All posts by Malin Johansson Östbring

BME @LIU 2022

On April 28th a conference named BME@LIU was held, a conference that focuses on Biomedical Engineering at Linköping University. Ghassan Mourad, one of the Cesar members, was an invited speaker. He presented his recently published RCT entitled: The Effect of Internet-Delivered Cognitive Behavioral Therapy Versus Psychoeducation Only on Psychological Distress in Patients With Noncardiac Chest Pain: Randomized Controlled Trial.

Cardiovascular spring summit

Several Cesar members participated in the Cardiovascular spring summit. Among these were several members of the Research Group for Digital Health & Care who presented not less than six different studies with the following titles, either as posters or moderated posters.

  • The effect of Internet-delivered cognitive behavioural therapy vs. psychoeducation only on psychological distress in patients with non-cardiac chest pain: a randomized controlled trial
  • Cost-effectiveness of Internet-delivered cognitive behavioural therapy (iCBT) in patients with cardiovascular disease and depressive symptoms
  • Internet based cognitive behavioural therapy in depressed patients with cardiovascular disease  -Effects on self-efficacy and it´s associations to changes in self-efficacy, depression and physical activity. A secondary analysis of data collected in a randomized controlled trial
  • The experience of Internet-delivered cognitive behavioural therapy among patients with non-cardiac chest pain
  • Effects of internet-delivered cognitive behavioral therapy for patients with cardiovascular disease and depression on quality of life: A sub-analysis of a randomized controlled trial
  • The effect of ICBT om anxiety in patients with cardiovascular disease. Secondary results from a randomized controlled trial

Congratulations Jeroen

This summer Jeroen Hendriks, Cesar member and researcher at Flinders University, Adelaide, Australia will be presented with the Sigma International Nurse Researcher Hall of Fame award.

Professor Jeroen Hendriks’ research focusses on the development of novel models of care, based on the concept of integrated care, for patients with atrial fibrillation (AF) and associated cardiovascular conditions, and also on the required redesigning process for implementation of such approaches in clinical practice. Based on this approach he and his team have developed specialised AF-Clinics with significant roles for nurses and allied professionals.

The Sigma Theta Tau International Honor Society of Nursing (ΣΘΤ) is the second-largest nursing organization in the world with approximately 135,000 active members. Since 2010 they have awarded nurse reserachers whose early career or long-term research has impacted the nursing profession. This year 32 professionals will be inducted in the International Nurse Researcher Hall of Fame, following the 238 who has been regocnized earlier. “These inspiring, world-renowned nurse researchers represent the staggering, collective impact of nursing and nursing research on global healthcare,” said Sigma President Kenneth Dion, PhD, MSN, MBA, RN, FAAN

The ceremony will be held at the 33rd International Nursing Research Congress in Edingburg, Scotland 21-25 July, and Jeroen will report from the congress.

Maria posted her thesis

Last week on the 10th of March 2022, the CESAR member Maria Ericsson, nurse specialist in medical care, had her posting (or “spikning” in Swedish) ceremony at Linköping University. Posting one’s doctoral thesis means that the doctoral student actually nail the thesis on a wall or a log. The posting ceremony is usually held on the same day as the formal posting, i.e., when the thesis is published electronically in DiVA and the printed thesis is delivered to the library. This should be done at least 3 weeks before the public defence (or “disputation” in Swedish) in order to make sure that the thesis is publicly available for reading before the defence.

Marias’s thesis is called No time to waste: Pre-hospital actions and time delays in patients with ST elevation myocardial infarction – temporal trends and prognostic impact on short- and long-term survival, and she will defend her thesis at Linköping University on the 1st of April. The abstract can be read in DiVA.

Pioneers in I-CBT

Our research group for digital health and care has pioneered the development of knowledge regarding internet-based cognitive behavioural therapy (I-CBT) in the treatment of psychological distress in patients with somatic disease.

Through several randomized studies, we know today that I-CBT can be used to reduce depression and anxiety in patients with heart disease and/or non-cardiac chest pain, both in the short and long term. Our results also show that treating psychological distress in these patients also leads to better quality of life and self-care ability. It has been suggested that physical activity can be used to treat psychological distress in these patients. This may be questionable, as in one of our studies we have found that depression must decrease before the physical activity rate begins to increase. A possible reason for this is that many of these patients are afraid that the heart may be damaged if they perform physically strenuous activity. So, we would suggest that these patients are offered a combination of CBT and physical activity. We also have preliminary results that show that I-CBT also leads to an increased “self-efficacy” but this is also a result of a reduced psychological distress. Overall, this shows the importance of reducing psychological distress in these patients.

In I-CBT treatment of patients with somatic disease, it is beneficial if the therapist has knowledge and experience of working with these patients. In our studies, the treatment was delivered by nurses with experience in cardiac care and patients with non-cardiac chest pain and with only a brief course in CBT. There are several explanations for why this works in I-CBT. One is that the therapeutic aspect of I-CBT is imbedded in the texts and homework assignments and not primarily therapist-related. A second explanation is that in I-CBT, the role of the therapist is more focused on encouraging and confirming the patient and therefore it is important that the person who acts as the therapist can meet the needs of the patient medically and psychologically. Another aspect is that the CBT program itself needs to be designed so that the patient recognizes himself, i.e., that the content is adapted to the context of heart disease or non-cardiac chest pain.

