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Stenberg, J., Melin, J., Lindberg, M. & Furuland, H. (2019). Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients. Hemodialysis International, 23(3), 402-413
Open this publication in new window or tab >>Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients
2019 (English)In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 23, no 3, p. 402-413Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Fluid management in hemodialysis patients is a controversial topic. Brain natriuretic peptide (BNP) is secreted from the heart in response to volume overload, and may be a marker of overhydration in hemodialysis patients. Our aim was to investigate the correlation between BNP and overhydration in a cohort of hemodialysis patients, and to find out whether BNP and overhydration correlate in repeated measurements within individuals with elevated BNP.

METHODS: The study was prospective, observational, and had a cross-sectional part and a longitudinal follow-up. The distribution of BNP was investigated in a cohort of 64 hemodialysis patients. Blood samples and bioimpedance spectroscopy measurements were performed before midweek dialysis. Subsequently, 11 study participants with elevated BNP concentrations (>500 pg/mL) were assessed in another nine dialysis sessions each. These individuals also had their cardiac function and heart rate variability (HRV) examined.

FINDINGS: BNP was above 500 pg/mL in 38% of the participants, and correlated positively with overhydration (rs = 0.381), inflammation and malnutrition, but not with systolic blood pressure. In comparison to participants with BNP below 500 pg/mL, participants with elevated BNP were older, had lower muscle strength, lower bodyweight and lower levels of hemoglobin and albumin. Echocardiography revealed cardiac anomalies in all 11 participants in the longitudinal follow-up, and HRV, as measured by SDNN, was pathologically low. In repeated measurements, the between-individuals variation of BNP in relation to overhydration was greater (SD = 0.581) than the within-person variation (SD = 0.285).

DISCUSSION: BNP correlates positively to overhydration, malnutrition, and inflammation. In a subgroup of patients with elevated BNP, who are mainly elderly and frail, BNP reflects individual variation in hydration status, and hence seems to be a modifiable marker of overhydration. These data suggest that BNP is best applied for measuring changes in hydration status within an individual over time.

Keywords
Fluid overload, bioimpedance, brain natriuretic peptide (BNP), hemodialysis, repeated measurements
National Category
Hematology
Identifiers
urn:nbn:se:hig:diva-30486 (URN)10.1111/hdi.12751 (DOI)000475503700025 ()30848066 (PubMedID)2-s2.0-85062773458 (Scopus ID)
Note

Funding:

- CUWX Counties Renal Patients' Foundation- Signe and Olof Wallenius Foundation- Uppsala County Council 

Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-12Bibliographically approved
Willmer, M., Westerberg Jacobson, J. & Lindberg, M. (2019). Exploratory and Confirmatory Factor Analysis of the 9-Item Utrecht Work Engagement Scale in a Multi-Occupational Female Sample: A Cross-Sectional Study. Frontiers in Psychology, 10, Article ID 2771.
Open this publication in new window or tab >>Exploratory and Confirmatory Factor Analysis of the 9-Item Utrecht Work Engagement Scale in a Multi-Occupational Female Sample: A Cross-Sectional Study
2019 (English)In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, article id 2771Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of the present study was to use exploratory and confirmatory factor analysis (CFA) to investigate the factorial structure of the 9-item Utrecht work engagement scale (UWES-9) in a multi-occupational female sample.

Methods: A total of 702 women, originally recruited as a general population of 7–15-year-old girls in 1995 for a longitudinal study, completed the UWES-9. Exploratory factor analysis (EFA) was performed on half the sample, and CFA on the other half.

Results: Exploratory factor analysis showed that a one-factor structure best fit the data. CFA with three different models (one-factor, two-factor, and three-factor) was then conducted. Goodness-of-fit statistics showed poor fit for all three models, with RMSEA never going lower than 0.166.

Conclusion: Despite indication from exploratory factor analysis (EFA) that a one-factor structure seemed to fit the data, we were unable to find good model fit for a one-, two-, or three-factor model using CFA. As previous studies have also failed to reach conclusive results on the optimal factor structure for the UWES-9, further research is needed in order to disentangle the possible effects of gender, nationality and occupation on work engagement.

