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Sund-Levander, Märtha
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Publications (10 of 55) Show all publications
Edvardsson, M., Sund-Levander, M., Milberg, A., Wressle, E., Marcusson, J. & Grodzinsky, E. (2018). Differences in levels of albumin, ALT, AST, gamma-GT and creatinine in frail, moderately healthy and healthy elderly individuals. Clinical Chemistry and Laboratory Medicine, 56(3), 471-478
Open this publication in new window or tab >>Differences in levels of albumin, ALT, AST, gamma-GT and creatinine in frail, moderately healthy and healthy elderly individuals
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2018 (English)In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 56, no 3, p. 471-478Article in journal (Refereed) Published
Abstract [en]

Background: Reference intervals are widely used as decision tools, providing the physician with information about whether the analyte values indicate ongoing disease process. Reference intervals are generally based on individuals without diagnosed diseases or use of medication, which often excludes elderly. The aim of the study was to assess levels of albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine and gamma-glutamyl transferase (gamma-GT) in frail, moderately healthy and healthy elderly indivuduals. Methods: Blood samples were collected from individuals amp;gt; 80 years old, nursing home residents, in the Elderly in Linkoping Screening Assessment and Nordic Reference Interval Project, a total of 569 individuals. They were divided into three cohorts: frail, moderately healthy and healthy, depending on cognitive and physical function. Albumin, ALT, AST, creatinine and gamma-GT were analyzed using routine methods. Results: Linear regression predicted factors for 34% of the variance in albumin were activities of daily living (ADL), gender, stroke and cancer. ADLs, gender and weight explained 15% of changes in ALT. For AST levels, ADLs, cancer and analgesics explained 5% of changes. Kidney disease, gender, Mini Mental State Examination (MMSE) and chronic obstructive pulmonary disease explained 25% of the variation in creatinine levels and MMSE explained three per cent of gamma-GT variation. Conclusions: Because a group of people are at the same age, they should not be assessed the same way. To interpret results of laboratory tests in elderly is a complex task, where reference intervals are one part, but far from the only one, to take into consideration.

Place, publisher, year, edition, pages
WALTER DE GRUYTER GMBH, 2018
Keywords
aging; analyte; clinical interpretation; frail; reference interval
National Category
Clinical Laboratory Medicine
Identifiers
urn:nbn:se:liu:diva-145114 (URN)10.1515/cclm-2017-0311 (DOI)000423681100022 ()28988219 (PubMedID)
Note

Funding Agencies|Landstinget i Ostergotland Sverige [LIO-359661]

Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-03-06
Vackerberg, N., Sund-Levander, M. & Thor, J. (2016). What Is Best for Esther? Building Improvement Coaching Capacity With and for Users in Health and Social Care-A Case Study. Quality Management in Health Care, 25(1), 53-60
Open this publication in new window or tab >>What Is Best for Esther? Building Improvement Coaching Capacity With and for Users in Health and Social Care-A Case Study
2016 (English)In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 25, no 1, p. 53-60Article in journal (Refereed) Published
Abstract [en]

While coaching and customer involvement can enhance the improvement of health and social care, many organizations struggle to develop their improvement capability; it is unclear how best to accomplish this. We examined one attempt at training improvement coaches. The program, set in the Esther Network for integrated care in rural Jonkoping County, Sweden, included eight 1-day sessions spanning 7 months in 2011. A senior citizen joined the faculty in all training sessions. Aiming to discern which elements in the program were essential for assuming the role of improvement coach, we used a case-study design with a qualitative approach. Our focus group interviews included 17 informants: 11 coaches, 3 faculty members, and 3 senior citizens. We performed manifest content analysis of the interview data. Creating will, ideas, execution, and sustainability emerged as crucial elements. These elements were promoted by customer focusembodied by the senior citizen trainershared values and a solution-focused approach, by the supportive coach network and by participants expanded systems understanding. These elements emerged as more important than specific improvement tools and are worth considering also elsewhere when seeking to develop improvement capability in health and social care organizations.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2016
Keywords
coaching; community health services; community participation; health services for the aged; quality improvement
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127593 (URN)10.1097/QMH.0000000000000084 (DOI)000373535000008 ()26783868 (PubMedID)
Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2017-11-30
Grodzinsky, E. & Sund-Levander, M. (2015). Assessment of Fever: Physiology, Immunology and Measurement in Clinical Practice (1ed.). Gleerups Utbildning AB
Open this publication in new window or tab >>Assessment of Fever: Physiology, Immunology and Measurement in Clinical Practice
2015 (English)Book (Other academic)
Abstract [en]

When we say that someone has a fever, what do we really mean? Most people only take their temperature when they have a fever, and with good reason: fever is part of a larger response in the body.

