Bakgrund: Anestesisjuksköterskan arbetar i en komplex vårdmiljö med självständigt ansvar för patientens anestesi under operation och förväntas bedöma och hantera komplexa vårdsituationer. Lärande till yrkesprofession sker delvis under utbildningen till specialistsjuksköterska inom anestesi och delvis inom ramen för det yrkeskollektiv som anestesisjuksköterskan arbetar. För att uppnå kompetens som anestesisjuksköterska krävs vissa komponenter i lärandet till yrkesprofession.

Syfte: Att beskriva anestesisjuksköterskors uppfattningar av lärandet till yrkesprofession.

Metod: Studien har en kvalitativ design med fenomenografisk forskningsansats.  Anestesisjuksköterskor från en operationsavdelning i sydöstra Sverige har intervjuats kring temat lärande till yrkesprofession. Intervjumaterialet har analyserats enligt fenomenografisk metod.

Resultat: Fyra beskrivningskategorier som handlade om lärande till yrkesprofession identifierades. Att lära sig utföra anestesisjukvård, att lära sig tänka och agera som anestesisjuksköterska, att lära sig bemöta patienter och att lära sig samarbeta.

Slutsats: Resultatet visar att för att lära sig vårda en patient i en anestesikontext krävs vissa komponenter. Det är viktigt att vara medveten om dessa komponenter när studenter eller nyanställda skall lära sig yrkesprofessionen. Genom klinisk träning och teoretisk förankring kan anestesisjuksköterskan lära sig vårda komplexa sjukdomstillstånd där patientens säkerhet och integritet bibehålls.

Världsmarknaden för läkemedlen beräknades år 2011 till 900 miljarder US$ enligt IMS-health. Marknaden för illegala läkemedel uppskattas vara värd mellan 75-200 miljarder dollar. I Sverige uppskattas den illegala läkemedelsmarknaden till motsvarande ≤0,5 %. Straffet för insmuggling av läkemedel till Sverige är böter eller max 2 års fängelse. Tullverket räknar med att man endast hittar 10 % av det som smugglas in. I andra länder kan straffet variera mellan böter (ekonomisk brottslighet i Afrika) till dödsstraff i Kina.

I Utvecklingsländerna uppskattas 10-30 % av alla läkemedel som säljs vara förfalskade, jmf 1 % I-länderna. l. Förekomsten av förfalskade läkemedel har många allvarliga konsekvenser på människor som exempelvis, utebliven effekt, toxiska reaktioner, förgiftningar, som kan i värsta fall leda till döden. Ett annat alvarligt problem är resistensutveckling, ökad spridning av smittsamammasjukdomar som exempel, tuberkulos och/ eller HIV/AIDS.

Syftet med detta examensarbete är att besvara frågan: Vilka problem ger den ökande förekomsten av förfalskade läkemedel i samhället. Undersökningen fokuserar på livstidsläkemedel, dvs ett läkemedel en person måste ta resten av sitt liv för behandling av sin kroniska sjukdom.

För att komma till rätta med de problem, som förfalskade läkemedel, skapar krävs ett mer utvecklat samarbete mellan olika läkemedelsmyndigheter, läkemedelsföretag, internationella polisorganisationer, tull m.fl. Arbetet med att utveckla förpackningar som är svåra att förfalska bör intensifieras. Straffsatser bör kanske ses över. Det är viktigt att öka medvetandet bland allmänheten om risker med att köpa läkemedel utanför apotek (t ex via nätet).

The photovoltaic (PV) panel can produce electrical energy that is very environmentally friendly and easy to use. The use of PV panels is suitable for supplying peak loads or at night using batteries as energy storage. However, the battery needs to manage for control, and the battery can last long. The solution to battery management problems is through research about the battery charging system. The DC-DC converter used is the Single Ended Primary Inductance Converter (SEPIC) type. Voltage Control of the battery charging using Adaptive Neuro-Fuzzy Inference System (ANFIS). In the simulation of bright conditions, ANFIS controls can track the charging point set point and obtain a voltage response with a rise time of 0.0028 s, a maximum overshoot of 0.027 %, a peak time of 0.008 s, and a settling time of 0.0193 s. When charging a solar tracker, PV battery gets a 0.25 % increase compared to a fixed PV panel. PV solar tracker can follow the direction of the sun's position. The irradiation value and maximum temperature affect the input voltage and input current that enters the converter. © The Authors, published by EDP Sciences, 2020.

World energy consumption increases with time, so that occur an energy imbalance. Many breakthroughs have developed to utilize renewable energy. The photovoltaic system is one of the easy-to-use renewable energies. The power conversion from PV fixed is still low, so the PV system is designed using the active dual-axis solar tracker. The PV tracker position can be adjusted to change the sun position to get maximum efficiency. The active dual-axis solar tracker system is integrated with the maximum power point tracking (MPPT) algorithm to keep PV operating at a maximum power point even though input variations change. The active dual-axis solar tracker system integrated with the maximum power point tracking (MPPT) algorithm to keep PV operating at a maximum power point even though input variations change. Tracking test simulation had done by comparing the output power of a fixed PV system with the active dual-axis solar tracker. Type-2 fuzzy logic based MPPT successfully increased the average output power by 10.48 % with the highest increase of 17.48 % obtained at 15:00 West Indonesia Time (GMT+7). The difference in power from a fixed PV system with the active dual-axis solar tracker of 36.08 W is from the output power worth 206.3 to 242.4 W. © The Authors, published by EDP Sciences, 2020.

Solid waste management is a challenge for the cities' authorities in developing countries mainly due to the increasing generation of waste, the burden posed on the municipal budget as a result of the high costs associated to its management, the lack of understanding over a diversity of factors that affect the different stages of waste management and linkages necessary to enable the entire handling system functioning. An analysis of literature on the work done and reported mainly in publications from 2005 to 2011, related to waste management in developing countries, showed that few articles give quantitative information. The analysis was conducted in two of the major scientific journals, Waste Management Journal and Waste Management and Research. The objective of this research was to determine the stakeholders' action/behavior that have a role in the waste management process and to analyze influential factors on the system, in more than thirty urban areas in 22 developing countries in 4 continents. A combination of methods was used in this study in order to assess the stakeholders and the factors influencing the performance of waste management in the cities. Data was collected from scientific literature, existing data bases, observations made during visits to urban areas, structured interviews with relevant professionals, exercises provided to participants in workshops and a questionnaire applied to stakeholders. Descriptive and inferential statistic methods were used to draw conclusions. The outcomes of the research are a comprehensive list of stakeholders that are relevant in the waste management systems and a set of factors that reveal the most important causes for the systems' failure. The information provided is very useful when planning, changing or implementing waste management systems in cities.

Background As global aging accelerates, routinely assessing the functional status and morbidity burden of older patients becomes paramount. The aim of this study is to assess the validity of the comprehensive clinical and functional Health Assessment Tool (HAT) based on four cohorts of older adults (60 + years) from the Swedish National study on Aging and Care (SNAC) spanning urban, suburban, and rural areas.Methods The HAT integrates five health indicators (gait speed, global cognition, number of chronic diseases, and basic and instrumental activities of daily living), providing an individual-level score between 0 and 10. The tool was constructed using nominal response models, first separately for each cohort and then in a harmonized dataset. Outcomes included all-cause mortality over a maximum follow-up of 16 years and unplanned hospital admissions over a maximum of 3 years of follow-up. The predictive capacity was assessed through the area under the curve (AUC) using logistic regressions. For time to death, Cox regressions were performed, and Harrell's C-indices were reported. Results from the four cohorts were pooled using individual participant data meta-analysis and compared with those from the harmonized dataset.Results The HAT demonstrated high predictive capacity across all cohorts as well as in the harmonized dataset. In the harmonized dataset, the AUC was 0.84 (95% CI 0.81-0.87) for 1-year mortality, 0.81 (95% CI 0.80-0.83) for 3-year mortality, 0.80 (95% CI 0.79-0.82) for 5-year mortality, 0.69 (95% CI 0.67-0.70) for 1-year unplanned admissions, and 0.69 (95% CI 0.68-0.70) for 3-year unplanned admissions. The Harrell's C for time-to-death throughout 16 years of follow-up was 0.75 (95% CI 0.74-0.75).Conclusions The HAT is a highly predictive, clinically intuitive, and externally valid instrument with potential for better addressing older adults' health needs and optimizing risk stratification at the population level.

