The aim: was to describe and compare a group of experts and critical care nurses' agreement in detecting delirium in intubated, ventilator treated patients with sedation / analgesia, before and after an in house training intervention with the instrument Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).Method: A quasi-experimental study, one group pretest - posttest design. A convenience sample of 17 critical care nurses in a general intensive care unit included. To detect delirium the instrument CAM-ICU was used, 21 paired tests before and 22 after an educational intervention.Main Results: The results showed that after an in house training intervention sensitivity and kappa coefficient improved of the characteristic 1 "acute onset and fluctuating course," an improvement that was significant. In other features, and overall values were signs of numerical improvement and deterioration in sensitivity, specificity and kappa coefficient but no significant change.Conclusion: Implementing a new instrument for detecting delirium in clinical practice requires education and follow-up. A small sample of critical care nurses with varying ability to use the new instrument and the fact that patients' status may change rapidly making it difficult to draw any conclusions from this study.

Sahlgrenska Academyat University of GothenburgDepartment of Internal Medicine and Clinical NutritionAbstractTitle: A vegetarian diet, a possible treatment complement for relief of symptoms ofrheumatoid arthritis? A systematic review.Author: Alexandra Ahlsén and Caroline ForsbergSupervisor: Mette AxelsenExaminer: Anna WinkvistProgramme: Dietician study programme, 180/240 ECTSType of paper: Examination paper, 15 hpDate: May 22, 2012Background: Rheumatoid arthritis (RA) is a chronic remitting polyarthritis that is relapsing.Symptoms are inflammation of the joints with pain, stiffness and degradation of joint tissue.In some cases, also other parts of the body are involved. The treatment consists ofmedications to reduce pain, inflammation and degradation of joint tissue. Today, the offerednutritional treatment is primarily focused on meeting energy requirements and nutrient needs.The diet has also been discussed as symptomatic treatment, and one of the factors believed toinfluence the symptoms is meat.Objective: To assess the evidence as to whether a vegetarian diet affects the symptoms ofrheumatoid arthritis, and if so, to suggest how it can be implemented in practical dieteticswork.Search strategy The databases used in the literature search was PubMed, Scopus, and AMED.The search words used were: "rheumatiod arthritis", "vegetarian", "vegan", "diet", "meat" and"animal protein".Selection criteria: Studies investigating a vegetarian diet on the symptoms of RA wereincluded. Only RCT, clinical trial, controlled clinical trial, human studies and original articlesin English or Swedish were included.

Syftet med denna systematiska litteraturöversikt var att utreda om det finns stöd i litteraturen avseende vilken betydelse kostens innehåll av polyfenoler och vitaminer kan ha för parodontala sjukdomar. Material och metod: En sökning i PubMed gjordes i mars 2012. Sökningen begränsades till humana studier på engelska och publicerade mellan januari 1990 och mars 2012. Kriterier för inkludering var: ?randomized controlled trial?, ?clinical controlled trial?, ?clinical trial? och ??humans.

Several bulls in Sweden are culled because of lameness. Studies of beef bulls have shown that osteochondrosis is an important underlying cause of hind limb problems (Persson, 2003; Dutra, 1998). Osteochondrosis in horses, dogs, swine, poultry and man are well documentated in the literature, but there are few studies in cattle. The prevalence of osteochondrosis in dairy bulls in Sweden is unknown. The aim of this study was to investigate the presence and localisation of osteochondrosis in the hindlimbs of dairy bulls. This study consists of 48 one-year-old bulls divided into four groups related to which farm they came from.

Bakgrund: Forskning- och utvecklingsarbete är något som bedrivs på många håll inom hälso- och sjukvården. Detta innebär att många patienter som söker vård och behandling kan komma att tillfrågas om att delta i forskning. En person som är sjuk, och i behov av vård, kan uppleva att man i patientrollen hamnar i en beroendeställning i förhållande till vårdpersonalen. Patienten är den hjälpsökande och vårdpersonalen är de som på grund av kunskap och förmåga att hjälpa patienten har en starkare ställning. Att vara patient och medverka i forskning kan innebära att patienten får ökad uppmärksamhet men patienten kan också uppleva att beroendeställningen gentemot vårdpersonalen förstärks.Syfte: Syftet var att beskriva patienters erfarenheter av att delta i forskning.Metod: En litteraturöversikt har gjorts där tio vetenskapliga, kvalitativa artiklar, med begränsning vuxna patienter, har utgjort grunden till resultatet.Resultat: Resultatet presenteras i fyra kategorier, vilka är; Överväganden inför beslut om att delta i forskning, Meningsfullhet av att delta i forskning, Upplevelse av hinder i samband med forskning samt Från känslan av stöd ? till känslan av övergivenhet.Diskussion: Resultatet har diskuterats i relation till livsvärldsperspektivet enligt Dahlberg och Segesten.

