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  • 1.
    Agren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Presentation av post-doctoral mentorship2014Conference paper (Refereed)
  • 2.
    Agren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Luttik, ML
    Caregiving tasks and caregiver burden over time: effects of an intervention for patients with post-operative heart failure and their partners.2014Conference paper (Refereed)
  • 3.
    Ahldén, Maria KC
    et al.
    Oslo University, Norway.
    Helén, Rönning
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Jönköping University.
    Agren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Facing the unexpected - A content analysis of how dyads face the challenges of postoperative heart failure2014In: Clinical Nursing Studies, ISSN 2324-7940, Vol. 2, no 2, p. 74-83Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to identify the challenges, strategies and needs of dyads who are dealing with postoperative heart failure.

    Background: An increasing number of patients with postoperative heart failure are living with their partner as primary caregiver. Heart failure is known to reduce quality of life but little is known about the strategies dyads use to cope with postoperative heart failure or what kind of support they need.

    Methods: Data were collected through semi-structured dialogue guides. Content analysis was performed to derive the main themes and categories of the data.

    Results: Three main themes were derived from the data; Everyday challenges, Strategies to deal with everyday challenges and Factors facilitating everyday life.

    Conclusions: Dyads living with postoperative heart failure find the change in everyday life challenging, but have strategies to handle the situation and know what kind of help they need. With the right help from health care, quality of life and self-care can be improved.

  • 4.
    Arestedt, K
    et al.
    Linnaeus University.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Inger Flemme, I F
    Halmstad University.
    Bedbra Moser, D M
    University Kentucky.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Psychometric properties of the swedish version of the Control Attitudes Scale (CAS) for patients with cardiac disease and their partners in EUROPEAN HEART JOURNAL, vol 31, issue , pp 230-2302010In: EUROPEAN HEART JOURNAL, Oxford University Press , 2010, Vol. 31, p. 230-230Conference paper (Refereed)
    Abstract [en]

    n/a

  • 5.
    Franzén Årestedt, Kristofer
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Flemme, Inger
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Psychometric properties of the Swedish version of the Control Attitude Sclae for patients with heart disease and their family members2010Conference paper (Refereed)
  • 6.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Quality of life and symptoms of depression in advanced heartfailure patients and their partners2010In: Current Opinion in Supportive and Palliative Care, ISSN 1751-4266, Vol. 4, no 4, p. 233-237Article in journal (Refereed)
    Abstract [en]

    Purpose of review: To provide an overview of factors related to quality of life and symptoms of depression in heart failure patients and their partners. Furthermore, to give an overview of interventions that can be effective in improving their quality of life and decrease depressive symptoms.Recent findings: Quality of life of patients with heart failure and their partners is poor compared with their age-matched peers from the general population and also compared with patients suffering from other chronic diseases. Furthermore, many heart failure patients are depressed. Depressive symptoms of patients and of their partners seem to be interrelated, making interventions complicated but needed.Although the number of studies that specifically target improvement of quality of life and depression in heart failure patients and their partners is still small, several interventions are known to improve quality of life, and these could be implemented in daily care.Summary: This review considers demographic and clinical factors that are related to quality of life and depressive symptoms and addresses interventions that can contribute to improvement of quality of life of heart failure patients and their partners and decrease depressive symptoms.Education on self-care management and physical exercise are important elements of disease management programs. A multidisciplinary care approach including optimizing medical therapy and optimal symptom management is advised, focusing both on the patient and the caregiver. Treatment and care should not only focus on heart failure, but also address the consequences of co-morbidities and the side-effects of therapies.

  • 7.
    Jonkman, Nini H.
    et al.
    University of Medical Centre Utrecht, Netherlands.
    Westland, Heleen
    University of Medical Centre Utrecht, Netherlands.
    Groenwold, Rolf H. H.
    University of Medical Centre Utrecht, Netherlands.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Atienza, Felipe
    Hospital Gen University of Gregorio Maranon, Spain.
    Blue, Lynda
    British Heart Fdn, Scotland.
    Bruggink-Andre de la Porte, Pieta W. F.
    Deventer Hospital, Netherlands.
    DeWalt, Darren A.
    University of N Carolina, NC USA.
    Hebert, Paul L.
    Heisler, Michele
    University of Washington, WA 98195 USA.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Kempen, Gertrudis I. J. M.
    Maastricht University, Netherlands.
    Leventhal, Marcia E.
    University of Basel, Switzerland.
    Lok, Dirk J. A.
    Deventer Hospital, Netherlands.
    Martensson, Jan
    Jonköping University, Sweden.
    Muniz, Javier
    University of A Coruna, Spain; INIBIC, Spain.
    Otsu, Haruka
    Hirosaki University, Japan.
    Peters-Klimm, Frank
    University of Heidelberg Hospital, Germany.
    Rich, Michael W.
    Washington University, MO 63110 USA.
    Riegel, Barbara
    University of Penn, PA 19104 USA.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Tsuyuki, Ross T.
    University of Alberta, Canada.
    van Veldhuisen, Dirk J.
    University of Medical Centre Groningen, Netherlands.
    Trappenburg, Jaap C. A.
    University of Medical Centre Utrecht, Netherlands.
    Schuurmans, Marieke J.
    University of Medical Centre Utrecht, Netherlands.
    Hoes, Arno W.
    University of Medical Centre Utrecht, Netherlands.
    Do Self-Management Interventions Work in Patients With Heart Failure? An Individual Patient Data Meta-Analysis2016In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 133, no 12, p. 1189-1198Article in journal (Refereed)
    Abstract [en]

