The Amager Project IV: suicidal behavior and aftercare: real world data (RWD) from a prospective observational project.

BACKGROUND: In an RCT study, OPAC (outreach, problem solving, adherence, continuity) approach to aftercare after suicide attempts had an effect. The present study used the OPAC method in a clinical setting on Amager Copenhagen to patients after suicide attempt (Group 1) and patients with suicide ideation (Group 2) in a real-world data (RWD) study. AIM: To study whether the OPAC method could provide real world evidence (RWE) for results from the RCT study and long-time prospects. METHOD: This RWD study included 506 patients and followed them for 5 years. Kaplan-Meyer showed 5 years results. Risk factors for 5 years were calculated. RESULTS: 206 males (mean age 37.9) and 300 females (mean age 35.2) participated. A decline in survival accelerated after 3 years. After a 2-year follow-up, Group 1 had an attempted suicide rate of 12,2% and Group 2 5,4%. After 5 years the numbers were 18% and 10%. There were 3 completed suicides. Risk factors were: earlier suicide attempts, one or both parents or they themselves were alcohol/drug abusers, and a poor social network. Group 1 showed the same result as the intervention group in our earlier RCT study. Group 2 did better. Both groups did better than the control group from our RCT study. CONCLUSION: The OPAC effect was translated into the daily clinic. Risk factors were previous suicide attempts, alcohol and drug abuse and poor social networks. More specific therapy is needed for some patients to prevent relapse. Focus on enhancing a sense of belongingness and/or treating substance abuse.

Prosody and schizophrenia. Objective acoustic measurements of monotonous and flat intonation in young Danish people with a schizophrenia diagnosis. A pilot study.

PURPOSE: Patients with schizophrenia have a flat and monotonous intonation. The purpose of the study was to find the variables of flat speech that differed in patients from those in healthy controls in Danish. MATERIALS AND METHODS: We compared drug-naïve schizophrenic patients 5 men, 13 women and 18 controls, aged 18-35 years, which had all grown up in Copenhagen speaking modern Danish standard (rigsdansk). We used two different tasks that lay different demands on the speaker to elicit spontaneous speech: a retelling of a film clip and telling a story from pictures in a book. A linguist used the computer program Praat to extract the phonetic linguistic parameters. RESULTS: We found different results for the two elicitation tasks (Task 1: a retelling of a film clip, task 2: telling a story from pictures in a book). There was higher intensity variation in task one in controls and higher pitch variation in task two in controls. We found a difference in intensity with higher intensity variation in the stresses in the controls in task one and fewer syllables between each stress in the controls. We also found higher F1 variation in task one and two in the patient group and higher F2 variation in the control group in both tasks. CONCLUSIONS: The results varied between patients and controls, but the demands also made a difference. Further research is needed to elucidate the possibilities of acoustic measures in diagnostics or linguistic treatment related to schizophrenia.

Exploring Patient Needs and Designing Concepts for Digitally Supported Health Solutions in Managing Type 2 Diabetes: Cocreation Study.

