Aim: To investigate whether the aetiology of in-hospital cardiac arrest (IHCA) is associated with long-term survival after 30-day survival.

Methods: A nationwide registry-based cohort study was conducted using the Swedish Registry for Cardiopulmonary Resuscitation. Adult IHCA patients in Sweden between 2018 and 2023 who survived ≥30 days were included. Aetiologies were merged into six categories (myocardial ischemia [reference], other cardiac, pulmonary, infectious, haemorrhagic and other non-cardiac). Cox (proportional hazards) regression models were used to estimate crude and multivariable adjusted (demographics, comorbidities, arrest characteristics) hazard ratios (HRs) with 95% CIs for all-cause mortality.

Results: Among 2692 30-day survivors (median age 71 years; 67% male), 886 deaths (33%) occurred over a median 3.7-year follow-up; overall one‑year survival was 86%. In the fully adjusted model, higher hazards of death were observed for infectious (HR 1.79, 95% CI 1.30–2.47), haemorrhagic (1.71, 1.20–2.43), and pulmonary aetiologies (1.61, 1.24–2.11), compared to myocardial ischemia. No difference was observed for cardiac and other non‑cardiac aetiologies.

Conclusions: Aetiology of in-hospital cardiac arrest is independently associated with long‑term prognosis after 30‑day survival. Compared with myocardial ischemia, infectious, haemorrhagic and pulmonary causes are associated with higher long‑term mortality. These findings support aetiology‑informed follow‑up after IHCA.

Background: Surviving sudden cardiac arrest often lead to long-term cognitive, emotional, and physical consequences. Although clinical guidelines recommend structured post-cardiac arrest follow-up, such follow-up is often lacking or inconsistent. Tailored digital interventions are scarce but may help address gaps in follow-up resources. The CARDIS trial evaluates the effects on patient-reported outcome measures of a co-created, web-based support programme designed to improve wellbeing, self management, and reintegration into everyday life for cardiac arrest survivors.

Methods: CARDIS is a multicentre, parallel-group, randomised controlled trial enrolling cardiac arrest survivors aged >18 years. Participants will be randomised 1:1 to intervention or control. Both groups will receive standard post-cardiac arrest care, including a routine followup visit with screening and management of cognitive, physical and emotional health, as well as a printed booklet. The intervention group will additionally receive access to a webbased selfguided support programme for 3 months. After study completion, control participants will be offered the programme.

Outcomes: Primary outcome is overall wellbeing and health (QWB) at 3 months. Secondary outcomes include self-reported cognitive problems, HRQoL, life satisfaction, symptoms of depre ssion and anxiety, post-traumatic stress, fatigue, and sleep disturbances. A process evaluation will evaluate social selection bias, adherence and participants experiences.

Discussion: The CARDIS trial will investigate the use of more accessible and standardised follow-up pathways by complementing existing care structures, thereby enhancing equity in long-term recovery and quality-of-life without requiring additional healthcare resources. The process evaluation will provide data on adherence, social selection, and engagement, essential for future implementation.

Trial registration: The trial is registered at clinicaltrials.gov (NCT07240714).

Background: Recovery after intensive care is a complex and sometimes prolonged process. There is no instrument available for measuring the physical, psychological, and social dimensions of recovery in this setting. The extent of impairment in each dimension and their relative contributions to well-being after survival from critical care is unknown. The aim of this study was to develop a standardised questionnaire for measuring recovery during the whole process after intensive care and evaluate its psychometric properties with focus on factor structure and internal consistency.

Method: The study was performed in two different phases, the development and psychometric evaluation. The development phase included four-steps: (1) identification of possible domains and items of relevance; (2) Delphi study to achieve consensus on critical items to include in the questionnaire; (3) questionnaire construction; (4) cognitive interviews. The psychometric evaluation phase was based on data from 166 patients, recruited from two general ICUs in Sweden. Ordinal confirmatory factor analysis (CFA) was conducted to examine the factor structure, and ordinal alpha and ordinal omega were used to assess internal consistency reliability.

Results: The preliminary version covering the domains of Psychological, Symptoms, Cognition, Daily activity, and Personal resilience in Post Intensive care Recovery (PIR). The hypothesised dimensions were confirmed in the CFA after some theoretically motivated adjustments, and all scales demonstrated satisfactory internal consistency reliability (alpha = 0.78-0.93, omega = 0.73-0.92).

