京都大学 / 新制・課程博士 / 博士(医学) / 甲第23060号 / 医博第4687号 / 新制||医||1048(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 齊藤 博英, 教授 湊谷 謙司, 教授 萩原 正敏 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13420号 / 論医博第2228号 / 新制||医||1052(附属図書館) / (主査)教授 川上 浩司, 教授 湊谷 謙司, 教授 山下 潤 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DGAM

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13426号 / 論医博第2230号 / 新制||医||1053(附属図書館) / (主査)教授 今中 雄一, 教授 森田 智視, 教授 石見 拓 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Randomized trials and cohort studies have shown sex differences in the implantation and response to Cardiac Resynchronization Therapy (CRT). Furthermore, gender roles are associated with precipitants of congestive heart failure. Cohort studies are well-suited to assessing implantation rates, long-term outcomes, and the role of sex and gender. Therefore, we systematically identified cohort studies that reported outcomes of CRT and evaluated the following: 1) prevalence and temporal changes in sex and gender reporting and analysis; and 2) sex differences in the implantation and response to CRT. Sex was increasingly considered but remained inadequately reported and analyzed. Gender was not considered in the studies. In clinical practice, fewer women received devices, despite benefiting from CRT more than men. Of note, the difference in response may be confounded by differences in the clinical profiles of men and women. There is a need for better integration of sex and gender in studies to understand better the reasons leading to the observed differences.

Bakgrund: Hjärtsvikt är ett globalt hälsoproblem med symtom som ökar risken för lidande och dödlighet. Egenvård är en behandlingsmetod som används hos individer med hjärtsvikt för att uppnå symtomförbättring och ökad livskvalitet. Forskning visar att vårdpersonal och närstående upplever bristfällig omvårdnad kring egenvården. Därmed är det viktigt att undersöka hur individer med hjärtsvikt upplever egenvård. Syfte: Syftet med denna litteraturöversikt var att beskriva individers upplevelser av egenvård vid hjärtsvikt. Metod: Kvalitativ, allmän litteraturöversikt med deskriptiv design. Resultat: Fem teman identifierades: “att följa råden om egenvård var svårt”; “motivation till att utföra egenvård ökade vid hälsoförbättring”; “egenvård utfördes för att förhindra sjukdomens påfrestningar på närstående”; “egenvården var emotionellt påfrestande”; “en god relation till vårdpersonalen motiverade till att utföra egenvård”. Rekommendationerna kring egenvård upplevdes svåra att följa speciellt vid anpassning till nya levnadsvanor och ny livssituation. Tecken på symtomförbättring, att bli fri från sjukdomens begränsningar och uppnå bättre hälsa, ökade motivationen. Känslan av att belasta närstående, var en annan anledning som ökade motivationen till att utföra egenvård. Egenvården förde med sig emotionella påfrestningar i form av oro och stress. En god relation till vårdpersonal ökade motivationen till att utföra egenvård, som ett resultat på god personcentrerad vård. Slutstats: Denna litteraturöversikt visar att egenvård är svår att följa och utföra, speciellt vid anpassning till nya levnadsvanor och livssituation, med emotionella påfrestningar som följd. Närstående och viljan till bättre hälsa, ökar motivationen till att utföra egenvård. Personcentrerad vård är grundläggande och betydelsefull för att uppnå målen med egenvård. / Background: Heart failure is a global health problem with symptoms that increase risk of suffering and mortality. Self-care is used as treatment for individuals with heart failure to achieve symptom improvement and increased quality of life. Research shows that healthcare professionals and peers experience inadequacies related to self-care. Therefore, it is important to explore how individuals experience self-care. Aim: The aim of this literature overview was to describe the experience of self-care in individuals with heart failure. Method: Qualitative, general literature overview with descriptive design. Result: Five themes were identified: “following recommendations on self-care was difficult”; "motivation to perform self-care increased with health improvement"; "self-care was performed to prevent burden on peers"; "self-care was emotionally straining"; "a good relationship with healthcare professionals motivated to perform self-care". Self-care recommendations were found difficult to follow, especially when adapting to a new lifestyle and situation. Signs of symptom improvement, desire to be free from the limitations of the disease and desire to achieve better health, increased motivation. The feeling of burden relatives was another reason that increased motivation to perform self-care. Self-care brought emotional strain in the form of anxiety and stress. A good relationship with healthcare professionals was important for motivation, as a result of person-centered care. Conclusion: This literature review shows that self-care is difficult to follow and perform, especially when adapting to new lifestyle and situation, with emotional strain as a result. Peers and the desire for better health, increased motivation to perform self-care. Person-centered care is essential and important for achieving the goals of heart failure self-care.

