Late gadolinium uptake demonstrated with magnetic resonance in patients where automated PERFIT analysis of myocardial SPECT suggests irreversible perfusion defect

<p>Abstract</p> <p>Background</p> <p>Myocardial perfusion single photon emission computed tomography (MPS) is frequently used as the reference method for the determination of myocardial infarct size. PERFIT^®is a software utilizing a three-dimensional gender specific, averaged heart model for the automatic evaluation of myocardial perfusion. The purpose of this study was to compare the perfusion defect size on MPS, assessed with PERFIT, with the hyperenhanced volume assessed by late gadolinium enhancement magnetic resonance imaging (LGE) and to relate their effect on the wall motion score index (WMSI) assessed with cine magnetic resonance imaging (cine-MRI) and echocardiography (echo).</p> <p>Methods</p> <p>LGE was performed in 40 patients where clinical MPS showed an irreversible uptake reduction suggesting a myocardial scar. Infarct volume, extent and major coronary supply were compared between MPS and LGE as well as the relationship between infarct size from both methods and WMSI.</p> <p>Results</p> <p>MPS showed a slightly larger infarct volume than LGE (MPS 29.6 ± 23.2 ml, LGE 22.1 ± 16.9 ml, p = 0.01), while no significant difference was found in infarct extent (MPS 11.7 ± 9.4%, LGE 13.0 ± 9.6%). The correlation coefficients between methods in respect to infarct size and infarct extent were 0.71 and 0.63 respectively. WMSI determined with cine-MRI correlated moderately with infarct volume and infarct extent (cine-MRI vs MPS volume r = 0.71, extent r = 0.71, cine-MRI vs LGE volume r = 0.62, extent r = 0.60). Similar results were achieved when wall motion was determined with echo. Both MPS and LGE showed the same major coronary supply to the infarct area in a majority of patients, Kappa = 0.84.</p> <p>Conclusion</p> <p>MPS and LGE agree moderately in the determination of infarct size in both absolute and relative terms, although infarct volume is slightly larger with MPS. The correlation between WMSI and infarct size is moderate.</p

Keratin 8/18 Regulation of Cell Stiffness-Extracellular Matrix Interplay through Modulation of Rho-Mediated Actin Cytoskeleton Dynamics

Cell mechanical activity generated from the interplay between the extracellular matrix (ECM) and the actin cytoskeleton is essential for the regulation of cell adhesion, spreading and migration during normal and cancer development. Keratins are the intermediate filament (IF) proteins of epithelial cells, expressed as pairs in a lineage/differentiation manner. Hepatic epithelial cell IFs are made solely of keratins 8/18 (K8/K18), hallmarks of all simple epithelia. Notably, our recent work on these epithelial cells has revealed a key regulatory function for K8/K18 IFs in adhesion/migration, through modulation of integrin interactions with ECM, actin adaptors and signaling molecules at focal adhesions. Here, using K8-knockdown rat H4 hepatoma cells and their K8/K18-containing counterparts seeded on fibronectin-coated substrata of different rigidities, we show that the K8/K18 IF-lacking cells lose their ability to spread and exhibit an altered actin fiber organization, upon seeding on a low-rigidity substratum. We also demonstrate a concomitant reduction in local cell stiffness at focal adhesions generated by fibronectin-coated microbeads attached to the dorsal cell surface. In addition, we find that this K8/K18 IF modulation of cell stiffness and actin fiber organization occurs through RhoA-ROCK signaling. Together, the results uncover a K8/K18 IF contribution to the cell stiffness-ECM rigidity interplay through a modulation of Rho-dependent actin organization and dynamics in simple epithelial cells

Relatives experiences of being present during cardiopulmonary resuscitation in hospitals

