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  • 51.
    Bratteby Tollerz, L. U.
    et al.
    Uppsala University, Sweden; Uppsala University, Sweden.
    Forslund, A. H.
    Uppsala University, Sweden; Uppsala University, Sweden.
    Olsson, R. M.
    Uppsala University, Sweden; Uppsala University, Sweden.
    Lidström, Helene
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten. Uppsala University, Sweden.
    Holmback, U.
    Uppsala University, Sweden; Uppsala University, Sweden.
    Children with cerebral palsy do not achieve healthy physical activity levels2015Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, nr 11, s. 1125-1129Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimThis study compared daily activity energy expenditure (AEE) in children with cerebral palsy with a control group and investigated whether the children achieved healthy levels of physical activity. MethodsWe enrolled eight children with bilateral cerebral palsy, from eight to 10years of age, and a group of controls matched for age and gender. For three days, physical activity was simultaneously measured by accelerometers and self-reports using a diary. The daily AEE results were compared between groups and methods. The number of children that achieved healthy physical activity levels in each group was explored. ResultsChildren with cerebral palsy had significantly lower daily AEE, as measured by accelerometers, than the controls, and they did not achieve the healthy moderate to heavy physical activity level defined in the Nordic Nutrition Recommendations. Self-reports using the diaries resulted in an overestimation of physical activity compared with the ankle accelerometer measurements in both groups. ConclusionOur investigation of physical activity in children with cerebral palsy and controls using accelerometers and a diary found low levels of daily AEE and physical activity, and these results were most prominent in the group with cerebral palsy. The diaries overestimated physical activity in both groups.

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  • 52.
    Breivik, Ingrid
    et al.
    Habilitation Centre, Östersund Hospital, Jämtland County Council, Sweden.
    Hemmingsson, Helena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Experiences of handwriting and using a computerized ATD in school: Adolescents with Asperger's syndrome2013Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 20, nr 5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Adolescents with Asperger's syndrome (AS), often have handwriting difficulties that affect their academic performance. The purpose of this descriptive multiple-case mixed-method study was to highlight how adolescents with AS experience writing in the school setting when writing by hand and when using a computerized Assistive Technology Device (ATD), for writing. A qualitative content analysis approach was used, including interviews with five adolescents, their parents, and their teachers. This was complemented by asking the adolescents to rate their perceived performance and satisfaction of writing with and without the ATD. All adolescents described handwriting difficulties, but a reduced ability to express oneself in writing was also common. Initiating and completing writing tasks was often so demanding that it caused resistance to the activity. Several advantages when using the ATD were described by the participants and the self-ratings showed higher scores for performance of and satisfaction with writing when the ATD was used. The results show that teachers' encouragement seemed to be important for the initiation and continuation of use of the ATD.

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  • 53.
    Brännström, Margareta
    et al.
    Umeå University, Umeå, Sweden.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Struggling with issues about cardiopulmonary resuscitation (CPR) for end-stage heart failure patients.2015Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, nr 2, s. 379-385Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Integrating heart failure and palliative care teams combines unique expertise from both cardiology and palliative care. However, professionals from the two arenas of life-saving cardiology and palliative care may well have different experiences with and approaches to patient care. Little is known how to optimally discuss cardiopulmonary resuscitation with patients and their relatives and what challenges are for healthcare providers.

    OBJECTIVE: The aim of this study was to describe the experiences and thoughts of members of an integrated heart failure and palliative care team concerning talking about CPR with end-stage heart failure patients.

    METHOD: We used a descriptive qualitative design, conducting group interviews during 2011 with professionals from different disciplines working with heart failure patients over a 1-year period. A qualitative content analysis was performed to examine the interview data.

    RESULTS: Professional caregivers in integrated heart failure and palliative homecare are struggling with the issue of CPR of end-stage heart failure patients. They wrestle with the question of whether CPR should be performed at all in these terminally ill patients. They also feel challenged by the actual conversation about CPR with the patients and their relatives. Despite talking them about CPR with patients and relatives is difficult, the study participants described that doing so is important, as it could be the start of a broader end-of-life conversation.

    CONCLUSION: Talking with patient and relatives about CPR in end-stage heart failure, as suggested in the current heart failure guidelines, is a challenge in daily clinical practice. It is important to discuss the difficulties within the team and to decide whether, whom, how and when to talk about CPR with individual patients and their relatives.

  • 54.
    Burckhardt, Carol
    et al.
    Department of Medicine Oregon Health and Sciences University, Portland, Oregon, US.
    Liedberg, Gunilla
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Maintaining work outside the home: difficulties of newly-diagnosed young women with fibromyalgia2001Ingår i: ACR Scientific Meeting,2001, Arthritis and Reumatism , 2001, s. 165-165Konferensbidrag (Refereegranskat)
    Abstract [en]

      

  • 55.
    Burckhardt, Carol S.
    et al.
    School of Nursing, Oregon Health and Science University, Portland, USA.
    Liedberg, Gunilla
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Henriksson, Chris M.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier. Linköpings universitet, Hälsouniversitetet.
    Aspegren-Kendall, Sally
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Rehabiliteringsmedicin. Linköpings universitet, Hälsouniversitetet.
    The Impact of Fibromyalgia on Employment Status of Newly-Diagnosed Young Women2005Ingår i: Journal of Musculoskeletal Pain, ISSN 1058-2452, Vol. 13, nr 2, s. 31-41Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To describe employment loss in young women with newly diagnosed fibromyalgia syndrome [FMS] and to identify variables that may explain early loss of employment.

    Methods: In this pilot studsy, 94 young women [18-39 years old] in the United States [USA] and Sweden completed demographics, global rating scales, and standardized questionnaires, including the Fibromyalgia Impact Questionnaire, SF-36 General Health Subscale, Beck Depression Inventory, Beck Anxiety Inventory, Arthritis Self-Efficacy Scale, Arthritis Impact Measurement Scales II Social Support Subscale, and Job Flexibility Scale, three times during the first 12 to 15 months after diagnosis.

    Results: At the time of diagnosis, 60 percent were in paid employment [USA 71 percent, Sweden 49 percent]. When the participants entered the study, within three months of diagnosis, only 46 percent were working [USA 56 percent, Sweden 37 percent]. Twelve months later, 41 percent were working [USA 55 percent, Sweden 28 percent]. Younger age, poorer physical functioning, and lower self-efficacy for pain management along with higher symptom interference with ability to do any work, and pain severity predicted unemployment with 75 percent accuracy.

    Conclusions: An early and notable decrease in the percentage of young women diagnosed with FMS and working in paid employment was seen in this pilot study. Because most of the job loss was associated with FMS symptoms, a larger study of strategies to control or ameliorate these symptoms in the work setting should be undertaken.

  • 56.
    Byrne, Molly
    et al.
    National University of Ireland, Galway.
    Doherty, Sally
    Royal College of Surgeons in Ireland, Dublin.
    Murphy, Andrew W
    National University of Ireland, Galway.
    McGee, Hannah M
    Royal College of Surgeons in Ireland, Dublin.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Communicating about sexual concerns within cardiac health services: Do service providers and service users agree?2013Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 92, nr 3, s. 398-403Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective

    Sexual assessment and counselling is a recommended, yet underprovided and challenging, aspect of cardiac rehabilitation. We compared the views of cardiac healthcare providers and patients in terms of their experiences of communication about sexual issues.

    Methods

    Cardiac patients (n = 382) completed telephone surveys and hospital cardiac rehabilitation staff (n = 60) and general practitioners (n = 61) returned postal questionnaires.

    Results

    Patients reported that sex was rarely discussed, yet nearly half of patients said they would have liked this opportunity. Most general practitioners (70%) reported not addressing sex with their patients and the majority of cardiac rehabilitators (almost 61%) reported that sexual problems were poorly addressed in their service. Patients perceived fewer barriers to communication (the main barrier was lack of privacy) than health professionals (the primary barrier for general practitioners was lack of time, and for cardiac rehabilitation staff, lack of training).

    Conclusion

    All participants agreed that sexual assessment and counselling is currently poorly implemented. A gap exists: patients, who generally want sexual issues to be addressed, perceive fewer barriers to communication than healthcare providers, who fear causing anxiety and discomfort by raising sexual issues with their patients.

    Practice implications

    Developing brief interventions for healthcare providers and information materials for patients are recommended.

  • 57.
    Byrne, Molly
    et al.
    National University of Ireland, Galway.
    Doherty, Sally
    Royal College of Surgeons in Ireland, Dublin.
    Murphy, Andrew W
    National University of Ireland, Galway.
    McGee, Hannah M
    Royal College of Surgeons in Ireland, Dublin.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    The CHARMS Study: cardiac patients' experiences of sexual problems following cardiac rehabilitation2013Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, nr 6, s. 558-566Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:Sexual problems are common among cardiac patients. Further information is required on patients' experiences of sexuality and preferences for sexual counselling.

    Aim:To characterise sexual dysfunction and related factors among patients following cardiac rehabilitation and examine related treatment delivery.

    Methods:Telephone interviews with 382 patients (32% response rate) recruited from six hospital rehabilitation centres.

    Results:Seventy-nine per cent were male; average age was 64 years (SD 9.8). Forty-seven per cent of the total sample reported no sexual relations in the previous year, and nearly a half of sexually active respondents reported at least one sexual problem. Erectile dysfunction (reported by 33%) and lack of interest in sex (reported by 10%) were the most common problems for men and women respectively. Twenty-three per cent reported that sex had deteriorated for them since their cardiac event, and for half of these this was considered a serious problem. In logistic regression analysis, higher anxiety (Hospital Anxiety and Depression Scale) and being male were associated with reporting a sexual problem (χ(2) = 37.85, p<0.001). Sixty-six per cent reported that sex was never discussed by a health professional and satisfaction with this aspect of care was low. Patients wanted these issues to be addressed and the majority (63%) claimed they would find it easy to discuss sexual problems with a health professional.

    Conclusions:Sexual inactivity and sexual problems are common in this group. Health professionals should address sexual issues with their patients, ideally in a private setting and within the broader context of addressing psychological wellbeing.

