| 1. |
- Wallin, Ewa, et al.
(author)
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Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest
- 2018
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 62:5, s. 625-647
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Journal article (peer-reviewed)abstract
- BACKGROUND:Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.METHODS:A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.RESULTS:Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.CONCLUSIONS:Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.
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| 2. |
- Wallin, Ewa, et al.
(author)
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Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia.
- 2015
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In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 96:Suppl1, s. 147-
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Journal article (other academic/artistic)abstract
- Aim of the study: To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.Method: A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patients treated with TH.Results: MRI of the brain was obtained at a median of 4 days (3-13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24-30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (p=0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600x10-6 mm2/s in any region survived to 6 months.Conclusions: In visual analyses of acute MRI, extensive acute lesions were found in the cortical regions and gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.
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| 3. |
- Wallin, Ewa, et al.
(author)
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Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later
- 2016
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In: Insights into Imaging 7:Suppl 1, 2016. - : Springer.
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Conference paper (peer-reviewed)abstract
- Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later,Purpose: To document the acute MRI findings in the brain of post-cardiac arrest (CA) patients treated with therapeutic hypothermia and their relationship to patient outcome after 6 months.Methods and Materials: MRI was performed prospectively 3-13 days (median 4) after CA in 56 patients regardless of the level of consciousness in three hospitals. The images were interpreted visually by two neuroradiologists. Apparent diffusion coefficient (ADC) was measured in predetermined areas in cerebral white matter, deep grey matter, cerebellar grey and white matter and the brainstem. Outcome was assessed using the Cerebral Performance Categories Scale (CPC ) and dichotomized into good and poor outcome.Results: Acute hypoxic lesions on diffusion-weighted MRI (DWI) were more common in patients with poor outcome (p=0.006) and affected mostly grey matter, deep or cortical, with or without involvement of underlying white matter. Pure white matter lesions were very few. Lesions in the occipital and temporal lobes, deep white matter and cerebellum were most associated with poor outcome. Reductions in the ADC, particularly in the occipital lobes, were more common in patients with poor outcome. None of the patients with an ADC below 604-678 x10-6 mm2/s (variation depending on the equipment and technique) in any region survived to 6 months.Conclusion: Extensive acute lesions in cortical regions and deep grey matter in visual analysis and regions with an ADC under the level 600-680 x10-6 mm2/s are associated with poor outcome. Lesions are fewer and mainly situated in the frontal and parietal lobes in patients with good outcome.
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| 4. |
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| 5. |
- Engström, Joakim, et al.
(author)
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Lung complications are common in intensive care treated patients with pelvis fractures : a retrospective cohort study
- 2016
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In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 24
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Journal article (peer-reviewed)abstract
- Background: The incidence of severe respiratory complications in patients with pelvis fractures needing intensive care have not previously been studied. Therefore, the aims of this registry study were to 1) determine the number of ICU patients with pelvis fractures who had severe respiratory complications 2) whether the surgical intervention in these patients is associated with the pulmonary condition and 3) whether there is an association between lung complications and mortality. We hypothesized that acute hypoxic failure (AHF) and acute respiratory distress syndrome (ARDS) 1) are common in ICU treated patients with pelvis fractures, 2) are not related to the reconstructive surgery, or to 3) to mortality.Methods: All patients in the database cohort (n = 112), scheduled for surgical stabilization of pelvis ring and/or acetabulum fractures, admitted to the general ICU at Uppsala University Hospital between 2007 and 2014 for intensive care were included.Results: The incidence of AHF/ARDS was 67 % (75/112 patients), i.e., the percentage of patients that at any period during the ICU stay fulfilled the AHF/ARDS criteria. The incidence of AHF was 44 % and incidence of ARDS was 23 %. The patients with AHF/ARDS had more lung contusions and pneumonia than the patients without AHF/ARDS. Overall, there were no significant changes in oxygenation variables associated with surgery. However, 23 patients with pre-operative normal lung status developed AHF/ARDS in relation to the surgical procedure, whereas 12 patients with AHF/ARDS normalized their lung condition. The patients who developed AHF/ARDS had a higher incidence of lung contusion (P = 0.04) and the surgical stabilization was performed earlier (5 versus 10 days) in these patients (P = 0.03).Conclusions: We found that the incidence of respiratory failure in ICU treated patients with pelvis fractures was high, that the procedure around surgical stabilization seems to be associated with a worsening in the respiratory function in patients with lung contusion, and that mortality was low and was probably not related to the respiratory condition.
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| 6. |
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| 7. |
- Hultström, Michael, 1978-, et al.
(author)
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Dehydration is associated with production of organic osmolytes and predicts physical long-term symptoms after COVID-19 : a multicenter cohort study
- 2022
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In: Critical Care. - : Springer Nature. - 1364-8535 .- 1466-609X. ; 26
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Journal article (peer-reviewed)abstract
- BACKGROUND: We have previously shown that iatrogenic dehydration is associated with a shift to organic osmolyte production in the general ICU population. The aim of the present investigation was to determine the validity of the physiological response to dehydration known as aestivation and its relevance for long-term disease outcome in COVID-19.METHODS: The study includes 374 COVID-19 patients from the Pronmed cohort admitted to the ICU at Uppsala University Hospital. Dehydration data was available for 165 of these patients and used for the primary analysis. Validation was performed in Biobanque Québécoise de la COVID-19 (BQC19) using 1052 patients with dehydration data. Dehydration was assessed through estimated osmolality (eOSM = 2Na + 2 K + glucose + urea), and correlated to important endpoints including death, invasive mechanical ventilation, acute kidney injury, and long COVID-19 symptom score grouped by physical or mental.RESULTS: Increasing eOSM was correlated with increasing role of organic osmolytes for eOSM, while the proportion of sodium and potassium of eOSM were inversely correlated to eOSM. Acute outcomes were associated with pronounced dehydration, and physical long-COVID was more strongly associated with dehydration than mental long-COVID after adjustment for age, sex, and disease severity. Metabolomic analysis showed enrichment of amino acids among metabolites that showed an aestivating pattern.CONCLUSIONS: Dehydration during acute COVID-19 infection causes an aestivation response that is associated with protein degradation and physical long-COVID.TRIAL REGISTRATION: The study was registered à priori (clinicaltrials.gov: NCT04316884 registered on 2020-03-13 and NCT04474249 registered on 2020-06-29).
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| 8. |
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| 9. |
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| 10. |
- Ahlström, Björn, et al.
(author)
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A comparison of impact of comorbidities and demographics on 60-day mortality in ICU patients with COVID-19, sepsis and acute respiratory distress syndrome
- 2022
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In: Scientific Reports. - : Springer Nature. - 2045-2322. ; 12
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Journal article (peer-reviewed)abstract
- Severe Coronavirus disease 2019 (COVID-19) is associated with several pre-existing comorbidities and demographic factors. Similar factors are linked to critical sepsis and acute respiratory distress syndrome (ARDS). We hypothesized that age and comorbidities are more generically linked to critical illness mortality than a specific disease state. We used national databases to identify ICU patients and to retrieve comorbidities. The relative importance of risk factors for 60-day mortality was evaluated using the interaction with disease group (Sepsis, ARDS or COVID-19) in logistic regression models. We included 32,501 adult ICU patients. In the model on 60-day mortality in sepsis and COVID-19 there were significant interactions with disease group for age, sex and asthma. In the model on 60-day mortality in ARDS and COVID-19 significant interactions with cohort were found for acute disease severity, age and chronic renal failure. In conclusion, age and sex play particular roles in COVID-19 mortality during intensive care but the burden of comorbidity was similar between sepsis and COVID-19 and ARDS and COVID-19.
