerald’s male range theory, Silverman’s and Eals’s hunter-gatherer theory, and Ecuyer-Dab’s and Robert’s twofold selection theory. The hunter-gatherer theory at present seems to be of the most importance, though the twofold selection theory may in the future challenge it. Regardless, united biological and evolutionary explanations would create the best comprehensive theory.

  • 10237.
    Wendelius, Mikael
    University of Skövde, Department of Computer Science.
    Korrelationen mellan användares effektivitet och subjektiva uppfattning på world wide web2002Independent thesis Basic level (degree of Bachelor)Student thesis
    Abstract [sv]

    Inom Human- Computer Interaction är användbarhet ett mycket centralt

    begrepp. Användbarhet kan i sin tur delas upp i effektivitetsmått och

    subjektiv uppfattning. Det råder idag delade meningar i forskarvärlden huruvida det existerar en korrelation mellan dessa två mått. Om denna korrelation existerar kanske vidare forskning visar att någon av de två inte utgör en nödvändig del av användbarhetsbegreppet. Om så är fallet skulle detta kunna leda till enklare och billigare design och utvärderingsprocesser. Den här undersökningen syftar till att undersöka om det existerar en korrelation mellan effektivitet och subjektiv uppfattning på world wide web samt att undersöka om det råder skillnader i denna korrelation mellan experter och noviser. För att undersöka detta har en användbarhetsutvärdering med 31 försöksdeltagare genomförts på en webbsida publicerad på www. Resultatet av undersökningen visar inte på några samband eller korrelationer och resultaten är endast marginellt signifikanta. Inga klara slutsatser kan därför dras utifrån resultaten.

  • 10238.
    Wendel-Örtqvist, Sara
    University of Skövde, School of Humanities and Informatics.
    The Female Assassin: Ett Game Writer manuskript om Franska Revolutionen2009Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Uppsatsen syftar till att diskutera och jämföra tre olika metoder för karaktärsutveckling och diskutera dessa i förhållande till The Female Assassin; ett spelmanuskript som utspelar sig under Franska Revolutionen. För att få en god bakgrund för examensarbetet valde jag att läsa ett antal böcker om Franska Revolutionen, karaktärsutveckling och Game Writing. Jag har använt mig av personlighetsdiamanter och mallen Character Template för att skapa karaktärer till manuskriptet. I rapporten diskuterar och jämför jag dessa två metoder samt arketyper. Jag kom fram till att de tre metoderna för att utveckla spelkaraktärer fungerar utmärkt och kan kombineras för att få fram mer avancerade karaktärer.

    Spelmanuskriptet är skrivet utifrån mitt High Concept om spelet La Meurtrière (se Bilaga 2) framtaget för kursen Modellkonstruktion för Interagerbara Medier/Spel A11. The Female Assassin handlar om de tre första åren under Franska Revolutionen och om den unga lönnmörderskan Élodie Bauchet. Jag använder mig av ludologi och narratologi för att undersöka och diskutera spelmanuskriptets spelmekanik och berättelse. Slutsatsen som jag drog efter att granskat manuskriptet genom narratologi och ludologi var att story i spel kan berättas genom spelmekanik och att det är att föredra framför så kallade cutscenes och dialog emellan spelkaraktärer.

     

  • 10239.
    Wendin, Johan
    University of Skövde, School of Informatics.
    BAKGRUNDSHISTORIENS PÅVERKAN PÅ SPELUPPLEVELSEN2014Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Digitala spel har utvecklats kraftigt de senaste 10 åren. Moderna spel kan skryta med otroliga världar med trovärdiga karaktären och visuella egenskaper som liknar modern film. Modern teknologi har förmågan att skapa världar som kan uppsluka vår uppmärksamhet som aldrig förut. Många moderna spel lägger även stort fokus på att skapa ett narrativ som ger kontext och mening till den virituella världen. Ett sätt att skapa narrativ i spel har varit att implementera en bakgrundshistoria som spelaren får ta del av innan man börjar interagera med spelet.

    Målet med denna rapport har varit att koppla teorier om the magic circle till teorier om perception, och immersion för att försöka få en bild över hur spelarna upplever spelvärlden.  För att sedan undersöka hur en bakgrundshistoria påverkar spelupplevelsen.

