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Aims and Objectives: To (i) determine the prevalence of delirium and identify delirium subtypes in surgical and non‐surgical patients aged ≥65 years, (ii) determine whether certain precipitating factors affect the prevalence of delirium and (iii) review patients' medical records for description of delirium symptoms and the presence of International Classification of Diseases (ICD‐10) coding for delirium in discharge summaries. Methodological Design and Justifications: Despite being a robust predictor of morbidity and mortality in older adults, delirium might be inadequately recognised and under‐reported in patients' medical records and discharge summaries. A point prevalence study (24‐h) of patients ≥65 years from surgical and non‐surgical wards was therefore conducted in a tertiary university hospital. Ethical Issues and Approval: The study was approved by the Data Protection Officer at the university hospital (2018/3454). Research Methods, Instruments and/or Interventions: Patients were assessed for delirium with 4AT and delirium subtypes with the Delirium Motor Subtype Scale. Information about room transfers, need and use of sensory aids and medical equipment was collected onsite. Patients' medical records were reviewed for description of delirium symptoms and of ICD‐10 codes. Results: Overall, 123 patients were screened (52% female). Delirium was identified in 27% of them. Prevalence was associated with advanced age (≥85 years). The uncharacterised delirium subtype was most common (36%), followed by hypoactive (30%), hyperactive (24%) and mixed (9%). There were significant associations between positive screening tests and the need and use of sensory aids. Delirium symptoms were described in 58% of the patients who tested positive for delirium and the ICD‐10 code for delirium was registered in 12% of these patients' discharge summaries. Conclusions: The high prevalence of delirium and limited use of discharge codes highlight the need to improve the identification of delirium in hospital settings and at discharge. Increased awareness and detection of delirium in hospital settings are vital to improve patient care. [ABSTRACT FROM AUTHOR]

Aims The recent rise in the number of nonagenarians (age ≥ 90 years) undergoing percutaneous coronary intervention (PCI) has revealed gaps in research, in particular on patients' experiences. Therefore, the aim of the study was to explore and describe nonagenarians' internal resources and their experiences of the in-hospital pathway. Methods and results Nineteen nonagenarian patients (women n = 9), mean age 91 years, 9 acutely, and 10 electively treated, were consecutively enrolled from a tertiary university hospital from June 2021 to February 2023. In-depth interviews were conducted during hospitalization, audiotaped and transcribed. The interviews were analysed using qualitative content analysis. Three sub-themes emerged from the nonagenarians' experiences with the PCI treatment trajectory: (i) Taking lifelong responsibility for own physical and mental health describes a population striving to live a healthy life and to stay independent. Physical and mental activities including healthy food choices had been an integral aspect of their lives from early childhood. (ii) Individual internal resources influenced the PCI pathway describes how their internal resources were used, from actively engaging in the decision-making process to withstanding discomfort during the PCI procedure. (iii) The post-PCI pathway was multifaceted describes a short stay at the cardiac ward with individual post-procedural experiences, close monitoring, and preparation for discharge including cardiac rehabilitation. Conclusion Nonagenarians undergoing PCI demonstrated a personal incentive to stay healthy and independent. Their internal resources of independence, stoicism, and resilience were used during their in-hospital stay contributing to a successful PCI procedure. Individual cardiac rehabilitation strategies were highlighted after discharge from hospital. [ABSTRACT FROM AUTHOR]

Aims Patients with symptomatic aortic valve stenosis are efficiently treated by aortic valve replacement (AVR), using a biological or mechanical valve. For some patients with mechanical valves, the metallic clicking sound may be problematic. The aim of this study was to investigate the perceived disturbance from the sound of a mechanical valve and the association between noise perception and symptoms of anxiety and depression. Methods and results The study had a cross-sectional design. In April 2013, all patients who had undergone AVR at one university hospital during the period 2000–12 were invited by post to participate. The primary variables were assessed using a valve-specific questionnaire and the Hospital Anxiety and Depression Scale. Of the 912 (77%) respondents, 245 had mechanical valves. Of these, 59 (24%) were women, the mean (standard deviation) age was 61 (11) years, and the mean time since surgery was 7 (3) years. The valve-specific questionnaire showed that 84% of the patients could sometimes or often hear the valve sound. A moderate positive correlation was found between valve prosthesis noise disturbance and anxiety, r = 0.35 (P = 0.001), and depression, r = 0.27 (P = 0.001). In a multiple linear regression analysis, valve noise perception was only significantly associated with anxiety among several other bio-psychosocial factors. Conclusion This study shows an association between valve noise disturbance and symptoms of anxiety and highlights the importance of preparing all patients for the sound from the mechanical valves that arises after surgery. [ABSTRACT FROM AUTHOR]

Aims In-hospital telemetry monitoring has been an integrated part of arrhythmia monitoring for decades. A substantial proportion of patients require arrhythmia monitoring during stays in non-intensive care units. However, studies exploring patients' experiences of telemetry monitoring are scarce. Therefore, the aim was to explore and describe patients' experiences of in-hospital telemetry monitoring in a non-intensive care setting. Methods and results Twenty face-to-face, semi-structured interviews were conducted. Interviews were conducted before discharge at two university hospitals in Norway. The patients were purposively sampled, resulting in a well-balanced population comprising 11 men and nine women, mean age 62 years (range 25–83). Average monitoring time was 9 days (range 3–14). Data were audiotaped, transcribed verbatim, and coded using NVivo software. Qualitative content analysis using an inductive approach was performed. Patients expressed a need for individualized information during telemetry monitoring. Their feelings of safety were related to responses from nurses from the central monitoring station when alarms from the telemetry were triggered. Despite perceived physical restrictions and psychological limitations associated with telemetry monitoring, they found monitoring to be beneficial because it facilitated the diagnosis of arrhythmia. Moreover, they expressed a need for improvements in wearable monitoring equipment. Patients expressed ambivalent feelings about discontinuing the telemetry and their readiness for discharge. Conclusion Patients need individualized information about the results of their telemetry monitoring in order to better understand the arrhythmia management and to increase their experience of safety after discharge. The limitations patients experienced should be taken into consideration in further upgrades of telemetry monitoring equipment. [ABSTRACT FROM AUTHOR]

Accumulating evidence has related the gut microbiota to colorectal cancer (CRC). Fusobacterium nucleatum has repeatedly been linked to colorectal tumorigenesis. The aim of this study was to investigate microbial composition in different sampling sites, in order to profile the microbial dynamics with CRC progression. Further, we characterized the tumor-associated F. nucleatum subspecies. Here, we conducted Illumina Miseq next-generation sequencing of the 16S rRNA V4 region in biopsy samples, to investigate microbiota alterations in cancer patients, patients with adenomatous polyp, and healthy controls in Norway. Further, Fusobacterium positive tumor biopsies were subjected to MinION nanopore sequencing of Fusobacterium-specific amplicons to characterize the Fusobacterium species and subspecies. We found enrichment of oral biofilm-associated bacteria, Fusobacterium, Gemella, Parvimonas, Granulicatella, Leptotrichia, Peptostreptococcus, Campylobacter, Selenomonas, Porphyromonas, and Prevotella in cancer patients compared to adenomatous polyp patients and control patients. Higher abundance of amplicon sequence variants (ASVs) classified as Phascolarctobacterium, Bacteroides vulgatus, Bacteroides plebeius, Bacteroides eggerthii, Tyzzerella, Desulfovibrio, Frisingicoccus, Eubacterium coprostanoligenes group, and Lachnospiraceae were identified in cancer and adenomatous polyp patients compared to healthy controls. F. nucleatum ssp. animalis was the dominating subspecies. F. nucleatum ssp. nucleatum, F. nucleatum ssp. vincentii, Fusobacterium pseudoperiodonticum, Fusobacterium necrophorum, and Fusobacterium gonidiaformans were identified in five samples. Several biofilm-associated bacteria were enriched at multiple sites in cancer patients. Another group of bacteria was enriched in both cancer and polyps, suggesting that they may have a role in polyp development and possibly early stages of CRC. [ABSTRACT FROM AUTHOR]

