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Kollberg, S. E., Häggström, A.-C. E., Claesson Lingehall, H. & Olofsson, B. (2019). Accuracy of Visually Estimated Blood Loss in Surgical Sponges by Members of the Surgical Team. AANA Journal, 87(4), 277-284
Open this publication in new window or tab >>Accuracy of Visually Estimated Blood Loss in Surgical Sponges by Members of the Surgical Team
2019 (English)In: AANA Journal, ISSN 0094-6354, Vol. 87, no 4, p. 277-284Article in journal (Refereed) Published
Abstract [en]

It is important that operating room personnel monitor the correct amount of blood loss during surgery in order to properly replace lost volume. The aim of this study was to investigate the accuracy of operating room personnel in visually estimating blood loss in surgical sponges. We performed an observational study with comparative descriptive design at a university hospital including all members of the surgical team. In total, 163 observations were completed. The participants estimated the amount of blood in surgical sponges in 4 stations with varying amounts of blood and/or numbers of sponges. Data were analyzed using the Wilcoxon signed rank, Kruskal-Wallis, and Mann-Whitney tests. Both overestimations and underestimations occurred. Underestimations dominated and tended to increase with major amounts of blood. Operating room personnel miscalculated the amount of blood by a median value of 30% regardless of profession, years of experience, and self-assessed ability about visual estimation. This study highlights that assessments of patients’ conditions can be partially based on methods often demonstrated to be inaccurate. Inaccurate visual estimation of blood loss might endanger patient safety.

Place, publisher, year, edition, pages
American Association of Nurse Anesthetists, 2019
Keywords
Blood loss, surgery, surgical sponges, visual estimation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-162902 (URN)
Available from: 2019-08-30 Created: 2019-08-30 Last updated: 2019-09-02Bibliographically approved
Berggren, M., Karlsson, Å., Lindelöf, N., Englund, U., Olofsson, B., Nordstöm, P., . . . Stenvall, M. (2019). Effects of geriatric interdisciplinary home rehabilitation on complications and readmissions after hip fracture: a randomized controlled trial. Clinical Rehabilitation, 33(1), 64-73
Open this publication in new window or tab >>Effects of geriatric interdisciplinary home rehabilitation on complications and readmissions after hip fracture: a randomized controlled trial
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2019 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 33, no 1, p. 64-73Article in journal (Refereed) Published
Abstract [en]

Objective: This pre-planned secondary analysis of geriatric interdisciplinary home rehabilitation, which was initially found to shorten the postoperative length of stay in hospital for older individuals following hip fracture, investigated whether such rehabilitation reduced the numbers of complications, readmissions, and total days spent in hospital after discharge during a 12-month follow-up period compared with conventional geriatric care and rehabilitation.

Design: Randomized controlled trial.

Setting: Geriatric department, participants' residential care facilities, and ordinary housing.

Subjects: Individuals aged ⩾70 years with acute hip fracture (n = 205) were included.

Intervention: Geriatric interdisciplinary home rehabilitation was individually designed and aimed at early discharge with the intention to prevent, detect, and treat complications after discharge.

Main measures: Complications, readmissions, and days spent in hospital were registered from patients' digital records and interviews conducted during hospitalization and at 3- and 12-month follow-up visits.

Results: No significant difference in outcomes was observed. Between discharge and the 12-month follow-up, among participants in the geriatric interdisciplinary home rehabilitation group (n = 106) and control group (n = 93), 57 (53.8%) and 44 (47.3%) had complications (P = 0.443), 46 (43.4%) and 38 (40.9%) fell (P = 0.828), and 38 (35.8%) and 27 (29.0%) were readmitted to hospital (P = 0.383); the median total days spent in hospital were 11.5 and 11.0 (P = 0.353), respectively.

Conclusion: Geriatric interdisciplinary home rehabilitation for older individuals following hip fracture resulted in similar proportions of complications, readmissions, and total days spent in hospital after discharge compared with conventional geriatric care and rehabilitation.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Falls, home rehabilitation, randomized controlled trial, hip fracture
National Category
Geriatrics Physiotherapy
Identifiers
urn:nbn:se:umu:diva-142127 (URN)10.1177/0269215518791003 (DOI)000454521300008 ()30064264 (PubMedID)2-s2.0-85052213545 (Scopus ID)
Note

Originally included in thesis in manuscript form with title: "Geriatric interdisciplinary home rehabilitation - effects on complications and readmissions after hip fracture: a randomized controlled trial"

Available from: 2017-11-22 Created: 2017-11-22 Last updated: 2019-01-14Bibliographically approved
Näsman, M., Niklasson, J., Saarela, J., Nygård, M., Olofsson, B., Conradsson, M., . . . Nyqvist, F. (2019). Five-year change in morale is associated with negative life events in very old age. Aging & Mental Health, 84-91
Open this publication in new window or tab >>Five-year change in morale is associated with negative life events in very old age
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2019 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, p. 84-91Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The objectives were to study changes in morale in individuals 85 years and older, and to assess the effect of negative life events on morale over a five-year follow-up period.