Every year many dogs in Sweden are bitten by the adder, a venomous snake (Vipera berus). Despite the fact that adder bites are so common in dogs there have been few investigations made that study the effects of treatment with glucocorticoids, a drug that is commonly used. We have carried out a literature study concerning adder bites in dogs and a prospective study where case history, clinical signs and treatment have been recorded in dogs that were presented at two veterinary hospitals after a confirmed or suspected adder bite. Fifty three dogs were included in the study out of which 22 were treated with glucocorticoids. In our study, the group of dogs treated with glucocorticoids was compared with the group of dogs that did not receive glucocorticoid treatment by the owner or on arrival at the clinic.

Sahlgrenska Academyat University of GothenburgDepartment Of Internal Medicine And Clinical NutritionAbstractTitle: The effect of CLA on body weight and body fat amongst overweight and obese.Author: Sierra De Goldsmith and Amanda EgebergSupervisor: Frode SlindeExaminer: Anna WinkvistProgram: Dietician study program 180/240 ECTSType of paper: Examination paper, 15 hpDate: April 12, 2012Background: Overweight and obesity represents a global problem as it is accompanied by an accumulation of body fat which increases the risk of developing diseases such as diabetes type 2, insulin resistance, cardio vascular diseases and certain types of cancer. Moreover, the prevalence is increasing worldwide. Many consider it difficult to reach a normal weight using only methods such as changing dietary- and exercise habits, this creating a market for products that facilitate weight loss and loss of body fat. The supplement of conjugated linoleic acid (CLA) is such a product. In animal studies, CLA has demonstrated a reduction in both body fat and weight.

St. John?s wort extract is composed of a large number of components, about 150, but the most studied and interesting substance are hyperforin and hypericin. The herb is very popular and it is known for its pharmacological efficacy in numerous disorders. It is used for treatment of mild to moderated depression as an alternative to synthetic antidepressants.

During the last years, meticillin resistant Staphylococcus pseudintermedius (MRSP) have caused an increasing number of infections in Swedish dogs. MRSP is resistant against a majority of the antimicrobials available for dogs in Sweden, making it difficult to treat the infection. Our knowledge of the bacterium is limited, making it hard to handle infected dogs in a proper way. The aim of this study was to investigate for how long time dogs, who have an infection caused by MRSP, become carriers of the bacterium. Other factors like treatment with antimicrobials, the correlation between clinical symptoms and carriage, common diagnoses and institutionalization where also looked upon.

The Bovine respiratory syncytial virus (BRSV) causes bronchiolitis and interstitial pneumonia, predominantly in calves, and is a major cause of bovine respiratory disease worldwide. In humans, BRSV is paralleled by the closely related Human respiratory syncytial virus (HRSV), an important cause of respiratory disease, most severe in infants.The clinical signs and pathology during RSV infection is caused, not only by the direct effects of viral replication, but also by the response of the host immune system. The immunopathology of RSV has long obfuscated our understanding of the disease, and development of effective treatment and vaccines will be very difficult until greater knowledge is gained.One of the components of the immune system that has come into focus in RSV research the last few years, is the Toll-like receptor 4 (TLR4). The TLR4 receptor is well known as the receptor that binds lipopolysaccaride (LPS), and initiates the host response to bacterial infection. Recently, it has been shown that the fusion protein of RSV also interacts with, and up-regulates the expression of, the TLR4 receptor.

