The effect of psychosocial interventions for sexual health in patients with pelvic cancer: a systematic review and meta-analysis.

AIM: The aim of this systematic review and meta-analysis was to explore and evaluate the effect of psychosocial interventions in improving sexual health outcomes among post-treatment patients with pelvic cancer. METHODS: Inclusion and exclusion criteria were pelvic cancer survivors; psychosocial interventions; studies with a control group and measures of sexual health. Five databases were searched for literature along with an inspection of the included studies' reference lists to extend the search. Risk of bias was assessed with the RoB2 tool. Standardised mean difference (SMD) with a random effects model was used to determine the effect size of psychosocial interventions for sexual health in patients with pelvic cancers. RESULTS: Thirteen studies were included, with a total number of 1,541 participants. There was a large heterogeneity regarding the type of psychosocial intervention used with the source found in a leave one out analysis. Six studies showed statistically significant improvements in sexual health, while three showed positive but non-significant effects. The summary effect size estimate was small SMD = 0.24 (95% confidence interval [CI]: 0.05 to 0.42, p = 0.01). DISCUSSION: There is limited research on psychosocial interventions for sexual health in pelvic cancer patients. There are also limitations in the different pelvic cancer diagnoses examined. Commonly, the included articles examined physical function rather than the whole sexual health spectrum. The small effect sizes may in part be due to evaluation of psychosocial interventions by measuring physical dysfunction. Future research should broaden sexual health assessment tools and expand investigations to more cancer types.

Incidence and risk factors for umbilical cord prolapse in labor when amniotomy is used and with spontaneous rupture of membranes: A Swedish nationwide register study.

INTRODUCTION: Umbilical cord prolapse (UCP) is a rare but severe obstetric complication in the presence of a rupture of the membranes. Although it is not possible to prevent a spontaneous rupture of the membranes (SROM), it is possible to prevent an amniotomy, which is a commonly used intervention in labor. This study aimed to explore the incidence and risk factors that are associated with UCP in labor when amniotomy is used vs SROM. MATERIAL AND METHODS: A retrospective nationwide register study was conducted of all births in Sweden from January 2014 to June 2020 that were included in the Swedish Pregnancy Register (n = 717 336). The main outcome, UCP, was identified in the data by the International Classification of Diseases (ICD-10) diagnosis code O69.0. Multiple binary logistic regression analysis was used to identify the risk factors. RESULTS: Amniotomy was performed in 230 699 (43.6%) of all pregnancies. A UCP occurred in 293 (0.13%) of these cases. SROM occurred in 298 192 (56.4%) of all cases, of which 352 (0.12%) were complicated by UCP. Risk factors that increased the odds of UCP for both amniotomy and SROM were: higher parity, non-cephalic presentation and an induction of labor. Greater gestational age reduced the odds of UCP. Risk factors associated with only amniotomy were previous cesarean section and the presence of polyhydramnios. Identified risk factors for UCP in labor with SROM were a higher maternal age and maternal origin outside of the EU. CONCLUSIONS: UCP is a rare complication in Sweden. Beyond confirming the previously recognized risk factors, this study found induction of labor and previous cesarean section to be risk factors in labor when amniotomy is used.

"Being the main character but not always involved in one's own care transition" - a qualitative descriptive study of older adults' experiences of being discharged from in-patient care to home.

BACKGROUND: The growing number of older adults with chronic diseases challenges already strained healthcare systems. Fragmented systems make transitions between healthcare settings demanding, posing risks during transitions from in-patient care to home. Despite efforts to make healthcare person-centered during care transitions, previous research indicates that these ambitions are not yet achieved. Therefore, there is a need to examine whether recent initiatives have positively influenced older adults' experiences of transitions from in-patient care to home. This study aimed to describe older adults' experiences of being discharged from in-patient care to home. METHODS: This study had a qualitative descriptive design. Individual interviews were conducted in January-June 2022 with 17 older Swedish adults with chronic diseases and needing coordinated care transitions from in-patient care to home. Data were analyzed using inductive qualitative content analysis. RESULTS: The findings indicate that despite being the supposed main character, the older adult is not always involved in the planning and decision-making of their own care transition, often having poor insight and involvement in, and impact on, these aspects. This leads to an experience of mismatch between actual needs and the expectations of planned support after discharge. CONCLUSIONS: The study reveals a notable disparity between the assumed central role of older adults in care transitions and their insight and involvement in planning and decision-making.

