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  • 1.
    Allemann, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sund-Levander, Märta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nurses' actions in response to nursing assistants' observations of signs and symptoms of infections among nursing home residents2015In: Nursing Open, ISSN 2054-1058, Vol. 2, no 3, p. 97-104Article in journal (Refereed)
    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.

  • 2. Edvardsson, M
    et al.
    Sund-Levander, Märtha
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    The number of erythrocytes and their middle cells2010Conference paper (Other academic)
  • 3.
    Edvardsson, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Finspång, Primary Health Care in Finspång.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Grodzinsky, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Rättsmedicinalverket, Linköping, Sweden.
    Clinical use of conventional reference intervals in the frail elderly2015In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 2, p. 229-235Article in journal (Refereed)
    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.

  • 4.
    Edvardsson, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Finspång, Health care Center Finspång.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Milberg, Anna
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Wressle, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Marcusson, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Division of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Sweden.
    Differences in levels of albumin, ALT, AST, gamma-GT and creatinine in frail, moderately healthy and healthy elderly individuals2018In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 56, no 3, p. 471-478Article in journal (Refereed)
    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.

    The full text will be freely available from 2018-10-09 12:17
  • 5. Edvarsson, M
    et al.
    Sund-Levander, Märtha
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Comparison of levels for immuniglobulin A, G, M and complement factors C3 and C4 in individuals 80 years and older, with current refrernce values2004Conference paper (Other academic)
  • 6.
    Grodzinsky, Ewa
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Assessment of Fever: Physiology, Immunology and Measurement in Clinical Practice2015 (ed. 1)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.

  • 7.
    Johansson, Rose-Marie
    et al.
    Jönköping University, Sweden.
    Malmvall, Bo-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Andersson-Gäre, Boel
    Futurum – The Academy of Healthcare, County Council, Jönköping and Jönköping University, Sweden.
    Larsson, Bruno
    County Hospital Ryhov, Jönköping, Sweden.
    Erlandsson, Ingrid
    County Hospital Ryhov, Jönköping, Sweden.
    Sund-Levander, Märta
    Höglandssjukhuset, Eksjö, Sweden.
    Rensfelt, Gunhild
    County Hospital Ryhov, Jönköping, Sweden.
    Mölstad, Sigvard
    Futurum, Sweden .
    Christensson, Lennart
    Jönköping University, Sweden.
    Guidelines for preventing urinary retention and bladder damage during hospital care2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 3-4, p. 347-355Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To develop evidence-based guidelines for adult patients in order to prevent urinary retention and to minimise bladder damage and urinary tract infection.

    BACKGROUND:

    Urinary retention causing bladder damage is a well known complication in patients during hospital care. The most common treatment for urinary retention is an indwelling urinary catheter, which causes 80% of hospital-acquired urinary tract infections. Appropriate use of bladder ultrasonography can reduce the rate of bladder damage as well as the need to use an indwelling urinary catheter. It can also lead to a decrease in the rate of urinary tract infections, a lower risk of spread of multiresistant Gram-negative bacteria, and lower hospital costs.

    DESIGN:

    An expert group was established, and a literature review was performed.

    METHODS:

    On the basis of literature findings and consensus in the expert group, guidelines for clinical situations were constructed.

    RESULTS:

    The main points of the guidelines are the following: identification of risk factors for urinary retention, managing patients at risk of urinary retention, strategies for patients with urinary retention and patient documentation and information.

    CONCLUSION:

    Using literature review and consensus technique based on a multiprofessional group of experts, evidence-based guidelines have been developed. Although consensus was reached, there are parts of the guidelines where the knowledge is weak.

    RELEVANCE TO CLINICAL PRACTICE:

    These guidelines are designed to be easy to use in clinical work and could be an important step towards minimising bladder damage and hospital-acquired urinary tract infections and their serious consequences, such as bacteraemia and the spread of multidrug-resistant bacteria in hospitals.

