Patienters livskvalitet efter coronar arteriell bypass-operation : En litteraturstudie

Introduktion: Coronar arteriell bypass-operation (CABG) är en stor operation som ofta innebär större livsstilsförändringar för patienten. Sjuksköterskan behöver vara medveten om de delar i livskvaliteten som påverkas efter CABG för att kunna förebygga eventuella försämringar i livskvaliteten. Syfte: Syftet med litteraturstudien var att belysa livskvaliteten hos patienter som genomgått coronar arteriell bypass-operation. Metod: Litteraturstudien genomfördes enligt Polit & Becks niostegsmodell. Litteratursökningar genomfördes i databaserna CINAHL och PubMed. Artiklarna genomgick en urvalsprocess och kvalitetsgranskning. Vid slutförd granskning återstod 10 artiklar där två huvudteman växte fram. Resultat: Resultatet redovisades i två huvudteman med tillhörande underteman. Det första huvudtemat var Patientens funktionalitet med undertemana Förekomst eller frånvaro av kroppsliga symtom och Känslor, ångest och depression. Det andra huvudtemat var Patientens sociala tillvaro med undertemana Stöd och förtroende och Socioekonomisk status. Slutsats: Många patienter upplevde en förbättring i livskvaliteten. Patienternas livskvalitet innan operationen hade betydelse för hur livskvaliteten blev efter. Sjuksköterskan behöver fokusera på att patienten får tillräckligt med information och stöd innan och efter operationen för att patienten inte ska ha orealistiska förväntningar av hur livskvaliteten kommer att bli efter operationen.

Regionen och EU? : Uppfattningar och attityder till EU-relaterade frågor i Västsverige

This thesis explores perceptions and preferences on regional action in EU-related frameworks among regional actors in Western Sweden. Building upon the literature on Europeanisation and the Fusion approach, three dimensions of Europeanisation are clarified and explored– download, upload and crossload – and together with a set of five variables that constitute the Micro Fusion Framework; a comprehensive analytical tool is developed. The thesis analyses the intense debate among the members of West Sweden that took place from 2011 to 2013 that focused on how to functionally organise the regional office in Brussels in order to meet future challenges. Surprisingly, the members eventually decided to terminate their cooperation and close the jointly owned office in Brussels in spite of the fact that it has been widely regarded as successful and effective. Diverging perceptions and preferences is understood in terms of three positions on regional action; a download-, upload- and a coherent oriented position. Finally, the thesis presents the empirical findings and discusses in relation to three fusion scenarios, infusion, defusion and clustered fusion. In terms of Micro Fusion Framework, the dynamics shaping why West Sweden was finally regarded as a dysfunctional arena for regional action are explained by a shift of attention and action among regional actors in Western Sweden that led to pressure for further institutional adaptation in order to meet the demand of how ‘to get the best out of the EU’. Further, this redefinition of how to handle EU-affairs within the upload-oriented position was accompanied by positive attitudes towards the potential to bypass the state and thereby pursue regional priorities directly in Brussels given the compound nature of the EU. In contrast, those regional actors that are found to be more download-oriented often question the benefits of uploading activities in practice and advocate close relations to the state. A coherent oriented position recognises the importance of activities related to both of the vertical dimensions of Europeanisation.

Atlantic salmon in regulated rivers : Migration, dam passage, and fish behavior

Hydropower dams block migration routes and disrupt longitudinal connectivity in rivers, thereby posing a threat to migratory fish species. Various fish passage solutions have been implemented to improve connectivity with varying success. A well-functioning passage solution must ensure safe and timely passage routes that are used by a substantial portion of the migrating fish. In this thesis, I report the results from telemetry studies where the behavior and survival of migrating Atlantic salmon spawners, post-spawners and smolts have been evaluated in relation to hydropower dam passage. I evaluate downstream passage performance at dams with no passage solutions in the River Klarälven, and with simple passage solutions in in the Winooski River. In the River Ätran, I study both upstream- and downstream passage performance at a dam with sophisticated passage solutions based on the best available technology. In addition, I have studied the survival and behavior of post-spawners and hatchery-released smolts. A substantial portion of the spawners survived spawning and initiated downstream migration. Most males migrated downstream in autumn following spawning, whereas females tended to stay in the river until spring. For hatchery-reared smolts, early release was associated with faster initiation of migration and higher survival compared to late release. Multiple dam passage resulted in high mortality for both smolts and kelts. For smolts, dam passage, even with simple passage solutions, was associated with substantial delay and mortality. High spill levels were linked to high survival and short delay for downstream migrating salmon. The best available passage solution, which consisted of a nature-like fishway and a low sloping intake rack to guide fish to a bypass, resulted in rapid passage of a large portion of the adult migrants.