BACKGROUND: Self-management of the progressive disease type 2 diabetes mellitus (T2DM) becomes part of the daily life of patients starting from the time of diagnosis. However, despite the availability of technical innovations, the uptake of digital solutions remains low. One reason that has been reported is that digital solutions often focus purely on clinical factors that may not align with the patient's perspective. OBJECTIVE: The aim of this study was to develop digital solutions that address the needs of patients with T2DM, designed from the user's perspective. The goal was to address the patients' expressed real-world needs by having the users themselves choose the scope and format of the solutions. METHODS: Using participatory methods, we conducted 3 cocreation workshops in collaboration with the Danish Diabetes Association, with 20 persons with T2DM and 11 stakeholders across workshops: user experience designers, researchers, and diabetes experts including a diabetes nurse. The overall structure of the 3 workshops was aligned with the 4 phases of the double diamond: initially discovering and mapping out key experienced issues, followed by a workshop on thematic mapping and definition of key concepts, and succeeded by an exploration and development of 2 prototypes. Subsequently, high-fidelity interactive prototypes were refined as part of the delivery phase, in which 7 formative usability tests were conducted. RESULTS: The workshops mapped experiential topics over time from prediagnosis to the current state, resulting in a detailed exploration and understanding of 6 themes related to and based on the experiences of patients with T2DM: diabetes care, diabetes knowledge, glucose monitoring, diet, physical activity, and social aspects of diabetes. Two prototypes were developed by the participants to address some of their expressed needs over time related to the 6 themes: an activity-based continuous glucose monitoring app and a web-based guide to diabetes. Both prototypes emphasize periods of structured self-measurements of blood glucose to support evolving needs for self-exploration through distinct phases of learning, active use, and supporting use. Periods of low or intermittent use may thus not reflect a failure of design in a traditional sense but rather be a sign of evolving needs over time. CONCLUSIONS: Our results indicate that the needs of patients with T2DM differ between individuals and change over time. As a result, the suggested digitally supported empowering health prototypes can be personalized to support self-exploration, individual preference in long-term management, and changing needs over time. Despite individuals experiencing different journeys with diabetes, users perceive the self-measurement of blood glucose as a universally useful tool to empower everyday decision-making.

Clinical Markers of 6 Pre-dominant Coping Behaviors in Living With Parkinson Disease: A Convergent Mixed Methods Study.

People with Parkinson's disease (PwP) experience a variety of symptoms and fluctuations in these, which they have to cope with every day. In tailoring a person-centered treatment to PwP there is a lack of knowledge about the association between pre-dominant coping behaviors and clinical markers among PwP. To describe and compare specific clinical markers between 6 suggested coping behaviors. Thirty-four PwP, who previously had been classified into 6 different pre-dominant coping behaviors, were included in this mixed methods study. Six primary variables were included in the descriptive analysis; motor function (UPDRS-III), non-motor symptoms score (NMS-Quest), change in bradykinesia score, apathy score (LARS), personality traits (NEO-FFI), and cognitive status (evaluated by a neuropsychologist). The merged results of this mixed methods study indicate that clinical markers as apathy, burden of non-motor symptoms, cognitive impairments and personality traits, have the potential to impact the coping behavior in PwP. In a clinical setting the markers; NMS-burden, degree of apathy, cognition, and personality traits may indicate specific coping behavior. Three of the six suggested typologies of coping behaviors differed from the other groups when comparing descriptive data. In order to improve patient care and guide the development of person-centered therapies, each PwP should be approached based on those typologies.

Increased shoulder pain across an exercise session and subsequent shoulder exercise: a prospective cohort study.

BACKGROUND: Shoulder complaints are common and the recommended first-line treatment is exercise therapy. However, it remains unknown if increased shoulder pain after an exercise session is a barrier for subsequent exercise dose, particularly in people with high fear-avoidance beliefs. Such knowledge could indicate ways to optimise shoulder rehabilitation. The aim was to examine whether increased shoulder pain across an exercise session was associated with a lower subsequent exercise dose, and if high fear-avoidance beliefs exaggerated this association. METHODS: We conducted a prospective cohort study using data from a randomised controlled trial in Central Denmark Region 2017-2019. Participants were employees (n = 79) with shoulder complaints and high occupational shoulder exposures. The intervention was a home-based or partly supervised exercise programme lasting 2-3 months. Linear mixed models were used to examine the associations between change in shoulder pain and exercise dose (number of repetitions, progression level (1-3), resistance level (1-3), and time until next exercise session [days]). RESULTS: At baseline, the participants had a median pain intensity at rest of 2 on a numerical rating scale (0-10). For a 1-cm increase in pain on a visual analogue scale (0-10 cm) during an exercise session, the subsequent number of repetitions, progression level and resistance level were - 1.3 (95% confidence interval [CI] - 3.4 to 0.9), 0.0 (95% CI - 0.1 to 0.0) and - 0.0 (95% CI - 0.1 to 0.0), respectively. Likewise, the time until next exercise session was - 0.6 (95% CI - 2.4 to 1.3) days for a 1-cm increase. There were no interactions with fear-avoidance beliefs. CONCLUSION: Increased pain across an exercise session was not associated with subsequent exercise dose, regardless of fear-avoidance beliefs, among employees with shoulder complaints and high occupational shoulder exposures. TRIAL REGISTRATION: The trial was registered at Clinicaltrials.gov 19/05/2017 (ID: NCT03159910).

