<p>Det största folkhälsoproblemet bland kvinnor är hjärt-kärlsjukdom. Kvinnor är underrepresenterade bland patienter som får behandling i form av CABG-operation . CABG-operation är ett stort kirurgiskt ingrepp som innebär påfrestningar och en stor förändring i livet. Syftet med litteraturstudien var att belysa kvinnors upplevelse av livskvalitet efter CABG-operation. Studien genomfördes som en systematisk litteraturstudie, en metod för att sammanställa alla vetenskapliga arbeten inom ett specifikt område. Sju artiklar som var relevanta till syftet och hade hög vetenskaplig kvalitet analyserades och sammanställdes till resultatet. Resultatet visade att de flesta kvinnor upplevde någon form av problem postoperativt. Kvinnorna upplevde sin fysiska funktion nedsatt efter operation för att under första året återgå till jämförbar nivå med friska kvinnor. Ensamhet påverkar den sociala rehabiliteringen negativt. Familj och vänner var en bidragande faktor till att den sociala rehabiliteringen förbättrades. Postoperativt var kvinnornas totala upplevelse av livskvalitet signifikant förbättrad. Fortsatt forskning bör inriktas på enbart kvinnors upplevelse av livskvalitet efter CABG-operation, för att enklare kunna applicera kunskapen i praktiken.</p>

<p> </p><p>The aim of the study was auditing medical records examine postoperative blood glucose levels after undergoing CABG surgery. Furthermore the aim was to determine if the ward staff abides the local guidelines frame of reference concerning each ward, regarding blood glucose measurements and blood glucose levels. The study included 70 patients undergoing CABG surgery at the cardiothoracic surgery, Uppsala University Hospital. The study was conducted by retrospective medical record auditing. Studied factors were postoperative blood glucose levels, number of registered blood glucose measurements, a current diagnosis of DM and preoperative HbA_1c. Mean level of blood glucose levels stayed continuously above the local guidelines frame of reference for both TIVA/TIMA and the care ward throughout the continuity of patient care. The number of registered blood glucose measurements per postoperative day at TIVA/TIMA where within the local guidelines. The result showed that the local guidelines frame of reference concerning the ward were not reached. A difference could be seen between patients with DM and patients without DM regarding the previously mentioned factors. Preoperative elevated levels of HbA_1c could have influenced the number of postoperative blood glucose measurements. Recommendations will therefore be too audit the current local guideline that concerns the treatment, therapy goals and the number of blood glucose measurements. Establishing criterions regarding termination of blood glucose measurements and the transfer day between TIVA/TIMA and the care ward are recommended.</p><p> </p>

The aim of the study was auditing medical records examine postoperative blood glucose levels after undergoing CABG surgery. Furthermore the aim was to determine if the ward staff abides the local guidelines frame of reference concerning each ward, regarding blood glucose measurements and blood glucose levels. The study included 70 patients undergoing CABG surgery at the cardiothoracic surgery, Uppsala University Hospital. The study was conducted by retrospective medical record auditing. Studied factors were postoperative blood glucose levels, number of registered blood glucose measurements, a current diagnosis of DM and preoperative HbA1c. Mean level of blood glucose levels stayed continuously above the local guidelines frame of reference for both TIVA/TIMA and the care ward throughout the continuity of patient care. The number of registered blood glucose measurements per postoperative day at TIVA/TIMA where within the local guidelines. The result showed that the local guidelines frame of reference concerning the ward were not reached. A difference could be seen between patients with DM and patients without DM regarding the previously mentioned factors. Preoperative elevated levels of HbA1c could have influenced the number of postoperative blood glucose measurements. Recommendations will therefore be too audit the current local guideline that concerns the treatment, therapy goals and the number of blood glucose measurements. Establishing criterions regarding termination of blood glucose measurements and the transfer day between TIVA/TIMA and the care ward are recommended.