METHOD: The present study is based on longitudinal data from the Umeå85+/GERDA-study, including individuals 85 years and older at baseline (n = 204). Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). Negative life events were assessed using an index including 13 negative life events occurring during the follow-up period. Linear regression was used for the multivariate analyses.

RESULTS: The majority of the sample (69.1%) had no significant changes in morale during the five-year follow-up. However, the accumulation of negative life events was significantly associated with a greater decrease in PGCMS. A higher baseline PGCMS score did not attenuate the adverse effect negative life events had on morale.

CONCLUSION: Morale seemed to be mainly stable in a five-year follow-up of very old people. It seems, nonetheless, that individuals are affected by negative life events, regardless of level of morale. Preventing negative life events and supporting individuals who experience multiple negative life events could have important implications for the care of very old people.

Place, publisher, year, edition, pages
Routledge, 2019
Keywords
Longitudinal studies, life events, mental health, morale
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-142034 (URN)10.1080/13607863.2017.1393795 (DOI)000461682000012 ()29077486 (PubMedID)
Funder
Västerbotten County CouncilNorrbotten County CouncilForte, Swedish Research Council for Health, Working Life and Welfare, 2013-1512Swedish Research Council
Available from: 2017-11-17 Created: 2017-11-17 Last updated: 2019-05-17Bibliographically approved
Näsman, M., Niklasson, J., Nygård, M., Olofsson, B., Lövheim, H., Gustafson, Y. & Nyqvist, F. (2019). Risk factors for a decrease in high morale in very old peopleover a 5‑year period: data from two Nordic countries. European Journal of Ageing
Open this publication in new window or tab >>Risk factors for a decrease in high morale in very old peopleover a 5‑year period: data from two Nordic countries
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2019 (English)In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380Article in journal (Refereed) Epub ahead of print
Abstract [en]

High morale could be considered to be an essential part of aging well and increased knowledge of how to prevent a decreasein high morale in very old age could have important implications for policy, and social and health care development. Theobjective was to identify social and health-related risk factors for a decrease in morale over 5 years in very old peopleamong those with high morale at baseline. The study is based on data derived from the Umeå85+/GERDA study conductedin Northern Sweden and Western Finland. The final sample consisted of 174 individuals who were 85 years and older atbaseline and who had completed the follow-up 5 years later. Morale was measured with The Philadelphia Geriatric CenterMorale Scale (PGCMS). A set of social and health-related variables were used to test which factors were associated with adecrease in morale over 5 years. Linear regression was used for the multivariable analyses. The sample had a mean changeof − 1.3 (SD = 2.5) in PGCMS scores from T1 to T2. The results from the regression analyses showed that development ofdepressive disorders, increased feelings of loneliness and the death of a child during the follow-up period were associatedwith a decrease in morale. The results from our study indicate that preventing the development of depressive disorders andincreasing loneliness are key factors in preventing a decrease in high morale. Additionally, very old people who have recentlylost an adult child should receive adequate psychosocial support

Keywords
Longitudinal studies · Aged 80 and over · Subjective well-being · Quality of life
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-163940 (URN)10.1007/s10433-019-00521-1 (DOI)2-s2.0-85068004240 (Scopus ID)
Available from: 2019-10-09 Created: 2019-10-09 Last updated: 2019-10-10
Smulter, N., Claesson Lingehall, H., Gustafson, Y., Olofsson, B. & Engström, K. G. (2019). The use of a screening scale improves the recognition of delirium in older patients after cardiac surgery: a retrospective observational study. Journal of Clinical Nursing, 28(11-12), 2309-2318
Open this publication in new window or tab >>The use of a screening scale improves the recognition of delirium in older patients after cardiac surgery: a retrospective observational study
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2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 11-12, p. 2309-2318Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: This study analyzed postoperative delirium (POD) in clinical practice after cardiac surgery, how it is detected and documented and if the use of a screening scale improves the detection rate.