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| 11. |
- Ahlström, Björn, et al.
(author)
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A nationwide study of the long-term prevalence of dementia and its risk factors in the Swedish intensive care cohort
- 2020
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In: Critical Care. - : BMC. - 1364-8535 .- 1466-609X. ; 24:1
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Journal article (peer-reviewed)abstract
- BackgroundDeveloping dementia is feared by many for its detrimental effects on cognition and independence. Experimental and clinical evidence suggests that sepsis is a risk factor for the later development of dementia. We aimed to investigate whether intensive care-treated sepsis is an independent risk factor for a later diagnosis of dementia in a large cohort of intensive care unit (ICU) patients.MethodsWe identified adult patients admitted to an ICU in 2005 to 2015 and who survived without a dementia diagnosis 1year after intensive care admission using the Swedish Intensive Care Registry, collecting data from all Swedish general ICUs. Comorbidity, the diagnosis of dementia and mortality, was retrieved from the Swedish National Patient Registry, the Swedish Dementia Registry, and the Cause of Death Registry. Sepsis during intensive care served as a covariate in an extended Cox model together with age, sex, and variables describing comorbidities and acute disease severity.ResultsOne year after ICU admission 210,334 patients were alive and without a diagnosis of dementia; of these, 16,115 (7.7%) had a diagnosis of sepsis during intensive care. The median age of the cohort was 61years (interquartile range, IQR 43-72). The patients were followed for up to 11years (median 3.9years, IQR 1.7-6.6). During the follow-up, 6312 (3%) patients were diagnosed with dementia. Dementia was more common in individuals diagnosed with sepsis during their ICU stay (log-rank p<0.001), however diagnosis of sepsis during critical care was not an independent risk factor for a later dementia diagnosis in an extended Cox model: hazard ratio (HR) 1.01 (95% confidence interval 0.91-1.11, p=0.873). Renal replacement therapy and ventilator therapy during the ICU stay were protective. High age was a strong risk factor for later dementia, as was increasing severity of acute illness, although to a lesser extent. However, the severity of comorbidities and the length of ICU and hospital stay were not independent risk factors in the model.ConclusionAlthough dementia is more common among patients treated with sepsis in the ICU, sepsis was not an independent risk factor for later dementia in the Swedish national critical care cohort.Trial registrationThis study was registered a priori with the Australian and New Zeeland Clinical Trials Registry (registration no. ACTRN12618000533291).
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| 12. |
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| 13. |
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| 14. |
- Ahlström, Björn
(author)
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The epidemiology of risk factors and short and long-term outcome in the Swedish intensive care cohort
- 2021
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Licentiate thesis (other academic/artistic)abstract
- Dissertation presented at Uppsala University to be publicly examined on Zoom: https://uu-se.zoom.us/j/7214327760, Tuesday, 11 May 2021 at 13:00 for the degree of Licentiate of Philosophy (Faculty of Medicine). The examination will be conducted in English and Swedish. Chairman of the Examining committee: Professor Karl Michaëlsson (Medical epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala) Abstract Ahlström, B. 2021. The epidemiology of risk factors and short- and long-term out-come in the Swedish intensive care cohort. 76 pp. Severe sepsis and septic shock, linked to persistent organ dysfunctions, have poor short- and long-term mortality outcomes. These conditions also adversely affect health-related quality of life. After intensive care with severe sepsis and septic shock, memory and other cognitive functions have shown deterioration. In addition, there are indications of an increased risk of dementia. Yet, whether severe sepsis and septic shock are independently linked to dementia or dementia development is linked to more general severe illness remains unclear. In the Swedish intensive care cohort we compared 16 115 one-year sepsis survivors without previous dementia to 194 219 patients (controls) admitted to intensive care for other reasons using a Cox proportional hazards model. The crude risk of dementia was increased in the severe sepsis and septic shock group. However, after adjustment for demographics, comorbidities and factors reflecting the severity of acute illness, severe sepsis and septic shock was found not to be a significant risk factor of incident dementia with a haz-ard ratio of 1.01 (95% confidence interval 0.91-1.11). Thus, we concluded that although the incidence of dementia is high after intensive care, severe sepsis or septic shock is not causative. Coronavirus disease 2019 (COVID-19) has put a tremendous strain on the healthcare system in general and intensive care, in particular, since its emergence in Wuhan, China, in late 2019. Risk factors of ICU admission and mortality from COVID-19 were reported early during the pandemic, but only as univariate variables. Under the hypothesis that there are several independent risk factors of critical COVID-19, we used statistical models to explore demographic characteristics and comorbidi-ties in the first 1 981 ICU-admitted patients with COVID-19 in Sweden. On the risk of ICU admission, we also included matched population controls in a 1:4 ratio. Hypertension, type 2 diabetes mellitus, chronic renal failure, asthma, obesity, solid organ transplant recipient and immunosuppressant medications were independent risk factors of ICU admission. Oral anticoagulants were associated with a protective effect. Stroke, asthma, chronic obstructive pulmonary disease and treatment with renin-angiotensin-aldosterone inhibitors were independent risk factors of ICU mortality. Treatment with statins was protective. Our findings suggest that there are several independent risk factors of ICU admission and ICU mortality in COVID-19.Björn Ahlström, Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, SE-75185 Uppsala, Sweden and Centre of clinical research, Region Dalarna, SE-79182 Falun, Sweden.
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| 15. |
- Ahlström, Björn
(author)
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The epidemiology of risk factors and short- and long-term outcome in the Swedish intensive care cohort
- 2024
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Doctoral thesis (other academic/artistic)abstract
- The sepsis syndrome is present in ¼ to ⅓ of patients in intensive care units (ICUs) worldwide. The short-term prognosis is grim, with a 30-day mortality of 30–35%; however, the long- term outcomes are now being explored, as multi-professional follow-up after ICU care is increasingly being implemented. In 2020 the first and second waves of another severe infection, the Coronavirus disease 2019 (Covid-19) hit Sweden. The number of ICU beds were scaled up by several hundred percent while we simultaneously tried to understand the disease. Reports on risk factors for adverse outcomes in Covid-19 started to appear, but we needed to know more. Thus, we initiated this project aiming at assessing sepsis as an independent risk factor for later morbidity and mortality. Subsequently, with the onset of the pandemic, our focus shifted to identifying risk factors for adverse outcomes in Covid-19 and describing the functional recovery after severe Covid-19. We used the Swedish Intensive Care Registry and several governmental registries to this end.In Cox regression, we compared one-year ICU sepsis survivors without previous dementia with ICU patients without sepsis, finding no increased risk of dementia during follow- up. In a similar cohort, we assessed the impact of sepsis on long-term mortality and causes of death in a series of Cox and multinomial models. We found a surprisingly small overall association between sepsis and mortality and a persistently increased risk of infectious causes of death in sepsis patients. We compared the prevalence of several common comorbidities and medications as risk factors for ICU admission and mortality in ICU patients with Covid-19 with that of age- and sex-matched population controls and in patients discharged alive with those that were deceased at discharge. We found associations between several comorbidities and medications with these adverse outcomes. To better understand the meaning of these comorbidities as risk factors for short-term mortality, we compared them in logistic regression models on patients with Covid-19, sepsis and acute respiratory distress syndrome (ARDS). We found very similar impacts from the comorbidities; however, greater age was more associated with mortality in Covid-19 than in either sepsis or ARDS. Finally, we investigated the long-term functional recovery in ICU patients with Covid-19 compared to hospital-admitted patients with Covid-19 and population controls matched to the ICU group. The ICU patients had a markedly impeded recovery that was not explained by demographics or comorbidities in statistical models.