Wonder-inspired leadership: Cultivating ethical and phenomenon-led healthcare.

Three forms of leadership are frequently identified as prerequisites to the re-humanization of the healthcare system: 'authentic leadership', 'mindful leadership' and 'ethical leadership'. In different ways and to varying extents, these approaches all focus on person- or human-centred caring. In a phenomenological action research project at a Danish hospital, the nurses experienced and then described how developing a conscious sense of wonder enhanced their ability to hear, to get in resonance with the existential in their meetings with patients and relatives, and to respond ethically. This ability was fostered through so-called Wonder Labs in which the notion of 'phenomenon-led care' evolved, which called for 'slow thinking' and 'slow wondrous listening'. For the 10 nurses involved, it proved challenging to find the necessary serenity and space for this slow and wonder-based practice. This article critiques and examines, from a theoretical perspective, the kind of leadership that is needed to encourage this wonder-based approach to nursing, and it suggests a new type of leadership that is itself inspired by wonder and is guided by 10 tangible elements.

Screening of novel excipients for freeze-dried protein formulations.

The typical excipients used as bulking agents and lyoprotectants for freeze-drying are usually limited to only a few selected substances, such as sucrose and mannitol. Considering the sheer diversity amongst proteins, it is doubtful that this limited choice should, in every case, provide the best possible option in order to achieve the most stable product. In this work, a screening of 12 proteins with 64 excipients was conducted in order to increase the knowledge space of potential excipients. Three critical quality attributes (CQAs) of the freeze-dried products, namely the solid state, the cake appearance and the protein integrity based on changes in tryptophan fluorescence were investigated by high throughput X-ray powder diffraction, image analysis and intrinsic fluorescence spectroscopy, respectively. It was found, that in some cases the excipient had a dominating influence on the CQAs, whilst in other cases the CQAs were primarily protein dependent, or that the CQAs were dependent on the combination of both. In the course of this investigation, a general view of potentially relevant excipients, and their interplay with various proteins, was obtained, thereby furthermore paving the way for the use of novel freeze-drying excipients.

Identification of Pre-Dominant Coping Types in Patients with Parkinson's Disease: An Abductive Content Analysis of Video-Based Narratives.

BACKGROUND: People with Parkinson's disease suffer from a range of various symptoms. Altered movement patterns frequently represent the prevailing symptom experience and influence the everyday life of the affected persons. OBJECTIVE: This qualitative study explores how persons with Parkinson's disease experience everyday life with a complex symptom profile and how they manage the consequential challenges in their daily life, as well as the motivation and consequences of these coping behaviours. METHODS: Thirty-four patients with Parkinson's disease were interviewed as an integrated part of the method Video-based Narrative. The interviews were analysed by means of qualitative content analysis according to Graneheim & Lundman. RESULTS: The analysis identified six predominant coping types with different behavioural traits: The convincing behaviour, The economizing behaviour, The encapsulating behaviour, The evasive behaviour, The adaptable behaviour, and The dynamic behaviour. The strategies embedded in each of the six types are diverse, but all participants seek to maintain their integrity in different ways leading to the main motivation "To stay the same person". CONCLUSION: Healthcare professionals should be aware of the patients' various coping behaviour in order to offer a person-centred approach. Psychoeducational interventions to promote coping skills may be essential in incorporating disease-related changes in the conduct of everyday life with Parkinson's disease to maintain integrity.

