| 1. |
- Aitken, Leanne M., et al.
(författare)
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What is the relationship between elements of ICU treatment and memories after discharge in adult ICU survivors?
- 2016
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Ingår i: Australian Critical Care. - : Elsevier BV. - 1036-7314 .- 1878-1721. ; 29:1, s. 5-14
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesPatients admitted to an intensive care unit (ICU) often experience distressing memories during recovery that have been associated with poor psychological and cognitive outcomes. The aim of this literature review was to synthesise the literature reporting on relationships between elements of ICU treatment and memories after discharge in adult ICU survivors.Review method usedIntegrative review methods were used to systematically search, select, extract, appraise and summarise current knowledge from the available research and identify gaps in the literature.Data sourcesThe following electronic databases were systematically searched: PubMed, Ovid EMBASE, EBSCOhost CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials. Additional studies were identified through searches of bibliographies. Original quantitative research articles written in English that were published in peer-review journals were included.Review methodsData extracted from studies included authors, study aims, population, sample size and characteristics, methods, ICU treatments, ICU memory definitions, data collection strategies and findings. Study quality assessment was based on elements of the Critical Appraisal Skills Programme using the checklists developed for randomised controlled trials and cohort studies.ResultsFourteen articles containing data from 13 studies met the inclusion criteria and were included in the final analysis. The relatively limited evidence about the association between elements of ICU treatment and memories after ICU discharge suggest that deep sedation, corticoids and administration of glucose 50% due to hypoglycaemia contribute to the development of delusional memories and amnesia of ICU stay.ConclusionsThe body of literature on the relationship between elements of ICU treatment and memories after ICU discharge is small and at its early stages. Larger studies using rigorous study design are needed in order to evaluate the effects of different elements of ICU treatment on the development of memories of the ICU during recovery.
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| 2. |
- Hallgren, Jenny, 1978-, et al.
(författare)
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‘Who will do it if I don’t?’ : Nurse anaesthetists’ experiences of working in the intensive care unit during the COVID-19 pandemic
- 2022
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Ingår i: Australian Critical Care. - : Elsevier. - 1036-7314 .- 1878-1721. ; 35:1, s. 52-58
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Tidskriftsartikel (refereegranskat)abstract
- Background: During the COVID-19 pandemic, the workload on the intensive care unit (ICU) increased nationally in Sweden as well as globally. Certified registered nurse anaesthetics (CRNAs) in Sweden were transferred at short notice to work with seriously ill patients with COVID-19 in the ICU, which is not part of the CRNAs’ specialist area. However, limited research has shed light on healthcare professionals’ experiences of the pandemic.Objectives: This study illuminates CRNAs’ experiences of working in the ICU during the COVID-19 pandemic.Methods: This study used a qualitative method with an inductive approach to interview nurse anaesthetists’ who worked in the ICU during the COVID-19 pandemic.Findings: The participants experienced ambivalent feelings towards their work in the ICU. They also lacked information, which created feelings of uncertainty and resulted in expectations that did not correspond to the reality. They described that due to an inadequate introduction, they could only provide “sufficient” care, which in many cases caused ethical stress. Not being able to get to know their new colleagues well enough to create effective cooperation created frustration. Even though the participants experienced the work in the ICU as demanding and challenging, overall, they enjoyed their time in the ICU and were treated well by their colleagues.Conclusions: While CRNAs cannot replace intensive care nurses (ICNs), they are a useful resource in the ICU in the care of patients with COVID-19. Healthcare workers who are allocated from their ordinary units to the ICU need adequate information and support from their work managers to be able to provide the best possible care and to stay healthy themselves.
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| 3. |
- Johansson, Lotta, 1965, et al.
