| 1. |
- Egholm, Cecilie Lindström, et al.
(författare)
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Facilitators for using data from a quality registry in local quality improvement work : a cross-sectional survey of the Danish Cardiac Rehabilitation Database
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate use of data from a clinical quality registry for cardiac rehabilitation in Denmark, considering the extent to which data are used for local quality improvement and what facilitates the use of these data, with a particular focus on whether there are differences between frontline staff and managers. Design Cross-sectional nationwide survey study. Setting, methods and participants A previously validated, Swedish questionnaire regarding use of data from clinical quality registries was translated and emailed to frontline staff, mid-level managers and heads of departments (n=175) in all 30 hospital departments participating in the Danish Cardiac Rehabilitation Database. Data were analysed descriptively and through multiple linear regression. Results Survey response rate was 58% (101/175). Reports of registry use at department level (measured through an index comprising seven items; score min 0, max 7, where a low score indicates less use of data) varied significantly between groups of respondents: frontline staff mean score 1.3 (SD=2.0), mid-level management mean 2.4 (SD=2.3) and heads of departments mean 3.0 (SD=2.5), p=0.006. Overall, department level use of data was positively associated with higher perceived data quality and usefulness (regression coefficient=0.22, p=0.019), management request for data (regression coefficient=0.40, p=0.008) and personal motivation of the respondent (regression coefficient=1.63, p<0.001). Among managers, use of registry data was associated with data quality and usefulness (regression coefficient=0.43, p=0.027), and among frontline staff, reported data use was associated with management involvement in quality improvement work (regression coefficient=0.90, p=0.017) and personal motivation (regression coefficient=1.66, p<0.001). Conclusions The findings suggest relatively sparse use of data in local quality improvement work. A complex interplay of factors seem to be associated with data use with varying aspects being of importance for frontline staff and managers.
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| 2. |
- Joshi, Vicky L., et al.
(författare)
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Observer-reported cognitive decline in out-of-hospital cardiac arrest survivors and its association with long-term survivor and relative outcomes
- 2024
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Ingår i: Resuscitation. - 0300-9572. ; 197
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Tidskriftsartikel (refereegranskat)abstract
- AimLong-term cognitive decline after out-of-hospital cardiac arrest (OHCA) is still poorly understood. This study describes long-term observer-reported cognitive decline among Danish OHCA survivors, including differences in years since the event, and investigates characteristics and self-reported outcomes associated with observer-reported cognitive decline.MethodsAdults who survived an OHCA from 2016 to 2019, and their relatives, completed the national DANish Cardiac Arrest Survivorship survey. Relatives completed the Informant Questionnaire on Cognitive Decline in the Elderly, Cardiac Arrest version (IQCODE-CA), the Hospital Anxiety and Depression Scale (HADS) and the World Health Organisation-Five Well-being index; and survivors completed the Two Simple Questions (everyday activities and mental recovery), the Modified Fatigue Impact Scale, HADS, and the Short World Health Organisation Disability Assessment Schedule 2.0. Potential associations between survivor characteristics and the IQCODE-CA were investigated using a multivariable logistic regression model. Self-reported outcomes among survivors and relatives, and the association with IQCODE-CA scores were investigated using separate logistic regression models.ResultsTotal median IQCODE-CA score was 3.04 (IQR: 3.00–3.27), with 47% having possible cognitive decline (score ≥ 3.04), consistent across time groups. Increasing age (OR 0.98, 95% CI: 0.97–0.99) and worse self-reported mental and physical outcomes for survivors and relatives, except ‘everyday activities’ were significantly associated with possible cognitive decline among survivors.ConclusionsNearly half of OHCA survivors may suffer long-term cognitive decline. Worse self-reported mental and physical outcomes among survivors and their relatives are associated with potential cognitive decline emphasising the need for post-OHCA care to include systematic neurocognitive assessment, tailored support and effective rehabilitation.
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| 3. |
- Lindstrom Egholm, Cecilie, et al.