Becker, W & Johansson, F. Sjuksköterskors erfarenheter av att främja egenvård hos patienter med hjärtsvikt. Examensarbete i omvårdnad 15 högskolepoäng. Malmö universitet: Fakulteten för Hälsa och samhälle, Institutionen för vårdvetenskap, 2021. Bakgrund: Hjärtsvikt är en sjukdom som ökar i världen, bara i Sverige lever över 200 000 individer med diagnosen. Mycket av den behandling och uppföljning som görs i samband med hjärtsvikt kan utföras av patienten själv. När patienten utför egenvårdsåtgärder som en del utav behandlingen har följsamheten stor betydelse för att motverka återinsjuknande och främja patientens livskvalitet. En viktig del i sjuksköterskans omvårdnadsarbete är att informera och utbilda men även att motivera och stötta patienter med hjärtsvikt. Syfte: Syftet med studien var att sammanställa litteratur om sjuksköterskors erfarenheter av främjande av följsamhet till egenvård hos patienter med hjärtsvikt. Metod: Litteraturöversikt baserad på 10 vetenskapliga artiklar. Metod och analys inspirerad av Friberg, (2017). Resultat: Grunden för att göra patienten delaktig i egenvård är att göra de medvetna om sin situation och vilka möjligheter det finns för att påverka diagnosen. Sjuksköterskorna upplevde att de var betydelsefulla för patientens deltagande och motivation till egenvård om de kunde hjälpa patienterna med förståelse och acceptans av sin sjukdom. En förutsättning för patientens möjlighet till egenvård var att den erhöll individanpassad information och utbildning.En konstruktiv relation mellan sjuksköterskan och patienten gynnar kommunikation och informationsutbyte. Slutsats: Sjuksköterskans arbete för att främja patienten egenvård gynnas av en etablerad kontakt och uppföljning av patientens hälsa med ett helhetsperspektiv. En kontinuerlig uppföljning i form av personlig kontakt kan utgöra grunden för att skapa en relation som i förlängningen ger upphov till ökad förståelse om patientens individuella situation och kunskapsbehov. Nyckelord: Egenvård, hjärtsvikt, information, motivation, utbildning. / Becker, W & Johansson, F. Nurses' experiences of promoting self-care in patients with heart failure. Degree project in nursing 15 credit points. Malmö University: Faculty of Health and Society, Department of Care Science, 2021. Background: Heart failure is a disease that is increasing worldwide, in Sweden alone over 200 000 individuals live with the diagnosis. Much of the treatment and follow-up associated with heart failure can be performed by the patient themselves. When the patient performs self-care measures as part of the treatment, compliance is of great importance in preventing relapse and promoting the patient's quality of life. An important part of the nurse's nursing work is to inform and educate, but also to motivate and support patients with heart failure. Aim: The aim of this study was to review the literature on nurses' experiences of promoting adherence to self-care in patients with heart failure. Method: Literature review based on 10 scientific articles. Method and analysis inspired by Friberg, (2017). Result: The basis for making patients involved in self-care is to make them aware of their situation and the possibilities available to influence the diagnosis. The nurses felt that they were important for patient participation and motivation for self-care if they could help patients with understanding and acceptance of their disease. A prerequisite for the patient's ability to self-care was that they received individually tailored information and education. A constructive relationship between the nurse and the patient fosters communication and information exchange. Conclusion: The nurse's work to promote the patient's self-care benefits from an established contact and follow-up of the patient's health with a holistic perspective. Continuous follow-up in the form of personal contact can form the basis for establishing a relationship that ultimately leads to a better understanding of the patient's individual situation and knowledge needs. Keywords: Heart failure, self-care, information, education, motivation.

No description available.