(författare)
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Evaluation of a sound environment intervention in an ICU : A feasibility study
- 2018
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Ingår i: Australian Critical Care. - Amsterdam : Elsevier. - 1036-7314 .- 1878-1721. ; 31:2, s. 59-70
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Tidskriftsartikel (refereegranskat)abstract
- Background: Currently, it is well known that the sound environment in intensive care units (ICU) is substandard. Therefore, there is a need of interventions investigating possible improvements. Unfortunately, there are many challenges to consider in the design and performance of clinical intervention studies including sound measurements and clinical outcomes.Objectives: (1) explore whether it is possible to implement a full-scale intervention study in the ICU concerning sound levels and their impact on the development of ICU delirium; (2) discuss methodological challenges and solutions for the forthcoming study; (3) conduct an analysis of the presence of ICU delirium in the study group; and (4) describe the sound pattern in the intervention rooms.Methods: A quasi-randomized clinical trial design was chosen. The intervention consisted of a refurbished two-bed ICU patient room (experimental) with a new suspended wall-to-wall ceiling and a low frequency absorber. An identical two-bed room (control) remained unchanged.Inclusion criteria: Patients >18 years old with ICU lengths of stay (LoS) >48. h. The final study group consisted of 31 patients: six from the rebuilt experimental room and 25 from the control room. Methodological problems and possible solutions were continuously identified and documented.Results: Undertaking a full-scale intervention study with continuous measurements of acoustic data in an ICU is possible. However, this feasibility study demonstrated some aspects to consider before start. The randomization process and the sound measurement procedure must be developed. Furthermore, proper education and training are needed for determining ICU delirium.Conclusion: This study raises a number of points that may be helpful for future complex interventions in an ICU. For a full-scale study to be completed a continuously updated cost calculation is necessary. Furthermore, representatives from the clinic need to be involved in all stages during the project.
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| 4. |
- Raiskila, Simo, et al.
(författare)
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Parent and nurse perceptions on the quality of family-centred care in 11 European NICUs
- 2016
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Ingår i: Australian Critical Care. - : Elsevier BV. - 1036-7314 .- 1878-1721. ; 29:4, s. 201-209
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Family-centred care (FCC) is a state-of-the-art practice in neonatal intensive care units (NICU) based on its shown benefits on the well-being of both infants and parents. However, there is no systematic knowledge about how FCC is implemented in different European contexts. OBJECTIVES: To describe parents' presence and the quality of FCC from the perspectives of mothers, fathers and nurses in 11 European NICUs. METHODS: A prospective survey was conducted in Finland, Sweden, Norway, Estonia, Spain and Italy. The perceived quality of FCC was measured using 8 text-message questions sent to the parents' mobile phones, one question each day, during the infant's hospital stay. Nurses answered corresponding questions through a Web questionnaire during a 3-month period. The responses were rated on a 7-point Likert scale. Parents who were not present in the unit during the day used a "0" response. RESULTS: A total of 262 families of preterm infants born before 35 gestational weeks participated in the study. Mothers gave 5045 responses, fathers gave 3971 responses and nurses gave 11,132 answers. The mothers were present during 92.7% and the fathers during 77.9% of the study days. The mothers rated the quality of FCC slightly higher than the fathers did (5.8 [95% CI 5.7-5.9] vs. 5.7 [95% CI 5.6-5.8], mean difference of 0.12 [95% CI 0.05-0.2], p<0.001). There was wide variation in the parents' presence and the quality of FCC between the units. The weakest aspects of FCC were emotional support, parents' participation in decision-making and fathers' participation in infant care. The perceived quality of FCC between the nurses and parents were comparable. CONCLUSIONS: This study showed a high perceived quality of FCC in 11 European units, as indicated by both parents and nurses. The innovative data-collection method and instrument successfully quantified each unit's FCC profile for further quality improvement and should be trialled in other NICUs and countries.
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| 5. |
- Tingsvik, Catarina, et al.
(författare)
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Long-term impact of COVID-19 on nursing and care delivery : A national survey among anaesthetic and critical care nurses
- 2024
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Ingår i: Australian Critical Care. - : Elsevier. - 1036-7314 .- 1878-1721.
