Retrospective analysis of health variables in a Reykjavík nursing home 1983-2002 (corrected)

Neðst á síðunni er að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenBACKGROUND: A municipal nursing home with 68 beds in Reykjavík, opened in mid-year 1982. OBJECTIVES: To analyse changes in demographic, health and outcome variables over 20 years. DESIGN: Retrospective analyses of data from medical records of all diseased persons with cross-sectional comparison of five four-year intervals. SETTING: Droplaugarstadir Nursing Home in Reykjavík. The nursing home is supervised by fully qualified nurses and provides maintenance rehabilitation. Medical services are delivered from a specialist geriatric hospital department. RESIDENTS: All residents who died 1983 to 2002 [corrected]. MEASUREMENTS: Demographic data, type of dwelling before admission, Nursing Home Pre-admission Assessment Score (NAPA), mobility- and cognitive score, drug usage and a list of medical diagnoses. All recorded health events during stay, falls and fractures, medical and specialist consultations. Advance directives, as recorded and end-of-life treatment, place of death, clinical diagnosis of cause of death and length of stay. RESULTS: The total number of medical records read numbered 385, including 279 females and 106 males. The mean age on admission was 85 (+/- 7) years. During the first 4 years the majority of residents came from their own private homes or residential settings but in the last four years, 60% were admitted directly from a hospital ward. The mortality rate was 17% per year in the first period and the majority died in a hospital. This ratio took a sharp turn as the mortality rate increased to 40%, and in the last period only 2 of 97 deaths took place in a hospital. Admission mobility- and cognitive scores showed increased disability with time. The most common diagnosis on admission was dementia (56%), ischemic heart disease (46%), fractures (35%) and strokes (27%). Parkinsonism and maturity onset diabetes had a low prevalence rate of 6%. A mean NHPA of 57 (+/- 17) points confirmed a high dependency selection. The mean number of drugs per patient was 5.3 (+/- 3), including 1.1 (+/- 1) for psychoactive drugs and sedatives. The most common health events during residents? stay were urinary and respiratory infections, heart failure, cardiac- and cerebral events and pulmonary disorders. Hip fractures occurred in 45 residents (12%) and other types of fractures in 47 during their stay in the nursing home. The number of medical visits and specialist referrals increased with time. Palliative care was the most common form of treatment at end of life. Pneumonia was most commonly recorded cause of death in medical notes. The yearly mortality rate was 29% and the mean length of stay was 3 (+/- 2,9) years for the whole period. LIMITATIONS: Retrospective analyses have many inherent drawbacks and the information in medical records tend to be scanty. Analyses of disabilities, as described in the medical record, can only be descriptive and health events are likely to be underreported. Statistical methods have a less meaningful role for interpretation as only diseased persons were included and survivors excluded. However, the length of time, uniform medical care and turnover rate of residents generate useful information on the patterns of the nursing home service during a time of considerable change. CONCLUSIONS: This retrospective analysis indicates increasing frailty in nursing home patients admitted over a period of 20 