Högskolan i Skövde

Background: Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are the first and second most common thyroid cancers comprising about 85% and 10% of all thyroid cancers. Simultaneous occurrence of medullary and papillary thyroid cancer has been reported with various presentations, but simultaneous occurrence of FTC in addition to PTC as differentiated cancers, is an unusual event that is rarely reported. Presentation of cases: We report our experience of six rare cases of synchronous coexistence of FTC and PTC with unique features. Case 1 is 31 old Egyptian female. Case 2 is a 61 year old Sudanese male. Case 3 is a 59 year old Sudanese male. Case 4 is a 56 years old Indian female. Case 5 is a 35 years old Filipina female. Case 6 is a 52 years old Qatari female. The six cases are special in their co-occurrence of two thyroid carcinoma, consisting of histologic features of follicular thyroid carcinomas, and classical papillary thyroid carcinoma, possibly the first case series of simultaneous occurrence of these two types of thyroid cancer in the Middle East and North Africa Region. Conclusions: We present rare cases of concurrent FTC and PTC. These six cases add more data highlighting the coincidental simultaneous coexistence of FTC and PTC. Endocrinologists and pathologists should be aware of and vigilant to this variety. © 2020 The Author(s)

Background: Depression among older adults is increasing. Since many of the older adults are seeking medical care, nurses are faced with depressed elders. Most older adults with depression have experienced insufficient care, since the knowledge about older adults with depression is lacking among nurses. This can cause older adults to experience suffering. To avoid this, it is important to describe the older adults' experiences with depression.

Method: A literature review that is based on eight qualitative articles. The articles have been both studied and analyzed and from that, a result has been produced. The databases Cinahl and PubMed have been used for article queries.

Aim: To describe older adults' experience with depression and its influence on daily life.

Findings: Older adults with depression experience both physical and psychic changes. The result brought four different categories, the influence of age on depression, a struggle against loneliness, the importance of autonomy for well-being and a strive for community and purpose.

Conclusion: The subject of depression is an area in which healthcare workers need more knowledge. Awider and more in-depth understanding of depression can both prevent and give a better understanding of the subject. This in turn can lead to that the patients get good individual healthcare which causes suffering to be avoided.

Attitudes and prejudice about ethnicity is a phenomenon that occurs in many different contexts. When working with people, attitudes about ethnicity is essential for how the workplace is experienced, both for the employees and clients. The work-life in Sweden consists of employees with different backgrounds and ethnicities. Norms about ethnicity create obstacles to achieve equality and the risk of ethnic discrimination enhances. The issue can be complex and requires employees to critically examine themselves and their colleagues. Experiences of attitudes depends on several individual factors, therefore they may differ in different workplaces. The purpose of this qualitative study was to investigate attitudes about ethnicity among Social Services' employees and how the attitudes affect the work with clients. With a social psychological approach, this study was conducted based on theories of social cognition theory, attitudes, social attribution theory and ethnicity, we and them-thinking & indirect discrimination. The essay contains ten semi-structured interviews with social workers in three different municipalities. The results show that it exists negative attitudes about ethnicity in the social services, both between employees and clients. How attitudes appear in the work is affected by several different factors such as experience, awareness of negative attitudes and open dialogues between employees. Whilst working with clients, the influence of attitudes has a basis in the employees´ level of understanding, treatment and ability to maintain the professional role. 

Individuals who have come to Sweden as unaccompanied refugee minors meet different difficulties. In previous research, the main focal points have been the unaccompanied minors' previous experiences of violence and war, and the importance of social support. The aims of this study were firstly to gain a greater understanding regarding stress and stress management among unaccompanied refugee minors, and secondly, to look at the importance of social relationships regarding stress management. This qualitative study is based upon ten semi-structured interviews. Ten young adults gave their subjective narrative. The interviewees had their roots in Afghanistan. They all came to Sweden as unaccompanied refugee minors. The interview was analyzed based on Bronfenbrenner´s Ecological systems theory and Lazarus stress theory, using thematic analysis. The results drawn were that unaccompanied refugee minors experience stress because of a) expressed and perceived demands from the family, b) for the family's situation in the home country, c) the oral interaction with ethnical Swedes, d) be able to find work, and e) not recognizing the physical environment. The result regarding stress management shows that social relations, help from professional contacts, and their own personality were of importance for the study participants. Furthermore, the results show that being able to work and to educate themselves were important stress management strategies. Friends from the homeland and the mother tongue were sources of comfort for the participants.

Background: Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared to R-RYGB (e.g., post sleeve gastrectomy or gastric banding) are controversial. Methods: Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011 - June 2015) at our center. One hundred and twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension and dyslipidemia in terms of remission, improvement, persistence, relapse and de novo. The current study also assessed mortality and complications rates. Results: There were no significant differences in the baseline characteristics of patients who received P-RYGB with those who received R-RYGB in terms of age, gender and preoperative BMI. However, at 18 months: a) Patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P <0.001), reflected by a higher mean delta BMI (P = 0.02), TWL%(P <0.0001) and EWL%(P < 0.0001); b) No differences were observed between the two patients groups in terms of glycemic parameters, lipid profiles, and control of T2DM, hypertension, and dyslipidemia; and, c) No deaths were reported among both patients groups, and complication rates were comparable. Conclusion: Although R-RYGB effectively addressed inadequate weight loss, weight regain and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared to P-RYGB. There were no significant differences between the two procedures in terms of their clinical control of T2DM, hypertension and dyslipidemia. Both procedures exhibited comparable complication rates. 

Bakgrund: Stroke är en av de vanligaste folksjukdomarna i Sverige och är en sjukdom som kan ge permanenta funktionsnedsättningar. Att vara patient och i behov av vård innebär att de har ett beroendeförhållande till sjuksköterskan. Alla individers upplevelse av stroke är unik. Vidare är det också viktigt att se hela personen och hens behov, inte bara sjukdomen.Syfte: Syftet med denna uppsats är att belysa strokedrabbade individer i arbetsför ålders upplevelse av att återgå till sina vardagliga liv.Metod: Det är en litteraturstudie där 10 vetenskapliga artiklar som hämtades från databasen CINAHL är inkluderade.Resultat: Efter att artiklarna som inkluderades i studien hade analyserats framkom två huvudkategorier i resultatet; Förlorad kontroll över den egna kroppen och Behov att hantera sin nya livssituation. Det utformades totalt fem underkategorier.Slutsats: Studien bidrar med kunskap om strokedrabbade individer i arbetsför ålders upplevelse att återgå till sina vardagliga liv. Efter stroke blir personerna begränsade i sin vardag och de kan drabbas av olika funktionsnedsättningar. Att utföra aktiviteter, återgå till sina jobb och ägna sig åt övriga sysselsättningar kan bli en utmaning som kan påverka deras sociala liv. Den nya livssituationen kan påverka deras självkänsla och självförtroende negativt. Många strokedrabbade individer lider av kognitiva svårigheter, kroppsliga förändringar, trötthet och rädslor vilket kan leda till att de undviker sociala sammanhang. För att de skall kunna hantera sin nya livssituation är de i behov av att utveckla nya rutiner och strategier i sin vardag.