National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hig:diva-31281 (URN)10.3389/fpsyg.2019.02771 (DOI)
Available from: 2019-12-12 Created: 2019-12-12 Last updated: 2019-12-13Bibliographically approved
Lindberg, M., Skytt, B. & Lindberg, M. (2019). Perceptions of infection control practices and the use of vignettes to alter infection control behavior: A feasibility study: Infection control practices. Florence Nightingale Journal of Nursing, 27(3), 231-240
Open this publication in new window or tab >>Perceptions of infection control practices and the use of vignettes to alter infection control behavior: A feasibility study: Infection control practices
2019 (English)In: Florence Nightingale Journal of Nursing, ISSN 2147-4923, Vol. 27, no 3, p. 231-240Article in journal (Refereed) Published
Abstract [en]

Aim: To explore the perceptions of infection control practices among healthcare personnel and evaluate the use of authentic vignettes as a means to alter infection control behavior.

Method: Four authentic vignettes were used as a part of reflective dialogues with healthcare personnel. An evaluation of the dialogues was performed with six healthcare personnel using the focus group technique. Qualitative content analysis was used to analyze the data.

Results: The mind-set to help one another and do one’s best in every situation was described as a core aspect in preventing the transmission of microorganisms. Having support, taking personal responsibility, being knowledgeable about infection control practices, and having a reasonable workload were seen to play decisive roles in controlling the spread of infection. Discussing authentic comprehensible vignettes with colleagues during the allotted time was considered a valuable method for improving infection control practices.

Conclusion: Meaningful insights on how best to use vignettes as a means to improve infection control practice were gained. These findings should be considered when designing theory-driven interventions in different contexts, which are aimed at improving infection control practices in health care.

Place, publisher, year, edition, pages
Istanbul: Istanbul University-Cerrahpaşa, 2019
Keywords
Feasibility test, healthcare-associated infection, healthcare personnel behavior, infection control practices, qualitative research
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-30704 (URN)10.5152/FNJN.2019.19005 (DOI)
Available from: 2019-09-27 Created: 2019-09-27 Last updated: 2019-11-28Bibliographically approved
Westergren, E., Ludvigsen, M. S. & Lindberg, M. (2019). Prevalence of musculoskeletal complaints among haemodialysis nurses – a comparison between Danish and Swedish samples. International Journal of Occupational Safety and Ergonomics
Open this publication in new window or tab >>Prevalence of musculoskeletal complaints among haemodialysis nurses – a comparison between Danish and Swedish samples
2019 (English)In: International Journal of Occupational Safety and Ergonomics, ISSN 1080-3548, E-ISSN 2376-9130Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose. The repetitiveness of priming and dismantling disposables for haemodialysis treatments might be an important contributor to musculoskeletal complaints. The objective was therefore to compare the prevalence of musculoskeletal complaints among haemodialysis nurses in Denmark and Sweden.

Materials and methods. For this cross-sectional study, nurses were recruited from haemodialysis centres in Denmark (n=194) and Sweden (n=351). Prevalence of musculoskeletal complaints was evaluated using the Nordic Musculoskeletal Questionnaire.

Results and conclusion. The percentage of nurses reporting musculoskeletal complaints from at least one part of their body was 90.2% in the Danish and 88.9% in the Swedish sample. The anatomical locations with the most complaints were the neck, lower back and hands. Except for the proportion of complaints concerning the neck, there were no differences between the countries. Absenteeism from work was mostly due to complaints regarding the hands. The prevalence of musculoskeletal complaints seems to be higher among haemodialysis nurses than among nurses in general. Because complaints concerning the hands are common, and also related to absenteeism from work, it is of particular importance that manufacturers of dialysis equipment and nurse managers acknowledge these occupational health and safety hazards in their efforts to create a good work environment.