Acne or pimples is an inflammatory skin reaction that occurs when the sebaceous glands or hair follicles become inflamed. This skin reaction is seen as a rash on or under the skin and mainly involves the face. Acne is most common in adolescence but can affect people of all ages. Acne is considered a contributing factor to social isolation, low self-esteem, depression, and suicidal thoughts.

During the 1950s, a new acne drug containing the active substance isotretinoin was developed. The drug began to be used in the early 1980s and is today the most effective drug in treating severe acne. Isotretinoin is a vitamin A acid derivative (13-cis-retonic-acid) that belongs to the drug group retinoids. Isotretinoin is intended for the treatment of severe scarring acne, as well as where the treatment of acne with other drugs such as antibiotics or topical treatment has not given the desired result. Isotretinoin is an effective drug in treating severe acne, but unfortunately also a drug that can cause troublesome and severe side effects. As isotretinoin crosses the blood-brain barrier, studies have been performed on whether there is a link between treatment with isotretinoin and mental reactions. There is a high incidence of psychiatric symptoms and suicidal ideation in people suffering from acne. It is difficult to distinguish whether the mental symptoms are drug-related or not.

The purpose of this literature review was to investigate whether there may be an association between the treatment of acne with the drug isotretinoin and the onset of psychiatric symptoms as well as suicide. To find relevant articles for this work, a search was performed in the PubMed database through Linnaeus University's library, which resulted in six relevant studies. Different self-assessment scales evaluated depression, anxiety, and quality of life in selected studies. The results of the studies are unequivocal, where none of the studies showed a connection between the occurrence of psychiatric symptoms and suicidal thoughts when treating acne with the drug isotretinoin. On the contrary, it indicated an improvement in psychiatric conditions reflected in acne reduction. However, there is insufficient evidence that these results can rule out the emergence of psychiatric symptoms and suicidal thoughts during treatment.

The aim of our study was to investigate HVB-home staff's perceptions of the temporary asylum law's impact on unaccompanied minors’ motivation for integration into Swedish society. On 24 November 2015, the government presented a temporary law to reduce the number of asylum seekers. The temporary law was intended to apply for three years and meant that Sweden went from having generous asylum legislation to following the EU's line for a minimum level for receiving asylum seekers. All asylum-seeking groups, such as refugees and people in need of protection, would receive temporary residence permits, except that there were exceptions for quota refugees who could obtain permanent residence permits. In the study, we used a qualitative method and conducted semi-structured interviews with five staff who had previously worked with unaccompanied children. Results from both interviews and previous research show that there are several factors that affect the mood of unaccompanied children and their integration into Swedish society. The study showed that previous psychological trauma, long waiting times for information about residence permits, loneliness and lack of meaningful activity had a negative impact on unaccompanied children's mood and motivation for integration.

Diabetes mellitus är en av de vanligaste endokrina sjukdomarna och de vanligaste formerna är typ I och typ II. Idag har ca 350 000 personer i Sverige diabetes och av dessa har 85-90% diabetes typ II. Typ II diabetes börjar med insulinresistens och så småningom blir det avtagande funktion av β- cellerna vilket leder till nedsatt insulinkänslighet och främsta orsakerna till typ II diabetes är övervikt och fetma. Det finns olika behandlingsrekommendationer för att behandla typ II diabetiker för att minska att sena komplikationer uppstår. Främst genom livsstilsförändringar som kost och fysisk aktivitet, men då dessa inte räcker till kan perorala läkemedel komma i efterhand och om inte det heller ger tillräcklig effekt kan insulinbehandling sättas in. Ca 50 % av typ II diabetiker får insulin efter 10 års sjukdom.

Syftet med arbetet är att undersöka om det finns en god implikation av att sätta in insulin tidigare än det som redan är rekommenderat.

Denna litteraturstudie är baserad på artiklar hämtade från databasen PubMed. Sammanlagt har fem randomiserade kontrollerade studier granskats.

Resultaten visar att en HbA1c-sänkning med ca 1,5 - 2,0 % kan erhållas samt också en bibehållen β- cellfunktion vid insättning av insulin. Insulinbehandlingen bör sättas in så snart HbA1c går över 7,5 % istället för att vänta en viss tid. Den kan sättas in hos behandlingsnaiva personer med framträdande symtom eftersom insulin fortfarande sänker HbA1c och det finns inget som tyder på att insulin inte kan sättas in tidigare än det som är rekommenderat.

Slutsatsen som dras är att stödja intensiv behandling som gör att HbA1c hålls på en så låg nivå det är möjligt och när målvärden för HbA1c inte kan hållas kan insulin med fördel sättas in hos typ II diabetiker som behandlats med perorala antidiabetika.

Syfte: Syftet med den här studien var att se om det är någon skillnad mellan ögonen när man utför testen Phenol röd tråd (PRTT) och Schirmers test, och därefter se om det visar någon skillnad mellan de två tester när man diagnostiserar om torra ögon.

Metod: 30 personer deltog i studien. Innan mätningar fyllde försökpersoner i informationsamtycke och enkäten Ocular Surface Disease Index (OSDI). De undersöktes med PRTT först och därefter utfördes Schirmers test. PRTT utfördes på 20 sekunder, det börjades alltid med höger öga, torka upp nedre fornix med en bomullspinne och till sist mättes den fuktiga delen. Schirmers test utfördes på 5 minuter. Testet består av en pappersremsa som placeras över undre ögonlocket. Resultatet kan läsas av remsan direkt.

Resultat: Resultatet visar att det inte fanns någon skillnad mellan ögonen och ingen signifikant skillnad mellan olika metoder. Studien visar att det inte fanns samband mellan någon av de två tester och OSDI symtomenkät.

Slutsats: Slutsatsen av denna studie var att det inte fanns någon skillnad mellan höger respektiv vänster öga när metoder Schirmers test och phenol röd tråd test utfördes. För tydligare resultat av de två tester krävs större urvalsgrupp.

Platelet transfusion is a treatment to prevent or stop bleeding. Platelets for transfusion (platelet-concentrate) are produced by separating the blood into erythrocyte-unit, plasma, leukocyte-unit, and interim platelet-unit (IPU). The IPUs are then placed on an agitation method. Platelet-concentrate is prepared by pooling 4–6 IPUs with platelet additive solution (PAS). The purpose of this study was to examine Trombomixer 307 as new agitation method for producing platelet-concentrate, and compare it with the current agitation method, the platelet-rocker. It is also investigated whether the implantation of the Trombomixer 307 can reduce the number of aggregated IPUs. The study was performed by placing 100 IPUs on the platelet-rocker and 100 IPUs on the Trombomixer 307. Additionally, 56 platelet-concentrates were prepared (28 from the Trombomixer 307 and 28 from the platelet-rocker), which then examined through quality control of the platelet yield index sum (PYI value), volume, leukocyte particle concentration (LPK) and platelet particle concentration (TPK). The results showed that 31 out of the 100 IPUs from Trombomixer and 47 of the 100 IPUs from the platelet-rocker were aggregated. IPUs from the Trombomixer had a significantly lower number of aggreged IPUs compared to IPUs from the platelet rocker (p = 0.029). The results also showed that platelet-concentrate from Trombomixer had lower LPK and TPK, while Platelet-concentrate from platelet-rocker showed better correlation between PYI sum and TPK. In conclusion, Trombomixer 307 fulfills requirements as an agitation method to produce platelet-concentrates and reduces the percentage of aggregated IPUs. However, platelet-rocker leads to better quality of platelet-concentrate.

