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.

The purpose of this study was to examine how young managers (26-32 years old) in municipal old-age care organizations, in Skåne and Blekinge, experience their professional roles as managers in relation to their age. One of the questions asked in this study was whether managers experienced that their age affected their managerial position, and in that case, how? In order to investigate this, a qualitative method was used, including interviews and observations. Seven interviews with young managers were conducted. My approach in the working process was influenced by Grounded theory as defined by Glaser and Strauss (1968).

As a patient you can find a lot of information concerning health and diseaseson the Internet. Purpose: The purpose of my study is to gain a betterunderstanding of how physicians relate to well-informed patientsfrom the point of doctor's changing role in meeting the patient related to theweb-based patient information. Today's patients are turning increasingly tothe Internet before they visit their doctor, this is due to the electronic healthinformation is available 24 hours a day, 7 days a week while the regulardoctor usually have several weeks of waiting. Problems that can arise with theWeb-based information is that the patient does not have a medical educationto know whether the information is appropriate or not. Method: To explorethese questions, I decided to use both qualitative semi-structured postalquestionnaires and telephone interviews in which the physicians preferreddifferently.

This report is the documentation of a project in the education Master of Science in Mechanical Engineering. The project was carried out at Alfakonsult AB. The purpose of the project was to map out the transference of information between the different operators in the supply chain of medicine in Sweden and to analyse this in order to reduce lead-time and the total throughputtime. The supply chain of medicine in Sweden consists of producers, distributors, one wholesaler, prescribers and patients. The mapping of the transference of information showed that most operators in the supply chain have done well introducing technical aids to facilitate the transference of information.

The effectiveness of communication in the Swedish healthcare system context has long been the subject of debate. Issues stemming from usability, accessability and interpretation affect the lives of patients, and yet the vocal groups in the healthcare communication debate are patients and administrators, not healthcare professionals. With the advent of eHealth services and new demands being put forth on the ability of healthcare professionals' to handle increasingly numerous and innovative systems, it is of more importance than ever to understand the healthcare professionals' work context. This article is based on interviews with five healthcare professionals concerning their views on electronic health records (EHR), eHealth services, trends in healthcare services development in Sweden, as well as their views on the future of eHealth solutions and health information technology (HIT). Analysis of collected information shows an apprehension among healthcare professionals towards electronic communication, as well as a dissatisfaction with the usability of modern healthcare systems.

Platelets are small fragments, but they are of crucial importance for the coagulation. The risk of spontaneous bleeding increases when the level of platelets falls below a thrombocyte particle concentration threshold value of 50 x 109/L. In those cases a platelet transfusion might be compulsory. Ongoing research tries to improve the quality of the platelets and to increase the safety of the method used. However, we still need to better understand which factors that affect how patients react upon platelet transfusion.

AbstractAim of the study: Aim of the study was to investigate whether there were any connections in time between different parts of care in patients with cardiac arrest and hypothermia treatment and cognitive and physical function six months after cardiac arrest and to investigate neurological outcome related to primary registered cardiac arrest rhythm after six months and if there were any changes in cognitive and physical functions as well as self-related health between discharge from hospital and six months after cardiac arrest.Method: The study included 39 patients admitted to three Swedish hospitals between 2008-2011. Cognitive and physical function was evaluated with Cerebral Performance Cathegory, CPC completed with Mini Mental State Examination, MMSE for cognitive function and Bartels Index, BI for physical function and Euroqol-VAS for evaluating the self-related health.Result:  A significant connection was shown between time to start hypothermia treatment and BI, patients with longer time showed improved physical function after six months.Majority of the participants (66,7 %) had Ventricular fibrillation/Ventricular tachycardia, VF /VT, as primary registered cardiac arrest rhythm and in this group CPC and BI was significant better compared with the asystole /Pulsless Electrical Aktivity, PEA group.CPC, MMSE, BI and Euroqol-VAS were all improved over time.Conclusion: Participants with VF /VT as primary registered cardias arrest rhythm had significant better cognitive and physical function 6 months after hypothermia-treated cardiac arrest compared with participants with asystole/PEA as primary registered rhythm. This shows the importance of access to defibrillators in public places in the society and in hospitals and optimal education of lay people and medical staff. Cognitive and physical function and self-rated health improves over time, which might be a very important reason to convey patients, relatives and medical staff to continue cognitive and physical rehabilitation. Keywords: Cardiac arrest, hypothermia, cognitive and physical function, wellbeeing.

