Hvordan kan sykepleier bidra til å trygge og ivareta barn som pårørende til pasienter med en kreftdiagnose.

SAMMENDRAG Bakgrunn: I Norge er det registrert at mer en 34 000 barn under 18 år har- eller har hatt en forelder med en kreftdiagnose (Kreftforeningen, 2022). Helsepersonell har veiledende lovverk for å kunne trygge og ivareta barn som pårørende, men barna kan fort bli nedprioritert i foreldrenes behandlingsforløp. Det kan være utfordrende for sykepleier, samt barnet når en forelder blir diagnostisert med kreft og et barn må være nærmeste pårørende. Hensikt: Hensikten med denne oppgaven er å undersøke hvordan sykepleier kan bidra til å trygge og ivareta barn som pårørende til pasienter med en kreftdiagnose. Metode: Oppgaven er en integrativ litteraturoversikt. Vi har analysert fire kvalitative forskningsartikler for å besvare hensikten. Resultater fra forskningsartiklene og relevant tilleggslitteratur utgjør grunnlaget for oppgaven. Resultat: Resultatene viser at sykepleier har manglende kompetanse i møte med barn som pårørende. Uklare retningslinjer og utfordringer som mangel på tid og rutiner er gjennomgående temaer i forskningsartiklene. Resultatene belyser viktigheten av å forbedre sykepleien som utøves. Nøkkelord: Barn, pårørende, sykepleier, ivaretakelse, foreldre og kreftdiagnose

Osteochondrosis in the central and third tarsal bones of young horses

Recently, the central and third tarsal bones of 23 equine fetuses and foals were examined using micro-computed tomography. Radiological changes, including incomplete ossification and focal ossification defects interpreted as osteochondrosis, were detected in 16 of 23 cases. The geometry of the osteochondrosis defects suggested they were the result of vascular failure, but this requires histological confirmation. The study aim was to examine central and third tarsal bones from the 16 cases and to describe the tissues present, cartilage canals, and lesions, including suspected osteochondrosis lesions. Cases included 9 males and 7 females from 0 to 150 days of age, comprising 11 Icelandic horses, 2 standardbred horses, 2 warmblood riding horses, and 1 coldblooded trotting horse. Until 4 days of age, all aspects of the bones were covered by growth cartilage, but from 105 days, the dorsal and plantar aspects were covered by fibrous tissue undergoing intramembranous ossification. Cartilage canal vessels gradually decreased but were present in most cases up to 122 days and were absent in the next available case at 150 days. Radiological osteochondrosis defects were confirmed in histological sections from 3 cases and consisted of necrotic vessels surrounded by ischemic chondronecrosis (articular osteochondrosis) and areas of retained, morphologically viable hypertrophic chondrocytes (physeal osteochondrosis). The central and third tarsal bones formed by both endochondral and intramembranous ossification. The blood supply to the growth cartilage of the central and third tarsal bones regressed between 122 and 150 days of age. Radiological osteochondrosis defects represented vascular failure, with chondrocyte necrosis and retention, or a combination of articular and physeal osteochondrosis

Patellar ligament desmopathy in the horse – a review and comparison to human patellar tendinopathy (‘Jumper’s knee’)

Patellar ligament desmopathy in horses is regarded as an uncommon condition with unclear aetiology. Of the three patellar ligaments in the horse, the intermediate is the one most often diagnosed with desmopathy in horses presenting with chronic lameness. This structure corresponds to the patellar tendon in humans. As diagnostic imaging modalities continuously improve, changes in echogenicity of the patellar ligaments are identified ultrasonographically with increasing frequency. However, disruption of the normal fibre pattern may be present also in patellar ligaments in horses that show no signs of lameness. Similarly, there is a poor correlation between pain and diagnostic imaging findings in human patellar tendinopathy. Consequently, there appears to be a knowledge gap pertaining to normal ultrasonographic variation and diagnostic criteria for disease of the patellar ligaments in horses. Furthermore, local anaesthetic techniques to verify the diagnosis are poorly described, and due to the low number of treated cases, no specific treatment modality can be recommended on a scientific basis. The aim of this paper is to review the current knowledge regarding the pathogenesis, diagnosis and management of patellar ligament desmopathy in horses, compare this condition with patellar tendinopathy in humans, and identify areas for further research to increase the diagnostic accuracy in horses. We conclude that there is a profound need for better descriptions of ultrasonographic variation and pathological changes of the equine patellar ligaments. Identification of areas of maximal ligament strain and descriptions of early histopathological changes could render more information on the possible aetiology, preventive measurements and treatment options of desmopathy. Description of regional innervation could aid in development of methods for diagnostic anaesthesia to verify pain originating from the ligaments

