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Effects of copper-doping on electrochromic properties of titanium dioxide films
No full textDoping with metal elements is a valid way to alter the electrochromic performance of single materials. The doped metal ions can modify the electronic structure of the pristine materials, this results in a change in the transfer and migration of electrons or ions in electrochromic reactions. In this work, a series of copper (Cu)-doped titanium dioxide (TiO2) films (0.5%, 1% and 5 wt%) were fabricated by a hydrothermal method and a subsequently spin-coated approach. The effects of doped Cu on the morphological structure, crystallinity, elemental chemical state and electrochromic properties of TiO2 films were evaluated by field emission scanning electron microscopy, high-resolution transmission electron microscopy, X-ray diffraction, X-ray photoelectron spectroscopy and electrochemical techniques. The doping of Cu into TiO2 exerts a substantial influence on its crystal structure, with a marked deterioration in crystallinity observed as the doping concentration increases. The results show that the ionic diffusion coefficient of the 0.5% Cu-TiO2 film is 7.74 × 10−10 cm2/s, the light modulation range is as high as 50.3%, the bleaching and colouring switching times are 1.95 and 16.43 s, respectively, and the light transmittance retention rate can be maintained after 200 cycles. Overall exhibits preferred electrochromic and electrochemical properties. This study indicates that Cu doping with moderate concentration is a feasible way to heighten the electrochromic property of TiO2.</p
Association between cerebral lesions and the severity of diabetic cardiovascular disease, retinopathy, and nephropathy-new lessons to learn from neuroimaging
No full textDiabetes is associated with cerebrovascular lesions detectable through neuroimaging. Neuroimaging is traditionally valued for its insights into the structure of the central nervous system. However, the brain is connected with other organs. The vascular system, hormones, and peripheral nerve system connect the brain to other sections of the body bidirectionaly. This interaction between the brain and other parts encourages us to look at the total body, not just its different parts separately. Growing evidence has shown the link between brain injuries and cardiac, retinal, and kidney disorders, suggesting that neuroimaging has the potential to provide valuable information about peripheral organs This is particularly crucial for a systemic disease like diabetes, which affects the entire body. In this review, we aim to first discuss the data that neuroimaging can reveal about the severity of diabetic retinopathy, nephropathy, and cardiovascular disease in diabetic patients. This interdisciplinary approach could guide the design of new randomized controlled trials, screening programs, and an integrated clinical practice. This study explores the mechanisms underlying the association between the brain and other organs in the context of diabetes. Then we will consider their implications for future research and clinical practice
Isoprenoids in eukaryotic phytoplankton: metabolic diversity, eco-physiology and biotechnological opportunities
No full textIsoprenoids are a diverse group of metabolites essential for algal physiology and ecology, which hold biotechnological potential. Despite recent interest in engineering microalgae for high-value isoprenoid production, understanding of their endogenous biosynthesis and regulatory networks remains fragmented. The major focus, in fact, is still on biotechnological applications rather than physiological relevance. This review bridges this gap by comprehensively evaluating isoprenoid biosynthesis and regulation across diverse microalgal taxa and by examining key differences and similarities between primary metabolic pathways: the chloroplast-localized 2-C-methyl-D-erythritol 4-phosphate and cytosolic mevalonate pathways. The distinct compartmentalization of these pathways is highlighted, especially in relation to lineage-specific evolutionary trajectories, which derive from primary and secondary endosymbiotic events. Unique enzymatic adaptations and lineage-specific carotenoid biosynthesis enzymes make algal isoprenoid metabolism distinct from that of plants, fungi, and animals to reflect their ecology and physiology. Furthermore, we explore emerging evidence on multiple regulatory systems in isoprenoid biosynthesis, such as transcriptional and post-transcriptional regulatory mechanisms, alongside feedback loops and metabolite sensing systems. We discuss the complex interplay between 2-C-methyl-D-erythritol 4-phosphate and mevalonate pathways, especially regarding metabolite crosstalk, differential localization of enzymes, and species-specific metabolic divergence. Using specialized metabolites like sterol sulfates and isoprenoid-derived domoic acid as examples, we highlight unresolved questions regarding isoprenoid ecological functions. Finally, we present synthetic biology strategies harnessing microalgal metabolism for sustainable terpenoid biosynthesis, identifying promising avenues for metabolic engineering and connecting this comprehensive review to the work currently ongoing in isoprenoid biotechnology.</p