Conclusion: This study suggests that the PIR demonstrates sound psychometric properties in factor structure and internal consistency. However, further evaluation is required before it can be recommended for clinical use.

Background: Discrimination and inequities in healthcare have gained increased attention worldwide. Although many healthcare systems strive to provide equal care, evidence indicates that treatment can be influenced by patient characteristics such as gender, age, race/ethnicity, and socioeconomic status. In particular, research exploring healthcare professionals’ perceptions on equality in acute, life-threatening conditions remains limited. This study aimed to describe Swedish healthcare professionals’ perceptions of unequal and equal care when treating patients with cardiac arrest.

Methods: The study adopted a qualitative inductive design, using semi-structured interviews with 12 physicians and nurses who work in acute care clinics in Sweden. Data were analysed using thematic analysis.

Results: The overarching theme, “Equal care under pressure—guided by principles, shaped by context”, captured how professionals perceive the provision of cardiopulonary resuscitation (CPR) during sudden cardiac arrest as fundamentally equal. CPR was described as an automatic, protocol-driven intervention offered to all patients, reinforcing the principle of equality and without any clear discrimination based on ethnicity, gender, or socioeconomic background. However, equality in practice was nuanced. Decision-making about CPR introduce ethical complexity, particularly for older patients from whom prognostic uncertainty and emotional factors could influence care. Team competence was critical for maintaining equity under pressure, while contextual factors such as location, cultural norms, and safety concerns could delay or complicate treatment. Finally, professionals emphasize the need for structured reflection, recognizing its role in learning and ethical decision-making. Together, these findings illustrate that while CPR was guided by principles of equal care, its delivery was shaped by clinical judgment, team dynamics, and situational realities.

Conclusions: Healthcare professionals perceive cardiac arrest care as predominantly equal. However, subtle vulnerabilities challenge this perception. Older age emerged as the most influential factor in CPR decisions, raising concerns about potential ageism and the need for clearer Do Not Attempt Resuscitation (DNAR) criteria and patient involvement. Promoting equality requires team competence, structured reflection, and proactive communication about resuscitation preferences. Further research should examine age, multimorbidity, psychiatric illness, DNAR practices, and gender differences to strengthen equity in cardiac arrest care.

Background and aim: Palliative care is provided at different care settings by different professionals, making management and organisation of services crucial. A comprehensive tool to systematically evaluate the quality of palliative care and identify potential areas for organizational improvement is highly warranted. The aim was to develop and examine the content validity of a questionnaire evaluating quality of palliative care from the perspectives of healthcare professionals in different care settings: the Quality of Palliative Care Questionnaire – Staff (QPCQ-S).

Methods: This methodological study included booth qualitative and quantitative methods. The QPCQ-S was developed from existing questionnaires. Questions were modified to represent broad perspectives of palliative care before being reviewed by an expert group consisting of researchers in palliative care. A preliminary version was reviewed by healthcare professionals (n = 16), and the response options were examined, based on responses from 98 healthcare professionals who had participated in a development project. Cognitive interviews (n = 13) were performed with healthcare professionals. Finally, the questionnaire was evaluated by 421 healthcare professionals within a nursing home context.

Results: Convergent validity was supported by the expert and advisory groups, and cognitive interviews. Problems with ceiling and floor effects was demonstrated for some items, which resulted in a more differentiated response scale for these items. A majority of the respondents reported the questions as important or fairly important (99.3%), and that the questions had provided them with the opportunity to give a true picture of palliative care (78.9%). However, a majority reported that the questions were difficult or fairly difficult to answer (64.0%), significantly more among nurse assistants compared to nurses, physicians and other professional with academic education (p = 0.031).

Conclusion: The QPCQ-S showed good content validity, and the questions were reported important, giving a true picture of palliative care. Careful preparation is needed considering by whom and in what context the CPCQ-S are best used for evaluation of palliative care.

Importance  

Health-related quality of life (HRQOL) follow-up can increase knowledge of cardiac arrest outcomes from the patient’s perspective. Whether HRQOL affects long-term survival is unknown.