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| 16. |
- Ahlström, Björn, et al.
(author)
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The swedish covid-19 intensive care cohort : Risk factors of ICU admission and ICU mortality
- 2021
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In: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 65:4, s. 525-533
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Journal article (peer-reviewed)abstract
- Background: Several studies have recently addressed factors associated with severe Coronavirus disease 2019 (COVID-19); however, some medications and comorbidities have yet to be evaluated in a large matched cohort. We therefore explored the role of relevant comorbidities and medications in relation to the risk of intensive care unit (ICU) admission and mortality.Methods: All ICU COVID-19 patients in Sweden until 27 May 2020 were matched to population controls on age and gender to assess the risk of ICU admission. Cases were identified, comorbidities and medications were retrieved from high-quality registries. Three conditional logistic regression models were used for risk of ICU admission and three Cox proportional hazards models for risk of ICU mortality, one with comorbidities, one with medications and finally with both models combined, respectively.Results: We included 1981 patients and 7924 controls. Hypertension, type 2 diabetes mellitus, chronic renal failure, asthma, obesity, being a solid organ transplant recipient and immunosuppressant medications were independent risk factors of ICU admission and oral anticoagulants were protective. Stroke, asthma, chronic obstructive pulmonary disease and treatment with renin-angiotensin-aldosterone inhibitors (RAASi) were independent risk factors of ICU mortality in the pre-specified primary analyses; treatment with statins was protective. However, after adjusting for the use of continuous renal replacement therapy, RAASi were no longer an independent risk factor.Conclusion: In our cohort oral anticoagulants were protective of ICU admission and statins was protective of ICU death. Several comorbidities and ongoing RAASi treatment were independent risk factors of ICU admission and ICU mortality.
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| 17. |
- Andersson, Ing-Marie, et al.
(author)
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A study visit to a vitual company
- 2012
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In: NGL 2012 Next Generation Learning Conference. - Falun : Högskolan Dalarna. - 9789185941476 ; , s. 69-74
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Conference paper (other academic/artistic)abstract
- To integrate study visits to different workplaces in higher education implies important benefits for the course quality. The study visit gives the students a better understanding for the real situations they will meet in working life. However for practical and economical reasons is that not always possible. The purpose of this project is to create a virtual company that shall replace the real one for study visits. The goal is to create a realistic picture and that intended use of it can come as close as possible to a real study visit. It is also important to facilitate linking theory and practice. The virtual company is built up by pictures, videos and text. All material is made available on a web page and when entering the students will meet a layout of the company. From that position is it possible to walk around and look at videos from different workstations. Besides that can they also listen to interviews with managers and representatives of staff as well as reading reports concerning productivity and the work environment. The focus of the study visit is work sciences, therefore the material also include some visualized information about work hazards. On the web page there are also a number of tasks for the students to carry out. Until the autumn 2011, 132 students at Dalarna University have visited and produced reports from the virtual company. They were studying in programs for mechanical engineering, production technicians and human resource management. An evaluation among some ten students showed that the study visit to the virtual company is flexible in time and effective, but that students wish to have even more detailed information about the company. Experiences from four years of use in a number of classes show that the concept is worth further development. Furthermore with production of new material the concept is likely to be applicable for other purposes.
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| 18. |
- Back Danielsson, Ing-Marie, 1964-, et al.
(author)
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Preface
- 2009
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Other publication (other academic/artistic)
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| 19. |
- Bark, Lovisa, et al.
(author)
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Central nervous system biomarkers GFAp and NfL associate with post-acute cognitive impairment and fatigue following critical COVID-19.
- 2023
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In: Scientific reports. - : Springer Nature. - 2045-2322. ; 13:1
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Journal article (peer-reviewed)abstract
- A high proportion of patients with coronavirus disease 2019 (COVID-19) experience post-acute COVID-19, including neuropsychiatric symptoms. Objective signs of central nervous system (CNS) damage can be investigated using CNS biomarkers such as glial fibrillary acidic protein (GFAp), neurofilament light chain (NfL) and total tau (t-tau). We have examined whether CNS biomarkers can predict fatigue and cognitive impairment 3-6months after discharge from the intensive care unit (ICU) in critically ill COVID-19 patients. Fifty-seven COVID-19 patients admitted to the ICU were included with analysis of CNS biomarkers in blood at the ICU and at follow up. Cognitive dysfunction and fatigue were assessed with the Montreal Cognitive Assessment (MoCA) and the Multidimensional Fatigue inventory (MFI-20). Elevated GFAp at follow-up 3-6months after ICU discharge was associated to the development of mild cognitive dysfunction (p=0.01), especially in women (p=0.005). Patients who experienced different dimensions of fatigue at follow-up had significantly lower GFAp in both the ICU and at follow-up, specifically in general fatigue (p=0.009), physical fatigue (p=0.004), mental fatigue (p=0.001), and reduced motivation (p=0.001). Women showed a more pronounced decrease in GFAp compared to men, except for in mental fatigue where men showed a more pronounced GFAp decrease compared to women. NfL concentration at follow-up was lower in patients who experienced reduced motivation (p=0.004). Our findings suggest that GFAp and NfL are associated with neuropsychiatric outcome after critical COVID-19.Trial registration The study was registered à priori (clinicaltrials.gov: NCT04316884 registered on 2020-03-13 and NCT04474249 registered on 2020-06-29).
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| 20. |
- Bergman, Lina, et al.
(author)
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Registered nurses' experiences of working in the intensive care unit during the COVID-19 pandemic
- 2021
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In: Nursing in Critical Care. - : John Wiley & Sons. - 1362-1017 .- 1478-5153. ; 26:6, s. 467-475
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Journal article (peer-reviewed)abstract
- BackgroundDuring the pandemic, increased numbers of patients requiring intensive care unit (ICU) admission required an increase in ICU capacity, including ICU staffing with competence to care for critically ill patients. Consequently, nurses from acute care areas were called in to staff the ICU along with experienced intensive care nurses.Aims and objectivesTo describe Swedish registered nurses' experiences of caring for patients with COVID-19 in ICUs during the pandemic.DesignMixed method survey design.MethodsAn online questionnaire was distributed through social media to registered nurses who had been working in the ICU during the COVID-19 outbreak. Data were collected for 1 week (May 2020) and analysed using content analysis and descriptive statistics.ResultsOf the 282 nurses who participated, the majority were ICU nurses (n = 151; 54%). Half of the nurses specialized in ICU reported that they were responsible for the ICU care of three or more patients during the pandemic (n = 75; 50%). Among non-intensive care nurses, only 19% received introduction to the COVID-19 ICU (n = 26). The analysis of data regarding nurses' experiences resulted in three categories: tumbling into chaos, diminished nursing care, and transition into pandemic ICU care. Participants described how patient safety and care quality were compromised, and that nursing care was severely deprioritized during the pandemic. The situation of not being able to provide nursing care resulted in ethical stress. Furthermore, an increased workload and worsened work environment affected nurses' health and well-being.ConclusionsThe findings from the present study indicate that nurses perceived that patient safety and quality of care were compromised during the pandemic. This resulted in ethical stress among nurses, which may have affected their physical and psychosocial well-being.Relevance to clinical practiceThe COVID-19 pandemic had a severe impact on nurses' work environment, which could result in burnout and staff turnover.
