Choosing to live with home dialysis-patients' experiences and potential for telemedicine support: a qualitative study

<p>Abstract</p> <p>Background</p> <p>This study examines the patients' need for information and guidance in the selection of dialysis modality, and in establishing and practicing home dialysis. The study focuses on patients' experiences living with home dialysis, how they master the treatment, and their views on how to optimize communication with health services and the potential of telemedicine.</p> <p>Methods</p> <p>We used an inductive research strategy and conducted semi-structured interviews with eleven patients established in home dialysis. Our focus was the patients' experiences with home dialysis, and our theoretical reference was patients' empowerment through telemedicine solutions. Three informants had home haemodialysis (HHD); eight had peritoneal dialysis (PD), of which three had automated peritoneal dialysis (APD); and five had continuous ambulatory peritoneal dialysis (CAPD). The material comprises all PD-patients in the catchment area capable of being interviewed, and all known HHD-users in Norway at that time.</p> <p>Results</p> <p>All of the interviewees were satisfied with their choice of home dialysis, and many experienced a normalization of daily life, less dominated by disease. They exhibited considerable self-management skills and did not perceive themselves as ill, but still required very close contact with the hospital staff for communication and follow-up. When choosing a dialysis modality, other patients' experiences were often more influential than advice from specialists. Information concerning the possibility of having HHD, including knowledge of how to access it, was not easily available. Especially those with dialysis machines, both APD and HHD, saw a potential for telemedicine solutions.</p> <p>Conclusions</p> <p>As home dialysis may contribute to a normalization of life less dominated by disease, the treatment should be organized so that the potential for home dialysis can be fully exploited. Pre-dialysis information should be unbiased and include access to other patients' experiences. Telemedicine may potentially facilitate a communication-based follow-up and improve safety within the home setting, making it easier to choose and live with home dialysis.</p

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Trends in maternal use of snus and smoking tobacco in pregnancy. A register study in southern Norway

Background: The use of tobacco products including Swedish snus (moist snuff) in pregnancy may cause adverse health outcomes. While smoking prevalence has decreased among fertile women in Norway, snus use has increased during the last years. We investigated whether these trends were reflected also during pregnancy in a population of women in Southern Norway. Methods: Data on smoking tobacco and snus use at three time points before and during pregnancy for 20,844 women were retrieved from the electronic birth record for the years 2012–2017. The results for the three-year period 2015–2017 were compared with a previously studied period 2012–2014. Prevalence and quit rates of tobacco use within groups of age, parity and education were reported. Within the same groups adjusted quit rates were analyzed using logistic regression. Mean birthweight and Apgar score of offspring were calculated for tobacco-users and non-users. Results: There was an increase of snus use before pregnancy from the period 2012–2014 to the period 2015–2017 from 5.1% (CI; 4.6 to 5.5) to 8.4% (CI; 7.8 to 8.9). Despite this, the use of snus during pregnancy did not increase from the first to the second period, but stabilized at 2.8% (CI; 2.5 to 3.2) in first trimester and 2.0% (CI; 1.7 to 2.2) in third trimester. Cigarette smoking decreased significantly both before and during pregnancy. Snus use and smoking during pregnancy were associated with a reduction in average birthweight, but no significant effects on Apgar scores. Odds ratios for quitting both snus and smoking tobacco during pregnancy were higher for women aged 25–34 years, for the primiparas and for those with a high level of education. Pregnant women were more likely to have quit tobacco use in the last time period compared to the first. Conclusions: While smoking during pregnancy was decreasing, the use of snus remained constant, levelling off to around 3% in first trimester and 2% in third trimester. Approximately 25% of those that used snus, and 40% that smoked before pregnancy, continued use to the third trimester. This calls for a continuous watch on the use of snus and other nicotine products during pregnancy

Trends in maternal use of snus and smoking tobacco in pregnancy. A register study in southern Norway