Disrupted everyday life in the trajectory of low back pain: A longitudinal qualitative study of the cross-sectorial pathways of individuals with low back pain over time.

Background: Low back pain is a leading cause of disability and sick days worldwide. This type of pain has a fluctuating and recurrent nature, and affects all aspects of a person's life, with profound psychosocial consequences. Objectives: This study aims to explore the everyday life of individuals with low back pain over time and across various contexts. Design: A longitudinal Grounded Theory study with the concept, conduct of everyday life, as the theoretical framework. Settings: The study was conducted in Denmark, and participants were sampled from a regional spine centre in a hospital context. Participants: Twenty-seven individuals with low back pain referred to a hospital for assessment and treatment for herniated discs were sampled. Participants were divided equally between women and men 37-71 years old. Method: Participants were followed through interviews and participant observation for 6-18 months. They were interviewed at least twice, at the beginning and end of the study period. The interviews took place in participants' homes. Data consisted of transcribed interviews and field notes. Results: Two themes, "When 'support' systems become disrupters" and "Adapting to a new life", describe important elements of the participants' conduct of everyday life through a period of low back pain and the time after. The first theme explains how healthcare and sickness benefit systems play an existential role in the individual's life during a period of low back pain. These systems made extensive, often conflicting, demands on participants, which challenged their everyday lives. The systems and their diverse needs could take precedence over other concerns, challenging participants' social self-understanding. In the second theme, we identified three typical patterns of how participants adapt to living with a potential exacerbation of low back pain over time: 1) Resignation, 2) Balancing and 3) Ignoring. Conclusions: From the participants' perspectives, healthcare and sickness benefits systems are supportive, but they often disrupt everyday life due to extensive and conflicting demands. Individuals with low back pain must continually adapt to everyday life. Therefore, professionals should support a balanced pattern of adapting to life with recurrent and fluctuating low back pain.

The temporality of uncertainty in decision-making and treatment of severe brain injury.

The aim of the study is to investigate how time and uncertainties of clinical action and decision-making plays out in the practical work of early neurorehabilitation in order to present new analytical ways to understand the underlying logics and dynamic social processes that take place during professional treatment of patients with severe acquired brain injury. Drawing on ethnographic fieldwork in a Danish neuro-intensive step-down unit (NISU) specialising in early neurorehabilitation, we found that negotiation of futures takes place in the modern ICU in the present by strategically building upon past experiences. We have argued that the clinical programme therefore cannot be understood only from a "here and now perspective", since the early neurorehabilitation practice is embedded in overlapping temporalities of the past, the present, and desired futures. The study discusses the underlying logics-often hidden or unnoticed-that impact clinical practice of early neurorehabilitation, in what we have termed a logic of clinical reenactment, a logic of future negotiation and a logic of paradox.

"Does the Response to Morning Medication Predict the ADL-Level of the Day in Parkinson's Disease?"

BACKGROUND: Individuals with Parkinson's Disease (PD) have bradykinesia during mobility tasks in the morning before intake of dopaminergic treatment and have difficulties managing Activities of Daily Living (ADLs). Early morning off (EMO) refers to off-states in the morning where the severity of bradykinesia is increased and causes a decrease in mobility related to wearing off of effects of medication. Measurements from devices capable of continuously recording motor symptoms may provide insight into the patient's response to medication and possible impact on ADLs. OBJECTIVES: To test whether poor or slow response to medication in the morning predicts the overall ADL-level and to assess the association between change in bradykinesia score (BKS) and the risk of having disabilities within three selected ADL-items. METHODS: In this cross-sectional study, the sample consists of 34 patients with light to moderate PD. Data collection encompasses measurements from the Parkinson KinetiGraph, and the ADL-limitations are assessed by the Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part II. RESULTS: The association between UPDRS- II and BKS from the algorithm was -0.082 (p < 0.01), 95% CL:-0.113; -0.042). The individuals experienced disabilities in performing "Speech" (p=0.004) and "Doing hobbies" (p=0.038) when being slow or poor responders to dopaminergic therapy. The PD patients' L-dopa equivalent dose seems to be a strong predictor of the ADL-level in the morning. CONCLUSION: Slow response to the medication dosages in the morning is correlated with disabilities in the overall ADL-level in PD. The combination of PD-drugs and precise, timely dosages must be considered in the improvement of the ADL-level in PD patients.

