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  • 701.
    van Veldhuisen, Dirk J
    et al.
    University Medical Center Groningen, University of Groningen, the Netherlands .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Hillege, Hans L
    University Medical Center Groningen, University of Groningen, Netherlands .
    Reply2013In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 62, no 6, p. 567-568Article in journal (Other academic)
  • 702.
    van Veldhuisen, Dirk J.
    et al.
    University of Groningen, Netherlands .
    Linssen, Gerard C M
    University of Groningen, Netherlands .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    van Gilst, Wiek H
    University of Groningen, Netherlands .
    Hoes, Arno W
    University of Medical Centre, Netherlands .
    Tijssen, Jan G P
    University of Medical Centre Groningen, Netherlands .
    Paulus, Walter J.
    Free University of Amsterdam, Netherlands .
    Voors, Adriaan A.
    University of Groningen, Netherlands .
    Hillege, Hans L.
    University of Groningen, Netherlands .
    B-Type Natriuretic Peptide and Prognosis in Heart Failure Patients With Preserved and Reduced Ejection Fraction2013In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 61, no 14, p. 1498-1506Article in journal (Refereed)
    Abstract [en]

    Objectives This study sought to determine the prognostic value of B-type natriuretic peptide (BNP) in patients with heart failure with preserved ejection fraction (HFPEF), in comparison to data in HF patients with reduced left ventricular (LV) EF (andlt;= 40%). less thanbrgreater than less thanbrgreater thanBackground Management of patients with HFPEF is difficult. BNP is a useful biomarker in patients with reduced LVEF, but data in HFPEF are scarce. less thanbrgreater than less thanbrgreater thanMethods In this study, 615 patients with mild to moderate HF (mean age 70 years, LVEF 33%) were followed for 18 months. BNP concentrations were measured at baseline and were related to the primary outcome, that is, a composite of all-cause mortality and HF hospitalization, and to mortality alone. The population was divided in quintiles, according to LVEF, and patients with reduced LVEF were compared with those with HFPEF. less thanbrgreater than less thanbrgreater thanResults There were 257 patients (42%) who had a primary endpoint and 171 (28%) who died. BNP levels were significantly higher in patients with reduced LVEF than in those with HFPEF (p andlt; 0.001). BNP was a strong predictor of outcome, but LVEF was not. Importantly, if similar levels of BNP were compared across the whole spectrum of LVEF, and for different cutoff levels of LVEF, the associated risk of adverse outcome was similar in HFPEF patients as in those with reduced LVEF. less thanbrgreater than less thanbrgreater thanConclusions BNP levels are lower in patients with HFPEF than in patients with HF with reduced LVEF, but for a given BNP level, the prognosis in patients with HFPEF is as poor as in those with reduced LVEF. (J Am Coll Cardiol 2013;61:1498-506)

  • 703.
    Veetnisha Gunnarsson, Nina
    et al.
    Jönköping University, Sweden.
    Hemmingsson, Helena
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Hydén, Lars-Christer
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Health Sciences.
    Borell, Lena
    Karolinska Institutet, Stockholm, Sweden.
    Managing Family Relations and Controlling Information While Supporting an Allergic Child2013In: Qualitative Sociology Review, ISSN 1733-8077, E-ISSN 1733-8077, Vol. 9, no 3, p. 205-219Article in journal (Refereed)
    Abstract [en]

    This paper explores parental (particularly mothers’) support in the daily lives of children with allergies in a Swedish context. An ordinary life is established by making comparisons to what other children without allergies presumably can do (and eat). Although the parents’ goal is to support their child in managing allergies, neither their practical nor their interactional strategies work in a clear-cut direction to promote the child’s ordinary life and identity. On the contrary, parents’ accounts convey that they function just as much against an everyday life and the child’s identity. When managing family relations, parents expect immediate family members (specifically grandparents)to understand and accommodate the child’s needs.

    However, claims of family responsibility are made through moral tales about lack of support from “generalized others.” Family responsibility is also downplayed in parents’ accounts as demands of support may put parents’ moral self at risk. The strategy of information control in certain situations and (non-family) relations used to keep the child safe may risk stigmatizing the child, alternatively, making the child into a social threat. One of the conclusions that could be drawn from this study is that claims of family support may be contradictory to other cultural principles that ascribe responsibilities between families and individuals, as the principles of individual freedom and autonomy.

  • 704.
    Vellone, Ercole
    et al.
    University of Roma Tor Vergata, Italy .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Fida, Roberta
    University of Roma La Sapienza, Italy .
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Rocco, Gennaro
    Centre Excellence Nursing Scholarship, Italy .
    Cocchieri, Antonello
    University of Roma Tor Vergata, Italy .
    Alvaro, Rosaria
    University of Roma Tor Vergata, Italy .
    The European Heart Failure Self-care Behaviour Scale: New insights into factorial structure, reliability, precision and scoring procedure2014In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, no 1, p. 97-102Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate a new factorial structure of the European Heart Failure Self-care Behaviour Scale 9-item version (EHFScBS-9), and to test its reliability, floor and ceiling effect, and precision. To propose a new 0-100 score with a higher score meaning better self-care. Methods: A sample of 1192 Heart Failure (HF) patients (mean age 72 years, 58% male) was enrolled. Psychometric properties of the EHFScBS-9 were tested with confirmative factor analysis, factor score determinacy, determining the floor and ceiling effect, and evaluating the precision with the standard error of measurement (SEM) and the smallest real difference (SRD). Results: We identified three well-fitting factors: consulting behaviour, autonomy-based adherence, and provider-based adherence (comparative fit index = 0.96). Reliability ranged from 0.77 to 0.95. The EHFScBS-9 showed no floor and ceiling effect except for the provider-based adherence which had an expected ceiling effect. The SEM and the SRD indicated good precision of the EHFScBS-9. Conclusion: The new factorial structure of the EHFScBS-9 showed supportive psychometric properties. Practice implications: The EHFScBS-9 can be used to compute a total and specific scores for each identified factor. This may allow more detailed assessment and tailored interventions to improve self-care. The new score makes interpretation of the EHFScBS-9 easier.

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  • 705.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Arts and Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Moons, Philip
    Katholieke Universiteit, Leuven, Belgium .
    Norekvål, Tone M
    Haukeland University Hospital, Norway .
    Smith, Karen
    Ninewells Hospital, UK .
    Martensson, Jan
    Jönköping University, Sweden .
    Thompson, David R
    Australian Catholic University, Melbourne, Australia .
    De Geest, Sabina
    Katholieke Universiteit, Leuven, Belgium .
    Lenzen, Mattie
    Erasmus MC, Rotterdam, The Netherlands .
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Anaemia and iron deficiency in cardiac patients: what do nurses and allied professionals know?2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11 Suppl 1, p. S90-5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiac nurses and allied professionals often take care of patients who also have anaemia or iron deficiency. To deliver optimal care, professionals should be knowledgeable about the prevalence, diagnosis, pathophysiology, and therapeutic management of these conditions. We therefore set out a survey to get a first impression on the current knowledge of nurses and allied professionals on anaemia and iron deficiency.

    METHOD: A questionnaire was designed for this study by the Undertaking Nursing Interventions Throughout Europe (UNITE) Study Group. Data were collected from 125 cardiovascular nurses and allied professionals visiting the 11th Annual Spring Meeting of the Council on Cardiovascular Nursing and Allied Professionals of the European Society of Cardiology.

    RESULTS: Most respondents had general knowledge on the definition of anaemia and iron deficiency and 54% of the respondents rated anaemia and iron deficiency as important when evaluating a cardiac patient. Specific knowledge regarding anaemia and more prominently of iron deficiency was not optimal.

    CONCLUSION: Although cardiac nurses and allied professionals have basic knowledge of anaemia and iron deficiency, they would benefit from additional knowledge and skills to optimally deliver patient care.

  • 706.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Exergaming in older adults: A scoping review and implementation potential for patients with heart failure2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 5, p. 388-398Article, review/survey (Refereed)
    Abstract [en]

    Background:

    Physical activity can improve exercise capacity, quality of life and reduce mortality and hospitalization in patients with heart failure (HF). Adherence to exercise recommendations in patients with HF is low. The use of exercise games (exergames) might be a way to encourage patients with HF to exercise especially those who may be reluctant to more traditional forms of exercise. No studies have been conducted on patients with HF and exergames.

