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  • 1. Antonsson, Ann-Christin
    et al.
    Sandström, Birgitta
    Reflektion: kärnan i omvårdnadshandledning2000In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 20, no 4, p. 38-41Article in journal (Refereed)
    Abstract [en]

    The nursingprofession is demanding and variable; nurses must have knowledge and proficiency practically, technically and be able to teamwork in the relation with all kinds of patients. At the same time they should perform nursing according to science and tried practice. One way to develop the engagement in patients and bring new knowledge into nursing is to participate in clinical supervision. The aim of the present study was to find out how nurses in somatic care describes what they learn and how knowledge integrates and develops in clinical supervision. Eight nurses were interviewed and their responses were taped, written down word for word and analysed according to a qualitative approach. The results shows that practically all knowledge were integrated by reflection. With the help of reflection the nurses could be taught by each others experiences, develop nursing and become skilful nurses.

  • 2.
    von Vogelsang, Ann-Christin
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm.
    Impact on life after intracranial aneurysm rupture: health-related quality of life and epidemiologic outcomes2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to describe impact on life up to ten years after intracranial aneurysm rupture in terms of health-related quality of life, changes in everyday life and descriptive epidemiology with the intention to contribute to an increased understanding of the long-term perceived consequences of that impact.

    Study I aimed to describe changes and transitions in everyday life during the first two years following an intracranial aneurysm rupture. A consecutive sample of 88 patients was followed-up at three time points. A majority of respondents perceived changes in their everyday life during the first two years following aneurysm rupture. Transitions were revealed within changes in personality, changed social roles and relationships, and changed abilities and behavior.

    In Study II epidemiology in relation to gender differences and treatment modalities ten years after aneurysm rupture was investigated. Ten years after the onset, 63.9% of the 468 admitted patients were still alive. The incidence in women was higher than that of men; they were older at onset and were diagnosed with more aneurysms. There were no significant differences in survival times between patients treated with different active aneurysm treatments, or between men and women.

    In Study III survivors from study II (n=217) were followed-up with questionnaires and telephone interviews, aiming to describe psychological, physical and cognitive functions ten years after intracranial aneurysm rupture. Compared to reference groups, the aneurysm respondents scored higher levels of anxiety and depression. Respondents with ruptured aneurysms in the posterior circulation of the brain scored significantly more symptoms of anxiety and depression. A small proportion, 2.8%, scored for severe physical disability and 21.7% scored below the cut-off value, indicating cognitive impairments.

    Study IV used the same sample as study III (n=217), and a general population sample (n=434) from the Stockholm Public Health Survey, matched by age and sex. The aim was to measure health-related quality of life (HRQoL), and to explore factors affecting HRQoL, ten years after intracranial aneurysm rupture. Compared to general population, the aneurysm sample reported significantly more problems with mobility, self-care, usual activities and anxiety/depression and had significantly lower overall HRQoL values. HRQoL in the aneurysm sample was most affected in respondents with worse neurological outcome, respondents with comorbidities, and respondents with low perceived recovery.

    In conclusion, intracranial aneurysm ruptures impacts upon life in several ways for an extensive period of time after the onset. The results indicate a need for follow-up and support, and to identify subgroups of aneurysm patients who might benefit from support: patients with ruptured aneurysms in the posterior circulation of the brain; patients with worse neurological outcome at hospital discharge; patients with comorbidities; and patients with low perceived recovery. Ten years after the onset of aneurysm rupture the majority of patients were still alive. Differences between men and women were apparent in incidence and clinical presentation at the onset of aneurysm rupture, not in survival times. Survival time was equal between patients within active treatment modalities.

  • 3. von Vogelsang, Ann-Christin
    Perioperativ neurokirurgisk vård2007In: Neurokirurgisk vård / [ed] Anna Blommengren & Birgitta Ohlgren (red.), Lund: Studentlitteratur, 2007, p. 247-256Chapter in book (Other academic)
  • 4.
    von Vogelsang, Ann-Christin
    et al.
    Red Cross University College of Nursing. Department of Neurobiology, Care Sciences, and Society, Karolinska Insitutet, Stockholm.
    Burström, Kristina
    Wengström, Yvonne
    Svensson, Mikael
    Forsberg, Christina
    Health-Related Quality of Life 10 Years After Intracranial Aneurysm Rupture: A Retrospective Cohort Study Using EQ-5D2013In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 72, no 3, p. 397-405Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experiencing an aneurysmal subarachnoid hemorrhage (SAH) could affect health-related quality of life (HRQoL) several years after the onset. Long-term studies are scarce, and there is a lack of knowledge of whether HRQoL is affected > 5 years after the onset and, if so, in what dimensions. In the general population, HRQoL decreases with age and with the occurrence of a disease and differs between sexes. Factors that may influence HRQoL after aneurysmal SAH include neurological outcome, perceived recovery, aneurysm treatment, and family support.

