| 1. |
- Jensen, Hanne Irene, et al.
(author)
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Conditions and strategies to meet the challenges imposed by the COVID-19-related visiting restrictions in the intensive care unit : A Scandinavian cross-sectional study
- 2021
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In: Intensive & Critical Care Nursing. - : Churchill Livingstone. - 0964-3397 .- 1532-4036.
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Journal article (peer-reviewed)abstract
- Objectives: To examine conditions and strategies to meet the challenges imposed by the coronavirus disease 2019 (COVID-19)-related visiting restrictions in Scandinavian intensive care units. Research methodology/design: A cross-sectional survey. Setting: Adult intensive care units in Denmark, Norway and Sweden. Main outcome measures: Likert scale responses and free-text comments within six areas: capacity and staffing, visiting policies and access to the unit, information and conferences with relatives, written information, children as relatives and follow-up initiatives. Results: The overall response rate was 53% (74/140 participating units). All intensive care units had planned for capacity extensions; the majority ranging between 11 and 30 extra beds. From March–June 2020, units had a mean maximum of 9.4 COVID-19 patients simultaneously. Allowing restricted visiting was more common in Denmark (52%) and Norway (61%) than in Sweden where visiting was mostly denied except for dying patients (68%), due to a particular increased number of COVID-19 patients. The restrictions forced nurses to compromise on their usual standards of family care. Numerous models for maintaining contact between relatives and patients were described. Conclusion: Visitation restrictions compromised the quality of family care and entailed dilemmas for healthcare professionals but also spurred initiatives to developing new ways of providing family care. © 2021 The Authors
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| 2. |
- Garnham, Laura, 1988-
(author)
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Causes and Consequences of Impulsivity in Red Junglefowl
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Throughout the animal kingdom, animals vary in cognition (i.e., how they acquire, process, store, and act on environmental information). Yet, the causes and consequences of this variation are currently unclear. Inhibitory control is one such aspect of cognition that typically varies between individuals within all species investigated. Variation in inhibitory control underlies variation in impulsivity (i.e., the tendency to act without planning or considering the consequences). The causes and consequences of variation in impulsivity are, themselves, rarely explored, despite that these may have important ecological and evolutionary implications. My thesis (spanning 5 papers), therefore, aimed to fill some of these gaps by taking a holistic approach and investigating causes and consequences of variation in impulsivity (specifically, impulsive action and persistence measured in a detour task) in red junglefowl (Gallus gallus) males and females, chicks and adults. The red junglefowl was an ideal species for this investigation. Firstly, they show individual variation in impulsivity throughout their lives. They are also typically food motivated, and easily habituated to handling and new situations, which means they commonly willingly participate in behavioural and cognitive tests. Furthermore, they are precocial, which means that they can be hatched and raised without mothers, thus reducing parental effects. Finally, the large, accumulated knowledge of red junglefowl behaviour and cognition aids interpretations regarding this. As differences in experience early in life have been found to affect impulsivity, papers I and II empirically explored whether variation in two previously uninvestigated experiences in early life (exposure to enrichment, and social group size, respectively) influenced impulsivity. The dopaminergic and serotonergic systems are important signalling systems in the brain, which have been found to link to impulsivity in other species. Therefore, in paper I, I also explored if variation in impulsive action and persistence was connected to variation in dopaminergic or serotonergic gene expression. As impulsivity links to inhibitory control, in looking at the effect of group size on impulsivity, paper II explored the hypotheses that social environment affects cognition (e.g., that social environments which are assumed to be more cognitively demanding will lead to better cognitive performance, a.k.a., the social intelligence hypothesis). To uncover potential mechanisms by which group size could affect impulsivity, besides from variation in cognitive demand, paper II also investigated if behaviours that could covary with group size linked to impulsivity. As emotional arousal has been linked to impulsivity, in another species, and impulsivity is implicated in welfare issues, paper III looked into how both positive and negative affective states (which can be used to measure welfare) related to impulsivity. Prior to my thesis, whether variation in impulsivity could potentially affect animal welfare was scarcely explored. To better understand the potential consequences of impulsivity, and, thus, how selection could act on impulsivity, papers IV and V looked at potential implications of variation in impulsivity for social status (paper IV and V), foraging efficiency, and risk taking (paper V). My results showed that impulsivity could be consistent over time periods of weeks (in chicks, paper II) to months (in adults, paper V). Thus, impulsivity describes a characteristic of the individual. However, individuals could still learn to become less impulsive (paper I). Exposure to enrichment in early life could affect how impulsively individuals behaved. Environmental enrichment increased impulsivity, as did cognitive enrichment to a greater degree (paper I). Impulsive action, and persistence, correlated somewhat with brain gene