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Orwelius, Lotti
Publications (10 of 27) Show all publications
Walther, S., Orwelius, L., Kristensson, M. & Sjöberg, F. (2019). Influence of income and education on outcomes of intensive care in a healthcare system with full universal health insurance - a nationwide analysis of individual-level data. Paper presented at ESICMs LIVES 2019, Berlin 28 September-2 October. Intensive Care Medicine Experimental, 7(Supplement 3), Article ID 000224.
Open this publication in new window or tab >>Influence of income and education on outcomes of intensive care in a healthcare system with full universal health insurance - a nationwide analysis of individual-level data
2019 (English)In: Intensive Care Medicine Experimental, ISSN 1646-2335, E-ISSN 2197-425X, Vol. 7, no Supplement 3, article id 000224Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

INTRODUCTION. Most patients admitted to intensive care are discharged to a general ward in the same hospital, but some patients require transfer to another hospital. Indications for interhospital transfers (IHT) include referral for specialist treatment, lack of intensive care beds at the referring ICU and repatriation to ICU in home hospital [1].

OBJECTIVES. To review mortality of ICU-patients undergoing IHT and analyse whether different indications for transfer render different mortalities.

METHODS. Retrospective cohort register study using the Swedish Intensive Care Registry (SIR) during 2016-2018. The SIR collects data from 98.8% of Swedish ICUs including data on discharge from ICUs to other hospitals/ICUs. Transfers were divided into three categories: transfer due to medical reasons, lack of ICU beds or repatriation to ICU in home hospital. We analysed odds ratios (ORs) for dying within 30 days after discharge from ICU using risk adjusted (SAPS3 score) multi-level mixed effect logistic regression with ICUs as random effect.

RESULTS. We identified 12,356 patients who were discharged to another ICU and hospital, i.e. inter-hospital transfers. The unadjusted mortality 30 days after IHT was 17.2 % compared to 12.4 % if discharged to ward in the same hospital. Mortality after IHT varied with the cause of discharge (Figure).Main diagnoses for transfer due to specialist treatment were subarachnoid haemorrhage, head injury and multi-trauma whilst for lack of ICU beds post cardiac arrest, respiratory failure and pneumonia dominated. Risk adjusted analysis showed a significantly increased risk of dying after discharge due to lack of ICU-beds in comparison with other reasons for IHTs

CONCLUSION. The adjusted risk of dying within 30 days after interhospital transfer was greater among critically ill patients when the transfer was due to lack of beds in the referring ICU. The increased mortality lingered for at least 6 months underlining the importance to identify causes and intervene to avoid unnecessary loss of life.

Place, publisher, year, edition, pages
Santarem, Portugal: Escola Superior de Educacao de Santarem, 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-163277 (URN)
Conference
ESICMs LIVES 2019, Berlin 28 September-2 October
Available from: 2020-01-23 Created: 2020-01-23 Last updated: 2020-02-03Bibliographically approved
Sjöberg, F. & Orwelius, L. (2016). Follow-up after intensive care. In: Bertrand Guidet, Andreas Valentin, Hans Flaatten (Ed.), Quality management in intensive care: a practical guide (pp. 180-186). Cambridge: Cambridge University Press
Open this publication in new window or tab >>Follow-up after intensive care
2016 (English)In: Quality management in intensive care: a practical guide / [ed] Bertrand Guidet, Andreas Valentin, Hans Flaatten, Cambridge: Cambridge University Press, 2016, p. 180-186Chapter in book (Other academic)
Place, publisher, year, edition, pages
Cambridge: Cambridge University Press, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-126608 (URN)9781107503861 (ISBN)
Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2016-11-15Bibliographically approved
Nilsson, E., Orwelius, L. & Kristenson, M. (2016). Patient-reported outcomes in the Swedish National Quality Registers. Journal of Internal Medicine, 279(2), 141-153
Open this publication in new window or tab >>Patient-reported outcomes in the Swedish National Quality Registers
2016 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 279, no 2, p. 141-153Article, review/survey (Refereed) Published
Abstract [en]

Patient-reported outcomes (PROs) are important in the healthcare system to gain understanding of patients views on the effects of a treatment. There is an abundance of available patient-reported outcome measures (PROMs), both disease specific and generic. In the Swedish healthcare system, the national quality registers are obliged to incorporate PROs for certification at a high level. A review of the latest annual applications for funding (n = 108) shows that at present, 93 national quality registers include some form of PROM or patient-reported experience measure (PREM). Half of the registers include some type of generic measure, more than half include disease/symptom-specific measures, and around 40% include PREMs. Several different measures and combinations of measures are used, the most common of which are the EQ-5D, followed by the SF-36/RAND-36. About one-fifth of the registers report examples of how patient-reported data are used for local quality improvement. These examples include enhancing shared decision-making in clinical encounters (most common), as a basis for care plans, clinical decision aids and treatment guidelines, to improve the precision of indications for surgery (patient and healthcare professional assessments may differ), to monitor complications after the patient has left hospital and to improve patient information. In addition, funding applications reveal that most registers plan to extend their array of PROMs and PREMs in future, and to increase their use of patient-reported data as a basis for quality improvement.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
Keywords
health-related quality of life; PREM; PROM; quality improvement; quality register
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-126847 (URN)10.1111/joim.12409 (DOI)000371617500003 ()26306802 (PubMedID)
Note