Det största folkhälsoproblemet bland kvinnor är hjärt-kärlsjukdom. Kvinnor är underrepresenterade bland patienter som får behandling i form av CABG-operation. CABG-operation är ett stort kirurgiskt ingrepp som innebär påfrestningar och en stor förändring i livet. Syftet med litteraturstudien var att belysa kvinnors upplevelse av livskvalitet efter CABG-operation. Studien genomfördes som en systematisk litteraturstudie, en metod för att sammanställa alla vetenskapliga arbeten inom ett specifikt område. Sju artiklar som var relevanta till syftet och hade hög vetenskaplig kvalitet analyserades och sammanställdes till resultatet. Resultatet visade att de flesta kvinnor upplevde någon form av problem postoperativt. Kvinnorna upplevde sin fysiska funktion nedsatt efter operation för att under första året återgå till jämförbar nivå med friska kvinnor. Ensamhet påverkar den sociala rehabiliteringen negativt. Familj och vänner var en bidragande faktor till att den sociala rehabiliteringen förbättrades. Postoperativt var kvinnornas totala upplevelse av livskvalitet signifikant förbättrad. Fortsatt forskning bör inriktas på enbart kvinnors upplevelse av livskvalitet efter CABG-operation, för att enklare kunna applicera kunskapen i praktiken.

Coronary atherosclerosis and plaque rupture leads to acute coronary thrombosis and myocardial infarction. Current treatment involves re-establishing vessel patency, but no treatments have been developed to target post-infarction inflammatory pathways. Such treatments may reduce cardiomyocyte injury, attenuate adverse remodelling and improve clinical outcome. Inflammation within the infarcted myocardium is associated with chemotaxis of neutrophils and monocytes to the site of injury. Early reperfusion therapy amplifies this inflammatory cell influx. Neutrophil release a variety of pro-inflammatory factors, including human neutrophil elastase (HNE). HNE has a wide range of substrates. Preclinical studies have demonstrated that neutrophil depletion or inhibition of neutrophil elastase attenuates post-ischemic inflammatory reperfusion injury within the myocardium. Recruitment of monocytes into the infarcted myocardium is followed by maturation and differentiation into macrophages. Macrophages play a key role in orchestrating inflammation and repair. Therapeutic manipulation of this healing process will only come from understanding mechanisms and targeting reparative pathways. “Ultrasmall superparamagnetic iron oxide particles” (USPIOs) extravasate through capillaries and are phagocytosed by tissue inflammatory cells. These cells are predominately macrophages, but neutrophils have also been shown to take up USPIOs. USPIO-enhanced MRI can identify areas of inflammation in models inflammation in various tissues. Therefore we hypothesised that USPIO enhanced MRI could identify and assess cellular inflammation of the myocardium. During coronary artery bypass graft surgery (CABG), the myocardium receives an immediate ischaemic insult that is exacerbated by post-ischaemic reperfusion inflammatory responses leading to increased myocardial injury. CABG surgery can therefore be used as a clinical model of myocardial infarction and inflammation. We investigated this with blood markers of inflammation, MRI scanning and USPIO. Elafin inhibits the destructive and inflammatory HNE enzyme. Beyond this elafin inhibits inflammatory cytokines and modulates the innate and adaptive immune systems. In preclinical studies elafin treatment is associated with reduced myocardial injury. As such, elafin has a marked potential for the treatment of cardiovascular disease involving inflammation. Therefore, we hypothesised that elafin will reduce perioperative ischaemic myocardial injury and inflammation in patients undergoing elective coronary artery bypass graft surgery. We demonstrated for the first time that USPIOs are taken up by the infarct tissue in patients with recent myocardial infarction and by the peri-infarct myocardium to a lesser degree. This represents a novel non-invasive method to further study cardiac inflammation and therapeutic interventions. All patients undergoing CABG surgery demonstrated >10-fold elevation above the 99th centile of cardiac troponin by high sensitivity assay (hs-cTnI) indicating the current universal definition of type 5 myocardial infarction lacks specificity. A peak hs-cTnI at 6 hours following CABG surgery appears to be related to the surgical process and non-specific myocardial injury whilst a continuing increase at 24 hours suggests myocardial infarction. We would suggest hs-cTnI sampling at 6 and 24 hours post CABG surgery together with ECG assessment for the routine detection and diagnosis of type 5 MI. Differing levels of humoral makers inflammation post CABG surgery occurred, and did not correlate directly with the length of cardiopulmonary bypass time or hs-cTnI release. For the first time we identified differing levels of inflammatory cell infiltrate into the myocardium post CABG. This varied from none to levels similar to infarcted myocardial tissues. Elafin did not attenuate myocardial ischemia-reperfusion injury and inflammation. Post-hoc analysis identified reduced cTnI concentrations at 6 hours in Elafin treated patients and it is possible that a bigger dose would have conferred protection out to 48 hours. Elafin did not attenuate the cellular infiltration into the myocardium post CABG surgery, but did appear to reduce inflammation in renal tissue. USPIO enhanced CMR holds major promise in the non-invasive assessment of myocardial inflammation post surgery.

No description available.