    Aim:

    This scoping review focuses on the feasibility and influence of exergames on physical activity in older adults, aiming to target certain characteristics that are important for patients with HF to become more physically active.

    Methods:

    A literature search was undertaken in August 2012 in the databases PsychInfo, PUBMED, Scopus, Web of Science and CINAHL. Included studies evaluated the influence of exergaming on physical activity in older adults. Articles were excluded if they focused on rehabilitation of specific limbs, improving specific tasks or describing no intervention. Fifty articles were found, 11 were included in the analysis.

    Results:

    Exergaming was described as safe and feasible, and resulted in more energy expenditure compared to rest. Participants experienced improved balance and reported improved cognitive function after exergaming. Participants enjoyed playing the exergames, their depressive symptoms decreased, and they reported improved quality of life and empowerment. Exergames made them feel more connected with their family members, especially their grandchildren.

    Conclusion:

    Although this research field is small and under development, exergaming might be promising in order to enhance physical activity in patients with HF. However, further testing is needed.

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  • 707.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Are virtual reality applications feasible to increase physical activity in heart failure patients? A systematic review2011Conference paper (Refereed)
  • 708.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Design of a study using a virtual reality application to improve physical activity in heart failure patients2011Conference paper (Refereed)
  • 709.
    Verheijden Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Turolla, Andrea
    Fondazione Ospedale San Camillo – I.R.C.C.S., Venice, Italy.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Using a game computer to stimulate activity at home in heart failure patients - The study design2011Conference paper (Refereed)
  • 710.
    Vessby, Karin
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Paediatric Habilitation Community Service.
    Kjellberg, Anette
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Participation in occupational therapy research: a literature review2010In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 73, no 7, p. 319-326Article in journal (Refereed)
    Abstract [en]

    Participation is a concept that is used and discussed, both within the field of occupational therapy and in other areas. The concept of participation is included in the International Classification of Functioning, Disability and Health (ICF) and the Model of Human Occupation. The aim of this study was to investigate how the concept of participation has been used in studies published in peer-reviewed journals. A literature review was performed using the search terms 'occupational therapy' and 'participation'. Papers published in peer-reviewed journals during the period 2004-2006 were included (n = 38). Content analysis was used when analysing the data.

     

    The results show that interview is the most common method of data collection and that the physical field is the clinical field that is most frequently represented in these papers. Three different categories were identified with regard to how the concept of participation has been used. These were client-centredness (n = 11), involvement in the environment (n = 19) and meaningfulness (n = 23). The three categories represent three dimensions of participation and are interpreted as occurring on micro or macro levels. Further research is needed and this review contributes to this development.

  • 711.
    Wagenaar, Kim P.
    et al.
    University of Medical Centre Utrecht, Netherlands.
    Broekhuizen, Berna D. L.
    University of Medical Centre Utrecht, Netherlands.
    Dickstein, Kenneth
    University of Bergen, Norway.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Hoes, Arno W.
    University of Medical Centre Utrecht, Netherlands.
    Rutten, Frans H.
    University of Medical Centre Utrecht, Netherlands.
    Effectiveness of an interactive platform, and the ESC/HFA website in patients with heart failure: design of the multicentre randomized e-Vita heart failure trial2015In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 17, no 12, p. 1310-1316Article in journal (Refereed)
    Abstract [en]

    AimsElectronic health support (e-health) may improve self-care of patients with heart failure (HF). We aim to assess whether an adjusted care pathway with replacement of routine consultations by e-health improves self-care as compared with usual care. In addition, we will determine whether the ESC/HFA (European Society of Cardiology/Heart Failure Association) website (HFM website) improves self-care when added to usual care. Finally, we aim to evaluate the cost-effectiveness of these interventions. MethodsA three-arm parallel randomized trial will be conducted. Arm 1 consists of usual care; arm 2 consists of usual care plus the HFM website; and arm 3 is the adjusted care pathway with an interactive platform for disease management (e-Vita platform), with a link to the HFM website, which replaces routine consultations with HF nurses at the outpatient clinic. In total, 414 patients managed in 10 Dutch HF outpatient clinics or in general practice will be included and followed for 12 months. Participants are included if they have had an established diagnosis of HF for at least 3 months. The primary outcome is self-care as measured by the European Heart Failure Self-care Behaviour scale (EHFScB scale). Secondary outcomes are quality of life, cardiovascular- and HF-related mortality, hospitalization, and its duration as captured by hospital and general practitioner registries, use of and user satisfaction with the HFM website, and cost-effectiveness. PerspectiveThis study will provide important prospective data on the impact and cost-effectiveness of an interactive platform for disease management and the HFM website. Clinical Trial Registrationunique identifier: NCT01755988

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  • 712.
    Waldreus, Nana
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Hahn, Robert G.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Sodertalje Sjukhus, Sweden .
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Skoog, Johan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Ewerman, Lea
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Lindenberger, Marcus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Thirst response to acute hypovolaemia in healthy women and women prone to vasovagal syncope2013In: Physiology and Behavior, ISSN 0031-9384, E-ISSN 1873-507X, Vol. 120, p. 34-39Article in journal (Refereed)
    Abstract [en]

    The present study measured self-perceived thirst and plasma angiotensin II (ATII) concentrations during graded hypovolaemic stress, induced by lower body negative pressure (LBNP), to elucidate the dependence of thirst on haemodynamics. A total of 24 women aged between 20 and 36 (mean age, 23) years rated their thirst on a visual analogue scale, graded from 0 to 100, when LBNP of 20,30 and 40 mm Hg was applied. Half of the women had a history of vasovagal syncope (VVS). The results showed that the thirst score increased three-fold when LBNP was applied, from 11 (median; 25th-75th percentiles, 9-25) to 34 (27-53; P andlt; 0.001). The women in the VVS group had twice as great an increase as those without a history of VVS (P andlt; 0.02). The plasma ATII concentration increased significantly in response to LBNP, both in the VVS group and in the control group, but the changes did not correlate with thirst. Application of LBNP decreased systolic and mean arterial pressures, cardiac output and pulse pressure (P andlt; 0.001 for all), but thirst correlated only with increase in heart rate and, independently, with reduction of mean arterial pressure. In conclusion, thirst and ATII increase in response to hypovolaemic stress, but are not statistically related. The haemodynamic parameter that was most strongly related to thirst was tachycardia.

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  • 713.
    Waldreus, Nana
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Hahn, Robert G
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Thirst in heart failure: a systematic literature review2013In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 15, no 2, p. 141-149Article, review/survey (Refereed)
    Abstract [en]

    Although patients with heart failure (HF) may suffer from severe thirst, this has received little attention in scientific studies. A systematic literature review was conducted to identify and analyse data on thirst in HF. less thanbrgreater than less thanbrgreater thanPubmed, Cochrane, Cinahl, and Medline databases were searched for original studies on patients with HF with thirst as an outcome measure. Of 174 screened citations, nine articles were included, in which a total of 4375 HF patients had been studied. Four studies comprising 181 patients provided visual analogue scale (VAS) scores. Median thirst intensity ranged from 23 to 75 mm (VAS 0100 mm). One study showed 2 prevalence of thirst in a placebo group and another study showed that 46 of HF patients (n 25) experienced thirst distress. Thirst was described as annoying and as a cause of suffering. In most studies, the main results reflect a poor description of several dimensions of thirst. Factors that affected thirst were related to treatment, HF condition, demographics, and emotions. The consequences of thirst in HF were related to compliance, preoccupation with thirst, and a negative impact on quality of life. less thanbrgreater than less thanbrgreater thanThirst may be increased and experienced as distressing in patients with HF, but there is limited knowledge about the causative factors. More research is needed to study the effects of thirst and effective interventions in order to relieve troublesome thirst in HF patients.

  • 714. Order onlineBuy this publication >>
    Waldréus, Nana
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Thirst in Patients with Heart Failure: Description of thirst dimensions and associated factors with thirst2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Nurses and other health care professionals meet patients with heart failure (HF) who report they are thirsty. Thirst is described by the patients as a concern, and it is distressing. Currently there are no standardized procedures to identify patients with increased thirst or to help a patient to manage troublesome thirst and research in the area of thirst is scarce. In order to prevent and relieve troublesome thirst more knowledge is needed on how thirst is experienced and what factors cause increased thirst.

