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BACKGROUND: Stroke is the disease with the highest costs for hospital care and also after discharge. Early supported discharge (ESD) has shown to be efficient and safe and the best results with well-organised discharge teams and patients with less severe strokes. The aim is to investigate if very early supported discharge (VESD) for stroke patients in need for on-going individualised rehabilitation at home is useful for the patient and cost effective. METHODS/DESIGN: A randomized controlled trial comparing VESD with ordinary discharge. Inclusion criteria: confirmed stroke, >18 years of age, living within 30 min from the stroke unit, on day 2 0-16 points on the National institute of health stroke scale (NIHSS) and 50-100 points on the Barthel Index (BI), with BI 100 then the patient can be included if the Montreal Cognitive Assessment is < 26. Exclusion criteria are: NIHSS >16, BI < 50, life expectancy < 1 year, inability to speak or to communicate in Swedish. The inclusion occurs on day 4 and in block randomization of 20 and with blinded assessor. Primary outcome: levels of anxiety and depression. Secondary outcomes: independence, security, level of function, quality of health, needs of support in activities of daily living and caregiver burden. Power calculation is based on the level of anxiety and with a power of 80%, p-value 0.05 (2 sided test) 44 persons per group are needed. Data is gathered on co-morbidity, re-entry to hospital, mortality and a health economic analysis. Interviews will be accomplished with a strategic sample of 15 patients in the intervention group before discharge, within two weeks after homecoming and 3 months later. Interviews are also planned with 15 relatives in the intervention group 3 months after discharge. DISCUSSION: The ESD studies in the Cochrane review present hospital stays of a length that no longer exist in Sweden. There is not yet, to our knowledge, any study of early supported discharge with present length of h

Aim To describe the experiences of children and adolescents being screened positive for hypertrophic cardiomyopathy and how this impacts their daily life. BACKGROUND: Hypertrophic cardiomyopathy is a hereditary disease and the most common medical cause of sudden death in childhood and adolescence. This is the reason for recommending screening in children with an affected first-degree relative. A diagnosis of hypertrophic cardiomyopathy implies lifestyle modifications, restrictions that may bring profound changes to the daily life of the affected individual. DESIGN: This is a descriptive qualitative interview study. METHODS: We interviewed 13 asymptomatic children or adolescents diagnosed with hypertrophic cardiomyopathy through family screening 12-24 months after the diagnosis. Analysis was conducted with qualitative content analysis. RESULTS: Children described an involuntary change, which affected their daily life with limitations and restrictions in life, both in the individual and social context. Lifestyle recommendations had the most severe impact on daily life and affected their social context. They tried to navigate in a world with new references, and after reorientation they felt hope and had faith in the future. CONCLUSIONS: Children diagnosed with hypertrophic cardiomyopathy through family screening went through an involuntary change resulting in limitations and restrictions in life. This study indicates that there is a need for support and that healthcare professionals have to consider the specific needs in these families. Our findings thus give guidance in how best to improve support to the patients and their family. Diagnosis in asymptomatic children should be accompanied by ideally multi-professional follow-up, focusing not only on medical issues.

BACKGROUND: Hypertrophic cardiomyopathy is hereditary and the commonest medical cause of sudden death in childhood and adolescence, which is the reason for recommending screening in children with an affected parent. A diagnosis of hypertrophic cardiomyopathy implies lifestyle modifications, restrictions that may bring profound changes to the affected individual and impacts on the whole family. OBJECTIVE: To describe parents' experiences of how the diagnosis of hypertrophic cardiomyopathy in their child affects daily life. METHOD: Twelve parents with asymptomatic children diagnosed with hypertrophic cardiomyopathy through family screening were interviewed 12-24 months after the diagnosis. Analysis was conducted with qualitative content analysis. RESULTS: Parents described the immediate reaction of shock, grief, and injustice but were also grateful that the child was still asymptomatic. The diagnosis caused a significant change in lifestyle for most families due mainly to restrictions of sports activities. Parents had to adapt to the new life and develop strategies to protect their child. Death became a reality causing feelings of vulnerability. Regular medical check-ups and access to the liaison nurse were described as important factors of reassurance. CONCLUSIONS: Parents experienced early diagnosis as positive in a long-term perspective. The main changes perceived were ascribed to lifestyle modifications. Parents with athletic children experienced the lifestyle modifications as more severe. They strived to create a new life where they could feel secure and have faith in the future, and emphasised the need of regular follow-up and support from health care professionals as "mental pain relief", which helped them achieve a new state of normality.

