Category Archives: Cesar Column

Mitt år som gästprofessor i USA

ICU

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

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

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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.

 

handskak

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.

ghassan-handledare

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.

 

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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.

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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.

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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.

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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”.

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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.

 

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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.

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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!

festlk

Nana Waldréus dissertation

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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!

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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 http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-126151

 

Nana Waldréus, PhD, RN

 

 

 

Ghassan Mourad dissertation

 

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Friday the 4th of December 2015 was the day I had been preparing for…for several year. This was the day for my dissertation. The day when I had to defend all the work I had performed during my doctoral studies. It was with mixed emotions that I looked forward to this day. From being far away it was suddenly time to roll up my sleeves and tackle the trickiest part of the doctoral studies.

The faculty opponent, Siv Söderberg, and the grading committee did a great job and made me feel that I had done a great piece of work. I really enjoyed discussing my thesis with all of them and I felt a bit disappointed when time was over…not really what I thought that I would feel. Off-course, passing this exam felt great and was a huge success. Looking back at it, dissertation day was a really good day that ended with a great party. I shared it with close friends and colleagues. This day was filled with a lot of nice speeches, song and dance performances, and I received a lot of nice gifts. It was a real ego boost hearing a lot of nice words about yourself, wow I could do that again!

Here is a short summary of my thesis:

This thesis presents results from four quantitative studies. Studies I and II had a longitudinal descriptive and comparative design. In study I, 267 patients participated. Out of these, 199 patients participated in study II. Participants in these studies were predominantly male (about 60 %) with a mean age of 67 years. Study III had a cross-sectional explorative and descriptive design including 552 patients (51 % women, mean age 64 years). Study IV was a pilot randomized controlled study including nine men and six women with a median age of 66 years. The intervention group received a four-session guided Internet-delivered cognitive behavioural therapy (CBT) and the control group received usual care.

The overall aim of this thesis was to improve care for patients with non-cardiac chest pain (NCCP) by describing related psychological distress, healthcare utilization and societal costs, and by evaluating an Internet-delivered cognitive behavioural intervention.

The specific aims for the four studies were:

Aim I: To compare depressive symptoms and healthcare utilization in patients admitted for later proven NCCP, compared to patients with ischemic heart disease presenting with acute myocardial infarction (AMI) and angina pectoris (AP) during a 1-year follow-up after an acute chest pain event.

Aim II: To present a detailed description of the costs of patients with NCCP compared to patients with AMI and AP from a societal perspective.

Aim III: To explore the prevalence of depressive symptoms, cardiac anxiety, and fear of body sensations in patients who were admitted to hospital because of chest pain and discharged with a NCCP diagnosis. Further, we aimed to describe how depressive symptoms, cardiac anxiety and fear of body sensations are related to each other and to healthcare-seeking behavior.

Aim IV: To test the feasibility of a short guided Internet-delivered CBT intervention and the effects on chest pain, cardiac anxiety, fear of body sensations, and depressive symptoms in patients with NCCP compared to usual care.

The main findings were that patients with NCCP experienced recurrent and persistent chest pain and psychological distress in terms of depressive symptoms, cardiac anxiety and fear of body sensations. The prevalence and severity of depressive symptoms in patients with NCCP did not differ from patients with AMI and patients with AP. NCCP was significantly associated with healthcare utilization and patients had similar amount of primary care and outpatient clinic contacts as patients with AMI. The estimated cumulative annual national societal cost for patients with NCCP was more than double that of patients with AMI and patients with AP, due to a larger number of patients with NCCP. Depressive symptoms, cardiac anxiety and fear of body sensations were related to increased healthcare utilization, but cardiac anxiety was the only variable independently associated with healthcare utilization. The short guided Internet-delivered CBT program seemed to be feasible and was perceived as easy to manage, with comprehensible language, adequate and varied content, and manageable homework assignments. Patients improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but this did not differ from the patients in the control group who received usual care. These findings imply that screening and treatment of psychological distress should be considered for implementation in the care of patients with NCCP. By reducing cardiac anxiety, patients may be better prepared to handle chest pain.