    OBJECTIVE: To measure HRQoL and to explore factors affecting HRQoL 10 years after aneurysmal SAH.

    METHODS: A consecutive sample of all patients admitted for intracranial aneurysm rupture at a neurosurgical clinic in Stockholm (n = 217, 79.5% of eligible) were followed up from 2007 to 2008, approximately 10 years after aneurysm rupture. HRQoL was measured with EQ-5D, and the results were compared with a general population sample from the Stockholm Public Health Survey 2006 matched by age and sex.

    RESULTS: Compared with the general population, the aneurysm sample reported significantly more problems in 4 of 5 EQ-5D dimensions—mobility, self-care, usual activities, and anxiety/depression—and had significantly lower EQ-5Dindex and EQ visual analog scale values. Within the aneurysm sample, HRQoL was most affected in respondents with worse Glasgow Outcome Scale values at hospital discharge, respondents with comorbidities, and respondents with low perceived recovery.

    CONCLUSION: Aneurysmal SAH affects HRQoL to a large extent, even 10 years after the onset, indicating a need for long-term follow-up and support after the onset

  • 5.
    von Vogelsang, Ann-Christin
    et al.
    Red Cross University College of Nursing. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Svensson, Mikael
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Forsberg, Christina
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Cognitive, Physical, and Psychological Status After Intracranial Aneurysm Rupture: A Cross-Sectional Study of a Stockholm Case Series 1996 to 19992013In: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 79, no 1, p. 130-135Article in journal (Refereed)
    Abstract [en]

    Objective

    We sought to (1) describe psychological, physical, and cognitive functions in patients 10 years after intracranial aneurysm rupture and (2) identify any differences in outcome variables between age groups, gender or aneurysm locations.

    Methods

    A consecutive sample of patients (n = 217) treated for intracranial aneurysm rupture at a neurosurgical clinic in Stockholm, Sweden, were followed-up in a cross-sectional design 10.1 years after the onset with questionnaires and telephone interviews. The outcome measures were psychological functions in terms of symptoms of anxiety or depression and physical and cognitive functions.

    Results

    Compared with the reference groups, the aneurysm patients scored greater levels of anxiety and depression than normal values. Patients with aneurysm rupture in the posterior circulation scored significantly more problems with anxiety and depression. Only 2.8% of the patients scored for severe physical disability. On a group level, cognition was lower than normal population levels; 21.7% of respondents scored below the cut-off value, indicating cognitive impairments.

    Conclusions

    Ten years after aneurysm rupture the majority of patients seem to be well-functioning physically, whereas the psychological and cognitive functions are affected. A screening of the mental health of these patients in connection to radiological follow-up might be helpful to identify which patients need further referral to psychiatric treatment for anxiety and depression disorders.

  • 6.
    von Vogelsang, Ann-Christin
    et al.
    Department of Neurosurgery, Karolinska University Hospital, SE-171 76 Stockholm.
    Wengström, Yvonne
    Forsberg, Christina
    Patient information after ruptured intracranial aneurysm rupture2004In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 48, no 6, p. 551-559Article in journal (Refereed)
    Abstract [en]

    Aim.  This paper reports an investigation into the effects of increased information for patients treated for intracranial aneurysm rupture.

    Background.  Intracranial aneurysm rupture is a grave condition that requires immediate care. It can be treated in two different ways, by surgery or by endovascular procedure. Intracranial aneurysm rupture can mean great changes in life, both for the patient and their spouse or relatives.

    Methods.  An intervention study was conducted using a quasi-experimental design. Participants were recruited consecutively over a period of 12 months and consisted of 62 patients treated for intracranial aneurysm rupture at a Swedish neurosurgical clinic. They were divided into two groups: an intervention group, who received written and oral information, and a comparison group, who received only oral information.

