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5. A retrospective multicenter cohort study of the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19

Author

Jonmarker, Sandra, Litorell, Jacob, Alarcon, Felix, Al-Abani, Kais, Björkman, Sofia, Farm, Maria, Grip, Jonathan, Söderberg, Mårten, Hollenberg, Jacob, Wahlin, Rebecka Rubenson, Kander, Thomas, Rimling, Liivi, Mårtensson, Johan, Joelsson-Alm, Eva, Dahlberg, Martin, and Cronhjort, Maria

Published
2023
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9. Adherence to evidence-based guidelines for prevention of urinary retention in hip surgery patients : a multicentre observational study

Author

Winberg, Madeleine, Hälleberg Nyman, Maria, Fjordkvist, Erika, Eldh, Ann Catrine, Joelsson-Alm, Eva, Winberg, Madeleine, Hälleberg Nyman, Maria, Fjordkvist, Erika, Eldh, Ann Catrine, and Joelsson-Alm, Eva

Abstract

Urinary retention is a healthcare complication putting patients at risk of unnecessary suffering and harm. Orthopaedic patients are known to face an increased such risk, calling for evidence-based preoperative assessment and corresponding measures to prevent bladder problems. The aim of this study was to evaluate healthcare professionals' adherence to risk assessment guidelines for urinary retention in hip surgery patients. This was an observational study from January 2021 to April 2021 with a descriptive and comparative design, triangulating three data sources: (I) Medical records for 1382 hip surgery patients across 17 hospitals in Sweden were reviewed for preoperative risk assessments for urinary retention and voiding-related variables at discharge; (II) The patients completed a survey regarding postoperative lower urinary tract symptoms, and; (III) data were extracted from a national quality registry regarding type of surgery, preoperative physical status, and perioperative urinary complications. Group differences were analysed with Chi-square/Fisher's exact test, t-test, Wilcoxon rank-sum test, or Mann-Whitney U-test. Logistic regression was used to analyse variables associated with completed risk assessments for urinary retention. Of all study participants, 23.4% (n = 323) had a preoperative documented risk assessment of urinary retention. Whether a risk assessment was performed was significantly associated with acute surgery [odds ratio (OR) 3.56, 95% confidence interval (CI) 2.48-5.12] and undergoing surgery at an academic hospital (OR 4.59, 95% CI 2.68-7.85). Acute patients were more often affected by urinary retention and had bladder issues and/or an indwelling catheter at discharge. More than every tenth patient (11. 9%, n = 53) completing the survey experienced intensified bladder problems after their hip surgery. The study shows a lack of adherence to risk assessment for urinary retention according to evidence-based guidelines, which negatively affects

Published
2024
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10. Mobilisation of post-ICU patients - a crucial teamwork between physiotherapists and nurses at surgical wards : A qualitative study

Author

Siesage, Katinka, Schandl, Anna, Johansson, Matheo, Nygren-Bonnier, Malin, Karlsson, Emelie, Joelsson-Alm, Eva, Siesage, Katinka, Schandl, Anna, Johansson, Matheo, Nygren-Bonnier, Malin, Karlsson, Emelie, and Joelsson-Alm, Eva

Abstract

PURPOSE: To describe experiences of the ward nurse in relation to extended physiotherapy and mobilising of post-ICU patients. METHODS: Individual semi-structured interviews were conducted with 17 registered nurses working on surgical wards in a Swedish regional hospital. Qualitative content analysis was used to analyse the data. The study was reported according to the consolidated criteria for reporting qualitative research (COREQ). RESULTS: The study findings are presented in three categories: challenges to mobilising post-ICU patients, shared responsibility facilitates mobilisation, and extended physiotherapy is beneficial for patients' wellbeing. Nurses stated that they lacked knowledge and skills to perform the safe mobilisation of post-ICU patients due to their complex medical history and needs. Collaboration with physiotherapists was perceived to facilitate mobilisation and to be beneficial for patients' wellbeing outcome. CONCLUSIONS: The study indicates that post-ICU patients are at risk of remaining immobilised because ward nurses find mobilisation too complex to conduct without support from physiotherapists. Shared responsibility through multi-professional teamwork regarding patient rehabilitation is perceived as contributing the knowledge required to achieve safe mobilisation that enhances autonomy and physical ability in post-ICU patients.

Published
2024
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11. Piloting and watch over in the end-of-life care of intensive care unit patients with COVID-19—A qualitative study

Author

Pettersson, Charlotta, Forsén, Johanna, Joelsson-Alm, Eva, Fridh, Isabell, Björling, Gunilla, Mattsson, Janet, Pettersson, Charlotta, Forsén, Johanna, Joelsson-Alm, Eva, Fridh, Isabell, Björling, Gunilla, and Mattsson, Janet

Abstract

Background: During the COVID-19 pandemic, intensive care units (ICUs) were under heavy pressure, with a significantly increased number of severely ill patients. Hospitals introduced restrictions, and families could not visit their ill and dying family members. Patients were cared for without privacy, and several died in shared patient rooms, leaving the intensive care nurse to protect the patient's need for loving care in a vulnerable situation at the end of life. Aims: This study aimed to investigate how piloting and watch over were revealed in end-of-life care for patients with COVID-19 in intensive care COVID-19. Study Design: A qualitative study was conducted with an abductive approach was conducted. Data were collected via semi-structured interviews to cover the research area while allowing the informant to talk freely about the topic; 11 informants were interviewed. Results: The findings are presented based on four categories: The road to the decision, End-of-life care, Farewell of close family members and Closure. Each category and subcategory reveal how piloting and watch over were addressed in the end-of-life care of patients with COVID-19 in the ICU during the pandemic. Overall findings indicated that workload and organization of care directly affect the quality of care given, the acceptance of privacy and the possibility of dignified end-of-life care. Conclusions: Workload directly affects the quality of care, risking dehumanization of the patient. Visiting restrictions hindered supporting family members through the various piloting phases. Visiting restrictions also forced the ICU nurses to take on the role of the relative in watching over the patient. Relevance to Clinical Practice: Collaboration with family members is essential for the intensive care nurse to be able to provide a person-centred and dignified end-of-life care.

Published
2024
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12. First-line managers' experience of guideline implementation during the COVID-19 pandemic

Author

Fjordkvist, Erika, Eldh, Ann Catrine, Winberg, Madeleine, Joelsson-Alm, Eva, Halleberg Nyman, Maria, Fjordkvist, Erika, Eldh, Ann Catrine, Winberg, Madeleine, Joelsson-Alm, Eva, and Halleberg Nyman, Maria

Abstract

Aim(s)To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic.DesignA descriptive, qualitative study.MethodsSemi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis.ResultsFirst-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines.ConclusionA health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice.Implications for the Profession and/or Patient CareRecognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation.ImpactDuring the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based prac, Funding Agencies|Forskningsradet om Haelsa, Arbetsliv och Valfard; Nyckelfonden; [STYA- 2020/0002]

Published
2024
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13. Patient participation in orthopaedic care-a survey on hip surgery patients' preferences for and experiences of engagement in their health and healthcare

Author

Sköld, Patricia, Hälleberg Nyman, Maria, Joelsson-Alm, Eva, Eldh, Ann Catrine, Sköld, Patricia, Hälleberg Nyman, Maria, Joelsson-Alm, Eva, and Eldh, Ann Catrine

Abstract

INTRODUCTION: Quality in health services is increasingly associated with enabling patients to participate in their own health and healthcare by recognising their resources and needs. Despite a growing recognition as to whether such participation is enabled, little is known regarding opportunities for preference-based patient participation in orthopaedic care. AIMS: To investigate preference-based participation for patients in orthopaedic care due to hip surgery. METHODS: Patients across 17 Swedish orthopaedic units who had had hip surgery, due to hip fracture or osteoarthritis, January-April 2021 were invited to complete the validated 4Ps questionnaire. Of 1514 patients, 458 patients returned the questionnaire with reports on their preferences for and experiences of participation. Each of the 4Ps' 12 items were analysed separately using descriptive and comparative statistics. RESULTS: A complete match in preferences for, and experiences of, participation was achieved with variation between items for 41%-50% of the patients; if almost matches were included, this occurred for 57%-77% of the patients. Less participation than preferred was most common in terms of having had reciprocal communication, opportunities for partaking in planning, and in learning how to manage symptoms/issues. Hip fracture surgery was significantly associated with experiencing lower levels of participation than preferred. CONCLUSION: Though standardised care promotes efficient hip surgery care, our study suggests a need for more person-centred opportunities to engage. A discrepancy was noted between patients' resources and preparation for their participation in and beyond the hip surgery process, particularly for self-care activities, calling for better use of nursing resources. ID: NCT04700969 with the U.S National Institutes of Health Clinical Registry.

Published
2024
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16. Adverse Events of Peripherally Administered Norepinephrine During Surgery: A Prospective Multicenter Study

Author

Christensen, Jens, primary, Andersson, Elisabeth, additional, Sjöberg, Fredric, additional, Hellgren, Elisabeth, additional, Harbut, Piotr, additional, Harbut, Joanna, additional, Sjövall, Fredrik, additional, von Bruhn Gufler, Christian, additional, Mårtensson, Johan, additional, Rubenson Wahlin, Rebecka, additional, Joelsson-Alm, Eva, additional, and Cronhjort, Maria, additional

Published
2024
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20. Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock

Author

Kjær, Maj-Brit Nørregaard, Meyhoff, Tine Sylvest, Sivapalan, Praleene, Granholm, Anders, Hjortrup, Peter Buhl, Madsen, Martin Bruun, Møller, Morten Hylander, Egerod, Ingrid, Wetterslev, Jørn, Lange, Theis, Cronhjort, Maria, Laake, Jon Henrik, Jakob, Stephan M, Nalos, Marek, Ostermann, Marlies, Gould, Doug, Cecconi, Maurizio, Malbrain, Manu L N G, Ahlstedt, Christian, Kiel, Louise Bendix, Bestle, Morten H, Nebrich, Lars, Hildebrandt, Thomas, Russell, Lene, Vang, Marianne, Rasmussen, Michael Lindhart, Sølling, Christoffer, Brøchner, Anne Craveiro, Krag, Mette, Pfortmueller, Carmen, Kriz, Miroslav, Siegemund, Martin, Albano, Giovanni, Aagaard, Søren Rosborg, Bundgaard, Helle, Crone, Vera, Wichmann, Sine, Johnstad, Bror, Martin, Yvonne Karin, Seidel, Philipp, Mårtensson, Johan, Hollenberg, Jacob, Wistrand, Mats, Donati, Abele, Barbara, Enrico, Karvunidis, Thomas, Hollinger, Alexa, Carsetti, Andrea, Lumlertgul, Nuttha, Joelsson-Alm, Eva, Lambiris, Nikolas, Aslam, Tayyba Naz, Friberg, Fredrik Femtehjell, Vesterlund, Gitte Kingo, Mortensen, Camilla Bekker, Vestergaard, Stine Rom, Caspersen, Sidsel Fjordbak, Jensen, Diana Bertelsen, Borup, Morten, Rasmussen, Bodil Steen, and Perner, Anders

Subjects
Quality of life, Sepsis, Septic shock, Intravenous fluid, 610 Medicine & health, Cognitive function, Long-term outcomes, Critical illness
Abstract

Purpose To assess long-term outcomes of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock included in the European Conservative versus Liberal Approach to Fluid Therapy in Septic Shock in Intensive Care (CLASSIC trial). Methods We conducted the pre-planned analyses of mortality, health-related quality of life (HRQoL) using EuroQol (EQ)-5D-5L index values and EQ visual analogue scale (VAS), and cognitive function using Mini Montreal Cognitive Assessment (Mini MoCA) test at 1-year. Deceased patients were assigned numerical zero for HRQoL as a state equal to death and zero for cognitive function outcomes as worst possible score, and we used multiple imputation for missing data on HRQoL and cognitive function. Results Among 1554 randomised patients, we obtained 1-year data on mortality in 97.9% of patients, HRQoL in 91.3%, and cognitive function in 86.3%. One-year mortality was 385/746 (51.3%) in the restrictive-fluid group versus 383/767 (49.9%) in the standard-fluid group, absolute risk difference 1.5%-points (99% confidence interval (CI) -4.8 to 7.8). Mean differences were 0.00 (99% CI -0.06 to 0.05) for EQ-5D-5L index values, -0.65 for EQ VAS (-5.40 to 4.08), and − 0.14 for Mini MoCA (-1.59 to 1.14) for the restrictive-fluid group versus the standard-fluid group. The results for survivors only were similar in both groups. Conclusions Among adult ICU patients with septic shock, restrictive versus standard IV fluid therapy resulted in similar survival, HRQoL and cognitive function at one year, but clinically important differences could not be ruled out.

Published
2023
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21. Facilitating facilitators to facilitate : Some general comments on a strategy for knowledge implementation in health services

Author

Eldh, Ann Catrine, Halleberg-Nyman, Maria, Joelsson-Alm, Eva, Wallin, Lars, Eldh, Ann Catrine, Halleberg-Nyman, Maria, Joelsson-Alm, Eva, and Wallin, Lars

Abstract

Numerous endeavours to ensure that day-to-day healthcare is both evidence-based and person-centred have generated extensive, although partial, comprehension of what guarantees quality improvement. To address quality issues, researchers and clinicians have developed several strategies as well as implementation theories, models, and frameworks. However, more progress is needed regarding how to facilitate guideline and policy implementation that guarantees effective changes take place in a timely and safe manner. This paper considers experiences of engaging and supporting local facilitators in knowledge implementation. Drawing on several interventions, considering both training and support, this general commentary discusses whom to engage and the length, content, quantity, and type of support along with expected outcomes of facilitators' activities. In addition, this paper suggests that patient facilitators could help produce evidence-based and person-centred care. We conclude that research about the roles and functions of facilitators needs to include more structured follow-ups and also improvement projects. This can increase the speed of learning with respect to what works, for whom, in what context, why (or why not), and with what outcomes when it comes to facilitator support and tasks.

Published
2023
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22. Rapid response team activation prior to in-hospital cardiac arrest: Areas for improvements based on a national cohort study

Author

Thorén, Anna, Jonsson, Martin, Spångfors, Martin, Joelsson-Alm, Eva, Jakobsson, Jan, Rawshani, Araz, Kahan, Thomas, Engdahl, Johan, Jadenius, Arvid, Boberg von Platen, Erik, Herlitz, Johan, Djärv, Therese, Thorén, Anna, Jonsson, Martin, Spångfors, Martin, Joelsson-Alm, Eva, Jakobsson, Jan, Rawshani, Araz, Kahan, Thomas, Engdahl, Johan, Jadenius, Arvid, Boberg von Platen, Erik, Herlitz, Johan, and Djärv, Therese

Abstract

Introduction: Rapid response teams (RRTs) are designed to improve the "chain of prevention" of in-hospital cardiac arrest (IHCA). We studied the 30-day survival of patients reviewed by RRTs within 24 hours prior to IHCA, as compared to patients not reviewed by RRTs. Methods: A nationwide cohort study based on the Swedish Registry of Cardiopulmonary Resuscitation, between January 1st, 2014, and December 31st, 2021. An explorative, hypothesis-generating additional in-depth data collection from medical records was performed in a small subgroup of general ward patients reviewed by RRTs. Results: In all, 12,915 IHCA patients were included. RRT-reviewed patients (n = 2,058) had a lower unadjusted 30-day survival (25% vs 33%, p < 0.001), a propensity score based Odds ratio for 30-day survival of 0.92 (95% Confidence interval 0.90-0.94, p < 0.001) and were more likely to have a respiratory cause of IHCA (22% vs 15%, p < 0.001). In the subgroup (n = 82), respiratory distress was the most common RRT trigger, and 24% of the RRT reviews were delayed. Patient transfer to a higher level of care was associated with a higher 30-day survival rate (20% vs 2%, p < 0.001). Conclusion: IHCA preceded by RRT review is associated with a lower 30-day survival rate and a greater likelihood of a respiratory cause of cardiac arrest. In the small explorative subgroup, respiratory distress was the most common RRT trigger and delayed RRT activation was frequent. Early detection of respiratory abnormalities and timely interventions may have a potential to improve outcomes in RRT-reviewed patients and prevent further progress into IHCA.