    För att undersöka bakgrundshistoriens påverkan på spelupplevelsen har det utvecklas ett spel med två versioner. Spelet som utvecklats är ett äventyrsspel i förstapersonsperspektiv där målet är att klara två utmaningar för att utföra en religiös ritual. En version av spelet har en kort introduktionssekvens av text med bakgrundshistoria, och den andra versionen av spelet har inte denna introduktionssekvens. I versionen utan bakgrundshistoria får spelarna alltså direkt börja interagera med mjukvaran efter att den startats. I den ena versionen av spelet har spelarna fått bygga sitt egna narrativ och kontext, och i den andra har de fått ta del av ett narrativ och kontext i form av en bakgrundshistoria.

    Påverkan på spelupplevelsen har undersökts genom att två grupper med testpersoner fått spela varsin version av spelet och sedan besvarat enkät och intervjufrågor. Dessa frågor har undersökt hur personerna upplevt immersion, narrativ, spelmekanik samt estetik. Denna information har sedan kopplats till Bartles (1996) taxonomi av spelartyper för att skapa ett mer generaliserbart resultat.

    Undersökningen kunde inte ge något klart resultat över bakgrundshistoriens påverkan på spelupplevelsen. Resultaten var väldigt spridda över de båda testgrupperna där immersionsnivåerna varierat kraftigt. För att få mer generaliserbara resultat skulle fler testpersoner behövas samt så skulle man behöva använda sig av en jämn grupp av de olika spelartyperna.

  • 10240.
    Wendt, Emelie
    University of Skövde, School of Humanities and Informatics.
    Hitta rätt - utveckling av navigationsstöd2008Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Detta arbete har utförts i samarbete med företaget Compute och fokuserar på att utveckla navigationsstöd för webbportaler med bokningssystem. Arbetet har delats upp i tre specifika mål: (1) integrera Information Foraging Theory (IFT) och Graphical User Interface principles (GUI-principer) genom att applicera dessa vid utvecklng av navigation för webbportaler med bokningssystem (2) konkretisera hur navigering kan förbättras på en webbportal med bokningssystem, utifrån ovanstående teroier och (3) arbetet skall resultera i en lista med rekommendationer som kan tillämpas vid utveckling av navigation. För att kunna  integrera IFT och GUI-principer har dessa i kombination med en teroertisk studie tillämpats vid prototyping. Prototyperna användes som verktyg för att konkretisera hur navigationen kunde förbättras på portalen. Prototyperna utvärderades och resulterade i en lista med rekommendationer. Resultaten från utvärderingen påvisade att en integrering av GUI-principer och IFT kan förbättra nvigationsförhållanden på en webbportal. Arbetes främsta bidrag är listan med rekommendationer som skall kunna tillämpas vid navigationsutveckling.

     

  • 10241.
    Wendt, Stefan
    University of Skövde, Department of Computer Science.
    Beskrivning av objektorienterade system med hjälp av designmönster2000Independent thesis Basic level (degree of Bachelor)Student thesis
    Abstract [sv]

    Designmönster har under senare år blivit ett allt mer vanligt förekommande begrepp inom objektorienterad systemutveckling. Designmönster har nämligen visat sig kunna höja abstraktionsnivån vid designbeslut, vilket dels leder till en effektivisering av denna process, men även minskar risken att fel begås då de döljer viss komplexitet. Designmönster har främst setts som ett sätt att återanvända gamla designlösningar, som har visat sig vara bra i vissa återkommande problemsituationer. En positiv effekt av att dessa används har också varit att ett gemensamt språk i termer av designmönster har skapats. I detta projekt har dock designmönster studerats utifrån aspekten att använda dessa för att förbättra dokumentationen av objektorienterade programvarusystem. Enligt teorier i litteraturen kan designmönster nämligen användas som hjälp vid dokumentering av programvarusystem. Syftet är då att öka förståelsen av systemets arkitektur, vilket skulle underlätta framtida förändringar av detta system. Genom resultatet av ett experiment som har genomförts på ett existerande objektorienterat programvarusystem, har projektet visat sig stödja dessa teorier. Dessutom har det visats att processen med att härleda designmönster ur ett existerande system även kan leda till förbättringsförslag i arkitekturen.