years. With time the residents are more often admitted directly from a hospital rather than from an individual dwelling. Most deaths took place in the nursing home and were preceded with informal or formal palliative care directives, which was a significant change over time. The data indicates growing efficiency in the nursing home selection processes due to the NHPA and improvements in holistic geriatric care. This development is in keeping with the Icelandic health care policy for elderly people to stay longer in their own home with access to a nursing home placement when needed.Tilgangur: Á síðustu árum hafa verið gerðar miklar skipulagsbreytingar á öldrunarþjónustu á Íslandi. Þessi afturvirka rannsókn beinist að því að meta áhrif þessara breytinga á lýðfræði og heilsufarsbreytur heimilismanna á Droplaugarstöðum, hjúkrunarheimili fyrir aldraða í Reykjavík. Efniviður og aðferðir: Lesnar voru sjúkraskrár allra vistmanna sem látist höfðu á árunum 1983-2002. Þessum 20 árum var skipt niður í fimm fjögurra ára tímabil. Skráð var aldur, kyn, hvaðan fólkið kom og stig á vistunarmati aldraðra. Metin var hreyfifærni og vitræn geta með fjögurra stiga kvarða, lyfjanotkun og sjúkdómsgreiningar við komu. Skráðar voru algengustu heilsufarsbreytur á dvalartíma, byltur og brot, vitjanir lækna og samráðskvaðningar. Stigun meðferðar, dánarstaður og dánarmein, meðalaldur og meðaldvalartími voru skráð. Niðurstöður: Rannsóknin náði til 385 heimilismanna, 279 kvenna og 106 karla. Meðalaldur við komu var 85 (± 7) ár fyrir bæði kynin og breyttist ekki marktækt á þessum 20 árum. Fyrstu fjögur árin komu flestir heimilismanna úr heimahúsum eða úr þjónustuíbúðum fyrir aldraða en á síðasta tímabilinu komu um 60% beint frá sjúkrahúsum. Hreyfihömlun og heilabilun voru talin algengustu vandamál heimilismanna við komu og algengi þeirra fór vaxandi með árunum. Algengustu sjúkdómsgreiningar við komu voru heila­bilun (56%), kransæðasjúkdómar (46%), beinbrot (35%) og heilaáföll (27%). Parkinsonsjúkdómur og fullorðinssykursýki komu mun sjaldnar fyrir, eða í um 6% tilfella. Meðalfjöldi stiga á vistunarmati aldr­aðra (eftir 1991) var 57 stig (± 17), fjöldi lyfja á mann við komu voru 5,3 (± 3) og inntaka geð- og róandi lyfja 1,1 (±1). Algengustu heilsufarsáföll á dvalartíma voru sýkingar í þvagfærum og lungum, kviðverkir, hjartabilun, hjarta- og heilaáföll og lungnateppa. Mjaðmarbrot voru 45 (12%) og önnur beinbrot 47. Skráðar vitjanir lækna fóru vaxandi með árunum. Dánartíðni fór vaxandi fyrstu árin en var að meðaltali 29% á ári yfir allt tímabilið. Líknarmeðferð var algengasta meðferðarstig heimilismanna undir lokin. Fyrstu fjögur árin áttu 64% andláta heimilismanna sér stað á sjúkrahúsi en aðeins 2% síðustu árin. Algengasta skráða dánarmeinið var lungnabólga. Meðaldvalartími mældist lengstur á árunum 1991-94 en styttist og var 2,6 ár á síðasta tímabilinu. Ályktun: Þessi afturvirka rannsókn sýnir vaxandi hrum­leika aldraðs fólks sem vistaðist á Droplaugarstöðum hjúkrunarheimili undanfarin 20 ár. Með árunum komu heimilismenn oftar beint frá legudeild á sjúkrahúsi. Á tímabilinu breyttist dánarstaður heimilismanna frá sjúkrahúsi yfir til heimilisins sjálfs í takt við breytt viðhorf til dánarferlis og samfara umræðu um útgefnar leiðbeiningar um lífslokameðferð. Niðurstöður benda til aukinnar skilvirkni í vistunarmati og heildrænni umönnunar á hjúkrunarheimilinu. Þessi þróun samræmist þeirri hugmyndafræði heilbrigðisyfirvalda að aldraðir búi sem lengst á eigin heimilum en hafi aðgang að hjúkrunarrýmum þegar allt um þrýtur heima

