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| 2. |
- Broers, C J M, et al.
(författare)
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The post-infarction nurse practitioner project : A prospective study comparing nurse intervention with conventional care in a non-high-risk myocardial infarction population.
- 2009
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Ingår i: Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. - 1568-5888. ; 17:2, s. 61-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To confirm the feasibility of nurse practitioner interventionin non-high-risk patients with recent myocardial infarction (MI). DESIGN: Observational study. SETTING: Acute coronary care unit in a teaching hospital. METHODS: We performed an open-label feasibility study to identify non-high-risk MI patients and evaluate the outcome of a new nurse practitioner intervention programme. The initial pilot phase served to identify the non-high-risk population. In the subsequent confirmation phase, 500 consecutive non-high-risk post-MI patients with preserved LV function without heart failure were included to receive nurse practitioner management. The nurse practitioner intervention started on transfer from the coronary care unit to the cardiology ward and continued thereafter for up to 30 days. MAIN OUTCOME MEASURES: Time to first event analysis of death from all causes or repeat myocardial infarction. RESULTS: 500 Patients without signs of heart failure or depressed LV function were identified as nonhigh- risk and eligible for inclusion in the nurse practitioner intervention programme. In the implementation phase, none of the patients died and 0.9% developed a repeat myocardial infarction after 30 days of follow-up. Compared with the pilot phase, patients in the implementation phase spent fewer days in hospital (mean 11.1 versus 6.2 days; p<0.001). CONCLUSION: It is feasible to identify non-high-risk post-MI patients, who can be managed adequately by a nurse practitioner. Embedding experienced nurse practitioners within critical care pathways may result in significant decreases in length of hospital stay. (Neth Heart J 2009;17:61-7.Neth Heart J 2009;17:61-7.).
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| 3. |
- Brunner-La Rocca, H.P., et al.
(författare)
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Challenges in personalised management of chronic diseases-heart failure as prominent example to advance the care process
- 2016
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Ingår i: EPMA Journal. - : Springer. - 1878-5077 .- 1878-5085. ; 7
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Forskningsöversikt (refereegranskat)abstract
- Chronic diseases are the leading causes of morbidity and mortality in Europe, accounting for more than 2/3 of all death causes and 75 % of the healthcare costs. Heart failure is one of the most prominent, prevalent and complex chronic conditions and is accompanied with multiple other chronic diseases. The current approach to care has important shortcomings with respect to diagnosis, treatment and care processes. A critical aspect of this situation is that interaction between stakeholders is limited and chronic diseases are usually addressed in isolation. Health care in Western countries requires an innovative approach to address chronic diseases to provide sustainability of care and to limit the excessive costs that may threaten the current systems. The increasing prevalence of chronic diseases combined with their enormous economic impact and the increasing shortage of healthcare providers are among the most critical threats. Attempts to solve these problems have failed, and future limitations in financial resources will result in much lower quality of care. Thus, changing the approach to care for chronic diseases is of utmost social importance.
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| 5. |
- Lenzen, M., et al.
(författare)
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Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization
- 2006
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 5:2, s. 115-121
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Tidskriftsartikel (refereegranskat)abstract
- Background: It has been recognized that a clinically significant portion of patients with coronary artery disease (CAD) continue to experience anginal and other related symptoms that are refractory to the combination of medical therapy and revascularization. The Euro Heart Survey on Revascularization (EHSCR) provided an opportunity to assess pharmacological treatment and outcome in patients with proven CAD who were ineligible for revascularization. Methods: We performed a secondary analysis of EHS-CR data. After excluding patients with ST-elevation myocardial infarction and those in whom revascularization was not indicated, 4409 patients remained in the analyses. We selected two groups: (1) patients in whom revascularization was the preferred treatment option (n = 3777, 86%), and (2) patients who were considered ineligible for revascularization (n = 632, 14%). Results: Patient ineligible for revascularization had a worse risk profile, more often had a total occlusion (59% vs. 37%, p < 0.001), were treated more often with ACE-inhibitors (65% vs. 55%, p < 0.001) but less likely with aspirin (83% vs. 88%, p < 0.001). Overall, they had higher case-fatality at 1-year (7.0% vs. 3.7%, p < 0.001). Regarding self-perceived health status, measured via the EuroQol 5D (EQ-5D) questionnaire, these same patients reported more problems on all dimensions of the EQ-5D. Furthermore, in the revascularization group we observed an increase between discharge and 1-year follow up (utility score from 0.85 to 1.00) whereas patients ineligible for revascularization did not improve over time (utility score remained 0.80). Conclusion: In this large cohort of European patients with CAD, those considered ineligible for revascularization had more co-morbidities and risk factors, and scored worse on self-perceived health status as compared to revascularized patients in the revascularization group. With the exception of ACE-inhibitors and aspirin, there were no major differences regarding drug treatment between the two groups. Given these clinically significant observations, there appears to be a role for nurse-led, multidisciplinary, rehabilitation teams that target clinically vulnerable patients whose symptoms remain refractory to standard medical care. © 2006 European Society of Cardiology.