Global virtual teamwork: reflections on the current and future research landscape
No full textThis paper aims to promote research on Global Virtual Teams (GVTs). We review current GVT research, introduce the X-Culture data set as one potential empirical data set for future research, and summarize relevant future research avenues.</p
Registry-based evaluation of demographic, socioeconomic and structural disparities in the clinical course of inflammatory bowel disease:A PhD study within clinical epidemiology
No full textBaggrund: Prævalensen for de kroniske inflammatoriske tarmsygdomme (IBD), herunder Crohn’s sygdom og ulcerøs colitis, er stigende globalt. De bagvedliggende sygdomsmekanismer er stadig ikke fuldt ud forstået og patienterne kan have meget forskellige symptomer og sygdomsforløb. Der er derfor et stort fokus på at identificere faktorer, der kan forudsige forskellige sygdomsforløb. Ud over et stort fokus på molekylærbiologiske prædikative faktorer, såsom specifikke biomarkører, er der i den kliniske forskning også et fokus på demografiske, socioøkonomiske og strukturelle prognostiske faktorer, som kan forudsige potentielle uligheder i sygdomsforløbet for patienterne. Den eksisterende viden om disse potentielle prognostiske faktorer peger dog i forskellige retninger. Her kan populationsbaserede datasæt baseret på information fra administrative databaser og sundhedsdatabaser, være en værdifuld kilde til at opnå mere viden om statistiske sammenhænge mellem potentielle prognostiske faktorer og IBD patienters sygdomsforløb over tid. Men hvordan bruger vi disse data bedst muligt, hvad er deres begrænsninger og kan de bidrage til klinisk beslutningstagen indenfor IBD? En kritisk vurdering af disse datas styrker og begrænsninger er afgørende for at kunne besvare disse spørgsmål.Formål: Dette ph.d.-projekt har derfor to overordnede formål: 1) at undersøge demografiske, socioøkonomiske og strukturelle forskelle i sygdomsforløbet ved IBD, fra diagnose til behandling og forløb efter operation, ved brug af landsdækkende registerdata og 2) at vurdere hvorvidt resultater fra register-baserede observationelle studier kan informere klinisk beslutningstagen indenfor IBD, baseret på den anvendte metodologi.Metode: Projektet består af to kohortestudier baseret på data fra de danske nationale registre og en systematisk litteraturgennemgang af observationelle studier baseret på administrative patientdata. Studie 1 (Paper I) inkluderede 12.871 incidente patienter med IBD diagnosticeret i perioden 01/01/2014 – 30/06/2018 og havde til formål at undersøge demografiske forskelle i fordelingen af brugen af diagnostiske procedurer. Studie 2 (Paper II) er en systematisk litteraturgennemgang og inkluderede 67 observationelle studier publiceret i perioden 01/01/2012 – 29/02/2024, og havde til formål at undersøge betydningen af køn og socioøkonomiske faktorer for behandlingsforløbet, herunder sandsynligheden for at få en tarmoperation, hospitalsindlæggelse og komme i medicinsk behandling med kortikosteroider og biologiske lægemidler. Studie 3 (Paper III) inkluderede 3.295 incidente patienter med IBD diagnosticeret i perioden 01/01/2012 – 01/12/2018 og havde til formål at undersøge forholdet mellem en strukturel faktor (hospitalskirurgisk volumen) og sygdomsforløb efter behandling, herunder IBD patienters sandsynlighed for at udvikle postoperative komplikationer. I projektet blev der anvendt forskellige statistiske metoder, herunder: likelihood-ratio tests til at vurdere statistisk signifikante forskelle i fordelingen af diagnostiske procedurer mellem grupper (Paper I); meta-analyse til at syntetisere resultaterne fra 23 inkluderede studier i litteraturgennemgangen (Paper II), og logistisk regression og Cox regression til at undersøge associationen mellem hospitalskirurgisk volumen og sandsynligheden for og tid til postoperative komplikationer (Paper III). Der blev foretaget omfattende justering for forskellige patientfaktorer, herunder sygdommens sværhedsgrad, for at imødegå risikoen for confounding by indication. Resultater: Baseret på resultaterne fra Paper I, viste dette projekt at størstedelen (92,5%) af patienter med IBD i Danmark har fået foretaget en diagnostisk procedure, herunder statistisk signifikant flere mænd end kvinder. Paper II viste at mænd havde statistisk signifikant højere sandsynlighed for tarmoperation end kvinder på tværs af flere lande, mens kvinder havde statistisk signifikant lavere adhærens til biologiske lægemidler end mænd. Der blev ikke fundet statistisk signifikante kønsforskelle i sandsynligheden for indlæggelse, undtagen for patienter med Crohn’s sygdom, hvor mænd havde