Introduction: Ectopic parathyroid adenoma is rare during pregnancy but poses multiple challenges in treatment. It presents as primary hyperparathyroidism which leads to symptoms and complications of hypercalcemia in both the mother and fetus. Presentation of case: A 38-year-old Sudanese female presented with diffuse bone pain and polyuria. Laboratory investigations revealed elevated serum calcium and parathyroid hormone. Ultrasound of the neck did not show any abnormal lesion, however 99mTc-sestamibi scan showed a right sided parathyroid adenoma, and an earlier CT scan showed the adenoma to be in an ectopic paraesophageal position. Focused surgical neck exploration was done, and the ectopic parathyroid adenoma was excised. Discussion: Preoperative localization of the ectopic parathyroid adenoma allows for a focused surgical procedure. Ultrasound is the safest during pregnancy, but 99mTc-sestamibi and CT scan may be necessary if ultrasound or initial bilateral neck exploration do not detect any adenoma. Mild elevations in maternal serum calcium can have detrimental effects on the fetus which suggests that a surgical approach may be necessary in the majority of cases. Conclusions: Ectopic parathyroid adenoma is rare during pregnancy and is detrimental to both the mother and fetus. Preoperative localization allows for a focused surgery which is a definitive treatment and can safely be performed during the 2nd trimester of pregnancy. 

Introduction: Papillary thyroid cancer (PTC) is the commonest form of well-differentiated endocrine carcinoma. It is categorized into indolent and aggressive, where the indolent subtypes (classic, follicular) rarely demonstrate aggressive behavior. We present a classic PTC presenting with a rapidly growing huge anterior neck mass that subsequently spontaneously ruptured subcutaneously resulting in ischemia, necrosis, and perforation of overlying skin leading to inflammation. Presentation of case: A 37-year-old female with no comorbidities presented to our emergency department with a neck swelling of 2 years duration that rapidly enlarged one week prior to presentation. Though the mass initially appeared of inflammatory nature, the tumor was a PTC, and she underwent total thyroidectomy with selective right side neck dissection and debridement of necrotic skin. The gross specimen revealed a fragmented non-intact right thyroid lobe mass causing pressure ischemia, necrosis and perforation of the skin. Histopathology showed a 9 × 9 × 5 cm classic PTC staged as pT3b N1b. Postoperative course was uneventful, she was discharged by the eighth postoperative day, and then she received a high dose of radioactive iodine ablation (RAI). Discussion: Classic PTC is usually of a smaller size and a relatively benign course compared to other PTC subtypes and thyroid cancers. It is indolent with favorable prognosis. Although it is associated with increased risk of lymph node metastases at the time of diagnosis, it is slow growing with high survival rates approaching 95%. Conclusion: Despite that classic PTC progresses slowly, it should still be suspected in neck swellings presenting with rapid and aggressive behavior. Prompt and systematic assessment is required with surgical intervention and radioactive iodine ablation therapy. 

Nonalcoholic fatty liver disease (NAFLD) is increasingly being linked to obesity. Although laparoscopic sleeve gastrectomy (LSG) is effective for weight loss that can ultimately resolve NAFLD, an initial transient deterioration of liver functions could be observed during the first few months post-operatively, after which a subsequent improvement of the liver functions might occur. Rapid weight loss, nutritional deficiencies, and protein malnutrition can all contribute to hepatic dysfunction and can affect the metabolism of medications such as acetaminophen leading to more insult to a compromised liver. We report acute liver failure after LSG associated with protein calorie malnutrition, multiple nutritional deficiencies in addition to concomitant use of therapeutic doses of acetaminophen. Treatment with N-acetylcysteine, and replacement of deficient multivitamins and trace elements resulted in significant improvement in liver functions. 

Background: The type 2 diabetes is a chronic disease that is increasing around the world. The disease causes a suffering, which leads to deterioration in health. Self-care is important so that patients are not bothered by the complications. Aim: Patient's experiences of living with type 2 diabetes. Method: A literature review was used, in which 12 qualitative articles were selected. Results: Consists of three themes; stress of living with diabetes, responsibility for lifestyle changes and support from the surrounding area. These three themes form six subthemes; the quality of life deteriorates, it creates concern, a struggle to change the diet, the will to exercise, support from relatives and health care. The results show that they create a constant struggle for the patient to manage diabetes, as it creates anxiety over the complications that diabetes can cause. It also shows how stressful it is with new lifestyle changes in terms of diet and physical activity. Relatives and care have a significant role to play in supporting patients. Conclusion: Shows how important it is for patients to receive support from both health care and their relatives in order to motivate them to change their lifestyle changes and reduce the risk of complications.

Background: Research shows that the choice of place of birth is important for the woman's birth experience. Home birth in a low-risk pregnancy is a safe alternative to giving birth in a hospital, however, interest in home birth is low in Sweden. In order for women to be able to make an active choice, an awareness of the alternatives available is required. The authors ask themselves whether women in Sweden know that home birth exists. Aim: To shed light on women's knowledge and understanding of home birth in Sweden. Aim: To shed light on women's knowledge and understanding of home birth in Sweden. Method: Questionguide analyzed with a qualitative hermeneutic text analysis. Results: Knowledge about home birth has been shown to vary. The result shows 4 main themes and 8 sub-themes. The main themes consist of "Women's interest in home birth varies", "The importance of information for decision-making", "Obstacles to home birth in Sweden" and "Home birth as a right".Conclusion: The study shows that there is risk that women do not know that homebirth exists. It also shows greater obstacles to the possibility of making an active choice of place of birth and undergoing a homebirth. 

Background: All care performed must be safe and evidence-based and must be well-founded with knowledge. Caregivers must start from person-centered care, where the patient's story is at the center. When the patient's life value is taken into account, the whole person is cared for and body, soul and spirit are respected. In the event of overcrowding and high workload, mistakes are made in the nursing care that can lead to the patient enduring a care injury and suffering. Nurses' responsibility is to care for patients and protect them from suffering and to respect their autonomy, dignity and integrity. Purpose: The purpose is to shed light on nurses' experiences of what conditions are required to maintain safe care in case of overcrowding in hospitals. Method: A literature-based method to contribute to safe and evidence-based nursing based on analysis of qualitative studies. Result: Four themes crystallized; Significance of experience at high workload and overcrowding, Person-centered care increases safety, Communication, cooperation and trust within the team, Good recovery and reduced work-related stress ensure nursing. Conclusion: Nurses who apply person-centred and evidence-based practice in their teams, create good conditions for patient-safe work even in the event of overcrowding.

Background: The use of social media has increased markedly over the past few years and is a part of everyday life among children and adolescents. This may cause both positive and negative health outcome, that may also affect the students´ self-esteem. A good self-esteem can both improve health and school performance. The school nursework with health promotion and has the opportunity to support and encouragestudents to a healthy use of social media, which can strengthen self-esteem.

Aim: The aim of this study is to describe the school nurses´ experience of how social media affects students´ self-esteem.

Method: Data were collected through interviews with nine school nurses who had experience working with students in middle school and/or in high school. The data material was analyzed according to qualitative content analysiswith an inductive approach.