Objective  

To investigate whether HRQOL 3 to 6 months after cardiac arrest is associated with long-term survival.

Design, Setting, and Participants  

This cohort study linked 5 national registers with nationwide coverage in Sweden across a 7-year period and included survivors of in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) between January 1, 2014, and December 31, 2019, with follow-up through June 30, 2021. Participants were adults surviving at least 90 days after IHCA or OHCA who completed follow-up EuroQoL 5-dimension 5-level (EQ-5D-5L) tool questionnaires. Analyses were performed December 2 to 20, 2024.

Exposures

 EQ-5D-5L level sum score (LSS; sum of EQ-5D-5L dimensions, ranging from 5 [no problems] to 25 [extreme problems in all dimensions]), and the visual analog scale EQ VAS, 3 to 6 months after cardiac arrest.

Main Outcome and Measures  

Long-term survival up to a maximum of 7 years among patients surviving IHCA and OHCA.

Results  

In total, 2000 survivors of IHCA (median [IQR] age, 73 [65-80] years, 66% male) and 1108 survivors of OHCA (median [IQR] age, 69 [59-75] years, 77% male) were included. There were 475 deaths among patients with IHCA and 132 deaths among patients with OHCA. For patients with IHCA, the LSS distribution was 394 (20%) for LSS 5, 1034 (52%) for LSS 6 to 10, and 572 (29%) for LSS 11 to 25. For patients with OHCA, the LSS distribution was 299 (27%) for LSS 5, 637 (58%) for LSS 6 to 10, and 168 (15%) for LSS 11 to 25. In the IHCA population, LSS 11 to 25 had higher hazard of death compared with LSS 5 (adjusted hazard ratio [AHR], 2.50 [95% CI, 1.82-3.43]), whereas LSS 6 to 10 did not (AHR, 1.21 [95% CI, 0.88-1.65]). In OHCA, no associations were found between LSS categories and long-term survival (LSS 11-25 vs LSS 5: AHR, 1.41 [95% CI, 0.83-2.42]; LSS 6-10 vs LSS 5: AHR, 0.88 [95% CI, 0.56-1.39]). In both IHCA and OHCA, spline modeling using LSS and EQ VAS as continuous variables showed significant increases in hazards of death with poorer HRQOL, although the estimates in the OHCA population showed greater uncertainty.

Conclusions and Relevance  

In this cohort study of patients who survived beyond 90 days after IHCA or OHCA, poorer HRQOL reported with EQ-5D-5L scores 3 to 6 months after cardiac arrest was associated with reduced long-term survival in both groups, with greater uncertainty for OHCA estimates. HRQOL assessment may help guide follow-up care.

The Family Talk Intervention is a family-centered intervention in six sessions, which can be a tool to help health care social workers support families with dependent children when someone in the family has a severe illness. However, the influence of contextual factors on the implementation of Family Talk Intervention warrants further investigation. The purpose of this study was to examine the organizational context of social workers and its association with the implementation of Family Talk Intervention among families in which a parent or child is severely ill with identified palliative care needs. The study was part of a larger intervention project where Family Talk Intervention was implemented through a structured program in three different clinical care contexts: advanced palliative care, adult cancer care, and advanced pediatric care. Two validated instruments were used to measure social workers' ratings of their organizational context and the implementation of Family Talk Intervention. Results showed that higher ratings on certain organizational aspects were significantly associated with higher implementation ratings. These aspects, namely informal interactions, social capital and culture of the workplace, should be studied further. These may serve as facilitators for the implementation of family-centered interventions like Family Talk Intervention, by social workers and should be observed and promoted during the implementation of interventive processes.

Background: The Patient-Experienced Continuity of care Questionnaire (PECQ) was developed to measure continuity of care (CoC) in primary care, but has only been evaluated in accordance with classical test theory, which has some weaknesses compared with modern test theory.

Aim: The aim of this study was to evaluate the measurement properties of the PECQ using the Rasch model.

Method: Data for this psychometric study were collected using questionnaires administered to patients aged 18 years and older with one or more chronic conditions. Participants were consecutively recruited from 18 public primary care centres. The final sample comprised 324 patients (54% female and 46% male) with a mean age of 71.8 years (SD = 12).