Hjärt- och kärlsjukdomar är den största dödsorsaken i världen. En av behandlingarna som kan ges vid detta är koronar bypass operation. Väntan inför denna operation kan upplevas oviss och skapa oro hos patienten. Syftet med litteraturstudien var att undersöka patientens upplevelse i väntan på koronar bypass operation. Metod: Studien genomfördes som en allmän strukturerad litteraturstudie med induktiv ansats där sex kvalitativa, en kvantitativ samt en artikel med mixad metod erhölls. Data bearbetades genom en innehållsanalys. Resultat: Resultatet visade att patienter upplever såväl emotionell som somatisk påfrestning i väntan på koronar bypass operation. De mest framträdande upplevelserna var att patienterna upplevde ängslan och oro, ovisshet, rädsla och fysiska restriktioner. Dessa upplevelser mynnade ut till två teman den emotionella väntan och den somatiska väntan. Konklusion: I väntan på koronar bypass operation var de mest framträdande upplevelserna ovisshet samt ängslan och oro. För att reducera ovissheten, ängslan och oron var det av största vikt att sjuksköterskan arbetade personcentrerat. En sjuksköterskeledd intervention samt möjlighet att prata med tidigare koronar bypass operation patienter visade en signifikant reducering av den emotionella påfrestningen. En ökad förståelse för patienters upplevelse i väntan på koronar bypass operation är av stor vikt för att möjliggöra personcentrerad omvårdnad. / Cardiovascular disease is the leading cause of death in the world. One of the treatments for this is to undergo a coronary artery bypass graft. The waiting time before surgery causes uncertainty and worry in some patients. The aim was to examine patients’ experience while waiting for coronary artery bypass. The Method used was a general structured literature study with an inductive approach, where sixarticles with a qualitative approach, one quantitative and one with mixed method were found. The data was processed through a content analysis. The Result showed that patients experience both emotional and somatic stress while waiting for coronary artery bypass surgery. The most dominant experiences and emotions that patients felt were anxiety, uncertainty, fear, and physical restrictions. These experiences and emotions resulted in two themes Emotional waiting and Somatic waiting. TheConclusion showed to reduce uncertainty and anxiety it was of the utmost importance that the nurse applied person-centered care. A nurse-led intervention as well as the opportunity to talk with former coronary artery bypass patients showed a significant reduction in emotional strain. An increased understanding of patient´s experience while waiting for coronary artery bypass is of great importance to enable person-centered care.

Background: Coronary heart disease (CHD) remains a major cause of death and ill- health in Scotland. Coronary artery bypass grafting (CABG) aims to relieve CHD symptoms, improve quality of life and increase life expectancy in high-risk groups. Partners may positively or negatively influence patient outcome, and they too may be adversely affected by the experience of CABG. Health care is currently organised around the patient. The partner's is seen as merely assisting patient recovery. Their health and well-being is neglected despite them being at an increased risk of CHD. Research has been limited in the partner variables that have been examined. Their health needs and concerns and the influence of the patient on partner outcome have seldom been examined and the effects of CABG on the dyad. The dyad has not previously been examined as an outcome variable of interest.