Background: Children with combined mental and somatic conditions pose a challenge to specialized health services. These cases are often characterized by multi-referrals, frequent use of health services, poor clinical and cost effectiveness, and a lack of coordination and consistency in the care. Reorganizing the health services offered to these children seems warranted. Patient reported experiences give important evidence for evaluating and developing health services. The aim of the present descriptive study was to explore how to improve specialist health services for children with multiple referrals for somatic and mental health conditions. Based on parent reported experiences of health services, we attempted to identify key areas of improvement.Methods: As part of a larger, ongoing project; "Transitioning patients' Trajectories", we asked parents of children with multiple referrals to both somatic and mental health departments to provide their experiences with the services their children received. Parents/guardians of 250 children aged 6-12 years with multi-referrals to the Departments of Pediatrics and Child and Adolescent Mental Health at Haukeland University Hospital between 2013 and 2015 were invited. Their experience was collected through a 14 items questionnaire based on a generic questionnaire supplied with questions from parents and health personnel. Possible associations between overall experience and possible predictors were analyzed using bivariate regression.Results: Of the 250 parents invited, 148 (59%) responded. Mean scores on single items ranged from 3.18 to 4.42 on a 1-5 scale, where five is the best possible experience. In the multiple regression model, perception of wait time (r = .56, CI = .44-.69 / β = 0.16, CI = .05-.28), accommodation of consultations (r = .71, CI = .62-.80 / β = 0.25, CI = .06-.45 / β = 0.27, CI = .09-.44), providing adequate information about the following treatment (r = .66, CI = .55-.77 / β = 0.26, CI = .09-.43), and collaboration between different departments at the hospital (r = .68, CI = .57-.78 / β = 0.20, CI = -.01-.40) were all statistically significantly associated with parents overall experience of care.Conclusions: The study support tailored interdisciplinary innovations targeting wait time, accommodation of consultations, communication regarding the following treatment and collaboration within specialist health services for children with multi-referrals to somatic and mental specialist health care services. [ABSTRACT FROM AUTHOR]

Climate change is one of the greatest threats currently facing the world's environment. In Norway, a change in climate will strongly affect the pattern, frequency, and magnitudes of stream flows. However, it is challenging to quantify to what extent the change will affect the flow patterns and floods from small rural catchments due to the unavailability or inadequacy of hydro-meteorological data for the calibration of hydrological models and due to the tailoring of methods to a small-scale level. To provide meaningful climate impact studies at the level of small catchments, it is therefore beneficial to use high-spatial- and high-temporal-resolution climate projections as input to a high-resolution hydrological model. In this study, we used such a model chain to assess the impacts of climate change on the flow patterns and frequency of floods in small ungauged rural catchments in western Norway. We used a new high-resolution regional climate projection, with improved performance regarding the precipitation distribution, and a regionalized hydrological model (distance distribution dynamics) between a reference period (1981–2011) and a future period (2070–2100). The flow-duration curves for all study catchments show more wet periods in the future than during the reference period. The results also show that in the future period, the mean annual flow increases by 16 % to 33 %. The mean annual maximum floods increase by 29 % to 38 %, and floods of 2- to 200-year return periods increase by 16 % to 43 %. The results are based on the RCP8.5 scenario from a single climate model simulation tailored to the Bergen region in western Norway, and the results should be interpreted in this context. The results should therefore be seen in consideration of other scenarios for the region to address the uncertainty. Nevertheless, the study increases our knowledge and understanding of the hydrological impacts of climate change on small catchments in the Bergen area in the western part of Norway. [ABSTRACT FROM AUTHOR]

Floods are one of the major climate-related hazards and cause casualties and substantial damage. Accurate and timely flood forecasting and design flood estimation are important to protect lives and property. The Distance Distribution Dynamic (DDD) is a parsimonious rainfall-runoff model which is being used for flood forecasting at the Norwegian flood forecasting service. The model, like many other models, underestimates floods in many cases. To improve the flood peak prediction, we propose a dynamic river network method into the model. The method is applied for 15 catchments in Norway and tested on 91 flood peaks. The performance of DDD in terms of KGE and BIAS is identical with and without dynamic river network, but the relative error (RE) and mean absolute relative error (MARE) of the simulated flood peaks are improved significantly with the method. The 0.75 and 0.25 quantiles of the RE are reduced from 41% to 23% and from 22% to 1%, respectively. The MARE is reduced from 32.9% to 15.7%. The study results also show that the critical support area is smaller in steep and bare mountain catchments than flat and forested catchments. [ABSTRACT FROM AUTHOR]

Background: Correct electrode placement and proper skin preparation for cardiac telemetry monitoring of patients at risk for arrhythmias increase the quality of the arrhythmic surveillance. Inconsistent arrhythmia surveillance can compromise patient safety and care outcomes. An inspection of international literature demonstrates that nurses generally do not adhere to cardiac monitoring standards. Aim: The aims of this study were to determine cardiovascular nurses' knowledge of and adherence to practice standards for cardiac surveillance and whether their knowledge and practice improves over time. Study design: A comparative study design was applied, and data were obtained by survey methodology. Methods: Nurse delegates at the Annual National Congress on Cardiovascular Nursing in Norway completed surveys in 2011 and 2017 (delegates from 44 and 38 hospitals, respectively). Results: In total, 363 cardiac nurses (70%) responded to the questionnaires. Of these, 95% were female, with a mean age of 41 years. In 2011, 97% of participants were unaware of international practice standards. However, by 2017 unawareness decreased to 78% (P <.001). Despite their lack of knowledge of practice standards, 94% of participants often or always prepared patients' skin for telemetry; this improved from 2011 to 2017 (P =.001). Overall, 73% of nurses never or seldom scrubbed or washed the patients' skin before electrode placement, and 38% of the electrodes were misplaced. In 2011, 49% of nurses used protective telemetry covers; this increased to 80% in 2017 (P <.001). Overall, 64% always informed patients of the purpose of cardiac monitoring. Conclusion: A significant percentage of nurses fail to adhere to recommendations for electrode placement, skin preparation and providing patients with telemetry information. In order to raise the quality of arrhythmic surveillance, investment in educational programmes in cardiac telemetry monitoring is required. Relevance to Clinical Practice: Improved in‐hospital telemetry practice is required to ensure patient safety and better care outcomes. [ABSTRACT FROM AUTHOR]

