Minst 500 000 av Sveriges befolkning har kroniskt obstruktiv lungsjukdom (KOL) och ungefär 250 000 har hjärtsvikt. De två patientgrupperna hade många likartade symtom och en sjuksköterskeledd gemensam primärvårdsmottagning för dessa patienter kunde innebära många vinster. Ett av distriktssköterskans kompetensområde var att ha stödjande samtal om hur den enskilde patienten hanterade sin sjukdom. Syftet med uppsatsen var att jämföra copingförmåga och copingstrategier mellan patienter med KOL och patienter med hjärtsvikt, samt att undersöka eventuella skillnader av grad av ångest, depression, påverkan på funktion av fatigue och andfåddhet utifrån copingförmåga och användande av olika copingstrategier.  Metoden var en beskrivande och jämförande tvärsnittsstudie. Patienter med KOL respektive hjärtsvikt från primärvården i tre landsting ingick i studien och de fick svara på en hemskickad enkät. De instrument som användes i denna studie var flera, bland annat Orientation to Life Questionnaire och Ways of Coping Questionnarie. Resultat: Patienter med hög KASAM skattade de olika symtomen lägre och patienter med låg KASAM skattade de olika symtomen högre. Patienter med KOL använde sig i högre grad av olika copingstrategier än vad patienter med hjärtsvikt gjorde.  Patienter med hög grad av de olika copingstrategierna skattade de olika symptomen högre än de med låg grad av de olika copingstrategierna, med vissa undantag. Konklusion: Resultaten är intressanta och bör tas i beaktande i mötet med dessa patienter i gemensamma primärvårdsmottagningar genom råd och stöd för att minska att symtomen från KOL respektive hjärtsvikt har en negativ inverkan på deras liv. / At least 500 000 of the Swedish population have chronic obstructive pulmonary disease (COPD) and about 250 000 have heart failure. The two patient groups had many similar symptoms and a joint nurse-led primary care clinic for these patients could have many benefits. One of the district nurse's competences is supportive conversations with the individual patient about how they cope with their situation. The aim of this study was to compare coping ability and coping strategies among patients with COPD and patients with heart failure, and to investigate possible differences of degree of anxiety, depression, impact on the function of fatigue and breathlessness based on coping ability and the use of coping strategies. The method used was quantitative and comparative cross-sectional. Patients with COPD and patients with heart failure from three county primary care clinics were included in the study and they were asked to answer a questionnaire sent to their homes. The instruments used in this study were several, including Orientation to Life Questionnaire and the Ways of Coping Questionnaire. Results degree of SOC affected patients' estimation of the different symptoms. The conclusion was also that patients with COPD used in higher levels of different coping strategies than patients with heart failure did and the higher the degree of the different coping strategies, the higher the various symptoms were estimated, with some exceptions. Conclusion, the results are interesting and should be considered in the care of these patients in joint primary care clinics through advice and support to reduce the negative impact that COPD and heart failure have on their lives.

