| 1. |
- Anistratov, Pavel, 1990-
(författare)
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Autonomous Avoidance Maneuvers for Vehicles using Optimization
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- To allow future autonomous passenger vehicles to be used in the same driving situations and conditions as ordinary vehicles are used by human drivers today, the control systems must be able to perform automated emergency maneuvers. In such maneuvers, vehicle dynamics, tire–road interaction, and limits on what the vehicle is capable of performing are key factors to consider. After detecting a static or moving obstacle, an avoidance maneuver or a sequence of lane changes are common ways to mitigate the critical situation. For that purpose, motion planning is important and is a primary task for autonomous-vehicle control subsystems. Optimization-based methods and algorithms for such control subsystems are the main focus of this thesis.Vehicle-dynamics models and road obstacles are included as constraints to be fulfilled in an optimization problem when finding an optimal control input, while the available freedom in actuation is utilized by defining the optimization criterion. For the criterion design, a new proposal is to use a lane-deviation penalty, which is shown to result in well-behaved maneuvers and, in comparison to minimum-time and other lateral-penalty objective functions, decreases the time that the vehicle spends in the opposite lane.It is observed that the final phase of a double lane-change maneuver, also called the recovery phase, benefits from a dedicated treatment. This is done in several steps with different criteria depending on the phase of the maneuver. A theoretical redundancy analysis of wheel-torque distribution, which is derived independently of the optimization criterion, complements and motivates the suggested approach.With a view that a complete maneuver is a sequence of two or more sub-maneuvers, a decomposition approach resulting in maneuver segments is proposed. The maneuver segments are shown to be possible to determine with coordinated parallel computations with close to optimal results. Suitable initialization of segmented optimizations benefits the solution process, and different initialization approaches are investigated. One approach is built upon combining dynamically feasible motion candidates, where vehicle and tire forces are important to consider. Such candidates allow addressing more complicated situations and are computed under dynamic constraints in the presence of body and wheel slip. To allow a quick reaction of the vehicle control system to moving obstacles and other sudden changes in the conditions, a feedback controller capable of replanning in a receding-horizon fashion is developed. It employs a coupling between motion planning using a friction-limited particle model and a novel low-level controller following the acceleration-vector reference of the computed plan. The controller is shown to have real-time performance.
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| 2. |
- Hjelmfors, Lisa, 1984-
(författare)
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Communication about the Heart Failure Trajectory in Patients, their Families and Health Care Professionals
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: There is an increasing awareness in the field of cardiology regarding the need for improved delivery of palliative care in patients with heart failure (HF). Professional guidelines have drawn attention to the importance of discussing the heart failure trajectory with patients and their families. These discussions can include, for example, talking about the prognosis, expectations for the future, and care at the end-of-life. It seems difficult for health care professionals to choose the right time for initiating these discussions. They often avoid these conversations because they are afraid of taking away hope and make the patients and their families anxious.Aim: The overall aim of this thesis was to improve communication about the heart failure trajectory in patients, their families, and health care professionals.Design and methods: This thesis includes five studies using different designs and data collection methods. Study I has a cross-sectional design using a questionnaire to collect data to describe heart failure nurses’ perceptions of and practice in discussing prognosis and end-of-life care with heart failure patients. Study II has a descriptive and comparative design, where a survey was performed to describe Swedish and Dutch heart failure nurses’ reasons for discussing or not discussing prognosis and end-of-life care with patients. Study III has an inductive and exploratory design, where HF patients participated in focus groups or individual interviews. Data was collected based on their perceptions of communication about the heart failure prognosis. Study IV was a small-scale ethnographic study describing and evaluating the delivery of a simulation when teaching third-year nursing students about end-of-life care at a Swedish university. Study V used co-design in which patients with HF from primary care, their family members and health care professionals (physicians and nurses) from palliative and HF care were invited to be constructive participants in the design process of a communication intervention. Health care professionals