Research visit to Hadera, Israel

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The 21st – 24th of April Anna Strömberg and Maria Liljeroos from Sweden, Ina Marie Thon 18056811_1585208204852954_5743854772903788760_nAamodt and Irene Lie from Norway and Edita Lycholip and Jelena Čelutkienė from Lithuania visited Itamar Dach and Michael Kleiner Shocat at the hospital in Hadera.

The visit was part of the NordForsk project “Symptom monitoring after hospitalisation in patients with advanced heart failure – a Nordic-Baltic study” https://www.nordforsk.org/no/programmer-og-prosjekter/prosjekter/symptom-monitoring-after-hospitalisation-in-patients-with-advanced-heart-failure-a-nordic-baltic-study

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The overall aim of this project is to develop a new approach to monitoring symptom and signs combining self-assessment tools and a non-invasive monitoring device (micro-Cor system) and to determine the effect of this approach in patients’ advanced HF. The primary outcome is cardiovascular readmission within 30-day readmission. Secondary outcomes include readmission and death for all-cause within 6 months, hospital days, emergency department (ED) visits, unplanned clinic visits, hospital cost, and self-care behavior.

 

 

This NordicBaltic – study including Norway, Sweden and Lithuania consists of an explorative, and experimental design employing validated questionnaires, microCor system, and interviews in order to provide a more complete understanding of HF patients self-care situation during 6 months after hospitalization.

MichaelDuring the visit, we learned from Dr Michael Kleiner Shocat how to use the microCor system on heart failure patients at Hadera hospital.

 

 

 

 

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As we stayed in Tel Aviv we travelled one hour to the hospital, and during that time we saw a bit of the beautiful country of Israel and also found time to take a swim in the ocean.

 

 

 

Forskar Grand Prix

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Last week a two-day seminar was held for all PhD-students working in Kalmar County Council and one part of this was an exercise of short presentations of your research for a public audience. This was held as a contest inspired by Forskar Grand Prix (https://forskargrandprix.se/), with engaging presentations of maximum 4 minutes. Two Cesar members are PhD students at Kalmar County Hospital and took part in the seminar and contest. Johan Israelsson presented his research of differences between two different automated external defibrillators with regard to sensitivity and specificity, and Malin Johansson Östbring talked about her search and trial of a method that can make coronary patients more adherent to their medicines so that they stay out of hospital. The competition was held in two groups of 10, with 15 voting PhD-students/researchers in each. The presenters in one group were so even that the final stood between three competitors. And after a thrilling final the two Cesar-members were chosen to take the crown! Luckily they had prepared two Grand Prix trophies.

Malin and Johan

 

Communication course on discussing the HF prognosis and end-of-life care

One of the research projects within the Cesar network is called TALK-HF (Developing and evaluating a Training program Aimed at reducing the Lack of Knowledge and communication concerning palliative care issues in Heart Failure patients.) This exciting project is led by professor Tiny Jaarsma. Other members in the project team is Anna Strömberg, Jan Mårtensson, Maria Friedrichsen, Anna Sandgren and Lisa Hjelmfors (PhD student).

The overall purpose of the study is to improve the quality of care for HF patients and their families, focusing on communication issues between them and health care professionals in order to improve their quality of life and also prevent unnecessary suffering and resource utilization. 

In order to try to improve communication a practical communication course was developed for health care professionals working in the area of cardiology. The course was partly web based, partly campus-based, with one practical communication skills training day. Other components of the course included lectures, individual tasks and group discussions. During the course the participants got knowledge about the importance of discussing the HF prognosis and end-of-life care with the patient and the family.  They got the chance to practice to discuss prognosis and end-of-life care with simulated patients and family members.

They also got a communication tool, a practical booklet (a Question Prompt List) that they could hand out to patients and families in their clinical practice. The QPL is a structured list of questions that serves as a prompt for patients to consider questions about prognosis and end-of-life care to ask the professional. By enabling patients and families to ask questions that concerns them about their future and living with a chronic illness such as HF, communication may be improved.

