Till Örebro universitet

Background: The aim of this study was to survey the relative importance of postoperative recovery targets and perioperative care items, as perceived by a large group of international dedicated professionals.

Methods: A questionnaire with eight postoperative recovery targets and 13 perioperative care items was mailed to participants of the first international Enhanced Recovery After Surgery (ERAS) congress and to authors of papers with a clear relevance to ERAS in abdominal surgery. The responders were divided into categories according to profession and region.

Results: The recovery targets 'To be completely free of nausea', 'To be independently mobile' and 'To be able to eat and drink as soon as possible' received the highest score irrespective of the responder's profession or region of origin. Equally, the care items 'Optimizing fluid balance', 'Preoperative counselling' and 'Promoting early and scheduled mobilisation' received the highest score across all groups.

Conclusions: Functional recovery, as in tolerance of food without nausea and regained mobility, was considered the most important target of recovery. There was a consistent uniformity in the way international dedicated professionals scored the relative importance of recovery targets and care items. The relative rating of the perioperative care items was not dependent on the strength of evidence supporting the items.

Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI.

Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI.

Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR =12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively).

Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI.

Background: Student participation in curriculum negotiation has been widely regarded as beneficial for student engagement, motivation, and learning. Within the physical education (PE) context however, several scholars claim that these benefits are seldom realized. Interestingly, most investigations into curriculum negotiation in PE focus on teacher actions and behavior. Investigations of students' actions in curriculum negotiation are rare. Further, while much of the literature claims curriculum negotiation is potentially beneficial for student learning, few of the conceptual and analytical frameworks utilized within previous PE literature are based on explicit learning theories.

Purpose: The purpose of this paper is to explore student participation in curriculum negotiation in Norwegian PE through the lens of an explicit learning theoretical perspective.

Method: A 10th grade class with 23 students (age 15-16) and an 8th grade class with 30 students (age 13-14) from 2 different schools, and their respective teachers were recruited for the project. Within these classes, participatory observation, video observations, and stimulated recall interviews were conducted to produce empirical material related to curriculum negotiation. The material then underwent qualitative thematic analysis where select parts of John Dewey's educational philosophy were used as the analytical framework.

Results and discussion: With a basis in the analytical framework developed from Deweyan educational philosophy, the results show that students within the two contexts participate in both explicit and implicit forms of curriculum negotiation. Explicit curriculum negotiations to a large degree appear to be governed by the teachers and are deemed by teachers to be part of strategies for upholding Norwegian legislations and recommendations for including students in curricular decision-making. While not as easily noticeable, implicit forms of negotiations were more prominent within the explored contexts. The analysis also suggests that from a Deweyan perspective, possibilities to increase learning through curriculum negotiations occur when teachers notice, help, and guide students in their own reflective processes surrounding how to act in PE. Such pedagogical action makes implicit negotiations occurring more explicit, and explicit negotiations more intelligent.

Previous research shows that enacting a new curriculum is a complex process. Teachers can be enthusiastic and committed to new curricular objectives, but they can also experience frustration and disappointment. Scholars have suggested that teachers who perceive lack of support, or tensions between their personal philosophies and the educational principles underpinning a new curriculum, struggle to enact new curricula in line with their intent. Our purpose in this article is to illustrate how two Physical Education (PE) teachers experienced the enactment of a new official curriculum. An action research approach was used as design of the study. Researchers cooperated with two PE teachers for 18 months. The empirical material consisted of 50 sets of field notes from the two teachers' teaching lessons, transcripts from one semi-structured qualitative interview with both teachers following the completion of the school year. The material also consisted of reflection logs produced by the teachers containing written notes about their experiences of the curriculum enactment. We used literature on educational change (Fullan, M., & Hargreaves, A. (1991). What's worth fighting fore? Working together for your school. Ontario Public School Teachers' Federation) as our theoretical framework. Our findings show that the teachers experienced the curriculum enactment in contradictory ways. Shifting from previous PE practices that focused on sports activities and emphasized teacher instruction, to pedagogical practices informed by the new PE curriculum (including sociocultural perspectives of learning and assessment), led to uncertainty, surprise, satisfaction, as well as distrust. Our findings also showed that the teachers' experiences of the enactment were influenced by perceived gender biases. We argue that teachers' beliefs and the teaching culture were particularly influential dimensions regarding the two PE teachers' experiences of the curriculum enactment. Practitioners and researchers attempting curriculum enactment in the future should pay careful attention to such dimensions, especially given that tensions and uncertainty often occur during any educational change.

Aim and objectives: Describe patients' and family members' perceptions of family support from nurses and other mental healthcare professionals, and quality of care in community mental healthcare service. Further, compare the perceptions of patients and family members.

Background: While patients value family involvement, family members feel unprepared and lack the necessary skills to be supportive. Since healthcare professionals predominantly focus on patients, they may fail to understand the complex needs of families. Family perceived support and quality of community mental health care may vary across patients and family members.

