Syftet med föreliggande litteraturstudie var att beskriva vad som framkommer om socialt stöd och livsstilsförändringar efter hjärtinfarkt. Studien är en beskrivande litteraturstudie som innefattar tio vetenskapliga artiklar vilka har granskats av författarna och därefter kvalitetsbedömts. Resultatet visade att livsstilsförändringar inte var lätta att genomföra. Det sociala stödet var viktigt för att de olika livsstilsförändringarna skulle klaras av och att stödets utformning skulle vara anpassat efter den hjärtinfarktdrabbades behov. För mycket eller för litet stöd hade negativ inverkan på hur patienten lyckades med livsstilsförändringarna. Personalen på sjukhuset hade stor inverkan på hur lyckad livsstilsförändringarna skulle bli. Sjukvårdspersonalen behövde stödja både hjärtinfarktdrabbade och anhöriga för att rehabiliteringen skulle bli lyckad. De slutsatser som dragits från föreliggande studie är, att socialt stöd påverkar hjärtinfarktdrabbades möjlighet att genomföra livsstilsförändringar. Det sociala stödet kan få både en positiv och negativ inverkan på livsstilsförändringar. Det har visat sig vara viktigt att sjuksköterskan samarbetar med den hjärtinfarktdrabbade. Att anpassa situationen och informationen till respektive individ kan förbättra stödet från sjukvården. / The purpose of this study was to describe what is found about social support and lifestyle changes after a myocardial infarction. The study is a descriptive literature review that includes ten scientific articles that have been reviewed and qualitatively evaluated by the authors. The results showed that lifestyle changes were not easy to conduct. Social support was essential to cope with lifestyle changes and it was important that the aid was designed to match each individual. Too much or too little support had adverse effects on the lifestyle changes that needed to be made. The hospital staff had a major impact on how successful lifestyle changes would be. The hospital staff needed to support both myocardial infarction victims and relatives to make the rehabilitation a success to assure a full recovery. The conclusions drawn from this study is that social support affects myocardial infarction victims and their opportunity to conduct lifestyle changes. Social support can have both positive and negative effects on lifestyle changes. It has also proved to be of great importance that the nurse is collaborating with the myocardial infarction victim. Adjustment to the situation and information to each individual could change the support from the healthcare.

Syftet med den föreliggande litteraturstudien var att beskriva kvinnors respektive mäns livskvalitet efter insjuknande i hjärtinfarkt och de copingstrategier som användes i hanteringen av vardagen. En deskriptiv litteraturstudie genomfördes utifrån sex kvalitativa samt åtta kvantitativa studier med övervägande delen hög kvalitet. Publikationsåren för de inkluderade artiklarna var mellan 2000 och 2010. Artikelsökningen genomfördes i databaserna MedLine (PubMed) samt Cinahl med följande sökord: Hjärtinfarkt, anpassning, psykologisk, livskvalitet och coping. Sammanfattningsvis var vanligt förekommande problem under den första tiden efter insjuknande i hjärtinfarkt fysiska symtom och emotionell utmattning där tillfredsställande behandling och god sjukdomsinsikt kunde leda till välbefinnande. Följande faktorer såsom stress, oro, ångest, nedstämdhet, depression samt kronisk trötthet hade negativ inverkan på den upplevda livskvaliteten, liksom alltför omfattande livsstilsförändringar. Att återgå till sitt arbete hade däremot positiva effekter ur de fysiska och psykologiska aspekterna på livskvaliteten. Likaså hade det sociala nätverket inverkan på välbefinnandet där män i huvudsak sökte stöd från sin partner medan kvinnor även sökte sympati från övriga anhöriga. Optimistiska copingstrategier var vanligast bland både kvinnor och män, dock använde sig kvinnor av fler copingstrategier och hade svårare att hantera sin vardag än vad män hade. För ytterligare evidens i copingstrategier och genusskillnader krävs ytterligare forskning av komparativ design. / The purpose of this study was to describe perceived quality of life and used coping in daily life of women and men after myocardial infarction, which is described in the literature review included studies and methodological quality. A descriptive literature review was conducted based on six qualitative and eight quantitative studies of high quality nature. In conclusion, the year of publication of the studies was between the years of 2000 and 2010. The databases MedLine (Pubmed) and Cinahl were used in the searching of scientific articles with the following keywords: Myocardial infarction, Adaptation, Psychological, Quality of life and Coping. Furthermore, the findings in satisfaction of treatment and good insight in illness was increased in terms of well-being. Return to work appeared to bring positive outcomes of the physical and psychological aspects in quality of life. By the same token, social network had an impact in terms of well-being, since men mainly perceived available support trough their partner as women in larger extension perceived available support from other relatives than men did. Optimistic coping was the most frequently used strategy by both women and men, however, women practiced several strategies of coping. Also, difficulties were found in women managing their daily life compared to men. Regarding coping strategies as well as gender differences, further research is to claim.

