Postdoc visit at St George´s University and Hospital, Ghassan Mourad









Between 10th and 14th of October 2016 I had the opportunity to visit Professor Tom Quinn, Associate Dean for Research and Education, and Director at the Centre for Health and Social Care Research at Kingston and St George´s Joint Faculty. The purpose of my visit was to exchange knowledge, build bridges and discuss possible future collaboration.



To start with, this has been one very inspirational and interesting week and I had the opportunity to meet with some very skilled researchers from different areas, who dedicated some of their time to discuss research plans. Professor Tom Quinn had arranged a very nice program for me to take part of. Some of these special meetings are described more in detail.

On Monday 10th October, I had a meeting with Kay Townsend, Cardiac Specialist Nurse who runs the Rapid Access Chest Pain Unit, and the ACS team consisting of Specialist Nurses Niamh Doyle, Monica Sanz, and Penny Mullord. We had a long and very interesting discussion about patients attending with chest pain with no evidence of cardiac disease. We found out that we had almost the same experiences regarding the difficulties in the encounter with these patients and although many times it is obvious that they have psychological distress, this is not dealt with and patients are getting discharged and not followed up. This is mainly due to how healthcare is structured and not least not having the resources to follow patients up. We also discussed possible joint projects that we could run.


Tuesday 11th October, I had the pleasure to meet with the Head of School of Nursing and Associate Dean, Julia Gale, and Research Coordinator, Associate Professor Ann Ooms. We discussed the Nursing programs at our faculties and how to make the Nursing education more research-based.



I also joined a meeting with the postdocs at the department and listened to their experiences. I then gave an invited talk about my research and had a nice discussion with the postdocs and some of the professors.


Wednesday 12th October, I attended the “Innovation and Excellence in Cardiac Services Conference” at the Royal College of General Practitioners, London. The conference was chaired by professor Tom Quinn and offered a nice variety of advanced and interesting clinical projects within cardiology.


Thursday 13th October, I had the opportunity to meet with Nurse Consultant and Clinical Director of Major Trauma Heather Jarman, who presented the work at the Accident & Emergency. We had a nice discussion and found out that we had similar experiences regarding frequent attendances by patients with non-cardiac chest pain. Heather confirmed that many patients are confused by the fact that the doctors ask them to seek hospital care in case of new chest pain events although they had presented with non-cardiac chest pain at several times. This apparently is because doctors don´t want to miss any acute cardiovascular event, but can lead to many unnecessary healthcare visits. My visit to the Accident & Emergency ended with a visit to the helipad at the top of the hospital, which offered a beautiful view of London.


I also participated in a couple of meetings with Professor Tom Quinn to learn more about how research projects including grant applications are planned in the UK and I had the opportunity to discuss similarities and differences compared to the Swedish system.

On Friday 14th October, my last day in London, I had a catch-up meeting with Professor Tom Quinn to sum up the week and discuss future plans. Tom and I had a nice sightseeing walk along the best parts of London that ended with a tasty lunch at the National Gallery. A perfect end of my visit.

To sum up, besides from all interesting scientific discussions and gained knowledge, the engagement and hospitality by Tom and his colleagues made this visit really nice. A big thank you to all of you who took care of me and made me feel welcome, especially Tom Quinn, Lucia Gavalova, Temitope Odubanjo, and the postdocs at Lucia´s office…no one mentioned, no one forgotten.

Leonie Klompstras disseration

Dear all!

After I started my PhD 6 years ago, on the 4th of October I defended my thesis. The title of the thesis is: “Physical activity in patients with heart failure: motivations, self-efficacy and the potential of exergaming”.


The picture chosen on the front of the thesis is from a great artist named Heather Hansen. She makes art with movement and is, like exergaming, an alternative for physical activity.



Professor Felicity Asten was my opponent and we had a nice 3-hour discussion about the start of the PhD, the results of the studies included and my future plans.


The main conclusions of the thesis were that one-third of the patients with heart failure had a low level of physical activity in their daily life. Level of education, exercise self-efficacy, and motivation were important factors to take into account when advising patients with heart failure about physical activity. In addition to a high level of motivation to be physically active, it is important that patients have a high degree of exercise self-efficacy. Exergaming has the potential to increase exercise capacity in patients with heart failure. The results also showed that this technology might be suitable for some patients while others may prefer other kinds of physical activity.