Result: The findings in the interviews fell into three categories: Positive influence on self-esteem, Negative influence on self-esteem and The significance of the nurses´ work. The theme that emerged in the study was a complex and challenging work.

Conclusion: There is a two-way complexity in the impact of social media on students´ self-esteem. The nurse´s mission to work in a health promotion way with the students´ health should be based on the students´ life world in collaboration with other professions. 

Background: When a person suffers from disease, sexuality can be affected through direct influence of the disease or as a side effect of, for example, medicines. Sexuality is a big part of health but a difficult topic to discuss. Method: A qualitative method was used, and data were collected through semi-structured interviews. The informants were nurses with a variation of working years from six months to 28 years. They discussed their experiences of talking about sexuality with patients. The interviews were recorded, transcribed and then a manifest qualitative content analysis was performed where main categories and subcategories created. Aim: To shed light on nurses´experiences of discussing sexuality with patients. Findings: Sexuality is seen as a complex subject to discuss, still it is considered an important matter to raise with patients. However, it is unclear to nurses whose responsibility it is to raise the subject. Individually conversations and having an open climate are components that promote the conversation. Culture, religion, language barriers and cognitive impairment is perceived as hindering, while there are divided opinions about the impact of gender and age. Conclusion: Sexuality is a taboo area but an important topic for nurses to elevate with patients, regardless of illness. More training in the subject is required to increase nurses' knowledge and self-confidence.

Background

Educational environments are considered important in strengthening students’ health status and knowledge, which are associated with good educational outcomes. It has been suggested to establish healthy universities based on a salutogenic approach – namely, health promotion. The aim of this study was to describe health-promoting resources and factors among first-semester students in higher education in healthcare and social work.

Methods

This cross-sectional study is based on a survey distributed among all students in seven healthcare and social work programmes at six universities in southern Sweden. The survey was carried out in 2018 using a self-reported, web-based questionnaire focussing on general health and well-being, lifestyle factors together with three validated instruments measuring health-promoting factors and processes: the Sense of Coherence (SOC) scale, Salutogenic Health Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ).

Results

Of 2283 students, 851 (37.3%) completed the survey, of whom 742 (87.1%) were women; 722 (84.8%) were enrolled on healthcare programmes, and 129 (15.2%) were enrolled on social work programmes. Most reported good general health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQ were, respectively, 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07). Well-being and several healthy lifestyles were related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressions showed that perceived well-being and no sleeping problems significantly predicted higher general health and higher SOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC.

Conclusions

Swedish students in higher education within the healthcare and social work sector report good general health and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), and in some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be of importance to both general health and health-promotive resources. This study contributes to knowledge about the health promotive characteristics of students in the healthcare and social work fields, which is of importance for planning universities with a salutogenic approach.

Background: Diabetes type 1 is a chronical disease. This incurable disease requires a lot of responsibility from the patient and can involve complications. Being affected by diabetes type 1 as a child means great challenges. In the first period, focus is on the development process towards independence. In person-centered care, it is important to highlight children's feelings and experiences to promote health throughout life.

Aim: To describe children's experiences of being affected by and living with diabetes type 1.

Method: A literature review that is a compilation of 11 qualitative studies. The participants in the literature study were 7–18 years old.

Findings: The results are presented based on two main categories, these were; During the first period and The daily life changes and six subcategories. The analysis resulted in the fact that being affected by a chronic disease means a major life change. The children experienced difficult feelings psychologically from receiving the diagnosis, especially in the first period after their diagnosis.

Conclusion: Factors that proved to be important for children with diabetes type 1 were that the children receive education and support in living with diabetes type 1, knowledge about the disease for independence and acceptance of the disease. The nurse's knowledge of communication and care is the basis for good care for children with diabetes type 1.

Introduction: Loneliness and social isolation among elderly are public health problems found in large parts of the world. Elderly people are expected to increase exponentially within the next few decades. Thus, the prevalence of lonely elderly people is also expected to increase. Social contact decreases with increasing age as a result of, among other factors, an increased burden of illness.

Aim: The purpose of this study was to investigate how internet use in the form of social connection can reduce loneliness and social isolation among older people.

Method: The study was based on a structured literature review. A total of 11 scientific articles have been included in the literature review. The articles were investigated through a thematic analysis with a deductive approach.

Results: The thematic analysis has resulted in four main themes; improved health status, distance-friendly communication, digital assets and resources, as well as participation – part of prevention. Additionally, seven sub-themes were identified; less loneliness and social isolation, maintaining social relationships, digital communication as a complement, easy-to-use devices and functions, lack of knowledge and experience, education and support, and the opportunity to influence own health and well-being.

Conclusion: Altogether, there is some evidence that indicates that internet use can positively affect the health status of older people and thus reduce loneliness and social isolation. However, there are barriers, obstacles, and factors that should be taken into consideration to enable the target group to take advantage of digital opportunities that are available and also facilitate their use.

In the media in the recent years, a negative picture of young Somali-Swedes has emerged, among other things linked to gang crime. It also affects the young Somali-Swedes who have not gone astray. As a contrast to those who ended up in crime, unemployment and exclusion, Somali-Swedish university students are highlighted in this study. The aim was to create an understanding of their identity formation and experience of meaningfulness and how it affects their well-being. The study was based on a social psychological perspective and has been analyzed with the help of the theories Sense of Coherence (SOC) and Social Identity Theory (SIT) as well as the concepts of ethnicity, in-betweenness and dual cultural belonging. The method was qualitative and qualitative semi-structured interviews were conducted with ten respondents. The respondents were university students of Somali-Swedish origin aged 21-24. The results showed that ethnicity, religious affiliation, family, friends and participation in civic society were important in the formation of identity. Religion, family and sense of purpose were described as important elements in creating meaning. In addition, it was common that adversity and negative treatment were turned into a source of motivation. The factors of success for well-being that were found were community, social support, faith, purposefulness and turning adversity into motivation. 

Violence in close relationships is a current and serious problem that affects both the victim and society negatively. This type of violence is often perpetrated by men against women. The number of calls to Sweden's women shelters has increased and there is also a supposed high number of women that doesn’t report their situation. The violence can be of both psychological and physical nature. Living in a destructive relationship can have drastic consequences for the victim's psychological well-being. Previous research shows that battered women find it difficult to get out of their relationship. This is a very important topic to study for these very reasons. A qualitative research method was conducted in this study. 10 women who have lived in a destructive relationship were interviewed. The result was analyzed with a thematic analysis. The purpose of the study was to investigate battered women’s experiences, in regards to how their self-image and self-esteem have changed. Theories regarding power and social support have also been used in order to analyze their social context. The results showed that the women experienced a negative self-image and self-esteem during and after the relationship. The power relationship was asymmetric, which also affected their self-image and self-esteem. Social support was perceived as important for rebuilding their self-image and self-esteem. 

