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  • 201.
    Mourad, Ghassan
    et al.
    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.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, 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 Health Sciences.
    Internet-based CBT in patients with non-cardiac chest pain - design of a randomized controlled pilot study2014Conference paper (Other academic)
    Abstract [en]

    Introduction: The majority of the patients seeking medical care due to chest pain are admitted for in-hospital cardiac "rule out" observation, but only one third of all patients have ischemic heart disease. More than half of these patients are diagnosed as "non-cardiac chest pain" (NCCP). Patients with NCCP utilize a substantial amount of healthcare resources, and contribute to high costs for society. Patients with NCCP may be suffering from pain-related fear and inappropriate health beliefs leading to avoidance of physical activities that they think could be harmful to their hearts. We hypothesize that these patients will gain from evaluating the accuracy and usefulness of their thoughts, and shifting their cognitive appraisals from unhealthy and maladaptive to constructive and adaptive.

    Purpose: To test the feasibility and effectiveness of an intervention based on CBT supporting patients to handle chest pain and related emotions, reactions and thoughts.

    Methods: A total of twenty patients will be recruited to this randomized controlled pilot study planned to start in April 2014. Eligible for the study will be persons over the age of 18 who during the last 6 months had sought care at least twice due to non-cardiac chest pain, and who screened positive for bodily sensations and/or avoidance of physical activity. The intervention will be a guided 4 weeks internet-based CBT programme with the following content: •Information to increase patients’ knowledge of chest pain and its impact on daily life. •Reflection upon the strategies patients use and how these can change to facilitate management of chest pain, and related emotions, reactions and thoughts. •Tailored moderate physical activity, 30 minutes per day, to get reassured that the heart tolerates physical activity and to decrease pain-related fear. •Relaxation exercise, 15 minutes per day, that can be used to cope with general stress and if appropriate to use in relation to chest pain. The control group will receive "care as usual".

    Outcomes: The primary outcome will be "fear of bodily sensations" measured with the Bodily sensations questionnaire. The secondary outcomes will be "illness perception, pain, anxiety, depressive symptoms, quality of life, healthcare utilization and costs".

    Study significance: This study will reveal if the intervention is feasible and what effects it has on how patients perceive and handle chest pain. In case of positive outcomes, the study participants as well as the patient group will benefit in terms of better health. In the long term, society will also benefit from a reduction in healthcare utilization and costs.

  • 202.
    Mourad, Ghassan
    et al.
    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.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, 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 Health Sciences.
    Self-reported health and quality of life among patients with non-cardiac chest pain2014Conference paper (Other academic)
    Abstract [en]

    Introduction: Chest pain is a common reason for patients to attend emergency departments and be admitted to coronary care units. However, the cause of pain is non-cardiac in more than 50 % of these patients and many patients remain undiagnosed and symptomatic. Patients with non-cardiac chest pain do not differ from the general population in terms of long-term mortality, but they suffer from recurrent chest pain and frequently seek both primary and emergency care. There is therefore a need for targeted interventions in order to support patients with non-cardiac chest pain and minimize healthcare utilization and costs. Previous studies point out different psychosocial factors to be related to non-cardiac chest pain. However, to date there are few models taking into account the complex relationship between different clinical and psychosocial components that may cause non-cardiac chest pain.

    Purpose: To study the prevalence of and relationship between pain, depressive symptoms, anxiety, somatization, fear of bodily sensations, illness perception and quality of life in patients with non-cardiac chest pain in order to design a treatment programme.

    Methods: The study will have a descriptive design. Eligible for the study will be patients over the age of 18 who have been diagnosed with non-cardiac chest pain in four hospitals within a region in southeast Sweden. One thousand patients will be recruited, through patient registers provided by the hospitals, within one month from the day of admission. Data collection will start in the fall of 2013. Study information, written informed consent, all questionnaires, and a pre-stamped envelope will be sent to all eligible patients. Two reminders will be sent to patients who do not respond within 3 weeks from mail-out.

    Outcomes: The study will report on the relationship between chest pain, depressive symptoms, anxiety, somatization, fear of bodily sensations, illness perception, and quality of life. Data will be collected using the Brief Pain Inventory-Short Form, Patient Health Questionnaire-9, Cardiac Anxiety Questionnaire, Patient Health Questionnaire-15, Bodily Sensations Questionnaire, Brief Illness Perception Questionnaire, and EuroQol 5D.

    Study significance: This study will survey the complex relationship between different psychosocial factors and non-cardiac chest pain. This information will be of great interest when designing the optimal interventional programme in order to support patients with non-cardiac chest pain.

  • 203.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. 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.
    Johansson, Peter
    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.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    The relationship between depressive symptoms, cardiac anxiety and fear of body sensations, and healthcare seeking behaviour in patients with non-cardiac chest pain2015In: EuroHeartCare 2015: Moderated Poster Session I Psycho-social & Prevention Sunday 14 June 2015 – 10:00 – 11:00, Sage Publications, 2015, p. 41-41, article id 116Conference paper (Other academic)
    Abstract [en]

    Background: Chest pain is one of the most common reasons for hospital admissions and more than 50 % of the patients admitted are diagnosed as non-cardiac and discharged without a clear explanation of the underlying cause for the chest pain. A number of patients with non-cardiac chest pain (NCCP) suffer from recurrent chest pain and use a substantial amount of healthcare resources leading to high healthcare and societal costs. Although depressive symptoms, anxiety, and fear of body sensations are prevalent in these patients and may have an impact on patients´ healthcare seeking behaviour, the relationship between these psychological factors and healthcare seeking behaviour is not fully elucidated. Objective: To investigate the prevalence of depressive symptoms, cardiac anxiety and fear of body sensations in patients acutely admitted to hospital due to chest pain and discharged with a NCCP diagnosis. Additionally, to explore how depressive symptoms, cardiac anxiety and fear of body sensations are related to each other and to healthcare seeking behaviour. Methods: Cross-sectional descriptive design. Data were collected from 552 patients diagnosed with NCCP in four Swedish hospitals within one month from discharge using the Patient Health Questionnaire-9, Cardiac Anxiety Questionnaire and Body Sensations Questionnaire. Healthcare seeking behaviour the year before study inclusion (i.e. the number of healthcare contacts) was self-reported by the patients. Results: Of the study population, 141 (26 %) reported at least moderate depressive symptoms, 229 (42 %) reported at least moderate cardiac anxiety, and 337 (62 %) reported some degree of fear of body sensations. There were strong positive relationships between depressive symptoms and cardiac anxiety (rs=.49, p<.01), depressive symptoms and fear of body sensations (rs=.50, p<.01), and cardiac anxiety and fear of body sensations (rs=.56, p<.01). 26 % of the study participants reported 2-3 healthcare contacts and 14 % reported more than 3 healthcare contacts due to chest pain. In a multivariable regression analysis, cardiac anxiety was the only variable independently associated with healthcare seeking behaviour. Conclusions: Symptoms of psychological distress were more frequently reported by the patients with NCCP that had more healthcare contacts. Especially cardiac anxiety was associated with healthcare seeking behaviour, and may therefore be an important target for intervention. The results from this study will guide the development of a web-based intervention targeting cardiac anxiety to improve patient outcomes and reduce healthcare use and costs.

  • 204.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. 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 Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jonsbu, E
    More and Romsdal Hospital Trust, Department of Psychiatry, Molde, Norway.
    Gustafsson, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Johansson, Peter
    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 Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Guided Internet-delivered cognitive behavioural therapy in patients with non-cardiac chest pain: -a pilot randomized controlled study2016In: Abstract book, Sage Publications, 2016, Vol. 15 (S1), p. S44-S44, article id P116Conference paper (Other academic)
    Abstract [en]

    Background: Patients with recurrent episodes of non-cardiac chest pain (NCCP) suffer from cardiac anxiety as they misinterpret the pain as being cardiac-related and avoid physical activity that they think could threaten their life. This could lead to increased healthcare utilization and costs. These patients might benefit from help and support to evaluate the perception and management of their chest pain. 

    Objective: To test the feasibility of a short guided Internet-delivered cognitive behavioural intervention and the effects on chest pain, cardiac anxiety, fear of body sensations and depressive symptoms in patients with NCCP compared to usual care.

    Methods: A pilot randomized controlled study was conducted. Fifteen patients, 9 men and 6 women between the age of 22 and 76 (median age of 66 years, q1-q3 57-73) were randomly assigned to either intervention (n=7) or control (n=8) group. Patients had recurrent NCCP and suffered from cardiac anxiety or fear of body sensations. The intervention consisted of a 4-session guided Internet-delivered cognitive behavioural therapy program containing psychoeducation, exposure to physical activity, and relaxation. The control group received usual care. All patients completed a web-based questionnaire on socio-demographic variables, chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms. 

    Results: Five out of the 7 patients in the intervention group completed all sessions as planned and two completed only parts of the program. The program was perceived as user-friendly with comprehensible language, adequate and varied content, and manageable homework assignments. The patients were engaged in the program for about 45-60 minutes per day and about 22 minutes’ therapist time was required to guide, support and give feedback to each patient throughout the program. Participating in the program empowered and motivated many of the patients to be active and complete the program. In general, patients in both the intervention and control groups improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but there were no significant differences between the groups. 