Background: Medications are used to treat, cure, or relieve symptoms of diseases, but there is a risk with the use of medications. Drug-related-problems are known to increase morbidity and mortality. Incorrect medical list and discrepancies in these lists can lead to drug-related problems as side effects, hospitalization, non-compliance, drug interactions and overtreated or undertreated patients. Discrepancies can be for example: more prescriptions than necessary, outdated prescriptions, i.e., medicines that will not be used, prescriptions with incorrect dosing and missing prescriptions i.e., medicines used by patients that cannot be seen in the medication list.

Purpose:  The aim of this study was to investigate discrepancies in the Swedish prescription list "My saved prescriptions at the pharmacy". The secondary aim was to investigate how common it is to use this prescription list or the dosage label on the medicine packaging to know which medicines to use and which dosage.

Methods: The data collection was performed by four pharmacy students at seven pharmacies in Sweden over a period of three weeks during Jan-Feb. 2021 where the prescription list was investigated together with patients to identify any discrepancies. The study included patients who was over 18 years old, spoke Swedish, had three or more prescribed drugs, and agreed to participate. 

Results A total of 215 patients were interviewed, where 61% had one or more discrepancies in their medication list. A total of 1717 prescriptions were analyzed, of which 10% were double prescriptions (n = 167), 8% outdated prescriptions (n = 141) and 3% prescriptions with the wrong dosage (n = 42). When analyzing the primary sources of information used by patients to know which medicine to use, the printout of the list "my saved prescriptions at the pharmacy” dominated (n = 72).  Most used information source to know drug dosage was the dosage label on the medicine packaging (n = 112).

Conclusions: It is important to have an updated and correct information in the medication list, to prevent drug-related-problems caused by discrepancies. It becomes even more important when we see that the medication list "My saved prescriptions at the pharmacy" and dosage label (containing the same information in the medication list), are the most used primary sources by patients to know which drug to use and in what dosage. Finally, results show a relationship between the number of prescribed drugs and the number of discrepancies that occur, and therefore we see more discrepancies in elderly patients who are usually ill and are being treated for several diseases. 

There are opportunities for further research to study e.g., which drug-related-problems are caused by discrepancies in the medication list as well as the degree of danger in these problems. 

The word communication originates from the Latin word communicare that means to do something in common. When human beings communicate with each other, we share thoughts, emotions, values and actions. The foundation in communication is found within the interpersonal communication, which is the act of communication between two persons. All types of communications include of verbal and nonverbal acts of communication.

The verbal communication consists of words either in speech or writing, the nonverbal act implies gestures, frequency of the tone and facial expressions.

Within the pharmaceutical profession, good communication between the pharmacist and the customer is important and can affect the customer’s health and quality of life in both direct as well as indirect ways. In recent years, the pharmacist's role in the pharmacy has drastically changed. Nowadays the care of the customer has gained more significance than before. To improve customer health and quality of life it is important that the pharmacist acts to promote a good relationship with the customer and the foundation for this relationship should be built on good terms of communication.

The purpose of this study was to study how common it is with communication errors between pharmacist and customer, and to demonstrate probable underlying causes. Secondary questions were, how is the drug advice the pharmacist provides affected by communication errors?

Collection of data for the study was done with structured observation charts, where the customer and pharmacist were strictly observed. A total of 316 meetings were observed and the data collected referred to prescriptions. In more than one-third of the observed meetings, there were communication errors between the pharmacist and the customer. Communication errors that arose concerned lack of eye contact, language barriers, choice of questions, background noise from colleagues and customers and discussions from generic exchanges. To reduce future communication errors, the pharmacist's actions should be strengthened, such as eye contact, clear follow-up questions and improved feedback.

Aim: This study aimed at exploring the experiences of primary health-care providers of their encounters with patients with type 2 diabetes, and their preferences and suggestions for future improvement of diabetes care. Background: Barriers to good diabetes care could be related to problems from health-care providers' side, patients' side or the healthcare system of the country. Treatment of patients with type 2 diabetes has become a huge challenge in Oman, where the prevalence has increased to high levels. Method: Semi-structured interviews were conducted with 26 health-care professionals, 19 doctors and seven nurses, who worked in primary health care in Oman. Qualitative content analysis was applied. Findings: Organizational barriers and barriers related to patients and healthcare providers were identified. These included workload and lack of teamwork approach. Poor patients' management adherence and influence of culture on their attitudes towards illness were identified. From the providers' side, language barriers, providers' frustration and aggressive attitudes towards the patients were reflected. Decreasing the workload, availability of competent teams with diabetes specialist nurses and continuity of care were suggested. Furthermore, changing professional behaviours towards a more patient-centred approach and need for health education to the patients, especially on self-management, were addressed. Appropriate training for health-care providers in communication skills with emphasis on self-care education and individualization of care according to each patient's needs are important for improvement of diabetes care in Oman.

The clinical support system Electronic Expert Support (EES) is available at all pharmacies in Sweden to examine electronic prescriptions when dispensing to prevent drug-related problems (DRPs). DRPs are common, and result in patient suffering and substantial costs for society. The aim of this research was to study the use of EES for the pediatric population (ages 0-12 years), by describing what types of alerts are generated for potential DRPs, how they are handled, and how the use of EES has changed over time. Data on the number and categories of EES analyses, alerts, and resolved alerts were provided by the Swedish eHealth Agency. The study shows that the use of EES has increased. The most common type of alert for a potential DRP among pediatric patients was regarding high doses in children (30.3% of all alerts generated). The most common type of alert for a potential DRP that was resolved among pediatrics was therapy duplication (4.6% of the alerts were resolved). The most common reason for closing an alert was dialogue with patient for verification of the treatment (66.3% of all closed alerts). Knowledge of which type of alerts are the most common may contribute to increased prescriber awareness of important potential DRPs.

Bakgrund: Föräldrar till barn med medfött hjärtfel hamnar ofta i en utmanande livssituation där de lever med stress, ovetskap om hur de ska vårda sitt barn och undrar om barnet kommer överleva. Samtidigt saknas en sammanställning som mer exakt visar vilka upplevelser föräldrarna har och hur sjuksköterskor ska kunna anpassa sin vård till föräldrarnas speciella livssituation.

Syftet med denna studie var att beskriva föräldrars erfarenheter av att vårda barn med medfött hjärtfel.

Metoden genomfördes genom en litteraturstudie som baserades på nio artiklar med kvalitativ ansats och analyserades genom tematisering.

Resultatet presenteras genom temana plötslig chock och stress, omställningar i vardagslivet och behov av samvaro och kommunikation. Föräldrarna upplevde plötslig chock och stress efter diagnos, där de kände sig osäkra över barnets möjligheter att överleva. Föräldrarna upplevde omställningar i vardagslivet eftersom de fick en ny föräldraroll och behövde hitta nya rutiner för att besöka sjukhus och vårda barnet i hemmet. Föräldrarnas behov av samvaro och kommunikation förändrades, där de behövde hitta ömsesidig förståelse med sjukvårdspersonal och andra familjer i samma livssituation. 

Slutsats(er): En slutsats blev att sjuksköterskor behöver förstå den chock och stress som föräldrarna kan uppleva. Genom att sjuksköterskor skapar rutiner för chock- och stresshantering direkt efter diagnos kan föräldrarnas känsla av trygghet och förståelse för sin nya livssituation öka.

Around 200,000–250,000 people suffer from heart failure in Sweden. Heart failure is a condition of impaired heart pumping capacity. The condition results in reduced quality of life, high morbidity and mortality and there have been many attempts to find suitable drug targets to minimize these consequences. Neurohormonal compensatory mechanisms, such as renin–angiotensin–aldosterone system, aim to restore blood pressure to normal levels again but in the long-term it also increases the stress on the heart. The hormone angiotensin II gets activated through this mechanism and is the reason behind the increased stress. Therefore, the hormone has been an important drug target for ACE inhibitors (ACEI) and AT1 blockers (ARB) to prevent antihypertensive effects. The enzyme neprilysin is another drug target whose inhibition is accomplished by using neprilysin inhibitors. Entresto® is a new medication that contains a neprilysin inhibitor and an ARB. The neprilysin inhibitory component, sacubitril, is activated by carboxylesterase 1 (CES1) but mutations in the gene encoding CES1 may cause a non-therapeutic effect. Additionally, patients with wild-type CES1 may risk unacceptable side effects such as rhabdomyolysis and Alzheimer's disease. The objective of this study is to investigate whether replacement of ACE inhibitors with Entresto is optimal in heart failure with regard to pharmacogenetics.