Background: The use of tobacco products including Swedish snus (moist snuff) in pregnancy may cause adverse health outcomes. While smoking prevalence has decreased among fertile women in Norway, snus use has increased during the last years. We investigated whether these trends were reflected also during pregnancy in a population of women in Southern Norway. Methods: Data on smoking tobacco and snus use at three time points before and during pregnancy for 20,844 women were retrieved from the electronic birth record for the years 2012–2017. The results for the three-year period 2015–2017 were compared with a previously studied period 2012–2014. Prevalence and quit rates of tobacco use within groups of age, parity and education were reported. Within the same groups adjusted quit rates were analyzed using logistic regression. Mean birthweight and Apgar score of offspring were calculated for tobacco-users and non-users. Results: There was an increase of snus use before pregnancy from the period 2012–2014 to the period 2015–2017 from 5.1% (CI; 4.6 to 5.5) to 8.4% (CI; 7.8 to 8.9). Despite this, the use of snus during pregnancy did not increase from the first to the second period, but stabilized at 2.8% (CI; 2.5 to 3.2) in first trimester and 2.0% (CI; 1.7 to 2.2) in third trimester. Cigarette smoking decreased significantly both before and during pregnancy. Snus use and smoking during pregnancy were associated with a reduction in average birthweight, but no significant effects on Apgar scores. Odds ratios for quitting both snus and smoking tobacco during pregnancy were higher for women aged 25–34 years, for the primiparas and for those with a high level of education. Pregnant women were more likely to have quit tobacco use in the last time period compared to the first. Conclusions: While smoking during pregnancy was decreasing, the use of snus remained constant, levelling off to around 3% in first trimester and 2% in third trimester. Approximately 25% of those that used snus, and 40% that smoked before pregnancy, continued use to the third trimester. This calls for a continuous watch on the use of snus and other nicotine products during pregnancy

A qualitative description of telemedicine for acute stroke care in Norway: technology is not the issue

BACKGROUND: To assist small hospitals in providing advanced stroke treatment, the Norwegian Directorate of Health has recommended telemedicine services. Telestroke enables specialists to examine patients via videoconferencing supplemented by teleradiology and to provide decision support to local health care personnel. There is evidence that telestroke increases thrombolysis rates. In Norway, telemedicine has mainly been used in non-critical situations. The first telestroke trials took place in 2008. The aim of this paper is to present an overview of telestroke trials and today’s status with telestroke in Norway. Based on the divergent experience from two health regions in Norway, the paper discusses crucial factors for the integration of telestroke in clinical practice. METHODS: This is a descriptive study based on multiple methods to obtain an overview of the practice and experience with telestroke in Norway. A Web and literature search for ‘telestroke in Norway’ was performed and compared with a survey of telemedicine services at the country's largest hospitals. These findings were supplemented by interviews with key personnel involved in telestroke in two of four health regions, as well as hospital field observations and log data of telestroke transmissions from five of the hospitals involved. RESULTS: In Norway, experience in telemedicine for acute stroke care is limited. At the beginning of 2014, three of four regional health authorities were working with telestroke projects and services. Integration of the service in practice is challenging, with varying experience. The problems are not attributed to the technology in itself, but to organization (availability of staff on duty 24/7 and surveillance of the systems), motivation of staff, logistics (patient delay), and characteristics of the buildings (lack of space). CONCLUSIONS: Prerequisites for successful integration of telestroke in clinical practice include realization of the collaboration potential in the technology with consistent procedures for training and triage, availability of the equipment, and providing advice beyond questions concerning thrombolysis

Bru - Torskenpakken

Bacheloroppgave - Høgskolen i Oslo og Akershus, Institutt for bygg- og energiteknikkGrunnet rasfare har Statens Vegvesen bestemt at det må utarbeides alternative vegløsninger til Fylkesveg 243 i Torsken Kommune. I den forbindelse ble det deriblant fremmet to fjordkrysningsalternativer som gjøres ved hjelp av fylling og bru. Denne oppgaven tar for seg dimensjonering av eget brudesign, som skal være en del av det ene fjordkrysningsalternativet. Oppgaven vil starte med å gi en oversikt over grunnlaget for oppgaven. Deretter vil oppgaven gå over i en inspirasjonsfase hvor ulike brutyper blir belyst og vurdert med tanke på estetikk. Det vil så velges to brutyper som analyseres statisk og geometrisk. I denne analysen vil de to brutypene utformes på ulike måter for å finne den mest gunstige utformingen. Deretter vil bruene dimensjoneres etter gitte krav, for så å bli sammenlignet og vurdert opp mot hverandre. Kriteriene som vil ligge til grunn for sammenligningen av bruene er estetikk, vekt, transport og montasje samt vedlikehold. Til slutt vil det bli konkludert med hvilken bru som egner seg best som en del av fjordkrysningen over Sifjorden