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| 14. |
- de Geest, S, et al.
(författare)
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Undertaking nursing interventions throughout Europe : Research activities of the working group on cardiovascular nursing of the European Society of cardiology
- 2002
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Ingår i: European Journal of Cardiovascular Nursing. - 1474-5151 .- 1873-1953. ; 1:3, s. 167-169
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Tidskriftsartikel (refereegranskat)abstract
- The working Group on Cardiovascular Nursing is actively involved in international research though the UNITE (Undertaking Nursing Research Throughout Europe) research program, a new initiative for the WGCN. A group of cardiovascular nursing researchers from a number of different European countries committed themselves to a research group that is designed to promulgate international research in the field of cardiac nursing. The first study was a survey on coronary risk factors in a cohort of cardiac nurses from Europe. At this moment four additional studies are planned aimed at the development of the nursing profession in Europe and improvement of care for patients with chronic cardiac disease. If, as hoped, these studies prove to be successful, it will provide the seed for other international collaborations of this type.
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| 15. |
- De Smedt, R H E, et al.
(författare)
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Perceived medication adverse effects and coping strategies reported by chronic heart failure patients.
- 2009
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Ingår i: International journal of clinical practice (Esher). - : Hindawi Limited. - 1368-5031 .- 1742-1241. ; 63:2, s. 233-42
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Data on medication adverse effects (AEs) in chronic heart failure (CHF) are primarily based on results from clinical trials. Little is known about AEs perceived by CHF patients in daily practice and how patients deal with these subjective AEs. AIMS: To describe the scope and nature of perceived AEs of CHF patients, their coping strategies and the relationship of perceived AEs to medication, patient characteristics and quality of life. METHODS: This cross-sectional observational study included a sample of 680 patients previously hospitalised for CHF. Perceived AEs and coping strategies were collected by interviews based on a structured questionnaire. Medication and clinical information were collected by chart review. RESULTS: Of the 670 CHF patients completing the questionnaire, 17% reported at least one AE. In total, 186 AEs were reported of which 15% could not be linked to any medication. Nausea (4%), dizziness (4%), itches (3%) and rash (3%) were the most prevalent. The drug associated with the highest AE rate was pravastatin (27%). On average, more than five different drugs could be related to the AEs headache, dizziness and nausea. Patients reporting AEs had a lower general health perception, younger age and were more often using antiarrhythmic drugs. Of patients experiencing AEs, 69% conferred with their doctor, 24% reported having done nothing in reaction and 2% discontinued their medication without discussing it with the doctor. CONCLUSION: Adverse effects are frequently perceived by CHF patients, but they are difficult to recognise and manage in daily practice.
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| 16. |
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| 18. |
- Deuling, J H H, et al.
(författare)
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Closure of the femoral artery after cardiac catheterization : a comparison of Angio-Seal, StarClose, and manual compression.
- 2008
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Ingår i: Catheterization and cardiovascular interventions. - : Wiley. - 1522-1946 .- 1522-726X. ; 71:4, s. 518-23
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To compare Angio-Seal (AS) and StarClose (SC) and manual compression (MC) on efficacy of hemostasis, complication rate, safety of early mobilization, and patient comfort. BACKGROUND: Closure of the femoral artery after cardiac catheterization can be obtained through different methods. Today, physicians can choose from a number of different devices to achieve arterial closure. METHODS: In a prospective trial 450 patients were randomized to AS, SC, or MC. Patients were mobilized 1 to 2 hr after device placement, and 6 hr after MC. Data were collected during hospital admission and by telephone at one month after hospital discharge. RESULTS: Devices were used in 138/150 allocated to AS and 124/150 allocated to SC patients (92% vs. 83%, P = 0.015) Patients with MC experienced more pain during sheath removal than patients receiving a device, and rated their period of bed rest as less comfortable. Oozing and need for pressure bandage at the puncture site were observed in 37 AS patients and 57 SC patients (25% vs. 38%, P = 0.002). Hematoma occurred in 15 AS patients, in 17 SC patients, and in 14 MC patients (11 vs. 14 vs. 9%, ns). CONCLUSION: There is no difference in safety between the three methods of arterial closure. SC was more often not used or successfully deployed. SC patients more often had continuing oozing. On patient comfort, closure devices performed better than MC. Early ambulation in patients with a closure device is safe. AS is the preferred method of arterial closure after cardiac catheterization.
