Bakgrund: Gastric bypass (GBP) är en viktminskningsoperation för patienter med ett BMI (Body Mass Index) >35. Operationen är en del av en viktminskningsprocess. Patienten bör själv ta ansvar i form av egenvård för att underhålla det nya levnadssättet för att främja hälsa. Syfte: Syftet med litteraturstudien är att sammanställa vetenskapligt underlag och beskriva patienters upplevelse av hälsa efter en gastric bypass operation. Metod: En deskriptiv design har använts i denna litteraturstudie som har baserats på totalt 10 vetenskapliga artiklar med inkludering av kvalitativ och kvantitativ ansats. Huvudresultat: Operationen hade bidragit till förändrade fysiska, psykiska och sociala upplevelser relaterat till hälsa. En tydlig reducering av vikten kunde utläsas och följdsjukdomar relaterat till fetma hade förbättrats. GBP operationen har bidragit till ökad livskvalitet, minskad social hämning och ökat intresse att delta i aktiviteter. Oönskade följder har rapporterats i form av överskottshud, gastrointestinala problem och osäkerhet. Slutsats: En GBP operation har visat sig vara en effektiv metod för patienters viktnedgång. Förändringar av det fysiska, psykiska och sociala upplevelser relaterat till hälsan har skett. Både positiva upplevelser och oönskade följder kan utläsas av resultatet från en GBP operation. Djupgående information och kunskap till patienter kan främja egenvård och bidra till återhämtning och följsamhet i det nya levnadssättet. / Background: Gastric bypass (GBP) is a weight loss surgery for patients with a BMI (Body Mass Index) >35. The surgery is part of the weight loss process. The patient should take responsibility in the form of self-care to maintain the lifestyle change to promote health. Aim: The aim of the literature study is to compile a scientific basis and describe the health experience of patients after a gastric bypass surgery. Method: In this literature study, a descriptive design has been used that has been based on a total of 10 scientific articles with the inclusion of a qualitative and quantitative approach. Main results: The operation had contributed to change of physical, mental and social experiences related to health. A clear weight reduction was observed and obesity comorbidity improved. The GBP surgery has contributed to improv the quality of life, reduced social inhibition and increased interest in participating in activities. Undesirable consequences in the form of excess skin, gastrointestinal problems and uncertainty have been reported. Conclusion: A GBP surgery has proven to be an effective method of weight loss for patients. There have been changes in the physical, mental and social experiences related to health. Both positive experiences and undesirable consequences can be deduced from the results of a GBP surgery. In-depth information and knowledge for patients can promote self-care and contribute to recovery and compliance in the new lifestyle.

The goal of the diploma thesis is to design and to assess a solution of a northern bypass of the road I/23, which will divert a transit traffic from Rosice. The town is situated approximately 25 kilometers west of Brno, in the South Moravian region. Three variants are worked out. The variant A and the variant B connects smoothly with a bypass of a neighboring village Zastávka. The variant A then copied a route designed in a local development plan and goes through a built-up part of the town Rosice in the area of the street Na Mýtě. The variant B is designed to avoid passage through this area and bypasses Rosice in north, behind a housing estate Kamínky. The variant C is designed in case an absence of a bypass of the village Zastávka. It connects with existing road I/23 in the village Zastávka in the area of an intersection of streets Lipová – Stará osada. The goal of the bypass is to divert the current transit traffic from Rosice

Indiana University-Purdue University Indianapolis (IUPUI) / Objective: Gold standard therapy for chronic limb threatening ischemia (CLTI) is revascularization but in patients in whom below-the-knee bypass is indicated autologous vein conduit may not be available. Contemporary outcomes of distal bypass with suboptimal conduits have not been well described and recent advances in non-surgical therapies raise the question of whether in some cases there is evidence that these should be considered. Methods: Data was obtained from the Vascular Quality Initiative (VQI) registry as well as from a multi-center, randomized clinical trial of cell therapy. Incidence of major amputation after distal bypass was estimated for the VQI cohort by conduit type using non-parametric survival analysis with death as a competing risk. A cox proportional hazards model was then fit to the pooled data in a stepwise fashion with death as a competing risk, including evaluations for appropriate transformation, time dependency and interactions for each included covariate, and hazard ratios were estimated for the risk of major amputation by treatment. Results: At 365 days, the estimated cumulative incidence of major amputation with death as a competing risk is 25% after distal bypass with non-autologous biologic conduit (0.2499, 95% CI 0.2242 - 0.2785), 13% for prosthetic (0.1276, 95% CI 0.1172 - 0.1389) and 9% for GSV (0.0900, 95% CI 0.0848 - 0.0956). The cox proportional hazards model found a significant interaction between age and treatment. Compared to bypass with non-autogenous biologic, the hazard ratios for bypass with GSV were 0.41 (p<0.0001), 0.41 (p<0.0001), 0.42 (p<0.0001) and 0.42 (p<0.0001) respectively at ages 55, 60, 65 and 70 and for bypass with prosthetic were 0.68 (p=0.0043), 0.67 (p=0.0004), 0.65 (p<0.0001) and 0.64 (p<0.0001) respectively and for autologous cell therapy 0.22 (p=0.0005), 0.34 (p=0.0011), 0.52 (p=0.0196) and 0.76 (p=0.3677) respectively. No significant differences were found between best medical management and distal bypass with non-autologous biologic. Conclusion: The risk of major amputation after distal bypass is lowest in patients with GSV conduit and highest following bypass with non-autologous biologic. Using a semi-parametric model, cell therapy was estimated to significantly decrease the risk of amputation compared to distal bypass with non-autologous biologic conduit in younger patients.

