| 1. |
- Kennedy, Catriona, et al.
(författare)
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Diagnosing dying : an integrative literature review
- 2014
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Ingår i: BMJ Supportive & Palliative Care. - London : BMJ Publishing Group Ltd. - 2045-435X .- 2045-4368.
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Tidskriftsartikel (refereegranskat)abstract
- Background To ensure patients and families receive appropriate end-of-life care pathways and guidelines aim to inform clinical decision making. Ensuring appropriate outcomes through the use of these decision aids is dependent on timely use. Diagnosing dying is a complex clinical decision, and most of the available practice checklists relate to cancer. There is a need to review evidence to establish diagnostic indicators that death is imminent on the basis of need rather than a cancer diagnosis.Aim To examine the evidence as to how patients are judged by clinicians as being in the final hours or days of life.Design Integrative literature review.Data sources Five electronic databases (2001–2011): Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL. The search yielded a total of 576 hits, 331 titles and abstracts were screened, 42 papers were retrieved and reviewed and 23 articles were included.Results Analysis reveals an overarching theme of uncertainty in diagnosing dying and two subthemes: (1) ‘characteristics of dying’ involve dying trajectories that incorporate physical, social, spiritual and psychological decline towards death; (2) ‘treatment orientation’ where decision making related to diagnosing dying may remain focused towards biomedical interventions rather than systematic planning for end-of-life care.Conclusions The findings of this review support the explicit recognition of ‘uncertainty in diagnosing dying’ and the need to work with and within this concept. Clinical decision making needs to allow for recovery where that potential exists, but equally there is the need to avoid futile interventions.
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| 3. |
- Lennquist, Anna, 1978, et al.
(författare)
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Physiology and mRNA expression in rainbow trout (Oncorhynchus mykiss) after long-term exposure to the new antifoulant medetomidine.
- 2011
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Ingår i: Comparative biochemistry and physiology. Toxicology & pharmacology : CBP. - : Elsevier BV. - 1532-0456. ; 154:3, s. 234-41
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Tidskriftsartikel (refereegranskat)abstract
- Medetomidine is under evaluation for use as an antifouling agent, and its effects on non-target aquatic organisms are therefore of interest. In this study, rainbow trout was exposed to low (0.5 and 5.0nM) concentrations of medetomidine for up to 54days. Recently we have reported on effects on paleness and melanophore aggregation of medetomidine in these fish. Here, specific growth rates were investigated together with a broad set of physiological parameters including plasma levels of growth hormone (GH), insulin-like growth factor-I (IGF-I) and leptin, glucose and haemoglobin (Hb), hematocrit (Ht), condition factor, liver and heart somatic indexes (LSI, HSI). Hepatic enzyme activities of CYP1A (EROD activity), glutathione S-transferases (GST) and glutathione reductase (GR) were also measured. Additionally, hepatic mRNA expression was analysed through microarray and quantitative PCR in fish sampled after 31days of exposure. Medetomidine at both concentrations significantly lowered blood glucose levels and the higher concentration significantly reduced the LSI. The mRNA expression analysis revealed few differentially expressed genes in the liver and the false discovery rate was high. Taken together, the results suggest that medetomidine at investigated concentrations could interfere with carbohydrate metabolism of exposed fish but without any clear consequences for growth.
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| 4. |
- Atanassova, N, et al.
(författare)
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Sequence-specific stalling of DNA polymerase gamma and the effects of mutations causing progressive ophthalmoplegia
- 2011
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Ingår i: Human Molecular Genetics. - 0964-6906. ; 20:6, s. 1212-1223
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Tidskriftsartikel (refereegranskat)abstract
- A large number of mutations in the gene encoding the catalytic subunit of mitochondrial DNA polymerase γ (POLγA) cause human disease. The Y955C mutation is common and leads to a dominant disease with progressive external ophthalmoplegia and other symptoms. The biochemical effect of the Y955C mutation has been extensively studied and it has been reported to lower enzyme processivity due to decreased capacity to utilize dNTPs. However, it is unclear why this biochemical defect leads to a dominant disease. Consistent with previous reports, we show here that the POLγA:Y955C enzyme only synthesizes short DNA products at dNTP concentrations that are sufficient for proper function of wild-type POLγA. In addition, we find that this phenotype is overcome by increasing the dNTP concentration, e.g. dATP. At low dATP concentrations, the POLγA:Y955C enzyme stalls at dATP insertion sites and instead enters a polymerase/exonuclease idling mode. The POLγA:Y955C enzyme will compete with wild-type POLγA for primer utilization, and this will result in a heterogeneous population of short and long DNA replication products. In addition, there is a possibility that POLγA:Y955C is recruited to nicks of mtDNA and there enters an idling mode preventing ligation. Our results provide a novel explanation for the dominant mtDNA replication phenotypes seen in patients harboring the Y955C mutation, including the existence of site-specific stalling. Our data may also explain why mutations that disturb dATP pools can be especially deleterious for mtDNA synthesis.
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| 5. |
- Athlin, Elsy, 1945-, et al.