You can access the whole framework at http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-122592. Please do not hesitate to contact me in case of any queries.

Thank you for your attention.

Ghassan Mourad, PhD, RN

 

A visiting scholar report from College of Nursing, University of Kentucky, Lexington, USA fall 2015

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First of all I want to thank the two persons that made this scholar visit possible, professor Anna Strömberg, my main supervisor, and professor Misook Chung at University of Kentucky who hosted my stay.

 

EtjänsteDuring four (mostly) warm and sunny weeks I had the privilege to visit professor Misook Chung who is a member of Riche Heart group at College of Nursing, University of Kentucky.

Professor Chung is very knowledgeable regarding mediator and moderator models and dyadic analysis and she shared her knowledge with me and taught me among other things how to analyse my data using Actor-Partner Independent Model.

 

klassenDuring my stay I attended several doctoral students classes. Subjects discussed weretheories and models to build a framework for your thesis, moderation models and self-care theories. I also attended RICH Heart team meetings were they once a week meet and discuss their ongoing research projects, grants and other issues.

 

 

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I was invited to present my own PhD-project at two different occasions and I also told about how doctoral studies are performed in Sweden. Both faculties and doctoral students were invited and they were all very interested and had a lot of questions. There are a lot of differences between the countries but there are also similarities. At the end of my stay I was invited to a short visit at deans office.

During the weekends I was on several trips with both Misook Chung and Terry Lennie. We visited a bourbon distillery, Woodford Reserve, and Shaker Village; a beautiful place on the country site, were we walked and had dinner.

The last Friday I was at the universities theatre were students from UK Dept. of Theatre and Dance presented “The importance of Being Earnest” by Oscar Wilde. The students were incredibly talented, and I’m sure some of them will become professional actors.

Results from the visit;

I have expanded my network with both professors and other PhD-students, which is good for future collaboration.

I have started to write a paper about mediation, I have almost finished a paper regarding Actor-Partner Independent Model and started to wright two abstracts that are going to be submitted to EuroHeartCare 2016.

I am grateful having had the possibility to do this scholar visit and start working together with Dr Chung and colleagues. Once again, thank you!

Best,

Maria Liljeroos

A visiting scholar report from University of Kentucky, Lexington, USA

 

First of all I would like to thank my supervisor prof. Anna Strömberg, Linköping University CAEthat gave me the opportunity to go on this inspiring trip across the Atlantic Ocean. I would also like to thank Sektionen för omvårdnadsinformatik for the award of 6000 SEK. Description of the visit I visited the RICH Heart Program at the College of Nursing during October 2014. I had the great opportunity to work with prof. Terry Lennie and colleagues. We co-worked with data about nutrition in heart failure. My ongoing doctoral project is about multifactorial aspects of appetite in heart failure and the work with nutrient data i.e. vitamins, minerals and energy intake has given me new perspective on nutrition in heart failure that will be of great importance for my future PhD work.

We have had interesting discussions on how to organize, analyze and interpret self-reported and objective data, and I have learned a lot about regression models, mediating and moderations. Although, the writing process is a critical part to learn and my mentor Terry Lennie gave me outstanding support. Prof Debra Moser and co-directors of RICH Heart coach the doctoral students with weekly meetings which provide the opportunities to discuss progression of studies, research grants and issues of more practical nature. This was of great value, I have experienced how a productive group of researchers collaborate and discuss research in different contexts.

I have attended doctoral seminars and was invited to present some of my PhD project. I had also the opportunity to participate in interesting lessons about nutrition which have given me a better understanding how importance it is to choose healthy diet in order to decrease the risk of cardiovascular disease. Nutrition research is a hot topic for the public and it is crucial to communicate results to mass media in a clear way since diet has major impact on people’s lifestyles.

Results; During the visit, we collaborated with data from current PhD project and the RICH Heart project. Our work has resulted to two abstracts that are submitted to the Euro Heart Care Congress, Dubrovnik, 2015. One abstract is about mental health and the relationship with appetite, physical activity and health status. The second abstract is about nutrient deficiency and its predictive value on health in heart failure. We have begun to write two manuscripts. Part of the work during my stay will be included in the thesis, dissertation is planned for 2017.

