| 1. |
- Gustafsson, Mikael, et al.
(författare)
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Pocket-sized ultrasound examination of fluid imbalance in patients with heart failure : A pilot and feasibility study of heart failure nurses without prior experience of ultrasonography.
- 2015
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Ingår i: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. - : Oxford University Press (OUP). - 1873-1953. ; 14:4, s. 294-302
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Detecting fluid imbalance in patients with chronic heart failure can be challenging. Use of a pocket-sized ultrasound device (PSUD) in addition to physical examination can be helpful to assess this important information.AIM: To evaluate the feasibility for nurses without prior experience of ultrasonography to examine fluid imbalance by the use of a PSUD on heart failure patients.METHOD: Four heart failure nurses and an expert cardiologist participated. The nurses underwent a four-hour PSUD training programme. One hundred and four heart failure outpatients were included. The examinations obtained information of pulmonary congestion, pleural effusion and the diameter of the vena cava inferior.RESULTS: Examinations took nine minutes on average. In 28% and 14% of the patients, pulmonary congestion and pleural effusion respectively were found by the nurses. The sensitivities and specificities for nurses' findings were 79% and 91%, and, 88% and 93% respectively. The inter-operator agreement between the nurses and the cardiologist reached a substantial level (kappa values: 0.71 and 0.66). The inter-operator agreement for vena cava inferior reached a fair level (kappa value=0.39). Bland-Altman plots of the level of agreement revealed a mean difference of vena cava inferior diameter of 0.11 cm, while the 95% lower and upper limits ranged from -0.78 cm to 1.00 cm.CONCLUSION: After brief training, heart failure nurses can reliably identify pulmonary congestion and pleural effusion with a PSUD. Assessment of vena cava inferior was less valid. PSUD readings, when added to the history and a physical examination, can improve nurse assessment of fluid status in patients with heart failure.
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| 2. |
- Johansson, Peter, et al.
(författare)
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Determinants of global preceived health in community-dwelling elderly screened for heart failure and sleep-disordered breathing.
- 2010
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Ingår i: European Journal of Cardiovascular Nursing. - : Wolters Kluwer. - 1474-5151 .- 1873-1953 .- 0889-4655 .- 1550-5049. ; 25:5, s. 16-26
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Tidskriftsartikel (refereegranskat)abstract
- The relationships between heart failure (HF), sleep-disordered breathing (SDB), insomnia, depressive symptoms, and excessive daytime sleepiness (EDS), as well as their relationship to Global Perceived Health (GPH) in an elderly community-dwelling population, have not been explored. Data from 331 community-dwelling elderly (71-87 years old) were collected by echocardiography, polygraphy, and specific questionnaires. Factor analyses and structural equation modeling were used to explore the relationships between HF, SDB, sleep, psychosocial factors, and GPH. Exploratory and confirmatory factor analyses derived a 5-factor model representing SDB, insomnia, systolic function, breathlessness/physical function, and psychosocial function. Structural equation modeling analyses were used to explore the relationships between the 5 factors and to GPH. Sleep-disordered breathing had a weak effect on systolic function, but no effects on any of the other factors or GPH were found. Psychosocial function and breathlessness/physical function directly affected GPH. Indirect effects on GPH, mediated by psychosocial function, were found for breathlessness/physical function and insomnia. Systolic function also had an indirect effect on GPH. The fact that SDB in the elderly has no obvious negative associations to sleep complaints or GPH does not exclude them from being adequately treated for SDB. However, the present study has shown that SDB, by means of self-rated sleep complaints and health-related quality of life, can be problematic to detect. Psychosocial function was the most important factor for perceived GPH as it had a direct effect, as well as mediated the factors breathlessness/physical function and insomnia effects, on GPH. This study indicates that interventions in clinical practice targeting psychosocial dysfunction, such as depressive symptoms, could help to improve GPH in the elderly with or without HF.
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| 3. |
- Johansson, Peter, 1962-, et al.
