Virkjum sjúklinga til að ræða um framtíðina og meðferðarmarkmið

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Bilið brúað milli bráðadeildar og hefðbundinnar göngudeildar þjónust: reynslan af sérhæfðri endurhæfingardeild (D28)

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Endurhæfing einstaklinga með alvarlega geðfötlun er flókið og margbreytilegt ferli sem tekur á öllum þáttum meðferðar. Hún krefst þolinmæði og fagmennsku margra meðferðaraðila. Frá upphafi verður að gera ráð fyrir löngu bataferli (1) Ýmis áföll og sjúkdómar geta orðið til þess að skjólstæðingur getur ekki nýtt hæfileika sína og getu til þess að sjá sér farborða og staðist kröfur samfélagsins. Heilsa og heilsuleysi er oft sett fram sem andstæður en í raun er heilsuleysi oft einskonar ferli, veikleiki á einhverju sviði sem birtist og þróast við vissar aðstæður og á þetta ekki síst við um marga geðsjúkdóma (1). Í þessum tilvikum er sjúkdómurinn hluti af lífi þessa fólks. Ljóst er að þegar sjúkdómurinn hindrar virka þátttöku einstaklinga í samfélaginu, er árangursrík meðferð og endurhæfing ásamt eftirfylgni forsenda þess að þeir geti aðlagast samfélaginu að nýju. Þannig má segja að endurhæfing feli í sér tvo megin þætti. Annars vegar meðferð sjúkdómsins sem hindrar sjúklinginn í þátttöku í eðlilegu lífi og hins vegar vinnu sjúklingsins að eigin aðlögun að samfélaginu og ábyrgð á eigin lífi. Einnig er mikilvægt að tekið sé tillit til þjóðfélagslegra aðstæðna. Áríðandi er að læknismeðferð og vinna þverfaglegra hópa meðferðaraðila sé stunduð samhliða, í nánu samstarfi við skjólstæðinginn og aukin áhersla sé lögð á reglulega eftirfylgni (2). Nú í dag eru til fjölmargar aðferðir og áætlanir fyrir endurhæfingu. Margar grundvallarreglur og einstakir þættir þeirra eru hluti af flestum áætlunum og hér á eftir eru settar fram nokkrar grunnreglur og hugtök úr ólíkum meðferðaráætlunum sem hafa mótað starfið á deild 28 (3). Allt fólk hefur getu til að þroskast og þeir sem búa við hindranir vegna sjúkdómseinkenna, geta bætt líkamlega og tilfinningalega hæfni sína

Áhrif hreyfingar á þunglyndi og kvíða, samanburður við sálfræðimeðferð

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadDepression and anxiety are common illnesses in our society. In fact, depression is the leading cause of disability in the world. Having good treatment options for those that suffer from anxiety and depression is important. The most common form of treatment is pharmacological treatment and psychological treatment. In recent years, research has shown good results on the use of exercise to treat depression and anxiety. The goal of this research was to study the effects an eight-week group exercise program would have on a group of people with depression and anxiety, and to compare the results to the results of a study that used a transdiagnostic cognitive behavioural therapy (TCBT) to treat groups of people with depression and anxiety. Participants exercised three times a week for eight weeks and answered questionnaires (BDI-II, BAI, CORE-OM, PSS og QOLS), at four intervals: at baseline, after four weeks, immediately after the intervention and at a three month follow up. The exercise was composed of endurance exercise three times a week at 60-80% of maximum heart rate and strength training twice a week. There was an increase in the time exercised and the difficulty level of the strength training the further into the exercise program. The results showed significant improvements on both de - pression and anxiety symptoms, and when compared to TCBT the effects of exercise were slightly better than TCBT

Frequency of symptoms and drug treatment among dying patients in the last 24 hours of life at Landspitali