  • 10242.
    Wengström, Y.
    et al.
    Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden / Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Bolam, K. A.
    Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden / School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
    Mijwel, S.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Sundberg, C. J.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden / Unit for Bioentrepreneurship, Karolinska Institutet, Solna, Sweden.
    Backman, M.
    Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden / Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Norrbom, J.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Rundqvist, H.
    Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.
    Optitrain: a randomised controlled exercise trial for women with breast cancer undergoing chemotherapy2017In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 17, article id 100Article in journal (Refereed)
    Abstract [en]

    Background: Women with breast cancer undergoing chemotherapy suffer from a range of detrimental disease and treatment related side-effects. Exercise has shown to be able to counter some of these side-effects and improve physical function as well as quality of life. The primary aim of the study is to investigate and compare the effects of two different exercise regimens on the primary outcome cancer-related fatigue and the secondary outcomes muscle strength, function and structure, cardiovascular fitness, systemic inflammation, skeletal muscle gene activity, health related quality of life, pain, disease and treatment-related symptoms in women with breast cancer receiving chemotherapy. The second aim is to examine if any effects are sustained 1, 2, and 5 years following the completion of the intervention and to monitor return to work, recurrence and survival. The third aim of the study is to examine the effect of attendance and adherence rates on the effects of the exercise programme. Methods: This study is a randomised controlled trial including 240 women with breast cancer receiving chemotherapy in Stockholm, Sweden. The participants are randomly allocated to either: group 1: Aerobic training, group 2: Combined resistance and aerobic training, or group 3: usual care (control group). During the 5-year follow-up period, participants in the exercise groups will receive a physical activity prescription. Measurements for endpoints will take place at baseline, after 16 weeks (end of intervention) as well as after 1, 2 and 5 years. Discussion: This randomised controlled trial will generate substantial information regarding the effects of different types of exercise on the health of patients with breast cancer undergoing chemotherapy. We expect that dissemination of the knowledge gained from this study will contribute to developing effective long term strategies to improve the physical and psychosocial health of breast cancer survivors.

  • 10243.
    Wennerberg, Josefin
    University of Skövde, School of Health and Education.
    Kvinnors upplevelser av att vårdas för sjukdomen Anorexia Nervosa- En studie av självbiografier2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Amongst young female adults in the western society, eating disorder is the third most common disease after asthma and obesity. About 10 % of the people who suffers from anorexia nervosa die due to the disease. Aim: This studies aim is to describe women’s experiences of being cared for Anorexia Nervosa. Method: This study was completed with a qualitative method and a narrative analysis. The gathering of data was founded on four autobiographies, written by women who has suffered from, and been cared for Anorexia Nervosa. Result: In the results, different experiences from the treatment for anorexia nervosa could be pointed out. The experience was divided into different themes and was clarified with quotations. The themes were To compete, To let go of the control, To be offended, To be seen, To get insight and To feel fear of being healthy. These themes reflected the women’s experiences from being cared for anorexia nervosa. Conclusion: This study can contribute so that health professionals receive a greater understanding about women’s experiences from being cared for Anorexia Nervosa. It could help the health professionals to promote these women’s need of care, it can also increase the women’s experience of health and well-being.

  • 10244.
    Wennergren, Oscar
    et al.
    University of Skövde, School of Informatics.
    Vidhall, Mattias
    University of Skövde, School of Informatics.
    Sörensen, Jimmy
    University of Skövde, School of Informatics.
    Transparency analysis of Distributed file systems: With a focus on InterPlanetary File System2018Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    IPFS claims to be the replacement of HTTP and aims to be used globally. However, our study shows that in terms of scalability, performance and security, IPFS is inadequate. This is a result from our experimental and qualitative study of transparency of IPFS version 0.4.13. Moreover, since IPFS is a distributed file system, it should fulfill all aspects of transparency, but according to our study, this is not the case. From our small-scale analysis, we speculate that nested files appear to be the main cause of the performance issues and replication amplifies these problems even further.