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| 21. |
- Carlsson, Ing-Marie, 1961-, et al.
(author)
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Creating a communication space in the healthcare context : Children’s perspective of using the eHealth service, Sisom
- 2021
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In: Journal of Child Health Care. - London : Sage Publications. - 1367-4935 .- 1741-2889. ; 25:1, s. 31-43
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Journal article (peer-reviewed)abstract
- According to the United Nation’s Convention of the Rights of the Child, children have the right to participate in their own healthcare and make their opinions heard. The aim of this study was thus to explore the impact of using an eHealth service, Sisom, to gain the children’s perspectives during their healthcare appointments. Data were gathered through individual interviews with a purposeful sample of 16 children, aged 6–13 years old, treated for different diseases and using the eHealth service, Sisom, during their healthcare appointments. The interviews were analysed using a constructivist grounded theory. The results showed that using Sisom made children’s voice heard by creating a communication space in the healthcare setting. This meant that the children got involved in the communication, were acknowledged as an important person who could give the answers to questions and were given time. Implementing the use of Sisom is a way to make children’s needs and preferences explicitly visible for decision-making in practice and thereby supporting the further development of child-centred care in practice. © The Author(s) 2020.
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| 22. |
- Carlsson, Ing-Marie, 1961-, et al.
(author)
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Place and space in relation to childbirth : a critical interpretive synthesis
- 2020
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In: International Journal of Qualitative Studies on Health and Well-being. - Abingdon : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 15:sup1
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Journal article (peer-reviewed)abstract
- Background: In nursing and midwifery, the concept of environment is considered a meta-concept. Research findings suggest that the location is not the only important factor, as both place and space influence the practices of midwives. Moreover, research on the geography of health suggests a connection between place and health that could be extended to reproductive health. Therefore, to move beyond and expand traditional research expressions, it is beneficial to illuminate the concepts of place and space in relation to childbirth.Purpose: This study was undertaken to produce a synthesis of previous qualitative research of issues in childbirth in relation to the concepts of place and space.Method: In this Critical Interpretive Synthesis (CIS), four electronic databases; CINAHL, Medline, PsycINFO and Sociological abstracts, were used for the literature search. In total 734 papers were screened, and 27 papers met the final inclusion criteria after assessment.Results: The synthesis reveals a need to create a space for childbirth underpinned by four aspects; a homely space, a spiritual space, a safe space, and a territorial space.Conclusion: Findings from this review will provide a basis for useful dialogue in midwifery education and in clinical settings. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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| 23. |
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| 24. |
- Claesson, Ing-Marie, et al.
(author)
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You just need to leave the room when you breastfeed : Breastfeeding experiences among obese women in Sweden – A qualitative study
- 2018
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In: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 18:1
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Journal article (peer-reviewed)abstract
- BackgroundThe benefits of breastfeeding for the infant as well for the mother are well-known. It is recognized that obese (Body Mass Index ≥30 kg/m2) women may have less antenatal intention to breastfeed, and shortened duration of breastfeeding compared with normal-weight women. This may result in adverse short- and long-term health for both mother and child, such as a shortened lactational amenorrhoea and decreased protection against breast cancer for the women, and an increased risk for infectious diseases and overweight/obesity among the children. Therefore, it is important to gain more knowledge and understanding of obese women’s experiences of breastfeeding in order to attain good health care. Hence, the aim of this study was to identify and describe obese women’s experiences of breastfeeding.MethodsThis is an explorative study. Data was collected 2 – 18 months after childbirth through semi-structured face-to-face interviews with 11 obese women with breastfeeding experience. The interviews were recorded and transcribed verbatim. Thematic analysis was used.ResultsThree themes emerged from the data analysis: Breastfeeding - a part of motherhood, the challenges of breastfeeding, and support for breastfeeding. The women described an antenatal hope for breastfeeding, the body’s ability to produce milk fascinated them, and the breast milk was seen as the best way to feed the child and also as promoting the attachment between mother and child. Breastfeeding was described as a challenge even though it is natural. The challenges concerned technical difficulties such as the woman finding a good body position and helping the child to achieve an optimum grip of the nipple. Another challenge was the exposure of the body connected to public breastfeeding. Support of breastfeeding was described as the importance of being confirmed as an individual behind the obesity, rather than an individual with obesity, and to obtain enough professional breastfeeding support.ConclusionsBreastfeeding was experienced as a natural part of being a mother. There were practical challenges for obese women concerning how to manage breastfeeding and how to handle the public exposure of the body. There was a need for realistic information about breastfeeding concerning both the child and the woman.
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| 25. |
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| 26. |
- Ekbom, Emil, et al.
(author)
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Impaired diffusing capacity for carbon monoxide is common in critically ill Covid-19 patients at four months post-discharge
- 2021
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In: Respiratory Medicine. - : Elsevier. - 0954-6111 .- 1532-3064. ; 182
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Journal article (peer-reviewed)abstract
- There is limited knowledge about the long-term effects on pulmonary function of COVID-19 in patients that required intensive care treatment. Spirometry and diffusing capacity for carbon monoxide (DLCO) were measured in 60 subjects at 3-6 months post discharge. Impaired lung function was found in 52% of the subjects, with reduced DLCO as the main finding. The risk increased with age above 60 years, need for mechanical ventilation and longer ICU stay as well as lower levels of C-reactive protein at admission. This suggests the need of follow-up with pulmonary function testing in intensive-care treated patients.
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| 27. |
- Eklund, Rakel, 1986-, et al.
(author)
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Surviving COVID-19 : patients' experiences of care and path to recovery
- 2024
-
In: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 19:1
-
Journal article (peer-reviewed)abstract
- Purpose: To examine patients' experiences of receiving care on an ICU for COVID-19 and the subsequent rehabilitation process.Methods: An explorative and inductive design was used. Participants were recruited from two university hospitals in Sweden. Patients admitted to the ICU due to COVID-19 from March 2020 to April 2021, who enrolled in the ICU follow-up, and understood and spoke Swedish were invited to participate. In total, 20 participants completed a semi-structured interview, of whom 18 were included in the thematic analysis.Results: The analysis resulted in two themes: "An isolated world with silver linings" and "Recovery in the wake of the pandemic". Findings show that patients cared for on an ICU for COVID-19 during the pandemic felt safe but experienced a sense of vulnerability. After discharge, physical rehabilitation was a slow process with frustrating day-to-day fluctuations. Mentally, participants felt isolated, fatigued, and emotionally sensitive. Patients reported that love and support from family and friends were crucial for the recovery process.Conclusions: This study highlights the challenges of recovering from COVID-19, emphasizing the importance of continued support from health care, public services, family and friends. It provides important insights into patients' experiences and can inform future healthcare strategies and policies.
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| 28. |
- Elfwen, Ludvig, et al.