This study is organized as a literature study in which five scientific articles (I-V) were analyzed and selected from PubMed database and through Linnaeus University's search engine, OneSearch. The studies show that Entresto is superior to enalapril in reducing the risk for cardiovascular death or hospitalization for heart failure. However, the effects of Entresto is dependent on a functioning CES1 gene because mutations like G143E cause a non-therapeutic effect. Enalapril has shown to be independent of such mutations.

Theoretically, inhibition of neprilysin may cause accumulation of amyloid-β peptides (Aβ), which associates with Alzheimer's disease. Study IV, with the purpose to investigate the effect of Entresto on Aβ isoforms, showed no significant change in Aβ concentrations in cerebrospinal fluid. However, further studies with longer duration were suggested. On the other hand, study V shows that a combination of Entresto and statins increases the plasma concentration of statins. That in turn would increase the risk of a development of rhabdomyolysis. The conclusion is that it is not optimal to replace enalapril with Entresto in heart failure with regard to pharmacogenetics.

Quartz crystal microbalance (QCM) methodology has been adopted to unravel important factors contributing to the "cluster glycoside effect" observed in carbohydrate-lectin interactions. Well-defined, glycosylated nanostructures of precise sizes, geometries and functionalization patterns were designed and synthesized, and applied to analysis of the interaction kinetics and thermodynamics with immobilized lectins. The nanostructures were based on Borromean rings, dodecaamine cages, and fullerenes, each of which carrying a defined number of carbohydrate ligands at precise locations. The synthesis of the Borromeates and dodecaamine cages was easily adjustable due to the modular assembly of the structures, resulting in variations in presentation mode. The binding properties of the glycosylated nanoplatforms were evaluated using flow-through QCM technology, as well as hemagglutination inhibition assays, and compared with dodecaglycosylated fullerenes and a monovalent reference. With the QCM setup, the association and dissociation rate constants and the associated equilibrium constants of the interactions could be estimated, and the results used to delineate the multivalency effects of the lectin-nanostructure interactions.

Aim

To practise emergency care situations during the education can be stressful. The aim of this study is to identify factors that cause stress in simulated emergency care.

Design

A descriptive observational study.

Methods

Video recordings (N = 26) subjected to observation with written field notes in turn subjected to interpretive qualitative content analysis.

Results

To assess the patient's condition and decide what measures to take trigger stress reactions. If the students failed to connect the correct and relevant information in the conversation with the physician, the students showed signs of stress. Also, to calculate medication dosages stress the students.

Background: IBS (Irritable Bowel Syndrome) is a functional gastrointestinal disorder, with an unclear etiology and pathophysiology. IBS is a common disorder in the Western population and is characterized by recurrent abdominal pain/ discomfort, bloating, flatulence, diarrhea and/ or constipation. There is currently no cure for IBS, but the interest in probiotics as an option of treatment has recently increased. Probiotics have been defined as live microorganisms that, when administered in adequate amounts, provide a health benefit on the host, and are believed to have a symptomatic effect in IBS. Probiotics have therefore been of interest for the treatment in IBS.

Purpose: The purpose of this study is to examine whether probiotics have a therapeutic effect and if it could be used as a treatment for IBS.

Method: Five randomized, double-blind, placebo-controlled studies were reviewed that examined the therapeutic effect of different probiotics in the IBS-patients. Articles were obtained through searches in the medical database PubMed, during the month of February 2016.

Results: Four of the five studies showed a significant improvement of symptoms especially in abdominal pain/ discomfort. The best results were seen in a study that investigated the probiotic Lactobacillus plantarum 299v. Three of the five studies showed a significant improvement in quality of life (QOL) of the subjects in the study. One of the five studies which examined the effect of Escherichia coli Nissle 1917, there was no significant difference between E.coli (probiotics) and placebo.

Conclusion: There is reasonable evidence that treatment with certain probiotics might provide improvement in symptoms of abdominal pain/ discomfort, and increase patients quality of life based on the five studies. Further studies are required to determine the most effective probiotic, dose and duration of IBS-treatment.

Asthma is a common disease throughout the world and affects different ages. Various studies have determined that 50% of the patients with severe asthma have higher values ​​of T-help cells Th2 and higher levels of IgE. There are different treatments for asthma, such as glucocorticoids, beta-2 agonists or muscarinic antagonists but most recently monoclonal antibodies are used, for the treatment of severe asthma, instead of cortisone, to reduce side effects of glucocorticoids.

Benralizumab is a monoclonal antibody directed against the alpha subunit of the interleukin-5 receptor. This study shows that benralizumab lowers the use of oral glucocorticoids in patients with severe types of asthma (eosinophilic asthma).

The purpose of this work was to evaluate the effect of benralizumab compared to glucocorticoids in the treatment of eosinophilic asthma and to show the safety and effect of benralizumab in long-term treatment. A search was made on PubMed with different blocks of the keywords benralizumab, asthma, treatment, glucocorticoids, and eosinophil* and five studies were chosen. They showed that treatment with benralizumab, a monoclonal antibody, together with Long-acting beta-2 agonist, (LABA) and Inhaled corticosteroids, (ICS) reduced the need for oral glucocorticosteroids (OCS) when treating eosinophilic asthma. The results showed no fatal or serious side effects in treatment with benralizumab for 5 years and also confirmed the appropriate dose of benralizumab in the treatment of eosinophilic asthma.

In conclusion

Benralizumab is a monoclonal antibody that is effective and safe in the treatment of eosinophilic asthma, and which enables decrease of oral glococortiocoids.

Bakgrund: Kvinnor som utsatts för våld i nära relarion kommer mer frekvent i kontakt med sjukvården än andra kvinnor. Flera kvinnor som söker vård för sina skador identifieras aldrig som offer för våld i nära relation. Detta beror på att flera sjuksköterskor saknar utbildning i att identifiera att våld förekommer. Det finns en osäkerhet hos sjuksköterskan i mötet med våldsutsatta kvinnor som gör att mötet med vården av kvinnan påverkas.

Syfte: Syftet var att belysa sjuksköterskans upplevelse och föreställningar av mötet med våldsutsatta kvinnor inom hälso-och sjukvården.

Metod: En systematisk litteraturstudie där sex kvalitativa artiklar och två kvantitativa artiklar har granskats, analyserats och kategoriserats.

Resultat: Det fanns en tydlig emotionell påverkan hos sjuksköterskor under och efter mötet med våldsutsatta kvinnor. En påverkan som ibland var så stor att det påverkade deras privatliv. Det visade sig även finnas ett stort utbildningsbehov att förbättra vården för våldsutsatta kvinnor och få sjuksköterskor att känna sig tryggare i rollen som vårdare för dessa kvinnor.

Slutsats: Det visade sig finnas ett ökat utbildningsbehov för sjuksköterskor i hur de ska bemöta och vårda kvinnor som utsatts för våld i nära relationer. Det fanns även ett behov av att bearbeta de känslor sjuksköterskan upplevde i mötet med kvinnorna. 

Syftet med föreliggande studie var att undersöka om och i sådana fall vilka faktorer som unga heterosexuella kvinnor upplevde som begränsande för sin sexualitet. Med hjälp av semistrukturerade intervjuer undersöktes i denna kvalitativa studie hur dessa deltagare upplevde sin sexualitet utifrån tre huvudområden; sociala strukturer, normer samt psykisk hälsa. Teorin “sexual scripting theory” applicerades på de tre huvudområdena, då paralleller drogs mellan dessa och teorins tre huvudbegrepp “cultural scripts”, “interpersonal scripts” och “intrapsychic scripts”. Resultatet av denna studie visade att patriarkala strukturer, samhällsideal, jämförelser med andra, förväntningar och föreställningar om kvinnans utseende samt beteende var hämmande för deltagarnas sexualitet. Resultatet visade även att det fanns tydliga samband mellan sexualiteten och den psykiska hälsan. Negativa sexuella erfarenheter upplevdes påverka deltagarnas psykiska hälsa och blev hämmande för framtida sexuella upplevelser. Många begränsande faktorer identifierades utifrån resultatet i denna studie och en inblick i deltagarnas förhållande till sin sexualitet utforskades. 