Incidence, causes and outcomes of lameness cases in a working military horse population: a field study

Reasons for performing study: Lameness is a common problem in the horse. Despite this, information on the incidence of lameness in horses in the UK is restricted to studies of lameness in performance horses, racehorses or referral hospital populations. Objectives: To determine the overall incidence and common causes of lameness in a working horse population and incidence, duration and outcome of conditions observed. Study design: Prospective questionnaire study. Methods: Questionnaires were used to record lameness episodes in 294 horses in an equine military establishment. Information recorded included age, years of service, type of work, causal lesion, time taken to return to work and outcome. Lameness problems could be reported by any staff involved in the horses' care and were diagnosed by a veterinary surgeon or qualified farrier. Trends between lame and nonlame populations were compared using Chi-square analysis. Lameness diagnoses were grouped and analysed by disease category. Results: Completed questionnaires for 273 horses were analysed. The mean monthly incidence of lameness was 2.1%, equivalent to an annual rate of 25.4 cases per 100 horses per annum, with a mean of 1.2 lameness episodes per horse in the lame population. Horse age and duration of service were not significantly different between lame and nonlame populations. The most common diagnoses were cellulitis (18.6%), skin wounds (16.3%) and foot/shoeing problems (11.6%) and 88% of cases had returned to previous levels of work by the conclusion of the study. Conclusions: This initial field study showed that lameness is a common occurrence in this working military horse population and the majority of cases make a full return to work. The most common causes of lameness identified in this study and outcomes of these conditions differ from existing literature. Potential relevance: This study highlights the need for further studies of lameness in the wider horse population

Objectively measured movement asymmetry in yearling Standardbred trotters

Background Lameness evaluation of Standardbred trotters can be challenging due to discrepancies in observed movement asymmetry between in-hand and track exercise, and between different trotting speeds. There are few studies on objective measurement of movement in Standardbreds, and little knowledge regarding biological variation and clinical significance of measured movement asymmetry in this breed. Objectives To quantify the prevalence and magnitude of objectively measured movement asymmetry in young Standardbred trotters, and identify associations with trainer, sex, height, track type and in-hand measurement prior to or after track trials. Study design Cross-sectional, observational study. Methods A total of 114 Standardbred yearlings were evaluated with a wireless inertial sensor system during trot in-hand and when driven on a track. After exclusions relating to lameness or technical difficulties, 103 horses were included in the study; 77 were evaluated in-hand and on the track, 24 only in-hand and 2 only on the track. Results Front and/or hindlimb parameters were above asymmetry thresholds previously established for other breeds during in-hand trials for 94 (93%) horses and during track trials for 74 (94%) horses. Most horses showed mild asymmetry. A minority of horses (20%) switched side of the asymmetry for one or more parameters between in-hand and track trials. Mixed model analyses revealed no significant effects of trial mode (in-hand or track trial, in-hand trial pre- or post-track trial, straight or oval track), trainer or horse height. Females had a significant but small reduction in asymmetry in one front limb parameter (HDmax) compared with males (1.7 mm, 95% CI 0.18-3.28,P = .03). Main limitations High data variability, reflected in large trial standard deviations, relating mainly to a lack of horse compliance. Conclusions A high proportion of Standardbred yearlings showed movement asymmetries. There was no group-level effect between in-hand and track trials, however, considerable individual variation was observed

Electrode fabrication and interface optimization for imaging of evoked peripheral nervous system activity with electrical impedance tomography (EIT)