Protein adsorption to poly(tetrafluoroethylene) membranes modified with grafted poly(acrylic acid) chains.

Protein adsorption to biomaterial surfaces is important for the function of such materials with anchorage-dependent cell adhesion requiring the presence of adsorbed proteins. The current study evaluated five solid surfaces with poly(acrylic acid) (PAA) grafted from the surface of a poly(tetrafluoroethylene) membrane with respect to the adsorption of serum albumin (SA), lactoferrin (Lf), and lysozyme (Lys) from a phosphate buffer and NaCl solution or water for specific combinations. With the use of x-ray photoelectron spectroscopy, the relative amounts and protein layer thickness were evaluated. SA adsorption was governed by ionic repulsive forces and hydrophobic interactions as evidenced from an increase in the protein adsorption at lower pH (6.5 compared to 7.4) and a correlation with surface coverage when water (pH 6.5) was used as the medium. The adsorption of Lf and Lys followed similar trends for all samples. In general, ionic attractive forces dominated and a strong correlation of increasing protein adsorption with the PAA chain length was evident. This study concluded that all surfaces appear suitable for use in biomaterial applications where tissue ingrowth is desired and that the enhanced protein adsorption in a medium with high ionic strength (e.g., biological fluid) correlates with the PAA chain length rather than the surface coverage.

A contribution to the ontology of the Fundamentals of Care framework from a wonder-based approach.

AIM AND OBJECTIVES: To critically discuss the ontological framework of Fundamentals of Care (FoC), as developed by Uhrenfeldt, et al. (2018), Journal of Clinical Nursing, 27, 3197-3204; to suggest theoretical improvements by taking a wonder-based approach; and to show how this approach can be applied in healthcare sectors. BACKGROUND: Based on a critical discussion of a discursive study on the ontology of FoC, studies in phenomenology of wonder and two action research projects involving "Wonder Labs," this article discusses whether the ontology and reflective practices behind FoC can be qualified further by an existential phenomenology of wonder and with practices of "Wonder Labs." DESIGN: This is a discursive study critically discussing Uhrenfeldt et al.'s primary focus on dyadic and relational openness and person-oriented attentiveness in a nurse-patient relationship. This is done by unfolding the phenomenology of wonder and wonder experiences at a hospice and a hospital, and by critically examining the psychologically influenced interpretation of Heidegger. CONCLUSION: The first attempts by Uhrenfeldt et al. to identify the philosophical roots and ontology of FoC by pointing to existential phenomenology and philosophy are acknowledged. However, in this article, we further elaborate this attempt by focusing on the phenomenology of wonder. We show that Heidegger speaking about "existential homecoming" referred to a philosophical practice focusing on the resonance with being, rather than on interpersonal and psychological relations. In conclusion, the article recognises the importance of integrating these two approaches described on the one hand as a person-oriented and lifeworld-led approach, and on the other hand as a being- and phenomenon-oriented approach to the nurse-patient relationship. RELEVANCE TO CLINICAL PRACTICE: To be open to the "musicality" of the being dimension, as the core values of FoC, a wonder-based approach to value clarifications and phenomenological dialogues is pivotal for the presence of openness, trust and attentiveness of the nurse-patient relationship. The practices of the "Wonder Lab" may be an approach for training nurses in hearing the call of this "ontological resonance."

