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Sökning: swepub > Umeå universitet > Högskolan i Borås

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1.
  • Wijk, H, et al. (författare)
  • Verksamhetsförlagd utbildning på avancerad nivå – ny utmaning för specialistutbildningar för sjuksköterskor
  • 2009
  • Ingår i: Vård i Norden. ; 29:94, s. 41-43
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this article is to discuss challenges in the development of Specialist Nursing Educations as a result of the 2007 Swedish Higher Education Reform: the implementation of the so-called Bologna process. Certain challenges follow this reform, particularly since the specialist nursing programmes will be part of the second cycle of the higher education system, and it will be possible to combine the professional degree with a masters degree (one year). Possible strategies in four areas related to the Specialist Nursing Education are discussed: integration of researchbased knowledge, experienced-based knowledge, improvement knowledge, and strategies for collaboration between university institutions and clinics. Specific didactical issues are raised.
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2.
  • Öresland, Stina, et al. (författare)
  • Nurses as guests or professionals in home health care
  • 2008
  • Ingår i: Nursing Ethics. - 0969-7330. ; 15:3, s. 371-383
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to explore and interpret the diverse subject of positions, or roles, that nurses construct when caring for patients in their own home. Ten interviews were analysed and interpreted using discourse analysis. The findings show that these nurses working in home care constructed two positions: ;guest' and ;professional'. They had to make a choice between these positions because it was impossible to be both at the same time. An ethics of care and an ethics of justice were present in these positions, both of which create diverse ethical appeals, that is, implicit demands to perform according to a guest or to a professional norm.
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3.
  • Öresland, Stina, et al. (författare)
  • Patients as 'safeguard' and nurses as 'substitute' in home health care
  • 2009
  • Ingår i: Nursing Ethics. - Sage Publications. - 0969-7330. ; 16:2, s. 219-230
  • Tidskriftsartikel (refereegranskat)abstract
    • One aim of this study was to explore the role, or subject position, patients take in the care they receive from nurses in their own home. Another was to examine the subject position that patients say the nurses take when giving care to them in their own home. Ten interviews were analysed and interpreted according to a discourse analytical method. The findings show that patients constructed their subject position as 'safeguard', and the nurses' subject position as 'substitute' for themselves. These subject positions provided the opportunities, and the obstacles, for the patients' possibilities to receive care in their home. The subject positions described have ethical repercussions and illuminate that the patients put great demands on tailored care.
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4.
  • Perman, Jeanna, 1981-, et al. (författare)
  • The VLDL receptor promotes lipotoxicity and increases mortality in mice following an acute myocardial infarction.
  • 2011
  • Ingår i: The Journal of clinical investigation. - 1558-8238. ; 121:7, s. 2625-40
  • Tidskriftsartikel (refereegranskat)abstract
    • Reduced oxygen availability promotes triglyceride accumulation in hearts (1) and cardiomyocytes (2). Although it is well established that lipid accumulation in hypoxic conditions can be at least partly explained by a metabolic shift from oxidation of glucose and fatty acids to glycolysis (3, 4), it is not clear whether these metabolic changes alone are sufficient or if there is also a requirement for increased uptake of lipids. Potential mechanisms for lipid uptake include receptor-mediated endocytosis of lipoproteins, lipoprotein lipase–catalyzed (LPL-catalyzed) hydrolysis of triglycerides (5), and protein-facilitated uptake of fatty acids (reviewed in ref. 6). Accumulation of triglycerides in the myocardium is