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Syftet med denna studie var att påvisa vilka känslor som väcktes hos föräldrarna inför sitt barns hjärttransplantation och hur deras upplevelse av informationen från vårdpersonalen uppfattades. För att kunna genomföra undersökningen användes en anonym enkätundersökning med semistrukturerade frågor. Undersökningens deltagarantal var litet på grund av att få barn blivit hjärttransplanterade på hjärtcentrat. Av sexton tillfrågade föräldrar svarade endast åtta på frågeformulären. I resultatet framkom att föräldrar under kontakten med hjärtcentrat hade både positiva och negativa upplevelser. Känslor såsom oro, rädsla, hopplöshet och ilska omnämndes ofta av föräldrarna. De flesta föräldrar upplevde i stort ett varmt, positivt och professionellt mottagande samt erhållen god information av vårdpersonalen. Sjuksköterskans roll i sin omvårdnadsprofession över dessa familjer kan ses som en värdefull länk mellan de olika yrkeskategorierna. / The purpose of this study was to investigate and enlighten which kind of emotions the parents experienced before their child’s heart transplant and also how they reacted upon information given from medical staff. To be able to investigate the issue the authors used a semistructured questionnaire from where the answers were collected. The questions were answered anonymously. The participating parents were only 16 due to a small and exclusive group of patients. The result shows that parents throughout the process had both positive and negative feelings and stressing emotions of anxiety, fear, feeling of despair and anger. Most parents experienced a warm, positive and professional reception as well as being well informed by the hospital staff. The nurse’s role could be seen as an interpreter between professional categories.

Introduktion: Förlust av tänder är idag vanligt förekommande och kan behandlas med hjälp av dentala implantat. För att installation av implantat ska vara möjlig, krävs tillräcklig benvolym där implantat ska installeras. När det föreligger bendefekter i anslutning till det lokala området för implantatinstallationen utgör simultaneous augmentation technique eller enstegsteknik ett behandlingsalternativ för bentransplantat. För att minimera kontamination med orala bakterier av det uppsamlade benet under beninsamlingsmetoder, används idag preoperativ sköljning med klorhexidin som ett steg i behandlingen.Syftet med denna studie är att undersöka möjligheten till ytterligare minimering av bakteriell kontamination vid implantatinstallation, med hjälp borstning av munhålan med klorhexidingel.Metod: 30 patienter deltog i en dubbelblindad, randomiserad studie där 15 patienter utgjorde en kontrollgrupp och 15 andra patienter fick genomgå den införda preoperativa tilläggsåtgärden. Ben- och paperpoint prov togs från samtliga patienter för bakteriell odling. Antalet kontaminerande bakterier uttrycktes som kolonibildande enheter (CFU/ml). En statistisk analys gjordes för att beräkna bakterieantal och kontaminationsgraden i respektive prov. Resultat: Medelvärdet för antal bakterier i benproven från samtliga patienter i kontrollgruppen beräknades till 8 126 CFU/ml respektive 2 946 CFU/ml i testgruppen dock var skillnaden inte signifikant (P = 0,357).Konklusion: Resultatet i denna studie visar ingen statistisk signifikant skillnad mellan patienter som erhållit den preoperativa profylaktiska tilläggsåtgärden, borstning med klorhexidingel, och patienter som inte erhållit detta hygiensupplement. Dessutom kunde ingen slutsats dras gällande effekten av denna tilläggsmetod på virulenta bakteriearterna P. gingivalis, P. Intermedia och A. actinomycetemcomitans. Ett större patientunderlag krävs i framtida randomiserade kontrollerade studier för att utvärdera denna metods effekt. / Introduction: Missing teeth can be replaced by dental implants. To achieve good results using dental implants, it is important that there is sufficient bone volume. In cases with bone defects, simultaneous augmentation technique becomes an alternative for bone augmentation. To minimize the contamination with oral bacteria during the bone collection, preoperative rinsing with chlorhexidine is today commonly used as a step in the treatment.The aim of this study is to examine the additional effect of preoperative brushing with chlorhexidine gel on avoiding bacterial contamination during the installation of dental implants.Method: 30 patients participated in a randomized, double blinded study. 15 patients were included in the control group and 15 patients underwent an additional step in the treatment with a preoperative brushing with chlorhexidine gel. Bone samples and paperpoint samples were collected and analyzed in a laboratory and a statistic analysis was performed to compare the number of bacterial colonies in samples from the two groups (CFU/ml) present and the degree of contamination.Results: The mean bacterial count in bone samples from all patients in the control group was calculated at 8 126 CFU/ml and 2 946 CFU/ml in the test group. CFU/ml was different between the groups (P = 0.357) but the difference was not significant (P <0.05).Conclusion: Brushing with chlorhexidine gel preoperatively showed no significant effects in the bacterial contamination of bone chips. No recommendation for adding this additional step in the standard treatment with dental implants can therefore be made today.

