Hirsla Community: Dissertations (Ritgerðir)

Svæfingar við líffæraflutninga : siðferðileg álitamál [M.A. ritgerð]

Fri, 26 Feb 2010 22:58:59 GMT

Titill: Svæfingar við líffæraflutninga : siðferðileg álitamál [M.A. ritgerð]

Höfundar: Guðbjörg Svava Ragnarsdóttir.

Útdráttur: This dissertation seeks answers to the question “ What moral questions rise among nurse anesthetists when they provide anesthesia to a donor who has been clarified brain dead?” To be able to answer this question fully, material from academic resources was explored and a qualitative research among nurse anesthetists who have given anesthesia to an organ donor was undertaken. In the litterature review, attitutes toward death and how they have changed through the centuries were examined. Moreover, the evolution of research of the human body was covered as well as the history of organ transplantations. Exploring the litterature of organ transplantations, it became evident that the ethics of organ transplantations came afterwards the operations themselves and many ethical mistakes were made during the early days of organ transplantations. It is arguable when a person who has been declared braindead is considered deceased. My conclusion, which is based on the reading of academic resources and the findings of the study, is that if a person can never gain consciousness again and all mental life has vanished it does not change the fate of the individual whether he is considered deceased, dying or alive. The person will not be able to wake up again. On the other hand it matters from a legal and ethical point of view. Some have gone as far as saying that we are removing organs from a living human that will not gain consciousness again.In the litterature review organ transplantation from non heartbeating donors where looked into. In those articles, very different opinions on this sensitive topic where introduced. Under those circumstances the time from which the person is declared dead until the transplantation begins must be very short. What matters concerning organ transplantation after cardiac arrest is whether it has been decided to bring the patient back to life and what kind of treatment he has been undergoing. Full treatment, full treatment but no resuscitation or is the person receiving palliative care. The time from cardiac arrest to organ removal is variable between countries. Shorter time benefits those waiting for organs while a longer time provides the patient with more security. Therefore a very clear and firm boundary which cannot be crossed is needed. In Iceland organ transplantation after cardiac arrest is very rare so there is no information on that in the study. Furthermore, in the litterature review, facts about organ transplantation, reasons for organ donation and arrangement of priority in choosing candidates for organ transplantation are looked upon. The results from the study itself where the following themes: sorrow, respect, doubt, justification and solitude. The participants experienced sorrow because of the course of events that lead to the organ donation. Respect for the donor and the relatives and their suffering was a keystone. Doubt of whether being doing the right thing or not came to most minds but some considered it a necessity to examine things carefully. The justification for organ transplantation is that others can obtain a new life. It was essential for the participants to gain this acknowledgement by getting some information about the utiliation of the organs, how many patients had organ transplants from the individual they anesthetized. The solitude consisted in not being able to talk about their experience to other people. The nurse anesthetists talked to each other though. Solitude sometimes also consisted in feeling and seeing the donors body fade away and die without others seeming to notice. Regarding the research question“ What moral questions rise among nurse anesthetists when they provide anesthesia to a donor who has been clarified brain dead?”, the study revealed following:Is it certain that the individual is brain dead and will never be able to gain consciousness again?Is it justifiable to remove the organs?In the light of these questions it is my belief that perhaps more education on organ transplantation is needed for nurse anesthetists. Further studies might then regularly observe how these nurses look at participating in these operations and wheter a choice should be given never to involve in organ transplantation.

Lýsing: Neðst á síðunni er hægt að nálgast ritgerðina í heild sinni með því að smella á hlekkinn Skoða/Opna (e.View/Open)

Symptoms and quality of life : a cross-sectional, descriptive, correlation study, evaluating the relationship between symptoms and quality of life in patients on opioids with advanced cancer [M.S. Thesis]

Sun, 28 Sep 2008 22:58:59 GMT

Titill: Symptoms and quality of life : a cross-sectional, descriptive, correlation study, evaluating the relationship between symptoms and quality of life in patients on opioids with advanced cancer [M.S. Thesis]