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| 19. |
- Dieperink, Willem, et al.
(författare)
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A 64-year old man who sustained many episodes of acute cardiogenic pulmonary edema successfully treated with Boussignac continuous positive airway pressure : a case report.
- 2007
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 119:2, s. 268-70
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Tidskriftsartikel (refereegranskat)abstract
- Continuous positive airway pressure (CPAP) is standard treatment for patients with acute cardiogenic pulmonary edema. We describe a patient who had 21 episodes of acute cardiogenic pulmonary edema due to very poor patient compliance. This 64-year old man had end-stage congestive heart failure based on systolic left ventricular dysfunction following two myocardial infarctions. In addition to routine medical treatment 15 episodes of pulmonary edema were successfully treated with Boussignac continuous positive airway pressure (BCPAP). The BCPAP system is a simple, disposable, FDA-approved device that delivers positive pressure without a ventilator. This extraordinary case underscores the utility of the BCPAP system to avoid repeated intubation and mechanical ventilation in patients with cardiogenic pulmonary edema.
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| 20. |
- Dieperink, W, et al.
(författare)
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Treatment of presumed acute cardiogenic pulmonary oedema in an ambulance system by nurses using Boussignac continuous positive airway pressure.
- 2009
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Ingår i: Emergency Medicine Journal. - : BMJ. - 1472-0205 .- 1472-0213. ; 26:2, s. 141-4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Early initiation of continuous positive airway pressure (CPAP) applied by face mask benefits patients with acute cardiogenic pulmonary oedema (ACPE). The simple disposable Boussignac CPAP (BCPAP) has been used in ambulances by physicians. In the Netherlands, ambulances are manned by nurses and not physicians. It was hypothesised that ambulance nurses are able to identify patients with ACPE and can successfully apply BCPAP. A prospective case series of patients with presumed ACPE treated with BCPAP by ambulance nurses is described. METHODS: After training of ambulance nurses, all 33 ambulances in the region were equipped with BCPAP. ACPE was diagnosed on clinical signs and pulse oximetry saturation (Spo(2)) <95%. BCPAP (5 cm H(2)O, Fio(2)>80%) was generated with an oxygen flow of 15 l/min. The physiological responses, experiences and clinical outcomes of the patients were collected from ambulance and hospital records, and ambulance nurses and patients received a questionnaire. RESULTS: From March to December 2006, 32 patients (age range 61-94 years) received BCPAP during transport to six different regional hospitals. In 26 patients (81%) a diagnosis of ACPE was confirmed. With BCPAP, median (IQR) Spo(2) increased from 79% (69-94%) to 96% (89-98%) within 20 min. The median (IQR) duration of BCPAP treatment was 26 min (21-32). The patients had no negative recollections of the treatment. Ambulance personnel were satisfied with the BCPAP therapy. CONCLUSION: When applied by ambulance nurses, BCPAP was feasible and effective in improving oxygen saturation in patients with ACPE. Although survival benefit can only be demonstrated by further research, it is considered that BCPAP can be implemented in all ambulances in the Netherlands.
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| 27. |
- Goossens, E, et al.
