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| 2. |
- Bremer, Anders, Docent, 1957-, et al.
(författare)
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Lived experiences of surviving in‐hospital cardiac arrest
- 2019
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 33:1, s. 156-164
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundOut‐of‐hospital cardiac arrest survivors suffer from psychological distress and cognitive impairments. They experience existential insecurity and vulnerability and are striving to return to a life in which well‐being and the meaning of life have partly changed. However, research highlighting the experiences of in‐hospital cardiac arrest survivors is lacking. This means that evidence for postresuscitation care has largely been extrapolated from studies on out‐of‐hospital cardiac arrest survivors, without considering potential group differences. Studies investigating survivors’ experiences of an in‐hospital cardiac arrest are therefore needed.AimTo illuminate meanings of people's lived experiences of surviving an in‐hospital cardiac arrest.DesignAn explorative, phenomenological hermeneutic method to illuminate meanings of lived experiences.MethodParticipants were identified through the Swedish national register of cardiopulmonary resuscitation and recruited from two hospitals. A purposive sample of eight participants, 53–99 years old, who survived an in‐hospital cardiac arrest 1–3 years earlier, was interviewed.FindingsThe survivors were striving to live in everyday life and striving for security. The struggle to reach a new identity meant an existence between restlessness and a peace of mind, searching for emotional well‐being and bodily abilities. The search for existential wholeness meant a quest for understanding and explanation of the fragmented cardiac arrest event and its existential consequences. The transition from hospital to home meant a transition from care and protection to uncertainty and vulnerability with feelings of abandonment, which called for a search for security and belonging, away from isolation and loneliness.ConclusionSurviving an in‐hospital cardiac arrest can be further understood by means of the concept of hospital‐to‐home transition. Following hospital discharge, patients felt vulnerable and abandoned when pending between denial and acceptance of the ‘new’ life. Hence, the healthcare system should play a significant role when it comes to facilitate cardiac arrest survivors’ security during hospital‐to‐home transition.
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| 3. |
- Hamnegård, Carl-Hugo, 1954, et al.
(författare)
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Effect of lung volume reduction surgery for emphysema on diaphragm function
- 2006
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Ingår i: Respir Physiol Neurobiol.. ; 150:2-3
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Tidskriftsartikel (refereegranskat)abstract
- Preoperative prediction of a successful outcome following lung volume reduction surgery (LVRS) for emphysema is imperfect. One mechanism could be improvement in respiratory muscle function yet controversy exists regarding the magnitude and mechanism of such an improvement. Therefore, we measured diaphragm strength in 18 patients before and after LVRS. Mean (S.D.) FRC fell from 6.53 to 5.40l (p=0.0001). Mean sniff transdiaphragmatic pressure increased from 76 to 87cmH(2)O (14%, p<0.03) and mean twitch transdiaphragmatic pressure (Tw Pdi) increased by 2.5cmH(2)O at 3 months (12%, p=0.03). There was a highly significant increase in twitch esophageal pressure (Tw Pes) (60%, p<0.0001), which was maintained at 12 months (46% increase, p=0.0004). No change was observed in quadriceps twitch tension in nine subjects in whom it was measured. After LVRS the ratio Tw Pes:Tw Pdi increased from 0.24 to 0.37 at 3 months (p=0.0003) and 0.36 at 12 months (p=008). Low values of Sn Pdi, Sn Pes, Tw Pes and a high RV/TLC ratio were the preoperative variables most predictive of improvement in shuttle walking distance. We conclude that LVRS improves diaphragm function primarily by alteration of lung volume. Patients with poor diaphragm function and high RV/TLC ratio preoperatively are most likely to benefit from the procedure.
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| 4. |
- Israelsson, Johan, et al.
(författare)
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Factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter-defibrillator
- 2018
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Ingår i: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 132, s. 78-84
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Tidskriftsartikel (refereegranskat)abstract
- AimTo explore factors associated with health-related quality of life (HRQoL) among cardiac arrest (CA) survivors treated with an implantable cardioverter-defibrillator (ICD) in relation to gender, and to compare their HRQoL with a general population.MethodsThis cross-sectional study included 990 adults treated with an ICD after suffering CA. All participants received a questionnaire including demographics, comorbidities and instruments to measure HRQoL (EQ-5D-3L and HADS), ICD-related concerns (ICDC), perceived control (CAS), and type D personality (DS-14). HRQoL (EQ-5D-3L) was compared to a general Swedish population, matched for age and gender. Linear regression analyses were used to explore factors associated with HRQoL.ResultsThe CA survivors reported better HRQoL in EQ index and less pain/discomfort compared to the general population (p < 0.001). In contrast, they reported more problems in mobility and usual activities (p < 0.01). Problems with anxiety and depression were reported by 15.5% and 7.4% respectively. The following factors were independently associated with all aspects of worse HRQoL: being unemployed, suffering more comorbidity, perceiving less control, and having a type D personality. Further, being female and suffering ICD-related concerns were independently associated with worse HRQoL in three of the four final regression models.ConclusionsThis extensive population-based study showed that most CA survivors living with an ICD rate their HRQoL as acceptable. In addition, their HRQoL is similar to a general population. Women reported worse HRQoL compared to men. Several factors associated with HRQoL were identified, and might be used when screening patients for health problems and when developing health promoting interventions.