    Background- Self-management interventions are widely implemented in the care for patients with heart failure (HF). However, trials show inconsistent results, and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in patients with HF and whether subgroups of patients respond differently. Methods and Results- A systematic literature search identified randomized trials of self-management interventions. Data from 20 studies, representing 5624 patients, were included and analyzed with the use of mixed-effects models and Cox proportional-hazard models, including interaction terms. Self-management interventions reduced the risk of time to the combined end point of HF-related hospitalization or all-cause death (hazard ratio, 0.80; 95% confidence interval [CI], 0.71-0.89), time to HF-related hospitalization (hazard ratio, 0.80; 95% CI, 0.69-0.92), and improved 12-month HF-related quality of life (standardized mean difference, 0.15; 95% CI, 0.00-0.30). Subgroup analysis revealed a protective effect of self-management on the number of HF-related hospital days in patients < 65 years of age (mean, 0.70 versus 5.35 days; interaction P=0.03). Patients without depression did not show an effect of self-management on survival (hazard ratio for all-cause mortality, 0.86; 95% CI, 0.69-1.06), whereas in patients with moderate/severe depression, self-management reduced survival (hazard ratio, 1.39; 95% CI, 1.06-1.83, interaction P=0.01). Conclusions- This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death and HF-related hospitalization alone and elicited a small increase in HF-related quality of life. The findings do not endorse limiting self-management interventions to subgroups of patients with HF, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients.

  • 8.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Agren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Franzén Årested, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Long term follow up after an integrated educational and psychosocial intervention in patient-partner dyads affected by heart failure.2014Conference paper (Refereed)
  • 9.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Factors influencing caregiver burden in partners of patients with heart failure, a long term follow up2013Conference paper (Other academic)
  • 10.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Long term follow up after an integrated educational and psychosocial intervention in patient-partner dyads affected by heart failure2012Conference paper (Other academic)
  • 11.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Long term follow up after an integrated educational and psychosocial intervention in patient-partner dyads affected by heart failure2012Conference paper (Other academic)
  • 12.
    Liljeroos, Maria
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Centre for Clinical Research, Sörmland County Council, Eskilstuna, Sweden.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Arts and Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Perceived caring needs in patient-partner dyads affected by heart failure: A qualitative study.2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2928-2938Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore the perceived caring needs in patient-partner dyads affected by heart failure to develop an understanding of potential areas of support.

    BACKGROUND: Being affected by heart failure has a great impact on both the patient and the partner but until now contemporary care has remained patient focused.

    DESIGN: A qualitative study design was used.

    METHODS: Eight focus group interviews were performed, which included nineteen patients diagnosed with heart failure and their cohabiting partner. Patients were aged between 55-89 years and partners' ages ranged from 48-87 years. Data were analysed using qualitative content analyses.

    RESULTS: The dyads perceived that caring needs could be summarised in two themes 'Dyads perceive a need for continuous guidance through the different phases of the illness trajectory' and 'Dyads perceive a need to share burden and support with each other and others'. The dyads described a need to learn more about heart failure to be able to manage everyday life. Regular outpatient clinic visits and access to telephone support were vital, and having someone who cared about the well-being of the partners was perceived as comforting. Both the patient and the partner need to be present at the clinic visits. Receiving the same information and being able to ask questions reduce insecurity. Meeting others in the same situation and sharing the burden in group sessions were proposed as an opportunity to support each other and others.

    CONCLUSIONS: There is a need to improve education and support for patient-partner dyads affected by heart failure.

    RELEVANCE TO CLINICAL PRACTICE: The result shows the importance to provide continuous healthcare contacts throughout the illness trajectory. Furthermore, partners should be included at follow-up, and support groups should be organised so that dyads can meet and support each other.

  • 13.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Perceived needs of supportive care in patient-partner dyads affected by heart failure2013Conference paper (Other academic)
  • 14.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Self-assessed needs of supportive care in patient-partner dyads affected by heart failure2012Conference paper (Other academic)
  • 15.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Self-assessed needs of supportive care in patient-partner dyads affected by heart failure2011Conference paper (Refereed)
  • 16.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    The cognitive, supportive and behaviour needs of participants in a nurse-led intervention targeting patients with heart failure and their partners2015Conference paper (Other academic)
  • 17.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linnaeus University, Sweden; Ersta Skondal University of Collage, Sweden; Ersta Hospital, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Long Term Follow-Up after a Randomized Integrated Educational and Psychosocial Intervention in Patient-Partner Dyads Affected by Heart Failure2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, p. e0138058-Article in journal (Refereed)
    Abstract [en]

    Background To date, contemporary heart failure care remains patient-focused, but awareness of the partners and families situation is increasing. Randomized studies have mainly evaluated the short-term effects of dyadic interventions. Therefore, the aim of this study was to determine the 24-month effects of an intervention with psych-educational support in dyads of heart failure patients and their partners. Methods This study used a randomized study design and 155 patient-partner dyads were enrolled. The intervention included a nurse-led program of three sessions addressing psychoeducational support. Results The intervention did not have any effect on health, depressive symptoms or perceived control among the patient-partner dyads after 24 months. Furthermore, time to first event did not differ significantly between the intervention group and the control patients. Conclusion This study may be regarded as a first step in trying to understand dyads need for supportive care. Individualized and more targeted interventions seem necessary to achieve a higher impact on dyad outcomes.