Climate change is one of the greatest threats to the World's environment. In Norway, the change will strongly affect the pattern, frequency and magnitudes of stream flows. However, it is highly challenging to quantify to what extent it will affect flow patterns and floods from small ungauged rural catchments due to unavailability or inadequacy of hydro-meteorological data for the calibration of hydrological models and tailoring methods to a small-scale level. To provide meaningful climate impact studies at small catchments, it is therefore beneficial to use high spatial and temporal resolution climate projections as input to a high-resolution hydrological model. Here we use such a model chain to assess the impacts of climate change on flow patterns and frequency of floods in small ungauged rural catchments in western Norway using a new high-resolution regional climate projection, with improved performance with regards to the precipitation distribution, and the regionalized hydrological model (Distance Distribution Dynamics) between the reference period (1981-2011) and a future period (2071-2100). The FDCs of all study catchments show there will be more wetter periods in the future than the reference period. The results also show that in the future period, the mean annual flow increases by 16.5 % to 33.3%, and there will be an increase in the mean autumn, mean winter and mean spring flows ranging from 4.3% to 256.3%. The mean summer flow decreases by 7.2% to 35.2%. The mean annual maximum floods increase by 28.9% to 38.3%, and floods of 2 to 200 years return periods increase by 16.1% to 42.7%. The findings of this study could be of practical use to regional decision-makers if considered alongside other previous and future findings. [ABSTRACT FROM AUTHOR]

Background: Sleep‐disordered breathing, including obstructive sleep apnoea and central sleep apnoea, is a common disorder among patients with chronic heart failure. Obstructive sleep apnoea is often treated with continuous positive airway pressure, but central sleep apnoea lacks a clear treatment option. Knowledge of how sleep‐disordered breathing is experienced (e.g. difficulties and care needs) and handled (e.g. self‐care actions) by the patients is limited, but needed, to provide patient‐centred care. Aim: To explore how newly verified sleep‐disordered breathing is experienced by patients with chronic heart failure. Methods: Data were collected through semi‐structured interviews and analysed with qualitative content analysis. Seventeen participants (14 men, three women), mean age 60 years (range 41–80) diagnosed with chronic heart failure and objectively verified sleep‐disordered breathing (nine obstructive, seven central and one mixed) were strategically selected from heart failure outpatient clinics at two Norwegian university hospitals. Results: Patients with chronic heart failure and newly verified sleep‐disordered breathing (SDB) described experiences of poor sleep that had consequences for their daily life and their partners. Different self‐care strategies were revealed, but they were based on 'common sense' and were not evidence‐based. The awareness of having SDB was varied; for some, it gave an explanation to their trouble while others were surprised by the finding. Conclusion: Patients with chronic heart failure and sleep‐disordered breathing experienced reduced sleep quality, influencing their daily life. Possible underlying causes of disrupted sleep, such as sleep‐disordered breathing, should be identified to establish proper patient‐centred treatment strategies. There is a need for new strategies to approach patients with chronic heart failure (i.e. those with central sleep apnoea) who are not subject to continuous positive airway pressure treatment for their sleep‐disordered breathing. [ABSTRACT FROM AUTHOR]

Background: Delirium affects nearly half of octogenarian patients after aortic valve replacement, resulting in impaired cognition, reduced awareness and hallucinations. Although healthcare professionals and relatives are often present during episodes, the nature of interactions with them is scarcely studied, and little is known about their long-term experiences. Purpose: The purpose of this study was to explore and describe how octogenarian patients with post-aortic valve replacement delirium experience interactions with healthcare professionals and relatives within the first year and four years later. Method: An explorative design with qualitative content analysis was used. Delirium was assessed for five consecutive days after aortic valve replacement using the Confusion Assessment Method. Delirious patients (n=10) were interviewed 6–12 months post-discharge and four years later (n=5). We used an inductive approach to identify themes in transcribed interviews. Findings: An overarching theme emerged: 'Healthcare professionals' and relatives' responses made a considerable impact on the delirium experience postoperatively and in a long-term'. Three sub-themes described the patients' experiences: 'the need for close supportive care', 'disrespectful behaviour created a barrier' and 'insensitive comments made lasting impressions'. Having healthcare professionals and relatives nearby made the patients feel secure, while lack of attention elevated patients' emotional distress. Four years later, patients clearly recalled negative comments and unsupportive actions in their delirious state. Conclusions: Healthcare professionals and relatives have an essential role in the aortic valve replacement recovery process. Inconsiderate behaviour directed at older patients in delirium elevates distress and has long-term implications. Supportive care focused on maintaining the patients' dignity and integrity is vital. [ABSTRACT FROM AUTHOR]

Purpose: Cardiopulmonary resuscitation (CPR) remains a cornerstone in the treatment of cardiac arrest, and is directly linked to survival rates. Nurses are often first responders and need to be skilled in the performance of cardiopulmonary resuscitation. As cardiopulmonary resuscitation skills deteriorate rapidly, the purpose of this study was to investigate whether there was an association between participants’ cardiopulmonary resuscitation training and their practical cardiopulmonary resuscitation test results. Methods: This comparative study was conducted at the 2014 EuroHeartCare meeting in Stavanger (n=133) and the 2008 Spring Meeting on Cardiovascular Nursing in Malmö (n=85). Participants performed cardiopulmonary resuscitation for three consecutive minutes CPR training manikins from Laerdal Medical®. Data were collected with a questionnaire on demographics and participants’ level of cardiopulmonary resuscitation training. Results: Most participants were female (78%) nurses (91%) from Nordic countries (77%), whose main role was in nursing practice (63%), and 71% had more than 11 years’ experience (n=218). Participants who conducted cardiopulmonary resuscitation training once a year or more (n=154) performed better regarding ventilation volume than those who trained less (859 ml vs. 1111 ml, p=0.002). Those who had cardiopulmonary resuscitation training offered at their workplace (n=161) also performed better regarding ventilation volume (889 ml vs. 1081 ml, p=0.003) and compression rate per minute (100 vs. 91, p=0.04) than those who had not. Conclusion: Our study indicates a positive association between participants’ performance on the practical cardiopulmonary resuscitation test and the frequency of cardiopulmonary resuscitation training and whether cardiopulmonary resuscitation training was offered in the workplace. Large ventilation volumes were the most common error at both measuring points. [ABSTRACT FROM AUTHOR]

Background: Although patients may experience a quick recovery followed by rapid discharge after percutaneous coronary interventions (PCIs), continuity of care from hospital to home can be particularly challenging. Despite this fact, little is known about the experiences of care across the interface between secondary and primary healthcare systems in patients undergoing PCI. Aim: To explore how patients undergoing PCI experience continuity of care between secondary and primary care settings after early discharge. Methods: The study used an inductive exploratory design by performing in-depth interviews of 22 patients at 6–8 weeks after PCI. Nine were women and 13 were men; 13 were older than 67 years of age. Eight lived remotely from the PCI centre. Patients were purposively recruited from the Norwegian Registry for Invasive Cardiology. Interviews were analysed by qualitative content analysis. Findings: Patients undergoing PCI were satisfied with the technical treatment. However, patients experienced an unplanned patient journey across care boundaries. They were not receiving adequate instruction and information on how to integrate health information. Patients also needed help to facilitate connections to community-based resources and to schedule clear follow-up appointments. Conclusions and implications: As high-technology treatment dramatically expands, healthcare organisations need to be concerned about all dimensions of continuity. Patients are witnessing their own processes of healthcare delivery and therefore their voices should be taken into greater account when discussing continuity of care. Nurse-led initiatives to improve continuity of care involve a range of interventions at different levels of the healthcare system. [ABSTRACT FROM AUTHOR]

The article focuses on a study that assessed pharmacological treatment and outcomes in patients with proven coronary artery disease who were ineligible for revascularization.

