| 1. |
- Danielson, Mattias, et al.
(author)
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Effects of methylprednisolone on blood-brain barrier and cerebral inflammation in cardiac surgery-a randomized trial
- 2018
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In: Journal of Neuroinflammation. - : Springer Science and Business Media LLC. - 1742-2094. ; 15
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Journal article (peer-reviewed)abstract
- Background: Cognitive dysfunction is a frequent complication to open-heart surgery. Cerebral inflammation caused by blood-brain barrier (BBB) dysfunction due to a systemic inflammatory response is considered a possible etiology. The effects of the glucocorticoid, methylprednisolone, on cerebrospinal fluid (CSF) markers of BBB function, neuroinflammation, and brain injury in patients undergoing cardiac surgery with cardiopulmonary bypass were studied. Methods: In this prospective, randomized, blinded study, 30 patients scheduled for elective surgical aortic valve replacement were randomized to methylprednisolone 15 mg/kg (n = 15) or placebo (n = 15) as a bolus dose administered after induction of anesthesia. CSF and blood samples were obtained the day before and 24 h after surgery for assessment of systemic and brain inflammation (interleukin-6, interleukin-8, tumor necrosis factor-alpha), axonal injury (total-tau, neurofilament light chain protein), neuronal injury (neuron-specific enolase), astroglial injury (S-100B, glial fibrillary acidic protein), and the BBB integrity (CSF/serum albumin ratio). Results: In the control group, there was a 54-fold and 17-fold increase in serum interleukin-6 and interleukin-8, respectively. This systemic activation of the inflammatory cytokines was clearly attenuated by methylprednisolone (p < 0. 001). The increase of the CSF levels of the astroglial markers was not affected. A postoperative BBB dysfunction was seen in both groups as the CSF/serum albumin ratio increased from 6.4 +/- 8.0 to 8.0 in the placebo group (p < 0.01) and from 5. 6 +/- 2.3 to 7.2 in the methylprednisolone group (p < 0.01) with no difference between groups (p = 0.98). In the CSF, methylprednisolone attenuated the interleukin-6 release (p < 0.001), which could be explained by the fall in systemic interleukin-6, and the serum to CSF gradient of IL-6 seen both at baseline and after surgery. In the CSF, methylprednisolone enhanced the interleukin-8 release (p < 0.001) but did not affect postoperative changes in CSF levels of tumor necrosis factor alpha. Serum levels of S-100B and neuron-specific enolase increased in both groups with no difference between groups. CSF levels of total tau, neurofilament light chain protein, and neuron-specific enolase were not affected in any of the groups. Conclusions: Preventive treatment with high-dose methylprednisolone attenuated the systemic inflammatory response to open-heart surgery with cardiopulmonary bypass, but did not prevent or attenuate the increase in BBB permeability or the neuroinflammatory response.
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| 2. |
- Finkel, Deborah, et al.
(author)
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Age and site differences in planned and performed actions in response to identified risks in older adults
- 2022
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In: Innovation in Aging. - : Oxford University Press. - 2399-5300. ; 6:Supplement_1, s. 840-840
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Journal article (other academic/artistic)abstract
- The Swedish health care system focuses on allowing older adults to “age in place”; however, that approach assumes that home health services are adequate to support health and prevent unnecessary decline. Data from the Senior Alert national quality register in Sweden were examined to compare the quality of care across care locations. First registration in Senior Alert was available for 2914 adults aged 57–109 (median age = 81): 3.6% dementia unit, 7.8% home health care, 4.4% rehabilitation unit, 62.8% hospital, 21.4% care home. There were significant differences across units in the number of identified risks in 4 categories: falls, malnutrition, oral health, and pressure ulcer. Individuals in rehabilitation units averaged 2.4 risks, individuals in dementia and care homes averaged 2.0 risks, and individuals in home health care and hospitals averaged 1.4 risks. For individuals with identified risks, the differences between planned and performed actions for each risk independently were greatest for those in home health care. Moreover, the correlation between total planned and performed actions in home health care was .79 for adults aged 65–80 years and .39 for adults aged 81 and over. The correlation did not differ across age for the other care units. Results suggest that individuals most in need of actions to address health risks (older adults in home health care) are least likely to have the actions performed. Training and support of workers responsible for home health care need to be improved if the “age in place” policy is to continue.
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| 3. |
- Jonasson, Lise-Lotte, 1956-, et al.