  • 10245.
    Wennerström, Berith
    et al.
    Skaraborg Hospital, Kärnsjukhuset.
    Warrén Stomberg, Margareta
    University of Skövde, School of Life Sciences.
    Modin, Marina
    Skaraborg Hospital, Kärnsjukhuset.
    Skullman, Stefan
    Skaraborg Hospital, Kärnsjukhuset.
    Patient symptoms after colonic surgery in the era of enhanced recovery - a long-term follow-up2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 5-6, p. 666-672Article in journal (Refereed)
    Abstract [en]

    Aims. The main purpose of this study was to analyse, prospectively, patient symptoms during the first four weeks following elective colon surgery. A secondary aim was to find areas to improve inpatient information and postoperative care.

    Background. Fast-track recovery following colon surgery has been proven beneficial to patients in the early postoperative phase. Less is known about the continuous recovery at home.

    Design. A prospective follow-up survey.

    Methods. Consecutive patients (n = 32) planned for elective colon surgery were evaluated. Both open and laparoscopic operations were included. All followed a fast-track protocol in hospital. Patient symptoms were recorded by validated quality of life questionnaires (EORTC QLQ-C 30, EORTC QLQ-CR 38 and Brief Pain Inventory). An interview was conducted five weeks and one year after surgery.

    Results. The hospital stay was six days, and 10% of patients were readmitted. The fast-track concept worked well. The main problems after discharge were fatigue, nausea and bowel disturbances. Pain was not a significant issue. Most symptoms had disappeared after four weeks.

    Conclusions. The first period at home is troublesome, and better information about common symptoms is needed. A direct telephone line has been set up to answer questions and to lower patient anxiety.

    Relevance to clinical practice. Clinical guidelines for patient’s discharge planning can be performed based on the results from this study. Further improvement regarding the epidural anaesthesia is needed to reduce minor side effects.

  • 10246.
    Wennlo, Josefin
    University of Skövde, School of Health and Education.
    Sockerskatts påverkan på barnfetma: En systematisk litteraturstudie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Many children consume more sugar than the recommended daily intake. According to the World Health Organization, 381 million children today are affected by obesity or overweight.

    Aim: The purpose of this study is to investigate whether the introduction of sugar tax can help reduce childhood obesity and overweight, which could be a contributing factor to improved opportunities for good health and longevity.

    Method: A systematic literature study where 15 scientific articles reflecting the study matter were analyzed and compiled.

    Result: Sugar sweetened beverage tax is most effective when it is volume based and is 20% or higher. That weight reduction taxation leads to depends on the consumer's age, gender and socioeconomic position. The biggest reduction is the weight reduction among children and adolescents, who consume the most sugar sweetened beverages in the population. 

    Discussion: The systematic review shows that it is no longer sustainable for nations to rely on the population to manage their calorie intake on their own. Taxing sugar sweetened beverages is both practical to implement and a necessary health measure. Once consumers feel a reluctance to consume the groceries, and understand the connection between high sugar intake and their own health, sugar tax gives.                    

  • 10247.
    Wennström, Berith
    et al.
    Department of Anaesthesia, Skaraborg Hospital, Skövde, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences. Faculty of Health Caring Sciences, Göteborg University, Sweden.
    Bodily and verbal expressions of postoperative symptoms in 3- to 6-year-old boys2008In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 23, no 1, p. 65-76Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate how small boys between 3 and 6 years of age describe bodily and verbal expressions of postoperative symptoms. The data collection was carried out at a large general hospital in Sweden and included both participant observations and semistructured interviews. The results provided a description of how 3- to 6-year-old boys bodily and verbally express postoperative symptoms. The results also showed that small children have difficulties in distinguishing pain, nausea, and anxiety and that postoperative discomfort was experienced in many different ways.