participated in a first feasibility testing of the intervention.Results: Most Swedish HF nurses had discussed prognosis (96%) and end-of-life care (84%) with a HF patient at some point in clinical practice. The nurses often reported that a physician was to have the main responsibility for such discussions (69%), but that the nurse was also believed to have a role to play (I). Prognosis and end-of-life care were, together with sexual activity, () the three least frequently discussed topics in HF clinics in both Sweden and the Netherlands (II). In conversations with 1,809 Swedish and Dutch HF patients, prognosis was discussed with 38% of the patients and end-of-life care was discussed with 10%. In study III, patients expressed different experiences of and preferences for communication about their HF prognosis. Many patients described that the health care professionals had not provided them with any prognosis information at all. The patients had different understandings of HF as a chronic illness, which had an impact on their preferences for communication about their prognosis (III). The simulation training described in the ethnographic study (IV) was part of an end-of-life care simulation during the last term of the 3- year bachelor degree level nursing education program, where students learn and practice basic palliative care. The students felt that the simulation training was a good opportunity to practice handling end-of- life situations as it gave them a chance to experience this situation and their own feelings and thoughts on death and dying. In study V, an intervention to improve communication about prognosis and end-of-life care in HF care was developed and some areas were feasibility tested. Heart failure patients, their families and health care professionals working in HF care or palliative care participated in the development process. Health care professionals (nurses and physicians) participated in the following feasibility testing of the intervention.Conclusions: This thesis shows that prognosis and end-of-life care are seldom discussed with HF patients in Swedish and Dutch heart failure care. and that many heart failure nurses have ambiguous attitudes towards discussing these topics with patients and their families (I+II). The patients described that they receive different messages concerning their heart failure, and that they also have different preferences for discussing the heart failure trajectory with health care professionals. The professionals need to understand the impact of heart failure on each patient and adapt the communication to each individual (III). End-of-life care simulation with skilled supervisors shows great promise for health care professionals to learn good communication skills in end-of-life care conversations (IV). A Question Prompt List and a communication course might be useful for improving communication about the heart failure trajectory in patients, their families, and health care professionals
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| 3. |
- Nahlen Bose, Catarina
(författare)
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Coping and emotional well-being in patients with chronic heart failure
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Chronic heart failure (CHF) is a serious illness, with a profound impact on the patient. Poor health-related quality of life (HRQoL) as well as anxiety and depression are prevalent in CHF and predict mortality and rehospitalization, yet, psychosocial factors are infrequently treated and cared for.Aim: To gather scientific evidence on illness perception and coping strategies to predict emotional well-being in patients with CHF and to establish a measurement model of coping strategies. Furthermore, to evaluate a nurse-led psychoeducational intervention, Coping Effectiveness Training (CET) adapted for patients with CHF.Methods: Studies I-III were cross sectional. Study IV was a randomized controlled trial aimed to improve emotional well-being (one-year follow-up). All studies used patient reported outcome measures and clinical data via medical journals.Results: Younger age and male gender were associated with higher levels of alcohol usage and/or drugs to cope, p < 0.01. Poor sense of coherence was associated with maladaptive coping (I). A four factorial model of Brief COPE displayed the best psychometric properties (II). Avoidant coping influenced negative affect (NA) (I), worse HRQoL (II) and greater anxiety and depression (III). CET (IV) improved personal control in the intervention group (IG) compared to the control group (CG), p = 0.036. Improved scores for the IG were detected in emotional well-being and HRQoL, p = ns. The IG demonstrated reduced NA, p = 0.022, excluding cases with clinical anxiety and depression. Time to cardiovascular readmission or death was non-significantly lower in the IG vs the CG (Hazard ratio 0.58 [0.29-1.18]) adjusted p = 0.135.Conclusions: Personal resources seemed to influence the coping strategies used by patients with CHF. Avoidant coping had an adverse influence on emotional wellbeing and illness perception in CHF. The perceived sense of control and illness burden were of importance for emotional well-being. A CET intervention for patients with CHF increased sense of control over the illness. CET also reduced NA in patients with no or mild symptoms of anxiety and depression.