The subject of this diploma thesis is a location study of the Rapotín and Velké Losiny bypass. The villages are located in the Olomouc region, Šumperk district. The bypass is designed as a relaying of existing road I/44. The main goal of the work is to reduce the traffic intensity and increase safety in the villages.

No description available.

No description available.

Extracorporeal circulation damages blood and causes harmful side effects such as stroke and/or systemic inflammatory response in patients. Reactions of blood components to extracorporeal circulation include complement and inflammatory reactions, coagulation and thrombogenesis, frank hemolysis, and platelet activation and adhesion to the extracorporeal circuit. Non-physiologic pressure and flow produced by blood pumps contribute to blood injury. Two pump types, roller and centrifugal, are used for maintaining flow, with various models available from different manufacturers. This study compared the effects of these two pumps in identical, isolated, artificial circuits to a non-pumped control for a period of 24 hours on heparinized porcine blood. Hematology parameters were used to evaluate blood damage. Mean corpuscular volume, mean corpuscular hemoglobin, white blood cell count, platelet count, and mean platelet volume were affected by time of circulation. Mean corpuscular hemoglobin, platelet count, and red cell distribution width were different between circulated and non-circulated blood, however no differences were found between the pumping systems in any parameter. Red blood cell count, total hemoglobin, and hematocrit were not affected by time or treatment. The changes observed in this study have implications for the use of extracorporeal circulation in the clinical setting and in future use of blood as a potential organ perfusion medium. / Master of Science

Bakgrund: Fetma och övervikt har blivit vanligare den senaste tiden och är idag ett stort hälsoproblem över hela världen. Många har svårt att gå ner i vikt på egen hand vilket har gjort att kirurgi har blivit allt vanligare de senaste åren. Gastric bypass är idag den vanligaste kirurgiska metoden för viktminskning och har visat goda resultat. Däremot kan den hälsorelaterade livskvalitén påverkas då operationen innebär en stor livsstilsförändring. Syfte: Syftet med denna studie var att beskriva vuxna personers upplevelse av hälsorelaterad livskvalité efter en gastric bypass operation. Metod: En litteraturöversikt med 11 kvantitativa och 3 kvalitativa vetenskapliga artiklar som ligger till grund för hur vuxna personer upplever sin hälsorelaterade livskvalité efter en gastric bypass operation. Resultat: Hälsorelaterad livskvalité (HRQOL) har visat en förbättring i samtliga studier efter en gastric bypass operation. HRQOL har haft sin topp efter 1 månad i samtliga skalor utifrån SF-36 frågeformulär. Slutsats: Den stora livsstilsförändringen som personer går igenom efter en gastric bypass operationen har visat förbättringar i HRQOL på både lång och kort sikt. Bidragande faktorer som kan påverka den förbättrade hälsorelaterade livskvalitén kan bland annat vara uppfyllda förväntningar av operationen och fysisk aktivitet. / Background: Obesity and overweight have become more frequent in recent years and is today a major health problem worldwide. A lot of people find it difficult to lose weight on their own which has made surgery become more common in recent years. Gastric bypass surgery is currently the most common surgical method of weight loss and have shown good results. However, the health-related quality of life is affected as the operation demand a major lifestyle change. Purpose: The purpose of this study was to describe adults’ experience of health-related quality of life after a gastric bypass surgery. Method: The study contains 11 quantitative and 3 qualitative scientific articles describing the adults’ experience of health-related quality of life after a gastric bypass surgery. Results: Health-related quality of life (HRQOL) has shown an improvement in all studies after a gastric bypass surgery. HRQOL has had its peak after 1 month in all scales based on the SF-36 questionnaire. Conclusion: The major lifestyle change that people go through after a gastric bypass surgery has shown improvements in HRQOL in both long and short term. Contributing factors that may affect the improved health-related quality of life can among other things be fulfilled expectations of the surgery and physical activity.