    Conclusions: A short guided Internet-delivered cognitive behavioural therapy program was feasible. Patients in both the intervention and control groups improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but no significant differences were found between the groups. Patients should be followed-up for longer periods to measure the long-term effects of the intervention.

  • 205.
    Mourad, Ghassan
    et al.
    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. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jonsbu, Egil
    Department of Psychiatry, More and Romsdal Hospital Trust, Molde, and Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
    Gustafsson, Mikael
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences. 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.
    Guided Internet-delivered cognitive behavioral therapy in patients with non-cardiac chest pain: a pilot randomized controlled study2015Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Patients with recurrent episodes of non-cardiac chest pain (NCCP) may suffer from cardiac anxiety and avoidance behavior, leading to increased healthcare utilization. These patients might benefit from help and support to evaluate the perception and management of their chest pain.

    Objective: To test the feasibility of a short guided Internet-delivered CBT intervention and the effects on chest pain, cardiac anxiety, fear of body sensations and depressive symptoms in patients with NCCP compared to usual care.

    Methods: A pilot randomized controlled study was conducted. Fifteen patients, nine men and six women with a median age of 66 years (range 22-76), were randomly assigned to either intervention (n=7) or control (n=8) group. Patients had recurrent episodes of non-cardiac chest pain and suffered from cardiac anxiety and/or fear of body sensations. The intervention consisted of a four-session guided Internet-delivered CBT program containing psychoeducation, physical activity, and relaxation. The control group received usual care. All patients completed a web-based questionnaire on socio-demographic variables, chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms.

    Results: Five out of the seven patients in the intervention group completed all sessions as planned and two joined only parts of the program. The program was perceived as userfriendly with understandable language, adequate and varied content, and manageable homework assignments. The patients were engaged in the program for about 60 minutes per day and about 22 minutes’ therapist time was required to guide, support and give feedback to each patient through the program. Participating in the program, particularly being guided and supported, empowered and motivated many of the patients to be active and complete the program. In general, patients in both intervention and control groups improved with regard to chest pain frequency, cardiac  anxiety, fear of body sensations, and depressive symptoms, but there were no significant differences between the groups.

    Conclusions: A short guided Internet-delivered CBT program was feasible. Patients in both intervention and control groups improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but no significant differences were found between the groups. Patients should be followed-up for longer periods to measure the long-term effects of the intervention.

  • 206.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. 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. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jonsbu, Egil
    More and Romsdal Hospital Trust, Norway; Norwegian University of Science and Technology, Norway.
    Gustafsson, Mikael
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Johansson, Peter
    Linköping University, Department of Social and Welfare Studies, 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 Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Guided Internet-delivered cognitive behavioural therapy in patients with non-cardiac chest pain - a pilot randomized controlled study2016In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 17, p. 1-12, article id 352Article in journal (Refereed)
    Abstract [en]

    Background: Patients with recurrent episodes of non-cardiac chest pain may experience cardiac anxiety and avoidance behavior, leading to increased healthcare utilization. These patients might benefit from help and support to evaluate the perception and management of their chest pain. The purpose of this study was to test the feasibility of a short guided Internet-delivered cognitive behavioural therapy (CBT) program and explore the effects on cardiac anxiety, fear of body sensations, depressive symptoms, and chest pain in patients with non-cardiac chest pain, compared with usual care. Methods: A pilot randomized controlled study was conducted. Fifteen patients with non-cardiac chest pain with cardiac anxiety or fear of body sensations, aged 22-76 years, were randomized to intervention (n = 7) or control (n = 8) groups. The four-session CBT program contained psychoeducation, physical activity, and relaxation. The control group received usual care. Data were collected before and after intervention. Results: Five of seven patients in the intervention group completed the program, which was perceived as user-friendly with comprehensible language, adequate and varied content, and manageable homework assignments. Being guided and supported, patients were empowered and motivated to be active and complete the program. Patients in both intervention and control groups improved with regard to cardiac anxiety, fear of body sensations, and depressive symptoms, but no significant differences were found between the groups. Conclusions: The Internet-delivered CBT program seems feasible for patients with non-cardiac chest pain, but needs to be evaluated in larger groups and with a longer follow-up period.

  • 207.
    Mourad, Ghassan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. 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. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    What are patients with heart failure willing to pay for an exergame intervention?2019Conference paper (Refereed)
    Abstract [en]

    Background: Regular physical activity in patients with heart failure (HF) improves physical capacity and quality of life, and may reduce health care utilization. One low-cost effective physical activity intervention to increase exercise capacity is exergaming. Exploring patients’ willingness to pay (WTP) for treatments/interventions is a way to obtain a monetary value for the health consequences of an intervention. This can further be used in economic evaluations.

    Aim: The aim of this study was to describe patients´ WTP for an exergame intervention and to determine factors influencing the WTP.

    Methods: This is a substudy of the Swedish cohort of the HF-Wii study (evaluating the effect of exergaming on exercise capacity in patients with HF; clinicaltrial.gov NCT01785121) including 34 patients who finished the 1-year follow-up. Structured telephone interviews were conducted focusing on WTP for the exergame intervention they received during the study including an exergame platform, an introduction lesson, installation of the exergame computer, and telephone follow-ups, and with an estimated cost of ∼€440 per patient. The WTP methodology used was adjusted for this specific study.

    Patients were also asked to rate their level of satisfaction with the intervention on a Numeric Rating Scale (NRS) from 0-10. In addition, information on background variables and income was collected during the interview, while data on six minute walk test (6MWT) and quality of life was retrieved from previous data collection in the main study.

    Results: In total, 29 patients with HF participated in this substudy, mean age 68±9 years, 69% males, and with a mean household disposable income/month of ∼€2700 (±1360). Ten patients (34.5%) had a clinically significant effect of the exergaming and improved more than 30 meters on the 6MWT.

    The average WTP for the exergame intervention was ∼€160 (range €0-580). Most patients were satisfied with the exergame intervention and the median score was 8 on the NRS. The satisfaction level was significantly related to WTP (rs=0.468, p=0.012). Patients with higher satisfaction levels were willing to pay more (€210±165) for the exergame intervention than those with lower satisfaction levels (€60±70), p=0.015. Income, changes in 6MWT, and quality of life showed no significant relationship to WTP.

    Conclusions: The WTP for an exergame intervention varied largely in patients with HF despite high satisfaction level with the intervention. The satisfaction level was the only factor influencing patients´ WTP. On average, patients were willing to pay about one-third of the cost of the exergame intervention. Future studies should focus on the cost-effectiveness of this intervention.

  • 208. Mårtenson, J
    et al.
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Karlsson, J-E
    Fridlund, B
    Patients with heart failure in primary health care: Effects of a nurse-led intervention on health-related quality of life and depression2005In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 7, no 3 SPEC. ISS., p. 393-403Article in journal (Refereed)
    Abstract [en]

    Aims: To determine the effects of a nurse-led intervention designed to improve self-management of patients with heart failure in a primary health care setting regarding health-related quality of life and depression. Methods: Patients at eight primary health care centres were screened by the Diagnosis Related Groups registry for the diagnosis of heart failure and eligibility for a cluster randomised study. A total of 153 patients were included (n=78 in the intervention group, 54% males, mean age 79 years, 59% in New York Heart Association class III-IV). The intervention involved patient and family education about heart failure and self-management and monthly telephone follow-up during 12 months by a primary health care nurse. Results: The effects of the nurse-led intervention were limited. Significant differences were found in the physical dimension measured by the SF-36 health survey, and in depression measured by the Zung Self-rating Depression Scale. In comparison within groups at the 3 and 12-month follow-up, the intervention group significantly maintained their health-related quality of life measured by the SF-36 health survey, and their experience of depression measured by the Zung Self-rating Depression Scale to a greater extent than in the control group, especially among women. Conclusion: A nurse-led intervention directed toward patients with heart failure in a primary health care setting resulted in limited effects between the groups, although the physical and mental status were retained during 12 months of follow-up to a greater extent than in the control group. © 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  • 209. Mårtensson, J
    et al.
    Fridlund, B
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Cardiovascular nursing in Sweden 2006 - New Challenges for clinical practice, education, and research2006In: Progress in Cardiovascular Nursing, ISSN 0889-7204, E-ISSN 1751-7117, Vol. 3, p. 162-165Article in journal (Refereed)
  • 210.
    Näsström, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Idvall, Eva
    Malmö Högskola.
    Mårtensson, Jan
    Hälsohögskolan i Jönköping.
    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.
    Heart failure at home - Patients' experiences of participation in structured home care2011Conference paper (Refereed)
  • 211.
    Näsström, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Idvall, Ewa
    Högskolan i Malmö.
    Mårtensson, Jan
    Hälsohögskolan i Jönköping.
    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.
    Heart failure at home - an observational study of participation among patients in structured home care2011Conference paper (Refereed)
  • 212.
    Näsström, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Idvall, Ewa
    Department of Care Science, Malmö University, Sweden.
    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.
    Heart failure patients’ descriptions of participation in structured home care2015In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 18, no 5, p. 1384-1396Article in journal (Refereed)
    Abstract [en]

    Background

    To strengthen the patient's position in health care, patient participation has been decreed in policy documents and legalizations. For patients suffering from heart failure, self-care is an important part of disease management and participation is crucial to succeed with this.

