Musculoskeletal disorders in Norway: trends in health care utilization and patient pathways: a nationwide register study.

OBJECTIVE: Describe trends in health care utilization, demographic characteristics and patient pathways among patients with musculoskeletal disorders (MSD) in Norway. DESIGN: Register-based cohort study. SETTINGS: Data were obtained from two Norwegian National registries; the Norwegian Control and Payment of Health Reimbursements Database (KUHR) and the Norwegian Patient Registry (NPR). SUBJECTS: Patients with MSD according to ICPC-2 and ICD-10 during 2014-2017. MAIN OUTCOME MEASURES: Patient pathways from the first contact and the following two years, described in a Sankey Diagram for all MSD patients and three common diagnoses: spine pain, osteoarthritis (OA) and fibromyalgia (FM). RESULT: About 26% of the Norwegian population consulted PHC annually while 7% were treated in SHC. Mean age was 47 and 53 years in PHC and SHC, respectively. The proportion of women increased by age. Spine pain was the most common diagnosis; 33% and 22% in PHC and SHC, respectively. Over 90% visited a GP first, 50% of them were treated by PT and/or in SHC during follow-up. Patients visiting the PT first were less likely to be treated in SHC. OA patients were most likely to be treated by more than one health care professional (>70%). CONCLUSION: One third of the Norwegian population consulted health care services due to MSD annually between 2014-2017. GP was the most consulted health care professional. Among MSD patients with long-term use of health care services, 50% were treated by a PT and/or in SHC in addition to a GP.

Adolescent Cancer Survivors and Their Parents' Experiences With the Transition Off Treatment to Survivorship: A Qualitative Interview Study.

Background: Transitioning from active cancer treatment to survivorship represents a vulnerable yet underresearched phase for adolescents and their families. Knowledge of their support needs, the challenges they experience, and how they manage them are useful to inform tailored follow-up care. Thus, we aimed to explore their transition experiences. Method: We interviewed 15 adolescents (12-19 years) who had transitioned off of treatment 1 to 47 months prior at Oslo University Hospital's Department of Paediatric Haematology and Oncology and their biological parents (n = 16). The interviews were analyzed using inductive, reflexive thematic analysis inspired by Braun and Clarke. NVivo-12 was used for data management. Results: Four main themes were identified: (a) consequences of cancer beyond transition, (b) transition back to normalcy, (c) survivorship competence, and (d) changes in roles and relationships. The families described happiness and relief but also said that the lingering effects of cancer treatment had a profound impact on day-to-day living. The adolescents expressed closeness with and dependency on their parents, and they perceived family and friends as essential for social readjustment. Discussion: Although adolescent survivors and their parents described a wide variety of strategies for returning to "normalcy," their perspectives also illustrate ongoing psychosocial and educational support needs that changed over time. Our findings indicate a need for improved preparation for and support through the transition. Nurses are well positioned to provide continuous and structured transition support tailored to the needs of the individual survivors and their families.

Prepared for survivorship? Multidisciplinary healthcare professionals' experiences with adolescents' transition off cancer treatment: A focus group study.

PURPOSE: Research indicates that re-entering everyday life after completed cancer treatment can be challenging for adolescents, and knowledge about how healthcare professionals prepare them is scarce. This study explored (a) healthcare professionals' experiences with adolescents with cancer transitioning off active cancer treatment; and (b) what healthcare professionals' do to prepare adolescents and their families for this transition; and c) their ideas to improve current practice. METHODS: We conducted 8 focus-group interviews with 56 multidisciplinary healthcare professionals working in paediatric oncology settings across Norway. The sample consisted of nurses, physicians, social workers, psychologists, physiotherapists, a nutritionist, a dentist, a teacher and a music therapist. Inductive thematic analyses was used. RESULTS: We identified three main themes: (a) the multifaceted nature of the end of the treatment phase; (b) navigating challenges in providing early survivorship care; and (c) healthcare professionals' views and wishes regarding their role in transition care. The healthcare professionals conveyed uncertainty regarding how and when to talk about survivorship during treatment. Post-treatment, healthcare professionals' challenges included time restrictions, meeting the families' individual information needs and providing tailored psychosocial care. Suggestions for improvements included checklists, defined roles and dedicated transition consultations. CONCLUSIONS: Healthcare professionals were aware of the challenges families face during transition, and felt many were not addressed adequately. Although they had similar concrete suggestions for improvements, system barriers and lack of time and focus on survivorship were seen to hamper implementation. Implementing a standardized transition programme with increased nurse involvement could potentially improve the transition phase for everyone involved.

