How to prevent the use of force in dementia care

Bachelor i sykepleie, 2012Problemstilling: Kan sykepleiere forhindre bruk av tvang til personer med demens i forbindelse med personlig hygiene ved bruk av tillitskapende kommunikasjon? Oppgavens avgrensning: Vi har i denne oppgaven valgt å ha hovedfokus på hvordan vi som sykepleiere kan forhindre bruken av tvang til personer med demens som bor i sykehjem. Vi har valgt å avgrense oppgaven til hvordan tillitskapende kommunikasjon og bruk av forskjellige kommunikasjonsteknikker kan forebygge og forhindre bruk av tvang. Grunnen til dette fokuset er at vi i praksis har sett viktigheten av å kunne kommunisere på en god og riktig måte. Det som fungerer for en pasient behøver ikke nødvendigvis fungere for en annen. Vi har valgt å benytte oss av Kari Martinsens omsorgsfilosofi i denne oppgaven. Vi vektlegger områdene som omhandler omsorg, tillit og synet på de svake. Vi mener dette vil kunne bygge oppunder vår oppgave og hjelpe med å svare på problemstillingen. Det fins mange typer av demens, vi har valgt å se på demens som en helhet i oppgaven. Vi kommer ikke inn på risikofaktorer eller behandlingsformer tilknyttet diagnosen. Innenfor etikk fins det fire etiske prinsipper. Vi ser på disse prinsippene som likeverdige og har i denne oppgaven valgt å knytte situasjonene opp imot nærhetsetikken og autonomi. Vi har selv erfart at pasienter med en demensdiagnose ofte kan være sårbar med tanke på selvbestemmelsesrett. Det fins flere ulike kommunikasjonsteknikker innenfor demens. Vi kommer i denne oppgaven kun til å ta for oss validering og reminisens

Baseline Gastrointestinal Eosinophilia Is Common in Oral Immunotherapy Subjects With IgE-Mediated Peanut Allergy

Rationale: Oral immunotherapy (OIT) is an emerging treatment for food allergy. While desensitization is achieved in most subjects, many experience gastrointestinal symptoms and few develop eosinophilic gastrointestinal disease. It is unclear whether these subjects have subclinical gastrointestinal eosinophilia (GE) at baseline. We aimed to evaluate the presence of GE in subjects with food allergy before peanut OIT.Methods: We performed baseline esophagogastroduodenoscopies on 21 adults before undergoing peanut OIT. Subjects completed a detailed gastrointestinal symptom questionnaire. Endoscopic findings were assessed using the Eosinophilic Esophagitis (EoE) Endoscopic Reference Score (EREFS) and biopsies were obtained from the esophagus, gastric antrum, and duodenum. Esophageal biopsies were evaluated using the EoE Histologic Scoring System. Immunohistochemical staining for eosinophil peroxidase (EPX) was also performed. Hematoxylin and eosin and EPX stains of each biopsy were assessed for eosinophil density and EPX/mm2 was quantified using automated image analysis.Results: All subjects were asymptomatic. Pre-existing esophageal eosinophilia (>5 eosinophils per high-power field [eos/hpf]) was present in five participants (24%), three (14%) of whom had >15 eos/hpf associated with mild endoscopic findings (edema, linear furrowing, or rings; median EREFS = 0, IQR 0–0.25). Some subjects also demonstrated basal cell hyperplasia, dilated intercellular spaces, and lamina propria fibrosis. Increased eosinophils were noted in the gastric antrum (>12 eos/hpf) or duodenum (>26 eos/hpf) in 9 subjects (43%). EPX/mm2 correlated strongly with eosinophil counts (r = 0.71, p < 0.0001).Conclusions: Pre-existing GE is common in adults with IgE-mediated peanut allergy. Eosinophilic inflammation (EI) in these subjects may be accompanied by mild endoscopic and histologic findings. Longitudinal data collection during OIT is ongoing

Density functional theory based screening of ternary alkali-transition metal borohydrides: A computational material design project

