Bakgrund: Varje år insjuknar omkring 30 000 personer i Sverige i stroke vilket innebär att många närstående också blir berörda. Det är viktigt att se den insjuknade personen tillsammans med de närstående som en helhet då familjen har en betydande roll i sjukdomsprocessen. Syfte: Syftet med studien var att belysa upplevelsen av att vara närstående till en anhörig som insjuknat i stroke. Metod: Litteraturstudie med tio vetenskapliga artiklar som grund. Resultat: Två kategorier framkom i resultatet; Plikten att vårda och Utanförskap med tillhörande subkategorier. Resultatet visade på att livet omkastades för de närstående. En stor omställning var att ens eget behov hamnade åt sidan, roller förändrades, det sociala livet begränsades och personen man en gång kände upplevdes vara någon annan. Slutsats: Mer implementering av forskningsresultat behövs för att göra sjuksköterskor mer upplysta om hur närstående upplever situationen när en familjemedlem insjuknar i stroke. Målet är att närstående ska känna delaktighet, acceptans och förståelse genom att sjuksköterskor ser hela familjen som en helhet där relationen bygger på trygghet, empati och respekt. / Background: Every year around 30 000 people in Sweden are affected by stroke, which means that many family members and relatives also are affected. It is important to see the person related with the related as a whole when the family has a significant role in the disease process. Aim: The aim of the study was to illustrate the experience of being related to a family member who is in stroke. Method: Literature study with ten articles. Results: Two categories appeared in the result; A Changed Life Situation and Being left outside, and their associated subcategories. The result showed that life was reversed for the related. One major change was that one's own needs ended aside, roles changes, social life was limited and the person who once felt experienced was someone else. Conclusion: More implementation of research results is needed to make nurses more informed about how close relatives experience the situation when a family member is in a stroke. The goal is that close relatives should feel participant, acceptance and understanding by seeing nurses the whole family as a whole where the relationship is based on security, empathy and respect.

It is standard practice in one-dimensional gasdynamic simulations of high performance two-stroke engines to model the exhaust tail pipe entry as an area change using an algorithm similar to the area change of the reverse cone. In the reverse cone the area continually steps down while at the tail pipe entry it changes from stepping down to constant area. At this point a vena contracta can form that effects the flow resistance of the tail pipe. In an effort to improve the accuracy of the gasdynamic simulations the area change algorithm at the tail pipe entry was replaced with a restriction algorithm that incorporates a coefficient of discharge and allows an increase in entropy on the expansion side. The coefficient of discharge is defined as the actual measured mass flow divided by the mass flow predicted by the restriction algorithm. An experimental set up was designed and constructed to measure mass flows for a variety of tail pipe entry geometries at a range of pressures covering the pressure ratios encountered in a real engine. From the mass flow results the coefficients of discharge for a range of pressure and area ratios and reverse cone angles could be calculated and arranged into matrix form to define Cd-maps. The Cd-maps were incorporated into the simulation software and tested to ensure that it functioned correctly. <p<Finally, the simulation results with and without the Cd-maps were compared to measured results and it was shown that incorporating this refinement improves the accuracy of the simulation results on the “over run” part of the power curve. This is the part of the power curve after maximum power and very important in the development of high performance two-stroke engines. These maps can be used for all future simulations on any engine size that uses the same tail pipe geometry. / Dissertation (MEng (Mechanical Engineering))--University of Pretoria, 2006. / Mechanical and Aeronautical Engineering / unrestricted