Design and methods: Cross-sectional study with patients suffering from mental illness and family members in community mental healthcare services in Norway. Altogether 86 participants, of whom 33 patients and 33 family members had a family relationship-paired samples. Participants filled in the translated version of the Iceland Family Perceived Support Questionnaire (FPSQ-N) and Quality in Psychiatric Care-Community Out-Patient (QPC-COP) and Community Out-Patient Next of Kin (QPC-COPNK). STROBE checklist was used.

Results: Family members scored family perceived support and quality of community mental health care lower than patients. Family members feel the loss of support. Patient and family members found the Patient-healthcare professionals' relationship to be of high quality, while family members gave low score to being respected and invited to take part in care by nurses and other mental healthcare professionals.

Conclusion: Family members' unmet need of support highlights the need for nurses and other community mental healthcare professionals to assess complex family needs and to intervene. Barriers to collaboration exist, and family members need to be respected and invited into community mental health care. Relevance to clinical practice Contributes knowledge of how to meet the family's needs and provides a basis for further care and treatment development in similar contexts nationally and internationally.

The aim of this study is to explore families' perceptions of everyday life when living with a young adult suffering from mental illness. Findings include: 1) Families balance between letting go and enabling the young adult to become independent while remaining close to help him/her complete education, work and have a social life. 2) Young adults try to deal with symptoms of mental illness by themselves and not be a burden, although longing for family members to understand them and the situation. 3) Healthcare professionals still hold back information although young adults have consented to giving family members insight.

The aim of this study was to evaluate the usefulness of Family-Centered Support Conversations (FCSC) offered in community mental health care in Norway to young adults and their families experiencing mental illness. The FCSC is a family nursing intervention based on the Calgary Family Assessment and Intervention Models and the Illness Beliefs Model and is focused on how family members can be supportive to each other, how to identify strengths and resources of the family, and how to share and reflect on the experiences of everyday life together while living with mental illness. Interviews were conducted with young adults and their family members in Norway who had received the FCSC intervention and were analyzed using phenomenography. Two descriptive categories were identified: "Facilitating the sharing of reflections about everyday life" and "Possibility of change in everyday life." The family nursing conversations about family structure and function in the context of mental illness allowed families to find new meanings and possibilities in everyday life. Health care professionals can play an important role in facilitating a safe environment for young adults and their families to talk openly about the experience of living with and managing mental illness.

We reviewed systematically sugammadex vs neostigmine for reversing neuromuscular blockade. We included 17 randomised controlled trials with 1553 participants. Sugammadex reduced all signs of residual postoperative paralysis, relative risk (95% CI) 0.46 (0.29-0.71), p=0.0004 and minor respiratory events, relative risk (95% CI) 0.51 (0.32-0.80), p=0.0034. There was no difference in critical respiratory events, relative risk (95% CI) 0.13 (0.02-1.06), p=0.06. Sugammadex reduced drug-related side-effects, relative risk (95% CI) 0.72 (0.54-0.95), p=0.02. There was no difference in the rate of postoperative nausea or the rate of postoperative vomiting, relative risk (95% CI) 0.94 (0.79-1.13), p=0.53, and 0.87 (0.65-1.17), p=0.36 respectively.

INTRODUCTION: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease.

METHODS: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint.

RESULTS: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found.

CONCLUSION: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.

Elektrokardiografi (EKG) är en metod för att registrera hjärtats elektriska aktivitet, används för att utreda eventuella patologier i hjärtats retledningssystem. Studien fokuserar på parametrar som är relaterade till förmaksdepolarisationen som på ett EKG speglas av P-vågen. Syftet var att utvärdera och analysera reliabiliteten vid upprepade mätningar av specifika EKG-parametrar samt att undersöka eventuella könsskillnader i en hjärtfrisk population. Studien bestod av 45 forskningspersoner. EKG-undersökningen utfördes vid ett tillfälle, därefter mättes EKG-parametrar manuellt på en EKG-utskrift. För att utvärdera mätningarnas reliabilitet inom och mellan observatörer användes intraklasskorrelationskoefficienten (ICC) och för analys av könsskillnader oparat t-test. ICC-värdet var ≥ 0,9 för P-vågsarea och PWAII. För PDV1 och II samt PTFV1 var ICC mellan 0,75–0,9. För PWPTII var ICC mellan 0,5–0,75, medan det var ≤ 0,5 för PWAV1. ICC varierade mellan 0,5–0,75 för PWPTV1. En jämförelse mellan manuell och automatisk tolkning av EKG-parametrarna visade god överensstämmelse. Det förelåg inga statistiskt signifikanta könsskillnader hos någon av EKG-parametrarna (p>0,05). Majoriteten av EKG-parametrar uppvisade god till utmärkt pålitlighet vid upprepande mätningar både inom och mellan observatörer. Det fanns även god överensstämmelse mellan manuell tolkning och automatisk algoritmtolkning. Inga signifikanta könsskillnader i EKG-parametrar kunde påvisas.

