Sahlgrenska Academyat University of GothenburgDepartment of Internal Medicine and Clinical NutritionAbstractTitle: BCAA supplementation in patients undergoing resection for liver cancerAuthor: Mikael Semaan and Viktor SjölingSupervisor: Fredrik BertzExaminer: Frode SlindeProgramme: Dietician study programme, 180/240 ECTSType of paper: Examination paper, 15 hpDate: April 10, 2013BackgroundLiver cancer is the fifth most common cancer worldwide and the third largest to cause death. Protein-energy malnutrition is common in patients with liver disease and they often suffer from changes in the hepatic metabolism of nutrients and other substances. There is a basis for recommending BCAA supplementation in other certain liver diseases. Given the similar clinical picture of liver cancer surgery, it is possible that supplementation of BCAA can be beneficial for these patients as well.ObjectiveThe aim was to study the scientific basis for the effect of branched chain amino acid (BCAA) supplementation in liver cancer patients. Can it improve their recovery in terms of nutritional status and albumin levels, and does it changes the duration of hospital stay, after surgery?Search strategyFive extensive searches were performed on PubMed and Cochrane after appropriate study material.

Background: Surgical complications has been the main cause of medical injuries and deaths worldwide. In 2008 WHO developed the checklist for safe surgery to reduce the number of surgical complications. The objective of the checklist is to strengthen already established safety routines and contribute to better cooperation and communication. Research shows that compliance to the checklist is deficient, which can affect patient safety.Aim: The aim was to study the extent to which theatre nurses participate in the use of the checklist.Method: Observational study was conducted with a descriptive design and quantitative approach. 24 observations were carried out with aid of an observation protocol of two surgical units at a hospital in central Sweden.Result: The results showed that Timeout initiated widely but compliance to all items was considerably lower.

Background: Vacuum assisted closure, VAC, is a method which can benefit wound closure. There are not many reliable studies about the effects of VAC in different types of wounds. Previous studies have shown that patients have experienced pain during dressing changes.Aim: The aim of the study was to survey in what kind of wounds the vascular surgery ward have been using VAC, to study the treatment process of VAC and how it has been documented and also to investigate if patients with VAC experienced pain during dressing changes.Method: The patients were chosen from a ledger, which contained 77 patients that had been treated with VAC on the vascular surgery ward. Data were collected with a journal survey protocol.Results: The result is based on 67 patients with a total of 79 wounds. VAC was shown to have a good effect on wound healing and infected surgical wounds were the most commonly wound category undergoing treatment with VAC.

The main objective of this research was to study how increased arterial oxygenation by the use of Pulsed Inhaled Nitric-Oxide (PiNO) influenced the metabolic and cardiovascular parameters on horses undergoing acute abdominal surgery because of colic. The parameters blood lactate, blood glucose, pH and heart rate were evaluated before and during anesthesia and closely after recovery. The study showed that blood lactate concentrations decreased significantly during anaesthesia in horses treated with PiNO compared to non-treated horses. It was also seen that the lactate concentration decreased most in horses with the highest levels before PiNO treatment. Since enhanced oxygen extraction ratio was evident in the PiNO group, improved oxygen delivery to the tissue may be a possible explanation for the improved situation.

Summary                                                               Overweight and obesity in Sweden and in the rest of the industrialized world continues to increase. This results in increased costs both to society and the healthcare system. Part of this development is the increasing consumption of sugar and that is what should be restricted to tackle this growing social problem. Part of the increased consumption of sugar in Sweden was the launch of pick and mix ingrocery stores.  This study aims to examine how store managers look at their public health responsibilities, and investigate how managers of grocery stores think about health and health aspects in general and about the sugar consumption in particular. Semi-structured "face to face" interviews was used to collect data and seven grocery store managers participated in the study.

ABSTRACTAim. To describe intensive care nurses´ experiences of caring for patients with postoperative delirium after heart surgery.Background. Delirium is a common condition after heart surgery. Previous research has focused more on pathophysiology, incidence, etiology, prevention, detection and management, and less on how nurses caring for patients with delirium experience it.Design. A qualitative interview study.Method.

Bakgrund: ERAS (Enhanced Recovery After Surgery) är ett standardiserat multimodalt vårdprogram vid elektiv kolorektalkirurgi, som syftar till snabbare återhämtning och kortare vårdtider genom ett tvärprofessionellt samarbete.  En vecka innan planerad operation träffar sjuksköterskan patienten för ett samtal om vårdförloppet. Syfte: Att identifiera och beskriva patientens upplevelse av sjuksköterskans ERAS- samtal och dess betydelse för patientens delaktighet i sin vård.   Metod: Datainsamlingen skedde genom kvalitativa intervjuer. Tolv patienter, nio män och tre kvinnor har intervjuats. De ljudinspelade samtalen har transkriberats ordagrant och analyserats med hjälp av tolkande fenomenologisk analys (Interpretative Phenomenological Analysis). Resultat: Analysarbetet resulterade i fem olika teman; bli sedd, trygghet, tillit, ansvar samt delaktighet. Alla teman relaterar till varandra och illustrerar en positiv och en negativ sida av den upplevda erfarenheten. Tillsammans bildar en helhet av upplevelsen; ERAS- samtalet och dess betydelse för patientens delaktighet. Konklusion: Resultatet visar att patienterna känner sig sedda under informationssamtalet.