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  • 58.
    Byström, Fanny
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Filosofiska fakulteten.
    Isaksson, Elise
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Filosofiska fakulteten.
    Kåhlin, Ida
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, NISAL - Nationella institutet för forskning om äldre och åldrande. Linköpings universitet, Filosofiska fakulteten.
    Participation in Daily Activities - perceptions of older people with intellectual disabilities2012Konferensbidrag (Övrigt vetenskapligt)
  • 59.
    Börjeson, Sussanne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Starkhammar, Hans
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Unosson, Mitra
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Berterö, Carina
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Common Symptoms and Distress Experienced Among Patients with Colorectal Cancer: A Qualitative part of Mixed Method Design2012Ingår i: Open Nursing Journal, E-ISSN 1874-4346, Vol. 6, nr 1, s. 100-107Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background :

    Colorectal cancer is one of the most common types of tumour in the world. Treatment side effects, together with the tumour symptoms, can result in a ‘symptom burden’. To understand the patient’s burden during chemotherapy treatment and plan effective symptom relief there is a need for more knowledge about the experience of symptoms from the patients’ perspective.

    Objectives :

    The study was designed to qualitatively identify and describe the most common symptoms among patients treated for colorectal cancer, and discover whether there are barriers to reporting symptoms.

    Methods :

    Thirteen Swedish patients diagnosed with colorectal cancer and treated with chemotherapy were interviewed face-to-face. The interviews were audio-taped and transcribed verbatim. The transcripts were analysed by following the principles of qualitative content analysis.

    Results :

    Nine symptoms/forms of distress were identified. Those most frequently expressed were fatigue, changed bowel habits, and affected mental well-being, closely followed by nausea, loss of appetite and neurological problems. Of particular note were the affected mental well-being, the magnitude of the neurological problems described, the symptoms related to skin and mucous membrane problems, and the reports of distressing pain. Barriers to symptom control were only expressed by the patients in passing and very vaguely.

    Conclusion :

    This study confirms other reports on most common symptoms in colorectal cancer. It also highlights the early onset of symptoms and provides data on less well-studied issues that warrant further study, namely affected mental well-being, the magnitude of the neurological problems and symptoms related to the skin and mucous membranes. Nurses need to be sensitive to the patients’ need presented and not only noting symptoms/distresses they have guidelines for.

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  • 60.
    Börsbo, Björn
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Rehabiliteringsmedicin. Linköpings universitet, Hälsouniversitetet.
    Liedberg, Gunilla M
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Wallin, Mia
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Gerdle, Björn
    Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Smärt och rehabiliteringscentrum. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin.
    Subgroups based on thermal and pressure pain thresholds in women with chronic whiplash display differences in clinical presentation - an explorative study2012Ingår i: Journal of Pain Research, E-ISSN 1178-7090, Vol. 5, s. 511-521Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To investigate the presence of subgroups in chronic whiplash-associated disorders (WAD) based on pain thresholds for pressure (PPT), cold (CPT), and heat (HPT) and to compare these subgroups with respect to symptomatology, disability, and health aspects. Methods: Two groups of female subjects – patients with chronic WAD (n = 28) and healthy controls (CON; n = 29) – were investigated. Quantitative sensory testing (QST) for thermal thresholds and algometry for PPT at four sites in the body (over the trapezius and tibialis anterior bilaterally) were determined. Habitual pain intensities, psychological strain, disability, and health aspects were registered using a questionnaire.Results: A cluster analysis based on PPT, CPT, and HPT identified two subgroups of chronic WAD: one sensitive subgroup (s-WAD; n = 21), and one less sensitive subgroup (ls-WAD; n = 6). S-WAD displayed widespread hyperalgesia, whereas ls-WAD had localized hyperalgesia in the neck area, with tendencies to supernormal values in remote areas of the body. Generally, s-WAD had a significantly worse situation than the CON with respect to symptomatology, disability, and health aspects. The ls-WAD group was intermediary between s-WAD and CON in these aspects.Conclusion: Different explanations, eg, severity of the pain condition per se, etiological factors, and pre-trauma differences in pain sensitivity, may exist for the differences in pain thresholds between the two subgroups. Future research should investigate the role of pain thresholds in the chronic stage to determine the efficacy of treatment interventions.

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  • 61.
    Carlander, Ida
    et al.
    Ersta Skondal University College.
    Sahlberg-Blom, Eva
    Ersta Skondal University College.
    Hellström, Ingrid
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV).
    Ternestedt, Britt-Marie
    Ersta Skondal University College.
    The modified self: family caregivers experiences of caring for a dying family member at home2011Ingår i: JOURNAL OF CLINICAL NURSING, ISSN 0962-1067, Vol. 20, nr 7-8, s. 1097-1105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim. The aim of this study was to explore situations in daily life that challenge caregivers self-image when caring for a dying family member at home. Background. Caregiving affects the health and daily lives of family caregivers. Patterns of challenging situations may provide insight into the home caregiving experience, thus contributing to our understanding of the influence it has on the caregivers self-image. Design. Qualitative descriptive study. Methods. Ten family caregivers who cared for a dying family member at home with support from an advanced home care team were interviewed 6-12 months after the death of the family member. The interviews were analysed with interpretive description. Result. Three patterns characterised the experiences of caregivers daily lives in caring for a dying family member at home: challenged ideals, stretched limits and interdependency. These patterns formed the core theme, the modified self. Situations that challenged the caregivers self-image were connected to experiences such as forbidden thoughts, intimacy and decreasing personal space. Conclusions. The caregivers met challenging situations in their daily lives that created a modified image of self. It is important to recognise the impact of caring for a dying family member at home. Relevance to clinical practice. This study argues for supporting family caregivers to maximise their potential to handle the demanding everyday life with a dying family member at home. This study contributes to understanding situations in the home that may challenge caregivers self-image and points out the importance of talking about caregiving experiences. From a clinical perspective, this study emphasises the significance of creating a climate, which allows family caregivers to express thoughts and feelings. Sharing experiences such as forbidden thoughts can be one way of handling the profoundly changed every day life.

  • 62.
    Carlander, Ida
    et al.
    Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden.
    Ternestedt, Britt-Marie
    Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden.
    Sandberg, Jonas
    Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden.
    Hellström, Ingrid
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden.
    Constructing family identity close to death2013Ingår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, nr 5, s. 379-388Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Daily life close to death involves physical, psychological, and social strain, exposing patients and their family members to major transitions affecting relational patterns and identity. For the individual family member, this often means sharing life with a changing person in a changing relationship, disrupting both individual identity and family identity. Our aim was to deepen the understanding of individual experiences that are important in constructing family identity close to death at home. We performed a secondary analysis of qualitative data collected through 40 interviews with persons with life-threatening illness and the family members who shared everyday life with them. The analysis resulted in interpretive descriptions which provided three patterns important for creating family identity, which we here call “we-ness” close to death. The patterns were: being an existential person, being an extension of the other, and being together in existential loneliness. Together, these three patterns seemed to play a part in the construction of family identity; we-ness, close to death. One important finding was the tension between the search for togetherness in “we-ness” while dealing with an existential loneliness, which seemed to capture an essential aspect of being a family of which one member is dying.

  • 63.
    Carlman, Lena-Carin
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier.
    Lindgren, Kerstin
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Redo för arbete: En studie kring arbetsförmåga hos personer efter förberedande arbetsträning2010Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    In recent decades, mental illness has increased in Sweden, and in parallel to this there has been an increase in unemployment. This implies that it is harder for people who have been away from employment for long periods due to ill health to return to work. The purpose of this study was to examine the work situation of people with mental illness who had undergone prevocational training, and to identify psychosocial factors relevant to their current work ability. The aim was also to describe how those who had undergone prevocational training perceived that it had affected their work ability. The study involved 19 participants who were interviewed and assessed with the Worker Role Interview, and an open question was asked about how they perceived that the prevocational training had affected their current work ability. The interview revealed that three of the participants were on sick leave, one was seeking a job, and 15 were working or studying. The results showed that the participants generally had support to acquire, return to, or continue employment concerning the psychosocial factors identified with the WRI. The WRI items showing the strongest support concerned the participants’ understanding of their abilities and limitations, their belief in their ability to work, and their understanding of what the working role involved. All participants perceived that the prevocational training had had a significant impact on their ability to return to work.

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  • 64.
    Cherma Yeste, Maria Dolores
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Klinisk farmakologi.
    Löfgren, Ulla-Britt
    Östergötlands Läns Landsting.
    Almkvist, Göran
    Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Vårdcentraler.
    Hallert, Claes
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland.
    Bengtsson, Finn
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Klinisk farmakologi.
    Prescription of antidepressant drugs in elderly nursing home patients.: A Follow-up investigation with focus on enantioselective citalopram analysis2007Konferensbidrag (Övrigt vetenskapligt)
  • 65.
    Chermá Yeste, Maria Dolores
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Löfgren, Ulla-Britt
    n/a.
    Almkvist, Göran
    n/a.
    Hallert, Claes
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Bengtsson, Finn
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk farmakologi.
    Assessment of the prescription of antidepressant drugs in elderly nursing home patients2008Ingår i: Journal of Clinical Psychopharmacology, ISSN 0271-0749, E-ISSN 1533-712X, Vol. 28, nr 4, s. 424-431Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the study was to investigate the use of antidepressant drugs among elderly people in nursing homes. Elderly residents who where found to have been prescribed at least one antidepressant drug according to the specific medication dispensing system were identified in 8 nursing homes in the county of Östergötland, Sweden. Data were collected from the medical record forms at the nursing home. Blood samples were drawn for the assessment of drug concentration, blood chemistry parameters and cytochrome P450 expression. At least one antidepressant drug was prescribed to 38% of elderly people in the nursing home studied. A total of 71 patients were evaluated, 80% women and 20% men. The median age was 84 years (range, 71-100 years). Indications for antidepressant drug treatment were found on 96% of medical record forms (depression, 60%); however, information relating to when treatment was initiated could not be found on 34% of medical record forms and a clear time schedule for how long this drug treatment was planned to continue could not be found either. A possible adverse effect of antidepressant drug treatment was retrieved in at least 77% of patients. Polypharmacotherapy was common; median number of drugs per patient was 11. Concentrations of drugs were higher than expected in 73%. Most patients were medicated with citalopram (n = 44). A clear interindividual variability of concentrations at each dose level was found for citalopram and for the metabolites desmethylcitalopram and didesmethylcitalopram. A significant correlation was found between the estimation of creatinine clearance and concentration-dose ratio of citalopram. Poor metabolizers, who had been prescribed an antidepressant drug that are substrate for the cytochrome P450 isoenzyme examined, have higher concentrations of prescribed antidepressant drug than do non-poor metabolizers in relation to dose. An increase in quality contribution to follow-up at antidepressant medications is needed. A more frequent clinical use of therapeutic drug monitoring and pharmacogenetic tests in addition to therapeutic drug monitoring may be one important tool in this process.