Over a short period of time, crime in Sweden has increased and become a serious and publicized social problem. It is a complex process to leave a criminal environment that can often involve a number of different challenges. Cohesion and social ties formed in criminal environments can delay the process of leaving due to a strong identification with the group. Support and efforts by society are important for an individual to be able to change his identity as a criminal. The purpose of this qualitative study was to investigate subjective experiences of how stigmatization, labeling processes and support efforts affected the exit process in the development to a non-criminal identity. The starting point for studies was a social psychological approach that was studied through theories of social identity, stigmatization, labeling and exit process. Ten respondents from the dropout activity Criminal Revenge in Society (KRIS) participated in studies and interviews using semi-structured interviews. The results showed that KRIS's support efforts have a positive impact on the development of a non-criminal identity by contributing to a feeling of support and acceptance. The respondents who had not made a geographical separation experienced labeling and stigma in a larger sense. Stamping processes and stigmatization were found to have a negative impact on the development to a non-criminal identity in the exit process. The membership of KRIS has functioned as a protected environment from labeling and stigmatization that facilitates identity formation in the exit process.

Background: Midline laparotomy is the definitive treatment for sigmoid volvulus after initial colonoscopic detorsion. We successfully adopted another technique at our center on 6 patients, treating sigmoid volvulus by left iliac fossa mini-incision. Presentation of cases: We report our experience of six non-consecutive cases of sigmoid volvulus treated by left iliac fossa mini-incision. The cases were a 33 year old Egyptian female, a 21 year old Bangladeshi male, a 58 year old Qatari male, a 30 year old Ethiopian male, a 36 year old Ugandan male, and a 58 year old Indian male. The six cases are unique in the surgical technique employed in their management. This is possibly the second case series of left iliac fossa mini-incision for sigmoid volvulus in the Middle East and North Africa Region. Discussion: All patients underwent initial colonoscopic detorsion followed by sigmoidectomy and anastomosis. The procedure was successful in treating the volvulus in five patients with no complication or recurrence over a mean follow up of 8 months (range: 1–36 months). One patient required further laparotomy and resection with anastomosis due to incompletely removed sigmoid colon. Conclusions: Left iliac fossa mini-incision for sigmoid volvulus is safe, feasible, cosmetically appealing and with low morbidity.

Introduction: Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor that originates from the parafollicular C cells of the thyroid gland. MTC can be due to sporadic or hereditary causes due to gain of function germ line mutations in the RET proto-oncogene. MTC presenting as ocular symptoms due to choroidal mass is rare with bad prognosis. Presentation of case: A 38-year-old Sudanese male presented to Hamad General Hospital, complaining of sudden painless decrease of vision of the right eye of 3 weeks duration. After investigations using imaging methods, the patient was discovered to have metastatic MTC that presented as choroidal mass and metastasized to his lung, bone, brain, pituitary, liver and mediastinum. Discussion: In terms of investigations, serum levels of calcitonin have superior diagnostic accuracy. Our patient undertook diagnostic imaging including ultrasonography, fine needle aspiration and computerized tomography (CT) scan and/or MRI imaging. He undertook total thyroidectomy and left neck dissection followed by stereotactic radiosurgery for the right orbit and pituitary. He then received systemic anti-RET therapy (Selpercatinib). At 5 months follow up there was dramatic drop in CEA from 888 μg/L to 164 μg/L, and calcitonin from >585.2 pmol/L to 354 pmol/L. Conclusion: Choroidal metastasis as initial presentation of MTC is extremely rare and challenging to diagnose. Surgeons need a high index of suspicion when ocular symptoms accompany a neck mass or thyroid-related symptoms. MTC has a progressive course with involvement of blood vessels and neck lymph nodes. Choroidal metastasis of MTC is challenging to manage.

Introduction: Noninvasive follicular thyroid neoplasm with papillary-like nuclear (NIFTP) is a new entity. No previous study reported prospective cases, outlining using many quantitative and qualitative variables. Methods: Retrospective analysis of all (15) prospective NIFTP cases diagnosed between 2017 and 2021 at our institution. Statistical quantitative analysis outlined demographic, history, ultrasound, histopathology and treatment characteristics. Qualitative analysis examined the cases, with details provided on three cases to highlight the different possible presentations and configurations. Results: Mean age was 41.5 ± 9.91 years, 73.3% were females, and mean BMI was 29.49 ± 5.74 kg/m2. About 87% patients were symptomatic; 86.6% had neck swelling. Ultrasound (US) showed multiple nodules in 71.4% of cases. Fine-needle aspiration cytology (FNAC) showed that follicular lesion of undetermined significance (42.8%) was most common, followed by benign nodule (21.3%). Using the Bethesda System for Reporting Thyroid Cytopathology, 7 cases were category III, 3 category IV, 3 category II, and 1 category I. 60% of patients underwent total thyroidectomy. All cases were diagnosed postoperatively, 2 patients had additional papillary microcarcinoma. In 3 cases, the NIFTP site in the histopathology of resected specimen was different than the US-recommended site of the FNAC. Conclusion: We found discrepancies in the site and diagnosis of the preoperative US recommendation for the FNAC vs the postoperative histopathology of the specimen. These suggest that NIFTP might be incidentally and postoperatively diagnosed, irrespective of US or FNAC findings, hence its ‘true’ incidence might remain underestimated. As NIFTP cases higher BMI, Future research could predict preoperative diagnosis of NIFTP and explore associations with BMI. 

Introduction: Non-invasive follicular thyroid neoplasm with papillary-like features (NIFTP) is a recently characterized lesion with very low malignant potential. This has allowed for less aggressive management of this tumor subtype. Papillary thyroid carcinoma (PTC) has malignant potential and requires different considerations in management. Presentation of case: A 33-year-old woman presented to our Thyroid Surgery Clinic with a left neck swelling slowly enlarging over 4 years, and recent right-sided neck pain. Neck ultrasound and fine needle aspiration for cytology found bilateral thyroid nodules, labelled as ‘follicular lesion of undetermined significance’ (FLUS). Final pathology report after total thyroidectomy identified four distinct tumors: bilateral NIFTP lesions and bilateral papillary microcarcinomas. Discussion: Management of NIFTP comprises partial or total thyroidectomy without further intervention. Management of PTC is the same but with the possible addition of radioactive ablation due to the increased malignant potential. This is the first report of bilateral NIFTP lesions and bilateral papillary microcarcinomas co-occurring together in the same patient, so management was challenging. The decision was made to give the patient low dose radioactive iodine ablation and continue monitoring. Ultrasound of the neck follow up 6 months later showed no residual thyroid tissue or local recurrence. Conclusion: Although rare, NIFTP can co-occur with PTC. Bilateral NIFTP with bilateral PTC is extremely rare. Surgeons and pathologists need to be aware of this rare entity that can co-occur in both thyroid lobes. Total thyroidectomy is the definitive treatment. Post-surgery surveillance is important and follow up needs to be watchful for any recurrence or metastasis. © 2020 The Author(s)

