Background
Approximately 30% of patients suffer from severe reflux after surgery for esophageal cancer, which may serve as a continuous reminder of the cancer and catalyze fear of recurrence.
...Objective
The aim of this study was to investigate the association between severe reflux and symptoms of anxiety and depression after esophageal cancer surgery.
Methods
This was a nationwide prospective cohort study including all Swedish patients who underwent esophageal cancer surgery between 2013 and 2018. Patients reported reflux on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire module for gastroesophageal symptoms and psychological distress on the Hospital Anxiety and Depression Scale at 1 and 2 years after surgery. Repeated-measures logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, body mass index, TNM classification, neoadjuvant therapy, surgery type, postoperative complications, antireflux medication, and elevated headrest at night.
Results
Among 154 included patients, 43 (28%) and 37 (24%) reported severe reflux 1 and 2 years after surgery, respectively. No association between severe reflux and anxiety (OR, 2.1; 95% CI, 0.7–6.3) or depression (OR, 1.2; 95% CI, 0.3–4.6) was found 1 year after surgery. After 2 years, there was still no association between severe reflux and anxiety (OR, 0.9; 95% CI, 0.3–2.8) or depression (OR, 1.2; 95% CI, 0.5–3.3).
Conclusions
Findings suggest that severe reflux is not associated with anxiety or depression after esophageal cancer surgery.
Implications for Practice
For esophageal cancer survivors, other factors than severe reflux may be more important for the psychological recovery.
Measuring patients satisfaction is an important part of continuous quality improvement in health care. In intensive care, family satisfaction is often used as a proxy for patient experience. At ...present, no suitable instrument to measure this has been fully validated in Sweden. The purpose of this study was to develop and validate a questionnaire intended to evaluate families’ satisfaction of quality of care in Swedish intensive care units.
Based on literature and the modification of pertinent items in two existing North American questionnaires, a Swedish questionnaire was developed. Content validity was assessed by experts, and the cognitive method Think Aloud was used with twelve family members of intensive care patients in two different intensive care units. Data was analysed using qualitative content analysis.
Seven items in the questionnaire were identified as problematic, causing eight problems concerning questioning of content and 23 concerning misunderstanding. Six of these items were changed in order to be understood the way they were intended, and one item was removed.
A family satisfaction questionnaire applicable in Swedish intensive care units has been developed and validated for respondents’ understanding of the questions being asked. However, further psychometric testing should be performed when more data are available.
OBJECTIVETo better match hospital resources to patients’ needs of trauma care, a protocol for facilitating in-hospital triage decisions was implemented at a Swedish level I trauma centre. In the ...protocol, physiological parameters, anatomical injuries and mechanism of injury were documented, and used to activate full or limited trauma team response. The aim of this study was to evaluate the efficacy of the criteria-directed protocol to determine in-hospital trauma triage in an emergency department.
METHODSLevel of triage and triage rates were compared before and after implementation of the protocol. Overtriage and undertriage were assessed with injury severity score higher than 15 as the cutoff for defining major trauma. Medical records for undertriaged patients were retrospectively reviewed.
RESULTSIn 2011, 78% of 1408 trauma team activations required full trauma response, with an overtriage rate of 74% and an undertriage rate of 7%. In 2013, after protocol implementation, 58% of 1466 trauma team activations required full trauma response. Overtriage was reduced to 52% and undertriage was increased to 10%. However, there were no preventable deaths in the undertriaged patients.
CONCLUSIONA criteria-directed protocol for use in the emergency department was efficient in reducing overtriage rates without risking undertriaged patients’ safety.