Context: Polycystic ovary syndrome (PCOS) is a heterogeneous condition affecting women of reproductive age. It is associated with dyslipidaemia and elevated plasma C-reactive protein (CRP), which increase the risks of cardiovascular disease (CVD).

Objective: To review the existing evidence on the effects of different pharmacological interventions on lipid profiles and CRP of women with PCOS.

Data Sources: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane Library, and Web of Science in April 2020 and updated the results in March 2021.

Study Selection: The study included randomized controlled trials (RCTs) and follows the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

Data Extraction: Two independent researchers extracted data and assessed for risk of bias using the Cochrane risk of bias tool. Covidence systematic review software were used for blinded screening and study selection.

Data Synthesis: In 29 RCTs, there were significant reductions in triglycerides with atorvastatin versus placebo [mean difference (MD): -0.21 mmol/L; 95% confidence interval (CI): -0.39, -0.03, I-2 = 0%, moderate grade evidence]. Significant reductions were seen for low-density lipoprotein cholesterol (LDL-C) with metformin versus placebo [standardized mean difference (SMD): -0.41; 95% CI: -0.85, 0.02, I-2 = 59%, low grade evidence]. Significant reductions were also seen for total cholesterol with saxagliptin versus metformin (MD: -0.15 mmol/L; 95% CI: -0.23, -0.08, I-2 = 0%, very low grade evidence). Significant reductions in C-reactive protein (CRP) were seen for atorvastatin versus placebo (MD: -1.51 mmol/L; 95% CI: -3.26 to 0.24, I-2 = 75%, very low-grade evidence).

Conclusion: There were significant reductions in the lipid parameters when metformin, atorvastatin, saxagliptin, rosiglitazone and pioglitazone were compared with placebo or other agents. There was also a significant reduction of CRP with atorvastatin.

Context: Polycystic ovary syndrome (PCOS) is a heterogeneous condition affecting women of reproductive age and is associated with increased body weight.

Objective: To review the literature on the effect of different pharmacological interventions on the anthropometric indices in women with PCOS.

Data sources: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library, and the Web of Science in April 2020 with an update in PubMed in March 2021.

Study selection: The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)2020.

Data extraction: Reviewers extracted data and assessed the risk of bias using the Cochrane risk of bias tool.

Results: 80 RCTs were included in the meta-analysis. Metformin vs placebo showed significant reduction in the mean body weight (MD: -3.13 kg; 95% confidence interval [CI]: -5.33 to -0.93, I-2 = 5%) and the mean body mass index (BMI) (MD: -0.75 kg/m(2); 95% CI: -1.15 to -0.36, I-2 = 0%). There was a significant reduction in the mean BMI with orlistat versus placebo (MD: -1.33 kg/m(2); 95% CI: -2.16 to -0.66, I-2 = 0.0%), acarbose versus metformin (MD: -1.26 kg/m(2); 95% CI: -2.13 to -0.38, I-2 = 0%), and metformin versus pioglitazone (MD: -0.91 kg/m(2); 95% CI: -1.62 to -0.19, I-2 = 0%). A significant increase in the mean BMI was also observed in pioglitazone versus placebo (MD: + 2.59 kg/m(2); 95% CI: 1.78-3.38, I-2 = 0%) and in rosiglitazone versus metformin (MD: + 0.80 kg/m(2); 95% CI: 0.32-1.27, I-2 = 3%). There was a significant reduction in the mean waist circumference (WC) with metformin versus placebo (MD: -1.21 cm; 95% CI: -3.71 to 1.29, I-2 = 0%) while a significant increase in the mean WC with pioglitazone versus placebo (MD: + 5.45 cm; 95% CI: 2.18-8.71, I-2 = 0%).

Conclusion: Pharmacological interventions including metformin, sitagliptin, pioglitazone, rosiglitazone orlistat, and acarbose have significant effects on the anthropometric indices in women with PCOS.

Objective: Polycystic ovary syndrome (PCOS) is a complex endocrine condition affecting women of reproductive age. It is characterized by insulin resistance and is a major risk factor for type 2 diabetes mellitus (T2DM). The objective was to review the literature on the effect of different pharmacological interventions on insulin resistance in women with PCOS.

Design: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library and the Web of Science in April 2020 and updated in March 2021. The study follows the 2020 Preferred Reporting Items for Systematic reviews and Meta-ana. Reviwers extracted data and assessed the risk of bias using the Cochrane risk of bias tool.