Höfundar: Sigríður Zoëga

Útdráttur: B A C K G R O U ND : Cancer patients experience multiple symptoms that affecttheir quality of life (QOL). Cancer related symptoms may be caused bythe disease itself or its treatment, but factors like age, gender, andconcurrent diseases may also influence the symptomatology. Thesymptoms-quality of life model shows the relationship between symptomsand QOL in cancer patients.G O A L OF P R O J E C T: To review the literature on quality of life andsymptomatology among cancer patients, to pull together a model thatexplains the relationship between symptoms and quality of life and to testselected aspects of the model.P A R T I C I P A N T S: 150 cancer patients on opioids, 62 (41%) men and 88 (59%)women, all Caucasians. The patients ranged in age from 20-92 years witha mean (SD) age of 64,7 (12,7) years.R E S E A R C H D E S I G N: Descriptive, cross-sectional, and correlational.R E S U L T S: The mean (SD) number of symptoms in the past 24 hours was 6,2(2,5), and 9,0 (3,3) in the past week. The most common symptoms werefatigue, pain, and weakness. Mean (SD) symptom severity was 0,7 (0,4) invthe past 24 hours and 0,9 (0,5) in the past week on a scale from 0-3.Gender and concurrent diseases were not related to number of symptoms,symptom severity or QOL, but increased age was associated with fewersymptoms and less symptom severity although age difference was notfound for global health/QOL score. Adjusted for age and gender, numberof symptoms explained 25,8% of the variance in global health/QOL. Alsoadjusting for age and gender, pain, fatigue, insomnia, and depressionexplained 33,6% of the variance in global health/QOL.C O N C L U S I O N: The symptomatology of Icelandic cancer patients is similarto cancer patients in other countries. Number of symptoms and theindividual symptoms of pain and notably fatigue are associated withdiminished QOL. Surprisingly insomnia and depression did not addsignificantly to the regression model. These results indicate that QOL ofcancer patients may be improved by assessing and treating cancer relatedsymptoms.; B A K G R U N N U R: Sjúklingar með krabbamein finna fyrir mörgum einkennumsem hafa áhrif á lífsgæði þeirra. Krabbameinstengd einkenni orsakastýmist af sjúkdómnum sjálfum eða meðferð hans, en þættir eins og aldur,kyn og aðrir sjúkdómar geta einnig haft áhrif á einkennamyndina.Einkenna-lífsgæðamódelið sýnir tengslin milli einkenna og lífsgæða hjásjúklingum með krabbamein.T I L G A N G U R V E R K E F N I S: Að skoða hugtakið lífsgæði og einkennamyndkrabbameinssjúklinga, að setja fram módel til að lýsa tengslunum millieinkenna og lífsgæða og að prófa ákveðna þætti módelsins.Þ Á T T T A K E N D U R: 150 krabbameinssjúklingar á ópíoíðum. Karlar voru 62talsins (41%) en konur 88 (59%). Allir þátttakendur voru hvítir. Aldurþátttakenda var á bilinu 20-92 ár en meðalaldur (SF) var 64,7 (12,7) ár.R A N N S Ó K N A R S N I Ð: Lýsandi, þversniðs, fylgnirannsóknarsnið.Niðurstöður: Meðalfjöldi (SF) einkenna síðasta sólarhringinn var 6,2 (2,5)en 9,0 (3,3) síðastliðna viku. Algengustu einkenni voru þreyta, verkir ogslappleiki. Meðalstyrkur (SF) einkenna var 0,7 (0,4) síðasta sólarhringinnen 0,9 (0,5) síðastliðna viku á skalanum 0-3. Fjöldi einkenna, styrkurþeirra og heilsu/lífsgæðaskor var ekki tengt kyni eða tilvist annarrasjúkdóma. Fjöldi einkenna og styrkur einkenna minnkaði hins vegar meðhækkandi aldri þótt heilsu/lífsgæðaskor væri óháð aldri. Fjöldi einkennaskýrði 25,8% af dreifingunni í heilsu/lífsgæðum þegar leiðrétt hafði veriðfyrir aldri og kyni. Annað aðhvarfsgreiningarmódel, einnig leiðrétt fyriraldri og kyni, sýndi að verkir, þreyta, svefnleysi og depurð skýrðu 33,6%af drefingunni í heilsu/lífsgæðum.ivÁ L Y K T A N I R: Einkennamynd íslenskra krabbameinssjúklinga á ópíoíðumsvipar til krabbameinssjúklinga í öðrum löndum. Fjöldi einkenna sem ogverkir, og einkum þreyta, eru tengd skertum lífsgæðum. Á óvart kom aðsvefnleysi og depurð höfðu ekki marktæk áhrif íaðhvarfsgreiningarmódeli. Niðurstöðurnar benda til þess að hægt sé aðstuðla að bættum lífsgæðum krabbameinssjúklinga með því að meta ogmeðhöndla krabbameinstengd einkenni.

Lýsing: Neðst á síðunni er hægt að nálgast ritgerðina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)

The efficiency of acupuncture for nulliparas in actuating cervical ripening and spontaneous labour after 41 weeks (± 2 days) of normal pregnancy: Pilot study [M.S. Thesis]

Thu, 29 May 2008 22:58:59 GMT

Titill: The efficiency of acupuncture for nulliparas in actuating cervical ripening and spontaneous labour after 41 weeks (± 2 days) of normal pregnancy: Pilot study [M.S. Thesis]

Höfundar: Anna Sigríður Vernharðsdóttir

Útdráttur: B A C K G R O U N D - Acupuncture is an ideal treatment alternative during pregnancy labour and birth as there are no severe side effects. Many studies report benefits of the use of acupuncture in actuating cervical ripening and spontaneous labour but its effectiveness needs to be assessed further. - O B J E C T I V E -This study serves as a pilot study for a future clinical trial that will evaluate the efficiency of acupuncture in actuating cervical ripening and spontaneous labour after 41 weeks (± 2 days) of normal pregnancy. - M E T H O D S -Healthy nulliparous women at 41 weeks (± 2 days) with a singleton normal pregnancy were randomized to either an acupuncture or control group. The control group received no treatment. The acupuncture group received one or two sessions of treatment: the first treatment at 41 weeks (±2 days) and the second at 41 weeks and 5 days (± 2 days), if they were not yet in spontaneous labour. Each acupuncture treatment consisted of four needles applied to the bilateral points Hegu (LI4) and Sanyinjiao (SP6). Cervical status was assessed using the modified Bishop score. The primary outcomes were: (1) the mean time from randomization to onset of the active phase of labour; (2) the incidences of medical inductions; and (3) ripening of the cervix from 41 weeks (± 2 days) to 41 weeks and 5 days (± 2 days). Secondary10outcomes included rates of Caesarean section, duration of labour and use of oxytocin during labour. As this was a pilot study, it was considered sufficient to have 16 participants in the study, eight in the acupuncture group and eight in the control group. - R E S U L T S -Sixteen women were randomized and completed the study procedure. No statistical difference in primary or secondary outcome was noted. -C O N C L U S I O N -As a pilot study, the sample size is small and no statistically significant results are presented. Data collection tools were reliable and no major practical difficulties were encountered. Some changes in the research plan for a future study are suggested. According to the study data, the intervention is probably of small effect size and therefore a large sample will be required to test the effectiveness of this intervention in a future clinical trial.