The meaning of continuity of care from the perspective of older people with complex care needs-A scoping review.

People aged 65 years or older with complex care needs are at risk of fragmented care. This may jeopardise patient safety. Complex care needs are defined as care needs that require the performance of time-consuming processes such as reviewing medical history, providing counselling, and prescribing medications. A scoping review was conducted with the aim of mapping the literature regarding continuity of care from the perspective of older people with complex care needs. Search results from seven databases (PubMed, Cinahl, PsycInfo, ASSIA, Web of Science, Google Scholar, Scopus, DOAJ), grey literature (BASE), and a hand-search search of key journals were used. A deductive analysis based on aspects of continuity of care was performed. The search resulted in 5704 records. After a title and abstract screening, 93 records remained. In total, 18 articles met the inclusion criteria and were included in the scoping review. Older people´s sense of continuity of care increases when fewer healthcare workers are involved in their care but help from skilled professionals is more important than meeting the same person. It is vital for older people's feeling of continuity of care that discharge planning involves them, their families, and care providers in an organised way.

Following a standardised pathway: Healthcare professionals' perspectives on person-centred care within ERAS for patients with colorectal cancer.

AIMS AND OBJECTIVES: To describe healthcare professionals' perceptions of person-centred care for patients with colorectal cancer, within the standardised care concept of Enhanced Recovery After Surgery. BACKGROUND: International guidelines for colorectal surgery describe standardised perioperative care. Combining standardised care with person-centred care could be accomplished using the person-centred nursing framework for establishing and maintaining relationships with patients. Despite strong evidence for the standardised care concepts' medical benefits, studies concerning the practice of person-centred care from a nursing point of view are sparse. DESIGN: A qualitative descriptive design was used. METHODS: Four focus groups interviews were performed including 22 healthcare professionals with 1-29 years' experience of caring for patients with colorectal cancer. Data were analysed using qualitative conventional content analysis. The COREQ checklist for reporting qualitative research was used. RESULTS: Three themes emerged in the analysis; Framework in the healthcare system, Facing differences in participation and Interacting with the person beyond the illness. Conditions for person-centred care were related to the interactions between patients and healthcare professionals, the structure of care were also considered relevant. CONCLUSION: There is a discrepancy between what is considered important to do and what is done in clinical practice to create conditions for patient participation. Interacting with patients and creating an interprofessional environment are important conditions, the structure of care is also a fundamental key to promoting person-centred care. There is a need for further improvement in care of patients with colorectal cancer to achieve person-centredness within standardised care. RELEVANCE TO CLINICAL PRACTICE: The findings provide valuable insights into what healthcare professionals consider to be important for achieving person-centred care. This knowledge can be useful in clinical practice and education programs. PATIENT OR PUBLIC CONTRIBUTION: At the outset of the study, three patients were interviewed aimed at improving the conditions for the healthcare professionals' focus groups.

Registered nurses' efforts to ensure safety for home-dwelling older patients.