(author)
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Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-An initial pilot-study of a randomized clinical trial
- 2019
-
In: Resuscitation. - : ELSEVIER IRELAND LTD. - 0300-9572 .- 1873-1570. ; 139, s. 253-261
-
Journal article (peer-reviewed)abstract
- Background: The clinical importance of immediate coronary angiography, with potentially subsequent percutaneous coronary intervention (PCI), in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation on the ECG is unclear. In this study, we assessed feasibility and safety aspects of performing immediate coronary angiography in a pre-specified pilot phase of the 'DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest' (DISCO) randomized controlled trial (ClinicalTrials.gov ID: NCT02309151). Methods: Resuscitated bystander witnessed OHCA patients > 18 years without ST-elevation on the ECG were randomized to immediate coronary angiography versus standard of care. Event times, procedure related adverse events and safety variables within 7 days were recorded. Results: In total, 79 patients were randomized to immediate angiography (n = 39) or standard of care (n = 40). No major differences in baseline characteristics between the groups were found. There were no differences in the proportion of bleedings and renal failure. Three patients randomized to immediate angiography and six patients randomized to standard care died within 24 h. The median time from EMS arrival to coronary angiography was 135 min in the immediate angiography group. In patients randomized to immediate angiography a culprit lesion was found in 14/38 (36.8%) and PCI was performed in all these patients. In 6/40 (15%) patients randomized to standard of care, coronary angiography was performed before the stipulated 3 days. Conclusion: In this out-of-hospital cardiac arrest population without ST-elevation, randomization to a strategy to perform immediate coronary angiography was feasible although the time window of 120 min from EMS arrival at the scene of the arrest to start of coronary angiography was not achieved. No significant safety issues were reported.
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| 29. |
- Göransson, Carina, 1967-, et al.
(author)
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Art of connectedness : Value-creating care for older persons provided with toileting assistance and containment strategies—A critical interpretive synthesis
- 2023
-
In: Journal of Clinical Nursing. - Chichester : Wiley-Blackwell Publishing Inc.. - 0962-1067 .- 1365-2702. ; 32:9-10, s. 1806-1820
-
Journal article (peer-reviewed)abstract
- Aims and objectivesThe aim was to conduct a synthesis of the literature on value-creating care for older persons with incontinence provided with toileting assistance and containment strategies, from the perspectives of older persons and healthcare professionals.BackgroundIncontinence is a health problem for many persons worldwide and the problem will increase as the global population ages. It can have a profound impact on a person's wellbeing, and assistance with toileting and containment strategies is common in home care settings and nursing homes.DesignThe design was a literature review with an iterative, reflexive and critical approach.MethodsA critical interpretive synthesis was conducted. Ten papers published between 2011 and 2019 were analysed. The PRISMA -ScR Checklist was used in this review.ResultsBased on the findings, the conceptual construct ‘The art of connectedness’ was developed, built on co-created care, personalised care and reflective care between the older person and healthcare professionals. Co-created care is based on establishing a relationship, building trust and respecting preferences. Personalised care consists of meeting the person's needs, promoting comfort and maintaining self-determination. Reflective care entails showing empathy, upholding the person's dignity and developing professional competence.ConclusionsValue-creating care consists conceptually of a connectedness that starts with co-creating the care together with the older person in a close relationship. Assistance is given and received based on the older person's individual needs and is highly valued by the older person as it helps them maintain self-determination. Reflective care is of importance for healthcare professionals.Relevance for practiceThe findings are hoped to enhance healthcare professionals’ understanding of how to improve the clinical encounter in nursing when providing assistance. They may also stimulate critical reflection among healthcare professionals on how to improve assistance to meet the older person's values. © 2022 The Authors.
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| 30. |
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| 31. |
- Halvorsen, Peter, et al.
(author)
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Health-related quality of life after surviving intensive care for COVID-19 : a prospective multicenter cohort study
- 2023
-
In: Scientific Reports. - : Springer Nature. - 2045-2322. ; 13:1
-
Journal article (peer-reviewed)abstract
- In survivors of severe coronavirus disease 2019 (COVID-19) incomplete mental and physical recovery may considerably impact daily activities and health-related quality of life (HRQoL). HRQoL can be evaluated with the RAND-36 questionnaire, a multidimensional instrument that assesses physical and mental aspects of health in eight dimensions. The objective was to investigate HRQoL in intensive care patients previously treated for COVID-19 at three Nordic university hospitals, in a prospective multi-center cohort study. HRQoL was measured using RAND-36, 3-9 months after discharge from intensive care units (ICU). One hospital performed a second follow-up 12 months after discharge. A score under the lower limit of the 95% confidence interval in the reference cohorts was considered as significantly reduced HRQoL. We screened 542 and included 252 patients. There was more than twice as many male (174) as female (78) patients and the median age was 61 (interquartile range, IQR 52-69) years. Hypertension was the most common comorbidity observed in 132 (52%) patients and 121 (48%) patients were mechanically ventilated for a median of 8 (IQR 4-14) days. In RAND-36 physical functioning, physical role functioning, general health (p < 0.001 for all) and social functioning (p < 0.05) were below reference, whereas bodily pain, emotional role functioning and mental health were not. In a time-to-event analysis female sex was associated with a decreased chance of reaching the reference HRQoL in the physical function, bodily pain and mental health dimensions. Higher body mass index was found in the physical functioning dimension and hypertension in the physical functioning, vitality and social functioning dimensions. Similar results were seen for diabetes mellitus in general health, vitality and mental health dimensions, as well as pulmonary illness in the physical role functioning dimension and psychiatric diagnosis in the social functioning dimension. Mechanical ventilation was associated with a decreased likelihood of achieving reference HRQoL in the bodily pain and physical functioning dimensions. Patients treated in an ICU because of COVID-19 had lower HRQoL 3-9 months after ICU discharge than 95% of the general population. Physical dimensions were more severely affected than mental dimensions. Female sex and several comorbidities were associated with a slower rate of recovery.
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| 32. |
- Hedlund, Ann, 1964-, et al.
(author)
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Studenters, anställdas och företags syn på arbete : En pilotstudie av Turism/Besöksnäring, Material, Energi & Miljö samt IT & Media
- 2014
-
Reports (other academic/artistic)abstract
- Denna rapport redovisar resultaten från ett pilotprojekt om studenters, anställdas och företagsrepresentanters syn på arbete. Rapporten dokumenterar insamlad data, redovisar genomförda inledande analyser, samt ger förslag till fortsatt forskning och samverkan. Syftet med studien är ökad kunskap om synen på arbete inom profilområdena Turism/Besöksnäring, Material, Energi & Miljö samt IT & Media. Därtill förväntas diskussioner kring resultatens användbarhet kunna ge underlag för utvecklingsprojekt för ökad attraktivitet.Studien har genomförts i form av fallstudier på fem företag inom respektive profilområde i Dalarna. Därtill har en enkätundersökning genomförts bland studenter vid Högskolan Dalarna inom motsvarande utbildningsområden på 21 olika utbildningsprogram. Statistiska beräkningar och begreppsanalyser har genomförts på insamlat material.I rapporten redovisas studenters, anställdas och företagsrepresentanters syn på arbete fördelat på de olika profilområdena. Därtill görs jämförelser mellan de olika grupperna.Slutsatser från studien är:Studenter ser arbete inom deras utbildningsområde som i hög grad attraktiva.Anställdas syn på vad som är viktigt för att göra ett arbete attraktivt är likartad oavsett profilområde, där relationer och ledarskap är viktigast.Nuvarande arbete anses som attraktivast av anställda inom Turism/Besöksnäring, därefter kommer Energi & Miljö följt av IT & Media och Material.Erfarenhet och kompetens gör arbetskraften attraktiv enligt arbetsgivarrepresentanter, även personliga egenskaper är av betydelse.Studenter ser arbete som viktigare än vad anställda gör.För samtliga profilområden finns skillnader mellan vad studenter förväntar sig att arbetet innehåller och vad anställda upplever att arbetet innebär.Sammantaget tycker studenter att arbete inom respektive utbildningsområde är attraktivare än vad anställda tycker om nuvarande arbete.Baserat på erfarenheter från denna pilotstudie ges följande förslag på idéer till fortsatt forskning och samverkan. En studie som i sin omfattning är representativ för de olika profilområdena för att stärka pilotstudiens resultat och indikationer. Utifrån behov göra olika analyser på den empiri som är tillgänglig från denna studie. Ett projekt som följer studenter ut i arbetslivet. Samarbetsprojekt mellan forskare, lärare och företag i syfte att förbättra förutsättningarna för ökad samstämmighet mellan utbildning och arbete. Skapa utbildningstillfällen på temana ledarskap och relationer.