  • 8.
    Sund Levander, Märtha
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Wahren, Lis Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Pharmacology.
    Assessment and prevention of shivering in patients with severe cerebral injury. A pilot study.2000In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 9, p. 55-61Article in journal (Refereed)
  • 9.
    Sund-Levander, Märta
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Svårt att formulera klara mål för omvårdnad vid feber1996In: Vårdfacket, ISSN 0347-0911, Vol. 20, no 6, p. 5p. 44-48Article in journal (Other academic)
  • 10.
    Sund-Levander, Märta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    The Challenge of Infections in Frail Elderly: The Story of Mr. Nilsson2015In: Clinical Medical Reviews and Case Reports, ISSN 2378-3656, Vol. 2, no 4Article in journal (Refereed)
    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.

  • 11.
    Sund-Levander, Märtha
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Det finns ingen normal feber2005In: Omvårdnadsmagasinet, ISSN 1652-0858, Vol. 3, no 01, p. 8-11Article in journal (Other academic)
  • 12.
    Sund-Levander, Märtha
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Feber1999Book (Other academic)
    Abstract [sv]

    Feber är fortfarande ett viktigt underlag för beslut om vård och behandling. Såväl tolkningen av hur och varför feber uppstår, som behandling vid feber har skiftat genom historien. Den kunskap som finns nu visar tydligt att feber är en positiv, naturlig reaktion mot kroppsfrämmande ämnen. Ibland kan feber dock innebära en ökad belastning för en redan svårt sjuk patient.

  • 13.
    Sund-Levander, Märtha
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Feber eller inte feber - det är frågan2012Conference paper (Other academic)
  • 14.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Genauigkeit beim Fiebermessen. Was ist normale Körpertemperatur?2013In: CNE.fortbildung. Certified Nursing Education, Vol. 3, p. 8-11Article in journal (Refereed)
  • 15.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Hitzfe- und Kälteempfindlichkeit. Körpertemperatur bei älteren Menschen2013In: CNE.fortbildung. Certified Nursing Education, Vol. 3, p. 12-16Article in journal (Refereed)
  • 16.
    Sund-Levander, Märtha
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Infektion hos äldre: Tidiga symtom och faktorer som ökar risken för försenad diagnos2003Conference paper (Other academic)
  • 17.
    Sund-Levander, Märtha
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Infektioner hos multisjuka äldre - varför missar vi dem?2012Conference paper (Other academic)
  • 18.
    Sund-Levander, Märtha
    Höglandssjukhuset, Eksjö.
    Kroppstemperatur2009In: Omvårdnadens grunder. Hälsa och ohälsa / [ed] Edberg AK & Wijk H, Lund: Studentlitteratur, 2009Chapter in book (Other academic)
  • 19.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Measurement and evaluation of body temperature: Implications for clinical practice2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The general aim was to explore factors influencing the normal variation and measurement of body temperature. Additional aims were to study morbidity, mortality and the clinical presentation of pneumonia and predictors for survival in elderly nursing-home residents. Two hundred and thirty seven non-febrile nursing home residents (aged 66-99 years) and 87 healthy adults (aged 19-59 years) were included. In elderly individuals, the morning ear and rectal body temperature was measured at baseline and pneumonia and survival was observed at one- two and three-year. In healthy adults the rectal, ear, oral and axillary temperature were measured simultaneously on one morning and repeated measurements were performed in three subjects.

    Overall, the range of normal body temperature was wider then traditionally stated. In elderly nursinghome residents, functional and cognitive impairment and BMI < 20 were related to a lower body temperature and medication with analgesics to a higher. Compared to adults < 60 years elderly persons had a higher average ear and a lower rectal temperature. Men and postmenopausal women < 60 years had lower body temperature than premenopausal women. The repeated measurements showed a wide individual variability irrespective of the site of measurement, and that replicated measurements do not improve accuracy. When comparing the rectal temperature with oral, ear and axillary readings the average difference was > 0.5°C with a wide individual variation.

