Language-supported labor ward visits for pregnant migrant women : Staff experiences in a Swedish hospital

INTRODUCTION: The aim of this study was to explore midwives' and assistant nurses' experiences of providing extra support to non-Swedish-speaking migrants by offering individual language-supported visits to the labor ward during pregnancy. METHODS: Semi-structured interviews were conducted with six guides, midwives or assistant nurses, working in the INFÖR (Individuell förlossningsförberedelse) project at Södertälje hospital in Sweden. INFOR includes a two-hour individual language-supported visit at the labor ward, for non-Swedish speaking pregnant women and their partners. An inductive thematic analysis was conducted. RESULTS: The guides described INFOR as being a bridge and creating safety, achieved by meeting with women and providing practical information. The guides felt that they fulfilled an important purpose, they were dedicated and adapted to the women's individual needs. Providing extra language-assisted support to migrant pregnant women was developing and enriching, but the guides highlighted some barriers. Communicating via an interpreter was a challenge and the women were in need of more and extended meetings. The guides wished that INFOR could become a standard part of antenatal care, but the model needs to be further developed, and a better system for recruitment must be introduced. CONCLUSIONS: The guides experienced that the INFOR model is valuable in creating safety to pregnant migrant women before birth. The model is appreciated by the expectant couples, midwives and assistant nurses, and could be implemented as standard care. However, it is important to adapt the visits to the women's and their families' needs and goals, and structure needs to be developed before implementation

Plasma activity of individual coagulation factors, hemodilution and blood loss after cardiac surgery: A prospective observational study

Background: Hemodilution and consumption of coagulation factors during cardiopulmonary bypass has been suggested to contribute to bleeding complications after cardiac surgery. The aim was to describe the activity of individual coagulation factors after CABG in relation to hemodilution and postoperative bleeding. Materials and Methods: Plasma concentrations of fibrinogen and plasma activity of FII, FV, FVII, FVIII, FIX, FX, FXI and FXIII adjusted for hemodilution were analysed in 57 CABG patients before, and 2 h and 24 h after surgery. Postoperative bleeding was registered and correlations to coagulation factor activity were calculated. Results: Adjusted plasma concentration of fibrinogen (-14± 6%), and plasma activity of FII (-9 ± 6%), FV (-13± 8%), FX (-13 ± 7%) and FXIII (-9 ± 14%) were reduced two hours after surgery compared to baseline (all p b 0.001). FVII (+3 ± 12%, p = 0.34) and FXI (+1 ± 19%, p = 0.50) were unchanged, while FVIII (+23± 44%, p = 0.006) and FIX (+ 23 ± 17%, p b 0.001) increased. Twenty-four hours after surgery fibrinogen (+ 45 ± 27%), FVIII (+ 93 ± 66%) and FIX (+ 33 ± 26%) were all increased (all p b 0.001), while FVII (-37 ± 14%, p b 0.001), FXI (-4 ± 18%, p = 0.02) and FXIII (-6 ± 15%, p = 0.004) were decreased. Median postoperative blood loss was 380 ml/12 h. There were significant inverse correlations between postoperative blood loss and fibrinogen concentration 2 h after surgery (r = -0.33, p = 0.019) and between postoperative blood loss and pre-and postoperative FXIII activity (r = -0.34, p = 0.009 and r = -0.41, p = 0.003, respectively), but not between blood loss and any of the other factors. Conclusions: There is a marked dissociation in plasma activity of individual coagulation factors after CABG. Plasma concentration of fibrinogen and factor XIII activity correlates inversely to postoperative blood loss after CABG

Validity of the Swedish Cardiac Surgery Registry

OBJECTIVES: Our goal was to validate the Swedish Cardiac Surgery Registry by reviewing the reported cardiac operations to assess the completeness and quality of the registered data and the EuroSCORE II variables.METHODS: A total of 5837 cardiac operations were reported to the Swedish Cardiac Surgery Registry in Sweden during 2015. A randomly selected sample of 753 patient records (13%) was scrutinized by 3 surgeons at all 8 units in Sweden performing open cardiac surgery in adults.RESULTS: Coverage was excellent with 99% [95% confidence interval (CI) 98-99%] of the performed procedures found in the registry. Reported waiting times for surgery were correct in 78% (95% CI 76-79%) of the cases. The main procedural code was correctly reported in 96% (95% CI 95-97%) of the cases. The correlation between reported and monitored logistic EuroSCORE II had a coefficient of 0.79 (95% CI 0.76-0.82), and the median difference in EuroSCORE II was 0% (interquartile range -0.4% to 0.4%). The majority of EuroSCORE II variables had good agreement and coherence; however, New York Heart Association functional class, preoperative renal dysfunction, left ventricular ejection fraction, Canadian Cardiovascular Society Class IV angina and poor mobility were less robust. Postoperative complications were rare and in general had a high degree of completeness and agreement.CONCLUSIONS: The reliability of the variables in the national Swedish Cardiac Surgery Registry was excellent. Thus, the registry is a valuable source of data for quality studies and research. Some EuroSCORE II variables require improved and stricter definitions to obtain uniform reporting and high validity

No-touch saphenous vein grafts in coronary artery surgery (SWEDEGRAFT) : Rationale and design of a multicenter, prospective, registry-based randomized clinical trial

The SWEDEGRAFT study (ClinicalTrials.gov Identifier: NCT03501303) tests the hypothesis that saphenous vein grafts (SVGs) harvested with the “no-touch” technique improves patency of coronary artery bypass grafts compared with the conventional open skeletonized technique. This article describes the rationale and design of the randomized trial and baseline characteristics of the population enrolled during the first 9 months of enrollment. The SWEDEGRAFT study is a prospective, binational multicenter, open-label, registry-based trial in patients undergoing first isolated nonemergent coronary artery bypass grafting (CABG), randomized 1:1 to no-touch or conventional open skeletonized vein harvesting technique, with a planned enrollment of 900 patients. The primary end point is the proportion of patients with graft failure defined as SVGs occluded or stenosed >50% on coronary computed tomography angiography at 2 years after CABG, earlier clinically driven coronary angiography demonstrating an occluded or stenosed >50% vein graft, or death within 2 years. High-quality health registries and coronary computed tomography angiography are used to assess the primary end point. The secondary end points include wound healing in the vein graft sites and the composite outcome of major adverse cardiac events during the first 2 years based on registry data. Demographics of the first 200 patients enrolled in the trial and other CABG patients operated in Sweden during the same time period are comparable when the exclusion criteria are taken into consideration. RCT# NCT0350130