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| 33. |
- Israelsson, Johan, et al.
(author)
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Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender
- 2017
-
In: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 114, s. 27-33
-
Journal article (peer-reviewed)abstract
- AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p<0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p<0.001) and symptoms of depression (p<0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.
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| 34. |
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| 35. |
- Lagedal, Rickard, et al.
(author)
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Design of DISCO—Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest study
- 2018
-
In: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 197, s. 53-61
-
Journal article (peer-reviewed)abstract
- Background Acute coronary syndrome is a common cause of out-of-hospital cardiac arrest (OHCA). In patients with OHCA presenting with ST elevation, immediate coronary angiography and potential percutaneous coronary intervention (PCI) after return of spontaneous circulation are recommended. However, the evidence for this invasive strategy in patients without ST elevation is limited. Observational studies have shown a culprit coronary artery occlusion in about 30% of these patients, indicating the electrocardiogram's (ECG's) limited sensitivity. The aim of this study is to determine whether immediate coronary angiography and subsequent PCI will provide outcome benefits in OHCA patients without ST elevation. Methods/design We describe the design of the DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest study (DISCO)—a pragmatic national, multicenter, randomized, clinical study. OHCA patients presenting with no ST elevation on their first recorded ECG will be randomized to a strategy of immediate coronary angiography or to standard of care with admission to intensive care and angiography after 3 days at the earliest unless the patient shows signs of acute ischemia or hemodynamic instability. Primary end point is 30-day survival. An estimated 1,006 patients give 80% power (α =.05) to detect a 20% improved 30-day survival rate from 45% to 54%. Secondary outcomes include good neurologic recovery at 30 days and 6 months, and cognitive function and cardiac function at 6 months. Conclusion This randomized clinical study will evaluate the effect of immediate coronary angiography after OHCA on 30-day survival in patients without ST elevation on their first recorded ECG.
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| 36. |
- Larsson, Ingrid, 1968-, et al.
(author)
-
Children and young people’s participation in developing interventions in health and well-being : a scoping review
- 2018
-
In: BMC Health Services Research. - London : BioMed Central. - 1472-6963. ; 18:507
-
Research review (peer-reviewed)abstract
- Background: Greater interest is being shown in participatory approaches, especially in research on interventions that concern children and young people'shealth and well-being. Although participatory approaches have user involvement in common, they differ in terms of the explicit guidance on how to actually involve and engage children and young people in health research. The aim of this scoping review was to systematically map recent research involving children and young people in the development of interventions targeting issues of health and well-being. Methods: An interpretative scoping literature review based on: a scientific literature search in (health and social science) databases, reference lists, a manual search in key journals and contact with existing networks was conducted. A total of 4458 references were identified through the literature search, of which 41 studies published between 2000 and 2017 were included in the review. The target population was children and young people under 25 years old. Level of participation was categorized according to Shier's Pathways to Participation Model. Results: The review showed that participatory approaches were most often used in the development of interventions in school settings and in community and healthcare settings and on issues concerning support in lifestyle or in managing illness or disease. The level of participation varied from children and young people taking part just as active informants, through stages of greater participation both in quantitative and qualitative terms, to children and youngpeople becoming an active agent involved as a co-researcher where the research process was shaped by views of a higher level of mutuality. Most of the studies were categorised at a medium level and only three studies were judged to involve the children and young people at the highest level. Conclusions: This scoping review showed that work remains in enabling children and young people to influence the development of interventions targeting health and well-being. In relation to level of sustainability in the interventions, it is relevant that goals, strategies and processes are formulated by those who can gain from the interventions. Participatory approaches aiming for a higher level of participation where children and young people work together with the researchers in partnerships are thus warranted. © 2018 The Author(s).
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| 37. |
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| 38. |
- Larsson, Ing-Marie, et al.
(author)
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Cold saline infusion and ice packs alone are effective in inducing and maintaining therapeutic hypothermia after cardiac arrest
- 2010
-
In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 81:1, s. 15-19
-
Journal article (peer-reviewed)abstract
- AIM OF THE STUDY: Hypothermia treatment with cold intravenous infusion and ice packs after cardiac arrest has been described and used in clinical practice. We hypothesised that with this method a target temperature of 32-34 degrees C could be achieved and maintained during treatment and that rewarming could be controlled. MATERIALS AND METHODS: Thirty-eight patients treated with hypothermia after cardiac arrest were included in this prospective observational study. The patients were cooled with 4 degrees C intravenous saline infusion combined with ice packs applied in the groins, axillae, and along the neck. Hypothermia treatment was maintained for 26h after cardiac arrest. It was estimated that passive rewarming would occur over a period of 8h. Body temperature was monitored continuously and recorded every 15min up to 44h after cardiac arrest. RESULTS: All patients reached the target temperature interval of 32-34 degrees C within 279+/-185min from cardiac arrest and 216+/-177min from induction of cooling. In nine patients the temperature dropped to below 32 degrees C during a period of 15min up to 2.5h, with the lowest (nadir) temperature of 31.3 degrees C in one of the patients. The target temperature was maintained by periodically applying ice packs on the patients. Passive rewarming started 26h after cardiac arrest and continued for 8+/-3h. Rebound hyperthermia (>38 degrees C) occurred in eight patients 44h after cardiac arrest. CONCLUSIONS: Intravenous cold saline infusion combined with ice packs is effective in inducing and maintaining therapeutic hypothermia, with good temperature control even during rewarming.
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| 39. |
- Larsson, Ing-Marie, et al.
(author)
-
Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment
- 2014
-
In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 85:2, s. 215-220
-
Journal article (peer-reviewed)abstract
- Aim of the study:To investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months after cardiac arrest (CA), in patients treated with therapeutic hypothermia (TH). Method: During a 4-year period at three hospitals in Sweden, 26 patients were prospectively included after CA treated with TH. All patients completed the questionnaires Hospital Anxiety and Depression Scale (HADS), Euroqol (EQ5D), Euroqol visual analogue scale (EQ-VAS) and Short Form 12 (SF12) at three occasions, at hospital discharge, and at one and 6 months after CA. Result: There was improvement over time in HRQoL, the EQ5D index (p = 0.002) and the SF12 physical component score (PCS) (p = 0.005). Changes over time in anxiety and depression were not found. Seventy-three percent of patients had an EQ-VAS score below 70 (scale 0–100) on overall health status at discharge from hospital; at 6 months the corresponding figure was 41%. Physical problems were the most com-mon complaint affecting HRQoL. A correlation was found between depression and HRQoL, and this was strongest at six months (rs = −0.44 to −0.71, p ≤ 0.001). Conclusion: HRQoL improves over the first 6 months after a CA. Patients reported lower levels of HRQoL on the physical as compared to mental component. The results indicate that the less anxiety and depression patients perceive, the better HRQoL they have and that time can be an important factor in recovery after CA.