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnInngangur: Tilgangur rannsóknarinnar er að meta tíðni 5 algengra einkenna og meðferð þeirra á síðasta sólarhring lífs hjá deyjandi sjúklingum á 11 lyflækningadeildum Landspítala og 7 hjúkrunarheimilum. Efniviður og aðferðir: Upplýsingum var safnað afturskyggnt úr skráningu í Meðferðarferli fyrir deyjandi sjúklinga í sjúkraskrá, af lyfjablöðum og úr lyfjafyrirmælakerfinu Therapy hjá 232 einstaklingum sem létust árið 2012. Niðurstöður: Um helmingur einstaklinganna lést á Landspítala (n=119) og var kynjahlutfall jafnt en 70% þeirra sem létust á hjúkrunarheimilum voru konur. Meðferðarferli fyrir deyjandi sjúklinga var tekið í notkun í 50% andláta á Landspítala og 58% á hjúkrunarheimilum. Í 45% tilvika var ferlið notað í sólarhring eða skemur fyrir andlát. Algengustu einkenni á síðasta sólarhring lífs voru verkir (51%), óróleiki (36%) og hrygla (36%). Tíðni einkenna var svipuð milli stofnana og sjúkdómahópa en marktækur munur var á óróleika hjá sjúklingum með krabbamein og sjúklingum með aðra sjúkdóma. Tæp 81% sjúklinga voru fast á morfínskyldum lyfjum, fastir morfínskammtar og skammtar gefnir eftir þörfum voru marktækt hærri hjá krabbameinssjúklingum og sjúklingum á Landspítala. Fastar lyfjagjafir við óróleika voru halóperidól (45%), díasepam (40%) og mídazólam (5%). Scopoderm-plástur var gefinn við hryglu hjá 70% sjúklinga. Ályktun: Töluverður fjöldi sjúklinga var með einkenni á síðasta sólarhring lífs, bæði á Landspítala og hjúkrunarheimilum. Niðurstöðurnar benda til þess að þörf sé á að yfirfara og bæta einkennameðferð, meðal annars með því að aðlaga betur morfínskammta að þörfum sjúklingsins, nota fasta skammta róandi lyfja við óróleika og nýta fleiri andkólínvirk lyf við hryglu.Introduction: The purpose of this study was to evaluate the frequency of 5 common symptoms and drug treatments prescribed and given in the last 24 hours of life in 11 medical units at Landspitali National University Hospital of Iceland (LUH) and in 7 nursing homes (NH). Material and methods: Data was collected retrospectively from 232 charts of patients who died in 2012, using documentation in the Liverpool Care Pathway (LCP) and the medication management system. Results: About half of the patients died at LUH with similar gender ratio but 70% of patients in NH were women. The LCP was used for 50% of all deaths at LUH and 58% in NH. In 45% of all deaths LCP was used for 24 hours or less. The most common symptoms were pain (51%), agitation (36%) and respiratory tract secretions (36%). Frequency of symptoms was similar between institutions and age groups. Cancer patients had significantly higher incidence of agitation and were prescribed and given higher doses of morphine compared to other groups. Regular medication for agitation was haloperidol (45%), diazepam (40%) and midazolam (5%). Close to 70% of the patients were treated with a scopolamin patch for death rattle. Conclusion: A large number of patients have symptoms in the last 24 hours of life both in hospital and in nursing homes. Symptom control can be improved by adjusting morphine doses to patients need, using regular doses of benzodiazepine for agitation and better use of anticholinergic medication for death rattle.Vísindasjóður Landspítala og Vísindasjóður Félags íslenskra hjúkrunarfræðing

Risky Obliviousness Within Fragmented Services: Experiences of Families With Disabled Children During the Covid‐19 Pandemic

Living on an island in a pandemic has its obvious advantages. However, in a globalised economy, border restrictions cannot keep the COVID‐19 virus completely at bay. Despite coordinated efforts at infection control and extensive vaccination, Iceland, a sparsely populated island in the north, was placed among the countries in the highest risk category by the ECDC. In this article, wereport a qualitative study carried out at the peak of the fourth COVID‐19 wave in 2021, when the pandemic had severely hit the Icelandic social and healthcare system, with a record‐breaking number of infections. Semi‐structured interviews were conducted with parents with seven disabled children. Guided by feminist standpoint theory and critical disability studies, we focused on how service structures affected and shaped parents’ and children’s experiences during the first waves of the pandemic. The findings suggest that the pandemic intensified the already precarious position of the families. During the pandemic, the gaps in the already fragmented services widened, and the families were left to navigate this new reality on their own. Preventive measures enforced by municipalities and healthcare services centred on non‐disabled people’s experiences and needs. Unprepared service systems distanced themselves from the families while maintaining governance and supervision over defining their need for support

Use and impact of external evaluation feedback in schools

Funding Information: None. Publisher Copyright: © 2022 The AuthorsPast findings concerning whether and how feedback from external evaluations benefit the improvement of schools are inconsistent and sometimes even conflicting, which highlights the contextual nature of such evaluations and underscores the importance of exploring them in diverse contexts. Considering that broad international debate, we investigated the use and impact of feedback from external evaluations in compulsory schools in Iceland, particularly as perceived by principals and teachers in six such schools. A qualitative research design was adopted to examine changes in the schools made during a 4–6-year period following external evaluations by conducting interviews with principals and teachers, along with a document analysis of evaluation reports, improvement plans and progress reports. The findings reveal that feedback from external evaluations has been used for instrumental, conceptual, persuasive and reinforcement-oriented purposes in the schools, albeit to varying degrees. According to the principals and teachers, the improvement actions presented in the schools’ improvement plans were generally implemented or continue to be implemented in some way, and the changes made have mostly been sustained.Peer reviewe

