Implementation of incident reporting systems in Norwegian nursing homes from a management perspective – a pilot study

Artikkelen beskriver en studie hvor hensikten var å beskrive i hvilken grad norske sykehjem har implementert system for avvikshåndtering fra et ledelsesperspektiv. Studien er gjennomført ved å sende spørreskjema til et utvalg norske kommuner. Totalt 30 svarte på undersøkelsen, og alle hadde etablert en hendelse rapporteringssystem, men funnene tyder på at vi ikke har klart å integrere systemene i praksis.An incident reporting system is important for continual improvement in nursing homes. The purpose of this study is to describe the extent to which Norwegian nursing homes have implemented incident reporting systems from a management perspective. The study is a cross-sectional study with a quantitative and descriptive design, and is conducted by sending questionnaires to a sample of Norwegian municipalities. A total of 30 responded to the survey and all had established an incident reporting system, but the findings indicate that we have failed to integrate the systems in practice. A large drop-off makes the results hard to generalize, and there is a need for further research and monitoring of status

Varenicline in the treatment of tobacco dependence

Varenicline, a partial agonist of α4β2 nicotinic acetylcholine receptors, is the most recently approved drug for smoking cessation. This paper reviews the outcomes of Phase 2 and Phase 3 clinical trials that assess the efficacy of varenicline in comparison to placebo and other smoking cessation pharmacotherapies, ie, sustained-release bupropion (bupropion SR) and nicotine transdermal patch. Varenicline has higher abstinence rates than placebo and the alternative active treatments at the end of standard regimen treatment periods. Significantly higher abstinence rates were also found with varenicline in comparison to both placebo and bupropion SR at the end of a 40-week non-treatment follow-up period. Varenicline typically tripled the abstinence rates compared with placebo. In addition, varenicline reduced craving and withdrawal symptoms as well as some of the positive experiences associated with smoking to a greater extent than placebo, bupropion SR, and nicotine replacement therapy (NRT). These findings are consistent with the proposed agonist/antagonist effects of varenicline. Preliminary studies assessing individual variables such as smoking dependency level and smoking reinforcement types provide justification to examine further the effects of varenicline according to these individual factors. Outcomes from such research could improve our understanding of varenicline’s mechanism of action and could ultimately help clinicians to develop individualized smoking cessation programs. Also, given varenicline’s ability to reduce the reward from smoking, it might be helpful to use it before cessation to motivate or prepare smokers for a quit attempt

Introducing oral tobacco for tobacco harm reduction: what are the main obstacles?

With the number of smokers worldwide currently on the rise, the regular failure of smokers to give up their tobacco addiction, the direct role of smoke (and, to a much lesser extent, nicotine) in most tobacco-related diseases, and the availability of less toxic (but still addictive) oral tobacco products, the use of oral tobacco in lieu of smoking for tobacco harm reduction (HR) merits assessment

Delamination initiation and propagation modelling with an enriched shell element formulation

For achieving good predictability of the deformation of structural composite components in crash simulations, a proper modelling of the delamination process is crucial. However, due to industrial restrictions on the simulation time of crash simulations, detailed modelling of each ply by separate elements through the thickness is not feasible. A potential remedy is to adopt the concept of adaptive shell elements which can be enriched whenever delaminations need to be accounted for. Hence, a structural model of a thinwalled laminate can thereby initially be built up from a single layer of shell elements through the thickness. During loading, the model is then enriched locally in critical areas where delamination is predicted. In this con- tribution, we show the potential of such an approach, where delamination cracks are adaptively introduced in the analysis based on a stress criterion in terms of the transverse stresses. A specific challenge is that these stresses are predicted with low accuracy in the FE model, whereby a post-processing step is proposed where an improved prediction is reconstructed based on the momentum balance equations. We show the potential of the proposed methodologys ability to capture initiating and propagating delaminations, and can conclude that the proposed methodology appears to be suitable for the simulation of thin-walled structures undergoing substantial delaminations

Malnutrition, functional ability and mortality among older people aged ⩾60 years: a 7-year longitudinal study

