Bengt Fridlund

Memory in relation to depth of sedation in adult mechanically ventilated intensive care patients

ObjectiveTo investigate the relationship between memory and intensive care sedation.Design and settingProspective cohort study over 18 months in two general intensive care units (ICUs) in district university hospitals.Patients313 intubated mechanically ventilated adults admitted for more than 24 h, 250 of whom completed the study.MeasurementsPatients (n = 250) were interviewed in the ward 5 days after discharge from the ICU using the ICU Memory Tool. Patient characteristics, doses of sedative and analgesic agents, and sedation scores as measured by the Motor Activity Assessment Scale (MAAS) were collected from hospital records after the interview.ResultsPatients with no recall (18%) were significantly older, had higher baseline severity of illness, and experienced fewer periods of wakefulness (median proportion of MAAS score 3; 0.37 vs. 0.70) than those who had memories of the ICU (82%). Multivariate analyses showed that increasing proportion of MAAS 0–2 and older age were significantly associated with having no recall. Patients with delusional memories (34%) had significantly longer ICU stay (median 6.6 vs. 2.2 days), higher baseline severity of illness, higher proportions of MAAS scores 4–6, and more administration of midazolam than those with recall of the ICU without delusional memories.ConclusionsHeavy sedation increases the risk of having no recall, and longer ICU stay increases the risk of delusional memories. The depth of sedation during total ICU stay as recorded with the MAAS may predict the probability of having memories of the ICU.

Depression and health-related quality of life in elderly patients suffering from heart failure and their spouses: a comparative study.

Little is known about the factors that influence the health outcome of elderly patients suffering from heart failure or the health of their spouses. The aim of this comparative study was to determine if older patients suffering from heart failure and their spouses experience similar levels of health‐related quality of life (HRQOL) and depression. The aim was also to identify those factors that contribute to HRQOL and depression in patient–spouse pairs.

Sexual Counseling for Individuals With Cardiovascular Disease and Their Partners A Consensus Document From the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP)

Sexual counseling for individuals with cardiovascular disease and their partners: a consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP)

Intensive care sedation of mechanically ventilated patients: a national Swedish survey

Sedation in critically ill patients is a complex issue and at the same time an important concept for ensuring patient comfort. The aim of this study was to review the current practice of sedation for patients on mechanical ventilation in Swedish intensive care units (ICUs). Questionnaires were sent by post to head nurses in 89 ICUs with mechanically ventilated patients. By August 2000, 87 (98%) questionnaires had been returned. The results show that mechanically ventilated patients were routinely sedated in 91% of ICUs. Midazolam or propofol in combination with an opioid were the drugs preferred by 76%. Heavy sedation was most usual in 63% of ICUs but, when asked about the sedation level preferred by nurses, 78% chose light sedation (P=0.001). Only 16% used sedation scales. This study indicates that local habits and personal attitudes seem to have a great impact on sedation routines. It therefore appears worthwhile for ICUs to review their practice and, if necessary, to consider implementing sedation scales and sedation guidelines. Research pertaining to potential complications and patient comfort in relation to different sedation levels as well as further validation of the efficacy of sedation scales is needed.

Sense of coherence—a determinant of quality of life over time in older female acute myocardial infarction survivors

AIMS To determine the relationships between different sense of coherence levels and quality of life, and in older female myocardial infarction survivors; to investigate how socio-demographic, clinical characteristics, sense of coherence self-reported symptoms and function affect quality of life; and to determine whether sense of coherence and quality of life are stable during a six-month follow-up. BACKGROUND Myocardial infraction confers new physical and mental challenges. However, research on sense of coherence and other factors involved in maintaining physical, psychosocial and environmental aspects of quality of life in older female myocardial infraction survivors is scant. DESIGN Survey. METHODS A postal survey was conducted of 145 women, aged 62-80 years, three months to five years after myocardial infarction (T1), with a follow-up after six months (T2). Self-reported socio-demographic and clinical data and hospital medical records data were collected. The sense of coherence scale (SOC-29) and the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF) were used. RESULTS We found a significant difference in quality of life between weak, moderate, and strong sense of coherence groups (p<0.001). Sense of coherence contributed to the level of all quality of life domains (p<0.001). Several clinical characteristics contributed to quality of life: (1) physical domain: comorbidities (p<0.001), previous myocardial infarction (p = 0.013), ejection fraction (p<0.011), length of hospital stay (p = 0.005) symptoms and function (p<0.001); (2) psychological domain: previous myocardial infarction (p = 0.031) and symptoms and function (p<0.001); and (3) environmental domain: education (p = 0.033) and symptoms and function (p = 0.003). On group level, both sense of coherence and quality of life were stable. Experiencing specific health changes (p<0.001), not major life events, influenced quality of life during the six-month follow-up. CONCLUSION Sense of coherence was an important stable determinant of quality of life domains in female myocardial infarction survivors. Although other factors were identified, further research is needed to elucidate additional determinants of quality of life. RELEVANCE TO CLINICAL PRACTICE These specific factors could guide clinicians in making treatment decisions that optimize the quality of life of their patients. Applying a salutogenic perspective through patient education may be important.