  • 66.
    Christina, Snöbohm
    et al.
    KI, sjukgymnastik.
    Friedrichsen, Maria
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, LAH/Linnéa-enheten.
    Heiwe, Sussanne
    KI, sjukgymnastik.
    Experiencing one's body after a diagnosis of cancer-a phenomenological study of young adults.2010Ingår i: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 19, nr 8, s. 863-869Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Young adults with cancer are still in the process of shaping their lives and are therefore at a vulnerable stage. Altered body image may change how patients cope with the disease and impact rehabilitation capacity.Objective: To describe the essence of how young adults with cancer experience their bodies.Methods: Interviews (12 informants), transcribed verbatim. Analysis: Giorgi's phenomenological method.Results: Identified themes: experience of 'physical body change', 'discomfort', 'the body at the moment without reflecting on the disease and treatment', 'body image' and 'grasping the illness'. Essences: The body as the bearer of life; conflict between age and disease; manifest changes in appearance, physically and mentally; the body no longer a whole; the body as influenceable and able to recover and heal.Conclusions: These patients undergo physical and mental changes that affect their self-image and health-related life quality. Thus, future studies need to explore interventions that may enhance the individualś perception of their body.

  • 67.
    Clark, Alexander M
    et al.
    University of Alberta, Canada.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Strachan, Patricia
    Stony Brook University , USA.
    Davidson, Patricia M
    Curtin University, Sydney, Australia. .
    Jerke, Megan
    Beattie, James M
    Heart of England NHS Foundation Trust, Birmingham.
    Duncan, Amanda S
    Ski, Chantal F
    Thompson, David R
    Effective communication and ethical consent in decisions related to ICDs2011Ingår i: Nature reviews. Cardiology, ISSN 1759-5010Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This Review examines recommendations and principles that promote good decision-making with regard to the insertion, deactivation, and potential malfunction of implantable cardioverter-defibrillators (ICDs). This guidance is important because ICDs are now used for primary and secondary prevention of arrhythmias in more than 20 diverse clinical populations, which accounts for the exponential increase in insertion rates over the past decade. Current guidelines require clinicians to provide personalized, culturally appropriate, and easy to understand information to patients on the benefits and harms of proposed treatment choices; however, obtaining valid informed consent for insertion and deactivation of ICDs is challenging. Initiating early conversations with patients and continuing this dialogue over time, implementation of localized care protocols, increased collaboration (particularly between cardiac and palliative care teams), and the provision of training for all health professionals involved in the care of these patients, can help to ensure that adequate informed consent is maintained throughout their care. In addition to providing information, health professionals should identify and address high levels of anxiety in patients and their next of kin and promote effective communication throughout decision making. In the future, use of standardized checklists or decision aids based on a clear understanding of the principles underlying key topics could support this process.

  • 68.
    Conraads, Viviane M
    et al.
    University of Antwerp Hospital.
    Deaton, Christi
    University of Manchester.
    Piotrowicz, Ewa
    Institute Cardiol, Warsaw.
    Santaularia, Nuria
    Xarxa Assistencial University of Manresa.
    Tierney, Stephanie
    University of Manchester.
    Piepoli, Massimo F
    AUSL Piacenza.
    Pieske, Burkert
    Medical University of Graz.
    Schmid, Jean-Paul
    University Hospital Bern.
    Dickstein, Kenneth
    University of Bergen.
    Ponikowski, Piotr P
    Mil Hospital.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Adherence of heart failure patients to exercise: barriers and possible solutions A position statement of the Study Group on Exercise Training in Heart Failure of the Heart Failure Association of the European Society of Cardiology2012Ingår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 14, nr 5, s. 451-458Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The practical management of heart failure remains a challenge. Not only are heart failure patients expected to adhere to a complicated pharmacological regimen, they are also asked to follow salt and fluid restriction, and to cope with various procedures and devices. Furthermore, physical training, whose benefits have been demonstrated, is highly recommended by the recent guidelines issued by the European Society of Cardiology, but it is still severely underutilized in this particular patient population. This position paper addresses the problem of non-adherence, currently recognized as a main obstacle to a wide implementation of physical training. Since the management of chronic heart failure and, even more, of training programmes is a multidisciplinary effort, the current manuscript intends to reach cardiologists, nurses, physiotherapists, as well as psychologists working in the field.

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  • 69.
    Coyne, James C
    et al.
    University of Groningen.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Luttik, Marie-Louise
    University of Groningen.
    van Sonderen, Eric
    University of Groningen.
    van Veldhuisen, Dirk J
    University of Groningen.
    Sanderman, Robbert
    University of Groningen.
    Lack of Prognostic Value of Type D Personality for Mortality in a Large Sample of Heart Failure Patients2011Ingår i: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 73, nr 7, s. 557-562Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms. Methods: We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression. Results: At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144). Conclusions: In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.

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  • 70.
    Cronfalk, B.S.
    et al.
    Department of Oncology–Pathology, Karolinska Institutet, Stockholm.
    Strang, P.
    Department of Oncology–Pathology, Karolinska Institutet, Stockholm.
    Ternestedt, B.-M.
    Department of Palliative Care Research, Ersta Sköndal University College, Stockholm.
    Friedrichsen, Maria
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, LAH-kliniken Linnéa ViN.
    The existential experiences of receiving soft tissue massage in palliative home care - An intervention2009Ingår i: Supportive Care in Cancer, ISSN 0941-4355, Vol. 17, nr 9, s. 1203-1211Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Soft tissue massage is currently used in palliative care for the relief of anxiety and pain. Only few studies have focused on patients deeper experience of receiving the massage. Aim: The purpose of this study was to explore how patients with cancer in palliative home care experienced soft tissue massage. Materials and methods: Twenty-two patients received soft tissue massage (hand or foot) nine times over a period of 2 weeks. Each session lasted for 25 min. Following the last massage session, a qualitative interview was conducted. The analysis was performed using a hermeneutic approach. Findings: Soft tissue massage generated feelings of existential respite with perceptions of being released from illness for a while. Two categories constituted the basis of the experiences: (1) "an experience of thoughtful attention" and (2) "a sensation of complete tranquility" resulting in the overarching theme "A time of existential respite." Conclusion: The patients experienced the massage to give meaning and to be important as it generated feelings of an inner respite. Relevance to clinical practice: Soft tissue massage appears to be an appreciated source of support to dying patients in palliative home care. The method is easy to comprehend and relatively short (25 min) which may imply that it is a suitable complement in nursing care for this patient group.

  • 71.
    Dahlgren, Lars-Ove
    et al.
    Linköpings universitet, Institutionen för Pedagogik och Psykologi. Linköpings universitet, Utbildningsvetenskap.
    Ahlner, Johan
    Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk farmakologi.
    Bergdahl, Björn
    Östergötlands Läns Landsting.
    Haglund, Lena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hejdeborn, Helene
    Linköpings universitet, Hälsouniversitetet.
    Kjellgren, Karin I.
    Linköpings universitet, Hälsouniversitetet.
    Vad blev det av PBI vid Hälsouniversitetet och var står vi nu?1993Ingår i: Problembaserad inlärning: erfarenheter från Hälsouniversitetet / [ed] Karin Kjellgren, Johan Ahlner, Lars Owe Dahlgren, Lena Haglund, Lund: Studentlitteratur AB, 1993, Vol. Sidorna 189-197, s. 189-197Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 72.
    Dahlén, Elsa M
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland.
    Länne, Toste
    Linköpings universitet, Institutionen för medicin och hälsa, Fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Lindström, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet.
    Grodzinsky, Ewa
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Nyström, Fredrik
    Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Endokrin- och magtarmmedicinska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland.
    Carotid intima-media thickness and apolipoprotein B/apolipoprotein A-I ratio in middle-aged patients with Type 2 diabetes2009Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 26, nr 4, s. 384-390Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims To explore the association between carotid intima-media thickness (IMT) and the apolipoprotein B (apoB)/apolipoprotein A-I (apoA-I) ratio compared with conventional lipids in middle-aged patients with Type 2 diabetes.

    Methods We analysed data from 247 patients with Type 2 diabetes, aged 55–66 years, in the Cardiovascular Risk factors in Patients with Diabetes—a Prospective study in Primary care (CARDIPP-1) study. Primary care nurses measured blood pressure and anthropometric characteristics. Blood samples were taken for laboratory analyses. The carotid IMT was determined by ultrasonography at the University Hospital in Linköping and at the County Hospital Ryhov, Jönköping, Sweden.

    Results The ApoB/apoA-I ratio (r = 0.207, P = 0.001), apoB (r = 0.166, P = 0.009) and non-high-density lipoprotein cholesterol (non-HDL-c) (r = 0.129, P = 0.046) correlated with IMT. Conventional lipids, high-sensitivity C-reactive protein (hsCRP), glycated haemoglobin (HbA1c) and systolic blood pressure were not significantly correlated to IMT. A stepwise logistic regression analysis was conducted with IMT as the dependent variable and the apoB/apoA-I ratio, HbA1c, hsCRP, low-density lipoprotein cholesterol (LDL-c), total cholesterol, non-HDL-c and treatment with statins as independent variables. Following adjustment for age and gender, only the apoB/apoA-I ratio remained significantly associated with IMT (odds ratio 4.3, 95% confidence intervals 1.7–10.8, P = 0.002).

    Conclusions We conclude that there was a significant association between the apoB/apoA-I ratio and IMT in middle-aged patients with Type 2 diabetes. The association was independent of conventional lipids, hsCRP, glycaemic control and use of statins.

  • 73.
    Daremo, Åsa
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier. Linköpings universitet, Hälsouniversitetet.
    Haglund, Lena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Activity and participation in psychiatric institutional care2008Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 15, nr 3, s. 131-142Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    National action plans emphasize the importance of strengthening the role of patients in health and medical care. Patients should feel that they can participate and that they are seen as a resource. In occupational therapy, the client-centred approach has developed, whereby it is key to enable patients to participate in their treatment. The International Classification of Functioning Disability and Health (ICF) has inspired this study, in which concepts such as activity and participation are central. The purpose of the study was to describe how patients in psychiatric institutional care conceive their opportunities to be active, and how they participate in their own treatment. Questionnaires were sent to patients who had received care during a six-month period. Ten patients were then selected for interview. The study shows that younger patients and patients who were treated involuntarily were generally more dissatisfied than other patients. The patients' perceptions of their environment were influenced by the values in the ward. Topics such as atmosphere in the ward, reception, continuity, and support were presented. Important factors related to activity and participation were: agreement concerning the treatment plan, discussions about expectations, creating conditions for engagement in activities, and providing the patients with opportunities to take responsibility for themselves.