(författare)
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A model for a national clinical final examination in the Swedish bachelor programme in nursing
- 2012
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Ingår i: Journal of Nursing Management. - Oxford : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 20:1, s. 90-101
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Tidskriftsartikel (refereegranskat)abstract
- Aim To describe the development and evaluation of a model for a national clinical final examination in the bachelor nursing education.Background After the transfer of nursing education to the academy, concerns have been raised among nurses, nurse leaders, lecturers and researchers about the nursing students clinical competence at the entrance to professional life.Methods During 2003 to 2005, a collaborative project was carried out between four universities and adjunctive health-care areas supplying clinical placements in Sweden. A two-part examination was agreed upon comprising a written theoretical test and a bedside test. An assessment tool for the bedside test was created. Nursing students, nurses and clinical lecturers participated voluntarily in the evaluation.Results The model was highly appreciated, and its relevance, usability, and validity were considered quite good for the assessment of nursing students clinical competence at the final stage of their education. Several deficiencies were revealed, which led to further development of the model.Conclusions and implications for nursing management The development and first evaluation of the model proved encouraging for further use, but it needs further evaluation. Involvement of nursing managers is necessary in order to satisfy new demands on competence and staffing of clinical nurses.
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| 6. |
- Bjuresäter, Kaisa, 1970-, et al.
(författare)
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Patients Living with Home Enteral Tube Feeding : Side effects, health-related quality of life and nutritional care
- 2014
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Ingår i: Clinical Nursing Studies. - : Sciedu Press. - 2324-7940 .- 2324-7959. ; 2:3, s. 64-75
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to examine patients’ perceptions of side effects, health-related quality of life (HRQL), generalhealth, and nutritional care among patients receiving home enteral tube feeding (HETF) at two occasions after dischargefrom hospital. Three questionnaires, one study-specific, the Short Form 12 (SF-12) and the Health Index (HI), were sent topatients with HETF (n=62) twice, two weeks after discharge from hospital and two months later. Forty patients respondedtwo weeks after discharge and out of these 29 patients also responded after two months. Data were collected in centralSweden from March 2006 to January 2010. Side effects were common at both points of data collection (70% of thepatients after two weeks and 72% after two month). Patients using bolus feeding reported significantly fewer side effectsthan patients using intermittent feeding. HRQL and HI scores for the total group were low at both points of data collection.The bolus feeding group reported significantly higher physical HRQL and emotional HI than the intermittent feedinggroup did. Most patients were satisfied with the information and support they received from the health care team. Thisstudy has revealed that patients treated with HETF experienced side effects limiting their daily life to a great extent.Differences in HRQL related to feeding methods were found. Individualized support and regular controls are needed inorder to meet patient needs. Bolus feeding may be a suitable feeding method to improve well-being.
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| 8. |
- Bjuresäter, Kaisa, 1970-, et al.
(författare)
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Struggling in an inescapable life situation : being a close relative of a person dependent on home enteral tube feeding
- 2012
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 21:7-8, s. 1051-1059
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To explore what it means to be a close relative of a person dependent on home enteral tube feeding (HETF) and how they can manage this situation. Background. Previous studies have shown that the situation of close relatives in home care in general can be burdensome and difficult. Research is scarce about experiences of close relatives when patients are treated with HETF. Design. A qualitative design was used, in accordance with grounded theory ( GT). Methods. Twelve close relatives were interviewed twice, using open- ended questions. Five were relatives of patients supported by home care services or advanced home care teams. Using the GT method, sampling, data collection and data analysis were carried out simultaneously. Results. One core category, ` Struggling in an inescapable life situation' and eight categories were found. The situation led to involuntary changes in the lives of the close relatives, something they could do little about. Their lives had become completely upturned and restricted by the HETF. Togetherness and pleasure was lost and they felt lonely. The relatives faced a new role of being informal caregivers and they had to adjust their daily life accordingly. They felt forced to take on a heavy responsibility for which they lacked support. The close relatives struggled to manage and to make the best of their new situation. Conclusions. This study highlighted the demands and vulnerability which is embedded in the role of being a close relative of a patient with HETF. It also pointed out their need for comprehensive support from the health care system.
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| 9. |
- Bremander, Ann, 1957-, et al.
(författare)
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Cultural adaptation, validity, reliability and responsiveness of the Swedish version of the effective musculoskeletal consumer scale (EC-17)
- 2012
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Ingår i: Musculoskeletal Care. - Chichester : John Wiley & Sons. - 1478-2189 .- 1557-0681. ; 10:1, s. 43-50
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Endorsed by the Outcome MEasures in Rheumatoid Arthritis in Clinical Trials (OMERACT) group, The Effective Consumer Scale (EC-17) was developed in English for patients with musculoskeletal diseases to assess the skills and perceptions important for participating in and managing health care. The objective of this study was culturally to adapt the questionnaire into Swedish and to study its psychometric properties.METHODS: After translation of the questionnaire into Swedish, two different groups of outpatients from two specialist rheumatology departments participated in the study. Face validity was assessed, together with internal consistency, test-retest and responsiveness of the questionnaire. Construct validity was assessed using the Arthritis Self-Efficacy Scale (ASES), and responsiveness to a five day educational intervention was analysed using the standardized response mean (SRM).RESULTS: Analyses were based on 124 patients with inflammatory rheumatic diseases, of whom 50 attended the intervention. Data quality met the requirements, with missing values <5%, and floor and ceiling effects <15%. Item total correlations were all >0.4, ranging from 0.49 to 0.88. Cronbach's alpha was 0.93 and 0.95 for the two groups. The test-retest correlation (ICC₂.₁) was 0.94, and there was a significant improvement as a result of the intervention, with an SRM of 0.43. However, the questionnaire had a higher construct validity with the ASES subscale 'other symptoms' than hypothesized a priori (r(s) 0.75).CONCLUSION: The Swedish version of the EC-17 met the required recommendations for face validity, internal consistency, test-retest reliability and responsiveness. Its construct validity needs to be further established, and the questionnaire needs further testing in different groups of patients and in different interventions. © 2012 John Wiley & Sons, Ltd.
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