Kidney transplant recipients must take immunosuppressive medications to prevent the rejection of their transplanted kidney. If female transplant recipients become pregnant, however, very limited data are available about the effects of these medications on their exposed offspring. This study specifically reviews two of the most commonly used immunosuppressive medications prescribed to transplant recipients, cyclosporine and tacrolimus, and evaluates physical and cognitive development of the recipients' children who were exposed to these medications in utero. Participants in this study (n = 71) were female kidney transplant recipients who (a) voluntarily consented to be part of the National Transplantation Pregnancy Registry, (b) took cyclosporine or tacrolimus while pregnant, (c) had a child who is under the age of 6 years at the time of the study, and (d) were reachable via phone. Participants were asked standardized assessment questions related to their child's cognition and physical abilities from the Development Assessment of Young Children (DAYC). Standard scores from the assessment were recorded and analyzed to show that children exposed to cyclosporine or tacrolimus showed higher cognitive scores on the DAYC compared to the normative population. Children exposed to cyclosporine also showed higher physical scores compared to the normative population. Children exposed to tacrolimus did not show significant differences in physical development from the normative population. When cyclosporine or tacrolimus are required during pregnancy, these results help provide reassurance to parents and medical care providers about the cognitive and physical development of their offspring. Practical implications for school psychologists, limitations of this research, and directions for future research were discussed. / School Psychology

The purpose of this randomized controlled trial was to determine the effects of pre-transplant music therapy on distress, pain, anxiety, mood, quality of life (QOL), and pain medication use during the preparation period for hematopoietic stem cell transplant (HSCT). Distress, the primary outcome, was measured via the Distress Thermometer. QOL was assessed with the Functional Assessment of Cancer Therapy – General 7 (FACT-G7). Participants self-rated pain and anxiety on Numeric Rating Scales (NRS) and mood on the Rogers Happy/Sad Faces Scale. Participants randomized to the experimental group received three music therapy sessions prior to stem cell infusion day. Repeated measures analysis of variance (RMANOVA) was employed to detect differences between groups for distress and QOL, and t-tests were used to detect differences between groups for pain, anxiety, and mood. Data collection is ongoing and will conclude when 50 patients have been accrued. This report presents interim data analysis, with complete data available for 23 participants. The experimental group had higher distress that was statistically significant at baseline and on Day -1. Music therapy did not affect distress but showed other limited beneficial effects. There were no differences between groups at any individual time point for pain, anxiety, or mood. At all three time points, decreases in anxiety from pre-session to post-session assessment were statistically significant in the experimental group. In the first and third music therapy session, differences between pre- and post-session mood scores were statistically significant in a positive direction. Differences in pain medication use could not be calculated because too few participants required pain medication. Although music therapy did not affect the primary outcome of distress, the positive short-term effects on anxiety and limited positive effects on mood are important to acknowledge. The small sample size likely contributed to the lack of findings on distress, although the longitudinal assessment of this outcome may have also been a factor. This study provides an initial understanding of how music therapy may be effective on distress and other variables during the pre-transplant hospitalization period for patients undergoing allogeneic HSCT, as it is the first research study to examine this treatment phase. There are few music therapy research studies with patients undergoing HSCT, which leaves many options for future research. It would be worthwhile to explore any short-term effects of music therapy on distress and QOL, as well as longitudinal effects on anxiety and mood. Optimal music therapy session duration and frequency during the pre-transplant hospitalization period remains unknown. Research opportunities exist during other phases of HSCT treatment, such as the out-patient pre-transplant period, duration of hospitalization, or post-transplant follow up. Understanding the effects of music therapy for patients suffering from Graft-Versus-Host Disease could also be beneficial as this is often debilitating and can be life-threatening. Finally, there is a need for qualitative music therapy studies with this patient population, as none currently exist but could provide additional insight for future research studies as well as clinical practice. / Music Therapy

Major depressive disorder (MDD) is a highly heterogeneous disorder, with some patients displaying immune activation and altered intestinal microbiota composition when compared to healthy controls. In recent years, the transfer of fecal microbiota pooled from several MDD patients has been used to model depression in recipient rodents. However, we have previously observed the induction of donor-specific phenotypes in mice receiving microbiota from individual irritable bowel syndrome and generalized anxiety disorder patients. Therefore, we assessed the efficacy of fecal microbiota transplant (FMT) using individual versus pooled MDD patient microbiota to induce depressive-like behaviour in recipient rodents. We observed that pooling microbiota from several patients abrogated microbial features unique to individual donors. Mice that received pooled microbiota displayed different behavioural and immune phenotypes when compared to mice that received individual patient microbiota. Two individual MDD microbiota donors, patients MDD1 and MDD5, altered the behaviour of recipient mice when compared to controls. We identified several microbial species that may underlie the anxiety- and depressive-like behaviours observed in MDD1 and MDD5 mice. Additionally, altered expression of neural and immune genes was observed along the gut-brain axis of mice colonized with MDD1 microbiota. As microglia activation may play a role in our model, we developed a protocol for the isolation and phenotyping of adult mouse microglia that will facilitate future research efforts. Overall, our results demonstrate the heterogeneity of the microbial underpinnings of MDD and support the use of individual patient microbiota in future FMT experiments. / Thesis / Master of Science (MSc)

This thesis focuses on the mapping of the microphone array’s response to match the characteristics of a human subject’s Head-Related Transfer Function (HRTF). The mapping of the response is first explored with a ‘monaural HRTF matching’ that filters the response independent of the arrival angles. For arbitrary array geometry with the listener external to the acoustic, the monaural HRTF matching did not provide listeners with enough spatial information to precisely localize sound sources. To correct this, a preprocessor control algorithm was added to the HRTF matching, a ‘binaural HRTF matching’ process. The binaural HRTF matching increased the listeners’ performance in perceiving the location of a sound source. With the addition of simulated head movement, the listeners’ perception increased by 20%. An issue with this approach is the use of HRTFs other than the listeners’ measured HRTF, creating a psychoacoustic based error in localization, i.e., front/back confusion. / Master of Science