  • 10248.
    Wennström, Berith
    et al.
    Department of Anaesthesia, Skaraborg Hospital, Kärnsjukhuset, Skövde, Sweden.
    Hallberg, Lillemor R.-M.
    Public Health and Health Care Science, School of Social and Health Sciences, Halmstad University, Sweden.
    Bergh, Ingrid
    Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Use of perioperative dialogues with children undergoing day surgery2008In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 62, no 1, p. 96-106Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study to explore what it means for children to attend hospital for day surgery. Background. Hospitalization is a major stressor for children. Fear of separation, unfamiliar routines, anaesthetic/operation expectations/experiences and pain and needles are sources of children's negative reactions. Method. A grounded theory study was carried out during 2005-2006 with 15 boys and five girls (aged 6-9 years) scheduled for elective day surgery. Data were collected using tape-recorded interviews that included a perioperative dialogue, participant observations and pre- and postoperative drawings. Findings. A conceptual model was generated on the basis of the core category 'enduring inflicted hospital distress', showing that the main problem for children having day surgery is that they are forced into an unpredictable and distressful situation. Pre-operatively, the children do not know what to expect, as described in the category 'facing an unknown reality'. Additional categories show that they perceive a 'breaking away from daily routines' and that they are 'trying to gain control' over the situation. During the perioperative period, the categories 'losing control' and 'co-operating despite fear and pain' are present and intertwined. Post-operatively, the categories 'breathing a sigh of relief' and 'regaining normality in life' emerged. Conclusion. The perioperative dialogue used in our study, if translated into clinical practice, might therefore minimize distress and prepare children for the 'unknown' stressor that hospital care often presents. Further research is needed to compare anxiety and stress levels in children undergoing day surgery involving the perioperative dialogue and those having 'traditional' anaesthetic care.

  • 10249.
    Wennström, Berith
    et al.
    Department of Anaesthesia, Skaraborg Hospital, Kärnsjukhuset, Skövde, Sweden / Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Nasic, Salmir
    Centre for Research and Development Skaraborg Hospital, Kärnsjukhuset, Skövde, Sweden.
    Hedelin, Hans
    Centre for Research and Development Skaraborg Hospital, Kärnsjukhuset, Skövde, Sweden / Skaraborg Hospital, Kärnsjukhuset, Skövde, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Evaluation of the Swedish version of the Child Drawing: Hospital Manual2011In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 5, p. 1118-1128Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of psychometric testing of the Swedish version of the Child Drawing: Hospital Manual.Background. Drawings have shown to be useful in assessing emotional status and anxiety in children because they generally speak to us more clearly and openly through their drawings than they are willing or able to verbally.Method. The Child Drawing: Hospital Manual was translated into Swedish according to World Health Organization guidelines (a routine procedure for translation of English instruments) in order to assess anxiety by analysing the drawings of 59 children (5–11 years), of whom nine were girls and 50 boys undergoing day surgery during 2007–2009.Results. Inter-rater reliability (five independent scorers) was high and internal consistency reliability was good (coefficient alpha = 0.77). Parts A and C, as well as the total scale score of the Child Drawing: Hospital Manual, discriminated anxiety significantly between the group of children undergoing day surgery and a comparison group of school children, indicating adequate construct validity.Conclusion. For the Swedish version of the Child Drawing: Hospital Manual, our study demonstrates evidence for adequate construct validity in Parts A and C (and total scale score), high inter-rater reliability and acceptable internal consistency reliability. However, some improvements are needed before the instrument will be a clinically useful assessment of anxiety in children undergoing day surgery.

  • 10250.
    Wennström, Berith
    et al.
    Department of Anaesthesia, Skaraborg Hospital, Skövde, Sweden.
    Törnhage, Carl-Johan
    Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden.
    Hedelin, Hans
    Centre for Research and Development, Skaraborg Hospital, Skövde, Sweden.
    Nasic, Salmir
    Centre for Research and Development, Skaraborg Hospital, Skövde, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Child drawings and salivary cortisol in children undergoing preoperative procedures associated with day surgery2013In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 28, no 6, p. 361-367Article in journal (Refereed)
    Abstract [en]

    Background

    Perioperative procedures in children can impair their emotional status negatively with stress and/or anxiety. Cortisol concentrations and drawings could be helpful in gaining information about a child's levels of stress and/or anxiety when attending the hospital for surgery.

    Purpose

    The purpose of this study was to determine the degree of anxiety and stress as well as to explore the association between objective measures of stress (cortisol concentration in saliva) and subjective assessment of hospital anxiety (children's drawings) as interpreted by the Swedish version of the Child Drawing: Hospital manual.

    Methods

    A total of 93 children scheduled for day surgery were included. Salivary cortisol was sampled preoperatively on the day of surgery at which time the children were also requested to make a drawing of a person at the hospital.

    Results

    Results showed no association between salivary cortisol concentration and the CD:H score.

    Conclusion

    The drawings and salivary cortisol concentration preoperatively on the day of surgery reflect different components of the conditions of fear, anxiety, or stress emerging in the situation.

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