associated with impaired cardiac function (7–10), but it is not known whether there is a causative link between these 2 phenomena. Intracellular triglycerides, which are stored in the hydrophobic core of lipid droplets and surrounded by amphipathic lipids and proteins (reviewed in ref. 11), are most likely very inert and thus not directly lipotoxic (12). However, it is possible that products formed during the degradation of triglycerides, such as diglycerides and fatty acids, and ceramides, which are formed from fatty acids, may have a pronounced effect on myocardial function and survival. Hypoxia/ischemia is also known to promote ER stress or the unfolded protein response. This response involves the production of chaperones to promote the folding process and maintain ER homeostasis, but unresolved ER stress leads to apoptotic cell death (reviewed in refs. 13, 14). Recent evidence suggests that ER stress plays an important role in the progression of cardiovascular diseases including ischemic heart disease, indicating that strategies to reduce ER stress may be beneficial in the ischemic heart (15). The aims of this investigation were to clarify the mechanisms behind the accumulation of lipids in the myocardium during ischemia and to determine the effect of lipid accumulation on survival following an acute myocardial infarction. We show that hypoxia/ischemia increased expression of the VLDL receptor (VLDLR) in HL-1 cardiomyocytes and mouse hearts, and that expression of the VLDLR was essential for lipid accumulation during hypoxia/ischemia. Furthermore, VLDLR mRNA expression was higher in ischemic versus nonischemic human hearts. Importantly, survival was increased and infarct size, ER stress, and apoptosis were reduced in Vldlr–/– compared with Vldlr+/+ mice following an induced myocardial infarction. We also demonstrated that blockade of the VLDLR with antibodies reduced ischemia-induced lipid accumulation, ER stress, and apoptosis in mouse heart tissue. We therefore propose that the VLDLR-induced lipid accumulation in the ischemic heart worsens survival by increasing ER stress and apoptosis.
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5.
  • Herlitz, Johan, 1949-, et al. (författare)
  • Can we define patients with no chance of survival after out-of-hospital cardiac arrest?
  • 2004
  • Ingår i: Heart. - 1468-201X. ; 90:10, s. 1114-8
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To evaluate whether subgroups of patients with no chance of survival can be defined among patients with out-of-hospital cardiac arrest. Patients: Patients in the Swedish cardiac arrest registry who fulfilled the following criteria were surveyed: cardiopulmonary resuscitation (CPR) was attempted; the arrest was not crew witnessed; and patients were found in a non-shockable rhythm. Setting: Various ambulance organisations in Sweden. Design: Prospective observational study. Results: Among the 16 712 patients who fulfilled the inclusion criteria, the following factors were independently associated with a lower chance of survival one month after cardiac arrest: no bystander CPR; non-witnessed cardiac arrest; cardiac arrest occurring at home; increasing interval between call for and arrival of the ambulance; and increasing age. When these factors were considered simultaneously two groups with no survivors were defined. In both groups patients were found in a non-shockable rhythm, no bystander CPR was attempted, the arrest was non-witnessed, the arrest took place at home. In one group the interval between call for and arrival of ambulance exceeded 12 minutes. In the other group patients were older than 80 years and the interval between call for and arrival of the ambulance exceeded eight minutes. Conclusion: Among patients who had an out-of-hospital cardiac arrest and were found in a non-shockable rhythm the following factors were associated with a low chance of survival: no bystander CPR, non-witnessed cardiac arrest, the arrest took place at home, increasing interval between call for and arrival of ambulance, and increasing age. When these factors were considered simultaneously, groups with no survivors could be defined. In such groups the ambulance crew may refrain from starting CPR.
6.
