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”.

InCept-projektet

Internationellt:

InCept är ett internationellt projekt som startade vt 2019 fokuserar på vårdtagarens upplevelse av primärvården utifrån; tillgänglighet, kontinuitet & samverkan/samordning. Det är ett internationellt projekt som utgår från Universitetet i Tübingen, Tyskland med projektledare Heidrun Sturm och för den svenska delen är Tiny Jaarsma ansvarig. Deltagande nationer är: Brasilien, Tyskland, Schweiz, Storbritannien, Holland & Sverige.

Forskargruppen har genom kvalitativa intervjuer samlat in material från patienter utifrån hur de upplever primärvårdens utifrån, tillgänglighet, kontinuitet och samverkan/samordning. Artikeln är sammanställd och planerad för publicering under maj/juni 2022.

Sverige:

Som en del av detta internationella projekt har vi börjat att arbeta på en artikel utifrån endast det svenska intervjumaterialet.

Vårt syfte har där varit: Den multisjuka äldre personens upplevelse av vårdkedjan.

Det är sammanlagt 7 intervjuer som vi har sammanställt och analyserat utifrån detta syfte och tanken är att publicera artikel i en vetenskaplig tidskrift. Vi som arbetar i projektet, och som ingår i forskargruppen Cesar, är Maria Liljeroos, Christina Andreae, Carina Wennerholm samt Tiny Jaarsma.

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)

Katharine Lembright Life Time Achievement Lecture

CESAR congratulates the American Heart Associations Katharine Lembright Life Time Achievement Lecture winner Professor Anna Strömberg.

On 15th of November 2021 Anna Strömberg was recongized for her work in cardiovascular nursing research.  She received a life time achievement award of the American Heart Association. During her lecture ‘Research in Heart Failure Care- Looking Back and into the Future’ she talked about changes in heart failure care, including shifts in eHealth for these patients.

We also will listen, meet and greet professor Anna Strömberg and congratulate her on the 16th of December 2021 when she will repeat this lecture in Linköping.

Congratulations Anna Strömberg!

Astrid Janzon Symposium 2021

The theme for the Astrid Janzon symposium 2021 was “Ethical issues in healthcare”. When the need for care is explosively greater than the care resources, which we live through in the ongoing covid-19 pandemic, timeless ethical issues about priorities in care and nursing come are very actual.

During the symposium, Emma Säfström (last years receiver stipendium) gave a great presentation on continuity of care after hospitalization due to cardiac condition.

Charlotte Sahlén Helmer from Linköping University received this years’ stipendium for her research in preventing stress and support interaction between preterm infants and their parents. 

Research visit from Tel Aviv: Semyon Melnikov

We are so delighted that since a couple of weeks we have a new active new member in our research group. At the moment Semyon is working with us online, because of the travel restrictions from Israel to Sweden due to COVID-19, but we hope he can join us physically in March when we will have two weeks where international researcher will visit and work together with members of the CESAR network.

Semyon received a grant of the ESC to visit Tiny Jaarsma and her group to work together on research to increase self-care in cardiac patients, especially in patients who received and LVAD. I asked Semyon to tell a bit about himself and his research interest.

I graduated with a BA in nursing from Tel Aviv University, Tel Aviv, Israel. An MSc and a PhD I performed in the Department of Cell and Developmental Biology, Sackler Faculty of Medicine at Tel Aviv University. My research explored the association between intracellular trafficking and signaling in mast cells. After graduation, I examined effects of various gene mutations on hypertension development among the affected subjects, in the clinical pharmacology lab at Sheba Medical Center, Ramat Gan, Israel.

Since 2014 I work as a teacher and a lecturer in the Nursing department at Tel Aviv University and since 2018 I am a senior lecturer. My main teaching topics are evidence-based practice, organ donation and transplantation, and cardiovascular nursing. I am mentoring seven MA students. I am a head of the PISGAH program for IDF soldiers, which grants an RN certificate and a BA degree in Nursing.

In Israel, the organization involved in research in the field of cardiac nursing is the Association for the Promotion of Cardiac Nursing and Intensive Care. The members of the Association conduct research in the various fields of cardiac nursing, present their research at national and international conferences and publish papers at scientific nursing journals.

My current research focuses in cardiovascular nursing, heart failure, heart transplantation, Ventricular Assist Device implantation, and Extracorporeal Membrane Oxygenation in patients with heart and lung failure. Another theme I am interested in explores factors affecting nurses’ readiness to report to work and nurses’ functioning during emergency situations and disasters.

My current research project in collaboration with Prof. Tiny Jaarsma and Dr. Naoko Perkio Kato from Linkoping University, Linkoping, Sweden, examines psychometric properties of the Self-Care Behavior Scale among patients with implanted Left Ventricular Assist Device and its suitability for use in different cultures.

Semyon Melnikov RN PhD

Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University

Tel Aviv, Israel

melniko@tauex.tau.ac.il

CESAR NETWORK meeting in Kalmar

We had a great CESAR NETWORK meeting in Kalmar.

In the first part of the meeting we learned a lot about the great research conducted within the innovative Cardiac Arrest REsearch group (iCARE). Johan Israelsson and Anders Bremer discussed the goal of this group to conduct research aimed at improving the care and care of people suffering from cardiac arrest in or outside hospitals, their relatives and survivors. Read more about this research group here: https://lnu.se/forskning/sok-forskning/the-innovative-cardiac-arrest-research-group-icare/

After this presentation Kristoffer Årestedt gave an inspiring presentation where he let us rethink about logistic regression analyses, how to interpret results and the use of the statistical program R. After lunch we discussed the future of our network and the project we planned together. It was great to meet everyone again after such a long time, to connect, to learn more about the iCARE research group, to discuss ongoing project and planned projects. Thank you Kristoffer, Anders & Johan!

CESAR receives ’Network grant’ from FORTE

In the yearly round of applications of the Swedish Research Council for Health, Working life and Welfare (FORTE) CESAR received a 500.000 SEK grant to the project ‘Expanding and developing an interdisciplinary research network to improve cardiovascular care.’ The coming three years we would like to broaden and further develop our network and would like to use FORTE funding to extend the network. We also plan to intensify the career development of junior researchers, intensify the output and increase the interdisciplinary research funding opportunities. Finally, we plan to increase implementation and utilization of research.

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.