Published
2023
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23. Patient related outcomes after receiving a person centred nurse led follow up programme among patients undergoing revascularisation for intermittent claudication : A secondary analysis of a randomised clinical trial

Author

Haile, Sara T, Johansson, Unn-Britt, Lööf, Helena, Linné, Anneli, Joelsson-Alm, Eva, Haile, Sara T, Johansson, Unn-Britt, Lööf, Helena, Linné, Anneli, and Joelsson-Alm, Eva

Abstract

OBJECTIVE: The aim was to evaluate the effect of a person centred nurse led follow up programme on health related quality of life (HRQoL), health literacy, and general self efficacy compared with standard care for patients undergoing revascularisation for intermittent claudication (IC), and to describe factors associated with HRQoL one year after revascularisation. METHODS: This was a secondary analysis of a randomised controlled trial. Patients with IC scheduled for revascularisation at two vascular surgery centres in Sweden between 2016 and 2018 were randomised to intervention or control. During the first year after surgery, the intervention group received a person centred follow up programme with three visits and two telephone calls with a vascular nurse, while the control group received standard follow up with two visits to a vascular surgeon or vascular nurse. Outcomes were HRQoL measured by VascuQol-6, health literacy, and general self efficacy measured by validated questionnaires. RESULTS: Overall, 214 patients were included in the trial; this secondary analysis comprised 183 patients who completed the questionnaires. One year after revascularisation, HRQoL had improved with a mean increase in VascuQol-6 of 7.0 scale steps (95% CI 5.9 - 8.0) for the intervention and 6.0 scale steps (95% CI 4.9 - 7.0) for the control group; the difference between the groups was not significant (p = .18). In an adjusted regression analysis, the intervention was associated with higher VascuQoL-6 (2.0 scale steps, 95% CI 0.08 - 3.93). There was no significant difference between the groups regarding health literacy or general self efficacy. The prevalence of insufficient health literacy among all participants was 38.7% (46/119) at baseline and 43.2% (51/118) at one year. CONCLUSION: In this study, a person centred, nurse led follow up programme had no significant impact on HRQoL, health literacy, or general self efficacy among patients undergoing revascularisation for IC. The prev

Published
2023
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24. Patients experiences of urinary retention and bladder care-A qualitative study in orthopaedic care

Author

Winberg, Madeleine, Nyman, Maria Halleberg, Fjordkvist, Erika, Joelsson-Alm, Eva, Eldh, Ann Catrine, Winberg, Madeleine, Nyman, Maria Halleberg, Fjordkvist, Erika, Joelsson-Alm, Eva, and Eldh, Ann Catrine

Abstract

Background: Urinary retention is a common complication associated with hip surgery. There are easily available, evidence-based clinical practice guidelines pre-scribing how to prevent both urinary retention and other voiding issues, by means of bladder monitoring and risk assessments. A detected lack of adherence to such guidelines increases risks for unnecessary suffering among patients but a greater understanding of patients experiences can benefit tailored interventions to address quality and safety gaps in orthopaedic nursing and rehabilitation.Purpose: The aim was to describe patients experiences of urinary retention, bladder issues, and bladder care in orthopaedic care due to hip surgery.Method: This was a qualitative study with a descriptive design: content analysis with an inductive approach was applied to interviews (n = 32) and survey free-text responses (n = 122) across 17 orthopaedic units in Sweden.Results: The patients had received no or limited details for the recurrent bladder care interventions (such as bladder scans and prompted voiding) while at the hospital. They relied on the staff for safe procedures but were left to themselves to manage and comprehend prevailing bladder issues. Despite the patients ex-periences of bladder issues or the risk of urinary retention postoperatively, the link to hip surgery remained unknown to the patients, leaving them searching for self -management strategies and further care.Conclusions: Patients perspectives on bladder care, urinary retention and bladder issues can serve as a means for increased understanding of procedures and issues, reinforcing improved implementation of guidelines, including person-centred information. Safer bladder procedures imply further patient engagement, highlighted in guidelines.

Published
2023
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25. The distorted memories of patients treated in the intensive care unit during the COVID-19 pandemic : A qualitative study

Author

Vogel, Gisela, Forinder, Ulla, Sandgren, Anna, Svensen, Christer, Joelsson-Alm, Eva, Vogel, Gisela, Forinder, Ulla, Sandgren, Anna, Svensen, Christer, and Joelsson-Alm, Eva

Abstract

Background: During the COVID-19 pandemic, patients cared for in the intensive care unit were exposed to many risk factors for developing delirium and subsequent distorted memories. Further, seeing healthcare professionals who have been dressed in personal protective equipment and face masks could have affected the patients ' memories. Therefore, the aim of this study was to explore memories and how they are experienced and managed by former patients who have been treated for COVID-19 in an intensive care unit. Methods: Sixteen former patients treated for COVID-19 at a large emergency hospital in Sweden were interviewed 3-8 months after discharge from the intensive care unit. The data were interpreted using thematic analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was followed in the reporting of the study. Findings: Participants ' descriptions of their memories of treatment in the intensive care unit for COVID-19 generated three themes: ' Distorted truth ' the content in the memories which implied facing death in an unreal distorted environment. ' Captive,' was the experience and feelings linked to memories with a feeling of being exposed and alone, and ' Coping with memories ' explained how participants managed the implications of the memories using a mixture of strategies. Conclusions: For former patients who were admitted to an intensive care unit after a diagnosis of COVID-19, memories caused considerable distress, which were similar to other intensive care patients ' experiences, before the pandemic. Emotion-focused and problem-focused strategies could be used to cope with these memories. Healthcare professionals wearing protective equipment gave the patient a distant feeling, but more important was to be treated with attention/care and respect. Implications for clinical practice: Awareness of the impact of distorted memories on patients who are severely ill and their needs and strategies to cope with these memories can form the

Published
2023
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26. Shifting focus: A grounded theory of how family members to critically ill patients manage their situation

Author

Vogel, Gisela, Joelsson-Alm, Eva, Forinder, Ulla, Svensen, Christer, Sandgren, Anna, Vogel, Gisela, Joelsson-Alm, Eva, Forinder, Ulla, Svensen, Christer, and Sandgren, Anna

Abstract

Objectives Critical illness is a life-threatening condition for the patient, which affects their family members as a traumatic experience. Well-known long-term consequences include impact on mental health and health-related quality of life. This study aims to develop a grounded theory to explain pattern of behaviours in family members of critically ill patients cared for in an intensive care unit, addressing the period from when the patient becomes critically ill until recovery at home. Research methodology/design We used a classic grounded theory to explore the main concern for family members of intensive care patients. Fourteen interviews and seven observations with a total of 21 participants were analysed. Data were collected from February 2019 to June 2021. Setting Three general intensive care units in Sweden, consisting of a university hospital and two county hospitals. Findings The theory Shifting focus explains how family members’ main concern, living on hold, is managed. This theory involves different strategies: decoding, sheltering and emotional processing. The theory has three different outcomes: adjusting focus, emotional resigning or remaining in focus. Conclusion Family members could stand in the shadow of the patients’ critical illness and needs. This emotional adversity is processed through shifting focus from one’s own needs and well-being to the patient’s survival, needs and well-being. This theory can raise awareness of how family members of critically ill patients manage the process from critical illness until return to everyday life at home. Future research focusing on family members’ need for support and information, to reduce stress in everyday life, is needed. Implications for Clinical Practice Healthcare professionals should support family members in shifting focus by interaction, clear and honest communication, and through mediating hope.

Published
2023
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27. Experiences of patient violence in Swedish intensive care units

Author

Sjöberg, Fredric, Salzmann-Erikson, Martin, Joelsson-Alm, Eva, Schandl, Anna, Sjöberg, Fredric, Salzmann-Erikson, Martin, Joelsson-Alm, Eva, and Schandl, Anna

Abstract

Introduction: In the intensive care unit (ICU), every second patient develops acute brain dysfunction and delirium, because of severe illness and/or medical treatment (1). ICU patients may have delusions and even believe that the healthcare personnel try to infict harm upon them (2). This belief in combination with psychomotor agitation may lead to violent incidents in intense resistance (3). Except for debilitating consequences for patients, violent incidents are major problems in healthcare causing physical and psychological harm to healthcare workers (4–6). However, systematic approaches to describe healthcare workers’ experiences and management of aggressive ICU patients are needed. Objectives: To explore ICU healthcare workers’ experiences and perceptions of violent behaviors in patients with acute brain dysfunction. Methods: A qualitative descriptive design including focus group interviews with 36 ICU healthcare workers (physicians, nurses, nurse assistants and physiotherapists) in 4 Swedish ICUs who had experience of managing aggressive patients with acute brain dysfunction. A six-step refective thematic analysis was used to analyse data. Results: Nurses and assistant nurses were perceived to be at a nincreased risk of being exposed to violence, while physicians were mostly exposed to verbal assaults and threats from relatives. Delusions were perceived to be associated with a higher risk of violence in bedside work. The healthcare workers stated that incidents were under-reported, where only serious threats or physical assaults were reported. Most violent situations were experienced as unavoidable due to the patients’ illness. Conclusions: This study contributes an understanding of workplace violence in the ICU and may serve as a basis for development of violence prevention strategies useful in care and treatment of delirious patients.

Published
2023

28. Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock

Author

Kjær, Maj Brit Nørregaard, Meyhoff, Tine Sylvest, Sivapalan, Praleene, Granholm, Anders, Hjortrup, Peter Buhl, Madsen, Martin Bruun, Møller, Morten Hylander, Egerod, Ingrid, Wetterslev, Jørn, Lange, Theis, Cronhjort, Maria, Laake, Jon Henrik, Jakob, Stephan M., Nalos, Marek, Ostermann, Marlies, Gould, Doug, Cecconi, Maurizio, Malbrain, Manu L.N.G., Ahlstedt, Christian, Kiel, Louise Bendix, Bestle, Morten H., Nebrich, Lars, Hildebrandt, Thomas, Russell, Lene, Vang, Marianne, Rasmussen, Michael Lindhart, Sølling, Christoffer, Brøchner, Anne Craveiro, Krag, Mette, Pfortmueller, Carmen, Kriz, Miroslav, Siegemund, Martin, Albano, Giovanni, Aagaard, Søren Rosborg, Bundgaard, Helle, Crone, Vera, Wichmann, Sine, Johnstad, Bror, Martin, Yvonne Karin, Seidel, Philipp, Mårtensson, Johan, Hollenberg, Jacob, Wistrand, Mats, Donati, Abele, Barbara, Enrico, Karvunidis, Thomas, Hollinger, Alexa, Carsetti, Andrea, Lumlertgul, Nuttha, Joelsson-Alm, Eva, Lambiris, Nikolas, Aslam, Tayyba Naz, Friberg, Fredrik Femtehjell, Vesterlund, Gitte Kingo, Mortensen, Camilla Bekker, Vestergaard, Stine Rom, Caspersen, Sidsel Fjordbak, Jensen, Diana Bertelsen, Borup, Morten, Rasmussen, Bodil Steen, Perner, Anders, Kjær, Maj Brit Nørregaard, Meyhoff, Tine Sylvest, Sivapalan, Praleene, Granholm, Anders, Hjortrup, Peter Buhl, Madsen, Martin Bruun, Møller, Morten Hylander, Egerod, Ingrid, Wetterslev, Jørn, Lange, Theis, Cronhjort, Maria, Laake, Jon Henrik, Jakob, Stephan M., Nalos, Marek, Ostermann, Marlies, Gould, Doug, Cecconi, Maurizio, Malbrain, Manu L.N.G., Ahlstedt, Christian, Kiel, Louise Bendix, Bestle, Morten H., Nebrich, Lars, Hildebrandt, Thomas, Russell, Lene, Vang, Marianne, Rasmussen, Michael Lindhart, Sølling, Christoffer, Brøchner, Anne Craveiro, Krag, Mette, Pfortmueller, Carmen, Kriz, Miroslav, Siegemund, Martin, Albano, Giovanni, Aagaard, Søren Rosborg, Bundgaard, Helle, Crone, Vera, Wichmann, Sine, Johnstad, Bror, Martin, Yvonne Karin, Seidel, Philipp, Mårtensson, Johan, Hollenberg, Jacob, Wistrand, Mats, Donati, Abele, Barbara, Enrico, Karvunidis, Thomas, Hollinger, Alexa, Carsetti, Andrea, Lumlertgul, Nuttha, Joelsson-Alm, Eva, Lambiris, Nikolas, Aslam, Tayyba Naz, Friberg, Fredrik Femtehjell, Vesterlund, Gitte Kingo, Mortensen, Camilla Bekker, Vestergaard, Stine Rom, Caspersen, Sidsel Fjordbak, Jensen, Diana Bertelsen, Borup, Morten, Rasmussen, Bodil Steen, and Perner, Anders

Abstract

Purpose: To assess long-term outcomes of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock included in the European Conservative versus Liberal Approach to Fluid Therapy in Septic Shock in Intensive Care (CLASSIC) trial. Methods: We conducted the pre-planned analyses of mortality, health-related quality of life (HRQoL) using EuroQol (EQ)-5D-5L index values and EQ visual analogue scale (VAS), and cognitive function using Mini Montreal Cognitive Assessment (Mini MoCA) test at 1 year. Deceased patients were assigned numerical zero for HRQoL as a state equal to death and zero for cognitive function outcomes as worst possible score, and we used multiple imputation for missing data on HRQoL and cognitive function. Results: Among 1554 randomized patients, we obtained 1-year data on mortality in 97.9% of patients, HRQoL in 91.3%, and cognitive function in 86.3%. One-year mortality was 385/746 (51.3%) in the restrictive-fluid group versus 383/767 (49.9%) in the standard-fluid group, absolute risk difference 1.5%-points [99% confidence interval (CI) − 4.8 to 7.8]. Mean differences were 0.00 (99% CI − 0.06 to 0.05) for EQ-5D-5L index values, − 0.65 for EQ VAS (− 5.40 to 4.08), and − 0.14 for Mini MoCA (− 1.59 to 1.14) for the restrictive-fluid group versus the standard-fluid group. The results for survivors only were similar in both groups. Conclusions: Among adult ICU patients with septic shock, restrictive versus standard IV fluid therapy resulted in similar survival, HRQoL, and cognitive function at 1 year, but clinically important differences could not be ruled out.

