"Jag råkade säga att jag har IBS"

Syftet med denna kvalitativa intervjustudie var att undersöka behov hos patienter med irritable bowel syndrome (IBS) angående vårdkontakter och vardagsliv. Uppsatsen syftade även till att undersöka IBS-patienters syn på stress kopplat till sjukdomen samt vilka strategier som används för att hantera symtom. Tio deltagare med IBS-symtom intervjuades. Tematisk analys användes och nio teman identifierades. Resultaten visade att patienter med IBS behöver att läkare lyssnar och tar deras symtom på allvar. Sjukvårdspersonal bör även bekräfta de fysiska symtomen i samband med att psykologisk hjälp erbjuds. Patienterna upplevde ett behov av att få prata om eller förklara sina besvär för anhöriga och kollegor. Andra strategier som användes för att hantera symtom var att de drabbade skaffade information om sjukdomen på internet och prövade sig fram med mat och medicin. Studien visade även att flera patienter inte ser stress som en bidragande faktor till IBS-besvär. Ett viktigt resultat från studien visar att vårdpersonal kan hjälpa IBS-patienter genom att lyssna, bekräfta deras symtom och ta dem på allvar

Psychological safety som prediktor för psykisk belastning och tecken på psykisk ohälsa: En kvantitativ tvärsnittsstudie på räddningstjänstpersonal

Studiens huvudsakliga syfte var att undersöka hur väl psychological safety i arbetslaget hos brandmän och styrkeledare statistiskt kan predicera upplevda krav, kontroll, stöd och stress på arbetet samt symptom på utmattningssyndrom. Studien ämnade även undersöka förekomst av psychological safety, stress, symptom på utmattning och iso-spänt arbete i urvalspopulationen samt huruvida demografiska frågor predicerar förekomsten av psychological safety. Undersökningen är en tvärsnittsstudie vilket innebär att orsakssamband inte kan fastställas. Enkäten bestod av nio demografiska frågor samt skattningsskalorna: Single Item Stress Questionnaire (SISQ), Job Content Questionnaire (JCQ), Karolinska Exhaustion Disorder Scale (KEDS) och en svensk version av Team Psychological Safety Survey. Enkäten distribuerades elektroniskt till cirka 450 stycken räddningstjänstpersonal på heltidsbrandstationer i Skåne. Studien bestod av 249 deltagare, varav 237 inkluderades. Resultatet visade att graden av psychological safety predicerade en liten del av upplevda krav (2.8%) och stressnivå (5.1%), en medelstor del av upplevd kontroll (10.6%), symptom på utmattning (9.2%) samt upplevt stöd (20.4%) i urvalspopulationen. Resultatet visade också en övervägande hög grad av psychological safety och en övervägande låg grad av upplevd stress i stickprovet. Majoriteten av urvalet upplevde sig inte vara i riskzonen för utmattningssyndrom eller iso-spänt arbete. Antalet arbetstimmar predicerade en liten del av graden av psychological safety (2.1%).The study aimed to examine how well psychological safety in teams of firefighters could predict perceived demands, control, support and stress at work as well as symptoms of exhaustion. The study further examined the prevalence of psychological safety, stress, symptom of exhaustion and iso-strained work and whether demographical data predicts prevalence of psychological safety. The design was cross-sectional meaning that a causal link cannot be determined. The survey consisted of nine demographical items and Single Item Stress Questionnaire (SISQ), Job Content Questionnaire (JCQ), Karolinska Exhaustion Disorder Scale (KEDS) and a Swedish version of Team Psychological Safety Survey. The survey was distributed electronically to approximately 450 employees at full-time fire stations in the south of Sweden. The study included 249 participants, whereof 237 were included. The results showed that the level of psychological safety predicted a small part of perceived demands (2.8%), stress level (5.1%) and a medium-sized part of perceived control (10.6%), support (20.4%) and symptoms of exhaustion (9.2%). The result showed a predominantly high level of psychological safety and low level of perceived stress. The majority of the population did not meet the criteria for the Swedish diagnose of exhaustion nor iso-strained work. The number of work-hours scheduled predicted a small part of the incidence of psychological safety (2.1%)

Determination of Safe Contrast Media Dosage to Estimated Glomerular Filtration Rate Ratios to Avoid Contrast-Induced Nephropathy After Elective Percutaneous Coronary Intervention

