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Browsing Artikler, rapporter og annet (klinisk medisin) by Title
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Now showing items 186-193 of 193
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Müller, Stig; How, Ole-Jakob; Hermansen, Stig Eggen; Stenberg, Thor Allan; Sager, Georg; Myrmel, Truls (Journal article; Tidsskriftartikkel; Peer reviewed, 21-Feb-2008)[+][-]
Abstract: Introduction: Arginine vasopressin (AVP) is increasingly used to restore mean arterial pressure (MAP) in low-pressure shock states unresponsive to conventional inotropes. This is potentially deleterious since AVP is also known to reduce cardiac output by increasing vascular resistance. The effects of AVP on blood flow to vital organs and cardiac performance in a circulation altered by cardiac ischemia are still not sufficiently clarified. We hypothesised that restoring MAP by low dose, therapeutic level AVP would reduce vital organ blood flow in a setting of experimental acute left ventricular dysfunction. Methods: Cardiac output (CO) and arterial blood flow to the brain, heart, kidney and liver were measured in nine pigs using transit-time flow probes. Left ventricular pressure-volume catheter and central arterial and venous catheters were used for haemodynamic recordings and blood sampling. Transient left ventricular ischemia was induced by intermittent left coronary occlusions resulting in a 17% reduction in cardiac output and a drop in MAP from 87 ± 3 to 67 ± 4 mmHg (p < 0.001). A low-dose therapeutic level of AVP (0.005 U/kg/min) was used to restore MAP to pre-ischemic values (93 ± 4 mmHg). Results: AVP further impaired systemic perfusion (CO and brain, heart and kidney blood flow reduced by 29, 18, 23 and 34%, respectively) due to a 2.0-, 2.2-, 1.9- and 2.1-fold increase in systemic, brain, heart and kidney specific vascular resistances. The hypoperfusion induced by AVP was associated with an increased systemic oxygen extraction. Oxygen saturation in blood drawn from the great cardiac vein fell from 29 ± 1 to 21 ± 3% (p = 0.01). Finally, these effects were reversed 40 min after AVP was withdrawn. Conclusion: Low dose AVP induced a pronounced reduction in vital organ blood flow in pigs after transient cardiac ischemia. This indicates a potentially deleterious effect of AVP in patients with heart failure or cardiogenic shock due to impaired coronary perfusion. URI: http://hdl.handle.net/10037/1422 File(s) in this item: 1
article.pdf (680.5Kb) -
Bolle, Stein Roald; Gilbert, Mads; Larsen, Frank Atle; Hagen, Oddvar (Journal article; Tidsskriftartikkel; Peer reviewed, 2009)[+][-]
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Holtan, Amy; Thørnblad, Renee (Journal article; Tidsskriftartikkel, 2009)[+][-]
Abstract: Objective: Kinship foster care has become the placement of choice in the Western world. This article explores the welfare, labour-force participation, and caregiving role of kinship foster mothers in Norway.
Method: The study supplements a quantitative study of Norwegian long-term kinship and nonkinship foster care with a qualitative study of parenting in formal kinship foster care. A total of 123 kinship and 88 nonkinship foster mothers participated in the quantitative study. The qualitative data is based on interviews with 22 kinship foster mothers about their caregiving experience.
Findings: Kinship foster care in Norway can be described as gendered, in that it is usually women who assume the responsibility for relatives’ children. The economic activity of most kinship foster mothers in Norway is comparable with that of the country’s female population in general. The prevalence of single providers among kinship foster mothers is no higher than for the country as a whole. The education level of kinship foster mothers is lower than the female population average.