Published
2023

29. Healthcare workers' experiences of patient safety in the intensive care unit during the COVID-19 pandemic : A multicentre qualitative study

Author

Berggren, Karin, Ekstedt, Mirjam, Joelsson-Alm, Eva, Swedberg, Lena, Sackey, Peter, Schandl, Anna, Berggren, Karin, Ekstedt, Mirjam, Joelsson-Alm, Eva, Swedberg, Lena, Sackey, Peter, and Schandl, Anna

Abstract

AimTo describe healthcare workers' experiences of preconditions and patient safety risks in intensive care units during the COVID-19 pandemic. BackgroundHealthcare workers' ability to adapt to changing conditions is crucial to promote patient safety. During the COVID-19 pandemic, healthcare workers' capacity to maintain safe care was challenged and a more in-depth understanding on frontline experiences of patient safety is needed. DesignA qualitative descriptive design. MethodsIndividual interviews were conducted with 29 healthcare workers (nurses, physicians, nurse assistants and physiotherapists) from three Swedish hospitals directly involved in intensive care of COVID-19 patients. Data were analysed with inductive content analysis. Reporting followed the COREQ checklist. ResultsThree categories were identified. Hazardous changes in working conditions describes patient safety challenges associated with the extreme workload with high stress level. Imperative adaptations induced by changed preconditions for patient safety which include descriptions of safety risks following adaptations related to temporary intensive care facilities, handling shortage of medical equipment and deviations from routines. Safety risks triggered by reorganisation of care describe how the diluted skill-mix and team disruptions exposed patients to safety risks, and that safety performance mostly relied on individual healthcare worker's responsibility. ConclusionsThe study suggests that healthcare workers experienced an increase in patient safety risks during the COVID-19 pandemic mainly because the extremely high workload, imperative adaptations, and reorganisation of care regarding skill-mix and teamwork. Patient safety performance relied on the individuals' adaptability and responsibility rather than on system-based safety. Relevance to Clinical PracticeThis study provides insights on how healthcare workers' experiences can be used as a source of information for recognition of patient saf

Published
2023
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33. Restriction of Intravenous Fluid in ICU Patients with Septic Shock

Author

Meyhoff, Tine S., Hjortrup, Peter B., Wetterslev, Jørn, Sivapalan, Praleene, Laake, Jon H., Cronhjort, Maria, Jakob, Stephan M., Cecconi, Maurizio, Nalos, Marek, Ostermann, Marlies, Malbrain, Manu, Pettilä, Ville, Møller, Morten H., Kjær, Maj-Brit N., Lange, Theis, Overgaard-Steensen, Christian, Brand, Björn A., Winther-Olesen, Marie, White, Jonathan O., Quist, Lars, Westergaard, Bo, Jonsson, Andreas B., Hjortsø, Carl J.S., Meier, Nick, Jensen, Thomas S., Engstrøm, Janus, Nebrich, Lars, Andersen-Ranberg, Nina C., Jensen, Jacob V., Joseph, Neeliya A., Poulsen, Lone M., Herløv, Louise S., Sølling, Christoffer G., Pedersen, Susan K., Knudsen, Kurt K., Straarup, Therese S., Vang, Marianne L., Bundgaard, Helle, Rasmussen, B. S., Aagaard, S. R., Hildebrandt, Thomas, Russell, Lene, Bestle, Morten H., Schønemann-Lund, Martin, Brøchner, Anne C., Elvander, Claes F., Hoffmann, Søren K.L., Rasmussen, Michael L., Martin, Yvonne K., Friberg, Fredrik F., Seter, Herman, Aslam, Tayyba N., Ådnøy, Sigrid, Seidel, Philipp, Strand, Kristian, Johnstad, Bror, Joelsson-Alm, Eva, Christensen, Jens, Ahlstedt, Christian, Pfortmueller, Carmen A., Siegemund, Martin, Greco, Massimiliano, Raděj, Jaroslav, Kříž, Miroslav, Gould, Doug W., Rowan, Kathy M., Mouncey, Paul R., Perner, Anders, Siegumfeldt, Rine Moulvad, and Vestergaard, Stine Rom

Subjects
PROTOCOL, Adult, SEPSIS, RESUSCITATION, MORTALITY, Critical Care/methods, ADULTS, General Medicine, Intensive Care Units, TRIALS, MANAGEMENT, Humans, Administration, Intravenous, 610 Medicine & health, Shock, Septic/mortality, Fluid Therapy/adverse effects
Abstract

BACKGROUND: Intravenous fluids are recommended for the treatment of patients who are in septic shock, but higher fluid volumes have been associated with harm in patients who are in the intensive care unit (ICU).METHODS: In this international, randomized trial, we assigned patients with septic shock in the ICU who had received at least 1 liter of intravenous fluid to receive restricted intravenous fluid or standard intravenous fluid therapy; patients were included if the onset of shock had been within 12 hours before screening. The primary outcome was death from any cause within 90 days after randomization.RESULTS: We enrolled 1554 patients; 770 were assigned to the restrictive-fluid group and 784 to the standard-fluid group. Primary outcome data were available for 1545 patients (99.4%). In the ICU, the restrictive-fluid group received a median of 1798 ml of intravenous fluid (interquartile range, 500 to 4366); the standard-fluid group received a median of 3811 ml (interquartile range, 1861 to 6762). At 90 days, death had occurred in 323 of 764 patients (42.3%) in the restrictive-fluid group, as compared with 329 of 781 patients (42.1%) in the standard-fluid group (adjusted absolute difference, 0.1 percentage points; 95% confidence interval [CI], -4.7 to 4.9; P = 0.96). In the ICU, serious adverse events occurred at least once in 221 of 751 patients (29.4%) in the restrictive-fluid group and in 238 of 772 patients (30.8%) in the standard-fluid group (adjusted absolute difference, -1.7 percentage points; 99% CI, -7.7 to 4.3). At 90 days after randomization, the numbers of days alive without life support and days alive and out of the hospital were similar in the two groups.CONCLUSIONS: Among adult patients with septic shock in the ICU, intravenous fluid restriction did not result in fewer deaths at 90 days than standard intravenous fluid therapy. (Funded by the Novo Nordisk Foundation and others; CLASSIC ClinicalTrials.gov number, NCT03668236.).

Published
2022
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34. Effects of a person-centred, nurse-led follow-up programme on adherence to prescribed medication among patients surgically treated for intermittent claudication : Randomized clinical trial

Author

Haile, Sara T, Joelsson-Alm, Eva, Johansson, Unn-Britt, Lööf, Helena, Palmer-Kazen, Ulrika, Gillgren, Peter, Linné, Anneli, Haile, Sara T, Joelsson-Alm, Eva, Johansson, Unn-Britt, Lööf, Helena, Palmer-Kazen, Ulrika, Gillgren, Peter, and Linné, Anneli

Abstract

BACKGROUND: Management of intermittent claudication should include secondary prevention to reduce the risk of cardiocerebrovascular disease. Patient adherence to secondary prevention is a challenge. The aim of this study was to investigate whether a person-centred, nurse-led follow-up programme could improve adherence to medication compared with standard care. METHODS: A non-blinded RCT was conducted at two vascular surgery centres in Sweden. Patients with intermittent claudication and scheduled for revascularization were randomized to the intervention or control (standard care) follow-up programme. The primary outcome, adherence to prescribed secondary preventive medication, was based on registry data on dispensed medication and self-reported intake of medication. Secondary outcomes were risk factors for cardiocerebrovascular disease according to the Framingham risk score. RESULTS: Some 214 patients were randomized and analysed on an intention-to-treat basis. The mean proportion of days covered (PDC) at 1 year for lipid-modifying agents was 79 per cent in the intervention and 82 per cent in the control group, whereas it was 92 versus 91 per cent for antiplatelet and/or anticoagulant agents. The groups did not differ in mean PDC (lipid-modifying P = 0.464; antiplatelets and/or anticoagulants P = 0.700) or in change in adherence over time. Self-reported adherence to prescribed medication was higher than registry-based adherence regardless of allocation or medication group (minimum P < 0.001, maximum P = 0.034). There was no difference in median Framingham risk score at 1 year between the groups. CONCLUSION: Compared with the standard follow-up programme, a person-centred, nurse-led follow-up programme did not improve adherence to secondary preventive medication. Adherence was overestimated when self-reported compared with registry-reported.

Published
2022
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35. Caregiver burden and emotional wellbeing in informal caregivers to ICU survivors : A prospective cohort study

Author

Milton, Anna, Schandl, Anna, Larsson, Ing-Marie, Wallin, Ewa, Savilampi, Johanna, Meijers, Katarina, Joelsson-Alm, Eva, Bottai, Matteo, Sackey, Peter, Milton, Anna, Schandl, Anna, Larsson, Ing-Marie, Wallin, Ewa, Savilampi, Johanna, Meijers, Katarina, Joelsson-Alm, Eva, Bottai, Matteo, and Sackey, Peter

Abstract

Background Informal caregivers to intensive care unit (ICU) survivors may develop post-intensive care syndrome family (PICS-F), including depression, anxiety and post-traumatic stress (PTS). Our primary aim was to investigate associations between caregiver burden in informal caregivers cohabiting with ICU survivors and patients’ physical and psychological outcomes. Methods A prospective, multicentre cohort study in four ICUs in Sweden. Adults cohabiting with ICU patients included in a previous study were eligible for inclusion. Three months post-ICU, informal caregivers received questionnaires assessing caregiver burden, health-related quality of life (HRQL) and symptoms of depression, anxiety and PTS. In parallel, patients reported their three-month physical and psychological status via validated questionnaires. The primary outcome of this study was to compare caregiver burden in informal caregivers to patients with and without adverse physical and psychological outcomes 3 months post-ICU. Secondary outcomes were correlations between caregiver burden and informal caregivers’ mental HRQL. Results Among 62 included informal caregivers, 55 (89%) responded to the follow-up questionnaires. Caregiver burden was higher among informal caregivers to patients with an adverse outcome, compared to informal caregivers to patients without an adverse outcome, caregiver burden scale score mean (±standard deviation) 52 (11) and 41 (13) respectively (p = 0.003). There was strong negative correlation between caregiver burden and informal caregivers’ mental HRQL (rs −0.74, p < 0.001). Conclusion Informal caregivers to ICU survivors with adverse physical or psychological outcome experience a higher caregiver burden. A higher caregiver burden correlates with worse caregiver mental HRQL. ICU follow-up programs should consider screening and follow-up of informal caregivers for mental health problems.

Published
2022
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36. Increasing patients’ awareness of their own health : Experiences of participating in follow-up programs after surgical treatment for intermittent claudication

Author

Haile, Sara, Lööf, Helena, Johansson, Unn-Britt, Linné, Anneli, Joelsson-Alm, Eva, Haile, Sara, Lööf, Helena, Johansson, Unn-Britt, Linné, Anneli, and Joelsson-Alm, Eva

Abstract

Introduction: Claudication is the most usual symptom of peripheral artery disease, it is described as painful contractions in the leg when walking and alleviated upon resting. People with claudication have an added risk of cardiocerebrovascular events, amputation, and death. Adherence to medical treatment and changes in lifestyles can lower this risk, but this secondary prevention therapy requires engagement, participation, and adherence from the patient. Objective: To explore patients’ experiences of participating in a 1-year multicentre clinical trial with two follow-up programs evaluating a nurse-led, patient-centered health-promoting programme after surgical treatment for claudication, the FASTIC study. Methods: A descriptive design with qualitative semi-structured interviews was used among participants in the FASTIC study. The study was conducted at two centres for vascular surgery in the city of Stockholm, Sweden. In all, 17 patients (nine men and eight women) who had completed the FASTIC study participated. Data was analysed using qualitative content analysis with an inductive approach. Results: Two main categories were identified, ‘Patient-Professional collaboration’ and ‘Experience of one´s health’, which were associated with four subcategories: facing opportunities and obstacles, cooperating based on the illness experience, increasing awareness of one's own health, and maintaining a healthy lifestyle. Conclusions: Patients' participation in follow-up programs after surgical treatment for claudication is highly valuable for an increased awareness of one's own health. A person-centered care with patient-professional collaboration is experienced as important for maintaining a health-promoting lifestyle.

Published
2022
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38. Stabilizing life : A grounded theory of surviving critical illness

Author

Vogel, Gisela, Joelsson-Alm, Eva, Forinder, Ulla, Svensen, Christer, Sandgren, Anna, Vogel, Gisela, Joelsson-Alm, Eva, Forinder, Ulla, Svensen, Christer, and Sandgren, Anna

Abstract

OBJECTIVES: The experience of critical illness among patients is both complex and multifaceted. It can make patients vulnerable to long-term consequences such as impairment in cognition, mental health and physical functional ability which affects health related quality of life. This study aims to explore patients' patterns of behaviour during the process from becoming critical ill to recovery at home. DESIGN: We used a classic grounded theory methodology to explore the main concern for intensive care patients. Thirteen participants were interviewed and seven different participants were observed. SETTING: Three general intensive care units in Sweden, consisting of a university hospital, a county hospital and a district hospital. FINDINGS: The theory Stabilizing life explains how patients' main concern, being out of control, can be resolved. This theory involves two processes, recapturing life and recoding life, and one underlying strategy, emotional balancing that is used during the whole process. CONCLUSION: The process from becoming critically ill until recovery home is perceived as a constant fight in actions and mind to achieve control and stabilize life. This theory can form the basis for further qualitative and quantitative research about interventions that promotes wellbeing during the whole process.

Published
2021
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39. ICU discharge screening for prediction of new-onset physical disability-A multinational cohort study

Author

Milton, Anna, Schandl, Anna, Soliman, Iwo, Joelsson-Alm, Eva, van den Boogaard, Mark, Wallin, Ewa, Brorsson, Camilla, Östberg, Ulrika, Latocha, Kristine, Savilampi, Johanna, Paskins, Stinne, Bottai, Matteo, Sackey, Peter, Milton, Anna, Schandl, Anna, Soliman, Iwo, Joelsson-Alm, Eva, van den Boogaard, Mark, Wallin, Ewa, Brorsson, Camilla, Östberg, Ulrika, Latocha, Kristine, Savilampi, Johanna, Paskins, Stinne, Bottai, Matteo, and Sackey, Peter

Abstract

BackgroundMethods to identify patients at risk for incomplete physical recovery after intensive care unit (ICU) stay are lacking. Our aim was to develop a method for prediction of new-onset physical disability at ICU discharge. MethodsMultinational prospective cohort study in 10 general ICUs in Sweden, Denmark, and the Netherlands. Adult patients with an ICU stay >= 12 hours were eligible for inclusion. Sixteen candidate predictors were analyzed with logistic regression for associations with the primary outcome; new-onset physical disability 3 months post-ICU, defined as a >= 10 score reduction in the Barthel Index (BI) compared to baseline. ResultsOf the 572 included patients, follow-up data are available on 78% of patients alive at follow-up. The incidence of new-onset physical disability was 19%. Univariable and multivariable modeling rendered one sole predictor for the outcome: physical status at ICU discharge, assessed with the five first items of the Chelsea critical care physical assessment tool (CPAx) (odds ratio 0.87, 95% confidence interval (CI) 0.81-0.93), a higher score indicating a lower risk, with an area under the receiver operating characteristics curve of 0.68 (95% CI 0.61-0.76). Negative predictive value for a low-risk group (CPAx score >18) was 0.88, and positive predictive value for a high-risk group (CPAx score <= 18) was 0.32. ConclusionThe ICU discharge assessment described in this study had a moderate AUC but may be useful to rule out patients unlikely to need physical interventions post-ICU. For high-risk patients, research to determine post-ICU risk factors for an incomplete rehabilitation is mandated.