    Objective

    To examine how heart failure patients receiving structured home care described participation in the care.

    Design

    Qualitative study.

    Setting and participants

    Thirteen men and six women, aged between 63 and 90 years, were interviewed. The informants received structured home care at four home care units in Sweden. The interviews were analysed using qualitative content analysis.

    Results

    Five categories with associated subcategories describing participation in care were identified: communication between patients and health-care professionals (HCPs) including time and space for dialogue and exchange of care-related information, accessibility to care through awareness of the plan for home visits or feasibility to initiate home visits, active involvement in care by engaging in self-care and collaboration with HCPs, trustful relation with HCPs, with confidence in competence and individually adapted care, options for decision making, by making decisions or entrusting decisions.

    Conclusions

    Patient participation could be strengthened through structured home care. Participation was facilitated when there was a balance between the patient's own preferences to influence care and the health-care professional's actions and values and the organization of care. Barriers to participation could depend on the health-care organization, lack of continuity and confidence in HCPs.

  • 213.
    Näsström, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Idvall, Ewa
    Malmö Högskola.
    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.
    Patients' descriptions of participation in structured heart failure home care2012Conference paper (Other academic)
  • 214.
    Näsström, Lena
    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.
    Idvall, Ewa
    Malmö University, Sweden; Skåne University Hospital, Sweden.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Linnaeus University, Sweden; Ersta Skondal University of Coll, Sweden; Ersta Hospital, Sweden.
    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.
    Patient participation in patients with heart failure receiving structured home care - a prospective longitudinal study2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, no 633Article in journal (Refereed)
    Abstract [en]

    Background: Patient participation is important for improving outcomes, respect for self-determination and legal aspects in care. However, how patients with heart failure view participation and which factors may be associated with participation is not known. The aim of this study was therefore to describe the influence of structured home care on patient participation over time in patients diagnosed with heart failure, and to explore factors associated with participation in care. Methods: The study had a prospective pre-post longitudinal design evaluating the influence of structured home care on participation in patients at four different home care units. Patient participation was measured using 3 scales and 1 single item. Self-care behavior, knowledge, symptoms of depression, socio-demographic and clinical characteristics were measured to explore factors associated with patient participation. Repeated measure ANOVA was used to describe change over time, and stepwise regression analyses were used to explore factors associated with patient participation. Results: One hundred patients receiving structured heart failure home care were included. Mean age was 82 years, 38 were women and 80 were in New York Heart Association functional class III. One aspect of participation, received information, showed a significant change over time and had increased at both six and twelve months. Better self-care behavior was associated with all four scales measuring different aspects of participation. Experiencing lower degree of symptoms of depression, having better knowledge, being of male sex, being of lower age, cohabiting and having home help services were associated with one or two of the four scales measuring different aspects of participation. Conclusion: Patients experienced a fairly high level of satisfaction with participation in care at baseline, and there was a significant improvement over time for participation with regard to received information after being admitted to structured home care. Higher level of patient participation was consistently associated with better self-care behavior. This study shows that patient participation may need to be further focused upon, and that the association with self-care may be interesting to target in future interventions.

  • 215.
    Näsström, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Luttik, Marie Louise
    Hanze University of Applied Sciences Groningen, Research Group Nursing Diagnostics, Groningen, the Netherlands.
    Idvall, Ewa
    Department of Care Science, Malmö University, and Department of Intensive Care and Perioperative Medicine, Skåne University 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.
    Exploring partners’ perspectives on participation in heart failure home-care: A mixed method design2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 5, p. 1208-1219Article in journal (Refereed)
    Abstract [en]

    Previous research has shown that partners are involved in the care of patients with heart failure. The aim of this study was to gain a better understanding of the partners ‘perspectives on participation in the care for patients with heart failure receiving structured home-care. A parallel convergent mixed method design with data from interviews analyzed with content analysis and questionnaires statistically analyzed (n=15). Results were analyzed with regard to whether they were comparable and convergent, expanded the understanding, or were inconsistent. Partners scored that they were satisfied with most aspects of participation, information and contact. Qualitative findings revealed four different aspects of participation; adapting to the caring needs and illness trajectory, mastering caregiving demands, interacting with health care providers, and gaining knowledge to comprehend the health situation. Results showed confirmatory results that were convergent and expanded knowledge that gave a broader understanding of partner participation in this context.

  • 216.
    Näsström, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Mårtensson, Jan
    Jonköping University, Sweden.
    Idvall, Ewa
    Malmö University, 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.
    Participation in Care Encounters in Heart Failure Home-Care2017In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 26, no 6, p. 713-730Article in journal (Refereed)
    Abstract [en]

    The purpose of this qualitative study was to observe care encounters during home visits in Heart failure (HF) home-care to identify and describe participation in care. Seventeen patients diagnosed with HF, and 10 registered nurses participated. Data from 19 video-recorded home visits were analyzed using qualitative content analysis. Two themes were identified: (a) Participation in the care encounter is made possible by interaction, including exchanging care-related information, care-related reasoning, collaboration; and (b) participation in the care encounter is made possible by an enabling approach, including the patients expressing their own wishes, showing an active interest, while the nurse is committed and invites to having a dialogue. The HF home-care context showed good potential for patient participation. Room for discussions and collaboration facilitated for the patients to be active partners in their care, which in turn may have positive effects on outcomes.

  • 217.
    Näsström, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Mårtensson, Jan
    Department of Nursing, School of Health Sciences, Jönköping, Sweden.
    Idvall, Ewa
    Department of Care Science, Malmö University, and Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Sweden.
    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.
    Participation in the Care Encounter among Patients with Heart Failure Receiving Home-care2013Manuscript (preprint) (Other academic)
    Abstract [en]

    Background Heart failure is a chronic condition that affects patients’ life situation. Living with heart failure puts high demands on self-care and patient participation. Patients often need advanced care due to deterioration of their heart failure symptoms, and one option is homecare. Prerequisites for participation may differ when receiving home-care.

    Objective The aim of this study was to identify and describe participation in care encounters during home visits in heart failure home-care.

    Participants and setting Seventeen patients diagnosed with heart failure, aged 63-95 years, and ten registered nurses participated. The patients received home-care from three different home-care providers in Sweden.

    Methods Data from nineteen home visits was collected through observations and documented by video-recordings. The verbal communication in these video-recordings was transcribed verbatim and complemented with non-verbal communication. Data was analysed using qualitative content analysis, and the video-recordings and transcribed material were analysed in parallel.

    Results We identified two themes with three and four categories respectively; (a) Participation in the care encounter is made possible by interaction, including exchange of care-related information, care-related reasoning, and collaboration, and (b) Participation in the care encounter is made possible by an enabling approach, including the patient expresses their own wishes and shows an active interest, and the nurse is committed and invites to a dialogue.

    Conclusion Our findings underline that patient participation is multifaceted and that the home-care context shows good potential for patient participation as the care encounters were categorised by interaction and an enabling approach.

  • 218.
    Oterhals, Kjersti
    et al.
    Haukeland University Hospital, Norway .
    Deaton, Christi
    University of Manchester, and Central Manchester NHS Foundation Trust, UK .
    De Geest, Sabina
    Katholieke University of Leuven, Belgium and University of Basel, Switzerland .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Lenzen, Mattie
    Erasmus MC, The Netherlands .
    Moons, Philip
    Katholieke University of Leuven, Belgium and Copenhagen University Hospital, Denmark.
    Mårtensson, Jan
    Jönköping University, Sweden .
    Smith, Karen
    Ninewells Hospital, Scotland and University of Dundee, Scotland .
    Stewart, Simon
    Baker IDI Heart and Diabet Institute, Australia .
    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.
    Thompson, David R.
    Australian Catholic University, Australia .
    Norekval, Tone M.
    Haukeland University Hospital, Norway and University of Bergen, Norway .
    European cardiac nurses current practice and knowledge on anticoagulation therapy2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, Vol. 13, no 3, p. 261-269Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Successful management of warfarin, new anti-thrombotic agents and self-monitoring devices requires that health care professionals effectively counsel and educate patients. Previous studies indicate that health care professionals do not always have the knowledge to provide patients with the correct information.

    AIMS:

    The purpose of this study was to investigate European cardiovascular nurses' knowledge on the overall management of anticoagulation therapy and examine if this knowledge was influenced by level of education and years in clinical practice.

    METHODS:

    A questionnaire including 47 items on practice patterns and knowledge on warfarin, new anticoagulants, warfarin-drug and warfarin-food interactions, and self-management of International Normalized Ratio (INR) was distributed to the attendants at a European conference in 2012.