  • 18.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Årested, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    A long-term follow up of experiences of and factors influencing caregiver burden in partners of patients with heart failure2013Conference paper (Other academic)
  • 19.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Long term effects of an integrated educational and psychosocial intervention in partners to patients affected by heart failure2014Conference paper (Other academic)
  • 20. Luttik, ML
    et al.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Agren, Susanna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Caregiving tasks and caregiver burden over time: effects on an intervention for patients with post-operative heart failure and their partners.2014Conference paper (Refereed)
  • 21.
    Strömberg, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Letter: Do partners to patients with heart failure experience caregiver burden? in EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, vol 11, issue 3, pp 367-3672012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, no 3, p. 367-367Article in journal (Other academic)
    Abstract [en]

    n/a

  • 22.
    Strömberg, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Prevalence and factors associated with depressive symptoms in partner of patients with chronic heart failure2012Conference paper (Other academic)
  • 23.
    Ågren, S
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Heart failure in the family - design and methodology of a randomised study evaluating education and psychosocial support to patients and their caregivers.2005Conference paper (Other academic)
  • 24.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Supportive care for patients with heart failure and their partners: A descriptive and interventional study2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Having the support of a partner is essential for both health related quality of life and survival in heart failure patients. However, caring for a patient with heart failure may affect the health related quality of life, well‐being and cause a burden for the partner. The partner is expected to be responsible for the care, which may have consequences for the heart failure patient’s long‐term health and well‐being. Further research to determine health related quality of life, well‐being, caregiver burden and needs of partners is warranted as well as studies evaluating interventions targeting patient‐partner dyads.

    Aim: The overall aim was to describe how the life situation of patient‐partner dyads was influenced by heart failure and to determine the effects of an intervention of follow‐up with education and psychosocial support for patient‐partner dyads.

    Design and methods: The thesis is based on three quantitative studies and one qualitative study. The first two studies were descriptive and included 135 dyads (patient‐partner) (I, II) and the randomised intervention study included a total of 155 dyads (IV). The qualitative study had a grounded theory approach. Thirteen partners were interviewed and data analysed using constant comparative method (III).

    Results: Caregiver burden was perceived as moderate in 30% of the partners and the rest experienced a low caregiver burden. The patients’ physical component score of SF‐36, partners’ mental component score of SF‐36 and perceived control explained 39% of the caregiver burden (I). Patients had lower health related quality of life compared to their partners in all dimensions except in the mental health domain of SF‐36 and lower qualityadjusted life year weights compared to their partners. Mental health scores were lower in partners compared to age and gender‐matched references. All other health related quality of life scores and the quality‐adjusted life year weights were comparable between the partners and the reference group. Patients had more depressive symptoms than their partners. There was no difference in the level of perceived control or knowledge about chronic heart failure between patients and partners (II). During grounded theory analysis confirmation was identified as describing the core category of the partners’ individual needs. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among partners (III). At the three month follow‐up the dyad‐intervention had improved perceived control in patients, but not in the partners. There were no other significant differences in the control and intervention group with regard to the dyads’ health related quality of life and symptoms of depression. There were also no differences in the patients’ self‐care behaviour and partners’ experiences of caregiver burden (IV).

    Conclusions and implications: Partners to patients with chronic heart failure are at risk of decreased mental well‐being. One third of the partners experienced a moderate caregiver burden and was therefore at a higher risk of poor mental health and decreased perceived control. During short‐term follow‐up the intervention with education and psychosocial support to dyads (patient‐partner) improved the level of perceived control in the chronic heart failure patient group. By identifying partnersʹ needs for security, rest for mind and body, and inner strength, healthcare professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions targeting dyads have been limited in previous research. Partners need to be prepared regarding the disease process, the daily regimen, hopes for the future and responsible care providers. They also need to be confirmed because they are vital to the patients’ recovery. Further, the effects of the intervention study should also include a long‐term follow‐up as well as an evaluation of the health‐economic perspective including direct and indirect costs of care.

    List of papers
    1. Do partners of patients with chronic heart failure experience caregiver burden?
    Open this publication in new window or tab >>Do partners of patients with chronic heart failure experience caregiver burden?
    2010 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 9, no 4, p. 254-262Article in journal (Refereed) Published
    Abstract [en]

    Aim: To describe the levels and identify independent predictors of caregiver burden in partners of patients with heart failure.

    Background: Care and support from a partner are important for the well-being of patients with heart failure and may potentially delay disease progression. However, caregiving may be associated with burden and stress and it is therefore important to understand which factors that influence caregiver burden. Theoretical models of caregiving describe the concept of burden as an outcome variable, including decreased well-being and health.

    Methods: Data for this descriptive cross sectional study were collected between January 2005 and September 2008. The dependent variable consisted of the Caregiver Burden Scale total score index. Socio-demographic and clinical characteristics, health-related quality of life, symptoms of depression, perceived control, and knowledge on heart failure were included in a regression analysis to determine independent predictors of caregiver burden.

    Results: The 135 partners had a mean-age of 69 years and 75% were females. Caregiver burden was perceived as medium in 30% of the partners. The patients’ Physical component score of SF-36 (p< 0.001), partners’ Mental component score of SF-36 (p< 0.001) and perceived control (p<0.01) accounted for 39% of the variance in caregiver burden.

    Conclusion: Caregiver burden was lower when the mental health of the partner and the physical health of the patient were better and the partner experienced higher control over the heart disease. A partner-centered approach to educate and support partners of patients with heart failure is essential to improve the life situation for patient-partner dyads.