Published
2020
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40. ICU discharge screening for prediction of new-onset physical disability—A multinational cohort study

Author

AIOS Anesthesiologie, Brain, Milton, Anna, Schandl, Anna, Soliman, Iwo, Joelsson-Alm, Eva, van den Boogaard, Mark, Wallin, Ewa, Brorsson, Camilla, Östberg, Ulrika, Latocha, Kristine, Savilampi, Johanna, Paskins, Stinne, Bottai, Matteo, Sackey, Peter, AIOS Anesthesiologie, Brain, Milton, Anna, Schandl, Anna, Soliman, Iwo, Joelsson-Alm, Eva, van den Boogaard, Mark, Wallin, Ewa, Brorsson, Camilla, Östberg, Ulrika, Latocha, Kristine, Savilampi, Johanna, Paskins, Stinne, Bottai, Matteo, and Sackey, Peter

Published
2020

41. The role of ventilatory support for long‐term outcomes after critical infection with COVID‐19: A prospective cohort study.

Author

Hanna, Gabriel, Bankler, Sara, Schandl, Anna, Roël, Mari, Hedman, Anders, Andersson Franko, Mikael, Lyngå, Patrik, Geborek, Anne, Joelsson‐Alm, Eva, Söderberg, Mårten, and Darlington, Pernilla

Subjects
COVID-19, LUNG volume measurements, PULMONARY function tests, LONGITUDINAL method, COMPUTED tomography
Abstract

Objectives: The full range of long‐term health consequences in intensive care unit (ICU) survivors with COVID‐19 is unclear. This study aims to investigate the role of ventilatory support for long‐term pulmonary impairment in critically ill patients and further to identify risk factors for prolonged radiological recovery. Methods: A prospective observational study from a single general hospital, including all with COVID‐19 admitted to ICU between March and August 2020, investigating the association between ventilatory support and the extent of residual parenchymal changes on chest computed tomography (CT) scan and measurement of lung volumes at follow‐up comparing high‐flow nasal oxygen (HFNO) or non‐invasive ventilation (NIV) with invasive ventilation. A semi‐quantitative score (CT involvement score) based on lobar involvement and a total score for all five lobes was used to estimate residual parenchymal changes. The association was calculated with logistic regression and adjusted for age, sex, smoking, and severity of illness. Results: Among the 187 eligible, 86 had a chest CT scan and 76 a pulmonary function test at the follow‐up with a median time of 6 months after ICU discharge. Residual lung changes were seen in 74%. The extent of pulmonary changes was similar regardless of ventilatory support, but patients with invasive ventilation had a lower total lung capacity 84% versus 92% of predicted (p < 0.001). Conclusions: The majority of ICU‐treated patients with COVID‐19 had residual lung changes at 6 months of follow‐up regardless of ventilator support or not, but the total lung capacity was lower in those treated with invasive ventilation. [ABSTRACT FROM AUTHOR]

Published
2022
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43. Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Author