BACKGROUND: The international development of health care, an ageing population and rapid technical development mean that more care is being performed in patient homes. This care environment is often unpredictable and involves both formal and informal caregivers, making it potentially unsafe. There is sparse knowledge about how patient safety is protected in home health care in Sweden and how registered nurses work to prevent risks and promote safe care. AIM: The aim of the study was to explore registered nurses' efforts to reduce perceived risks for home-dwelling older patients and ensure safe home health care. METHOD: We used a qualitative design with individual interviews with 13 registered nurses working in municipalities in southeast Sweden. The narratives were analysed with inductive content analysis. FINDINGS: The findings showed that the registered nurses tried to secure a safe care environment and took an active role in care, striving to stay one step ahead of the patient. These three types of efforts are likely interdependent, suggesting they are all needed to reduce perceived risks for home-dwelling older patients and ensure patient safety in home health care. CONCLUSIONS: It is a challenge for registered nurses to maintain patient safety when performing care in patient homes. Continuity of care is required and must be based not only on self-reliance among registered nurses but also on trusting relationships with patients, next of kin, colleagues and other personnel, as well as on the development of organisational conditions adapted to patient needs.

Nurse anesthetists' perceptions of heat conservation measures in connection with surgery - a phenomenographic study.

BACKGROUND: To minimize the risk of perioperative hypothermia, it is recommended that healthcare professionals be familiar with heat conservation measures and use passive and active warming methods, in line with international guidelines. However, there is a low level of adherence perioperatively to the use of heat conservation measures. To understand why, there is a need to capture the nurse anesthetists' perspective. The aim is to describe nurse anesthetists' perceptions of heat conservation measures in connection with surgery. METHODS: An inductive descriptive design with a phenomenographic approach was chosen. A total of 19 nurse anesthetists participated and were interviewed. Data were analyzed according to Larsson and Holmström's phenomenographic seven-step model. RESULTS: Six ways of understanding the phenomenon heat conservation measures in connection with surgery were found: the preventive, the useable, the untenable, the caring, the adaptive, and the routine care approach. These approaches were related to each other in a flexible way, allowing for several to co-exist at the same time, depending on the situation. CONCLUSIONS: Nurse anesthetists want to prevent the patients' heat loss and maintain normothermia, regardless of the type of surgery. This willingness, motivation, and intention enable the use of heat conservation measures. However, there are perceptions that have an impact, such as doubts and uncertainty, access, time and financial constraints, preconditions, routines or habits, and lack of availability of education/training. These barriers will require support from an organizational level to promote lifelong education and guidelines. As well as offer education at the nurse anesthetists' program.

Prevalence of amniotomy in Sweden: a nationwide register study.

BACKGROUND: Amniotomy is a commonly used labor intervention with uncertain evidence, and there are complications connected to the intervention. Yet, the Swedish prevalence of amniotomy is unknown. The aim of the study was therefore to describe the prevalence of amniotomy in Sweden. METHODS: This nationwide register-based study included 330,913 women giving birth in 2017-2020. Data were collected from the Swedish Pregnancy Register in which the majority of data is collected via direct transfer from medical records. Prevalence of amniotomy was described for all births, for nulliparous and multiparous women with spontaneous onset of labour, and at the hospital level. Descriptive statistics and chi-square test were used to analyse the data. RESULTS: For all births, the prevalence of amniotomy was 40.6%. More amniotomies were performed in Robson group 1 compared to Robson group 3; 41.1% vs 32.3% (p < 0.001). The prevalence for all births remained the same during the study period; however, a decrease from 37.5 to 34.1%, was seen in Robson group 1 and Robson group 3 (p < 0.001). Variations in the prevalence between hospitals were reported. The hospitals with the fewest number of births annually had the highest prevalence of amniotomy (45.0%), and the lowest prevalence was reported at the University hospitals (40.4%) (p < 0.001). CONCLUSIONS: Amniotomy is a common labor intervention in Sweden, given that almost half of the laboring women underwent the intervention. Our results, regarding variations in the prevalence between hospitals, could imply a potential for fewer amniotomies in Swedish childbirth care.

Patients' and providers' perspectives on e-health applications designed for self-care in association with surgery - a scoping review.