    The yearly incidence of nursing-home acquired pneumonia varied between 6.9% and 13.7%. Functional impairment, chronic obstructive pulmonary disease (COPD) and male sex were related to a higher risk of acquiring pneumonia and presenting non-specific symptoms were common. Age and functional impairment predicted mortality, irrespective of gender, while cerebral vascular insult, a lower body mass index and malnutrition in women and heart disease, COPD, medication with sedatives and mortality rate index in men were gender specific predictors. Surviving women had a higher baseline body temperature than non-surviving, while no such difference was found in men.

    When assessing body temperature, it is important to consider the site of measurement, technical design, operator technique, age and gender and, in elderly nursing-home residents, physical and cognitive impairment, body constitution and medication with analgesics. The best approach is to use an unadjusted mode, without adjusting to another site. To prevent a delayed diagnosis of pneumonia, one should be aware of a low baseline body temperature and lack of specific clinical symptoms in elderly nursing-home residents. Preserving and/or improving functional, cognitive, nutritional status and preventing agitation and confusion would improve survival in nursing-home residents.

    List of papers
    1. The impact of ADL-status, dementia and body mass index on normal body temperature in elderly nursing home residents
    Open this publication in new window or tab >>The impact of ADL-status, dementia and body mass index on normal body temperature in elderly nursing home residents
    2002 (English)In: Archives of gerontology and geriatrics, ISSN 0167-4943, Vol. 35, no 2, p. 161-169Article in journal (Refereed) Published
    Abstract [en]

    A subset of seniors might demonstrate a lower body temperature compared with younger subjects. However, data on normal body temperature in seniors are sparse. The aim of the study was to study normal body temperature with a view of predicting factors of low body temperature in non-febrile seniors. Elderly women (n=159) and 78 men, aged ≥65 years, living in community resident homes were included in the study. Data on chronic diseases and medication were collected from medical records. Tympanic and rectal temperature was measured twice daily; once at 7–9 AM and then at 6–8 PM. In addition, body mass index (BMI), activities of daily living (ADL) status, as well as details regarding dementia and malnutrition were recorded. The variation in tympanic and rectal temperatures ranged from 33.8 to 38.4 °C and 35.6 to 38.0 °C, respectively. ADL status, dementia and BMI were significantly related to lower and analgesic to higher tympanic temperature. Dementia was significantly related to lower rectal temperature. Therefore, dementia, BMI, ADL status and analgesic shall not be overlooked when assessing temperature in seniors. More research is needed to further clarify the influence of these predictive factors, as well as the impact of BMI and malnutrition.

    Keyword
    Dementia, Activities of daily living status, Body mass index, Normal body temperature in elderly
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13663 (URN)10.1016/S0167-4943(02)00019-5 (DOI)
    Available from: 2004-12-19 Created: 2004-12-19 Last updated: 2009-06-04
    2. Errors in body temperature assessment related to individual variation, measuring technique and equipment
    Open this publication in new window or tab >>Errors in body temperature assessment related to individual variation, measuring technique and equipment
    2005 (English)In: International journal of nursing practice, ISSN 1322-7114, Vol. 10, no 5, p. 216-223Article in journal (Refereed) Published
    Abstract [en]

    Errors in body temperature measurement might seriously influence the evaluation of an individual's health condition. We studied individual variation, measurement technique and the equipment used when assessing body temperature. In the first part of the study, three volunteers performed repeated measurements for five mornings. In the second part, the morning rectal, oral, ear and axillary temperatures were measured once in 84 men and women (19–59 years). The repeated measurements showed a daily temperature difference of 0.1–0.4°C in rectal and oral temperatures, 0.2°C−1.7°C in the ear and 0.1–0.9°C in the axillary temperatures. In the sample of 84 subjects, men and postmenopausal women had a lower mean body temperature compared to premenopausal women. The mean deviation between rectal temperature, and oral, ear and axillary temperatures, respectively, was > 0.5°C, with a large individual variation. In conclusion, in order to improve the evaluation of body temperature, the assessment should be based on the individual variation, the same site of measurement and no adjustment of oral, ear or axillary temperatures to the rectal site.

