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- Cederholm, Jan, et al.
(author)
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Systolic blood pressure and risk of cardiovascular diseases in type 2 diabetes : an observational study from the Swedish national diabetes register
- 2010
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In: Journal of Hypertension. - 0263-6352 .- 1473-5598. ; 28:10, s. 2026-2035
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Journal article (peer-reviewed)abstract
- Objectives: To estimate risks of fatal/nonfatal coronary heart disease (CHD), stroke and cardiovascular disease (CVD) with SBP in an observational study of patients with type 2 diabetes. Methods: Twelve thousand, six hundred and seventy-seven patients aged 30–75 years, treated with antihypertensive drugs, without previous congestive heart failure, followed for 5 years. Results: Risk curves of CHD and stroke increased progressively with higher baseline or updated mean SBP in a Cox model, in all participants, and in two subgroups without (n = 10 304) or with (n = 2373) a history of CVD, with no J-shaped risk curves at low SBP levels. Hazard ratios for CHD and stroke per 10-mmHg increase in updated mean SBP in all participants, adjusting for clinical characteristics and traditional risk factors, were 1.08 (1.04–1.13) and 1.20 (1.13–1.27), P < 0.001. With updated mean SBP of 110–129 mmHg as reference, SBP of at least 140 mmHg showed risk increases of 37% for CHD, 86% for stroke and 44% for CVD (P = 0.001 to <0.001), whereas SBP of 130–139 mmHg showed nonsignificant risk increases for these outcomes. With baseline SBP of 110–129 mmHg, CHD and CVD risks increased with further SBP reduction, hazard ratios were 1.77 and 1.73 (P = 0.002), but decreased considerably for CHD, stroke and CVD with higher baseline SBP. Conclusion: Risks of CHD and stroke increased progressively with higher SBP, with no J-shaped curves, although risk increase was significant only for SBP of at least 140 mmHg, but not comparing 130–139 and 110–129 mmHg. Additionally, baseline SBP of 110–129 mmHg showed increased CHD and CVD risk with further SBP reduction during follow-up, whereas baseline SBP of at least 130 showed benefits.
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| 2. |
- Nilsson, Peter, et al.
(author)
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Trends in blood pressure control in patients with type 2 diabetes : data from the Swedish National Diabetes Register (NDR)
- 2011
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In: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 20:6, s. 348-354
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Journal article (peer-reviewed)abstract
- We assessed blood pressure (BP) trends in patients with type 2 diabetes from a national diabetes register using three cross-sectional samples (aged 30?85 years) in 2005, 2007 and 2009, and in patients from 2005 followed individually until 2009. The prevalence of hypertension was 87% among all 180 369 patients in 2009, although lower in subgroups with ages 30?39, 40?49 and 50?59 years: 40%, 60% and 77%. In the three cross-sectional surveys, mean BP decreased (141/77?136/76 mmHg), uncontrolled BP? 140/90 mmHg decreased (58?46%), and antihypertensive drug treatment (AHT) increased (73?81%). Comparatively in 79 185 patients followed individually for 5 years, mean BP decreased (141/77?137/75 mmHg), uncontrolled BP ?140/90 mmHg decreased (58?47%) and AHT increased (73?82%). Independent predictors of BP decrease were BMI decrease (stronger) and increase in AHT. AHT occurred among 81% of all patients in 2009. In 57 645 patients on AHT followed individually, mean BP decreased (143/77?138/75 mmHg) and uncontrolled BP ?140/90 mmHg decreased (63?50%). Among 5164 patients with nephropathy on AHT followed individually, BP <130/80 mmHg increased (12?21%). In conclusion, BP control improved from 2005 to 2009, relative to BMI decrease and AHT increase, although still about half had BP ?140/90 mmHg.
