Side differences in cerebrovascular accidents after cardiac surgery: A statistical analysis of neurologic symptoms and possible implications for anatomic mechanisms of aortic particle embolization

BackgroundAortic manipulation and particle embolization have been identified to cause cerebrovascular accidents in cardiac surgery. Recent data suggest that left-hemispheric cerebrovascular accident (right-sided symptoms) is more common, and this has been interpreted as being caused by aortic cannula stream jets. Our aim was to evaluate symptoms of cerebrovascular accident and side differences from a retrospective statistical analysis.MethodsDuring a 2-year period, 2641 consecutive cardiac surgery cases were analyzed. Patients positive for cerebrovascular accident were extracted from a database designed to monitor clinical symptoms. A protocol was used to confirm symptom data with the correct diagnosis in patient records. Patients were subdivided into 3 groups: control, immediate cerebrovascular accident, and delayed cerebrovascular accident.ResultsAmong pooled patients, immediate and delayed cerebrovascular accidents were 3.0% and 0.9%, respectively. The expected predisposing factors behind immediate cerebrovascular accidents were significant, although the type of operation affected this search. Aortic quality was a strong predictor (P < .001). The rate of delayed cerebrovascular accident was unaffected by surgery group. Left-sided symptoms of immediate cerebrovascular accident were approximately twice as frequent (P = .016) as on the contralateral side. This phenomenon was observed for pooled patients and for isolated coronary bypass procedures (n = 1882; P = .025).ConclusionsImmediate cerebrovascular accident and aortic calcifications are linked. The predominance of left-sided symptoms may suggest that aortic manipulation and anatomic mechanisms in the aortic arch are more likely to cause cerebrovascular accidents than effects from cannula stream jets

Nurses' experiences of pain relief for patients in hospice

Bakgrund: I Sverige avlider ca 90 000 personer årligen, varav cirka 80% är i behov av palliativ vård. Smärta är ett av de vanligaste symtomen för patienter i palliativ vård. Studier har visat att många personer dör med smärta trots ordinerade vidbehovsläkemedel. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av smärtlindring till patienter på hospice. Metod: Semistrukturerade intervjuer genomfördes med fem sjuksköterskor på hospice. Intervjuerna transkiberades ordagrant och analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i fyra katergorier och elva underkategorier. Kategorierna var; bedöma behov av smärtlindring, arbeta i team för att lindra smärta, arbeta för smärtlindring och hantera känslor i arbetet. Konklusion: Bedömning av smärta med skattningsinstrument är viktigt för att kunna ge adekvat smärtlindring. Ökad kunskap om skattningsinstrument behövs för att dessa ska användas korrekt. Sjuksköterskor behöver ökad kunskap om farmakologiska och icke farmakologiska metoder för att lindra smärta. Ett välfungerande team med olika kompetenser ökar möjligheterna för adekvat smärtlindring.Background: In Sweden, about 90,000 people die annually, of wich about 80% need palliative care. Pain is one of the most common symptoms for patients in palliative care. However, earlier studies have shown that many people die with pain despite prescrition of individual medications as needed. Aim: The aim of this study was to describe nurses´experiences with pain relief to patients in hospice. Methods: Semi-structured interviews were conducted with five nurses at the hospice. The interveiws were transcribed verbatim and analyzed with qualitative content analysis. Results: The ananlysis resulted in four categories and eleven subcatergories. The categories were; assess the need for pain relief, work in teams to relieve pain, work for pain relief and manage emotions at work. Conclusion: The use of pain assassment scales is important to provide adequate pain relief. Increased knowledge of assessment instruments is needed for these to be used correctly. Nurses need increased knowledge of pharmacological and non-pharmacological methods to relieve pain. A well-functioning team with different competencies increases the possibilites for adequate pain relief.

Kvantitativa lättnaders påverkan på den svenska ekonomin

The purpose of this study is to examine the economies of Japan, the United States and the United Kingdoms, where the central banks have adopted the use of an unconventional monetary policy known as quantitative easing. By studying money supply, GDP growth, inflation and the price of these countries' currencies relative to ten other currencies this essay wants to evaluate if the Riksbank, with the help of quantitative easing, can increase inflation and what might happen with aggregate demand and the value of the krona. The results show that inflation and GDP growth had an upward trend during periods of quantitative easing. The results also show that Britain's currency depreciated against all the currencies in this study and the Japanese currency depreciated against the half of the currencies. However, this study could not observe any correlation between quantitative easing in the United States and a depreciated dollar. This study has reached the conclusion that the Riksbank's use of quantitative easing should create a positive trend for both inflation and aggregate demand and that the krona should depreciate.Validerat; 20150617 (global_studentproject_submitter