The dissociation of molecules, even the most simple hydrogen molecule, cannot be described accurately within density functional theory because none of the currently available functionals accounts for strong on-site correlation. This problem led to a discussion of properties that the local Kohn-Sham potential has to satisfy in order to correctly describe strongly correlated systems. We derive an analytic expression for the nontrivial form of the Kohn-Sham potential in between the two fragments for the dissociation of a single bond. We show that the numerical calculations for a one-dimensional two-electron model system indeed approach and reach this limit. It is shown that the functional form of the potential is universal, i.e., independent of the details of the two fragments.We acknowledge funding by the Spanish MEC (Grant No. FIS2007-65702-C02-01), “Grupos Consolidados UPV/EHU del Gobierno Vasco” (Grant No. IT-319-07), and the European Community through e-I3 ETSF project (Grant Agreement No. 211956).Peer reviewe

Hvordan forebygge bruk av tvang i demensomsorgen

Problemstilling: Kan sykepleiere forhindre bruk av tvang til personer med demens i forbindelse med personlig hygiene ved bruk av tillitskapende kommunikasjon? Oppgavens avgrensning: Vi har i denne oppgaven valgt å ha hovedfokus på hvordan vi som sykepleiere kan forhindre bruken av tvang til personer med demens som bor i sykehjem. Vi har valgt å avgrense oppgaven til hvordan tillitskapende kommunikasjon og bruk av forskjellige kommunikasjonsteknikker kan forebygge og forhindre bruk av tvang. Grunnen til dette fokuset er at vi i praksis har sett viktigheten av å kunne kommunisere på en god og riktig måte. Det som fungerer for en pasient behøver ikke nødvendigvis fungere for en annen. Vi har valgt å benytte oss av Kari Martinsens omsorgsfilosofi i denne oppgaven. Vi vektlegger områdene som omhandler omsorg, tillit og synet på de svake. Vi mener dette vil kunne bygge oppunder vår oppgave og hjelpe med å svare på problemstillingen. Det fins mange typer av demens, vi har valgt å se på demens som en helhet i oppgaven. Vi kommer ikke inn på risikofaktorer eller behandlingsformer tilknyttet diagnosen. Innenfor etikk fins det fire etiske prinsipper. Vi ser på disse prinsippene som likeverdige og har i denne oppgaven valgt å knytte situasjonene opp imot nærhetsetikken og autonomi. Vi har selv erfart at pasienter med en demensdiagnose ofte kan være sårbar med tanke på selvbestemmelsesrett. Det fins flere ulike kommunikasjonsteknikker innenfor demens. Vi kommer i denne oppgaven kun til å ta for oss validering og reminisens

The more the merrier? The effect of family size and birth order on children's education

There is an extensive theoretical literature that postulates a trade off between child quantity and quality within a family. However, there is little causal evidence that speaks to this theory. Using a rich dataset on the entire population of Norway over an extended period of time, we examine the effects of family size and birth order on the educational attainment of children. While we find a negative correlation between family size and children's education, when we include indicators for birth order and/or use twin births as an instrument, family size effects become negligible. In addition, birth order has a significant and large negative effect on children's education. We also study adult earnings, employment, and teenage childbearing, and find strong evidence for birth order effects with these outcomes, particularly among women. These findings suggest the need to revisit economic models of fertility and child 'production', focusing not only on differences across families but differences within families as well

Women's values and preferences and health state valuations for thromboprophylaxis during pregnancy : A cross-sectional interview study