No description available.

Background: Evidence-based medicine (EBM) receives significant attention worldwide. Many studies have used questionnaires to discuss the factors obstructing the practice of EBM. There has however been no large-scale data analysis on who and when to practice EBM. This study aims to fill this gap in research by applying nationally representative data to analyze EBM practice after the provision of new evidence regarding rosiglitazone prescription. Methods: We used the National Health Insurance Database in Taiwan to analyze the changes in the prescription of rosiglitazone after meta-analysis found the drug to increase the risk of myocardial infarction. The study period was 18 months from the second quarter of 2007 to the fourth quarter in 2008. Two models of doctors¡¦ prescription behaviors were analyzed in the study. We conducted univariate analyses to distinguish significant differences in the variable and applied multivariate logistic analyses to predict the probability of physicians ceasing to prescribe rosiglitazone. Results: We found a significant improvement in EBM practice from specialists and experienced physicians. When compared to other specialists, endocrinologists were four times more likely to change rosiglitazone prescription (OR: 4.129, 95% CI: 2.484-6.863). Doctors with more than 10 years of specialist experience performed better in EBM practice than younger doctors. The hospital level that a physician worked at was not a significant factor. Local urbanization and economic status did not affect the practice of EBM by physicians in clinics either. Conclusions: Our study found that the EBM was still not well practiced among doctors in Taiwan. The practice of new evidence depended on the specialty or professional experience. Younger doctors and doctors working in medical centers seemed not to practice EBM well. In clinics, patients did not have enough influence to modify the doctor¡¦s prescription behavior. There was a significant time lag between the EBM emergence and EBM practice. This suggests that setting up an authoritative organization to provide timely EBM recommendations is very important. Further improvements to the practice of EBM are still urgently needed within the medical community.

The heart and microvasculature have characteristics of a complex adaptive system. Extreme challenges faced by these organ systems cause structural changes which lead to global adaptation. To assess the impact of myocardial interstitial edema on the mechanical properties of the left ventricle and the myocardial interstitium, we induced acute and chronic interstitial edema in dogs. With chronic edema, the primary form of collagen changed from type I to III and left ventricular chamber compliance significantly increased. The resulting functional adaptation allows the chronically edematous heart to maintain left ventricular chamber compliance when challenged with acute edema, thus, preserving cardiac function over a wide range of interstitial fluid pressures. To asses the effect of microvascular occlusions, we reintroduced the Pallid bat wing model and developed a novel mathematical model. We hypothesized that microvessels can switch from predominantly pressure-mediated to shear-mediated responses to ensure dilation during occlusions. Arterioles of unanesthetized Pallid bats were temporarily occluded upstream (n=8) and parallel (n=4) to vessels of interest (20-65 mm). In both cases, the vessels of interest rapidly dilated (36+24 %, 37+33 %), illustrating that they responded appropriately to either decreased pressure or increased shear stress. The model not only reproduced this switching behavior, but reveals its origin as the nonlinear shear-pressure-radius relationship. The properties of the heart and microvasculature were extended to characterize a “Research-Intensive Community” (RIC) model, to provide a feasible solution consistent with the Boyer Commission, to create a sustainable physiology research program. We developed and implemented the model with the aim of aligning diverse goals of participants while simultaneously optimizing research productivity. While the model radically increases the number of undergraduate students supported by a single faculty member, the inherent resilience and scalability of this complex adaptive system enables it to expand without formal institutionalization.