  • 74.
    Daremo, Åsa
    et al.
    Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Psykiatriska kliniken. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Kjellberg, Anette
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Haglund, Lena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Occupational performance and affective symptoms for patients withdepression disorder2015Ingår i: Advances in Psychiatry, ISSN 2356-685X, E-ISSN 2314-7768, s. 1-6, artikel-id 438149Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aimof this study was to describe recovering over time in occupational performance and in affective symptoms for patients with depression disorder by using different assessments and methods for collecting data. A longitudinal design with data collections on repeated occasions was used. The Occupational Circumstances Assessment Interview and Rating Scale and Occupational Self- Assessment were used formeasuring occupational performance, and for affective symptoms, a Comprehensive Psychopathological Rating Scale Self-Assessment was used. Fourteen patients with depression disorder were included in the study. The result indicates that affective symptoms improve earlier than occupational performance. Furthermore, self-assessment seems to reflect more improvement to the patient than interview-based assessment. Different kinds of assessment and different kinds of data collection methods seem to facilitate the understanding of the patients recovering. In addition habituationwas themost important item for the patients to manage.One implication for practice is that patients may need an extended period of treatment supporting occupational performance.

  • 75.
    Daremo, Åsa
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier. Linköpings universitet, Hälsouniversitetet.
    Kjellberg, Anette
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Haglund, Lena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Values of different assessments when measuring occupational performance in mental healthManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    The aims of this study were to investigate if there was harmony between assessments for medical symptoms and assessments for occupational performance, and if they could replace each other when the occupational therapist collected information for patients with depressive disorders. Another aim was to investigate how the collected information was used in the treatment plan. The study showed that even if the symptoms of the disease have improved at the end of the treatment, the patient still has problems with occupational performance. Using both interview and self-assessments is important, and it is also very urgent to formulate goals based around the patient´s social environment.

  • 76.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Lindelof, Ann
    Region Östergötland, Närsjukvården i östra Östergötland.
    Wallen, Torbjorn
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN. Vastervik Hospital, Sweden.
    Lindahl, Tomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi.
    Hallert, Claes
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland.
    Point-of-care monitoring of warfarin treatment in community dwelling elderly - A randomised controlled study2015Ingår i: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 21, nr 5, s. 298-301Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of this study was to assess clinical effectiveness and costs of launching point-of-care monitoring of warfarin treatment in community dwelling frail elderly patients. A prospective multicentre controlled randomised study over 12 months comparing a point-of-care strategy with usual monitoring routines was carried out in primary healthcare centres and anticoagulation clinics in southeast Sweden. The subjects were community dwelling elderly across rural southeast Sweden on chronic warfarin treatment. Main outcome measures were time in therapeutic range (TTR), rate of treatment-related adverse events and costs. The study comprised 103 elderly people (61% women) mean age 86 yrs (range 75-98) treated with warfarin for median 9 yrs (range 1-18). Patients randomised to start point-of-care monitoring (n = 55) showed 75.9% in TTR before trial vs. 72.6% during trial (ns). The patients randomised to continue on usual monitoring routines (n = 48) showed 75.2% in TTR prior to trial vs. 72.9% during trial (ns). The point-of-care monitoring showed potential savings of SEK 624 per patient annually (based partly on effects that were not statistically significant). The study shows that point-of-care monitoring of warfarin treatment in community dwelling elderly in rural areas is as effective as usual monitoring routines and that it may offer savings to society.

  • 77.
    de Boer, Rudolf A
    et al.
    University of Groningen, the Netherlands.
    Cao, Qi
    University of Groningen, the Netherlands.
    Postmus, Douwe
    University of Groningen, the Netherlands.
    Damman, Kevin
    University of Groningen, the Netherlands.
    Voors, Adriaan A
    University of Groningen, the Netherlands.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    van Veldhuisen, Dirk J
    University of Groningen, the Netherlands.
    Arnold, William D
    Alere San Diego, Inc., San Diego, California.
    Hillege, Hans L
    University of Groningen, the Netherlands.
    Silljé, Herman H W
    University of Groningen, the Netherlands.
    The WAP four-disulfide core domain protein HE4: a novel biomarker for heart failure.2013Ingår i: JACC. Heart failure, ISSN 2213-1787, Vol. 1, nr 2, s. 164-169Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: This study investigated clinical determinants and added prognostic value of HE4 as a biomarker not previously described in heart failure (HF).

    BACKGROUND: Identification of plasma biomarkers that help to risk stratify HF patients may help to improve treatment.

    METHODS: Plasma HE4 levels were determined in 567 participants of the COACH (Coordinating study evaluating outcomes of Advising and Counseling in Heart failure). Patients had been hospitalized for HF and were followed for 18 months. The primary endpoint of this study was a composite of all-cause mortality and HF hospitalization.

    RESULTS: HE4 showed a strong correlation with HF severity, according to New York Heart Association functional class and brain natriuretic peptide (BNP) levels (p < 0.001). HE4 also showed a positive correlation with GDF15 (p < 0.001) and, in addition, correlated with kidney function (estimated glomerular filtration rate [eGFR]; p < 0.001). Cox regression analysis revealed that a doubling of HE4 levels was associated with a hazard ratio (HR) of 1.73 (95% confidence interval [CI]: 1.53 to 1.95) for the primary outcome (p < 0.001). After correction for age, gender, BNP, and eGFR, the HR was 1.46 (95% CI: 1.23 to 1.72; p < 0.001), and after additional adjustment for GDF15, the HR lowered to 1.30 (95% CI: 1.07 to 1.59; p = 0.009). The area under the curve in the receiver-operating characteristic curve analysis increased from 0.727 to 0.752 when HE4 was included in the clinical evaluation (p = 0.051). The integrated discrimination improvement and net reclassification index for reclassification showed significant improvements when HE4 was added to the clinical model, and this remained significant after BNP inclusion in the model.

    CONCLUSIONS: HE4 plasma levels are correlated with markers of HF severity, show prognostic value, and can improve risk assessment in HF.

  • 78.
    de Boer, Rudolf A
    et al.
    University of Groningen.
    Lok, Dirk J A
    Deventer Hospital, The Netherlands.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    van der Meer, Peter
    University of Groningen.
    Voors, Adriaan A
    University of Groningen.
    Hillege, Hans L
    University of Groningen.
    van Veldhuisen, Dirk J
    University of Groningen.
    Predictive value of plasma galectin-3 levels in heart failure with reduced and preserved ejection fraction2011Ingår i: Annals of Medicine, ISSN 0785-3890, E-ISSN 1365-2060, Vol. 43, nr 1, s. 60-68Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: galectin-3 is an emerging biomarker which has been studied in relatively small heart failure (HF) cohorts with predominantly systolic HF. We studied the prognostic value of base-line galectin-3 in a large HF cohort, with preserved and reduced left ventricular ejection fraction (LVEF), and compared this to other biomarkers.

    METHODS: we studied 592 HF patients who had been hospitalized for HF and were followed for 18 months. The primary end-point was a composite of all-cause mortality and HF hospitalization.

    RESULTS: a doubling of galectin-3 levels was associated with a hazard ratio (HR) of 1.97 (1.62-2.42) for the primary outcome (P < 0.001). After correction for age, gender, BNP, eGFR, and diabetes the HR was 1.38 (1.07-1.78; P = 0.015). Galectin-3 levels were correlated with higher IL-6 and CRP levels (P < 0.002). Changes of galectin-3 levels after 6 months did not add prognostic information to the base-line value (n = 291); however, combining plasma galectin-3 and BNP levels increased prognostic value over either biomarker alone (ROC analysis, P < 0.05). The predictive value of galectin-3 was stronger in patients with preserved LVEF (n = 114) compared to patients with reduced LVEF (P < 0.001).

    CONCLUSIONS: galectin-3 is an independent marker for outcome in HF and appears to be particularly useful in HF patients with preserved LVEF.

  • 79.
    De Smedt, R H
    et al.
    University of Groningen, The Netherlands.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Ranchor, A V
    University of Groningen, The Netherlands.
    van der Meer, K
    University of Groningen, The Netherlands.
    Groenier, K H
    University of Groningen, The Netherlands.
    Haaijer-Ruskamp, F M
    University of Groningen, The Netherlands.
    Denig, P
    Coping with adverse drug events in patients with heart failure: Exploring the role of medication beliefs and perceptions.2012Ingår i: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 27, nr 5, s. 570-587Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study describes coping strategies that patients with heart failure (HF) use to manage adverse drug events (ADEs). The included coping strategies were social support seeking, information seeking, non-adherence and taking alleviating medication. The role of beliefs about medication and ADE perceptions in explaining these coping strategies was assessed using the Self-Regulation Model. We performed a cross-sectional study including 250 HF patients who experienced an ADE. Patients completed validated questionnaires assessing their coping strategies, ADE perceptions and medication beliefs. Social support (60%) and information seeking (32%) were the most commonly used strategies to cope with ADEs. Non-adherence was reported by 7% of the patients. Multivariate linear regression analysis showed that demographics, clinical factors and medication beliefs explained only a small amount of the variance in coping strategies, whereas ADE perceptions explained a substantial amount of variance. Path analysis showed that patients' perceptions about the timeline, consequences and controllability of ADEs by the health care provider were directly related to their coping behaviour. The effect of patients' medication beliefs on their coping strategies was consistent with mediation through their ADE perceptions. Our results support the value of the Self-Regulation Model in understanding patients' coping behaviour with regard to ADEs.