Physical activity on prescription for children with obesity: a focus group study exploring experiences in paediatric healthcare

BackgroundInsufficient physical activity is a growing public health concern and is closely linked to obesity in both adults and children. Swedish physical activity on prescription (PAP) is effective in increasing physical activity levels in adults, but knowledge about how PAP is used in paediatric healthcare is lacking. Therefore, this study aimed to explore experiences of working with PAP for children with obesity amongst paediatric staff and managers.MethodsSeven focus group discussions with 26 participants from paediatric outpatient clinics in western Sweden were conducted. Data were analysed both inductively and deductively, framed by the Normalization Process Theory's four core constructs: coherence, cognitive participation, collective action, and reflexive monitoring.ResultsThe PAP work for children with obesity was experienced to be about helping children to become physically active, and less about losing weight. Identified barriers for using PAP were the non-uniform nature of the work and a perceived lack of guidelines. Collaboration with physiotherapists and physical activity organisers outside the organisation was identified as an important facilitator. An important contextual factor for implementing PAP is the collaboration between paediatric clinics and physical activity organisers. In the transition between these stakeholders, maintaining a family-centred approach when working with PAP was experienced as challenging.ConclusionsPAP is a well-known intervention that is inconsistently used for children with obesity. The intervention should include a family-centred approach for this patient group. It also needs to align better with existing collaborations with other healthcare units as well as with new forms of collaboration with physical activity organisers in the community

The validity of plagioclase-melt geothermometry for degassing-driven magma crystallization

Any quantitative interpretation of the formation conditions of igneous rocks requires methods for determining crystallization temperature. Accurate application of such thermobarometers relies on the attainment of equilibrium in the system to be studied. This may be particularly difficult in silicic magmas, where diffusivities are low and crystallization kinetics sluggish. Moreover, progressive degassing of volatile-rich magmas during ascent can result in continuous changes in effective undercooling, causing particular problems in achieving equilibrium between melt and crystals that grow in response to decompression. We consider these problems in the context of plagioclase-melt equilibria for magmas undergoing decompression and degassing-driven crystallization, using two published thermometers. The two thermometers show similar trends with key parameters but absolute temperatures can vary significantly. Analysis of decompression experiments conducted at constant temperature shows systematic variations in calculated temperature and equilibrium constant with varying decompression rate and quench pressure. This indicates that an unrecognized lack of equilibration could result in significant temperature overestimates and potentially spurious results. This highlights the need to assess for equilibrium, and we discuss problems associated with some commonly used indicators of equilibration. Finally, retrospective analysis of published plagioclase-hosted melt inclusion suites from five subduction zone volcanoes shows systematic increases in calculated temperature and decreases in equilibrium constant with decreasing H2O concentration. While this could represent the signature of latent heat of crystallization, we suggest that such patterns should be treated with caution unless there is clear evidence of sustained equilibrium between plagioclase and melt during decompression.M.C.S.H. acknowledges support from a Royal Society University Research Fellowship.This is the author accepted manuscript. The final version is available from the Mineralogical Society of America via http://dx.doi.org/10.2138/am-2016-531

Drug sensitivity testing on patient-derived sarcoma cells predicts patient response to treatment and identifies c-Sarc inhibitors as active drugs for translocation sarcomas

BACKGROUND: Heterogeneity and low incidence comprise the biggest challenge in sarcoma diagnosis and treatment. Chemotherapy, although efficient for some sarcoma subtypes, generally results in poor clinical responses and is mostly recommended for advanced disease. Specific genomic aberrations have been identified in some sarcoma subtypes but few of them can be targeted with approved drugs. METHODS: We cultured and characterised patient-derived sarcoma cells and evaluated their sensitivity to 525 anti-cancer agents including both approved and non-approved drugs. In total, 14 sarcomas and 5 healthy mesenchymal primary cell cultures were studied. The sarcoma biopsies and derived cells were characterised by gene panel sequencing, cancer driver gene expression and by detecting specific fusion oncoproteins in situ in sarcomas with translocations. RESULTS: Soft tissue sarcoma cultures were established from patient biopsies with a success rate of 58%. The genomic profile and drug sensitivity testing on these samples helped to identify targeted inhibitors active on sarcomas. The cSrc inhibitor Dasatinib was identified as an active drug in sarcomas carrying chromosomal translocations. The drug sensitivity of the patient sarcoma cells ex vivo correlated with the response to the former treatment of the patient. CONCLUSIONS: Our results show that patient-derived sarcoma cells cultured in vitro are relevant and practical models for genotypic and phenotypic screens aiming to identify efficient drugs to treat sarcoma patients with poor treatment options.Peer reviewe