    Keyword
    body temperature, gender, individual variation, repeated measurements, standardized
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13664 (URN)10.1111/j.1440-172X.2004.00483.x (DOI)
    Available from: 2004-12-19 Created: 2004-12-19 Last updated: 2009-06-04
    3. Morbidity, mortality and clinical presentation of nursing homeacquired pneumonia in a Swedish population
    Open this publication in new window or tab >>Morbidity, mortality and clinical presentation of nursing homeacquired pneumonia in a Swedish population
    Show others...
    2003 (English)In: Scandinavian journal of infectious diseases, ISSN 0036-5548, Vol. 35, no 5, p. 306-310Article in journal (Refereed) Published
    Abstract [en]

    Pneumonia has been estimated to be the second most common infection in nursing-home residents. However, to the authors' knowledge, no such Swedish data are available. Therefore, this study investigated the incidence, risk factors, and 30 d case-fatality rate and clinical presentation of nursing home-acquired pneumonia (NHAP) in 234 nursing-home residents aged 66-99 y. Activities of daily living (ADL status), malnutrition and body mass index were measured at baseline. The residents were then followed prospectively during 1 y for symptoms and signs of pneumonia. Pneumonia was verified clinically and/or radiologically in 32 residents, corresponding to a yearly incidence of 13.7%. The 30 d case-fatality rate was 28%. Cough and sputum production were the most specific, and fever ≥38.0°C rectally and cognitive decline were the most common non-specific presenting symptoms. Chronic obstructive pulmonary disease, ADL status >5 and male gender were risk factors for acquiring pneumonia. In conclusion, NHAP is associated with high morbidity and mortality in Sweden. In order not to delay treatment, it is necessary to be aware that specific symptoms of pneumonia may be lacking in the clinical presentation in the nursing-home setting.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13665 (URN)10.1080/00365540310008456 (DOI)
    Available from: 2004-12-19 Created: 2004-12-19 Last updated: 2009-08-21
    4. Gender differences in predictors for survival in elderly nursing-home residents: A 3-year follow-up
    Open this publication in new window or tab >>Gender differences in predictors for survival in elderly nursing-home residents: A 3-year follow-up
    2007 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 1, p. 18-24Article in journal (Refereed) Published
    Abstract [en]

    This study focus on predicting factors of survival possible to modify by nursing care, and the incidence and mortality rate of nursing-home-acquired pneumonia, allocated to 1, 2 and 3 years of follow ups. The residents consisted of 156 women and 78 men living in special housing for the elderly. Data on chronic disease and medication were obtained at baseline, and activities of daily living (ADL) status, nutritional status and body temperature were assessed. The incidence of pneumonia was noted prospectively for 1 year and retrospectively for the following 2 years. Predictive factors for survival were explored by Cox hazard regression analysis. The results showed that age, functional and cognitive impairment were predictors of mortality irrespective of gender, while poor nutritional status in women and chronic obstructive pulmonary disease, heart disease and medication with sedatives in men were gender-specific predictors. ADL correlated positively with dementia and negatively with S-albumin irrespective of gender, while malnutrition correlated positively with ADL in women and positively with chronic obstructive pulmonary disease in men. To promote the quality of daily living in elderly individuals, it is of importance to improve the capabilities in daily functions and nutritional status, especially in women with functional impairment, and to prevent anxiety particularly in men. The findings also clarify that pneumonia is as common as cerebral vascular insult and heart failure as cause of death in this population.