Bakgrund: Hjärtsvikt är vanligt förekommande i den svenska befolkningen och är den vanligaste orsaken till sjukhusinläggning. Bristande följsamhet till den farmakologiska hjärtsviktbehandlingen är idag ett stort problem inom sjukvården. Detta bidrar till ökade sjukhusinläggningar samt ökad dödlighet hos hjärtsviktspatienterna. Icke-farmakologisk behandling har dock kunnat ses som ett komplement till den farmakologiska behandlingen. Syfte: Syftet med denna litteraturstudie var att beskriva patienters följsamhet till, samt beskrivningar och upplevelser av, att följa icke-farmakologiska riktlinjer i samband med hjärtsvikt. En granskning av kvaliteten beträffande de inkluderade studiernas undersökningsgrupp utfördes även. Metod: En beskrivande litteraturstudie där 12 vetenskapliga artiklar inkluderades.  Artiklarna söktes vid databaserna Pubmed och Cinahl. Delar från studiernas resultat plockades ut och analyserades. Dessa delades sedan upp under kategorier och underkategorier passande för att svara till litteraturstudiens frågeställningar. Resultat: Generellt var följsamheten till de icke-farmakologiska behandlingsriktlinjerna bristande. Flest antal hinder identifierades beträffande riktlinjer gällande saltrestriktioner. Törst, glömska, samt fysiska symtom var även de stora hinder till en följsam icke-farmakologisk behandling. De största fördelarna som identifierades till en följsam behandling var ökat välmående samt minskade sjukhusinläggningar. Slutsats: En generellt bristande följsamhet till de icke-farmakologiska behandlingsriktlinjerna gällande salt- och vätskerestriktioner, regelbunden vägning samt träning förekommer bland hjärtsviktspatienter. Många hinder till en följsam behandling identifierades, men även fördelar till att vara följsam till icke-farmakologiska behandlingsriktlinjer beskrevs i studierna. / Background: Heart failure is a common disease among the Swedish population today and it is also the number one cause of hospitalisation. A lack of compliance with the pharmacological treatment for heart failure is a big issue within the medical services today. This significantly contributes to increased hospitalisation as well as higher mortality rates among Heart failure patients. However, non-pharmacological treatments have been found to be a rather good complement to the pharmacological treatment.  Aim: The purpose of this literature study was to describe patients’ compliance with, as well as their experiences and accounts of, following non-pharmacological guidelines in connection to heart failure. An examination of the included studies’ focus groups and their quality was done as well. Method: A descriptive literature study where twelve scientific articles were included. The articles were found on the databases Pubmed and Cinahl. Parts of the study’s results were selected and analysed. These were then divided into categories and subcategories that suited the literature study’s research questions. Result: The compliance with the non-pharmacological treatment guidelines was generally inadequate. The most obstacles were found concerning the guidelines the patients got regarding the restrictions on salt. Thirst, forgetfulness, and physical symptoms were also big obstacles for complying with a non-pharmacological treatment. The biggest advantages of complying with the treatment that were identified were an increased sense of well-being and decreased hospitalisation. Conclusion: A general lack of compliance with the non-pharmacological treatment guidelines concerning the restrictions on salt and fluid, regular weigh-ins, and exercise occur among heart failure patients. Many obstacles to complying with treatment were identified, but the advantages of complying with non-pharmacological treatment guidelines were also described in the study.

Bei Patienten mit akut dekompensierter Herzinsuffizienz beziehungsweise kardiogenem Schock ist die Kurz- und die Langzeitprognose stark reduziert. Ziel dieser prospektiv klinischen Studie war die Feststellung des Maximums des NTproBNP-Wertes in der Akutphase innerhalb der ersten zwölf Stunden nach Krankenhausaufnahme sowie die Untersuchung der NTproBNP-Spiegel als Prädiktor der 18-Monatsmortalität in dieser Patientengruppe. Es wurden insgesamt 148 Patienten in zwei Studienabschnitten eingeschlossen, wobei die Kurz- und Langzeitverläufe aller Patienten zu den Zeitpunkten 0, 12, 24 und 48 Stunden, 7 und 14 Tagen sowie 1, 3 und 18 Monaten untersucht wurden. Bei 32 Patienten wurden zusätzlich regelmäßige zweistündliche Untersuchungen der NTproBNP-Werte innerhalb der ersten zwölf Stunden (2, 4, 6, 8 und 10 Stunden nach Aufnahme) durchgeführt. Für Patienten mit akut dekompensierter Herzinsuffizienz bzw. kardiogenem Schock ohne akuten Myokardinfarkt fanden sich innerhalb der ersten zwölf Stunden keine siginifikant erhöhten NTproBNP-Plasmaspiegel im Vergleich zum Aufnahmewert, eine statistische Signifikanz bezüglich der 18-Monatsmortalität fand sich in dieser Gruppe innerhalb der ersten 48 Stunden nur zum Zeitpunkt 12 Stunden nach Aufnahme. In der Gruppe der Patienten mit dekompensierter Herzinsuffizienz bzw. kardiogenem Schock im Rahmen eines akuten Myokardinfarktes dagegen fanden sich statistisch signifikant steigende NTproBNP-Werte zu allen Zeitpunkten innerhalb der ersten zwölf Stunden im Vergleich zum Aufnahmewert, wobei nach zwölf Stunden der Maximalwert erreicht wurde. Weiterhin zeigten in dieser Gruppe die NTproBNP-Werte eine statistische Signifikanz in Hinsicht auf die 18-Monatsmortalität zu fast allen Zeitpunkten außer 4 Stunden nach Aufnahme. Zusammenfassend kann somit mit Bestimmung der NTproBNP-Werte 12 Stunden nach Krankenhausaufnahme unabhängig von der Genese der akuten kardialen Dekompensation eine Kurz- und Langzeitprognoseabschätzung erfolgen.