Det råder delade meningar angående närståendes närvaro under hjärt-lungräddning på sjukhus. Trots internationella riktlinjer från Emergency Nursing Association som säger att närstående bör erbjudas möjlighet att närvara under hjärt- lungräddning så följs ej dessa generellt på sjukhusen. Syftet: Var att beskriva närståendes upplevelser att närvara under hjärt-lungräddning på sjukhus. Metod: En litteraturstudie har gjorts där 13 vetenskapliga artiklar har granskats. Resultat: Närstående ville ha en valmöjlighet om de skulle närvara eller ej. De flesta närstående var nöjda med sitt beslut att närvara och skulle göra det igen trots att situationen upplevdes som svår. Närstående kände samhörighet med patienten och upplevde att de hanterade situationen bättre om de fick kontinuerlig information om händelseförloppet samt hade en stödperson vid sin sida. Sorgen underlättades då de delat den sista stunden med sin närstående. Slutsats: Närståendes närvaro under hjärt-lungräddning är fortfarande ett relativt outforskat område. Valmöjligheten att närvara är viktig, likaså kontinuerlig information och att ha en stödperson hos sig under hjärt-lungräddningen anses väsentligt. Närstående som varit närvarande under hjärt- lungräddning uppvisar lägre tendens till negativa psykologiska effekter och upplever även att sorgeprocessen underlättas.A difference of opinion exists regarding the issue of relatives being present during cardiopulmonary resuscitation in hospital. Despite international guidelines from the Emergency Nursing Association stating that relatives should be offered the opportunity to be present during cardiopulmonary resuscitation, this is generally not the case. The aim: of this study was to describe relatives' experiences of being present during cardiopulmonary resuscitation in hospital. Method: A literature review in which 13 scientific papers have been reviewed. Results: Relatives preferred to be given the option to attend the cardiopulmonary resuscitation or not. Most relatives were satisfied with their decision to attend and would do it again even though the situation was perceived as difficult. Relatives experienced an emotional connection with the patient and felt that they handled the situation better if they were given continuous information on the events and had a support person at their side. Relatives also felt it easier to cope with the grieving process when they had shared their loved ones last moment. Conclusion: The attendance of relatives during cardiopulmonary resuscitation is still a relatively unexplored area. To be given the option to attend or not is important, as is continuous information during the resuscitation as well as a support person throughout the process. Relatives who were present during resuscitation showed lower tendency to experience negative psychological effects, and that the grieving process felt easier to go through

Lek, lärande och utveckling : Sex pedagogers syn på lekens betydelse för förskolebarns utveckling och lärande

Syftet med studien är att undersöka hur pedagoger använder sig av leken i sin verksamhet och vad de har för syn på lekens betydelse för förskolebarns lärande och utveckling. Studien bygger på litteratur om tidigare forskning kring lek samt kvalitativa intervjuer med sex pedagoger verksamma inom förskola och förskoleklass. Resultatet av vår studie visar att både pedagogerna och de forskare vi tagit del av anser att leken är en viktig bit av barns lärande och utveckling. Pedagogerna lyfter fram leken som barnens arbetsredskap och poängterar hur viktigt det är att skapa goda förutsättningar för lek. De använder leken på ett medvetet sätt i sin verksamhet och är eniga om att begreppen lek, lärande och utveckling är sammanhängande och inte går att skilja åt. Studien visar att leken mestadels ses som god och befrämjande men också att leken har en baksida som enligt pedagogerna kan innehålla inslag av maktutövande och förtryck

Patients' experiences of physical activity while coping with substance use disorder : a systematic review with a qualitative approach

Bakgrund: Substansberoende är ett globalt problem som inte bara påverkar människan på individnivå utan hela samhället. Den psykosociala omvårdnaden med samtal om livsstilsförändringar blir alltmer viktig. Fysisk aktivitet har visat sig ha positiv effekt för personer med substansbrukssyndrom. Det är betydelsefullt att specialistsjuksköterskan får ökad kunskap och fler redskap för att stödja dessa patienter. Via personcentrad vård och en god vårdrelation som tar tillvara patientens upplevelse kan mer specifikt utformade omvårdnadsåtgärder med fysisk aktivitet utformas. Syfte: Att undersöka patienters upplevelse av fysisk aktivitet vid substansbrukssyndrom. Metod: Litteraturöversikt med systematisk ansats Resultat: Att delta i fysisk aktivitet genererade starka känslor och ledde till beteendeförändringar. Patienterna upplevde att den sociala aspekten av fysisk aktivitet var stödjande. Genom fysisk aktivitet fick patienterna möjlighet att erhålla nya färdigheter. Det simultana och holistiska upplägget av fysisk aktivitet uppskattades. Relationen till FA-ledaren och egenskaperna hos denne upplevdes ha en inverkan på motivationen hos patienterna. Slutsats: Via fysisk aktivitet kan patienter med substansbrukssyndrom uppleva ökad förståelse för den egna kroppens kapacitet, ny upplevd kontroll samt erhålla nya färdigheter som att hantera utmaningar och negativa känslor bättre. Specialistsjuksköterskan har möjlighet att via god personcentrerade vård med motiverande samtalet öka sannolikheten för att fysiska aktivitet som omvårdnadsåtgärd implementeras och har effekt.Background: Substance use disorder is a global concern that does not only affect the individual negatively but also the society at large. The psychosocial nursing care with dialogue about lifestyle changes is becoming more important. Physical activity has had many confirmed positive effects for patients suffering from substance use disorder. It is important that the specialist nurse is given more knowledge and tools to care for and motivate these patients. Through patient-centered care and a good care relation that takes advantage of the patients' experience more specific care actions with physical activity can be designed to cater for this group's special needs. Aim: To examine patient experience of physical activity while coping with substance use disorder. Method: Literature review Results: Involvement in physical activity generated strong emotions and led to behavior changes. The patients experienced that the social aspect of physical activity was supportive. Through physical activity the patients could obtain new skills. The relation to and the characteristics of the PA-leader had an impact on the patient's motivation. Conclusion: Through physical activity patients with substance use disorder can gain increased understanding of their body’s capacity, new sense of control and new skills such as being able to manage challenges and negative feelings better. The specialist nurse has an opportunity through patient centered care with motivational interviewing to increase the possibility that physical activity is being implemented and has effect. 