BACKGROUND: Cardiac surgery is considered a routine procedure with few complications. However, POD remains a concern, although often being overlooked in clinical practice.

DESIGN: Retrospective observational analysis.

METHODS: Patients 70 years and older with POD (n=78) undergoing cardiac surgery were included in the study. Discharge summaries of both nurses and physicians were reviewed together with the clinical database for information about POD, to be compared with symptom screening using the Nursing Delirium Screening Scale (Nu-DESC). A quantitative content analysis was used for the review of discharge summaries, with a coding scheme adopted from the Nu-DESC method. The STROBE checklist was followed.

RESULTS: In discharge summaries 41 of the 78 POD patients were correctly recognized, and 22 of these were identified in the clinical database. Screening by the Nu-DESC identified delirium at a measurably higher rate, 56/78 patients. The review of discharge summaries showed that patients expressing 'inappropriate behaviour' was the most easily identified sign for POD for both nurses and physicians.

CONCLUSIONS: Healthcare professionals underdiagnose delirium after cardiac surgery, with a low detection rate described in both discharge summaries and in the clinical database. Recognition of delirium improved when Nu-DESC was used for systematic screening.

RELEVANCE TO CLINICAL PRACTICE: This study emphasizes the need for better screening for the detection of delirium in daily clinical practice. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Assessments scales, Cardiac surgery, Clinical database, Documentation, Postoperative delirium
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-157010 (URN)10.1111/jocn.14838 (DOI)000467448000026 ()30791158 (PubMedID)2-s2.0-85062685218 (Scopus ID)
Note

Originally included in thesis in manuscript form

Available from: 2019-03-05 Created: 2019-03-05 Last updated: 2019-08-06Bibliographically approved
Olofsson, B., Persson, M., Bellelli, G., Morandi, A., Gustafson, Y. & Stenvall, M. (2018). Development of dementia in patients with femoral neck fracture who experience postoperative delirium: A three-year follow-up study. International Journal of Geriatric Psychiatry, 33(4), 623-632
Open this publication in new window or tab >>Development of dementia in patients with femoral neck fracture who experience postoperative delirium: A three-year follow-up study
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2018 (English)In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 33, no 4, p. 623-632Article in journal (Refereed) Published
Abstract [en]

Objectives It remains unclear to what extent postoperative delirium (POD) affects the incidence of dementia in hip fracture patients, and the methods used to detect delirium and dementia require validation. The aim of this study was to investigate the development of dementia within 3 years of femoral neck fracture repair surgery, with a focus on POD as a potential predictive factor.

Methods Patients were assessed for cognition, delirium, depression, psychological well-being, and nutritional status during their hospitalization as well as 4, 12, and 36 months after the operation. Logistic regression models were used to analyse factors associated with POD and factors associated with the development of dementia.

Results The study sample consisted of 135 patients without a history of dementia, of whom 20 (14.8%) were delirious preoperatively and 75 (55.5%) postoperatively. Three years after their operations, 43/135 patients (31.8%) were diagnosed with dementia. A greater portion of patients diagnosed with dementia (39/43, 90.6%) than patients with no dementia (36/92, 39.1%) were included among the 75 patients who had experienced POD (P<0.001). In a logistic regression model, after adjustment for covariates (age, sex, diabetes, delirium pre- and postoperatively, hyperactive delirium, days with delirium, urinary tract infection, and Mini Nutritional Assessment score), POD emerged an independent predictor for the development of new dementia (odds ratio, 15.6; 95% confidence interval, 2.6-91.6) within 3 years after the operation.

Conclusion Geriatric hip fracture patients who exhibit POD should be monitored closely for the development of dementia.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
cognitive impairment, femoral neck fracture, geriatrics, logistic regression, mortality
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-146141 (URN)10.1002/gps.4832 (DOI)000426505700008 ()29292537 (PubMedID)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2019-01-08Bibliographically approved
Smulter, N., Lingehall, H. C., Gustafson, Y., Olofsson, B., Engström, K. G., Appelblad, M. & Svenmarker, S. (2018). Disturbances in Oxygen Balance During Cardiopulmonary Bypass: A Risk Factor for Postoperative Delirium. Journal of Cardiothoracic and Vascular Anesthesia, 32(2), 684-690
Open this publication in new window or tab >>Disturbances in Oxygen Balance During Cardiopulmonary Bypass: A Risk Factor for Postoperative Delirium
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2018 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 32, no 2, p. 684-690Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to determine risk factors for postoperative delirium after cardiac surgery, specifically associated with the conduct of cardiopulmonary bypass (CPB).