Reducing shoulder complaints in employees with high occupational shoulder exposures: study protocol for a cluster-randomised controlled study (The Shoulder-Café Study).

BACKGROUND: In Denmark, exercise therapy in combination with work modification is the first-choice treatment for persons with shoulder complaints and high occupational shoulder exposures. To obtain this treatment they must visit several healthcare providers, which makes usual care fragmented and uncoordinated. Therefore, we developed a new intervention which unifies the expertise that is needed. The main hypotheses are that a group-based Shoulder-Café intervention will more effectively reduce (1) shoulder complaints and (2) occupational shoulder exposures than an individual-based Shoulder-Guidance intervention (active control - enhanced usual care). METHODS: A cluster-randomised trial is conducted including 120 employees with high occupational shoulder exposures. Companies (clusters) are randomised to either Shoulder-Café or Shoulder-Guidance with a 1:1 allocation ratio. Participants are 18-65 years old and have an Oxford Shoulder Score (OSS) ≤ 40. Both interventions include a home-based shoulder-exercise programme, assessment of shoulder exposures by technical measurements and self-report, and general information on how to reduce shoulder exposures. The Shoulder-Café course also includes three café meetings with physiotherapist-supervised exercises, clinical shoulder evaluation, education on shoulder anatomy, workplace-orientated counselling, and an opportunity for a workplace visit by a health and safety consultant. The primary outcomes are the OSS at 6-month follow-up (hypothesis I), and the mean number of min/day with the arm elevated > 60° shortly after the end of the intervention (hypothesis II). We will use a mixed-model analysis that allows for company clustering, and data will be analysed according to the intention-to-treat principle. DISCUSSION: Persons with shoulder complaints and high occupational shoulder exposures are an obvious target group for secondary prevention efforts. We developed the Shoulder-Café to reduce shoulder complaints and shoulder exposures while unifying the expertise that is needed to evaluate and treat shoulder complaints. If the intervention is effective, it would warrant widespread implementation. TRIAL REGISTRATION: Clinicaltrials.gov, ID: NCT03159910. Registered on 18 May 2017.

Lumbar Spine Fusion Patients' Use of an Internet Support Group: Mixed Methods Study.

BACKGROUND: Internet use within health care contexts offers the possibility to provide both health information and peer support. Internet Support Groups (ISGs) for patients may offer advantages, which are not found in face-to-face support. In patients undergoing lumbar spine fusion (LSF), ISGs could have a particular potential, as peer support on the web might bridge the decreased satisfaction with social life and social isolation found within these patients. ISGs might in this way contribute to increasing the functioning and overall health-related quality of life. However, LSF patients may generally belong to a group of citizens not prone to internet and online peer support. However, our knowledge of how LSF patients use ISGs is limited. OBJECTIVE: The aim of this study was to describe the characteristics of users of an ISG and thematically explore the content of ISG interactions in Danish patients undergoing instrumented LSF because of degenerative spine disorders. METHODS: Participants were recruited from a randomized controlled trial and included in a prospective cohort with a mixed methods design. Sociodemographic characteristics and information on psychological well-being (symptoms of anxiety and depression) were obtained at baseline and 1 to 5 weeks before surgery. Usage of the ISG was registered from baseline until 3 months after surgery. All posts and comments were collected, and content analysis was performed. RESULTS: A total of 48 participants comprised the study population, with a mean age of 53 years (range 29-77). Of the participants, 54% (26/48) were female, 85% (41/48) were cohabitating, 69% (33/48) were unemployed, and the majority (69% [33/48]) had secondary education. Approximately one-third of the participants had symptoms of depression (35%, 17/48) and anxiety (29%, 14/48). Overall, 90% (43/48) of the participants accessed the ISG. No correlations were found between sociodemographic characteristics and access to the ISG. Women were more prone to be active users, contributing with posts (P=.04). Finally, active users contributing with posts or comments had viewed more pages, whereas passive users, users without posts or comments, had more interactions with the ISG (P<.001). The ISG contained 180 conversation threads, generating 354 comments. The 180 conversation threads in the ISG were constituted by 671 independent dialogue sequences. On the basis of those 671 dialogue sequences, 7 thematic categories emerged. CONCLUSIONS: Sociodemographic characteristics were not predictors of ISG use in this study, and active use was found to be gender dependent. Content of interactions on the ISG emerged within 7 thematic categories and focused on social recognition, experience of pain or use of pain medication, experience of physical activity or physical rehabilitation, expression of psychosocial well-being, advising on and exploring the ISG, and employment, which seemed to correspond well with the prevalent occurrence of symptoms of anxiety and depression.