Earth's life-sustaining oceans harbor diverse bacterial communities that display varying composition across time and space. While particular patterns of variation have been linked to a range of factors, unifying rules are lacking, preventing the prediction of future changes. Here, analyzing the distribution of fast- and slowgrowing bacteria in ocean datasets spanning seasons, latitude, and depth, we show that higher seawater temperatures universally favor slower-growing taxa, in agreement with theoretical predictions of how temperaturedependent growth rates differentially modulate the impact of mortality on species abundances. Changes in bacterial community structure promoted by temperature are independent of variations in nutrients along spatial and temporal gradients. Our results help explain why slow growers dominate at the ocean surface, during summer, and near the tropics and provide a framework to understand how bacterial communities will change in a warmer world.

The bioregeneration of activated carbon (AC) in biological activated carbon (BAC) systems is limited by sorption-desorption hysteresis and transport between the adsorbent and biomass. In this study, we investigated these limitations and whether a biofilm covering the AC surface is required. Consequently, BAC reactors were operated at different shear stress and AC surface smoothness, since this may affect biofilm formation. The experiments were carried out in BAC and blank reactors treating synthetic wastewater containing the pharmaceutical metoprolol. After start-up, all reactors removed metoprolol completely; however, after 840 h the removal dropped due to saturation of the AC. In the blank reactors, the removal dropped to 0% while in the BAC reactors removal recovered to >99%, due to increased biological activity. During the initial phase, the metoprolol was adsorbed, rather than biodegraded. At the end, the AC from the BAC reactors had higher pore volume and sorption capacity than from the blank reactors, showing that the AC had been bioregenerated. At high shear (G = 25 s(-1)), the rough AC granules (R-a = 13 mu m) were covered with a 50-400 gm thick biofilm and the total protein content of the biofilm was 2.6 mg/gAC, while at lower shear (G = 8.8 s(-1)) the rough AC granules were only partly covered. The biofilm formation at lower shear (G = 8.8 s(-1)) on smooth AC granules (R-a = 1.6 mu m) was negligible. However, due to the presence of suspended biomass the reactor performance or bioregeneration were not reduced. This showed that direct contact between the AC and biomass was not essential in mixed BAC systems. The microbial analyses of the suspended biomass and the biofilm on AC surface indicated that metoprolol was mainly biodegraded in suspension. (C) 2017 Elsevier B.V. All rights reserved.

Little is known about the giant devil ray (Mobula mobular), an endangered species endemic to the Mediterranean. Gaza is the only region where this species is targeted, hence, this fishery was studied to address the knowledge gap on fishery interactions, species behavior, and life-history traits. Devil rays have been frequenting this maritime area for at least the past 50 years for a short window from February to April. Landings are reported from 2005 to 2016, along with disc-width (DW) measurements for recent years. A total of 304 M. mobular (over 90% males) were landed in Gaza from 2014 to 2016, most which were mature and appeared to be mating (over 90% of males had sperm-filled claspers), providing critical insight that this area may serve as a mating ground. Yearly landings are shown here to closely match the allowed fishing distance from shore, which changes regularly, indicating that the rays are normally caught between 6 and 12 n.m. offshore. Width-weight conversion parameters are calculated for the first time for this species: a = 2.68 x 10(-6) and b = 4.39. Fresh protein drives this local fishery, as food security is a major issue. An export market for gill plates was reported intermittently, and is no longer possible due to strict trade restrictions. We highlight the lack of awareness of fishers regarding the IUCN's Red List 'Endangered' status of devil rays, and stress the urgent need for national protection of this species, particularly due to the species' very slow life-history traits and probable usage of this area as a mating ground.

Background: Acidithiobacillus caldus is a sulfur oxidizing extreme acidophile and the only known mesothermophile within the Acidithiobacillales. As such, it is one of the preferred microbes for mineral bioprocessing at moderately high temperatures. In this study, we explore the genomic diversity of A. caldus strains using a combination of bioinformatic and experimental techniques, thus contributing first insights into the elucidation of the species pangenome. Principal Findings: Comparative sequence analysis of A. caldus ATCC 51756 and SM-1 indicate that, despite sharing a conserved and highly syntenic genomic core, both strains have unique gene complements encompassing nearly 20% of their respective genomes. The differential gene complement of each strain is distributed between the chromosomal compartment, one megaplasmid and a variable number of smaller plasmids, and is directly associated to a diverse pool of mobile genetic elements (MGE). These include integrative conjugative and mobilizable elements, genomic islands and insertion sequences. Some of the accessory functions associated to these MGEs have been linked previously to the flexible gene pool in microorganisms inhabiting completely different econiches. Yet, others had not been unambiguously mapped to the flexible gene pool prior to this report and clearly reflect strain-specific adaption to local environmental conditions. Significance: For many years, and because of DNA instability at low pH and recurrent failure to genetically transform acidophilic bacteria, gene transfer in acidic environments was considered negligible. Findings presented herein imply that a more or less conserved pool of actively excising MGEs occurs in the A. caldus population and point to a greater frequency of gene exchange in this econiche than previously recognized. Also, the data suggest that these elements endow the species with capacities to withstand the diverse abiotic and biotic stresses of natural environments, in particular those associated with its extreme econiche.

Background/Aim: Effect of capsicodendrin on the NF-KB pathway was studied in MCF-7 cancer cells. Materials and Methods: The transcription factor assay was used to screen for NF-KB activity. The effect on IKK beta, ICAM-1, and caspase-7 were studied using western blot. Caspase-1 was studied using Promega Caspase-Glo (R) assay. Reactive oxygen species (ROS) were detected using the fluorescent probe DCFH-DA. The potentiometric dye JC-1 was used to assess mitochondrial membrane potential (Delta psi m) and the cell cycle was examined using a fluorescence-activated cell sorter. Results: NF-kappa B p65 inhibitory effect was IC50=8.6 mu M and cytotoxic activity was IC50=7.5 mu M. The upstream IKK and the downstream ICAM-1 were down-regulated. Sub G1-phase population increased to 81% after 12 h of treatment with capsicodendrin (10 mu M) and there was no loss of Delta psi M. Conclusion: Increased levels of intracellular ROS promoted activity of caspase-1 and induced cell death in MCF-7 cells. Capsicodendrin may be a future anticancer agent that prevents the progression of metastatic breast cancer.

This chapter is a summary of 5-years of research regarding children’s emerging abstract concepts. A longitudinal study focusing on children’s conversations during a series of activities with a chemistry focus was designed and implemented. Results show that practical experience with magnifying glasses, microscopes, and the deconstruction of several items did not provide enough backdrop for the children to imagine what an even smaller world would look like. Instead, the children applied their experiences from the macroscopic world to describe what they saw. It was not until aminations, zooming in from the macroscopic to the atomic and molecular levels were used that the children’s concept of small began to develop. Results show that the next stage of concept development, besides using descriptions from everyday experiences was the realization these were new experiences, that it was in fact something new they were seeing. Animation technology also helped the children realize that atoms and molecules are everywhere in everything, suggesting that the time elapsed between the transition from the macroscopic level to the submicroscopic level also provided the children with a sense of scale.

This study focuses on the design of play-based learning activities for chemistry in preschool. Viewing chemistry as a part of our past and present culture instead of as a subject, provides the backdrop for a more holistic approach to chemistry within this specific environment. A cultural-historical perspective, together with scaffolding, emergent science skills and sustained shared thinking, made up the framework for the design of the learning activities. Results show that when scaffolding and emergent science skills are used within the design, they provide good support for both the content and the teacher in the actual learning situation. Working with scaffolding was also beneficial for professional development. However, for a progressive and inclusive activity design, it is essential to take into account aspects of the immediate environment and methods for direct evaluation.