(författare)
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Implementation of a politically initiated national clinical guideline for cardiac rehabilitation in hospitals and municipalities in Denmark
- 2018
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Ingår i: Health Policy. - : ELSEVIER IRELAND LTD. - 0168-8510 .- 1872-6054. ; 122:9, s. 1043-1051
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Tidskriftsartikel (refereegranskat)abstract
- A politically initiated national clinical guideline was launched in Denmark in 2013 to improve quality and equality of cardiac rehabilitation (CR) services. The guideline is to be implemented in both hospital and community (municipality) settings due to shared responsibility for provision of CR services. Little is known about implementation outcomes of a guideline in these two settings. We aimed to study this by determining the extent to which Danish CR services in hospitals and municipalities adhered to national recommendations following the launch of the guideline. The study employed an observational, longitudinal design. Data were gathered by a questionnaire survey to compare CR services at baseline, measured in 2013 immediately before the guideline was launched, with CR services at a two-year follow up in 2015. All Danish hospital departments offering CR services (N = 36) and all municipalities (N = 98) were included. Data were analysed using inferential statistics. Hospitals reported improvement of both content and quality of CR services. Municipalities reported no change in content of services, and lower level of fulfilment of one quality aspect. The results suggest that the guideline had different impact in hospitals and municipalities and that the differences in content and quality of services between the two settings increased in the study period, thus contradicting the guidelines aim of uniform, evidence-based content of CR services across settings. (C) 2018 Elsevier B.V. All rights reserved.
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| 4. |
- Lindström Egholm, Cecilie, et al.
(författare)
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Struggling with practices
- 2019
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Ingår i: BMC Health Services Research. - : BMC. - 1472-6963. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe use of clinical quality registries as means for data driven improvement in healthcare seem promising. However, their use has been shown to be challenged by a number of aspects, and we suggest some may be related to poor implementation. There is a paucity of literature regarding barriers and facilitators for registry implementation, in particular aspects related to data collection and entry. We aimed to illuminate this by exploring how staff perceive the implementation process related to the registries within the field of cardiac rehabilitation in England and Denmark.MethodsA qualitative, interview-based study with staff involved in collecting and/or entering data into the two case registries (England N=12, Denmark N=12). Interviews were analysed using content analysis. The Consolidated Framework for Implementation Research was used to guide interviews and the interpretation of results.ResultsThe analysis identified both similarities and differences within and between the studied registries, and resulted in clarification of staffs experiences in an overarching theme: Struggling with practices and five categories; the data entry process, registry quality, resources and management support, quality improvement and the wider healthcare context. Overall, implementation received little focused attention. There was a lack of active support from management, and staff may experience a struggle of fitting use of a registry into a busy and complex everyday practice.Conclusion The study highlights factors that may be important to consider when planning and implementing a new clinical quality registry within the field of cardiac rehabilitation, and is possibly transferrable to other fields. The results may thus be useful for policy makers, administrators and managers within the field and beyond. Targeting barriers and utilizing knowledge of facilitating factors is vital in order to improve the process of registry implementation, hence helping to achieve the intended improvement of care processes and outcomes.
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| 5. |
- Palm Johansen, Pernille, et al.
(författare)
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The CopenHeartSF trial-comprehensive sexual rehabilitation programme for male patients with implantable cardioverter defibrillator or ischaemic heart disease and impaired sexual function: protocol of a randomised clinical trial
- 2013
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Ingår i: BMJ Open. - : BMJ Publishing Group: BMJ Open / BMJ Journals. - 2044-6055. ; 3:11, s. 3967-
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Sexuality is an important part of peoples physical and mental health. Patients with heart disease often suffer from sexual dysfunction. Sexual dysfunction has a negative impact on quality of life and well-being in persons with heart disease, and sexual dysfunction is associated with anxiety and depression. Treatment and care possibilities seem to be lacking. Studies indicate that non-pharmacological interventions such as exercise training and psychoeducation possess the potential of reducing sexual dysfunction in patients with heart disease. The CopenHeartSF trial will investigate the effect of a comprehensive sexual rehabilitation programme versus usual care. Methods and analysis CopenHeartSF is an investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 central randomisation to sexual rehabilitation plus usual care versus usual care alone. Based on sample size calculations, 154 male patients with impaired sexual function due to implantable cardioverter defibrillator or ischaemic heart disease will be included from two university hospitals in Denmark. All patients receive usual care and patients allocated to the experimental intervention group follow a 12-week sexual rehabilitation programme consisting of an individualised exercise programme and psychoeducative consultation with a specially trained nurse. The primary outcome is sexual function measured by the International Index of Erectile Function. The secondary outcome measure is psychosocial adjustment to illness by the Psychosocial Adjustment to Illness Scale, sexual domain. A number of explorative analyses will also be conducted. Ethics and dissemination CopenHeartSF is approved by the regional ethics committee (no H-4-2012-168) and the Danish Data Protection Agency (no 2007-58-0015) and is performed in accordance with good clinical practice and the Declaration of Helsinki in its latest form. Registration Clinicaltrials.gov identifier: NCT01796353.
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| 6. |
- Rasmussen, Trine Bernholdt, et al.