Background: In addition to favourable results regarding mortality and morbidity it is important to identify the impact transcatheter aortic valve implantation (TAVI) has on patients’ quality of life. Aims: The aims were: (i) to describe clinical characteristics, self-reported health and quality of life in octogenarians before TAVI intervention; (ii) to determine changes in self-reported health and quality of life one month after TAVI; and (iii) to establish the clinical importance of the findings. Methods: A prospective cohort study was conducted on consecutively enrolled octogenarians with severe aortic stenosis undergoing TAVI (N = 65). Self-reported health and quality of life were recorded at baseline and one month later using two global questions from the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF), the generic Short Form Health 12 and the disease-specific Minnesota Living with Heart Failure Questionnaire. Results: One month after TAVI, WHOQOL-BREF showed that self-reported health improved moderately (p < 0.001), while quality of life improved slightly, but not statistically significantly (p = 0.06). There were changes in all Short Form Health 12 domains, except social functioning and role emotional. The estimated changes were 3.6 to 5.8 with large confidence intervals. The Physical Component Summary increased statistically significantly from baseline to 30 days (30.6–34.7; p = 0.02), but the Mental Component Summary did not (46.9–50.0; p = 0.13). Conclusion: Despite being an advanced treatment performed in a high risk population, TAVI in octogenarians improves short-term self-reported global health and generic physical health and quality of life. These patient-reported outcomes have importance, particularly in this age group. [ABSTRACT FROM AUTHOR]

Background: Myocardial infarction (MI) patients may find it challenging to adhere to lifestyle advice and medications. Understanding motivational factors and barriers to change is crucial. However, empirical evidence on patients’ ability to effect lifestyle changes at the time of discharge is limited. Aim: The aim of this study was to identify at the time of hospital discharge the goals, resources, and barriers to future change in MI patients. Methods: We conducted a qualitative interview study with a purposive sample of 20 MI patients (eight women) in a cardiac department at a university hospital in Norway. All interviews were conducted before hospital discharge, transcribed verbatim, and analysed using qualitative content analysis. Findings: Three themes suggested that, at the time of discharge, patients’ views of their MI were complex and diverse. Patients were motivated to change their lifestyle and contemplated taking their life in new directions, adopting a change of life perspective. Frequently, patients struggled to understand the context of living with an MI, manage symptoms, and understand the precipitating causes of MI. There were also patients who wanted to maintain their present lifestyle and live as normal as possible. They just wanted to keep going. Conclusions and implications: There is a need for a different approach to communicating with MI patients at the time of discharge. Person-centred care that allows personal narratives to emerge may enable health-care professionals to offer more individualised guidance to MI patients that will help them cope with the everyday challenges they experience after discharge. [ABSTRACT FROM AUTHOR]

Objectives To determine how development of delirium after surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) could predict activity of daily living (ADL) and instrumental ADLs (IADL) disability, cognitive function, and self-reported health in individuals aged 80 and older. Design Prospective cohort study. Setting Tertiary university hospital. Participants Individuals aged 80 and older undergoing elective SAVR or TAVI (N = 136). Measurements Delirium was assessed for 5 days using the Confusion Assessment Method. The Barthel Index, Nottingham Extended ADL Scale, and SF-12 were used to determine ADL and IADL ability and self-reported health at baseline and 1- and 6-month follow-up. Cognition was assessed using the Mini-Mental State Examination at baseline and 6-month follow-up. Results Participants had lower IADL scores 1 month after SAVR than at baseline (baseline 58, 1 month: delirium 42, no delirium 50, P ≤ .02), but scores had returned to baseline levels at 6 months. The Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) Physical Component Summary (PCS) score was higher at 6-month follow-up (48) than at baseline (39), especially in participants who did not develop delirium ( P < .001). No differences in other outcomes were found. Regression models suggest that delirium may help predict IADL disability 1 month after baseline ( P ≤ .07) but does not predict large differences in ADL disability, cognitive function, or SF-12-scores. Individuals who underwent TAVI and developed delirium had lower ADL (baseline 19, 1-month 16, P < .001) and IADL (baseline 49, 1-month 40, P = .003) scores at 1-month follow-up. SF-12 PCS score (baseline 30) increased from baseline to 1- (35, P = .04) and 6- (35, P = .02) month follow-up in individuals who underwent TAVI and did not develop delirium. Delirium after TAVI predicted greater ADL and IADL disability at 1-month but not at 6-month follow-up. Conclusion Individuals who develop delirium after SAVR and TAVI have poorer short-term IADL function but do not seem to have long-term reductions in physical, mental, or self-reported health. [ABSTRACT FROM AUTHOR]

Background: While the overall incidence of acute myocardial infarction in Norway decreased in 2001–2009, this was not observed for younger adults. Smoking cessation, physical activity and healthy diet are associated with reduced risk of recurrent cardiovascular events and mortality among individuals with established coronary heart disease (CHD). Aims: We investigated whether adults in their 40s with or without CHD had 1) attempted to improve their health behaviour during the previous year, and 2) had confidence in their ability to improve their health behaviour over the next five years. Methods: Study participants were 22,019 40–49 year olds from the Hordaland Health Study. Associations between improvements and intentions regarding health behaviours and prevalent CHD were assessed with logistic regression analyses. Results: One hundred and seventy-five (0.8%) participants reported to have CHD. After controlling for demographic, lifestyle and psychosocial variables, attempts to improve health behaviour during the prior year were associated with a threefold increased odds of prevalent CHD (odds ratio 3.07; 95% confidence interval, 1.91–4.95). Confidence in improving health behaviour during the subsequent five years was not associated with increased odds of prevalent CHD. Conclusions: Adults in their 40s with CHD were more likely to have attempted to improve their health behaviour during the past year compared with those without CHD. Healthcare providers should take advantage of these positive attitudes to encourage further positive improvements. [ABSTRACT FROM AUTHOR]

Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase. Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI. Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days. Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01). Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase. [ABSTRACT FROM AUTHOR]

Objectives: Medical history, physical examination and laboratory testing are not optimal for the assessment of volume status in heart failure (HF) patients. We aimed to study the clinical influence of focused ultrasound of the pleural cavities and inferior vena cava (IVC) performed by specialised nurses to assess volume status in HF patients at an outpatient clinic.Methods: HF outpatients were prospectively included and underwent laboratory testing, history recording and clinical examination by two nurses with and without an ultrasound examination of the pleural cavities and IVC using a pocket-size imaging device, in random order. Each nurse worked in a team with a cardiologist. The influence of the different diagnostic tests on diuretic dosing was assessed descriptively and in linear regression analyses.Results: Sixty-two patients were included and 119 examinations were performed. Mean±SD age was 74±12 years, EF was 34±14%, and N-terminal pro-brain natriuretic peptide (NT-proBNP) value was 3761±3072 ng/L. Dosing of diuretics differed between the teams in 31 out of 119 consultations. Weight change and volume status assessed clinically with and without ultrasound predicted dose adjustment of diuretics at follow-up (p<0.05). Change of oedema, NT-proBNP, creatinine, and symptoms did not (p≥0.10). In adjusted analyses, only volume status based on ultrasound predicted dose adjustments of diuretics at first visit and follow-up (all ultrasound p≤0.01, all other p≥0.2).Conclusions: Ultrasound examinations of the pleural cavities and IVC by nurses may improve diagnostics and patient care in HF patients at an outpatient clinic, but more studies are needed to determine whether these examinations have an impact on clinical outcomes.Trial Registration Number: NCT01794715. [ABSTRACT FROM AUTHOR]