Going through laparoscopic liver resection in patients with colorectal liver metastases-A qualitative study.

AIM: Colorectal cancer is one of the most common cancers worldwide. Surgery is seen as the only curative treatment. There are two approaches to liver resection: open or laparoscopic surgery. Knowledge from the patient perspective can illuminate how it is experienced going through laparoscopic surgery. We aimed to study patient perspectives of the experience of undergoing laparoscopic liver resection surgery in patients with colorectal liver metastases. DESIGN: This study has a qualitative research design. Nine patients participated in semi-structured interviews 6 months after surgery. Data were analysed according to Kvale's five-step analysis method. RESULTS: Though the patients were satisfied with the laparoscopic approach, they expressed unmet informational needs about the new technique, time after discharge and surgery outcomes related to having metastatic cancer. Healthcare professionals should provide information and support that recognizes the needs of patients with cancer undergoing laparoscopic liver resection surgery.

Biphasic mechanosensitivity of T cell receptor-mediated spreading of lymphocytes.

Mechanosensing by T cells through the T cell receptor (TCR) is at the heart of immune recognition. While the mechanobiology of the TCR at the molecular level is increasingly well documented, its link to cell-scale response is poorly understood. Here we explore T cell spreading response as a function of substrate rigidity and show that remarkably, depending on the surface receptors stimulated, the cellular response may be either biphasic or monotonous. When adhering solely via the TCR complex, T cells respond to environmental stiffness in an unusual fashion, attaining maximal spreading on an optimal substrate stiffness comparable to that of professional antigen-presenting cells. However, in the presence of additional ligands for the integrin LFA-1, this biphasic response is abrogated and the cell spreading increases monotonously with stiffness up to a saturation value. This ligand-specific mechanosensing is effected through an actin-polymerization-dependent mechanism. We construct a mesoscale semianalytical model based on force-dependent bond rupture and show that cell-scale biphasic or monotonous behavior emerges from molecular parameters. As the substrate stiffness is increased, there is a competition between increasing effective stiffness of the bonds, which leads to increased cell spreading and increasing bond breakage, which leads to decreased spreading. We hypothesize that the link between actin and the receptors (TCR or LFA-1), rather than the ligand/receptor linkage, is the site of this mechanosensing.

Association between general self-efficacy, social support, cancer-related stress and physical health-related quality of life: a path model study in patients with neuroendocrine tumors.

BACKGROUND: A diagnosis of neuroendocrine tumors (NET) provides challenges to patients and clinicians due to physical side effects of and mental response to treatment resulting in increased perceived stress. General self-efficacy, social support and cancer-related stress are key factors in coping. Thus, knowledge of these factors may be of value in improving health-related quality of life (HRQoL). The aim of the study was to examine the relationships between general self-efficacy, social support, cancer-related stress and HRQoL in patients with NET using a path model. METHODS: 196 Norwegian patients living with NET were enrolled in this cross-sectional study. Inclusion criteria were: patients with tumors restricted to the GI tract; ability to speak and write Norwegian; over 18 years of age; undergoing medical treatment for NET. Measures used in the study were background characteristics, Health-related Quality of Life (SF-36), the Impact of Event Scale (IES), General Self-efficacy and the Interpersonal Support Evaluation List (ISEL). Relationships between sociodemographic variables, general self-efficacy, social support, cancer-related stress and mental and physical components scores were tested by path analysis with AMOS 22 using maximum standard likelihood estimation. RESULTS: The sample consisted of 50.5 % women and the average age was 65 years and the median disease duration was 4 years. Sociodemographic variables of gender, education and whether the patient lived alone or with someone were unrelated (directly or indirectly) to HRQoL. Age was directly and negatively correlated with physical HRQoL, general self-efficacy and social support in a well-fitting path model. General self-efficacy modified the negative effects of age on physical HRQoL. Physical and mental HRQoL were not associated with cancer-related stress. Higher social support was related to less stress. CONCLUSION: Intervening to improve general self-efficacy and social support for patients with NET may improve their HRQoL.