BACKGROUND: Before and after major surgery, access to information in a user-friendly way is a prerequisite for patients to feel confident in taking on the responsibility for their surgical preparation and recovery. Several e-health applications have been developed to support patients perioperatively. The aim of this review was to give an overview of e-health applications designed for self-care associated with surgery by providing a scoping overview of perspectives from providers and patients. METHODS: We searched the following data sources to identify peer-reviewed quantitative and qualitative studies published between 2015 and 2020: CINAHL, Google Scholar, MEDLINE, PsycInfo, Web of Science, and Scopus. After identifying 960 titles, we screened 638 abstracts, of which 72 were screened in full text. Protocol register: https://doi.org/10.17605/OSF.IO/R3QND . RESULTS: We included 15 studies which met our inclusion criteria. Data from several surgical contexts revealed that the most common self-care actions in e-health applications were preoperative preparations and self-assessments of postoperative recovery. Motivational factors for self-care were information, combined with supportive reminders and messages, and chat features. Although there was great variance in research designs and technical solutions, a willingness to engage with and adhere to e-health seemed to increase patients' self-care activities and thereby accelerate return to work and normal activities. In addition, the need for physical visits seemed to decrease. Even though age groups were not primarily studied, the included studies showed that adult patients of any age engaged in surgical self-care supported by e-health. The providers' perspectives were not found. CONCLUSIONS: E-health applications supporting perioperative self-care indicated a positive impact on recovery. However, experiences of healthcare professionals delivering e-health associated with surgery are missing. Additionally, studies based on patients' perspectives regarding willingness, adherence, and motivation for self-care supported by e-health are sparse. A need for studies examining the supporting role of e-health for self-care in the surgical context is therefore needed.

Seven lessons from the coronavirus pandemic for primary health care: A qualitative study of registered and assistant nurses in Sweden.

AIM: The aim of this study was to explore lessons from the pandemic by registered and assistant nurses in Swedish primary health care (PHC) of potential relevance for the future operation of PHC. METHODS: Twenty-one semi-structured interviews were conducted with registered and assistant nurses. We used a purposeful sampling strategy to achieve a diverse sample with regard to size and location of PHC centres. Data were analysed using qualitative content analysis. RESULTS: Analysis yielded two categories: lessons from the pandemic pertaining to PHC personnel and patient behaviours (adaptability of the personnel; importance of hygiene and maintaining physical distance; and importance of being attentive to illness symptoms) and lessons from the pandemic related to primary healthcare work routines (effectiveness of digital job meetings; advantages of digital patient consultations; importance of keeping infectious patients separate from other patients; and the need to allow only pre-booked patient appointments). CONCLUSIONS: The seven sub-categories represent seven lessons from the pandemic. The lessons generated both instrumental knowledge, which the nurses could apply in work-related decisions, and conceptual knowledge which yielded improved understanding of problems and potential solutions for PHC.

Working conditions in primary care: a qualitative interview study with physicians in Sweden informed by the Effort-Reward-Imbalance model.

BACKGROUND: Many problems with primary care physicians' psychosocial working conditions have been documented. Many studies on working condition have used the Effort-Reward-Imbalance (ERI) model, which posits that poor health and well-being may result from imbalances between the level of effort employees perceive that they put into their work and the rewards they receive. The model has not been used in qualitative research or applied to investigate primary care physicians' working conditions. The aim of this study was to apply the ERI model to explore the perceived efforts and rewards by primary care physicians in Sweden and approaches they take to cope with potential imbalances between these efforts and rewards. METHODS: The study has a qualitative design, using semi-structured interviews. A purposeful sampling strategy was used to achieve a heterogeneous sample of primary care physicians who represented a broad spectrum of experiences and perceptions. We recruited 21 physicians; 15 were employed in public health care and 6 by private health care companies. RESULTS: The analysis of the interviews yielded 11 sub-categories: 6 were mapped to the efforts category, 3 were attributed to the rewards category and 2 were approaches to coping with effort/reward imbalances. Many of the statements concerned efforts in the form of high workload, restricted autonomy and administrative work burden. They also perceived resource restrictions, unpredictability of work and high expectations in their role as physicians as efforts. Three types of rewards emerged; the physicians found their job to be stimulating and meaningful, and the work climate to be supportive. The physicians coped with imbalances by means of job enrichment and using decisional latitude. CONCLUSIONS: Primary care physicians perceive numerous types of efforts in their job, which is consistent with research concerning work stress and associated consequences, such as poor subjective health and well-being. There are also rewards according to primary care physicians, but the findings suggest a lack of reciprocity in terms of efforts and rewards although firm conclusions cannot be drawn since the study did not investigate the magnitude of the various efforts and rewards or the effectiveness of the approaches the physicians use to cope with imbalances. The ERI model was found to be useful to explore physicians' primary care work and working conditions but its applicability likely depends on the type of work or professions being studied.

Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses.

BACKGROUND: Health care organizations are constantly changing as a result of technological advancements, ageing populations, changing disease patterns, new discoveries for the treatment of diseases and political reforms and policy initiatives. Changes can be challenging because they contradict humans' basic need for a stable environment. The present study poses the question: what characterizes successful organizational changes in health care? The aim was to investigate the characteristics of changes of relevance for the work of health care professionals that they deemed successful. METHODS: The study was based on semi-structured interviews with 30 health care professionals: 11 physicians, 12 registered nurses and seven assistant nurses employed in the Swedish health care system. An inductive approach was applied using questions based on the existing literature on organizational change and change responses. The questions concerned the interviewees' experiences and perceptions of any changes that they considered to have affected their work, regardless of whether these changes were "objectively" large or small changes. The interviewees' responses were analysed using directed content analysis. RESULTS: The analysis yielded three categories concerning characteristics of successful changes: having the opportunity to influence the change; being prepared for the change; valuing the change. The interviewees emphasized the importance of having the opportunity to influence the organizational changes that are implemented. Changes that were initiated by the professionals themselves were considered the easiest and were rarely resisted. Changes that were clearly communicated to allow for preparation increased the chances for success. The interviewees did not support organizational changes that were perceived to be implemented unexpectedly and/or without prior communication. They conveyed that it was important for them to understand the need for and benefits of organizational changes. They particularly valued and perceived as successful organizational changes with a patient focus, with clear benefits to patients. CONCLUSIONS: Organizational changes in health care are more likely to succeed when health care professionals have the opportunity to influence the change, feel prepared for the change and recognize the value of the change, including perceiving the benefit of the change for patients.

Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology.

BACKGROUND: Patient safety in home healthcare is largely unexplored. No-harm incidents may give valuable information about risk areas and system failures as a source for proactive patient safety work. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and thus aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home healthcare. METHODS: A structured retrospective record review using a trigger tool designed for home healthcare. A random sample of 600 home healthcare records from ten different organizations across Sweden was reviewed. RESULTS: In the study, 40,735 days were reviewed. In all, 313 no-harm incidents affected 177 (29.5%) patients; of these, 198 (63.2%) no-harm incidents, in 127 (21.2%) patients, were considered preventable. The most common no-harm incident types were "fall without harm," "deficiencies in medication management," and "moderate pain." The type "deficiencies in medication management" was deemed to have a preventability rate twice as high as those of "fall without harm" and "moderate pain." The most common potential contributing cause was "deficiencies in nursing care and treatment, i.e., delayed, erroneous, omitted or incomplete treatment or care." CONCLUSION: This study suggests that it is feasible to identify no-harm incidents and potential contributing causes such as omission of care using record review with a trigger tool adapted to the context. No-harm incidents and potential contributing causes are valuable sources of knowledge for improving patient safety, as they highlight system failures and indicate risks before an adverse event reach the patient.

Usage of do-not-attempt-to-resuscitate orders in a Swedish community hospital - patient involvement, documentation and compliance.