statistisk signifikant højere sandsynlighed for indlæggelse. Ingen statistisk signifikante kønsforskelle i brug af kortikosteroider og evidensgrundlaget for uddannelses- og indkomstrelaterede forskelle i sandsynligheden for tarmoperation, indlæggelse og medicinsk behandling var begrænset og viste modstridende resultater. Paper III viste, at patienter med IBD opereret på hospitaler med et lavt hospitalskirurgisk volumen havde lavere sandsynlighed for at udvikle postoperative komplikationer end patienter opereret på hospitaler med et højt hospitalskirurgisk volumen, mens der for medium volumen ikke var en statistisk signifikant forskel. Ved opdeling på typen af IBD, var forskellen signifikant for patienter med ulcerøs colitis, men ikke for patienter med Crohn’s sygdom.Konklusion: Resultaterne fra denne register-baserede evaluering viste, at der kan findes kønsbaserede og strukturelle uligheder i diagnostik og behandling af IBD, mens entydig evidens for socioøkonomiske uligheder ikke kunne påvises. Projektet identificerede også nogle begrænsninger ved brugen af registerbaserede observationelle studier i klinisk beslutningstagen indenfor IBD. Disse omfattede udfordringer relateret til umålt confounding, upræcise register-variable samt variation mellem studier, hvilket kan udfordre fortolkningen af aggregerede estimater. Desuden understreger resultaterne behovet for at fortolke statistisk signifikante fund i lyset af deres kliniske relevans. Projektet bidrager således med værdifulde indsigter i brugen af registerbaserede data til vurdering af uligheder i diagnosticering og behandling af IBD på tværs af de specifikke potentielle prognostiske faktorer køn, uddannelse, indkomst og hospitalskirurgisk volumen. Background: The prevalence of chronic inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, is rising globally. The underlying disease mechanisms are still not fully understood, and patients may present with very diverse symptoms and disease courses. Therefore, there is considerable focus on identifying factors that can help predict different disease courses. In addition to the growing interest in molecular and biological predictive factors, such as specific biomarkers, clinical research has also turned attention to demographic, socioeconomic, and structural prognostic factors that may help identify potential disparities in disease outcomes. However, existing evidence on these potential prognostic factors is inconsistent. Population-based datasets derived from administrative and health databases offer valuable opportunities to examine statistical associations between these prognostic factors and long-term disease courses among patients with IBD. Yet important questions remain: How can these data be used most effectively? What are their limitations? And to what extent can they inform clinical decision-making in IBD? A critical evaluation of the strengths and limitations of these data is essential to address these questions.Aim: Therefore, this PhD project has two overarching aims: 1) to investigate demographic, socioeconomic, and structural disparities in the clinical course of IBD, from diagnosis to treatment and surgical outcomes, using nationwide registry data; and 2) to assess whether findings from registry-based observational studies can inform clinical decision-making in IBD, based on the methodology used.Methodology: The project includes two cohort studies based on data from Danish national registries and a systematic literature review of observational studies using administrative patient data. Study 1 (Paper I) included 12,871 patients with incident IBD diagnosed in the period 01/01/2014 – 30/06/2018, and aimed to explore demographic differences in the use of diagnostic procedures. Study 2 (Paper II) is a systematic literature review including 67 observational studies published in the period 01/01/2012 – 29/02/2024, aiming to investigate the impact of sex and socioeconomic factors on treatment courses, including the likelihood of bowel surgery, hospitalizations, and medical treatment with corticosteroids and biological therapy. Study 3 (Paper III) involves 3,295 incident patients with IBD diagnosed in the period 01/01/2012 – 01/12/2018, and aimed to assess the relationship between a structural factor (hospital surgical volume) and disease outcomes following treatment, including the likelihood of developing postoperative complications. Various statistical methods were used in the project, including likelihood-ratio tests for assessing significant differences in diagnostic procedure distributions among groups (Paper I); meta-analysis to synthesize results from 23 studies included in the literature review (Paper II); and logistic regression and Cox regression to examine the association between hospital surgical volume and the probability and timing of postoperative complications (Paper III). Extensive adjustments were made for various patient factors, including disease severity, to mitigate the risk