The purpose of the study was to review the current veterinary literature regarding gastric dilatation and volvulus (GDV) considering pathophysiology and treatment, and to evaluate the operative technique (incisional gastropexy) used during the years 2005 and 2006 at the University Animal Hospital (Universitetsdjursjukhuset), SLU, Uppsala, Sweden. GDV has a complicated pathophysiology which foremost effects the circulatory system. Progress is often acute and it is not unusual that patients are affected with shock. The initial treatment targets to alleviate the shock by fluid therapy and decompression of the stomach. There is a high risk of recurrence in the long term perspective unless the stomach is surgically fixated by gastropexy. The study describes two different techniques for gastropexy; incisional gastropexy, and funduspexy. Long term complications were rare among the patients that were treated surgically, while about half out of the eighteen dogs that undergo surgery do experience complications of various severity in the short term..

The health care formulation of the principle of autonomy can be expressed as follows; ?you shall not treat a patient without the informed consent of the patient, or his or her lawfulsurrogate, except in narrowly defined emergencies?. The principle of beneficence refers to a moral obligation to act for the benefit of others. In heath care, the good or benefit in question is the restoration of the health of the patient. In fulfilling this obligation of beneficence, the physician sometimes intentionally overrides the patient?s preferences or actions for the purpose of benefiting the patient.

ABSTRACTThe aim of this study was to describe various methods of treatment and effects of treatment of ADHD, and to investigate wheater there is an association between adults with ADHD and obesity. Method:  Literature review. Twelve quantitative scientific articles were found in the data bases PubMed, Cinahl and MedLine.  Result: ADHD is a cognitive impairment that can lead to serious complications such as obesity. Studies show that drug treatments of adults with ADHD have positive effects in terms of reduced symptoms, increased efficiency and improved quality of life, but drugs can also cause side effects in form of loss of appetite and insomnia. For adults with ADHD and obesity drugs that affect metabolism have a significant impact on patients ability to lose weight.

Background:Malnutrition is a nursing issue that causes both physical and psychological suffering of those who are affected. In order to achieve care that is safe and has a good quality, it must be based on the assessment and actions of the state. District nurses play a central role in this work. Aim: The aim of this study was to describe the district nurses' work with identifying and addressing malnutrition in older people in nursing Home Care of the Community. Method: Six interviews with district nurses were conducted.

Background: The Swedish population is aging [1] and malnutrition is a common problem among elderly people [2]. A method called food registration is used to monitor the patients? nutritional intake, with the purpose of reducing the risk of patients deteriorating in nutritional status during hospitalisation. However, the current method is not satisfactory and many food registration lists are incomplete. [3-6] Thus, patients do not receive a qualitative nutritional care since the assessment of the patients? nutritional status is based on incomplete documentation.Purpose: The purpose of this master thesis is to increase the quality in the nutrition monitoring process in the geriatric units B72 and B74 at Karolinska University Hospital in Huddinge, Sweden.

Feelings the nurses and the students experience in their encounter with death and dying patients..

The prehospital management of patients with acute myocardial infarction (AMI)now includes 12-lead electrocardiogram transmission directly from the ambulance to hospital.If the ECG shows ST-elevated myocardial infarction the patient should be transported directlyto a hospital with capability for percutaneous coronary intervention (PCI).                                               Aim: The aim of this study was to describe how ambulance nurses experienced the prehospital management of patients with AMI who are transported by ambulance directly to hospital for PCI.                                                Method: Semi structured interviews were conducted with eight ambulance nurses. Data were analysed using qualitative content analysis. The categories that emerged were: Use ofcompetence, Responsibility and Insufficiency. Result: The result showed that the ambulance nurses felt secure when they cared for patients transported directly to PCI. The nurses assessed the patient and decided how he or she should be cared for.

Bakgrund: Förekomsten av diabetes typ 2 ökar ständigt och undervisning med patienter är betydelsefullt i sjuksköterskors omvårdnadsarbete. Undervisning kan dock upplevas mer blockerande än stödjande. Syfte: Att beskriva sjuksköterskors stöd i undervisningen angående förändring av kost- och motionsvanor hos patienter med diabetes typ 2. Metod: En litteraturstudie har gjorts baserad på åtta vetenskapliga artiklar. Resultat: Bemötande och identifiera behov; empati, respekt och engagemang samt att vara insatt i var patienter befinner sig i förändringsprocessen förbättrar möjligheterna att påverka.