  • 80.
    De Smedt, Ruth H E
    et al.
    University of Groningen, The Netherlands.
    Denig, Petra
    University of Groningen, The Netherlands.
    Haaijer-Ruskamp, Flora M
    University of Groningen, The Netherlands.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Self-reported adverse drug events and the role of illness perception and medication beliefs in ambulatory heart failure patients: A cross-sectional survey2011Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, nr 12, s. 1540-1550Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Identifying patients with heart failure (HF) who are at risk of experiencing symptomatic adverse drug events (ADEs) is important for improving patient care and quality of life. Several demographic and clinical variables have been identified as potential risk factors for ADEs but limited knowledge is available on the impact of HF patients beliefs and perceptions on their experience of ADEs. less thanbrgreater than less thanbrgreater thanObjective: The purpose of the study was to identify the relationship between HF patients illness perception and medication beliefs and self-reported ADEs. less thanbrgreater than less thanbrgreater thanDesign: A cross-sectional survey was performed between November 2008 and March 2009. less thanbrgreater than less thanbrgreater thanSettings: One university medical centre, two regional hospitals and 20 general practitioners in the Netherlands participated in the study. less thanbrgreater than less thanbrgreater thanParticipants: 495 patients with HF were included. less thanbrgreater than less thanbrgreater thanMethods: Patients completed the validated Revised Illness Perception Questionnaire (IPQR) and the Beliefs about Medication Questionnaire (BMQ) which collected data on their illness perception and medication beliefs. In addition, data on ADEs as experienced in the previous four weeks were collected through an open-ended question and a symptom checklist. Multivariate logistic regression was performed to identify factors associated with these ADEs. less thanbrgreater than less thanbrgreater thanResults: In total, 332 (67%) patients had experienced ADEs in the previous four weeks, of whom 28% reported dry mouth, 27% dizziness and 19% itchiness as the most prevalent. In the adjusted multivariate analysis, disease-related symptoms (illness identity) (OR for 1-5 symptoms 3.57: 95% CI 2.22-5.75, OR for andgt;5 symptoms 7.37; 95% CI 3.44-15.8), and general beliefs about medication overuse (OR 1.07; 95% CI 1.01-1.13) were independently associated with experiencing ADEs, whereas none of the demographic or clinical factors were significant. less thanbrgreater than less thanbrgreater thanConclusions: HF patients who perceive a high number of disease symptoms and have negative medication beliefs are at higher risk of experiencing self-reported ADEs. We suggest that future studies and interventions to improve ADE management should focus on negative medication beliefs and assisting patients in differentiating disease symptoms from ADEs. (C) 2011 Published by Elsevier Ltd.

  • 81.
    De Smedt, Ruth H E
    et al.
    University of Groningen.
    Haaijer-Ruskamp, Flora M
    University of Groningen.
    van der Meer, Klaas
    University of Groningen.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Perceived Adverse Drug Events in Heart Failure Patients Perception and Related Factors2011Ingår i: JOURNAL OF CARDIOVASCULAR NURSING, ISSN 0889-4655, Vol. 26, nr 3, s. 250-260Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Patients with heart failure (HF) often perceive adverse drug events (ADEs), affecting quality of life. For weighing the benefits and burden of medication in HF care, knowledge on patients perception of ADEs is needed. Our aim was to assess these ADE perceptions and to identify factors related to these perceptions. Methods: A cross-sectional study was performed including HF patients recruited from primary care and outpatient clinics. Patients were included in the analysis if they perceived an ADE in the past 4 weeks. This information was collected using an open-ended question and a symptom checklist. Data on ADE perception were obtained using a modified version of the Revised Illness Perception Questionnaire. Demographic, clinical, and ADE characteristics were collected by self-administered questionnaire and chart review. The relations between these factors and ADE perceptions were analyzed using regression analyses. Results: In total, 261 HF patients perceived an ADE and completed the questionnaire. Patients reported 814 ADEs, of which 26% of the patients reported dizziness and 24% reported dry mouth as being the most prevalent. Almost half of the patients (46%) perceived their ADE as something serious, with major consequences for their daily life (40%) and reported to be worried (36%) about the ADE. Patients perceived the ADE as a chronic problem (91%), and the majority believed more in the ability of the health care provider to control the ADE (61%) than in their own ability (46%). Demographic and clinical variables had a limited contribution to the explained variance of ADE perceptions after adjusting for ADE characteristics, such as perceived severity. Conclusion: Patients with HF perceive particular negative consequences and emotional distress of symptomatic ADE. Open communication between patients and providers with attention for patients ADE perceptions would be valuable during the decision process of ADE management and may result in a regimen aligned with patients preferences and needs.

  • 82.
    de Vries, Arjen E
    et al.
    University Medical Centre Groningen, The Netherlands.
    de Jong, Richard M
    University Medical Centre Groningen, The Netherlands.
    van der Wal, Martje H L
    University Medical Centre Groningen, The Netherlands.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    van Dijk, Rene B
    Martini hospital Groningen, The Netherlands.
    Hillege, Hans L
    University Medical Centre Groningen, The Netherlands.
    The value of INnovative ICT guided disease management combined with Telemonitoring in OUtpatient clinics for Chronic Heart failure patients. Design and methodology of the IN TOUCH study: a multicenter randomised trial2011Ingår i: BMC health services research, ISSN 1472-6963, Vol. 11, s. 167-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Although the value of telemonitoring in heart failure patients is increasingly studied, little is known about the value of the separate components of telehealth: ICT guided disease management and telemonitoring. The aim of this study is to investigate the value of telemonitoring added to ICT guided disease management (DM) on the quality and efficiency of care in patients with chronic heart failure (CHF) after a hospitalisation.

    METHODS/DESIGN: The study is divided in two arms; a control arm (DM) and an intervention arm (DM+TM) in 10 hospitals in the Netherlands. In total 220 patients will be included after worsening of CHF (DM: N = 90, DM+TM: N = 130). Total follow-up will be 9 months. Data will be collected at inclusion and then after 2 weeks, 4.5 and 9 months. The primary endpoint of this study is a composite score of: 1: death from any cause during the follow-up of the study, 2: first readmission for HF and 3: change in quality of life compared to baseline, assessed by the Minnesota Living with Heart failure Questionnaire. The study has started in December 2009 and results are expected in 2012.

    CONCLUSIONS: The IN TOUCH study is the first to investigate the effect of telemonitoring on top of ICT guided DM on the quality and efficiency of care in patients with worsening HF and will use a composite score as its primary endpoint.

    TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR1898.

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  • 83.
    de Vries, Arjen E
    et al.
    Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands.
    van der Wal, Martje H L
    Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands.
    Bedijn, Wendy
    Martini Hospital, Department of Cardiology, Groningen, The Netherlands.
    de Jong, Richard M
    Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands.
    van Dijk, Rene B
    Martini Hospital, Department of Cardiology, Groningen, The Netherlands .
    Hillege, Hans L
    Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Follow-up and treatment of an instable patient with heart failure using telemonitoring and a computerised disease management system: A case report2012Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, nr 4, s. 432-438Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In the last decades, the introduction of information and communication technology (ICT) in healthcare promised an improved quality of care while reducing workload and improving cost-effectiveness. This might be realised by the use of computer guided decision support systems and telemonitoring. This case study describes the process of care of a patient with chronic heart failure, who was treated with a computerised disease management system in combination with telemonitoring. With the help of these appliances, we think we were probably able to prevent at least two readmissions for heart failure in a period of 10months. We also gained more insight into patient's behaviour with regards to compliance with the heart failure regimen at home. Frequent contact at distance and the online availability of physiological measurements at home facilitated patient tailored education and helped the patient to react adequately to symptoms of deterioration. Additionally, up-titration of heart failure medication was performed without contacting the patient at the outpatient clinic.

  • 84.
    de Vries, Arjen E.
    et al.
    University of Medical Centre Groningen, Netherlands .
    van der Wal, Martje H. L.
    University of Medical Centre Groningen, Netherlands .
    Nieuwenhuis, Maurice M. W.
    University of Medical Centre Groningen, Netherlands .
    de Jong, Richard M.
    University of Medical Centre Groningen, Netherlands .
    van Dijk, Rene B.
    Martini Hospital, Netherlands .
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hillege, Hans L.
    University of Medical Centre Groningen, Netherlands .
    Health Professionals Expectations Versus Experiences of Internet-Based Telemonitoring: Survey Among Heart Failure Clinics2013Ingår i: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 15, nr 1, s. 73-83Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Although telemonitoring is increasingly used in heart failure care, data on expectations, experiences, and organizational implications concerning telemonitoring are rarely addressed, and the optimal profile of patients who can benefit from telemonitoring has yet to be defined. less thanbrgreater than less thanbrgreater thanObjective: To assess the actual status of use of telemonitoring and to describe the expectations, experiences, and organizational aspects involved in working with telemonitoring in heart failure in the Netherlands. less thanbrgreater than less thanbrgreater thanMethods: In collaboration with the Netherlands Organization for Applied Scientific Research (TNO), a 19-item survey was sent to all outpatient heart failure clinics in the Netherlands, addressed to cardiologists and heart failure nurses working in the clinics. less thanbrgreater than less thanbrgreater thanResults: Of the 109 heart failure clinics who received a survey, 86 clinics responded (79%). In total, 31 out of 86 (36%) heart failure clinics were using telemonitoring and 12 heart failure clinics (14%) planned to use telemonitoring within one year. The number of heart failure patients receiving telemonitoring generally varied between 10 and 50; although in two clinics more than 75 patients used telemonitoring. The main goals for using telemonitoring are "monitoring physical condition", "monitoring signs of deterioration" (n=39, 91%), "monitoring treatment" (n=32, 74%), "adjusting medication" (n=24, 56%), and "educating patients" (n=33, 77%). Most patients using telemonitoring were in the New York Heart Association (NYHA) functional classes II (n=19, 61%) and III (n=27, 87%) and were offered the use of the telemonitoring system "as long as needed" or without a time limit. However, the expectations of the use of telemonitoring were not met after implementation. Eight of the 11 items about expectations versus experiences were significantly decreased (Pandlt;.001). Health care professionals experienced the most changes related to the use of telemonitoring in their work, in particular with respect to "keeping up with current development" (before 7.2, after 6.8, P=.15), "being innovative" (before 7.0, after 6.1, P=.003), and "better guideline adherence" (before 6.3, after 5.3, P=.005). Strikingly, 20 out of 31 heart failure clinics stated that they were considering using a different telemonitoring system than the system used at the time. less thanbrgreater than less thanbrgreater thanConclusions: One third of all heart failure clinics surveyed were using telemonitoring as part of their care without any transparent, predefined criteria of user requirements. Prior expectations of telemonitoring were not reflected in actual experiences, possibly leading to disappointment. (J Med Internet Res 2013;15(1):e4) doi:10.2196/jmir.2161

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  • 85.
    de Vries, Arjen E.
    et al.
    University of Medical Centre Groningen, Netherlands.
    van der Wal, Martje H L.
    University of Medical Centre Groningen, Netherlands.
    Nieuwenhuis, Maurice M W.
    University of Medical Centre Groningen, Netherlands.
    de Jong, Richard M:
    University of Medical Centre Groningen, Netherlands.
    van Dijk, Rene B.
    Martini Hospital, Netherlands.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hillege, Hans L.
    University of Medical Centre Groningen, Netherlands.
    Jorna, Rene J.
    University of Groningen, Netherlands.
    Perceived barriers of heart failure nurses and cardiologists in using clinical decision support systems in the treatment of heart failure patients2013Ingår i: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 13, nr 54Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Clinical Decision Support Systems (CDSSs) can support guideline adherence in heart failure (HF) patients. However, the use of CDSSs is limited and barriers in working with CDSSs have been described as a major obstacle. It is unknown if barriers to CDSSs are present and differ between HF nurses and cardiologists. Therefore the aims of this study are; 1. Explore the type and number of perceived barriers of HF nurses and cardiologists to use a CDSS in the treatment of HF patients. 2. Explore possible differences in perceived barriers between two groups. 3. Assess the relevance and influence of knowledge management (KM) on Responsibility/Trust (R&T) and Barriers/Threats (B&T).