Objective: The aim of this study was to determine the role of race as a significant risk factor for prediction of outcomes in heart failure (HF). Methods: The data was collected on demographics, detailed history of HF, family history, vital signs, medication and laboratory profile for 585 patients from Heart failure Treatment Center of Emory University after year of 2000. Outcome of HF was defined as combination of death, placement of left ventricular assisted devise, heart transplant or emergency transplant. The independent relationship between race and outcomes of HF was evaluated by univariate and multivariate logistic regression analyses. The survival analysis was done by Cox regression modeling. Results: Among 585 HF patients, 58.1% were whites and 41.9% were blacks and 28.2% HF patients had positive outcomes. Although Whites tended to have a more positive outcome (34.6%) than blacks (28.9%), the difference was not statistically significant. Factors predicting the outcome in whites were male gender (OR 5.02), history of hypertension (OR 2.3), ventricular arrhythmias (OR 2.4), placement of AICD(OR 0.09), low EF% (OR 0.95), high NYHA class (OR 3.25), use of beta blockers (OR 0.12), aldosterone blockers (OR 2.19), furosemide (2.18); while in blacks they were age in years (OR 0.96), history of PTCA (OR 7.04), dislipidemia (OR 3.90), depression (OR 0.01), placement of AICD (OR 0.14), low EF% (OR 0.92), systolic blood pressure (OR 0.96), high NYHA class (OR 4.01), use of beta blockers (OR 0.14), torsemide (OR 2.86), and digoxin (OR 4.91) etc. Blacks had higher survival than whites (p < 0.001). Conclusion: There is no significant difference in combined outcome (death, transplant, emergency transplant, and Left Ventricular Assisted Devise placement) of HF between whites and blacks. There are differences regarding the risk factors, which are more prominent in each race. Further exploration is required to evaluate the race as significant risk factor for predicting the outcome in HF.

Širdies nepakankamumas (ŠN) turi įtakos paciento fizinei ir psichologinei savijautai, kasdieninei veiklai ir socialiniam funkcionavimui. Kai ŠN progresuoja, pacientas turi prisitaikyti prie atsiradusių sveikatos pokyčių. Labai svarbu pacientus mokyti, nes žinių apie ŠN sustiprėjimas palengvina prisitaikymą prie atsiradusių pokyčių dėl ligos ir turi reikšmės savirūpai. Tikslas: Įvertinti sergančiųjų širdies funkcijos sutrikimais pacientų žinias apie širdies nepakankamumą ir savirūpą Tyrimo metodika. Tyrime dalyvavo 70 pacientų, kurie buvo mokomi pagal parengtą mokymo programą ir apklausti naudojant standartizuotus klausimynus „Olandų klausimyną vertinantį paciento žinias apie širdies nepakankamumą“ ir „Europos širdies nepakankamumo savirūpos vertinimo klausimyną“ prieš ir po mokymo ligoninėje bei praėjus 1 mėn. po mokymo. Rezultatai. Tyrimo metu nustatyta, kad 83,2 proc. (54) pacientų žinios prieš mokymą buvo nepakankamos, 13,9 proc. (9) pacientų žinios – vidutinės ir tik 3,1 proc. (2) pacientų – pakankamos. Įvertinus sergančiųjų ŠN žinias užbaigus gydymą ligoninėje nustatytos nepakankamos žinios - 13,8 proc. (9) pacientų, vidutinės žinios - 75,4 proc. (49) pacientų, o pakankamos žinios – 10,7 proc. (7) pacientų. Nustatyta, kad po mokymo praėjus 1 mėnesiui daugiau nei pusės 53,1 proc. (41) pacientų žinios buvo vidutinės, o 35,3 proc. (23) pacientų – nepakankamos ir tik 1,5 proc. (1) pacientų – pakankamos žinios. Kas tai yra ŠN, prieš mokymą žinojo 70,8 proc. pacientų, o... [toliau žr. visą tekstą] / Heart failure (HF) affects the physical and psychological well-being of the patient, his daily activities and social functions. The patient must adapt to his health changes when HF is in progress. It is very important to teach patients since the higher level of knowledge on HF facilitates the better adaptation to the changes resulting from the illness, and are significant for the self-care behaviour. Aim of the study: to evaluate the knowledge of the patients about the HF syndrome and about self-care behaviour. Methods. 70 patients were participating in the research, they were trained according to the prepared educational program, and surveyed by using the standardized questionnaires: the ”Dutch heart failure knowledge scale” and “The European heart failure self-care behaviour scale”, before and after the patients education in a hospital, and in one month after the training. Results. It has been found that 83.2 percent (54) patients had insufficient knowledge, 13.9 percent (9) of patients had the average level, and only 3.1 percent (2) patients had sufficient knowledge before the training. After the patients education on HF in the hospital, the insufficient level of knowledge was identified for 15.8 percent (9) of patients, average level of knowledge was estimated for seven to 5.4 percent (49) of patients, and sufficient knowledge for 10.7 percent (7) of patients. Following one month after the training, more than half of patients - 53.1 percent (41) had the average knowledge... [to full text]

