Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Chronic obstructive pulmonary disease (COPD) has been recognized as a leading cause of mortality in older adults involving acute exacerbations as life-threatening events that lead to frequent hospitalization for care. Informal caregivers have been essential to helping older adults with COPD during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A lack of empirical knowledge exists regarding the experience of informal caregivers of older adults with AECOPD in situation awareness for recognizing, understanding, and responding to an AECOPD in an emergent situation. This qualitative descriptive study explored situation awareness and its components of perception, comprehension and projection of next steps, including the caregiver’s confidence level during the AECOPD event. Fifteen informal caregivers, ages 31-77 years (mean age 48), who provided care for older adults with COPD were interviewed from an underserved community health center. The overarching theme derived from this study was something was wrong and something needed to be done. Subthemes emerged as a heightened sense of awareness, caregiver tipping point, planning next steps, caregiver confidence, and caregiver commitment. This study utilized situation awareness theory as a relevant guiding framework in exploring the experience of lay informal caregivers caring for older adults with AECOPD events. Study findings provided a description of the complex processes involved, including confidence level, for informal caregiver’s in situation awareness to recognize and respond to an AECOPD event in the older adult. Future targeted interventions need to address strategies to enhance individualized care for older adults with AECOPD events for managing care at home.

Syfte: Att utvärdera vilken rökavvänjnings metod som är mest effektiv vid kronisk obstruktiv lungsjukdom. Det som undersöktes var de förbättringar i patientresultatet av de olika rökavvänjnings metoderna. Mål: Databassökning samt identifiering av relevant litteratur.Bedömning av kvaliteten på de inkluderade studierna ochsammanställning och sammanfattning av dokumentationen respektive resultat. Studie typer: Sammanställningar och systematiska sammanställningar. Källor: MEDLINE, CINAHL och Cochrane Bibliotek. Metoder: Litteratursökning utfördes, sammanställningarna bedömdes med AMSTAR 2 och PRISMA formulären. Informationen sammanställdes i tabell som sammanfattade resultaten. Resultat: 10 systematiska sammanställningar med medel till hög PRISMA och AMSTAR 2 poäng samlades med en variation av 370 – 13000 KOL-patienter. Dödlighet, sjuklighet och livskvalité visade positiva resultat, andel personer som slutade röka visade också signifikanta siffror.Slutsats: Det finns bevis av interventioner som har positiv effekt på KOL-patienter att sluta röka. Intensiv farmakoterapi rådgivning och motiverande samtal visade bästa resultat för en KOL-patient. / Purpose: To evaluate which smoking cessation method is most effective in chronic obstructive pulmonary disease. What was investigated were the improvements in the patient result of different smoking cessation methods. Objective: Database search and identification of relevant literature.Assessment of quality of the included studiescompilation and summary of the documentation and the result. Studies: Reviews and systematic reviews. Sources: MEDLINE, CINAHL and Cochrane Library. Methods: Literature search was performed, the reviews were assessed with AMSTAR 2 and PRISMA. The information was extracted in tables.Results: 10 systematic reviews with high PRISMA and AMSTAR 2 score were collected with a variety of 370-13000 COPD patients. Mortality, morbidity and quality of life showed positive results, the proportion of people who quit smoking also showed significant numbers. Conclusion: There is evidence of interventions that have a positive effect on COPD patients to quit smoking. Intensive pharmacotherapy counseling and motivational interviewing showed the best results for a COPD patient.

Objective: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with heart failure, yet little is known about the impact of this condition in patients with acute decompensated heart failure (ADHF), especially from a more generalizable, community-based perspective. The primary objective of this study was to describe the in-hospital and post discharge mortality and treatment of patients hospitalized with ADHF according to COPD status. Methods: The study population consisted of patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 4 study years: 1995, 2000, 2002, and 2004. Results: Of the 9,748 patients hospitalized with ADHF during the years under study, 35.9% had a history of COPD. The average age of this population was 76.1 years, 43.9% were men, and 93.3% were white. At the time of hospital discharge, patients with COPD were less likely to have received evidence-based heart failure medications, including beta-blockers and ACE inhibitors/angiotensin receptor blockers, than patients without COPD. Multivariable adjusted in-hospital death rates were similar for patients with and without COPD. However, among patients who survived to hospital discharge, patients with COPD had a significantly higher risk of dying at 1 (adjusted RR 1.10; 95% CI 1.06, 1.14) and 5-years (adjusted RR 1.40; 95% CI 1.28, 1.42) after hospital discharge than patients who were not previously diagnosed with COPD. Conclusions: COPD is a common co-morbidity in patients hospitalized with ADHF and is associated with a worse long-term prognosis. Further research is required to understand the complex interactions of these diseases and to ensure that patients with ADHF and COPD receive optimal treatment modalities.