Lýsing: Neðst á síðunni er hægt að nálgast ritgerðina í heild sinni með því að smella á hlekkinn View/Open

Cognitive development in adult children of Alzheimer’s patients : a neuropsychological reassessment: 7 year follow up [M.S. Thesis]

Tue, 29 Jul 2008 22:58:59 GMT

Titill: Cognitive development in adult children of Alzheimer’s patients : a neuropsychological reassessment: 7 year follow up [M.S. Thesis]

Höfundar: Magnús Jóhannsson

Útdráttur: Previous studies on first-degree relatives of Alzheimer’s disease (AD) patients haverevealed a higher risk of developing dementia, and that subtle cognitive impairment canbe detected before overt clinical signs appear using neuropsychological tests. Findings onchildren of AD patients are very scarce within the literature. The main aim of this studywas to explore the cognitive development of adult children (AC) of AD patients inIcelandic pedigrees selected from an ongoing genetic research, over a seven-year period.The subjects were 83 AC (age range 46-74) with a family history of AD and a controlgroup (NC) constituting 30 individuals (age range 48-73) without any known first-degreerelative with dementia. Cognitive abilities were assessed using neuropsychological testsof orientation, verbal and non-verbal memory, abstract reasoning, language,concentration, mental speed, and visuo-spatial and constructional abilities. Participantswith known central or peripheral nervous disorders were excluded from the study.Primary results revealed no statistical difference between the two groups on any of theneuropsychological tests from time 1 to time 2, over a seven year period. These findingsplace the onset of subtle cognitive impairments in adult children of AD patients after theage of 60 years. When comparing the AC group to 76 AD patients and 92 siblings of ADpatients, participating in the genetic study, one AC had stronger resemblance to the ADgroup than other AC on the neuropsychological measures. Furthermore, 10% of the ACgroup had stronger resemblance to the siblings of AD patient in the neuropsychologicalmeasures than the rest of the group, indicating a possible trend within the AC group.

Lýsing: Neðst á síðunni er hægt að nálgast ritgerðina í heild sinni með því að smella á hlekkinn View/Open

Geislaskammtar í hjarta við geislameðferð gegn brjóstakrabbameini [M.S. ritgerð]

Fri, 28 Nov 2008 22:58:59 GMT

Titill: Geislaskammtar í hjarta við geislameðferð gegn brjóstakrabbameini [M.S. ritgerð]

Höfundar: Jaroslava Baumruk

Útdráttur: Aukin tíðni hjartasjúkdóma er þekkt afleiðinggeislameðferðar við meðhöndlun brjóstakrabbameins einkumá árum áður þegar stuðst var við ófullkomnari tækni ogtækjabúnað. Með þróun í hugbúnaði og myndgerð hafa meðalannars komið fram nýjungar á borð við styrkmótaðageislameðferð (Intensity Modulated Radiation Therapy) ogöndunarstýrða meðferðartækni (Respiratory Gating) sem gerakleift að bæta geisladreifingu innan meðferðarsvæðis og þaðsem meira er áhættulíffærum (Organs at Risk) eins og hjartaer hlíft við háum geislaskömmtum.Markmið rannsóknarinnar var að meta geislaskammtinn íhjarta sjúklinga sem fengu skáreita geislameðferð á brjóstvef.Ennfremur að kanna hvort öndunarstýrð geislameðferð hlífiáhættulíffærum eins og hjarta og hvort styrkmótuðgeislameðferð auki nákvæmi í dreifingu geislaskammta innanmeðferðarsvæðis og áhættulíffæra.Þátttakendur voru 20 konur sem höfðu gengist undirfleygskurð vegna brjóstakrabbameins á vinstra brjósti átímabilinu janúar til september 2007.viiiHefðbundnar tölvusneiðmyndir (CT myndir) voru teknar afbrjósti og brjóstholi við eðlilega öndun. Teknar vorusambærilegar tölvusneiðmyndir þar sem sjúklingur dregur aðsér andann og heldur honum niðri meðan myndataka ferfram. Gert var hefðbundið geislaplan grundvallað áhefðbundnum tölvusneiðmyndum og annað byggt á myndumteknum þegar sjúklingur hefur dregið að sér andann og heldurhonum niðri til að sjá áhrif öndunarstýrðrar geislameðferðar ágeisladreifingu innan meðferðarsvæðis og í hjarta. Auk þessvar gert styrkmótað geislaplan grundvallað átölvusneiðmyndum teknum þegar sjúklingur hefur dregið aðsér andann og heldur honum niðri.Í viðmiðunarhópnum voru 20 konur með krabbamein ívinstra brjósti og aðrar 20 í því hægra, valdar af handahófi.Þær höfðu fengið hefðbundna geislameðferð á árunum 2005-2006. Geisladreifing innan meðferðarsvæðis og í hjarta varkönnuð hjá þeim til samanburðar.Gerð voru skammtadreifirit og skráðir voru hámarks,lágmarks og meðaltals geislaskammtar fyrir meðferðarsvæðiðog hjarta, bæði með venjulegri hefðbundinni geislaplönun ogixplönun grundvallaðri á öndunrstýrðri sneiðmyndatöku. Í ljóskom að óveruleg hætta er á að fá óæskilega háageislaskammta í hjarta með öndunarstýrðri meðferð. Húnsýnir tölfræðilega marktækt minni geislaskammt í hjarta.Samkvæmt niðurstöðum í þessu verkefni fengu 20%sjúklinga meira en 40 Gy í 3% af rúmmáli hjarta miðað viðhefðbundna skáreitameðferð á vinstra brjóst. Þegar skoðuðvar öndunarstýrð meðferð fékk enginn sjúklingur 40 Gy í 3%af rúmmáli hjarta. Styrkmótuð geislameðferð bætir enn frekargeisladreifingu innan meðferðarsvæðis og hlífirhjartavöðvanum betur. Þar fékk enginn sjúklingur 40 Gy í 2%af rúmmáli hjarta.Ályktun þessa verkefnis er að öndunarstýrða geislameðferðætti að taka í notkun á Landspítala fyrir sjúklinga meðbrjóstakrabbamein, sem fá geislameðferð á brjóstvef eðabrjóstsvæðið, til að hlífa hjarta við ónauðsynlegri geislun.; Heart diseases are a well-known frightful long-termcomplication of radiotherapy, especially where oldertreatments, obsolete technology or inadequate equipmentswere used. Through advanced technology, both in softwareand digital imaging, Intensity Modulated Radiation Therapyand Respiratory Gating have been developed. These newtechnological methods in radiotherapy give the possibility forbetter depolarization in the target and organs at risk such asthe heart and to protect them from excess radiation doses.The purpose of this research was to put forth a schemeregarding radiation doses in the heart of the patients whoreceived tangential-radiotherapy in the breast andfurthermore investigate if respiratory gating protects the riskorgans such as the heart. Also if intensity modulated radiationtherapy increases the accuracy of the distribution of radiationdoses within the treatment area and the organs at risk.Participants were 20 women who had undergone alumpectomy because of breast cancer on the left breast duringthe period from January to September 2007. Routinexicomputer tomographic images covering the breast and thoraxwere taken during natural breathing. Furthermore comparabletomographic images were taken when the patient breaths andholds the breath which is the basis for breath controlledradiotherapy, Respiratory Gating. Conventional treatmentplan was made on routine computer tomographic images aswell as on the computer tomographic images when the patientbreaths and holds the breath. An intensity modulatedradiation therapy plan was made on the images when thepatient breaths and holds the breath to see changes in thedepolarization within the target and the heart. In the referencegroup there were 20 women having cancer in the left breastand another 20 in the right breast, chosen randomly. They gotconventional radiotherapy in the years 2005-2006.Depolarization within the target and the heart wasinvestigated for comparison.Dose volume histograms were calculated for the maximum,minimum and average radiation dose for the target and theheart and were registered for conventional treatment plan andanother one, when the patient breaths and holds the breath.xiiThe research shows that there is an insubstantial risk gettingunnecessary radiation doses in the heart using respiratorygating. Statistically it shows less radiation doses in the heart.According to the results of this project 20% of the patientsgot more than 40 Gy in 3% of the heart volume usingtraditional tangential radiotherapy on the left breast. On theother hand using respiratory gating the results show that nopatient got 40 Gy in 3% of the heart volume. The intensitymodulated radiation radiotherapy improves depolarizationwithin the target and shelters the cardiac muscle even more.The conclusion of this project shows that it is important tostart using respiratory gating in the treatment at theLandspítali for patients suffering from breast cancer, in orderto protect the heart for unnecessary radiation.