    Aim: The aim of this thesis was to describe the thirst experience of patients with HF and describe the relationship of thirst with physiologic, psychologic and situational factors. The goal was to contribute to the improvement of the care by identifying needs and possible approaches to prevent and relieve thirst in patients with HF.

    Methods: The studies in this thesis used a cross-sectional design (Study I) and prospective observational designs (II-IV). Studies include data from patients with HF who were admitted to the emergency department for deterioration in HF (I, IV) or visited an outpatient HF clinic for worsening of HF symptoms (III); others were patients who were following up after HF hospitalization (II), and patients with no HF diagnosis who sought care at the emergency department for other illness (I). Patients completed questionnaires on thirst intensity, thirst distress, HF self-care behaviour, feeling depressive and feeling anxious. Data on sociodemographic, clinical characteristics, pharmacological treatment and prescribed fluid restriction were retrieved from hospital medical records and by asking the patients. Data were also collected from blood, urine and saliva samples to measure biological markers of dehydration, HF severity and stress.

    Results: Thirst was prevalent in 1 out of 5 patients (II) and 63% of patients with worsening of HF symptoms experienced moderate to severe thirst distress at hospital admission (IV). Patients at an outpatient HF clinic who reported thirst at the first visit were more often thirsty at the follow-up visits compared to patients who did not report thirst at the first visit (II). Thirst intensity was significantly higher in patients hospitalized with decompensated HF compared to patients with no HF (median 75 vs. 25 mm, visual analogue scale [VAS] 0-100 mm; P < 0.001) (I). During optimization of pharmacological treatment of HF, thirst intensity increased in 67% of the patients. Thirst intensity increased significantly more in patients in the high thirst intensity group compared to patients in the low thirst intensity group (median +18 mm vs. -3 mm; P < 0.001) (III). Patients who were admitted to the hospital with high thirst distress continued to have high thirst distress over time (IV). A large number of patients were bothered by thirst and feeling dry in the mouth when they were thirsty (III, IV). Patients with a fluid restriction had high thirst distress over time and patients who were feeling depressed had high thirst intensity over time (IV). Thirst was associated with fluid restriction (III-IV), a higher serum urea (IIIII), and depressive symptoms (II).

    Conclusions: A considerable amount of patients with HF experiences thirst intensity and thirst distress. Patients who reported thirst at the first follow-up more often had thirst at the subsequent follow-ups. The most important factors related to thirst intensity or thirst distress were a fluid restriction, a higher plasma urea, and depressive symptoms. Nurses should ask patients with HF if they are thirsty and measure the thirst intensity and thirst distress, and ask if thirst is bothering them. Each patient should be critically evaluated if a fluid restriction really is needed, if the patient might be dehydrated or needs to be treated for depression.

    List of papers
    1. Thirst in the elderly with and without heart failure
    Open this publication in new window or tab >>Thirst in the elderly with and without heart failure
    2011 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 53, no 2, p. 174-178Article in journal (Refereed) Published
    Abstract [en]

    Elderly patients with heart failure (HF) may be troubled by thirst, despite the fact that elderly have an impaired ability to sense thirst. The present study was undertaken to compare the intensity of thirst in patients with and without HF and to evaluate how this symptom relates to the health-related quality of life and indices of the fluid balance. Forty-eight patients (mean age 80 years) admitted to hospital with worsening HF (n = 23) or with other acute illness (n = 25) graded their thirst and estimated their health-related quality of life (HRQoL). Serum sodium was measured and urine samples were assessed for color and electrolyte content. The HF patients reported significantly more intensive thirst (median = 75 mm) compared with those in the control group (median = 25 mm; p less than 0.0001). There was no statistically significant relationship between thirst and HRQoL, which was low overall. Serum sodium and urine color did not differ significantly between the groups, but the urine of the HF patients had a lower sodium concentration and osmolality. We conclude that elderly patients with worsening HF have considerably increased thirst and, hence, intense thirst should be regarded as a symptom of HF.

    Place, publisher, year, edition, pages
    Elsevier, 2011
    Keywords
    Thirst of elderly; Aged heart failure patients; Quality of life; Dehydration
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-69768 (URN)10.1016/j.archger.2010.10.003 (DOI)000292547000044 ()
    Available from: 2011-08-10 Created: 2011-08-08 Last updated: 2017-12-08Bibliographically approved
    2. Thirst Trajectory and Factors Associated With Persistent Thirst in Patients With Heart Failure
    Open this publication in new window or tab >>Thirst Trajectory and Factors Associated With Persistent Thirst in Patients With Heart Failure
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    2014 (English)In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 20, no 9, p. 689-695Article in journal (Refereed) Published
    Abstract [en]

    Background: Thirst is often increased in patients with heart failure (HF) and can cause distress during the course of the condition. The aim of the present study was to describe the trajectory of thirst during an 18-month period and to identify variables associated with persistent thirst in patients with HF. Methods and Results: Data were collected from 649 patients with HF with the use of the Revised Heart Failure Compliance Scale at 1, 6, 12, and 18 months after a period of hospital treatment for worsening HF. Thirst trajectory was described for the 4 follow-up visits and logistic regression analysis was used to identify factors independently associated with persistent thirst. In total, 33% (n = 212) of the patients reported thirst on greater than= 1 occasions and 34% (n = 46) continued to have thirst at every follow-up visit. Nineteen percent (n = 121) of the patients had persistent thirst. Patients with persistent thirst were more often younger and male and had more HF symptoms. Higher body mass index and serum urea also increased the risk of persistent thirst. Conclusions: Patients with HF who were thirsty at the 1-month follow-up were more often also thirsty at subsequent visits. Assessment of thirst is warranted in clinical practice because one-fifth of patients suffer from persistent thirst.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Thirst; heart failure; trajectory; persistent thirst
    National Category
    Clinical Medicine Sociology
    Identifiers
    urn:nbn:se:liu:diva-111268 (URN)10.1016/j.cardfail.2014.06.352 (DOI)000341799300010 ()24951934 (PubMedID)
    Available from: 2014-10-15 Created: 2014-10-14 Last updated: 2019-06-27Bibliographically approved
    3. Changes in Thirst Intensity During Optimization of Heart Failure Medical Therapy by Nurses at the Outpatient Clinic.
    Open this publication in new window or tab >>Changes in Thirst Intensity During Optimization of Heart Failure Medical Therapy by Nurses at the Outpatient Clinic.
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    2016 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 31, no 5, p. E17-E24Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Thirst can be aggravated in patients with heart failure (HF), and optimization of HF medication can have positive impact on thirst.

    OBJECTIVES: The aims of this study were to describe changes in thirst intensity and to determine factors associated with high thirst intensity during optimization of HF medication.

    METHODS AND RESULTS: Patients with HF (N = 66) who were referred to an HF clinic for up-titration of HF medication were included. Data were collected during the first visit to the clinic and at the end of the treatment program. Data were dichotomized by the median visual analog scale score for thirst, dividing patients into 2 groups: low thirst intensity (0-20 mm) and high thirst intensity (>20 mm on a visual analog scale of 0-100 mm). In total, 67% of the patients reported a higher thirst intensity after the HF up-titration program. There was no difference in thirst intensity between the patients who reached target doses and those who did not. Plasma urea level (odds ratio, 1.33; 95% confidence interval, 1.07-1.65) and fluid restriction (odds ratio, 6.25; 95% confidence interval, 1.90-20.5) were independently associated with high thirst intensity in patients with HF.