To read the whole thesis click here.

I had a great day and enjoyed a nice party at a fantastic place in the evening with a salsa band. Thank you for everyone who made this day special and unforgettable!


The 8th Joint Scandinavian Conference in Cardiothoracic Surgery

Skärmavbild 2016-08-30 kl. 12.28.42

Brynja Ingadottir was an invited speaker at the 8th Joint Scandinavian Conference in Cardiothoracic Surgery  which was held 17-19 August 2016 in Reykjavik Iceland. She presented in the session of SATNU (Scandinavian Association of Thoracic Nurses) about the use of technology in patient education with special focus on the serious game on pain management after surgery which is a part of her Ph.D thesis. The game has been developed in collaboration with Linköping University (Tiny Jaarsma and Ingela Thylén), Reykjavik University, University of Iceland and Landspitali University Hospital, Reykjavik, Iceland.

Nana Waldréus dissertation

2016-04-18 13.48.58

The D-day on the 18th of April 2016 was finally here! D as for dissertation. Four and a half years is quite a long time working hard with your studies and manuscripts. Doing your courses and attending seminars, as well as participating on congresses. Although the work was hard many times, I will always remember these years as so rewarding. Not only that I learned so much, but I also grew as a human being. I thought I had prepared my “mind” for the upcoming defense of my dissertation. When preparing myself the last months, I realized that it is impossible to be prepared for everything. One just has to be in the present moment and trust yourself. So, only two days before the D-day, I went to the EuroHeartCare congress in Athen with CESAR´s, having a doctoral students’ abstract presentation about thirst in patients with heart failure! Being in the present moment.

Professor Anna Forsberg, from Lunds University, was the faculty opponent and did a great work asking me all kinds of relevant and interesting questions about my thesis. The grading committee did also a great work highlighting significant aspects of my research. I was so in the present moment, that when there were no more questions, I realized that three hours had passed! It felt like one hour…. The D-day ended with a nice dinner with my dear friends whom I had the good fortune to get to know during these years!

2016-04-18 12.59.41

My thesis has the title “Thirst in Patients with Heart Failure: Description of thirst dimensions and associated factors with thirst”. The aim of the thesis was to describe the thirst experience of patients with heart failure and describe the relationship of thirst with physiologic, psychologic and situational factors. The goal was to contribute to the improvement of the care by identifying needs and possible approaches to prevent and relieve thirst in patients with heart failure.

The main results of the four studies in the thesis were:

  • Thirst was prevalent in 1 out of 5 patients with stable heart failure
  • 63% of patients with worsening of heart failure symptoms experienced moderate to severe thirst distress at hospital admission
  • Thirst intensity was significantly higher in patients hospitalized with decompensated heart failure compared to patients with no HF (median 75 vs. 25 mm, visual analogue scale [VAS] 0-100 mm; P < 0.001)
  • Patients at an outpatient heart failure clinic who reported thirst at the first visit were more often thirsty at the follow-up visits compared to patients who did not report thirst at the first visit
  • Patients with heart failure who were admitted to the hospital with high thirst distress continued to have high thirst distress over time
  • Patients with heart failure who had a fluid restriction had high thirst distress over time
  • Patients with heart failure who were feeling depressed had high thirst intensity over time
  • Thirst was associated with fluid restriction, a higher serum urea, and depressive symptoms


In conclusion, patients with heart failure experience thirst intensity and thirst distress. Nurses should ask patients with heart failure if they are thirsty and measure the thirst intensity and thirst distress, and ask if thirst is bothering them. Each patient should be critically evaluated if a fluid restriction really is needed, if the patient might be dehydrated or needs to be treated for depression.

The thesis can be accessed at


Nana Waldréus, PhD, RN




A short report from the 18th Cardiovascular Spring Meeting, Gothenburg – 2016

This year’s spring meeting had a great attendance with about 1500 persons. The program was composed by a rich number of interesting sessions, free lectures, posters and research projects. A new prize was also given out “Mona Schlyter clinical prize”.