Bakgrund: Stroke är ett samlingsbegrepp för hjärninfarkter och hjärnblödningar. Stroke ger ofta livslånga men, såsom afasi. Afasi innebär en reducerad förmåga att förstå talat/skrivet språk och/eller en reducerad förmåga att uttrycka sig adekvat. För att en god och personcentrerad vård ska kunna erbjudas patienter med stroke så är en fungerande kommunikation en förutsättning. Syfte: Syftet är att beskriva faktorer som påverkar personcentrerad vård och kommunikation mellan sjuksköterskan och patienter som drabbats av strokeinducerad afasi. Metod: Studien är en litteraturöversikt. Studien är baserad på 15 vetenskapliga artiklar som lästs och analyserats och där gemensamma teman identifierats. Resultat: Resultatet visade på ett antal strategier som främjade eller försvårade en god kommunikation mellan sjuksköterskan och patienter som drabbats av strokeinducerad afasi. Dessa strategier berörde sju områden: Verbal kommunikation, Icke verbal kommunikation, Att se patienten som en kompetent och unik individ, Uppmärksamhet och engagemang, Tidsaspekten vid kommunikation med afasidrabbade, Den omgivande miljöns betydelse för kommunikationen samt Personalens utbildning och kompetens. Konklusion: Det finns inget standardsvar på hur kommunikationen ska gå till, varje individ är unik och varje situation kräver sin unika lösning. Dock finns det ett antal aspekter och metoder som är betydelsefulla och användbara vid kommunikation med afasidrabbade. Dessa används i olika utsträckning inom vården. / Background: Stroke is a collective term for cerebral infarction and cerebral hemorrhage. Stroke often causes lifelong detrimental effects, such as aphasia. Aphasia means a reduced ability to understand spoken/written language and/or a reduced ability to express oneself adequately. To enable a good and person-centred care for the patients, an effective communication is a prerequisite. Aim: The aim of this study is to describe the factors that influence the person-centred care and communication between the nurse and patients affected by stroke induced aphasia. Method: The study is a literature review on bachelor level. The study is based on 15 scientific articles that have been red and analyzed and where common themes have been identified. Result: The results revealed a number of strategies that promoted and hindered good communication between the nurse and people affected by stroke induced aphasia. These strategies concern seven areas: Verbal communication, Nonverbal communication, Seeing the patient as a competent and unique individual, Attention and involvement, The time aspect of communication with patients with aphasia, The importance of the surrounding environment for communication and The personnel's education and skills . Conclusion: There is no standard answer to how communication shall be achieved, each individual is unique and every situation requires a different solution. However, there are a number of aspects and methods that are important and useful when communicating with aphasic people. These are used to different degrees in health care.

No description available.

Stroke increases neurogenesis (birth of new neurons) through upregulation of ciliary neurotrophic factor (CNTF), a potent neurogenic cytokine made almost exclusively in the central nervous system. Previous study found that CNTF is induced and needed to stimulate neurogenesis in the subventricular zone (SVZ) of mouse brain in a stroke model. CNTF also has a neuroprotective function. Focal adhesion kinase (FAK), protein tyrosine kinase 2, is ubiquitously expressed in various cell types and mediates cell adhesion and migration. We previously discovered that systemic inhibition of FAK upregulates CNTF expression in the SVZ, making FAK a pharmacological target to increase CNTF to promote neurogenesis and neuroprotection after stroke. This study examined whether systemic FAK inhibitor treatment after stroke regulates SVZ neurogenesis and neuroprotection using a middle cerebral artery occlusion (MCAO) to induce a stroke in adult male C57BL/6 mice. A filament was inserted in the external carotid artery and then fed through the carotid bifurcation into the internal carotid artery to the base of the middle cerebral artery. After 30 minutes of occlusion, the filament was removed to restore blood flow. Mice were randomly assigned to receive 3 daily doses of saline or FAK inhibitor (FAK14, i.p., 3 mg/kg) and treatment started at 6 hours, 12 days, or 58 days after MCAO. Because CNTF has a neuroprotective function, the amount of tissue damage was analyzed to compare treatment groups. The neuroprotective role of FAK14 was examined by measuring MCAO-induced infarction. The infarct size was measured using the absence of NeuN (neuronal cell marker) and GFAP (activated astrocytes) and presence of CD68 (activated microglia). FAK14 given at 6 hours post-stroke reduced the infarct size to 38% of the uninjured side of the brain compared to 46% with saline. Proliferating cells were labeled by injecting bromodeoxyuridine (BrdU, 50 mg/kg), the mice were processed 2 h after the last BrdU injection, and proliferated cells in the SVZ were counted with unbiased stereology. There were no significant differences in the total numbers of BrdU+ cells between saline and FAK14 at 3, 14 and 60 days. Future studies are needed to confirm the levels of CNTF at the various times of treatment. If there is no difference in CNTF expression or increased expression of counteracting cytokines, no difference in neurogenesis between groups would be expected. The neuroprotective effect of FAK14 during the acute phase following injury could provide novel pharmacological options to stroke patients extending the current therapeutic treatment window.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13397号 / 論医博第2221号 / 新制||医||1051(附属図書館) / (主査)教授 伊佐 正, 教授 中本 裕士, 教授 渡邉 大 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background: Mechanical thrombectomy is the gold standard for treating patients with certain acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, even with major advancements and increasing procedural volumes, acute endovascular therapy remains a high-risk procedure with a considerable 90-day mortality rate, affected by a variety of factors. Purpose: To investigate various clinical and procedural factors associated with 90-day mortality in patients undergoing mechanical thrombectomy for emergent treatment of AIS and determine which of these factors made unique contributions to post-thrombectomy prognosis. Methods: We examined a prospective registry of 323 patients treated with endovascular thrombectomy for AIS between 2016 and 2019 at a high-volume comprehensive stroke center in central Massachusetts. We developed two multivariable logistic regression models adjusting for the contributions of baseline characteristics and recanalization parameters, to identify potential predictors of mortality at 90 days. Results: Among 323 AIS patients treated with mechanical thrombectomy, the overall rate of successful recanalization was 86% and the overall post-procedure mortality rate was 29% by 90 days. After univariate analysis, a baseline multivariable model comprised of: history of stroke (OR 0.28, 95% CI 0.09 – 0.68), pre-stroke modified Rankin Scale (mRS 2: OR 3.75, 95% CI), severe admission National Institutes of Health Stroke Scale (NIHSS 21–42: OR 12.36, 95% CI 1.48 – 103.27), internal carotid artery (ICA) occlusion (OR 2.77, 95% CI 1.18 – 6.55), and posterior circulation occlusion (OR 2.69, 95% CI 1.06 – 6.83) was prognostic of 90-day mortality. A second multivariable model also found the procedural factors of: clot obtained after each pass (OR 0.49, 95% CI 0.24 – 1.00), successful recanalization (OR 0.21, 95% CI 0.06 – 0.8) and symptomatic intracranial hemorrhage (sICH; OR 17.89, 95% CI 5.22 – 61.29) to be identifiable predictors of post-thrombectomy mortality. Conclusion: Death within 90 days after thrombectomy was increased among patients with higher pre-stroke disability, higher stroke severity on admission, ICA or posterior occlusion, and those with sICH complication. A history of stroke, clot extraction after each device pass, and successful recanalization are associated with decreased 90-day mortality. These identifiable contributors may inform patient selection, prognosis evolution, and shared decision-making regarding emergent thrombectomy for treatment of AIS.