<p>Successful treatment of myocardial infarction requires anearly and accurate diagnosis. Recent studies have shown thatacute myocardial scintigraphy has a high predictive value forprognosis of myocardial events. Three dimensional (3D)perfusion data obtained with SPECT are however very rare in theemergency department (ED).</p><p>We have developed a mobile tomographic system for myocardialscintigraphy, which can be used in the ED. The objectives ofthe studies presented were:</p><p>    To develop software and hardware for a mobile tomographicgamma camera system: the Cardiotom</p><p>    To demonstrate that a mobile tomographic system can beused in a clinical situation</p><p>    To evaluate the limitations of Ectomography when usingfiltered back projection for reconstruction</p><p>    To develop a method of reconstruction that compensatesfor the incomplete data acquisition associated with theacquisition geometry of Ectomography</p><p>Three prototypes of a mobile tomographic gamma camera systemhave been designed and built at the Division of MedicalEngineering, which all have been used in a clinical setting.The systems are based on Ectomography, a limited view anglemethod, also developed by us. Instead of rotating the entiregamma camera detector around the patient as in SPECT, a slanthole collimator is rotated in front of a stationary detector.Since short imaging times are important in the ED and the heartonly occupies a small area of the detector, system sensitivityhas been increased by dividing the collimator into segmentswith different projection directions. In myocardial imaging, 4segments are used and within 10 minutes from the start ofacquisition, reconstructed short axis view sections areavailable for interpretation.</p><p>Using the Cardiotom in an experimental animal study, weverified that the system could be used to quantify myocardialarea at risk and final infarct size. This conclusion was madefrom a comparison of images obtained from the Cardiotom andpathological staining of the myocardium, analysedpost-mortem.</p><p>Inherent limitations of Ectomography were evaluated withboth phantom studies and computer simulated data, reconstructedusing filtered back-projection Results show that moderatedeviation from optimal position of the detector with respect tothe myocardium will have little or no influence on thediagnostic information when assessed from short axis sectionimages and polar tomograms. However, long axis section imagesappear elongated when reconstructed using filteredback-projection.</p><p>We have shown that this elongation distortion can besuppressed using iterative reconstructions techniques, and wehave implemented such an algorithm, called three-dimensionalTotal Variation Expectation Maximisation (3DTV-EM). Resultswere that elongation distortion was reduced and depthresolution improved. The reconstruction technique was alsoevaluated for SPECT reconstruction and was found to decreasethe noise in reconstructed images, when compared to thetwo-dimensional TV-EM algorithm. Noise pattern were also foundto be more uniform for the 3DTV-EM algorithm compared totwo-dimensional TV-EM.</p><p>In conclusion, we have shown that the Cardiotom may beuseful in a clinical acute setting, providing valuablediagnostic information. Rapid positioning is possible, sincemoderate deviation from optimal positioning will cause few orno artefacts. Image quality can be improved if iterativetechniques are used for image reconstruction instead offiltered back-projection.</p><p><b>Keywords</b>: acute studies, myocardial infarction,scintigraphy, mobile gamma camera, tomography.</p>