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Tidskriftsartikel (refereegranskat)abstract
- Background: The coronavirus disease 2019 (COVID-19) pandemic has put an exceptional strain on intensive care delivery and has significantly impacted nursing practice in the intensive care unit, consequently affecting nurses' working environment and health. Little is known about the long-term impact on the nursing workforce and care delivery in intensive care and anaesthetic departments.Aim/objective: This cross-sectional study aimed to describe the long-term impact of the COVID-19 pandemic on the nursing profession and nursing care from the perspectives of anaesthetic and critical care nurses.Methods: In this study, an online questionnaire with open- and close-ended questions was distributed to registered nurses working in anaesthesia and intensive care between February 8 and March 7, 2022. The data were analysed using content analysis and descriptive statistics.Results: Of the 514 registered nurses who responded to the questionnaire, 256 (50%) worked in anaesthesia care and 215 (42%) in intensive care. The long-term impact of COVID-19 was expressed in three categories: nursing care on hold, insights and experiences forming a new professional identity, and the impact of organisational conditions on the profession. Critical care nurses considered nursing care comparable to that before the COVID-19 pandemic. Nurse anaesthetics experienced changes in nursing tasks and activities compared to that before the COVID-19 pandemic.Conclusions: Nursing care is still influenced by the pandemic due to the lack of resources and persistent high workload and needs to be reclaimed and prioritised. Re-establishing high-quality nursing care is a shared responsibility of the organisation and nursing profession, and the organisation needs to create prerequisites for this. Furthermore, nurses' views and insights into their profession developed both positively and negatively during the pandemic, which must be further considered, including the profession's values.
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| 6. |
- Tingsvik, Catarina, et al.
(författare)
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Meeting the challenge : ICU-nurses' experiences of lightly sedated patients
- 2013
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Ingår i: Australian Critical Care. - : Elsevier BV. - 1036-7314 .- 1878-1721. ; 26:3, s. 124-129
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSedation of intensive care patients is necessary for comfort and to implement appropriate treatment. The trend of sedation has gone from deep to light sedation. The topic is of interest to intensive care nursing because patients are generally more awake, which requires a different clinical approach than caring for deeply sedated patients.PurposeThe aim of this study was to describe intensive care unit (ICU) nurses experiences of caring for patients who are lightly sedated during mechanical ventilation.MethodsA qualitative approach was used. Semi-structured interviews with nine intensive care nurses were conducted. The interview texts were subjected to qualitative content analysis, resulting in the formulation of one main category and six sub-categories.FindingsThe nurses’ experience of lightly sedated patients was described as a challenge requiring knowledge and experience. The ability to communicate with the lightly sedated patient is perceived as important for ICU nurses. Individualised nursing care respecting the patients’ integrity, involvement and participation are goals in intensive care, but might be easier to achieve when the patients are lightly sedated.ConclusionThe results reinforce the importance of communication in nursing care. It is difficult however to create an inter-personal relationship, encourage patient involvement, and maintain communication with deeply sedated patients. When patients are lightly sedated, the nurses are able to communicate, establish a relationship and provide individualised care. This is a challenge requiring expertise and patience from the nurses. Accomplishing this increases the nurses satisfaction with their care. The positive outcome for the patients is that their experience of their stay in the ICU might become less traumatic.
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| 7. |
- Watson, Kirsty, et al.