Background: Pregnant women with prior venous thromboembolism (VTE) are at risk of recurrence. Prophylaxis with low molecular weight heparin (LWMH) reduces that risk but is inconvenient, costly, and may be associated with increased risks of obstetrical bleeding. The views of pregnant women, crucial when making prophylaxis recommendations, are currently unknown. Methods: Cross-sectional international multicenter study. We included women with a history of VTE who were either pregnant or planning pregnancy. We provided information regarding risk of VTE recurrence with and without LMWH and determined participant's willingness to receive LMWH prophylaxis through direct choice exercises, preference-elicitation (utilities) for health states (e.g. burden of LMWH prophylaxis), and a probability trade-off exercise. Results: Of 123 women, more women at high risk than those at low risk of recurrence (86.4% vs. 60.0%; p=0.003) chose to use LMWH. The median threshold reduction in VTE at which women were willing to accept use of LMWH, given a 16% risk of VTE without prophylaxis, was 3% (interquartile range: 1 to 6). Participants' evaluation of the relevant health states varied widely and was unrelated to their direct choices to use or not use LMWH. Conclusions: Although the majority of women with a previous VTE, pregnant or planning pregnancy choose to take LMWH during pregnancy, a minority -and in low risk women, a large minority-do not. Our results highlight the need for individualized shared decision-making (SDM) in the clinical encounter, and for guideline panels to make weak recommendations in favor of LMWH that make clear the need for SDM. (C) 2015 Elsevier Ltd. All rights reserved.Peer reviewe

Longitudinal trajectory of quality of life for patients with melanoma brain metastases: A secondary analysis from a whole brain radiotherapy randomized clinical trial

Purpose: Brain metastases are common in patients with advanced melanoma. This study describes 12-month quality of life (QoL) trajectories following local management of 1–3 melanoma brain metastases. Methods: This study assessed QoL data collected during a multi-center, prospective, open-label, phase III randomized controlled trial comparing the efficacy of adjuvant whole brain radiotherapy (WBRT) with observation after local treatment of 1–3 melanoma brain metastases. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Core (QLQ-C30) and Brain Tumour (BN-20) questionnaires at baseline and every 2 months, for 12 months.Using growth mixture modelling, QoL trajectories were identified for global health status, QLQ-C30 and BN-20 subscales for patients with baseline and at least one follow-up assessment. Multivariable logistic regression was used to examine associations between trajectories, demographic, and clinical factors. Results: After combining QoL data from observation and WBRT arms, QLQ-C30 and BN-20 trajectories were calculated for 139 and 137 patients respectively. Depending on the QoL domain, 9–54 % of patients reported a deterioration in QoL. Older age (≥65 years) was significantly associated with deterioration in global health status (OR = 2.88, 95 %CI = 1.27–6.54), physical (OR = 3.49, 95 %CI = 1.29–9.41), role (OR = 4.15, 95 %CI = 1.77–9.71), social (OR = 4.42, 95 % CI = 1.57–12.46), cognitive (OR = 6.70, 95 % CI = 1.93–23.29) and motor functioning (OR = 4.95, 95 %CI = 1.95–12.61) and increased future uncertainty (OR = 0.20, 95 %CI = 0.07–0.53). Female sex (OR = 0.10, 95 %CI = 0.02–0.41), not having neurosurgery at baseline (OR = 0.09, 95 %CI = 0.02–0.52), 2–3 brain metastases (OR = 5.75, 95 %CI = 1.76–18.85) or receiving adjuvant WBRT (OR = 6.77, 95 %CI = 2.00–22.99) were associated with poorer physical, emotional, cognitive and social outcomes respectively. Conclusions: Poorer QoL outcomes in the first 12 months after diagnosis of melanoma brain metastases were observed in patients aged ≥ 65 years, females, having 2–3 brain metastases, non-surgical treatment of metastases or adjuvant WBRT.Clinical Trial Registration Number:Whole Brain Radiotherapy Trial (WBRTMel) was registered with the Australian Clinical Trials Registry (ACTRN12607000512426) and ClinicalTrials.gov (NCT01503827).Study Support:This project was funded by Cancer Australia PdCCRS (Grants No. 512358, 1009485, and 1084046) and the National Helath and Medical Research Coucil of Australia (NHMRC; Grant No. 1135285).ADT was supported by a Cancer Australia Priority-driven Collaborative Cancer Research Scheme. Project #1046923. RLM was supported by an NHMRC Fellowship #1194703 and a University of Sydney, Robinson Fellowship. JFT was supported by an NHMRC Program Grant #1093017