    RESULTS:

    The response rate was 32% (n=206), of whom 84% reported having direct patient contact. Warfarin was the most common used oral anticoagulation in daily practice. One third offered their patients both patient self-testing and patient self-management of INR. The mean total score on the knowledge questions was 28±6 (maximum possible score 53). Nurses in direct patient care had a higher mean score (p=0.011). Knowledge on warfarin and medication-interactions were low, but knowledge on warfarin-diet interactions and how to advise patients on warfarin as somewhat better.

    CONCLUSION:

    European cardiac nurses need to improve their knowledge and practice patterns on oral anticoagulation therapy. This area of knowledge is important in order to deliver optimal care to cardiac patients and to minimise adverse effects of the treatment.

  • 219.
    Perkiö Kato, Naoko
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, Japan.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Casida, Jesus M
    Johns Hopkins University School of Nursing, Baltimore, MD, USA.
    Lee, Christopher S.
    Boston College, Willian F. Connell School of Nursing, Chestnut Hill, MA, 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.
    Ben Gal, Tuvia
    Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Israel.
    Development of an Instrument for Measuring Self-Care Behaviors After Left Ventricular Assist Device Implantation.2019In: Progress in transplantation, ISSN 2164-6708, article id 1526924819874358Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Successful long-term left ventricular assist device (LVAD) therapy necessitates a high degree of self-care. We aimed to develop an instrument that measures self-care behaviors in adult patients living with an LVAD.

    METHODS: We used the method to develop patient-reported outcomes recommended by the US Food and Drug Administration. Prior to developing the instrument, a literature review was conducted to generate items using the middle-range theory of self-care of chronic illness as a guiding framework. A 2-round Delphi method, involving 17 clinicians with expertise in heart failure and assist devices from the Netherlands, Israel, United States, Canada, and Japan, was used to generate and select items. In the first Delphi survey, the levels of importance, relevance, and clarity of items in the instrument were evaluated. The second Delphi survey was performed to gain consensus on the final selection of items. We also examined face validity.

    RESULTS: A preliminary 37-item version of the Self-Care Behavior Scale was produced. The first panel judged 33 items as important and relevant, taking out 4 items due to vague wording and duplication and adding in 4 items. In the final 33-item version, 19 items address self-care maintenance behaviors, 10 items address self-care monitoring behaviors, and 4 items address self-care management behaviors. Patients (N = 25) did not have any difficulties understanding items and report any missing items.

    CONCLUSION: The 33-item Self-Care Behavior Scale for patients with heart failure having an LVAD has been developed and is ready for further psychometric testing.

  • 220.
    Perkiö Kato, Naoko
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. University of Tokyo, Japan; Research Abroad, Japan.
    Johansson, Peter
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Okada, Ikuko
    University of Tokyo, Japan.
    de Vries, Arjen E.
    University of Medical Centre Groningen, Netherlands.
    Kinugawa, Koichiro
    University of Tokyo, Japan.
    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.
    Heart Failure Telemonitoring in Japan and Sweden: A Cross-Sectional Survey2015In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 17, no 11, p. e258-Article in journal (Refereed)
    Abstract [en]

    Background: Telemonitoring of heart failure (HF) patients is increasingly discussed at conferences and addressed in research. However, little is known about actual use in specific countries. Objective: We aimed to (1) describe the use of non-invasive HF telemonitoring, (2) clarify expectations of telemonitoring among cardiologists and nurses, and (3) describe barriers to the implementation of telemonitoring in Japan and Sweden. Methods: This study used a cross-sectional survey of non-invasive HF telemonitoring. A total of 378 Japanese (120 cardiologists, 258 nurses) and 120 Swedish (39 cardiologists, 81 nurses) health care professionals from 165 Japanese and 61 Swedish hospitals/clinics nationwide participated in the study (210 in Japan and 98 in Sweden were approached). Data were collected between November 2013 and May 2014 with a questionnaire that was adapted from a previous Dutch study on telemonitoring. Results: The mean age of the cardiologists and nurses was 47 years and 41 years, respectively. Experience at the current position caring for HF patients was 19 years among the physicians and 15 years among the nurses. In total, 7 Japanese (4.2%) and none of the Swedish health care institutions used telemonitoring. One fourth (24.0%, 118/498) of the health care professionals were familiar with the technology (in Japan: 21.6%, 82/378; in Sweden: 30.0%, 36/120). The highest expectations of telemonitoring (rated on a scale from 0-10) were reduced hospitalizations (8.3 in Japan and 7.5 in Sweden), increased patient self-care (7.8 and 7.4), and offering high-quality care (7.8 and 7.0). The major goal for introducing telemonitoring was to monitor physical condition and recognize signs of worsening HF in Japan (94.1%, 352/374) and Sweden (88.7%, 102/115). The following reasons were also high in Sweden: to monitor effects of treatment and adjust it remotely (86.9%, 100/115) and to do remote drug titration (79.1%, 91/115). Just under a quarter of Japanese (22.4%, 85/378) and over a third of Swedish (38.1%, 45/118) health care professionals thought that telemonitoring was a good way to follow up stable HF patients. Three domains of barriers were identified by content analysis: organizational barriers "how are we going to do it?" (categories include structure and resource), health care professionals themselves "what do we need to know and do" (reservation), and barriers related to patients "not everybody would benefit" (internal and external shortcomings). Conclusions: Telemonitoring for HF patients has not been implemented in Japan or Sweden. However, health care professionals have expectations of telemonitoring to reduce patients hospitalizations and increase patient self-care. There are still a wide range of barriers to the implementation of HF telemonitoring.

  • 221.
    Pettersen, Trond R.
    et al.
    Haukeland Hosp, Norway.
    Martensson, Jan
    Jönköping Univ, Sweden.
    Axelsson, Asa
    Univ Gothenburg, Sweden.
    Jorgensen, Marianne
    Stavanger Univ Hosp, Norway.
    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.
    Thompson, David R.
    Univ Melbourne, Australia.
    Norekval, Tone M.
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    European cardiovascular nurses and allied professionals knowledge and practical skills regarding cardiopulmonary resuscitation2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 4, p. 336-344Article in journal (Refereed)
    Abstract [en]

    Purpose: Cardiopulmonary resuscitation (CPR) remains a cornerstone in the treatment of cardiac arrest, and is directly linked to survival rates. Nurses are often first responders and need to be skilled in the performance of cardiopulmonary resuscitation. As cardiopulmonary resuscitation skills deteriorate rapidly, the purpose of this study was to investigate whether there was an association between participants cardiopulmonary resuscitation training and their practical cardiopulmonary resuscitation test results. Methods: This comparative study was conducted at the 2014 EuroHeartCare meeting in Stavanger (n=133) and the 2008 Spring Meeting on Cardiovascular Nursing in Malmo (n=85). Participants performed cardiopulmonary resuscitation for three consecutive minutes CPR training manikins from Laerdal Medical (R). Data were collected with a questionnaire on demographics and participants level of cardiopulmonary resuscitation training. Results: Most participants were female (78%) nurses (91%) from Nordic countries (77%), whose main role was in nursing practice (63%), and 71% had more than 11 years experience (n=218). Participants who conducted cardiopulmonary resuscitation training once a year or more (n=154) performed better regarding ventilation volume than those who trained less (859 ml vs. 1111 ml, p=0.002). Those who had cardiopulmonary resuscitation training offered at their workplace (n=161) also performed better regarding ventilation volume (889 ml vs. 1081 ml, p=0.003) and compression rate per minute (100 vs. 91, p=0.04) than those who had not. Conclusion: Our study indicates a positive association between participants performance on the practical cardiopulmonary resuscitation test and the frequency of cardiopulmonary resuscitation training and whether cardiopulmonary resuscitation training was offered in the workplace. Large ventilation volumes were the most common error at both measuring points.

  • 222.
    Pihl, Emma
    et al.
    Jonkoping University.
    Cider, Asa
    Sahlgrens University Hospital.
    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.
    Fridlund, Bengt
    Jonkoping University.
    Martensson, Jan
    Jonkoping University.
    Exercise in elderly patients with chronic heart failure in primary care: Effects on physical capacity and health-related quality of life2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 3, p. 150-158Article in journal (Refereed)
    Abstract [en]

    Introduction: Chronic heart failure (CHF) limits exercise capacity which influences physical fitness and health-related quality of life (HRQoL). less thanbrgreater than less thanbrgreater thanAim: The aim was to determine the effects on physical capacity and HRQoL of an exercise programme in elderly patients with CHF in primary care. less thanbrgreater than less thanbrgreater thanMethods: An exercise intervention was conducted as a prospective, longitudinal and controlled clinical study in primary care in elderly patients with CHF. Endurance exercise and resistance training were conducted as group-training at the primary care centre and as home training. Follow-up on physical capacity and HRQoL was done at 3, 6 and 12 months. less thanbrgreater than less thanbrgreater thanResults: Exercise significantly improved muscle endurance in the intervention group (n 29, mean age 76.2 years) compared to the control group (n 31. mean age 74.4 years) at all follow-ups except for shoulder flexion right at 12 months (shoulder abduction p=0.006. p=0.048. p=0.029; shoulder flexion right p=0.002. p=0.032. p=0.585: shoulder flexion left p=0.000, p=0.046, p=0.004). Six minute walk test improved in the intervention group at 3 months (p=0.013) compared to the control group. HRQoL. measured by EQ5D-VAS significantly improved in the intervention group at 3 and 12 months (p=0.016 and p=0.034) and SF-36, general health (p = 0.048) and physical component scale (p=0.026) significantly improved at 3 months compared to the control group. less thanbrgreater than less thanbrgreater thanConclusion: This study shows that exercise conducted M groups in primary care and in the patients homes could be used in elderly patients with CHF. The combination of endurance exercise and resistance training has positive effects on physical capacity. However. the minor effects in HRQoL need further verification in a study with a larger study population. 