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| 4. |
- Hasan, Baha, 1977-
(författare)
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An Ontological Approach to support Knowledge Sharing between Product Design and Assembly Process Planning (APP)
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Modern manufacturing organizations have to cope with several critical issues arising from the need for mass customization such as short product life-cycles, an increasing number of product variants and frequently changing customer requirements. One of the main factors that could aid overcoming those challenges is the use of information and communication technology (ICT) applications over a collaborative manufacturing environment, in which all stakeholders share and exchange knowledge across different manufacturing domains and applications. However, the use of ICT applications over a collaborative manufacturing environment is limited at the domain level by semantic conflicts arising from the use of different ways to describe the same objects and facts arising from different conceptualizations. Similarly, ICT usage is limited on the application level by interoperability problems arising from diverse heterogeneity between different ICT applications and tools.This research presents a semantic approach to support knowledge sharing within the assembly domain. More specifically, this research is focusing on capturing and sharing assembly design knowledge and integrating the assembly design domain and the Assembly Process Planning (APP) domain. Assembly design and APP are very important engineering domains for successful manufacturing system design, which requires an efficient collaborative environment for best utilization of the assembly resources. However, though these domains represent different perspectives in understanding of the same concepts, both domains use different software applications, which might cause interoperability issues.In this thesis, a novel integration approach has been proposed; this approach is composed of two stages: the first stage includes modelling and recognition of assembly knowledge semantics from SolidWorks (SW) CAD software by using SolidWorks’ Application Programmable Interface (SW-API). The second stage includes sharing the recognized assembly knowledge semantics by using a knowledge-based system in the form of a three-layer ontology architecture which provides a common semantic base to support knowledge sharing across assembly design and APP both on the domain and the application level. Each ontology layer shares a set of concepts from the most generic level to the most specialized level. The foundation ontology layer represents the general key concepts in the assembly design and APP domains. More specialized assembly design concepts and APP concepts are represented both in the domain ontology layer, and the application ontology layer. In the latter, concepts related to SolidWorks CAD software and to assembly robotic devices are represented.
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| 5. |
- Jiang, Nan
(författare)
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Radiation-Induced Xerostomia in Chinese Patients with Head and Neck Cancer – An Explorative and Interventional study
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Radiation-induced xerostomia is a common oral complication of patients with head and neck cancer (HNC) undergoing radiotherapy (RT). This can lead to a series of functional oral disorders, particularly dental caries, and ultimately negatively affect their oral health and health-related quality of life (HRQoL).Aims: The overall aim of this thesis was to understand the living experience of radiation-induced xerostomia and to determine the effects of an integrated supportive program based on multicomponent oral care strategies in Chinese patients with HNC.Methods: A qualitative descriptive study was conducted to describe how patients (13 men and 7 women) with HNC experienced radiation-induced xerostomia (Ⅰ). A cross-sectional study of patients (n=80) with HNC was conducted to accomplish the validation of the Chinese version of the xerostomia questionnaire (XQ) (Ⅱ). A randomized controlled trial (n=79) was conducted to determine the effect of an integrated supportive program (with a combination of face-to-face health education and coaching sections) on xerostomia, saliva characteristics (Ⅲ), oral health, and HRQoL (IV).Results: Five categories emerged from the manifest content of the interviews: communication problems, physical problems, psychosocial problems, treatment problems, and relief strategies. The meaning underlying these categories formed a theme, which was the latent content of the interview: Due to lack of information regarding xerostomia, patients had to find their own ways to deal with the problem (Ⅰ). The Chinese version of XQ was a unidimensional scale (1-factor solution explained 75.6 of the total variance) and had good psychometric properties with excellent internal consistency (Cronbach’s α of 0.95), test-retest reliability (intraclass correlation coefficient of 0.92), and good criterion-related validity and content validity (Ⅱ). The integrated supportive program showed significant inter-group differences in xerostomia (P=0.046), unstimulated saliva flow rate (P=0.035), plaque index (P=0.038), Oral Health Impact Profile-14 (P=0.002), and Functional Assessment Cancer Therapy-Head & Neck (P=0.001) over the 12-month follow-up, with better outcomes in the intervention group (Ⅲ & Ⅳ).Conclusion: This thesis contributes knowledge regarding the experiences of living with xerostomia from a patient perspective, noting that xerostomia has a profound impact on a patient's physical, psychological, and social quality of life. There is lack of assessment tools for xerostomia in the Chinese population, and the Chinese version of XQ proved to be a valid and simple self-administered tool to measure and monitor the xerostomia level in patients with HNC. The integrated supportive program with multicomponent oral care strategies demonstrated positive effects on relieving xerostomia, increasing unstimulated saliva flow rate, and improving their oral health and HRQoL. These findings provide a basis for improvement in the management of xerostomia and oral health of Chinese patients with HNC through the integration of oral care in nursing.