    Place, publisher, year, edition, pages
    Amsterdam, Netherlands: Elsevier, 2010
    Keywords
    Caregiver burden, depression, health-related quality of life, heart failure, partner, nursing 1
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-56227 (URN)10.1016/j.ejcnurse.2010.03.001 (DOI)000284683700009 ()
    Available from: 2010-05-03 Created: 2010-05-03 Last updated: 2017-12-12Bibliographically approved
    2. The influence of chronic heart failure in patient-partner dyads: a comparative study addressing issues of health-related quality of life
    Open this publication in new window or tab >>The influence of chronic heart failure in patient-partner dyads: a comparative study addressing issues of health-related quality of life
    2011 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 26, no 1, p. 65-73Article in journal (Refereed) Published
    Abstract [en]

    Background: Patients with chronic heart failure (HF) and their partners face many challenges associated with heart disease. High social support in a close relationship has been found to improve survival in patients with HF. However, caring for a patient with HF may have negative effects on the health-related quality of life (HRQOL) of the partner responsible for the care. The main focus in health care is still on improving the patients’ HRQOL, but the awareness of partners’ and families’ role and situation is increasing. Therefore further studies are needed to clarify these issues and the importance of partners in relation to HRQOL of patients with HF.

    Objectives: To describe and compare HRQOL, quality-adjusted life year (QALY) weights, symptoms of depression, perceived control and knowledge in patients with chronic HF and their partners and to compare HRQOL and QALY weights in the partners with an age- and gender-matched group.

    Methods: Data was collected from 135 patient-partner dyads at two Swedish hospitals. Data on the reference group was collected from the same region.

    Results: Patients had lower HRQOL in all dimensions (p < 0.001) except in the mental health domain and lower QALY weights compared to their partners (p < 0.001). Mental health scores were lower in partners compared to the age and gender-matched references (p < 0.001). All other HRQOL scores and the QALY weights were comparable between partners and reference group. Patients had more depressive symptoms than their partners (p < 0.001). There was no difference in the level of perceived control or knowledge about chronic HF between patients and partners.

    Conclusion: Being a partner to a patient with chronic HF markedly affects the mental aspect of HRQOL. Interventions focusing on education and psychosocial support may potentially promote effective coping in partners and enhance their ability to support the patient.

    Place, publisher, year, edition, pages
    Aspen Publishers, 2011
    Keywords
    Heart failure, partner, health-related quality of life, quality-adjusted life year, knowledge
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-56228 (URN)10.1097/JCN.0b013e3181ec0281 (DOI)000285138300015 ()
    Available from: 2010-05-03 Created: 2010-05-03 Last updated: 2017-12-12
    3. Addressing spouses unique needs after cardiac surgery when recovery is complicated by heart failure
    Open this publication in new window or tab >>Addressing spouses unique needs after cardiac surgery when recovery is complicated by heart failure
    Show others...
    2009 (English)In: HEART and LUNG, ISSN 0147-9563, Vol. 38, no 4, p. 284-291Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Cardiac surgery places extensive stress on spouses who often are more worried than the patients themselves. Spouses can experience difficult and demanding situations when the partner becomes critically ill.

    OBJECTIVES: To identify, describe, and conceptualize the individual needs of spouses of patients with complications of heart failure after cardiac surgery.

    METHODS: Grounded theory using a mix of systematic coding, data analysis, and theoretical sampling was performed. Spouses, 10 women and 3 men between 39 and 85 years, were interviewed.

    RESULTS: During analysis, the core category of confirmation was identified as describing the individual needs of the spouses. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among spouses.

    CONCLUSIONS: By identifying spouses needs for security, rest for mind and body, and inner strength, health care professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions to confirm spouses needs are important because they are vital to the patients recovery.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20176 (URN)10.1016/j.hrtlng.2008.10.002 (DOI)
    Available from: 2009-09-01 Created: 2009-08-31 Last updated: 2013-09-03Bibliographically approved
    4. Dyads affected by chronic heart failure: a randomised study evaluating effects of education and psychosocial support to patients and their partners
    Open this publication in new window or tab >>Dyads affected by chronic heart failure: a randomised study evaluating effects of education and psychosocial support to patients and their partners
    2012 (English)In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 18, no 5, p. 359-366Article in journal (Refereed) Published
    Abstract [en]

    Background: Chronic heart failure (HF) may cause great suffering for both patients and their partners. High marital quality with sufficient emotional support has been found to influence long-term survival in patients with chronic HF. However, emotional reactions of burden, stress and depression have been found to be associated with the partner’s new role. Psychosocial support, and patients-partner education is usually not included in standard chronic HF care despite recommendations in international guidelines.

    Aim: To evaluate the effects of an integrated dyad care programme with education and psychosocial support to patients with chronic HF and their partners during a post-discharge period of 3 months after acute deterioration of chronic HF.

    Methods: A randomised, controlled design with a follow up assessment after 3 months was used. The dyads in the control group received care as usual. The experimental group participated in an integrated care intervention, delivered in three modules through nurse-led face-to-face counselling, a computer-based CD-ROM program and other written teaching materials.

    Results: The intervention improved perceived control (P<0.05) in patients, but not in the partners. There were no other significant differences between the groups with regard to the dyads’ health related quality of life and depressive symptoms, patients’ self-care behaviour and partners’ experiences of caregiver burden.

    Conclusion: This is the first major randomised study evaluating a programme focusing on the development of problem solving skills to assist the dyads in managing heart failure. The intervention significantly improved the level of perceived control in the patient group.