BACKGROUND/OBJECTIVES: This study aimed to assess the association between risk of malnutrition and 7-year mortality, controlling for functional ability, socio-demographics, lifestyle behavior and diseases, and investigate the interaction between risk of malnutrition and functional ability on the risk of mortality. SUBJECTS/METHODS: A longitudinal study on home-living and special-housing residents aged [greater than or equal to] 60 years was conducted. Of 2312 randomly invited participants, 1402 responded and 1203 provided information on both nutritional status and functional ability. The risk of malnutrition was estimated by the occurrence of at least one anthropometric measure (BMI, MAC and CC) below cut-off in addition to the presence of at least one subjective measure (decreased food intake, weight loss and eating difficulty). RESULTS: At baseline, 8.6% of subjects were at risk of malnutrition and during the 7-year follow-up 34.6% subjects died. The risk of malnutrition was independently associated with 7-year mortality (hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.28-2.65). Additional independent predictors were dementia (HR 2.76, 95% CI 1.85-4.10), activity of daily living (ADL) dependence (HR 2.08, 95% CI 1.62-2.67), heart disease (HR 1.44, 95% CI 1.16-1.78), diabetes (HR 1.41, 95% CI 1.03-1.93) and older age (HR 1.09, 95% CI 1.07-1.10). Moreover, the risk of malnutrition and ADL dependence in combination predicted the poorest survival rate (18.7%, P < 0.001). CONCLUSIONS: The risk of malnutrition significantly increases the risk of mortality in older people. Moreover, risk of malnutrition and ADL dependence together explain a significantly poorer survival rate; however, the importance of this interaction decreased in the multivariable model and risk of malnutrition and ADL dependence independently explained a significant risk of mortality

How Do Older Persons Understand the Purpose and Relevance of Preventive Home Visits? A Study of Experiences after a First Visit

The aim of this study was to explore and describe older persons’ experiences of their first Preventive Home Visit. Preventive Home Visits (PHV) are health services that aim to promote older persons' health, prevent functional decline, and reduce the need for comprehensive healthcare. The knowledge base to guide the design of effective PHV interventions is scarce. Studies that explore older persons' experiences of the first visit are essential, as compliance with the service is a prerequisite for positive outcomes. An explorative and descriptive design was applied. Qualitative research interviews with ten older persons who had received the first PHV the previous year were analysed with regard to manifest and latent content. The findings revealed that the understanding of the purpose of PHV varied. For some participants, the concepts and aims of health promotion and disease prevention were difficult to comprehend. The possibility to prepare for the visit was sought. All participants appreciated the service; the dialogue quality was good and a trusted municipal contact person provided security. To enhance compliance and ensure effective PHV, the invitation to the PHV service should include clearly stated aims and specific information about the first visit. An individualised, person-centred approach should be applied

Patient education in the hospital-at-home care context

The objective of this study is to describe adult patients’ and their family caregivers’ experiences of patient education in the hospital-at-home care context. Methods included a cross-sectional descriptive study including three hospital-at-home units in Finland. Adult, non-palliative patients (n = 27) and their family caregivers (n = 18) were interviewed pairwise by telephone, and the data analyzed with inductive thematic content analysis. COREQ guidelines were used to plan and guide the study design. Results concluded both patients and family caregivers seemed to have quite similar knowledge expectations, which only differs slightly from findings in other in- or outpatient contexts. In the hospital-at-home context, there is an evident need for clinical coaching and guidance in relation to self-care activities and for future-oriented education about the services available after hospital-at-home care. Six themes describing patients’ and family caregivers’ experiences of patient education in the hospital-at-home care context emerged, from patient-centered, goal-oriented and empowering education to the bypassed education of both patients and family caregivers. We conclude that in the hospital-at-home care context, the patient is not alone in his/her illness but instead the patient and family caregiver together form a unit. Thus, the need exists for extended, iterative patient education in hospital-at-home care: need for clinical coaching, guidance and support in relation to self-care activities and for future-oriented education about the services available after HAH care. Such extended patient education, in which patients’ family caregivers were included, strengthens the patient-family caregiver relationship, minimizes caregiver burden and the need for additional healthcare services. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Acta societatis pro fauna et flora Fennica 79

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