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| 5. |
- Israelsson, Johan, et al.
(författare)
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Factors associated with health status and psychological distress among cardiac arrest (CA) survivors living with an implantable cardioverter-defibrillator (ICD)
- 2017
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Konferensbidrag (refereegranskat)abstract
- Background: The aim was to explore factors associated with health status and psychological distress among ICD-implanted CA survivors. Materials and methods: This cross-sectional study included all eligible adult ICD-implanted CA survivors in the Swedish ICD and Pacemaker Registry, 2011-2012. Health status and psychological distress were measured with the EQ-5D-5L (EQ index & EQ VAS) and the Hospital Anxiety and Depression Scale (HADS) respectively. Linear regression analyses were used to explore associations between explanatory- and outcome variables.Results: In total, 990 patients (22% women) with a median age of 68 (q1-q3=60-74) were included. Time since the CA varied between 6 months to 23 years. The median values for EQ index and EQ VAS were 0.85 (q1-q3=0.73-1.00) and 80 (q1-q3=69-90) respectively. Gender, comorbidity, receiving ICD-shock/-s, perceived control and personality were independently associated with health status. The final models explained 25% (EQ index) and 30% (EQ VAS) of the total variance (according to the R2 values). The median values for HADS Anxiety and HADS Depression were 3 (q1-q3=1-6) and 2 (q1-q3=1-4) respectively. Age, gender, comorbidity, living alone, ICD-related concerns, perceived control and personality were independently associated with psychological distress. The final models explained 51% (HADS Anxiety) and 44% (HADS Depression) of the total variance.Conclusion: Age, gender, living alone, comorbidity, receiving ICD-shock/-s, ICD-related concerns, perceived control and personality were associated with health status and/or psychological distress. These results contribute to a better understanding of the life situation among CA survivors, and may be important to develop individualized post CA care.
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| 7. |
- Moonen, M., et al.
(författare)
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Effects of lung volume reduction surgery on distribution of ventilation and perfusion
- 2005
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Ingår i: Clin Physiol Funct Imaging. ; 25:3
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Tidskriftsartikel (refereegranskat)abstract
- Summary Lung volume reduction surgery (LVRS) results in functional improvements in most patients. The mechanisms behind the improvements are not clear. We hypothesized that reduced inequalities in ventilation to perfusion ratio (V/Q) may be a contributing explanation. Nine patients who underwent LVRS were investigated by ventilation and perfusion scintigrams before and after surgery. In addition, 8 healthy subjects were investigated once. The relative ventilation, perfusion and V/Q were calculated in 1 x 1 cm lung elements. Normal range of the element count-rate was determined by the corresponding results in the normal subjects. Results of this small study show a significant effect of LVRS on V/Q, with reduction of shunt-like elements. We conclude that the functional improvement after LVRS to some extent may be explained by decreased V/Q inequality.
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| 8. |
- Scherstén, Henrik, 1956, et al.
(författare)
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ECMO kan vara brygga till lungtransplantation : Ny metod räddar liv vid akut lungsvikt, visar retrospektiv studie.
- 2011
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Ingår i: Läkartidningen. - 0023-7205. ; 108:32-33, s. 1493-7
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Tidskriftsartikel (refereegranskat)abstract
- Lungtransplantation har utförts i Sverige sedan 20 år. Patienter som snabbt försämras i akut lungsvikt och inte återhämtar sig med konservativ behandling har tidigare bedömts som inte transplantabla och därför avlidit. Sedan några år använder vi i utvalda fall extrakorporeal membranoxygenering (ECMO) som brygga till lungtransplantation hos annars döende patienter. Överlevnaden för patienter som behandlats med ECMO syftande till lungtransplantation var 73 procent (8/11). Överlevnaden för dem som sedan genomgick lungtransplantation var 89 procent (8/9). Ingreppen genererade en hel del morbiditet, dock mest av övergående natur. Vi anser att ECMO-behandling i selekterade fall kan erbjudas yngre och medelålders patienter, trots att behandlingen i sig väcker frågor om morbiditet, kostnader och resursförbrukning. Det återstår att utvärdera långtidsresultaten hos patienter som genomgått ECMO-behandling som brygga till lungtransplantation.