Bakgrund: Stroke är en av vanligaste folksjukdomen i Sverige. Stroke är ett samlingsbegrepp för hjärnblödning och hjärninfarkt. Sjukdomen påverkar alla aspekter av livet, även anhöriga. I sjuksköterskans yrkesroll ingår att bidra med goda stöd och information till anhöriga samt etablera en relation som bygger på förtroende. Syfte: Att beskriva upplevelsen av att vara anhörig till en person som drabbas av stroke. Metod: En litteraturöversikt baserad på elva kvalitativa artiklar genomfördes enligt Fribergs metodbeskrivning. Sökning skedde genom databaserna CinahL och PubMed med sökord ”Stroke” Family” ”Caregivers” och ”Experience”. Analysarbetet resulterade i ett huvudtema ”Livet är förändrat” med fyra tillhörande subteman ”ett förändrat vardagsliv”, ”ett förändrat ansvarstagande”, ”ett förändrat Personligt liv” och ”ett förändrat hälsotisstånd”. Resultat: Resultaten visade att anhöriga upplevde förändringar i vardagsrutiner och hälsotisstånd. Utöver att de hade ett nytt ansvar som påverkade deras sociala liv. Anhöriga upplevde en känsla av oro, ansträngning att hålla samtidigt olika roller, upplevelse av isolering och förluster av sociala kontakter. Sammanfattning: Litteraturöversikt visade att anhöriga är i behov av hjälp och stöd. Anhörigas hälsa påverkas i stor utsträckning av de olika livsförändring och den nya vårdande rollen de antar. Därför bör sjukvårdspersonalen hitta strategier för att ge anhöriga det stöd som de behöver för att kunna känna sig trygga i den ny livssituation. / Background: Strokes is one of the most common endemic diseases in Sweden. Stroke is a collective term for cerebral hemorrhage and cardiac infarctions. The disease affects all aspects of life, as well as family members. The role of the nurse includes contributing with support and information to family members and establishing a relation that builds on trust. Aim: To describe the experience of being a family member to a person that has been affected by a stroke. Method: A literature review based on eleven qualitative articles was conducted according to Fribergs method description. The searches were made through the databases CinahL and Pubmed with the keywords” Stroke” Family”,” Caregivers” and” Experience”. The analysis work resulted in a main theme “Life is changed” and four sub-themes “a changed everyday life”, “a changed responsibility taking”, “a changed personal life” and “a changed state of health. Results: The results showed that family members experienced changes in daytoday routines and state of health. They had new responsibilities that affected their social lives. Family members also experienced feelings of worry, weariness to continuously hold different roles, experience of isolation and loss of social contacts. Conclusion: The literature review shows that relatives are in great need of help and support. The health of relatives is affected to a great extent by the different changes to their day to day lives which a stroke and the new caretaker role brings. Therefor the health care system needs to give relatives the support they need to be able to feel safe in their new life situation.