Exploring the chemical space for freeze-drying excipients.

Commonly, a limited number of generally accepted bulking agents and lyoprotectants are used for freeze-drying; predominantly mannitol, glycine, sucrose and trehalose. The purpose of this study was to combine a theoretical approach using molecular descriptors with a large scale experimental screening to evaluate the suitability of a broad range of excipients for freeze-drying. A large selection of sugars, polyols and amino acids was characterized by modulated differential scanning calorimetry (mDSC) and X-ray powder diffraction (XRPD) after well-plate based freeze-drying. The calculated molecular descriptors were investigated with both hierarchical cluster analysis and principal component analysis. A clear clustering of the excipients according to the size-related and weight-related descriptors was observed; however other relevant descriptors could also be identified. From a practical perspective, a trend was observed with regard to a higher likelihood for amorphisation and a higher glass transition temperature of the maximally freeze-concentrated solution with increasing molecular size. A translation of the molecular descriptors on pharmaceutical performance was more successful for lyoprotectants than for bulking agents. Additionally, in the course of the experimental screening, several new potential bulking agents and lyoprotectants were identified.

A web-based platform to accommodate symptoms of anxiety and depression by featuring social interaction and animated information in patients undergoing lumbar spine fusion: a randomized clinical trial.

BACKGROUND: Approximately one-third of patients undergoing spine surgery have symptoms of anxiety and depression that correlate with pain, disability, and lower health-related quality of life. The use of web-based informative strategies before surgery and principles from cognitive behavioral therapy, have been applied in other patient groups, facilitating mobility and encouraging beneficial coping behavior. PURPOSE: To examine the effect of a web-based Spine Platform featuring Interaction and Information by Animation (w-SPIINA) on symptoms of anxiety and depression, pain, disability, and health-related quality of life. STUDY DESIGN: A single-center, two-arm, randomized controlled trial PATIENT SAMPLE: One hundred fourteen consecutive patients scheduled for instrumented lumbar spine fusion due to degenerative disc disease or spondylolisthesis. OUTCOME MEASURES: Primary outcome was the change in self-reported Hospital Anxiety and Depression Scale (HADS) scores from baseline to 3-month follow-up. Secondary outcomes were change in HADS 1-day before surgery 2days and 6 months after and changes in self-reported disability measured on the Oswestry disability index (ODI), quality of life (EQ-5D-5L questionnaire), and the low back pain rating scale (LBPRS) 2days and 3 and 6 months after surgery. METHOD: Patients were randomized to either a control group receiving a standard information regimen or an intervention group gaining access to w-SPIINA in addition to the standard regimen. The independent charity Helsefonden contributed $45,000, the Health Research Fund of the Regional Hospital Central Jutland contributed $10,000, and the Toyota foundation contributed $10,000 to remunerate a dedicated investigator. The authors have no conflict of interest to declare. RESULTS: There was no statistically significant difference within the w-SPIINA group and the control group regarding changes in HADS at 3-month follow-up (p≥.37). Approximately 40% reached minimum clinically important difference (MCID) in the w-SPIINA group on the HADS at 3 months. In the control group 50% reached MCID on anxiety subscale and 35% on the depression subscale at 3 months. No statistically significant differences were found between groups with regard to the overall outcomes at any of the predefined time points. CONCLUSION: Providing patients with access to w-SPIINA in addition to a standard information regimen had no additional effect on HADS and patient-reported outcomes1day before, 2days, 3 or 6 months after surgery. However, a high compliance and degree of interaction with w-SPIINA indicates that this mode of web-based support could be applicable in this group of patients.