    Keyword
    activities of daily living, gender, malnutrition, nursing care, pneumonia, survival
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13666 (URN)10.1111/j.1471-6712.2007.00431.x (DOI)
    Available from: 2004-12-19 Created: 2004-12-19 Last updated: 2017-12-13
  • 20.
    Sund-Levander, Märtha
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Når patienten har feber2000 (ed. 1)Book (Other academic)
    Abstract [da]

    Feber udgør stadig et vigtigt grundlag for beslutninger om pleje og behandling. Tolkningen af hvordan og hvorfor feber opstår og hvilken behandling, man skal vælge, har skiftet op igennem historien. Den viden, vi har nu, viser tydeligt, at feber er en positiv naturlig reaktion på fremmede stoffer i kroppen. Somme tider kan feber dog medføre en øget belastning for en patient, der allerede er svært syg. Uanset hvor meget feber påvirker en patient, har alle mennesker brug for pleje, når de har feber. For at patienten kan få en sikker pleje, skal vurdering og forholdsregler baseres på videnskab og erfaring. Dette er den første lærebog, der beskriver feber både ud fra et teoretisk fysiologisk perspektiv og et praktisk plejeperspektiv.Undervejs i teksten er der henvisninger til en omfattende referenceliste sidst i bogen.

    Bogen er inddelt i fire dele. Første del skildrer, hvordan mennesket opfattede feber i "gamle dage". Anden del beskriver, hvordan kropstemperaturen reguleres, hvordan man måler temperaturen, og hvilke faktorer, der påvirker normal kropstemperatur. Tredje del beskriver feber fysiologisk, og diskuterer hvordan feber defineres. Fjerde del beskriver patientens plejebehov og foreslår forholdsregler ved pleje af feberpatienter med udgangspunkt i søgeordene i VIPS (en forskningsbaseret metode til dokumentation af pleje af Margareta Ehnfors, Anna Ehrenberg og Ingrid Thorell-Ekstrand). Bogen afsluttes med nogle patientbeskrivelser, som man kan bruge til at tænke over selv eller diskutere med andre.

    Bogen henvender sig først og fremmest til sygeplejestuderende på grunduddannelsen og sygeplejersker under videreuddannelse. Den kan også bruges af andre studerende inden for sundhedssektoren og i den kliniske sygepleje.

  • 21.
    Sund-Levander, Märtha
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Omvårdnad vid feber. Tradition eller vetenskap?1996Conference paper (Other academic)
  • 22.
    Sund-Levander, Märtha
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Omvårdnad vid feber: Tradition eller vetenskap1998Conference paper (Other academic)
  • 23.
    Sund-Levander, Märtha
    FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Time for a change to assess and evaluate body temperature in clinical practice2011Conference paper (Other academic)
  • 24.
    Sund-Levander, Märtha
    FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Time for a change to assess and evaluate body temperature in clinical practice - Part I2011Conference paper (Other academic)
  • 25.
    Sund-Levander, Märtha
    FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Time for a change to assess and evaluate body temperature in clinical practice Part II: Implications for clinical practice2011Conference paper (Other academic)
  • 26.
    Sund-Levander, Märtha
    et al.
    FoU enheten, Höglandssjukhuset, Eksjö.
    Areskoug-Josefsson, Kristina
    Värnamo sjukhus.
    Josephson, Iréne
    Länssjukhuset Ryhov, Jönköping.
    Öberg, Ulrika
    Länssjukhuset Ryhov, Jönköping.
    Kammerlind, Ann-Sofi
    Länssjukhuset Ryhov, Jönköping.
    Hinder och möjligheter för evidensbaserad vård inom Landstinget i Jönköpings län - en enkätstudie2011Report (Other academic)
  • 27.
    Sund-Levander, Märtha
    et al.
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Areskoug-Josefsson, Kristina
    Värnamo sjukhus.
    Josephson, Iréne
    Länssjukhuset Ryhov, Jönköping.
    Öberg, Ulrika
    Länssjukhuset Ryhov, Jönköping.
    Kammerlind, Ann-Sofi
    Länssjukhuset Ryhov, Jönköping.
    Hinder och möjligheter för evidensbaserad vård inom Landstinget i Jönköpings län. En enkätstudie2011Conference paper (Other academic)
  • 28.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Forsberg, C
    Wahren, Lis Karin
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Normal kroppstemperatur relaterat till ålder och kön: En systematisk litteraturgenomgång2001Conference paper (Other academic)
  • 29.
    Sund-Levander, Märtha
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Forsberg, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery.
    Wahren, Lis Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV), Science in Nursing.
    Normal oral, rectal, tympanic and axillary body temperature in adult men and women: A systematic literature review2002In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 2, p. 122-128Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate normal body temperature in adult men and women. A systematic review of data was performed. Searches were carried out in MEDLINE, CINAHL, and manually from identified articles reference lists. Studies from 1935 to 1999 were included. Articles were classified as (1) strong, (2) fairly strong and (3) weak evidence. When summarizing studies with strong or fairly strong evidence the range for oral temperature was 33.2-38.2░C, rectal: 34.4-37.8░C, tympanic: 35.4-37.8░C and axillary: 35.5-37.0░C. The range in oral temperature for men and women, respectively, was 35.7-37.7 and 33.2-38.1░C, in rectal 36.7-37.5 and 36.8-37.1░C, and in tympanic 35.5-37.5 and 35.7-37.5░C. The ranges of normal body temperature need to be adjusted, especially for the lower values. When assessing body temperature it is important to take place of measurement and gender into consideration. Studies with random samples are needed to confirm the range of normal body temperature with respect to gender and age.