of confounding by indication. Results: The results of Paper I revealed that the majority (92.5%) of IBD patients in Denmark underwent a diagnostic procedure, and significantly more men than women. Paper II found that men had a statistically significantly higher likelihood of bowel surgery than women across multiple countries, while women exhibited significantly lower adherence to biological drugs than men. There were no significant sex differences in the likelihood of hospitalizations, except for patients with Crohn's disease, where men had a significantly higher likelihood of hospitalizations. No sex differences were found in corticosteroid use, and evidence for education and income-related disparities in surgery, hospitalizations, and medical treatment was limited and contradictory. Paper III revealed that IBD patients operated on at hospitals with low surgical volume had a lower likelihood of postoperative complications than those at high-volume hospitals, but no significant differences observed for medium volume. The difference was significant for patients with ulcerative colitis but not for patients with Crohn's disease.Conclusion: This registry-based evaluation found sex-based and structural disparities in the diagnosis and treatment of IBD, while definitive evidence of socioeconomic inequalities could not be established. The project also identified important limitations in using registry-based observational studies to inform clinical decision-making in IBD. These included challenges related to unmeasured confounding, imprecision of specific registry variables, and between-study heterogeneity which may challenge the interpretability of pooled estimates. Moreover, the findings underscore the need to interpret statistically significant results in light of their clinical relevance. Finally, the project provides valuable insights into using registry-based data to assess disparities in IBD diagnosis and treatment across prognostic factors such as sex, education, income, and hospital surgical volume.
Patients' Experiences of Day Surgery:A Qualitative Systematic Review
No full textAim: To examine how patients experience day surgery. Design: Systematic review using Thomas and Harden's framework for synthesis and analysed through Ricoeur's theory of interpretation. Methods and Data Sources: Systematic searches in MEDLINE, CINAHL and EMBASE (September 2023) identified qualitative studies focusing on patients' lived experiences with day surgery (defined as < 24-h hospital stay). Studies were required to provide qualitative data on patient experiences and be published in English or Scandinavian languages. Forward and backward citation searches were also conducted in Scopus. Results: Thirty-four studies met the inclusion criteria. The analysis revealed four key themes: (1) ‘Perceptions of the day surgery concept shape patient expectations’; (2) ‘Navigating expectation and reality: Surprises and challenges in day surgery’; (3) ‘Navigating through postoperative recovery: Feelings of responsibility and insecurity following day surgery’; and (4) ‘The vital role of support from both family and professionals during recovery after day surgery’. Conclusion: Patients' expectations of day surgery strongly influence their overall experience, while the complex self-care demands of postoperative recovery underscore the need for robust support systems involving families and healthcare professionals. Implications for Patient Care: This review highlights the importance of thorough preoperative counselling and ongoing support for patients' complex postoperative self-care. These findings suggest that improved patient-centred care and targeted support could enhance recovery outcomes in day surgery pathways. Impact: Problem addressed: The study explores the often-overlooked challenges that patients face with postoperative self-care following day surgery. Main findings: Expectations of day surgery as ‘minor’ often conflict with patients' emotional and physical self-care needs, revealing a need for comprehensive support. Research impact: Insights from this review can inform patient-centred care practices in day surgery settings globally, underscoring the critical role of family and professional support. Patient or Public Contribution: No patient or public contribution. Trial Registration: Registered with PROSPERO: CRD42023414310.</p
Early clinical implementation and evaluation of an NLP-Based AI system for thrombophilia assessment using electronic health records