(författare)
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Sexual counselling of cardiac patients in Europe: culture matters
- 2011
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Ingår i: International journal of clinical practice (Esher). - : Blackwell Publishing. - 1368-5031 .- 1742-1241. ; 65:10, s. 1092-1099
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sexual problems are common amongst cardiac patients, and concerns may arise when resuming sexual activities after a cardiac event. Sexual counselling is therefore indispensible. Culture is an identified barrier to talking about sex, but research is lacking on whether and how culture influences nurses in providing sexual counselling. Design: This cross-sectional descriptive study assessed four areas related to sexual counselling provided by cardiovascular nurses. We investigated the impact of culture on these areas by surveying cardiovascular nurses living in Denmark, Norway and two regions of Belgium - Flanders, Dutch-speaking region and Wallonia, French-speaking region. Methods: Overall, 819 participants were recruited as they attended cardiovascular nursing congresses in Denmark, Norway and Belgium. Subjects completed the Undertaking Nursing Interventions Throughout Europe (UNITE) sexual counselling questionnaire, measuring practice, responsibility, confidence and perceived comfort of patients. Controlling for demographic, educational and professional covariates, we performed multiple linear regression analysis to determine the impact of culture on sexual counselling. Results: All four subscale scores were independently associated with culture. Danish nurses counselled patients significantly more often, reported feeling more responsibility and confidence and estimated more comfort in patients than Norwegian, Flemish and Walloon nurses. Conclusions: This study showed that culture matters with respect to sexual counselling for cardiac patients. Interventions should be developed improving sexual counselling of cardiac patients. Educational courses and training of healthcare professionals on sexual counselling should be more sensitive to sociocultural differences. Cross-cultural perspectives may bias attitudes of professionals as they deal with concerns of cardiac patients about resuming sexual activity.
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| 28. |
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| 29. |
- Hjelmfors, A-L, et al.
(författare)
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Patient perspectives of prognosis communication
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:Suppl. 1, s. S65-S66
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several studies describe that patients with heart failure (HF) find it important to discuss prognosis and that they want to be informed about the expectations about the illness progression. However, little is known about their actual preferences for professional communication about prognosis.Purpose: to explore patient’s perspectives regarding communication with health care professionals about the HF prognosis.Methods: 15 patients participated in focus group interviews and a further 9 patients completed individual semi-structured interviews. The patients (75% men, 52-87 years of age) were in NYHA I-III, and were not diagnosed with any other major life threatening disease. Data was analysed using thematic analysis to identify and interpret patterns in the data.Results: One overarching theme was identified: “The tension between hoping for the best and preparing for the worst” with three sub-themes. Ignorance is bliss. Describes how patients preferred to avoid thinking about the HF prognosis because they did not want to lose hope for the future. They lived one day at the time, focusing on here and now, wanting to forget about the illness altogether. Patients also preferred to decide themselves whether they wanted to talk about the prognosis with professionals or not. Nothing but the truth. Describes how patients wanted to know the objective and absolute truth about their illness and its’ prognosis and were afraid to live under false expectations. The truth about their prognosis was that they might die because of their illness. Even though the truth may hurt, they believed that knowing the truth was necessary to live as good as possible. Good news only. Patients described that they knew that HF was a chronic illness but they were ambivalent in their approach towards discussing prognosis. They wanted to know the truth about their prognosis, but at the same time they did not want to know anything since they fear they might hear something they do not want to, as this may hurt. They only wanted to receive “good” and positive information from the professionals, since they perceived such information to be something that they can benefit from.Conclusions: This study shows that patients have different preferences for communication about prognosis and uses different approaches in order to cope living with a serious condition such as heart failure. Professionals need to respect the strategies a patient uses, and be ready to support the patient according to their needs, preferences and life situation.
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| 30. |
- Hjelmfors, A-L, et al.
(författare)
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Patient perspectives of prognosis communication
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16, s. S65-S66
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 31. |
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| 32. |
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| 33. |
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| 34. |
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| 35. |
- Jaarsma, Tiny, et al.
(författare)
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Effects of education and support on self-care and resource utilization in patients with heart failure
- 1999
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 20:9, s. 673-682
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To test the effect of education and support by a nurse on self-care and resource utilization in patients with heart failure. METHODS: A total of 179 patients (mean age 73, 58% male, NYHA III-IV) hospitalized with heart failure were evaluated prospectively. Patients were randomized to the study intervention or to 'care as usual'. The supportive educative intervention consisted of intensive, systematic and planned education by a study nurse about the consequences of heart failure in daily life, using a standard nursing care plan developed by the researchers for older patients with heart failure. Education and support took place during the hospital stay and at a home visit within a week of discharge. Data were collected on self-care abilities, self-care behaviour, readmissions, visits to the emergency heart centre and use of other health care resources. RESULTS: Education and support from a nurse in a hospital setting and at home significantly increases self-care behaviour in patients with heart failure. Patients from both the intervention and the control group increased their self-care behaviour within 1 month of discharge, but the increase in the intervention group was significantly more after 1 month. Although self-care behaviour in both groups decreased during the following 8 months, the increase from baseline remained statistically significant in the intervention group, but not in the control group. No significant effects on resource utilization were found. CONCLUSIONS: Intensive, systematic, tailored and planned education and support by a nurse results in an increase in patients' self-care behaviour. No significant effects were found on use of health care resources. Additional organisational changes, such as longer follow-up and the availability of a heart failure specialist would probably enhance the effects of education and support.