8 February 2017 was an interesting and exciting day in the course when it was time for the practical communication training day and 15 participants (3 physicians and 13 nurses) from different regions in Sweden met at Linkoping University. The morning started with group discussions were participants reflected and shared clinical experiences of discussing prognosis with patients and family. The researchers facilitated the discussions and posed critical questions to support the learning situation. After lunch it was time for simulation training were each participant got the chance to practice to have a conversation about prognosis and end-of-life care with a person who simulated to be a patient with HF. Simulation can be defined as a situation or an event which is made to resemble clinical practice to enhance student learning. In this simulated conversation, the patient posed questions from the QPL to the participants (who acted in their real professional roles as a nurse or a physician). The patient asked about how life could be living with HF, what would happen to the ICD in the end-of-life and what support there is for family members when the patient gets more ill etc. Those participants who wanted also got the chance to simulate being a family member to the patient and participate in the conversation. This gave an extra dimension to the training where they could get a better understanding of” the other side” of the conversation. The participants took turn and simulated or acted as observers during the training. During the simulation training, the researchers were present in the room, but did not participate in the conversations or interact with the participants. Directly after the simulation training, a post-simulation debriefing was held were the researchers guided the discussions and the participants were given the possibility to debrief and reflect on their own experiences of the simulation. All participants were engaged in the training and provided feed-back to each other on how the simulation went. The day ended with a joint group reflection of the training day. The participants were satisfied with the day and thought it was great to meet other colleagues to discuss and learn from each other as well as practicing to have conversations with simulated patients and family members. The research team is now evaluating the course and plan for a RCT study to test the effectiveness of the course to improve professional communication about prognosis and end-of-life care in cardiology.

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The web-based course (in Swedish)

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The front page of the QPL (in Swedish)

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Examples of questions in the QPL (in Swedish)

/Lisa Hjelmfors

 

Objectively measure physical activity with an accelerometer

Dear All,

Last week (20-21 March), Anna Strömberg, Maria Bäck and me attended a course called “Objectively measure physical activity with an accelerometer.” This course was given by VerviVita, and was in Stockholm.

We all know the importance of physical activity. Most of the guidelines in disease management suggest that physical activity is important to increase quality of life and decrease hospital admission and depression. Also the World Health Organization emphasizes the importance of physical activity. Physical inactivity is the number 4 leading risk factor that attributes to death (see figure below).

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For me the most interesting lectures during the course were from Maria Hagströmer (see picture below). She is a senior lecturer working at Karolinska Institute at the division of physiotherapy. To read more on the research she is involved in click here.

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She discussed that physical activity is very broad. It includes household tasks, work, transport, fitness related activity and leisure time. Therefore it is very important at forehand to decide what you want part of physical activity you want to measure in your studies.

 

 

She also pointed out that it is still very hard to measure physical activity. Over the years the measurements for physical activity changed a lot. From self-reported physical activity questionnaires in the 60s, till wearables now (2010s).

With wearables you can objectively measure the amount of movements, but you still can’t know what the people exactly did. Also it can’t track all activities, for example riding a bike. Because there are a lot of different kinds of measuring physical activity, it is very hard to compare results given in research today. It is important to decide on a measurement, so in the future comparisons in physical activity can be made.

In the course, we learned how to practically handle an activity monitor called Actigraph. They explained how this device is measuring physical activity and how to handle the data you receive.

We all got inspired on how to include data on physical activity in our research and planned to have a follow-up meeting how to handle the data in the HF-Wii study.

Kind regards,

Leonie

Presenting about exergaming and CESAR in Australia

During a 20 day research visit in Australia I worked in the Mary McKillop Institute for Health Research with colleague researchers in the area of cardiovascular caring research. New collaborative ideas were developed and further advanced and publications written, rewritten and planned in the area of HF and AF care.  During this stay I also was able to present on two occasions on exergaming and virtual reality.

The first presentation was during a symposium where I presented on the ideas behind the HF-Wii study. I also debated with 5 other people on what the best kind of interventions are to improve quality of life: nutrition, exercise or something else? I was debating for other healthy intervention such as for example a sauna!

TJ

Picture: The debate team of 6 researchers

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On March 10 and 11 I presented two key note lectures in Brisbane at the Australasian Cardiovascular Nursing College symposium, one on International collaboration in which I also told about the CESAR network!

 

 

 

Jaarsma T. Keynote lecture: Using virtual reality to improve self-care. Australasian Cardiovascular Nursing College symposium. 10-11 March Brisbane, Australia. http://www.acnc.net.au/images/Online_Submission/acncprogram2017.pdf

 

Mitt år som gästprofessor i USA

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Många forskare gör ”post doc” utomlands direkt efter disputationen. Men det är inte bara som nydisputerad man kan få chansen att arbeta utomlands under en period. Även professorer kan kasta loss, lämna den invanda vardagen och dra iväg för att forska och undervisa på ett annat universitet långt hemifrån. Hela förra året 2016 hade jag förmånen att få jobba på School of Nursing, University of California i Irvine söder om Los Angeles (http://www.nursing.uci.edu).