Design: Prospective observational study.

Setting: Heart Centre, University Hospital.

Participants: The study included 142 patients aged 70 years and older scheduled for elective cardiac surgery with CPB.

Interventions: Risk factor analysis comprised information collected from the hospital clinical and CPB dedicated databases in addition to the medical chart. Delirium was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criterion using the Mini Mental State Examination and the Organic Brain Syndrome scale.

Measurements and Main Results: Assessments of delirium diagnosis were executed preoperatively and on the following first and fourth postoperative days. Delirium occurred in 55% (78/142) of the patients. Patients with delirium were identified with significantly higher body weight and body surface area preoperatively, accompanied with longer CPB time, higher positive fluid balance per CPB, and lower systemic pump flow related to body surface area. Furthermore, the duration of the mixed venous oxygen saturation (SvO2) below 75% was significantly longer during CPB. The result from the multivariable logistic regression analysis included the duration of SvO2 below 75%, fluid balance per CPB and patient age as independent risk factors for postoperative delirium.

Conclusions: The influence of the SvO2 level during CPB, fluid balance, and patient age should be recognized as risk factors for postoperative delirium after cardiac surgery in patients 70 years and older.

Place, publisher, year, edition, pages
Saunders Elsevier, 2018
Keywords
cardiac surgery, cardiopulmonary bypass, mixed venous oxygen saturation, postoperative delirium, risk factors
National Category
Nursing Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-144659 (URN)10.1053/j.jvca.2017.08.035 (DOI)000429083200014 ()29153931 (PubMedID)
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2019-05-22Bibliographically approved
Unneby, A., Svensson, O., Gustafson, Y. & Olofsson, B. (2017). Femoral nerve block in a representative sample of elderly people with hip fracture: a randomised controlled trial. Injury, 48(7), 1542-1549
Open this publication in new window or tab >>Femoral nerve block in a representative sample of elderly people with hip fracture: a randomised controlled trial
2017 (English)In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, no 7, p. 1542-1549Article in journal (Refereed) Published
Abstract [en]

Introduction: The number of elderly people with hip fracture and dementia is increasing, and many of these patients suffer from pain. Opioids are difficult to adjust and side effects are common, especially with increased age and among patients with dementia. Preoperative femoral nerve block is an alternative pain treatment. Aim: To investigate whether preoperative femoral nerve block reduced acute pain and opioid use after hip fracture among elderly patients, including those with dementia. Patients and methods: In this randomised controlled trial involving patients aged >= 70 years with hip fracture (trochanteric and cervical), including those with dementia, we compared femoral nerve block with conventional pain management, with opioid use if required. The primary outcome was preoperative pain, measured at five timepoints using a visual analogue scale (VAS). Preoperative opioid consumption was also registered. Results: The study sample comprised 266 patients admitted consecutively to the Orthopaedic Ward. The mean age was 84.1 (+/- 6.9) years, 64% of participants were women, 44% lived in residential care facilities, and 120 (45.1%) had dementia diagnoses. Patients receiving femoral nerve block had significantly lower self-rated pain scores from baseline to 12 h after admission than did controls. Self-rated and proxy VAS pain scores decreased significantly in these patients from baseline to 12 h compared with controls (p < 0.001 and p = 0.003, respectively). Patients receiving femoral nerve block required less opioids than did controls, overall (2.3 +/- 4.0 vs. 5.7 +/- 5.2 mg, p < 0.001) and in the subgroup with dementia (2.1 +/- 3.3 vs. 5.8 +/- 5.0 mg, p < 0.001). Conclusion: Patients with hip fracture, including those with dementia, who received femoral nerve block had lower pain scores and required less opioids before surgery compared with those receiving conventional pain management. Femoral nerve block seems to be a feasible pain treatment for elderly people, including those with dementia. 