Lýsing: Neðst á síðunni er hægt að nálgast ritgerðina í heild sinni með því að smella á hlekkinn View/Open

Normal birth and the issues of safety and risk : the perceptions of midwives in an Icelandic context [M.S. Thesis]

Mon, 29 Oct 2007 22:58:59 GMT

Titill: Normal birth and the issues of safety and risk : the perceptions of midwives in an Icelandic context [M.S. Thesis]

Höfundar: Valgerður L. Sigurðardóttir

Útdráttur: Wellbeing and safety of mother and child is a guiding light in midwifery care. Forthe last decades medicalisation has increased in childbirth practice and more riskthinking is dominant in the childbirth environment. Physiological births havedecreased and this has been of concerns in midwifery internationally where theconcepts of safety and risk in relation to normal births, have been up for the debate.The aim of this study was to explore how midwives perceive the issues of safetyand risk in an Icelandic context. A qualitative study about how midwives makedecisions, describe and perceive safety and risk in normal birth was conducted.Data was collected by a convenience sample of eighteen midwives with differentbackground in two focus group interviews, all of them practicing in two birth unitsin Landspitali-University Hospital. Data was analysed in themes and underthemeswithin an ethnographical tradition. The findings suggest that place of birth and riskmindset had influence on midwives´ confidence and inner knowledge and how theydefine normal birth. Being able to be present with the woman during birth isimportant in order to form a reciprocal relationship, built on trust. That kind ofrelationship created a sense of safety and an opportunity to use clinical skills andinner knowledge to decide about the best care for the women. If this kind ofrelationship was not created it could result in lack of safety. Procedure policieswhich are paradoxical to their knowledge and work based on conflicting models ofcare also created a lack of safety, which could be described as a feeling of beingwatched. This affected midwives´ and women´s autonomy for decisionmaking. Yet,the midwives described how they sometimes step out of frameworks and make anautonomous decision built on midwifery knowledge, clinical assessment and thewoman´s choice. In that way they provided evidence based care.; Eðlilegar fæðingar, öryggi og áhætta: skynjun íslenskra ljósmæðraVelferð og öryggi móður og barns eru leiðarljós í ljósmóðurstarfinu. Áundanförnum áratugum hefur sjúkdómsvæðing barneignarferlisins vaxið og virðistumhverfi fæðinga einkennast í auknum mæli af áhættuhugsun. Innanljósmóðurfræðinnar á alþjóðavísu er áhyggjuefni að eðlilegum fæðingum áníhlutana fækkar samhliða því að tíðni íhlutana eykst og því hafa hugtökin öryggi ogáhætta í tengslum við eðlilegar fæðingar verið til umfjöllunar. Markmið þessarareigindlegu rannsóknar var að skoða hvernig ljósmæður skynja hugtökin öryggi ogáhættu í fæðingum á Íslandi; hvernig ljósmæður taka ákvarðanir og skynja öryggiog áhættu í fæðingarhjálp, sérstaklega með tilliti til eðlilegra fæðinga. Gögnum varsafnað með tveimur rýnihópaviðtölum með menningarbundinni nálgun(ethnographic tradition) við samtals átján ljósmæður sem störfuðu á fæðingargangiog í Hreiðri á Landspítala-háskólasjúkrahúsi. Úrtak var valið með þægindaúrtakiþar sem þátttakendur höfðu mismunandi bakgrunn m.t.t starfsreynslu og menntunar.Gögn voru greind í þemu og undirþemu. Í niðurstöðum kom fram að fæðingarstaðurog áhættuhugsun í umhverfi hefur áhrif á sjálfstraust og innri þekkingu ljósmæðraog hvernig þær skilgreina eðlilega fæðingu. Ljósmæður töldu yfirsetu mikilvægavegna möguleika til að mynda gagnkvæmt samband, byggt á trausti, milli konu ogljósmóður. Það skapaði öryggistilfinningu og tækifæri til að nota klíníska færni oginnri þekkingu til að ákveða bestu umönnun fyrir hverja konu fyrir sig. Ef slíktsamband myndaðist ekki fannst þeim það draga úr öryggistilfinningu. Mismunandiumönnunarmódel og verklagsreglur sem brjóta í bága við þekkingu þeirra ásamt þvíað þurfa að vinna samkvæmt mismunandi hugmyndafræði gat líka skapað óöryggi,sem gat lýst sér í tilfinningu um að vera undir smásjá. Það hafði áhrif á sjálfræðiþeirra og kvenna til ákvarðanatöku um umönnun í fæðingu. Ljósmæður lýstu þóákveðnu ferli þar sem þær fóru út fyrir ramma reglna, en þá var ákvörðun byggð ágagnreyndri þekkingu, klínísku mati og samráði við konuna.