Control of natural transformation in salivarius Streptococci through specific degradation of σX by the MecA-ClpCP protease complex.

Competence for natural DNA transformation is a tightly controlled developmental process in streptococci. In mutans and salivarius species, the abundance of the central competence regulator σ(X) is regulated at two levels: transcriptional, by the ComRS signaling system via the σ(X)/ComX/SigX-inducing peptide (XIP), and posttranscriptional, by the adaptor protein MecA and its associated Clp ATPase, ClpC. In this study, we further investigated the mechanism and function of the MecA-ClpC control system in the salivarius species Streptococcus thermophilus. Using in vitro approaches, we showed that MecA specifically interacts with both σ(X) and ClpC, suggesting the formation of a ternary σ(X)-MecA-ClpC complex. Moreover, we demonstrated that MecA ultimately targets σ(X) for its degradation by the ClpCP protease in an ATP-dependent manner. We also identify a short sequence (18 amino acids) in the N-terminal domain of σ(X) as essential for the interaction with MecA and subsequent σ(X) degradation. Finally, increased transformability of a MecA-deficient strain in the presence of subinducing XIP concentrations suggests that the MecA-ClpCP proteolytic complex acts as an additional locking device to prevent competence under inappropriate conditions. A model of the interplay between ComRS and MecA-ClpCP in the control of σ(X) activity is proposed.

Improvement in Stress, General Self-Efficacy, and Health Related Quality of Life following Patient Education for Patients with Neuroendocrine Tumors: A Pilot Study.

The purpose of the study was to evaluate changes in general self-efficacy, health related quality of life (HRQoL), and stress among patients with neuroendocrine tumors (NET) following a multidisciplinary educational intervention. Forty-one patients were enrolled in this exploratory pilot study. A total of 37 patients completed the full 26-week intervention based on the principles of self-efficacy. General self-efficacy was measured by the General Self-Efficacy Scale, HRQoL was measured with the SF-36, and stress was measured with the Impact of Event Scale. Mixed effect models were used to evaluate changes in general self-efficacy, mental and physical components of HRQoL, and stress adjusting for demographic and clinical variables. Results showed significant improvements in patients' general self-efficacy (ß = 0.71; P < 0.05), physical component scores of HRQoL (ß = 3.09; P < 0.01), and stress (ß = -2.10, P = 0.008). Findings suggest that patients with NET have the capacity to improve their ability to cope with their disease, problem-solve, improve their physical status, and reduce their stress following an educational intervention based on the principles of self-efficacy. These preliminary data provide a basis for future randomized controlled trials to test interventions to improve HRQoL for patients with NET.

Patient experiences following liver transplantation due to liver metastases from colorectal cancer.

PURPOSE: Colorectal cancer is the second leading cause of cancer-related death in the western world. Little is known about patients undergoing liver transplantation (Ltx) due to liver metastases from colorectal cancer. This study aimed to explore individual patients' experiences having undergone this procedure as a treatment for liver metastases secondary to colorectal cancer. METHOD: Exploratory research methodology was used, whereby in-depth interviews with 9 patients were carried out 6 months after they had undergone liver transplantation. Median patient age was 56 years at the time of the surgery. The interviews were transcribed verbatim and qualitative content analysis was applied to the data. RESULTS: Three main themes emerged during the analysis phase. The first theme explored the informants' positive feelings about receiving experimental treatment that might prolong their life. The second theme related to the challenge presented by their feelings oscillating frequently between hope and despair. The final theme considered the strong wishes expressed by patients to live their lives as normally as possible thereafter. This last theme related in part to the patients' physical condition, side effects from medication and any relationships with loved ones. CONCLUSION: These findings offer new insight into the situation of patients undergoing liver transplantation due to liver metastases from colorectal cancer. In spite of the risks and side effects of major surgery and the transplant medication all participants expressed an overall view that having undergone liver transplantation was a very positive experience.