Keywords
Work-related musculoskeletal disorders; haemodialysis; nurse; NMQ; prevalence; ergonomics
National Category
Work Sciences
Identifiers
urn:nbn:se:hig:diva-30852 (URN)10.1080/10803548.2019.1688018 (DOI)
Funder
AFA Insurance, 170075University of Gävle, N/A
Available from: 2019-10-30 Created: 2019-10-30 Last updated: 2019-11-28Bibliographically approved
Lindberg, M. (2019). Single-case experimental designs: a clinical research opportunity in renal care. Journal of Renal Care, 45(2), 72-73
Open this publication in new window or tab >>Single-case experimental designs: a clinical research opportunity in renal care
2019 (English)In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686, Vol. 45, no 2, p. 72-73Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Nursing Urology and Nephrology
Identifiers
urn:nbn:se:hig:diva-30526 (URN)10.1111/jorc.12278 (DOI)000468625600002 ()31115184 (PubMedID)2-s2.0-85066092837 (Scopus ID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-20Bibliographically approved
Stenberg, J., Keane, D., Lindberg, M. & Furuland, H. (2019). Systematic fluid assessment in haemodialysis: Development and validation of a decision aid. Journal of Renal Care
Open this publication in new window or tab >>Systematic fluid assessment in haemodialysis: Development and validation of a decision aid
2019 (English)In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: About a third of patients undergoing haemodialysis have poorly controlled fluid status, which may affect survival. Clinical assessment is subjective and imprecise, which has led to the increasing use of devices based on bioimpedance spectroscopy (BIS). However, BIS cannot provide a simple target applicable to all patients. Our aim was to develop and validate a decision aid combining clinical assessment of fluid status with information from BIS in target weight determination.

METHODS: The decision aid was based on empirical experience and a literature review identifying physiological parameters already used in the clinical assessment of fluid status. Content validity was established by patient representatives, interdisciplinary stakeholders and external experts, who assessed item relevance and comprehensiveness. Reliability was assessed by inter-rater agreement analysis between nurses assessing typical patient cases.

RESULTS: The decision aid for Recognition and Correction of Volume Alterations (RECOVA) consists of three parts (1) a scoring system; (2) thresholds and triggers; (3) a decision aid algorithm. Agreement between raters in the assessment of symptoms was almost perfect, with Intraclass Correlation Coefficient > 0.90. Agreement in clinical response was only fair, but increased to moderate, with training and self-reported confidence.

CONCLUSION: RECOVA may enable systematic clinical assessment of fluid status, facilitating early recognition of fluid alterations, and incorporation of bioimpedance into target weight management. However, implementation into clinical practice will require training of staff. Clinical intervention studies are required to evaluate if RECOVA facilitates response to and correction of recognised fluid alterations.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Bioimpedance, Fluid management, Haemodialysis, Overhydration, Validation
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-30913 (URN)10.1111/jorc.12304 (DOI)000493824500001 ()31682083 (PubMedID)2-s2.0-85074763845 (Scopus ID)
Available from: 2019-11-20 Created: 2019-11-20 Last updated: 2019-11-22Bibliographically approved
Lindberg, M. (2018). Evidence-based Renal Care: Does it Matter. Journal of Renal Care, 44(2), 63-64
Open this publication in new window or tab >>Evidence-based Renal Care: Does it Matter
2018 (English)In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686, Vol. 44, no 2, p. 63-64Article in journal, Editorial material (Other academic) Published
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-26540 (URN)10.1111/jorc.12244 (DOI)000431659600001 ()29722205 (PubMedID)2-s2.0-85046335554 (Scopus ID)
Available from: 2018-05-04 Created: 2018-05-04 Last updated: 2018-06-05Bibliographically approved
Stenberg, J., Henriksson, C., Lindberg, M. & Furuland, H. (2018). Perspectives on clinical use of bioimpedance in hemodialysis: focus group interviews with renal care professionals.. BMC Nephrology, 19(1), Article ID 121.
Open this publication in new window or tab >>Perspectives on clinical use of bioimpedance in hemodialysis: focus group interviews with renal care professionals.
2018 (English)In: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 19, no 1, article id 121Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Inadequate volume control may be a main contributor to poor survival and high mortality in hemodialysis patients. Bioimpedance measurement has the potential to improve fluid management, but several dialysis centers lack an agreed fluid management policy, and the method has not yet been implemented. Our aim was to identify renal care professionals' perceived barriers and facilitators for use of bioimpedance in clinical practice.