    Keywords
    Chronic heart failure, family, perceived control, quality of life, intervention, nursing
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-56231 (URN)10.1016/j.cardfail.2012.01.014 (DOI)000304078700002 ()
    Note
    funding agencies|Linkoping University||Swedish Research Council||Swedish Institute for Health Sciences||Heart and Lung Foundation||Heart and Lung Disease National Association||Lions Research Foundation||Health Sciences Centre||Available from: 2010-05-03 Created: 2010-05-03 Last updated: 2017-12-12Bibliographically approved
  • 25.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Psychoeducational support to post cardiac surgery heart failure patients and their partners: A randomised pilot study2015In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 1, p. 10-18Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Postoperative heart failure is a serious complication that changes the lives of both the person who is critically ill and family in many ways. The purpose of this study was to evaluate the effects of an intervention in postoperative heart failure patient-partner dyads regarding health, symptoms of depression and perceived control.

    RESEARCH METHODOLOGY/DESIGN: Pilot study with a randomised controlled design evaluating psychosocial support and education from an interdisciplinary team.

    SETTING: Patients with postoperative heart failure and their partners.

    MAIN OUTCOME MEASURES: SF-36, Beck Depression Inventory, Perceived Control at baseline, 3 and 12 months.

    RESULTS: A total of 42 patient-partner completed baseline assessment. Partners in the intervention group increased health in the role emotional and mental health dimensions and patients increased health in vitality, social function and mental health dimensions compared with the control group. Patients' perceived control improved significantly in the intervention group over time.

    CONCLUSION: Psychoeducational support to post cardiac surgery heart failure dyads improved health in both patients and partners at short term follow-up and improved patients' perceived control at both short and long-term follow-up. Psychoeducational support appears to be a promising intervention but the results need to be confirmed in larger studies.

  • 26.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Eriksson, Anna
    Hälsostödjande samtal2015Conference paper (Other academic)
    Abstract [en]

    Families who have a seriously ill family member in an intensive care unit face a demanding situation,threatening the normal functioning of the family. The burden onfamilies can be reduced by usingavailable resources, cohesiveness, supportive communication, flexibility and othersocial resources outsidethe family.If health promoting conversationsoffered to the family's ownabilities is strengthened, thisshould result in health promoting values to the family. In order to gain a better understanding of familyadaptation, we must not only see the family as a unit but also acknowledge the experiences of eachmember of the family.

    To investigate outcomes of the nurse led intervention, “Health promoting conversations with families” on family functioning and wellbeing in families with a member who has had critical illness.

    The study is a RCT study using a pre-test, post-test intervention and control group design. The inclusioncriteria will be: Patients over the age of 18, a minimum of 72 hours at the intensive care unit, and at leastone family member (>15 years) to each patient interested in participating. Within the study, quantitativeand qualitative data will be collected and analysed with descriptive and analytical statistical methods ofthe quantitative data and content analysis of the qualitative data.

    The conversations were considered to be healing and learning, because the family members can completememory loss from other family members' stories. Families showed a tendency to less stress and morehope, better mental health but poorer physical health in a pilot study. The project highlights knowledgeabout the health benefits of conversations about families where a family member has suffered from poorhealth. The health promoting conversations has a structure that makes conversations relatively easy toimplement in everyday healthcare and will be beneficial for many patients with critical illness and theirfamilies.

  • 27.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    A comparative study addressing health-related quality of life, symptoms of depression, perceived control and knowledge in patients with heart failure and their partners.2009In: Esc congress, Barcelona, 2009Conference paper (Refereed)
  • 28.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Caregiver burden experienced by partners to heart failure patients.2009In: Heart Failure, Nice, 2009Conference paper (Refereed)
  • 29.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    University of California Los Angeles.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Dyads affected by chronic heart failure, a randomised study evaluating the effects of education and psychosocial support in EUROPEAN HEART JOURNAL, vol 31, issue , pp 945-9462010In: EUROPEAN HEART JOURNAL, Oxford University Press , 2010, Vol. 31, p. 945-946Conference paper (Refereed)
    Abstract [en]

    n/a

  • 30.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Health-related quality of life, symptoms of depression, perceived control and self-estimated knowledge in patient-partner dyads dealing with chronic heart failure.2009In: 9th Annual Spring Meeting on Cardiovascular Nursing, CCNAP, 2009Conference paper (Refereed)
  • 31.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Heart failure in patient-partner dyads - a comparison of the partner group and an age-and-gender-matched reference population in HRQL.2009In: Heart Failure Congress, Nice., 2009Conference paper (Refereed)
  • 32.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Informal caregiving of heart failure in patient-partner dyads - a comparative study addressing health-related quality of life, symptoms of depression, perceived control and knowledge.2009In: ESC Congress Barcelona., 2009Conference paper (Refereed)
  • 33.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, L
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    The influence of heart failure in patient-partner dyads - a comparative study addressing health-related quality of life, symptoms of depression, perceived control and knowledge.2009In: Heart Failure, Nice., 2009Conference paper (Refereed)
  • 34.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing University of California Los Angeles USA.
    Davidson, Thomas
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    The influence of chronic heart failure in patient-partner dyads: a comparative study addressing issues of health-related quality of life2011In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 26, no 1, p. 65-73Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic heart failure (HF) and their partners face many challenges associated with heart disease. High social support in a close relationship has been found to improve survival in patients with HF. However, caring for a patient with HF may have negative effects on the health-related quality of life (HRQOL) of the partner responsible for the care. The main focus in health care is still on improving the patients’ HRQOL, but the awareness of partners’ and families’ role and situation is increasing. Therefore further studies are needed to clarify these issues and the importance of partners in relation to HRQOL of patients with HF.