(författare)
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Global perceived health and health-related quality of life in elderly primary care patients with symptoms of heart failure
- 2008
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Ingår i: European Journal of Cardiovascular Nursing. - : Elsevier. - 1474-5151 .- 1873-1953. ; 7:4, s. 269-276
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim was to examine whether a single question about global perceived health (GPH) is associated with the domains of health-related quality of life (HR-QoL) as assessed by the SF-36, and whether the scores in these domains differ from the different scores of the GPH in relation to left ventricular ejection fraction (LVEF). Method: The study included 412 elderly outpatients with symptoms of heart failure (HF). Echocardiography was used to determine their LVEF, and GPH was assessed by the first question on the SF-36. Results: The correlations between GPH and the different domains in SF-36 ranged from 0.33 to 0.64 in patients with LVEF ≥ 50% and was between 0.29 and 0.59 in patients with LVEF < 40%. Regression analyses revealed GPH to be the strongest predictor of HR-QoL. Patients with LVEF < 40% rating poor GPH differed significantly (p < 0.05) from those with good or moderate GPH in six of the eight HR-QoL domains. Conclusion: One question about GPH gives a good general description of HR-QoL and may therefore be used as a simple tool to assess HR-QoL in elderly outpatients with clinical symptoms of HF.
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| 4. |
- Johansson, Peter, et al.
(författare)
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Sleep disordered breathing, insomnia, and health related quality of life - A comparison between age and gender matched elderly with heart failure or without cardiovascular disease
- 2010
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Ingår i: European Journal of Cardiovascular Nursing. - : Elsevier Science B.V., Amsterdam.. - 1474-5151 .- 1873-1953. ; 9:2, s. 108-117
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aims of this study are (I) to compare the prevalence of sleep disordered breathing (SDB) and insomnia between elderly with heart failure (HF) and age and gender matched elderly without cardiovascular disease (CVD), and (II) to examine the association between HF, SDB and insomnia, as well as their impact on health related quality of life (Hr-QoL). Methods: Three hundred and thirty-one elderly (71-87 years) community-living individuals underwent sleep recordings and echocardiography. Questionnaires assessed insomnia and Hr-QoL. Comparisons were made between age and gender matched individuals with HF (n=36) and without CVD (n=36). Results: The HF group had higher mean apnoea-hypopnoea index (17.6 vs. 6.3, pless than0.001). Moderate/severe SDB was found in 42% of those with HF vs. 8% in those without CVD (p=0.001). Those with HF had more difficulties maintaining sleep (DMS) (72% vs. 50%, p=0.05) and excessive daytime sleepiness (EDS) (25% vs. 8%, p=0.05) and scored worse Hr-QoL in five of eight SF-36 domains. In regression analysis SDB had no association to Hr-QoL. DMS associated to the physical-, and non restorative sleep to the mental domain of Hr-QoL. SDB had no correlations to insomnia or EDS. Conclusions: SDB, DMS and EDS are more common in elderly with HF. SDB is not an obvious cause for sleep complaints or poor Hr-QoL in elderly.
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| 5. |
- Johansson, Peter, et al.
(författare)
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The contribution of hypoxia to the association between sleep apnoea, insomnia, and cardiovascular mortality in community-dwelling elderly with and without cardiovascular disease
- 2015
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 14:3, s. 222-231
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Tidskriftsartikel (refereegranskat)abstract
- Aims:This study explores if nightly hypoxia (i.e. percentage of sleep time with oxygen saturation lower than 90% (SaO2<90%)) contributed to the association between sleep-disordered breathing (SDB) and insomnia in community-dwelling elderly with and without cardiovascular disease (CVD). A second aim was to explore a potential cut-off score for hypoxia to predict insomnia and the association of the cut-off with clinical characteristics and cardiovascular mortality.Method:A total of 331 community-dwelling elderly aged 71–87 years underwent one-night polygraphic recordings. The presence of insomnia was recorded by a self-report questionnaire. The presence of CVD was objectively established and mortality data were collected after three and six years.Results:In both patients with CVD (n=119) or without CVD (n=212) SDB was associated with hypoxia (p<0.005). Only in the patients with CVD was hypoxia associated with insomnia (p<0.001) which mediated an indirect effect (p<0.05) between SDB and insomnia. Hypoxia of more than 1.5% of sleep time with SaO2<90% was found to be a critical level for causing insomnia. According to this criterion 32% (n=39) and 26% (n=55) of those with and without CVD had hypoxia, respectively. These groups did not differ with respect to age, gender, body mass index, diabetes, hypertension, respiratory disease or levels of SDB. However, in the CVD group, hypoxia was associated with cardiovascular mortality at the three-year follow-up (p=0.008) and higher levels of insomnia (p=0.002).Conclusion:In the elderly with CVD, SDB mediated by hypoxia can be associated with more insomnia and a worse prognosis.
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