IntroductionThere is a growing need for alternative forms of care to address citizen demands and ensure a competent healthcare workforce across municipalities and regions. One of these forms of care is the use of mobile care units. The aim of the current study was to describe physicians and nurses experiences of providing care to patients within a mobile care unit in Sweden.MethodData were collected between March 2022 and January 2023 through qualitative interviews with 14 physicians and nurses employed in various mobile care units in different regions in Sweden. These interviews were transcribed verbatim and subjected to content analysis, with the study adhering to the Standards for Reporting Qualitative Research (SRQR).ResultsThe analysis resulted in two main categories: "Unlocking the potential of mobile care", and "The challenges of moving hospitals to patients' homes"; and seven subcategories. The respondents viewed mobile care at home as highly advantageous, positively impacting both patients and caregivers. They believed their contributions enhanced patients' well-being, fostering a welcoming atmosphere. They also noted receiving more quality time for each patient, enabling thorough assessments, and promoting a person-centered approach, which resulted in more gratifying mutual relationships. However, they experienced that mobile care also had challenges such as geographical limitations, limited opening hours and logistical complexity, which can lead to less equitable and efficient care.ConclusionsPhysicians and nurses in mobile care units emphasized positive outcomes, contributing to patient well-being through a person-centered approach. They highlighted increased quality time, comprehensive assessments, and overall satisfaction, praising the mobile care unit's unique continuity for enhancing safety and fostering meaningful relationships in the patient's home environment. In order for mobile care to develop and become a natural part of healthcare, challenges such as geographical limitations and logistics need to be addressed.

AimsTo describe assistant nurses experiences of thirst and ethical challenges in relation to thirst in terminally ill patients in specialized palliative care (PC) units.DesignA qualitative, reflexive thematic design with an inductive analysis was used.MethodsData were collected during November 2021-January 2023. Twelve qualitative interviews with assistant nurses working in five different specialized PC units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. The study was guided by the Standards for Reporting Qualitative Research (SRQR).ResultsTwo main themes were found in this study. (1) A world of practice for thirst relief where assistant nurses present a task-oriented world where the knowledge of thirst is an experience-based unspoken knowledge where mainly routines rule. (2) Ethical challenges presents different ethical problems that they meet in their practice, such as when patients express thirst towards the end of their life but are too severely ill to drink or when they watch lack of knowledge in the area among other health professionals.ConclusionThirst in dying patients is a neglected area that assistant nurses work with, without communicating it. Their knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patients record. There is a need for nurses to take the lead in changing nursing practice regarding thirst.Patient or Public ContributionNo patient or public contribution.ImpactIn palliative care, previous studies have shown that dying patients might be thirsty. Assistant nurses recognize thirst in dying patients, but thirst is not discussed in the team. Nurses must consider the patients fundamental care needs and address thirst, for example in the nursing process to ensure patients quality of life in the last days of life.Reporting MethodThe study was guided by the SRQR.What does this Article Contribute to the Wider Global Clinical Community?Thirst is a distressing symptom for all humans. However, when a patient is dying, he or she loses several functions and can no longer drink independently. The knowledge from this article contributes to our understanding of current practice and shows an area that requires immediate attention for the improvement of fundamental palliative care delivery.

Background: Depression exists in mild, moderate, and severe depressive attacks.Evidence suggests that depression is linked to anemia. Several studies have establisheda correlation between depression and anemia. In previous studies, a venous blood samplewas normally used to analyze the average value of hemoglobin and parameters oferythrocytes. The current study examined full blood count (FBC) in different populationsof erythrocytes in individuals with depression (DE) compared to a healthy control group(CON).