BAKGRUND: CABG blir en allt vanligare åtgärd vid kranskärlssjukdom inom svensk sjukvård. Målet med operationen är att lindra symtom vid kärlkramp och hjärtinfarkt samt att reducera mortaliteten. SYFTE: Syftet var att beskriva patienters emotionella upplevelser under det första året efter en CABG operation. METOD: En allmän litteraturstudie som grundades på kvalitativa vetenskapliga artiklar genomfördes. Resultatet baserades på sju vetenskapliga artiklar som söktes fram via elektroniska databaser och därefter granskades och analyserades.

I ett internationellt perspektiv har Sverige hög amningsfrekvens, men under 2000-talet har amningsfrekvensen sjunkit och stora regionala skillnader ses. Kvinnorna rekommenderas att helamma sex månader. Mödravårdcentralen (MVC) informerar om bröstmjölkens hälsoeffekter som till exempel att bröstmjölken skyddar barn mot allergier. Forskning visar att överviktiga och feta kvinnor har kortare amningsduration, men få studier behandlar svenska förhållanden. Syfte: Syfte med fördjupningsarbetet är att studera samband mellan mammans BMI relaterat till amningsduration och mammans skattning av barnets hälsa de tre första levnadsåren.

Sahlgrenska Academyat University of GothenburgDepartment of Internal Medicine and Clinical NutritionAbstractTitle: The relation between alcohol and abdominal obesityAuthor: Anna Eriksson och Karin EdenholmSupervisor: Fredrik BertzExaminer: Ingrid LarssonProgramme: Dietician study programme, 180/240 ECTSType of paper: Examination paper, 15 hpDate: May 30, 2013Background: Abdominal obesity is a part of the metabolic syndrome, which has a worldwideprevalence of 20-25 %. The problem with abdominal obesity is the accumulation of visceraladipose tissue, which is an important risk factor for cardiovascular disease. Alcohol haseffects on metabolism, and can also lead to an increase in total energy intake; these twofactors can lead to an increase in accumulation of visceral fat. Besides this there are studiesthat show that a moderate alcohol intake could be good for your health. The context gets morecomplicated since different studies have shown contradictory results concerning theassociation between alcohol, different types of alcoholic beverages and measurements ofabdominal fat.Objective: The objective of this article review is to assess the evidence of whether alcoholintake is associated with accumulation of visceral adipose tissue, using the measurementswaist circumference (WC) and waist-hip ratio (WHR).Search strategy: The databases used in the literature study were PubMed and Scopus.

The aim has been to see if physical education (PE) is more an arena for bullying than swedish language education, in a swedish urban school. Furthermore to get an insight in the students sense of exposure to bullying in the locker room and during PE class. In the purpose is also included to analyse the answers in a gender perspective.Questions are: Is PE to wider extent an arena for bullying compared to swedish language education? Is the students? opinion that they feel worried about being and changing clothes in the locker room due to other students bad intentions? Do the students think that boys and girls bully in different ways?The method used is a questionnaire answered by 69 students in seventh and eighth grade in Åsö compulsory school. Furthermore, interviews has been made with a boy, a girl at the school and a teacher in PE to get a deeper insight above the questionnaire.Results of the study showed that the students to a wide extent, 100 % of the girls (g) and 89 % of the boys (b) thought that bullying can look different between PE and swedish language class.

Introduktion: Övervikt och fetma är ett globalt växande folkhälsoproblem vilket leder till enorma ekonomiska samhällskostnader. Fetmakirurgi, bland annat Reglerbart gastriskt band (Adjustable Gastric Banding, AGB), har visat långsiktiga effekter på viktminskning, medan icke-kirurgisk fetmabehandling har visat mindre tydliga effekter. Detta har lett till att fetmakirurgin ökat dramatiskt. Trots detta har vissa kirurgipatienter svårigheter i att upprätthålla viktminskning över tid. Fetmakirurgi kan även leda till senkomplikationer och biverkningar.

Syftet med denna studie var att undersöka hur fetma/övervikt påverkar lederna och utveckling av artros och hur sjuksköterskan kan informera, undervisa i förebyggande syfte. Metoden är en litteraturstudie. Tolv vetenskapliga artiklar granskades enl. Polit et al (2001) kriterier för vetenskaplighet. Därefter inleddes analysen där fyra huvudteman framträdde: BMI och påverkan på lederna, Smärtpåverkan vid artros, Genusskillnader vid artros och övervikt samt Sjuksköterskans undervisande roll.

Fetma är ett samhällsproblem i alla åldersgrupper på många håll i världen. Fetma och övervikt hos barn och ungdomar kan ge både fysiskt och psykiskt negativa effekter. Det finns flera orsaker till att fetma uppkommer, olika faktorer som livsstil, miljö, och arv kan samverka i utvecklingen av fetma. I det svenska samhället är risken för fetma ökad eftersom det finns nästintill obegränsad tillgång till fett- och energirik kost samt att de individuella kraven på fysisk aktivitet är låga..

Bakgrund: Fetma/övervikt är ett av de största folkhälsoproblemen i världen. Fetma är en produkt av flera genetiska, sociokulturella, socioekonomiska och miljömässiga faktorer och leder till fysisk, psykisk och social ohälsa. Detta har visats ha en negativ påverkan på dessa personers livskvalitet då de ofta möts av fördomar samt att de upplever begränsningar i sitt dagliga liv. Som ett led av detta ökade hälsoproblem har de bariatriska operationerna blivit en vanlig och effektiv metod i fetma behandlingen. Syfte: Att beskriva livskvalitet samt hur den förändras över tid hos patienter med övervikt och fetma som genomgått bariatriska operationer.