  • 223.
    Pihl, Emma
    et al.
    Hälsohögskolan i Jönköping.
    Cider, Åsa
    Hälsohögskolan i Jönköping.
    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.
    Fridlund, Bengt
    Hälsohögskolan i Jönköping.
    Mårtensson, Jan
    Hälsohögskolan i Jönköping.
    Exercise in elderly patients with chronic heart failure in primary care, effects on physical capacity and quality of life2011Conference paper (Refereed)
  • 224.
    Pihl, Emma
    et al.
    Department of Medicine, Cardiac Care Unit, Halmstad Central Hospital and School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
    Jacobsson, Anna
    Department of Medicine, Cardiac Care Unit, Halmstad Central Hospital and School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
    Fridlund, Bengt
    School of Social and Health Sciences, Halmstad University, Halmstad and Department of Nursing, Lund University, Lund, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Mårtensson, Jan
    School of Social and Health Sciences, Halmstad University, Halmstad and Development Unit for Primary Health Care, Qulturum, Jönköping, Sweden.
    Depression and health-related quality of life in elderly patients suffering from heart failure and their spouses: A comparative study2005In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 7, no 4, p. 583-589Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about the factors that influence the health outcome of elderly patients suffering from heart failure or the health of their spouses. The aim of this comparative study was to determine if older patients suffering from heart failure and their spouses experience similar levels of health-related quality of life (HRQOL) and depression. The aim was also to identify those factors that contribute to HRQOL and depression in patient-spouse pairs. Methods: Data were collected from 47 couples, using the Short Form 36 (SF-36) and Zung Self-rating Depression Scale (SDS) questionnaires. Results: Patients suffering from heart failure and their spouses differed significantly in their experience of the physical, but not the mental, health-related quality of life, with patients experiencing significantly worse physical functioning. Physical symptoms of heart failure seemed to dominate the experience of the patient and was positively related to mental health and inversely related to the New York Heart Association classification (NYHA class) and patients' depression. Depressive symptoms as reflected in SDS showed no significant difference between patients and spouses. Patients' depression was positively related to high NYHA class, while spouse depression was positively related with higher age of the patient. Conclusion: Physical symptoms seem to dominate the experience of heart failure. © 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  • 225. Pulignano, G
    et al.
    Del Sindaco, D
    Jaarsma, T
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Mårtensson, J
    Dracup, K
    Giulivi, A
    Giovannini, E
    Clinical determinants of self-care behaviour in elderly heart failure patients.2004Conference paper (Other academic)
  • 226.
    Riegel, Barbara
    et al.
    Univ Penn, PA 19104 USA.
    Barbaranelli, Claudio
    Sapienza Univ Rome, Italy.
    Sethares, Kristen A.
    Univ Massachusetts Dartmouth, MA USA.
    Daus, Marguerite
    Univ Penn, PA 19104 USA.
    Moser, Debra K.
    Univ Kentucky, KY USA.
    Miller, Jennifer L.
    Univ Kentucky, KY USA.
    Haedtke, Christine A.
    Indiana Univ Purdue, IN USA.
    Feinberg, Jodi L.
    NYU Langone Med Ctr, NY USA.
    Lee, Solim
    Univ Penn, PA 19104 USA.
    Strömberg, Anna
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Development and initial testing of the self-care of chronic illness inventory2018In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 74, no 10, p. 2465-2476Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to develop and psychometrically test the self-care of chronic illness Inventory, a generic measure of self-care. Background: Existing measures of self-care are disease-specific or behaviour-specific; no generic measure of self-care exists. Design: Cross-sectional survey. Methods: We developed a 20-item self-report instrument based on the Middle Range Theory of Self-Care of Chronic Illness, with three separate scales measuring Self-Care Maintenance, Self-Care Monitoring, and Self-Care Management. Each of the three scales is scored separately and standardized 0-100 with higher scores indicating better self-care. After demonstrating content validity, psychometric testing was conducted in a convenience sample of 407 adults (enrolled from inpatient and outpatient settings at five sites in the United States and ResearchMatch.org). Dimensionality testing with confirmatory factor analysis preceded reliability testing. Results: The Self-Care Maintenance scale (eight items, two dimensions: illnessrelated and health-promoting behaviour) fit well when tested with a two-factor confirmatory model. The Self-Care Monitoring scale (five items, single factor) fitted well. The Self-Care Management scale (seven items, two factors: autonomous and consulting behaviour), when tested with a two-factor confirmatory model, fitted adequately. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model. Conclusion: The self-care of chronic illness inventory is adequate in reliability and validity. We suggest further testing in diverse populations of patients with chronic illnesses.

  • 227.
    Riegel, Barbara
    et al.
    Univ Penn, PA 19104 USA.
    Jaarsma, Tiny
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Lee, Christopher S.
    Boston Coll, MA 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.
    Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness2019In: Advances in Nursing Science, ISSN 0161-9268, E-ISSN 1550-5014, Vol. 42, no 3, p. 206-215Article in journal (Refereed)
    Abstract [en]

    The Middle-Range Theory of Self-Care of Chronic Illness has been used widely since it was first published in 2012. With the goal of theoretical refinement in mind, we evaluated the theory to identify areas where the theory lacked clarity and could be improved. The concept of self-care monitoring was determined to be underdeveloped. We do not yet know how the process of symptom monitoring influences the symptom appraisal process. Also, the manner in which self-care monitoring and self-care management are associated was thought to need refinement. As both of these issues relate to symptoms, we decided to enrich the Middle-Range Theory with knowledge from theories about symptoms. Here, we propose a revision to the Middle-Range Theory of Self-Care of Chronic Illness where symptoms are clearly integrated with the self-care behaviors of self-care maintenance, monitoring, and management.

  • 228.
    Riegel, Barbara
    et al.
    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. University of Pennsylvania School of Nursing, Philadelphia, USA.
    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.
    A Middle-Range Theory of Self-Care of Chronic Illness2012In: Advances in Nursing Science, ISSN 0161-9268, E-ISSN 1550-5014, Vol. 35, no 3, p. 194-204Article in journal (Refereed)
    Abstract [en]

    Nearly 50% of adults have one or more chronic illnesses. Self-care is considered essential in the management of chronic illness, but the elements of self-care in this context have not been specified in a middle-range theory. This article describes a middle-range theory of self-care that addresses the process of maintaining health with health promoting practices within the context of the management required of a chronic illness. The key concepts include self-care maintenance, self-care monitoring, and self-care management. Assumptions and propositions of the theory are specified. Factors influencing self-care including experience, skill, motivation, culture, confidence, habits, function, cognition, support from others, and access to care are described.

  • 229.
    Riley, Jillian P.
    et al.
    Imperial Coll, England.
    Astin, Felicity
    University of Salford, England.
    Crespo-Leiro, Marisa G.
    University of A Coruna, Spain.
    Deaton, Christi M.
    University of Cambridge, England.
    Kienhorst, Jens
    Elisabeth Krankenhaus Essen, Germany.
    Lambrinou, Ekaterini
    Cyprus University of Technology, Cyprus.
    McDonagh, Theresa A.
    Kings Coll Hospital London, England.
    Rushton, Claire A.
    Keele University, England.
    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.
    Filippatos, Gerasimos
    Hospital Attikon, Greece.
    Anker, Stefan D.
    University of Medical Centre Gottingen UMG, Germany.
    Heart Failure Association of the European Society of Cardiology heart failure nurse curriculum2016In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 18, no 7, p. 736-743Article in journal (Refereed)
    Abstract [en]

    Recent advances in care and management of heart failure have improved outcome, largely as a result of the developing evidence basis for medications, implantable devices and the organization of heart failure follow-up. Such developments have also increased the complexity of delivering and coordinating care. This has led to a change to the way in which heart failure services are organized and to the traditional role of the heart failure nurse. Nurses in many countries now provide a range of services that include providing care for patients with acute and with chronic heart failure, working in and across different sectors of care (inpatient, outpatient, community care, the home and remotely), organising care services around the face-to-face and the remote collection of patient data, and liaising with a wide variety of health-care providers and professionals. To support such advances the nurse requires a skill set that goes beyond that of their initial education and training. The range of nurses roles across Europe is varied. So too is the nature of their educational preparation. This heart failure nurse curriculum aims to provide a framework for use in countries of the European Society of Cardiology. Its modular approach enables the key knowledge, skills, and behaviours for the nurse working in different care settings to be outlined and so facilitate nursing staff to play a fuller role within the heart failure team.