Funding Agencies|Quality Register Center Stockholm; PROMcenter; Swedish Intensive Care Register; Executive Committee for the National Quality Registers

Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2018-03-23
Orwelius, L., Åkerman, E., Wickerts, C.-J. & Walther, S. (2015). Health-related quality of life at 2, 6 and 12 months after critical illness - lessons learnt from a nationwide follow-up of 4,500 ICU admissions. In: : . Paper presented at ESICM Lives 2015, Berlin Germany, 3-7 October 2015 (pp. A408). Springer, 3
Open this publication in new window or tab >>Health-related quality of life at 2, 6 and 12 months after critical illness - lessons learnt from a nationwide follow-up of 4,500 ICU admissions
2015 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Introduction

The development of intensive care medicine has led to improved survival of patients with complex illnesses and extensive injuries. Survivors are at risk of acquiring physical and functional deficits that may have negative effects on health-related quality of life (HRQoL). The significance of measuring HRQoL has been underlined by critical care researchers since poor HRQoL is associated with an adverse prognosis.

Objective

The aim of this work was to examine the development of HRQoL at 2, 6 and 12 months after ICU discharge in a mixed ICU patient population with an ICU-stay > 96 hrs.

Methods

We analysed admissions during 2008-2014 to 49 ICUs that submitted follow-up data to the Swedish Intensive Care Registry (SIR, http://www.icuregswe.org). HRQoL was measured using the Short Form 36 (SF36) questionnaire at 2, 6, and 12 months after discharge from ICU. SF36 domains, age, gender, illness severity on admission (SAPS3 probabilities) and length of ICU-stay were analysed for the entire cohort and for important diagnostic groups. SF36 scores were compared to an age- and gender-adjusted Swedish normal population. Differences in SF36 domains were analysed using non-parametric methods. Medians and interquartile ranges are presented.

Results

Complete SF36 responses were analysed for 4453, 4019 and 2515 admissions at 2, 6 and 12 months, respectively. HRQoL at 2 months in patients that subsequently were lost to follow-up was generally similar to those with follow-up, but they were younger, less ill and had shorter ICU-stay. Full longitudinal data with complete SF36 responses were obtained in 1438 patients [Age: 66 yrs. (57-73 yrs.), female gender: 37.2%, SAPS3 prob: 0.36 (0.19-0.55), ICU-stay: 7.0 days (4.9-11.5 days)]. SF36 improved over time in all domains (P < 0.001, Table), although some domains remained stable from 6 to 12 months. Patterns of recovery differed between important diagnostic groups (i.e. sepsis, out-of-hospital cardiac arrest, COPD, ARDS). A large proportion of patients (10-25% depending on SF36 domain) had HRQoL scores at 12 months which was below 2 standard deviations of the age- and gender-adjusted Swedish norm. The cardiac arrest group were among those with best, and the COPD group were among those with worst HRQoL at 12 months.

Conclusions

HRQoL recovered over 12 months in critically ill patients with a prolonged ICU stay. Recovery varied between diagnostic groups and a large proportion of patients had markedly depressed HRQoL. These findings may have important implications for follow-up and care after critical illness.

Place, publisher, year, edition, pages
Springer, 2015
Series
Intensive Care Medicine Experimental, ISSN 2197-425X
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-125566 (URN)10.1186/2197-425X-3-S1-A408 (DOI)
Conference
ESICM Lives 2015, Berlin Germany, 3-7 October 2015
Available from: 2016-02-26 Created: 2016-02-26 Last updated: 2016-08-19
Berkius, J., Engerström, L., Orwelius, L., Nordlund, P., Sjöberg, F., Fredrikson, M. & Walther, S. M. (2013). A prospective longitudinal multicentre study of health related quality of life in ICU survivors with COPD. Critical Care, 17(5), R211
Open this publication in new window or tab >>A prospective longitudinal multicentre study of health related quality of life in ICU survivors with COPD
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2013 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 5, p. R211-Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Mortality amongst COPD patients treated on the ICU is high. Health-related quality of life (HRQL) after intensive care is a relevant concern for COPD patients, their families and providers of health care. Still, there are few HRQL studies after intensive care of this patient group. Our hypothesis was that HRQL of COPD patients treated on the ICU declines rapidly with time.