Heart failure is a complex chronic disease affecting 6.6 million people in the United States, with an annual cost of $39.2 billion per year. African Americans are at an especially high risk for poor outcomes and readmissions from heart failure complications, as they are 2.5 times more likely to develop heart failure than other ethnic groups. This disease requires a high level of patient self-care management, and evidence suggests that African Americans do not always receive culturally sensitive education, which can lead to suboptimal self-care practices. The practice-focused question for this educational program asked whether nurses of African American patients with heart failure could use a culturally sensitive health education toolkit to improve patients’ knowledge of self-care management. The purpose of this doctoral project was to determine if a culturally sensitive toolkit could increase nursing knowledge. The population focus was nurses caring for African American heart failure patients with frequent readmissions from a high-risk heart failure clinic in New Jersey. The use of Hofstede’s cultural dimensions and an exhaustive literature review guided this doctoral project. The tool used to assess participants’ pre- and post-knowledge was the cultural awareness and sensitivity tool. There were 11 participants comprised of nurses, nurse case managers, and advanced practice nurses; they exhibited a 1.92% improvement in knowledge after the education session. This outcome shows that this educational program was effective and has the potential to contribute to social change by educating nurses on providing effective, culturally sensitive self-care education to African American heart failure patients to increase their adherence to self-care practices.

La sélénoprotéine T (SelT) est une protéine thiorédoxine-like abondamment exprimée au cours du développement embryonnaire chez le rat, mais son expression tend à disparaître après la naissance, notamment dans le coeur, suggérant un rôle limité de la SelT à l’âge adulte. Néanmoins, nous avons pu montrer que la SelT est réexprimée au niveau cardiaque suite à une ligature de l’artère coronaire (LC), suggérant le rôle potentiellement protecteur de cette protéine au cours des pathologies cardiovasculaires. Le but de notre projet fut donc d’évaluer les effets cardiaques d’une thérapie par la SelT au cours de l’insuffisance cardiaque, moyennant soit une thérapie protéique, soit une thérapie génique visant à surexprimer la SelT au niveau cardiaque ou au niveau systémique. La supplémentation en SelT (15μg/kg/jour, minipompes ip) a permis d’améliorer significativement le débit cardiaque et la fraction de raccourcissement du VG, mais également d’améliorer les pressions télé-systoliques et télé-diastoliques du ventricule gauche ainsi que la perfusion coronaire. Ces changements sont associés à une diminution du stress oxydant cardiaque ainsi qu’à une répression des mécanismes inflammatoires cardiaques. L’ensemble de ces améliorations a été observé sans modification de la taille d’infarctus. En parallèle, nous avons pu montrer qu’une injection intraveineuse d’un rAAV9-SelT (1.1011vg) une semaine après la LC permettait de diminuer significativement la dilatation ventriculaire gauche 3 mois après la LC. De manière concomitante, la thérapie génique par la SelT améliore le débit cardiaque ainsi que la perfusion cardiaque. Ces changements sont associés à une amélioration de la compliance et de l’élastance cardiaque. Par ailleurs, l’injection intramusculaire d’un rAAV8-SelT suivant le même protocole que précédemment. Nous avons pu montrer que le traitement par cet AAV permettait de diminuer significativement la dilatation du VG et d’améliorer la fraction de raccourcissement. De plus, la thérapie génique a permis d’améliorer la perfusion cardiaque ainsi que la relaxation coronaire endothélium-dépendante. Nous avons également pu montrer que l’ensemble des effets de la SelT sont médiés par le résidu Sec, dès lors que la modification de ce résidu par une alanine, annihile totalement l’ensemble des effets positifs observés au cours de notre étude. Ainsi, nos résultats ont permis de montrer clairement que le rôle bénéfique d’un traitement par la SelT au cours de l’ICC, et ce, grâce à un mécanisme sélénocystéine-dépendant. La SelT semble donc être une cible thérapeutique prometteuse pour le traitement de cette pathologie. / Selenoprotein T (SelT) is a thioredoxin-like protein, which is abundantly but transiently expressed in the heart during the embryonic development, suggesting that SelT plays a limited role during adulthood. However, data from our laboratory show that cardiac SelT expression increases after myocardial infarction. This suggests that SelT may play a yet unrevealed role in cardiovascular diseases but SelT’s potential protective role is unknown. Thus, we sought to investigate the cardiac effects of a SelT-mediated therapy in chronic heart failure (CHF) using either a protein or gene therapy through either a protein supplementation, or rAAV encoding for different forms of SelT. SelT supplementation (15μg/kg/day, IP, administered for 1 month starting 7 days after MI) resulted in a restoration of cardiac output and LV fractional shortening (sham: 178,1±14,8; MI: 161,1±7,7; MI+SelT; 177,6 ±8,0 and sham: 44,5±5,1; MI: 17,1±0,8; MI+SelT: 25,6±2,4, respectively), in association with an improvement of LV end-diastolic and end-systolic pressures as well as LV tissue perfusion. These changes were associated with a lower oxidative status and with a decrease in inflammation pathways (-32,7% vs MI for oxidative stress and - 27,2% and - 31,4% for inflammation, measured by electron paramagnetic resonance and western blotting analyses of IL1ß and IL6 expressions, respectively). All these effects were observed at identical infarct sizes. In parallel, a single intravenous injection of rAAV9-SelT (1.1011 virus - genome copies) one week after MI resulted in an increased cardiac SelT expression 3 weeks after injection (+150%, p<0.05). This SelT - overexpression reduced HF-induced increase in left ventricular diameters in both systole and diastole (at 1 and 3 months post-MI). Simultaneously, SelT improved stroke volume and cardiac output, without change in heart rate or body weight. Moreover, cardiac perfusion was improved by rAAV9-SelT in both interventricular septum and in the border zone of the infarct. These changes were associated with an improvement in cardiac compliance and elastance parameters assessed by invasive pressure/volume curves (compliance: sham: 18.2 ±1.5; HF: 11.0±1.0; HF+rAAV9-SelT: 15.3±0.5 and elastance: sham: 1.3±0.2; HF: 2.8±0.2; HF+rAAV9-SelT: 1.4±0.2, respectively; p<0.05 vs. HF). The third part of this project consisted in a single intramuscular injection of rAAV8-SelT (1.1011 virus-genome copies, 7 days after CAL) of either the normal form (rAAV8-SelTSec), either the modified form in which the Sec residue is replaced by an Ala (rAAV8-SelTAla). rAAV8-SelTSec administration resulted in a significant increase in cardiac SelT levels as soon as 3 weeks post-administration. After 3 months, SelTSec reduced LV dilation and restored cardiac output. Simultaneously SelT improved both LV elastance and compliance. In contrast, administration of the rAAV8-SelTAla did not modify the CHF-related cardiac dysfunction, suggesting that the selenocysteine residue is essential to the normal protein function. Our results clearly show that increasing SelT to supra-normal levels reduces CHF-induced cardiac dysfunction through a selenium-dependent pathway. These results suggest that SelT might be a promising therapeutic option in the treatment of CHF.