Cardiovascular disease is common in Chronic Obstructive Pulmonary Disease (COPD), and forced expiratory volume in one second (FEV1) independently predicts cardiovascular morbidity and mortality. Pathological changes in the systemic vasculature have been proposed as potential mechanisms linking COPD to cardiovascular disease, and patients with COPD may be at increased risk of acute myocardial infarction during acute exacerbations. Notwithstanding causation, FEV1 may be a useful prognostic marker in patients undergoing cardiac surgery. This thesis examined these three aspects of cardiovascular co-morbidity in relation to COPD and FEV1. In 2,241 consecutive cardiac surgery patients, FEV1 was associated with length of hospital stay (p<0.001) and mortality (p<0.001) adjusting for age, sex, height, body mass index, socioeconomic status, smoking, cardiovascular risk factors, chronic pulmonary disease, and type/urgency of surgery. In a survey of Scottish Respiratory Consultants there was no consensus regarding the investigation and management of acute coronary syndrome in exacerbation of COPD. In a case-series of 242 patients with exacerbations 2.5% (95% CI 1.0 to 5.6%) had chest pain, raised serum troponin and serial electrocardiogram changes suggestive of acute coronary syndrome. However, over half reported chest pain, while raised troponin was not associated with chest pain or serial ECG changes. Carotid-radial pulse wave velocity (PWV), aortic distensibility, and aortic calcification were measured to assess the relationship of the systemic vasculature to FEV1 and emphysema severity on CT. In adjusted analyses, emphysema was associated with PWV in patients with COPD (p = 0.006) and, in population based samples, with extent of distal aortic calcification (p=0.02) but not with aortic distensibility (p=0.60). This thesis found that FEV1 was associated with mortality and length of hospital stay in patients undergoing cardiac surgery, and that chest pain and raised troponin were common but unrelated in exacerbation of COPD. In the vascular studies distal but not proximal vascular pathology was associated with FEV1, and if COPD is truly related to systemic arterial disease, the distal arterial tree is implicated.

Η τηλεϊατρική στηρίζεται στην εφαρμογή της σύγχρονης τεχνολογίας των τηλεπικοινωνιών,της πληροφορικής και τον ηλεκτρονικών υπολογιστών για παροχή υπηρεσιών υγείας, σε απομακρυσμένες περιοχές. Συνδυάζει δηλαδή την τεχνολογία με την ιατρική θέτοντας τις δυνατότητες της πρώτης στην διάθεση της δεύτερης. / The telemedicine is supported in the application of modern technology of telecommunications, information technology and computers for benefit of services of health, in removed regions. It combines that is to say the technology with the medicine placing the possibilities first in the disposal second.