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| 6. |
- Karlsson, Kåre
(författare)
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Health problems and work-related stress in Swedish ambulance personnel
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Previous studies have shown a high incidence of both acute and post-traumatic stress among ambulance personnel. It has been shown that ambulance personnel are at a higher risk of being affected of heart disease, high blood pressure and cancer. Studies have also seen a higher incidence of substance abuse and suicide. One cause of these health problems can be work-related stress. No previous research has focused on the body's physical reactions in the form of changes in heart rate and stress hormones in ambulance personnel in connection with work-related stress. Nor is there any overall picture of what actually affects Swedish ambulance personnel in terms of reported morbidity.Aim: The overall aim of the thesis is to investigate health problems in Swedish ambulance personnel and to study if there are any factors related to the work environment and the special conditions occurring in the prehospital environment that can be linked to the findings that appear.The questions that should be answered are: Are there health problems that affect Swedish ambulance personnel to a higher extent than other professions in Sweden? Are there any factors relating to morbidity that can be linked to the profession and can be regarded as potentially dangerous? If so, are there methods to prevent health problems that can be implemented in daily work?Methods: Studies I, II and III were all studies where stress markers (heart rate and cortisol levels) were measured during different conditions linked to the profession. Study I was a study where this was measured during physical exertion e.g. to carry a stretcher. Study II was a validated theoretical stress test to see how the ambulance personnel reacted to unknown factors. Study III meant measuring stress markers during priority-1 alarms. Study IV was carried out as a longitudinal register study where data about ICD-codes was collected from Statistics Sweden and the National Board of Health and Welfare.Results: In study I it was shown that the use of lifting aids reduced the measurable stress in the form of both reduced heart rate and decreased cortisol levels. Study II showed that personnel were stressed of the unknown test though women had the highest salivary cortisol levels before the Trier social stress test while the highest value for men occurred 10 to 20 minutes after the test. Study III showed that there was an increase in heart rate during priority-1 alarms that could not be linked to physical activity. It also indicated/showed that traffic accidents, patients with heart attacks in need of acute PCI or thrombectomy and alarms regarding children generate the highest stress onset seen as prolonged elevation of cortisol levels. This was seen regardless of gender, age, education or experience in all three studies. Study IV showed that Swedish ambulance personnel run the risk of being affected by certain diseases such as cardiac arrhythmias and injuries as arthrosis of the knee, dorsopathies and intervertebral disc disorders to a greater extent compared to other health care workers and other professions in Sweden.Conclusion: Swedish ambulance personnel have a higher incidence of certain health problems and diseases such as paroxysmal tachycardia, atrial fibrillation and flutter, other cardiac arrhythmias, high blood pressure, of the knee and dorsopathies and intervertebral disc disorders compared to other professions. These conditions can be caused by work-related stress, although they are not the only cause. Some factors that cause a stress reaction that can be linked to the ambulance profession have emerged in the studies. But the extent to which these factors alone cause the health problems that Swedish ambulance personnel suffer from is more difficult to determine with certainty based on these studies. Using shoulder straps reduces both heart rate and cortisol secretion.Clinical implications: Greater use of aids both in terms of lifting, moving and carrying heavy loads should mean that the physical load on the body would be reduced. These aids could also prevent some musculoskeletal problems that have emerged in this thesis by relieving and distributing the burden throughout the body. An important aspect in preventing work-related stress is that sufficient time is given for recovery. The organizations need to be dimensioned so that there is sufficient standby time so that there is time for recovery and reflection but also time for education and training. This is something that is far from reality in many Swedish ambulance organizations. It is also time to seriously discuss what is an actual reality in many countries, namely that employees in the ambulance service can benefit from a lower retirement age after a certain number of years of service.
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| 7. |
- Lovén Wickman, Ulrica, 1966-
(författare)
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Self-care: the way to find balance in life : development and evaluation of a self-care questionnaire for patients with inflammatory bowel disease
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Inflammatory bowel disease (IBD), ulcerative colitis (UC), and Crohn’s disease (CD) occur worldwide and are life-long chronic conditions. The symptoms, which include abdominal pain and frequent diarrhea, cause limitations in life. Thus, patients with IBD need self-care in accordance with their symptoms, their own commitment to maintaining health, and decisions on symptom management. To strengthen self-care, there is a need for a tool that assesses self-care in patients with IBD, which aims to support the patient dialogue about self-care.The overall aim of this thesis was to develop and evaluate a questionnaire for the clinical assessment of self-care, and to explore self-care in relation to disease activity and to health-related quality of life (HRQOL) in patients with IBD.Design and method: The thesis includes four studies, where studies I, II and IV were conducted in Sweden, and study III was conducted in the United States (U.S.). In study I, a descriptive design, interviews were conducted with twenty adult patients, in order to explore self-care in patients with IBD. In study II, the self-care questionnaire was developed and tested with 193 patients with IBD in Sweden. In study III, a crosssectional descriptive design, the self-care questionnaire was translated into English, and the responses of 67 patients in the U.S. were evaluated. Finally, in study IV, a cross-sectional exploratory design was used to explore self-care