Background: Early mobilisation is endorsed after abdominal surgery. Healthcare professionals are key figures in mobilisation. However, their experiences of barriers and enablers of mobilisation ...shortly after abdominal surgery is yet not fully explored. Therefore, the aim was to describe the healthcare professionals' experiences of postoperative mobilisation shortly after abdominal surgery.Methods: This study has a qualitative descriptive design. In November 2017, individual interviews were conducted with a convenience sampling of ten nurses, three nurse assistants and four physiotherapists who participated in an interventional trial mobilising adult patient within two hours after abdominal surgery. Data were analysed with inductive content analysis. Reporting of the study followed the COREQ checklist.Findings: The study findings are presented in two categories: 'a responsibility for the patient' and 'prerequisites and challenges' with five subcategories. The healthcare professionals had initial concerns that mobilisation shortly after surgery would not be safe for the patient and would add extra burden on their workload. However, with time, their perceptions changed to believing that it enhanced the recovery and was feasible to conduct at the postoperative recovery unit.Conclusion: Mobilisation shortly after abdominal surgery at the postoperative recovery unit, was found to be beneficial for the patients without reducing patient safety. However, it is important to assure that sufficient resources and adequate competence are available if such intervention should be implemented in clinical practice.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Patient participation in healthcare is important for optimizing treatment outcomes and for ensuring satisfaction with care. Therefore, this study aims to identify barriers to patient participation in ...the critical care unit, as identified by critical care nurses.
Qualitative data were collected in four focus group interviews with 17 nurses from two separate hospitals. The interviews were analyzed using qualitative content analysis.
The results show three main categories: nurse’s attitude toward caring, the organization of the critical care unit and the patient’s health condition.
Barriers for patient participation in the ICU were found and this lead to a power imbalance between patient and nurse. In contrast to other care settings, this imbalance could be a consequence of the critical care organization and its degree of highly specialized care. The clinical application of our results is that these barriers should be considered when implementing patient participation in such a highly technological care situation as a critical care unit.
ObjectiveThe purpose of the study was to investigate whether low education level was associated with patients’ health-related quality of life (HRQOL) after oesophageal cancer resection.SettingA ...nationwide cohort study in Sweden.ParticipantsIn total, 378 patients who underwent oesophageal cancer surgery in 2001–2005 were followed up 6 months and 3 years after surgery.Outcome measuresHRQOL was assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and the oesophageal cancer-specific module. The association between level of education and HRQOL was calculated with linear regression models, providing mean score differences (MD) and 95% CIs. Data were analysed separately for women and men.ResultsEducation level was not associated with HRQOL recovery after oesophageal cancer surgery. However, when data were stratified by sex, lower education was associated with worse emotional function (MD −13; 95% CI −22 to −3), more symptoms of insomnia (MD 20; 95% CI 8 to 32) and reflux (MD: 15; 95% CI 3 to 26) for women, but not for men. Among women, low education was in general associated with worse functioning and more symptoms.ConclusionsLow education was not associated with worse HRQOL after oesophageal cancer surgery. However, when data were stratified for sex, low education level was associated with worse functioning and more symptoms in certain HRQOL domains for women, particularly in a short-term perspective. For men, no such association was found.
Background
The purpose was to investigate if potentially stressful reminders of the intensive care unit (ICU) stay influenced variability in transient skin conductance responses, and whether such ...changes were associated with post‐traumatic stress symptoms (PTSS), and development of symptoms over time.
Methods
Thirty patients with an ICU length of stay > 48 h were included in the study. Within the week after ICU discharge (T1), patients were exposed to authentic ICU sound and questions regarding traumatic ICU memories while skin conductance reactivity was monitored. PTSS was assessed using PTSS‐10 at T1 and again 3 months later (T2). Changes in number of skin conductance fluctuations per second (NSCF) between baseline and during the cueing conditions and in relation to PTSS scores (T1) were investigated. PTSS scores at T2 and changes between T1 and T2 (PTSS‐CS) were used to investigate if reactivity in NSCF could predict symptoms of PTSD.
Results
The results showed increases in NSCF during both situational and verbal cueing, compared to baseline. However, no relation to PTSS scores was indicated. Negative correlations between NSCF during situational cueing and both PTSS‐T2 and PTSS‐CS were found among women, but not among men.
Conclusion
A low variability, or reactivity in skin conductance responses to situational cues could imply a risk of developing, or not being able to recover from, symptoms of PTSD in women. As such, the measurement could be used to predict this risk in women. However, further studies are necessary to evaluate this area of application.
Patient experiences of initial trauma care Granström, Anna; Strömmer, Lovisa; Falk, Ann-Charlotte ...
International emergency nursing,
January 2019, 2019-01-00, 20190101, Letnik:
42
Journal Article
Recenzirano
•Patients felt safe in a frightening situation.•Trauma team members were mostly perceived as professional, well-organised and efficient.•Patients were suffering from pain.•Patients felt excluded from ...the dialogue and abandoned when they abruptly were left alone.
