Ewa Wallin

Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment

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 common 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.

Does age, gender or educational background effect patient satisfaction with short stay surgery?

Abstract Patient satisfaction is an area of special interest to health care workers. The aim was to investigate if a patient’s age, gender or educational background effected their satisfaction with short stay surgery. The results showed that the 275 patients were quite satisfied with the care. The findings did not indicate a correlation between age or gender and patient satisfaction. There is however some agreement implying that patients with a higher educational level have a different view of the care given than patients with lower educational background. A standardization of design and questionnaire is necessary to be able to correlate patient satisfaction related patient characteristics.

Post-cardiac arrest serum levels of glial fibrillary acidic protein for predicting neurological outcome

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.

Relatives' experiences during the next of kin's hospital stay after surviving cardiac arrest and therapeutic hypothermia

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.

Intra-individual variations and temporal trends in dioxin levels in human blood 1987-2002

OBJECTIVES In Sweden, an important source for exposure to persistent organochlorine pollutants, such as PCDD and PCDF, is through intake of fatty fish from the Baltic Sea off the Eastern coast of Sweden. The present study assesses temporal trends for human levels of PCDD/F between 1987 and 2002 among 26 men from Sweden. In addition, we investigate the impact of potential determinants (age, relative change in BMI and fish consumption) on the relatively change in individual PCDD/F congener levels between 1987 and 2002. METHODS In 1987, nine of the men did not eat fatty fish from the Baltic Sea, eight had a moderate intake, and nine were high consumers. For the same individuals, blood samples were collected in 1987 as well as in 2002, and the concentrations of seven PCDD and 10 PCDF congeners were analyzed at the same laboratory. RESULTS The WHO-TEQ levels for PCDD/F did not significantly change over the 15-year period. There were, however, some specific congeners that significantly had changed over time. None of the investigated determinants were associated with the change over time for the specific PCDD/F congeners. CONCLUSION The present study may be of importance for risk assessment and setting standards for food contamination with PCDD/F, especially regarding intake of fatty fish from the Baltic Sea.

Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender

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.

Design of DISCO—Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest study

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 electrocardiograms (ECGs) 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 (&agr; = .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.

Characteristics of jugular bulb oxygen saturation in patients after cardiac arrest: A prospective study

Using cerebral oxygen venous saturation post‐cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post‐ CA in cases where TTM 33°C was applied.

Migration dermatology : an issue to consider?

The recent waves of migration across Europe have resulted in a rapid change of the patient population in many major cities in Europe, affecting the demand for health care and specifically dermatological care, as highlighted recently in an editorial of this journal. The psychosocial burden of the migrant population is often considerable, with stressful living conditions and reduced access to health care, however there is still little research on the health of migrant populations, probably because of methodological challenges and the lack of international consensus on the definition of migration status. This article is protected by copyright. All rights reserved.

Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest

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.