  • 30.
    Sund-Levander, Märtha
    et al.
    Höglandssjukhuset, Eksjö, Sweden.
    Grodzinsky, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    What is the evidence base for the assessment and evaluation of body temperature?2010In: Nursing Times, ISSN 0029-6589, Vol. 106, no 1, p. 10-13Article in journal (Refereed)
    Abstract [en]

    Measurement and management of body temperature is often based on traditionand personal ideas and beliefs rather than evidence based knowledge. This article summarises the literature to provide a guide to evidence based assessment and evaluation of body temperature in clinical practice.

  • 31.
    Sund-Levander, Märtha
    et al.
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Grodzinsky, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Edvardsson, M
    The use of blood composition parameters to detect infection in elderly residentszinsky: A challenge2010Conference paper (Other academic)
  • 32.
    Sund-Levander, Märtha
    et al.
    Högland Hospital, Eksjö, Sweden.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Accuracy when assessing and evaluating body temperature in clinical practice: Time for a change2012Conference paper (Other academic)
  • 33.
    Sund-Levander, Märtha
    et al.
    Högland Hospital, Eksjö, Sweden.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Accuracy when assessing and evaluating body temperature in clinical practice: Time for a change2012In: Thermology International, ISSN 1560-604X, Vol. 22 Appendix 1, no 3, p. 25-32Article, review/survey (Other academic)
  • 34.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Jönköping County Council, Sweden.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Assessment of body temperature measurement options2013In: British Journal of Nursing, ISSN 0966-0461, E-ISSN 2052-2819, Vol. 22, no 16, p. 942-950Article in journal (Refereed)
    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.

  • 35.
    Sund-Levander, Märtha
    et al.
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Errors in body temperature assessment related to individual variation, measuring technique and equipment - consequences for laboratory tests ordered?2008Conference paper (Other academic)
  • 36.
    Sund-Levander, Märtha
    et al.
    FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Grodzinsky, Ewa
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Time for a change to assess and evaluate body temperature in clinical practice2009In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 15, no 4, p. 241-249Article, review/survey (Other academic)
    Abstract [en]

    The definition of normal body temperature as 37°C still is considered the norm worldwide, but in practice there is a widespread confusion of the evaluation of body temperature, especially in elderly individuals. In this paper, we discuss the relevance of normal body temperature as 37°C and consequences in clinical practice. Our conclusion is that body temperature should be evaluated in relation to the individual variability and that the best approach is to use the same site, and an unadjusted mode without adjustments to other sites. If the baseline value is not known, it is important to notice that frail elderly individuals are at risk of a low body temperature. In addition, what should be regarded as fever is closely related to what is considered as normal body temperature. That is, as normal body temperature shows individual variations, it is reasonable that the same should hold true for the febrile range.