    CONCLUSIONS: Thirst intensity increased in two-thirds of the patients during a time period of optimization of HF medication. Fluid restriction and plasma urea levels were associated with high thirst intensity.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2016
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-125914 (URN)10.1097/JCN.0000000000000319 (DOI)000382251400003 ()26696035 (PubMedID)
    Note

    Funding agencies: Mats Klebergs Stiftelse; Lindhes Advokatbyra

    Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2019-06-27Bibliographically approved
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  • 715.
    Waldréus, Nana
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Arts and Sciences. Sodertalje Sjukhus, Sweden.
    van der Wal, Martje H. L.
    University of Groningen, Netherlands.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Sodertalje Sjukhus, Sweden.
    van Veldhuisen, Dirk J.
    University of Groningen, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Arts and Sciences.
    Thirst Trajectory and Factors Associated With Persistent Thirst in Patients With Heart Failure2014In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 20, no 9, p. 689-695Article in journal (Refereed)
    Abstract [en]

    Background: Thirst is often increased in patients with heart failure (HF) and can cause distress during the course of the condition. The aim of the present study was to describe the trajectory of thirst during an 18-month period and to identify variables associated with persistent thirst in patients with HF. Methods and Results: Data were collected from 649 patients with HF with the use of the Revised Heart Failure Compliance Scale at 1, 6, 12, and 18 months after a period of hospital treatment for worsening HF. Thirst trajectory was described for the 4 follow-up visits and logistic regression analysis was used to identify factors independently associated with persistent thirst. In total, 33% (n = 212) of the patients reported thirst on greater than= 1 occasions and 34% (n = 46) continued to have thirst at every follow-up visit. Nineteen percent (n = 121) of the patients had persistent thirst. Patients with persistent thirst were more often younger and male and had more HF symptoms. Higher body mass index and serum urea also increased the risk of persistent thirst. Conclusions: Patients with HF who were thirsty at the 1-month follow-up were more often also thirsty at subsequent visits. Assessment of thirst is warranted in clinical practice because one-fifth of patients suffer from persistent thirst.

    Download full text (pdf)
    fulltext
  • 716.
    Wallin, A.K.
    et al.
    Wallin, Å.K., Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden, Department of Clinical Sciences, Malmö, Lund University, Malmö University Hospital, SE-205 02 Malmö, Sweden.
    Andreasen, N.
    Karolinska Institutet, Department of Neurotec, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Eriksson, S.
    Section of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
    Batsman, S.
    Båtsman, S., Department of Primary Care, Kalix Vårdcentral, Kalix, Sweden.
    Nasman, B.
    Näsman, B., Section of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
    Ekdahl, Anne
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Kilander, L.
    Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden.
    Grut, M.
    Department of Geriatric Medicine, Cognitive Section, Danderyd Hospital, Danderyd, Sweden.
    Ryden, M.
    Rydén, M., Department of Geriatric Medicine, Cognitive Section, Danderyd Hospital, Danderyd, Sweden.
    Wallin, A.
    Institute of Neuroscience, Section of Psychiatry, Göteborg/Sahlgrenska University Hospital, Mölndal, Sweden, Institute of Clinical Neuroscience, Göteborg University, Göteborg, Sweden.
    Jonsson, M.
    Institute of Neuroscience, Section of Psychiatry, Göteborg/Sahlgrenska University Hospital, Mölndal, Sweden, Institute of Clinical Neuroscience, Göteborg University, Göteborg, Sweden.
    Olofsson, H.
    Memory Clinic, Uddevalla Hospital, Uddevalla, Sweden.
    Londos, E.
    Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
    Wattmo, C.
    Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
    Eriksdotter, Jonhagen M.
    Eriksdotter Jönhagen, M., Karolinska Institutet, Department of Neurotec, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Minthon, L.
    Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
    Bjorkman, A.
    Björkman, A., Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
    Wunsch, A.
    Department of Primary Care, Kalix Vårdcentral, Kalix, Sweden.
    Mannberg, L.
    Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
    Kallman, A.
    Källman, A., Department of Geriatric Medicine, University Hospital Linköping, Linköping, Sweden.
    Hellström, Ingrid
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Soderin, M.
    Söderin, M., Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden.
    Sjodin, C.
    Sjödin, C., Karolinska Institutet, Department of Neurotec, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Grut, M.
    Department of Geriatric Medicine, Cognitive Section, Danderyd Hospital, Danderyd, Sweden.
    Mohlin, E.
    Department of Geriatric Medicine, Cognitive Section, Danderyd Hospital, Danderyd, Sweden.
    Dahl, C.
    Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
    Gustavsson, K.
    Institute of Clinical Neuroscience, Göteborg University, Göteborg, Sweden.
    Holm, B.
    Memory Clinic, Uddevalla Hospital, Uddevalla, Sweden.
    Donepezil in Alzheimer's disease: What to expect after 3 years of treatment in a routine clinical setting2007In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 23, no 3, p. 150-160Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Clinical short-term trails have shown positive effects of donepezil treatment in patients with Alzheimer's disease. The outcome of continuous long-term treatment in the routine clinical settings remains to be investigated. Methods: The Swedish Alzheimer Treatment Study (SATS) is a descriptive, prospective, longitudinal, multicentre study. Four hundred and thirty-five outpatients with the clinical diagnosis of Alzheimer's disease, received treatment with donepezil. Patients were assessed with Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), global rating (CIBIC) and Instrumental Activities of Daily Living (IADL) at baseline and every 6 months for a total period of 3 years. Results: The mean MMSE change from baseline was positive for more than 6 months and in subgroups of patients for 12 months. After 3 years of treatment the mean change from baseline in MMSE-score was 3.8 points (95% CI, 3.0-4.7) and the ADAS-cog rise was 8.2 points (95% CI, 6.4-10.1). This is better than expected in untreated historical cohorts, and better than the ADAS-cog rise calculated by the Stern equation (15.6 points, 95% CI, 14.5-16.6). After 3 years with 38% of the patients remaining, 30% of the them were unchanged or improved in the global assessment. Conclusion: Three-year donepezil treatment showed a positive global and cognitive outcome in the routine clinical setting. Copyright © 2007 S. Karger AG.

  • 717.
    Wallin, Mia
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Liedberg, Gunilla
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Gerdle, Björn
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Thermal Detection and Pain Thresholds but Not Pressure Pain Thresholds Are Correlated With Psychological Factors in Women With Chronic Whiplash-associated Pain2012In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 28, no 3, p. 211-221Article in journal (Refereed)
    Abstract [en]

    Whiplash-associated disorders (WAD) have been associated with sensory disturbances such as hypersensitivity or hypoesthesia. Different psychological factors seem to be important for prognosis and symptom presentation in WAD. Multivariate correlations between pain thresholds for pressure (PPT), cold and heat (CPT, HPT), detection thresholds for cold and warmth, pain intensity variables, and psychological aspects in women with chronic WAD (n = 28) and in healthy pain-free controls (n = 29) were investigated. Quantitative Sensory Testing (QST) for thermal thresholds and algometry for PPT at various sites in the body were used. Psychological aspects, including catastrophizing, anxiety, and depression were registered using a questionnaire. WAD showed generalized decreased PPT and CPT, altered HPT and cold detection thresholds in the upper part of the body, and a worse psychological situation. Multivariate correlations were found between QST and PPT variables, habitual pain, and psychological factors in WAD. Different psychological variables were generally stronger predictors of CPT and HPT than pain intensity in WAD. Pain intensity aspects were generally the strongest predictors of PPT in WAD. In contrast, no correlations existed between QST and PPT variables and psychological variables in controls. These results indicate the need to consider that a blend of factors influences the pain thresholds in chronic WAD and emphasize the need for a biopsychosocial model when interpreting QST and PPT variables.

  • 718.
    Wastberg, Birgitta A
    et al.
    Lund University.
    Haglund, Lena
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Eklund, Mona
    Malmö University.
    Psychometric properties of the Worker Role Self-assessment instrument used to evaluate unemployed people in Sweden2009In: SCANDINAVIAN JOURNAL OF OCCUPATIONAL THERAPY, ISSN 1103-8128, Vol. 16, no 4, p. 238-246Article in journal (Refereed)
    Abstract [en]

    The aim was to determine the psychometric properties of the new Worker Role Self-assessment (WRS) instrument. The content validity, utility, test-retest reliability, sensitivity to change, and predictive validity of the WRS were investigated in two subject samples, which were selected at work and pain rehabilitation clinics, respectively. One of these groups consisted of 23 clients and four occupational therapists, and the other comprised 83 clients. All clients in both samples were unemployed. The results showed that both the clients and the occupational therapists perceived the content validity and the utility of the WRS as good. The test-retest reliability showed mostly good to moderate agreement, and the internal consistency was satisfactory. One of the items showed predictive validity for work capacity, and the same item was sensitive to change. However, a ceiling effect reduced the utility and the sensitivity to change. Our findings indicate that the WRS is promising as a tool that clinicians can use to evaluate the capacity for return to work and for planning interventions, although some revisions are needed to counteract the ceiling effect.