(author)
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Corroborating indicates nurses' ethical values in a geriatric ward
- 2011
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In: International Journal of Qualitative Studies on Health and Well-being. - Stockholm (Järfälla), Sverige : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 6:3, s. -10
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Journal article (peer-reviewed)abstract
- Aim. The aim of the study was to identify nurses’ ethical values, which become apparent through their behavior in the interactions with older patients in caring encounters at a geriatric clinic.Background. Descriptions of ethics in caring practice are a problem since they are vague compared with the four principles of autonomy, beneficence, non-maleficence, and justice.Methods. A Grounded Theory methodology was used. In total, 65 observations and follow-up interviews with 20 nurses were conducted, and data were analysed by constant comparative analysis.Findings. Three categories were identified: showing consideration, connecting, and caring for. These categories formed the basis of the core category: “Corroborating”. In corroborating the focus is on the person in need of integrity and self-determination, that is, the autonomy principle. A similar concept was earlier described in regard to confirming. Corroborating deals more with support and interaction. It is not enough to be kind and show consideration, i.e. to benefit someone; nurses must also connect and care for the older person, i.e. demonstrate non-maleficence, in order to corroborate that person.Conclusion. The findings of this study can improve the ethics of nursing care. There is a need for research on development of a high standard of nursing care to corroborate the older patients in order to maintain their autonomy, beneficence and non-maleficence. The principal of justice was not specifically identified as a visible nursing action. However, all older patients received treatment, care and reception in an equivalent manner.
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| 4. |
- Jonasson, Lise-Lotte, et al.
(author)
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Corroborating indicates nurses’ ethical values in a geriatric ward
-
Other publication (other academic/artistic)abstract
- Aim. The aim of the study was to identify nurses’ ethical values, which become apparent through their behavior in the interactions with older patients in caring encounters at a geriatric clinic. Background. Descriptions of ethics in caring practice are a problem since they are vague compared with the four principles of autonomy, beneficence, non-maleficence, and justice. Methods. A Grounded Theory methodology was used. In total, 65 observations and follow-up interviews with 20 nurses were conducted, and data were analysed by constant comparative analysis. Findings. Three categories were identified: showing consideration, connecting, and caring for. These categories formed the basis of the core category: ―Corroborating‖. In corroborating the focus is on the person in need of integrity and self-determination, that is, the autonomy principle. A similar concept was earlier described in regard to confirming. Corroborating deals more with support and interaction. It is not enough to be kind and show consideration, i.e. to benefit someone; nurses must also connect and care for the older person, i.e. demonstrate nonmaleficence, in order to corroborate that person. Conclusion. The findings of this study can improve the ethics of nursing care. There is a need for research on development of a high standard of nursing care to corroborate the older patients in order to maintain their autonomy, beneficence and non-maleficence. The principal of justice was not specifically identified as a visible nursing action. However, all older patients received treatment, care and reception in an equivalent manner.
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| 5. |
- Jonasson, Lise-Lotte, et al.
(author)
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Empirical and normative ethics : a synthesis relating to the care of older patients
- 2011
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In: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 18:6, s. 814-824
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Journal article (peer-reviewed)abstract
- The aim of this study was to synthesize the concepts from empirical studies and analyze, compare and interrelate them with normative ethics. International Council of nurses (ICN) and the Health and Medical Service Act are normative ethics. Five concepts were used in the analysis; three from the grounded theory studies and two from the theoretical framework on normative ethics. A simultaneous concept analysis resulted in five outcomes; interconnectedness, interdependence, corroboratedness, completeness and good care are all related to the empirical perspective of the nurse’s interaction with the older patient, and the normative perspective, i.e. that found in ICN code and SFS law. Empirical ethics and normative ethics are intertwined according to the findings of this study. Normative ethics are supporting documents for nurses as professionals and by extension also beneficial for older patients.
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| 6. |
- Jonasson, Lise-Lotte, 1956-, et al.
(author)
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Ethical values in caring encounters on a geriatric ward from the next of kin´s perspective : An interview study
- 2010
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In: International Journal of Nursing Practice. - : Wiley. - 1322-7114 .- 1440-172X. ; 16:1, s. 20-26
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Journal article (peer-reviewed)abstract
- The aim of this study was to identify and describe the governing ethical values that next of kin experience in interaction with nurses who care for elderly patients at a geriatric clinic. Interviews with fourteen next of kin were conducted and data were analysed by Constant comparative analysis. Four categories were identified: Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category: “Being amenable”, a concept identified in the next of kin’s description of the ethical values that they and the elderly patients perceive in the caring encounter. Being amenable means that the nurses are guided by ethical values; taking into account the elderly patient and the next of kin. Nurses’ focusing on elderly patients’ well-being as a final criterion affects the next of kin and their experience of this fundamental condition for high quality care seems to be fulfilled.
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| 7. |
- Ludvigsson, Mikael, 1976-, et al.