Conclusion: Social welfare authorities should pave the way for more men to become caregivers, and for development of the system to strengthen the position of women in relation to the their services.Description: This is a submitted (preprint) version. The article is published with altered title in European Journal of Social Work 12(2009) number 4, p. 465-478, which is available at http://dx.doi.org/10.1080/13691450902840655 URI: http://hdl.handle.net/10037/2359 File(s) in this item: 1
article.pdf (110.1Kb) -
Dybwik, Knut; Tollåli, Terje; Nielsen, Erik Waage; Brinchmann, Berit Støre (Journal article; Tidsskriftartikkel; Peer reviewed, 2010)[+][-]
Abstract: There is wide variation in the provision of home mechanical ventilation (HMV) throughout Europe, but the provision of home mechanical ventilation can also vary within countries. In 2008, the overall prevalence of HMV in Norway was 19.9/100,000, and there were huge regional differences in treatment prevalence. The aim of this study is to find explanations for these differences. We gathered multidisciplinary respondents involved in HMV treatment from five hospitals in five different counties to six focus group conversations to explore respondents’ views of their experiences systematically. We based the analysis on grounded theory. We found that uneven distribution of ‘‘enthusiasm’’ between hospitals seems to be an important factor in the geographical distribution of HMV. Furthermore, we found that the three subcategories, 'high competence,' 'spreading competence,' and 'multidisciplinary collaboration,' are developed and used systematically in counties with 'enthusiasm.' This culture is the main category, which might explain the differences, and is described as 'wise enthusiasm.' The last subcategory is 'individual attitudes' about HMV among decision-making physicians. The most important factor is most likely the uneven distribution of highly skilled enthusiasm between hospitals. Individual attitudes about HMV among the decision makers may also explain why the provision of HMV varies so widely. Data describing regional differences in the prevalence of HMV within countries is lacking. Further research is needed to identify these differences to ensure equality of provision of HMV. Description: This paper is part of Knut Dybwig's doctoral thesis. Available in Munin at http://hdl.handle.net/10037/3692 URI: http://hdl.handle.net/10037/3839 File(s) in this item: 1
article.pdf (143.2Kb) -
Solberg, Tore; Sørlie, Andreas; Sjåvik, Kristin; Nygaard, Øystein Petter; Ingebrigtsen, Tor (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: Loss to follow-up may bias the outcome assessments of clinical registries. In this study, we wanted to determine whether outcomes were different in responding and non-responding patients who were included in a clinical spine surgery registry, at two years of follow-up. In addition, we wanted to identify risk factors for failure to respond. 633 patients who were operated for degenerative disorders of the lumbar spine were followed for 2 years using a local clinical spine registry. Those who did not attend the clinic and those who did not answer a postal questionnaire—for whom 2 years of outcome data were missing—and who would be lost to follow-up according to the standard procedures of the registry protocols, were defined as non-respondents. They were traced and interviewed by telephone. Outcome measures were: improvement in health-related quality of life (EQ-5D), leg pain, and back pain; and also general state of health, employment status, and perceived benefits of the operation. We found no statistically significant differences in outcome between respondents (78% of the patients) and nonrespondents (22%). Receipt of postal questionnaires (not being summoned for a follow-up visit) was the strongest risk factor for failure to respond. Forgetfulness appeared to be an important cause. Older patients and those who had complications were more likely to respond. Interpretation A loss to follow-up of 22% would not bias conclusions about overall treatment effects and, importantly, there were no indications of worse outcomes in non-respondents. URI: http://hdl.handle.net/10037/3955 File(s) in this item: 1
article.pdf (270.7Kb) -
Hamran, Torunn (Journal article; Tidsskriftartikkel; Peer reviewed, 2007)[+][-]
Abstract: Scandinavian welfare research has paid more and more attention to the role played by women in building institutions for children, the sick and the elderly. The new institutions were generally called ”homes” and it was precisely this linkage between women and homes that may have led to clear perceptions of what the new ”homes” were like. Concepts like motherliness, homeliness and intimacy are presented as important characteristics, despite (or because of ) the lack of empirical evidence. Historical research has shown that the home was highly idealised around the turn of the last century, but this idealisation was prescriptive and did not necessarily reflect real homes. The aim of this article is to argue that an institution, or any social system, cannot be perceived in isolation from the particular parties that created them – or from the place where they were created. Only then is it possible to say something about which or whose concept of a home was (attempted) realised. A phenomenological perspective on the home will often take as its starting point people’s need for identity, intimacy, security and meaningfulness. From a sociological point of view, the aspects that phenomenology pinpoints as important are created through time-consuming work and relevant categories can be connected with how the work is organised. ”A home” can be a lot of things, so the analysis must draw on both material, structural and symbolic aspects. URI: http://hdl.handle.net/10037/1224 File(s) in this item: 1
article.pdf (158.2Kb) -
Elstad, Ingunn (Chapter; Bokkapittel, 2007)[+][-]
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Dybwik, Knut; Tollåli, Terje; Nielsen, Erik Waage; Brinchmann, Berit Støre (Journal article; Tidsskriftartikkel; Peer reviewed, 2011)[+][-]
Abstract: An increasing number of individuals with complex health care needs now receive life-long and lifeprolonging ventilatory support at home. Family members often take on the role of primary caregivers. The aim of this study was to explore the experiences of families giving advanced care to family members dependent on home mechanical ventilation. Using qualitative research methods, a Grounded Theory influenced approach was used to explore the families’ experiences. A total of 15 family members with 11 ventilator-dependent individuals (three children and eight adults) were recruited for 10 in-depth interviews. The core category, “fighting the system,” became the central theme as family members were asked to describe their experiences. In addition, we identified three subcategories, “lack of competence and continuity”, “being indispensable” and “worth fighting for”. This study revealed no major differences in the families’ experiences that were dependent on whether the ventilator-dependent individual was a child or an adult. These findings show that there is a large gap between family members’ expectations and what the community health care services are able to provide, even when almost unlimited resources are available. A number of measures are needed to reduce the burden on these family members and to make hospital care at home possible. In the future, the gap between what the health care can potentially provide and what they can provide in real life will rapidly increase. New proposals to limit the extremely costly provision of home mechanical ventilation in Norway will trigger new ethical dilemmas that should be studied further. Description: This article is part og Knut Dybwig's doctoral thesis. Available in Munin at http://hdl.handle.net/10037/3692 URI: http://hdl.handle.net/10037/3841 File(s) in this item: 1
article.pdf (233.8Kb)
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