The Werkö lecture: “Taking the congestion out of heart failure” was held by Prof Lynne Warner Stevenson from Boston, USA. Here main point was that congestion is a central feature of HF. Readmission of patients with HF is common, about 50% seeks hospitals for worsened HF. Studies have showed that RV diastolic pressure is central prior an event and monitoring pressure could might be a better indicator than weight to predict hospitalizations.

Session: Secondary prevention in cardiovascular diseases
Joep Perk, Kalmar. A new secondary prevention model for IHD is developed. Five steps are considered to be of importance to reduce the risk for further cardiovascular events. The goal is to have regular follow up the first year and to advice patients to stop smoking, be physical active and eat health food, be careful with alcohol and keep blood pressure under 140/90 mmHg. LDL-kolesterol should be lower than 1,8 mmol/l. If patient succeed, the best points will be 5.

Session: A paradigm shift in the treatment of heart failure
Lars Lund, Stockholm gave an inspiring talk about Sakubitril/valsartan (Entresto). This is a new combination medicine for use in heart failure that decrease both mortality and morbidity up to 20%.
Treatment will be given to those who follow the criteria for the study population.

Sessions: Heart failure in elderly, what to do when there is lack of evidence?
Kurt Boman, Skellefteå held a speech about what guidelines tells about acute HF in elderly. In fact, as most studies in HF has been done in people under 75 there is no evidence for how to treat elderly with HF. Guidelines describes briefly that it is important to take age, comorbidity in considering in HF treatment. Kurt says that it is challenge to extrapolate data from younger to older patients and that we need studies that are designed for elderly patients’ as well.

Session: Challenge of adherence to treatment of heart failure
Tiny Jaarsma, Linköping talked about technology in heart failure and that technology are an important source for self-care management. Carina Hjelm, Linköping talked about the importance of cognition in heart failure.

Session: Technology to improve self-care management
Maria Liljeroos, Linköping held a speech about the website in which help patients’ with heart failure to get fast and clear self-care advice.
Leonie Klompstra, Norrköping visualized that Gamification help patients with heart failure to be more active and thereby having better outcomes. Please visit the website
Congrats to all of you who awarded prizes!

  • The Fridlunds prize was given to Peter Johansson, Linköping
  • Mona Schlyter prize was given to Nina Lahti, Stockholm for the project to optimize the care for patients with heart failure.
  • Ulla Walfridsson, Linköping awarded prize for best free lecture and got also travel grants from The Swedish Heart Association travel grants.


Some of the Cesar members standing from left:
Carina Hjelm, Leonie Klompstra, Maria Liljeroos, Christina Andreae


More information about the spring meeting is available by

Written by Christina Andreae

EuroHeartCare 2016 in Athens


Many Cesars participated in this year’s Congress, both with posters and presentations.


Why is it so difficult to talk about prognosis? T. Jaarsma (Norrkoping, SE)


How can we best deliver effective cardiac rehabilitation for people with Heart Failure. M. Back (Gothenburg, SE)

Managing the challenge of polypharmacy in heart failure patients for further development. M. Liljeroos (Eskilstuna, SE)


Arrhythmia: nurse-led management. J. M. L. Hendriks (Sittard, NL)


Fluid restriction predicts thirst distress in patients with heart failure. N. Waldreus, M.H.L. Van Der Wal, M.L. Chung, T. Jaarsma (Linkoping, SE; Groningen, NL; Lexington, US)


To telemonitoring or not to telemonitor: that is the question. Underlying thoughts from nurses and physicians in Japan and Sweden.N. Kato, P. Johansson, I. Okada, K. Kinugawa, A. Stromberg, T. Jaarsma (Linkoping, SE; Tokyo and Toyama, JP)

Participation in the care encounter among patients with heart failure receiving home-care. L. Nasstrom, J. Martensson, E. Idvall, A. Stromberg (Linköping, Jönköping and Malmö, SE)


Patients and caregivers symptoms of depressive symptoms mediate the relationship between perceived control and well-being. M. Liljeroos, A. Stromberg, M. Chung (Linkoping, SE; Lexington, US)