Assessment of Fever, a problem-based learning (PBL) textbook, uses inter-professional discussions of scenarios from clinical practice to examine the question of body temperature. The authors start by examining the historical perspective and go on to consider technical measurement accuracy and thermoregulation from a physiological and immunological perspective. They address evaluations of body temperature and inflammatory activity in various conditions. They end by discussing how evidence-based knowledge can inform clinical practice, looking at different scenarios in the shape of case histories and realistic situations from clinical practice. These clinical scenarios are pertinent both in an inter-professional perspective in clinical practice and in the advanced education of health-care professionals, research scientists, and technicians. Each chapter concludes with a number of reflections and additional questions that the reader will be able to answer using the material presented in the book.

Place, publisher, year, edition, pages
Gleerups Utbildning AB, 2015. p. 162 Edition: 1
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Sciences
Identifiers
urn:nbn:se:liu:diva-118351 (URN)978-91-406-8696-1 (ISBN)
Available from: 2015-05-27 Created: 2015-05-27 Last updated: 2015-08-31Bibliographically approved
Edvardsson, M., Sund-Levander, M., Ernerudh, J., Theodorsson, E. & Grodzinsky, E. (2015). Clinical use of conventional reference intervals in the frail elderly. Journal of Evaluation In Clinical Practice, 21(2), 229-235
Open this publication in new window or tab >>Clinical use of conventional reference intervals in the frail elderly
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2015 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 2, p. 229-235Article in journal (Refereed) Published
Abstract [en]

Rationale, aims and objectives

Reference intervals provided by the laboratory are commonly established by measuring samples from apparently healthy subjects in the ages 18–65 years, excluding elderly individuals with chronic diseases and medication. The aim of our study was to establish whether current reference intervals for immune parameters and chemical biomarkers are valid for older individuals including those with chronic diseases, so-called frail elderly.

Methods

Data from our cohort of 138 non-infected nursing home residents (NHR), mean age 86.8 years, range 80–98, were compared with raw data, as basis for the development of reference intervals, obtained from reference populations, like blood donors (IgA, IgG, IgM, C3 and C4) and from the Nordic Reference Interval Project (NORIP) (alanine aminotransferase, albumin, aspartate aminotransferase, creatinine, gamma-glutamyl transferase, lactate dehydrogenase, phosphate, sodium and urea). Immune parameters were measured by nephelometry and in NORIP the measurements were performed by means of different routine methods, in more than 100 laboratories.

Results

Only nine individuals (7%) of NHR were found to be free from chronic disease. C3, C4 (P < 0.001) and IgG levels (P < 0.05) were higher, while IgM levels (P < 0.001) were lower in NHR compared with reference blood donors. Levels of alanine aminotransferase, phosphate (P < 0.001), albumin (P < 0.05) and sodium (P < 0.01) were lower while creatinine and urea levels were higher (P < 0.001) in NHR compared with NORIP subjects.

Conclusion

Comparing laboratory results from elderly people with conventional reference intervals can be misleading or even dangerous, as normal conditions may appear pathological, or vice versa and thus lead to unnecessary or even harmful treatment.

Keywords
ageing; biomarker; clinical practice; nursing home resident
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-117172 (URN)10.1111/jep.12294 (DOI)000351871200009 ()25494854 (PubMedID)
Available from: 2015-04-21 Created: 2015-04-21 Last updated: 2018-03-06
Veronese, N., Cereda, E., Solmi, M., Fowler, S., Manzato, E., Maggi, S., . . . Correll, C. (2015). Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects. Obesity Reviews, 16(11), 1001-1015
Open this publication in new window or tab >>Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects
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2015 (English)In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 16, no 11, p. 1001-1015Article, review/survey (Refereed) Published
Abstract [en]

Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5–24.9, 25–29.9, ≥30 kg/m2), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI = 1.26–1.58) for underweight, 0.85 (95% CI = 0.73–0.99) for overweight and 0.74 (95% CI = 0.57–0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR = 1.65 [95% CI = 1.13–2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
Body mass index;elderly;mortality;nursing home
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-121461 (URN)10.1111/obr.12309 (DOI)000363424300007 ()26252230 (PubMedID)
Note

Funding agencies: Baxter; Abbott; Fresenius-Kabi; Pfizeer; Nestle; Sanofi; Novo Nordisk; Boehringer Ingelheim; Merck; BMS; Feinstein Institute for Medical Research; Janssen/JJ; National Institute of Mental Health (NIMH); National Alliance for Research in Schizophrenia and 

Available from: 2015-09-21 Created: 2015-09-21 Last updated: 2018-12-03Bibliographically approved
Allemann, H. & Sund-Levander, M. (2015). Nurses' actions in response to nursing assistants' observations of signs and symptoms of infections among nursing home residents. Nursing Open, 2(3), 97-104
Open this publication in new window or tab >>Nurses' actions in response to nursing assistants' observations of signs and symptoms of infections among nursing home residents
2015 (English)In: Nursing Open, ISSN 2054-1058, Vol. 2, no 3, p. 97-104Article in journal (Refereed) Published
Abstract [en]

Aims

To describe what nurses do during episodes of suspected infection in elderly nursing home residents and if these actions are linked to who is initiating an episode and whether the episode is considered an infection or not.