The study explores children's emerging understanding of an important science concept in chemistry. Play-based learning activities were designed for children to experience and imagine the concept of 'small' as used in chemistry, moving from the visually experienced level of 'small' towards more imaginative understandings. Data were collected through visual ethnography. Analyses of six vignettes of conversations between children and the teacher illustrate development of children's understanding of the focus concept. Deconstruction of everyday items familiar to the children and visual computer animations provided experiences that enabled children to transition from a macro-level of understanding to visualise the molecular/atomic level to differentiate between macro- and micro-understandings of 'small'. A process of 'sustained shared thinking' could describe the teaching/learning processes evident in the children's and teacher's conversations. The analyses suggest that sustained and shared conversations between children and teachers should stem from children's everyday experiences. ResumeL'etude explore chez les enfants la comprehension emergente d'un concept scientifique important en chimie. Des activites d'apprentissage basees sur le jeu ont ete concues pour que les enfants experimentent et imaginent le concept du 'petit' tel qu'il est utilise en chimie, en passant de la decouverte visuelle au niveau du 'petit' vers des comprehensions plus imaginatives. Des donnees ont ete recueillies par le biais de l'ethnographie visuelle. L'analyse de six vignettes de conversations entre les enfants et l'enseignant illustre le developpement chez les enfants de la comprehension du concept examine. La deconstruction d'objets quotidiens familiers pour les enfants et d'animations visuelles sur ordinateur ont fourni des experiences qui ont permis aux enfants de passer d'un niveau de comprehension macro a une visualisation du niveau moleculaire /atomique, et de faire la difference entre les comprehensions macro et micro du 'petit'. Un processus de 'pensee partagee soutenue' pourrait decrire les processus d'enseignement /apprentissage evidents dans les conversations entre enfants et enseignants. Les analyses suggerent que les conversations soutenues et partagees entre les enfants et les enseignants devraient decouler des experiences quotidiennes des enfants. ResumenEl presente estudio explora la comprension reciente de los ninos de un importante concepto de ciencia en el campo de la quimica. Se disenaron actividades ludicas de aprendizaje para que los ninos experimentaran e imaginaran el concepto de tamano "pequeno" segun se utiliza en el campo de la quimica, alternando entre el nivel de experiencia visual del concepto "pequeno" hasta una comprension mas imaginativa. Se recolecto informacion por medio de etnografia visual. Analisis de seis fragmentos de conversaciones entre los ninos y el educador ilustraron el desarrollo de la comprension de los ninos del concepto principal. La deconstruccion de elementos cotidianos comunes para los ninos y las animaciones visuales computarizadas brindaron experiencias que les permitieron a los ninos navegar desde un nivel macro de comprension a visualizar el nivel molecular/atomico, asi como diferenciar entre la comprension macro y micro del concepto "pequeno". Los procesos de ensenanza/aprendizaje que se evidencian en las conversaciones entre ninos y educadores se pueden describir mediante un proceso de "constante pensamiento comun". Los analisis sugieren que conversaciones constantes y compartidas entre ninos y educadores deben emanar de las experiencias cotidianas de los infantes.

Determination of erythrocyte count in cerebrospinal fluid (CSF-EPC) is used to exclude various intracranial hemorrhage, especially subarachnoid hemorrhage (SAH). SAH means a bleeding between the pia mater and arachnoidea which occurs due to rupture of an aneurysm in the subarachnoid space. Manual counting of erythrocytes in the cerebrospinal fluid with Bürkers chamber and microscopy has been the gold standard for the past decades, but the manual method is time consuming and requires great experience. The purpose of this study was to evaluate if manual analysis of  CSF-EPC with counting chamber, and light microscopy can be replaced by automated analysis of CSF-EPC with Hematology Analyzer XN-1000 (Sysmex). Fortyeight cerebrospinal fluid samples with various concentrations of erythrocytes ware prepared by diluting known concentration of erythrocytes in cell-free CSF. Prepared CSF-samples with added erythrocytes were analyzed first on the XN-1000. Thereafter, manual counting of erythrocytes was performed using Bürkers counting chamber. A linear regression was established to describe the correlation between the automated analysis of the CSF-EPC and manual analysis of the CSF-EPC. Imprecision in the analysis of the CSF-EPC on the XN-1000 (Sysmex) was assessed by within-run imprecision. A very good correlation (r = 0.999) was found between the XN-1000 and manual counting. For results in the lower range, 100 - 5000 (10⁶/L), correlation was also good (r = 0.997). The coefficient of variation was 19,8 % at CSF-EPC of 370 x 10⁶/L and 3.1 % at CSF-EPC of 25 950 x 10⁶/L. The sensitivity for analysis of CSF-EPC on XN-1000 was 370 x 10⁶/L. The conclusion is that the analysis of Csv-EPC on XN-1000 can be used for clinical diagnostics of CSF- samples. However, it should be noted that XN-1000 has poor sensitivity for low CSF-EPC values < 370 x 10⁶/L. To ensure high diagnostic quality even in CSF-samples with low erythrocyte counts are recommended a reference limit of < 500 x 10⁶/L as a practical cut off for supplemental microscopic counting in routine healthcare laboratories.

Meat is skeletal muscle from different animals, such as pigs, cattle or sheep. Pseudomonas are bacteria that may cause food spoilage. The bacteria live in our environment and can cause problems due to biofilm formation in hospitals and industries. The slaughterhouse KLS Ugglarps has found that some pig cuttings have become discolored with at blue color and they wanted to find out what caused it. Pseudomonas aeruginosa had previously been found in the production area and was suspected as the cause.Meat, with and without discoloration, was investigated using various microbiological methods to see which bacterium cause the blue color. Different colonies were isolated and identified. The methods used were API 20NE, gram staining and oxidation test. A reference isolate was used as control. It was found that it was not P. aeruginosa but instead Pseudomonas fluorescens that caused the blue color. This was confirmed by applying the isolated bacteria to sterile meat and the blue color did appear after incubation. A screening for the source of contamination was performed in the production area to see if the bacterium could be found before start-up and during production. The samples taken showed that there were bacteria at both time points and that the production surfaces at the beginning of the production line were more prone to contamination than the other surfaces.

Background: Populations in many high-income countries are ageing, with an ever-increasing proportion of the population aged 65 years or older. Despite increasingly better health in older people, susceptibility to chronic illness increase with age. As life expectancy increases, the length of time people can live with chronic illness increases correspondingly, mainly due to improved medication treatments. Decreased number of hospital beds per capita and length of stay in hospital has gained primary care an increasing role in the healthcare system, with higher demands on patients and their knowledge and abilities to manage medications and self-management.

Aim: The overarching aim of this thesis was to explore how medication regimens are communicated in primary care consultations and in written discharge letters.

Methods: In Study I, passive participant observations of primary care consultations were audio-recorded, transcribed and analysed using content analysis. Study II had a convergent mixed methods design. An assessment matrix, constructed based on previous research, was used to assess and quantify discharge letter content. The quantified discharge letter content, questionnaires and register data were used to calculate correlations between discharge letter content and readmission rate as well as self-rated quality of care transition. Finally, associations between discharge letter content and time to readmission were calculated both univariable and multivariable. In addition to discharge letter content, several other potential independent variables were included in the multivariable analysis.

Results: Both studies show that physicians were prone to give information about medications and blood-samples or other examinations performed in advance to the consultation (Study I) or during the hospital admission (Study II). The physicians were, however, less prone to inform patients about self-management and lifestyle changes, symptoms to be aware of, and what to do in case they would appear. Communication was occasionally hindered by misunderstandings, e.g., when vague expressions or words with ambiguous meaning was used. Ambiguities e.g., arose due to dialectal disparity. Although physicians mainly communicated in plain language with patients, medication names imposed a significant problem for patients and in communication about medications. Discharge letter content was not associated to readmissions, the only significant predictor variables for time to readmission were previous admission the past 180 days and birth outside the Nordic countries. Discharge letters with more content were, on the other hand, correlated to worse self-estimated quality of care transition from hospital to home (Study II).