Background Although crucial, research on nurses' knowledge on the use of implantable cardioverter defibrillators ( ICDs) is scant. The aims of the study were to investigate (i) the level of nurses' knowledge on care of patients with ICDs, (ii) whether knowledge level is related to education and type of hospital where nurses practice and (iii) whether knowledge level changes among nurses over time. Methods We developed a questionnaire comprising 27 items in four parts: (1) Sociodemographics, (2) Technical facts about ICDs, (3) Daily life challenges and (4) Self-evaluation of knowledge. After validation, surveys were conducted during 1-week cardiac educational courses in 2003-2010. In total, 463 nurses working in cardiology-related areas participated, yielding a response rate of 91%. Results Practical and technical knowledge about ICDs was lacking. Nurses were unaware or did not know that mobile phones can affect the device (80%), that patients are restricted from driving heavy vehicles (69%), and that ICDs can deliver unintended shock therapy (73%). However, they were aware that ICD patients can resume sexual (87%) and physical activity (85%). There were few significant differences with regard to education and type of hospital where nurses practiced, but significant time trends in correct answers regarding kitchen appliances, resumption of physical activity and shock delivery. Conclusion Over an 8-year period, despite the increased usage of ICDs, overall nurses had a lack of knowledge in relation to specific key clinical issues on the care of ICD patients. As a consequence, these patients may fail to receive qualified care. Future research should assess knowledge of other health care professionals and focus on interventions that increase and maintain an appropriate knowledge level in care of ICD patients. Relevance to clinical practice The level of nurses' knowledge on care of patients with ICDs needs to be systematically raised in order to ensure appropriate counselling and nursing care. [ABSTRACT FROM AUTHOR]

Aims To investigate the extent to which perceived support from healthcare professionals and shock anxiety is related to device acceptance among implantable cardioverter defibrillator recipients. Background Device acceptance can be influenced by several factors, one of which is shock anxiety associated with poor device acceptance. Reduced shock anxiety, as well as increased device acceptance, has been reported after psycho-educational programmes. As healthcare professionals appear to play a significant role in providing support and education during regular follow-up visits, they may constitute an important social support system that could be another factor influencing device acceptance. However, little is known about the relationship between perceived support from healthcare professionals and device acceptance among recipients. Design A cross-sectional survey design. Methods A sample comprising implantable cardioverter defibrillator recipients completed questionnaires assessing perceived support from healthcare professionals, shock anxiety and device acceptance. Demographic and clinical data were collected by self-report and from medical records in September-October 2010. Results The descriptive results indicated that approximately 85% of the recipients experienced high device acceptance. Regression analysis demonstrated that constructive support from healthcare professionals was positively associated with device acceptance and moderated the negative relationship between shock anxiety and device acceptance. Non -constructive support and shock anxiety had a negative statistical association with device acceptance. Conclusions Healthcare professionals may represent a valuable constructive support system that can enhance device acceptance among implantable cardioverter defibrillator recipients, partly by preventing shock anxiety from leading to poor device acceptance. Non-constructive communication on the part of healthcare professionals could hinder device acceptance. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate (1) the extent to which shock anxiety and perceived support from healthcare professionals are related to post-traumatic stress disease ( PTSD) symptoms and (2) the extent to which perceived support from healthcare professionals moderates the relationship between shock anxiety and PTSD symptoms in implantable cardioverter defibrillator recipients. An additional aim was to describe the level of PTSD symptoms and perceptions of support from healthcare professionals. Background Studies examining PTSD symptoms among implantable cardioverter defibrillator recipients are still sparse. In addition, little is known about how perceived support from healthcare professionals is related to PTSD symptoms. Design Cross-sectional survey design. Methods Recipients ( n = 167) with implantable cardioverter defibrillator attending an outpatient device clinic completed questionnaires assessing shock anxiety, PTSD symptoms and perceived support from healthcare professionals. Results The results indicated that between ten and 15% of the recipients experienced moderate to severe symptoms of PTSD. Although a majority perceived constructive support from healthcare professionals, 12% perceived nonconstructive support. Regression analysis demonstrated that shock anxiety and perceived nonconstructive support from healthcare professionals had a statistically significant (p < 0·01) association with PTSD symptoms. Moreover, the results suggest that associations between shock anxiety and PTSD symptoms were significantly (p < 0·01) moderated by perceived nonconstructive support from healthcare professionals. Young age, short time since implantation and secondary prevention indication were also significantly associated with PTSD symptoms. Conclusions The results indicate that nonconstructive support from healthcare professionals can increase the tendency to develop PTSD symptoms, particularly in those who experience shock anxiety. Relevance to clinical practice Healthcare professionals should pay more attention to the way in which they communicate information to the recipients during follow-up visits. Clinically based strategies and interventions targeting shock anxiety and PTSD symptoms should be carried out. [ABSTRACT FROM AUTHOR]

The article discusses the 6th Annual Spring Meeting in Bergen, Norway organized by the Working Group on Cardiovascular Nursing of the European Society of Cardiology and the Norwegian National Society of Cardiovascular Nurses.

Aim To describe how patients adapt to living with a mechanical aortic heart valve. Background Aortic valve replacement with a mechanical prosthesis is preferred for patients with life expectancy of more than 10 years as they are more durable than bioprosthetic valves. Mechanical valves have some disadvantages, such as higher risk of thrombosis and embolism, increased risk of bleeding related to lifelong oral anticoagulation treatment and noise from the valve. Design An explorative design with a phenomenographic approach was employed. Methods An explorative design with a phenomenographic approach was applied. Interviews were conducted over 4 months during 2010-2011 with 20 strategically sampled patients, aged 24-74 years having undergone aortic valve replacement with mechanical prosthesis during the last 10 years. Findings Patients adapted to living with a mechanical aortic heart valve in four ways: 'The competent patient' wanted to stay in control of his/her life. 'The adjusted patient' considered the implications of having a mechanical aortic valve as part of his/her daily life. 'The unaware patient' was not aware of warfarin-diet-medication interactions. 'The worried patient' was bothered with the oral anticoagulation and annoyed by the sound of the valve. Patients moved between the different ways of adapting. Conclusions The oral anticoagulation therapy was considered the most troublesome consequence, but also the sound of the valve was difficult to accept. Patient counselling and adequate follow-up can make patients with mechanical aortic heart valves more confident and competent to manage their own health. We recommend that patients should participate in a rehabilitation programme following cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Shock anxiety has been documented irrespective of shock exposure in implantable cardioverter defibrillator (ICD) recipients. The presence of tachyarrhythmia may lead to an anticipation of receiving a shock and thereby give rise to shock anxiety. The aims were to assess: (1) the level of shock anxiety in a sample of ICD recipients, (2) the relationship between such anxiety and shock exposure, and (3) the relationship between recent tachyarrhythmia and shock anxiety. Methods: ICD recipients (n = 167) completed the Florida Shock Anxiety Scale measure of shock anxiety. The recipients were divided into three groups: (1) Recipients with no documented tachyarrhythmia over the previous 12 months (n = 56), (2) recipients with documented tachyarrhythmia over the previous twelve months (n = 54), and (3) recipients with any history of shocks (n = 57). Results: Of the recipients, 44% experienced some form of shock anxiety, whereas 15% reported general shock anxiety. Analyses of covariance revealed that recipients with recent tachyarrhythmia (F = 7.675 df = 9/100, P = 0.007) as well as recipients with a shock history (F = 9.976, df = 9/103, P = 0.002) reported higher levels of shock anxiety than recipients with no recent tachyarrhythmia. Conclusion: This study indicates that although a substantial proportion of the ICD recipients experienced some form of shock anxiety, only a relatively small proportion reported general shock anxiety. ICD recipients with recent tachyarrhythmia, in addition to recipients with shock history, appear to be at greater risk for development of shock anxiety. This implies that these recipients may profit from clinical-based strategies and interventions targeting shock anxiety (PACE 2012; 35:1369-1376) [ABSTRACT FROM AUTHOR]