    Methods

    A questionnaire was developed including; B&T, R&T, and KM. For analyses, descriptive techniques, 2-tailed Pearson correlation tests, and multiple regression analyses were performed.

    Results

    The response- rate of 220 questionnaires was 74%. Barriers were found for cardiologists and HF nurses in all the constructs. Sixty-five percent did not want to be dependent on a CDSS. Nevertheless thirty-six percent of HF nurses and 50% of cardiologists stated that a CDSS can optimize HF medication. No relationship between constructs and age; gender; years of work experience; general computer experience and email/internet were observed. In the group of HF nurses a positive correlation (r .33, P<.01) between years of using the internet and R&T was found. In both groups KM was associated with the constructs B&T (B=.55, P=<.01) and R&T (B=.50, P=<.01).

    Conclusions

    Both cardiologists and HF-nurses perceived barriers in working with a CDSS in all of the examined constructs. KM has a strong positive correlation with perceived barriers, indicating that increasing knowledge about CDSSs can decrease their barriers.

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  • 86.
    Deaton, Christi
    et al.
    University of Manchester and Central Manchester Foundation Trust .
    Froelicher, Erika Sivarajan
    University of California, San Francisco.
    Wu, Lai Har
    The Hong Kong Polytechnic University.
    Ho, Camille
    Hong Kong Adventist Hospital.
    Shishani, Kawkab
    Washington State University.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    The global burden of cardiovascular disease2011Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10 Suppl 2, s. S5-13Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Cardiovascular disease (CVD) today is responsible for approximately one-third of deaths worldwide, and that figure will surely increase in both developing and developed countries as risk factors for the disease--primarily dyslipidemia, hypertension, obesity, diabetes, physical inactivity, poor diet, and smoking--continue to increase. Although these risk factors are modifiable, to date there is a relative paucity of measures to prevent or control them, particularly in developing countries. A population strategy combined with a high-risk strategy for CVD prevention could greatly reduce the burden of disease in the coming decades. Many initiatives are working, but many more are needed. This chapter provides background on the global burden of CVD and provides the context for the subsequent chapters addressing nurses' roles in reversing the bleak predictions for the ravages of CVD if risk factors are left unchecked in the coming decades.

  • 87.
    Deaton, Christi
    et al.
    University Manchester, Sch Nursing Midwifery and Social Work, Manchester M20 3RA, Lancs, England.
    Sivarajan Froelicher, Erika
    University Calif San Francisco, Sch Med, Sch Nursing and Epidemiol and Biostat, San Francisco, CA USA.
    Har Wu, Lai
    Hong Kong Polytech University, Hong Kong, Hong Kong, Peoples R China.
    Ho, Camille
    Hong Kong Adventist Hospital, Hong Kong, Hong Kong, Peoples R China.
    Shishani, Kawkab
    Washington State University, Coll Nursing, Spokane, WA USA.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    The Global Burden of Cardiovascular Disease2011Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 26, nr 4, s. S5-S14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Cardiovascular disease (CVD) today is responsible for approximately one-third of deaths worldwide, and that figure will surely increase in both developing and developed countries as risk factors for the disease-primarily dyslipidemia, hypertension, obesity, diabetes, physical inactivity, poor diet, and smoking-continue to increase. Although these risk factors are modifiable, to date there is a relative paucity of measures to prevent or control them, particularly in developing countries. A population strategy combined with a high-risk strategy for CVD prevention could greatly reduce the burden of disease in the coming decades. Many initiatives are working, but many more are needed. This chapter provides background on the global burden of CVD and provides the context for the subsequent chapters addressing nurses roles in reversing the bleak predictions for the ravages of CVD if risk factors are left unchecked in the coming decades.

  • 88.
    Dell'Acqua, Pierangelo
    et al.
    Linköpings universitet, Institutionen för teknik och naturvetenskap, Medie- och Informationsteknik. Linköpings universitet, Tekniska högskolan.
    Klompstra, Leonie Verheijden
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Samini, Ali
    Linköpings universitet, Institutionen för teknik och naturvetenskap, Medie- och Informationsteknik. Linköpings universitet, Tekniska högskolan.
    An Assistive Tool for Monitoring Physical Activities in Older Adults2013Konferensbidrag (Refereegranskat)
    Abstract [en]

    Active living in older adults reduces disabilities and increases quality of life. Adherence to physical activity is low in older adults, therefore new possibilities to motivate to exercise must be explored. One of this new possibilities is to use exergaming. In this paper, we present an assistive tool for monitoring daily, physical activities in older adults with access to exergaming in their home environments. The proposed system employs the Kinect device and allows one to analyse the body movements. From a pilot study, we proved that the system can detect movements through exergaming. In the future we plan to implement the developed monitoring tool as well as exergaming in nursing homes.

  • 89.
    Deshpande, Shilpa
    et al.
    Model of Human Occupation Clearinghouse, University of Illinois at Chicago, USA.
    Kielhofner, Gary
    University of Illinois at Chicago, USA.
    Henriksson, Chris
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier. Linköpings universitet, Medicinska fakulteten.
    Haglund, Lena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Olson, Linda
    Rusch University, Chicago, USA.
    Forsyth, Kirsty
    Chicago.
    A user's manual for the Occupational Circumstances Assessment Interview and Rating Scale2002Bok (Övrigt vetenskapligt)
    Abstract [en]

    The OCAIRS provides a structure for gathering, analyzing, and reporting data on the extent and nature of an individual's occupational participation. It can be used with a wide range of clients, and would be appropriate for any adolescent or adult client who has the cognitive and emotional ability to participate in an interview. The OCAIRS provides a structured and theoretically based means of developing interview skills in evaluation and treatment.

  • 90.
    Doherty, S.
    et al.
    National University of Ireland, Galway.
    Byrne, M.
    National University of Ireland, Galway.
    Murphy, A.
    National University of Ireland, Galway.
    McGee, H. M.
    Royal College of Surgeons in Ireland, Dublin.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    The CHARMS Study: Predictors of sexual dysfunction among patients post hospitalcardiac rehabilitation2012Ingår i: Psychology & Health, ISSN 0887-0446, Vol. 27, nr Supplement 1, s. 37-37Artikel i tidskrift (Refereegranskat)
  • 91.
    Dolva, Anne-Stine
    et al.
    Lillehammer University College, Norway.
    Gustavsson, Anders
    Stockholm University.
    Borell, Lena
    Karolinska Institutet, Stockholm.
    Hemmingsson, Helena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Facilitating peer interaction - support to children with Down syndrome in mainstream schools2011Ingår i: European Journal of Special Needs Education, ISSN 0885-6257, E-ISSN 1469-591X, Vol. 26, nr 2, s. 201-213Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study addresses the support provided by class staff in order to facilitate social participation of pupils with Down syndrome and peers in regular classes, and how they experience the interaction between the pupils. Data were collected through field observations of six pupils with Down syndrome in their class in mainstream schools, their six teachers and teachers’ assistants. Qualitative interviews were conducted with the teachers and teachers’ assistants. The analysis showed different support strategies, implying both environmental adaptations and individual support in order to facilitate peer interaction. A major finding was the role of the ‘supported ego’, mainly provided by teachers’ assistants. This role accommodated to the differences between the pupils, by compensating for the cognitive difficulties (i.e., perceptions, understanding and agency) of the pupils with Down syndrome. We concluded that class staff strived to keep the class as one unit by creating opportunities for participation for all the pupils through different strategies depending on their role and responsibility.

  • 92.
    Dong, Huan-Ji
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Marcusson, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Wressle, Ewa
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Unosson, Mitra
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Obese very old women have low relative handgrip strength, poor physical function, and difficulty in daily living2015Ingår i: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, nr 1, s. 20-25Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate how anthropometric and body composition variables, and handgrip strength (HS) affect physical function and independent daily living in 88-year-old Swedish women.

    Participants: A cross-sectional analysis of 83 community-dwelling women, who were 88 years old with normal weight (n=30), overweight (n=29), and obesity (n=24) in Linköping, Sweden, was performed.

    Measures: Assessments of body weight (Wt), height, waist circumference (WC), and arm circumference were performed by using an electronic scale and measuring tape. Tricep skinfold thickness was measured by a skinfold calliper. Fat mass (FM) and fat-free mass (FFM) were measured by bioelectrical impedance analysis, and HS was recorded with an electronic grip force instrument. Linear regression was used to determine the contributions of parameters as a single predictor or as a ratio with HS to physical function (Short Form-36, SF-36PF) and instrumental activities of daily living (IADL).

    Results: Obese women had greater absolute FM and FFM, and lower HS corrected for FFM and HS-based ratios (i.e., HS/Wt, HS/body mass index [BMI]) than their normal weight and overweight counterparts. After adjusting for physical activity levels and the number of chronic diseases, HS-based ratios explained more variance in SF-36PF scoring (R2: 0.52–0.54) than single anthropometric and body composition variables (R2: 0.45–0.51). WC, HS, and HS-based ratios (HS/Wt and HS/FFM) were also associated with the number of IADL with no difficulty.