Lýsing: Neðst á síðunni er hægt að nálgast ritgerðina í heild sinni með því að smella á hlekkinn View/Open

Samanburður á tveimur aðferðum við endurhæfingu á hjartasjúklingum [M.S. ritgerð]

Thu, 29 Oct 1998 22:58:59 GMT

Titill: Samanburður á tveimur aðferðum við endurhæfingu á hjartasjúklingum [M.S. ritgerð]

Höfundar: Ólöf Ragna Ámundadóttir

Útdráttur: Sjúklingar með kransæðasjúkdóma á Íslandi sem fara í annars stigs hjartaendurhæfingugeta valið á milli tveggja þjálfunaraðferða: 1) Endurhæfing á Reykjalundi,endurhæfingarstofnun þar sem einstaklingurinn dvelur í 4 vikur; eða 2) Endurhæfing áEndurhæfingarstöð hjarta- og lungnasjúklinga þar sem er þjálfað þrisvar sinnum í viku aðheiman, klukkutíma í senn, alls 24 skipti. Markmið rannsóknarinnar var að bera samanskammtíma- og langtímaárangur þessara tveggja þjálfunaraðferða. Jafnframt að kanna hvortárangurinn væri jafngóður á báðum stöðum, fyrir annars vegar einstaklinga sem höfðufengið kransæðastíflu og hins vegar einstaklinga sem höfðu farið í kransæðaaðgerð(kransæðahjáveitu eða kransæðavíkkun) í fyrirbyggjandi skyni. Hámarkssúrefnisupptaka,afkastageta, uppsöfnun á mjólkursýru og líkamssamsetning var metin í stöðluðu þrekprófifyrir endurhæfingartímabilið, strax að því loknu og þrettán mánuðum síðar. Heilsutengdlífsgæði voru mæld með stöðluðum spurningalista fyrir endurhæfingartímabilið og þrettánmánuðum eftir lok þess. Þrjátíu og sjö einstaklingar luku rannsókninni. Meðaltalshámarkssúrefnisupptaka á þyngdareiningu var í upphafi 22,8 ml kg-1mín-1, eftir annars stigshjartaendurhæfinguna 26,0 ml kg-1 mín-1 og þrettán mánuðum síðar 25,3 ml kg-1 mín-1.Meðaltals afkastageta var í sömu mælingum 1,80 vött-kg-1, 2,12 vött-kg-1 og 2,0 vött-kg-1,og meðaltals mjólkursýruþröskuldur (4 mM) var við 1,41 vött-kg-1 1,57 vött-kg-1 og 1,56vött-kg-1. Aukningin sem varð í hámarkssúrefnisupptöku, afkastagetu ogmjólkursýruþröskuldi meðan á endurhæfingunni stóð var tölfræðilega marktæk í öllumofangreindum mælingum og var það líka þrettán mánuðum seinna. Einstaklingar sem höfðufengið kransæðastíflu og fóru í endurhæfingu á HL-stöðina bættu sig marktækt minna ísúrefnisupptöku og afköstum en aðrir. Allir sem höfðu farið í kransæðavíkkun eftirkransæðastíflu voru í þessum hóp. Þátttakendur í rannsókninni byggðu upp vöðvamassa og- v -minnkuðu þyngd fitu á meðan á rannsókninni stóð. Fimm þættir af tólf sem mældir vorumeð spurningalista um heilsutengd lífsgæði voru tölfræðilega marktækt betri þrettánmánuðum eftir lok endurhæfingartímabilsins, það er heilsufar, þrek, líkamsheilsa og líðan.Þegar þjálfunaraðferðirnar tvær voru bornar saman fannst enginn tölfræðilega marktækurmunur á þeim í ofangreindum þáttum. Árangur annars stigs endurhæfingar hjartasjúklingahér á landi er sambærilegur við það sem þekkist annars staðar og ekki er munur á árangriþeirra tveggja þjálfunaraðferða sem notaðar eru hérlendis fyrir þá sem höfðu farið ífyrirbyggjandi kransæðaaðgerð.; Patients with cardiovascular diseases who undergo phase II cardiac rehabilitation canchoose between the following two rehabilitation programs: 1) Reykjalundur RehabilitationCenter, a four week intensive inpatient rehabilitation; or 2) The Heart and LungRehabilitation Center (HL-Center), an outpatient clinic where patients train three times aweek for one hour at a time for 8-10 weeks. The purpose of this study was to compare theshort-term and long-term outcome measures of the two rehabilitation programs. Also tocompare the outcome measures both of patients with a history of myocardial infarct and ofpatients who underwent a coronary operation without a history of myocardial infarct. Peakoxygen uptake, blood lactate build-up, peak performance and body composition weremeasured by a standard cardio-pulmonary exercise test before the phase II heartrehabilitation program began, immediately after it was completed and 13 months later.Quality of life was measured by a standardized questionnaire before and thirteen monthsafter conclusion of the phase II cardiac rehabilitation. Thirty seven patients completed thestudy. Mean peak oxygen uptake before the rehabilitation program was 22.8 ml kg-1min-1,after the phase II rehabilitation 26.0 ml kg-1 min-1 and thirteen months later 25.3 ml kg-1min-1. Mean peak performance was 1.80 w-kg-1, 2.12 w-kg-1 and 2.0 w-kg-1, respectively.Mean lactate threshold (4 mM) was at 1.41 w-kg-1 1.57 w-kg-1 1.56 w-kg-1, respectively.The improvement in these three measurements over the phase II cardiac rehabilitationperiod was statistically significant and also thirteen months later. Patients who had a historyof myocardial infarct and underwent phase II cardiac rehabilitation at the HL-Centerincreased their peak oxygen uptake and peak performance significally less than the otherpatients. All of those who underwent percutaneous transluminal coronary angioplasty(PTCA) after myocardial infarct were in the first group. The patients gained muscle massand reduced their fat tissue over the study period. Quality of life results indicatedsignificant improvement at the end of the study in five out of twelve factors measured:general health, concentration, energy, physical health and general well being. However,there was no statistically significant difference between the programs. This study indicatesthat the results of cardiac rehabilitation in Iceland are in accord with other studies. There isno statistical difference between these two rehabilitation programs in Iceland in the factorsmeasured for patient without a history of myocardial infarct.