Introduction: Giant/large gallstones have high risk of complications, and technical difficulties during surgery. This case series is the largest ever reported. Presentation of cases: Case 1: Female (44 years), with one year intermittent right upper quadrant colicky pain. Ultrasound: large gallstone (normal gallbladder). Elective laparoscopic cholecystectomy (LC): 6 × 4 × 3.3 cm gallstone. Case 2: Female (41 years), presented to emergency room with 3 days right upper quadrant pain/tenderness, vomiting, and positive murphy's sign. Ultrasound: large gallstone, calculus cholecystitis. Emergency LC: 4.5 × 3.1 × 3.5 cm gallstone. Case 3: Male (38 years), with history of gallstones and acute cholecystitis presented with intermittent right upper quadrant pain (2 months) and vomiting. Normal abdominal examination. Ultrasound: large gallstone. Elective LC: 4.1 × 4 × 3.6 cm gallstone. Conclusions: Gallstones >5 cm are very rare, with higher risk of complications. Gallbladder should be removed even if asymptomatic. Gallstones >3 cm have increased risk for gallbladder cancer, biliary enteric fistula and ileus. LC has challenges that include grasping the gallbladder wall, exposure of Calot's triangle, and retrieval of gallbladder out of the abdomen. LC appears to be procedure of choice and should be performed by an experienced surgeon, considering the possibility of conversion to open cholecystectomy in case of inability to expose the anatomy or intraoperative difficulties. © 2020 The Author(s)

Background: Breast cancer is the most common type of cancer that affects women worldwide. In Sweden approximately 20 women fall ill with breast cancer every day, and it's most common for women from the middle age upwards to be affected. Women who are treated for breast cancer may have a reduced quality of life, which increases suffering and reduces self-confidence. Aim: To describe women’s experience of living with breast cancer. Method: A qualitative and quantitative scientific literature review, which is based on 11 scientific articles. Findings: The findings of the selected articles in the literature review gave three main categories and five subcategories, which were compiled based on previous research on women’s experiences of living with breast cancer. Discussion: Women with breast cancer diagnosis had different experiences and changed emotions. Women felt insecure and lost control of their lives which was difficult to accept. The women were presented with many different existential thoughts and questions, which increased the need to be heard and seen. The family support and healthcare support was extremely necessary to be able to continue with the treatment and be able to manage the disease.Conclusion: The diagnosis of breast cancer is a worrying disease that affected the women and their existence. Deeper research would be crucial to what help those patients can get to manage their disease and its treatments more easily.

After serving a prison sentence, an individual may experience social and economic exclusion, which further increases the risk of recidivism. Although it is expected that such individuals should be able to support themselves after serving a prison sentence, the study highlights the fact that they may encounter several obstacles in their attempt to obtain legal employment. The research questions concerned the sources of information that contribute to the individual's perceived self-efficacy. The purpose of this study is to gain an understanding of how an individual’s perceived self-efficacy affects her/his opportunities to obtain legal employment after serving a prison sentence for drug offenses. A social psychological perspective was chosen, which was studied with the help of Albert Bandura's theory. This qualitative study is based on semi-structured interviews with eight individuals who served prison sentences for drug offenses and managed to find legal employment afterwards. The collected empirical data were processed by means of thematic analysis. The results showed that perceived self-efficacy had both a positive and a negative effect on the possibility of obtaining legal employment after serving a prison sentence. All respondents stated that the motivation derived from family, acquaintance or partner support was the key to a successful transition. Society's anti-support/ in the form of criminal record as well as lack of work experience and a driving license reduced the possibility of obtaining legal employment

Aims and Objectives: To explore the lived experience of young adults diagnosed with cancer and to increase our understanding of how to help them with their caring needs. Background: Being diagnosed with cancer is normally related with an existential crisis. This indicates that the individual cannot avoid thoughts of death, loneliness, guilt, and meaninglessness. In person-centered care, the caretaker should have a holistic view of the person. Professionals must meet the patient´s different needs to strengthen health and well-being for the diagnosed. This approach encourages the traditionally passive patient to become an active consumer who works in partnership with the healthcare provider. Design: For this study, a content analysis of narratives was conducted, targeting age groups of 20–29 to take part of young adults' experiences. Methods: Qualitative analysis of narratives and followed checklist (e.g., COREQ). Results: During the analyzing phase, two main themes emerged: Interactions with Professionals and Cancer Voyager. In the results, both positive and negative feelings regarding encounters and support received from the professionals were described, this affected the young adults' well-being and their ability to participate during treatments. The young adults felt as being on a journey with no control over which direction the road may take. Conclusion: Outcome of the result shows the importance of making the young adult, one in a team. When working in a person-centered way, patients gain control by owning their own responsibility during treatments. Implications for Nursing Practice: There is a need in nursing education to address existential matters, to make nursing students ready to be approach but such questions in their professional work. Also, we believe that the experienced nurse must be given means to feel confident to handle questions about existential matters. By developing skills in the area of e-Health, collaboration through support groups, and last but not least switching to patient-centered care, we can offer effective and evidence-based care tailored for this population. 

Background: In 2008, the WHO Surgical safety checklist was introduced to reduce mortality, improve patient safety and reduce risk of medical injuries in connection to surgery by means of a communication tool ensuring that checks and interventions are performed. Previous studies show a variation in compliance to the checklist, and that different items not are entirely performed. Aim: To describe the surgical team’s compliance to time-out and sign-out in the WHO Surgical safety checklist. Method: A quantitative cross-sectional study conducted as a non-participatory observational study. Data was collected during 24 observations at two hospitals using a structured observational protocol. Data was analysed using SPSS and reported through descriptive statistics, using pie and bar charts as well as tables and discussion. Result: Time-out was initiated in 95,8 % of the observations and completed in 4,2%. Sign-out was initiated in 100 % of the observations and 29,2 % were completed. No member of the surgical team was responsible for performing the safety checks. In 19 of 22 observations, all three parts of the checklist were signed in Orbit before the sign-out was completed. Conclusion: Both time-out and sign-out are carried out to a great extent, however, compliance with all items of the checklist varies. The study shows a discrepancy between the actual use of the checklist and the administratively reported use of the checklist.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women in their reproductive age. It is characterized by hyperandrogenism, menstrual cycle irregularities and polycystic ovarian morphology. PCOS can cause infertility and is usually associated with a number of metabolic dysfunctions such as insulin resistance and aberrant fat metabolism in major metabolic organs such as skeletal muscles. These dysfunctions increase the risk for developing diabetes and cardiovascular diseases. The exact etiology of PCOS is still unknow, but a number of genetic, epigenetic and environmental factors have been identified. In order to understand the links between PCOS and its related metabolic dysfunction, and to unravel its complex pathophysiology, extensive research is constantly done. In this study, 84 differentially expressed genes have been identified in skeletal muscles of women with PCOS (n=13) compared to controls (n=12) by array-based RNA profiling. Using gene set enrichment analysis, it is demonstrated that these genes are components of metabolic pathways that are related to fat metabolism and transport. In vitro verification of differential gene expression of 5 genes of interest in skeletal muscles from prenatally androgenized mice was done using RT-PCR, and shows statistically significant differential expression of 2 out of 5 genes. This study confirms the role of fat metabolism in PCOS pathogenesis and uses knowledge learned from obesity and diabetes to suggest directions for further research, which is warranted to develop new treatments that will; hopefully, reduce the devastating effects of PCOS on the lives of women and the economies of communities worldwide.