Design

Prospective descriptive study. Data were collected in 2008–2010.

Methods

Summarized and categorized documentation by nursing assistants and nurses was used for summative content analysis.

Results

Nurses' actions seem to be related to who initiated the episode and if the episodes are categorized as ‘non-infection’, ‘possible infection’ or ‘infection’. Actions could be ‘observation’, ‘screenings’, ‘engaged in waiting’, ‘follow-ups’, ‘nurse-prescribed actions’, ‘diagnosing’, ‘contacting the physician’, ‘carrying out an action prescribed by the physician’, ‘contacting an ambulance or arranging an emergency visit to the hospital’ and ‘prescribing screening’. As NAs often initiate episodes of suspected infection by observing changed conditions, it seems important to include the NA in the decision-making process as these observations could detect possible early signs and symptoms of infections.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
Documentation; nursing assistants; summative content analysis
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-123974 (URN)10.1002/nop2.22 (DOI)
Available from: 2016-01-15 Created: 2016-01-15 Last updated: 2017-05-02Bibliographically approved
Tingström, P., Milberg, A., Rodhe, N., Ernerudh, J., Grodzinsky, E. & Sund-Levander, M. (2015). Nursing assistants: "He seems to be ill" - a reason for nurses to take action: validation of the Early Detection Scale of Infection (EDIS). BMC Geriatrics, 15(122)
Open this publication in new window or tab >>Nursing assistants: "He seems to be ill" - a reason for nurses to take action: validation of the Early Detection Scale of Infection (EDIS)
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2015 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, no 122Article in journal (Refereed) Published
Abstract [en]

Background: Signs and symptoms of infection in frail elderly are atypical, causing delay in diagnosis and treatment. To improve communication between healthcare staff of signs and symptoms of infection we developed an instrument, using qualitative data from observations by nursing assistants when they suspected infection. The aim of this study was to assess the validity of nursing assistants observations by developing and testing the instrument for early detection of infection in elderly nursing home residents. Methods: The early detection of infection (EDIS) instrument was based on data from focus interviews with nursing assistants. Over one year the nursing assistants used EDIS to document episodes of suspected early signs and symptoms of infection in 204 nursing home residents. Two physicians classified documented episodes as "no infection", "possible infection", and "infection". The content validity of the 13 items of the EDIS was established to explore the relationships between the items. The construct validity was used to explore the relationship between the items and the presence or absence of infection. The predictive value of the developed model was evaluated by the percentage of correct classifications of the observed cases. Generalized linear model (ordinal multinomial distribution and logit link) was used. Results: Of the 388 events of suspected infection, 20 % were assessed as no infection, 31 % as possible infection and 49 % as infection. Content validity analysis showed that 12/13 of the items correlated significantly with at least one other statement. The range in number of significant inter-correlations was from 0 ("pain") to 8 ("general signs and symptoms of illness"). The construct validity showed that the items "temperature", "respiratory symptoms" and "general signs and symptoms of illness" were significantly related to "infection", and these were also selected in the model-building. These items predicted correct alternative responses in 61 % of the cases. Conclusion: The validation of EDIS suggests that the observation of "general signs and symptoms of illness", made by nursing assistants should be taken seriously in detecting early infection in frail elderly. Also, the statement "He/She is not as usual" should lead to follow-up.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2015
Keywords
Nursing home residents; Clinical assessment; Instrument validation; Instrument construction
National Category
Clinical Medicine Sociology
Identifiers
urn:nbn:se:liu:diva-122527 (URN)10.1186/s12877-015-0114-0 (DOI)000362866800002 ()26459627 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden; Futurum/The Academy for Health and Care, Jonkoping County, Sweden

Available from: 2015-11-09 Created: 2015-11-06 Last updated: 2017-12-01
Sund-Levander, M. & Grodzinsky, E. (2015). The Challenge of Infections in Frail Elderly: The Story of Mr. Nilsson. Clinical Medical Reviews and Case Reports, 2(9)
Open this publication in new window or tab >>The Challenge of Infections in Frail Elderly: The Story of Mr. Nilsson
2015 (English)In: Clinical Medical Reviews and Case Reports, ISSN 2378-3656, Vol. 2, no 9Article in journal (Refereed) Published
Abstract [en]

Signs and symptoms of infection in Nursing Home Residents (NHR) are often atypical with a lack of specific ones, causing a delay in diagnosis and treatment. The complexity of detecting infections in NHR can be explained by difficulties in understanding and interpreting non-specific signs and symptoms and co-existing chronic diseases that blur the clinical picture. The case of Mr. Nilsson illustrates the process from the first signs and symptoms of infection to diagnosis in an elderly person with severe cognitive decline and physical impairment. What we can learn from this case is to reflect on changed behavior from habitual status and/or non-specific symptoms as possible suspected infection, and to consider a rise from individual baseline temperature, so called DiffTemp™, instead of traditional decided cut-off values for fever.