Objective. Non-invasive imaging techniques are undoubtedly the ideal methods for continuous monitoring of neural activity. One such method, fast neural electrical impedance tomography (EIT) has been developed over the past decade in order to image neural action potentials with non-penetrating electrode arrays. Approach. The goal of this study is two-fold. First, we present a detailed fabrication method for silicone-based multiple electrode arrays which can be used for epicortical or neural cuff applications. Secondly, we optimize electrode material coatings in order to achieve the best accuracy in EIT reconstructions. Main results. The testing of nanostructured electrode interface materials consisting of platinum, iridium oxide, and PEDOT:pTS in saline tank experiments demonstrated that the PEDOT:pTS coating used in this study leads to more accurate reconstruction dimensions along with reduced phase separation between recording channels. The PEDOT:pTS electrodes were then used in vivo to successfully image and localize the evoked activity of the recurrent laryngeal fascicle from within the cervical vagus nerve. Significance. These results alongside the simple fabrication method presented here position EIT as an effective method to image neural activity

Conditioned serum in vitro treatment of chondrocyte pellets and osteoarthritic explants

Background: Autologous conditioned serum (ACS) is used to treat osteoarthritis in horses, although its effects are not fully investigated.Objectives: To investigate the effects of equine serum and conditioned serum on chondrocytes stimulated with interleukin (IL)-1 beta and cartilage explants with mild osteoarthritis.Study design: In vitro experimental study.Methods: The effect of three different serum preparations (unincubated control [PS], serum incubated 24 h [PS24h] and serum incubated 24 h in ACS containers [PCS]) pooled from lame horses were tested in two in vitro models. IL-1 beta and IL-1 receptor antagonist (IL-1Ra) concentrations were measured in all sera. In model 1, chondrocyte pellet cultures were stimulated with IL-1 beta prior to treatment with the serum preparations for 2 and 48 h. Microarray, polymerase chain reaction, and matrix metallopeptidase-13 analyses were performed. In model 2, cartilage explants from horses with structural osteoarthritis were treated with PS or PCS on days 0, 6 and 12, or left untreated, and evaluated at day 24 using the OARSI grading scale for histological evaluation of articular cartilage.Results: The IL-1Ra concentration in PS24h and PCS was significantly higher than in PS. In model 1, inflammation- and cartilage matrix degradation-related genes were upregulated after 48 h in all treatment groups versus untreated controls. Cartilage matrix molecules, aggrecan and collagens, were downregulated in PS24h- and PCS-treated pellets versus untreated controls. Growth factor signalling genes were upregulated-FGF7 in all treatment groups, BMP2 in PS24h-, and INHBA in PCS-treated-compared with untreated controls. In model 2, the OARSI score at day 24 was not significantly different between treatment groups.Main limitations: Results from in vitro models cannot be directly translated to in vivo situations.Conclusions: In vitro treatment with conditioned serum did not alleviate IL-1 beta-induced responses in chondrocyte pellets or lead to morphological improvement in osteoarthritic cartilage explants

Splenic Nerve Neuromodulation Reduces Inflammation and Promotes Resolution in Chronically Implanted Pigs.

Neuromodulation of the immune system has been proposed as a novel therapeutic strategy for the treatment of inflammatory conditions. We recently demonstrated that stimulation of near-organ autonomic nerves to the spleen can be harnessed to modulate the inflammatory response in an anesthetized pig model. The development of neuromodulation therapy for the clinic requires chronic efficacy and safety testing in a large animal model. This manuscript describes the effects of longitudinal conscious splenic nerve neuromodulation in chronically-implanted pigs. Firstly, clinically-relevant stimulation parameters were refined to efficiently activate the splenic nerve while reducing changes in cardiovascular parameters. Subsequently, pigs were implanted with a circumferential cuff electrode around the splenic neurovascular bundle connected to an implantable pulse generator, using a minimally-invasive laparoscopic procedure. Tolerability of stimulation was demonstrated in freely-behaving pigs using the refined stimulation parameters. Longitudinal stimulation significantly reduced circulating tumor necrosis factor alpha levels induced by systemic endotoxemia. This effect was accompanied by reduced peripheral monocytopenia as well as a lower systemic accumulation of CD16+CD14high pro-inflammatory monocytes. Further, lipid mediator profiling analysis demonstrated an increased concentration of specialized pro-resolving mediators in peripheral plasma of stimulated animals, with a concomitant reduction of pro-inflammatory eicosanoids including prostaglandins. Terminal electrophysiological and physiological measurements and histopathological assessment demonstrated integrity of the splenic nerves up to 70 days post implantation. These chronic translational experiments demonstrate that daily splenic nerve neuromodulation, via implanted electronics and clinically-relevant stimulation parameters, is well tolerated and is able to prime the immune system toward a less inflammatory, pro-resolving phenotype