Quality of life following liver transplantation in patients with liver metastases from colorectal carcinoma.

PURPOSE: To study quality of life (QoL) in patients with liver metastases from colorectal carcinoma (CRC) following liver transplantation (Ltx). METHODS: Ten patients participated in a prospective explorative pilot study. Inclusion criteria were nonresectable liver-only metastases determined by CT/MRI-, PET/CT- scans and colonoscopy, and ECOG 0-1. Primary outcome was QoL assessed by the EORTC-C30 questionnaires at baseline, and at 3, 6 and 12 months after Ltx. RESULTS: The patients' age ranged from 50 to 63 years. Nine of 10 patients were observed for 12 months. One patient did not return the form at 6 months and died shortly after because of recurrence of the malignant disease. Compared to baseline, Ltx resulted in sustained excellent global health status scale (score of 100) in one patient, improved scores in 4 and unchanged scores in 3 patients at 12 months. The majority of the patients also reported good functional scores at follow-ups. Although two patients had marked symptoms both before and after Ltx, the patients in general reported low levels of pain and fatigue before and after surgery. CONCLUSION: The present study indicates that CRC patients with liver-only metastases who receive Ltx have good QoL and have mostly minor symptoms the first year after Ltx.

Pain and quality of life with chronic obstructive pulmonary disease.

BACKGROUND: Pain as a symptom may be underrecognized in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: The aim of this study is to explore the prevalence and intensity of pain, its location, how demographic and clinical variables may be related to pain, and how pain is associated with quality of life (QOL). METHODS: In this cross-sectional study, 154 patients with COPD answered the Brief Pain Inventory, Respiratory Quality of Life Questionnaire, and Quality of Life Scale, and performed spirometry. RESULTS: Seventy-two percent of the patients indicated the location of pain on a body diagram. Lower lung function, higher score of pain intensity, and pain interference were associated with lower disease QOL. A higher score of pain interference was associated with lower global QOL. When controlling for disease QOL in the equation of global QOL, pain interference was no longer significant. CONCLUSION: The experience of pain is related to disease QOL in patients with COPD.

Experiences of self-blame and stigmatisation for self-infliction among individuals living with COPD.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major health problem estimated to become the third leading cause of death and the fifth leading cause of disability by 2020. Tobacco control is the most effective protective intervention, and it serves as a key element in patient counselling. However, a focus on tobacco control may cause unintended and adverse effects to individuals who already suffer from the disease. AIM: The current study aims to understand how patients with COPD experience daily life in a society with heavy emphasis on tobacco control. METHOD: The design was longitudinal and descriptive. The sample included thirteen men and five women with COPD, recruited from pulmonary rehabilitation units. Data were collected by means of qualitative interviews and analysed using qualitative content analysis with search for meanings. FINDINGS: The main theme was a feeling of being exiled in the world of the healthy, because of self-blame and society's stigmatisation of COPD as a self-inflicted disease. The participants experienced feelings of disgrace through subtle blame and a lack of support from their social network, health care encounters and larger society. This seemed to increase illness-related strain and a need for defensive actions. LIMITATIONS: A small convenience sample, local cultural influence, the study's wide scope and lack of health professionals' views must be considered. CONCLUSION: This study illuminates the challenge of how to combine health advice on smoking cessation with nonblaming psycho-social support throughout the course of COPD. An awareness of the potential for stigma, the nature of nicotine dependence and broadened causal explanations for the disease may improve the ability of caregivers to address patient strain and its negative association with coping and well-being. Dilemmas in health communication concerning COPD patients' experience of stigma and negative emotional response should be further explored.