No full textBackground: Thrombophilia evaluation requires integration of biochemical findings with clinical history, much of which is embedded in unstructured electronic health record (EHR) text. Manual chart review is labour-intensive and prone to omissions. Natural language processing (NLP) offers a potential alternative by automatically identifying and highlighting relevant information to support more efficient and accurate assessments. Methods: We developed a transformer-based NLP model for thrombosis and integrated it with previously validated bleeding (transformer-based), anticoagulant, and antithrombotics (rule-based) models in an AI system that highlights key phrases in unstructured Danish EHRs to expedite clinician chart review. The system was implemented in routine clinical care to support thrombophilia evaluations. We retrospectively evaluated its performance based on 50 real-world EHRs reviewed by clinicians using the system. Eye-tracking was used to assess information-seeking behaviour during simulated reviews, and semi-structured interviews explored adoption potential post-implementation. Results: The thrombosis model achieved high sentence-level performance (sensitivity 98.8%, specificity 99.8%). In retrospective review, AI-assisted clinicians identified all previously documented findings, and identified additional relevant information in 68% of cases. Eye-tracking showed a 33% reduction in review time and improved identification of relevant content. Users adopted two distinct navigation styles: AI-guided scanning and manual scrolling, reflecting varied trust and cognitive strategies. Interviews revealed strong support for system accuracy and efficiency, with integration and training identified as key challenges. Conclusion: This evaluation highlights the potential of NLP tools to support clinical decision-making. Clear model design, sentence-level transparency, and user-centred evaluation are essential for safe and effective integration into clinical workflows.</p
Morning-based resistance exercise improves afternoon jumping performance, stretch-shortening-cycle muscle power, and lower limb stiffness in top-level ice hockey players
No full textPrecompetition training (PCT) performed as nonexhaustive bouts of morning-based resistance exercise (e.g., resistance priming) may positively affect afternoon physical performance. Specifically, experimental evidence points toward improved force- and power-related performance. The present study aimed to examine the effect of a morning PCT session on afternoon mechanical muscle function, as reflected by changes in maximal isolated isometric knee extensor (KE) strength (maximal voluntary contraction), and KE rapid force capacity (rate of force development: RFD), countermovement jump (CMJ) kinematics and kinetics, and lower limb stiffness (LLS). Fifteen Danish elite ice hockey players from the U20 National Team (18–20 years) performed (a) a PCT test day consisting of a back squat-lift session of 4 sets of 3 repetitions, with a maximal intentional speed at 50, 65, 75, and 85% 1 repetition maximum, respectively, in the morning (9:00 hours) followed by CMJ and KE testing in the afternoon (15:00 hours), and (b) a control (CON) test day consisting of afternoon (15:00 hours) testing only. Results showed that enhanced stretch-shortening-cycle (SSC) muscle function was observed during CMJ testing after PCT compared with CON (p ≤ 0.05), as evidenced by increases (p < 0.05) in maximal jump height (+3.5% [0.5–6.5]), peak vertical ground reaction force in the descending phase (+5.1% [0.3–9.9]), take-off impulse in the ascending phase (+1.6% [0.2–3.1]), LLS (+23.1 [−4.3 to 50.6]), and mean ascending take-off power (+4.8% [1.7–7.9]). In contrast, PCT did not elicit changes in KE strength or RFD. In conclusion, morning-based PCT in the form of lower-body resistance exercise improves lower limb SSC muscle function later in the day in this cohort of high-level athletes
The Quest to Improve Psychological Outcomes in Patients with an Implantable Cardioverter Defibrillator: Clinical Effectiveness of the ACQUIRE-ICD Intervention
No full textDenne afhandling undersøger den psykologiske tilpasning hos patienter med en implanterbar cardioverter defibrillator (ICD), også kaldet en indopereret hjertestarter. ICD’er er førstelinjebehandling til forebyggelse af pludselig hjertedød hos patienter i høj risiko for livstruende arytmier. Mange ICD-patienter oplever psykologisk belastning i form af angst, depression og udfordringer med at acceptere deres ICD. Moderne ICD-opfølgning er baseret på fjernmonitorering, hvilket gør det sværere at opspore patienter med behov for psykologisk støtte. Internetbaserede interventioner kan potentielt tilbyde en skalérbar og omkostningseffektiv løsning, men deres effektivitet for ICD-patienter mangler fortsat at blive fastlagt.Den internetbaserede ACQUIRE-ICD intervention blev udviklet med henblik på at imødekomme ICD-patienters behov. Interventionen bestod af regelmæssig screening for depression, angst og selvoplevet helbredstilstand med mulighed for online psykologisk behandling ved behov, strukturerede samtaler med hjertesygeplejersker, individualiserede målsætningsværktøjer til understøttelse af adfærdsændringer, omfattende undervisningsmateriale samt et online forum med andre ICD-patienter. ACQUIRE-ICD-interventionen blev testet i et nationalt, multi-center, randomiseret kontrolleret forsøg med 478 patienter, som