Kirmeier, Eva, Eriksson, Lars I., Lewald, Heidrun, Jonsson Fagerlund, Malin, Hoeft, Andreas, Hollmann, Markus, Meistelman, Claude, Hunter, Jennifer M., Ulm, Kurt, Blobner, Manfred, Abad Gurumeta, Alfredo, Abernethy, Caroline, Abigail, Patrick, Achaibar, Kira, Adam, Emily, Afshari, Arash, Agudelo Montoya, M. Elizabeth, Akgün, Fatma Nur, Aletti, Gabriele, Alkış, Neslihan, Allan, Katie, Allan, Ashley, Allaouchiche, Bernard, Allcock, Clare, Almasy, Emoke, Amey, Isobel, Amigoni, Maria, Andersen, Elin, Andersson, Peder, Anipchenko, Natalya, Antunes, Pedro, Armstrong, Earlene, Aslam, Tayyba Naz, Aslin, Bjorn, Assunção, José Pedro, Ausserer, Julia, Avvai, Mary, Awad, Nahla, Ayas Montero, Begoña, Ayuso, Mercedes, Azevedo, Patricia, Badarau, Victoria, Badescu, Roxana, Baiardo Redaelli, Martina, Baird, Colin, Baird, Yolanda, Baker, Tim, Balaji, Packianathaswamy, Bălan, Cristina, Balandin, Alina, Balescu-Arion, Carmen, Baliuliene, Vilda, Baltasar Isabel, Jorge, Baluch, Saif Nasr, Bandrabur, Daniela, Bankewitz, Carla, Barber, Katrina, Barbera, Francesco, Barcraft-Barnes, Helena, Barletti, Valentina, Barnett, Gill, Baron, Kirsty, Barros, Ana, Barsan, Victoria, Bartlett, Pauline, Batistaki, Chrysanthi, Baumgarten, Georg, Baytas, Volkan, Beauchamp, Nigel, Becerra Cayetano, Isabel A., Bell, Stephanie, Bellandi, Mattia, Belletti, Alessandro, Belmonte Cuenca, Julio, Benitez-Cano, Adela, Beretta, Luigi, Berger, Marc, Bergmann, Nicole, Bergmark, Kristina, Bermudez Lopez, Maria, Bernotaite, Monika, Beurskens, Charlotte, Bidd, Heena, Bifulco, Francesca, Bignami, Elena, Bilic, Aleksandar, Bilskiene, Diana, Bischoff, Petra, Bishop, Luke, Bjonness, Therese, Blaylock, Hether, Blethyn, Kate, Blincoe, Thomas, Blokhin, Ivan, Blunt, Nadia, Boer, Christa, Bois, Grégory, Bonicolini, Eleonora, Booth, Joanna, Borecka-Kedzierska, Miroslawa, Borstnar, Katarina, Borys, Michał, Boselli, Emmanuel, Bouvet, Lionel, Bouwman, Arthur, Bowen, Leonora, Bowrey, Sarah, Boxall, Leigh, Božić, Teodora, Bradley, Tom, Branco, Teresa, Brazzi, Luca, Brazzoni, Marcella, Brear, Tracy, Brogly, Nicolas, Brohi, Farooq, Broms, Jacob, Bubliauskas, Andrius, Bucolo, Gea Erika, Buerkle, Hartmut, Buggy, Donal, Buhre, Wolfgang, Bukauskas, Tomas, Butturini, Francesco, Byttner, Anders, Cabrera Díaz, Itahísa, Calderon, Adriana, Calhau, Ricardo, Callejo, Angel, Cammu, Guy, Campesato, Manuela, Can, Özlem S, Candeias, Margarida, Cantor, Andreea, Carise, Elsa, Carmona, Cristina, Carreteiro, Joana, Carrieri, Cosima, Carter, Anna, Casal, Manuela, Casanova, Irene, Cascella, Marco, Casero, Luis M., Casiraghi, Guiseppina Maria, Castelo-Branco, Laila, Castro Arranz, Carlos, Cernea, Daniela Denisa, Cervantes, Jesoporiol, Chandler, Ben, Charnock, Robert, Chatzimicali, Aikaterini, Chinery, Elane, Chishti, Ahmed, Chondhury, Priyakam, Christie, Emily, Christodoudiles, George, Ciardo, Stefano, Cimpeanu, Luminata, Cindea, Iulia, Cinnella, Gilda, Clark, Sebastian, Clayton, Matthew, Cocu, Simona, Collyer, Thomas, Colvin, Carie, Cope, Sean, Copeta, Filomena, Copotoiu, Sanda-Maria, Correia de Barros, Filinto, Corso, Ruggero Massimo, Cortegiani, Andrea, Costa, Gabriela, Cowton, Amanda, Cox, Nicolas, Craig, James, Cricca, Valentina, Cronin, John, Cunha, Mariana, Cuomo, Arturo, Curley, Katherine, Czuczwar, Mirosław, Dabrowska, Domenika, Damster, Sabrine, Danguy des Déserts, Marc, Daniliuc, Aura, Danninger, Thomas, Darwish, Imad, Dascalu, Corina, Davies, Kirsty, Davies, Simon, De Boer, Hans, De Flaviis, Adelisa, De Selincourt, Gabrielle, Deana, Cristian, Debaene, Bertrand, Debreceni, Gabor, Dedhia, Jatin, Delgado Garcia, Isabel, Della Rocca, Giorgio, Delroy-Buelles, Llana, Desai, Tejal, Dhillon, Parveen, Di Giacinto, Ida, Di Mauro, Piero, Diaz Gomez, Tamara V., Dimitrovski, Aleksandar, Dinic, Vesna, Dîrzu, Dan-Sebastian, Divander, Mona Britt, Dolinar, Janez, Domingues, Susana, Doolan, James, Downes, Charlotte, Dragoescu, Nicoleta Alice, Droc, Gabriela, Dum, Elisabeth, Dumitrescu, Alexandra, Duncan, Louise, Dzurňáková, Paul, Eberl, Susanne, Edwards, Jayne, Edwards, Mark, Ekelund, Kim, Ekengren, Patrik, Elghouty, Eyad, Ellerkmann, Richard, Ellis, Helen, Elme, Andreas, Ernst, Thomas, Errando, Carlos Luis, Estenes, Simao, Ewaldsson, Callis, Farid, Nahla, Featherstone, James, Febres, Daniela, Fedorov, Sergey, Feggeler, Johanna, Feijten, Prisca, Fellmann, Tobias, Fernandez Candil, Juan, Fernandez Castineira, Ana, Fernández Castineira, Juan, Fernando, Aruna, Ferrando, Carlos, Ferreira, Leonia, Ferreira, Patrick, Feyling, Anders, Filipescu, Daniela, Fleischer, Andreas, Floris, Leda, Foerster, Urs, Fox, Benjamin, Franke, Uwe, Frasca, Denis, Frey, Christian, Frost, Victoria, Fullin, Giorgio, Fumagalli, Jacopo, Furneval, Julie, Fusari, Maurizio, Gallacher, Stuart, Galushka, Svetlana, Gambale, Giorgio, Gambino, Irene, Garcia-Perez, Maria Luisa, Garg, Sanjeev, Garlak, Justyna, Gavranovic, Zeljka, Gavrilov, Roman, Gaynor, Lames, Gecaj Gashi, Agreta, Georghiou, Maria, Gerjevic, Bozena, Gferer, Gudrun, Giarratano, Antonino, Gibson, Andy, Gievski, Vanja, Giles, Julian, Gillberg, Lars, Gilowska, Katarzyna, Gilsanz Rodriguez, Fernando, Gioia, Antonio, Giovannoni, Cecilia, Girotra, Vandana, Gkinas, Dimitrios, Gkiokas, George, Godoroja, Daniela, Goebel, Ulrich, Goel, Vandana, Gonzalez, Matilde, Goranovic, Tatjana, Gornik-Wlaszczuk, Ewa, Gosavi, Smita, Gottfridsson, Peter, Gottschalk, André, Granell, Manuel, Granstrom, Anna, Grassetto, Alberto, Greenwood, Anna, Grigoras, Ioana, Grintescu, Ioana, Gritsan, Alexey, Gritsan, Galina, Grynyuk, Andriy, Guadagnin, Giovanni Maria, Guarnieri, Marcello, Güçlü, Çiğdem, Guerrero Diez, Maria, Gunenc, Ferim, Günther, Ulf, Gupta, Pawan, Guttenthaler, Vera, Hack, Yvonne, Hafisayena, Ade, Hagau, Natalia, Haldar, Jagannath, Hales, Dawn, Hancı, Volkan, Hanna-Jumma, Sameer, Harazim, Hana, Harlet, Pierre, Harper, Daniel, Harris, Benjamin, Harvey, Orla, Hashimi, Medita, Hawkins, Lesley, Hayes, Conrad, Heaton, James, Heier, Tom, Helliwell, Laurence, Hemmes, Sabrine, Henderson, Kate, Hermanides, Jeroen, Hermanns, Henning, Herrera Hueso, Berta, Hestenes, Siv, Hettiarachchi, Roshane, Highgate, Judith, Hodgson, Keith, Hoelbling, Daniel, Holland, Jonathan, Horhota, Lucian, Hormis, Anil, Hribar, Renata, Hua, Alina, Humphreys, Sally, Humphries, Ryan, Humpliková, Simona, Hunt, Janez, Husnain, Ali, Hussein, Ahmed, Hyams, Benjamin, Iannuccelli, Fabrizio, Ilette, Katie, Ilyas, Carl, Inan, Turgay, India, Immaculada, Ionițăv, Victor, Irwin, Foo, Jain, Vipul, Janez, Benedikt, Jankovic, Radmilo, Jenkins, Sarah, Jenko, Matej, Jimenez, Raquel, Jiménez Gomez, Bárbara, Joachim, Sugganthi, Joelsson-Alm, Eva, John, John, Jonikaite, Lina, Jovic, Miomir, Jungwirth, Bettina, Junke, Etienne, Kabakov, Borys, Kadaoui, Salah-Din, Kanski, Andrzej, Karadag, Süheyla, Karbonskiene, Aurika, Karjagin, Juri, Kasnik, Darja, Katanolli, Fatos, Katsika, Eleni, Kaufmann, Kai, Keane, Helen, Kelly, Martin, Kent, Melanie, Keraitiene, Grazina, Khudhur, Ahmed, Khuenl-Brady, Karin, Kidd, Laurie, King, Siobhan, Kirchgäßner, Katharina, Klancir, Tino, Klucniks, Andris, Knotzer, Johann, Knowlden, Peter, Koers, Lena, Kompan, Janez, Koneti, Kiran K, Kooij, Fabian, Koolen, Eric, Koopman - van Gemert, Anna Wilhelmina Margaretha Maria, Kopp, Kristen, Korfiotis, Dimitrios, Korolkov, Oleg, Kosinová, Martina, Köstenberger, Markus, Kotzinger, Oskar, Kovačević, Marko, Kranke, Peter, Kranke, Eva, Kraus, Christiane, Kraus, Stephanie, Kubitzek, Christiane, Kucharski, Rafal, Kucukguclu, Semih, Kudrashou, Allaksandr, Kumar, Vinayak, Kummen, Live, Kunit, Cornelia, Kushakovsky, Vlad, Kuvaki, Bahar, Kuzmanovska, Biljana, Kyttari, Aikaterina, Landoni, Giovanni, Lau, Gary, Lazarev, Konstantin, Legett, Samantha, Legrottaglie, Anna Maria, Leonardi, Silvia, Leong, Maria, Lercher, Helene, Leuvrey, Matthieu, Leva, Brigitte, Levstek, Meta, Limb, James, Lindholm, Espen, Linton, Fiona, Liperi, Corradero, Lipski, Fabian, Lirk, Philipp, Lisi, Alberto, Lišková, Katarina, Lluch Oltra, Aitana, Loganathan, Vinothan, Lombardi, Stefania, Lopez, Eloisa, Lopez Rodríguez, Maria, Lorenzini, Laura, Lowicka, Malgorzata, Lugovoy, Alexander, Luippold, Madeleine, Lumb, Andrew, Macas, Andrius, Macgregor, Mark, Machado, Humberto, Maciariello, Maria, Madeira, Isabel, Maitan, Stefan, Majewski, Jacek, Maldini, Branka, Malewski, Georgia, Manfredini, Livia, Männer, Olja, Marchand, Bahareh, Marcu, Alexandra, Margalef, Jordi, Margarson, Michael, Marinheiro, Lucia, Markic, Ana, Markovic Bozic, Jasmina, Marrazzo, Francesco, Martin, Jane, Martin Ayuso, Maria, Martinez, Esteher, Martino, Enrico Antonio, Martinson, Victoria, Marusic-Gaser, Katarina, Mascarenhas, Catia, Mathis, Cindy, Matsota, Paraskevi, Mavrommati, Eleni, Mazul Sunko, Branka, McCourt, Killian, McGill, Neil, McKee, Raymond, Meço, Başak Ceyda, Meier, Sonja, Melbourne, Susan, Melbybråthen, Grethe, Meli, Andrea, Melia, Aiden, Melotti, Rita Maria, Menga, Maria Rosaria, Mercer, Pauline, Merotra, Susan, Mescolini, Silvia, Metterlein, Thomas, Michalov, Martin, Michlig, Sam, Midgley, Susan, Milić, Morena, Milojevic, Milan, Miñana, Amanda, Minto, Gary, Mirabella, Lucia, Mirea, Liliana, Mittelstädt, Ludger, Moeglen, Aude, Moise, Alida, Mokini, Zhirajr, Molin, Anna, Moltó, Luis, Monea, Maria Concetta, Montalto, Francesca, Montgomery, Jane, Montgomery, Claire, Montillo, Gerardo, Moore, Sally, Moore, Faye, Moreira, Zelia, Moreno, Tania, Moreno, Ricardo, Moret, Enrique, Moreton, Sarah, Morgan, Marianne, Moro Velasco, Concepción, Morri, Davide, Moull, Alice, Moura, Fernando, Mráz, Peter, Mrozek, Katarzyna, Mukhtar, Karim, Muniyappa, Sudeshkumar, Murray, Heather, Murthy, Burra VS, Mushambi, Mary, Nadolski, Maria, Nardelli, Pasquale, Nardin, Giordano, Navarro Pérez, Rosalía, Naveiro, Andrea, Negri, Manuela, Nesek Adam, Visnja, Neskovic, Vojislava, Neuwersch, Stefan, Neves, Miriam, Nguyen, Bavinh, Ní Eochagáin, Aisling, Nicholas, Caroline, Nightingale, Jeremy, Norrie, Kylie, Novak-Jankovic, Vesna, Novakova, Andrea, Novillo, Marta, Numan, Sandra, Oduro-Dominah, Louise, Oldner, Anders, Oliveira, Isabel, Ologoiu, Daniela, Oloktsidou, Irini, O'Reilly, Rosalind, Orlando, Alessandro, Ovezov, Alexey, Ozbilgin, Sule, Paal, Peter, Padin Barreiro, Lidia, Palugniok, Ryszard, Papaioannou, Alexandra, Papapostolou, Konstantinos, Paranthaman, Prabhakar, Pardey Bracho, Gilda, Parente, Suzana, Parfeni, Alexandru, Pasin, Laura, Passey, Samuel, Pastor, Ernesto, Patch, Sarah, Patil, Andan, Paunescu, Marilena-Alina, Pehboeck, Daniel, Pereira, Manuela, Pereira, Carla, Perez Caballero, Paula, Pérez García, Aníbal, Pérez Soto, Antonia, Perez Tejero, Gisela, Perez-Cerda, Francisco, Pesenti, Antonio, Petta, Rocco, Philippe, Simon, Pickering, David, Pico Veloso, Jandro, Pina, Pedro, Pinho-Oliveira, Vítor, Pinol, Santiago, Pinto, Rita, Pistidda, Laura, Pitterle, Manuela, Piwowarczyk, Paweł, Plotnikova, Olga, Pohl, Holger, Poldermann, Jorinde, Polkovicová, Lucia, Pompei, Livia, Popescu, Mihai, Popović, Radmila, Pota, Vincenzo, Potocnik, Miriam, Potręć, Beata, Potter, Alison, Pramod, Nalwaya, Prchalova, Martina, Preckel, Benedikt, Pugh, Richard, Pulletz, Mark, Radoeshki, Aleksandar, Rafi, Amir, Ragazzi, Riccardo, Raineri Santi, Maurizio, Rajamanickam, Tamiselvan, Rajput, Zahra, Ramachandran, Rajeskar, Ramasamy, Radhika, Ramessur, Suneil, Rao, Roshan, Rasmussen, Anders, Rato, André, Razaque, Usman, Real Navacerrada, M. Isabel, Reavley, Caroline, Reid, James, Reschreiter, Henrik, Rial, Erick, Ribas Carrasco, Patricia, Ribeiro, Sandy, Rich, Nathalie, Richardson, Lydia, Rimaitis, Kestutis, Rimaitis, Marius, Ringvold, Else-Marie, Ripke, Fabian, Ristescu, Irina, Ritchie, Keith, Ródenas, Frederic, Rodrigues, Patrícia, Rogers, Emma, Rogerson, David, Romagnoli, Stefano, Romero, Esther, Rondovic, Goran, Rose, Bernd Oliver, Roth, Winfried, Rotter, Marie-Therese, Rousseau, Guy, Rudjord, Anders, Rueffert, Henrik, Rundgren, Malin, Rupprecht, Korbinian, Rushton, Andrew, Russotto, Vincenzo, Rypulak, Elżbieta, Ryszka, Maciej, Sà, Jacinta, Sà Couto, Paula, Saby, Sandrine, Sagic, Jelena, Saleh, Omar, Sales, Gabriele, Sánchez Sánchez, Yván, Sanghera, Sumayer, Şanli Karip, Ceren, Santiveri Papiol, Francisco Javier, Santos, Sofia, Sarno, Stephen, Saul, Daniel, Saunders, David, Savic, Nenad, Scalco, Loïc, Scanlon, Deborah, Schaller, Stefan, Schax, Christoph, Scheffer, Gert Jan, Schening, Anna, Schiavone, Vincenzo, Schmidt-Ehrenberg, Florian, Schmidt-Mutter, Catherine, Schönberg, Christina, Schopflin, Christian, Schreiber, Jan-Uwe, Schultz, Marcus, Schurig, Marlen, Scott, Carmen, Sebestian, Siby, Sehgal, Selena, Sem, Victoria, Semenas, Egidijus, Serafini, Elena, Serchan, Pashalitsa, Shields, Martin, Shobha, Ramakrishnan, Shosholcheva, Mirjana, Siamansour, Tanja, Siddaiah, Narendra, Siddiqi, Khalid, Sinclair, Rhona, Singh, Permendra, Singh, Rajendra, Sinha, Aneeta, Sinha, Ashok, Skinner, Amanda, Smee, Elizabeth, Smekalova, Olga, Smith, Neil, Smith, Thomas, Smitz, Carine, Smole, Daniel, Sojčić, Nataša, Soler Pedrola, Maria, Somanath, Sameer, Sonksen, Julian, Sorella, Maria Christina, Sörmus, Alar, Soro, Marina, Soto, Carmen, Spada, Anna, Spadaro, Savino, Spaeth, Johannes, Sparr, Harald, Spielmann, Annika, Spindler-Vesel, Alenka, Stamelos, Matthaios, Stancombe L, Liucia, Stanculescu, Andreea, Standl, Thomas, Standley, Tom, Stanek, Ondrej, Stanisavljević, Snežana, Starczewska, Malgorzata, Stäuble, Christiane, Steen, Julie, Stefan, Oana Maria, Stell, Elizabeth, Stera, Caterina, Stevens, Markus, Stoerckel, Marlène, Stošić, Biljana, Stourac, Petr, Stroumpoulis, Konstantinos, Struck, Rafael, Suarez de la Rica, Alejandro, Sultanpori, Altaf, Sundara Rajan, Rajinikanth, Suying, Ong, Svensen, Christer, Swan, Louise, Syrogianni, Paulina, Sysiak, Justyna, Szederjesi, Janos, Taddei, Stefania, Tan Hao, Ern, Tanou, Virginia, Tarabová, Katarina, Tardaguila Sancho, Paula, Tarroso, Maria, Tartaglione, Marco, Taylor, Emma, Tbaily, Lee, Telford, Richard, Terenzoni, Massimo, Theodoraki, Kassiani, Thornley, Helen, Tiganiuc, Liviu, Toim, Hardo, Tomescu, Dana, Tommasino, Concezione, Toni, Jessica, Toninelli, Arturo, Toretti, Ilaria, Townley, Stephen, Trepenaitis, Darius, Trethowan, Brian, Tsaousi, Georgia, Tsiftsi, Aikaterini, Tudor, Adrada, Turan, Güldem, Turhan, Sanem Çakar, Unic-Stojanovic, Dragana, Unterbuchner, Christoph, Unzueta, Carmen, Uranjek, Jasna, Ursic, Tomaz, Vaida, Simona, Valldeperas Ferrer, Silvia, Valldeperas Hernandez, Maria Inmaculada, Valsamidis, Dimitri, Van Beek, Rienk, Van dasselaer, Nick, Van Der Beek, Tim, Van Duivenvoorde, Yoni, Van Klei, Wilton A., Van Poorter, Frans, Van Zaane, Bas, Van Zundert, Tom, Van Zyl, Rebekka, Vargas Munoz, Ana Milena, Varsani, Nimu, Vasconcelos, Pedro, Vassilakis, Georgios, Vecchiatini, Tommaso, Vecera, Lubomir, Vercauteren, Marcel, Verdouw, Bas, Verheyen, Veerle, Verri, Marco, Vicari Sottosanti, Luigi Giancarlo, Vico, Manuel, Vidal Mitjans, Patricia, Vilardi, Anna, Vissicchio, Daniela, Vitale, Giovanni, Vitković, Bibiana, Vizcaychipi, Marcela Paola, Voicu, Alexandra, Voje, Minca, Volfová, Ivana, Volta, Carlo Alberto, Von Lutterotti, Theresa, von Tiesenhausen, Anna, Vrecic-Slabe, Simona, Vukcevic, Dejan, Vukovic, Rade, Vullo, P. Agostina, Wade, Andrew, Wallberg, Hanna, Wallden, Jakob, Wallner, Johann, Walther Sturesson, Louise, Watson, Davina, Weber, Stefan, Wegiel Leskiewiq, Anna, Weller, Debbie, Wensing, Carine, Werkmann, Markus, Westberg, Henrik, Wikström, Erik, Williams, Benedict, Wilson, Robin, Wirth, Steffen, Wittmann, Maria, Wood, Laura, Wright, Stella, Zachoval, Christian, Zambon, Massimo, Zampieri, Silvia, Zampone, Salvatore, Zangrillo, Alberto, Zani, Gianluca, Zavackiene, Asta, Zieglerder, Raphael, Zonneveldt, Harry, Zsisku, Lajos, Zucker, Tom-Philipp, Żukowski, Maciej, Zuleika, Mehrun, Zupanĕiĕ, Darja, Kirmeier, Eva, Eriksson, Lars