Patients' experiences of physical activity while coping with substance use disorder : a systematic review with a qualitative approach

Bakgrund: Substansberoende är ett globalt problem som inte bara påverkar människan på individnivå utan hela samhället. Den psykosociala omvårdnaden med samtal om livsstilsförändringar blir alltmer viktig. Fysisk aktivitet har visat sig ha positiv effekt för personer med substansbrukssyndrom. Det är betydelsefullt att specialistsjuksköterskan får ökad kunskap och fler redskap för att stödja dessa patienter. Via personcentrad vård och en god vårdrelation som tar tillvara patientens upplevelse kan mer specifikt utformade omvårdnadsåtgärder med fysisk aktivitet utformas. Syfte: Att undersöka patienters upplevelse av fysisk aktivitet vid substansbrukssyndrom. Metod: Litteraturöversikt med systematisk ansats Resultat: Att delta i fysisk aktivitet genererade starka känslor och ledde till beteendeförändringar. Patienterna upplevde att den sociala aspekten av fysisk aktivitet var stödjande. Genom fysisk aktivitet fick patienterna möjlighet att erhålla nya färdigheter. Det simultana och holistiska upplägget av fysisk aktivitet uppskattades. Relationen till FA-ledaren och egenskaperna hos denne upplevdes ha en inverkan på motivationen hos patienterna. Slutsats: Via fysisk aktivitet kan patienter med substansbrukssyndrom uppleva ökad förståelse för den egna kroppens kapacitet, ny upplevd kontroll samt erhålla nya färdigheter som att hantera utmaningar och negativa känslor bättre. Specialistsjuksköterskan har möjlighet att via god personcentrerade vård med motiverande samtalet öka sannolikheten för att fysiska aktivitet som omvårdnadsåtgärd implementeras och har effekt.Background: Substance use disorder is a global concern that does not only affect the individual negatively but also the society at large. The psychosocial nursing care with dialogue about lifestyle changes is becoming more important. Physical activity has had many confirmed positive effects for patients suffering from substance use disorder. It is important that the specialist nurse is given more knowledge and tools to care for and motivate these patients. Through patient-centered care and a good care relation that takes advantage of the patients' experience more specific care actions with physical activity can be designed to cater for this group's special needs. Aim: To examine patient experience of physical activity while coping with substance use disorder. Method: Literature review Results: Involvement in physical activity generated strong emotions and led to behavior changes. The patients experienced that the social aspect of physical activity was supportive. Through physical activity the patients could obtain new skills. The relation to and the characteristics of the PA-leader had an impact on the patient's motivation. Conclusion: Through physical activity patients with substance use disorder can gain increased understanding of their body’s capacity, new sense of control and new skills such as being able to manage challenges and negative feelings better. The specialist nurse has an opportunity through patient centered care with motivational interviewing to increase the possibility that physical activity is being implemented and has effect. 