METHODS: Fifty-one COPD patients (COPD-ICU group) with an ICU stay longer than 24 hours received a questionnaire at 6, 12 and 24 months after discharge from ICU. HRQL was measured using two generic instruments: the EuroQoL instrument (EQ-5D and EQ-VAS) and the Short Form 36 Health Survey (SF-36). The results were compared to HRQL of two reference groups from the general population; an age- and sex-adjusted reference population (Non-COPD reference) and a reference group with COPD (COPD reference).

RESULTS: HRQL of the COPD-ICU group at 6 months after discharge from ICU was lower compared to the COPD reference group: Median EQ-5D was 0.66 vs. 0.73, P=0.08 and median EQ-VAS was 50 vs.55, P<0.05. There were no significant differences in the SF-36 dimensions between the COPD-ICU and COPD-reference groups, although the difference in physical functioning (PF) approached statistical significance (P=0.059). Patients in the COPD-ICU group who were lost to follow-up after 6 months had low HRQL scores at 6 months. Scores for patients who died were generally lower compared to patients who failed to respond to the questionnaire. The PF and social functioning (SF) scores in those who died were significantly lower compared to patients with a complete follow up. HRQL of patients in the COPD-ICU group that survived a complete 24 months follow up was low but stable with no statistically significant decline from 6 to 24 months after ICU discharge. Their HRQL at 24 months was not significantly different from HRQL in the COPD reference group.

CONCLUSIONS: HRQL in COPD survivors after intensive care was low but did not decline from 6 to 24 months after discharge from ICU. Furthermore, HRQL at 24 months was similar to patients with COPD who had not received ICU treatment.

Place, publisher, year, edition, pages
BioMed Central, 2013
National Category
Clinical Medicine Health Sciences
Identifiers
urn:nbn:se:liu:diva-100737 (URN)10.1186/cc13019 (DOI)000331540900132 ()24063309 (PubMedID)
Available from: 2013-11-11 Created: 2013-11-11 Last updated: 2017-12-06Bibliographically approved
Orwelius, L., Fredrikson, M., Kristenson, M., Walther, S. & Sjöberg, F. (2013). Health-related quality of life scores after intensive care are almost equal to those of the normal population: a multicenter observational study. Critical Care, 17(5), R236
Open this publication in new window or tab >>Health-related quality of life scores after intensive care are almost equal to those of the normal population: a multicenter observational study
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2013 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 5, p. R236-Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:

Health-related quality of life (HRQoL) in patients treated in intensive care has been reported to be lower compared with age- and sex-adjusted control groups. Our aim was to test whether stratifying for coexisting conditions would reduce observed differences in HRQoL between patients treated in the ICU and a control group from the normal population. We also wanted to characterize the ICU patients with the lowest HRQoL within these strata.

METHODS:

We did a cross-sectional comparison of scores of the short-form health survey (SF-36) questionnaire in a multicenter study of patients treated in the ICU (n = 780) and those from a local public health survey (n = 6,093). Analyses were in both groups adjusted for age and sex, and data stratified for coexisting conditions. Within each stratum, patients with low scores (below -2 SD of the control group) were identified and characterized.

RESULTS:

After adjustment, there were minor and insignificant differences in mean SF-36 scores between patients and controls. Eight (n = 18) and 22% (n = 51) of the patients had low scores (-2 SD of the control group) in the physical and mental dimensions of SF-36, respectively. Patients with low scores were usually male, single, on sick leave before admission to critical care, and survived a shorter time after being in ICU.

CONCLUSIONS:

After adjusting for age, sex, and coexisting conditions, mean HRQoL scores were almost equal in patients and controls. Up to 22% (n = 51) of the patients had, however, a poor quality of life as compared with the controls (-2 SD). This group, which more often consisted of single men, individuals who were on sick leave before admission to the ICU, had an increased mortality after ICU. This group should be a target for future support.

Place, publisher, year, edition, pages
BioMed Central, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102566 (URN)10.1186/cc13059 (DOI)000331540900052 ()24119915 (PubMedID)
Available from: 2013-12-13 Created: 2013-12-13 Last updated: 2018-12-19Bibliographically approved
Orwelius, L., Willebrand, M., Gerdin, B., Ekselius, L., Fredrikson, M. & Sjöberg, F. (2013). Long term health-related quality of life after burns is strongly dependent on pre-existing disease and psychosocial issues and less due to the burn itself. Burns, 39(2), 229-235
Open this publication in new window or tab >>Long term health-related quality of life after burns is strongly dependent on pre-existing disease and psychosocial issues and less due to the burn itself
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2013 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 2, p. 229-235Article in journal (Refereed) Published
Abstract [en]

Background

Health-related quality of life (HRQoL) is reduced after a burn, and is affected by coexisting conditions. The aims of the investigation were to examine and describe effects of coexisting disease on HRQoL, and to quantify the proportion of burned people whose HRQoL was below that of a reference group matched for age, gender, and coexisting conditions.

