| 1. |
- Hedberg, Berith, 1951-, et al.
(författare)
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Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation
- 2018
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 17:5, s. 446-455
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making.AIM: The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms.METHODS: A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale-Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data.RESULTS: Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication.CONCLUSION: Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.
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| 2. |
- Hedberg, Berith, 1951-, et al.
(författare)
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Factors associated with involvement in risk communication and confidence in shared decision making among patients with atrial fibrillation.
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:Suppl. 1, s. S74-S75
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial fibrillation (AF) is a highly prevalent arrhythmia. Effective communication of risks (e.g., risk for stroke) and benefits to patients (e.g., treatment with oral anticoagulants) is crucial for shared decision making. Knowledge about how patients experience confidence and satisfaction in communication in relation to their health status is limited.Aim: The aim was to explore factors associated with involvement in risk communication and confidence in shared decision making among patients with AF.Method: A cross-sectional design was used and 322 patients (39 % women), mean age 67 years (SD 10.3 years) with AF were included at four hospitals in Sweden. Clinical examinations and self-rating scales for risk communication (COMRADE), uncertainty in illness (MUIS-C), depressive symptoms (HADS), mastery of daily life (MDL), as well as physical and mental health (SF-36) were used to collect data after a follow-up visit at the outpatient clinic 3 months post an AF episode.Results: Paroxysmal, persistent and permanent AF occurred among 32%, 34% and 7% of the patients, respectively. Patients whom had undergone DC-conversion (53%) and had anticoagulants (37%). Seven percent had been treated by a percutan ablation. Heart failure (15%) and ischemic heart disease (12%) were the most common co-morbidities. CHA2DS2-VASc >2 were seen among 62% of the patients. Overall, multiple regression analyses showed that uncertainty in illness and mastery of daily life were significantly associated with confidence in decisions and uncertainty in illness and hypertension were significantly associated with satisfaction in communication. Higher uncertainty in illness and poorer mastery of daily life were associated with poor confidence in decisions. Higher uncertainty in illness and occurrence of hypertension were associated with poor satisfaction in communication. Clinical AF variables (i.e.,symptom or treatment related) or depressive symptoms were not significantly associated with satisfaction in communication or confidence in decisions in the multiple regression analysis. The final models explained 29% and 30% of the variance in confidence in decision making and satisfaction in communication.Conclusion: In this cross-sectional study, including patients with AF, confidence in decision making and satisfaction in communication are associated with uncertainty in illness, mastery of daily life and hypertension.
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| 3. |
- Malm, Dan, 1954-, et al.
(författare)
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Effects of brief mindfulness-based cognitive behavioural therapy on health-related quality of life and sense of coherence in atrial fibrillation patients
- 2018
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 17:7, s. 589-597
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to evaluate the effects of a brief dyadic cognitive behavioural therapy (CBT) programme on the health-related quality of life (HRQoL), as well as the sense of coherence in atrial fibrillation patients, up to 12 months post atrial fibrillation.Methods: A longitudinal randomised controlled trial with a pre and 12-month post-test recruitment of 163 persons and their spouses, at a county hospital in southern Sweden. In all, 104 persons were randomly assigned to either a CBT (n=56) or a treatment as usual (TAU) group (n=55). The primary outcome was changes in the HRQoL (Euroqol questionnaire; EQ-5D), and the secondary outcomes were changes in psychological distress (hospital anxiety and depression scale; HADS) and sense of coherence (sense of coherence scale; SOC-13).Results: At the 12-month follow-up, the CBT group experienced a higher HRQoL than the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.015; P=0.02). The sense of coherence improved in the CBT group after the 12-month follow-up, compared to the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.16; P=0.04). The association between the intervention effect and the HRQoL was totally mediated by the sense of coherence (z=2.07, P=0.04).Conclusions: A dyadic mindfulness-based CBT programme improved HRQoL and reduced psychological distress up to 12 months post atrial fibrillation. The sense of coherence strongly mediated the HRQoL; consequently, the sense of coherence is an important determinant to consider when designing programmes for atrial fibrillation patients.
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| 4. |
- Malm, Dan, 1954-, et al.