Results: In 58 randomized controlled trials there were significant reductions in the fasting blood glucose (FBG) with metformin versus placebo (standardized mean difference [SMD]: -0.23; 95% confidence interval [CI]: -0.40, -0.06; I-2 = 0%, low-grade evidence), and acarbose versus metformin (mean difference [MD]: -10.50 mg/dl; 95% CI: -15.76, -5.24; I-2 = 0%, low-grade evidence). Significant reductions in fasting insulin (FI) with pioglitazone versus placebo (SMD: -0.55; 95% CI: -1.03, -0.07; I-2 = 37%; p = .02, very-low-grade evidence). A significant reduction in homoeostatic model assessment of insulin resistance (HOMA-IR) was seen with exenatide versus metformin (MD: -0.34; 95% CI: -0.65, -0.03; I-2 = 0%, low-grade evidence). No effect on homoeostatic model assessment of beta cells (HOMA-B) was observed.

Conclusions: Pharmacological interventions, including metformin, acarbose, pioglitazone and exenatide have significant effects on FBG, FI, HOMA-IR but not on HOMA-B.

Context: Polycystic ovary syndrome (PCOS) is one of the commonest endocrine disorders affecting women of reproductive age, and metformin is a widely used medication in managing this condition.

Aim: To review the available literature comprehensively on the therapeutic impact of metformin on the clinical and metabolic parameters of women with PCOS.

Data source: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane Library and the Web of Science and selected sources for grey literature from their inception to April 2020. An updated search in PubMed was performed in June 2022.

Data synthesis: Two reviewers selected eligible studies and extracted data, and the review is reported following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results: In 24 eligible randomised controlled trials (RCTs) involving 564 participants who received metformin therapy, metformin was associated with significant reduction in body weight by 3.13 kg (95% CI: -5.33, -0.93), body mass index (BMI) by 0.82 kg/m(2) (95% CI: -1.22, -0.41), fasting blood glucose [standardised mean difference (SMD): -0.23; 95% CI: -0.40, -0.06], low-density lipoprotein cholesterol (LDL-C) (SMD: -0.41; 95% CI: -0.85, 0.03), total testosterone (SMD: -0.33; 95% CI: -0.49, -0.17), androstenedione (SMD: -0.45; 95% CI: -0.70, -0.20), 17-hydroxyprogesterone (17-OHP) (SMD: -0.58; 95% CI: -1.16, 0.00) and increase the likelihood of clinical pregnancy rate [odds ratio (OR): 3.00; 95% CI: 1.95, 4.59] compared with placebo.

Conclusion: In women with PCOS, metformin use has shown a positive impact in reducing body weight, BMI, total testosterone, androstenedione, 17-OHP, LDL-C, fasting blood glucose and increasing the likelihood of pregnancy in women with PCOS.

Context: Polycystic ovary syndrome (PCOS) is a complex endocrine disease that affects women of reproductive age and is characterised by biochemical and clinical androgen excess.

Aim: To evaluate the efficacy of pharmacological interventions used to decrease androgen hormones in women with PCOS.

Data source: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library and the Web of Science from inception up to March 2021. Data synthesis Two reviewers selected eligible studies and extracted data, and the review is reported according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results: Of the 814 randomised clinical trials (RCTs) located in the search, 92 met the eligibility criteria. There were significant reductions in total testosterone level with metformin versus (vs) placebo (SMD: - 0.33; 95% CI - 0.49 to - 0.17, p < 0.0001, moderate grade evidence) and dexamethasone vs placebo (MD:-0.86 nmol/L; 95% CI - 1.34 to - 0.39, p = 0.0004, very low-grade evidence). Significant reductions in the free testosterone with sitagliptin vs placebo (SMD: - 0.47; 95% CI - 0.97 to 0.04, p = 0.07, very low-grade evidence), in dehydroepiandrosterone sulphate (DHEAS) with flutamide vs finasteride (MD: - 0.37 mu g/dL; 95% CI - 0.05 to - 0.58, p = 0.02, very low-grade evidence), a significant reduction in androstenedione (A4) with rosiglitazone vs placebo (SMD: - 1.67; 95% CI - 2.27 to - 1.06; 59 participants, p < 0.00001, very low-grade evidence), and a significant increase in sex hormone-binding globulin (SHBG) with oral contraceptive pill (OCP) (35 mu g Ethinyl Estradiol (EE)/2 mg cyproterone acetate (CPA)) vs placebo (MD: 103.30 nmol/L; 95% CI 55.54-151.05, p < 0.0001, very low-grade evidence) were observed.

Conclusion: Metformin, OCP, dexamethasone, flutamide, and rosiglitazone use were associated with a significant reduction in biochemical hyperandrogenemia in women with PCOS, though their individual use may be limited due to their side effects.

PROSPERO registration No CRD42020178783.