  • 230.
    Rushton, Claire A.
    et al.
    Keele University, England.
    Green, Julie
    Keele University, England.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Walsh, Pauline
    Keele University, England.
    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.
    Kadam, Umesh T.
    Keele University, England.
    The challenge of multimorbidity in nurse education: An international perspective2015In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 35, no 1, p. 288-292Article in journal (Refereed)
    Abstract [en]

    The rise in prevalence of chronic diseases has become a global healthcare priority and a system wide approach has been called for to manage this growing epidemic. Whilst healthcare reform to tackle the scale of chronic disease and other long term conditions is still in its infancy, there is an emerging recognition that in an ageing society, people often suffer from more than one chronic disease at the same time. Multimorbidity poses new and distinct challenges and was the focus of a global conference held by the Organization of Economic Cooperation and Development (OECD) in 2011. Health education was raised as requiring radical redesign to equip graduates with the appropriate skills to face the challenges ahead. We wanted to explore how different aspects of multimorbidity were addressed within pre-registration nurse education and held an international (United Kingdom-Sweden) nurse workshop in Linkoping, Sweden in April 2013, which included nurse academics and clinicians. We also sent questionnaire surveys to final year student nurses from both countries. This paper explores the issues of multimorbidity from a patient, healthcare and nurse education perspective and presents the preliminary discussions from the workshop and students survey.

  • 231.
    Rushton, Claire A.
    et al.
    Keele University, Stoke-on-Trent, UK .
    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.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Kadam, Umesh T.
    Keele University, Stoke-on-Trent, UK .
    Multidrug and optimal heart failure therapy prescribing in older general practice populations: a clinical data linkage study2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 1, p. 003698-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To investigate multidrug therapy in the cardiovascular disease (CVD) population and whether it was associated with suboptimal drug prescribing in heart failure (HF).

    DESIGN:

    A population-based cross-sectional clinical data linkage study.

    SETTING:

    The clinical database populations were registered with three general practices in North Staffordshire that are part of a research network.

    PARTICIPANTS:

    3155 patients aged 50 years and over were selected on the basis of a CVD-related prescription and a CVD consultation code applied to their electronic medical record in a 2-year time period. All available diagnostic data were linked to all drugs prescribed data during this time period. Two study groups were: (1) HF and (2) non-HF CVD (reference group).

    EXPOSURE:

    A standard drug formulary system was used to define four multidrug count categories based on the number of different British National Formulary drug chapters prescribed at the same time.

    PRIMARY AND SECONDARY OUTCOME MEASURES:

    Optimal HF therapy was defined as the prescribing of ACE inhibitor (ACEi) or a combination of ACEi and β-blocker in the 2-year time window. An additional three specific CVD drug categories that are indicated in HF were also measured.

    RESULTS:

    The HF group, compared with the reference group, had higher non-CVD multidrug therapy (26% with 7 or more counts compared with 14% in the non-HF CVD reference group). For the first-choice optimal drug treatment for HF with ACEi (64%) or ACEi and β-blocker combined therapy (23%), the multidrug-adjusted associations between the HF group and the reference group were OR 3.89; 95% CI 2.8 to 5.5 and 1.99; 1.4 to 2.9, respectively. These estimates were not influenced by adjustment for sociodemographic factors and multidrug counts.

    CONCLUSIONS:

    Multidrug therapy prescribing is much higher in the HF group than in a comparable CVD group but did not influence optimal drug prescribing.

  • 232.
    Rönning, H
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nielsen, N-E
    Swahn, E
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Follow up of adults with congenitally malformed hearts with focus on computer-based education and psychosocial support improves knowledge, results from a randomised intervention study.2010Conference paper (Refereed)
  • 233.
    Rönning, Helén
    et al.
    School of Health Sciences, Jönköping University, Sweden.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    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.
    Thilen, Ulf
    Lund University Hospital, Sweden.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Development and evaluation of a computer-based educational program for adults with congenitally malformed hearts2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 1, p. 78-86Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a lack of educational material for adults with congenitally malformed hearts. Computer-based education has shown to have significant effects on knowledge and management of chronic diseases. AIM: The aim of this study was to develop and evaluate a computer-based educational program for adults with congenitally malformed hearts. METHODS: The program was developed by a multidisciplinary team. Data were collected by questionnaires, observations, and structured interviews. RESULTS: The final product was a computer-based educational program consisting of ten separate modules, one for each particular malformation. The program was experienced as stimulating and easy to use. The appearance and quantity of the text was graded as good and the content as relevant and very useful. CONCLUSION: This is the first computer-based program developed for adults with congenitally malformed hearts. The evaluation found the program to have great potential as an important tool for improving care. Further studies are needed to test the outcomes of the program on knowledge, perceived control over the heart condition, anxiety/depression. and health-related quality of life. PRACTICE IMPLICATIONS: The program may be used as a complement to verbal information and every adult with a congenitally malformed hearts can receive individualized information from a personal CD.

  • 234.
    Rönning, Helén
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    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.
    Description and initial evaluation of an educational and psychosocial support model for adults with congenitally malformed hearts2011In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 83, no 2, p. 247-251Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Various programmes for adults with congenitally malformed hearts have been developed, but detailed descriptions of content, rationale and goals are often missing. The aim of this study was to describe and make an initial evaluation of a follow-up model for adults with congenitally malformed hearts, focusing on education and psychosocial support by a multidisciplinary team (EPS).

    METHODS: The model is described in steps and evaluated with regards to perceptions of knowledge, anxiety and satisfaction.

    RESULTS: The EPS model included a policlinic visit to the physician/nurse (medical consultation, computer-based and individual education face-to-face as well as psychosocial support) and a 1-month telephone follow-up. Fifty-five adults (mean age 34, 29 women) with the nine most common forms of congenitally malformed hearts participated in the EPS model as well as the 3-months follow-up. Knowledge about congenital heart malformation had increased in 40% of the participants at the 3-months follow-up.

    CONCLUSION: This study describes and evaluates a model that combines a multidisciplinary approach and computer-based education for follow-up of adults with congenitally malformed hearts. The EPS model was found to increase self-estimated knowledge, but further evaluations need to be conducted to prove patient-centred outcomes over time.

    PRACTICE IMPLICATIONS: The model is now ready to be implemented in adults with congenitally malformed hearts.

  • 235.
    Rönning, Helén
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    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.
    Educational needs in adults with congenitally malformed hearts2008In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 18, no 5, p. 473-479Article in journal (Refereed)
    Abstract [en]

    Background and aim: The number of adults with congenitally malformed hearts is growing, and there is an increasing demand for their continuous follow-up. At present, different programmes have been established for adults with congenital cardiac disease, but there is a lack of knowledge regarding how education and psychosocial support should be given to achieve effects. Before developing educational programmes, it is necessary to be aware of the perspective of the patients. The aim of our study, therefore, was to describe how adults with congenitally malformed hearts experience their educational needs.

    Methods: The study had a qualitative design. We interviewed 16 adults, aged from 19 to 55 years, with congenitally malformed hearts.

    Results: Two-way communication emerged as crucial to individualising education. Without good communication, those with congenitally malformed hearts, receiving information from providers of healthcare, are unable to transfer the information received. Thus, individualised education gives access to knowledge and the tools required to manage important areas in life, such as the congenital cardiac malformation, physical activity, the situation of life, treatment, and resources available for healthcare. The information given should provide easy access to knowledge through proper educational materials and methods, and be given with respect for the individual. This is facilitated if the education is tailored to the requirements of the individual in a holistic approach, and is provided through good communication.

    Conclusion: Our investigation shows that a structured educational programme needs to start from the perspective of the individual patient, and that two-way Communication needs to be taken into consideration to enhance knowledge.

  • 236.
    Rönning, Helén
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    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.
    Evaluation of knowledge, perceived control, symptoms of anxiety and depression related to a model for follow-up in adults with congenitally malformed hearts: a randomised control trial2011Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To evaluate the effects of a model including computer-based and individualised education and psychosocial support for adults with congenitally malformed hearts.

    Design: Prospective randomised controlled multicentre trial.

    Setting: Four hospital outpatient clinics in Sweden.

    Participants: Adults with congenitally malformed hearts.

    Interventions: Comparing usual care twith education and psychosocial support by a multidisciplinary team.

    Main Outcome Measures: Knowledge and perceived control regarding the heart condition, and symptoms of anxiety and depression at baseline, 3 and 12-months follow-up.

    Results: Out of 114 included participants, 58 were randomised to the control group, and 56 to the intervention group. The average age was 34 (SD 13.5) years. Results showed a significant between-group treatment effect in general knowledge after 3 months (effect size 0.63, p=<0.01), and 12-month (effect size 0.53, p= 0.02). Knowledge regarding endocarditis also increased significantly between-group after 3 months (effect size 0.87, p= <0.01), and over time between baseline and 3 months (effect size 1.43, p=<0.001), and between baseline and 12-months (effect size 0.58, p= 0.02). There were no changes in knowledge in domains regarding self-management of medical treatment and contraceptives and pregnancy in any of the groups. Further, the intervention did neither increase nor decrease the perceived control over the heart condition or symptoms of anxiety and depression.