I., Lewald, Heidrun, Jonsson Fagerlund, Malin, Hoeft, Andreas, Hollmann, Markus, Meistelman, Claude, Hunter, Jennifer M., Ulm, Kurt, Blobner, Manfred, Abad Gurumeta, Alfredo, Abernethy, Caroline, Abigail, Patrick, Achaibar, Kira, Adam, Emily, Afshari, Arash, Agudelo Montoya, M. Elizabeth, Akgün, Fatma Nur, Aletti, Gabriele, Alkış, Neslihan, Allan, Katie, Allan, Ashley, Allaouchiche, Bernard, Allcock, Clare, Almasy, Emoke, Amey, Isobel, Amigoni, Maria, Andersen, Elin, Andersson, Peder, Anipchenko, Natalya, Antunes, Pedro, Armstrong, Earlene, Aslam, Tayyba Naz, Aslin, Bjorn, Assunção, José Pedro, Ausserer, Julia, Avvai, Mary, Awad, Nahla, Ayas Montero, Begoña, Ayuso, Mercedes, Azevedo, Patricia, Badarau, Victoria, Badescu, Roxana, Baiardo Redaelli, Martina, Baird, Colin, Baird, Yolanda, Baker, Tim, Balaji, Packianathaswamy, Bălan, Cristina, Balandin, Alina, Balescu-Arion, Carmen, Baliuliene, Vilda, Baltasar Isabel, Jorge, Baluch, Saif Nasr, Bandrabur, Daniela, Bankewitz, Carla, Barber, Katrina, Barbera, Francesco, Barcraft-Barnes, Helena, Barletti, Valentina, Barnett, Gill, Baron, Kirsty, Barros, Ana, Barsan, Victoria, Bartlett, Pauline, Batistaki, Chrysanthi, Baumgarten, Georg, Baytas, Volkan, Beauchamp, Nigel, Becerra Cayetano, Isabel A., Bell, Stephanie, Bellandi, Mattia, Belletti, Alessandro, Belmonte Cuenca, Julio, Benitez-Cano, Adela, Beretta, Luigi, Berger, Marc, Bergmann, Nicole, Bergmark, Kristina, Bermudez Lopez, Maria, Bernotaite, Monika, Beurskens, Charlotte, Bidd, Heena, Bifulco, Francesca, Bignami, Elena, Bilic, Aleksandar, Bilskiene, Diana, Bischoff, Petra, Bishop, Luke, Bjonness, Therese, Blaylock, Hether, Blethyn, Kate, Blincoe, Thomas, Blokhin, Ivan, Blunt, Nadia, Boer, Christa, Bois, Grégory, Bonicolini, Eleonora, Booth, Joanna, Borecka-Kedzierska, Miroslawa, Borstnar, Katarina, Borys, Michał, Boselli, Emmanuel, Bouvet, Lionel, Bouwman, Arthur, Bowen, Leonora, Bowrey, Sarah, Boxall, Leigh, Božić, Teodora, Bradley, Tom, Branco, Teresa, Brazzi, Luca, Brazzoni, Marcella, Brear, Tracy, Brogly, Nicolas, Brohi, Farooq, Broms, Jacob, Bubliauskas, Andrius, Bucolo, Gea Erika, Buerkle, Hartmut, Buggy, Donal, Buhre, Wolfgang, Bukauskas, Tomas, Butturini, Francesco, Byttner, Anders, Cabrera Díaz, Itahísa, Calderon, Adriana, Calhau, Ricardo, Callejo, Angel, Cammu, Guy, Campesato, Manuela, Can, Özlem S, Candeias, Margarida, Cantor, Andreea, Carise, Elsa, Carmona, Cristina, Carreteiro, Joana, Carrieri, Cosima, Carter, Anna, Casal, Manuela, Casanova, Irene, Cascella, Marco, Casero, Luis M., Casiraghi, Guiseppina Maria, Castelo-Branco, Laila, Castro Arranz, Carlos, Cernea, Daniela Denisa, Cervantes, Jesoporiol, Chandler, Ben, Charnock, Robert, Chatzimicali, Aikaterini, Chinery, Elane, Chishti, Ahmed, Chondhury, Priyakam, Christie, Emily, Christodoudiles, George, Ciardo, Stefano, Cimpeanu, Luminata, Cindea, Iulia, Cinnella, Gilda, Clark, Sebastian, Clayton, Matthew, Cocu, Simona, Collyer, Thomas, Colvin, Carie, Cope, Sean, Copeta, Filomena, Copotoiu, Sanda-Maria, Correia de Barros, Filinto, Corso, Ruggero Massimo, Cortegiani, Andrea, Costa, Gabriela, Cowton, Amanda, Cox, Nicolas, Craig, James, Cricca, Valentina, Cronin, John, Cunha, Mariana, Cuomo, Arturo, Curley, Katherine, Czuczwar, Mirosław, Dabrowska, Domenika, Damster, Sabrine, Danguy des Déserts, Marc, Daniliuc, Aura, Danninger, Thomas, Darwish, Imad, Dascalu, Corina, Davies, Kirsty, Davies, Simon, De Boer, Hans, De Flaviis, Adelisa, De Selincourt, Gabrielle, Deana, Cristian, Debaene, Bertrand, Debreceni, Gabor, Dedhia, Jatin, Delgado Garcia, Isabel, Della Rocca, Giorgio, Delroy-Buelles, Llana, Desai, Tejal, Dhillon, Parveen, Di Giacinto, Ida, Di Mauro, Piero, Diaz Gomez, Tamara V., Dimitrovski, Aleksandar, Dinic, Vesna, Dîrzu, Dan-Sebastian, Divander, Mona Britt, Dolinar, Janez, Domingues, Susana, Doolan, James, Downes, Charlotte, Dragoescu, Nicoleta Alice, Droc, Gabriela, Dum, Elisabeth, Dumitrescu, Alexandra, Duncan, Louise, Dzurňáková, Paul, Eberl, Susanne, Edwards, Jayne, Edwards, Mark, Ekelund, Kim, Ekengren, Patrik, Elghouty, Eyad, Ellerkmann, Richard, Ellis, Helen, Elme, Andreas, Ernst, Thomas, Errando, Carlos Luis, Estenes, Simao, Ewaldsson, Callis, Farid, Nahla, Featherstone, James, Febres, Daniela, Fedorov, Sergey, Feggeler, Johanna, Feijten, Prisca, Fellmann, Tobias, Fernandez Candil, Juan, Fernandez Castineira, Ana, Fernández Castineira, Juan, Fernando, Aruna, Ferrando, Carlos, Ferreira, Leonia, Ferreira, Patrick, Feyling, Anders, Filipescu, Daniela, Fleischer, Andreas, Floris, Leda, Foerster, Urs, Fox, Benjamin, Franke, Uwe, Frasca, Denis, Frey, Christian, Frost, Victoria, Fullin, Giorgio, Fumagalli, Jacopo, Furneval, Julie, Fusari, Maurizio, Gallacher, Stuart, Galushka, Svetlana, Gambale, Giorgio, Gambino, Irene, Garcia-Perez, Maria Luisa, Garg, Sanjeev, Garlak, Justyna, Gavranovic, Zeljka, Gavrilov, Roman, Gaynor, Lames, Gecaj Gashi, Agreta, Georghiou, Maria, Gerjevic, Bozena, Gferer, Gudrun, Giarratano, Antonino, Gibson, Andy, Gievski, Vanja, Giles, Julian, Gillberg, Lars, Gilowska, Katarzyna, Gilsanz Rodriguez, Fernando, Gioia, Antonio, Giovannoni, Cecilia, Girotra, Vandana, Gkinas, Dimitrios, Gkiokas, George, Godoroja, Daniela, Goebel, Ulrich, Goel, Vandana, Gonzalez, Matilde, Goranovic, Tatjana, Gornik-Wlaszczuk, Ewa, Gosavi, Smita, Gottfridsson, Peter, Gottschalk, André, Granell, Manuel, Granstrom, Anna, Grassetto, Alberto, Greenwood, Anna, Grigoras, Ioana, Grintescu, Ioana, Gritsan, Alexey, Gritsan, Galina, Grynyuk, Andriy, Guadagnin, Giovanni Maria, Guarnieri, Marcello, Güçlü, Çiğdem, Guerrero Diez, Maria, Gunenc, Ferim, Günther, Ulf, Gupta, Pawan, Guttenthaler, Vera, Hack, Yvonne, Hafisayena, Ade, Hagau, Natalia, Haldar, Jagannath, Hales, Dawn, Hancı, Volkan, Hanna-Jumma, Sameer, Harazim, Hana, Harlet, Pierre, Harper, Daniel, Harris, Benjamin, Harvey, Orla, Hashimi, Medita, Hawkins, Lesley, Hayes, Conrad, Heaton, James, Heier, Tom, Helliwell, Laurence, Hemmes, Sabrine, Henderson, Kate, Hermanides, Jeroen, Hermanns, Henning, Herrera Hueso, Berta, Hestenes, Siv, Hettiarachchi, Roshane, Highgate, Judith, Hodgson, Keith, Hoelbling, Daniel, Holland, Jonathan, Horhota, Lucian, Hormis, Anil, Hribar, Renata, Hua, Alina, Humphreys, Sally, Humphries, Ryan, Humpliková, Simona, Hunt, Janez, Husnain, Ali, Hussein, Ahmed, Hyams, Benjamin, Iannuccelli, Fabrizio, Ilette, Katie, Ilyas, Carl, Inan, Turgay, India, Immaculada, Ionițăv, Victor, Irwin, Foo, Jain, Vipul, Janez, Benedikt, Jankovic, Radmilo, Jenkins, Sarah, Jenko, Matej, Jimenez, Raquel, Jiménez Gomez, Bárbara, Joachim, Sugganthi, Joelsson-Alm, Eva, John, John, Jonikaite, Lina, Jovic, Miomir, Jungwirth, Bettina, Junke, Etienne, Kabakov, Borys, Kadaoui, Salah-Din, Kanski, Andrzej, Karadag, Süheyla, Karbonskiene, Aurika, Karjagin, Juri, Kasnik, Darja, Katanolli, Fatos, Katsika, Eleni, Kaufmann, Kai, Keane, Helen, Kelly, Martin, Kent, Melanie, Keraitiene, Grazina, Khudhur, Ahmed, Khuenl-Brady, Karin, Kidd, Laurie, King, Siobhan, Kirchgäßner, Katharina, Klancir, Tino, Klucniks, Andris, Knotzer, Johann, Knowlden, Peter, Koers, Lena, Kompan, Janez, Koneti, Kiran K, Kooij, Fabian, Koolen, Eric, Koopman - van Gemert, Anna Wilhelmina Margaretha Maria, Kopp, Kristen, Korfiotis, Dimitrios, Korolkov, Oleg, Kosinová, Martina, Köstenberger, Markus, Kotzinger, Oskar, Kovačević, Marko, Kranke, Peter, Kranke, Eva, Kraus, Christiane, Kraus, Stephanie, Kubitzek, Christiane, Kucharski, Rafal, Kucukguclu, Semih, Kudrashou, Allaksandr, Kumar, Vinayak, Kummen, Live, Kunit, Cornelia, Kushakovsky, Vlad, Kuvaki, Bahar, Kuzmanovska, Biljana, Kyttari, Aikaterina, Landoni, Giovanni, Lau, Gary, Lazarev, Konstantin, Legett, Samantha, Legrottaglie, Anna Maria, Leonardi, Silvia, Leong, Maria, Lercher, Helene, Leuvrey, Matthieu, Leva, Brigitte, Levstek, Meta, Limb, James, Lindholm, Espen, Linton, Fiona, Liperi, Corradero, Lipski, Fabian, Lirk, Philipp, Lisi, Alberto, Lišková, Katarina, Lluch Oltra, Aitana, Loganathan, Vinothan, Lombardi, Stefania, Lopez, Eloisa, Lopez Rodríguez, Maria, Lorenzini, Laura, Lowicka, Malgorzata, Lugovoy, Alexander, Luippold, Madeleine, Lumb, Andrew, Macas, Andrius, Macgregor, Mark, Machado, Humberto, Maciariello, Maria, Madeira, Isabel, Maitan, Stefan, Majewski, Jacek, Maldini, Branka, Malewski, Georgia, Manfredini, Livia, Männer, Olja, Marchand, Bahareh, Marcu, Alexandra, Margalef, Jordi, Margarson, Michael, Marinheiro, Lucia, Markic, Ana, Markovic Bozic, Jasmina, Marrazzo, Francesco, Martin, Jane, Martin Ayuso, Maria, Martinez, Esteher, Martino, Enrico Antonio, Martinson, Victoria, Marusic-Gaser, Katarina, Mascarenhas, Catia, Mathis, Cindy, Matsota, Paraskevi, Mavrommati, Eleni, Mazul Sunko, Branka, McCourt, Killian, McGill, Neil, McKee, Raymond, Meço, Başak Ceyda, Meier, Sonja, Melbourne, Susan, Melbybråthen, Grethe, Meli, Andrea, Melia, Aiden, Melotti, Rita Maria, Menga, Maria Rosaria, Mercer, Pauline, Merotra, Susan, Mescolini, Silvia, Metterlein, Thomas, Michalov, Martin, Michlig, Sam, Midgley, Susan, Milić, Morena, Milojevic, Milan, Miñana, Amanda, Minto, Gary, Mirabella, Lucia, Mirea, Liliana, Mittelstädt, Ludger, Moeglen, Aude, Moise, Alida, Mokini, Zhirajr, Molin, Anna, Moltó, Luis, Monea, Maria Concetta, Montalto, Francesca, Montgomery, Jane, Montgomery, Claire, Montillo, Gerardo, Moore, Sally, Moore, Faye, Moreira, Zelia, Moreno, Tania, Moreno, Ricardo, Moret, Enrique, Moreton, Sarah, Morgan, Marianne, Moro Velasco, Concepción, Morri, Davide, Moull, Alice, Moura, Fernando, Mráz, Peter, Mrozek, Katarzyna, Mukhtar, Karim, Muniyappa, Sudeshkumar, Murray, Heather, Murthy, Burra VS, Mushambi, Mary, Nadolski, Maria, Nardelli, Pasquale, Nardin, Giordano, Navarro Pérez, Rosalía, Naveiro, Andrea, Negri, Manuela, Nesek Adam, Visnja, Neskovic, Vojislava, Neuwersch, Stefan, Neves, Miriam, Nguyen, Bavinh, Ní Eochagáin, Aisling, Nicholas, Caroline, Nightingale, Jeremy, Norrie, Kylie, Novak-Jankovic, Vesna, Novakova, Andrea, Novillo, Marta, Numan, Sandra, Oduro-Dominah, Louise, Oldner, Anders, Oliveira, Isabel, Ologoiu, Daniela, Oloktsidou, Irini, O'Reilly, Rosalind, Orlando, Alessandro, Ovezov, Alexey, Ozbilgin, Sule, Paal, Peter, Padin Barreiro, Lidia, Palugniok, Ryszard, Papaioannou, Alexandra, Papapostolou, Konstantinos, Paranthaman, Prabhakar, Pardey Bracho, Gilda, Parente, Suzana, Parfeni, Alexandru, Pasin, Laura, Passey, Samuel, Pastor, Ernesto, Patch, Sarah, Patil, Andan, Paunescu, Marilena-Alina, Pehboeck, Daniel, Pereira, Manuela, Pereira, Carla, Perez Caballero, Paula, Pérez García, Aníbal, Pérez Soto, Antonia, Perez Tejero, Gisela, Perez-Cerda, Francisco, Pesenti, Antonio, Petta, Rocco, Philippe, Simon, Pickering, David, Pico Veloso, Jandro, Pina, Pedro, Pinho-Oliveira, Vítor, Pinol, Santiago, Pinto, Rita, Pistidda, Laura, Pitterle, Manuela, Piwowarczyk, Paweł, Plotnikova, Olga, Pohl, Holger, Poldermann, Jorinde, Polkovicová, Lucia, Pompei, Livia, Popescu, Mihai, Popović, Radmila, Pota, Vincenzo, Potocnik, Miriam, Potręć, Beata, Potter, Alison, Pramod, Nalwaya, Prchalova, Martina, Preckel, Benedikt, Pugh, Richard, Pulletz, Mark, Radoeshki, Aleksandar, Rafi, Amir, Ragazzi, Riccardo, Raineri Santi, Maurizio, Rajamanickam, Tamiselvan, Rajput, Zahra, Ramachandran, Rajeskar, Ramasamy, Radhika, Ramessur, Suneil, Rao, Roshan, Rasmussen, Anders, Rato, André, Razaque, Usman, Real Navacerrada, M. Isabel, Reavley, Caroline, Reid, James, Reschreiter, Henrik, Rial, Erick, Ribas Carrasco, Patricia, Ribeiro, Sandy, Rich, Nathalie, Richardson, Lydia, Rimaitis, Kestutis, Rimaitis, Marius, Ringvold, Else-Marie, Ripke, Fabian, Ristescu, Irina, Ritchie, Keith, Ródenas, Frederic, Rodrigues, Patrícia, Rogers, Emma, Rogerson, David, Romagnoli, Stefano, Romero, Esther, Rondovic, Goran, Rose, Bernd Oliver, Roth, Winfried, Rotter, Marie-Therese, Rousseau, Guy, Rudjord, Anders, Rueffert, Henrik, Rundgren, Malin, Rupprecht, Korbinian, Rushton, Andrew, Russotto, Vincenzo, Rypulak, Elżbieta, Ryszka, Maciej, Sà, Jacinta, Sà Couto, Paula, Saby, Sandrine, Sagic, Jelena, Saleh, Omar, Sales, Gabriele, Sánchez Sánchez, Yván, Sanghera, Sumayer, Şanli Karip, Ceren, Santiveri Papiol, Francisco Javier, Santos, Sofia, Sarno, Stephen, Saul, Daniel, Saunders, David, Savic, Nenad, Scalco, Loïc, Scanlon, Deborah, Schaller, Stefan, Schax, Christoph, Scheffer, Gert Jan, Schening, Anna, Schiavone, Vincenzo, Schmidt-Ehrenberg, Florian, Schmidt-Mutter, Catherine, Schönberg, Christina, Schopflin, Christian, Schreiber, Jan-Uwe, Schultz, Marcus, Schurig, Marlen, Scott, Carmen, Sebestian, Siby, Sehgal, Selena, Sem, Victoria, Semenas, Egidijus, Serafini, Elena, Serchan, Pashalitsa, Shields, Martin, Shobha, Ramakrishnan, Shosholcheva, Mirjana, Siamansour, Tanja, Siddaiah, Narendra, Siddiqi, Khalid, Sinclair, Rhona, Singh, Permendra, Singh, Rajendra, Sinha, Aneeta, Sinha, Ashok, Skinner, Amanda, Smee, Elizabeth, Smekalova, Olga, Smith, Neil, Smith, Thomas, Smitz, Carine, Smole, Daniel, Sojčić, Nataša, Soler Pedrola, Maria, Somanath, Sameer, Sonksen, Julian, Sorella, Maria Christina, Sörmus, Alar, Soro, Marina, Soto, Carmen, Spada, Anna, Spadaro, Savino, Spaeth, Johannes, Sparr, Harald, Spielmann, Annika, Spindler-Vesel, Alenka, Stamelos, Matthaios, Stancombe L, Liucia, Stanculescu, Andreea, Standl, Thomas, Standley, Tom, Stanek, Ondrej, Stanisavljević, Snežana, Starczewska, Malgorzata, Stäuble, Christiane, Steen, Julie, Stefan, Oana Maria, Stell, Elizabeth, Stera, Caterina, Stevens, Markus, Stoerckel, Marlène, Stošić, Biljana, Stourac, Petr, Stroumpoulis, Konstantinos, Struck, Rafael, Suarez de la Rica, Alejandro, Sultanpori, Altaf, Sundara Rajan, Rajinikanth, Suying, Ong, Svensen, Christer, Swan, Louise, Syrogianni, Paulina, Sysiak, Justyna, Szederjesi, Janos, Taddei, Stefania, Tan Hao, Ern, Tanou, Virginia, Tarabová, Katarina, Tardaguila Sancho, Paula, Tarroso, Maria, Tartaglione, Marco, Taylor, Emma, Tbaily, Lee, Telford, Richard, Terenzoni, Massimo, Theodoraki, Kassiani, Thornley, Helen, Tiganiuc, Liviu, Toim, Hardo, Tomescu, Dana, Tommasino, Concezione, Toni, Jessica, Toninelli, Arturo, Toretti, Ilaria, Townley, Stephen, Trepenaitis, Darius, Trethowan, Brian, Tsaousi, Georgia, Tsiftsi, Aikaterini, Tudor, Adrada, Turan, Güldem, Turhan, Sanem Çakar, Unic-Stojanovic, Dragana, Unterbuchner, Christoph, Unzueta, Carmen, Uranjek, Jasna, Ursic, Tomaz, Vaida, Simona, Valldeperas Ferrer, Silvia, Valldeperas Hernandez, Maria Inmaculada, Valsamidis, Dimitri, Van Beek, Rienk, Van dasselaer, Nick, Van Der Beek, Tim, Van Duivenvoorde, Yoni, Van Klei, Wilton A., Van Poorter, Frans, Van Zaane, Bas, Van Zundert, Tom, Van Zyl, Rebekka, Vargas Munoz, Ana Milena, Varsani, Nimu, Vasconcelos, Pedro, Vassilakis, Georgios, Vecchiatini, Tommaso, Vecera, Lubomir, Vercauteren, Marcel, Verdouw, Bas, Verheyen, Veerle, Verri, Marco, Vicari Sottosanti, Luigi Giancarlo, Vico, Manuel, Vidal Mitjans, Patricia, Vilardi, Anna, Vissicchio, Daniela, Vitale, Giovanni, Vitković, Bibiana, Vizcaychipi, Marcela Paola, Voicu, Alexandra, Voje, Minca, Volfová, Ivana, Volta, Carlo Alberto, Von Lutterotti, Theresa, von Tiesenhausen, Anna, Vrecic-Slabe, Simona, Vukcevic, Dejan, Vukovic, Rade, Vullo, P. Agostina, Wade, Andrew, Wallberg, Hanna, Wallden, Jakob, Wallner, Johann, Walther Sturesson, Louise, Watson, Davina, Weber, Stefan, Wegiel Leskiewiq, Anna, Weller, Debbie, Wensing, Carine, Werkmann, Markus, Westberg, Henrik, Wikström, Erik, Williams, Benedict, Wilson, Robin, Wirth, Steffen, Wittmann, Maria, Wood, Laura, Wright, Stella, Zachoval, Christian, Zambon, Massimo, Zampieri, Silvia, Zampone, Salvatore, Zangrillo, Alberto, Zani, Gianluca, Zavackiene, Asta, Zieglerder, Raphael, Zonneveldt, Harry, Zsisku, Lajos, Zucker, Tom-Philipp, Żukowski, Maciej, Zuleika, Mehrun, and Zupanĕiĕ, Darja