Background: A substantial burden associated with MI has been reported. Thus, how survivors experience their quality of life (QOL) is now being given increasing attention. However, few studies have involved women and a comparison with the general population. The aims of this study were to determine the QOL of female MI survivors, to investigate whether their QOL differed from that of the general population, and to evaluate the clinical significance of the findings. Methods: Two cross-sectional surveys were performed; on female MI survivors and the general Norwegian population. The MI survey included women aged 62-80 years, three months to five years after their MI. One hundred and forty-five women responded, yielding a response rate of 60%. A subset of women in the same age range (n = 156) was drawn from a study of 1893 randomly selected Norwegian citizens. QOL was measured in both groups with the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF). Results: The majority (54%) of the female MI survivors presented with ST-elevation in their ECG, 31% received thrombolysis, and 38% had reduced left ventricular ejection fraction. Female MI survivors reported significantly lower satisfaction with general health (p = 0.020) and overall QOL (p = 0.017) than women from the general population. This was also the case for the physical and environmental QOL domains (p < 0.001), but not for the psychological and social relationship domains. Estimated effect sizes between the two groups of participants ranged from 0.1 to -0.6. Conclusion: The burden of MI significantly affects the physical health of elderly women. Still, female MI survivors fare as well as the general female population on psychosocial QOL domains. Action should be taken not only to support women's physical needs but also to reinforce their strengths in order to maintain optimal QOL. [ABSTRACT FROM AUTHOR]

This paper highlights how Norwegian cardiac nursing is meeting challenges in cardiovascular health of the Norwegian population since the early 1970s, and how the education of cardiac nurses is subsequently evolving. [ABSTRACT FROM AUTHOR]

• We used 1 × 1 km spatial and 1-hour temporal resolution hydro-meteorological data. • We used a parsimonious distance distribution dynamics (DDD) hydrological model. • We considered three different methods of regionalizations of the model parameters. • The three methods of regionalization perform satisfactorily. • This work contributes to water resource and flood management in small ungauged catchments. Streamflow data is important for studies of water resources and flood management, but an inherent problem is that many catchments of interest are ungauged. The lack of data is particularly the case for small catchments, where flow data with high temporal resolution is needed. This paper presents an analysis of regionalizing parameters of the Distance Distribution Dynamics (DDD) rainfall-runoff model for predicting hourly flows at small-ungauged rural catchments. The performance of the model with hourly time resolution has been evaluated (calibrated and validated) for 41 small gauged catchments in Norway (areas from 1 km2–50 km2). The model parameters needing regionalization have been regionalized using three different methods: multiple regression, physical similarity (single-donor and pooling-group based methods), and a combination of the two methods. Seven independent catchments, which are not used in the evaluation, are used for validation of the regionalization methods. All the three methods (the multiple regression, pooling-group, and combined methods) perform satisfactorily (0.5 ≤ KGE < 0.75). The combined method (which combines multiple regression and pooling-group) performed slightly better than the other methods. Some model parameters, namely those describing recession characteristics, estimated by the regionalization methods, appear to be a better choice than those estimated locally from short period of hydro-meteorological data for some test catchments. The single-donor method did not perform satisfactorily. The satisfactory performance of the combined method shows that regionalization of DDD model parameters is possible by combining multiple regression and physical similarity methods. [ABSTRACT FROM AUTHOR]

Abstract Background Percutaneous coronary intervention is the most common therapeutic intervention for patients with narrowed coronary arteries due to coronary artery disease. Although it is known that patients with coronary artery disease often do not adhere to their medication regimen, little is known about what patients undergoing percutaneous coronary interventions find challenging in adhering to their medication regimen after hospital discharge. Objectives To explore patients' experiences in adhering to medications following early post-discharge after first-time percutaneous coronary intervention. Design An abductive qualitative approach was used to conduct in-depth interviews of patients undergoing first-time percutaneous coronary intervention. Settings Participants were recruited from a single tertiary university hospital, which services a large geographical area in western Norway. Patients fulfilling the inclusion criteria were identified through the Norwegian Registry for Invasive Cardiology. Participants Participants were patients aged 18 years or older who had their first percutaneous coronary intervention six to nine months earlier, were living at home at the time of study inclusion, and were prescribed dual antiplatelet therapy. Patients who were cognitively impaired, had previously undergone cardiac surgery, and/or were prescribed anticoagulation therapy with warfarin or novel oral anticoagulants were excluded. Purposeful sampling was used to include patients of different gender, age, and geographic settings. Twenty-two patients (12 men) were interviewed between December 2016 and April 2017. Methods Face-to-face semi-structured interviews were conducted, guided by a set of predetermined open-ended questions to gather patient experiences on factors relating to medication adherence or non-adherence. Transcribed interviews were analysed by qualitative content analysis. Findings Patients failed to adhere to their medication regimen for several reasons; intentional and unintentional reasons, multifaceted side effects from heart medications, scepticism towards generic drugs, lack of information regarding seriousness of disease after percutaneous coronary intervention, psychological impact of living with coronary artery disease, and these interacted. There were patients who felt that the medication information they received from physicians and nurses was uninformative and inadequate. Side effects from heart medications were common, ranging from minor ones to more disabling side effects, such as severe muscle and joint pain and fatigue. Patients found well established medication taking routines and aids to be necessary, and these improved adherence. Conclusion Patients undergoing first-time percutaneous coronary intervention face multiple, interacting challenges in trying to adhere to prescribed medications following discharge. This study highlights the need for a more structured follow-up care in order to improve medication adherence and to maximise their self-care abilities. [ABSTRACT FROM AUTHOR]