(author)
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Responding to Elder Abuse in GERiAtric care (REAGERA) educational intervention for healthcare providers : a non-randomised stepped wedge trial
- 2022
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In: BMJ Open. - London, United Kingdom : BMJ Publishing Group Ltd. - 2044-6055. ; 12:5
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Journal article (peer-reviewed)abstract
- Introduction Elder abuse is prevalent and associated with different forms of ill health. Despite this, healthcare providers are often unaware of abusive experiences among older patients and many lack training about elder abuse. The overall aim of this study is to determine the effectiveness of an educational intervention on healthcare providers' propensity to ask older patients questions about abusive experiences. Methods and analysis Healthcare providers at hospital clinics and primary healthcare centres in Sweden will undergo full-day education about elder abuse between the fall of 2021 and spring of 2023. The education consists of (1) theory and group discussions; (2) forum theatre, a form of interactive theatre in which participants are given the opportunity to practise how to manage difficult patient encounters; and (3) post-training reflection on changing practices. The design is a non-randomised cluster, stepped wedge trial in which all participants (n=750) gradually transit from control group to intervention group with 6-month interval, starting fall 2021. Data are collected using the Responding to Elder Abuse in GERiAtric care-Provider questionnaire which was distributed to all clusters at baseline. All participants will also be asked to answer the questionnaire in conjunction with participating in the education as well as at 6-month and 12-month follow-up. Main outcome is changes in self-reported propensity to ask older patients questions about abuse post-intervention compared with pre-intervention. Linear mixed models including cluster as a random effect will be used to statistically evaluate the outcome. Ethics and dissemination The study has been approved by the Swedish Ethical Review Authority. The results will be published in peer-reviewed journals and conference proceedings. If the intervention is successful, a manual of the course content will be published so that the education can be disseminated to other clinics.
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| 8. |
- Reinsfelt, Björn, et al.
(author)
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Open-heart surgery increases cerebrospinal fluid levels of Alzheimer-associated amyloid β
- 2013
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In: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 57:1, s. 82-88
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Journal article (peer-reviewed)abstract
- BACKGROUND: Neurocognitive dysfunction occurs frequently after open-heart surgery. It has been suggested that cognitive decline after cardiac surgery with cardiopulmonary bypass (CPB) could be a functional consequence of Alzheimer's disease (AD)-like neuropathological changes. The aim of the present study was to evaluate the cerebrospinal fluid (CSF) levels of amyloid β peptide (Aβ(1-42) ) and soluble fragments of amyloid precursor protein (sAPP) as well as the cerebral inflammatory response to open-heart surgery. METHODS: Ten patients undergoing aortic valve replacement with CPB were included. CSF was obtained the day before and 24h after surgery for assessment of CSF levels of Aβ(1-42) α-cleaved sAPP and β-cleaved sAPP (sAPP-β). Furthermore, CSF and serum levels of the inflammatory cytokines: tumour necrosis factor alpha (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) were also assessed. RESULTS: Cardiac surgery with CPB increased CSF levels of Aβ(1-42) from 447±92 to 641±83ng/l (P=0.011), while CSF levels of sAPP-β decreased from 276±35 to 192±21ng/ml (P=0.031). CSF levels of TNF-α increased from ≤0.60 to 0.79±0.26ng/l (P=0.043), IL-6 from 1.89±0.53 to 22.8±6.9ng/l (P=0.003) and IL-8 from 39.8±7.8 to 139±18.3ng/l (P<0.001). CONCLUSIONS: Cardiac surgery with CPB causes a profound cerebral inflammatory response, which was accompanied by increased post-operative CSF levels of the AD biomarker Aβ(1-42) . We hypothesize that these changes may be relevant to Alzheimer-associated amyloid build-up in the brain and cognitive dysfunction after cardiac surgery with CPB.
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| 9. |
- Reinsfelt, Björn, et al.
(author)
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The effects of isoflurane-induced electroencephalographic burst suppression on cerebral blood flow velocity and cerebral oxygen extraction during cardiopulmonary bypass.
- 2003
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In: Anesthesia and analgesia. - 0003-2999. ; 97:5, s. 1246-50
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Journal article (peer-reviewed)abstract
- We investigated the effects of isoflurane-induced burst suppression, monitored with electroencephalography (EEG), on cerebral blood flow velocity (CBFV), cerebral oxygen extraction (COE), and autoregulation in 16 patients undergoing cardiac surgery. The experimental procedure was performed during nonpulsatile cardiopulmonary bypass (CPB) with mild hypothermia (32 degrees C) in fentanyl-anesthestized patients. Middle cerebral artery transcranial Doppler flow velocity, right jugular vein bulb oxygen saturation, and jugular venous pressure (JVP) were continuously measured. Autoregulation was tested during changes in mean arterial blood pressure (MAP) within a range of 40-80 mm Hg, induced by sodium nitroprusside and phenylephrine before (control) and during additional isoflurane administration to an EEG burst-suppression level of 6-9/min. Isoflurane induced a 27% decrease in CBFV (P < 0.05) and a 13% decrease in COE (P < 0.05) compared with control. The slope of the positive relationship between CBFV and cerebral perfusion pressure (CPP = MAP - JVP) was steeper with isoflurane (P < 0.05) compared with control, as was the slope of the negative relationship between CPP and COE (P < 0.05). We conclude that burst-suppression doses of isoflurane decrease CBFV and impair autoregulation of cerebral blood flow during mildly hypothermic CPB. Furthermore, during isoflurane administration, blood flow was in excess relative to oxygen demand, indicating a loss of metabolic autoregulation of flow.
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| 10. |
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