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| 9. |
- Thylén, Anders, 1957
(författare)
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Hyaluronan in malignant pleural mesothelioma with special reference to diagnosis, tumourbiology and prognosis
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Malignant pleural mesothelioma (MPM), the primary malignant tumour of the pleural cavity, is an uncommon and treatment resistant tumour. The prognosis is poor. In many, but not all cases the concentration of hyaluronan (Hya) is increased in pleural effusion. The clinical relevance of Hya in MPM is not clear. The primary aims of the present study were to examine the role of Hya in the diagnosis, the clinical follow-up, the prognosis and to immunohistochemically characterize Hya-producing MPM. A secondary aim was to evaluate the safety and efficacy of augmenting the antineoplastic effect of cisplatin by combining it with tirapazamine in a phase II trial in patients with MPM.All the cases of MPM in the present study were histologically confirmed. The compatibility of three different methods, a high-performance liquid-chromatographic method (HPLC), a radiometric assay and a semiquantitative precipitationtest for analysis of Hya in pleural effusion was examined. Hya- and non-Hya-producing MPM were immunohistochemically characterized using monoclonal antibodies towards epithelial membrane antigen (EMA), vimentin and cytokeratin (CAM 5.2). Various clinical variables, including Hya in the pleural exudate were evaluated for prognosis in 100 patients with MPM. The relation between circulating Hya and tumourvolume as estimated from serially performed CT scans was investigated in two studies. Twenty-two patients were included into the phase II study.The HPLC-method for analysis of Hya in pleural effusion recognized significantly more cases of MPM than the precipitation test. The HPLC-method and the radiometric assay were comparable in diagnosing MPM although the former in general showed higher values of Hya.The ability of MPM to produce Hya was correlated to strong reactivity towards EMA , CAM 5.2 and weak reactivity against vimentin. Elevated content of Hya in the pleural fluid was identified as a significantly favourable prognostic factor. In the subgroup of Hya producing MPM changes in tumourvolume were related to changes in concentration of Hya in serum. The response to the combination therapy of cisplatin and tirapazamine was poor. In summary, Hya may qualify as a tumour marker for MPM. Analysis of Hya in pleural effusion may serve as a diagnostic aid and analysis of circulating Hya may help monitor patients with increased synthesis of Hya in pleural effusion. The ability of the tumour to produce Hya is a marker for better prognosis. The biological properties, immunophenotype and capacity to synthesize Hya, should be taken into account in future therapeutic trials in MPM
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| 10. |
- Waldemar, Annette, et al.
(författare)
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Experiences of family-witnessed cardiopulmonary resuscitation in hospital and its impact on life : An interview study with cardiac arrest survivors and their family members
- 2023
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 32:19-20, s. 7412-7424
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore experiences of cardiac arrest in-hospital and the impact on life for the patient who suffered the arrest and the family member who witnessed the resuscitation.Background: Guidelines advocate that the family should be offered the option to be present during resuscitation, but little is known about family-witnessed cardiopulmonary resuscitation in hospital and the impact on the patient and their family.Design: A qualitative design consisting of joint in-depth interviews with patients and family members.Methods: Family interviews were conducted with seven patients and their eight cor- responding family members (aged 19–85 years) 4–10 months after a family-witnessed in-hospital cardiac arrest. Data were analysed using interpretative phenomenological analysis. The study followed the guidelines outlined in the consolidated criteria for reporting qualitative research (COREQ) checklist.Results: The participants felt insignificant and abandoned following the in-hospital cardiac arrest. Surviving patients and their close family members felt excluded, alone and abandoned throughout the care process; relationships, emotions and daily life were affected and gave rise to existential distress. Three themes and eight subordinate themes were identified: (1) the intrusion of death—powerless in the face of the fragility of life, highlights what it is like to suffer a cardiac arrest and to cope with an immediate threat to life; (2) being totally exposed—feeling vulnerable in the care relationship, describes how a lack of care from healthcare staff damaged trust; (3) learning to live again—making sense of an existential threat, pertaining to the family's reactions to a difficult event that impacts relationships but also leads to a greater appreciation of life and a positive view of the future.Conclusion: Surviving and witnessing a cardiac arrest in-hospital is a critical event for everyone involved. Patients and family members are vulnerable in this situation and need to be seen and heard, both in the hospital and after hospital discharge. Consequently, healthcare staff need to show compassion and attend to the needs of the family, which involves continually assessing how family members are coping during the process, and providing support and information during and after resuscitation.Relevance to clinical practice: It is important to provide support to family members who witness the resuscitation of a loved one in-hospital. Structured follow-up care is crucial for cardiac arrest survivors and their families. To promote person-centred care, nurses need interprofessional training on how to support family members during resuscitation, and follow-up care focusing on providing resources for multiple challenges faced by survivors (emotional, cognitive, physical) and families (emotional) is needed.Patient or public contribution: In-hospital cardiac arrest patients and family members were involved when designing the study.