The aim of this study was to conduct an instrument test of the Canadian questionnaire Alberta Context Tool (ACT) version Long-Term care for Swedish conditions. ACT is designed in order to measure the context in the care environment and different behaviours related to the changes in clinical practice. In total, 159 Licensed Practical Nurses (LPNs) and Registered Nurses (RNs) within municipality care of the elderly were included in the survey. The test included the instrument's reliability and face validity.The reliability test was implemented through calculation of Cronbach´s Alpha, and showed internal consistency for five of the scales of the ACT-instrument with Cronbach´s Alpha values ranging between 0,728 and 0,873. However, three dimensions got lower values (0,558 - 0,683).The analysis was carried out with content analysis and carried out for LPNs and RNs in separate groups.

The Bovine respiratory syncytial virus (BRSV) causes bronchiolitis and interstitial pneumonia, predominantly in calves, and is a major cause of bovine respiratory disease worldwide. In humans, BRSV is paralleled by the closely related Human respiratory syncytial virus (HRSV), an important cause of respiratory disease, most severe in infants.The clinical signs and pathology during RSV infection is caused, not only by the direct effects of viral replication, but also by the response of the host immune system. The immunopathology of RSV has long obfuscated our understanding of the disease, and development of effective treatment and vaccines will be very difficult until greater knowledge is gained.One of the components of the immune system that has come into focus in RSV research the last few years, is the Toll-like receptor 4 (TLR4). The TLR4 receptor is well known as the receptor that binds lipopolysaccaride (LPS), and initiates the host response to bacterial infection. Recently, it has been shown that the fusion protein of RSV also interacts with, and up-regulates the expression of, the TLR4 receptor.

The aim: was to describe and compare a group of experts and critical care nurses' agreement in detecting delirium in intubated, ventilator treated patients with sedation / analgesia, before and after an in house training intervention with the instrument Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).Method: A quasi-experimental study, one group pretest - posttest design. A convenience sample of 17 critical care nurses in a general intensive care unit included. To detect delirium the instrument CAM-ICU was used, 21 paired tests before and 22 after an educational intervention.Main Results: The results showed that after an in house training intervention sensitivity and kappa coefficient improved of the characteristic 1 "acute onset and fluctuating course," an improvement that was significant. In other features, and overall values were signs of numerical improvement and deterioration in sensitivity, specificity and kappa coefficient but no significant change.Conclusion: Implementing a new instrument for detecting delirium in clinical practice requires education and follow-up. A small sample of critical care nurses with varying ability to use the new instrument and the fact that patients' status may change rapidly making it difficult to draw any conclusions from this study.

Sahlgrenska AcademyAt University of GothenburgDepartment of Internal Medicine and Clinical NutritionAbstractTitle: The obesity paradox, myth or truth in adults with cardiovascular disease.Author: Louise Svensson och Amanda NilssonSupervisor: Fredrik BertzExaminer: Ingrid LarssonProgramme: Dietician study programme, 180/240 ECTSType of paper: Examination paper, 15 hpDate: May 30, 2013Background: It has long been generally accepted that obesity is a risk factor for many diseases. Despite this, new research indicates that a higher BMI could be a protective factor for those with a chronic cardiovascular disease. This discovery is called the obesity paradox and could change the perception of patients' BMI in both public health and clinical work.Objective: The objective of this systematic review article is to examine the scientific evidence for the existence of the obesity paradox in chronic cardiovascular disease, i.e. if a BMI >25 kg/m2 is associated with lower mortality among adults with chronic cardiovascular disease.Search strategy: The databases used in the literature study were PubMed, Summon, Scopus and Cochrane. The keywords were: obesity paradox, cardiovascular, heart, male, BMI, intentional weight loss, cardiovascular mortality and mortality heart failure.Selection criteria: Studies, which had an adult population classified after BMI that suffered from chronic cardiovascular disease and had all-cause mortality and cardiovascular mortality as endpoints, were included.Data collection and analysis: Ten studies were included.

Renal dysplasi (RD) is a congenital chronic renal disease affecting young dogs. It is a rather common disease that occurs in a large number of dogs and in some breeds there is a familiar incidence or suspected hereditary background. Both the etiology and pathogenesis are still unknown, but a theory about the cause of RD is that the two components that form the kidney, the uretheric bud and the metanephrogenic blastema, don´t interact normally in the embryo. Kidneys affected by RD contain fetal (immature) structures that are inappropriate for the state of development/age of the dog and abnormal structures caused by an abnormal differentiation. Affected dogs usually are under .