    Conclusion: Obese very old women have a high WC, but their HS is relatively low in relation to their Wt and FFM. These parameters are better than BMI for predicting physical function and independent daily living.

  • 93.
    Dong, Huan-Ji
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Unosson, Mitra
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Wressle, Ewa
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Marcusson, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Health Consequences Associated with Being Overweight or Obese: A Swedish Population-Based Study of 85-Year-Olds2012Ingår i: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 60, nr 2, s. 243-250Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To determine whether being overweight or obese is associated with significant health outcomes in an 85-year-old population. less thanbrgreater than less thanbrgreater thanDESIGN: A cross-sectional population-based study. less thanbrgreater than less thanbrgreater thanSETTING: Linkoping, Sweden. less thanbrgreater than less thanbrgreater thanPARTICIPANTS: Three hundred thirty-eight people born in 1922 were identified using the local authoritys register. less thanbrgreater than less thanbrgreater thanMEASUREMENTS: Data related to sociodemographic characteristics, health-related quality of life (HRQoL), assistance use, and the presence of diseases were collected using a postal questionnaire. Anthropometry and functional status were assessed during home and geriatric clinic visits. Diseases were double-checked in the electronic medical records, and information about health service consumption was obtained from the local healthcare register. less thanbrgreater than less thanbrgreater thanRESULTS: Overweight (body mass index (BMI) 25.0-29.9 kg/m(2)) and obese (BMI andgt;= 30.0 kg/m(2)) participants perceived more difficulty performing instrumental activities of daily living (IADLs) and had more comorbidity than their normal-weight counterparts (BMI 18.5-24.9 kg/m(2)), but their overall HRQoL and health service costs did not differ from those of normal-weight participants. After controlling for sociodemographic factors, being overweight did not influence IADLs or any comorbidity, but obese participants were more likely to perceive greater difficulty in performing outdoor activities (odds ratio (OR) = 2.1, 95% confidence interval (CI) = 1.1-4) and cleaning (OR = 2.2, 95% CI = 1.2-4.2) than their normal-weight counterparts. Although obesity was also associated with multimorbidity (OR = 3, 95% CI = 1.2-8), the health service cost of each case of multimorbidity (n = 251) was highest in normalweight participants and nearly three times as much as in obese participants (ratio: 2.9, 95% CI = 1.1-8.1). less thanbrgreater than less thanbrgreater thanCONCLUSION: For 85-year-olds, being obese, as opposed to overweight, is associated with self-reported activity limitations and comorbidities. Overweight older adults living in their own homes in this population had well-being similar to that of those with normal weight.

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  • 94.
    Dontje, Manon L
    et al.
    Hanze University of Applied Sciences and University Medical Center Groningen, University of Groningen, the Netherlands.
    van der Wal, Martje H L
    University Medical Center Groningen, University of Groningen, the Netherlands.
    Stolk, Ronald P
    University Medical Center Groningen, University of Groningen, the Netherlands.
    Brügemann, Johan
    University Medical Center Groningen, University of Groningen, the Netherlands.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Wijtvliet, Petra E P J
    Martini Hospital Groningen, the Netherlands.
    van der Schans, Cees P
    Hanze University of Applied Sciences, Groningen, the Netherlands.
    de Greef, Mathieu H G
    Institute of Human Movement Sciences, University of Groningen and Hanze University of Applied Sciences, Groningen, the Netherlands.
    Daily Physical Activity in Stable Heart Failure Patients2014Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, nr 3, s. 218-226Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:: Physical activity is the only nonpharmacological therapy that is proven to be effective in heart failure (HF) patients in reducing morbidity. To date, little is known about the levels of daily physical activity in HF patients and about related factors.

    OBJECTIVE:: The objectives of this study were to (a) describe performance-based daily physical activity in HF patients, (b) compare it with physical activity guidelines, and (c) identify related factors of daily physical activity.

    METHODS:: The daily physical activity of 68 HF patients was measured using an accelerometer (SenseWear) for 48 hours. Psychological characteristics (self-efficacy, motivation, and depression) were measured using questionnaires. To have an indication how to interpret daily physical activity levels of the study sample, time spent on moderate- to vigorous-intensity physical activities was compared with the 30-minute activity guideline. Steps per day was compared with the criteria for healthy adults, in the absence of HF-specific criteria. Linear regression analyses were used to identify related factors of daily physical activity.

    RESULTS:: Forty-four percent were active for less than 30 min/d, whereas 56% were active for more than 30 min/d. Fifty percent took fewer than 5000 steps per day, 35% took 5000 to 10 000 steps per day, and 15% took more than 10 000 steps per day. Linear regression models showed that New York Heart Association classification and self-efficacy were the most important factors explaining variance in daily physical activity.

    CONCLUSIONS:: The variance in daily physical activity in HF patients is considerable. Approximately half of the patients had a sedentary lifestyle. Higher New York Heart Association classification and lower self-efficacy are associated with less daily physical activity. These findings contribute to the understanding of daily physical activity behavior of HF patients and can help healthcare providers to promote daily physical activity in sedentary HF patients.

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  • 95.
    Downs, Jenny
    et al.
    University of Western Australia.
    Bergman, Anke
    University of Western Australia.
    Carter, Philippa
    University of Western Australia.
    Anderson, Alison
    University of Western Australia.
    M Palmer, Greta
    Royal Childrens Hospital, Melbourne.
    Roye, David
    Columbia University.
    van Bosse, Harold
    Shriners Hospital Children.
    Bebbington, Ami
    University of Western Australia.
    Larsson, Eva-Lena
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Smith, Brian G
    Yale University.
    Baikie, Gordon
    Royal Childrens Hospital, Melbourne.
    Fyfe, Sue
    Curtin University of Technology.
    Leonard, Helen
    University of Western Australia.
    Guidelines for Management of Scoliosis in Rett Syndrome Patients Based on Expert Consensus and Clinical Evidence2009Ingår i: SPINE, ISSN 0362-2436, Vol. 34, nr 17, s. E607-E617Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design. Modified Delphi technique. Objective. To develop guidelines for the clinical management of scoliosis in Rett syndrome through evidence review and consensus expert panel opinion. Summary of Background Data. Rett syndrome is a rare disorder and clinical expertise is thus with small case series. Scoliosis is a frequent association and the evidence base dealing with scoliosis management in this syndrome is limited. Parents of affected girls and women have expressed needs for more information about scoliosis and Rett syndrome. Methods. An initial draft of scoliosis guidelines was created based on literature review and open-ended questions where the literature was lacking. Perspectives of four parents of Rett syndrome patients informed this initial draft. Access to an online and a Microsoft Word formatted version of the draft were then sent to an international, multidisciplinary panel of clinicians via e-mail with input sought using a 2-stage modified Delphi process to reach consensus agreement. Items included clinical monitoring and intervention before the diagnosis of scoliosis; monitoring after the diagnosis of scoliosis; imaging; therapy and conservative management; bracing; and preoperative, surgical, and postoperative considerations. Results. The first draft contained 71 statements, 65 questions. The second draft comprised 88 items with agreement to strong agreement achieved on 85, to form the final guideline document. A comprehensive, life-span approach to the management of scoliosis in Rett syndrome is recommended that takes into account factors such as physical activity, posture, nutritional and bone health needs. Surgery should be considered when the Cobb angle is approximately 40 to 50 and must be supported by specialist management of anesthesia, pain control, seizures, and early mobilization. Conclusion. Evidence-and consensus-based guidelines were successfully created and have the potential to improve care of a complex comorbidity in a rare condition and stimulate research to improve the current limited evidence base.

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  • 96. Beställ onlineKöp publikationen >>
    Eckerblad, Jeanette
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Symptom burden among people with chronic disease2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Chronic diseases tend to increase with old age. Older people with chronic disease are commonly suffering from conditions which produce a multiplicity of symptoms and a decreased health-related quality of life. Nurses have a responsibility to prevent, ease or delay a negative outcome through symptom management, or assist in achieving an acceptable level of symptom relief.

    Aim: The overall aim of the thesis was to describe different aspects of symptom burden from the perspective of community-dwelling people with chronic disease.

    Methods: This thesis is based upon four papers that used both quantitative and qualitative data to describe different aspects of symptom burden, experienced by people with chronic diseases. Paper (I) is a cross-sectional study with 91 participants diagnosed with chronic obstructive pulmonary disease. Papers (II and IV) are based upon secondary outcome data from a randomized controlled trial with 382 community-dwelling older people with multimorbidity. Paper (II) is a cross-sectional study and Paper (IV) has a descriptive and an explorative design reporting on the trajectory of symptom prevalence and symptom burden. Paper (III) is a qualitative study with participants from the AGe-FIT.

    Results: Among people diagnosed with COPD the most prevalent symptoms with the highest symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy, with just a few differences between participants with moderate and severe airflow limitation (I). For older people with multimorbidity, pain was the symptom with the highest prevalence and burden. Other highly prevalent symptoms were lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score (II). The symptoms experienced by the older people were persistent and the symptom burden remained high over time (IV). The experience of living with a high symptom burden was described as an endless struggle. The analysis revealed an overall theme, “To adjust and endure” and three sub-themes, “to feel inadequate and limited”, “to feel dependent”, and “to feel dejected” (III).

    Conclusions: The results of this thesis indicate the importance of early symptom identification. People with chronic diseases have an unmet need for optimized treatment that focuses on the total symptom burden, and not only disease specific symptoms. A large proportion of older people with multimorbidity suffer a high and persistent symptom burden, and the prevalence and trajectory of pain are high. Older people sometimes think their high age is the reason they experience a diversity of symptoms, and they do not always communicate these to their health-care provider.

    Delarbeten
    1. Symptom burden in stable COPD patients with moderate or severe airflow limitation
    Öppna denna publikation i ny flik eller fönster >>Symptom burden in stable COPD patients with moderate or severe airflow limitation
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    2014 (Engelska)Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 43, nr 4, s. 351-357Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVES:

    To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations.

    BACKGROUND:

    Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation.

    METHODS:

    A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations.

    RESULTS:

    The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups.

    CONCLUSIONS:

    Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management.