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| 36. |
- Jaarsma, T, et al.
(författare)
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Heart failure management programmes in Europé
- 2006
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 5:3, s. 197-205
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Tidskriftsartikel (refereegranskat)abstract
- Background: The ESC guidelines recommend that an organised system of specialist heart failure (HF) care should be established to improve outcomes of HF patients. The aim of this study was therefore to identify the number and the content of HF management programmes in Europe. Method: A two-phase descriptive study was conducted: an initial screening to identify the existence of HF management programmes, and a survey to describe the content in countries where at least 30% of the hospitals had a programme. Results: Of the 43 European countries approached, 26 (60%) estimated the percentage of HF management programmes. Seven countries reported that they had such programmes in more than 30% of their hospitals. Of the 673 hospitals responding to the questionnaire, 426 (63%) had a HF management programme. Half of the programmes (n = 205) were located in an outpatient clinic. In the UK a combination of hospital and home-based programmes was common (75%). The most programmes included physical examination, telephone consultation, patient education, drug titration and diagnostic testing. Most (89%) programmes involved nurses and physicians. Multi-disciplinary teams were active in 56% of the HF programmes. The most prominent differences between the 7 countries were the degree of collaboration with home care and GP's, the role in palliative care and the funding. Conclusion: Only a few European countries have a large number of organised programmes for HF care and follow up. To improve outcomes of HF patients throughout Europe more effort should be taken to increase the number of these programmes in all countries. © 2006 European Society of Cardiology.
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| 37. |
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| 38. |
- Jaarsma, Tiny, et al.
(författare)
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[Information needs and problems of patients with myocardial infarct and coronary bypass. A study of information needs and problems from the viewpoint of Orem's theory]
- 1994
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Ingår i: Verpleegkunde. - 0920-3273. ; 8:4, s. 233-242
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Tidskriftsartikel (refereegranskat)abstract
- Problems and information needs of patients six months after myocardial infarction or after coronary artery bypass surgery were assessed in this study. The theoretical framework was provided by the theory of Orem (1991). Data on problems experienced and need for more or other information were collected by semi-structured interviews. Results show that almost all (81) of the 82 patiënts did experience problems the first six months after discharge. Most (60) of the 82 patients stated they had needed more or other information concerning one or more topics. Most information was needed concerning: knowledge of the disease, convalescence, tiredness, risk factors, medication, emotional reactions en deleterious effects of treatment. The relationship between problems, information needs, health condition and character of the topic (affective or cognitive) was also examined.
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| 39. |
- Jaarsma, Tiny, et al.
(författare)
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Problems of cardiac patients in early recovery
- 1995
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 21:1, s. 21-27
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Tidskriftsartikel (refereegranskat)abstract
- Most studies of the problems and information needs of patients describe these only for the period of hospitalization. In this study, however, the authors focused on the first 6 months after discharge. Eighty-two cardiac patients, admitted to a university hospital with a myocardial infarction (MI) or for coronary artery bypass surgery (CABS), were interviewed 6 months after discharge. Questions required them to describe problems they experienced in early recovery and what information they needed. All but one of the 82 patients stated they had experienced problems during the first 6 months after discharge. Most problems described concerned: emotional reactions (59%), their change in physical condition (59%), deleterious effects of treatment (56%) and convalescence (54%). Topics on which most patients needed additional or different information were: deleterious effects of the treatment (26%), physical condition (24%), risk factors (24%), convalescence (24%) and knowledge of the disease (24%).
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| 40. |
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| 41. |
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| 42. |
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| 43. |
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| 44. |
- Jaarsma, T, et al.
(författare)
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The European Journal of Cardiovascular Nursing.
- 2009
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 8:1, s. 1-
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Tidskriftsartikel (refereegranskat)
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| 45. |
- Jaarsma, Tiny, et al.
(författare)
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The relationship of nursing theory and research : the state of the art
- 1993
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 18:5, s. 783-787
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Tidskriftsartikel (refereegranskat)abstract
- Recently, the relationship between theory and research has received more attention. It seems that in the past 10 to 15 years more research studies have been published that are more or less conceptualized within (nursing) theories. However, it is not always clear how the theory has been used. The purpose of this study was to analyse the role of theory in nursing practice research. To this end, papers published in six nursing journals between 1986 and 1990 have been studied. It can be concluded that, in comparison with earlier analyses, the use of theories in nursing research studies has increased (from 13% to 21%), but the use of nursing theories has not become more frequent. However, the testing of nursing theories is minimal. On the other hand, research results are being cumulated progressively in regard to theory or to other research.