Using co-design to develop communication interventions in heart failure care. A.-L. Hjelmfors, A.S. Stromberg, M.F. Friedrichsen, A.S. Sandgren, J.M. Martensson, T.J. Jaarsma (Linkoping, Kalmar and Jonkoping, SE)

Octo-nonagenerians outlook on life and death when living with an implantable cardioverter defibrillator. A cross-sectional study. I. Thylen, A. Stromberg, D. Moser (Linköping, SE; Lexington, US)

Guided Internet-delivered cognitive behavioural therapy in patients with non-cardiac chest pain a pilot randomized controlled study. G. Mourad, A. Stromberg, E. Jonsbu, M. Gustafsson, P. Johansson, T. Jaarsma (Norrköping and Linköping, SE; Molde, NO)

The virtual Swedish bowling competition. T.J. Jaarsma, L.K. Klompstra, L.H. Hjelmfors, A.S. Stromberg (Linkoping, SE)

Exploring partners’ perspectives on participation in heart failure home-care – a mixed method design. L. Nasstrom, M.L. Luttik, E. Idvall, A. Stromberg (Linköping and Malmö, SE; Groningen, NL)

Do patients and caregivers perceived control impact depression and well-being in patients with heart failure and partners? M. Liljeroos, K.A. Arestedt, A.S. Stromberg, M.C. Chung (Uppsala and Linkoping, SE; Lexington, US)

Self-efficacy, motivation and physical activity in heart failure patients. L. Klompstra, T. Jaarsma, A. Stromberg (Norrkoping and Linkoping, SE)

Disease severity is related to psychosocial distress in chronic heart failure patients, but not in caregivers: results from an observational study. A. Stromberg, M.L. Chung, T. Jaarsma, M.L. Luttik, E. Lewis, F. Calado, R. Lahoz, E. Hudson, C. Deschaseaux (Linkoping, SE; Lexington and Boston, US; Groningen, NL; Basel, CH; Dublin,IE)


Cesar Network hope to see you all in Jönköping next year!

Tiny Jaarsma as Adjunct Visiting professor at Mary MacKillop Institute for Health Research, ACU, Melbourne

Since June 2105 I have been appointed at the Mary MacKillop Institute for Health Research as Adjunct Visiting professor. The Mary MacKillop Institute aims to identify critical gaps within community and healthcare services, with an explicit goal to improve health outcomes via innovative individual, community and health service-focused programs.

In this collaboration I work together with researchers in different areas, expanding on my current research that I perform at LiU and exploring new fields of research collaboration. This collaboration takes place during regular visits and also more virtual contacts, like skype and email. During a recent visit in March 2016 I presented my work in a lunchtime symposium ( : During the same visit I also presented on the anniversary celebration where the impressive work of the institute was presented. Here on the picture I pose as international jury member (with dr M Piano from the US and dr ML Lochen from Norway) and 2 prize winners of the best research idea.


The Mary MacKillop Institute has different active institutes that perform research in a lot of areas related to the subject the CESAR- network members are involved. I hope that we can set up an exchange between our groups in the near future.



Scholar visit at University of California, Irvine 9-21 March 2016


For my last article of my dissertation I visited my second supervisor, Anna Strömberg, to learn more about qualitative content analysis.

This University of Calafornia Irvine was founded in 1965 and unlike most other University of California campuses, UCI was not named at the city it was built in, but after James Irvine, a landowner. The city Irvine is later built around the campus (see picture below).



Anna Strömberg and me worked for almost 2 weeks very close together to analyze interviews within the HF-Wii study ( on experiences of patients with heart failure in exergaming.

At the end of my visit we made a first draft of the article and I learned a lot about qualitative research and analyzing interviews.

Outside of work we also participated in whale watching: where we saw whales, dolphins, sea lions and seals (see pictures below).


We also had a great medieval dinner party (see pictures below) on invitation of professor Lorraine S. Evangelista.


The two weeks were really great and I learned a lot! Therefore I also want to thank Anna Strömberg, her family (Tomas, David and especially Jonatan for learning me the American way) and Lorraine Evangelista.
//Leonie Klompstra