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| 40. |
- Larsson, Ing-Marie, 1963-, et al.
(author)
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Healthcare workers' structured daily reflection on patient safety, workload and work environment in intensive care. A descriptive retrospective study
- 2022
-
In: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 68
-
Journal article (peer-reviewed)abstract
- Objectives: To describe the results of use of structured daily reflection assessments among healthcare workers at an intensive care unit over the course of one year. Methods: In this descriptive retrospective study, data were analysed both quantitatively and qualitatively. The data encompassed 1095 work shifts, evaluated by healthcare workers at an intensive care unit using a structured daily reflection instrument. The areas evaluated were patient safety, workload and work environment, and free-text comments were possible.Findings: The results showed that 36% (n = 395) of work shifts, most of them daytime shifts (44%; n = 161), were affected. Workload was the area that affected most work shifts (29%; n = 309). Missed nursing care, complex care and inaccurate communication impacted patient safety, while patient care, multitasking and working conditions affected workload. Work environment was impacted by organisational factors, environment, lack of control and moral stress.Conclusion: Using daily reflection among healthcare workers in the intensive care unit illuminated areas that affect patient safety, workload, and work environment. The importance of communication and collaboration and how they can impact patient safety, workload, and the work environment were highlighted by the team.
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| 41. |
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| 42. |
- Larsson, Ing-Marie, 1963-, et al.
(author)
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Poor long-term recovery after critical COVID-19 during 12 months longitudinal follow-up
- 2023
-
In: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 74
-
Journal article (peer-reviewed)abstract
- OBJECTIVES: This study aimed to describe the burden of illness and impact on health and working situation among former intensive care patients treated for COVID-19.METHODS: A prospective cohort study was performed at one intensive care unit of a university hospital in Sweden during the first wave of COVID-19 in spring 2020. The burden of illness in health status, cognitive, physical, and psychological outcomes, and working situation were assessed at four and 12 months after discharge from intensive care, using nine validated instruments.RESULTS: Forty-six participants treated for COVID-19 participated in both follow-ups and were included in this study. General fatigue was reported by 37 of 46 participants (82%) at both follow-ups (p = 1.000). For overall health status 28 (61%) participants at the first follow-up and 26 (57%) (p = 0.414) at the second reported lower values than the general population. Cognitive impairment was seen in 22 (52%) participants at four months and in 13 (31%) at 12 months (p = 0.029). The proportion of participants on sick-leave decreased between the first and second follow-up (24% vs 13%, p = 0.025), but the proportion of participants working full-time was almost the same at both follow-ups (35% vs 37%, p = 0.317).CONCLUSIONS: The burden of illness of patients treated in intensive care due to COVID-19 included cognitive, physical, and psychological impacts. Cognitive functions were improved after 12 months, but no clear improvements could be distinguished in the physical or psychological outcome. Higher burden of illness was associated with inability to return to work.
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| 43. |
- Larsson, Ing-Marie, 1963-
(author)
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Post-Cardiac Arrest Care : Therapeutic Hypothermia, Patient Outcomes and Relatives’ Experiences
- 2014
-
Doctoral thesis (other academic/artistic)abstract
- The overall aim of the thesis was to study post-resuscitation care of cardiac arrest (CA) patients with a focus on therapeutic hypothermia treatment, outcomes up to six months post-CA and relatives’ experiences during the hospital stay.In Paper I, the aim was to asses effectiveness of hypothermia treatment with cold, 4°C, intravenous crystalloid infusion combined with ice packs. In conclusion, the described cooling method was found to be useful for inducing and maintaining hypothermia, allowed good temperature control during rewarming and to be feasible in clinical practice.The aim in Paper II was to investigate biomarkers and the association of serum glial fibrillary acidic protein (GFAP) levels with outcome, and to compare GFAP with neuron-specific enolas (NSE) and S100B. The result showed increased GFAP levels in the poor outcome group, but did not show sufficient sensitivity to predict neurological outcome. Both NSE and S100B were shown to be better predictors. A combination of the investigated biomarkers did not increase the ability to predict neurological outcome.In Paper III, the aim was to investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months post-CA. There was improvement over time in HRQoL, but changes over time in anxiety and depression were not found. Physical problems seemed to affect HRQoL more than psychological problems. The results also indicate that the less anxiety and depression patients perceive, the better their HRQoL.In the fourth paper, the aim was to describe relatives’ experiences during the next of kin’s hospital stay after surviving a CA. The analysis resulted in three themes: The first period of chaos, Feeling secure in a difficult situation, and Living in a changed existence.In conclusion, the results of the thesis have helped to improve knowledge within the areas studied and reveal aspects that should be taken into account in the overall treatment of this group of patients. The thesis have also shown the importance of developing an overall view and establishing a chain of care from an individual’s CA until follow-up for both the patient and his/her relatives.
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| 44. |
- Larsson, Ing-Marie, et al.
(author)
-
Post-cardiac arrest serum levels of glial fibrillary acidic protein for predicting neurological outcome
- 2014
-
In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 85:12, s. 1654-1661
-
Journal article (peer-reviewed)abstract
- Aim of the study: To investigate serum levels of glial fibrillary acidic protein (GFAP) for evaluation of neurological outcome in cardiac arrest (CA) patients and compare GFAP sensitivity and specificity to that of more studied biomarkers neuron-specific enolas (NSE) and S100B. Method: A prospective observational study was performed in three hospitals in Sweden during 2008-2012. The participants were 125 CA patients treated with therapeutic hypothermia (TH) to 32-34. °C for 24. hours. Samples were collected from peripheral blood (n. =. 125) and the jugular bulb (n. =. 47) up to 108. hours post-CA. GFAP serum levels were quantified using a novel, fully automated immunochemical method. Other biomarkers investigated were NSE and S100B. Neurological outcome was assessed using the Cerebral Performance Categories scale (CPC) and dichotomized into good and poor outcome. Results: GFAP predicted poor neurological outcome with 100% specificity and 14-23% sensitivity at 24, 48 and 72. hours post-CA. The corresponding values for NSE were 27-50% sensitivity and for S100B 21-30% sensitivity when specificity was set to 100%. A logistic regression with stepwise combination of the investigated biomarkers, GFAP, did not increase the ability to predict neurological outcome. No differences were found in GFAP, NSE and S100B levels when peripheral and jugular bulb blood samples were compared. Conclusion: Serum GFAP increase in patients with poor outcome but did not show sufficient sensitivity to predict neurological outcome after CA. Both NSE and S100B were shown to be better predictors. The ability to predict neurological outcome did not increased when combining the three biomarkers.
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| 45. |
- Larsson, Ing-Marie, et al.