Bakgrund: stroke betraktas som ett samlingsnamn för hjärninfarkt och hjärnblödning. Stroke är ett globalt folkhälsoproblem som tillhör de fem vanligaste dödsorsakerna i Sverige. Risken att drabbas av stroke skiljer sig mellan åldrar, socioekonomi och insjuknandet ser olika ut även geografiskt. Stroke kan förekomma i olika åldrar, men äldre personer har större risk att drabbas av stroke än yngre personer. Stroke kan orsaka funktionsnedsättningar och leda till många olika begränsningar i patients vardagsliv. Antalet strokefall har minskat bland både kvinnor och män under perioden 2007–2018. Syfte: Var att undersöka patientens upplevelse av sitt liv efter stroken. Metod: En litteraturöversikt med induktiv ansats valde och endast vetenskapliga artiklar med kvalitativ metod har använts i studien. För analysering av data användes Fribergs (2017) metod för kvalitativ forskning. Resultat: Litteratursökningen gav tio artiklar för vidare analys. Resultatet av samtliga artiklar har tillsammans bildat underlag för den kvalitativa innehållsanalysen. Resultatet redovisar strokepatienters känslor och upplevelser i vardagen och presenterar följder och konsekvenser av stroke. Huvudresultatet av studien var att patienter upplevde besvär av såväl fysisk, psykisk, emotionell som social karaktär. Slutsats: Patienten upplever en förändrad syn över sin livsvärld efter stroke. Sjukdomen kan leda till förlust av förmågor och många begränsningar i det vardagliga livet. / Introduction: stroke is considered a collective name for cerebral infarction and cerebral hemorrhage. Stroke is a global public health problem that is one of the five most common causes of death in Sweden. The risk of suffering a stroke differs between ages, socioeconomics and the disease also differ geographically. Stroke can occur at different ages, but older people are at greater risk of having a stroke than younger people. Stroke can cause disabilities and lead to many different limitations in the patient's daily life. The number of stroke cases has decreased among both women and men during the period 2007–2018. Aim: was to examine the patient's experience of his life after the stroke. Method: a literature review with an inductive approach was chosen and only scientific articles with a qualitative method were used in the study. For analysis of data, Friberg's (2017) method was used to qualitative research.  Results: The literature search yielded ten articles for further analysis. The results of all articles have together formed the basis for the qualitative content analysis. The results report stroke patients' feelings and experiences in everyday life and present the consequences and consequences of stroke. The main result of the study was that patients experienced problems of a physical, mental, emotional and social nature. Conclusion: The patient experiences a changed view of their life world after stroke. The disease can lead to loss of abilities and many limitations in everyday life.

Bakgrund: Stroke är en sammanfattande benämning på två akuta sjukdomstillstånd: hjärnblödning och hjärninfarkt. Sjukdomen är en folksjukdom och risken att drabbas ökar bland annat med dåliga levnadsvanor och ålder. Vid behandling av stroke är tid en avgörande faktor för att minska konsekvenserna. Att som sjuksköterska ha en god förståelse kring svårigheter som uppstår i samband med stroke är betydelsefullt. Syfte: Att beskriva upplevelser i vardagslivet hos vuxna personer som drabbats av stroke. Metod: En litteraturöversikt med induktiv ansats där tretton kvalitativa studier ingår som har analyserats enligt Fribergs analysbeskrivning i fem steg. Resultat: Vid den kvalitativa analysen framkom att det förekommer olika dimensioner av upplevelser: fysiska, psykiska, sociala och existentiella. Dessa dimensioner är tätt sammankopplade och har en påverkan på den drabbade personens vardagsliv. Slutsats: Egenvården och vardagen påverkas dramatiskt när en person drabbas av stroke. Som sjuksköterska är det grundläggande med en holistisk syn på den drabbade personen för att kunna skapa en förståelse kring upplevelser efter stroke samt möjliggöra en god och effektiv vård. / Background: Stroke is a term for two acute states of diseases: cerebral haemorrhage and cerebral infarction. Stroke is a common disease and the risk of having a stroke increases with bad living habits and age. Time is a crucial factor when it comes to the treatment of stroke and to reduce the consequences of stroke. For a nurse it is important to understand difficulties that arise after stroke. Aim: To describe experiences in everyday life of adults affected by stroke. Method: A literature review performed with an inductive approach consisting of thirteen qualitative articles that have been analysed according to Friberg’s analysis description in five steps. Result: The end result showed that experiences exist in different dimensions: physical, mental, social and existential. These dimensions are closely connected and affect everyday life for adults affected by stroke. Conclusion: Everyday life and self-care are dramatically affected when the person is affected by stroke. As a nurse, it is fundamental to have a holistic view of the affected person in order to create an understanding of post-stroke experiences and to enable a good and effective care.