Conclusions: Physicians informed patients about tests and examinations performed in the past time, and comprehensive information was provided about medications, both during consultations and in discharge letters. However, information about symptoms to be aware of and measures to take in case they would appear was scarce in consultations and discharge letters. In conversations where lifestyle changes were raised, the topic was quickly dropped without recommendations or offering support if the patient showed unconcern. Lifestyle changes in relation to chronic illness and medications were rarely discussed. Improved lifestyle as a means of reducing the need for medications was not discussed or informed about in discharge letters. Discharge letter content did not have any impact on readmissions.

Background

Care transitions are high-risk processes, especially for people with complex or chronic illness. Discharge letters are an opportunity to provide written information to improve patients' self-management after discharge. The aim of this study is to determine the impact of discharge letter content on unplanned hospital readmissions and self-rated quality of care transitions among patients 60 years of age or older with chronic illness.

Methods

The study had a convergent mixed methods design. Patients with chronic obstructive pulmonary disease or congestive heart failure were recruited from two hospitals in Region Stockholm if they were living at home and Swedish-speaking. Patients with dementia or cognitive impairment, or a "do not resuscitate" statement in their medical record were excluded. Discharge letters from 136 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of "SAFE-D score". Bivariate correlations between SAFE-D score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between SAFE-D score and time to readmission.

Results

All discharge letters contained at least five of eleven key elements. In less than two per cent of the discharge letters, all eleven key elements were present. Neither SAFE-D score, nor single key elements correlated with 30-day or 90-day readmission rate. SAFE-D score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.

Conclusions

While written summaries play a role, they may not be sufficient on their own to ensure safe care transitions and effective self-care management post-discharge.

Trial registration

Clinical Trials. giv, NCT02823795, 01/09/2016.

Aim: To determine the impact of discharge letter content on unplanned hospital readmissions within 30 and 90 days, and to identify correlations between discharge letter content and quality of care transitions among patients with chronic illness.

Design: A convergent mixed methods design.

Methods: Discharge letters from 154 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of 'discharge letter score'. Bivariate correlations between discharge letter score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between discharge letter score and time to readmission.

Results: All discharge letters contained at least five of eleven key elements. In less than four percent, all eleven key elements were present. Neither discharge letter score nor single key elements correlated with 30-day or 90-day readmission rate. Discharge letter score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.

Conclusion: Discharge letter score is not correlated with either 30-day or 90-day readmission rate or with time to readmission at 90 days, when patient characteristics are adjusted for.

Implications for the profession and patient care: Written discharge summaries are not enough to facilitate safe care transitions and self-management after discharge. A person-centred approach, providing written and verbal information to patients, encouraging patient involvement soon after discharge, may be needed to avoid readmission.

Objective To explore communication about medication management during annual consultations in primary care. Design: passive participant observations of primary care consultations.

Setting Two primary care centres in southern Sweden.

Participants Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis.

Results Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further.

Conclusion Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity.No data are available.

Abstrakt

Bakgrund: Patienter som vårdas i samband med operation lider ofta av någon grad av preoperativ oro. Att uppleva oro beskrivs vara ett obehagligt och känslomässigt tillstånd som avger en negativ ansträngning och stress på kroppen. Oron påverkar patienterna både psykiskt och fysiskt. Det finns ett värde för operationssjuksköterskan att få en fördjupad förståelse för patientens upplevelse av preoperativ oro. Operationssjuksköterskan har en utmaning i sitt möte med patienten att skapa en säker vårdmiljö både gällande den tekniska säkerheten och den icke-tekniska för att förebygga vårdskador samtidigt som patienten behöver vårdas med värdighet. Syfte: Beskriva patienters upplevelse av preoperativ oro i samband med en operation. Metod: Studien är utförd som en strukturerad litteraturstudie med kvalitativ ansats enligt Bettany-Saltikov och McSherry (2016). Resultat: Studien resulterade i två teman med två kategorier till respektive tema under sig. Temat begränsad tillgång till livet efter operation har kategorierna negativa händelser i samband med operation och det förändrade livet efter operationen under sig. Temat maktlöshet inför det främmande har kategorierna att inte kunna påverka och att vara patient i en okänd miljö under sig. Slutsats: Patienternas upplevelse av oro visar sig olika beroende på deras individuella specifika livssituation. Deras oro har ofta kopplingar till erfarenheter som livet erbjudit. Sambandet mellan oro och relationerna till vårdpersonal i den preoperativa perioden visar vilken betydelse bemötandet har i relation till patienternas upplevelse. Operationssjuksköterskan, och övrig vårdpersonal, kan påverka patientens möjlighet till trygghet och minskning av lidande genom ett personcentrerat förhållningssätt i sina möten.

Background: Palliative care is performed throughout the continuum of care, from home care to specialized care in an institution. Palliative care is buildt on a holistic approach that is secured through patient-centered care where the patient's participation is central.

Objective: Highlighting adult patients' experiences of participation when they are cared for in late stage palliative care.

Method: The study is a systematic literature review mainly based on the methodology described by Forsberg and Wengström (2013).

Results: The theme opportunities and obstacles in the experience of their participation emerged, with four categories below: the management of their disease situation, overwhelming new living situations, be seen as an individual and not to be seen as an                                    individual. It was discovered that patients in the late stage palliative phase found opportunities to participate in their care by gathering knowledge about their disease and their future. This knowledge created understanding, giving them the tools to manage and participate in their care. An obstacle to patients’ participation appeared to be when the patients experienced neglect by health professionals.

Conclusion: Adult patients' experiences of participation when they are cared for in late stage palliative care cannot be described as a single phenomenon, but needs to be described by an integrated approach of the patient. The unique patient forms a dynamic whole, and needs to be treated as the unique individual he/she is.

Bakgrund: Endometrios är en sjukdom som drabbar var tionde kvinna i fertil ålder, vilket gör sjukdomen till en av de vanligaste gynekologiska sjukdomarna som drabbar kvinnor världen över. Trots detta är forskningen kring sjukdomen bristfällig och begränsad, vilket föranleder fördröjd diagnostisering och bristande behandlingsmetoder. Detta utgör ett problem då endometrios är en sjukdom som i de flesta fall föranleder svåra symtom samt följdproblem som infertilitet och depression. Syfte: Att beskriva kvinnors upplevelse av att leva med sjukdomen endometrios. Metod: Kvalitativ litteraturöversikt med en induktiv ansats. Resultat: Studiens resultat mynnade ut i tre huvudteman; Livet i smärtans skugga, Striden för erkännande och gehör samt Min kvinnliga identitet är försvagad och åtta subteman; Smärtans fysiska avtryck, Smärtans psykiska avtryck, Smärtan styr kalendern, Kamp mellan smärta och plikt, Kamp för rätt diagnos, Kamp för förståelse från omgivningen, Hinder för reproduktiv hälsa och slutligen Förändrad självbild - att tappa sig själv. Alla dessa framkom efter en sammanställning av kvinnors upplevelser av att leva med sjukdomen endometrios. Slutsats: Hela kvinnornas liv påverkades negativt till följd av sjukdomen och dess följdproblem. För att detta ska kunna förändras krävs det utökad kunskap inom såväl hälso- och sjukvården som i samhället som ytterligare forskning.

Biologic drugs are effective against numerous diseases but they are very expensive. The European Medicines Agency approved sales of biosimilars in 2006. Biosimilars are copies of already approved biologic drugs, but they are not considered to be exact copies like generic drugs are. Only living organisms can produce substances with the complexity of biologic drugs. Differences in pH, enviroment, and the purification process during the production of biologic drugs can affect the structure of the final product. Differences in the production processes can affect properties like the glycosylation pattern of the molecules which in turn can influence the effect of the drug. This is the reason biosimilars are not considered as exact copies of the original drug. The patent for Remicade^® a TNF inhibitor expired in 2015 which led to the introduction of the first biosimilar for monoclonal antibodies (CT-P13) on the European market. The aim of this study was to investigate the efficacy, safety profile, immunogenicity and pharmacokinetics equivalence between CT-P13 and the original drug for infliximab, Remicade^®. And to investigate if it was safe to switch from Remicade to CT-P13.