A quantitative polymerase chain reaction (PCR) for the fucK gene was developed for specific detection of Haemophilus influenzae. The method was tested on sputum and nasopharyngeal aspirate (NPA) from 78 patients with community-acquired pneumonia (CAP). With a reference standard of sputum culture and/or serology against the patient's own nasopharyngeal isolate, H. influenzae etiology was detected in 20 patients. Compared with the reference standard, fucK PCR (using the detection limit 10(5) DNA copies/mL) on sputum and NPA showed a sensitivity of 95.0% (19/20) in both cases, and specificities of 87.9% (51/58) and 89.5% (52/58), respectively. In a receiver operating characteristic curve analysis, sputum fucK PCR was found to be significantly superior to sputum P6 PCR for detection of H. influenzae CAP. NPA fucK PCR was positive in 3 of 54 adult controls without respiratory symptoms. In conclusion, quantitative fucK real-time PCR provides a sensitive and specific identification of H. influenzae in respiratory secretions.

Background: There is no consensus regarding the timing of surgery in children with smaller burn size, specifically in deep dermal burns. Delayed surgery has risks in terms of infection and delayed wound healing. Early surgery also risks the removal of potentially viable tissue. Our aim was to investigate the effect of the timing of surgical intervention on the size of the area operated on and the time to wound healing. Methods: A retrospective analysis for all children (<18 years) with burn size <20% body surface area (BSA%) during 2009–2020 who were operated on with a split-thickness skin graft. The patients were grouped by the timing of the first skin graft operation: early = operated on within 14 days of injury; delayed = operated on more than two weeks after injury. Results: A total of 84 patients were included in the study, 43 who had an early operation and 41 who had a delayed operation. There were no differences between the groups regarding burn size, or whether the burns were superficial or deep. The mean duration of healing time was seven days longer in the group with delayed operation (p = 0.001). The area operated on was somewhat larger (not significantly so) in the group who had early operation. Nine children had two skin graft operations, eight in the early group and one in the delayed group (p = 0.03). Conclusion: The patients who were operated on early had the advantage of a shorter healing time, but there was a higher rate of complementary operations and a tendency towards a larger burn excision.

Bakgrund: Alzheimers sjukdom är den vanligaste demenssjukdomen och är en av våra största folksjukdomar. Det är en degenerativ sjukdom som är svårbehandlad. Alzheimers sjuka är i behov av vård och assistans. Anhöriga försöker anpassa sig efter de nya omständigheterna och utmaningar som Alzheimers sjukdom medför.Syftet: Syftet var att beskriva anhörigas erfarenheter av att vårda närstående med Alzheimers sjukdom.Metod: En litteraturstudie med systematisk sökning och deskriptiv design utfördes. Artiklarna söktes fram i databaserna Cinahl, Medline och PsycInfo.Resultat: Anhöriga som var vårdgivare till en anhörig med Alzheimers sjukdom upplevde många påfrestningar. Det är ett stressigt arbete och att bli vårdgivare har förändrat deras liv. Diagnosen skapade även konflikter i relationer eftersom de behövde samarbeta. Vilket kön vårdgivaren har och vilken relation som personer har till vårdtagaren spelar roll i vårdprocessen.Slutsats: Anhöriga erfarenhet att vårda närstående med Alzheimers sjukdom påverkar deras liv mestadels negativt. Det är en svår utmaning för de anhöriga att ta på sig rollen som vårdgivare. Alzheimers sjukdom ökar i världen och det är viktigt att sjuksköterskor och andra professioner inom hälso-och sjukvård kan stödja de anhöriga som är vårdgivare och få en inblick i vad de går igenom.

Bakgrund: Ingen kan fly från döden. Det är en process som ställer en inför psykiska, fysiska, sociala men främst existentiella utmaningar och svårigheter. Intensivvården med dess livsuppehållande behandling är en ung konst. Exempelvis började maskiner för artificiell ventilation användas under 50- talet. I vår nutid omfattas vård i livets slutskede av den palliativa vården. Socialstyrelsen publicerade 1992 en handbok som gav vägledning i form av riktlinjer om vissa etiska frågor bakom livsuppehållande behandling.

Syfte: Att skapa en överblick över de juridiska dimensionerna i beslutet om att avstå från eller avbryta livsuppehållande medicinska åtgärder, och att granska de viktigaste etiska argumenten kring denna fråga.

Metod: Studien baserades på en texttolkande, hermeneutisk metod. Begrepps- och argumentationsanalys genomfördes. Relevant litteratur valdes utifrån projektarbetets frågeställning som sedan analyserades ur ett etiskt perspektiv.

Resultat: Exempel på livsuppehållande behandlingar är andningsunderstödjande behandlingar så som respirator, assisterad cirkulation i form av HLR samt dialys eller tillförsel av blodprodukter, vätska och näring. En patient som är beslutskapabel har rätt att neka livsuppehållande behandling. Om patienten inte är beslutskapabel ska de som känner patienten bäst i samråd med vårdteamet besluta vad patienten hade önskat om denne var beslutskapabel. Ett ställningstagande bör alltid utgå från patientens bästa intresse.