Published
2019

44. Health-related quality of life after general surgical intensive care

Author

Vogel, Gisela, Forinder, Ulla, Sandgren, A., Svensen, C., Joelsson-Alm, Eva, Vogel, Gisela, Forinder, Ulla, Sandgren, A., Svensen, C., and Joelsson-Alm, Eva

Abstract

BACKGROUND: Impaired mental and physical health are common complications after intensive care that could influence the patient's health-related quality of life (HRQoL). Earlier research has mainly focused on HRQoL in mixed surgical and medical ICU populations. This study aimed to describe and analyze factors associated with HROoL after discharge from a general surgical ICU. METHODS: A prospective cohort study was conducted in a general surgical ICU in Sweden between 2005 and 2012. Adult patients (≥18 years) with an ICU length of stay ≥96 hours were included. HRQoL was measured at 3, 6, and 12 months after discharge from the ICU using a questionnaire (SF-36). A linear mixed model was used to analyze changes over time and Wilcoxon Signed Rank Tests were used to compare the 12-months results to an age and gender matched reference population in Sweden. Linear regression analyses were performed to explore the impact on HRQoL from background variables. RESULTS: Of 447 patients eligible for the study, 276 patients (62%) answered SF-36 at least once at 3, 6 or 12 months after ICU care and were included in the study. HRQoL improved over time but was still significantly lower at 12 months compared to the reference population. Female gender, age <75 years, living single, and ICU-stay of more than 14 days were associated with lower HRQoL. CONCLUSION: General surgical ICU patients reports low HRQoL 1 year after ICU stay. The impaired HRQoL could be a long-lasting problem with major consequences for the individual, family, and society.

Published
2018
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45. Bladder distension : aspects of a healthcare-related injury

Author

Joelsson-Alm, Eva and Joelsson-Alm, Eva

Abstract

Lower urinary tract symptoms (LUTS) are common health problems. For the individual, LUTS is troublesome and can greatly affect the health-related quality-of- life (HRQOL). One cause of LUTS is urinary retention (inability to void in the presence of a full bladder); a well-known complication following hospital care. If the bladder volume exceeds 500 ml there is a risk of overdistension of the muscle fibres in the bladder wall; bladder distension. This can result in motility problems with post-void residual volumes, urinary tract infections and an inability to void. If the bladder becomes stretched too far, or for a long period, the bladder may be permanently damaged and lose its ability to contract sufficiently for the rest of the person’s life. Bladder damage due to overdistension can be classified as a patient injury; harm caused to a patient as a result of their healthcare, and which could have been avoided. The overall aim of this thesis was to improve patient-safety by providing research evidence for bladder monitoring procedures and increase knowledge and awareness of bladder distension as a healthcare-related injury. Study I was a prospective observational study of peri-operative bladder volumes among orthopaedic or general surgical patients. Bladder volumes were measured on three occasions; after emptying the bladder before being transported to the operating theatre, and then both immediately before and after surgery. Thirty-three of the included 147 patients (22%) developed bladder distension (>500 ml), eight preoperatively and 25 postoperatively. Orthopaedic patients were more likely to develop both preoperative and postoperative bladder distension than surgical patients and had significantly higher post-void residual volumes Age, gender and time of anaesthesia could not predict bladder distension. Study II was a randomised controlled trial testing whether a protocol with frequent pre-operative ultrasound monitoring of bladder volumes starting in the ER cou

Published
2012

46. Perioperative bladder distension : a prospective study

Author

Joelsson-Alm, Eva, Nyman, Claes R., Lindholm, Christina, Ulfvarson, Johanna, Svensén, Christer, Joelsson-Alm, Eva, Nyman, Claes R., Lindholm, Christina, Ulfvarson, Johanna, and Svensén, Christer

Abstract

Objective. Postoperative urinary retention and bladder distension are frequent complications of surgery. The aim of this study was to determine the incidence of perioperative bladder distension in a surgical setting and to identify predisposing factors among patients undergoing common general and orthopaedic procedures. Material and methods. This was a prospective observational study of 147 adult patients admitted to orthopaedic and surgical departments. Bladder volumes were measured with an ultrasound scanner on three occasions: after emptying the bladder before being transported to the operating theatre, and then immediately before and after surgery. Results. Thirty-three patients (22%) developed bladder distension (500 ml), eight preoperatively and 25 postoperatively. A total of 21 patients (14%) had a bladder volume 300 ml immediately before surgery. Orthopaedic patients were more likely to develop preoperative bladder distension than surgical patients and had significantly higher postvoid residual volumes. In the binary logistic regression analysis age, gender and time of anaesthesia could not predict bladder distension. Patients undergoing orthopaedic surgical procedures, however, were prone to bladder distension (odds ratio 6.87, 95% confidence interval 1.76 to 26.79, p=0.006). Conclusions. This study shows that orthopaedic surgical patients are more prone to bladder distension perioperatively. The conventional method of encouraging patients to void at the ward before being transported to the operating theatre does not necessarily mean an empty bladder at the start of the operation.

Published
2009
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47. Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Author