Background: Web-based technology has recently become an important source for sharing health information with patients after an acute cardiac event. Therefore, consideration of patients' perceived electronic health (eHealth) literacy skills is crucial for improving the delivery of patient-centered health information., Objective: The aim of this study was to translate and adapt the eHealth Literacy Scale (eHEALS) to conditions in Norway, and to determine its psychometric properties. More specifically, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing, and cross-cultural validity) of the eHEALS in self-report format administered to patients after percutaneous coronary intervention., Methods: The original English version of the eHEALS was translated into Norwegian following a widely used cross-cultural adaptation process. Internal consistency was calculated using Cronbach α. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability. Confirmatory factor analysis (CFA) was performed for a priori-specified 1-, 2-, and 3-factor models. Demographic, health-related internet use, health literacy, and health status information was collected to examine correlations with eHEALS scores., Results: A total of 1695 patients after percutaneous coronary intervention were included in the validation analysis. The mean age was 66 years, and the majority of patients were men (1313, 77.46%). Cronbach α for the eHEALS was >.99. The corresponding Cronbach α for the 2-week retest was .94. The test-retest ICC for eHEALS was 0.605 (95% CI 0.419-0.743, P<.001). The CFA showed a modest model fit for the 1- and 2-factor models (root mean square error of approximation>0.06). After modifications in the 3-factor model, all of the goodness-of-fit indices indicated a good fit. There was a weak correlation with age (r=-0.206). Between-groups analysis of variance showed a difference according to educational groups and the eHEALS score, with a mean difference ranging from 2.24 (P=.002) to 4.61 (P<.001), and a higher eHEALS score was found for patients who were employed compared to those who were retired (mean difference 2.31, P<.001). The eHEALS score was also higher among patients who reported using the internet to find health information (95% CI -21.40 to -17.21, P<.001), and there was a moderate correlation with the patients' perceived usefulness (r=0.587) and importance (r=0.574) of using the internet for health information. There were also moderate correlations identified between the eHEALS score and the health literacy domains appraisal of health information (r=0.380) and ability to find good health information (r=0.561). Weak correlations with the mental health composite score (r=0.116) and physical health composite score (r=0.116) were identified., Conclusions: This study provides new information on the psychometric properties of the eHEALS for patients after percutaneous coronary intervention, suggesting a multidimensional rather than unidimensional construct. However, the study also indicated a redundancy of items, indicating the need for further validation studies., Trial Registration: ClinicalTrials.gov NCT03810612; https://clinicaltrials.gov/ct2/show/NCT03810612., (©Gunhild Brørs, Tore Wentzel-Larsen, Håvard Dalen, Tina B Hansen, Cameron D Norman, Astrid Wahl, Tone M Norekvål, The CONCARD Investigators. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 28.07.2020.)

Introduction: Percutaneous coronary intervention (PCI) aims to provide instant relief of symptoms, and improve functional capacity and prognosis in patients with coronary artery disease. Although patients may experience a quick recovery, continuity of care from hospital to home can be challenging. Within a short time span, patients must adjust their lifestyle, incorporate medications and acquire new support. Thus, CONCARD PCI will identify bottlenecks in the patient journey from a patient perspective to lay the groundwork for integrated, coherent pathways with innovative modes of healthcare delivery. The main objective of the CONCARD PCI is to investigate (1) continuity of care, (2) health literacy and self-management, (3) adherence to treatment, and (4) healthcare utilisation and costs, and to determine associations with future short and long-term health outcomes in patients after PCI., Methods and Analysis: This prospective multicentre cohort study organised in four thematic projects plans to include 3000 patients. All patients undergoing PCI at seven large PCI centres based in two Nordic countries are prospectively screened for eligibility and included in a cohort with a 1-year follow-up period including data collection of patient-reported outcomes (PRO) and a further 10-year follow-up for adverse events. In addition to PROs, data are collected from patient medical records and national compulsory registries., Ethics and Dissemination: Approval has been granted by the Norwegian Regional Committee for Ethics in Medical Research in Western Norway (REK 2015/57), and the Data Protection Agency in the Zealand region (REG-145-2017). Findings will be disseminated widely through peer-reviewed publications and to patients through patient organisations., Trial Registration Number: NCT03810612., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Continuity of cardiac care after hospital discharge is a priority, especially as healthcare systems become increasingly complex and fragmented. There are few available instruments to measure continuity of cardiac care, especially from the patient perspective. The aim of this study was (1) to translate and adapt the Heart Continuity of Care Questionnaire (HCCQ) to conditions in Norway, and (2) to determine its psychometric properties in self-report format administered to patients after percutaneous coronary intervention (PCI)., Methods: The HCCQ was first translated into Norwegian from the original English version, following a widely used cross-cultural adaptation process. Data were collected before hospital discharge and in a follow-up after 2 months. To assess psychometric properties, a confirmatory factor analysis (CFA) was performed and three aspects of construct validity were evaluated: structural validity, hypotheses testing and cross-cultural validation. Internal consistency of the HCCQ subscales was calculated using Cronbach's alpha, while intra-class correlation (ICC) was used to assess test-retest reliability. Additionally, socio-demographic and patient-reported data were collected to correlate with HCCQ scores., Results: Of those included at baseline, 436 (76%) completed the questionnaires after 2 months. CFA suggested that the fit of the HCCQ data to a 3-factor model was modest (RMSEA = 0.11, CFI = 0.90, TLI = 0.90). However, convergent validity was satisfactory, based on existing research. Internal consistency was good, as indicated by its Cronbach's alphas: total continuity of care (0.95); informational (0.93), relational (0.87), and management (0.89) continuity. The ICC for the total HCCQ score was 0.80 (95% CI [0.71, 0.87] p < 0.001). As indicated by negative care experiences (rated as 1 or 2 on the five-point scale), patients seemed to have limited knowledge about medical treatment, lifestyle modification and follow-up after PCI. Participation in cardiac rehabilitation and longer consultations with the general practitioner after hospital discharge were positively correlated with better continuity of care., Conclusions: Implementation of the HCCQ will likely support healthcare providers and researchers in identifying problem areas of continuity of cardiac care and in evaluating interventions aimed at improving continuity of care.