Slutsats: Att endast utgå från vetenskap och beprövad erfarenhet kan i vissa ögon ses som >hjärtlöst<. Beslutet måste vara baserat på empati, medmänsklighet, vetenskap, beprövad erfarenhet men framför allt med patientens bästa intresse i absoluta fokus.

The existing limitations in analytical techniques for characterization and quantification of nanoscale plastic debris (NPD) in organisms hinder understanding of the parental and trophic transfer of NPD in organisms. Herein, we used iron oxide-doped polystyrene (PS) NPD (Fe-PS-NPD) of 270 nm and Europium (Eu)-doped PS-NPD (Eu-PS-NPD) of 640 nm to circumvent these limitations and to evaluate the influence of particle size on the trophic transfer of NPD along an algae-daphnids food chain and on the reproduction of daphnids fed with NPD-exposed algae. We used Fe and Eu as proxies for the Fe-PS-NPD and Eu-Ps-NPD, respectively. The algae cells (Pseudokirchinella subcapitata) were exposed to 4.8 × 10¹⁰ particles/L of Fe-PS-NPD or Eu-PS-NPD for 72 h. A high percentage (>60%) of the NPD was associated with algal cells. Only a small fraction (<11%) of the NPD, however, was transferred to daphnids fed for 21 days on the NPD-exposed algae. The uptake and trophic transfer of the 270 nm Fe-PS-NPD were higher than those for the 640 nm Eu-PS-NPD, indicating that smaller NPD are more likely to transfer along food chains. After exposure to Fe-PS-NPD, the time to first brood was prolonged and the number of neonates per adult significantly decreased compared to the control without any exposure and compared to daphnids exposed to the Eu-Ps-NPD. The offspring of daphnids exposed to Eu-PS-NPD through algae, showed a traceable concentration of Eu, suggesting that NPD are transferred from parents to offspring. We conclude that NPD can be transferred in food chains and caused reproductive toxicity as a function of NPD size. Studies with prolonged exposure and weathered NPD are endeavored to increase environmental realism of the impacts determined.

In order to facilitate data-driven solutions for early detection of atrial fibrillation (AF), the 2017 CinC conference challenge was devoted to automatic AF classification based on short ECG recordings. The proposed solutions concentrated on maximizing the classifiers F ₁ score, whereas the complexity of the classifiers was not considered. However, we argue that this must be addressed as complexity places restrictions on the applicability of inexpensive devices for AF monitoring outside hospitals. Therefore, this study investigates the feasibility of complexity reduction by analyzing one of the solutions presented for the challenge.

Introduction: Nitric oxide (NO) is crucial in numerous infant physiological processes, includingcardiovascular health and organ protection. Breast milk is the primary source of NO for infants. Nitriteand nitrate are surrogate markers for NO production. The relationship between nitrite and nitrateconcentrations in maternal breast milk and saliva and breastfeeding outcomes is poorly investigated.

Introduction: Nitric oxide (NO) is crucial in numerous infant physiological processes, includingcardiovascular health and organ protection. Breast milk is the primary source of NO for infants. Nitriteand nitrate are surrogate markers for NO production. The relationship between nitrite and nitrateconcentrations in maternal breast milk and saliva and breastfeeding outcomes is poorly investigated.

Methods: Data for this longitudinal cohort study was obtained from a pilot study conducted in Dalarna,Sweden, from 2021 to 2022. The Cayman colometric test kit determined nitrite/nitrate concentrationsin milk and saliva samples. Statistical analyses included descriptive statistics, Friedman'stest for change over time, and the Mann-Whitney U test to compare breastfeeding status.

Results: Twenty-five mothers provided breast milk and saliva samples. Median nitrite/nitrate concentrationsin breast milk decreased significantly until day 60 postpartum, but no statistically significantchanges were observed in nitrite/nitrate concentrations in saliva. Additionally, no statisticallysignificant differences were found between mothers who exclusively breastfed and those who partiallyor did not breastfeed in either sample type.

Conclusions: Our study showed that early breast milk contains higher nitrite/nitrate concentrationsthan mature milk. Further extended and larger studies are required to evaluate the association withbreastfeeding outcomes.

BACKGROUND: It is not clear to what extent chewing is improved by unilateral oral rehabilitation with implant-supported fixed partial prostheses (ISFPPs).

AIM: This study aimed to investigate whether patients treated with unilateral ISFPPs in the maxilla use their prostheses during mastication to the same extent as they used their contralateral natural teeth. A further aim was to investigate whether there is a correlation between preferred chewing side and laterality.

MATERIAL AND METHODS: Chewing side preference was assessed in 15 participants treated with unilateral ISFPPs in the maxilla. The first, second, third, fifth, and tenth chewing cycles were assessed, and the test was repeated ten times. All participants also answered a questionnaire about their chewing side preference.