    Conclusion: Education and psychosocial support by a multidisciplinary team was effective in improving and maintaining knowledge about self-management in adults with heart malformation. Future research is needed to determine the long-time effects on selfmanagement behaviours and perceived control.

  • 237.
    Rönning, Helén
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    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.
    Follow up of adults with congenitally malformed hearts with focus on computer-based education and psychosocial support improves knowledge, results from a randomised intervention study in EUROPEAN HEART JOURNAL, vol 31, issue , pp 229-2292010In: EUROPEAN HEART JOURNAL, Oxford University Press , 2010, Vol. 31, p. 229-229Conference paper (Refereed)
    Abstract [en]

    n/a

  • 238.
    Rönning, Helén
    et al.
    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.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    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.
    Development and psychometric evaluation of the knowledge scale for adults with congenitally malformed hearts2013In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 28, no 3, p. 228-237Article in journal (Refereed)
    Abstract [en]

    Background and Research Objective: Adults with congenitally malformed hearts have knowledge gaps regarding their heart condition, and their level of knowledge is not routinely assessed during follow-up. One reason for this is that there are few validated, user-friendly questionnaires to assess knowledge about congenital heart disease and its effects on daily life. Failure to identify low levels of knowledge could lead to less motivated and insecure individuals not actively involved in treatment and care of their heart condition. Therefore, the objective of this study was to develop and test a knowledge scale for adults with congenitally malformed hearts.

    Participants and Methods: The development and psychometric evaluation of the Knowledge Scale for Adults With Congenitally Malformed Hearts (KnoCoMH) followed 2 phases: (1) development and evaluation of the initial version, with face validity and content validity assessed by experts and adults with congenitally malformed hearts, and (2) evaluation and refinement of the KnoCoMH in adults with congenitally malformed hearts, including item difficulty level, internal consistency, and test-retest reliability.

    Results: The development and evaluation of a knowledge scale for adults with congenitally malformed hearts resulted in the KnoCoMH including 46 items in 4 domains: General Knowledge, with a Kuder-Richardson formula 20 (KR-20) value of 0.68; Medical Treatment, with a KR-20 value of 0.74; Endocarditis Prophylaxis, with a KR-20 value of 0.90; and Contraceptives and Pregnancy, with a KR-20 value of 0.65. Test-retest evaluation showed significant correlations between 0.50 and 0.67 (P < .01) in all 4 domains. There was good variation in item difficulty, with a mean value of 0.56 in General Knowledge, 0.62 in Medical Treatment, 0.33 in Endocarditis Prophylaxis, and 0.48 in Contraceptives and Pregnancy.

    Conclusions: The KnoCoMH has acceptable psychometric properties for most of the knowledge domains included. It can be used for evaluating knowledge among adults with congenitally malformed hearts and its associations with other outcomes. However, further studies are advisable to test construct validity, predictive validity, and responsiveness.

  • 239.
    Savarese, Gianluigi
    et al.
    Karolinska Inst, Sweden.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    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.
    Nurse-Led Heart Failure Clinics Are Associated With Reduced Mortality but Not Heart Failure Hospitalization2019In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 8, no 10, article id e011737Article in journal (Refereed)
    Abstract [en]

    Background-Follow-up in a nurse-led heart failure (HF) clinic is recommended in HF guidelines, but its association with outcomes remains controversial, with previous studies including few and highly selected patients. Thus, large analyses of "real-world" samples are needed. Aims were to assess: (1) independent predictors of and (2) prognosis associated with planned referral to nurse-led HF clinics. Methods and Results-We analyzed data from the SwedeHF (Swedish HF Registry) using multivariable logistic regressions to identify independent predictors of planned referral to a nurse-led HF clinic and multivariable Cox regressions to test associations between planned referral and outcomes (all-cause death, HF hospitalization, and their composite). Of 40 992 patients, 39% were planned to be referred to a follow-up in a nurse-led HF clinic. Independent characteristics associated with planned referral were shorter duration of HF, clinical markers of more-severe HF, such as lower ejection fraction, higher New York Heart Association class and N-terminal pro-B-type natriuretic peptide, and lower blood pressure, as well as cohabitating versus living alone, male sex, fewer comorbidities, and more use of HF treatments. After adjustments, planned referral to a nurse-led HF clinic was associated with reduced mortality and mortality/HF hospitalization, but not HF hospitalization alone. Conclusions-In this nation-wide registry, 39% of our identified HF cohort was planned to be referred to a nurse-led HF clinic. Planned referral reflected more-severe HF, but also sex- and family-related factors, and it was independently associated with lower risk of death, but not of HF hospitalization.

  • 240.
    Schjodt, Inge
    et al.
    Aarhus Univ Hosp, Denmark.
    Johnsen, Soren P.
    Aalborg Univ, Denmark.
    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.
    Kristensen, Nickolaj R.
    Aarhus Univ Hosp, Denmark.
    Logstrup, Brian B.
    Aarhus Univ Hosp, Denmark; Aarhus Univ, Denmark.
    Socioeconomic Factors and Clinical Outcomes Among Patients With Heart Failure in a Universal Health Care System2019In: JACC. Heart failure, ISSN 2213-1779, E-ISSN 2213-1787, Vol. 7, no 9, p. 746-755Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES This study examined the associations between socioeconomic factors (SEF), readmission, and mortality in patients with incident heart failure (HF) with reduced ejection fraction (HFrEF) in a tax-financed universal health care system. BACKGROUND Lack of health insurance is considered a key factor in health inequality, leading to poor clinical outcomes. However, data are sparse for the association between SEF and clinical outcomes among patients with HF in countries with tax-financed health care systems. METHODS A nationwide population-based cohort study of 17,122 patients with incident HFrEF was carried out. Associations were assessed between individual-level SEF (cohabitation status, education, and income) and all-cause, HF, and non-HF readmission and mortality within 1 to 30, 31 to 90, and 91 to 365 days, as well as hospital bed days within 1 year after HF diagnosis. RESULTS Low income was associated with a higher risk of all-cause readmission (adjusted hazard ratio [HR]: 1.24; 95% confidence interval [CI]: 1.08 to 1.43) and non-HF readmission (HR: 1.36; 95% CI: 1.17 to 1.58) within days 31 to 90 as well as with a higher risk of all-cause (HR: 1.27; 95% CI: 1.14 to 1.41), HF (HR: 1.26; 95% CI: 1.02 to 1.55) and non-HF readmission (HR: 1.25; 95% CI: 1.12 to 1.39) within days 91 to 365. Low-income patients also had a higher use of hospital bed days and risk of mortality during follow-up. CONCLUSIONS In a tax-financed universal health care system, low income was associated with a higher risk of all-cause and non-HF readmission within 1 to 12 months after HF diagnosis and with HF readmission within 3 to 12 months among patients with incident HFrEF. Low-income patients also had a higher number of hospital bed days and a higher rate of mortality during follow-up. (C) 2019 by the American College of Cardiology Foundation.

  • 241.
    Schjødt, Inge
    et al.
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
    Larsen, Palle
    Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence; The Centre of Clinical Guidelines - Danish National Clearing House.
    Johnsen, Søren Paaske
    Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
    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.
    Løgstrup, Brian Bridal
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
    Risk factors for readmission to hospital in adult patients with heart failure and reduced ejection fraction: a systematic review protocol2017In: The JBI Database of Systematic Reviews and Implementation Reports, E-ISSN 2202-4433, Vol. 15, no 6, p. 1561-1574Article, review/survey (Refereed)
    Abstract [en]

    The objective of this systematic review is to identify and synthesize the best available evidence on risk factors associated with hospital readmission at different time points within the first year after heart failure (HF) hospitalization in patients suffering from HF with reduced ejection fraction (EF).More specifically, the question is: what are the risk factors for the prediction of hospital readmission within seven, 15, 30, 60, 90, 180 and 365 days of discharge in hospitalized patients with HF with reduced EF aged 18 years or older?