Darbo tikslas: įvertinti širdies ir kvėpavimo funkcijos bei gyvenimo pilnatvės pokyčius po ilgalaikių etapinių aerobinių fizinių treniruočių ir rizikos veiksnių koregavimo pacientams sergantiems vidutiniu ir sunkiu lėtiniu širdies nepakankamumu. • Buvo sukurta aerobinių fizinių treniruočių metodika, paremta pacientų anaerobinio slenksčio vertinimu spiroergometrijos tyrimo metu – pacientams buvo skiriamas fizinis krūvis, kuris 10 proc. mažesnis už jų anaerobinį slenkstį. • Buvo taikyta originali individuali aerobinė fizinė treniruotė su poilsio pertraukėlėmis širdies nepakankamumu sergantiems pacientams. • Taikyta ilgalaikė 6 mėn., trijų etapų, aerobinių fizinių treniruočių ir rizikos veiksnių koregavimo programa. Tarp etapų buvo atliekama spiroergometrijos tyrimas. • Sukurta Niujorko širdies asociacijos širdies nepakankamumo funkcinių klasių pokyčių vertinimo metodika. • Nustatyta, kad sunkiu širdies nepakankamumu sergantiems pacientams ilgalaikės etapinės aerobinės fizinės treniruotės ir rizikos veiksnių koregavimas gerina širdies ir kvėpavimo funkcijos rodiklius (širdies kairiojo skilvelio išstūmimo frakciją, pikinį VO2, MET, nueitą nuotolį 6 minučių ėjimo mėginio metu) bei gyvenimo pilnatvę. • Nustatyta, kad ilgalaikių etapinių aerobinių fizinių treniruočių ir rizikos veiksnių koregavimo teigiamas poveikis išlieka 12 mėnesių pacientams sergantiems vidutiniu ir sunkiu širdies nepakankamumu. Tiriamųjų kontingentą sudarė sergantys vidutiniu ir sunkiu lėtiniu ŠN pacientai... [toliau žr. visą tekstą] / Aim of the study: to evaluate the cardiopulmonary system and quality of life changes after longterm stage-by-stage aerobic exercise training and risk factors correction in patients suffering moderate and severe chronic heart failure (HF). • Creation of aerobic exercise training methodology based on spiroergometric evaluation of AT – patients undergo physical load 10% less than their AT. • Use of individual aerobic exercise training including rest intervals for patients with severe heart failure • Use of longterm (6 months) stage-by-stage aerobic exercise training and risk factors correction program, including spiroergometry testing. • Creation of evaluative technique (methodology) for changes in NYHA classes. • Establishing that patients with severe HF have improvement of cardiopulmonary function (left ventricular ejection fraction, oxygen uptake – peak VO2, metabolic equivalent of task MET, 6-minutes walk test) and quality of life following longterm stage-by-stage aerobic exercise training and risk factors correction. • Establishment that positive effect of longterm stage-by-stage exercise training persists 12 months in patients with moderate and severe HF. The study included patients with confirmed diagnosis of HF (NYHA classes II–IV) (n = 93). In cardiology setting, exercise training was started in the ward. Before discharge, the patient underwent the testing of cardiopulmo¬nary function (left ventricular ejection fraction, oxygen uptake – peak VO2, metabolic equivalent... [to full text]