  • 719.
    Wennberg, Birgitta
    et al.
    Stockholms läns landsting.
    Kjellberg, Anette
    Linköping University. Linköping University, Department of Social and Welfare Studies. Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Delaktighet i vardagen för personer med lindrig utvecklingsstörning vid användning av kognitivt stödConference paper (Refereed)
  • 720.
    Wennberg, Birgitta
    et al.
    Klara Mera - Centre for cognitive support, Rosenlund, Sweden.
    Kjellberg, Anette
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Participation when using cognitive assistive devices - from the perspective of people with intellectual disabilities2010In: Occupational Therapy International, ISSN 1557-0703, Vol. 17, no 4, p. 168-176Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe how people with intellectual disabilities experienced their participation in everyday activities when using cognitive assistive devices. The purpose of cognitive assistive devices is to compensate for cognitive problems, to enhance independence when performing activities and to support decision making in daily life. Nine persons, 17–37 years old, with mild intellectual disability were selected by purposive sampling. Data collection was conducted by semi-structured interviews. The results showed that participation in everyday activities increased when using cognitive assistive devices. The persons experienced having more control and health benefits using cognitive assistive devices in daily activities. There were participation restrictions related to attitudes from the social network towards participation, and attitudes towards the use of cognitive assistive devices from the persons themselves and from the social network. Occupational therapists should be aware of the social factors that may influence a client's participation in everyday activities when using cognitive assistive devices. There is a need for more research with clients with intellectual disabilities and further research concerning long-time use of cognitive assistive devices.

  • 721.
    Wilhelmsson, Margareta
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Svensson, Annemie
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Nurses views of interprofessional education and collaboration: A comparative study of recent graduates from three universities2013In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 27, no 2, p. 155-160Article in journal (Refereed)
    Abstract [en]

    Today interprofessional education (IPE) is spread throughout the world. In Sweden only one of the existing nursing programs has an IPE curriculum on several levels during the training. The aim of this study was to examine how nurses who recently graduated from universities with IPE or non-IPE curricula perceive the importance of different educational goals and whether they found themselves prepared for their profession, and especially for collaboration with other professions. Three universities with different commitments to IPE were studied. We used a survey with eight different targets: communication skills, cooperation with other professions, problem-solving capability, self-directed learning skills, whether their education has prepared them to work professionally, to perform research, to take care of acutely ill patients, to work preventively and working as a nurse. The participants were asked whether their undergraduate education had prepared them for these targets and whether they perceived that the targets were important goals for their education. A main result in this study was that nurses who had recently graduated from the IPE university perceived to a greater extent that their undergraduate training had prepared them to work together with other professions in comparison with nursing students from non-IPE universities.

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  • 722.
    Willemsen, Suzan
    et al.
    University Medical Center Groningen, Netherlands.
    Hartog, Jasper W L
    University Medical Center Groningen, Netherlands.
    van Veldhuisen, Dirk J
    University Medical Center Groningen, Netherlands.
    van der Meer, Peter
    University Medical Center Groningen, Netherlands.
    Roze, Joline F
    University Medical Center Groningen, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Schalkwijk, Casper
    Maastricht University, Netherlands .
    van der Horst, Iwan C C
    University Medical Center Groningen, Netherlands.
    Hillege, Hans L
    University Medical Center Groningen, Netherlands.
    A Voors, Adriaan
    University of Groningen, Netherlands .
    The role of advanced glycation end-products and their receptor on outcome in heart failure patients with preserved and reduced ejection fraction2012In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 164, no 5, p. 742-U146Article in journal (Refereed)
    Abstract [en]

    Introduction Advanced glycation end products (AGEs) are increased in patients with heart failure (HF). We studied the predictive value of plasma AGEs N-E-(carboxymethyl) lysine (CML), pentosidine, and the soluble form of its receptor (sRAGE) in a large HF population. less thanbrgreater than less thanbrgreater thanMethods In 580 patients hospitalized with HF, plasma AGEs were measured before discharge when patients were clinically stable. Patients were followed for a period of 18 months. Primary end point was a composite of death and HF admissions. CML was determined by liquid chromatography mass spectrometry, pentosidine by high-performance liquid chromatography and sRAGE by sequential sandwich immunoassay. less thanbrgreater than less thanbrgreater thanResults Mean age was 71 +/- 11 years, 62% were men, and mean left ventricular ejection fraction was 0.32 +/- 0.14. At baseline, mean CML level was 2.16 +/- 0.73 mu mol/L, median pentosidine was 0.043 (0.030-0.074) mu mol/L, and median sRAGE level was 2.92 (1.90-4.59) ng/mL. CML and pentosidine levels were independently related to the composite end-point (HR, 1.20 per SD; 95% CI, 1.05-1.37; P = .01 and HR, 1.15 per SD; 95% CI, 1.00-1.31; P = .045, respectively) and HF hospitalization (HR, 1.27 per SD; 95% CI, 1.10-1.48; P = .001 and HR, 1.27 per SD; 95% CI, 1.10-1.47; P = .001, respectively). Furthermore, CML levels were independently related to increased mortality (P = .006). Whereas sRAGE levels were univariately predictive for outcome, in multivariate models sRAGE did not reach statistical significance. less thanbrgreater than less thanbrgreater thanDiscussion In HF patients, both CML and pentosidine predict HF hospitalization and the combined primary end-point (mortality or HF-hospitalization), whereas sRAGE did not predict events. In addition, CML was significantly and independently associated with a higher risk for mortality. (Am Heart J 2012;164:742-749.e3.)

  • 723.
    Winberg, Anette
    et al.
    Hälsa och habilitering, Landstinget i uppsala län, Uppsala.
    Lidström, Helene
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Anpassning och hjälpmedel för delaktighet2016In: Arbetsterapi för barn och ungdom / [ed] Ann-Christin Eliasson, Helene Lidström, Marie Peny-Dahlstrand, Lund: Studentlitteratur AB, 2016, 1, p. 203-212Chapter in book (Other academic)
  • 724. Order onlineBuy this publication >>
    Wissendorff Ekdahl, Anne
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Frail and Elderly Hospital Patients: The Challenge of Participation in Medical Decision Making2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: In research, patient participation in medical decision-making has been shown to be associated with higher patient satisfaction and improvement of treatment outcomes. But when it comes to patient participation when being old and frail there are pitfalls and the research in this area is sparse.

    The aim of this thesis is to explore participation in medical decision making of the frail elderly patient in hospital from the perspectives of patients themselves and the health care staff. In this thesis frail, elderly patients is defined as individuals 75 years old or older, who during the past 12 months have received inpatient hospital care three or more times and who have three or more diagnoses in three or more diagnostic groups according to the classification system ICD-10.

    The participants were frail patients’ in hospital or newly discharged and it was health care personnel working with frail elderly patients. In three of the studies the method was mainly qualitative (Paper I, III, IV) and in one (Paper II) quantitative. The qualitative methods were one-to-one tape-recorded interviews of 25 patients (Paper I and IV), 18 personnel (III and IV), 5 focus group interviews of physicians (Paper III) and 26 days of observations in hospital wards (IV). Chosen methodologies of analysis were content analysis and Grounded Theory. The quantitative study (II) was a cross-sectional survey using telephone interviews with patients (n= 156). This material was descriptively analysed and examined using weighted kappa statistics.

    Results: The results reported in Paper II show that elderly patients generally want to participate more in medical decision making than they do, though preferences for degree of participation are highly individualized – both findings important to consider in clinical practice.

    According to the patients important key concepts of patient participation in medical decision making are to be listened to and to be informed (Paper I). The main reasons for not being able to participate included having many illnesses and generally, overall bad medical condition (Paper II). Also, cited as a problem was difficulty in understanding medical information, for example when given by a foreign-speaking physician (Paper I, II and IV). Frail, elderly patients complained that they were less informed than was their preference (Paper I, II and IV).

    Moderate agreement was obtained between patient’s preferred and actual roles in medical decision making. Patients often expressed gratitude and confidence in their health care (Paper I and IV), but also, sympathy for stressed health care personnel who had so much to do.

