Background Amniotomy is a commonly used labour intervention with uncertain evidence. In a recent Norwegian study, amniotomy was identified as an unrecognized risk factor for severe perineal trauma (SPT), however, the sample size was small. The aim of the present study was therefore, to investigate whether amniotomy is a risk factor for SPT, and to examine whether the timing of performing amniotomy affects the occurrence of SPT.

Methods This nationwide register-based study included 477 321 women who gave birth in 2014–2020. Data were collected from the Swedish Pregnancy Register. Simple and multiple binary logistic regression analyses was used to investigate the association between amniotomy and SPT, adjusted for other risk factors.

Results A significant association between amniotomy and SPT was found in the simple logistic regression for both nulliparous [OR 1.33; 95% CI, 1.28-1.38] and multiparous women [OR 1.12; 95% CI, 1.03-1.22]. However, this association did not remain in the multiple logistic regression in neither nulliparous [OR 0.96; 95% CI, 0.87-1.07] nor multiparous women [OR 0.83; 95% CI, 0.67-1.03].  An increased duration between amniotomy and birth decreased the odds for SPT in nulliparous women (OR 0.97; 95% CI, 0.96-0.98).

Conclusions Performing amniotomy near the birth in nulliparous women entailed an increased risk for SPT, indicating the importance of a controlled and slow birth of the baby, to prevent SPT.

Potential impact This study adds to the body of knowledge of amniotomy and SPT. Awareness of risk factors for SPT is essential to improve obstetric management for women giving birth.

Ethics and conflicts of interest The study followed the principles of the Declaration of Helsinki (World Medical Association, 2018). Ethical approvals were given by the Swedish Ethical Review Authority (No. 2019–03626, 2020–04657 and 2023-04074-02).

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.

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 [beta -2.32, P .39; CI -7.64-3.00]. Baseline patient activation [beta 0.65, P < .001; CI 0.40-0.91] and depression [beta -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.

Background: Patients diagnosed with colorectal cancer follow standardized care pathways with diagnostic procedures and tailored treatment to ensure high-quality surgical care. The focus is primarily on surgical procedures and outcomes, and patients and healthcare professionals describe shortcomings in individual support and a lack of opportunities for participation.

Aims and Objectives: To describe patient experiences within standardized care pathways for colorectal cancer.

Methods: A qualitative descriptive design was used. The study was conducted at a surgery unit in southern Sweden. Convenience sampling was used and included sixteen patients. Data were collected using in-depth semi-structured interviews and analysed using qualitative conventional content analysis.

Results: Three themes emerged in the analysis: Travelling along the colorectal cancer care pathway, bearing the mark of the disease, and telling one’s story. According to the patients’ narratives, interacting and continuous relationships with healthcare professionals were highlighted as important, feelings such as loneliness and the need for inclusion played a significant role to achieve participation.

Conclusion: There is a discrepancy between the intentions of standardized care pathways and the patients experience within. Despite having access to healthcare professionals during standardized care pathways, patients may still experience feelings of loneliness and exclusion. Continuous contact with a specialist/contact nurse is seen as crucial to facilitate individual support and active participation. These insights underscore the importance of the role of specialist nurses in providing person-centered care within standardized care pathways, in bridging the gaps between clinical practice and patient expectations.

IntroductionUmbilical 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 methodsA 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.ResultsAmniotomy 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.ConclusionsUCP 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. This is the largest study examining the incidence of umbilical cord prolapse (UCP) and its risk factors in labors when an amniotomy is used and those with a spontaneous rupture of membranes. The incidence of UCP was similar for both labors with an amniotomy and those with a spontaneous rupture of membranes. This study confirms previously recognized risk factors for UCP and identifies some differences in risk factors between labors with amniotomy and those with a spontaneous rupture of membranes.image

Background: The growing number of older adults worldwide coupled with chronic disease challenges already strained healthcare systems. Healthcare and social care is obliged to coordinate care and support upon discharge. In addition, individuals have a legal right and willingness to participate in the planning for support. Despite efforts to make healthcare person-centered and improve the interaction between different healthcare providers in clinical practice, previous research indicates that healthcare systems remain fragmented, having poor coordination when delivering care.

Aim: To describe older adults' experiences of being discharged from in-patient care to home.

Methods: This study had a qualitative descriptive design, enabling straight descriptions of older adults' experiences of being discharged from in-patient care to home. Individual semi-structured interviews were conducted with 17 older adults (aged 65 years, or older) living in the south of Sweden, with chronic diseases and in need of coordinated care transitions. Data were analyzed using inductive qualitative content analysis.

Results: The analysis yielded four generic categories and the main category “Being the main character but not always involved in one's own care transition”. This indicates that older adults are not always involved in the planning and decision-making regarding their care transition leading to a 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 findings are significant in the context of person-centered care, which emphasizes the importance of tailoring healthcare services to the individual's unique needs and preferences.

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.

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.

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. (c) 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

PurposeAt the outbreak of the COVID-19 pandemic, health care was at the centre of the crisis. New demands made existing organizational practices and services obsolete. Primary health care had a great deal of responsibility for COVID-19-related care. The pandemic demanded effective leadership to manage the new difficulties. This paper aims to explore experiences and perceptions of managers in primary health care in relation to their efforts to manage the COVID-19 crisis in their everyday work. Design/methodology/approachThe authors used a qualitative approach based on 14 semi-structured interviews with managers in primary health care from four regions in Sweden. The interviews were conducted during September to December 2020. Data were analysed using conventional qualitative content analysis. FindingsData analysis yielded three categories: lonely in decision-making; stretched to the limit; and proud to have coped. The participants felt lonely in their decision-making, and they were stretched to the limit of their own and the organization's capacity. The psychosocial working conditions in primary care worsened considerably during the pandemic because demands on leaders increased while their ability to control the work situation decreased. However, they also expressed pride that they and their employees had managed the situation by being flexible and having a common focus. Originality/valueLooking ahead and using lessons learnt, and apart from making wise decisions under pressure, an important implication for primary health-care leaders is to not underestimate the power of acknowledging the virtues of humanity and justice during a crisis. Continuing professional education for leaders focusing on crisis leadership could help prepare leaders for future crises.