RESULTS: Most of the participants presented bilateral chewing, but two (13%) chewed only on the ISFPP. There was no statistically significant association between the objectively assessed chewing side and dental status (natural teeth or ISFPPs) during any of the recorded chewing cycles (p >.1). There were statistically significant correlations between both the subjectively reported usually preferred chewing side and the subjective chewing side preference during the test, and the objectively assessed chewing side for the first three chewing cycles (p <.01). No correlation was found between handedness and the objectively assessed chewing side.

CONCLUSION: In the present study, most participants chewed bilaterally, and chewing was performed both on the ISFPP and on the natural teeth. No correlation was found between the preferred chewing side, objectively or subjectively determined, and laterality.

Bakgrund

Det saknas tillräckligt med kunskap om medicinerna som används vid akut lugnandeinjektion (ALI) och evidensen som finns visar allvarliga biverkningar vid intag av dessamediciner. De riktlinjer som finns kring ALI baseras mestadels på klinisk erfarenhet och påen svag vetenskaplig grund. Denna studie syftar till att undersöka personalens erfarenheteroch tankar kring ALI i slutenvårdspsykiatrin i Region Örebro län.

Syfte

Syftet med studien var att undersöka hur ALI i psykiatrin hanteras och vilka förbättringarsom kan göras utifrån relevant kunskap?

Metod

En kvalitativ intervjustudie där Flanagans Critical Incident Technique användes. 5 personal från psykiatrin intervjuades, en kompletterande telefonintervju gjordes, Direct ContentAnalys användes för att analysera och sammanställa data.

Resultat

Resultatet visade att situationer med hot och våld och tillvägagångssätt vid ALI hanteradesenligt riktlinjer. De mediciner som läkare använde vid ALI var enligt rekommendationer fråntidigare studier. Efter injektion av ALI observerades patienten och vitalparametrar togs vilketär enligt riktlinjer. I intervjuerna framkom att vissa situationer kunde hanteras bättre, t.ex. nären döv patient blev agiterad. Det framkom även att personal efterfrågade tydligare rutiner ochbättre struktur för att ny personal ska delges seniora kollegors erfarenhet och kunskap.

Slutsats

Riktlinjer efterföljs på slutenvårdspsykiatrin i Region Örebro län. Men ny personal behöverbättre färdigheter för att kunna hantera agiterade patienter. Samt behövs det forskas mer påalternativa metoder.

Introduction: Removable partial dentures (PRD) are among the treatment options available for partially edentulous patients. The usage of RPD and patient satisfaction with the prosthesis relates to Oral health related quality of life (OHRQoL).

Aim: The aim of this study was to evaluate the use of RPDs, satisfaction with the prostheses as well as OHRQoL in patients provided with a RPD in general practice. A further aim was to identify possible factors related to RPD usage, patient satisfaction and OHRQoL.

Material and method: A cross-sectional survey study, utilizing a questionnaire regarding patient satisfaction with different aspects of the participants RPD, the Swedish version of OHIP-14 questionnaire and the usage of the prosthesis.

Results: A majority of respondents, (83.6%) reported that they used their prosthesis daily or often. The overall satisfaction rate among respondents was 83.0% with 39.3% stating that they were highly satisfied with the prosthesis and the mean OHIP- 14 score was 8.5, SD 10.2. The chewing ability was reported to be improved by 58.9% but impairment in chewing was reported by 26.8%. Pain from supporting teeth and soft tissue, sociodemographic factors and dissatisfaction with pre-treatment information and personal treatment were associated with not using the RPD.

Conclusions: In the present study, treatment with RPD was in most patients associated with improvement in chewing and appearance. Insufficient pretreatment information, perception of treatment and pain from supporting tissue was associated with reduced use of and satisfaction with the RPD.

Introduction: Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is an important and growing issue in the care of patients with cystic fibrosis (CF), and a major cause of morbidity and mortality.

Objective: The objective of the study was to describe the frequency of MDR-PA recovered from the lower respiratory samples of pediatric and adult CF patients, and its antibiotic resistance pattern to commonly used antimicrobial agents including beta-lactams, aminoglycosides, and fluoroquinolones.

Materials and Methods: The lower respiratory isolates of P. aeruginosa were obtained from inpatients and outpatients CF clinics from a tertiary care teaching hospital for the period from October 2014 to September 2015. The identification and antimicrobial susceptibility for all the isolates were performed by using the BD Phoenix (TM) and E-test in compliance with Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: A total of 61 P. aeruginosa samples were isolated from thirty CF patients from twenty families. Twelve sputum samples were positive for MDR-PA (seven nonmucoid and five mucoid isolates) from five CF patients (five families) with moderate-to-very severe lung disease given MDR-PA frequency of 19.7%. The median age of the study group was 20 (range 10-30) years. Three CF patients were on chronic inhaled tobramycin and two on nebulized colistin. The antimicrobial patterns of isolates MDR-PA showed the highest rate of resistance toward each gentamycin, amikacin, and cefepime (100%), followed by 91.7% to ciprofloxacin, 75% to tobramycin, 58.3% to meropenem, and 50% to piperacillin-tazobactam. None of the isolates were resistant to colistin during the study period.