En tidig morgon i början av januari lämnade vi ett Linköping där termometern visade minus 17 grader och landade 14 timmar senare i soliga Kalifornien. Solen fortsatte sedan att skina nästan alla de 365 dagarna som vi var där. Det är något vi saknat under de två månader som vi nu varit hemma i Sverige!

Att jobba utomlands, även om det bara är tillfälligt, kräver en långsiktig planering. Speciellt när två akademiker med ett barn i skolåldern flyttar som vi gjorde. Det är mycket som ska klaffa med både jobb, skola och boende och det var många timmar av förberedelse innan allt föll på plats. Vi spenderade en ansenlig del av vår fritid sista halvåret innan vi åkte med alla förberedelser som t.ex. visumansökningar, ambassadbesök, försäkringar, vaccinationer som sonen behövde för att få börja i skolan. Vi gjorde även ett besök under tre veckor cirka ett halvår innan vi flyttade då vi hyrde hus, besökte skolor och skrev på alla papper på universitetet. Väl på plats i USA var det ytterligare en del administration och praktiska uppgifter att fixa som att ansöka om ”social security number” och ta amerikanskt körkort med både uppkörning och teoriprov. Universitetet och universitetssjukhuset krävde också att man genomgick diverse webutbildningar för etikprövning, HIPAA (Health Insurance Portability and Accountability Act), IT- och labsäkerhet, universitetsadministration mm.

Min man är också forskare och professor inom bio-optik så vi hade förmånen att kunna arbeta i två bra forskningsmiljöer på samma universitet. Vi har båda under en längre tid samarbetat med kollegor på University of California Irvine och det var en viktig förutsättning för att ganska snabbt kunna komma igång med forskningen där när vi flyttade dit. Det var en positiv överraskning att det gick så pass lätt att komma igång med att både forska och undervisa där. Välkomnande, hjälpsamma kollegor och en välfungerade administrativ organisation var nyckeln till att allt fungerade lättare än vi trott. Redan efter ett par månader kände vi oss som hemma på campus.

Staden Irvine där vi bodde är en lugn oas vid kusten med mycket låg brottlighet och väldigt bra kommunala skolor. Det var en häftig upplevelse att Irvine till 50 % består av befolkning med rötter i Asien. Ibland kändes det som man var i Japan, Kina eller Korea när man gick omkring på campus eller besökte olika områden i staden som nästan bara hade asiatiska affärer och restauranger. Vår 13-åriga son märkte också av den asiatiska dominansen i skolan, han var alltid väldigt lång och blond och matte var nästan alla elevernas favoritämne.

Vi fick bo på Campus hela året, där bara fast anställda lärare/forskare på universitetet får köpa hus, tack vare att vi kunde hyra hus av två olika familjer som var iväg på var sin sabbatstermin. Att bo på Universitetsområdet var härligt med gångavstånd till jobbet och sonen kunde åka gul skolbuss till skolan varje dag. Det var så skönt att inte behöva sitta i bilköer flera timmar om dagen som många andra gör i södra Kalifornien

Det har varit en stor förmån och mycket lärorikt att få inblick i ett utländskt universitets inre arbete. Jag har undervisat och handlett doktorander och samarbetat i olika forskningsprojekt med duktiga amerikanska kollegor kring palliativ vård, fysisk aktivitet, teknikstöd för egenvård och närståendes roll i vården av patienter med hjärtsvikt.

Genom min status som gästprofessor kunde jag också röra mig ganska fritt på olika sjukhus och jag hade förmånen att kunna besöka hjärtsviktskliniker och kardiologavdelningar på flera olika sjukhus. Bland annat fick jag möjlighet att var med på två olika hjärtsviktsenheter på sjukhuset vid University of Califonia Irvine och San Diego där man hade palliativ vård för hjärtsviktspatienter som en integrerad del av sin verksamhet och där hjärtsviktssjuksköterskor och kardiologer samarbetade nära det palliativa teamet.

Jag hade även möjlighet att studera omvårdnadsorganisationen på Magnetsjukhus och sjukhus som var i färd med att ansöka om magnetstatus (http://www.nursecredentialing.org/).

 

På fritiden gjorde vi flera oförglömliga resor. Vi körde bil längs Kaliforniens vackra kust på AS med utsiktHighway 1, från LA till underbara San Fransisco med sevärdheter som Golden Gate bron, Alcatraz och Redwood skogar. Under påsken vandrade vi i Death Valley och Grand Canyon samt besökte galna Las Vegas Under sommarsemestern var vi en vecka på östkusten och besökte Washington DC, Philadelphia och New York. Innan vi åkte hem avslutade vi med ett besök på Big Island Hawaii med vulkaner, regnskogar och fantastisk snorkling. Jag hann dessutom vara med på Heart Failure Society of America kongressen i Florida och AHA kongressen i New Orleans.