    Objectives: To describe and compare HRQOL, quality-adjusted life year (QALY) weights, symptoms of depression, perceived control and knowledge in patients with chronic HF and their partners and to compare HRQOL and QALY weights in the partners with an age- and gender-matched group.

    Methods: Data was collected from 135 patient-partner dyads at two Swedish hospitals. Data on the reference group was collected from the same region.

    Results: Patients had lower HRQOL in all dimensions (p < 0.001) except in the mental health domain and lower QALY weights compared to their partners (p < 0.001). Mental health scores were lower in partners compared to the age and gender-matched references (p < 0.001). All other HRQOL scores and the QALY weights were comparable between partners and reference group. Patients had more depressive symptoms than their partners (p < 0.001). There was no difference in the level of perceived control or knowledge about chronic HF between patients and partners.

    Conclusion: Being a partner to a patient with chronic HF markedly affects the mental aspect of HRQOL. Interventions focusing on education and psychosocial support may potentially promote effective coping in partners and enhance their ability to support the patient.

  • 35.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing, University of California, Los Angeles, USA.
    Davidsson, Thomas
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    The influence of chronic heart failure in patient-partner dyads - a comparative study addressing issues of health-related quality of life2009Conference paper (Other academic)
    Abstract [en]

    Background: Patients with chronic heart failure (HF) and their partners face many challenges associated with heart disease. High social support in a close relationship has been found to improve survival in patients with HF. However, caring for a patient with HF may have negative effects on the health-related quality of life (HRQOL) of the partner responsible for the care. The main focus in health care is still on improving the patients’ HRQOL, but the awareness of partners’ and families’ role and situation is increasing. Therefore further studies are needed to clarify these issues and the importance of partners in relation to HRQOL of patients with HF.

    Objectives: To describe and compare HRQOL, quality-adjusted life year (QALY) weights, symptoms of depression, perceived control and knowledge in patients with chronic HF and their partners and to compare HRQOL and QALY weights in the partners with an age- and gender-matched group.

    Methods: Data was collected from 135 patient-partner dyads at two Swedish hospitals. Data on the reference group was collected from the same region.

    Results: Patients had lower HRQOL in all dimensions (p < 0.001) except in the mental health domain and lower QALY weights compared to their partners (p < 0.001). Mental health scores were lower in partners compared to the age and gender-matched references (p < 0.001). All other HRQOL scores and the QALY weights were comparable between partners and reference group. Patients had more depressive symptoms than their partners (p < 0.001). There was no difference in the level of perceived control or knowledge about chronic HF between patients and partners.

    Conclusion: Being a partner to a patient with chronic HF markedly affects the mental aspect of HRQOL. Interventions focusing on education and psychosocial support may potentially promote effective coping in partners and enhance their ability to support the patient.

  • 36.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    University of California Los Angeles .
    Hjelm, Carina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dyada affected by chronic heart failure - a randomised study evaluating effects of education and psychosocial support on patients and their partners.2010Conference paper (Refereed)
  • 37.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    University of California, Los Angeles.
    Hjelm, Carina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dyads affected by chronic heart failure - a randomised study evaluating effects of education and psychosocial support on patients and their partners.2010Conference paper (Refereed)
  • 38.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing University of California Los Angeles USA.
    Hjelm, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Dyads affected by chronic heart failure: a randomised study evaluating effects of education and psychosocial support to patients and their partners2012In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 18, no 5, p. 359-366Article in journal (Refereed)
    Abstract [en]

    Background: Chronic heart failure (HF) may cause great suffering for both patients and their partners. High marital quality with sufficient emotional support has been found to influence long-term survival in patients with chronic HF. However, emotional reactions of burden, stress and depression have been found to be associated with the partner’s new role. Psychosocial support, and patients-partner education is usually not included in standard chronic HF care despite recommendations in international guidelines.

    Aim: To evaluate the effects of an integrated dyad care programme with education and psychosocial support to patients with chronic HF and their partners during a post-discharge period of 3 months after acute deterioration of chronic HF.

    Methods: A randomised, controlled design with a follow up assessment after 3 months was used. The dyads in the control group received care as usual. The experimental group participated in an integrated care intervention, delivered in three modules through nurse-led face-to-face counselling, a computer-based CD-ROM program and other written teaching materials.

    Results: The intervention improved perceived control (P<0.05) in patients, but not in the partners. There were no other significant differences between the groups with regard to the dyads’ health related quality of life and depressive symptoms, patients’ self-care behaviour and partners’ experiences of caregiver burden.

    Conclusion: This is the first major randomised study evaluating a programme focusing on the development of problem solving skills to assist the dyads in managing heart failure. The intervention significantly improved the level of perceived control in the patient group.

  • 39.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Evangelista, Lorraine S.
    UC Irvine Program Nursing Science, CA USA .
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Cost-effectiveness of a nurse-led education and psychosocial programme for patients with chronic heart failure and their partners2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 15-16, p. 2347-2353Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  This randomised controlled trial was conducted to estimate the cost-effectiveness of a nurse-led education and psychosocial support programme for patients with heart failure (HF) and their partners.

    Background.  There are few studies evaluating cost-effectiveness of interventions among HF patient–partner dyads.

    Methods.  Dyads randomised to the experimental group received nurse-led counselling, computer-based education and written materials aimed at developing problem-solving skills at two, six and 12 weeks after hospitalisation with HF exacerbation. The dyads in the control group received usual care. A cost-effectiveness analysis that included costs associated with staff time to deliver the intervention and travel costs was conducted at 12 months. Quality-adjusted life-year (QALY) weights for patients and partners were estimated by SF-6D.