Take home message; If you are planning to visit a research group, I think you may need to stay for a month or for a longer period. It take time to get access to the University facilities, getting to know co-workers and to understand new project and dataset. Provide a plan to achieve your goals. “Shoot for the moon, even if you miss, you’ll land among the stars.” (Norman Vincent Peale). For a fruitful collaborating, and developing new skills, be open and curious and take the opportunity to collaborate with data from the research group you are visiting. Try to combine research by discovering the town, and have fun with new friends! I feel privileged that I got the opportunity to work together with prof. Terry Lennie and his colleagues and I look forward to our continued collaboration. Many thanks!

Christina Andreae, RN, PhD student at Linköping University 2014-12-01

EuroHeartCare 2014 from the eyes of three CESARS

April 3rd we were a big group of people from the CESAR network who set the course on EuroHeartCare 2014. This year the theme of the conference was ”Heart and Mind” and the conference was held in Stavanger, a beautiful city located on a peninsula on the southwest coast of Norway.

EHC1

Some PhD-students attended the pre-conference and took part in the the Masterclass which was about ” How to build a successful international collaboration” lead by Professor Anna Strömberg (Linköping, Sweden) and Professor Debra Moser (Lexington,USA). It was a great opportunity for newer researchers to get together and learn more about collaboration, how to build successful networks and get to know other people who are in the beginning of their research career. We who attended had an interesting afternoon and look forward to a new masterclass next year!

EHC2The next day the sun was shining and inside the conference hall people started to prepare for the first interesting day of the conference. Many of the CESAR members had own presentations and posters during the conference. In the session about Ischaemic heart disease, Jan Mårtensson talked about ”The international statement on sexual counselling and its application in practice”. Jan had an interesting presentation about the importance of sexual health in cardiac patients’ and partner’s life and concluded that health care professionals need help to implement guidelines for sexual counseling in their daily practice. This presentation later got the award ”Best moderated poster”.

EHC3Another CESAR member who also was awared ”Best moderated poster” was Johan Israelsson discussing ”Post cardiac arrest care and follow-up in Sweden- a national survey”. Johan emphazised the importance of improving post cardiac arrest care with for exemple implementing national guidelines for such care.

 

 

 

 

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In the evening of the first day, the Stavanger Convention Bureau invited all attendees of the conference to join a bus sightseeing tour of Stavanger. It was a pleasant trip through a beautiful landscape showing for exemple the reconstructed Iron age Farms and the Swords in Rock, which is a commemorate of Harald Hårfagre’s uniting of Norway into one kingdom in year 872. The tour ended with a walk through Old Stavanger with its white wooden cottages.

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Day two of the conference showed up with rain and Kenneth Dickstein said during his talk something like ”today Stavanger has shown its true colours” meaning that it was more likely that one experienced rain rather than sun visiting Stavanger.

 

For one of the CESAR members this second day was a bit extra exciting. PhD student Leonie Verheijden Klompstra had been invited as speaker in the symposium Heart-Mind interventions: Turn negatives into postitives. Leonie talked about using game computers to increase physical activity in heart failure patients. In her own studies she evaluates the feasibility of using nintendo Wii as exergaming in heart failure patients. In her speech, Leonie talked about fun as a key factor in becoming and staying physical active and highlighted research which patients expressed as fun, like yoga, greek and walsh dancing.  Afterwards she got great and enthusiastic feedback.

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Next years EuroHeartCare will be held in Dubrovnik, Croatia, we already look forward!

 

Text written by Leonie Verheijden Klompstra and Lisa Hjelmfors

All photos taken by Ghassan Mourad.

Exchanges with China

Janne på muren

Tianjin is a city that is 13 Swedish mil from Beijing in one of the most expansive parts of China, and has 13.5 million inhabitants. I am responsible for building up a partnership with Tianjin Medical University and worked for three weeks in October with the help of funds from the Linnaeus- Palme program.