Coping with the unfamiliar: How do children cope with hospitalization in relation to acute and/or critical illness? A qualitative metasynthesis.

The aim of this study was to identify and describe how young children cope with hospitalization in relation to acute and/or critical illness. The study is a qualitative metasynthesis inspired by the approach described by Sandelowski and Barroso. Based on an exhaustive literature search, six studies were included. Data were analyzed through a taxonomic analysis. The findings revealed that the hospitalized children face a variety of challenges during admission to the hospital due to acute and/or critical illness. The main challenge was that hospitalized children strive to cope with different aspects of 'the unfamiliar' that emerge in their illness treatment and hospital stay. The unfamiliar refers to unknown experiences on a physical, emotional, and relational level. Subsequently, children cope with the unfamiliar by striving to convert the hospital stay into something more similar to everyday life, using strategies to secure basic needs and constructing familiarity in the hospital stay. The consequences of the children's coping behavior are discussed and how children strive to keep their integrity intact during illness and hospitalization are revealed.

Does Information Become Actual Knowledge in Surgical Spine Patients? A Qualitative Study.

BACKGROUND: It is seldom questioned, if information delivered (to a patient) actually produces knowledge. There is a lack of understanding of how patients in general, surgical patients in particular, perceive, process, and translate clinical information in their everyday lives. The objective of this study was to elucidate how patients undergoing spinal fusion surgery manage and assimilate information provided by clinicians and how they adapt and embrace this information pre- and postsurgery. METHODS: The study employed qualitative methods of ethnographic observation and semistructured interview with a total of 14 individuals, that is, spinal fusion patients (n = 6) and clinicians (n = 8) over a 4-month period in 2014. RESULTS: The results highlight that in the course of treatment, patients embrace or reject information on the basis of their previous experience, expectations, and confidence in their own ability. Overall, patients adjusting to everyday life after spinal fusion surgery used 4 strategies of information processing about their individual life situation. Patients do not use just one of these strategies but may use a number of strategies depending on the situation. Such production of knowledge is pivotal to the behavior of patients through their treatment trajectory. CONCLUSIONS: This study points to the challenges of supporting patients to assimilate information and affect health-related behaviors, recognizing that knowledge and behavior change are emergent processes in patients and not a linear outcome of information.

Fluorophore labeling of a cell-penetrating peptide significantly alters the mode and degree of biomembrane interaction.

The demand for highly efficient macromolecular drugs, used in the treatment of many severe diseases, is continuously increasing. However, the hydrophilic character and large molecular size of these drugs significantly limit their ability to permeate across cellular membranes and thus impede the drugs in reaching their target sites in the body. Cell-penetrating peptides (CPP) have gained attention as promising drug excipients, since they can facilitate drug permeation across cell membranes constituting a major biological barrier. Fluorophores are frequently covalently conjugated to CPPs to improve detection, however, the ensuing change in physico-chemical properties of the CPPs may alter their biological properties. With complementary biophysical techniques, we show that the mode of biomembrane interaction may change considerably upon labeling of the CPP penetratin (PEN) with a fluorophore. Fluorophore-PEN conjugates display altered modes of membrane interaction with increased insertion into the core of model cell membranes thereby exerting membrane-thinning effects. This is in contrast to PEN, which localizes along the head groups of the lipid bilayer, without affecting the thickness of the lipid tails. Particularly high membrane disturbance is observed for the two most hydrophobic PEN conjugates; rhodamine B or 1-pyrene butyric acid, as compared to the four other tested fluorophore-PEN conjugates.