expression of dopaminergic and serotonergic genes (DRD1, TPH; paper I). The social group size individuals experimentally experienced in early life did not affect their impulsivity (paper II). However, variation in impulsivity was connected to variation in activity, boldness, neophobia, and stress (paper II). Further, more impulsive individuals had less negative, more positive, affective states, but only when they were young chicks, and not as older chicks or adults (paper VI). No links were found between impulsivity and social status (paper IV and V), foraging efficiency, or risk taking (paper V). Taken together, paper I suggests that underlying explanations to observed individual variation in impulsivity could include variation in early life experiences and in dopaminergic and serotonergic gene expression, while paper II suggests that impulsivity may not be influenced by social aspects early in life. Papers II and III demonstrate that variation in impulsivity can associate with variation in behaviours and affective states (though these associations may vary over ontogeny), with the latter finding implying that variation in impulsivity could have welfare implications. Papers IV and V indicate that variation in impulsivity may have limited consequences for individuals in contexts that could affect reproduction or survival. Thus, it may not necessarily be costly to individuals if they are more impulsive than others. This, in turn, could help explain why variation in inhibitory control exists, because limited consequences of variation could result in low selection against variation. Overall, through the investigations conducted in its 5 papers, my thesis improves our understanding the potential causes and consequences of variation in impulsivity. As impulsivity is underlain by an aspect of cognition (inhibitory control), in exploring the causes and consequences of variation in impulsivity, my thesis also provides knowledge on causes and consequences of individual variation in cognition.
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| 3. |
- Jensen, Hanne Irene, et al.
(author)
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Practice Recommendations for End-of-Life Care in the Intensive Care Unit.
- 2020
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In: Critical care nurse. - : AACN Publishing. - 1940-8250 .- 0279-5442. ; 40:3, s. 14-22
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Journal article (peer-reviewed)abstract
- TOPIC: A substantial number of patients die in the intensive care unit, so high-quality end-of-life care is an important part of intensive care unit work. However, end-of-life care varies because of lack of knowledge of best practices.CLINICAL RELEVANCE: Research shows that high-quality end-of-life care is possible in an intensive care unit. This article encourages nurses to be imaginative and take an individual approach to provide the best possible end-of-life care for patients and their family members.PURPOSE OF PAPER: To provide recommendations for high-quality end-of-life care for patients and family members.CONTENT COVERED: This article touches on the following domains: end-of-life decision-making, place to die, patient comfort, family presence in the intensive care unit, visiting children, family needs, preparing the family, staff presence, when the patient dies, after-death care of the family, and caring for staff.
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| 4. |
- Lauridsen, Susanne Vahr, et al.
(author)
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Effect of a Smoking and Alcohol Cessation Intervention Initiated Shortly Before Radical Cystectomy—the STOP-OP Study : A Randomised Clinical Trial
- 2022
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In: European Urology Focus. - : Elsevier BV. - 2405-4569. ; 8:6, s. 1650-1658
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Journal article (peer-reviewed)abstract
- Background: Evidence concerning the reduction of postoperative complications due to smoking and alcohol drinking in patients undergoing radical cystectomy is incomplete. Objective: To evaluate the efficacy of a 6-wk smoking and/or alcohol cessation intervention, initiated shortly before surgery and continued until 4 wk after, in reducing complications. Design, setting, and participants: Between 2014 and 2018, we enrolled 104 patients with high-risk bladder cancer who were daily smokers or consuming at least 3 units of alcohol daily in a multicentre randomised clinical trial. Intervention: Patients were randomised to a 6-wk intensive smoking and/or alcohol cessation intervention or treatment as usual. Outcome measurements and statistical analysis: The primary endpoint was the number of patients developing any postoperative complication, or death, within 30 d after surgery. The secondary endpoints were successful quitters, health-related quality of life, length of stay, time back to habitual activity, and mortality. An intention-to-treat analysis was applied to evaluate treatment effect. Results and limitations: There were some differences in baseline demographic and lifestyle characteristics. Postoperatively, 64% in the intervention group versus 70% in the control group (risk ratio [RR] 0.91, confidence interval [CI] 0.68–1.21, p = 0.51) developed complications. Significantly fewer patients developed three or more complications after 30 d (RR 0.39; CI 0.18–0.84, p = 0.01). The rates of successful quitting were 51% in the intervention group and 27% in the control group (RR 2, CI 1.14–3.51, p = 0.01). The external validity of this trial may be limited because 53% of eligible patients refused participation. Conclusions: Despite a significant effect on the quit rate at completion of the intervention, this multimodal prehabilitation did not show a significant difference regarding our primary outcome postoperative complications. Patient summary: A 6-wk smoking and alcohol cessation intervention in relation to bladder cancer surgery did not reduce postoperative complications, but it was effective in supporting people to quit in the short term.