  • 37.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Loyd, Dan
    Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics . Linköping University, The Institute of Technology.
    Wahren, Lis Karin
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Errors in body temperature assessment related to individual variation, measuring technique and equipment2005In: International journal of nursing practice, ISSN 1322-7114, Vol. 10, no 5, p. 216-223Article in journal (Refereed)
    Abstract [en]

    Errors in body temperature measurement might seriously influence the evaluation of an individual's health condition. We studied individual variation, measurement technique and the equipment used when assessing body temperature. In the first part of the study, three volunteers performed repeated measurements for five mornings. In the second part, the morning rectal, oral, ear and axillary temperatures were measured once in 84 men and women (19–59 years). The repeated measurements showed a daily temperature difference of 0.1–0.4°C in rectal and oral temperatures, 0.2°C−1.7°C in the ear and 0.1–0.9°C in the axillary temperatures. In the sample of 84 subjects, men and postmenopausal women had a lower mean body temperature compared to premenopausal women. The mean deviation between rectal temperature, and oral, ear and axillary temperatures, respectively, was > 0.5°C, with a large individual variation. In conclusion, in order to improve the evaluation of body temperature, the assessment should be based on the individual variation, the same site of measurement and no adjustment of oral, ear or axillary temperatures to the rectal site.

  • 38.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Wahren, Lis Karin
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Gender differences in predictors for survival in elderly nursing-home residents: A 3-year follow-up2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 1, p. 18-24Article in journal (Refereed)
    Abstract [en]

    This study focus on predicting factors of survival possible to modify by nursing care, and the incidence and mortality rate of nursing-home-acquired pneumonia, allocated to 1, 2 and 3 years of follow ups. The residents consisted of 156 women and 78 men living in special housing for the elderly. Data on chronic disease and medication were obtained at baseline, and activities of daily living (ADL) status, nutritional status and body temperature were assessed. The incidence of pneumonia was noted prospectively for 1 year and retrospectively for the following 2 years. Predictive factors for survival were explored by Cox hazard regression analysis. The results showed that age, functional and cognitive impairment were predictors of mortality irrespective of gender, while poor nutritional status in women and chronic obstructive pulmonary disease, heart disease and medication with sedatives in men were gender-specific predictors. ADL correlated positively with dementia and negatively with S-albumin irrespective of gender, while malnutrition correlated positively with ADL in women and positively with chronic obstructive pulmonary disease in men. To promote the quality of daily living in elderly individuals, it is of importance to improve the capabilities in daily functions and nutritional status, especially in women with functional impairment, and to prevent anxiety particularly in men. The findings also clarify that pneumonia is as common as cerebral vascular insult and heart failure as cause of death in this population.

  • 39.
    Sund-Levander, Märtha
    et al.
    FoU enheten, Höglandssjukhuset, Eksjö.
    Hedberg, Berith
    Hälsohögskolan Jönköping.
    Utvärdering av samverkan i vårdkedjan2009Report (Other academic)
  • 40.
    Sund-Levander, Märtha
    et al.
    Futurum/Akademin för hälsa och vård, Landstinget i Jönköpings län.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Clinical decision making process of early nonspecific signs of infection in institutionalized elderly persons: experience of nursing assistants2010Conference paper (Other academic)
  • 41.
    Sund-Levander, Märtha
    et al.
    FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Clinical decision-making process for early nonspecific signs of infection in institutionalised elderly persons: experience of nursing assistants2010Conference paper (Other academic)
  • 42.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. FoU-enheten, Höglandssjukhuset, Eksjö, Sweden.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Clinical decision-making process for early nonspecific signs of infection in institutionalised elderly persons: experience of nursing assistants2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 1, p. 27-35Article in journal (Refereed)
    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.