  • Herlitz, J, et al. (författare)
  • Changes in demographic factors and mortality after out-of-hospital cardiac arrest in Sweden
  • 2005
  • Ingår i: Coron Artery Dis. - 0954-6928. ; 16:1, s. 51-7
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To describe changes between 1992 and 2003 in age, sex, factors at resuscitation and survival among patients suffering from out-of-hospital cardiac arrest in Sweden. Methods This was a prospective observational study including various ambulance organizations in Sweden. Patients suffering from out-of-hospital cardiac arrest between 1992 and 2003 included in the Swedish Cardiac Arrest Registry were followed for survival to 1 month. Results In all 19 791 cases took part in the survey. There was a slight increase in mean age from 68 to 70 years (P=0.025) and an increase of females from 29 to 32% (P=0.0001). There was a change in witnessed status (P<0.0001) with an increase in crew-witnessed cases and a decrease in non-witnessed cases. There was a decrease in cases of a cardiac etiology from 75 to 61% (P<0.0001) and a decrease in the percentage found in ventricular fibrillation from 36 to 25% (P<0.0001). When crew-witnessed cases were excluded the proportion receiving bystander cardiopulmonary resuscitation (CPR) increased from 30 to 42% (P<0.0001). There was a slight increase in the overall proportion of patients hospitalized alive from 16 to 20% (P=0.032). There was no significant change in the overall proportion of survivors at 1 month after cardiac arrest (4.5% in 1992 and 5.0% in 2003). Conclusions Among patients suffering from out-of-hospital cardiac arrest in Sweden some changes took place. The most important ones were a decrease in the proportion of patients found in ventricular fibrillation and an increase in the proportion of patients receiving bystander CPR. The proportion of patients admitted alive to hospital increased moderately, whereas the proportion of patients alive after 1 month remained unchanged.
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7.
  • Herlitz, J, et al. (författare)
  • Characteristics and outcome among children suffering from out of hospital cardiac arrest in Sweden
  • 2005
  • Ingår i: Resuscitation. - 0300-9572. ; 64:1, s. 37-40
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To evaluate the characteristics, outcome and prognostic factors among children suffering from out of hospital cardiac arrest in Sweden.METHODS: Patients aged below 18 years suffering from out of hospital cardiac arrest which were not crew witnessed and included in the Swedish cardiac arrest registry were included in the survey. This survey included the period 1990-2001 and 60 ambulance organisations covering 85% of the Swedish population (8 million inhabitants).RESULTS: In all 457 children participated in the survey of which 32% were bystander witnessed and 68% received bystander CPR. Ventricular fibrillation was found in 6% of the cases. The overall survival to 1 month was 4%. The aetiology was sudden infant death syndrome in 34% and cardiac in 11%. When in a multivariate analysis considering age, sex, witnessed status, bystander CPR, initial rhythm, aetiology and the interval between call for, and arrival of, the ambulance and place of arrest only one appeared as an independent predictor of an increased chance of surviving cardiac arrest occurring outside home (adjusted odds ratio 8.7; 95% CL 2.2-58.1).CONCLUSION: Among children suffering from out of hospital cardiac arrest in Sweden that were not crew witnessed, the overall survival is low (4%). The chance of survival appears to be markedly increased if the arrest occurs outside the patients home compared with at home. No other strong predictors for an increased chance of survival could be demonstrated.
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8.
  • Herlitz, J, et al. (författare)
  • Decrease in the occurrence of ventricular fibrillation as the initially observed arrhythmia after out-of-hospital cardiac arrest during 11 years in Sweden
  • 2004
  • Ingår i: Resuscitation. - 0300-9572. ; 60:3, s. 283-90
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To describe the change in the occurrence of ventricular fibrillation as initially observed arrhythmia among patients suffering from out-of-hospital cardiac arrest in Sweden. Patients: All patients included in the Swedish cardiac arrest registry between 1991 until 2001. The registry covers 85% of the population in Sweden. Methods: All patients with bystander witnessed out-of-hospital cardiac arrest included in the Swedish Cardiac Arrest Registry between 1991 and 2001 from the same ambulance organisation each year were included in the survey. Results: Over 11 years, among patients in Sweden with a bystander witnessed out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was attempted (n = 9666), the occurrence of ventricular fibrillation as the initially obseved arrhythmia decreased from 45% in 1991 to 28% in 2001 (P < 0.0001) if the arrest occurred at home, and from 57% to 41% if the arrest occurred outside home (P < 0.0001). This was found despite the fact that the proportion who received bystander CPR increased from 29% in 1991 to 39% in 2001 if the arrest occurred at home (P < 0.0001) and from 54% to 60% if the arrest occurred outside home (NS). There was a significant increase in age among patients with out-of-hospital cardiac arrest at home, no change in the estimated interval between collapse and call but an increase in the interval between call and arrival of the ambulance among patients with out-of-hospital cardiac arrest outside home. Conclusion: During 11 years in Sweden, there was a marked decrease in the proportion of patients found in ventricular fibrillation among patients with a bystander witnessed cardiac arrest regardless whether the arrest occurred at home or outside home. A modest increase in age and interval between call for, and arrival of, the ambulance was associated with these findings. (C) 2003 Elsevier Ireland Ltd. All rights reserved.