Material and Methods: All DE, n=24 were diagnosed with DSM-IV and ICD-10. CON,n=54 served as controls. A Percoll™ gradient was used to separate erythrocytes intodifferent density fractions. In all fractions, FBC, i.e., red blood cell count (RBC),hemoglobin concentration (Hb), mean corpuscular hemoglobin (MCH), mean bodyhemoglobin concentration (MCHC) and mean body volume (MCV) were analyzed usinga CELL-DYN 4000. As a comparison, a second blood sample was also taken, where themean values of FBC were analyzed.

Results: When the mean value of FBC was analyzed, no significant difference was foundbetween the groups. In contrast, when erythrocytes were separated by density, a lesseramount of Hb was found amongst the smaller erythrocytes, i.e. fractions nos. 8-17 (p <0.05). No significant difference was found when measuring MCH and MCHC in the samedensity fractions.

Conclusion: The current study provides evidence that smaller erythrocytes that weredivided by density have less hemoglobin. However, erythrocytes which were notseparated by density i.e. mean values of hemoglobin showed no difference between thegroups. For that reason, it may be of value to perform an extended analysis oferythrocytes and hemoglobin as a complement to the average value of hemoglobin. Thismay be of value when DE patients are investigated for anemia.

IntroductionProvision of mobile care at the home of patients appears to become necessary as the population becomes increasingly older. But there are challenges in moving emergency care from hospitals to the home of patients. The aim of the study was therefore to describe the experiences of the mobile care in Sweden.MethodSemi structured interviews were conducted with 12 persons with experience of mobile care in Sweden, such as nurses, physicians, civil servants and politicians. Qualitative latent content analysis was used as an analysis method.ResultThe results show that cooperation is of utmost importance to achieve functioning mobile care. Cooperation both on an inter-organizational level and on a close team-work is required for all of the involved parties in mobile care to take on a joint responsibility for the patient. As mobile care is primarily provided to elderly multimorbid patients, a comprehensive view on patient care is required in which the patient and their relatives experience security.ConclusionMobile care is seen as a moving care that comes to the seeking person and not the other way around. The resources are distributed where they make the most use, that is, closest to the individual. Mobile care is seen as a complement to the traditional hospital care. This means a different way of working that requires close collaboration between different categories of personnel and organizations, where there should not be any discussions about boundaries, rather, the discussion should include patients needs and situation instead.

Introduction: Fibromyalgia (FMS) is a pain syndrome characterized by chronic widespread pain and hyperalgesia/allodynia. Many affected are women and risk factors are unidentified. Today, a certain number of set criteria of disease signs and symptoms must be met for the diagnosis to be made. These criteria are used because of the lack of reliable biomarkers or other medical examination. The current study examines if in vivo platelet activity varies between FMS and controls without FMS.

Material and Methods: The study involves 24 females (age 38 + 9 (SD) years) with diagnosed FMS. 25 healthy females (age 50 + 12 (SD) years) without FMS served as controls. After sampling the whole platelet population was separated according to density with a linear Percoll™, into 17 density fractions. Platelet counts was carried out in all fractions using a routine cell counter. In addition, a flow cytometer was used to measure platelet bound fibrinogen without platelet agonist, reflecting in vivo platelet activity.

Results: The study groups did not differ with respect to the distribution of platelets in the gradient. FMS sufferers demonstrated a significant higher platelet bound fibrinogen in most of the platelet density fractions. In particular, significant differences (p < 0.05) were obtained in fractions numbers 2-14 and 16. In difference, fractions numbers 1, 15 and 17 did not show any significant variance.

Discussion: This is the first study to examine in vivo platelet activity in FMS. The results indicate that FMS is associated with elevated in vivo platelet activity compared to individuals without FMS. The clinical significance and the biochemical mechanisms regarding platelet heterogeneity are still uncertain. The results stimulate further research to elucidate the importance of platelet diversity in FMS

Rationale

According to literature, the inflammatory response and platelets are associated with coronary heart disease mortality. In this study, we examine if similar relationships exist after acute cerebral infarctions.