In several interview studies, patients have described that the I-CBT program and the therapist have been perceived as trustworthy and knowledgeable and that they have felt understood, seen, and heard. They describe experiencing an affinity with therapists and programs. CBT is a kind of school and is about learning. The patients have described that through CBT treatment they have just learned to understand and be able to manage their disease. But they also described that the treatment can be laborious and require them to be active themselves. But at the same time, this is probably what also leads to positive results for the patient. We have previously found that reducing depression was linked to how many times the patient logged on to the treatment platform.

Healthcare currently has a lack of access to CBT and many of the patients are at risk of not receiving any treatment for their psychological distress. Our results show that I-CBT can increase access to CBT and is cost-effective, from a health economic perspective. For example, on average, about 2 hours per patient are consumed during an I-CBT treatment. For a nine-week course of treatment, this results in a saving of approximately 5.5 hours per patient, or 75%, of the treatment time that would have been consumed during a standard CBT treatment. We have also reported that I-CBT for depression in patients with CVD is within the levels required to be described as a cost-effective treatment. Another advantage is that I-CBT can be obtained at home and at times that suit the patients regardless of where they live geographically. In our studies, the treatment has been based on Campus Norrköping and provided to patients living in south-eastern Sweden. Thus, I-CBT can be considered “Nära Vård”.

Cesars celebrated

Last week there was an historic event at Länssjukhuset Kalmar; nine colleagues of different professions who had defended their thesis during the year were celebrated by the hospital and the research unit of Region Kalmar county. The wooden stocks now had a few more leaves and more leaves are to come as the commitment to increase research within Region Kalmar county has only just began to bear fruit. Among the nine doctors were three Cesar members, and the differnt foci of their research reflects the multiprofessionality of the Cesar network.

Malin Johansson Östbring, pharmacist and Pharm Dr, Charlotta Lans, physiotherapist and PhD, Frida Andreasson, social worker and PhD in front of the newly installed wood of knowledge at Länssjukhuset

Exercise training and testing in patients with heart failure (Charlotta Lans)

Doing informal care: Identity, couplehood, social health and information and communication technologies in older people’s everyday lives (Frida Andreasson)

Pharmaceutical care in coronary heart disease (Malin Johansson Östbring)

Refractory angina – thesis to be defended

Enhanced external counterpulsation (EECP) treatment has shown to be a potential treatment for patients with RAP, and it is recommended in the European guidelines for symptom relief in patients with debilitating angina refractory to optimal medical and revascularisation strategies. In Sweden, only two ongoing EECP clinics have been established, and the awareness of EECP as a treatment option for patients with RAP is insufficient among healthcare professionals in general. The treatment can be an attractive option since it is non-invasive and can be conducted by nurses at an outpatient clinic. Therefore, it is important to increase and deepen the knowledge of EECP treatment and increase the evidence of its applicability and effects.

Eline Wu works as a cardiac nurse at the Heart and Vascular Theme at Karolinska University in Stockholm. Eline has had professor Anders Broström and professor Jan Mårtensson as her supervisors since her master’s degree. On Friday, November 19th, 2021, she will defend her doctoral thesis focusing on Enhanced external counterpulsation treatment in patients with refractory angina pectoris.

The research was conducted through qualitative and quantitative methods. The findings presented in this thesis provide insight into how patients with RAP experienced the situation before, during, between sessions, and after an EECP treatment. The thesis also demonstrates that patients received several beneficial effects from treatment. Moreover, patients with more significant functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularizations, had three-fold higher odds to receive treatment benefit. Finally, it also demonstrates that the treatment completion rate was high, and the occurrence of adverse events was low. Thus, the treatment can be considered safe and well-tolerated in patients with RAP.

Cesars with impact

One is usually very revealed and happy ones the manuscript is accepted – and published, then we move on to other projects on our lists. But what happens to our published work is also worth to celebrate, ones we get that feed-back. EJCN now in a HeartBeat article celebrates the papers who received most attention (altmetric score) and most downloads during 2020. And Cesars were attributable in 1 of 4 with best altmetric score, and in 4 of the 5 most dowloaded articles.

Informal care and family life

Frida Andréasson and the co-authors Tina Mattsson (Lund University) and Elizabeth Hanson (Linnaeus University) recently published an article based on ethnographic research. Data was collected through observations and interviews with older couples in an informal care situation. The article shows how the process of becoming a carer/care recipient creates a new life situation for couples. The findings reveal changes that happen to family roles, the social isolation that can appear and the strategies used to enable couples to find balance and a sense of autonomy in their lives as a family.

Carer’s week in Eskilstuna

Between the 4th and 8th of October Carer´s week is taking place in Eskilstuna, Sweden. The focus is on informal care and carers, and different activities are being arranged targeting carers and the public. 

On the 5th of October Cesar member Frida Andréasson presented about a research project in which an online support programme for carers of people with heart failure has been developed. Frida talked about the development of the programme and the ongoing RCT study to measure effects. She was also able to show the now finished online support programme and it´s content for the audience. Several Cesar members are involved in the research project in different ways.