fik indopereret en ICD for første gang. Data fra dette forsøg danner grundlaget for denne afhandling.Udover behovet for effektive psykologiske interventioner er det ligeledes vigtigt at opnå en bedre forståelse af, hvordan depression, angst og accept af ICD’en udvikler sig over tid, og hvilke patienter der er i særlig risiko for psykologisk belastning. Derudover er valide patientrapporterede måleinstrumenter afgørende for at kunne drage pålidelige konklusioner om psykologiske udfald. Spørgeskemaet Florida Patient Acceptance Survey (FPAS), der måler accept af ICD’en, blev anvendt som primært endepunkt i ACQUIRE-ICD-forsøget. Imidlertid er der fortsat behov for mere viden om spørgeskemaets psykometriske egenskaber og faktorstruktur. For at adressere ovenstående videnshuller består afhandlingen af tre indbyrdes forbundne studier med forskellige metodiske tilgange.Artikel 1, hovedpublikationen fra forsøget, evaluerede den kliniske effekt af ACQUIRE-ICD-interventionen som tillæg til sædvanlig behandling med henblik på at forbedre accept af ICD’en (primært endepunkt) samt reducere symptomer på depression og angst (sekundære endepunkter) ved 12 måneders opfølgning. I modstrid med vores hypotese viste interventionen ingen forbedring af de psykologiske udfald sammenlignet med sædvanlig behandling.Artikel 2, den longitudinelle kohorteanalyse, havde til formål at undersøge prævalens, forløb og risikofaktorer for depression, angst og accept af ICD’en over en toårig periode efter ICD-implantationen. Resultaterne viste, at 16,1% af patienterne rapporterede klinisk relevante angst- eller depressionssymptomer ved ICD-implantation, hvorefter prævalensen faldt til 8,9% efter to år. Accept af ICD’en samt symptomer på depression og angst viste en markant forbedring i løbet af de første seks måneder, efterfulgt af en periode med relativ stabilitet frem til toårs-opfølgningen. Både alder under 60 år og symptomatisk hjertesvigt ved ICD-implantation blev identificeret som risikofaktorer for lavere accept af ICD’en samt øgede angst- eller depressionssymptomer.Artikel 3, den psykometriske valideringsundersøgelse, testede FPAS’ psykometriske egenskaber og faktorstruktur. FPAS udviste acceptable psykometriske egenskaber både ved ICD-implantation samt ved 1-års opfølgning. Den forkortede tre-faktor version blev identificeret som den mest psykometrisk velegnede, som ligeledes reducerer patientbyrden, idet de skal udfylde færre spørgsmål. Som en del af afhandlingen blev der ligeledes udviklet en online FPAS-beregner for at øge tilgængeligheden af spørgeskemaet for forskere og klinikere.Samlet set bidrager denne afhandling til en udvidet forståelse af ICDpatienters psykologiske tilpasning. Selvom ACQUIRE-ICD-interventionen ikke viste klinisk effekt, tydeliggør resultaterne, hvordan psykologiske udfald udvikler sig efter ICD-implantation, bidrager til identifikation af risikopatienter og forbedrer måling af accept af ICD’en gennem den psykometriske validering af FPAS. Disse forskningsbidrag kan understøtte udviklingen af mere målrettede og effektive interventioner, forbedre klinisk risikostratificering og styrke forskningsmetodologien inden for kardiologisk psykologi.This thesis addresses the psychological adjustment of patients living with animplantable cardioverter defibrillator (ICD). While ICDs are the frontline treatment for prevention of sudden cardiac death in patients at high risk of lifethreatening arrhythmias, many ICD patients experience significant psychological distress such as anxiety, depression, and challenges in accepting and livingwith their device. Modern clinical ICD management relies on remote devicemonitoring which limits the opportunities for detecting patients in need of psychological support. Web-based interventions may offer a scalable and costeffective way of addressing this unmet care need, but their effectiveness in ICDpatients remains uncertain.The web-based, multi-component, ACQUIRE-ICD intervention was designed to meet the needs of ICD patients. The intervention consisted of regularscreening for depression, anxiety, and health status with the possibility of onlinepsychological treatment if needed, structured conversations with cardiac nurses, personalised goal-setting tools facilitating behaviour change, comprehensiveeducational resources, and an online peer-to-peer support forum. The ACQUIRE-ICD intervention was tested in a national, multi-centre, two-arm, randomized controlled superiority trial enrolling 478 first-time ICD patients. Datafrom this trial form the basis of this thesis.Alongside the search for effective psychological interventions, a betterunderstanding is required of how depression, anxiety and device acceptanceunfold over time and which ICD patients are at increased risk of poor psychological outcomes. Moreover, accurate assessment through patient-reportedoutcome measures (PROMs) is essential for drawing valid conclusions regarding psychological outcomes. The Florida Patient Acceptance