    Results.  A total of 155 dyads were included. The intervention cost was €223 per patient. Participants in both groups showed improvements in QALY weights after 12 months. However, no significant difference in QALY weights was found between the patients in the two groups, nor among their partners.

    Conclusion.  The intervention was not proven cost-effective, neither for patients nor for partners. The intervention, however, had trends (but not significant) effects on the patient–partner dyads, and by analysing the QALY gained from the dyad, a reasonable mean cost-effectiveness ratio was achieved.

    Relevance to clinical practice.  The study shows trends of a cost-effective education and psychosocial care of HF patient–partner dyads.

  • 40.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    University of California, Los Angeles.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Do partners of patients with chronic heart failure experience caregiver burden?2010Conference paper (Refereed)
  • 41.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing University of California Los Angeles USA.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Do partners of patients with chronic heart failure experience caregiver burden?2010In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 9, no 4, p. 254-262Article in journal (Refereed)
    Abstract [en]

    Aim: To describe the levels and identify independent predictors of caregiver burden in partners of patients with heart failure.

    Background: Care and support from a partner are important for the well-being of patients with heart failure and may potentially delay disease progression. However, caregiving may be associated with burden and stress and it is therefore important to understand which factors that influence caregiver burden. Theoretical models of caregiving describe the concept of burden as an outcome variable, including decreased well-being and health.

    Methods: Data for this descriptive cross sectional study were collected between January 2005 and September 2008. The dependent variable consisted of the Caregiver Burden Scale total score index. Socio-demographic and clinical characteristics, health-related quality of life, symptoms of depression, perceived control, and knowledge on heart failure were included in a regression analysis to determine independent predictors of caregiver burden.

    Results: The 135 partners had a mean-age of 69 years and 75% were females. Caregiver burden was perceived as medium in 30% of the partners. The patients’ Physical component score of SF-36 (p< 0.001), partners’ Mental component score of SF-36 (p< 0.001) and perceived control (p<0.01) accounted for 39% of the variance in caregiver burden.

    Conclusion: Caregiver burden was lower when the mental health of the partner and the physical health of the patient were better and the partner experienced higher control over the heart disease. A partner-centered approach to educate and support partners of patients with heart failure is essential to improve the life situation for patient-partner dyads.

  • 42.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hjelm, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing, University of California, Los Angeles, USA.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Dyads affected by chronic heart failure: a randomised study evaluating effects of education and psychosocial support to patients and their partners2011Conference paper (Other academic)
  • 43.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berg, Sören
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Addressing spouses unique needs after cardiac surgery when recovery is complicated by heart failure2009In: HEART and LUNG, ISSN 0147-9563, Vol. 38, no 4, p. 284-291Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiac surgery places extensive stress on spouses who often are more worried than the patients themselves. Spouses can experience difficult and demanding situations when the partner becomes critically ill.

    OBJECTIVES: To identify, describe, and conceptualize the individual needs of spouses of patients with complications of heart failure after cardiac surgery.

    METHODS: Grounded theory using a mix of systematic coding, data analysis, and theoretical sampling was performed. Spouses, 10 women and 3 men between 39 and 85 years, were interviewed.

    RESULTS: During analysis, the core category of confirmation was identified as describing the individual needs of the spouses. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among spouses.

    CONCLUSIONS: By identifying spouses needs for security, rest for mind and body, and inner strength, health care professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions to confirm spouses needs are important because they are vital to the patients recovery.

  • 44.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berg, Sören
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Addressing spouses' unique needs after cardiac surgery when recovery is complicated by heart failure2009Conference paper (Other academic)
    Abstract [en]

    BACKGROUND: Cardiac surgery places extensive stress on spouses who often are more worried than the patients themselves. Spouses can experience difficult and demanding situations when the partner becomes critically ill.

    OBJECTIVES: To identify, describe, and conceptualize the individual needs of spouses of patients with complications of heart failure after cardiac surgery.

    METHODS: Grounded theory using a mix of systematic coding, data analysis, and theoretical sampling was performed. Spouses, 10 women and 3 men between 39 and 85 years, were interviewed.

    RESULTS: During analysis, the core category of confirmation was identified as describing the individual needs of the spouses. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among spouses.

    CONCLUSIONS: By identifying spouses’ needs for security, rest for mind and body, and inner strength, health care professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions to confirm spouses’ needs are important because they are vital to the patients’ recovery.

  • 45.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Ivarsson, Bodil
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    Psychosocial impact in family members before and up to two years after heart or lung transplantation.2015Conference paper (Other academic)
  • 46.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Ivarsson, Bodil
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    The Unsteady Mainstay of the Family: Adult Children’s Retrospective View on Social Support in Relation to Their Parent’s Heart Transplantation2015Conference paper (Other academic)
  • 47.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Ivarsson, Bodil
    Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Lund, Sweden; Department of Cardiothoracic Surgery/THAI, Skåne University Hospital and Medical Services, Lund, Sweden.
    Rönning, Helén
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    The Unsteady Mainstay of the Family: Now Adult Children's Retrospective View on Social Support in Relation to Their Parent's Heart Transplantation.2014In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2014, article id 541241Article in journal (Refereed)
    Abstract [en]

    The needs for support among children with a seriously ill parent, who is waiting for heart transplantation, are unknown today. The aim was to describe now adult children's experiences of social support in relation to a parent's heart transplant during childhood. Nine females and four males were interviewed. The median age for the children was 18 at the transplantation and their parents had been ill before for 18 months (median) and on waiting list for 161 days (mean). Three categories emerged: health care professionals' approaches, family and friends' approaches, and society approaches. Our results show that there was lack of support for children of heart transplantation patients. Support in the shape of information was in most cases provided by the sick or healthy parent. It is of great clinical importance to develop psychosocial support programs for children with a seriously ill parent waiting for heart transplantation (before, during, and after surgery).