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A measure of cognitive vulnerability : development and validation of the Anxiety Attitude and Belief Scale [PhD Thesis]

Sat, 28 Jun 2008 22:58:59 GMT

Titill: A measure of cognitive vulnerability : development and validation of the Anxiety Attitude and Belief Scale [PhD Thesis]

Höfundar: Solveig E. Jónsdóttir

Útdráttur: The cognitive model of emotional disorders has inspired considerable research effort, much of it self-report and questionnaire-based. This methodological focus has been criticized on several grounds and poses a challenge for those attempting to index relevant cognitive constructs. The aim of the study described here is to further develop and validate the Anxiety Attitude and Belief Scale-Revised (AABS-R). The measure was designed to index attitudes and beliefs that may represent a cognitive vulnerability to anxiety problems. The development of the scale involved an emphasis on avoiding confounding with affect, thus averting some of the criticisms of self-report cognitive measures. First, construct validation through cognitive interviewing was undertaken. Four undergraduate students completed 53 questions on the AABS-R while thinking aloud. The ensuing verbal protocols were coded by a blind rater according to the specific cognitive processes participants engaged in. Results indicated that items generally tap into cognitive rather than affective processes. Subsequently, the reliability, psychometric properties and validity of the scale were investigated in an online anxiety disorder support group and student sample. Participants (N = 346) completed an online battery of tests, which included the AABS-R as well as criterion measures. Exploratory factor analyses suggested the existence of five factors, which index domains of theoretical interest. The final 33-item measure total and factor scores demonstrated adequate internal consistency. A correlational analysis was consistent with convergent, but only partly with the discriminant validity of the AABS-33. As predicted, the AABS-33 appears to be a reliable, valid and potentially clinically useful index of anxiety vulnerability, which may overcome the shortcomings of well-established anxiety measures. The findings are discussed within the broader literature on cognitive theory and its’ operationalization, ‘transdiagnostic processes’ and notions of validity.

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Respiratory movement measuring instrument : reliability, reference values and clinical utility [PhD Thesis]

Mon, 29 Oct 2007 22:58:59 GMT

Titill: Respiratory movement measuring instrument : reliability, reference values and clinical utility [PhD Thesis]