<p>Nukleärmedicinska bilder som exempelvis SPECT (Single Photon Emission Tomogra-phy) är en bildgenererande teknik som ofta används i många applikationer vid mätning av fysiologiska egenskaper i den mänskliga kroppen. En vanlig sorts undersökning som använder sig av SPECT är myokardiell perfusion (blodflöde i hjärtvävnaden), som ofta används för att undersöka t.ex. en möjlig hjärtinfarkt. För att göra det möjligt för läkare att ställa en kvalitativ diagnos baserad på dessa bilder, måste bilderna först segmenteras och roteras av en biomedicinsk analytiker. Detta utförs på grund av att hjärtat hos olika patienter, eller hos patienter vid olika examinationstillfällen, inte är lokaliserat och roterat på samma sätt, vilket är ett väsentligt antagande av läkaren vid granskning</p><p>av bilderna. Eftersom olika biomedicinska analytiker med olika mängd erfarenhet och expertis roterar bilderna olika uppkommer variation av de slutgiltiga bilder, vilket ofta kan vara ett problem vid diagnostisering.</p><p>En annan sorts nukleärmedicinsk undersökning är vid kvantifiering av dopaminreceptorer i de basala ganglierna i hjärnan. Detta utförs ofta på patienter som visar symptom av Parkinsons sjukdom, eller liknande sjukdomar. För att kunna bestämma graden av sjukdomen används ofta ett utförande för att räkna ut olika kvoter mellan områden runt dopaminreceptorerna. Detta är ett tröttsamt arbete för personen som utför kvantifieringen och trots att de insamlade bilderna är tredimensionella, utförs kvantifieringen allt för ofta endast på en eller flera skivor av bildvolymen. I likhet med myokardiell perfusionsundersökningar är variation mellan kvantifiering utförd av olika personer en möjlig felkälla.</p><p>I den här rapporten presenteras en ny metod för att automatiskt segmentera hjärtats vänstra kammare i SPECT-bilder. Segmenteringen är baserad på en intensitetsinvariant lokal-fasbaserad lösning, vilket eliminerar svårigheterna med den i myokardiella perfusionsbilder ofta varierande intensiteten. Dessutom används metoden för att uppskatta vinkeln hos hjärtats vänstra kammare. Efter att metoden sedan smått justerats används den som ett förslag på ett nytt sätt att automatiskt kvantifiera dopaminreceptorer i de basala ganglierna, vid användning av den radioaktiva lösningen DaTSCAN.</p> / <p>Nuclear medical imaging such as SPECT (Single Photon Emission Tomography) is an imaging modality which is readily used in many applications for measuring physiological properties of the human body. One very common type of examination using SPECT is when measuring myocardial perfusion (blood flow in the heart tissue), which is often used to examine e.g. a possible myocardial infarction (heart attack). In order for doctors to give a qualitative diagnose based on these images, the images must first be segmented and rotated by a medical technologist. This is performed due to the fact that the heart of different patients, or for patients at different times of examination, is not situated and rotated equally, which is an essential assumption for the doctor when examining the images. Consequently, as different technologists with different amount of experience and expertise will rotate images differently, variability between operators arises and can often become a problem in the process of diagnosing.</p><p>Another type of nuclear medical examination is when quantifying dopamine transporters in the basal ganglia in the brain. This is commonly done for patients showing symptoms of Parkinson’s disease or similar diseases. In order to specify the severity of the disease, a scheme for calculating different fractions between parts of the dopamine transporter area is often used. This is tedious work for the person performing the quantification, and despite the acquired three dimensional images, quantification is too often performed on one or more slices of the image volume. In resemblance with myocardial perfusion examinations, variability between different operators can also here present a possible source of errors.</p><p>In this thesis, a novel method for automatically segmenting the left ventricle of the heart in SPECT-images is presented. The segmentation is based on an intensity-invariant local-phase based approach, thus removing the difficulty of the commonly varying intensity in myocardial perfusion images. Additionally, the method is used to estimate the angle of the left ventricle of the heart. Furthermore, the method is slightly adjusted, and a new approach on automatically quantifying dopamine transporters in the basal ganglia using the DaTSCAN radiotracer is proposed.</p>

Mental stress ischemia (MSI) is associated with poor prognosis for coronary artery disease (CAD) and is amenable to treatment, yet no easily administered test exists to diagnose it. Given the known increase in systemic vascular tone in response to stress, we studied the ability of peripheral arterial tonometry (PAT), a noninvasive functional measure of arterial tone, to predict those vulnerable to MSI. Seventy-seven patients with chronic stable CAD were subjected to mental stress with concomitant assessment of myocardial perfusion and pulse wave amplitude. Nuclear perfusion imaging was used to document MSI, and PAT was used to measure pulse wave and microarterial tone. A ratio of PAT measurements during stress to those before stress was used to characterize vascular responses. Serum catecholamines and endothelin-1 (ET-1) were simultaneously measured. Subjects who experienced MSI had a lower average PAT ratio than those who did not (0.76 ¡À 0.04 vs. 0.91 ¡À 0.05, P = 0.03). A receiver operating characteristics curve for PAT ratio predicting MSI had an area under the curve of 0.613 (standard error, 0.065, one-sided P = 0.04). Maxima of sensitivity and specificity were observed at a threshold of 0.78 to define an abnormal PAT ratio. Cross-tabulation of groups above and below this threshold with groups of subjects with and without MSI showed a significant predictive relationship between PAT ratio and MSI (P = 0.03). Subjects at or below this threshold (¡Ü0.78) displayed a significant increase in norepinephrine levels during mental stress (235 pg/ml at baseline, 259 pg/ml during mental stress, P = 0.007). Subjects above this threshold (>0.78) displayed a significant decline in their ET-1 levels 24 hours after mental stress (1.15 pg/ml after mental stress, 0.93 pg/ml 24 hours later, P = 0.01), while those at or below threshold had a continued increase. PAT ratio is a complex functional measure of peripheral arterial tone that significantly predicts the occurrence of MSI. It may have clinical value as an easily administered screening test for MSI.