Results: The PECQ demonstrated satisfactory measurement properties in terms of individual item fit, response category functioning, targeting and differential item functioning by age. Minor issues were identified regarding global model fit, local independence, reliability and non-uniform differential item functioning by sex.

Conclusions: Overall, the results show that PECQ has sound psychometric properties in adult patients with chronic disease and can be used to measure CoC in primary care settings.

Impact: This study addresses the need for accurate measurement of patient experiences of CoC, and the Rasch model was therefore used to evaluate the PECQ. As the instrument demonstrated good fit to the Rasch model, the findings have important implications for healthcare researchers, policymakers and practitioners. The PECQ provides a scientifically sound tool for evaluating CoC, enabling more accurate quality assessments and supporting targeted interventions in both Swedish and international primary care contexts where the instrument is adapted.

Patient or Public Contribution: Patients were actively involved in the study by participating in the cognitive validation of the questionnaire items. Their contributions helped ensure that the content was understandable, relevant and appropriately tailored to the target population. By providing feedback on the wording and content, the patients contributed to the development of a user-friendly and contextually grounded instrument, which was subsequently validated in this study using the Rasch model.

Background: Managing and controlling hypertension remains a challenge for many patients, underscoring the need for more effective strategies. Although self-monitoring of blood pressure can greatly support the management of hypertension, combining it with questionnaires for self-assessment of self-care might further improve blood pressure control and patients'health situation. There is extensive research on self-monitoring and self-management but research on the presumed added value of using self-assessment questionnaires in conjunction with self-monitoring of blood pressure, and how patients perceive these methods, remains lacking.

Methods: Qualitative explorative study design involving 15 semi-structured in-depth interviews with primary care patients with hypertension who self-monitored their blood pressure and who were given a self-assessment questionnaire on self-care of hypertension for review. Data were analysed inductively using reflexive thematic analysis.

Results: Self-monitoring of blood pressure promoted increased understanding of one's body and the self-assessment questionnaire regarding self-care elicited reflection on one's health situation. This was seen as providing opportunities for patients to actively co-create health and self-care in collaboration with healthcare professionals. The latter were expected to become more engaged and better meet patients' information needs about the illness and treatment, and to make use of patients'self-reported data for shared decision-making in hypertension management. Although sustainable self-care is often portrayed as autonomous, it appeared to rely on active support and engagement from healthcare professionals.

Conclusions: Self-monitoring of blood pressure combined with self-assessment of self-care was thought to have the potential to promote deeper awareness of personal health and improve the patient-professional relationship. This highlights that sustainable self-care requires quality support and meaningful engagement between patient and healthcare professional, rather than being a completely independent endeavour. Further research could shed light on whether self-monitoring of blood pressure combined with consistent use of self-assessment questionnaires can promote a culture of collaboration and shared decision-making in hypertension care.

Background: The psychosocial needs of families involving a child with a life-limiting or life-threatening condition are well recognized. However, evidence-based interventions that address the needs of the entire family remain scarce, even though family health can be maintained and supported if interventions encompass each individual family member, as well as the family as a unit. The aim was to evaluate the family talk intervention (FTI), regarding family communication, and psychosocial health, for families involving a child with a life-limiting or life-threatening condition. Methods: This pre-post study without a control group involved families of children with a life-limiting or life-threatening condition receiving FTI at a pediatric hospital and a hospice in Sweden. The study is registered at clinicaltrials.gov (ID NCT05020158, date of registration: 23 August 2021). FTI is a family-based intervention with the goal of facilitating family communication about illness-related topics, e.g., prognosis, support parenting, and making all children's needs visible. In total, 105 participants from 29 families were included. Surveys measuring self-assessed family communication and satisfaction, anxiety, resilience, parenting skills, and children's mental problems were answered at three time points: baseline (before intervention), at the end of the intervention, and six months later. Changes over time were analyzed using linear mixed-effects models. Results: Significant improvements were reported in family communication, family satisfaction, parenting skills, and levels of anxiety over time. Children's mental health problems were reduced over time regarding emotional symptoms, conduct problems, peer relationship difficulties, and hyperactivity. No changes were found regarding resilience. Conclusion: The results suggest that FTI contributes to improved family communication and psychosocial health for families involving a child with a life-limiting or life-threatening condition. This highlights the value of a systemic approach that actively involves all family members.