    The frail elderly patients do sometimes feel like a burden to the health care (Paper I and IV). The professionals gave expressions of trying to avoid taking care of frail elderly patients and at the same time expressions of frustration and bad conscience not being able to take good care of them due to lack of time and lack of beds (Paper III, IV). Especially the physicians felt they were trapped between the needs of the patients’ and the remunerations system rewarding time-constricted health care production (number of investigations, operations, easy accessibility) – not a time-consuming holistic view on all illnesses and medications including communication with the patients and all caregivers involved (Paper III).

    Both patients and the professionals perceive the hospital as some kind of “institution of power”, difficult to challenge, and the decisions of which one has to accept.

    Conclusion: In this thesis there are shown a number of challenges to participation in medical decision making by frail, elderly patients, which thus limits quality of care for this patient group. Health care is revealed as not well adapted to meet these patients’ complex needs. A model is presented that explains how the organisation of health care, and the reimbursement system, does not facilitate a holistic view. The health care professionals appear to adapt to the organisation and the remuneration system, which leads to practices, such as, rapid discharges and a tendency to examine the patient for only one or a few problems. Finally a suggestion for a model to improve care of frail elderly patients is presented. This model includes the need of more hospital wards being able to work with a holistic view, better skills in gerontology and geriatrics and a more adapted remuneration system for the frail, elderly patients.

    List of papers
    1. They do what they think is the best for me: Frail elderly patients' preferences for participation in their care during hospitalization.
    Open this publication in new window or tab >>They do what they think is the best for me: Frail elderly patients' preferences for participation in their care during hospitalization.
    2010 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 80, no 2, p. 233-240Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To deepen the knowledge of frail elderly patients' preferences for participation in medical decision making during hospitalization. METHODS: Qualitative study using content analysis of semi-structured interviews.

    RESULTS: Patient participation to frail elderly means information, not the wish to take part in decisions about their medical treatments. They view the hospital care system as an institution of power with which they cannot argue. Participation is complicated by barriers such as the numerous persons involved in their care who do not know them and their preferences, differing treatment strategies among doctors, fast patient turnover in hospitals, stressed personnel and linguistic problems due to doctors not always speaking the patient's own language.

    CONCLUSION: The results of the study show that, to frail elderly patients, participation in medical decision making is primarily a question of good communication and information, not participation in decisions about medical treatments.

    PRACTICE IMPLICATIONS: More time should be given to thorough information and as few people as possible should be involved in the care of frail elderly. Linguistic problems should be identified to make it possible to take the necessary precautions to prevent negative impact on patient participation.

    Keywords
    Patient participation; Frail elderly; Hospitalization; Semi-structured interviews; Content analysis
    National Category
    Geriatrics
    Identifiers
    urn:nbn:se:liu:diva-52427 (URN)10.1016/j.pec.2009.10.026 (DOI)000280384500015 ()
    Note
    Original Publication: Anne Ekdahl, Lars Andersson and Maria Friedrichsen, They do what they think is the best for me: Frail elderly patients' preferences for participation in their care during hospitalization., 2010, Patient Education and Counseling, (80), 2, 233-240. http://dx.doi.org/10.1016/j.pec.2009.10.026 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/ Available from: 2010-02-02 Created: 2009-12-18 Last updated: 2017-12-12Bibliographically approved
    2. Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised?: A cross-sectional survey
    Open this publication in new window or tab >>Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised?: A cross-sectional survey
    2011 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 11, no 46Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND:

    Medical decision making has long been in focus, but little is known of the preferences and conditions for elderly people with co-morbidities to participate in medical decision making. The main objective of the present study was to investigate the preferred and the actual degree of control, i.e. the role elderly people with co-morbidities wish to assume and actually had with regard to information and participation in medical decision making during their last stay in hospital.This study was a cross-sectional survey including three Swedish hospitals with acute admittance. The participants were patients aged 75 years and above with three or more diagnoses according to the International Classification of Diseases (ICD-10) and three or more hospitalisations during the last year.

    METHODS:

    We used a questionnaire combined with a telephone interview, using the Control Preference Scale to measure each participant's preferred and actual role in medical decision making during their last stay in hospital. Additional questions were asked about barriers to participation in decision making and preferred information seeking role. The results are presented with descriptive statistics with kappa weights.

    RESULTS:

    Of the 297 elderly patients identified, 52.5% responded (n = 156, 46.5% male). Mean age was 83.1 years. Of the respondents, 42 of 153 patients said that they were not asked for their opinion (i.e. no shared decision making). Among the other 111 patients, 49 had their exact preferred level of participation, 37 had less participation than they would have preferred, and 23 had more responsibility than they would have preferred. Kappa statistics showed a moderate agreement between preferred and actual role (κw = 0.57; 95% CI: 0.45-0.69). Most patients wanted to be given more information without having to ask. There was no correlation between age, gender, or education and preferred role. 35% of the patients agreed that they experienced some of the various barriers to decision making that they were asked about: 1) the severity of their illness, 2) doctors with different treatment strategies, 3) difficulty understanding the medical information, and 4) difficulty understanding doctors who did not speak the patient's own language.

    CONCLUSIONS:

    Physicians are not fully responsive to patient preferences regarding either the degree of communication or the patient's participation in decision making. Barriers to participation can be a problem, and should be taken into account more often when dealing with hospitalised elderly people.

    Place, publisher, year, edition, pages
    London, UK: BioMed Central Ltd., 2011
    Keywords
    decision making, elderly
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-70696 (URN)10.1186/1471-2318-11-46 (DOI)
    Available from: 2011-09-20 Created: 2011-09-14 Last updated: 2017-12-08Bibliographically approved
    3. Too complex and time-consuming to fit in! Physicians' experiences of elderly patients and their participation in medical decision making: a grounded theory study
    Open this publication in new window or tab >>Too complex and time-consuming to fit in! Physicians' experiences of elderly patients and their participation in medical decision making: a grounded theory study
    2012 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 3Article in journal (Refereed) Published
    Abstract [en]

    Objective To explore physicians' thoughts and considerations of participation in medical decision making by hospitalised elderly patients.

    Design A qualitative study using focus group interviews with physicians interpreted with grounded theory and completed with a questionnaire.

    Setting and participants The setting was three different hospitals in two counties in Sweden. Five focus groups were conducted with physicians (n=30) in medical departments, with experience of care of elderly patients.

    Results Physicians expressed frustration at not being able to give good care to elderly patients with multimorbidity, including letting them participate in medical decision making. Two main categories were found: ‘being challenged’ by this patient group and  ‘being a small part of the healthcare production machine’. Both categories were explained by the core category ‘lacking in time’. The reasons for the feeling of ‘being challenged’ were explained by the subcategories ‘having a feeling of incompetence’, ‘having to take relatives into consideration’ and ‘having to take cognitive decline into account’. The reasons for the feeling of ‘being a small part of the healthcare production machine’ were explained by the subcategories ‘at the mercy of routines' and ‘inadequate remuneration system’, both of which do not favour elderly patients with multimorbidity.

    Conclusions Physicians find that elderly patients with multimorbidity lead to frustration by giving them a feeling of professional inadequacy, as they are unable to prioritise this common and rapidly growing patient group and enable them to participate in medical decision making. The reason for this feeling is explained by lack of time, competence, holistic view, appropriate routines and proper remuneration systems for treating these patients.

    Place, publisher, year, edition, pages
    B M J Group, 2012
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-80824 (URN)10.1136/bmjopen-2012-001063 (DOI)000315044800075 ()
    Available from: 2013-03-28 Created: 2012-08-30 Last updated: 2017-12-07Bibliographically approved
    4. ‘Are decisions about dischargeof elderly hospital patients mainlyabout freeing blocked beds?’: A qualitative observational study
    Open this publication in new window or tab >>‘Are decisions about dischargeof elderly hospital patients mainlyabout freeing blocked beds?’: A qualitative observational study
    Show others...
    2012 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 2, no 6, p. 1-9Article in journal (Refereed) Published
    Abstract [en]

    Objective: To explore the interactions concerning thefrail and elderly patients having to do with dischargefrom acute hospital wards and their participation inmedical decision-making. The views of the patients andthe medical staff were both investigated.

    Design: A qualitative observational and interviewstudy using the grounded theory.

    Setting and participants: The setting was threehospitals in rural and urban areas of two counties inSweden of which one was a teaching hospital. The datacomprised observations, healthcare staff interviews andpatient interviews. The selected patients were all aboutto be informed that they were going to be discharged.