Association of breathlessness with multiple symptoms in chronic obstructive pulmonary disease.

AIM: This paper is a report of an exploration of relationships between demographic and clinical variables and the symptoms of breathlessness, depression, anxiety, fatigue, sleeping difficulties and pain for patients with chronic obstructive pulmonary disease. BACKGROUND: Research into chronic obstructive pulmonary disease has focused on single symptoms and we lack knowledge about possible associations between several symptoms. METHODS: A total of 154 patients with chronic obstructive pulmonary disease participated in a cross-sectional study from June 2006 to December 2007 (response rate 40%). All underwent pulmonary lung function tests and completed questionnaires including demographic variables, the Brief Pain Inventory, Hospital Anxiety and Depression Scale, Lee Fatigue Scale, General Sleep Disturbance Scale and the Respiratory Quality of Life Questionnaire. Bivariate correlation and multiple regression analyses were performed. RESULTS: Breathlessness was statistically significantly positively associated with the other symptoms, after controlling for demographic and clinical variables. Younger age was statistically significantly related to more breathlessness, anxiety and sleeping difficulties and lower levels of education was statistically significantly related to more breathlessness, depression and anxiety. In relation to clinical variables, smoking was statistically significantly related to more depression, whereas more co-morbidity was statistically significantly related to more breathlessness and pain. Poorer lung function was statistically significantly related to more breathlessness. However, higher lung function was related to more sleeping difficulties. CONCLUSION: Breathlessness is associated with symptoms such as depression, anxiety, fatigue, sleeping difficulties and pain, suggesting the need for an expanded focus on symptoms in chronic obstructive pulmonary disease guidelines, health care and research.

Changes in cardiac and cognitive function and self-reported outcomes at one year after coronary artery bypass grafting.

OBJECTIVE: Although health status after coronary artery bypass grafting improves at the group level, individual outcomes demonstrate variation. We aimed to evaluate relative importances of changes in cardiac and cognitive function and symptom status regarding physical and mental health at 1 year after coronary artery bypass grafting. METHODS: Outcomes in multivariable regression analysis (n = 86) were self-reported physical and mental health (Medical Outcomes Study 36-Item Short Form) at 12 months' follow-up, adjusting for baseline. Independent variables were change in exercise capacity (staged ergometer protocol), cognitive function (neurocognitive test battery), and self-reported improvement of angina. Graft patency was evaluated by angiography (82/86 patients). RESULTS: After surgery, health status was comparable to the age- and sex-matched population norm. Improvement of angina was associated with gain in physical health in the range of 0.5 SD (beta = 0.23, P = .012). Change in observed physical exercise capacity (mean +/- SD 199 +/- 426 W x min) accounted for 9% of variance in physical health (beta = 0.42, P = .001). Positive change in cognitive function was significantly related to mental (beta = 0.52, P = .007) but not physical health. Graft occlusion (22/82 patients) was not significantly related to health status. CONCLUSIONS: Individual variation in objective functional performance and symptom relief is significant for self-reported health status, beyond the predictive ability of preoperative health status, sex, and graft patency. Awareness of the extent and impact of outcome variation is important when counseling patients before and after coronary artery bypass grafting.

Anxiety in the operating theatre: a study of frequency and environmental impact in patients having local, plexus or regional anaesthesia.