Bakgrund: I Sverige lever ungefär två procent av befolkningen med hjärtsvikt. Hjärtsvikt är en obotlig sjukdom som har en dålig prognos som jämförs med cancer. Syfte: Att belysa och sammanställa forskning som beskriver patienters upplevelser av att leva med hjärtsvikt. Metod: Denna studie är en litteraturöversikt som fokuserar på genomförda studier som är vetenskapligt granskade. Resultat: Två teman framkom vilket var begränsat liv och förändrat liv. Nio subteman skapades var att aldrig vara utvilad, att känna sig kvävd, att inte våga somna, att känna sig fängslad, förändrad livsstil, en oviss framtid, glädjen försvinner, att ge kontrollen till någon annan och att kunna gå vidare med livet. Konklusion: Hjärtsvikt begränsar patienters liv de fysiska begränsningar som är på grund av främst andfåddhet samt trötthet. Hjärtsvikt förändrar patienters liv genom att få en annan livsstil samt att de blir påverkade emotionellt som leder till minskad livskvalitet. Sjuksköterskor kan med denna kunskap få en ökad förståelse hur det är att leva med hjärtsvikt för att därigenom kunna ge en mer personcentrerad vård. / Background: In Sweden, approximately two percent of the population lives with heart failure. Heart failure in an in incurable disease that has a bad prognosis and compared to cancer. Purpose: To elucidate and compile research that describes patients’ experiences of living with heart failure. Method: This study is a Literature Review that focuses on studies that have been scientifically reviewed. Results: Two themes were found that were limited lives and changed lives. Nine sub-themes created were, to never be rested, to feel suffocated, to not dare fall asleep, living in prison, changed lifestyle, uncertain the future, the joy that disappears, to give control to someone else and to move on with life. Conclusion: Heart failure limits patient’ lives to the physical limitations that are mainly due to dyspné and fatigue. Heart failure changes patients by changing their lifestyle and being emotionally affected which leads to reduced quality of life. With this knowledge, nurses can gain an increased understanding of what it is to live with heart failure, thereby being able to provide more person-centered care.