Design

Between 2005 and 2007, individuals (n = 61) hospitalized with acute stroke were investigated 2.1 ± .3 (SD) days after hospital admission. After 9.3 ± .7 (SD) years, 29 patients (age 79 ± 8 [SD]; 12 women) had died. They were compared with survivors (age 69 ± 9 [SD]; 9 women) with respect to inflammatory parameters and platelet features such as activity and reactivity.

Results and conclusion

Inflammation and platelets at the acute event do not forecast long-term survival of stroke sufferers

Objective

Platelets may well be significant in the pathogenesis of cerebral infarction. Platelets vary substantially according to gender. The scope of our current work is to establish if female and male stroke sufferers differ regarding platelet reactivity.

Patients and methods

73 Consecutive individuals stricken by acute ischemic cerebral infarction (31 females, 42 males) participated. All stroke subtypes were included. Platelet counts was determined electronically. Platelet reactivity i.e. the presence of surface-bound fibrinogen following provocation was analyzed with a flow cytometer. ADP (1.7 μmol/L) and a thrombin receptor agonist (TRAP-6) (57 μmol/L) were the agonists used.

Results

Female stroke sufferers had higher platelet counts (p = 0.013) but their platelets were less reactive. The p values were (p = 0.038) and (p = 0.016) for ADP and TRAP-6, respectively.

Conclusion

The current study demonstrates that women suffering acute cerebral infarction have less reactive platelets. It is concluded that gender affects platelets. Our study indicates that it may be beneficial to individualize platelet inhibition of stroke sufferers according to gender.

Introduction: Alzheimers disease (AD) is a progressive form of dementia characterized by an increase in the toxic substance beta-amyloid in the brain. Platelets display a substantial heterogeneity with respect to density. They further contain a substantial amount of beta-amyloid precursor protein. Platelets take up and store serotonin (5-HT) that plays an important role in the pathogenesis of severe depression. The current study aims to investigate platelet serotonin content in different platelet density populations. Material and methods: The study involved 8 patients (age 70 +/- 8 (SD) years) (3 females/5 males) with moderate AD. 6 healthy elderly subjects (age 66 +/- 9 (SD) years) (3 females/3 males) served as controls. The platelet population was divided into 17 subpopulations according to density, using a linear Percoll (TM) gradient. Platelets were counted in all fractions. After cell lysis an ELISA technique was employed to determine the 5-HT content in each platelet subfraction. Results: The two study groups did not differ significantly regarding platelet distribution in the gradients, but AD sufferers have a significantly higher 5-HT content (p less than 0.05) in the lighter platelet populations. Discussion: AD-type dementia proved to be associated with lighter platelets containing more 5-HT. It is possible that platelets from AD patients release less 5-HT. It is speculated that AD synapses are affected in a manner comparable to platelets, which could explain why 5-HT reuptake inhibitors are less effective in AD dementia.

BACKGROUND:

The current study investigates circulating eosinophils and neutrophils in Alzheimer's (AD) type dementia with respect to density (kg/L). The existence of β-amyloid plaques in the brain is a feature of AD. Sporadic scientific reports indicate that the disease affects circulating neutrophils. In contrast, numerous publications investigate inflammatory reactions in AD brains. Locally, the plaques evoke a substantial inflammatory response involving activated microglia and astrocytes.

METHODS:

Subjects with probable AD (n = 39) were included and compared with elderly individuals (n = 22) lacking apparent memory problems. We sampled 10 mL venous blood in citrate. Granulocytes were separated according to density in linear Percoll™ gradients. Subsequently, the gradients were divided into density subfractions (n = 16). In every fraction, determination of eosinophil and neutrophil counts was carried out.

RESULTS:

AD sufferers displayed less granulocytes in fractions nos. 13-15 containing light cells. For these fractions, the P-values proved to be (P < 0·001; not significant; P = 0·03) and (P = 0·01; P = 0·01; not significant), for eosinophils and neutrophils, respectively.