The articles for the study were collected from PubMed, a medical and bioscientific database, and five studies were chosen for further analysis. The articles were not limited to a specific indication for infliximab, so the studies included patients with rhematoid arthritis (RA), ankylosing spondylitis (AS) and inflammatory bowel disease (IBD). The short-term equivalence between Remicade^® and CT-P13 was analysed in the studies but more studies including long-term equivalence are needed. Based on the primary endpoints in the studies it seems to be safe to switch from Remicade^® to CT-P13 and short-term equivalence seems to exist between CT-P13 and Remicade^® considering the efficacy, safety profile, immunogenicity and pharmacokinetics equivalence in patients with RA, AS and IBD.

Surface modification with heparin is a powerful biomaterial coating strategy that protects against innate immunity activation since heparin is a part of the proteoglycan heparan sulfate on cell surfaces in the body. We studied the heparinization of cellular and material surfaces via lipid conjugation to a heparin-binding peptide. In the present study, we synthesized fragmented heparin (fHep)-conjugated phospholipids and studied their regulation of the innate immune system on a lipid bilayered surface using liposomes. Liposomes have versatile applications, such as drug-delivery systems, due to their ability to carry a wide range of molecules. Owing to their morphological similarity to cell membranes, they can also be used to mimic a simple cell-membrane to study protein-lipid interactions. We investigated the interaction of complement-regulators, factor H and C4b-binding protein (C4BP), as well as the coagulation inhibitor antithrombin (AT), with fHep-lipids on the liposomal surface. Herein, we studied the ability of fHep-lipids to recruit factor H, C4BP, and AT using a quartz crystal microbalance with dissipation monitoring. With dynamic light scattering, we demonstrated that liposomes could be modified with fHep-lipids and were stable up to 60 days at 4 degree celsius. Using a capillary western blot-based method (Wes), we showed that fHep-liposomes could recruit factor H in a model system using purified proteins and assist in the degradation of the active complement protein C3b to iC3b. Furthermore, we found that fHep-liposomes could recruit factor H and AT from human plasma. Therefore, the use of fHep-lipids could be a potential coating for liposomes and cell surfaces to regulate the immune system on the lipid surface.

Alternative liposome surface coatings for PEGylation to evade the immune system, particularly the complement system, have garnered significant interest. We previously reported poly(2-methacryloyloxyethyl phosphorylcholine) (MPC)-based lipids (PMPC-lipids) and investigated the surface modification of liposomes. In this study, we synthesize PMPC-lipids with polymerization degrees of 10 (MPC10-lipid), 20 (MPC20-lipid), 50 (MPC50-lipid), and 100 (MPC100-lipid), and coated liposomes with 1, 5, or 10 mol% PMPC-lipids (PMPC-liposomes). Non-modified and PEGylated liposomes are used as controls. We investigate the liposome size, surface charge, polydispersity index, and adsorption of plasma proteins to the liposomes post incubation in human plasma containing N,N,N′,N′-ethylenediamine tetraacetic acid (EDTA) or lepirudin by some methods such as sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), western blotting, and automated capillary western blot, with emphasis on the binding of complement protein C3. It is shown that the coating of liposome PMPC-lipids can suppress protein adsorption more effectively with an increase in the molecular weight and molar ratio (1-10 mol%). Apolipoprotein A-I is detected on PMPC-liposomes with a higher molecular weight and higher molar ratio of PMPC-lipids, whereas α2-macroglobulin is detected on non-modified, PEGylated, and PMPC-liposomes with a shorter polymer chain. In addition, a correlation is shown among the PMPC molecular weight, molar ratio, and C3 binding. The MPC10-lipid cannot inhibit C3 binding efficiently, whereas surface modifications with 10 mol% MPC20-lipid and 5 mol% and 10 mol% MPC50-lipid suppress both total protein and C3 binding. Hence, liposome modification with PMPC-lipids can be a possible strategy for avoiding complement activation.

Poly(ethylene glycol) (PEG) is frequently used for liposomal surface modification. However, as PEGylated liposomes are cleared rapidly from circulation upon repeated injections, substitutes of PEG are being sought. We focused on a water-soluble polymer composed of 2-methacryloyloxyethyl phosphorylcholine (MPC) units, and synthesized poly(MPC) (PMPC)-conjugated lipid (PMPC-lipid) with degrees of MPC polymerization ranging from 10 to 100 (calculated molecular weight: 3 to 30 kDa). In addition, lipids with three different alkyl chains, myristoyl, palmitoyl, and stearoyl, were applied for liposomal surface coating. We studied the interactions of PMPC-lipids with plasma albumin, human complement protein C3 and fibrinogen using a quartz crystal microbalance with energy dissipation, and found that adsorption of albumin, C3 and fibrinogen could be suppressed by coating with PMPC-lipids. In particular, the effect was more pronounced for PMPC chains with higher molecular weight. We evaluated the size, polydispersity index, surface charge, and membrane fluidity of the PMPC-lipid-modified liposomes. We found that the effect of the coating on the dispersion stability was maintained over a long period (98 days). Furthermore, we also demonstrated that the anti-PEG antibody did not interact with PMPC-lipids. Thus, our findings suggest that PMPC-lipids can be used for liposomal coating.

Complement components have a reputation to be very labile. One of the reasons for this is the spontaneous hydrolysis of the internal thioester that is found in both C3 and C4 (but not in C5). Despite the fact that approximate to 20,000 papers have been published on human C3 there is still no reliable method to store the protein without generating C3(H2O), a fact that may have affected studies of the conformation and function of C3, including recent studies on intracellular C3(H2O). The aim of this work was to define the conditions for storage of native C3 and to introduce a robust method that makes C3 almost resistant to the generation of C3(H2O). Here, we precipitated native C3 at the isoelectric point in low ionic strength buffer before freezing the protein at -80 degrees C. The formation of C3(H2O) was determined using cation exchange chromatography and the hemolytic activity of the different C3 preparations was determined using a hemolytic assay for the classical pathway. We show that freezing native C3 in the precipitated form is the best method to avoid loss of function and generation of C3(H2O). By contrast, the most efficient way to consistently generate C3(H2O) was to incubate native C3 in a buffer at pH 11.0. We conclude that we have defined the optimal storage conditions for storing and maintaining the function of native C3 without generating C3(H2O) and also the conditions for consistently generating C3(H2O).

Operationssjuksköterskor utför en mängd olika uppgifter för att resultatet av patientens operation eller behandling ska bli så bra som möjligt. Trots detta fortsätter patienterna att lida skada av vården och hela 10 procent av alla patienter som opereras beräknas vara drabbade. Den vanligaste vårdskadan är vårdrelaterade infektioner och inkluderar postoperativa sårinfektioner, som också är den vanligaste komplikationen efter ett kirurgiskt ingrepp. Sjukvårdsskador leder till stort lidande för patienten och höga kostnader för sjukvården och samhället.

Bakgrund: Att vårda en döende människa är komplicerat och sjuksköterskan bör ha ett professionellt förhållningssätt samt ett holistiskt synsätt. Att vårda palliativa patienter kan vara både den svåraste och den mest privilegierade uppgiften som en sjuksköterska kan genomföra. Syfte: Att beskriva sjuksköterskans erfarenheter av att vårda palliativa patienter i hemsjukvården. Metod: Litteraturstudie baserat på 11 vetenskapliga artiklar med kvalitativ design. Artiklarna hämtades från databaserna Cinahl och PubMed. Resultat: Fem huvudkategorier; Vårdrelationen mellan sjuksköterska, patient och anhöriga, Teamarbete, Vårdmiljö, Emotionella utmaningar, Etiska utmaningar. Slutsats: För att en sjuksköterska ska utvecklas i sitt arbete är det viktigt att reflektera över de egna värderingarna och medvetandegöra dessa. Sjuksköterskan bör ge patienten och anhöriga stöd genom att samtala och vara närvarande. Resultaten visade att det var av stor betydelse att samarbetet från kollegor fungerade, då teamarbetet är en central del i det palliativa vårdandet.