Conclusion: The study results emphasize that the emergence of a significant problem in the clinical isolates of P. aeruginosa in CF patients that dictate appropriate attention to the antibiotic management after proper surveillance.

INTRODUCTION: The role of microbial translocation (MT) in HIV patients living with HIV from low- and middle-income countries (LMICs) is not fully known. The aim of this study is to investigate and compare the patterns of MT in patients from Vietnam, Ethiopia and Sweden.

METHODS: Cross-sectional samples were obtained from treatment-naïve patients living with HIV-1 and healthy controls from Vietnam (n=83; n=46), Ethiopia (n=9492; n=50) and Sweden (n=51; n=19). Longitudinal samples were obtained from a subset of the Vietnamese (n=24) in whom antiretroviral therapy (ART) and tuberculostatics were given. Plasma lipopolysaccharide (LPS), sCD14 and anti-flagellin IgG were determined by the endpoint chromogenic Limulus Amebocyte Assay and enzyme-linked immunosorbent assay.

RESULTS: All three biomarkers were significantly increased in patients living with HIV-1 from all countries as compared to controls. No differences were found between males and females. Vietnamese and Ethiopian patients had significantly higher levels of anti-flagellin IgG and LPS, as compared to Swedes. ART reduced these levels for the Vietnamese. Vietnamese patients given tuberculostatics at initiation of ART had significantly lower levels of anti-flagellin IgG and higher sCD14. The biomarkers were lower in Vietnamese who did not develop opportunistic infection.

CONCLUSIONS: Higher MT is common in patients living with HIV compared to healthy individuals, and in patients from LMICs compared to patients from a high-income country. Treatment with tuberculostatics decreased MT while higher levels of MT are associated with a poorer clinical outcome.

BACKGROUND: Formation of an HIV-1 particle with a conical core structure is a prerequisite for the subsequent infectivity of the virus particle. We have previously described that glycineamide (G-NH2) when added to the culture medium of infected cells induces non-infectious HIV-1 particles with aberrant core structures.

RESULTS: Here we demonstrate that it is not G-NH2 itself but a metabolite thereof that displays antiviral activity. We show that conversion of G-NH2 to its antiviral metabolite is catalyzed by an enzyme present in bovine and porcine but surprisingly not in human serum. Structure determination by NMR suggested that the active G-NH2 metabolite was alpha-hydroxy-glycineamide (alpha-HGA). Chemically synthesized alpha-HGA inhibited HIV-1 replication to the same degree as G-NH2, unlike a number of other synthesized analogues of G-NH2 which had no effect on HIV-1 replication. Comparisons by capillary electrophoresis and HPLC of the metabolite with the chemically synthesized alpha-HGA further confirmed that the antiviral G-NH2-metabolite indeed was alpha-HGA.

CONCLUSION: alpha-HGA has an unusually simple structure and a novel mechanism of antiviral action. Thus, alpha-HGA could be a lead for new antiviral substances belonging to a new class of anti-HIV drugs, i.e. capsid assembly inhibitors.

Upon maturation of the human immunodeficiency virus type 1 (HIV-1) virion, proteolytic cleavage of the Gag precursor protein by the viral protease is followed by morphological changes of the capsid protein p24, which will ultimately transform the virus core from an immature spherical to a mature conical structure. Virion infectivity is critically dependent on the optimal semistability of the capsid cone structure. We have reported earlier that glycineamide (G-NH(2)), when added to the culture medium of infected cells, inhibits HIV-1 replication and that HIV-1 particles with aberrant core structures were formed. Here we show that it is not G-NH(2) itself but a metabolite thereof, alpha-hydroxy-glycineamide (alpha-HGA), that is responsible for the antiviral activity. We show that alpha-HGA inhibits the replication of clinical HIV-1 isolates with acquired resistance to reverse transcriptase and protease inhibitors but has no effect on the replication of any of 10 different RNA and DNA viruses. alpha-HGA affected the ability of the HIV-1 capsid protein to assemble into tubular or core structures in vitro and in vivo, probably by binding to the hinge region between the N- and C-terminal domains of the HIV-1 capsid protein as indicated by matrix-assisted laser desorption ionization-mass spectrometry results. As an antiviral compound, alpha-HGA has an unusually simple structure, a pronounced antiviral specificity, and a novel mechanism of antiviral action. As such, it might prove to be a lead compound for a new class of anti-HIV substances.