Bakgrund: De senaste tjugo åren har förekomsten av fetma fördubblats i världen och räknas därför till en global epidemi och är ett stort folkhälsoproblem. I samband med detta har även det kirurgiska ingreppet gastric bypass blivit allt vanligare. Det är därför viktigt att sjuksköterskor och personer som överväger denna operation får en ökad förståelse och kunskap om hur patienter som genomgått operationen upplever livet efter. Syfte: syftet med denna studie var att beskriva kvinnors upplevelser efter en gastric bypass operation. Metod: I studien användes kvalitativ ansats för att studera bloggar skrivna av kvinnor som genomgått en gastric bypass operation. Fjorton Bloggar analyserades. Resultat/ Diskussion: Resultatet visar att kvinnorna får en bättre livskvalité då de har lättare att röra på sig och inte längre upplever obehag när de deltar i sociala sammanhang. Dock finns en baksida med operationen, de har svårt att ställa om till den nya livsstilen som är ett måste för att undvika komplikationer. Många av kvinnorna upplever också identitetskriser. Slutsats: Det är av stor vikt att patienter som genomgår gastric bypass operation får hjälp med förhållningssätt och information kring kosthållning för att kunna få en hälsosam och bestående viktminskning och livsstil. Vidare forskning om hur kvinnorna mår psykiskt innan respektive efter operationen behöver göras då fler människor väljer denna viktminskningsmetod. / Background: The worldwide prevalence of obesity has doubled in the last twenty years and is therefore classified as a global epidemic and is therefore a major health problem. This has initiated the gastric bypass surgery to increase. It is therefore important that nurses and people considering this operation have a better understanding and knowledge the life after the surgery. Objective: The aim of this study was to describe women's experiences after a gastric bypass surgery. Method: This study used qualitative method to study the blogs written by women who have gone through gastric bypass surgery. It contains 14 analysed blogs. Results/ Discussion: The result shows that women have a better quality of life when it´s easier for them to move around and don’t feel the discomfort when they are participating in social activities. However, there is a downside to the surgery. They find it difficult to adjust to the new lifestyle, in order to avoid the complications. Some of these women are also experiencing identity crisis. Conclusion: It is therefore significant for patients who have gone through gastric bypass surgery to get the support they need with attitudes and information about diet to have a healthy and permanent weight loss and lifestyle. Further research on how women experience the psychological health before and after the surgery needs to be done since obesity is increasing and more people are choosing this method for weight loss.

Coronary artery bypass graft (CABG) är en väl etablerad behandling för patienter med kranskärlssjukdom. Operationen är utmanande och påfrestande för patienten och upplevelserna efter genomgången operation är varierade. Att som sjuksköterska ha kännedom om patienters upplevelser tiden efter operationen är av betydelse för att möjliggöra god omvårdnad och återhämtning för patienten. Syftet var att belysa patienters upplevelser tiden efter en CABG. Studien grundades på 11 vetenskapliga artiklar och genomfördes som en litteraturstudie. Fyra teman framkom i resultatet; den relationella upplevelsen, den kroppsliga upplevelsen, den mentala skörheten och en ny syn på livet. Det framkom att patienterna upplevde stödet från omgivningen som det viktigaste för god återhämtning. Information från vårdpersonalen ansågs till viss del bristfällig av patienterna. Flera upplevde smärta efter operationen och hade delvis symtom kvar, men dessa avtog med tiden. Centralt efter operationen var även oro, men med tiden kom förbättrad livskvalitet och motivation. Det framkom att en CABG var en stor påfrestning för patienten och upplevelserna var både positiva och negativa. Kunskapsluckor avseende patientupplevelser efter operationen finns och ytterligare forskning bör fokusera på området för att ge sjuksköterskestudenter och sjuksköterskor ökad kunskap i mötet med denna patientgrupp. / Coronary artery bypass graft (CABG) is a well-established treatment for patients with coronary artery disease. The surgery is challenging and stressful for the patient and experiences varied after surgery. It’s important for the nurse to be aware of patients’ experiences after surgery to enable good care and recovery for the patient. The aim was to illuminate patients’ experiences during the time after a CABG. The study was based on 11 scientific articles and was conducted as a literature review. Four themes emerged; the relational experience, the bodily experience, the mental fragility and a new view on life. The result showed that patients' experienced the support from the surroundings as the most important for good recovery. Information given by caregivers were in some cases considered inadequate by the patients. Patients experienced pain after surgery and had partial symptoms left, which subsided with time. Concern was a central experience after surgery, but over time came improved quality of life and motivation. A CABG is a major strain for the patients and the experiences were both positive and negative. There are gaps in knowledge regarding patient experiences after the surgery and further research should focus on that area to give nursing students and nurses knowledge in the meeting with these patients.