BACKGROUND: To characterize patients dying in a community hospital with or without attempting cardiopulmonary resuscitation (CPR) and to describe patient involvement in, documentation of, and compliance with decisions on resuscitation (Do-not-attempt-to-resuscitate orders; DNAR). METHODS: All patients who died in Kalmar County Hospital during January 1, 2016 until December 31, 2016 were included. All information from the patients' electronic chart was analysed. RESULTS: Of 660 patients (mean age 77.7 ± 12.1 years; range 21-101; median 79; 321 (48.6%) female), 30 (4.5%) were pronounced dead in the emergency department after out-of-hospital CPR. Of the remaining 630 patients a DNAR order had been documented in 558 patients (88.6%). Seventy had no DNAR order and 2 an explicit order to do CPR. In 43 of these 70 patients CPR was unsuccessfully attempted while the remaining 27 patients died without attempting CPR. In 2 of 558 (0.36%) patients CPR was attempted despite a DNAR order in place. In 412 patients (73.8%) the DNAR order had not been discussed with neither patient nor family/friends. Moreover, in 75 cases (13.4%) neither patient nor family/friends were even informed about the decision on code status. CONCLUSIONS: In general, a large percentage of patients in our study had a DNAR order in place (88.6%). However, 27 patients (4.3%) died without CPR attempt or DNAR order. DNAR orders had not been discussed with the patient/surrogate in almost three fourths of the patients. Further work has to be done to elucidate the barriers to discussions of CPR decisions with the patient.

Validation of the patient activation measure in patients at discharge from hospitals and at distance from hospital care in Sweden.

BACKGROUND: The Patient Activation Measure (PAM) is a recognized measure of how active patients are in their care, and has been translated into several languages and cultural contexts. Patient activity, self-care, and health literacy have become increasingly important aspects of health care, and thus reliable measures of these are needed. However, a Swedish translation of PAM is currently lacking. The aim of the study was to translate and assess the validity and reliability of the Swedish PAM-13. METHODS: A self-report questionnaire was handed out to 521 patients at ten medical, geriatric, and surgical wards, and one Virtual Health Room. The Rasch model was employed, using the partial credit model, to assess the functioning of the PAM scale, item fit, targeting, unidimensionality, local independence, differential item functioning (DIF), and person-separation index. Evidence of substantive, content, structural, and external validity was examined. RESULTS: Of the 521 patients who were consecutively handed a questionnaire, 248 consented to participate, yielding a response rate of 47.6%. The average measure for each category advanced monotonically. The difficulty of the PAM items ranged from - 1.55 to 1.26. The infit and outfit values for the individual items were acceptable. Items 1, 2, and 4 showed disordered thresholds. The mean person location was 1.48 (SD = 1.66). The person-item map revealed that there were no item representations at the top of the scale. The evidence for unidimensionality was ambiguous and response dependency was seen in some items. DIF was found for age. The person separation index was 0.85. CONCLUSION: The Swedish PAM-13 was reliable, but was not conclusively found to represent one underlying construct. It seems that the Swedish PAM-13 lacks strong evidence for substantive, content, and structural validity. Although valid and reliable measures of ability for activation in self-care among patients are highly warranted, we recommend further development of PAM-13 before application in everyday clinical care.

What is palliative care? Perceptions of healthcare professionals.

BACKGROUND: Despite increased attention and knowledge in palliative care, there is still confusion concerning how to interpret the concept of palliative care and implement it in practice. This can result in difficulties for healthcare professionals in identifying patients whom would benefit from palliative care, which, in turn, could lead to a delay in meeting patients' needs. AIM: To explore healthcare professionals' perceptions of palliative care. METHOD: Data were collected through twelve interprofessional focus group interviews in community care and hospital wards in south Sweden (n = 74). All interviews were analysed with latent content analysis. RESULTS: Three domains were revealed: first, a blurred conceptual understanding as participants described palliative care using synonyms, diagnoses, phases, natural care and holism; second, a challenge to communicate transitions concerned the importance of how and when the transition to palliative care was communicated and documented; finally, a need for interprofessional collaboration was described as well as the consequences for severely ill persons, relatives and healthcare professionals when it was not established. CONCLUSION: The perceptions about how to interpret palliative care differed as well as when palliative care should be offered and decided, which might have practical consequences. How long a person has left to live is of great significance for decision-making, caregiving and preparation in palliative care. The challenge is to use interprofessional communication to promote understanding and collaborate across varied care levels. Integrating palliative care across diverse care levels could be one way to reduce the ambiguity of palliative care.