in relation to patient characteristics, disease activity, and HRQOL among 234 patients. For a total of 421 patients, the data was analyzed using content analysis, and descriptive and analytic statistics (studies I, II, III and IV).Results: Among patients with IBD, self-care relates to symptom recognition, handling of symptoms, planning life, and seeking new options. Self-care varied according to how the patient managed daily life with regard to the symptoms of the disease (study I). Based on the results from study I, the self-care questionnaire was developed in Swedish, resulting in a valid and reliable questionnaire comprising 22 items (study II). The questionnaire was translated to English, and performed self-care activities were associated with a lower degree of well-being in relation to age and gender (study III). The patients were taking medication for IBD, paying attention to their intestinal symptoms, adapting their diet, managing their stress, planning their day and avoiding activities (studies III and IV). Self-care was more frequent in patients with CD when it came to paying attention to psychological symptoms; diet adaption; avoiding various activities including sex; and looking for new approaches to living with IBD. A greater degree of self-care activities was associated with a lower degree of HRQOL (IV).Conclusion: The results indicate the importance of identifying the total symptom experience, and of the patient’s need to discuss self-care, in order to strengthen selfcare and achieve better treatment. The self-care questionnaire can be a useful tool to benefit the discussion of self-care for the patient, and to secure health literacy, medication adherence, and HRQOL. The valid and reliable self-care questionnaire is available for patients with IBD at gastroenterology clinics or out-patient clinics, as primary care. Disease activity affects self-care, and consequently the self-care activities.
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| 8. |
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| 9. |
- Tingsvik, Catarina
(författare)
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Weaning from mechanical ventilation – from the patient, next-of-kin and healthcare professionals’ perspective
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Critically ill patients with failing respiratory and vital body functions might need invasive mechanical ventilation (IMV). When the patient’s condition improves, the need for respiratory support decreases and weaning from IMV begins. Even though weaning is a central part of intensive care, a stringent and well-accepted definition of this concept is lacking, implying that meanings, descriptions, strategies, and routines vary. The weaning process involves the expertise of diverse healthcare professionals (HCP), whose roles differ between different contexts. Today, person-centred care (PCC) is common and widely spread in healthcare. Still, it is unclear how PCC is recognised, used,and implemented in intensive care and during weaning. The overall aim of the thesis was to explore and describe the process when weaning patients from invasive mechanical ventilation in the ICU from thepatient, next-of-kin, and health care professionals’ perspective. To achieve the thesis's overall and specific aims, four studies (study I-IV) using a qualitative, explorative and descriptive design were conducted. In study I, the patients’ perspectives on weaning were explored, i.e., their lived experience of being on IMV during weaning. Data were collected through 20 interviews and analysed by using a hermeneutic phenomenological approach. Study II explored the meaning of being a next-of-kin when the patient was weaning. The study included eight next-of-kin who were asked to write diary notes based on their experience while the patient was weaning, followed by interviews after the patient’s time in the intensive care unit (ICU). Data were analysed using a hermeneutic phenomenological approach. Study III and IV described and explored the HCP’ perspectives on weaning and the factors that influenced their decision-making. Twenty ICU nurses (study III) and 16 physicians (study IV) were interviewed to describe and explore the factors that influenced decision-making when weaning patients from IMV. Data were inductively analysed using qualitative content analysis.It was found that weaning was not a separate phenomenon for the patient and next-of-kin. It was challenging to distinguish and was intertwined with experiences of intensive care. Patients and next-of-kin had both favourable and depressing experiences, but the favourable ones were more clearly described than in previous research. Moreover, it was essential for the patients to be treated with humanity. This helped them endure the physical and cognitive strains of IMV and intensive care, gain confidence in their body’sability, be given hope, and experience a safe environment. This was strengthened by several circumstances where the relationship with others was central. For next-of-kin, it was essential to be close to the patient as this gave them strength to get through the ICU-time and with their support, patients’less favourable experiences were alleviated. Furthermore, their resources, capabilities, and suffering varied between persons and over time.Weaning was a delimited process with a clear goal for HCP, which was strongly influenced and linked to other care processes. ICU nurses and physicians conducted the weaning and decision-making aligned with the patient’s medical condition, strengths, and wishes. Weaning rarely followed any protocol and planning was not done consistently. Understanding the importance of a caring relationship for decision-making and how this could affect patients and the experiences of next-of-kin was lacking. Moreover, there seem to be ambiguities and unspoken expectations within and between the professions in the allocation of responsibilities regarding weaning.Furthermore, the teamwork dynamic influenced the weaning process, decision-making, and the prerequisites for person-centred weaning.These findings contribute to new, current, and in-depth knowledge of the weaning process. Based on this thesis's four perspectives, the concept of person-centred weaning appeared, which means to strive to retain and consider the patient as a capable person despite failing vital functions, voicelessness, vulnerability, and extended need for support and assistance. Furthermore, HCP need to be aware of the dynamic within the weaning process and the impact of the care culture on the quality and experience of the weaning. There is a need to optimise the team's prerequisites, collaboration, and resources at an organisational level to perform person-centred weaning and maybe optimise the weaning process.