Chronic obstructive pulmonary disease (COPD) is one of the most widespread diseases globally. A commonly reported symptom is impaired nutritional status, which is often discussed in the literature as difficult to assess. Because nurses play a key role in the care of patients with COPD, knowledge needs to be supplemented with clinically relevant methods that can be used for identification of nutritional needs. The overall aim of this thesis is to investigate factors associated with the nutritional status of persons with COPD and to describe the assessment of nutritional status in different settings and for persons of varying ages. Both qualitative and quantitative methods were used. Two studies with descriptive and exploratory designs (I, II) and two studies with comparative (III), and correlational design (IV). In three of the studies participants were persons with COPD (I, III, IV), whereas one involved registered nurses (RNs). Qualitative data were collected using diaries (I), vignettes (II) and interviews (I, II) and analyzed using qualitative content analysis. Data collection (III, IV) included body size and body composition measurements, assessment of nutritional status using the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), the Evaluation of Nutritional Status (ENS), and lung function measurements. These were analyzed using statistical methods. The main findings from the interviews with 13 respondents in PHC in study I showed that eating difficulties alone do not cause reduced nutritional intake for persons with COPD. Eating is only one aspect in a chain of meal-related situations that involve additional physiological and psychological demands. Assessment of nutritional status, performed by 19 RNs, consisted mainly of single observations. For a half of the RNs it was more important to establish trustful relationships with patients than to give nutritional information, while the other RNs had different opinions on when it was best to provide nutritional information and assess nutritional status. Study III findings showed poor nutritional status for nearly half of the 50 older participants. Many who were identified as malnourished lived alone and were dependent on daily community services. Six out of the 81 participants in Study IV were similarly identified as malnourished by each of the three instruments (MNA, MUST and ENS). There was a significant correlation between each of the instruments and body composition, assessed as fat-free mass index (FFMI). The MNA Short Form (MNA-SF) incorrectly identified thirteen participants’ nutritional status as not needing attention for their nutritional status. To be evaluated as ‘in need of qualified help with nutrition’ by the ENS the respondents needed to be identified as malnourished by the MNA. A general conclusion is that nutritional status is complex for persons with COPD and is difficult to measure by currently recommended methods. Individuals’ experiences are important to elicit because some of their experiences, in combination with RNs’ judgement, might serve as a hindrance for nursing care and delay the sharing of important information. The methods currently recommended for identification of nutritional status should be used with caution, and assessment should not depend on one single method. The findings from this thesis can contribute to early accurate identification of nutritional status and prompt interventions that have importance for an improved disease trajectory and better quality of life for individuals with COPD.

Bakgrund: KOL är en relativt vanlig och obotlig sjukdom som orsakar en gradvis försämring på andningen. Hur man upplever sjukdomen kan skilja sig åt mellan individer och mellan olika stadier av sjukdomen. Det är därför av stor vikt att sjuksköterskan får insikt i dessa upplevelser för att kunna erbjuda god omvårdnad till dessa personer. Syfte: Syftet med litteraturstudien är att beskriva personers upplevelser av att leva med KOL samt att beskriva vilka datainsamlingsmetoder som använts i de inkluderade artiklarna. Metod: Litteraturstudie med en deskriptiv design. De 12 inkluderade artiklarna är av kvalitativ ansats och söktes fram via databaserna Cinahl och PubMed. Innehållet i artiklarnas resultat granskades för att urskilja likheter och skillnader samt de inkluderade artiklarnas datainsamlingsmetod.Huvudresultat: Resultatet i litteraturstudien påvisade att personer med KOL upplevde psykiska, fysiska och sociala aspekter som påverkade personernas liv. Den psykiska påverkan gjorde att personerna fick göra många förändringar i livet. Andningssvårigheterna gjorde att den fysiska förmågan blev nedsatt. Sjukdomen påverkade även den sociala samhörigheten med andra människor. För att hantera och underlätta livet med KOL använde personerna sig av olika strategier. Den vanligaste datainsamlingsmetod som framkom i artiklarna var semistrukturerade intervjuer. Slutsats: Personerna med KOL påverkades psykiskt, fysiskt och socialt av att leva med sjukdomen. Personerna använde sig av olika strategier för att hantera sitt liv med sjukdomen. Det är viktigt som sjuksköterska att ha kunskap om personernas upplevelser av att leva med KOL eftersom det gör att det blir lättare att bevara personernas integritet, värdighet, och autonomi som kan öka personernas välbefinnande. / Background: COPD is a relative common and incurable disease that causes a progressive deterioration of breathing. How to experience the disease may differ between individuals and between different stages of the disease. It is therefore essential that nurses gain insight into these experiences to provide good care to these people. Aim: The aim of this study was to describe people's experiences of living with COPD. Furthermore, the aim of this study was to describe the included articles data collection method. Method: A literature study with a descriptive design. The 12 included articles are of qualitative approach and sought out through the databases CINAHL and PubMed. The contents of the articles results were reviewed to identify similarities and differences and also the included articles data collection method. Main result: The results of the literature study showed that people with COPD experienced psychological, physical and social aspects that affect people's lives. The psychological impact was that the people had to make many changes in life. Breathing difficulties made the physical ability to reduce. The disease also affected the social affinity with other people. To manage and facilitate life with COPD people used different strategies. The most common data collection method that emerged in the articles were semi-structured interviews. Conclusion: The people with COPD were affected psychologically, physically and socially to live with the disease. The people used different strategies to manage their life with the disease. It is important that nurses having knowledge of people´s experience of living with COPD because it makes it easier to preserve people´s integrity, dignity, and autonomy that can increase people's well-being.