Survey (FPAS)measuring device acceptance was used as the primary endpoint in the ACQUIRE-ICD trial. However, key questions remain regarding the psychometricproperties and factor structure of the instrument. To address these knowledgegaps, this thesis is comprised of three interrelated studies each employing different methodological approaches. Paper 1, the main trial report, evaluated the clinical effectiveness of theACQUIRE-ICD intervention as an add-on to usual care in improving deviceacceptance (primary endpoint) and reducing symptoms of depression and anxiety (secondary endpoints) at 12 months follow-up. Counter to our hypothesis,the intervention did not improve psychological outcomes compared with usualcare alone.Paper 2, the longitudinal cohort analysis, aimed to examine the prevalence, trajectories and risk factors of depression, anxiety and device acceptanceover a two-year period following ICD implantation. The results showed that16.1% of patients in our sample reported clinically relevant anxiety or depressive symptoms around the time of ICD implantation, with the prevalence decreasing to 8.9% at two-years follow-up. Device acceptance and symptoms ofdepression and anxiety showed a marked initial improvement from ICD implantation to six months, followed by a period of relative stability until two-yearsfollow-up. Age under 60 years and symptomatic heart failure severity at ICDimplantation were significant predictors of lower device acceptance and increased symptoms of depression and anxiety.Paper 3, the psychometric validation study, assessed the psychometricperformance and factor structure of the FPAS. The FPAS demonstrated acceptable psychometric properties at ICD implantation and at one-year follow-up.The shortened, three-factor, version was identified as most suitable, reducingpatients burden through fewer items to complete. In addition, an online FPAScalculator was developed to enhance the accessibility of the instrument forresearchers and clinicians.Collectively, the insights from this thesis advance the understanding ofpsychological adjustment in ICD patients. Although the ACQUIRE-ICD intervention did not demonstrate clinical effectiveness, the findings clarify how psychological outcomes evolve after ICD implantation, help identify patients at risk, andrefine the measurement of device acceptance through psychometric validationof the FPAS. These research contributions may support the development ofmore targeted and efficient interventions, inform clinical risk stratification andstrengthen research methodology in cardiac psychology
Navigating the Intensive Care Unit-to-Home Trajectory:A Qualitative Study of Relatives' Experiences of Life During and After Critical Illness
No full textBackground: Intensive care unit (ICU) admissions are highly stressful for both patients and their relatives. Many patients develop post-intensive care syndrome (PICS), which includes physical, mental, cognitive and social impairments complicating recovery. Relatives involved in the critical illness trajectory may develop PICS-family (PICS-F). Despite healthcare support, relatives continue to experience stress. Understanding their experiences is essential to improve family-centred care during and after ICU. Aim: The aim of this study was to explore relatives' experiences of being a relative throughout the pathway from the ICU to home. Study Design: This qualitative study employed a phenomenological-hermeneutic approach inspired by Ricoeur. We conducted semi-structured interviews with 15 relatives during the ICU stay and at three- and six-month follow-ups. The Consolidated Criteria for Reporting Qualitative Research checklist was applied. Results: Three themes emerged: (1) Relatives during the ICU—living in two worlds with fear of missing out: Relatives felt torn between hospital and home, overwhelmed by stress and fear of missing crucial moments; (2) Relatives in transitions—a new stage marked by uncertainty: The relatives assumed major responsibilities with limited information; and (3) Returning home—a prolonged, seemingly never-ending journey: Caregiving continued as the relatives adapted to a changed everyday life. Across all phases, relatives described a heavy burden, vulnerability and emotional strain. Conclusions: Relatives navigate two demanding worlds—the high-stress ICU environment and home—resulting in exhaustion, stress and isolation. Transitioning home brings uncertainty, as caregiving roles expand with little support. Structured, long-term support and family-centred care are essential to reduce anxiety and improve outcomes for patients and relatives. Relevance to Clinical Practice: Relatives require structured, continuous support and clear communication throughout ICU recovery. Future research should develop strategies to reduce the burden of PICS-F and enhance family post-ICU support. Study Registration: It was registered with the legal office of the Central Denmark Region (file no. 1-16-02-286-21).</p