Background and Objectives: To avoid the risk of developing contrast-induced nephropathy (CIN), it has been suggested that patients be subjected to a minimal necessary dose of contrast medium (CM-dose). However, often it is not easy to determine such a dose. This study assessed the usefulness of the ratio of CM-dose to estimated glomerular filtration rate (eGFR) in predicting the risks of CIN and sought to determine the safe level of CM-dose/eGFR in patients undergoing non-emergent percutaneous coronary intervention (PCI). Subjects and Methods: We enrolled a total of 226 patients and calculated the ratio of CM-dose using grams of iodine (g-I) to eGFR, thus expressing it as g-I/eGFR. Among the CIN patients, those with nephropathy requiring dialysis (NRD) were also evaluated. Results: Overall, there were 16 cases (7.1%) of CIN. On univariate and multivariate regression analysis, g-I/eGFR alone was found to be an independent predictor for CIN (hazard ratio=10.73, p<0.001). In an receiver operating characteristic analysis, fair discrimination for CIN was found at a g-I/eGFR level of 1.42 (C statics=0.867), and at this value, the sensitivity and specificity were 81.3 % and 80%, respectively. Of patients (n=51) with g-I/ eGFR ≥1.42, 23.6 % (13/51) and 7.8 % (4/51) developed, while those with g-I/eGFR <1.42 (n=171) had a lower incidences of CIN (1.8%, 2/171, p<0.001) and NRD (0%, 0/171, p<0.001). Conclusion: It can be concluded that a g-I/eGFR <1.42 is a simple, useful indicator for determining the safe CM-dose based on the pre-PCI eGFR values. Furthermore, g-I/eGFR might hav

Assessment of glomerular filtration rate with dynamic computed tomography in normal Beagle dogs

The objective of our study was to determine individual and global glomerular filtration rates (GFRs) using dynamic renal computed tomography (CT) in Beagle dogs. Twenty-four healthy Beagle dogs were included in the experiment. Anesthesia was induced in all dogs by using propofol and isoflurane prior to CT examination. A single slice of the kidney was sequentially scanned after a bolus intravenous injection of contrast material (iohexol, 1 mL/kg, 300 mgI/mL). Time attenuation curves were created and contrast clearance per unit volume was calculated using a Patlak plot analysis. The CT-GFR was then determined based on the conversion of contrast clearance per unit volume to contrast clearance per body weight. At the renal hilum, CT-GFR values per unit renal volume (mL/min/mL) of the right and left kidneys were 0.69 ± 0.04 and 0.57 ± 0.05, respectively. No significant differences were found between the weight-adjusted CT-GFRs in either kidney at the same renal hilum (p = 0.747). The average global GFR was 4.21 ± 0.25 mL/min/kg and the whole kidney GFR was 33.43 ± 9.20 mL/min. CT-GFR techniques could be a practical way to separately measure GFR in each kidney for clinical and research purposes

Measuring Residual Renal Function in Hemodialysis Patients without Urine Collection

This is the peer reviewed version of the following article: Wong, J., Kaja Kamal, R. M., Vilar, E. and Farrington, K. (2017), 'Measuring Residual Renal Function in Hemodialysis Patients without Urine Collection', Seminars in Dialysis, Vol. 30 (1): 39–49, which has been published in final form at doi: 10.1111/sdi.12557. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. © 2016 Wiley Periodicals, Inc.Many patients on hemodialysis retain significant residual renal function (RRF) but currently measurement of RRF in routine clinical practice can only be achieved using inter-dialytic urine collections to measure urea and creatinine clearances. Urine collections are difficult and inconvenient for patients and staff, and therefore RRF is not universally measured. Methods to assess RRF without reliance on urine collections are needed since RRF provides useful clinical and prognostic information and also permits the application of incremental hemodialysis techniques. Significant efforts have been made to explore the use of serum based biomarkers such as cystatin C, β-trace protein and β2 -microglobulin to estimate RRF. This article reviews blood-based biomarkers and novel methods using exogenous filtration markers which show potential in estimating RRF in hemodialysis patients without the need for urine collection.Peer reviewedFinal Accepted Versio

Contrast media as markers of GFR

Determination of the glomerular filtration rate (GFR) is generally considered as the most important parameter of quantifying renal function. The GFR is determined as renal or plasma clearance of an ideal filtration marker which is freely filtered by the kidney, does not undergo metabolism, tubular secretion or absorption. Markers that fulfil these demands are inulin, 51Cr-EDTA, 99mTc-DTPA, labelled or unlabelled contrast media. The renal clearance of inulin is the classic reference method for estimation of the GFR. This method is however not practical for routine clinical purposes. Radionucleids have therefore been used as alternative filtration markers since the 60s. Drawbacks related to radiation exposure especially in children and pregnant women and the safety in handling radiolabelled markers have led to an increasing interest in using non-radioactive markers. The development of simple and reliable methods to determine the concentration of contrast media in plasma and urine, such as high-performance liquid chromatography (HPLC) and X-ray fluorescence analysis have made this possible. The non-ionic low osmolar contrast medium iohexol has become the most commonly used contrast medium for GFR measurements in Europe. However, other contrast media with similar pharmacokinetics may be equally suitable as GFR markers