This was the third time I was there and taught and discussed the continued work to develop the partnership even more. There is a lot of interest from both sides to create a strong partnership between our institutions, which is very stimulating. The plan is that this collaboration will be far reaching and will take place on many levels, both a continuing teacher and student exchange at an undergraduate level, but also at an advanced and research level.

I was one of the supervisors for the first student who received a PhD in nursing at Tianjin Medical University, PhD Xiao-Ying Zang. At the end of this year another two of the teachers, Qi Lu and Lan Wang will be enrolled at the research school, School of Health Sciences, Jönköping University with me as the main supervisor. Their research will address COPD and stroke, but we discuss the possibility also to cooperate in the cardiovascular field in the future.

At a visit to Tianjin Medical Hospital I had the opportunity to see their cardiac clinic and talk with the head nurse and she was very interested to learn more about how we work, etc. Among others we decided that next year (for it will be at least three weeks next year too)  I will give lectures for the nurses at the hospital and not only at the university. There is a lot of similarities, but of course also a lot of differences in how we treat and follow-up our patients. For example, team-based and person-centered care is not common. China is the only country in the world where there are more doctors than nurses (RNs 0.9 per doctor), which of course makes its mark in the nursing care.

Jan Mårtensson

Column by a new PhD

 

Carina Hjelm (1)I would like to tell you about the day I defended my dissertation, Friday the 13th of September. Yes, I made it despite that fateful date. I am very superstitious, but I was told by many people that this date had been really good for them. Now, Friday the 13th is my lucky day. The whole day was wonderful, the faculty opponent Ingrid Fagerberg was well prepared and we discussed my research for 4 hours. I managed to answer the grading committee’s questions and the evening was spent in the company of good friends, with speeches, singing, comedy, dance performances, presents and flowers. The day was absolutely wonderful and a real ego boost! I congratulate all of you who still have this ahead of you; writing the introductory chapter of the dissertation is hard work, but D-day is totally wonderful and exciting, and marks the end of your time as a doctoral student.

I thought I’d briefly describe the research findings presented in my dissertation:

This thesis is based on four quantitative studies. The data from study I and II were collected in a prospective longitudinal design, including Swedish same-sex twin pairs born in 1913 or earlier in Sweden. The study was conducted 1991-2002 and a total of 702 individuals aged 80 and older were included.

Study III and IV had a cross- sectional design and included stable HF patients, median 72 years of age, living in the community in the south of Sweden. Data were collected between 2009 and 2012. Study III included a total of 137 patients and Study IV included 142 patients.

The overall aim of this thesis was to explore cognitive function in elderly patients with chronic heart failure with focus on prevalence, risk factors, sleep and self-care.

The specific aims of the four studies were:

Aim I To examine the relationship between heart failure and specific cognitive abilities in octogenarians with regard to level and change over time.

Aim II To compare the prevalence of dementia in individuals 80 years or older with CHF and those in the same age group without CHF, and to identify the factors related to dementia in individuals diagnosed with CHF.

Aim III To compare sleep and wake patterns, insomnia, daytime sleepiness and cognitive function in community-dwelling CHF patients, with and without SDB, and to investigate the association between sleep-related factors and cognitive dysfunction.

Aim IV To test the relationship between cognitive function and self-care in patients with heart failure after adjusting for the contribution of age, education, functional status, myocardial stress, sleep and depression. Further, the relationship between cognitive function and self-care was explored with symptoms of depression and sleep as moderators.

I had a lot of interesting results, which you can find in my publications. In this column however, the editor wanted me to jump (!) to the conclusion…
Octogenarians suffering from HF have a decreased performance in spatial and episodic memory and they also have a higher risk for developing dementia. Cognitive dysfunction as well as higher prevalence of dementia can contribute to decreased adherence to prescribed therapy and self-care management, and lead to other socio-behavioural problems. Insomnia was the only sleep-related factor significantly influencing global cognitive function in patients with stable HF with few comorbidities. Self-care was found to be associated with psychomotor speed. This may influence sustained attention negatively and the ability to carry out more than one task at the same time. This may lead to decreased attention for receiving and understanding information on self-care.

If you have any further queries, please do not hesitate to contact me. Thank you for your attention.

Carina Hjelm, PhD