Objectives: Improving patients' health status is a central goal for cardiac surgery. Knowledge remains sparse on how combined CABG or other factors influence long-term, self-reported health status after aortic valve replacement (AVR). The aims of this study were (i) to identify significant factors influencing self-reported health status of patients assessed up to 13 years after AVR; and (ii) to compare their health with the age- and gender-matched general population., Methods: A survey questionnaire was sent to 1191 patients who had undergone AVR with or without concomitant CABG between 2000 and 2012. Physical and mental sum scores of Short Form 12 were used as dependent variables and 34 independent variables including the Minnesota living with Heart Failure Questionnaire (MLHFQ) were evaluated by hierarchical linear regression. A comparison was made with the Norwegian general population. Clinical data were obtained from the local cardiac surgery database., Results: In all, 912 patients (77%) responded (mean age: 73 years; 63% men). Of these, 59% had an isolated AVR. The mean assessment interval since surgery was 6 years. Several factors significantly predicted worse physical health: low education level (b: -2.8, P = 0.005), higher preoperative EuroSCORE (b: -0.88, P = 0.007), high NYHA class (b: -4.5, P < 0.001), depression (b: -5.62, P = 0.012), worse MLHFQ physical scores (b: -0.70, P < 0.001), arthritis (b: -5.13, P = 0.003), osteoporosis (b: -6.96, P = 0.010) and cancer (b: -4.48, P = 0.047) accounting for 60% of the variation (P < 0.001). Living alone (b: -3.60, P < 0.001), anxiety (b: -12.99, P < 0.001), depression (b: -6.82, P < 0.001) and worse MLHFQ emotional score (b: -0.50, P < 0.001) predicted poor mental health status, and explained 58% of the variation among AVR patients (P < 0.001). Both genders had poorer physical and mental health than their age-matched general population peers, particularly those in older age groups., Conclusions: AVR patients, regardless of gender, had worse physical and mental health than the general population. Living alone, educational level, physical symptom status, anxiety and depression were the most important predictors of physical and mental health status after AVR. Implementing new screening protocols for psychosocial risk factors and individualized rehabilitation programmes may contribute to improved health in AVR patients., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Postoperative delirium (PD) after transcatheter aortic valve implantation (TAVI) remains to be explored. We sought to (1) determine the incidence of PD in octogenarians who underwent TAVI or surgical aortic valve replacement (SAVR), (2) identify its risk factors, and (3) describe possible differences in the onset and course of PD between treatment groups. A prospective cohort study of consecutive patients aged ≥80 years with severe aortic stenosis who underwent elective TAVI or SAVR (N = 143) was conducted. The incidence of PD was assessed for 5 days using the Confusion Assessment Method (CAM). Risk factors for PD were studied with logistic regression. Patients treated with TAVI were older (p ≤0.001), had lower cognitive scores (p = 0.007), and more co-morbidities (p = 0.003). Despite this, significantly fewer (p = 0.013) patients treated with TAVI (44%) experienced PD compared to patients treated with SAVR (66%). Undergoing SAVR (p = 0.02) and having lower cognitive function (p = 0.03) emerged as risk factors for PD, whereas gender, activities of daily living, frailty, atrial fibrillation, and postoperative use of opioids and anxiolytics did not. Patients treated with TAVI and without PD during the first 2 postoperative days were unlikely to experience PD on subsequent days. The onset of PD after SAVR could occur at any time during the postoperative evaluation. In conclusion, SAVR in octogenarian patients with aortic stenosis might be considered as a predisposing factor for PD. Our data also suggest that the onset of PD was more unpredictable after SAVR., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: In-hospital telemetry monitoring is important for diagnosis and treatment of patients at risk of developing life-threatening arrhythmias. It is widely used in critical and non-critical care wards. Nurses are responsible for correct electrode placement, thus ensuring optimal quality of the monitoring. The aims of this study were to determine whether a complex educational intervention improves (a) optimal electrode placement, (b) hygiene, and (c) delivery of critical information to patients (reason for monitoring, limitations in cellular phone use, and not to leave the ward without informing a member of staff)., Methods: A prospective interventional study design was used, with data collection occurring over two six-week periods: before implementation of the intervention (n=201) and after the intervention (n=165). Standard abstraction forms were used to obtain data on patients' clinical characteristics, and 10 variables related to electrode placement and attachment, hygiene and delivery of critical information., Results: At pre-intervention registration, 26% of the electrodes were misplaced. Twelve per cent of the patients received information about limiting their cellular phone use while monitored, 70% were informed of the purpose of monitoring, and 71% used a protective cover for their unit. Post-intervention, outcome measures for the three variables improved significantly: use of protective cover (p<0.001), information about the purpose of monitoring (p=0.005) and information about limitations in cellular phone use (p=0.003). Nonetheless, 23% of the electrodes were still misplaced., Conclusion: The study highlights the need for better, continued education for in-hospital telemetry monitoring in coronary care units, and other units that monitor patients with telemetry., (© The European Society of Cardiology 2013.)

Aim: The purpose of this study was to examine the experiences of partners of patients who had cardiac arrest and subsequent hypothermia treatment in an intensive care unit (ICU)., Method: Nine in-depth interviews were conducted 5 months to 1 year after hospitalization. The participants were partners of patients who had survived cardiac arrest and had undergone hypothermia treatment without serious brain damage. All the interviews were analysed using Giorgi's phenomenological method., Findings: Six main themes emerged from the analysis: (1) terrified by witnessing the cardiac arrest; (2) ambivalence towards the ICU room and the cold body; (3) need for honest and realistic information; (4) anticipating the awakening; (5) social network as support and burden; and (6) the frightening homecoming., Conclusion: The essential structure of the partners' experiences of loved ones' cardiac arrest and hypothermia treatment was characterized by ambivalence; they experienced both fear and relief. There may be a relationship between experiences before entering the ICU and reactions during hypothermia treatment and afterwards. Some partners experienced a feeling of guilt after the resuscitation event, and especially during the awakening phase. After discharge, the partners described feeling anxiety., Relevance to Clinical Practice: Nurses play a pivotal role in providing partners with information and in nurturing hope and feelings of security. Partners need to fully understand the reason for hypothermia treatment to enable them to accept the cold body as part of a life-saving process. We recommend follow-up after discharge. This may increase the partners' sense of security and control., (© 2012 The Authors. Nursing in Critical Care © 2012 British Association of Critical Care Nurses.)

Background: Patient-reported outcomes are increasingly seen as complementary to biomedical measures. However, their prognostic importance has yet to be established, particularly in female long-term myocardial infarction (MI) survivors. We aimed to determine whether 10-year survival in older women after MI relates to patient-reported outcomes, and to compare their survival with that of the general female population., Methods: We included all women aged 60-80 years suffering MI during 1992-1997, and treated at one university hospital in Norway. In 1998, 145 (60% of those alive) completed a questionnaire package including socio-demographics, the Sense of Coherence Scale (SOC-29), the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF) and an item on positive effects of illness. Clinical information was based on self-reports and hospital medical records data. We obtained complete data on vital status., Results: The all-cause mortality rate during the 1998-2008 follow-up of all patients was 41%. In adjusted analysis, the conventional predictors s-creatinine (HR 1.26 per 10% increase) and left ventricular ejection fraction below 30% (HR 27.38), as well as patient-reported outcomes like living alone (HR 6.24), dissatisfaction with self-rated health (HR 6.26), impaired psychological quality of life (HR 0.60 per 10 points difference), and experience of positive effects of illness (HR 6.30), predicted all-cause death. Major adverse cardiac and cerebral events were also significantly associated with both conventional predictors and patient-reported outcomes. Sense of coherence did not predict adverse events. Finally, 10-year survival was not significantly different from that of the general female population., Conclusion: Patient-reported outcomes have long-term prognostic importance, and should be taken into account when planning aftercare of low-risk older female MI patients.

Background: Although myocardial infarction (MI) is linked with both physical and psychological impairments, the possibility of patients also experiencing positive outcomes of MI has received far less attention in research and in clinical practice. In particular, this aspect has been under-investigated in older persons and in women., Aim: The purpose of this study was to investigate possible positive effects of illness, describe the patient characteristics and explore the nature and frequency of these effects in older women after MI., Methods: A cross-sectional postal survey was conducted in 145 women aged 62-80 years, three months to five years after MI. Self-reported socio-demographic and clinical data, in addition to data from medical records, were collected. A single-item question--"All in all, was there anything positive about experiencing an MI?"--was used to assess positive effects of illness, in addition to an open-ended question on the nature of possible positive effects., Results: A majority of the women (65%) reported positive effects from their MI experience. The women perceiving positive effects did not differ from those who did not on socio-demographic and clinical variables, except for being older (p=0.007) and less often readmitted (p=0.029). The groups did not differ significantly as to disease severity and time since MI. Four themes emerged from the open-ended questioning on the nature of perceived positive effects of the illness: Appreciating Life (55%), Getting Health Care (42%), Making Lifestyle Changes (36%), and Taking More Care of Self and Others (29%)., Conclusions: The findings contribute to a more complete picture of psychosocial issues in women after MI by providing evidence that positive effects are often experienced despite physical limitations. Nurses may use this knowledge as a tool in patient education and communication, although further research is needed to determine the most optimal interventions for MI patients.