(författare)
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The incidence and characteristics of ventilator-associated pneumonia in a regional nontertiary Australian intensive care unit: A retrospective clinical audit study
- 2022
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Ingår i: Australian Critical Care. - : ELSEVIER SCIENCE INC. - 1036-7314 .- 1878-1721. ; 35:3, s. 294-301
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation in the intensive care unit. The incidence, patient characteristics, and outcomes have not been described in a regional Australian setting. Objectives: The primary objective was to establish the incidence of VAP in a regional intensive care unit using predetermined diagnostic criteria. The secondary objective was to compare the agreement between criteria-based and physician-based diagnostic processes. The tertiary objectives were to compare patient characteristics and clinical outcomes of cases with and without VAP. Methods: A retrospective clinical audit was performed of adult patients admitted to Rockhampton Intensive Care Unit, Australia, between 2013 and 2016. We included all patients ventilated for >72 h and not diagnosed with a pneumonia before or during the first 72 h of ventilation. Results: A total of 170 cases met the inclusion criteria. The incidence of VAP as per the criteria-based diagnosis was 27.3 cases per 1000 ventilator days (95% confidence interval [CI]: 18.4-36.2) and as per the physician-based diagnosis was 25.8 cases per 1000 ventilator days (95% CI: 17.1-34.4). There was a moderate chance-corrected agreement between the criteria-and physician-based diagnosis. Very obese cases (body mass index [BMI] >40) were nearly four times more likely to develop VAP than cases with normal BMI (BMI <30) (odds ratio: 3.664; 95% CI: 1.394-9.634; p = 0.008). After controlling for sex, BMI category, comorbidities, and Acute Physiology and Chronic Health Evaluation II scores, there was a trend (p = 0.283) for higher adjusted mortality rate for cases with VAP (10.1%, 95% CI: 4.8-21.5) than for those without VAP (6.1%, 95% CI: 3.0-12.4). Cases with VAP had a higher total hospital cost ($123,223 AUD vs $66,425 AUD, p < 0.001), than cases without VAP. Conclusions: This is the first study reporting incidence of VAP in an Australian regional intensive care unit setting. An increased length of stay and significantly higher hospital costs warrant research investigating reliable and valid clinical prediction rules to forecast those at risk of VAP.
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| 8. |
- Åkerman, Eva, 1961-, et al.
(författare)
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Preferred content and usefulness of a photodiary as described by ICU-patients-A mixed method analysis
- 2013
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Ingår i: Australian Critical Care. - : Elsevier. - 1036-7314 .- 1878-1721. ; 26:1, s. 29-35
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Tidskriftsartikel (refereegranskat)abstract
- Many ICU-patients have memory-gaps which may affect their recovery. A tool in the recovery can be an ICU-diary to explain and clarify thoughts and events from the ICU-period. There are different standards for the content in the ICU-diary. The aim of this study was to identify the preferred content and usefulness of an ICU-diary as described by ICU-patients.Method: a descriptive, exploratory cohort design with a mixed method approach. The patients answered a questionnaire (n=115) and participated in an interview (n=15) six months after the ICU-stay. Data analysis was carried out in three stages; the questionnaire was analysed by descriptive statistics and categorized by content (four open-ended questions) and the interviews were analysed by manifest content analysis.Results: The patients explained that detailed information about daily activities and medical facts had to be included to understand and give a sense of coherence of what had happened. The content in the ICU-diary had to be chronological in order to follow the process in which photos were an important part. The patients re-read the ICU-diary during the recovery which helped them to fill in the memory gaps and used it as a tool for communication.Conclusion; To construct a coherent story, it was essential that the ICU-diary was complete and were amplified by photos, all appearing in a chronological order. The results of this study could form a basis for further developments of standards and guidelines for ICU-diaries
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| 9. |
- Bergman, Lina, 1985, et al.
(författare)
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Improving quality and safety during intrahospital transport of critically ill patients: A critical incident study.