Keywords
Assessment, Fever, Infection, Interleukin, Nursing home resident
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-123975 (URN)10.23937/2378-3656/1410058 (DOI)
Available from: 2016-01-15 Created: 2016-01-15 Last updated: 2019-01-09Bibliographically approved
Sund-Levander, M. & Grodzinsky, E. (2013). Assessment of body temperature measurement options. British Journal of Nursing, 22(16), 942-950
Open this publication in new window or tab >>Assessment of body temperature measurement options
2013 (English)In: British Journal of Nursing, ISSN 0966-0461, E-ISSN 2052-2819, Vol. 22, no 16, p. 942-950Article in journal (Refereed) Published
Abstract [en]

Assessment of body temperature is important for decisions in nursing care, medical diagnosis, treatment and the need of laboratory tests. The definition of normal body temperature as 37°C was established in the middle of the 19th century. Since then the technical design and the accuracy of thermometers has been much improved. Knowledge of physical influence on the individual body temperature, such as thermoregulation and hormones, are still not taken into consideration in body temperature assessment. It is time for a change; the unadjusted mode should be used, without adjusting to another site and the same site of measurement should be used as far as possible. Peripheral sites, such as the axillary and the forehead site, are not recommended as an assessment of core body temperature in adults. Frail elderly individuals might have a low normal body temperature and therefore be at risk of being assessed as non-febrile. As the ear site is close to the hypothalamus and quickly responds to changes in the set point temperature, it is a preferable and recommendable site for measurement of body temperature.

Place, publisher, year, edition, pages
London: MA Healthcare Ltd, 2013
Keywords
Axillary, Ear, Oral, Rectal, Evidence-based, Measurement
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-98138 (URN)24037397 (PubMedID)
Available from: 2013-09-30 Created: 2013-09-30 Last updated: 2017-12-06Bibliographically approved
Sund-Levander, M. & Tingström, P. (2013). Clinical decision-making process for early nonspecific signs of infection in institutionalised elderly persons: experience of nursing assistants. Scandinavian Journal of Caring Sciences, 27(1), 27-35
Open this publication in new window or tab >>Clinical decision-making process for early nonspecific signs of infection in institutionalised elderly persons: experience of nursing assistants
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 1, p. 27-35Article in journal (Refereed) Published
Abstract [en]

Aim: To illuminate nursing assistants experiences of the clinical decision-making process when they suspect that a resident has an infection and how their process relates to other professions.

Background: The assessment of possible infection in elderly individuals is difficult and contributes to a delayed diagnosis and treatment, worsening the goal of good care. Recently we explored that nursing assistants have a keen observational ability to detect early signs and symptoms that might help to confirm suspected infections early on. To our knowledge there are no published papers exploring how nursing assistants take part in the clinical decision-making process.

Design: Explorative, qualitative study.

Setting: Community care for elderly people.

Participants: Twenty-one nursing assistants, 2261years.

Methods: Focus groups with verbatim transcription. The interviews were subjected to qualitative content analysis for manifest and latent content with no preconceived categories.

Findings: The findings are described as a decision-making model consisting of assessing why a resident feels unwell, divided into recognition and formulation and strategies for gathering and evaluating information, influenced by personal experiences and preconceptions and external support system and, secondly, as taking action, consisting of reason for choice of action and action, influenced by feedback from the nurse and physician.

Conclusion: Nursing assistants assessment is based on knowing the resident, personal experiences and ideas about ageing. Nurses and physicians response to the nursing assistants observations had a great impact on the latters further action. A true inter-professional partnership in the clinical decision-making process would enhance the possibility to detect suspected infection early on, and thereby minimize the risk of delayed diagnosis and treatment and hence unnecessary suffering for the individual.

Relevance to clinical practice: In order to improve the clinical evaluation of the individual, and thereby optimise patient safety, it is important to involve nursing assistants in the decision-making process.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2013
Keywords
decision-making process, elderly people, infection and nonspecific signs
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90195 (URN)10.1111/j.1471-6712.2012.00994.x (DOI)000314819900005 ()22536887 (PubMedID)
Available from: 2013-04-03 Created: 2013-03-21 Last updated: 2017-12-06Bibliographically approved
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