CONCLUSIONS:

The present work describes that less circulating light granulocytes are a feature of AD demented individuals. It is to hypothesize that it is a sign of impaired granulocyte turnover and cell damage. It is concluded that AD affects inflammatory cells in the periphery and that the behaviour of granulocytes in dementia is worthwhile further studies.

Visualiseringsbordet är ett nytt verktyg som inte tidigare testats för anatomiundervisning. Med visualiseringsbordets hjälp kan stora mängder data från datortomografi och MR omvandlas till tredimensionella bilder som visas i naturlig storlek på en pekskärm (bordet). Bilderna kan förstoras, förminskas och roteras i tre dimensioner (3D) och kan också beskäras. Kroppens olika lager kan ”kläs av och på” med hjälp av enkla manöverknappar.¹

För att få idéer om bordets pedagogiska värde gjordes en förstudie där anatomiamanuenser vid Hälsouniversitetet fick pröva bordet. Resultaten låg till grund för några av de pilotprojekt som genomförts.

Pilotprojekt för att testa bordets pedagogiska potential har utvärderats genom enkäter och intervjuer med lärare och studenter i Linköping och i Göteborg. Pilotprojekten genomfördes i undervisningen av läkarstudenter termin 2 och 5 i Linköping och termin 4 i Göteborg samt sjuksköterskestudenter termin 1, sjukgymnaststudenter termin 1 och biomedicinska analytiker-studenter termin 3 i Linköping.

På HU har 600 studenter erbjudits möjlighet att testa visualiseringsbordet i olika samman-hang. De undervisningsmodeller som använts är: PBL basgruppsarbete om nedre extremitet, lärarledd visning av anatomiska strukturer (introduktion), uppföljning av ryggföreläsning i mindre grupper, neuromorfologi kopplat till dissektion av hjärna och neurohistologi i bas-grupp och för självstudier. I Göteborg introducerades bordet för alla läkarstudenter i termin 4i storgrupp (120 studenter) och användes därefter för anatomigenomgångar i mindre grup-per. Bordet användes även för självstudier och examination.

De utvärderingar som gjorts av pilotprojekten visar att studenterna uppskattar att arbeta vidbordet. De positiva aspekter studenter genomgående lyfter fram är:

• Realismen ”Det är på riktigt inte som i böckerna”
• Variationen – ingen kropp är den andra lik
• Motivationen ”Wow”, ”Det är bara så häftigt!”
• Förståelse för helheten ”Tänk så nära allt ligger vartannat!”
• Det egna utforskandet – att få vrida och vända själv
• Repetition – undersöka om och om igen
• Den dynamiska diskussionen runt bordet

Studenterna utvärderar således visualiseringsbordet positivt, men de flesta studenter ser visualiseringsbordet som ett komplement till andra sätt att lära anatomi. Läkarstudenter, som har mycket dissektioner, anser inte att dessa kan ersättas med undervisning med hjälp av radiologiskt material, vilket överensstämmer med andra studier^2,3.

Negativt med bordet är att mjukdelar syns dåligt. Skelett och kontrastfyllda kärl syns bra medan muskler är svårare att se. Funktionaliteten är bra men kan förbättras och det krävs engagerade lärare för att skapa bra undervisningsmoduler. Sammantaget är visualiseringsbor-det ett fascinerande undervisningsverktyg med stor potential, men fortsatt utvecklingsarbetebåde tekniskt och pedagogiskt behövs. Även Örebro Universitet arbetar med visualiserings-bordet.

Referenser

1. Lundström et al. 2011 Multi-Touch Table for Medical visualization: Application to Orthopedic Surgery Planning, IEEE Transactions on Visualization and Computer Graphics
2. Silén et al. 2008 Advanced 3D visualization in student-centered medical education, Medical Teacher
3. Andrew W et al. 2013 The Role of Radiology in Preclinical Anatomy, Academic Radiology