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| 11. |
- Waldemar, Annette, et al.
(författare)
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Family presence during in-hospital cardiopulmonary resuscitation : effects of an online intervention on self-confidence and attitudes of healthcare professionals
- 2024
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953.
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Tidskriftsartikel (refereegranskat)abstract
- AimsGuidelines support family-witnessed resuscitation (FWR) during cardiopulmonary resuscitation in hospital if deemed to be safe, yet barriers amongst healthcare professionals (HCPs) still exist. This study aimed to evaluate the effects of an educational online video intervention on nurses’ and physicians’ attitudes towards in-hospital FWR and their self-confidence in managing such situations.Methods and resultsA pre- and post-test quasi-experimental study was conducted October 2022 to March 2023 at six Swedish hospitals involving the departments of emergency care, medicine, and surgery. The 10 min educational video intervention was based on previous research covering the prevalence and outcome of FWR, attitudes of HCP, patient and family experiences, and practical and ethical guidelines about FWR. In total, 193 accepted participation, whereof 91 answered the post-test survey (47.2%) with complete data available for 78 and 61 participants for self-confidence and attitudes, respectively. The self-confidence total mean scores increased from 3.83 to 4.02 (P < 0.001) as did the total mean scores for attitudes towards FWR (3.38 to 3.62, P < 0.001). The majority (71.0%) had positive views of FWR at baseline and had experiences of in hospital FWR (58.0%). Self-confidence was highest amongst participants for the delivery of chest compressions (91.2%), defibrillation (88.6%), and drug administration (83.3%) during FWR. Self-confidence was lowest (58.1%) for encouraging and attending to the family during resuscitation.ConclusionThis study suggests that a short online educational video can be an effective way to improve HCP’s self-confidence and atti- tudes towards the inclusion of family members during resuscitation and can support HCP in making informed decisions about FWR.
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| 12. |
- Waldemar, Annette, et al.
(författare)
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In-hospital family-witnessed resuscitation with a focus on the prevalence, processes, and outcomes of resuscitation : A retrospective observational cohort study
- 2021
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Ingår i: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 165:August, s. 23-30
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Tidskriftsartikel (refereegranskat)abstract
- Aim: International and national guidelines support in-hospital, family-witnessed resuscitation, provided that patients are not negatively affected. Empirical evidence regarding whether family presence interferes with resuscitation procedures is still scarce. The aim was to describe the prevalence and processes of family-witnessed resuscitation in hospitalised adult patients, and to investigate associations between family-witnessed resuscitation and the outcomes of resuscitation.Methods: Nationwide observational cohort study based on data from the Swedish Registry of Cardiopulmonary Resuscitation.Results: In all, 3257 patients with sudden, in-hospital cardiac arrests were included. Of those, 395 had family on site (12%), of whom 186 (6%) remained at the scene. It was more common to offer family the option to stay during resuscitation if the cardiac arrest occurred in emergency departments, intensive-care units or cardiac-care units, compared to hospital wards (44% vs. 26%, p < 0.001). It was also more common for a staff member to be assigned to take care of family in acute settings (68% vs. 56%, p = 0.017). Mean time from cardiac arrest to termination of resuscitation was longer in the presence of family (20.67 min vs. 17.49 min, p = 0.020), also when controlling for different patient and contextual covariates in a regression model (Stand (b) 0.039, p = 0.027). No differences were found between family-witnessed and non-family-witnessed resuscitation in survival immediately after resuscitation (57% vs. 53%, p = 0.291) or after 30 days (35% vs. 29%, p = 0.086).Conclusions: In-hospital, family-witnessed resuscitation is uncommon, but the processes and outcomes do not seem to be negatively affected, suggesting that staff should routinely invite family to witness resuscitation.
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