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2017
Keywords
Hip fracture, Femoral neck fracture, Femoral nerve block, Pain, Opioid, Preoperative period, Frail derly, Dementia
National Category
Orthopaedics Nursing
Identifiers
urn:nbn:se:umu:diva-138233 (URN)10.1016/j.injury.2017.04.043 (DOI)000405997100041 ()28501287 (PubMedID)
Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2018-06-09Bibliographically approved
Niklasson, J., Näsman, M., Nyqvist, F., Conradsson, M., Olofsson, B., Lövheim, H. & Gustafson, Y. (2017). Higher morale is associated with lower risk of depressive disorders five years later among very old people. Archives of gerontology and geriatrics (Print), 69, 61-68
Open this publication in new window or tab >>Higher morale is associated with lower risk of depressive disorders five years later among very old people
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2017 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 69, p. 61-68Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to investigate whether higher morale, i.e. future-oriented optimism, at baseline was associated with lower risk of depressive disorders five years later among very old people.Methods The Umeå85+/GErontological Regional Database, a population-based study with a longitudinal design, recruited participants in Sweden and Finland aged 85, 90 and ≥95 years. The sample in the present study included 647 individuals (89.1±4.4 years (Mean±SD), range 85-103). After five years, 216 were alive and agreed to a follow-up (92.6±3.4 years, range 90-104). The Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale. The depressive disorder diagnosis was determined according to DSM-IV based on medical records and interview data including assessment scales for depressive disorders. A number of sociodemographic, functional and health-related variables were analysed as possible confounders.Results For those with no depressive disorders at baseline, the only baseline variable significantly associated with depressive disorders five years later was the PGCMS score. A logistic regression model showed lower risk of depressive disorders five years later with higher baseline PGCMS scores (odds ratio 0.779 for one point increase in PGCMS, p<0.001). The association remained after adjusting for social isolation (p<0.1 association with depressive disorders five years later).Conclusion Our results indicate that the higher the morale, the lower the risk of depressive disorders five years later among very old people. The PGCMS seems to identify those very old individuals at increased risk of depressive disorders five years later. Preventive measures could befocused on this group.

Keywords
Morale, Depressive disorders, Geriatric psychiatry, Aged, 80 and over, Salutogenic factor, Future-oriented optimism
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-129655 (URN)10.1016/j.archger.2016.11.008 (DOI)000390449000009 ()27889589 (PubMedID)
Available from: 2017-01-08 Created: 2017-01-08 Last updated: 2018-06-09Bibliographically approved
Claesson Lingehall, H., Smulter, N., Lindahl, E., Lindkvist, M., Engström, K. G., Gustavsson, Y. & Olofsson, B. (2017). Preoperative Cognitive Performance and Postoperative Delirium Are independently Associated With Future Dementia in Older People Who Have Undergone Cardiac Surgery: A Longitudinal Cohort Study. Critical Care Medicine, 45(8), 1295-1303
Open this publication in new window or tab >>Preoperative Cognitive Performance and Postoperative Delirium Are independently Associated With Future Dementia in Older People Who Have Undergone Cardiac Surgery: A Longitudinal Cohort Study
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2017 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 45, no 8, p. 1295-1303Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate if postoperative delirium was associated with the development of dementia within 5 years after cardiac surgery.

Design: Longitudinal cohort study.

Setting: Cardiothoracic Division, Umeå University Hospital, Sweden.

Patients: Patients aged 70 years old or older (n = 114) scheduled for routine cardiac procedures with cardiopulmonary bypass without documented dementia were enrolled in 2009.

Intervention: Structured assessments were performed preoperatively, 1 and 4 days after extubation, and 1, 3, and 5 years postoperatively.

Measurements and Main Results: Patients were assessed comprehensively, including cognitive and physical function, coexisting medical conditions, demographic characteristics, and medications. Diagnoses of delirium, depression, and dementia were made according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria. During the 5-year period, 30 of 114 participants (26.3%) developed dementia. Postoperative delirium had occurred in 87% of those who later developed dementia. A multivariable logistic regression model showed a lower preoperative Mini-Mental State Examination score (p < 0.001; odds ratio, 0.68; 95% CI, 0.54–0.84) and the occurrence of postoperative delirium (p = 0.002; odds ratio, 7.57; 95% CI, 2.15–26.65) were associated with dementia occurrence.

Conclusions: Our findings suggest that older patients with reduced preoperative cognitive functions or who develop postoperative delirium are at risk of developing dementia within 5 years after cardiac surgery. Cognitive functions should be screened for preoperatively, those who develop postoperative delirium should be followed up to enable early detection of dementia symptoms, and management should be implemented.

Keywords
cardiac surgery, cardiovascular disease, delirium, dementia, older people
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-135501 (URN)10.1097/CCM.0000000000002483 (DOI)000405469600027 ()
Available from: 2017-05-30 Created: 2017-05-30 Last updated: 2018-06-09Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3754-5026

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