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| 3. |
- Berg, Katarina, 1959-
(author)
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Patients’ perspectives on recovery from day surgery
- 2012
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Doctoral thesis (other academic/artistic)abstract
- A large number of elective surgical patients in Sweden and elsewhere have their surgical procedure performed in a day surgery context. The surgical care event, with its postoperative surveillance, is brief at the surgery unit and patients are discharged home with the intention that they should manage postoperative recovery mainly themselves. However, several patients attest to being in an exposed situation when assuming responsibility for recovery at home. The overall aim of this thesis was to attain comprehensive knowledge of postoperative recovery following day surgery from a patient perspective.A questionnaire, the Post-discharge Surgical Recovery scale, was translated into Swedish and evaluated regarding its psychometric properties in a Swedish context. A sample of 607 day surgery patients who had undergone orthopaedic, general or gynaecological surgery self-rated their recovery at postoperative Days 1, 7 and 14 using the Post-discharge Surgical Recovery scale and the Quality of Recovery-23. Health-related quality of life was assessed before and 30 days after the surgical procedure, using the EQ-5D. In a second sample, 31 patients were interviewed in their homes regarding their recovery after day surgery. The interviews were conducted on postoperative Days 11-37, and focused on the meaning of recovery, self-care and perceptions of recovery. Data were explored by means of a phenomenographic analysis.The Post-discharge Surgical Recovery scale showed satisfactory psychometric properties when used among Swedish day surgery patients. Following discharge, recovery included both physical and emotional perspectives. Recovery varied, and influencing factors were found to be type of surgery, age, perceived health and emotional status on the first postoperative day. Orthopaedic patients had a more protracted recovery process compared to general surgery and gynaecological patients, along with more postoperative pain and lower health-related quality of life. Patients perceived that postoperative recovery comprised different internal and external factors and a large amount of responsibility regarding their recovery and surgical outcome. To be prepared for recovery at home, patients wanted knowledge and understanding about the normal range of recovery following their specific surgical procedure, and needed support from different sources in their surroundings.This thesis provides insight into day surgery patients’ postoperative situation. Based on the studies, individualized and well thought-out support appears favourable in order to have confident and well prepared patients at home. In contrast to smooth and easy patient care at the surgery unit, the postoperative phase seems to be a weak link in the day surgical continuity of patient care. Postoperative care needs to be further improved to increase quality and patients’ overall satisfaction with the day surgical experience. Attention should be paid to patients’ physical and emotional resources and needs.
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| 4. |
- Berg, Katarina, 1959-
(author)
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Postoperative recovery in daysurgery : Evaluation of psychometric properties and clinical usefulness of a questionnaire in day surgery
- 2010
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Licentiate thesis (other academic/artistic)abstract
- Background: Day surgery has increased during recent decades in many countries and represents approximately 50% of surgical procedures performed in Sweden. Day surgery implies that the patient is admitted and operated on during the same day and discharged without an overnight stay at the surgery unit. Undergoing a day surgical procedure thereby means that the major part of the postoperative recovery takes place in the patient’s home, leaving the patient and his/her supportive network responsible for the postoperative care. Day surgery also implies that health care professionals have to adapt to outpatient care and find valid measurements for monitoring a patient’s recovery progress after discharge.Aims: The aim of Study I was to evaluate the psychometric properties of a translated version of the Post-discharge Surgical Recovery (PSR) scale in a Swedish day surgery sample in terms of data quality, internal consistency, dimensionality and responsiveness. The aim of Study II was to describe postoperative recovery on postoperative days 1, 7 and 14 after different orthopaedic day surgical procedures, as well as to identify possible predictors associated with postoperative recovery two weeks after surgery.Methods: Six-hundred and seven patients who had undergone an orthopaedic surgical procedure (n=358), general surgery (n=182) or gynaecological surgery (n=67) were included. To assess postoperative recovery, the PSR scale and the emotional state, physical comfort and physical independency dimensions of the Quality of Recovery-23 (QoR-23) were used. In addition, patients’ background data and self ratings of their ability to work or handle usual business and general health were obtained. Data were collected preoperatively and on postoperative days 1, 7 and 14. In Study I data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach’s alpha. The dimensionality was determined using an exploratory factor analysis, and the responsiveness was evaluated through the standardized response mean (SRM) and the area under the receiver operating characteristics curve (AUC). In Study II, patients’ postoperative recovery and general health were compared over time using Friedmann’s ANOVA and between surgical groups of patients using the Kruskal-Wallis test. To determine predictors of recovery, a multiple linear regression analysis was performed with the PSR score on postoperative day 14 as the dependent variable.Results: In Study I, two items were deleted from the Swedish version of the PSR scale. This was based on several low inter-item (<0.30) and item-total correlations (<0.40) and substantial ceiling effects (65%). After the deletion of two items, the Cronbach’s coefficient alpha was 0.90 and the average interitem correlation was 0.44. According to the factor analysis, a single dimension was found explaining the common variance to 44%. The SRM (1.14) indicated a robust ability to detect changes in recovery. The AUC was 0.60 for the entire scale, but varied (0.58-0.81) when the PSR score on postoperative day 1 was categorized into three intervals. In Study II, the shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery (p<0.001). Significant predictors of recovery on postoperative day 14 were age, perceived health and emotional status on postoperative day 1 and type of surgery, and explained the dependent variable to 33%.Conclusions: The Swedish version of the PSR scale seems to be a consistent and valid instrument for the assessment of postoperative recovery at home in Sweden. The recovery process for orthopaedic day surgery patients differs, with shoulder surgery patients in particular showing poor recovery, which could be considered when day surgery patient education programmes are developed.
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