    Results: The patients were seldom invited toparticipate in the decision-making regarding discharge.Generally, most communications regarding dischargewere between the doctor and the nurse, after which thepatient was simply informed about the decision. It wasobserved that the discharge information was oftengiven in an indirect way as if other, albeit absent,people were responsible for the decision. Interviewswith the healthcare staff revealed their preoccupationwith the need to free up beds: ‘thinking aboutdischarge planning all the time’ was the core category.This focus not only failed to fulfil the complex needs ofelderly patients, it also generated feelings of frustrationand guilt in the staff, and made the patients feelunwelcome.

    Conclusions: Frail elderly patients often did notparticipate in the medical decision-making regardingtheir discharge from hospital. The staff was highlyfocused on patients getting rapidly discharged, whichmade it difficult to fulfil the complex needs of thesepatients.

    Keywords
    Frail elderly, Patient Participation, Discharge Planning, Qualitative observational study, Grounded theory, Hospital
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81401 (URN)10.1136/bmjopen-2012-002027 (DOI)000315081400135 ()
    Note

    On the day of the defence date the title of this article was: “Focusing on acquiring available beds!” : The process of discharging elderly patients: A qualitative observational study.

    Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2017-12-07
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    Frail and Elderly Hospital Patients: The Challenge of Participation in Medical Decision Making
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  • 725.
    Wissendorff Ekdahl, Anne
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Geriatric Medicine in Norrköping.
    Hellström, Ingrid
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Geriatric Medicine in Norrköping.
    Andersson, Lars
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Friedrichsen, Maria
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Too complex and time-consuming to fit in! Physicians' experiences of elderly patients and their participation in medical decision making: a grounded theory study2012In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 3Article in journal (Refereed)
    Abstract [en]

    Objective To explore physicians' thoughts and considerations of participation in medical decision making by hospitalised elderly patients.

    Design A qualitative study using focus group interviews with physicians interpreted with grounded theory and completed with a questionnaire.

    Setting and participants The setting was three different hospitals in two counties in Sweden. Five focus groups were conducted with physicians (n=30) in medical departments, with experience of care of elderly patients.

    Results Physicians expressed frustration at not being able to give good care to elderly patients with multimorbidity, including letting them participate in medical decision making. Two main categories were found: ‘being challenged’ by this patient group and  ‘being a small part of the healthcare production machine’. Both categories were explained by the core category ‘lacking in time’. The reasons for the feeling of ‘being challenged’ were explained by the subcategories ‘having a feeling of incompetence’, ‘having to take relatives into consideration’ and ‘having to take cognitive decline into account’. The reasons for the feeling of ‘being a small part of the healthcare production machine’ were explained by the subcategories ‘at the mercy of routines' and ‘inadequate remuneration system’, both of which do not favour elderly patients with multimorbidity.

    Conclusions Physicians find that elderly patients with multimorbidity lead to frustration by giving them a feeling of professional inadequacy, as they are unable to prioritise this common and rapidly growing patient group and enable them to participate in medical decision making. The reason for this feeling is explained by lack of time, competence, holistic view, appropriate routines and proper remuneration systems for treating these patients.

    Download full text (pdf)
    fulltext
  • 726.
    Wissendorff Ekdahl, Anne
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Geriatric Medicine in Norrköping.
    Linderholm, Märit
    Valdemarsviks Primary Care Center, 615 30 Valdemarsvik, County Council of Eastern Gotland, Sweden.
    Hellström, Ingrid
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Geriatric Medicine in Norrköping.
    Andersson, Lars
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Friedrichsen, Maria
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Center of Palliative Care.
    ‘Are decisions about dischargeof elderly hospital patients mainlyabout freeing blocked beds?’: A qualitative observational study2012In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 2, no 6, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the interactions concerning thefrail and elderly patients having to do with dischargefrom acute hospital wards and their participation inmedical decision-making. The views of the patients andthe medical staff were both investigated.

    Design: A qualitative observational and interviewstudy using the grounded theory.

    Setting and participants: The setting was threehospitals in rural and urban areas of two counties inSweden of which one was a teaching hospital. The datacomprised observations, healthcare staff interviews andpatient interviews. The selected patients were all aboutto be informed that they were going to be discharged.

    Results: The patients were seldom invited toparticipate in the decision-making regarding discharge.Generally, most communications regarding dischargewere between the doctor and the nurse, after which thepatient was simply informed about the decision. It wasobserved that the discharge information was oftengiven in an indirect way as if other, albeit absent,people were responsible for the decision. Interviewswith the healthcare staff revealed their preoccupationwith the need to free up beds: ‘thinking aboutdischarge planning all the time’ was the core category.This focus not only failed to fulfil the complex needs ofelderly patients, it also generated feelings of frustrationand guilt in the staff, and made the patients feelunwelcome.

    Conclusions: Frail elderly patients often did notparticipate in the medical decision-making regardingtheir discharge from hospital. The staff was highlyfocused on patients getting rapidly discharged, whichmade it difficult to fulfil the complex needs of thesepatients.

    Download full text (pdf)
    fulltext
  • 727.
    Wästberg, Birgitta A.
    et al.
    Lund University, Sweden .
    Haglund, Lena
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Eklund, Mona
    Lund University, Sweden.
    The Work Environment Impact Scale - Self-Rating (WEIS-SR) evaluated in primary health care in Sweden2012In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 42, no 3, p. 447-457Article in journal (Refereed)
    Abstract [en]

    Objective: To develop a self-report alternative to the Work Environment Impact Scale (WEIS). Participants: First the novel instrument was used and evaluated by ten occupational therapists and 45 clients in primary health care. Then the instrument was used by 26 clients who participated in a rehabilitation programme in another primary health care district. Methods: The instrument was investigated in two steps. First content validity and utility were investigated through a questionnaire addressed to occupational therapists and their clients respectively. The response distribution was calculated by frequencies. Internal consistency was investigated. In the second step, a revised version of the instrument was investigated for test-retest reliability and internal consistency. The test-retest reliability was calculated by weighted kappa. The internal consistency of the WEIS-SR was calculated by means of Cronbachs alpha. Results: In step one the content validity was good to moderately good, the utility was good, and the internal consistency was satisfactory (0.72). In step two the internal consistency was good (0.88/0.89) and the test-retest reliability was mostly good to moderate (0.35-0.78, median 0.61). Conclusions: The instrument will be further investigated in other populations and take into consideration additional psychometric properties such as sensitivity to change, predictive validity, and concurrent validity.

  • 728.
    Yngman-Uhlin, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Friedrichsen, Maria
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of LAH/Linnéa.
    Gustavsson, Maria
    Kalmar Regional Hospital.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Edéll-Gustafsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Circling around in tiredness: perspectives of patients on peritoneal dialysis2010In: Nephrology Nursing Journal : Journal of The American Nephrology Nurses Association, ISSN 1526-744X, E-ISSN 2163-5390, Vol. 37, no 4, p. 407-413Article in journal (Refereed)
    Abstract [en]

    The experience of tiredness linked to poor sleep in patients on peritoneal dialysis was explored using the qualitative method phenomenology. Eight women and six men in southeast Sweden were interviewed. The patients' descriptions were characterized by a circular structure "circling around in tiredness." This study illustrates the problems of tiredness and illuminates the need for healthcare professionals to assess the impact of tiredness and highlight the need for strategies to improve the patient's situation.

  • 729.
    Yngve, Moa
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Ekbladh, Elin
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Clinical Utility of the Worker Role Interview - A Survey Study among Swedish Users2015In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 22, no 6, p. 417-423Article in journal (Refereed)
    Abstract [en]

    Background: Work ability assessments are used to guide interventions designed to reduce or eliminate work disability and facilitate work participation. The clinical utility of assessments concerns the extent to which the assessment results support clinical decision-making. Aim: The aim was to investigate how users perceive the clinical utility of the Swedish version of the Worker Role Interview (WRI-S). An additional aim was to investigate differences in clinical utility related to the users’ level of WRI-S experience, attendance at courses on WRI-S application, and knowledge of the Model of Human Occupation. Material and methods: Data are based on 187 respondents’ answers to a web-based questionnaire and analysed through descriptive and inferential statistics. Results: In total, the respondents performed 12 000 WRI-S assessments. The respondents were mainly satisfied with the clinical utility of the WRI-S and experienced the assessment as supporting clinical practice. The main hindrance affecting clinical utility was the amount of time needed for conducting a WRI-S assessment. Experienced users and users with very good knowledge of MOHO conduct WRI-S assessments in a more time-effective manner. Conclusion: This study contributes to further development of the clinical utility of the Swedish version of the WRI-S, mainly focusing on time consumption.