Es werden in einer kumulativen Dissertationsschrift zwei wissenschaftliche Arbeiten zusammengefasst. Die erste Arbeit beschreibt die Etablierung der Kontrastmittelechokardiografie zur Charakterisierung des Herzinfarktmodells an der Ratte im zeitlichen Verlauf. Es wird der Ablauf der geometrischen Änderungen am linken Herz nach Herzinfarkt gezeigt. Zusätzlich wird die Methode mit anderen etablierten echokardiografischen Methoden verglichen. Hier wird die Messung der linksventrikulären Querschnittsfläche der Volumenbestimmung nach der modifizierten Simpson-Methode gegenübergestellt. Es wird gezeigt, dass die Flächenmessungen, bei Nichtverfügbarkeit der Kontrastmittelechokardiografie eine valide Methode zur Verlaufsbeobachtung im Modell darstellt. Die zweite Arbeit untersucht im Rattenversuch den Einfluss von mesenchymalen Vorläuferzellen aus Nabelschnurblut auf die Entwicklung des Herzversagens nach Herzinfarkt. Die Injektion der Zellen erfolgt direkt in das Herzmuskelgewebe am Rand des Infarktareals. Zusätzlich zur Phänotypisierung mittels Echokardiografie wurden hämodynamische Messungen, sowie immunhistochemische und molekularbiologische Untersuchungen vorgenommen. Es konnte in einem Multigruppendesign gezeigt werden, dass im vorliegenden Versuch durch die Injektion von Vorläuferzellen kein Einfluss auf die geometrischen und biomechanischen Änderungen nach Herzinfarkt genommen werden konnte. Es konnten jedoch zusätzlich Differenzen zwischen den Versuchsgruppen in der Genexpression von Signalmolekülen der extrazellulären Matrix gezeigt werden, welche Spekulationen über den Einfluss der Zellen auf parakrine Mechanismen im Herzgewebe zulassen.

RNA interference (RNAi) is a conservative post-transcriptional gene silencing mechanism that can be mediated by small interfering RNAs (siRNAs). Given the effectiveness and specificity of RNAi, the administration of siRNA molecules is a promising approach to cure diseases caused by abnormal gene expression. However, as siRNA is susceptible to degradation by nucleases and it can hardly penetrate cell membranes due to its polyanionic nature, a successful translation of the RNAi mechanism for therapeutic purposes is contingent on the development of safe and efficient delivery systems. This dissertation described the development of novel siRNA delivery systems on the basis of polymeric and dendrimeric materials and also demonstrated the application of one optimized delivery system to deliver therapeutic siRNAs in a cardiovascular disease model in vivo. We studied a linear peptide polymer made from cell penetrating peptide monomers and investigated the contribution of the polymeric structure, degradability, and ligand conjugation to the siRNA loading capacity, biocompatibility, and transfection efficiency of polymeric materials. With the obtained knowledge and experience, we invented a neutral crosslinked delivery system aiming to solve the inherent drawbacks of traditional cationic delivery systems that are based on electrostatic interactions. The new concept utilized buffering amines to temporarily bind siRNA and a crosslinking reaction to immobilize the formed particles, and targeting ligands modified on the neutral dendrimer surface further enhanced the interactions between the delivery vehicles and target cells. The obtained delivery system allowed stability, safety, controllability, and targeting ability for siRNA delivery, and the method developed here could be transformed to other polymeric or dendrimeric cationic materials to make them safer and more efficient. To exploit the therapeutic potential of siRNA delivery, we developed a tadpole-shaped dendrimeric material to deliver siRNA against an Angiotensin II receptor in a rat ischemia-reperfusion model. Our results showed that the nonaarginine-conjugated tadpole dendrimer was capable of delivering siRNA effectively to cardiac cells both in vitro and in vivo, and the successful down-regulation of the Angiotensin II receptor preserved the cardiac functions and reduced the infarct size post-myocardial infarction. This dissertation paves a way for transforming multifunctional non-viral siRNA delivery systems into potent therapeutic strategies for the management of cardiovascular diseases.