Introdução: Estudos clínicos e epidemiológicos têm revelado aumento do risco de doença coronária nos pacientes portadores de diabetes mellitus. A progressão da aterosclerose coronária documentada angiograficamente é identificada e utilizada com freqüência na prática clínica. Entretanto, o seu significado prognóstico ainda é pouco conhecido. Neste estudo, analisamos o significado dessa progressão em uma amostra de pacientes diabéticos e não diabéticos, portadores de doença arterial coronária e submetidos ao tratamento clínico, angioplastia ou cirurgia. Métodos. Foram avaliados 392 pacientes com cineangiocoronariografia inicial e após cinco anos de seguimento. A progressão foi definida como o surgimento de uma nova lesão ou o aumento em cerca de 20% de uma lesão prévia. A identificação da progressão foi realizada em pacientes submetidos previamente aos tratamentos clínico, cirúrgico e angioplastia. A progressão da doença foi analisada nos territórios correspondentes das artérias descendente anterior, circunflexa e coronária direita. A amostra englobou um grupo de 138 pacientes diabéticos e 254 pacientes não diabéticos. Dos 392 pacientes da amostra, formaram-se os seguintes grupos de intervenção: RCM (n=136) - 57 diabéticos e 79 não diabéticos; ATC (n=146) - 42 diabéticos e 104 não diabéticos; TM (n=110) - 38 diabéticos e 72 não diabéticos. Também se analisou também o percentual de progressão da doença, correlacionando-a com os fatores de risco e com a necessidade de novas intervenções. Resultados. Não se observou nenhuma diferença entre os grupos diabéticos e não diabéticos quanto à idade, sexo, HAS, tabagismo e distúrbios lipídicos. Além disso, não se demonstraram diferenças de progressão nesta amostra, quando comparados o grupo dos diabéticos e o de não diabéticos; entretanto, quando estratificados por intervenção, observou-se menor progressão da doença nos pacientes do grupo cirúrgico com diabetes mellitus (69,7%, p=0,014). Por outro lado, observou-se maior progressão no território das artérias descendente anterior (71,5%) e coronária direita (64,3%) dos pacientes diabéticos submetidos à angioplastia (p=0,024, p=0,047). Conclusão. Os resultados deste estudo permitiram concluir que, em cinco anos, o diabetes mellitus não impôs maior progressão angiográfica da doença aterosclerótica quando se compararam os grupos de pacientes diabéticos e de não diabéticos. Entretanto, a análise dos pacientes diabéticos submetidos a ATC revelou significativo aumento da progressão da doença nos territórios da coronária direita e da descendente anterior. Por outro lado, os pacientes diabéticos do grupo cirúrgico apresentaram menor progressão da doença. / Background: Epidemiologic and clinical studies have shown an increased risk of coronary artery disease (CAD) among patients with diabetes mellitus (DM). Angiographic progression of coronary atherosclerosis is frequently observed in clinical practice and is used as an end-point in clinical trials; however, its prognostic significance is unclear. In this study, we prospectively analyzed the angiographic progression in diabetic and nondiabetic patients treated by medication, angioplasty or surgery. Methods: At baseline and 5- year follow-up angiograms were obtained in 392 randomized patients. Progression was defined as an increase in diameter of stenosis by >20% of at least one coronary lesion. We tried to assess the coronary disease progression in the clinical, surgical, and angioplasty groups in the LAD, LCX, and RCA arteries in diabetic (n=138) and nondiabetic patients (n=254). A total of 392 subjects randomly assigned to CABG (n=136), 57 diabetic and 79 non diabetic, PCI (n=146),42 diabetic and 104 non diabetic or medical treatment(n=110) 38 diabetic and 72 non diabetic Also, we analyzed the relation of the rate of progression with morbidity and the need for an additional intervention. Results: No significant differences in relation to age, sex, hypertension, smoking, or lipid disorders were observed between the groups. Furthermore, no differences concerning CAD progression were shown when diabetic and nondiabetic subject were compared. However, when the type of treatment was stratified, the surgery group had less progression in the diabetic group (69.7% p =0.014). On the other hand, more progression in the PCI group was observed in RCA (64.3 %) and LAD (71.5%) territories in diabetic group (p=0.047; p=0.024). No relation was found between progression and the rate of events in both groups. Conclusion: Diabetes was not associated with greater progression of CAD in patients with stable CAD and preserved ventricular function during 5-year follow-up. However, the diabetic patients who underwent PCI had more progression of CAD compared with nondiabetic subjects in RCA and LAD territories.The surgery group shown less progression of the disease in the diabetic group.

<p>The purpose of this study was to investigate the presence of arterial insufficiency in patients undergoing CABG surgery and whether arterial insufficiency is a risk factor for postoperative wound infections in the harvesting leg. Patients who had CABG surgery were enrolled consecutively. A total of 144 patients participated in the study. During their hospital stay demographic data was recorded, as well as pre-, intra-, and postoperative tests and risk factors. The patients answered a questionnaire regarding postoperative wound infections 30 days after surgery patients answered a questionnaire regarding infections. The known and potential risk factors that were recorded were BMI, HB, tobacco usage, diagnosed diabetes, hyperglycemia, duration of surgery, the lowest temperature during surgery and clinical or subclinical arterial insufficiency. The result showed that 34% had postoperative wound infections in the harvesting leg and 26 patients had an ABI (Ankel Brachial Index) indicating arterial insufficiency. There was no significant relationship between ABI and postoperative wound infections in the lower extremity in the total study group (p = 0.36) nor among men (p = 0.92). There was a significant correlation between ABI and postoperative wound infections in the lower extremity (p = 0.02) among women. The conclusion is that arterial insufficiency is more prevalent in women. The relationship between postoperative infections of the lower limbs and arterial insufficiency was significant for the participating women, but not in the total group nor among the men.</p>