(författare)
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Impact of a cognitive behavioral intervention on quality of life and psychological distress in patients with atrial fibrillation : the importance of relatives
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:Suppl. 1, s. S49-S50
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although there is an evidence to support the efficacy of cognitive behavioral therapy (CBT) in improving quality of life and decreasing psychological distress in patients with cardiovascular diseases but involving patient’s and relatives in the CBT and its effect on patient’s general health, has not been evaluated.Aim: The aim was to determine whether involving the relatives in CBT for patients with Atrial Fibrillation (AF) enhances treatment outcomes relative to treatment as usual group (TAU).Method: In a randomized controlled trial, 78 patients diagnosed with AF were randomly assigned to experimental (EXP) or TAU groups. In the EXP group, patients and relative participated in a 6-week program while the patient in the TAU group received standard care. Short Form 36(SF-36), Hospital Anxiety and Depression Scale (HADS),Euro-QoL 5-Dimension Self-Report Questionnaire (EQ-5D) and Sense of Coherence (SOC-13) were completed at baseline and at 12-month follow-up. Results: In all 78 patients completed the assessment at 12 months. The two groups were similar for sociodemographic and clinical variables at baseline. The EXP group reported significantly higher scores in EQ-5D (F= 6.18, p = 0.01) and SOC (F= 4.15, p = 0.04) than TAU group. Compared with TAU group, patients in EXP group reported significantly lower depression (F= 4.58, p = 0.04). Thirteen percent of Indirect effect of the intervention on improving patient’s quality of life in the EXP group was related to the SOC improvement (z = 11.83, p < .01).Conclusions: This study provides evidence that patients and their relatives’ involvement is more effective in improving quality of life and decreasing psychological distress than those who receiving standard care. Our results also indicate that interventions should initially focus on increasing patient’s sense of coherence.
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| 5. |
- Pakpour, Amir H., et al.
(författare)
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Can a multifaceted intervention including motivational interviewing improve medication adherence, quality of life and mortality rates in older patients undergoing coronary artery bypass surgery?
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:Suppl. 1, s. S1-S2
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for a long time, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence is therefore important. The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery.Methods: Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment as usual (TAU; n = 144) groups using cluster randomization with center level. Medication adherence was evaluated using Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL using Short-Form 36.Data were collected at baseline; three, six, and eighteen months after intervention. Survival status was followed up at eighteen months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses.Results: Compared to patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved six months after surgery (p <0.01) and remained so eighteen months after surgery (p< 0.01). QoL also increased among patients in the EXP group as compared to those who received TAU at eighteen month post-surgery (physical component summary score p= 0.02; mental component summary score p = 0.04). HR in the EXP group compared to the TAU group was 0.38 (p = 0.04).Conclusion: The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after eighteen months. QoL and survival rates increased as a function of better medication adherence.
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| 6. |
- Pakpour, Amir H., et al.
(författare)
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Cardiac rehabilitation teams‘ psychosocial determinants for sexual counseling of women with Takotsubo cardiomyopathy : A theory-based longitudinal study
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:Suppl. 1, s. S53-S54
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with Takotsubo cardiomyopathy (TSCM) especially female, may be at risk of poor psychological adjustment and deteriorated health related quality of life. Sexual dysfunction is a significant problem for patients with TSCM. Therefore, Sexual counseling should be integrated into the cardiac rehabilitation services. However, cardiac rehabilitation teams reluctant to address patient’s sexual problems. The aim of this study was to determine factors which effect on performing sexual counseling among cardiac rehabilitation team.Methods: In this longitudinal study, two hundred and forty-four specialists (i.e., physical therapists, nurses, psychologists, social workers, rehabilitation specialists and cardiologists), who were working in cardiac rehabilitation teams participated in the study at eight referral hospitals in Iran (i.e., Tehran, Qazvin, Tabriz and Zahedan). The teams were asked to complete study measures including sexual knowledge (25 items), attitude (12 items), subjective norm (5 items), perceived behavioral control (8 items), behavioral intention (2 items) and perceived barriers (17 items). Six month later, the teams were then contacted to ask the frequency of the sexual counseling sessions during the past six months.Results: Cardiac rehabilitation teams reported that sex was rarely discussed with patients (14.3%). Attitudes, subjective norms and perceived behavioral control (PBC) emerged as significant direct predictors of intention to perform sexual consulting. Multiple logistic regression analysis showed that cardiac rehabilitation teams with strong behavioral intention (OR = 1.83, 95 % CI, 1.08 to 3.10) and low perceived barriers (OR = 0.69, 95 % CI, 0.49 to 0.97) were more likely to perform the subsequent sexual consulting.Conclusions: Existing cardiac rehabilitation activities are likely to continue to fail to promote patient’s sexual functioning after cardiac events in the absence of effective strategies to reduce the underlying barriers toward sexual counseling. Interventions should be targeted on reducing barriers toward sexual counseling in cardiac rehabilitation teams.
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| 7. |
- Pakpour, Amir H., et al.