Correct initial treatment of trauma patients reduces mortality and morbidity. However, the initial examination may be perceived as traumatic because of the stressful situation, the unfamiliar setting and the shock of being seriously injured. To date, little is known about patient's experiences of initial trauma management. The aim of this study was to explore trauma patients' experiences of being exposed to initial full trauma team assessment at a Level 1 trauma centre.
Interviews with 16 patients who had been exposed to initial trauma care were conducted at a Level 1 trauma centre, at a Swedish University Hospital. The interviews were transcribed verbatim and analysed with qualitative content analysis.
Patients' experiences of initial trauma care can be summarized as: feeling safe in a frightening situation. The trauma team members were mostly perceived as professional, well-organised, and efficient. Yet, the patients described an emotional response to the trauma, physical discomfort during the examination, and feeling prioritised or being ignored in the encounter with the trauma team members.
The initial trauma care may be improved if the trauma team members keep the patient's physical and emotional wellbeing in focus and maintain an informative dialogue with the patient during the whole process.
Guidelines recommend follow-up for patients after an intensive care unit (ICU) stay. Methods for identifying patients with psychological problems after intensive care would be of value, to optimize ...treatment and to improve adequate resource allocation in ICU follow-up of ICU survivors. The aim of the study was to develop a predictive screening instrument, for use at ICU discharge, to identify patients at risk for post-traumatic stress, anxiety or depression.
Twenty-one potential risk factors for psychological problems - patient characteristics and ICU-related variables - were prospectively collected at ICU discharge. Two months after ICU discharge 252 ICU survivors received the questionnaires Post-Traumatic Stress Symptom scale -10 (PTSS-10) and Hospital Anxiety and Depression Scale (HADS) to estimate the degree of post-traumatic stress, anxiety and depression.
Of the 150 responders, 46 patients (31%) had adverse psychological outcome, defined as PTSS-10 >35 and/or HADS subscales ≥8. After analysis, six predictors were included in the screening instrument: major pre-existing disease, being a parent to children younger than 18 years of age, previous psychological problems, in-ICU agitation, being unemployed or on sick-leave at ICU admission and appearing depressed in the ICU. The total risk score was related to the probability for adverse psychological outcome in the individual patient. The predictive accuracy of the screening instrument, as assessed with area under the receiver operating characteristic curve, was 0.77. When categorizing patients in three risk probability groups - low (0 to 29%), moderate (30 to 59%) high risk (60 to 100%), the actual prevalence of adverse psychological outcome in respective groups was 12%, 50% and 63%.
The screening instrument developed in this study may aid ICU clinicians in identifying patients at risk for adverse psychological outcome two months after critical illness. Prior to wider clinical use, external validation is needed.
Objectives
The full range of long‐term health consequences in intensive care unit (ICU) survivors with COVID‐19 is unclear. This study aims to investigate the role of ventilatory support for ...long‐term pulmonary impairment in critically ill patients and further to identify risk factors for prolonged radiological recovery.
Methods
A prospective observational study from a single general hospital, including all with COVID‐19 admitted to ICU between March and August 2020, investigating the association between ventilatory support and the extent of residual parenchymal changes on chest computed tomography (CT) scan and measurement of lung volumes at follow‐up comparing high‐flow nasal oxygen (HFNO) or non‐invasive ventilation (NIV) with invasive ventilation. A semi‐quantitative score (CT involvement score) based on lobar involvement and a total score for all five lobes was used to estimate residual parenchymal changes. The association was calculated with logistic regression and adjusted for age, sex, smoking, and severity of illness.
Results
Among the 187 eligible, 86 had a chest CT scan and 76 a pulmonary function test at the follow‐up with a median time of 6 months after ICU discharge. Residual lung changes were seen in 74%. The extent of pulmonary changes was similar regardless of ventilatory support, but patients with invasive ventilation had a lower total lung capacity 84% versus 92% of predicted (p < 0.001).
Conclusions
The majority of ICU‐treated patients with COVID‐19 had residual lung changes at 6 months of follow‐up regardless of ventilator support or not, but the total lung capacity was lower in those treated with invasive ventilation.
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