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2014
    Nyckelord
    Chronic obstructive pulmonary disease; Symptom assessment; Symptom experience; Respiratory nursing
    Nationell ämneskategori
    Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-109384 (URN)10.1016/j.hrtlng.2014.04.004 (DOI)000338972500022 ()24856227 (PubMedID)
    Tillgänglig från: 2014-08-15 Skapad: 2014-08-15 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    2. Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study
    Öppna denna publikation i ny flik eller fönster >>Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study
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    2015 (Engelska)Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, nr 1Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: Globally, the population is ageing and lives with several chronic diseases for decades. A high symptom burden is associated with a high use of healthcare, admissions to nursing homes, and reduced quality of life. The aims of this study were to describe the multidimensional symptom profile and symptom burden in community-dwelling older people with multimorbidity, and to describe factors related to symptom burden. Methods: A cross-sectional study including 378 community-dwelling people greater than= 75 years, who had been hospitalized greater than= 3 times during the previous year, had greater than= 3 diagnoses in their medical records. The Memorial Symptom Assessment Scale was used to assess the prevalence, frequency, severity, distress and symptom burden of 31 symptoms. A multiple linear regression was performed to identify factors related to total symptom burden. Results: The mean number of symptoms per participant was 8.5 (4.6), and the mean total symptom burden score was 0.62 (0.41). Pain was the symptom with the highest prevalence, frequency, severity and distress. Half of the study group reported the prevalence of lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score. Conclusion: The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management.

    Ort, förlag, år, upplaga, sidor
    BioMed Central, 2015
    Nyckelord
    Chronic disease; Older people; Symptom assessment
    Nationell ämneskategori
    Sociologi Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-114010 (URN)10.1186/1471-2318-15-1 (DOI)000347569800001 ()25559550 (PubMedID)
    Anmärkning

    Funding Agencies|Faculty of Health sciences, Linkoping University; county council of Ostergotland; Signe and Olof Wallenius trust fund; Solstickan; Swedish Association of Geriatric Medicine; Mundipharma

    Tillgänglig från: 2015-02-06 Skapad: 2015-02-05 Senast uppdaterad: 2019-06-27
    3. To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity
    Öppna denna publikation i ny flik eller fönster >>To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity
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    2015 (Engelska)Ingår i: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 28, nr 4, s. 322-327Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Context Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life. Objectives The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.

    Method A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-€“89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.

    Results The experience of living with a high symptom burden revealed the overall theme, “To adjust and endure” and three sub-themes. The first sub-theme was "To feel inadequate and limited". Participants reported that they no longer had the capacity or the ability to manage, and they felt limited and isolated from friends or family. The second sub-theme was "To feel dependent". This was a new and inconvenient experience; the burden they put on others caused a feeling of guilt. The final sub-theme was "To feel dejected". The strength to manage and control their conditions was gone; the only thing left to do was to sit or lie down and wait for it all to pass.

    Conclusion This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that are possible to treat or improve.

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2015
    Nyckelord
    Multimorbidity, Older people, Symptom burden, Content analysis
    Nationell ämneskategori
    Omvårdnad Gerontologi, medicinsk/hälsovetenskaplig inriktning
    Identifikatorer
    urn:nbn:se:liu:diva-122740 (URN)10.1016/j.apnr.2015.03.008 (DOI)000366148700012 ()
    Tillgänglig från: 2015-11-19 Skapad: 2015-11-19 Senast uppdaterad: 2021-04-12Bibliografiskt granskad
    4. Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the RCT AGe-FIT study
    Öppna denna publikation i ny flik eller fönster >>Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the RCT AGe-FIT study
    2016 (Engelska)Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, nr 11, s. 2773-2783Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aim

    The aim of this study was to follow the symptom trajectory of community-dwelling older people with multimorbidity and to explore the effect on symptom burden from an ambulatory geriatric care unit, based on comprehensive geriatric assessment.

    Background

    Older community-dwelling people with multimorbidity suffer from a high symptom burden with a wide range of co-occurring symptoms often resulting to decreased health-related quality of life. There is a need to move from a single-disease model and address the complexity of older people living with multimorbidity.

    Design

    Secondary outcome data from the randomized controlled Ambulatory Geriatric Assessment Frailty Intervention Trial (AGe-FIT).

    Methods

    Symptom trajectory of 31 symptoms was assessed with the Memorial Symptom Assessment Scale. Data from 247 participants were assessments at baseline, 12 and 24 months, 2011–2013. Participants in the intervention group received care from an ambulatory geriatric care unit based on comprehensive geriatric assessment in addition to usual care.

    Results

    Symptom prevalence and symptom burden were high and stayed high over time. Pain was the symptom with the highest prevalence and burden. Over the 2-year period 68–81% of the participants reported pain. Other highly prevalent and persistent symptoms were dry mouth, lack of energy and numbness/tingling in the hands/feet, affecting 38–59% of participants. No differences were found between the intervention and control group regarding prevalence, burden or trajectory of symptoms.

    Conclusions

    Older community-dwelling people with multimorbidity had a persistent high burden of symptoms. Receiving advanced interdisciplinary care at an ambulatory geriatric unit did not significantly reduce the prevalence or the burden of symptoms.

    Ort, förlag, år, upplaga, sidor
    Wiley-Blackwell Publishing Inc., 2016
    Nyckelord
    Registration clinicaltrials.gov identifier: NCT01446757 Keywords Symptom management, Community Care, Older people, Quality of care
    Nationell ämneskategori
    Omvårdnad Gerontologi, medicinsk/hälsovetenskaplig inriktning
    Identifikatorer
    urn:nbn:se:liu:diva-122741 (URN)10.1111/jan.13032 (DOI)000386079500019 ()27222059 (PubMedID)
    Anmärkning

    At the time for thesis presentation publication was in status: Manuscript

    At the time for thesis presentation publication was named: Symptom trajectory and symptom burden in older people with multimorbidity, data from the RCT AGe-FIT study

    Tillgänglig från: 2015-11-19 Skapad: 2015-11-19 Senast uppdaterad: 2019-06-27Bibliografiskt granskad
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  • 97.
    Eckerblad, Jeanette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Eriksson, Helene
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Kärner, Anita
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Edéll-Gustafsson, Ulla
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Nurses conceptions of facilitative strategies of weaning patients from mechanical ventilation-A phenomenographic study2009Ingår i: Intensive and Critical Care Nursing, ISSN 0964-3397, Vol. 25, nr 5, s. 225-232Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Mechanical ventilator withdrawal can amount up to 40% of total ventilator time. Being on a mechanical ventilator is associated with risk of anxiety, post-traumatic stress syndrome, nosocomial pneumonia and premature mortality. Purpose: The purpose of the present study was to describe different conceptions of nurses facilitating decision-making strategies regarding weaning patients from mechanical ventilations cared for in intensive care unit (ICU). Method: Semi-structured interviews were analysed within the phenomenographic framework. Twenty ICU nurses were interviewed. Findings: The findings revealed three main categories of nurses facilitating decision-making strategies: "The intuitive and interpretative strategy" featured nurses pre-understandings. "The instrumental strategy" involved analysis and assessment of technological and physiological parameters. "The cooperative strategy" was characterised by interpersonal relationships in the work situation. Absence of a common strategy and lack of understanding of others strategies were a source of frustration. The main goals were to end mechanical ventilator support, create a sense of security, and avoid further complications. Conclusion: Although these findings need to be confirmed by further studies we suggest that nurses variable use of individual strategies more likely complicate an efficient and safe weaning process of the patients from mechanical ventilation.

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  • 98.
    Eckerblad, Jeanette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hellström, Ingrid
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Jakobsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Lungmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Lungmedicinska kliniken US.
    Kentsson, Magnus
    Landstinget i Jönköpings län.
    Skargren, Elisabeth
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Tödt, Kristina
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Unosson, Mitra
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Theander, Kersti
    Karlstad Universitet.
    Symptom Prevalence And Symptom Distress In Patients With COPD2012Konferensbidrag (Övrigt vetenskapligt)
  • 99.
    Eckerblad, Jeanette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Theander, Kersti
    Faculty of Health, Science and Technology, Department of Health Sciences, Nursing, Karlstad University, Karlstad, Sweden.
    Ekdahl, Anne
    Region Östergötland, Närsjukvården i centrala Östergötland, Geriatriska kliniken. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Hellström, Iingrid
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten. Ersta Sköndal University College, Stockholm, Sweden.
    To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity2015Ingår i: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 28, nr 4, s. 322-327Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Context Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life. Objectives The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.

    Method A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-€“89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.

    Results The experience of living with a high symptom burden revealed the overall theme, “To adjust and endure” and three sub-themes. The first sub-theme was "To feel inadequate and limited". Participants reported that they no longer had the capacity or the ability to manage, and they felt limited and isolated from friends or family. The second sub-theme was "To feel dependent". This was a new and inconvenient experience; the burden they put on others caused a feeling of guilt. The final sub-theme was "To feel dejected". The strength to manage and control their conditions was gone; the only thing left to do was to sit or lie down and wait for it all to pass.

    Conclusion This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that are possible to treat or improve.

    Ladda ner fulltext (pdf)
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  • 100.
    Eckerblad, Jeanette
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Theander, Kersti
    Karlstad University, Sweden.
    Ekdahl, Anne
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken. Karolinska Institute KI, Sweden.
    Unosson, Mitra
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Wiréhn, Ann-Britt
    Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Milberg, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Region Östergötland, Närsjukvården i östra Östergötland, LAH Öst. Region Östergötland, Närsjukvården i östra Östergötland, Palliativt kompetenscentrum.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study2015Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Globally, the population is ageing and lives with several chronic diseases for decades. A high symptom burden is associated with a high use of healthcare, admissions to nursing homes, and reduced quality of life. The aims of this study were to describe the multidimensional symptom profile and symptom burden in community-dwelling older people with multimorbidity, and to describe factors related to symptom burden. Methods: A cross-sectional study including 378 community-dwelling people greater than= 75 years, who had been hospitalized greater than= 3 times during the previous year, had greater than= 3 diagnoses in their medical records. The Memorial Symptom Assessment Scale was used to assess the prevalence, frequency, severity, distress and symptom burden of 31 symptoms. A multiple linear regression was performed to identify factors related to total symptom burden. Results: The mean number of symptoms per participant was 8.5 (4.6), and the mean total symptom burden score was 0.62 (0.41). Pain was the symptom with the highest prevalence, frequency, severity and distress. Half of the study group reported the prevalence of lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score. Conclusion: The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management.

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