Tove Lindhardt

Women's experiences and behaviour at onset of symptoms of ST segment elevation acute myocardial infarction.

Background: Minimizing time from onset of symptoms to treatment (treatment delay) is crucial for patients with ST segment elevation acute myocardial infarction (STEMI), and one of the great challenges is to reduce the delay relating to the prehospital behaviour of the patient (patient delay). Studies indicate that women delay longer than men and insights into this area could lead to improved health education programmes aimed at reducing patient delay in women with STEMI. Method: Open interviews with 14 women with STEMI were held during their hospital stay from June to September 2009. The interviews were aimed at exploring determinants of treatment delay, and were carried out and analysed within a phenomenological framework. Findings: Three themes emerged important for the delay in seeking medical assistance: (1) Knowledge and ideas of AMI symptoms and risks. (2) Ambivalence whether to call for medical assistance or to cope with the situation. (3) Actions and strategies taken after onset of symptoms. Conclusions: Three factors determined whether women showed appropriate behaviour for reduced patient delay after onset of symptoms: (1) identifying the symptoms as being of cardiac origin, (2) having a prepared action plan in case of an emergency situation, and (3) living with someone or contacting other persons.

Wake and light therapy for moderate-to-severe depression – a randomized controlled trial

To examine the efficacy of using wake and light therapy as a supplement to standard treatment of hospitalized patients with depression.

Collaboration Between Relatives of Older Patients and Nurses in Acute Medical Wards: Confirmatory Factor Analysis of the Revised Family Collaboration Scale

Background: Relatives of older people are often involved in their care prior to hospital admission, and may hold valuable knowledge which, if involved, could improve decision-making related to care. Hence, collaboration is required and to monitor this, valid and feasible instruments are needed. The Family Collaboration Scale (FCS) was developed for this purpose, and has been found valid and reliable. Our study tested a shorter version, while assessing collaboration between nurses and 388 relatives. Results: The study provided support for reliability and construct validity of the revised scale. Its feasibility may benefit from adjustments, as older relatives, those with less education and those delivering extensive help, were less likely to complete the scale. Collaboration was rated as poor to average. Poor collaboration was significantly more often reported by women and relatives reporting guilt and powerlessness.

Predictors of response to combined wake and light therapy in treatment-resistant inpatients with depression

ABSTRACT There is growing evidence for combined chronotherapeutic interventions as adjunctive treatments for major depression. However, as the treatments can be demanding, we need to identify predictors of response. This study aimed to describe predictors of response, remission and deterioration in the short-term phase, as well as predictors of long-term response. The predictors investigated were gender, type of depression, severity of depression, treatment resistance, quetiapine use, general self-efficacy, educational level and positive diurnal variation. Follow-up data from 27 inpatients with moderate-to-severe depression participating in a chronotherapeutic intervention were analysed. As a supplement to standard treatment, they completed 3 wake therapy sessions in the first week, 30 min daily light treatment and sleep-time stabilisation in the entire 9-week study period. Patients had a significant decrease of depressive symptoms during the first 6 days measured by HAM-D6. At Day 6, 41% of the patients responded to the treatment and 19% fulfilled the criteria of remission. Deterioration by the end of wake therapy sessions was however not uncommon. In the short-term phase, mild degree of treatment resistance was associated with remission and low educational level associated with deterioration. Positive diurnal variation (mood best in the evening) was a predictor of both short-term and long-term response to combined wake and light therapy. Furthermore, patients with evening chronotypes (measured with morningness-eveningness score) were more responsive. Our results suggest that targeting the combined chronotherapeutic intervention at patients with positive diurnal variation and evening types is a viable option.