(author)
-
Relatives' experiences during the next of kin's hospital stay after surviving cardiac arrest and therapeutic hypothermia
- 2013
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In: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 12:4, s. 353-359
-
Journal article (peer-reviewed)abstract
- Aim: To describe relatives’ experiences during the next of kin’s hospital stay after surviving a cardiac arrest (CA) treated with hypothermia at an intensive care unit (ICU).Methods: Twenty relatives were interviewed when the person having suffered the CA was discharged from hospital, 1.5 to 6 weeks post-CA. Data were analysed using qualitative content analysis.Results: Three themes are described: The first period of chaos, Feeling secure in a difficult situation, and Living in a changed existence. Relatives found it difficult to assimilate the medical information and wanted it in written form. They wanted honest and clear information about their next of kin’s condition and prognosis. They lacked rehabilitation plans after discharge from the medical ward. Relatives felt a need to maintain telephone contact with family members and friends, which was time-consuming. They felt guilty and had a conscience about these feelings. Relatives felt uncertain about the future, but still hopeful.Conclusion: Relatives asked for more information and individual rehabilitation plans. Booklets describing CA, the ICU stay and continuing care and rehabilitation directed at both the patients and their relatives are needed. Follow-up visits to the ICU staff, for both patients and relatives, need to be arranged. Hospitals should consider having a rehabilitation plan for this group of patients, which is presented by a team of healthcare professionals and that focuses on the individual’s situation, including the consequences of their heart disease and brain damage.
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| 46. |
- Larsson, Ingrid, 1968-, et al.
(author)
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Parents’ experiences of an e-health intervention implemented in pediatric healthcare : a qualitative study
- 2019
-
In: BMC Health Services Research. - London, UK : BioMed Central. - 1472-6963. ; 19
-
Journal article (peer-reviewed)abstract
- Background: The growing field of participation in healthcare has the potential to provide a number of benefits for children, patients, healthcare professionals and also the healthcare systems. According to the Convention on the Rights of the Child (UNCRC), children have the right to participate in their own healthcare and make their voice heard. Children’s opportunities for understanding their conditions, sharing their views and participating in decisions regarding their care depend on healthcare professionals but also on parents’ ability to communicate and include children. E-health solutions can remove barriers to children’s communication with healthcare professionals. The aim of this study was to explore parents’ perspectives on the outcomes of an e-health solution, Sisom, used by children during healthcare appointments.Methods: The empirical data is based on interviews with 16 parents. In the present study constructivist, grounded theory was chosen as the method.Results: The theory of enhancing participation, by orientating communication about healthcare towards the voice of the child instead of the parents, summarizes the process of how the outcome of Sisom for children lead to enhanced participation, by making the child the main actor and an agent in his/her own healthcare. The facilitators for achieving participation in Sisom were four interrelated outcomes; engaging, voice-guarding, raising awareness and integrity preserving. In addition to generating increased participation, it emerged that the use of Sisom also initiated a process, which was evident in all four subcategories that facilitated the child in coping with the experience of having an illness.Conclusions: We conclude, that Sisom orientated communication about healthcare towards the voice of the child instead of the parents as well as including the child in the dialogue with the healthcare professional and thus increasing the child’s participation and human rights. © 2019 The Author(s)
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| 47. |
- Lilja, Gisela, et al.
(author)
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Uppföljning av patient och närstående efter hjärtstopp varierar stort
- 2015
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In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 112
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Journal article (peer-reviewed)abstract
- The return to a good life after successfully resuscitated cardiac arrest may be hindered by cardiovascular morbidity, psychological distress and the consequences of anoxic brain injury. To support the return to everyday life, patients and their relatives are in need of health care follow-up with multiple focuses. Usually, this follow-up consists of at least one of three parallel tracks; cardiology for interventions and secondary prevention, post intensive care follow-up to capture and prevent consequences of the traumatic event and the ICU stay, or neurological follow-up for patients with neurological sequels. None of these tracks include all patients. In addition, survivors are usually included and followed with patient related outcome measures (PROM) through the multiple Swedish national quality registers. The different clinical follow-up systems and the registers are not coordinated and assessments and questions may be repeated multiple times. A more integrated follow-up model has the potential to benefit the patient and their relatives and to reduce costs.
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| 48. |
- Milton, Anna, et al.
(author)
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Caregiver burden and emotional wellbeing in informal caregivers to ICU survivors-A prospective cohort study
- 2022
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In: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 66:1, s. 94-102
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Journal article (peer-reviewed)abstract
- Background: Informal caregivers to intensive care unit (ICU) survivors may develop post-intensive care syndrome family (PICS-F), including depression, anxiety and post-traumatic stress (PTS). Our primary aim was to investigate associations between caregiver burden in informal caregivers cohabiting with ICU survivors and patients' physical and psychological outcomes.Methods: A prospective, multicentre cohort study in four ICUs in Sweden. Adults cohabiting with ICU patients included in a previous study were eligible for inclusion. Three months post-ICU, informal caregivers received questionnaires assessing caregiver burden, health-related quality of life (HRQL) and symptoms of depression, anxiety and PTS. In parallel, patients reported their three-month physical and psychological status via validated questionnaires. The primary outcome of this study was to compare caregiver burden in informal caregivers to patients with and without adverse physical and psychological outcomes 3 months post-ICU. Secondary outcomes were correlations between caregiver burden and informal caregivers' mental HRQL.Results: Among 62 included informal caregivers, 55 (89%) responded to the follow-up questionnaires. Caregiver burden was higher among informal caregivers to patients with an adverse outcome, compared to informal caregivers to patients without an adverse outcome, caregiver burden scale score mean (+/- standard deviation) 52 (11) and 41 (13) respectively (p = 0.003). There was strong negative correlation between caregiver burden and informal caregivers' mental HRQL (r(s) -0.74, p < 0.001).Conclusion: Informal caregivers to ICU survivors with adverse physical or psychological outcome experience a higher caregiver burden. A higher caregiver burden correlates with worse caregiver mental HRQL. ICU follow-up programs should consider screening and follow-up of informal caregivers for mental health problems.
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| 49. |
- Milton, A., et al.
(author)
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Development of an ICU discharge instrument predicting psychological morbidity : a multinational study
- 2018
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In: Intensive Care Medicine. - : Springer. - 0342-4642 .- 1432-1238. ; 44:12, s. 2038-2047
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Journal article (peer-reviewed)abstract
- Purpose: To develop an instrument for use at ICU discharge for prediction of psychological problems in ICU survivors.Methods: Multinational, prospective cohort study in ten general ICUs in secondary and tertiary care hospitals in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay12h were eligible for inclusion. Patients in need of neurointensive care, with documented cognitive impairment, unable to communicate in the local language, without a home address or with more than one limitation of therapy were excluded. Primary outcome was psychological morbidity 3months after ICU discharge, defined as Hospital Anxiety and Depression Scale (HADS) subscale score11 or Post-traumatic Stress Symptoms Checklist-14 (PTSS-14) part B score>45.Results: A total of 572 patients were included and 78% of patients alive at follow-up responded to questionnaires. Twenty percent were classified as having psychological problems post-ICU. Of 18 potential risk factors, four were included in the final prediction model after multivariable logistic regression analysis: symptoms of depression [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.10-1.50], traumatic memories (OR 1.44, 95% CI 1.13-1.82), lack of social support (OR 3.28, 95% CI 1.47-7.32) and age (age-dependent OR, peak risk at age 49-65years). The area under the receiver operating characteristics curve (AUC) for the instrument was 0.76 (95% CI 0.70-0.81).Conclusions: We developed an instrument to predict individual patients' risk for psychological problems 3months post-ICU, http://www.imm.ki.se/biostatistics/calculators/psychmorb/. The instrument can be used for triage of patients for psychological ICU follow-up.Trial registration: The study was registered at clinicaltrials.gov, NCT02679157.
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