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| 46. |
- Jaarsma, T, et al.
(författare)
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[Value of basic and intensive management of patients with heart failure; results of a randomised controlled clinical trial]
- 2008
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Ingår i: Nederlandsch tijdschrift voor geneeskunde. - 0028-2162 .- 1876-8784. ; 152:37, s. 2016-21
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the efficacy of 2 nurse-directed programmes of different intensity for the counselling and follow-up of patients hospitalised for heart failure, compared with standard care by a cardiologist. DESIGN: Multicentre randomised clinical trial (www.trialregister.nl: NCT 98675639). METHOD: A total of 1023 patients were randomized after hospitalisation for heart failure to 1 of 3 treatment strategies: standard care provided by a cardiologist, follow-up care from a cardiologist with basic counselling and support by a nurse specialising in heart failure, or follow-up care from a cardiologist with intensive counselling and support by a nurse specialising in heart failure. Primary end points were the time to rehospitalisation due to heart failure or death and the number of days lost to rehospitalisation or death during the 18-month study period. Data were analysed on an intent-to-treat basis. RESULTS: Mean patient age was 71 years, 38% were women, 50% had mild heart failure and 50% had severe heart failure. During the study, 411 patients (40%) were rehospitalised due to heart failure or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (differences not significant). The time to rehospitalisation or death was similar in the 3 groups: hazard ratios for the basic and intensive support groups versus the control group were 0.96 (95% CI: 0.76-1.21; p = 0.73) and 0.93 (95% CI: 0.73-1.17; p = 0.53), respectively. The number of days lost to rehospitalisation or death was 39,960 in the control group; this number was 15% less in the intervention groups, but the difference was not significant. However, there was a trend toward lower mortality in the intervention groups. In all 3 groups, more visits occurred than planned, which may have had a considerable effect on care, notably in the control group. CONCLUSION: The results of this study indicated that the provision of additional counselling and support by a nurse specialising in heart failure as an adjuvant to intensive follow-up care provided by a cardiologist does not always lead to a reduction in rehospitalisation frequency.
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| 47. |
- Jonkman, Nini H., et al.
(författare)
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Do self-management interventions work in patients with heart failure? An individual patient data meta-analysis
- 2016
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Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 0009-7322 .- 1524-4539. ; 133:12, s. 1189-1198
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: -Self-management interventions are widely implemented in care for patients with heart failure (HF). Trials however show inconsistent results and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in HF patients and whether subgroups of patients respond differently.METHODS AND RESULTS: -Systematic literature search identified randomized trials of self-management interventions. Data of twenty studies, representing 5624 patients, were included and analyzed using mixed effects models and Cox proportional-hazard models including interaction terms. Self-management interventions reduced risk of time to the combined endpoint HF-related hospitalization or all-cause death (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.71-0.89), time to HF-related hospitalization (HR, 0.80; 95%CI, 0.69-0.92), and improved 12-month HF-related quality of life (standardized mean difference 0.15; 95%CI, 0.00-0.30). Subgroup analysis revealed a protective effect of self-management on number of HF-related hospital days in patients <65 years (mean number of days 0.70 days vs. 5.35 days; interaction p=0.03). Patients without depression did not show an effect of self-management on survival (HR for all-cause mortality, 0.86; 95%CI, 0.69-1.06), while in patients with moderate/severe depression self-management reduced survival (HR, 1.39; 95%CI, 1.06-1.83, interaction p=0.01).CONCLUSIONS: -This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death, HF-related hospitalization alone, and elicited a small increase in HF-related quality of life. The findings do not endorse limiting self-management interventions to subgroups of HF patients, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients.
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| 48. |
- Jonkman, Nini H., et al.
(författare)
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What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? : An Individual Patient Data Meta-analysis
- 2016
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Ingår i: Journal of Cardiac Failure. - : Elsevier BV. - 1071-9164 .- 1532-8414. ; 22:11, s. 861-871
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Tidskriftsartikel (refereegranskat)abstract
- Background To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations.Methods and Results Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95% confidence interval [CI] 0.97–0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95% CI 0.96–0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95% CI 0.92–0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics.Conclusion No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.
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