AIMS: To estimate the frequency of intraoperative anxiety, the influence of environmental factors on intraoperative anxiety and to study the relationship between intraoperative anxiety and generalised anxiety and depression. BACKGROUND: Previous research has documented that surgery is associated with increased stress and anxiety, which have an adverse effect on patient outcomes. Few studies have been conducted to obtain patients' perspectives about the influence of the operating theatre environment on anxiety. DESIGN: The study used a survey design including questionnaires. METHOD: Clinical variables were noted from the anaesthesia medical records. The sample (n = 119) comprised patients undergoing elective surgery and emergency operations within 24 hours of admission. Anxiety was assessed by the Jakobsen's questionnaire and the Hospital Anxiety and Depression scale. RESULTS: Twenty-three per cent felt anxious on arrival at the operating theatre, 35% were anxious at induction of anaesthesia, while 12% felt anxious after induction. At start of surgery 15% experienced anxiety and during surgery 9% were anxious. Continuous information reduced the experience of anxiety in 49% of the patients and the opportunity to ask questions during the intraoperative period reduced anxiety in 55%. The sight of technical equipment and surgical instruments was reported to increase anxiety in 9% and 6% of the sample, respectively. Patients with higher levels of general anxiety and depression also experienced significantly higher levels of anxiety in the intraoperative period. CONCLUSIONS: In this study patients experience highest level of anxiety at induction of anaesthetics. The operating theatre environments impact on patients' anxiety are in less degree influenced by the sight and hearing of the technical equipment and the surroundings. Continuous information and opportunity to ask questions reduces patients' anxiety. Results indicate that there is a significant positive relationship between generalised anxiety and depression prior to admission and anxiety experienced during the intraoperative period. RELEVANCE TO CLINICAL PRACTICE: Generalised anxiety and depression prior to surgery should be identified to implement nursing interventions to reduce anxiety in the operating theatre.

Health related quality of life in patients with neuroendocrine tumors compared with the general Norwegian population.

PURPOSE: Health related quality of life (HRQoL) was characterized among patients with neuroendocrine tumor (NET) and compared with the general Norwegian population. METHODS: A cross sectional, comparative design was chosen, and the samples comprised 196 NET patients and 5,258 individuals from the general Norwegian population. We used Chi-square cross tab calculations to evaluate sociodemographic characteristics, T-tests for independent samples and Analysis of Variance (ANOVA) in order to compare HRQoL (SF-36) scores across a range of background variables. Furthermore, T-tests were used to analyze differences in HRQoL scores between the samples. RESULTS: NET patients demonstrated significantly lower on all HRQoL subscales when compared with the general population with the lowest values on general health, physical limitation and vitality. Individuals above 70 years reported lower scores on physical functioning and physical limitations compared with those who were younger. Individuals with higher levels of education reported increased physical functioning compared with those with less education and full-time or part-time workers described higher physical functioning and less physical limitations compared with those who were retired. CONCLUSIONS: All SF-36 HRQoL scores were significantly lower among the NET patients when compared with the general population. Assistance from health personnel to NET patients should focus on those domains.

Nursing pain management--a qualitative interview study of patients with pain, hospitalized for cancer treatment.

Pain is a significant symptom in cancer patients. Understanding of patients' experiences in relation to pain management is important in evidence-based nursing in the field of pain. The aim of this study was to explore cancer patients' experiences of nursing pain management during hospitalization for cancer treatment. Eighteen cancer patients participated in the study, all with advanced cancer, including skeleton metastases. The female participants all had breast cancer, and the male participants all had prostate cancer. Data were collected by in-depth interviews, and qualitative description was used to entail low-inference interpretation to reach an understanding of the essence of pain and nursing pain management. Patients found it somewhat difficult to express their expectations of nursing pain management and competencies. However, 1) being present and supportive; 2) giving information and sharing knowledge; 3) taking care of medication; and 4) recognizing the pain emerged as themes in nursing pain management. Although patients believed that nurses were caring persons, they perceived differences between nurses in the ways they handled pain management. Furthermore, some patients experienced a lack of information from nurses in relation to pain management. Although cancer patients' experiences showed the importance of nurses in pain management, it seems that nurses should have a clearer role in cancer pain management in relation to counseling and patient education. The results from this study can increase nurses' awareness of their role in pain management as a first step in improving pain management for patients.

Quality of life in chronic low back pain patients treated with instrumented fusion.