- 2020
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Ingår i: Australian critical care : official journal of the Confederation of Australian Critical Care Nurses. - : Elsevier BV. - 1036-7314. ; 33:1, s. 12-19
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Tidskriftsartikel (refereegranskat)abstract
- Intrahospital transport is a high-risk procedure for critically ill patients, yet there is little known about how the transport team manages critical incidents that occur.The aim of this study was to explore critical care nurses' and physicians' experiences and practices associated with critical incidents during the transfer process in critically ill patients.As a part of an ethnographic study, semistructured interviews were performed using the critical incident technique. Data were collected in two intensive care units at one university hospital in a Swedish metropolitan city. Critical care nurses (n=15) and physicians (n=5) were interviewed, together describing a total of 46 critical incidents. Data were analysed using qualitative content and thematic analysis approaches.Content analysis of nurses' and physicians' practices resulted in a description of requirements for safe transports, including organisational prerequisites, professional skills and attributes, as well as actions and behaviours of safely performing transfers. Exploring the experiences of nurses and physicians in transporting critically ill patients yielded three main themes. The first theme, a hazardous process, revealed how caring for critically ill patients during intrahospital transfers was perceived as an unsafe, demanding task that presents several threats to the patient's safety. However, despite worries and concerns, participants trusted their own abilities to handle unexpected events, resulting in the second theme, performing when it matters. The third theme, towards safe practice, captured suggestions for improvement and attitudes towards existing safety hazards.To prevent and manage critical incidents during intrahospital transport, findings of this study suggest that nontechnical skillssuch as situational awareness and teamworkare essential. In addition, the team must possess the requisite technical skills and knowledge to undertake transports. Finally, organisations are required to provide a supportive and sustainable transport environment that includes fewer transport-related hazards.
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| 10. |
- Fagerdahl, A. M., et al.
(författare)
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Patient experience of necrotising soft-tissue infection from diagnosis to six months after intensive care unit stay: A qualitative content analysis
- 2020
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Ingår i: Australian Critical Care. - : Elsevier BV. - 1036-7314. ; 33:2, s. 187-192
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Necrotizing soft tissue infection (NSTI) is a severe, life-threatening condition requiring immediate diagnosis and treatment to avoid widespread tissue destruction and death. Current research seeks to explain the complex interaction between patient and disease agent, whereas only few studies have addressed the patient perspective. Objective: The present study aimed to describe the patient experience of NSTI in the first six months after diagnosis. Methods: The study had a qualitative design with patient involvement. We interviewed 27 NSTI survivors at six months after diagnosis and applied content analysis to capture their experiences. Patients were recruited from two referral centers in Sweden and one in Denmark. Findings: We identified three categories representing chronological stages of the illness trajectory depicting pivotal patient experiences: regaining awareness in the intensive care unit, transitioning to the ward, and returning home to normal life. Fear of infection or reinfection permeated all stages of the trajectory. Each stage was characterized by ambivalence: at first the relief of being alive and distress of serious illness, then the relief of independence and distress of abandonment, and finally the relief of being home and distress of still being dependent on others. Conclusion: Fear of infection and reinfection during and after hospitalization characterized lives of NSTI survivors and their family. This fear was potentially debilitating in daily life, working life and social life. Healthcare professionals need to be aware of these modifiable factors to help alleviate the concerns of patient and family throughout the illness trajectory. (C) 2019 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
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| 11. |
- Hargovan, Satyen, et al.