(författare)
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Help seeking behavior for sexual dysfunction in female patients with Takotsubo cardiomyopathy : A longitudinal application of the theory of planned behavior
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:Suppl. 1, s. S32-S33
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many cardiac female patients suffer from sexual dysfunction and do not seek appropriate help. Understating help-seeking intentions and behavior is fundamental to develop interventions targeted to increase using sexual health services in the patients with Takotsubo cardiomyopathy (TSCM). TSCM is a reversible weakening of the left ventricle that produces symptoms that are similar to acute myocardial infarction (e.g., shortness of breath or chest pain). A variety of psycho-affective triggers and predispositions such as stress, anxiety, depression, phobia, and anhedonia have been recognized as risk factors for TSCM. The aim of the study was to investigate the application of the Ajzen’s theory of planned behavior (TPB) in explaining female TSCM patient’s behavior in seeking treatment for sexual dysfunction.Methods: In this longitudinal study, one hundred and sixty-three female patients with TSCM were screened for sexual dysfunction by the Female Sexual Function Index (FSFI ⩽ 26.55) at eight referral hospitals in Iran (i.e.Tehran, Qazvin, Tabriz and Zahedan). The patients were then asked to complete study measures including attitude, subjective norm, perceived behavioral control, behavioral intention, self-stigma and perceived barriers at baseline. A measure of using sexual health services was obtained from electronic patient’s records. Hierarchical linear regression and logistic regressions were used to assess how well the variables of the TPB predicted behavioral intention and using sexual health services.Results: Seventy-eight female patients with TCSM were diagnosed to have sexual dysfunction (mean age 62.19 ± 8.03 years). Attitudes, perceived behavioral control (PBC) and subjective norms all predicted charitable giving intentions. Patients with strong behavioral intention (OR = 1.92, 95% CI, 1.36 to 2.73) were more likely to use sexual health services at 18 months of follow-up. Patients with high Self stigma (OR = 0.664, 95 % CI, 0.48 to 0.92) and perceived barriers (OR = 0.93, 95 % CI, 0.89 to 0.98) were less likely to use sexual health services at 18 months of follow-up.Conclusions: The results suggest that interventions designed to promote help seeking behavior for sexual dysfunction in TSCM patients should focus on reducing barriers and self-stigma and the development of a positive attitude as well the PBC.
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| 8. |
- Pakpour, Amir H., et al.
(författare)
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Prospective case-control study of sexual dysfunction in female patients with Takotsubo cardiomyopathy
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:Suppl. 1, s. S85-S86
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Tidskriftsartikel (refereegranskat)abstract
- Background: Regarding the lack of earlier studies on sexual function in female patients with Takotsubo cardiomyopathy (TSCM), the current study aimed at an investigation of psychological and quality of life measures associated with sexual function in female patients with TSCM.Methods: In this Prospective case-control study, female patients with TSCM from university hospitals in Tehran and Qazvin were enrolled and matched (1:1.1) with acute myocardial infarction (AMI) along with healthy controls (94 patients per group). Data on hospital anxiety and depression scale, SF-12, female sexual function index and female sexual distress scale were assessed at baseline, 6 months and 18 months. Multilevel logistic regressions ought associations between variables.Results: Sexual function, anxiety and depression at baseline were different among the groups with worse situations in female patients with TSCM (p < 0.01). Quality of life at baseline was similar among patient groups but at lower state than healthy controls. Overall, quality of life subscales especially among female patients with TSCM showed a downward trend, indicating deterioration overtime. Higher prevalence of sexual dysfunction in TSCM group was seen compared to female patients with AMI and control group over time (OR, 3.10 and 2.28 respectively). Sexual functioning was found to be a mediator between anxiety and quality of life which positively impacts on patient’s quality of life.Conclusions: Since the psychological and quality of life measures as well as sexual function indicated a descending trend across time, there is a necessity to intervene for these women by focus on problems like anxiety to control health deterioration.
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| 9. |
- Saffari, Mohsen, et al.
(författare)
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Investigating sexual problems, psychological distress and quality of life in female patients with Takotsubo cardiomyopathy : A prospective case-control study
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:7, s. 614-622
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Tidskriftsartikel (refereegranskat)abstract
- Background: Takotsubo cardiomyopathy (TSCM) has detrimental effects on both physical and psychological health of sufferers. However, little is known whether TSCM also affects sexual functioning in female patients.Aim: The aim of this study was to investigate psychological distress (depression and anxiety), health-related quality of life, and sexual functioning in women with TSCM and compare them with women with acute myocardial infarction and with healthy controls.Methods: A three group prospective case-control design was used. Female patients with TSCM or acute myocardial infarction, as well as healthy controls (94 in each group), were recruited across eight Iranian university hospitals. Data were collected at baseline and after six and 18 months using the Hospital Anxiety and Depression Scale, the Short Form-12, the Female Sexual Function Index and the Female Sexual Distress Scale. Multilevel logistic regression was conducted.Results: The TSCM group showed worst sexual functioning and the highest level of anxiety and depression at baseline (p<0.01) compared with the two other groups. The TSCM and AMI groups showed comparable health-related quality of life at baseline, which was lower in both groups compared with the healthy controls (p<0.01). Overall, depression, anxiety and health-related quality of life showed a significant change over time, especially in the TSCM group, with health-related quality of life decreasing, while anxiety and depression were increasing. Compared with the acute myocardial infarction and healthy control groups, the TSCM group showed a higher prevalence of sexual problems (odds ratios = 3.10 and 2.28, respectively) across time. Moreover, sexual functioning was found to be a mediator between anxiety and health-related quality of life in the TSCM group.Conclusion: Depression, anxiety, health-related quality of life, and sexual dysfunction tend to increase over time in female patients with TSCM; thus, healthcare providers should pay attention to these problems and provide appropriate treatment where necessary.
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