Purpose: To investigate cardiovascular nurses' experiences of and attitudes towards the presence of family members during resuscitation of adult patients. Methods: A 36-item questionnaire exploring the experiences of and attitudes towards family members being present in the resuscitation room was distributed to a convenience sample of nurses attending three national and one international cardiovascular nursing conferences held in Europe during 2007. Results: Of 820 questionnaires distributed, 411(50%) completed ones were returned. Of these 411 respondents, 178 (44%) had experienced at least one situation of families being present. Positive (23%) and negative (21%) experiences of family presence were equally distributed. Only 28 (7%) respondents stated that their unit had a protocol covering family presence. Nurses in Ireland (n=30; 59%) and the UK (n=18; 55%) were most likely to have experienced family presence and protocols relating to this were most commonly found in the UK (n=4; 14%). Conclusion: Less than half of the included European cardiovascular nurses had experienced a situation of families being present during resuscitation and protocols pertaining to this were rare. There was no clear attitude towards family presence, though experience in nursing made nurses more favourable towards it.

In the case of an out-of-hospital cardiac arrest (OHCA) the influence of a bystander spouse is decisive for the chance of survival. The aim was to describe spouses' experiences of witnessing their partners' cardiac arrest at home, focusing on the time before the event and when it happened. Methods: Fifteen spouses were interviewed. The interviews were recorded and verbatim transcribed. Qualitative content analysis was conducted. Results: In the domain entitled “Time before cardiac arrest”, four themes emerged in the analysis process: “Lack of early warning signs”, “Difficulty interpreting early warning signs”, “Interpreting signs in the light of previous illness” and “Denial of serious illness”. In the domain entitled “The cardiac arrest event”, three themes emerged: “Perceiving the seriousness”, “Being unable to influence” and “Doing what is in one's power”. The emergency call services' (ECS) ability to instruct and help the spouses to do what they can becomes evident in these themes. Conclusion: Spouses who experienced an out-of-hospital-cardiac arrest demonstrated a lack of confidence in or ability to interpret early warning signs and symptoms. This lack of confidence also extended to the process of cardiopulmonary resuscitation (CPR). The support from the ECS and CPR training was acknowledged as helpful and important. Further research is required to determine which interventions can improve people's ability to intervene as early as possible.

Background: Family presence (FP) in the resuscitation room is still controversial, and its appropriateness for patient and family has been discussed. We examined both positive and negative experiences in order to establish the reasons for the difference. Aim: The aim of the present literature review was to describe patients', relatives' and staff's opinions and experiences of FP during invasive procedures and resuscitation. Method: 12 original papers, published between January 1995 and February 2003, were reviewed. Most patients and relatives agreed that they had positive experiences of FP. They described how FP enhanced the feeling of support and connectedness within the family. Family members believed that FP helped them in their grieving process. Most staff members without FP experience felt that FP would increase the risk of psychological distress for the family. Those who had participated in an FP programme believed that FP was not only beneficial for the family but also for staff. Conclusion: Family presence during resuscitation and acute care has the potential to enhance the care of the patient and to benefit everyone involved. However, implementation of FP during resuscitation must take account of potential problems.

Since it is suggested that only effective cardiopulmonary resuscitation (CPR) improves survival rates, quality control of training outcomes is important and comparisons between different training methods are desirable. The aim of this study was to test a model of quality assurance, consisting of a computer program combined with the Brennan et al. checklist, for evaluation of CPR performance. A small group of trained medical professionals (cardiac care unit nurses) (n = 10) was used in this pilot study. The result points out several points of concern: half of the participants did not open the airway prior to breathing control. Over 90% of all inflations were ‘too fast’ and 71% were ‘too much’. Only 6.5% of the inflations were correct. On average, the participants made 5.4 inflations per minute. Concerning chest compressions, 40% were ‘too deep’ while only 4% were ‘too shallow’. In spite of the fact that the participants had an average rate at 95 compressions per minute the number of compressions varied between 32 and 51 during 1 minute. When new guidelines are discussed, it would be beneficial if they were tested by a number of people to investigate if following the guidelines is at all possible. © 2001 Lippincott Williams & Wilkins, Inc.