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| 10. |
- Wu, Eline
(författare)
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Enhanced external counterpulsation treatment in patients with refractory angina pectoris with emphasis on physical capacity, health-related quality of life and safety : An explorative and interventional study
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients with refractory angina pectoris (RAP) suffer from debilitating symptoms with considerable limitation of functional capacity and impaired health-related quality of life (HRQoL) despite optimised medical therapy. In addition, frequent angina symptoms are strongly associated with psychological distress. The challenging management of RAP and the severe limitations and symptomatology experienced by these patients underscore the need for further research in more novel treatment approaches. Enhanced external counterpulsation (EECP) is a potential non-invasive treatment that can decrease limiting symptoms in patients with RAP and is generally given as 35 one-hour sessions (i.e., one course) over seven weeks.Aim: The overall aim was to obtain a deeper understanding of patients’ experiences undergoing EECP treatment and to evaluate the effects of the treatment with focus on physical capacity, HRQoL and safety.Methods: An explorative and interventional study comprising both qualitative (paper I) and quantitative (papers II, III, and IV) study designs were performed. In paper I, semi-structured interviews took place with 15 strategically selected patients who had finished an EECP course at the two existing EECP clinics in Sweden. Data were analysed using inductive qualitative content analysis. In paper II, a quasi-experimental study with one-group pre-test/post-test design with a six-month follow-up was performed with 50 patients who had undergone one EECP course. The following pre- and post-treatment data were collected: medication use, six-minute walk test (6MWT), functional class according to the Canadian Cardiovascular Society (CCS), self-reported (i.e., questionnaire data) cardiac anxiety, and HRQoL. The questionnaires were also completed at a six-month follow-up. In paper III and IV, sociodemographic, medical, and clinical data related to EECP were collected by reviewing medical records of 119 patients with RAP who had undergone one EECP course and a 6MWT pre- and post-treatment. An increased walking distance by 10% post treatment, measured with 6MWT, was considered an adequate treatment response.Results: In paper I, the findings were divided into four content areas, each comprising three categories: (1) experiences before EECP was initiated comprised of uncharted territory, be given a new opportunity and gain insight; (2) experiences during EECP sessions comprised physical discomfort, need of distraction, and sense of security; (3) experiences between EECP sessions comprised physical changes, socializing, and coordinating everyday life; and (4) experiences after one course of EECP treatment comprised improved physical well-being, improved mental well-being and maintaining angina in check. In paper II, patients used significantly less short-acting nitrates (p <. 001), walking distance increased on average by 46 m (p < .001), and CCS class improved after one EECP course (p < .001). In addition, all but one subscale of cardiac anxiety and all HRQoL components improved significantly, and the positive effects were maintained at the six-month follow-up (p < .05). In paper III, 49 (41.2%) of the 119 patients, were responders to EECP. CCS class ≥ 3, left ventricle ejection fraction < 50%, and previous revascularisation (i.e., ≤ one type of intervention) were predictors of response (p < .05). In paper IV, the treatment completion rate was high, and the occurrence of adverse events (AE) was low. Most device-related AE required nursing actions, while medical actions were needed more in the non-device-related AE. The AE distribution did not differ between responders and non-responders. Skin lesion/blister occurred mostly in responders and paraesthesia occurred mostly in non-responders.Conclusions: The EECP treatment was perceived as an unknown option among these patients but also as be given a new opportunity to get better. The presence and care provided by the cardiac nurse contributed to a sense of security during treatment. The treatment resulted in reduced symptom burden, improved physical capacity and HRQoL, and less cardiac anxiety, leading to increased physical activity and enhanced life satisfaction for patients with RAP. Moreover, the EECP should be considered preferentially for patients who have a greater functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularisation. The EECP treatment appears to be a safe and well-tolerated treatment option in patients with RAP.
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