  • 242. Scholte op Reimer, Wilma
    et al.
    Moons, Philip
    De Geest, Sabina
    Fridlund, Bengt
    Heikkilä, Johanna
    Jaarsma, Tiny
    Lenzen, Mattie
    Martensson, Jan
    Norekvål, Tone M
    Smith, Karin
    Stewart, Simon
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Thompson, David R
    Cardiovascular risk estimation by professionally active cardiovascular nurses: Results from the Basel 2005 Nurses Cohort2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 4, p. 258-263Article in journal (Refereed)
    Abstract [en]

    Background: Nurses play a key role in the prevention of cardiovascular disease (CVD) and one would, therefore, expect them to have a heightened awareness of the need for systematic screening and their own CVD risk profile. The aim of this study was to examine personal awareness of CVD risk among a cohort of cardiovascular nurses attending a European conference. Methods: Of the 340 delegates attending the 5th annual Spring Meeting on Cardiovascular Nursing (Basel, Switzerland, 2005), 287 (83%) completed a self-report questionnaire to assess their own risk factors for CVD. Delegates were also asked to give an estimation of their absolute total risk of experiencing a fatal CVD event in the next 10 years. Level of agreement between self-reported CVD risk estimation and their actual risk according to the SCORE risk assessment system was compared by calculating weighted Kappa (κw). Results: Overall, 109 responders (38%) self-reported having either pre-existing CVD (only 2%), one or more markedly raised CVD risk factors, a high total risk of fatal CVD (≥ 5% in 10 years) or a strong family history of CVD. About half of this cohort (53%) did not know their own total cholesterol level. Less than half (45%) reported having a 10-year risk of fatal CVD of < 1%, while 13% reported having a risk ≥ 5%. Based on the SCORE risk function, the estimated 10-year risk of a fatal CVD event was < 1% for 96% of responders: only 2% had a ≥ 5% risk of such an event. Overall, less than half (46%) of this cohort's self-reported CVD risk corresponded with that calculated using the SCORE risk function (κw = 0.27). Conclusion: Most cardiovascular nurses attending a European conference in 2005 poorly understood their own CVD risk profile, and the agreement between their self-reported 10-year risk of a fatal CVD and their CVD risk using SCORE was only fair. Given the specialist nature of this conference, our findings clearly demonstrate a need to improve overall nursing awareness of the role and importance of systematic CVD risk assessment. © 2006 European Society of Cardiology.

  • 243.
    Sedlar, Natasa
    et al.
    National Institute Public Heatlh, Slovenia.
    Lainscak, Mitja
    Gen Hospital Murska Sobota, Slovenia; University of Ljubljana, Slovenia.
    Mårtensson, Jan
    Jonköping University, 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.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Australian Catholic University, Australia.
    Farkas, Jerneja
    National Institute Public Heatlh, Slovenia; Gen Hospital Murska Sobota, Slovenia.
    Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 4, p. 272-282Article, review/survey (Refereed)
    Abstract [en]

    Background: Self-care is an important element in the comprehensive management of patients with heart failure. The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed and tested to measure behaviours performed by the heart failure patients to maintain life, healthy functioning, and wellbeing. Aims: The purpose of this review was to evaluate the importance of factors associated with heart failure self-care behaviours as measured by the EHFScBS. Methods: Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect). Obtained associating factors of heart failure self-care were qualitatively synthesised and the association levels of most commonly addressed factors were further explored. Results: We identified 30 studies that were included in the review; a diverse range of personal and environmental factors associated with self-care behaviours in heart failure patients were identified. Age, health-related quality of life, gender, education, New York Heart Association class, depressive symptoms and left ventricular ejection fraction were most often correlated with the EHFScBS score. Consistent evidence for the relationship between self-care behaviours and depression was found, while their association with New York Heart Association class and health-related quality of life was non-significant in most of the studies. Associations with other factors were shown to be inconsistent or need to be further investigated as they were only addressed in single studies. Conclusion: A sufficient body of evidence is available only for a few factors related to heart failure self-care measured by the EHFScBS and indicates their limited impact on patient heart failure self-care. The study highlights the need for further exploration of relationships that would offer a more comprehensive understanding of associating factors.

  • 244.
    Sedlar, Natasa
    et al.
    National Institute Public Heatlh, Slovenia.
    Socan, Gregor
    University of Ljubljana, Slovenia.
    Farkas, Jerneja
    National Institute Public Heatlh, Slovenia; Gen Hospital Murska Sobota, Slovenia.
    Mårtensson, Jan
    Jonköping University, 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.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Australian Catholic University, Australia.
    Lainscak, Mitja
    Gen Hospital Murska Sobota, Slovenia; University of Ljubljana, Slovenia.
    Measuring self-care in patients with heart failure: A review of the psychometric properties of the European Heart Failure Self-Care Behaviour Scale (EHFScBS)2017In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, no 7, p. 1304-1313Article, review/survey (Refereed)
    Abstract [en]

    Objective: The aim of this study was to review and evaluate the evidence related to psychometric properties of the European Heart Failure Self-Care Behaviour Scale (EHFScBS) that was developed and tested to measure health maintenance behaviours of heart failure (HF) patients and translated into several languages. Methods: PRISMA guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect), to identify relevant studies. A literature search was undertaken in November 2015. An integrative review, aiming to bring together all evidence relating to the psychometric properties (validity, reliability) of the EHFScBS was conducted. Results: 13 eligible studies were included. The results showed content, discriminant and convergent validity of the 9-and 12-item scale across the samples, while the factor structure of both versions of the scale was inconsistent. Most commonly used reliability estimates (Cronbachs alpha) of the total scale were satisfactory. Conclusion: Overall, published data demonstrate satisfactory psychometric properties of the EHFScBS, indicating that the scale is a reliable and valid tool for measuring health maintenance behaviours of HF patients. Practice implications: Taking the findings regarding the factorial structure of the scale into account, we recommend the use of the total EHFScBS score or scores on specific items. (C) 2017 Elsevier B.V. All rights reserved.

  • 245.
    Stolfo, Davide
    et al.
    Karolinska Inst, Sweden; Azienda Sanit Univ Integrata Trieste, Italy.
    Uijl, Alicia
    Karolinska Inst, Sweden; Univ Utrecht, Netherlands.
    Vedin, Ola
    Uppsala Univ, Sweden; Boehringer Ingelheim GmbH and Co KG, 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.
    Faxen, Ulrika Ljung
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Rosano, Giuseppe M. G.
    IRCCS San Raffaele Pisana Rome, Italy.
    Sinagra, Gianfranco
    Azienda Sanit Univ Integrata Trieste, Italy.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Savarese, Gianluigi
    Karolinska Inst, Sweden.
    Sex-Based Differences in Heart Failure Across the Ejection Fraction Spectrum Phenotyping, and Prognostic and Therapeutic Implications2019In: JACC. Heart failure, ISSN 2213-1779, E-ISSN 2213-1787, Vol. 7, no 6, p. 505-515Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES This study assessed sex-related differences in a large cohort of unselected patients with heart failure (HF) across the ejection fraction (EF) spectrum. BACKGROUND Females are under-represented in randomized clinical trials. Potential sex-related differences in HF may question the generalizability of trials. METHODS In the Swedish Heart Failure Registry population multivariate Cox and logistic regression models were fitted to investigate differences in prognosis, prognostic predictors, and treatments across mates and females. RESULTS Of 42,987 patients, 37% were females (55% with HF with preserved EF [HFpEF], 39% with HF with mid-range EF [HFmrEF], and 29% with HF with reduced EF [HFrEF]). Females were older and more symptomatic and more likely to have hypertension and kidney disease but less likely to have diabetes and ischemic heart disease. After adjustments, females were more likely to use beta-blockers and digoxin but less likely to receive HF device therapy. Crude mortality/HF hospitalization rates for HFpEF (hazard ratio [HR]: 1.16) and HFmrEF (HR: 1.14) were significantly higher in females but lower in females with HFrEF (HR: 0.95). After adjustments, the risk was significantly tower in females regardless of EF (HR: 0.80 in HFrEF, HR: 0.91 in HFmrEF, and HR: 0.93 in HFpEF). The main sex-related differences in prognostic predictors concerned diabetes in HFrEF and anemia in HFmrEF. CONCLUSIONS Mates and females with HF showed different characteristics across the EF spectrum. Mates reported a lower crude risk of mortality/morbidity in HFpEF and HFmrEF but higher risk of HFrEF, although after adjustments, prognosis was better in females regardless of EF. The observed sex-related differences highlight the need for an adequate representation of females in HF randomized controlled trials to improve generatizabitity. (C) 2019 by the American College of Cardiology Foundation.

  • 246.
    Strömberg, A
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ahlén, H
    Fridlund, B
    Högskolan i Jönköping.
    Dahlström, U
    Interactive education on CD-ROM -  a new tool in education of heart failure patients2000Conference paper (Other academic)
  • 247.
    Strömberg, A
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Blixt, F
    Andersson, F
    Johansson, I
    Patients' experiences of driving restrictions during treatment with implantable cardioverter defibrillator.2007Conference paper (Other academic)
  • 248.
    Strömberg, A
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Broström, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dahlström, U
    Fridlund, B
    Högskolan i Jönköping.
    Patients' compliance with heart failure treatment1998Conference paper (Refereed)
  • 249.
    Strömberg, A
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Fridlund, B
    Högskolan i Jönköping.
    Dahlström, U
    Effects of an interactive, computer-based education on knowledge, compliance and quality of life in patients with heart failure. A randomized, controlled, multicentre trial.2000Conference paper (Other academic)
  • 250.
    Strömberg, A
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hammargård, J
    Fant, D
    Johansson, I
    Experiences of shocks in patients with implantable cardioverter defibrillator.2007Conference paper (Other academic)
2345678 201 - 250 of 353
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