  • 43.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Normal tympanic and rectal body tempterature in elderly men and women2001Conference paper (Other academic)
  • 44.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Prevention of shivering in patients with severe cerebral injury1999Conference paper (Other academic)
  • 45.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    The impact of ADL-status, dementia and body mass index on normal body temperature in elderly nursing home residents2002In: Archives of gerontology and geriatrics, ISSN 0167-4943, Vol. 35, no 2, p. 161-169Article in journal (Refereed)
    Abstract [en]

    A subset of seniors might demonstrate a lower body temperature compared with younger subjects. However, data on normal body temperature in seniors are sparse. The aim of the study was to study normal body temperature with a view of predicting factors of low body temperature in non-febrile seniors. Elderly women (n=159) and 78 men, aged ≥65 years, living in community resident homes were included in the study. Data on chronic diseases and medication were collected from medical records. Tympanic and rectal temperature was measured twice daily; once at 7–9 AM and then at 6–8 PM. In addition, body mass index (BMI), activities of daily living (ADL) status, as well as details regarding dementia and malnutrition were recorded. The variation in tympanic and rectal temperatures ranged from 33.8 to 38.4 °C and 35.6 to 38.0 °C, respectively. ADL status, dementia and BMI were significantly related to lower and analgesic to higher tympanic temperature. Dementia was significantly related to lower rectal temperature. Therefore, dementia, BMI, ADL status and analgesic shall not be overlooked when assessing temperature in seniors. More research is needed to further clarify the influence of these predictive factors, as well as the impact of BMI and malnutrition.

  • 46.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Wahren, Lis-Karin
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Prevention och kontroll av frossa hos patienter med svår skallskada1999Conference paper (Other academic)
  • 47.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Wahren, Lis-Karin
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Hamrin, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences.
    Nursing care in fever: Assessment and implementation1998In: Nordic Journal of Nursing Research & Clinical Studies /Vård i Norden, ISSN 0107-4083, Vol. 18, no 2, p. 27-30Article in journal (Refereed)
  • 48.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Örtqvist, Åke
    Stockholm County, Norrbacka, Sweden.
    Grodzinsky, Ewa
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Klefsgård, Örjan
    Högland Hospital, Eksjö, Sweden.
    Wahren, Lis Karin
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Morbiditet, mortalitet och klinisk presentation av pneumoni bland äldre i särskilt boende2002Conference paper (Other academic)
  • 49.
    Sund-Levander, Märtha
    et al.
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Örtqvist, Åke
    Department of Communicable Diseases and Prevention, Stockholm County, Stockholm.
    Grodzinsky, Ewa
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Klefsgård, Örjan
    Department of Radiology, Högland Hospital, Eksjö.
    Wahren, Lis Karin
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Morbidity, mortality and clinical presentation of nursing homeacquired pneumonia in a Swedish population2003In: Scandinavian journal of infectious diseases, ISSN 0036-5548, Vol. 35, no 5, p. 306-310Article in journal (Refereed)
    Abstract [en]

    Pneumonia has been estimated to be the second most common infection in nursing-home residents. However, to the authors' knowledge, no such Swedish data are available. Therefore, this study investigated the incidence, risk factors, and 30 d case-fatality rate and clinical presentation of nursing home-acquired pneumonia (NHAP) in 234 nursing-home residents aged 66-99 y. Activities of daily living (ADL status), malnutrition and body mass index were measured at baseline. The residents were then followed prospectively during 1 y for symptoms and signs of pneumonia. Pneumonia was verified clinically and/or radiologically in 32 residents, corresponding to a yearly incidence of 13.7%. The 30 d case-fatality rate was 28%. Cough and sputum production were the most specific, and fever ≥38.0°C rectally and cognitive decline were the most common non-specific presenting symptoms. Chronic obstructive pulmonary disease, ADL status >5 and male gender were risk factors for acquiring pneumonia. In conclusion, NHAP is associated with high morbidity and mortality in Sweden. In order not to delay treatment, it is necessary to be aware that specific symptoms of pneumonia may be lacking in the clinical presentation in the nursing-home setting.

  • 50.
    Sun-Levander, M
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Mångfald, dynamik, lärande. Iscensättningen av problematiken genus och mångfald i undervisningen vid LiU2004Report (Other academic)
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