  • 730.
    Yu, Doris S F
    et al.
    Chinese University of Hong Kong.
    Lee, Diana T F
    Chinese University of Hong Kong.
    Thompson, David R
    Australian Catholic University.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Woo, Jean
    Chinese University of Hong Kong.
    Leung, Edward M F
    United Christian Hospital, Hong Kong.
    Psychometric properties of the Chinese version of the European Heart Failure Self-care Behaviour Scale.2010In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 4, p. 458-467Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Effective self-care is the cornerstone of the successful management of heart failure (HF). The European Heart Failure Self-care Behaviour Scale is a brief, reliable and valid scale to measure this important construct among patients with HF. Although the EHFScBS has been translated to different languages, no Chinese version is available. Indeed, previous findings investigating the psychometric properties of EHFScBS indicated ambiguity of the conceptual structure of this scale. AIM: The aim of this study was to translate the European Heart Failure Self-care Behaviour Scale (EHFScBS) into Chinese and to test its psychometric properties in the Chinese patients with HF. METHODS: The EHFScBS (English Version) was translated to Chinese using Brislin's forward and backward translation method. Panel review was used to examine its semantic equivalence and content validity. The EHFScBS (Chinese Version) was then tested with a convenience sample of 143 Chinese HF patients who attended a specialist clinic from January to September 2007. RESULTS: The content validity index (CVI) of the EHFScBS (Chinese version) was satisfactory (Item CVI=0.96; Scale CVI=0.89), with Cronbach's alpha 0.82. Convergent validity was supported by a moderate relationship, statistical significant with a measure for social support (r=-0.36, p<0.001). However, the findings did not support the hypothesised three-factor structure of the EHFScBS (Chinese Version). Instead, all items except one fit well a two-factor structure to measure help-seeking and regimen-complying behaviours. CONCLUSION: The adequate psychometric properties and clear conceptual structure of EHFScBS (Chinese Version) warrant its use in Chinese patients with HF.

  • 731.
    Zannad, Faiez
    et al.
    Université de Lorraine, Nancy, France.
    Garcia, Angeles Alonso
    European Medicines Agency, Madrid, Spain.
    Anker, Stefan D
    Charité Medical School, Berlin, Germany.
    Armstrong, Paul W
    University of Alberta, Edmonton, Canada.
    Calvo, Gonzalo
    Hospital Clinic of Barcelona, Spain.
    Cleland, John G F
    Castle Hill Hospital, Kingston-upon-Hull, UK.
    Cohn, Jay N
    University of Minnesota, Minneapolis, USA.
    Dickstein, Kenneth
    University of Bergen, Stavanger University Hospital, Norway.
    Domanski, Michael J
    Mount Sinai School of Medicine, New York, USA.
    Ekman, Inger
    Sahlgrenska Academy, Gothenburg University, Sweden.
    Filippatos, Gerasimos S
    Athens University Hospital Attikon, Greece.
    Gheorghiade, Mihai
    Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
    Hernandez, Adrian F
    Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Koglin, Joerg
    Merck, Sharpe & Dohme Corporation, Whitehouse Station, NJ, USA.
    Konstam, Marvin
    Tufts University, Boston, MA, USA.
    Kupfer, Stuart
    Takeda Pharmaceuticals, Deerfield, IL, USA.
    Maggioni, Aldo P
    ANMCO Research Center, Florence, Italy.
    Mebazaa, Alexandre
    Hopital Lariboisiere, Paris, France.
    Metra, Marco
    University of Brescia, Italy.
    Nowack, Christina
    Bayer Pharma AG, Wuppertal, Germany.
    Pieske, Burkert
    Medical University of Graz, Austria.
    Piña, Ileana L
    Montefiore Medical Center, Bronx, NY, USA.
    Pocock, Stuart J
    London School of Hygiene and Tropical Medicine, UK.
    Ponikowski, Piotr
    Medical University, Military Hospital, Wroclaw, Poland.
    Rosano, Giuseppe
    IRCCS San Raffaele Hospital, Rome, Italy.
    Ruilope, Luis M
    Hospital 12 de Octubre, Madrid, Spain.
    Ruschitzka, Frank
    University Hospital Zurich, Switzerland.
    Severin, Thomas
    Novartis Pharma AG, Basel, Switzerland.
    Solomon, Scott
    Brigham and Women's Hospital, Boston, MA, USA.
    Stein, Kenneth
    Boston Scientific Corporation, St. Paul, MN, USA.
    Stockbridge, Norman L
    Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, MD, USA.
    Stough, Wendy Gattis
    Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA.
    Swedberg, Karl
    Sahgrenska University, Hospital/Östra, Göteborg, Sweden.
    Tavazzi, Luigi
    Villa Maria Cecilia Hospital, Cotignola, Italy.
    Voors, Adriaan A
    University Medical Center, Groningen, The Netherlands.
    Wasserman, Scott M
    Amgen Inc., Thousand Oaks, CA, USA.
    Woehrle, Holger
    ResMed, Ulm, Germany.
    Zalewski, Andrew
    Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
    McMurray, John J V
    University of Glasgow, UK.
    Clinical outcome endpoints in heart failure trials: a European Society of Cardiology Heart Failure Association consensus document2013In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 15, no 10, p. 1082-1094Article, review/survey (Refereed)
    Abstract [en]

    Endpoint selection is a critically important step in clinical trial design. It poses major challenges for investigators, regulators, and study sponsors, and it also has important clinical and practical implications for physicians and patients. Clinical outcomes of interest in heart failure trials include all-cause mortality, cause-specific mortality, relevant non-fatal morbidity (e.g. all-cause and cause-specific hospitalization), composites capturing both morbidity and mortality, safety, symptoms, functional capacity, and patient-reported outcomes. Each of these endpoints has strengths and weaknesses that create controversies regarding which is most appropriate in terms of clinical importance, sensitivity, reliability, and consistency. Not surprisingly, a lack of consensus exists within the scientific community regarding the optimal endpoint(s) for both acute and chronic heart failure trials. In an effort to address these issues, the Heart Failure Association of the European Society of Cardiology (HFA-ESC) convened a group of expert heart failure clinical investigators, biostatisticians, regulators, and pharmaceutical industry scientists (Nice, France, 1213 February 2012) to evaluate the challenges of defining heart failure endpoints in clinical trials and to develop a consensus framework. This report summarizes the groups recommendations for achieving common views on heart failure endpoints in clinical trials.

  • 732.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Luttik, Marie Louise A.
    Hanze University of Appl Science, Netherlands.
    Caregiving tasks and caregiver burden; effects of an psycho-educational intervention in partners of patients with post-operative heart failure2015In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 44, no 4, p. 270-275Article in journal (Refereed)
    Abstract [en]

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

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  • 733.
    Öhman, Annika
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Medicine and Health Sciences.
    Nygård, Louise
    Karolinska Institutet.
    Meanings and motives for for engagement in self-chosen daily life occupations among individuals with Alzheimer's disease.2005In: OTJR (Thorofare, N.J.), ISSN 1539-4492, E-ISSN 1938-2383, Vol. 25, no 3, p. 89-97Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to uncover and describe the meanings and motives for engagement in self-chosen daily life occupations for elderly individuals with Alzheimer's disease dwelling in the community. Six participants with Alzheimer's disease were included. Data were collected through repeated interviews and observations focusing on their motives for their self-chosen occupational engagement and the significance of the daily occupations. The analysis used a qualitative comparative and interpretative method. The findings show that the participants' occupations supported their ordinary pattern of everyday life and provided them with an opportunity to be in a coherent context. The occupations also allowed them to experience and communicate autonomy and certain characteristics of their identity and provided them with a private sphere. The findings revealed certain crucial but double-edged environmental keys to occupation. By identifying and supporting everyday occupations with personal meaning and value, therapists and caregivers may contribute to the well-being of individuals with Alzheimer's disease living in their own homes.

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