(författare)
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The 4-Hour Cairns Sepsis Model: A novel approach to predicting sepsis mortality at intensive care unit admission
- 2021
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Ingår i: Australian Critical Care. - : Elsevier BV. - 1036-7314. ; S1036-7314:20, s. 30367-2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sepsis commonly causes intensive care unit (ICU) mortality, yet early identification of adults with sepsis at risk of dying in the ICU remains a challenge. Objective: The aim of the study was to derive a mortality prediction model (MPM) to assist ICU clinicians and researchers as a clinical decision support tool for adults with sepsis within 4 h of ICU admission. Methods: A cohort study was performed using 500 consecutive admissions between 2014 and 2018 to an Australian tertiary ICU, who were aged ≥18 years and had sepsis. A total of 106 independent variables were assessed against ICU episode-of-care mortality. Multivariable backward stepwise logistic regression derived an MPM, which was assessed on discrimination, calibration, fit, sensitivity, specificity, and predictive values and bootstrapped. Results: The average cohort age was 58 years, the Acute Physiology and Chronic Health Evaluation III-j severity score was 72, and the case fatality rate was 12%. The 4-Hour Cairns Sepsis Model (CSM-4) consists of age, history of renal disease, number of vasopressors, Glasgow Coma Scale, lactate, bicarbonate, aspartate aminotransferase, lactate dehydrogenase, albumin, and magnesium with an area under the receiver operating characteristic curve of 0.90 (95% confidence interval = 0.84–0.95, p < 0.00001), a Nagelkerke R2 of 0.51, specificity of 0.94, a negative predictive value of 0.98, and almost identical odds ratios during bootstrapping. The CSM-4 outperformed existing MPMs tested on our data set. The CSM-4 also performed similar to existing MPMs in their derivation papers whilst using fewer, routinely collected, and inexpensive variables. Conclusions: The CSM-4 is a newly derived MPM for adults with sepsis at ICU admission. It displays excellent discrimination, calibration, fit, specificity, negative predictive value, and bootstrapping values whilst being easy to use and inexpensive. External validation is required.
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| 12. |
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| 13. |
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| 14. |
- Kaminski, Kathryn M., et al.
(författare)
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When do stop-loss rules stop losses?
- 2014
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Ingår i: Journal of financial markets. - : Elsevier BV. - 1386-4181 .- 1878-576X. ; 18, s. 234-254
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Tidskriftsartikel (refereegranskat)abstract
- We propose a simple analytical framework to measure the value added or subtracted by stop-loss rules-predetermined policies that reduce a portfolio's exposure after reaching a certain threshold of cumulative losses-on the expected return and volatility of an arbitrary portfolio strategy. Using daily futures price data, we provide an empirical analysis of stop-loss policies applied to a buy-and-hold strategy using index futures contracts. At longer sampling frequencies, certain stop-loss policies can increase expected return while substantially reducing volatility, consistent with their objectives in practical applications.
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| 15. |
- Åkesdotter, Cecilia, et al.
(författare)
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The prevalence of Mental Health Problems in elite athletes
- 2020
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Ingår i: Journal of Science and Medicine in Sport. - : Elsevier. - 1440-2440 .- 1878-1861. ; :4, s. 329-335
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesThe first aim was to examine mental health problems (MHP) in elite athletes addressing prevalence, sex-differences, onset, recurrent episodes, help-seeking, symptoms of specific disorders and previous psychiatric diagnoses. The second aim was to investigate if sport-specific instruments could indicate clinical levels of psychiatric symptoms.DesignCross-sectional survey.MethodsElite athletes (representing different Swedish national teams and applying for a university scholarship (n = 333) answered a web-based survey. Females represented 58.9%. Mean age was 24.6(±3.1) years and 77.2% were individual-and 22.8% team-sport athletes.ResultsLifetime prevalence of MHP was 51.7% (females 58.2%, males 42.3%). Point prevalence was 11.7% (females 13.8%, males 8.8%). Onset of first MHP episode peaked at age 19 with 50% of onsets between ages 17–21. Recurrent episodes were common, and females sought help more than males (females 37.8%, males 16.8%). Overall 19.5% reached the clinical cut-offs for symptoms of anxiety and/or depression (females 26.0%, males 10.2%). Previous psychiatric diagnoses existed among 8.1% (females 10.7%, males 4.4%). A depressive disorder, an eating disorder or a trauma and stress related disorder (self-reported as burnout) were most common. Finally, most sport-specific instruments (80%) demonstrated a fair diagnostic accuracy compared to clinically validated instruments.ConclusionsLifetime prevalence of MHP was reported by more than half of the athletes. Symptoms manifested in young age and recurrent episodes were common. Sport-specific instruments indicating when symptoms reach clinical levels are potentially useful for data summary purposes on a group level, but without sufficiently high sensitivity and specificity to be recommend for applied work with athletes.
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