Effects on patient activation of eHealth support in addition to standard care in patients after radical prostatectomy: Analysis of secondary outcome from a randomized controlled trial.

INTRODUCTION: Prostate cancer is often treated with radical prostatectomy, but surgery can leave patients with side effects. Patients who actively take part in their rehabilitation have been shown to achieve better clinical outcomes. eHealth support has the potential to increase patient activation, but has rarely been evaluated in long-term randomized controlled trials. Therefore, we evaluated the effects on patient activation of eHealth support (electronic Patient Activation in Treatment at Home, ePATH) based on motivational theory. The aim was to investigate the effects of eHealth support on patient activation at 6 and 12 months after radical prostatectomy, compared with standard care alone, and associations with baseline patient activation and depression. METHODS: A multicentre randomized controlled trial with two study arms was conducted. Men planned for radical prostatectomy at three county hospitals in southern Sweden were included and randomized to the intervention or control group. The effects of ePATH on the secondary outcome, patient activation, were evaluated for one year after surgery using the patient activation measure and analysed using a linear mixed model. RESULTS: The study included 170 men during 2018-2019. In the intervention group, 64% (53/83) used ePATH. The linear mixed model showed no significant differences between groups in patient activation [ß -2.32, P .39; CI -7.64-3.00]. Baseline patient activation [ß 0.65, P < .001; CI 0.40-0.91] and depression [ß -0.86, P .03; CI -1.64- -0.07] statistically impacted patient activation scores over one year. CONCLUSIONS: ePATH had no impact on patient activation during long-term prostate cancer rehabilitation. However, patient activation at baseline and depression scores significantly influenced patient activation, underlining the need to assess these aspects in prostate cancer surgery rehabilitation. TRIAL REGISTRATION: ISRCTN Registry ISRCTN18055968, (07/06/2018); https://www.isrctn.com/ISRCTN18055968; International Registered Report Identifier: RR2-10.2196/11625.

Primary healthcare in the aftermath of the COVID-19 pandemic: a qualitative interview study in Sweden.

OBJECTIVE: To explore how primary healthcare workers in Sweden experienced and perceived the long-term impact of the pandemic on their work. DESIGN: This is a descriptive qualitative study with individual semistructured interviews conducted 2 years after the onset of COVID-19. Data were analysed using an inductive thematic approach. SETTING: Swedish primary healthcare units in rural and urban locations. PARTICIPANTS: 29 healthcare providers (6 registered nurses, 7 assistant nurses, 8 physicians and 8 managers) in Swedish primary healthcare. RESULTS: Data analysis yielded three overarching themes: (1) primary healthcare still affected by the pandemic; (2) primary healthcare changes made permanent; and (3) lessons learnt for handling future crises affecting primary healthcare. The participants experienced a high workload, even after the pandemic, and concluded that it would take years to catch up both mentally and workwise. Four lessons were learnt for future handling of crises that might affect primary healthcare: the importance of creating a cohesive primary healthcare management system to provide clarity regarding recommendations for how primary healthcare personnel should work, the need for management support at all levels, restricting and adapting the flow of information for primary healthcare and ascertaining the necessary resources if primary healthcare is to take on additional tasks. CONCLUSION: Two years after the onset of the COVID-19 pandemic, primary healthcare workers in Sweden experienced that their work was still affected by the pandemic. Our findings highlight the importance of ensuring sufficient recovery time and providing opportunities for reflection on the experiences of primary healthcare personnel. This also includes preparedness for managing the heavy workload and strained energy levels of healthcare workers in the aftermath of a crisis.

Retrospective record review in proactive patient safety work - identification of no-harm incidents.