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| 5. |
- Lauridsen, Susanne Vahr, et al.
(author)
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The gold standard program (GSP) for smoking cessation : a cohort study of its effectiveness among smokers with and without cancer
- 2023
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In: Acta oncologica (Stockholm, Sweden). - 1651-226X. ; 62:7, s. 774-781
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Journal article (peer-reviewed)abstract
- BACKGROUND: Smoking cessation treatment is an important prognostic factor for survival after a cancer diagnosis, especially for tobacco-related cancers. After being diagnosed with lung cancer, approximately 50% of patients continue smoking or frequently relapse after a quit attempt. Given the importance of smoking cessation treatment for cancer survivors, the objective was to compare the effectiveness of a 6-week intensive smoking cessation intervention, the Gold Standard Program (GSP), among cancer survivors compared with smokers without cancer. Second, we compared successful quitting among socioeconomically disadvantaged cancer survivors with that among nondisadvantaged cancer survivors.MATERIALS AND METHODS: This was a cohort study based on 38,345 smokers from the Danish Smoking Cessation Database (2006-2016). Linkage to the National Patient Register was used to identify cancer survivors undergoing the GSP after being diagnosed with cancer (except nonmelanoma skin cancer). Linkage to the Danish Civil Registration System was used to identify participants who died, went missing, or emigrated before the follow-up. Logistic regression models were applied to evaluate effectiveness.RESULTS AND CONCLUSION: Six percent (2438) of the included smokers were cancer survivors at the time they undertook the GSP. Their 6-month successful quitting showed no difference compared to that of smokers without cancer, neither before nor after adjustment; 35% versus 37% in crude rates and an aOR of 1.13 (95% CI: 0.97-1.32). Likewise, the results for disadvantaged compared to nondisadvantaged cancer survivors were not significantly different (32% versus 33% and an adjusted aOR of 0.87 (95% CI 0.69-1.11)). Overall, an intensive smoking cessation program seems effective in helping both people without cancer and cancer survivors become successful quitters.
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| 6. |
- Raffing, Rie, et al.
(author)
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Facilitators and barriers for young medical doctors writing their first manuscript for publication
- 2021
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In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:16
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Journal article (peer-reviewed)abstract
- Although scientific publication is often mandatory in medical professions, writing the first research article for publication is challenging, especially as medical curricula have only a minor focus on scientific writing. The aim was therefore to identify facilitators and barriers experienced by medical doctors writing their first scientific article for publication. An explorative inductive approach made use of semi-structured interviews for collecting data until saturation. Data were ana-lyzed with systematic text condensation. Several barriers were identified: (a) writing in general; (b) writing in English; (c) dealing with content, structure, and presentation; and (d) navigating in the author group. Good supervision in the initial writing phase was a facilitating factor. Medical doctors requested a course in which they could work on their own articles and give feedback to fellow stu-dents. They valued skilled lecturers and individual supervision, and they wanted to learn about author instructions, how to present text correctly, and how to sell their core message. Their goal was to create a useful end product and to obtain European Credit Transfer System (ECTS) points. The facilitators and barriers that medical doctors experience when writing their first scientific article for publication and their course requests should be reflected in the learning objectives and content of future courses.
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| 7. |
- Tønnesen, Hanne, et al.