 

 

AS havHela året åkte vi så ofta vi kunde till de olika stränder som bara låg 15-20 minuter bort med bil från vårt hus för att bodysurfa, snorkla, bada eller bara promenera och njuta av utsikten över Stilla Havet. Det var väldigt exotiskt att få se valar, delfiner, sälar, pelikaner och sjölejon på nära håll längst stränderna.

Med fantastiskt spännande och vibrerande Los Angeles bara en timme bort med bil blev det naturligtvis en hel del besök dit också.  Både jag och maken har spelat mycket basket tidigare i livet och yngste sonen har ett brinnande basketintresse så det blev mycket basket i alla former under året. Allt från att se NBA matcher med LA Clippers i Staples Arena till otaliga pojklagsträningar och matcher/turneringar med sonens lag.

Vi hade ett fantastiskt år på alla sätt, allt både på jobbet och fritiden överträffade våra förväntningar. Vi har fått mycket ny kunskap och inspiration och flera nya spännande forskningssamarbeten. Det var trevligt att få lära känna många nya vänner och kollegor. University of California var ett fantastiskt universitet att jobba på och under året jag var där hände väldigt mycket spännande på omvårdnadsinstitutionen. De fick bl.a. en privat donation på 40 miljoner dollar (den störst enskilda gåvan i universitetets historia) och etablerade ”School status” från Program in Nursing Science till School of Nursing.

Hur kan jag då summera mina upplevelser av året på University of California Irvine. Jag har upplevt och lärt mig oerhört mycket. Jag har utmanats att gå utanför min bekvämlighetzon och vågat pröva nya saker både i jobbet och privat.  Jag har varit en utlänning och fått känna på hur det är att folk frågar var du kommer ifrån så fort du öppnat munnen. På det hela tagen ett helt oförglömligt år och jag vill uppmuntra alla som vill och kan att ta chansen att jobba utomlands om ni längtar efter att utvecklas och göra något nytt.

Men allt har sin tid och det känns mycket bra att nu vara hemma i Sverige igen. Att sitta i fikarummet med kollegor och att ha möte med forskargruppen ansikte mot ansikte istället för via Skype är något jag uppskattar mycket. Jag njuter också av att vara tillbaka i patientmöten och jobba kliniskt på hjärtsviktsmottagningen och inte minst att befinna sig i den svenska sjukvården som är mycket mer jämlik och resurseffektiv än den amerikanska.

Anna Strömberg

Astrid Janzon scholarship

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On 25 November 2016, Lisa Hjelmfors, behavioural scientist, doctoral student at the Department of Social and Welfare Studies (ISV) and Cesar member , received the Astrid Janzon scholarship of SEK 70,000.

“The scholarship constitutes a much-appreciated contribution to my postgraduate studies,” says Lisa.

The reasons for the awarding of the scholarship were as follows:

People with chronic coronary heart disease constitute one of the largest patient groups in Sweden. Having good communication skills is a very important part of being a nurse and thereby a central element of nursing, the main field of study. The planned study has a clear intervention that will be carried out in collaboration between the patient, relatives and staff. The study has been well-designed and the question at issue is very much in line with Astrid Janzon’s wishes.

Here you can read more about Lisas research and the scholarship.

Maria Liljeroos dissertation

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First of all we would like to congratulate Maria Liljeroos with her PhD title, her impressive defense and her, very nice to read, book! The title of her dissertation is “Caring needs in patient-partner dyads affected by heart failure. An evaluation of a dyadic psycho-educational intervention.”

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On the picture from left to right: Tiny jaarsma, Anna Strömberg, Susanna Ågren

Her dissertation discusses the importance of the partners’ role as a critical extension of the formal healthcare system. It will become crucial to find new ways to support dyads affected by heart failure. Her thesis is the first step in understanding dyads’ perceived caring needs, and can guide in clinical work when designing new dyadic interventions. To read her whole thesis click here.

In a nice interview, Maria highlighted the importance of a dyadic approach in heart failure clinics. To see the whole interview please click on the picture.

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American Heart Congress 2016, New Orleans, Louisiana

 

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First of all we want to congratulate Tiny Jaarsma with her award for distinguished scientist!!

The price is so well deserved and we are very proud that we have now in Sweden a Professor with this price from American Heart!