Meðferðarferli fyrir deyjandi sjúklinga

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Innan heilbrigðiskerfisins er sífellt verið að leita leiða til að tryggja sem best gæði þeirra þjónustu sem er veitt. Í mörgum nágrannalöndum okkar hefur verið lögð áhersla á að veita öndvegisþjónustu við lok lífs bæði á líknarheimilum (e. hospice) og á líknardeildum (e. palliative care units) og hefur Bretland verið þar fremst í flokki. Hins vegar deyr þar á landi einungis lítill hluti sjúklinga á líknarheimilum eða líknardeildum (4% árið 2003) en um 56% á sjúkrahúsum (Murphy o.fl., 2007). Til samanburðar áttu 53% andláta sér stað á sjúkrahúsum á Íslandi árið 2008 og um 8% allra andláta á landinu voru á líknardeildunum tveimur á Landspítala (LSH). Í Bretlandi þótti mikilvægt að koma hugmyndafræði og skipulagi umönnunar og meðferðar, sem veitt er á líknarheimilum, yfir á aðrar stofnanir þar sem sjúklingar deyja. Liverpool Care Pathway for the dying, sem þýtt hefur verið á íslensku meðferðarferli fyrir deyjandi sjúklinga, var þróað sem samstarfsverkefni milli Marie Curie Cancer Care stofnunarinnar í Liverpool og Háskólans í Liverpool. Markmið þess var að færa hugmyndafræði líknar um umönnun og meðferð sjúklinga síðustu klukkustundir eða daga lífsins frá líknarheimilum yfir á aðrar stofnanir, svo sem sjúkrahús og öldrunarstofnanir. Með meðferðarferlinu er reynt að tryggja deyjandi sjúklingum ákveðin gæði í umönnun og meðferð við lok lífs, sama hvar þeir liggja, sem og að tryggja stuðning við aðstandendur bæði fyrir og eftir andlát ástvinar þeirra. Á sama tíma er stefnt að því að auka þekkingu og færni heilbrigðisstarfsfólks varðandi umönnun og meðferð á síðustu dögum lífs (Ellershaw og Wilkinson, 2003; Jack o.fl., 2003; Gambles o.fl., 2006)

Analysis of stimulant drugs in the wastewater of five Nordic capitals

Publisher's version (útgefin grein)Wastewater-based epidemiology is an efficient way to assess illicit drug use, complementing currently used methods retrieved from different data sources. The aim of this study is to compare stimulant drug use in five Nordic capital cities that include for the first time wastewater samples from Torshavn in the Faroe Islands. Currently there are no published reports that compare stimulant drug use in these Nordic capitals. All wastewater samples were analyzed using solid phase extraction and ultra-high performance liquid chromatography coupled to tandem mass spectrometry. The results were compared with data published by the European Monitoring Centre for Drugs and Drug Addiction based on illicit drugs in wastewater from over 50 European cities. Confirming previous reports, the results showed high amphetamine loads compared with other European countries. Very little apparent abuse of stimulant drugs was detected in Torshavn. Methamphetamine loads were the highest from Helsinki of the Nordic countries, indicating substantial fluctuations in the availability of the drug compared with previous studies. Methamphetamine loads from Oslo confirmed that the use continues to be high. Estimated cocaine use was found to be in the lower range compared with other cities in the southern and western part of Europe. Ecstasy and cocaine showed clear variations between weekdays and weekends, indicating recreational use. This study further demonstrates geographical trends in the stimulant drug market in five Nordic capitals, which enables a better comparison with other areas of the continent.We wish to acknowledgesupport by COST (EuropeanCooperation inScience and Technology) [Grant number ES1307], as well as the Icelan-dic Research Fund [Grant number 163049-051] and the University ofIceland Research Fund [Grant number HI17060092].Peer Reviewe

Generalizable Deep Learning-Based Sleep Staging Approach for Ambulatory Textile Electrode Headband Recordings