Lek, lärande och utveckling : Sex pedagogers syn på lekens betydelse för förskolebarns utveckling och lärande

Syftet med studien är att undersöka hur pedagoger använder sig av leken i sin verksamhet och vad de har för syn på lekens betydelse för förskolebarns lärande och utveckling. Studien bygger på litteratur om tidigare forskning kring lek samt kvalitativa intervjuer med sex pedagoger verksamma inom förskola och förskoleklass. Resultatet av vår studie visar att både pedagogerna och de forskare vi tagit del av anser att leken är en viktig bit av barns lärande och utveckling. Pedagogerna lyfter fram leken som barnens arbetsredskap och poängterar hur viktigt det är att skapa goda förutsättningar för lek. De använder leken på ett medvetet sätt i sin verksamhet och är eniga om att begreppen lek, lärande och utveckling är sammanhängande och inte går att skilja åt. Studien visar att leken mestadels ses som god och befrämjande men också att leken har en baksida som enligt pedagogerna kan innehålla inslag av maktutövande och förtryck

From crisis to self-confidence and adaptation; Experiences of being a parent of a child with VACTERL association : A complex congenital malformation

Aim Knowledge is scarce regarding mothers' and fathers' experiences of being a parent of a child with VACTERL association-a complex malformation. The aim of the study was to describe experiences of being a parent of a child with VACTERL association. Method Semi-structured interviews were performed with ten mothers and nine fathers face-to-face or by telephone and analyzed by using Qualitative content analysis. Results The parents described crisis reactions at the discovery of malformations in their child. Involvement in care was reported from the initial hospital admission until actively taking responsibility for treatments at home. Eventually the health condition became an integrated part of everyday life. The parents expressed the importance of meeting other families with a child with VACTERL. Descriptions were given of more or less professionalism with perceived discrepancies of knowledge and experience between the healthcare professionals in the tertiary hospital and those in the local hospital. Difficulties in receiving medical support during the initial period at home were described. Furthermore, emotional support and practical arrangements regarding parental accommodation and transportation varied. Conclusion Being a parent of a child with VACTERL association involves crisis, mixed emotional reactions and shared responsibility for the child ' s treatment and care with the professional care providers. Psychological processing, good medical care and support from experts, and peer support from other parents is essential in the parents' struggle to reach self-confidence and adaptation. A care plan with individualized tailored care for each child including a training and support plan for the parents is warranted. To reduce the described discrepancies in knowledge and experience between the local and tertiary hospital, video sessions with the parents and responsible professionals at the local and tertiary hospital could be an appropriate mode of transferring information at discharge and follow up of the child

Positive effect on patient experience of video-information given prior to cardiovascular magnetic resonance imaging, a clinical trial

Aims: To evaluate the effect of video information given before cardiovascular magnetic resonance imaging on patient anxiety and to compare patient experiences of cardiovascular magnetic resonance imaging versus myocardial perfusion scintigraphy. To evaluate if additional information has an impact on motion artefacts. Background: Cardiovascular magnetic resonance imaging and myocardial perfusion scintigraphy are technically advanced methods for the evaluation of heart diseases. Although cardiovascular magnetic resonance imaging is considered to be painless, patients may experience anxiety due to the closed environment. Design: A prospective randomized intervention study, not registered. Methods: The sample (n=148) consisted of 97 patients referred for cardiovascular magnetic resonance imaging, randomized to receive either video information in addition to standard text-information (CMR-video/n=49) or standard text-information alone (CMR-standard/n=48). A third group undergoing myocardial perfusion scintigraphy (n=51) was compared with the cardiovascular magnetic resonance imaging-standard group. Anxiety was evaluated before, immediately after the procedure and one week later. Five questionnaires were used: Cardiac Anxiety Questionnaire, State-Trait-Anxiety Inventory, Hospital-Anxiety and Depression-scale, MRI-Fear-Survey-Schedule and the MRI-Anxiety-Questionnaire. Motion artefacts were evaluated by three observers, blinded to the information given. Data were collected between April 2015 and April 2016. The study followed the CONSORT guidelines RESULT: The CMR-video group scored lower (better) than the cardiovascular magnetic resonance imaging-standard group in the factor Relaxation (p=0.039) but not in the factor Anxiety. Anxiety levels were lower during scintigraphic examinations compared to the CMR-standard group (p&lt;0.001). No difference was found regarding motion artefacts between CMR-video and CMR-standard. Conclusion: Patient ability to relax during cardiovascular magnetic resonance imaging increased by adding video information prior the exam, which is important in relation to perceived quality in nursing. No effect was seen on motion artefacts. Relevance To Clinical Practice: Video information prior to examinations can be an easy and time effective method to help patients cooperate in imaging procedures