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9.
  • Herlitz, J, et al. (författare)
  • Efficacy of bystander CPR: intervention by lay people and by health care professionals
  • 2005
  • Ingår i: Resuscitation. - 0300-9572. ; 66:3, s. 291-5
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Early cardiopulmonary resuscitation (CPR) by bystanders prior to the arrival of the rescue team has been shown to be associated with increased survival after out-of-hospital cardiac arrest. The aim of this survey was to evaluate the impact on survival of no bystander CPR, lay bystander CPR and professional bystander CPR. Methods: Patients suffering an out-of-hospital cardiac arrest in Sweden between 1990 and 2002 who were given CPR and were not witnessed by the ambulance crew were included. Results: In all, 29,711 patients were included, 36% of whom received bystander CPR prior to the arrival of the rescue team. Among the latter, 72% received CPR from lay people and 28% from professionals. Survival to I month was 2.2% among those who received no bystander CPR, 4.9% among those who received bystander CPR from lay people (p<0.0001) and 9.2% among those who received bystander CPR from professionals (p < 0.0001 compared with bystander CPR by lay people). In a multivariate analysis, lay bystander CPR was associated with improved survival compared to no bystander CPR (OR: 2.04; 95% Cl: 1.72-2.42), and professional bystander CPR was associated with improved survival compared to lay bystander CPR (OR: 1.37; 95% CI: 1. 12-1.67). Conclusion: Among patients suffering an out-of-hospital cardiac arrest, bystander CPR by lay persons (excluding health care professionals) is associated with an increased chance of survival. Furthermore, there is a distinction between lay persons and health care providers; survival is higher when the latter perform bystander CPR. However, these results may not be explained by differences in the quality of CPR.
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10.
  • Herlitz, J, et al. (författare)
  • Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden
  • 2005
  • Ingår i: Am Heart J. - 1097-6744. ; 149:1, s. 61
  • Tidskriftsartikel (refereegranskat)abstract
    • AiM To describe factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in Sweden. Patients and Methods All patients suffering from an out-of-hospital cardiac arrest, which were not crew witnessed, in Sweden and in,whom cardiopulmonary resuscitation (CPR) was attempted and who were registered in the Swedish Cardiac Arrest Registry. This registry covers about 85% of the Swedish population and has been running since 1990. Results In all, 33 453 patients, 71% of whom had a cardiac etiology, were included in the survey. The following were independent predictors for an increased chance of survival in order of magnitude: (1) patients found in ventricular fibrillation (odds ratio [OR] 5.3, 95% confidence limits [CL] 4.2-6.8), (2) the interval between call for and arrival of the ambulance less than or equal to the median (OR 3.6, 95% CL 2.9-4.6), (3) cardiac arrest occurred outside the home (OR 2.2, 95% CL 1.9-2.7), (4) cardiac arrest was witnessed (OR 2.0, 95% CL 1.6-2.7), (5) bystanders performing CPR before the arrival of the ambulance (OR 2.0, 95% CL 1.7-2.4), and (6) age less than or equal to the median (OR 1.6, 95% CL 1.4-2.0). When none of these factors were present, survival to 1 m was 0.4%; when all factors were present, survival was 23.8%. Conclusion Among patients suffering from an out-of-hospital cardiac arrest, which were not crew witnessed, in Sweden and in whom CPR was attempted, 6 factors for an increased chance of survival could be defined. These include (1) initial rhythm, (2) delay to arrival of the rescue team, (3) place of arrest, (4) witnessed status, (5) bystander CPR, and (6) age.
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