Publisher Copyright: © 2013 IEEE.Reliable, automated, and user-friendly solutions for the identification of sleep stages in home environment are needed in various clinical and scientific research settings. Previously we have shown that signals recorded with an easily applicable textile electrode headband (FocusBand, T 2 Green Pty Ltd) contain characteristics similar to the standard electrooculography (EOG, E1-M2). We hypothesize that the electroencephalographic (EEG) signals recorded using the textile electrode headband are similar enough with standard EOG in order to develop an automatic neural network-based sleep staging method that generalizes from diagnostic polysomnographic (PSG) data to ambulatory sleep recordings of textile electrode-based forehead EEG. Standard EOG signals together with manually annotated sleep stages from clinical PSG dataset (n = 876) were used to train, validate, and test a fully convolutional neural network (CNN). Furthermore, ambulatory sleep recordings including a standard set of gel-based electrodes and the textile electrode headband were conducted for 10 healthy volunteers at their homes to test the generalizability of the model. In the test set (n = 88) of the clinical dataset, the model's accuracy for 5-stage sleep stage classification was 80% (κ = 0.73) using only the single-channel EOG. The model generalized well for the headband-data, reaching 82% (κ = 0.75) overall sleep staging accuracy. In comparison, accuracy of the model was 87% (κ = 0.82) in home recordings using the standard EOG. In conclusion, the CNN model shows potential on automatic sleep staging of healthy individuals using a reusable electrode headband in a home environment.Peer reviewe

Deep learning-based algorithm accurately classifies sleep stages in preadolescent children with sleep-disordered breathing symptoms and age-matched controls

Funding Information: This study was funded by Nordforsk (NordSleep, no. 90458) via Business Finland (no. 5133/31/2018) and via the Icelandic Centre for Research, the Icelandic Research Fund (no. 174067), the Landspitali University Hospital Science Fund 2019 (no. 893831), the European Union’s Horizon 2020 Research and Innovation Programme (grant no. 965417), the National Health and Medical Research Council (NHMRC) of Australia (project nos. 2001729 and 2007001), the Academy of Finland (project no. 323536), the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (project nos. 5041794 and 5041803), and the Finnish Anti-Tuberculosis Association and the Research Foundation of the Pulmonary Diseases. The birth cohort study was funded by the European Commission: (a) under the 6th Framework Program (FOOD-CT-2005-514000) within the collaborative research initiative “EuroPrevall” and (b) under the 7th Framework Program (FP7-KBBE-2012-6; grant agreement no. 312147) within the collaborative project “iFAAM.” Additional funds were received by the Icelandic birth cohort center from Landspitali University Hospital Science Fund, and GlaxoSmithKline Iceland. The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication. Publisher Copyright: Copyright © 2023 Somaskandhan, Leppänen, Terrill, Sigurdardottir, Arnardottir, Ólafsdóttir, Serwatko, Sigurðardóttir, Clausen, Töyräs and Korkalainen.INTRODUCTION: Visual sleep scoring has several shortcomings, including inter-scorer inconsistency, which may adversely affect diagnostic decision-making. Although automatic sleep staging in adults has been extensively studied, it is uncertain whether such sophisticated algorithms generalize well to different pediatric age groups due to distinctive EEG characteristics. The preadolescent age group (10-13-year-olds) is relatively understudied, and thus, we aimed to develop an automatic deep learning-based sleep stage classifier specifically targeting this cohort. METHODS: A dataset (n = 115) containing polysomnographic recordings of Icelandic preadolescent children with sleep-disordered breathing (SDB) symptoms, and age and sex-matched controls was utilized. We developed a combined convolutional and long short-term memory neural network architecture relying on electroencephalography (F4-M1), electrooculography (E1-M2), and chin electromyography signals. Performance relative to human scoring was further evaluated by analyzing intra- and inter-rater agreements in a subset (n = 10) of data with repeat scoring from two manual scorers. RESULTS: The deep learning-based model achieved an overall cross-validated accuracy of 84.1% (Cohen's kappa κ = 0.78). There was no meaningful performance difference between SDB-symptomatic (n = 53) and control subgroups (n = 52) [83.9% (κ = 0.78) vs. 84.2% (κ = 0.78)]. The inter-rater reliability between manual scorers was 84.6% (κ = 0.78), and the automatic method reached similar agreements with scorers, 83.4% (κ = 0.76) and 82.7% (κ = 0.75). CONCLUSION: The developed algorithm achieved high classification accuracy and substantial agreements with two manual scorers; the performance metrics compared favorably with typical inter-rater reliability between manual scorers and performance reported in previous studies. These suggest that our algorithm may facilitate less labor-intensive and reliable automatic sleep scoring in preadolescent children.Peer reviewe