  • 48.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Sjöberg, Trygve
    Skånes universitetssjukhus, Lund.
    Ekmehag, Björn
    Akademiska sjukhuset, Uppsala.
    Wiborg, Maj-Britt
    Skånes universitetssjukhus, Lund.
    Ivarsson, Bodil
    Avdelningen för thoraxkirurgi, Institutionen för kliniska vetenskaper, Lunds universitet; Medicinsk service, Region Skåne.
    Patients' self-perceived health, coping, anxiety, depression and stress before and up to 2 years after a heart or lung transplantation.2015Conference paper (Other academic)
    Abstract [en]

    Background: Psychosocial factors are important aspects for patients before, on waiting list, and after a heart or lung transplantation.

    Aim: To illuminate patients' self-­‐perceived health, coping, anxiety, depression and stress before and up to 2 years after heart or lung transplantation.

    Method: Fifty-­‐four adult patients (28 cardiac and 26 lung) were included. They responded to questionnaires about quality of life, coping, anxiety, depression and stress when they were accepted for the transplant waiting list, then 6 months, 1 year and 2 years after a heart or lung transplantation. 

    Result: Mean waiting time was 37 weeks for cardiac patients and 29 weeks for lung patients. The patients had a lower coping ability and self-­‐perceived health at baseline and showed an improvement over time after the transplantation. Excluding pain, which increased and persisted over time after the transplantation, especially for the lung patients. Twenty-­‐three percent of all patients showed clinically anxiety before transplantation compared to 0-­‐8 % after transplantation. However, both before and after, clinical depression was significantly less frequent. Nearly half (44 %) of the patients scored medium or high level of intrusion stress and 38% of avoidance stress before the transplantation, which declined gradually over the years.

    Conclusion: Transplantation has led to positive psychosocial effects at 6 months, 1 year and 2 years after the heart or lung transplantation for most of the patients. The healthcare professionals must ensure to be aware of the challenges faced by their patients in daily living, not only the symptoms of their severe chronic disease but also psychosocial factors mainly before but even after a heart or lung transplantation. Patients have an underlying serious, chronic disease where severe long-­‐term life-­‐threatening complications suddenly can occur

  • 49.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Department of Cardiothoracic Surgery, Lund University, Lund, Sweden.
    Sjöberg, Trygve
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Ekmehag, Björn
    Uppsala University, Sweden; Uppsala University Hospital, Sweden.
    Wiborg, Maj-Britt
    Caring Science, Uppsala University, Sweden; Uppsala University Hospital, Uppsala, Sweden; Department of Cardiology, Skåne University Hospital Lund, Lund, Sweden.
    Ivarsson, Bodil
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Psycho-social aspects before and up to 2 years after heart or lung transplantation - experience of patients and their next of kin.2017In: Clinical Transplantation, ISSN 0902-0063, E-ISSN 1399-0012, Vol. 31, no 3, article id e12905Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychosocial factors are important for patients undergoing heart (HTx) or lung (LTx) transplantation, and for their next of kin (NoK).

    AIM: To describe health-related quality of life (patients only), anxiety, depression, stress, coping ability and burden (NoK only) for patients and their NoK before and up to 2 years after HTx or LTx.

    DESIGN: Adult patients (28 heart and 26 lung) and their appointed NoK were surveyed with questionnaires about specific psychosocial topics when they were accepted for the transplantation waiting list and 6 months, 1 year, and 2 years after transplantation.

    FINDINGS: Patients' coping ability and self-perceived health were low at baseline and improved over time after the transplantation. However, lung patients took longer time to recover in terms of health-related quality of life, depression, and stress than heart patients. Similarly, NoK of lung patients experienced a higher burden and more stress 1 year after transplantation than NoK of heart patients.

    CONCLUSIONS: Healthcare professionals should be aware of the psychosocial challenges patients and their NoK face in daily living and provide support both before and after heart or lung transplantation. Especially, given that these patients have a serious, chronic, underlying disease. This article is protected by copyright. All rights reserved.

  • 50.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Luttik, Marie Louise A.
    Hanze University of Appl Science, Netherlands.
    Caregiving tasks and caregiver burden; effects of an psycho-educational intervention in partners of patients with post-operative heart failure2015In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 44, no 4, p. 270-275Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the effects of a psycho-educational intervention on caregiver burden in partners of patients with postoperative heart failure. Background: Since partners of cardiac surgery patients play a significant role in the patients recovery, it is important to address their needs during hospitalization and after discharge. Methods: Forty-two patients with postoperative heart failure and their partners participated in a randomized controlled pilot study. Dyads in the intervention group received psycho-educational support from a multidisciplinary team. Dyads in the control group received usual care. Results: No significant differences were found in the performance of caregiving tasks and perceived caregiver burden in the control versus the intervention group. Conclusion: A pilot study exploring the effects of a psycho-educational intervention in patients and their partners did not reveal significant effects with regard to reduced feelings of burden in partners. Alleviating caregiver burden in partners may need a more intense or specific approach. (C) 2015 Elsevier Inc. All rights reserved.

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