Kirmeier E. a, Eriksson L. I. c, Lewald H. a, Jonsson Fagerlund, M. c Hoeft, A. f Hollmann, M. g Meistelman, C. e Hunter, J. M. d Ulm, K. b Blobner, M. aEmail Author, Abad Gurumeta, A. Abernethy, C. Abigail, P. Achaibar, K. Adam, E. Afshari, Agudelo Montoya, M. E. Akgün, F. N. Aletti, G. Alkış, N. Allan, K. Allan, A. Allaouchiche, B. Allcock, C. Almasy, E. Amey, I. Amigoni, M. Andersen, E. Andersson, P. Anipchenko, N. Antunes, P. Armstrong, E. Aslam, T. N. Aslin, B. Assunção, J. P. Ausserer, J. Avvai, M. Awad, Ayas Montero, B. Ayuso, M. Azevedo, P. Badarau, V. Badescu, Baiardo Redaelli, M. Baird, C. Baird, Y. Baker, T. Balaji, P. Bălan, C. Balandin, A. Balescu-Arion, C. Baliuliene, Baltasar Isabel, J. Baluch, S. N. Bandrabur, D. Bankewitz, C. Barber, K. Barbera, F. Barcraft-Barnes, H. Barletti, V. Barnett, G. Baron, K. Barros, A. Barsan, V. Bartlett, P. Batistaki, C. Baumgarten, G. Baytas, V. Beauchamp, Becerra Cayetano, I. A. Bell, S. Bellandi, M. Belletti, Belmonte Cuenca, J. Benitez-Cano, A. Beretta, L. Berger, M. Bergmann, N. Bergmark, Bermudez Lopez, M. Bernotaite, M. Beurskens, C. Bidd, H. Bifulco, F. Bignami, E. Bilic, A. Bilskiene, D. Bischoff, P. Bishop, L. Bjonness, T. Blaylock, H. Blethyn, K. Blincoe, T. Blokhin, I. Blunt, N. Boer, C. Bois, G. Bonicolini, E. Booth, J. Borecka-Kedzierska, M. Borstnar, K. Borys, M. Boselli, E. Bouvet, L. Bouwman, A. Bowen, L. Bowrey, S. Boxall, L. Božić, T. Bradley, T. Branco, T. Brazzi, L. Brazzoni, M. Brear, T. Brogly, N. Brohi, F. Broms, J. Bubliauskas, A. Bucolo, G. E. Buerkle, H. Buggy, D. Buhre, W. Bukauskas, T. Butturini, F. Byttner, Cabrera Díaz, I. Calderon, A. Calhau, R. Callejo, A. Cammu, G. Campesato, M. Can, Ö. S. Candeias, M. Cantor, A. Carise, E. Carmona, C. Carreteiro, J. Carrieri, C. Carter, A. Casal, M. Casanova, I. Cascella, M. Casero, L. M. Casiraghi, G. M. Castelo-Branco, Castro Arranz, C. Cernea, D. D. Cervantes, J. Chandler, B. Charnock, R. Chatzimicali, A. Chinery, E. Chishti, A. Chondhury, P. Christie, E. Christodoudiles, G. Ciardo, S. Cimpeanu, L. Cindea, I. Cinnella, G. Clark, S. Clayton, M. Cocu, S. Collyer, T. Colvin, C. Cope, S. Copeta, F. Copotoiu, S. -M., Correia de Barros, F. Corso, R. M. Cortegiani, A. Costa, G. Cowton, A. Cox, N. Craig, J. Cricca, V. Cronin, J. Cunha, M. Cuomo, A. Curley, K. Czuczwar, M. Dabrowska, D. Damster, Danguy des Déserts, M. Daniliuc, A. Danninger, T. Darwish, I. Dascalu, C. Davies, K. Davies, De Boer, De Flaviis, De Selincourt, G. Deana, C. Debaene, B. Debreceni, G. Dedhia, Delgado Garcia, Della Rocca, G. Delroy-Buelles, L. Desai, T. Dhillon, Di Giacinto, Di Mauro, Diaz Gomez, T. V. Dimitrovski, A. Dinic, V. Dîrzu, D. -S., Divander M. B., Dolinar J., Domingues S., Doolan J., Downes C., Dragoescu N. A., Droc G., Dum E., Dumitrescu A., Duncan L., Dzurňáková P., Eberl S., Edwards J., Edwards M., Ekelund K., Ekengren P., Elghouty E., Ellerkmann R., Ellis H., Elme A., Ernst T., Errando C. L., Estenes S., Ewaldsson C., Farid N., Featherstone J., Febres D., Fedorov S., Feggeler J., Feijten P., Fellmann T., Fernandez Candil, Fernandez Castineira, Fernández Castineira, J. Fernando, A. Ferrando, C. Ferreira, L. Ferreira, P. Feyling, A. Filipescu, D. Fleischer, A. Floris, L. Foerster, U. Fox, B. Franke, U. Frasca, D. Frey, C. Frost, V. Fullin, G. Fumagalli, J. Furneval, J. Fusari, M. Gallacher, S. Galushka, S. Gambale, G. Gambino, I. Garcia-Perez, M. L. Garg, S. Garlak, J. Gavranovic, Z. Gavrilov, R. Gaynor, Gecaj Gashi, A. Georghiou, M. Gerjevic, B. Gferer, G. Giarratano, A. Gibson, A. Gievski, V. Giles, J. Gillberg, L. Gilowska, Gilsanz Rodriguez, F. Gioia, A. Giovannoni, C. Girotra, V. Gkinas, D. Gkiokas, G. Godoroja, D. Goebel, U. Goel, V. Gonzalez, M. Goranovic, T. Gornik-Wlaszczuk, E. Gosavi, S. Gottfridsson, P. Gottschalk, A. Granell, M. Granstrom, A. Grassetto, A. Greenwood, A. Grigoras, I. Grintescu, I. Gritsan, A. Gritsan, G. Grynyuk, A. Guadagnin, G. M. Guarnieri, M. Güçlü, Guerrero Diez, M. Gunenc, F. Günther, U. Gupta, P. Guttenthaler, V. Hack, Y. Hafisayena, A. Hagau, N. Haldar, J. Hales, D. Hancı, V. Hanna-Jumma, S. Harazim, H. Harlet, P. Harper, D. Harris, B. Harvey, O. Hashimi, M. Hawkins, L. Hayes, C. Heaton, J. Heier, T. Helliwell, L. Hemmes, S. Henderson, K. Hermanides, J. Hermanns, Herrera Hueso, B. Hestenes, S. Hettiarachchi, R. Highgate, J. Hodgson, K. Hoelbling, D. Holland, J. Horhota, L. Hormis, A. Hribar, R. Hua, A. Humphreys, S. Humphries, R. Humpliková, S. Hunt, J. Husnain, A. Hussein, A. Hyams, B. Iannuccelli, F. Ilette, K. Ilyas, C. Inan, T. India, I. Ionițăv, V. Irwin, F. Jain, V. Janez, B. Jankovic, R. Jenkins, S. Jenko, M. Jimenez, Jiménez Gomez, B. Joachim, S. Joelsson-Alm, E. John, J. Jonikaite, L. Jovic, M. Jungwirth, B. Junke, E. Kabakov, B. Kadaoui, S. -D., Kanski A., Karadag S., Karbonskiene A., Karjagin J., Kasnik D., Katanolli F., Katsika E., Kaufmann K., Keane H., Kelly M., Kent M., Keraitiene G., Khudhur A., Khuenl-Brady K., Kidd L., King S., Kirchgäßner K., Klancir T., Klucniks A., Knotzer J., Knowlden P., Koers L., Kompan J., Koneti K. K., Kooij F., Koolen E., Koopman - van Gemert, A. W. M. M. Kopp, K. Korfiotis, D. Korolkov, O. Kosinová, M. Köstenberger, M. Kotzinger, O. Kovačević, M. Kranke, P. Kranke, E. Kraus, C. Kraus, S. Kubitzek, C. Kucharski, R. Kucukguclu, S. Kudrashou, A. Kumar, V. Kummen, L. Kunit, C. Kushakovsky, V. Kuvaki, B. Kuzmanovska, B. Kyttari, A. Landoni, G. Lau, G. Lazarev, K. Legett, S. Legrottaglie, A. M. Leonardi, S. Leong, M. Lercher, H. Leuvrey, M. Leva, B. Levstek, M. Limb, J. Lindholm, E. Linton, F. Liperi, C. Lipski, F. Lirk, P. Lisi, A. Lišková, Lluch Oltra, A. Loganathan, V. Lombardi, S. Lopez, Lopez Rodríguez, M. Lorenzini, L. Lowicka, M. Lugovoy, A. Luippold, M. Lumb, A. Macas, A. Macgregor, M. Machado, H. Maciariello, M. Madeira, I. Maitan, S. Majewski, J. Maldini, B. Malewski, G. Manfredini, L. Männer, O. Marchand, B. Marcu, A. Margalef, J. Margarson, M. Marinheiro, L. Markic, Markovic Bozic, J. Marrazzo, F. Martin, Martin Ayuso, M. Martinez, E. Martino, E. A. Martinson, V. Marusic-Gaser, K. Mascarenhas, C. Mathis, C. Matsota, P. Mavrommati, Mazul Sunko, B. McCourt, K. McGill, N. McKee, R. Meço, B. C. Meier, S. Melbourne, S. Melbybråthen, G. Meli, A. Melia, A. Melotti, R. M. Menga, M. R. Mercer, P. Merotra, S. Mescolini, S. Metterlein, T. Michalov, M. Michlig, S. Midgley, S. Milić, M. Milojevic, M. Miñana, A. Minto, G. Mirabella, L. Mirea, L. Mittelstädt, L. Moeglen, A. Moise, A. Mokini, Z. Molin, A. Moltó, L. Monea, M. C. Montalto, F. Montgomery, J. Montgomery, C. Montillo, G. Moore, S. Moore, F. Moreira, Z. Moreno, T. Moreno, R. Moret, E. Moreton, S. Morgan, Moro Velasco, C. Morri, D. Moull, A. Moura, F. Mráz, P. Mrozek, K. Mukhtar, K. Muniyappa, S. 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Ewa, Gosavi, Smita, Gottfridsson, peter, Gottschalk, André, Granell, Manuel, Granstrom, Anna, Grassetto, Alberto, Greenwood, Anna, Grigoras, Ioana, Grintescu, Ioana, Gritsan, Alexey, Gritsan, Galina, Grynyuk, Andriy, Guadagnin, Giovanni Maria, Guarnieri, Marcello, Güçlü, Çiğdem, Guerrero Diez, Maria, Gunenc, Ferim, Günther, Ulf, Gupta, Pawan, Guttenthaler, Vera, Hack, Yvonne, Hafisayena, Ade, Hagau, Natalia, Haldar, Jagannath, Hales, Dawn, Hancı, Volkan, Hanna-Jumma, Sameer, Harazim, Hana, Harlet, Pierre, Harper, Daniel, Harris, Benjamin, Harvey, Orla, Hashimi, Medita, Hawkins, Lesley, Hayes, Conrad, Heaton, Jame, Heier, Tom, Helliwell, Laurence, Hemmes, Sabrine, Henderson, Kate, Hermanides, Jeroen, Hermanns, Henning, Herrera Hueso, Berta, Hestenes, Siv, Hettiarachchi, Roshane, Highgate, Judith, Hodgson, Keith, Hoelbling, Daniel, Holland, Jonathan, Horhota, Lucian, Hormis, Anil, Hribar, Renata, Hua, Alina, Humphreys, Sally, Humphries, Ryan, Humpliková, Simona, Hunt, Janez, Husnain, 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Marku, Kotzinger, Oskar, Kovačević, Marko, Kranke, Peter, Kranke, Eva, Kraus, Christiane, Kraus, Stephanie, Kubitzek, Christiane, Kucharski, Rafal, Kucukguclu, Semih, Kudrashou, Allaksandr, Kumar, Vinayak, Kummen, Live, Kunit, Cornelia, Kushakovsky, Vlad, Kuvaki, Bahar, Kuzmanovska, Biljana, Kyttari, Aikaterina, Landoni, Giovanni, Lau, Gary, Lazarev, Konstantin, Legett, Samantha, Legrottaglie, Anna Maria, Leonardi, Silvia, Leong, Maria, Lercher, Helene, Leuvrey, Matthieu, Leva, Brigitte, Levstek, Meta, Limb, Jame, Lindholm, Espen, Linton, Fiona, Liperi, Corradero, Lipski, Fabian, Lirk, Philipp, Lisi, Alberto, Lišková, Katarina, Lluch Oltra, Aitana, Loganathan, Vinothan, Lombardi, Stefania, Lopez, Eloisa, Lopez Rodríguez, Maria, Lorenzini, Laura, Lowicka, Malgorzata, Lugovoy, Alexander, Luippold, Madeleine, Lumb, Andrew, Macas, Andriu, Macgregor, Mark, Machado, Humberto, Maciariello, Maria, Madeira, Isabel, Maitan, Stefan, Majewski, Jacek, Maldini, Branka, Malewski, Georgia, Manfredini, Livia, Männer, Olja, Marchand, Bahareh, Marcu, Alexandra, Margalef, Jordi, Margarson, Michael, Marinheiro, Lucia, Markic, Ana, Markovic Bozic, Jasmina, Marrazzo, Francesco, Martin, Jane, Martin Ayuso, Maria, Martinez, Esteher, Martino, Enrico Antonio, Martinson, Victoria, Marusic-Gaser, Katarina, Mascarenhas, Catia, Mathis, Cindy, Matsota, Paraskevi, Mavrommati, Eleni, Mazul Sunko, Branka, McCourt, Killian, McGill, Neil, McKee, Raymond, Meço, Başak Ceyda, Meier, Sonja, Melbourne, Susan, Melbybråthen, Grethe, Meli, Andrea, Melia, Aiden, Melotti, Rita Maria, Menga, Maria Rosaria, Mercer, Pauline, Merotra, Susan, Mescolini, Silvia, Metterlein, Thoma, Michalov, Martin, Michlig, Sam, Midgley, Susan, Milić, Morena, Milojevic, Milan, Miñana, Amanda, Minto, Gary, Mirabella, Lucia, Mirea, Liliana, Mittelstädt, Ludger, Moeglen, Aude, Moise, Alida, Mokini, Zhirajr, Molin, Anna, Moltó, Lui, Monea, Maria Concetta, Montalto, Francesca, Montgomery, Jane, Montgomery, Claire, Montillo, Gerardo, Moore, Sally, Moore, Faye, Moreira, Zelia, Moreno, Tania, Moreno, Ricardo, Moret, Enrique, Moreton, Sarah, Morgan, Marianne, Moro Velasco, Concepción, Morri, Davide, Moull, Alice, Moura, Fernando, Mráz, Peter, Mrozek, Katarzyna, Mukhtar, Karim, Muniyappa, Sudeshkumar, Murray, Heather, Murthy, Burra VS, Mushambi, Mary, Nadolski, Maria, Nardelli, Pasquale, Nardin, Giordano, Navarro Pérez, Rosalía, Naveiro, Andrea, Negri, Manuela, Nesek Adam, Visnja, Neskovic, Vojislava, Neuwersch, Stefan, Neves, Miriam, Nguyen, Bavinh, Ní Eochagáin, Aisling, Nicholas, Caroline, Nightingale, Jeremy, Norrie, Kylie, Novak-Jankovic, Vesna, Novakova, Andrea, Novillo, Marta, Numan, Sandra, Oduro-Dominah, Louise, Oldner, Ander, Oliveira, Isabel, Ologoiu, Daniela, Oloktsidou, Irini, O'Reilly, Rosalind, Orlando, Alessandro, Ovezov, Alexey, Ozbilgin, Sule, Paal, Peter, Padin Barreiro, Lidia, Palugniok, Ryszard, Papaioannou, Alexandra, Papapostolou, Konstantino, Paranthaman, Prabhakar, Pardey Bracho, Gilda, Parente, Suzana, Parfeni, Alexandru, Pasin, Laura, Passey, Samuel, Pastor, Ernesto, Patch, Sarah, Patil, Andan, Paunescu, Marilena-Alina, Pehboeck, Daniel, Pereira, Manuela, Pereira, Carla, Perez Caballero, Paula, Pérez García, Aníbal, Pérez Soto, Antonia, Perez Tejero, Gisela, Perez-Cerda, Francisco, Pesenti, Antonio, Petta, Rocco, Philippe, Simon, Pickering, David, Pico Veloso, Jandro, Pina, Pedro, Pinho-Oliveira, Vítor, Pinol, Santiago, Pinto, Rita, Pistidda, Laura, Pitterle, Manuela, Piwowarczyk, Paweł, Plotnikova, Olga, Pohl, Holger, Poldermann, Jorinde, Polkovicová, Lucia, Pompei, Livia, Popescu, Mihai, Popović, Radmila, Pota, Vincenzo, Potocnik, Miriam, Potręć, Beata, Potter, Alison, Pramod, Nalwaya, Prchalova, Martina, Preckel, Benedikt, Pugh, Richard, Pulletz, Mark, Radoeshki, Aleksandar, Rafi, Amir, Ragazzi, Riccardo, Raineri Santi, Maurizio, Rajamanickam, Tamiselvan, Rajput, Zahra, Ramachandran, Rajeskar, Ramasamy, Radhika, Ramessur, Suneil, Rao, Roshan, Rasmussen, Ander, Rato, André, Razaque, Usman, Real Navacerrada, M. 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Agostina, Wade, Andrew, Wallberg, Hanna, Wallden, Jakob, Wallner, Johann, Walther Sturesson, Louise, Watson, Davina, Weber, Stefan, Wegiel Leskiewiq, Anna, Weller, Debbie, Wensing, Carine, Werkmann, Marku, Westberg, Henrik, Wikström, Erik, Williams, Benedict, Wilson, Robin, Wirth, Steffen, Wittmann, Maria, Wood, Laura, Wright, Stella, Zachoval, Christian, Zambon, Massimo, Zampieri, Silvia, Zampone, Salvatore, Zangrillo, Alberto, Zani, Gianluca, Zavackiene, Asta, Zieglerder, Raphael, Zonneveldt, Harry, Zsisku, Lajo, Zucker, Tom-Philipp, Żukowski, Maciej, Zuleika, Mehrun, and Zupanĕiĕ, Darja

Subjects
Pulmonary and Respiratory Medicine, pulmonary complications, muscle relaxants, Post-anaesthesia complications, Neuromuscular Blockade, pulmonary complication, muscle relaxant, neuromuscular block, postoperative pulmonary complication, business.industry, Retrospective cohort study, post-operative pulmonary complications, Neuromuscular monitoring, Neuromuscular Blocking Agents, Sugammadex, NO, Anaesthesia, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Anesthesia, Medicine, General anaesthesia, Neuromuscular Agents, 030212 general & internal medicine, MED/41 - ANESTESIOLOGIA, Prospective cohort study, business, medicine.drug
Abstract

Background: Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods: We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings: Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj −4·4%, 95% CI −5·5 to −3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj −2·6%, 95% CI −3·9 to −1·4) and the administration of reversal agents (1·23, 1·07–1·41; −1·9%, −3·2 to −0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj −0·3%, 95% CI −2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; −0·4%, −3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation: We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications. Funding: European Society of Anaesthesiology.

Published
2019
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48. Facilitating facilitators to facilitate-Some general comments on a strategy for knowledge implementation in health services.

Author

Eldh AC, Hälleberg-Nyman M, Joelsson-Alm E, and Wallin L

Abstract

Numerous endeavours to ensure that day-to-day healthcare is both evidence-based and person-centred have generated extensive, although partial, comprehension of what guarantees quality improvement. To address quality issues, researchers and clinicians have developed several strategies as well as implementation theories, models, and frameworks. However, more progress is needed regarding how to facilitate guideline and policy implementation that guarantees effective changes take place in a timely and safe manner. This paper considers experiences of engaging and supporting local facilitators in knowledge implementation. Drawing on several interventions, considering both training and support, this general commentary discusses whom to engage and the length, content, quantity, and type of support along with expected outcomes of facilitators' activities. In addition, this paper suggests that patient facilitators could help produce evidence-based and person-centred care. We conclude that research about the roles and functions of facilitators needs to include more structured follow-ups and also improvement projects. This can increase the speed of learning with respect to what works, for whom, in what context, why (or why not), and with what outcomes when it comes to facilitator support and tasks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Eldh, Hälleberg-Nyman, Joelsson-Alm and Wallin.)

Published
2023
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49. [Mobile intensive care group for better patient monitoring and secure personnel].

Author

Nordlund K and Joelsson-Alm E

Subjects
Attitude of Health Personnel, Critical Pathways, Humans, Inservice Training, Interprofessional Relations, Monitoring, Physiologic methods, Monitoring, Physiologic standards, Patient Care Team organization & administration, Program Evaluation, Quality Assurance, Health Care, Surveys and Questionnaires, Workforce, Critical Care organization & administration, Emergency Service, Hospital organization & administration, Intensive Care Units organization & administration
Published
2009

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