What relatives of older medical patients want us to know - a mixed-methods study

BackgroundRelatives of acutely hospitalised older medical patients often act as case managers during a hospital trajectory. Therefore, relatives’ experiences of collaboration with staff and their involvement in care and treatment are highly important. However, it is a field facing many challenges. Greater knowledge of the values and areas that are most important to relatives is needed to facilitate the health care staff to better understand and prepare themselves for collaboration with relatives and to guide family care.MethodsThe aims were to 1) describe the aspects of collaboration with staff during the hospital care trajectory emphasised by relatives of older medical patients 2) compare the characteristics of relatives who wrote free-text notes and those who did not. Relatives of acutely hospitalised older medical patients responded to a structured questionnaire (n = 180), and nearly half wrote free-text comments (n = 79). Free text was analysed with qualitative content analysis. Differences between (+) free text/ (−) free text groups were analysed with χ2 test and Kruskal-Wallis test.ResultsAnalysis disclosed three categories I) The evasive white flock, concerning the experienced evasiveness in staff attitudes and availability, II) The absence of care as perceived by the relatives and III) Invisible & unrecognised describing relatives’ experience of staff’s lack of communication, involvement and interactions with relatives especially regarding discharge.Significant differences were found between relatives who wrote free-text and those who did not regarding satisfaction, trust and having a health care education.ConclusionsThis study provides knowledge of aspects relatives of older medical patients find particularly problematic and, further, of characteristics of relatives using the free-text field. Overall, these relatives were met with evasiveness from staff, an absence of care and felt invisible and unrecognised in the lacking collaboration with staff. Hence, strategies to ensure quality care and systematic involvement of relatives are needed, and the findings in this study may contribute to, and guide, quality improvement of family centered care in acute hospital wards.

A qualitative study of COPD-patients’ experience of a telemedicine intervention

BACKGROUND Clinically stable patients with chronic obstructive pulmonary disease (COPD) are often followed at regular intervals regardless of the needs. Our aim was to investigate the patient perspective on receiving telemedicine with weekly submission of readings and regular video consultations (Net-COPD) as an alternative to visits in the respiratory outpatient clinic and investigating the role of telemedicine in management of severe COPD. DESIGN Descriptive design and the method is qualitative based on semistructured interviews. METHODS Fourteen intervention patients participated from the Danish randomized clinical trial Net-COPD project. The transcribed interviews were analysed using manifest and latent content analysis. FINDINGS Participants reported that Net-COPD brought enhanced wellbeing and a sense of security in knowing that nurses kept an eye on them and initiated appropriate interventions in case of changes in the patients condition. This was experienced as a lifeline to the respiratory outpatient clinic, which could be contacted when needed. Through monitoring, moreover, patients developed increased awareness and better self-management of their disease. Patients also experienced more focused and less stressful meetings via video consultations, than in respiratory outpatient visits. Nevertheless it was important that it was the same health staff patient met in the video consultations. CONCLUSION Participation in telemedicine increased the patient empowerment primarily by the sharing of data with a permanent staff of nurses. This knowledge was used to keep control of the disease in the form of extra readings and the systematic use of learned initiatives. This gave patients and relatives a sense of security.

Food'to'go - a feasibility study of post-discharge delivery of protein- and energy-enforced meals for older patients by the use of information and communications technology (ICT)

Background Older patients are often excluded from e-health projects on account of low IT-literacy levels. This is a barrier for their access to many current and future health care offers. The Food‘n’Go research an innovation programme aims to develop, test and implement information technology solutions to increase participation and empowerment of older patients and their families, in relation to frequent problems during and following hospitalisation. The present feasibility study is part of this programme.

47 Oral Women's Experiences at Onset of Symptoms of ST Segment Elevation Acute Myocardial Infarction

74.8% male, roughly one quarter were over 75 years old, and 47.6% had had an anterior STEMI. There were no gemder differences in time from symptom onset to first medical contact (p = 0.52), and there was no significant interaction between gender and pre-hospital ECG programme status in this variable (p = 0.61). The time from first medical contact to first ECG was significantly longer in women than in men (p = 0.006), and this held true both before and after pre-hospital ECG programme implementation. Conclusions: Although there are some limitations, these findings suggest that there may not be significant differences between men and women in time to seek treatment for ACS. However, significantly longer times for women than men in acquisition of the first ECG is concerning. Possible explanations include women having more and therefore possibly vaguer symptoms, leading to uncertainty about possible etiology of presenting symptoms. Also, age, comorbidities and other factors may be significant co-variates, which has not been explored in this analysis. Further research of these hypotheses is warranted.