Method

A nationwide study covering 9 years and examined HRQoL 12 and 24 months after the burn with the SF-36 questionnaire. The reference group was from the referral area of one of the hospitals.

Results

The HRQoL of the burned patients was below that of the reference group mainly in the mental dimensions, and only single patients were affected in the physical dimensions. The factor that significantly affected most HRQoL dimensions (n = 6) after the burn was unemployment, whereas only smaller effects could be attributed directly to the burn.

Conclusion

Poor HRQoL was recorded for only a small number of patients, and the decline were mostly in the mental dimensions when compared with a group adjusted for age, gender, and coexisting conditions. Factors other than the burn itself, such as mainly unemployment and pre-existing disease, were most important for the long term HRQoL experience in these patients.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Health related quality of life, Burn, Pre-existing disease, Control group, Co-morbidity, Long term, SF-36, Unemployment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-91552 (URN)10.1016/j.burns.2012.11.014 (DOI)000316520400005 ()
Available from: 2013-04-26 Created: 2013-04-26 Last updated: 2017-12-06Bibliographically approved
Orwelius, L., Lobo, C., Teixeira Pinto, A., Carneiro, A., Costa-Pereira, A. & Granja, C. (2013). Sepsis patients do not differ in health-related quality of life compared with other ICU patients. Acta Anaesthesiologica Scandinavica, 57(9), 1201-1205
Open this publication in new window or tab >>Sepsis patients do not differ in health-related quality of life compared with other ICU patients
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2013 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 9, p. 1201-1205Article in journal (Refereed) Published
Abstract [en]

Introduction less thanbrgreater than less thanbrgreater thanThe aim of the present multicentre study is to assess health-related quality of life in patients with community-acquired sepsis, severe sepsis, or septic shock (CAS) 6 months after discharge from the intensive care unit (ICU) and to compare the health-related quality of life of the ICU survivors with CAS with ICU survivors with other ICU diagnoses. less thanbrgreater than less thanbrgreater thanMethods less thanbrgreater than less thanbrgreater thanProspective, multicentre study in nine combined medical and surgical ICUs in Portugal. Health-related quality of life was assessed 6 months after ICU stay, using EuroQol-5D (EQ-5D) mailed to patients. ICU-related factors were obtained from the local ICU database and the local database for the SACiUCI follow-up study. less thanbrgreater than less thanbrgreater thanResults less thanbrgreater than less thanbrgreater thanA total of 313 (52%) surviving patients answered the questionnaire, and of these 91 (29%) were admitted for CAS. There were no significant differences in health-related quality of life between the two study groups. less thanbrgreater than less thanbrgreater thanConclusion less thanbrgreater than less thanbrgreater thanPatients admitted to ICU for CAS did not perceived different health-related quality of life compared with ICU patients admitted for other diagnoses.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-101389 (URN)10.1111/aas.12164 (DOI)000324320200016 ()
Note

Funding Agencies|Australian National Health and Medical Research Council|402764|Fundacao para a Ciencia e Tecnologia|PIC/IC/83312/2007|

Available from: 2013-11-22 Created: 2013-11-21 Last updated: 2017-12-06
Orwelius, L., Walther, S., Gren, H., Mårdh, C., Karlström, G. & Sjöberg, F. (2012). Assessing outcome after critical illness by use of a nation intensive care registry (SIR). In: : . Paper presented at 25th Annual Congress of the European Society of Intensive Care Medicine, 13–17 October 2012, Lisbon, Portugal.
Open this publication in new window or tab >>Assessing outcome after critical illness by use of a nation intensive care registry (SIR)
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2012 (English)Conference paper, Published paper (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103377 (URN)
Conference
25th Annual Congress of the European Society of Intensive Care Medicine, 13–17 October 2012, Lisbon, Portugal
Available from: 2014-01-19 Created: 2014-01-19 Last updated: 2014-02-03
Orwelius, L., Walther, S. & Sjöberg, F. (2012). Assessing patient reported outcome measures (PROM) after critical illness using a nationwide intensive care registry. In: Proceedings of the 20th International Health Promoting Hospitals and Health Services: . Paper presented at 20th International Conference on health Promoting Hospitals and Health Services, 11-13 April 2012, Taipei, Taiwan.
Open this publication in new window or tab >>Assessing patient reported outcome measures (PROM) after critical illness using a nationwide intensive care registry
2012 (English)In: Proceedings of the 20th International Health Promoting Hospitals and Health Services, 2012Conference paper, Published paper (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103376 (URN)
Conference
20th International Conference on health Promoting Hospitals and Health Services, 11-13 April 2012, Taipei, Taiwan
Available from: 2014-01-19 Created: 2014-01-19 Last updated: 2014-01-31
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