METHODS: Qualitative data were collected through four focus group interviews with 24 renal care professionals: dieticians, nephrologists and nurses, recruited voluntarily from a nation-wide selection of hemodialysis centers, having access to a bioimpedance-device. The participants were connected to each other and a moderator via equipment for telemedicine and the sessions were recorded. The interviews were semi-structured, focusing on the participants' perceptions of use of bioimpedance in clinical practice. Thematic content analysis was performed in consecutive steps, and data were extracted by employing an inductive, interactive, comparative process.

RESULTS: Several barriers and facilitators to the use of bioimpedance in clinical practice were identified, and a multilevel approach to examining barriers and incentives for change was found to be applicable to the ideas and categories that arose from the data. The determinants were categorized on five levels, and the different themes of the levels illustrated with quotations from the focus groups participants.

CONCLUSIONS: Determinants for use of bioimpedance were identified on five levels: 1) the innovation itself, 2) the individual professional, 3) the patient, 4) the social context and 5) the organizational context. Barriers were identified in the areas of credibility, awareness, knowledge, self-efficacy, care processes, organizational structures and regulations. Facilitators were identified in the areas of the innovation's attractiveness, advantages in practice, and collaboration. Motivation, team processes and organizational capacities appeared as both barriers and facilitators.

Keywords
Barriers, Bioimpedance, Dry weight, Facilitators, Focus groups, Renal dialysis
National Category
Urology and Nephrology Nursing
Identifiers
urn:nbn:se:hig:diva-26640 (URN)10.1186/s12882-018-0907-4 (DOI)000433236500004 ()29792174 (PubMedID)2-s2.0-85047621661 (Scopus ID)
Available from: 2018-05-29 Created: 2018-05-29 Last updated: 2018-12-13Bibliographically approved
Lindberg, M., Skytt, B., Wågström, B.-M., Arvidsson, L. & Lindberg, M. (2018). Risk behaviours for organism transmission in daily care activities: a longitudinal observational case study. Journal of Hospital Infection, 100(3), e146-e150
Open this publication in new window or tab >>Risk behaviours for organism transmission in daily care activities: a longitudinal observational case study
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2018 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 100, no 3, p. e146-e150Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: To understand healthcare personnel's infection prevention behaviour has long been viewed as a key factor in preventing healthcare-associated infections. Suboptimal hand hygiene compliance and handling of materials, equipment and surfaces present the main risks for potential organism transmission. Further exploration is needed regarding the role of context-specific conditions and the infection prevention behaviours of healthcare personnel. Such knowledge could enable the development of new intervention strategies for modifying behaviour.

AIM: To describe risk behaviours for organism transmission in daily care activities over time.

METHODS: Unstructured observations of healthcare personnel carrying out patient related activities were performed on 12 occasions over a period of 18 months.

FINDINGS: Risk behaviours for organism transmission occur frequently in daily care activities and the results shows that the occurrence is somewhat stable over time. Interruptions in care activities contribute to an increased risk for organism transmission that could lead to subsequent healthcare-associated infection.

CONCLUSION: Interventions aimed at reducing the risks of healthcare-associated infections need to focus on strategies that address: hand hygiene compliance; the handling of materials, equipment, work clothes and surfaces; as well as the effects of interruptions in care activities if they are to alter healthcare personnel's infection prevention behaviour sufficiently.

Keywords
Hand hygiene, Healthcare-associated infections, Hygiene, Infection control, Interruptions, Observation of practice
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hig:diva-27851 (URN)10.1016/j.jhin.2018.07.041 (DOI)000448006000024 ()30081148 (PubMedID)2-s2.0-85054148028 (Scopus ID)
Available from: 2018-09-05 Created: 2018-09-05 Last updated: 2019-11-26Bibliographically approved
Lindberg, M. (2017). Fluid removal in haemodialysis - is yours too fast?. Journal of Renal Care, 43(2), 71-72
Open this publication in new window or tab >>Fluid removal in haemodialysis - is yours too fast?
2017 (English)In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686, Vol. 43, no 2, p. 71-72Article in journal, Editorial material (Other academic) Published
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:hig:diva-25756 (URN)000405688000001 ()
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2018-03-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1289-9896

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