AIM: The aim of this study was to examine pain and quality of life in a group of preoperative chronic low back pain patients (n = 25) and a group of postoperative chronic low back pain patients (n = 101) treated with instrumented fusion 1-8 years ago. BACKGROUND: Reduced quality of life is common in chronic low back pain patients and the aim of treatment is to improve quality of life. DESIGN: In the present study, a comparative survey design was used. METHODS: The McGill Pain Questionnaire and the SF-36 Health Survey were used to examine pain and quality of life. RESULTS: The pre- and postoperative groups did not differ with regard to age, gender, education, other chronic conditions or previous spinal surgery. Compared with the preoperative group, the postoperative group reported significantly lower total, sensory, affective and evaluative pain, used less pain medication (p < 0.05) and reported better scores in all SF-36 components (p < 0.05), except for general health. The effect size was > or =0.8 for all pain components and > or =0.4 for all SF-36 components, except for general health (effect size = 0.009). With regard to long-term follow-up, patients who underwent surgery 5-8 years ago reported better physical role functioning (p < 0.05) compared with those who underwent surgery 1-2 years ago. CONCLUSION: Results showed that the postoperative group reported significantly less pain and better physical and mental health compared with the preoperative group. However, despite surgery, the postoperative group reported suffering from pain and reduced quality of life. Relevance to clinical practice. Psychosocial interventions focusing on psychosocial consequences of pain are needed to modify the pain experience and increase the quality of life in patients who have undergone this kind of surgery.

The pain experience and future expectations of chronic low back pain patients following spinal fusion.

AIM: In a sample of patients who underwent instrumented spinal fusions for chronic low back pain (CLBP), the purposes of this study were: to determine the amount of pain patients experienced and to determine the impact of length of time since surgery, use of pain medication and their outlook on the future on these pain intensity scores. BACKGROUND: An increasing number of people report CLBP and one of the treatments is instrumented fusion. METHOD: The study used a cross-sectional design. Visual analogue scales were used to measure pain intensity in different locations and a single item measured patients' view of the future. Data were collected in November 2001. RESULTS: The sample consisted of 101 patients (71% women) aged 26-59 years treated with instrumented fusion 1-8 years ago. As many as 87% reported pain 1-8 years after the surgery. Most patients reported pain of low-to-moderate intensity in the neck and shoulders, back and hips, feet and legs and in total pain. As many as 45% of the patients did not take pain medication and patients using more analgesics reported more pain than those using fewer analgesics (p < 0.05). Patients with a more positive outlook on the future reported significantly less pain in all of the locations that were evaluated (p < 0.01). CONCLUSION: A high percentage of patients with CLBP continue to experience pain 1-8 years after spinal fusion. A positive outlook towards the future seems to be associated with less pain in these patients. Relevance to clinical practice. Patients who continue to experience pain and have a more negative outlook on the future may benefit from psychoeducational interventions that teach them how to better cope with their pain.

Women with newly diagnosed breast cancer and their perceptions of needs in a health-care context.

AIM: The purpose of this study was to investigate how women with newly diagnosed breast cancer experience their needs in a health-care context. DESIGN: A qualitative design, using a focus group, was used to identify women's perceptions of needs. METHOD: A group of seven women met six times over a period of 10 weeks during 2004. Meetings were audio-recorded, and the data were coded and analysed using Kvale's methods of qualitative content analysis. FINDINGS: Women described experiences related to two categories of needs that influenced their ability to cope with changed life situations: the need for knowledge and the need for psychosocial support. These categories may be divided into three themes: knowledge and psychosocial support related to physical, emotional and social perspectives of daily living. CONCLUSIONS: Findings suggest that health-care services provided by breast diagnostic centres should be based on requirements defined by women with breast cancer. In addition to medical treatment, services ought to meet women's needs for knowledge and psychosocial support at the time of diagnosis, and during and after treatment. This study can provide nurses and other health professionals with a deeper understanding of women's demands as they face challenges related to breast cancer. RELEVANCE FOR CLINICAL PRACTICE: The findings from this study underline the need to include emotional and social perspectives in standards for breast cancer diagnosis and treatment, and can provide a foundation for the development of user-designed health services.