Background: The Covid-19 pandemic created a change in the work of organizations, as general advice was that employers should enable teleworking. This generated an intensification in the use of flexible work arrangements. FWA was previously not a priority approach in organizations, but it quickly became a necessity to be able to continue running businesses. FWA is made possible with the help of digital aids, and during the pandemic, the development of technology was also accelerated. Digital technology allows individuals to perform their work in alternative locations and at different times, this relationship is not regulated to the same extent as when organizations only work in the office. The increased use of FWA has had a positive effect on organizations, but it has also entailed new challenges.

Purpose: The thesis aims to investigate and thereby increase the understanding of how employees in organizations experienced and worked with flexible work arrangements before, during and after the pandemic.

Method: The study is based on a qualitative method with semi-structured interviews, through the interviews the authors have gained empiricism. This also collected secondary data from various sources such as scientific articles.

Empirical and Conclusion: The respondents' answers to the interview questions are presented in the empirical work, where the authors highlight different quotes and summarize different points of view that are highlighted during the interviews. The conclusion highlights how crucial digital technology is for working with FWA, as well as what challenges and opportunities there are in working with FWA and how it can play out in the future.

Introduction: Appendiceal mucinous neoplasm is a rare type of appendiceal tumors which can present in a variety of symptoms and is difficult to diagnose. Preoperative diagnosis depends mainly on diagnostic imaging such as ultrasonography and computerized tomography (CT) scan. This uncommon case report discusses an appendiceal mucinous neoplasm mimicking a left adnexal mass on presentation, physical examination and diagnostic imaging findings. Presentation of case: This is a 61-year-old female found to have a large left adnexal mass during follow up ultrasonography. The patient refused further imaging, and during laparotomy, she was found to have an appendicular mucocele with normal left and right ovaries. Discussion: Appendectomy was done and the final pathology came as appendiceal mucinous neoplasm. Her post-operative course and 3 years follow up were uneventful. Conclusions: The equivocal signs and symptoms along with the anatomical position of appendiceal mucocele makes it difficult to diagnose and can mimic other types of tumors. Therefore, it should be considered in the deferential diagnosis of lower abdominal and pelvic masses. 

Background: Appendicular neoplasms are rare, most commonly as carcinoids followed by appendicular mucinous neoplasms (AMN). To date, there remains controversy regarding the best treatment of AMN and factors affecting its prognosis. Method: Retrospective chart review of patients operated for appendicular pathology (January 2011–December 2018, follow up to December 2020) at our institution. For all AMN patients, data included pre-operative clinical presentation, and operative/post-operative findings. Results: 12454 patients underwent appendectomy, of whom 50 (0.4%) had AMN histopathologically (mean age = 47.2). Most patients had laparoscopic appendectomy as primary surgery. Low grade AMN was the most common subtype (n = 41, 82%), and pseudomyxoma peritonei (PMP) was found in 8 (16%) patients. Based on histopathology and margin involvement, the 50 patients were categorized into 3 prognostic categories of recurrence risk (no risk, 24 patients; low risk, 8; high recurrence risk, 18 patients). Disease-free survival (DFS) was lowest for high recurrence risk group (P < 0.001). Eleven (22%) patients had AMN involving resection margin, of whom 3 had no completion surgery and had no recurrence. Higher tumor markers were associated with lower DFS, however it was not statistically significant. Conclusion: AMNs are rare but serious due to the risk of PMP. Laparoscopic approach for AMN may be feasible. Prognostic categories were significantly inversely correlated with recurrence risk; hence useful in predicting prognosis. Contrary to previous proposals, AMNs with acellular mucin at margin or local acellular mucin spillage may not require secondary surgery, especially if the patient is in low recurrence risk group. Tumor markers may predict risk of recurrence. 

Background – Hip fracture is a global problem and the incidence increases with increasing age. The largest risk factor for hip injury is fallings combined with osteroporosis. Patients with hip fractures require a lot of care resources and have a long recovery process.Aim – Older persons experience of the aftermath within healthcare after a hip fracture.Method – This study was conducted as a literature review based on scientific articles with qualitative and quantitative design.Results/ Conclusion – Patients´ experienced impaired independence and need of help to cope with normal everyday activities. There are several factors that affect the patient's recovery process, including depression, motivation and fear of falling again. Patients need support from both healthcare professionals and relatives in order to return to an independent life. Four main findings have been identified in the literature study; the first finding is that the patient has a slow recovery, the second is deficiencies in care, the third is the patients' psychological impact on the recovery process and the fourth is reduced independence and communication.

Background: Within the surgical specialist care, both elective, acute, and palliative patients are cared for. There is research that describes nurses' experiences of caring for these patients separately. However, there is limited research on nurses' experiences of caring for these groups of patients simultaneously.

Aim: Describe nurses' experiences of caring for elective, acute and palliative patients simultaneously in a surgical ward.

Method: Qualitative interview study with seven nurses. The data was analyzed through qualitativecontent analysis.

Findings: The results revealed two main categories, with three subcategories belonging to each main category. The main category: Patient variations create stimulation and set requirements gives a description of the patients' varied nursing needs, the importance of adaptation and job satisfaction. The main category: The impact of the work environment on care and health, describes the pressured work environment, the need for prioritization and the feeling of inadequacy.

Conclusion: Caring for acute, elective and palliative patients simultaneously is described as varied and instructive. At the same time, it requires adaptation. Furthermore, the high workload creates the need to prioritize, which leads to the suffering of certain parts of the care and patient groups. The results also suggest that it’s particularly difficult to care for palliative patients in a curative ward.

Background: Violence against women in close relationships is increasing sharply in society. The consequences of being subjected to violence are multiple and affect both physical and mental stresses that affect women's life situation. The emergency department is the main care unit that abused women seek out. The work structure makes it difficult for the nurse to pay attention to abused women. Nurses have a responsibility to detect signs of violence early.

Aim: To shed light on factors that affect nurses' meeting with the abused women in close relationships at the emergency department.

Method: The study is literature-based on qualitative research consisting of 10 scientific articles.

Findings: Two main themes were presented in the results, which were organizational challenges and relational challenges. Emergency nurses experienced a lack of time and routines to be able to meet and offer good care to the abused women. There was also a lack of knowledge among nurses in caring for these women. Nurses also experienced difficulties in creating a good care relationship with women exposed to violence, which hindered the implementation of person-centred work.

Conclusion: Nurses need more training and clearer guidelines and routines in the emergency department in order to be able to offer good and safe care for women exposed to violence. The employer also needs to reduce the workload for nurses as they find their work environment stressful and exhausting.

Background: Foot drop is defined as a weakness in the ankle and foot dorsiflexors. A disruption of the neural pathway starting from the motor prefrontal cortex and ending in the peroneal nerve can lead to foot drop. Foot drop due to lower motor neuron injury is well documented. However, foot drop due to a central cause of cervical disc prolapse is very rare. Case presentation: A 55-year-old male presenting with neck pain, right and left arms radicular pain and numbness, and unilateral right foot drop following cervical disc prolapse. The patient presented with upper motor neuron lesion signs. MRI showed cervical disc prolapse at two levels, confirming central cause of foot drop. The patient underwent anterior cervical decompression and fusion surgery. Discussion: Following decompression and fusion of involved cervical spine disc pathology, the patient had complete recovery of his right foot drop. Conclusions: Central causes, although rare, should be considered in the differential diagnosis of foot drop. Causes could be due to the compression effect of the cortico-spinal tract of the cervical spinal cord. Satisfactory results can be achieved upon correcting the causative lesion. 