 

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We also like to congratulate Debra Moser with her Mentor of the year award!

The American Heart started this year on the 12th to the 17th of November in New Orleans. For us it was the first time to be at this congress and it was really impressive. The congress offered so many great sessions and it was impossible to listen to them all. We are so proud that the CESAR group was well represented at the congress:

Johan Israelsson had an abstract accepted for an poster presentation about health status and psychological distress in cardiac arrest.

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Tiny Jaarsma had three talks:

On talk in the session International Collaborations and Multi-Site Studies with the title “Reaching Above and Abroad in Cardiovascular and Stroke Nursing”. The second talk in the session Making Time for the “Sex talk”: sexual Rehabilitation with Cardiovascular Diseases with the title “The “Sex Talk” Sexual Counseling & Rehabilitation Interventions and CVD. And a third talk in the session Innovative Interventions, Assessments, and Analytic Approaches in Heart Failure patients with the title “Measuring Thirst in Patients With Heart Failure: The Thirst Distress Scale for Patients with Heart Failure is Ready to Use!”. The last talk was based on an abstract submission writing together with two other CESAR members: Nana Waldreus and Naoko Perkiö Kato.

marisolAnna Strömberg had one of her American PhD students (Marysol Cacciata) presenting a rapid-fire presentation with the title “Dose-response
Relationships Between Exercise Intensity, Mood States, and Quality of Life in Heart Failure Patients.

Anna also had rapid fire talk in the session Symptom and Management of Patients and Caregivers Across the Continuum of Heart failure with the title “Examining the Relationship between Perceived Control Over the Heart Disease, Depressive Symptoms and Wellbeing and in Patients With Heart Failure and Their Spouses, an Actor-Partner Interdendence Model.

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Leonie Klompstra had a rapid-fire oral presentation on the experiences of patients with heart failure in serious gaming, where Anna Strömberg & Tiny Jaarsma were co-authors.

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The congress was amazing, and a great addition was New Orleans. What a great city of Jazz, good food, ghost hunting tours and beignets with café au lait.

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Christina Andreae & Leonie Klompstra

Linköping 2016-11-30

 

 

 

 

 

 

 

 

Writing week Irvine 2016

From the 7th of November to the 10th of November we had a writing week in Irvine, California at the University Anna Strömberg is now visiting professor.

A lot of people from Linköping University joined the writing week: Anna Strömberg, Tiny Jaarsma, Kristofer Årestedt, Johan Israelsson, Lisa Hjelmfors, Maria Liljeroos, Ulla Walfridsson, Christina Andreae & Leonie Klompstra. But also researchers from University of California Irvine (Lorraine Evangelista, Maryson Cacciata, Jenny Peterson & Janett Hildebrand) and one researcher from Johns Hopkins University School of Nursing Beth Fahlberg joined.

Most of us came the weekend before, so we could overcome our jetlag, but also to see something of California. Anna arranged beach hopping Huntington Beach and a whale and dolphin boat trip (Newport Beach) on the Saturday. Unfortunately we didn’t see whales, but we have seen approximately 200 dolphins, which was amazing.

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After the dolphin watching we went for a beach walk at Scenic view Crystal Cove/Laguna Beach. It was really misty, but this made the walk mysterious and beautiful.

 

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On Sunday we went on Shopping in San Diego in a BIG shopping mall called Outlet shopping Carlsbad, San Diego/La Jolla. First a short stopover to view the wonderful ocean!

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From Monday it was working time at the University of California, Irvine. In the morning it was time for setting our writing goals for the week. In the afternoon, we all had elevator pitch presentation with our research interests and the goals we all had. In the afternoon we went to UCI Health (the university hospital), where Lorraine Evangelista gave a presentation about her work.

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On Tuesday we started to work on our individual goals and in the afternoon Anna Strömberg gave a presentation about tips in dyadic research. There was a great discussion afterwards on how to include dyads in future studies.

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On Wednesday we started with our individual writing and in the afternoon Kristofer Årestedt gave a presentation on instrument development and testing. The analyses shown were new for many of us and showed how important it is to test (new) instruments included in your own studies.

 

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tjOn the last day of the wring, we again started with individual writing and afterwards we had a presentation from Tiny Jaarsma on Theories in Nursing research. A good discussion followed in when to have your framework ready and how to include existing theories in research.

 

On Thursday evening we were invited by Lorraine Evangelista for an all American dinner show, with pirated and princesses.

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It was amazing to meet so many new people and getting inspired in writing and conducting research!

Christina Andreae & Leonie Klompstra

Linköping 2016-11-30