    Instruments.  Self-report questionnaires were sent to patients’ homes 1–3 months after the aneurysm rupture. The questionnaires consisted of one study-specific instrument with questions about understanding of the information given and the State-Trait Anxiety Inventory, which measures worry or anxiety.

    Findings.  The intervention group considered that the information that they received was somewhat easier to understand and that it corresponded more closely to their needs, compared with the comparison group. The majority of patients in both groups expressed a need for more and improved information. Levels of anxiety were high for the majority of patients, but no significant difference was evident between groups. Furthermore, the results showed that the majority of patients were given information without their spouse or relatives being present.

    Conclusion.  Increased information seems to be needed for these patients. There is a need to continue the work to improve information-giving to them and their relatives.

  • 7.
    von Vogelsang, Ann-Christin
    et al.
    Red Cross University College of Nursing. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Svensson, Mikael
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.
    Forsberg, Christina
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Descriptive Epidemiology in Relation to Gender Differences and Treatment Modalities 10 Years After Intracranial Aneurysm Rupture in the Stockholm Cohort 1996–19992013In: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 80, no 3-4, p. 328-334Article in journal (Refereed)
    Abstract [en]

    Objective

    To describe epidemiology in relation to gender differences and treatment modalities 10 years after intracranial aneurysm rupture in the Stockholm cohort 1996–1999.

    Methods

    A total of 468 consecutive patients with aneurysmal subarachnoid hemorrhage were followed-up in a retrospective cohort design 10 years after rupture. Information on medical history, clinical variables, and treatments were obtained from patient records. Causes of death were obtained from patient records and The Swedish Cause of Death Register. Incidence of ruptured aneurysms per 100,000 people were calculated from male, female, and overall population data per year from 1996–1999.

    Results

    Ten years after aneurysm rupture 63.9% (n = 296) of patients were still alive. The overall 28-day case fatality was 19.4%; most often deaths were due to the initial hemorrhage. There were no significant differences in survival time between patients treated with clipping (8.4 years, 95% confidence interval 8.1–8.8), compared with endovascularly treated patients (8.2 years, 95% confidence interval 7.4–9.1) (log rank P = 0.550). The female incidence was higher than that of men, and women were significantly older at the onset of aneurysm rupture (55.7 vs. 52.8 years, P = 0.027).

    Conclusions

    Ten years after rupture, most treated patients were still alive. The mortality was highest in the first month after rupture, due to the initial hemorrhage. Gender differences were apparent in incidence, but 10 years after the rupture mortality rates and survival times were equal between men and women. Survival time was equal between patients within active treatment modalities.

  • 8.
    von Vogelsang, Ann-Christin
    et al.
    Red Cross University College of Nursing. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Svensson, Mikael
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.
    Forsberg, Christina
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Transitional experiences in patients following intracranial aneurysm rupture2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 9-10, p. 1263-1273Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    To describe changes and transitions in everyday life in the first two years following an intracranial aneurysm rupture.

    Background

    An intracranial aneurysm rupture causes a haemorrhagic stroke, and the physical and mental consequences of this condition are numerous and complex. In Sweden, some, but not all, patients receive rehabilitation for this condition. Patients with this type of stroke are not included in the national stroke registry; thus, information on the recovery period for these particular patients is lacking.

    Design

    A longitudinal mixed methods study design was used.

    Methods

    The sample was consecutive and consisted of 88 patients (84·6% of 104 eligible), acutely admitted to a neurosurgical clinic in Stockholm for intracranial aneurysm rupture. Data were collected through a postal study-specific questionnaire at 6 months, 1 year and 2 years postaneurysm rupture. Intramethod mixing was used in the data collection, and quantitative and qualitative data were analysed parallel with statistical and qualitative content analysis.

    Results

    A majority of participants perceived changes in their everyday lives during the first two years following aneurysm rupture, and the changes were ongoing with little differences reported between 6 months and 2 years after the onset. Internal changes, or transitions, were revealed within changes in personality, changed social roles and relationships and changed abilities and behaviour.

    Conclusions

    Recovering from an intracranial aneurysm rupture involves a period of intense changes and transitions, a vulnerable period for many people that may be made easier to manage by the intervention of nurses.

    Relevance to clinical practice

    Patients experiencing transitions in the recovery period after intracranial aneurysm rupture may benefit from nursing interventions that support them through the transitional process. Nurse-led follow-up care by a specialist nurse from the neurosurgical clinic may be a possible way to provide support.

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