BACKGROUND: In contrast to other safety critical industries, well-developed systems to monitor safety within the healthcare system remain limited. Retrospective record review is one way of identifying adverse events in healthcare. In proactive patient safety work, retrospective record review could be used to identify, analyze and gain information and knowledge about no-harm incidents and deficiencies in healthcare processes. The aim of the study was to evaluate retrospective record review for the detection and characterization of no-harm incidents, and compare findings with conventional incident-reporting systems. METHODS: A two-stage structured retrospective record review of no-harm incidents was performed on a random sample of 350 admissions at a Swedish orthopedic department. Results were compared with those found in one local, and four national incident-reporting systems. RESULTS: We identified 118 no-harm incidents in 91 (26.0%) of the 350 records by retrospective record review. Ninety-four (79.7%) no-harm incidents were classified as preventable. The five incident-reporting systems identified 16 no-harm incidents, of which ten were also found by retrospective record review. The most common no-harm incidents were related to drug therapy (n = 66), of which 87.9% were regarded as preventable. CONCLUSIONS: No-harm incidents are common and often preventable. Retrospective record review seems to be a valuable tool for identifying and characterizing no-harm incidents. Both harm and no-harm incidents can be identified in parallel during the same record review. By adding a retrospective record review of randomly selected records to conventional incident-reporting, health care providers can gain a clearer and broader picture of commonly occurring, no-harm incidents in order to improve patient safety.

Effects of Web-Based and Mobile Self-Care Support in Addition to Standard Care in Patients After Radical Prostatectomy: Randomized Controlled Trial.

BACKGROUND: Prostate cancer is a common form of cancer that is often treated with radical prostatectomy, which can leave patients with urinary incontinence and sexual dysfunction. Self-care (pelvic floor muscle exercises and physical activity) is recommended to reduce the side effects. As more and more men are living in the aftermath of treatment, effective rehabilitation support is warranted. Digital self-care support has the potential to improve patient outcomes, but it has rarely been evaluated longitudinally in randomized controlled trials. Therefore, we developed and evaluated the effects of digital self-care support (electronic Patient Activation in Treatment at Home [ePATH]) on prostate-specific symptoms. OBJECTIVE: This study aimed to investigate the effects of web-based and mobile self-care support on urinary continence, sexual function, and self-care, compared with standard care, at 1, 3, 6, and 12 months after radical prostatectomy. METHODS: A multicenter randomized controlled trial with 2 study arms was conducted, with the longitudinal effects of additional digital self-care support (ePATH) compared with those of standard care alone. ePATH was designed based on the self-determination theory to strengthen patients' activation in self-care through nurse-assisted individualized modules. Men planned for radical prostatectomy at 3 county hospitals in southern Sweden were included offline and randomly assigned to the intervention or control group. The effects of ePATH were evaluated for 1 year after surgery using self-assessed questionnaires. Linear mixed models and ordinal regression analyses were performed. RESULTS: This study included 170 men (85 in each group) from January 2018 to December 2019. The participants in the intervention and control groups did not differ in their demographic characteristics. In the intervention group, 64% (53/83) of the participants used ePATH, but the use declined over time. The linear mixed model showed no substantial differences between the groups in urinary continence (ß=-5.60; P=.09; 95% CI -12.15 to -0.96) or sexual function (ß=-.12; P=.97; 95% CI -7.05 to -6.81). Participants in the intervention and control groups did not differ in physical activity (odds ratio 1.16, 95% CI 0.71-1.89; P=.57) or pelvic floor muscle exercises (odds ratio 1.51, 95% CI 0.86-2.66; P=.15). CONCLUSIONS: ePATH did not affect postoperative side effects or self-care but reflected how this support may work in typical clinical conditions. To complement standard rehabilitation, digital self-care support must be adapted to the context and individual preferences for use and effect. TRIAL REGISTRATION: ISRCTN Registry ISRCTN18055968; https://www.isrctn.com/ISRCTN18055968. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/11625.