Höfundar: María Ragnarsdóttir

Útdráttur: Methods to evaluae respiratory function such as inspection, palpation, tapemeasurements, auscultation, chest radiographs and lung volume measurements havebeen used for a long time. During the last decades several additional evaluationmethods have emerged measuring for example respiratory muscle strength andmovements. However, few instruments measuring real time bilateral respiratoryupper thoracic, lower thoracic and abdominal movements are available and nonemeasuring simultaneously all variables of the respiratory movement pattern.The aims of the studies were to develop an instrument to measure respiratorymovements and test its reliability. The instrument, Respiratory Movement MeasuringInstrument (RMMI), was developed at the Bioengineering Department at LandspitaliUniversity Hospital according to the ideas of the author. Furthermore, to collectreference values for the instrument and investigate its usefulness in clinical practice.The RMMI was used to measure respiratory motion among two groups of healthyindividuals in order to obtain reference values and test the reliability of themeasurements. To test the clinical usefulness, a group of patients with ankylosingspondylitis (AS) and patients undergoing cardiac surgery (pre- and postoperatively)were studied. Respiratory motion, and lung volumes were measured and abnormalsigns on chest radiographs rated among the cardiac surgery patients pre-operativelyand one, 12, and 52 weeks postoperatively.Respiratory movements did not decrease significantly with increasing age from 20 to69 years. The only significant gender difference was that the men had significantlygreater abdominal motion during deep breathing. Separate reference values aretherefore presented for males and females. Correlations of respiratory movementsmeasured on two consecutive days was strong for both quiet and deep breathing. TheAS patients had significantly reduced upper thoracic movements compared withreference values. The cardiac surgery patients had highly significantly reducedaverage lung volumes, abdominal and lower thoracic movements and showed one ormore abnormal sign on a chest radiograph one week post-operatively. Twelve weeksafter the operation average abdominal movement was still significantly reduced, butupper thoracic movement had increased. One year after the operation abdominalmovement had still not fully recovered but average upper thoracic movement wassignificantly increased. When the cardiac surgery patients were divided into Mediangroupand IMA-group according to surgical procedure, abdominal motion wassignificantly more reduced among the IMA-group 12 weeks post-operatively. Bothgroups had symmetrical abdominal motion pre-operatively, but significantlyasymmetrical among the IMA-group 12 week post-operatively. Both groups hadsymmetrical abdominal movements 52 weeks post-operatively, but the IMA-grouphad significantly reduced abdominal movements. Abdominal movements were stillsignificantly decreased compared with pre-operative values one year after cardiac surgery.The RMMI is a reliable instrument and is easy to use in clinical practice formeasuring respiratory movement and respiratory movement pattern.; Löng hefð er fyrir notkun ýmissa aðferða til skoðunar á starfsemi öndunarfæra. Máþar nefna þreifingu, málbandsmælingu á ummáli brjóstkassa, röntgenmyndatöku ogmælingar á rúmtaki lofts í lungum. Á síðustu áratugum hafa ýmsar aðferðir bæst íhópinn til dæmis aðferðir til að mæla styrk öndunarvöðva og öndunarhreyfingar.Tæki sem mælir öndunarhreyfingar efri og neðri hluta brjóstkassa og kviðar á báðumlíkamshelmingum samtímis, auk öndunartíðni og takts hefur ekki verið þróað áður.Markmið rannsóknanna voru að þróa tæki til mælinga á öndunarhreyfingum ogkanna áreiðanleika þess. Tækið, öndunarhreyfingamælirinn ÖHM-Andri, var hannaðá heilbrigðistæknideild Landspítalans samkvæmt hugmynd höfundar. Ennfremur aðsafna viðmiðunargildum og kanna notagildi ÖHM-Andra í daglegu starfisjúkraþálfara.Öndunarhreyfingar tveggja hópa heilbrigðra einstaklinga voru mældar með ÖHMAndraí þeim tilgangi að safna viðmiðunargildum og prófa áreiðanleika tækisins.Öndunarhreyfingar minnkuðu ekki marktækt með hækkandi aldri frá 21 til 69 ára.Eini munurinn á öndunarhreyfingum karla og kvenna var að karlar höfðu marktæktmeiri kviðarhreyfingar við djúpa öndun. Viðmiðunargildi eru því gefin upp sér fyrirkarla og konur. Sterk fylgni var milli öndunarhreyfinga sem mældar voru tvo daga íröð bæði í hvíldar- og djúpri öndun.Til að kanna notagildi ÖHM-Andra voru öndunarhreyfingar sjúklinga með hryggiktmældar. Einnig voru lungnarúmmál og öndunarhreyfingar mældar og röntgenmyndiraf lungum metnar hjá hjartasjúklingunum fyrir skurðaðgerð og einni, 12 og 52 vikumeftir aðgerð.Hárifja öndunarhreyfingar hryggiktarsjúklinga voru marktækt minni en hjáheilbrigðum einstaklingum, sem hefði líklega ekki komið í ljós við hefðbundnamæliaðferð með málbandi.Hjartaskurðsjúklingarnir voru með marktækt skert lungnarúmtak, lágrifja- og kviðarhreyfingar og röntgenmyndir af lungum sýndu eitt eða fleiri óeðlileg einkenni vikueftir skurðaðgerð. Kviðarhreyfingar voru enn marktækt skertar 12 vikum eftiraðgerð, en hárifja hreyfingar voru auknar. Ári eftir hjartaskurðaðgerð höfðukviðarhreyfingar enn ekki náð sama hreyfiferli og fyrir skurðaðgerð, en hárifjahreyfingar voru marktækt auknar.Sjúklingum sem fóru í hjartaskurðaðgerð var skipt í tvo hópa. Median-haki varnotaður í skurðaðgerðinni hjá öðrum hópnum (Median-hópur), en hjá hinum bæðiMedian- og Internal Mammary Artery-haki (IMA-hópur). Tólf vikum eftirskurðaðgerð voru kviðarhreyfingar marktækt minni hjá IMA-hópnum. Fyrirskurðaðgerð voru kviðarhreyfingar beggja hópa samhverfar, 12 vikum síðar voru þærósamhverfar hjá IMA-hópnum, en samhverfar hjá báðum hópum ári eftirskurðaðgerð. Ári eftir hjartaskurðaðgerð voru kviðarhreyfingar hjá IMA-hópnum ennmarktækt minni en fyrir aðgerð.ÖHM-Andri er áreiðanlegt tæki og auðvelt í notkun við daglega vinnu til mælinga áöndunarhreyfingum og munstri öndunarhreyfinga.

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Reynsla dætra af flutningi foreldra sem þjást af heilabilun á hjúkrunarheimili [M.S. ritgerð]

Fri, 30 Sep 2005 22:58:59 GMT

Titill: Reynsla dætra af flutningi foreldra sem þjást af heilabilun á hjúkrunarheimili [M.S. ritgerð]