Nurses' experiences of pain relief for patients in hospice

Bakgrund: I Sverige avlider ca 90 000 personer årligen, varav cirka 80% är i behov av palliativ vård. Smärta är ett av de vanligaste symtomen för patienter i palliativ vård. Studier har visat att många personer dör med smärta trots ordinerade vidbehovsläkemedel. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av smärtlindring till patienter på hospice. Metod: Semistrukturerade intervjuer genomfördes med fem sjuksköterskor på hospice. Intervjuerna transkiberades ordagrant och analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i fyra katergorier och elva underkategorier. Kategorierna var; bedöma behov av smärtlindring, arbeta i team för att lindra smärta, arbeta för smärtlindring och hantera känslor i arbetet. Konklusion: Bedömning av smärta med skattningsinstrument är viktigt för att kunna ge adekvat smärtlindring. Ökad kunskap om skattningsinstrument behövs för att dessa ska användas korrekt. Sjuksköterskor behöver ökad kunskap om farmakologiska och icke farmakologiska metoder för att lindra smärta. Ett välfungerande team med olika kompetenser ökar möjligheterna för adekvat smärtlindring.Background: In Sweden, about 90,000 people die annually, of wich about 80% need palliative care. Pain is one of the most common symptoms for patients in palliative care. However, earlier studies have shown that many people die with pain despite prescrition of individual medications as needed. Aim: The aim of this study was to describe nurses´experiences with pain relief to patients in hospice. Methods: Semi-structured interviews were conducted with five nurses at the hospice. The interveiws were transcribed verbatim and analyzed with qualitative content analysis. Results: The ananlysis resulted in four categories and eleven subcatergories. The categories were; assess the need for pain relief, work in teams to relieve pain, work for pain relief and manage emotions at work. Conclusion: The use of pain assassment scales is important to provide adequate pain relief. Increased knowledge of assessment instruments is needed for these to be used correctly. Nurses need increased knowledge of pharmacological and non-pharmacological methods to relieve pain. A well-functioning team with different competencies increases the possibilites for adequate pain relief.

Föräldrars val av förskoleform : en enkätundersökning av föräldrars motiv

I dagens samhälle förväntas människor göra en mängd val där det finns möjlighet att välja bland annat husläkare, pensionsavtal och abonnemang av olika slag. Även inom förskolan råder denna valfrihet, där föräldrar kan välja mellan olika förskoleformer. Valfrihet kan medföra konkurrens mellan förskolor, vilket i sin tur kan höja verksamhetens kvalitet. De fristående förskolorna har en betydelsefull roll, inte minst genom den mångfald av pedagogiska inriktningar som de representerar. Examensarbetets teoretiska utgångspunkter behandlar valfrihet och olika förskoleformer. Syftet med denna studie är att undersöka vilka motiv föräldrar kan ha idag för sitt val av förskoleform. Den övergripande frågeställningen är: Vilka motiv styr föräldrars val av förskoleform? För att få svar på frågeställningen i undersökningen har enkäter använts. Undersökningen har genomförts bland föräldrar/vårdnadshavare i sex olika förskolor som representeras av förskoleformerna kommunala förskolor, personal- och föräldrakooperativ. Svarsfrekvensen av undersökningen blev relativt god med 78 % och resultatet visar att förskolans personal och närhet till hemmet är två framträdande motiv för föräldrarna. Detta ligger i linje med tidigare forskning som också visar dessa faktorer som viktiga. Skillnaderna är inte så stora mellan de olika förskoleformerna vad gäller viktiga faktorer som styr föräldrars val. Det framkommer inte av resultatet att själva förskoleformen är av stor betydelse, endast två svaranden har angivit det som viktigt. Däremot styrs valen mer av vissa gemensamma faktorer

Conservative or surgical management of orbital schwannomas : a population-based case series

Introduction: Orbital schwannomas (OS) are rare occurrences with no more than 500 cases reported in the literature. The tumor's potential to compromise the delicate neuro-ophthalmic structures within the orbit prompts surgical removal. Tumor removal is performed by ophthalmologists, often requiring a multidisciplinary surgical approach. The literature contains a very limited number of cases managed non-surgically. However, the inherent risks of orbital surgery warrant a comparison of the outcomes of conservative and surgical management strategies. Aims: To review the national Swedish experience with the management of orbital schwannomas. Methods: The study center is the primary Swedish referral center for the multidisciplinary management of orbital tumors, including schwannomas. During the period of 2005 to 2021, 16 patients with an OS diagnosis were managed at the center. Results: Four patients initially underwent surgery where gross total resection (GTR) was achieved in three (75%) and subtotal resection (STR) in one (25%) case. The remaining 12 patients, who had a low risk of neuro-ophthalmic impairment, were managed conservatively with radiological and clinical examinations at regular intervals. After an average follow-up of 17 months, surgery was performed in three of these cases (25%). No recurrences or tumor growths were detected on radiological follow-ups (mean 50 months), and all patients experienced postoperative improvement at clinical follow-up (mean 65 months). The remainder of the conservatively treated patients (n=9) experienced no clinical progression (mean 30 months). A slight radiological tumor progression was detected in one patient after 17 months. Conclusion: There were no differences in long-term outcome between patients who had been managed with early surgery and those operated later after an initially conservative management. Conservatively treated patients had minimal to no symptoms and remained clinically stable throughout the follow-up period. Based on these findings, conservative management may successfully be adopted in cases with mild symptoms, no signs of compressive optic neuropathy and low risk of neuro-ophthalmic impairment. Conversion to surgical management is indicated upon clinical deterioration or tumor growth. Based on the findings of this study a decision tree for the management of orbital schwannomas is suggested