Introduction: The lockdown imposed by the COVID-19 pandemic rendered teledentistry (TD) necessary to maintain the continuity of oral health services and avoid missing emergency dental conditions, while minimizing face-to-face visits. Our objective was to evaluate the ability of a newly introduced triage-based TD service to deliver its goals, by evaluating its processes and outcomes and assessing the demand for TD. Methods: This cross-sectional report assessed the triage processes and outcomes (triage category, referral to emergency/dental facility undertaken, remote medications prescribed, and procedures performed at the point of referral); and evaluated the demand for the newly introduced TD service during 5 months of the first wave of the pandemic. Results: Of 850 calls, about 70.6% of the samples were managed remotely; 29.4% were categorized as emergency/urgent and referred to the emergency/dental facility. Compared with other complaints, orofacial dental pain was the most common reason for the calls (41.6%, p < 0.0001). About 14.71% of callers received prescription for medications remotely. The most demanded disciplines were general dentistry, orthodontics, and oral surgery, respectively (p < 0.0001). Of those referred to a dental facility, 31.84% required no clinical intervention, 28.7% received orthodontic appliance repair, and 14.3% and 11.2% had urgent dental extractions or root canal treatments. Demand on the service fluctuated through various distinct stages of the lockdown. Conclusions: There has been continuous demand for the newly introduced TD service throughout the period of the current report despite the fluctuations, with most complaints managed remotely. TD was effective and suitable for triage, service delivery, and care during the pandemic.

Objectives: To assess the reliability of synchronous audioconferencing teledentistry (TD) in making tentative diagnosis compared to definitive clinical face-to-face (CFTF) diagnosis; and whether agreement was influenced by dentist's experience, caller-patient relationship, and time of call. Methods: All patients calling the TD hotline during COVID-19 pandemic, triaged as emergency/ urgent and referred for CFTF care were included (N=191). Hotline dentists triaged the calls, made tentative audio-dentistry (AD) diagnosis, while dentists at point of referral made the definitive CFTF diagnosis. Cohen's weighted kappa (κ) assessed the extent of agreement between AD vs CFTF diagnosis. Results: There was significantly very good pair-wise agreement (κ = 0.853, P < 0.0001) between AD and CFTF diagnosis. AD diagnosis of pulpitis and periodontitis exhibited the most frequent disagreements. Tele-dentists with ≥ 20 years’ experience exhibited the highest level of agreement (κ =0.872, P < 0.0001). There was perfect agreement when mothers mediated the call (κ = 1, P < 0.0001), and very good agreement for calls received between 7 am-2 pm (κ = 0.880, P < 0.0001) compared to calls received between 2-10 pm (κ = 0.793, P < 0.0001). Conclusions: Remote tentative diagnosis using AD is safe and reliable. Reliability was generally very good but varied by dentist's experience, caller-patient relationship, and time of call. Clinical significance: The findings suggest that using AD in the home environment is safe and reliable, deploying providers with variable years of experience. The findings have generalizability potential to a variety of similar circumstances, healthcare settings and epi/pandemic situations. 

Background: Care at the end of life aims to promote well-being, relieve suffering and to keep up the quality of life. Family members and their loved ones must be supported because of a holistic view where physical, mental, social, and spiritual needs are provided with the help of a multi-professional care team. Family members can contribute with knowledge that is important in care, at the same time they may need support from healthcare professionals to be able to support their loved ones. Factors that affect the quality of palliative care are the healthcare professionals' beliefs, attitudes, and experiences. Objectives: To highlight the relatives’ experience of palliative care. Method: The study was conducted as a qualitative literature review based on 15 scientific articles. The articles were obtained from the databases CINAHL, PubMed and Medline. Results: Results from this study show that family members experience fear, stress, and inadequacy for their loved ones in the final stages of life. Family members emphasize that participation in the patient's care, various support and communication with nurses make it easier for them to accept the situation. Conclusion: Family members may feel limited in their daily lives due to change in the family situation because of the long-term illness of their loved one. To handle the new situation that the family members are not used to, it is important that the healthcare professionals include them in the meeting, which is called a breakpoint conversation. Nurses require evidence-based training on families' conference communication and collaboration skills to be able to support family members.

High-throughput genotyping which results in identification and mapping a vast number of single nucleotide polymorphisms help improving the performance of genome-wide association studies and moreover, connecting DNA variants to phenotypes of target. Many genotyping protocols are depended on polymerase chain reaction (PCR) amplification of genes or markers, since PCR is an easy, fast, sensitive, and cost effective technique. The main aim of this study was to set up a method for identifying the important genotypes of stress and sense of coherence. Since recent studies on human have shown that, oxytocin secretion decrease in response to stress, this study investigated those likely associations among single-nucleotide polymorphisms (SNPs) in the rs53576 and rs225498 of oxytocin receptor (OXTR) gene with stress. Moreover, SNPs in the 5-HTTLPR gene were examined as polymorphisms in 5' region of serotonin-transporter (5-HT) gene (17q11.2, 5-HTTLPR) causing changes in the transcription of 5-HT gene, which are apparently correlated with personality traits such as, depression, anxiety, and stress in human. In this experiment the extracted DNA from the blood samples were used to analyze two polymorphisms by using PCR and Fragment Analyzer techniques. To set up the PCR experiment different reagents such as dNTPs amount and also the annealing temperature were evaluated to get the optimal results. Based on the obtained results from the fragment analysis and data analysis the set up method was work meanwhile hypotheses was rejected. There were no significant differences between these two polymorphism sites of OXTR and 5HTTLPT from serotonin receptor gene with stress and sense of coherence (SOC). Therefore the limitation of samples selection can be considered as one of the major reasons for rejecting the hypothesis, so in next experiments the more number of participants with more specific category (for example, age, sex, different region) can be used.

Bakgrund: Långvarig smärta är ett komplext fenomen vilket är en unik och individuell upplevelse hos varje människa. Smärtproblematik och lidande har ofta ett samband, såväl fysiskt som psykiskt. Sjuksköterskan har en roll i att försöka eliminera eller lindra patientens lidande vilket innefattar smärtan som många gånger är grundorsaken till lidandet. Beakta patientens livsvärld, främja hälsa och välbefinnande samt att skapa en vårdrelation är områden vilka innefattar sjuksköterskans roll. Syfte: Syftet är att beskriva sjuksköterskors upplevelser av att vårda och lindra lidande hos patienter med långvarig smärta. Metod: I studien tillämpades en kvalitativ narrativ intervjumetod. Deltagarna inhämtades via snöbollstekniken. Elva sjuksköterskor delgav upplevelser i form av berättelser som skickades via e-post och de insamlade berättelserna analyserades med en kvalitativ innehållsanalys på en manifest nivå. Resultat: Ur analysen av datamaterialet framkom tre övergripande huvudkategorier vilka var; Att skapa en vårdande relation, Smärtlindring avgörande för meningsfullhet i arbetet samt Teamsamverkan både som möjligheter och hinder. Huvudkategorier bildades utifrån åtta subkategorier. Konklusion: Studien har synliggjort att sjuksköterskor upplever stödjande och djupa samtal bidragande till att lindra lidande. Smärtbehandlingens effekter avgör huruvida sjuksköterskan känner sig meningsfull och upplever sin roll. Teamsamverkan kan utgöra såväl möjligheter som hinder i vården och påverkar både patienten och sjuksköterskan.