Höfundar: Júlíana Sigurveig Guðjónsdóttir

Útdráttur: Tilgangur rannsóknarinnar er að varpa ljósi á hvernig hjúkrunarheimilisvistunaldraðra einstaklinga sem þjást af heilabilun ber að og hvernig náinn ættingireynir slík umskipti. Um er að ræða túlkandi fyrirbærafræðilega rannsókn þar semtekin voru tvö u.þ.b. klukkustundarlöng viðtöl við sjö dætur aldraðra foreldra semnýlega höfðu flutt á sérdeildir fyrir þennan hóp sjúklinga á fimmhjúkrunarheimilum. Fyrra viðtalið fór fram á fyrstu fjórum til sex vikum eftirflutninginn og það síðara innan þriggja mánaða. Úrvinnsla gagna fólst í því aðgreina og túlka inntak viðtalanna til þess að varpa ljósi á upplifun viðmælendaminna við þessi þáttaskil.Niðurstöður eru settar fram í eftirfarandi fjórum meginþemum sem eru:A) „Að þrauka við að halda hlutum gangandi“ B) „Að setja foreldri sitt frá sér“C) „Að fara úr stað í stað“ og D) „Að foreldri manns búi við svona lítil lífsgæði.“Fyrsta þemað „Að þrauka við að halda hlutum gangandi“ endurspeglar aðaldraðir sem þjást af heilabilun séu lengur heima en heilsa og aðstæður leyfa meðgóðu móti. Það kom fram að dæturnar í þessari rannsókn höfðu reynt allt sem þærgátu til að halda foreldrum sínum heima sem lengst með því m.a. að fáheimahjúkrun og aðra aðstoð sem til féll. Dæturnar töldu sig góðu vanar þegar þærvísuðu til þjónustu dagdeilda sem starfræktar eru fyrir sjúklinga sem þjást afheilabilun. Þegar dæturnar sáu fram á að geta ekki þraukað lengur við að sinnalasburða foreldrum sínum heima áttu þær hvergi innangengt á hjúkrunarheimili ogvissu ekki hvenær úrlausn fengist.Annað þemað „Að setja foreldri sitt frá sér“ sýnir að það fylgdi því mikiðátak fyrir aðstandendur að þiggja pláss á hjúkrunarheimili og setja foreldra sína frásér. Þátttakendur töldu sig ekki hafa val um hjúkrunarheimili þegar til kastannakom. Fyrirvarinn að innlögn var stuttur, oft einn til tveir dagar. Dætrunum fannstskorta á aðstoð, stuðning og leiðbeiningar frá heilbrigðisstarfsmönnun við þauafdrifaríku tímamót sem flutningur á hjúkrunarheimili er. Sérstaklega hvað varðarupplýsingar um starfsemi hjúkrunarheimila, þá þjónustu sem þau veita og ekki sístundirbúning fyrir flutning. Skipulögð aðlögun var ónóg. Í stað þess spyrja mennsig áfram. Það veitti þátttakendum öryggistilfinningu og var léttir þegarforeldrarnir komust inn á hjúkrunarheimili. Eftir flutning upplifðu dæturnar eftirsjáog missi. Þær söknuðu „þess sem var.“Eins og kemur fram í þriðja þemanu „að fara úr stað í stað“ kom það mjögá óvart hversu mikill þvælingur var á foreldrum viðmælenda minna innanhjúkrunarheimilanna og flestar dæturnar komust að því að þær höfðu litla stjórn áaðstæðum þegar inn var komið. Þvælingurinn og það að vera óheppinn meðherbergisfélaga hafði slæm áhrif. Þeim foreldrum sem leið verst fannst þeir hvergieiga heima. Það kom fram í viðtölunum að allir foreldrarnir voru í raun í óvissu umendanlegan íverustað á hjúkrunarheimilunum.Í fjórða þemanu „Að foreldri manns búi við svona lítil lífsgæði“ kemurfram að heimilisbragur á deildunum var fremur bágborinn. Deildirnar virkuðuvlíflausar og óvirkar og stærri deildirnar órólegri en þær minni. Þetta gerði það aðverkum að dæturnar litu á deildirnar sem geymslustaði frekar en heimili. Að öllujöfnu fannst þeim þó grunnþörfum þokkalega sinnt og mataræði gott. Dætrunumfannst skipta miklu máli að starfsfólk legði metnað sinn í að hugsa um foreldranaog stuðla að því að þeim liði vel, eins og á góðum heimilum. Í því fólst m.a. að þeirværu huggulegir til fara. Mikilvægt var einnig fyrir öryggistilfinningu foreldrannaað starfssemin væri í föstum skorðum með góðu eftirliti. Þjálfun og afþreying varmun minni en vonir dætranna stóðu til og alltof lítið var farið út af stofnununum ít.d. göngutúra að þeirra mati.Niðurstöður þessarar rannsóknar sýna að álaginu við flutning og þessimiklu umskipti er veitt lítil athygli. Mikilvægt er að bæta upplýsingar, fræðslu ogveita stuðning við þessi þáttaskil. Einnig þarf að huga að því að efla faglegan þáttþjónustunnar á sérdeildum fyrir sjúklinga sem þjást af heilabilun.; The purpose of the study is to give insight into how admittance of elderlyindividuals, suffering from dementia, to a nursing home comes about and how aclose relative experiences such a change. This is an interpretativephenomenological study that entails two interviews, one hour each, with sevendaughters of elderly parents who had recently been admitted to a special ward forthis group of patients in five different nursing homes. The former interview tookplace during the first four to six weeks after the admittance and the latter withinthree months of the transfer. In the analysis and interpretation of the data, theexperience of my interviewees of this transition was brought forward.Four main themes emerged that were put forward as follows: “To persevereand keep things going”; “To place one’s parent away”; “Moving from one place toanother” and “That one’s parent should experience such a limited quality of life.”The first theme, “To persevere and keep going” reflects that elderly personswho suffers from dementia stays longer at home than their health and conditionwould normally permit. It also reveals that the daughters in this study had triedtheir very best to keep their parents at home for as long as possible by getting theservices of a visiting nurse and other occasional assistance. The daughters spokevery highly of the services of the day care centers where most of the parents hadbeen taken care of. When the daughters realised that they were unable to persevereany longer in attending their feeble parents at home, they were unable to secure aplace for them in a nursing home and didn’t know when a solution might be found.The second theme, “To place one’s parent away”, shows that it was aconsiderable effort for the relatives to accept such notion as a place in a nursinghome and send their parent away. The participants felt that when the time came,they did not have a real choice of nursing homes. The notice of admittance wasshort, usually one or two days. The daughters experienced lack of assistance,support and instructions from the nursing staff at this critical juncture that atransfer to a nursing home is, especially as regards information on the practiceswithin a nursing home, on the services available and last, but not least, on how toprepare for the transfer. Organized adjustment was insufficient and instead peoplehad to ask their way around. It gave the participants a sense of security and was arelief when their parents were admitted to a nursing home. The daughtersexperienced sorrow and loss when the transfer had occurred. They missed “whathad been.”As is revealed in the third theme, “Moving from one place to another”, itcame as a complete surprise to the interviewees how often their parents had toviiexchange location within the nursing home and most of the daughters realized thatthey had very little control over the circumstances their parents were in. Thischange of placements and mismatching roommates had severe effects. The parentswho suffered the most felt that they did not belong anywhere. It was broughtforward in the interviews that the parents were in fact uncertain about where theirpermanent place within the nursing homes would be.The fourth theme, “That one´s parent should experience such limitedquality of live”, reflects that the domestic atmosphere of the wards is rather poor.The wards seemed to be insentient and inactive, and the larger wards were morefidgety than the smaller ones. Consequently, the daughters considered the wards tobe more of a depository than a home. But on the whole they felt that their parents´basic needs were adequately attended to and the food was good. The daughtersconsidered it to be of great importance that the nursing staff should put their pridein being attentive to the parents and secure their well being, by e.g. dressing themnicely, as if they were in a good private home. It was also considered important forthe parents´sense of security that the daily activities were routinized and thenursing home care was well supervised. There was considerably less exercise andrecreation available than the daughters had expected and outdoor activities, such asshort walks, were rare.The conclusion of this study is that the stress of the transfer and theimplications of the transition are given scant notice. It is important to improve theflow of information to relatives and to render support at this transition in life. Itshould also be considered to intensify the professional aspect of the service inspecial wards for patients suffering from dementia.

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