The intent of this project was to integrate an existing mobile phone-based telemonitoring system into a home care nursing environment. Analyses were conducted to examine nursing workflows and home care constraints. User-centric design, development, and testing were used to modify the current telemonitoring system for a home care pilot study with heart failure clients. Interim results show technology acceptance by home care nurses and improved self-awareness in clients; the telehomecare system offers its greatest value as an opportunity for client education following clinical alerts. The pilot study will continue with a focus on increased client recruitment and selectivity towards those most in need of chronic disease management. It is expected that the system will result in an improvement in health outcomes and more efficient delivery of home care visits. The results from this study will provide insight into the impact of a new service delivery model for home care nurses.

The intent of this project was to integrate an existing mobile phone-based telemonitoring system into a home care nursing environment. Analyses were conducted to examine nursing workflows and home care constraints. User-centric design, development, and testing were used to modify the current telemonitoring system for a home care pilot study with heart failure clients. Interim results show technology acceptance by home care nurses and improved self-awareness in clients; the telehomecare system offers its greatest value as an opportunity for client education following clinical alerts. The pilot study will continue with a focus on increased client recruitment and selectivity towards those most in need of chronic disease management. It is expected that the system will result in an improvement in health outcomes and more efficient delivery of home care visits. The results from this study will provide insight into the impact of a new service delivery model for home care nurses.

Integrin-linked kinase (ILK) is an important mechanoreceptor that mediates many cellular signaling pathways. Its dysregulation causes dilated cardiomyopathy and other complications in the heart. Restoration of ILK improves cardiac function and survival, but the exact mechanism is unknown. Recent studies in our lab suggest that the cardioprotective properties of ILK may be related to its regulation of sarco/endoplasmic reticulum calcium ATPase (SERCA2a). The protein expressions of ILK and SERCA2a are positively correlated based on adenoviral transduction of ILK and siRNA targeting ILK in human induced pluripotent stem cell-derived cardiomyocytes. From analysis of their calcium transients, ILK transduction resulted in increased beat rate and faster calcium clearance while siRNA knockdown produced the opposite effect. The use of SERCA-specific inhibitor thapsigargin nullified the observed effects of ILK transduction. Based on these results, we conclude that ILK’s cardioprotective properties are partly related to improving calcium handling in cardiomyocytes through the regulation of SERCA2a.

Integrin-linked kinase (ILK) is an important mechanoreceptor that mediates many cellular signaling pathways. Its dysregulation causes dilated cardiomyopathy and other complications in the heart. Restoration of ILK improves cardiac function and survival, but the exact mechanism is unknown. Recent studies in our lab suggest that the cardioprotective properties of ILK may be related to its regulation of sarco/endoplasmic reticulum calcium ATPase (SERCA2a). The protein expressions of ILK and SERCA2a are positively correlated based on adenoviral transduction of ILK and siRNA targeting ILK in human induced pluripotent stem cell-derived cardiomyocytes. From analysis of their calcium transients, ILK transduction resulted in increased beat rate and faster calcium clearance while siRNA knockdown produced the opposite effect. The use of SERCA-specific inhibitor thapsigargin nullified the observed effects of ILK transduction. Based on these results, we conclude that ILK’s cardioprotective properties are partly related to improving calcium handling in cardiomyocytes through the regulation of SERCA2a.