(författare)
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Comprehensive cardiac rehabilitation for patients following infective endocarditis: results of the randomized CopenHeartIE trial.
- 2022
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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. ; 21:3, s. 261-270
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Tidskriftsartikel (refereegranskat)abstract
- Infective endocarditis is a complex and highly mortal disease requiring lengthy treatment. Physical and mental deconditioning is common. Nonetheless, rehabilitation is virtually unexplored in this population. The aim of this trial was therefore to investigate the effects of cardiac rehabilitation in patients following endocarditis.In a randomized trial, adults with left-sided or cardiac device endocarditis were randomized 1:1 to 12 weeks of physical exercise training and five psycho-educational consultations (cardiac rehabilitation) vs. usual care without rehabilitation (control). Primary outcome was mental health measured by SF-36 Mental Component Summary (MCS) at 6 months. Secondary outcome was physical capacity measured by peak oxygen uptake (VO2) at 4 months. Exploratory outcomes were investigated. Low inclusion rate resulted in trial termination before reaching the target sample size. A total of 117 participants (mean age: 60years, 81% male) were randomized to cardiac rehabilitation (n=58) or to control (n=59). Mental health and physical capacity at baseline were generally poor (MCS: 38.9-42.2 points, VO2 peak: 16.1-16.6mL/kg/min). Cardiac rehabilitation compared with control showed no effect on mental health (MCS: 44.6 points vs. 48.8 points, P=0.41) or physical capacity (VO2 peak: 19.9mL/kg/min vs. 18.0mL/kg/min, P=0.09). Effects favouring the intervention were identified in exploratory outcomes including general fatigue (P=0.005), and physical capacity as maximal power (W) (P=0.005). Adherence to the intervention was 28%.Results indicate no effect of cardiac rehabilitation in patients following endocarditis; however, lack of statistical power and poor adherence render findings inconclusive. Valuable insight into patients' capabilities and safety was gained, and further investigations into rehabilitation needs and modes of delivery in this high-need population should be a future priority.
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| 7. |
- Rasmussen, Trine Bernholdt, et al.
(författare)
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High readmission rates and mental distress after infective endocarditis - Results from the national population-based CopenHeart IE survey.
- 2017
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Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 235, s. 133-140
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Tidskriftsartikel (refereegranskat)abstract
- Infective endocarditis (IE) is a severe disease requiring lengthy hospitalisation. Little is known about patients' recovery after IE. The aims of this study in IE patients were; (i) to describe mortality, readmission, self-reported health and rehabilitation up to 1year post-discharge, (ii) to examine associations between self-reported health and readmission, and (iii) to investigate predictors of readmission and mortality.All adults treated for IE in Denmark, January-June 2011 (N=347), were followed in registers. Eligible individuals (n=209) were invited to participate in a questionnaire survey (responders n=122). Responses were compared with those of a background reference population and a heart valve surgery population. Mortality and readmission data from registers 12months post-discharge were investigated.Patients discharged after treatment for IE had a mortality of 18% (95% confidence interval (CI): 14%-23%) one year post-discharge and 65% (95% CI: 59%-71%) had been readmitted, the majority (82%) acutely. Patients had lower self-reported health compared to the background population (physical component scale (PCS); mean (standard deviation (SD)): 42.2 (11.1) vs. 47.1 (12.1), (p=0.0004), mental component scale (MCS); 50.1 (11.7) vs. 53.8 (9.2), (p=0.006), and more were sedentary (29 vs. 15%), (p=0.002). Large proportions had clinical signs of anxiety and depression, 25% and 22% respectively, exceeding a hospital anxiety and depression scale (HADS) cut-off score of 8. Almost half (47%) had not been offered cardiac rehabilitation (CR).After IE, mortality and readmission rates were high and self-reported physical and mental health poor. These findings call for changes in in-hospital and post-discharge management.
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| 8. |
- Rasmussen, Trine Bernholdt, et al.
(författare)
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Validity, reliability and responsiveness of the Body Image Quality of Life Inventory in patients treated for infective endocarditis.
- 2017
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Ingår i: Scandinavian journal of caring sciences. - : Wiley. - 1471-6712 .- 0283-9318. ; 31:1, s. 183-190
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Tidskriftsartikel (refereegranskat)abstract
- Suffering through infective endocarditis (IE) can drastically alter a person's physical appearance, and body image-related concerns have been reported by patients. The extent and severity of the phenomenon has not previously been explored, as no quantitative measure has been validated in this patient population. The purpose of this study was thus to assess the validity, reliability and responsiveness of the Danish Body Image Quality of Life Inventory (BIQLI-DA) on patients treated for IE.
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