Factors influencing the patient during weaning from mechanical ventilation : a national survey

Successful weaning depends on the application of skilled judgement and decision making to nursing and medical interventions. The intensive care nurse is in an unique position for adopting a holistic approach to weaning. Such an approach needs teamwork and consideration of all the factors that could influence the outcome of the weaning phase. The aim of this study was to conduct a survey, to establish the factors taken into consideration and documented during weaning at the intensive care units (ICUs) in Sweden. A questionnaire was developed and sent to all 92 ICUs. The results identified that nutrition, communication, analgesics and sedatives, psychological and metabolic factors, as well as weaning methods and measurable parameters were taken into consideration. Written instructions for weaning were used by only three ICUs and weaning protocols were not common. A holistic approach to the discontinuation of mechanical ventilation is a valuable means of improving the quality of care and merits further research.

“Striving for a Good Life” – The Management of Rheumatoid Arthritis as Experienced by Patients

Aim To generate a theoretical model how patients experience their management of rheumatoid arthritis (RA) in everyday life. Method An explorative design with the grounded theory approach was used by interviewing 16 informants with RA. Results The generated theoretical model emerged in a core category- Striving for a good life with two categories; making use of personal resources and grasping for support from others, which formed the base of managing RA. When relating these categories together, four dimensions emerged which characterised patients’ different ways of managing RA: mastering, relying, struggling and being resigned. Discussion The management of RA incorporated the use of personal resources and the grasping for support from others. Both self-management strategies and patients’ need of support were highlighted as aspects that were of importance when managing RA. Patients’ experiences of their need of support to manage RA give extended knowledge that is of importance for nurses and other healthcare providers. The relationship between patients and healthcare providers is always the key to a good encounter. Interventions to increase self-management in RA have to incorporate this knowledge when trying to increase patients’ self-efficacy and with their experience of support.

Trends in the misuse of androgenic anabolic steroids among boys 16-17 years old in a primary health care area in Sweden.

Objective - To evaluate the effects of an appearance programme in preventing the misuse of androgenic anabolic steroids among male adolescents in a primary health care area in Sweden. Methods - Attitudes to steroid hormones among 16-17 years old male and female adolescents are discussed. A well-established anonymous multiple-choice questionnaire was answered by 921 adolescents and statistically analysed. Results - The misuse of androgenic anabolic steroids tended to decrease after the intervention. Conclusions - The misuse of androgenic anabolic steroids did not increase, and even tended to decrease, after the intervention, indicating that drug-abuse among male adolescents can be decreased through discussions about appearance and attitudes. Repeat and prospective studies have to be done before this intervention programme can be generalised.OBJECTIVE To evaluate the effects of an appearance programme in preventing the misuse of androgenic anabolic steroids among male adolescents in a primary health care area in Sweden. METHODS Attitudes to steroid hormones among 16-17 years old male and female adolescents are discussed. A well-established anonymous multiple-choice questionnaire was answered by 921 adolescents and statistically analysed. RESULTS The misuse of androgenic anabolic steroids tended to decrease after the intervention. CONCLUSIONS The misuse of androgenic anabolic steroids did not increase, and even tended to decrease, after the intervention, indicating that drug-abuse among male adolescents can be decreased through discussions about appearance and attitudes. Repeat and prospective studies have to be done before this intervention programme can be generalised.

Views of xerostomia among health care professionals: a qualitative study.

AIM To explore and describe views of xerostomia among health care professionals. BACKGROUND Xerostomia (dry mouth) is caused by changes in quality and quantity of saliva due to poor health, certain drugs and radiation therapy. It is a common symptom, particularly among older people and has devastating consequences with regard to oral health and general well-being. METHODS Data were obtained and categorised by interviewing 16 health care professionals. Qualitative content analysis was chosen as the method of analysis. DESIGN Qualitative. RESULTS The latent content was formulated into a theme: xerostomia is a well-known problem, yet there is inadequate management of patients with xerostomia. The findings identified three categories expressing the manifest content: awareness of xerostomia, indifferent attitude and insufficient support. CONCLUSIONS Although xerostomia was recognised as commonly occurring, it was considered to be an underestimated and an ignored problem. Proper attention to conditions of xerostomia and subsequent patient management were viewed as fragmentary and inadequate. Additional qualitative studies among patients with xerostomia would be desirable to gain further understanding of the problems with xerostomia, its professional recognition and management. RELEVANCE TO CLINICAL PRACTICE A holistic view, positive professional attitudes and enhanced knowledge of xerostomia seem essential to augment collaboration among health care professionals and to improve compassion for and support of patients with xerostomia.

Urinary incontinence among a 65-year old Swedish population : medical history and psychosocial consequences

Urinary incontinence (UI) is a disability caused by an impairment, which can lead to a handicap of importance for nursing care. This means that UI is not only a practical-medical concern but also a socio-economic problem. The purpose of the study was to determine the prevalence of UI among 65 year-olds in a Swedish Health Care District and to compare gender differences concerning medical history and psychosocial consequences. In a Primary Health Care District, a questionnaire pertaining to UI was mailed to all women and men 65 years of age (N=458). A total of 91% (n=419) was sufficient for data analysis, which was performed by descriptive and inferential statistics. It was found that 28% (n=61) of the women and 9% (n=21) of the men were afflicted with UI. Women reported significantly more urge incontinence (p<.05) as well as stress incontinence (p<.05). Information from the health service about UI had been given to 46% (n=28) of the women and 33% (n=7) of the men. The strongest reason reported, both in women (42%, n=26) and men (40%, n=8), for not seeking help from the health service was that UI was a normal condition for people of their age. Most of the women had to urinate at least twice per night (42%) compared to once per night (44%) for the men. It is important to establish a UI clinic at every main Primary Health Care Centre which builds on nursing care and whose aim is to inform the general public that UI is a common problem, that it leads to psychosocial consequences, and that the health service can offer active rehabilitation interventions.