Mangelfull kommunikasjon om legemiddelbruk i primærhelsetjenesten

Beskriver en kvalitativ studie hvor hensikten var å undersøke informasjonsutveksling mellom fastlege, kommunehelsetjenesten og sykehus.Bakgrunn: legemiddelbruk i primærhelsetjenesten involverer mange personer: legen som ordinerer, ulike typer helsepersonell som håndterer legemidlene og pasientene selv. Vi ønsket å studere sider ved feilmedisinering knyttet til mangelfull kommunikasjon mellom ulike behandlere, pleiepersonell og pasienter. Materiale og metode: vi foretok semistrukturerte intervjuer med et tilfeldig utvalg leger og legesekretærer ved ni av fastlegekontorene i Tromsø kommune og av et strategisk utvalg av helsepersonell. Vi foretok observasjon ved et utvalg av sykehjem og enheter i hjemmetjenesten. Observasjonene ble loggført, intervjuene tatt opp på bånd og transkribert og materialet analysert. Resultater: nødvendig informasjon om pasientenes legemiddelbruk var vanskelig tilgjengelig og tidkrevende å få tak i for involvert personell. Kvaliteten av informasjonen ble opplevd som varierende og upålitelig. Fem av ni primærleger betraktet resepten som tilstrekkelig informasjon til hjemmetjenesten ved endring i pasientens medisinering. Legen signerte nesten aldri forskrivninger i hjemmetjenestens journal. Manglende tilgang til informasjon gjorde at nattjenestepersonell ofte ikke visste hvilke legemidler de ga pasientene. Sykehusepikrisen fungerte dårlig som informasjonskilde. Tre av ni leger oppdaterte legemiddelarket i elektronisk pasientjournal umiddelbart ved epikrisemottak. Fortolkning: det er behov for forbedring av informasjonsoverføring og kommunikasjon rundt forordning av legemidler i primærhelsetjenesten, ved skifte av omsorgsnivå, og der hjemmetjenesten har overtatt medisineringsansvaret for pasienten

Mangelfull kommunikasjon om legemiddelbruk i primærhelsetjenesten

BAKGRUNN. Legemiddelbruk i primærhelsetjenesten involverer mange personer: legen som ordinerer, ulike typer helsepersonell som håndterer legemidlene og pasientene selv. Vi ønsket å studere sider ved feilmedisinering knyttet til mangelfull kommunikasjon mellom ulike behandlere, pleiepersonell og pasienter. MATERIALE OG METODE. Vi foretok semistrukturerte intervjuer med et tilfeldig utvalg leger og legesekretærer ved ni av fastlegekontorene i Tromsø kommune og av et strategisk utvalg av helsepersonell. Vi foretok observasjon ved et utvalg av sykehjem og enheter i hjemmetjenesten. Observasjonene ble loggført, intervjuene tatt opp på bånd og transkribert og materialet analysert. RESULTATER. Nødvendig informasjon om pasientenes legemiddelbruk var vanskelig tilgjengelig og tidkrevende å få tak i for involvert personell. Kvaliteten av informasjonen ble opplevd som varierende og upålitelig. Fem av ni primærleger betraktet resepten som tilstrekkelig informasjon til hjemmetjenesten ved endring i pasientens medisinering. Legen signerte nesten aldri forskrivninger i hjemmetjenestens journal. Manglende tilgang til informasjon gjorde at nattjenestepersonell ofte ikke visste hvilke legemidler de ga pasientene. Sykehusepikrisen fungerte dårlig som informasjonskilde. Tre av ni leger oppdaterte legemiddelarket i elektronisk pasientjournal umiddelbart ved epikrisemottak. FORTOLKNING. Det er behov for forbedring av informasjonsoverføring og kommunikasjon rundt forordning av legemidler i primærhelsetjenesten, ved skifte av omsorgsnivå, og der hjemmetjenesten har overtatt medisineringsansvaret for pasienten