(author)
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Two novel prehabilitation apps to help patients stop smoking and risky drinking prior to hip and knee arthroplasty
- 2023
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In: International Orthopaedics. - : Springer Nature. - 0341-2695 .- 1432-5195. ; 47:11, s. 2645-2653
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Journal article (peer-reviewed)abstract
- PURPOSE: Daily smoking or risky drinking increases the risk of complications after surgery by ~50%. Intensive prehabilitation aimed at complete cessation reduces the complication rate but is time-consuming. The purpose of this study was to carry out preoperative pilot tests (randomized design) of the feasibility (1A) and validation (1B) of two novel prehabilitation apps, habeat® (Ha-app) or rehaviour® (Re-app).METHODS: Patients scheduled for hip or knee arthroplasty with daily smoking, risky drinking, or both were randomised to one of the two apps. In part 1A, eight patients and their staff measured feasibility on a visual analog scale (VAS) and were interviewed about what worked well and the challenges requiring improvement. In part 1B, seven patients and their staff tested the improved apps for up to two weeks before validating the understanding, usability, coverage, and empowerment on a VAS and being interviewed.RESULTS: In 1A, all patients and staff returned scores of ≥5 for understanding the apps and mostly suggested technical improvements. In 1B, the scores varied widely for both apps, with no consensus achieved. Two of four patients (Ha-app) and one-third of the patients (Re-app) found the apps helpful for reducing smoking, but without successful quitting. The staff experienced low app competencies among patients and high time consumption. Specifically, patients most often needed help for the Ha-app, and the staff most often for Re-app; however, the staff reported the Re-app dashboard was more user-friendly. Support and follow-up from an addiction specialist staff member were suggested to complement the apps, thereby increasing the time consumption for staff.CONCLUSIONS: This pilot study to test prototype apps generated helpful feedback for the app developers. Based on the patient and staff comments, multiple improvements in functionality seem required before scaling up the evaluation for effect on prehabilitation and postoperative complications.
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| 8. |
- Van den Bulcke, Bo, et al.
(author)
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Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States.
- 2020
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In: Intensive care medicine. - 1432-1238. ; 46:1, s. 46-56
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Journal article (peer-reviewed)abstract
- Apart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one's job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics.Perceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries.Of 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave.This is the first large multicenter study showing an independent association between clinicians' intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL.
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| 9. |
- Wan, Feng, et al.
(author)
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Ultrasmall TPGS-PLGA Hybrid Nanoparticles for Site-Specific Delivery of Antibiotics into Pseudomonas aeruginosa Biofilms in Lungs
- 2020
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In: ACS Applied Materials and Interfaces. - : American Chemical Society (ACS). - 1944-8244 .- 1944-8252. ; 12:1, s. 380-389
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Journal article (peer-reviewed)abstract
- Inhaled antibiotic treatment of cystic fibrosis-related bacterial biofilm infections is challenging because of the pathological environment of the lungs. Here, we present an "environment-adaptive" nanoparticle composed of a solid poly lactic-co-glycolic acid (PLGA) core and a mucus-inert, enzymatically cleavable shell of d-α-tocopheryl polyethylene glycol 1000 succinate (TPGS) for the site-specific delivery of antibiotics to bacterial biofilms via aerosol administration. The hybrid nanoparticles with ultrasmall size were self-assembled via a nanoprecipitation process by using a facile microfluidic method. The interactions of the nanoparticles with the biological barriers were comprehensively investigated by using cutting-edge techniques (e.g., quartz crystal microbalance with dissipation monitoring, total internal reflection fluorescence microscopy-based particle tracking, in vitro biofilm model cultured in a flow-chamber system, and quantitative imaging analysis). Our results suggest that the mucus-inert, enzymatically cleavable TPGS shell enables the nanoparticles to penetrate through the mucus, accumulate in the deeper layer of the biofilms, and serve as sustained release depot, thereby improving the killing efficacy of azithromycin (a macrolide antibiotic) against biofilm-forming Pseudomonas aeruginosa. In conclusion, the ultrasmall TPGS-PLGA hybrid nanoparticles represent an efficient delivery system to overcome the multiple barriers and release antibiotics in a sustained manner in the vicinity of the biofilm-forming bacteria.
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