The industry is nowadays going through a transformation in networking technologies which leads to what it is called Industry 4.0. This stage of the industry is arriving from the hand of the internet of things. Having connected all the elements within a factory allows to control and keep track of them telematically. Virtual commissioning is in charge of designing, testing and debugging the system before it is even built. This project tries to approach virtual reality to virtual commissioning and create the virtual model of a human in these simulated environments. Technology allows introducing human interaction for many purposes such as operator training. To do this project properly a methodology will be followed for the design and creation. Once the background, frame of reference and literature review are established, the development can start. The development of the project has taken place alongside Simumatik Open Emulation Platform, consisting of creating the body of a person, as simple as possible, following ergonomics, into this platform for commissioning purposes. The model will be able to interact with the virtual environment like robots, boxes, and sensors. To sum up, the complexity of the model will be limited to the inputs coming from the head and the hands. There exist infinite solutions for which position should be the rest of the body, therefore, this project aims to fix some variables to find valid solutions. Finally, the project achieved building a digital human model in which the main goal was building the arms that are estimated. The model is capable of interact with Simumatik´s environment that has been created specifically to show the functionalities of this project, being detected for sensors and robots of the system.

Background: Men's violence against women is seen as a serious and widespread problem around the world. Both psychological and physical violence can affect a woman's life situation. In addition to injuries, violence can cause suicidal thoughts, anxiety and depression. Nurses play a significant role in meeting women exposed to violence. Therefore, the degree authors believes that the nurse should be an expert in her profession when the subject of violence is pointed out in order to be able to provide the right support in the best possible way. Method: A literature study based on nine articles with a qualitative approach. Aim: Women's experiences of violence in close relationships from a global perspective. Findings: From the datamaterial five area were identified; Feelings of shame and guilt in an endangered life, Remain due to financial dependence, Physical and mental illness due to violence during the relationship, Being seen and heard by healthcare professionals and The fear of a new relationship. Conclusion: Several women experienced the fear of staying in a violent relationship. The mental and physical violence had negative consequences, but also a great deal of suffering for the women. Care, support and the right care were considered important in the care for the nurse to be able to help women exposed to violence

Background: The word caesarean section is Latin and means that the baby is delivered through the uterine wall with an incision far down on the abdomen. Nearly 200,000 babies are born each year in Sweden and of these, 17.3 per cent are delivered by caesarean section. Previous literature describes the importance of clear and well-established communication in the surgical team responsible for the patient, so that patient safety standards are met, and safe care can be provided in an emergency caesarean section. Aim of the study: To describe the operating team's experiences of communication during an emergency caesarean section. Methodology: A qualitative study where data were collected via 14 questionnaires designed according to the critical incident technique and data were analyzed according to a qualitative content analysis and reported by table, citation and running text. Results: Communication is important in acute caesarean sections, though depending on who is part of the surgical team and what experience they have, the quality of the communication can vary. Elements, besides professional experience, for a well-functioning communication were time, attitude, and clarity. Conclusion: The result shows that the communication patterns varies depending on whom is a part of the team, where routines and professional experience form the communication. The operating team needs to work actively with a functioning communication as it is important for a positive team work, a good atmosphere in the ward and safe care.

Purpose:

The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD).

The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities.

Methods:

We retrieved the records of all patients (n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence.

Results:

A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases.

The overall mean hospital stay was 8.45 days (range 2–21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample.

Conclusion:

Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.

Objective: No study compared the grooved stent to the widely used standard smooth (nongrooved) stent in humans. We compared stone clearance, complications, and patient tolerance of the grooved stent vs standard JJ stent. Patients and Methods: Single-blinded randomised trial among patients planned for pre-extracorporeal shockwave lithotripsy (ESWL) stenting. Adult patients with unilateral ureteric/ renal stones planned for ESWL were randomly assigned to receive (Percuflex) smooth ureteric stent or (Visiostar) grooved lithotripsy stent and blinded to the stent type. We collected and compared the baseline data and outcomes (stone-free rate, complications, and stent-related symptoms) of both patient groups. Results: A total of 96 adults were included (48 per arm). There were no significant differences between the groups at baseline in terms of demographics, body mass index, comorbidities, renal function, number of ESWL sessions, and stone characteristics, including pre-ESWL stone volume (mean [SD] smooth 310.2 [301.6] vs grooved 270.7 [278.6] mm3, P = 0.5). Stone clearance was statistically insignificant between the groups, although clinically relevant (smooth stent 70.8% vs grooved stent 81.2%, P = 0.2). Grooved-stent patients reported comparable urinary symptoms score (P = 0.05) and operative complications (P = 0.6), but significantly more urinary tract infections (UTIs) not requiring hospitalisation (P = 0.003). Conclusions: Although statistically insignificant, the grooved stent exhibited higher stone clearance compared to the smooth stent, with similar complication rates excpet that patients with grooved stents reported more UTIs. A re-visit to the size of the outer diameter of the grooved stent could enhance its stone clearance properties, and further development of its coating material could lead to better patient satisfaction.

Introduction: Overweight and obesity are today a growing public health challenge and are increasing in most age groups globally. They are a contributing cause of public health diseases such as cardiovascular disease, type 2 diabetes and certain types of cancer. Nurses often have the task of motivating patients to a healthier lifestyle in order to achieve both reduced weight and increased well-being. However, in general, nurses in care lack sufficient knowledge to be able to help patients. Aim: A structured literature review aimed to explore the role of the nurse had in health promotion and prevention intervention studies conducted in health care, where the intention was to help patients with overweight or obesity achieve weight loss. Method: The literature selection process was based on the PRISMA model to ensure a structured approach. Ten original scientific articles, both qualitative and quantitative, were retrieved from the databases PubMed and CINAHL. The checklists used to review the quality of the articles were the Critical Appraisal Skills Program. In the data analysis, appropriate themes were created based on the ten selected articles. Results: Four themes are reported in the results which are: Methods and tools to enable individual adaptation of the meeting between nurse and patient, Meeting structure that offers the patient continuous support, Digital tools have been shown effective in terms of follow-up and evaluation during a behavior change process and Many expectations of the nurse who do not always hold the right knowledge tool. Conclusion: The results showed that person-centered care, empowerment and FaR (physical activity) prescriptions seem to benefit the weight loss results. Nurses need guidance on how to best treat patients with overweight and obesity, and then building trust between nurse and patient seems to be essential for weight loss efforts to give good results.