BARN SOM ANHÖRIGA Samverkan utifrån barnets bästa

Syftet med vår studie är att explorativt undersöka hur företrädare för socialtjänst och psykiatrin ser på behovet av samverkan för att stödja barn till föräldrar med psykisk ohälsa, samt hur och på vilket sätt samverkan sker mellan dessa organisationer när det gäller aktuell målgrupp. För att svara på våra frågeställningar valde vi att genomföra en kvalitativ studie som bygger på åtta semistrukturerade intervjuer med professionella inom socialtjänst och öppenpsykiatri. Vi har i denna studie utgått ifrån nyinstitutionell teori och samverkansteori för att tolka och analysera vår empiri, även barnperspektivet har varit en viktig utgångspunkt i vår analysprocess. Utifrån vårt resultat kan vi konstatera av den samverkan som idag finns mellan öppenpsykiatrin och socialtjänsten när det gäller barn som anhöriga i princip är obefintlig. En trolig anledning till detta ligger i att behovet av samverkan har drivits fram av politikers vision om en helhetssyn mellan psykiatrin och socialtjänsten men visionen har inte brutits ner i specifika mål som går att realisera i verkligheten. Däremot framkom en tydlig önskan om att hitta samverkansformer som tar till vara på öppenpsykiatrins och socialtjänstens kunskap och kompetens och bidrar till en helhetssyn på barnet som anhörig

Att synas är att lyckas

En kortfilm där påståendet "att synas är att lyckas" avhandlas med hjälp av fyra intervjuer: Jaqe, Karin Ericson, Andrea Arvidsson och Murat Dal

Konsumenters val och uppfattning av elbolag : ett miljöperspektiv

Syftet med denna studie är att beskriva och förklara eventuella samband mellan miljömedvetet beteende, uppfattad konsumentpåverkan och val och uppfattning av elbolag, samt hur informanterna uppfattade sitt elbolags marknadskommunikation. Kvantitativ metod tillämpades, där 273 informanter svarade på en enkät. Ett bekvämlighetsurval gjordes bland studenter på Högskolan Väst. Data analyserades i SPSS, där bland annat en faktoranalys, Pearson korrelationsanalys och T-test användes. Teoriavsnittet behandlade teorier och tidigare forskning gjort kring marknadskommunikation, gröna marknadsföring, den gröna konsumenten, den gröna konsumentens köpprocess samt grön marknadsföring inom grön el. Studien fann ett starkt linjärt signifikant samband mellan miljömedvetet konsumentbeteende och val och uppfattning av elbolag. Vidare fanns det ett samband mellan ålder och miljömedvetet beteende. Ju äldre informanterna var desto mer miljömedvetet beteende hade dem. Det fanns dessutom en signifikant skillnad mellan kvinnor och män. Kvinnliga informanterna hade i genomsnitt ett mer miljömedvetet beteende än manliga informanterna. Sambandet i ålder och skillnaderna i könen hittades dock inte vad gäller informanters val och uppfattning av elbolag. Vidare fann studien att informanter i hög grad ansåg att de med sitt konsumentbeteende kunder påverka omgivningen i en positiv riktning. Det fanns ett signifikant samband mellan val och uppfattning av elbolag och uppfattad konsumentpåverkan. Ju mer informanterna ansåg att de med sitt konsumentbeteende kan påverka omgivningen desto mer påverkade detta deras val och uppfattning av elbolag. Kvinnor tänker i genomsnitt mer på hur produkter de köper påverkar miljön och andra människor än de manliga informanterna. Vad gäller informanternas uppfattning av deras elbolags marknadskommunikation ansåg dessa att den var bristfällig. Då tidigare forskning påvisat att studenter kan vara en bra målgrupp för elbolag som säljer grön energi och då även denna studie uppvisat på att informanterna i hög grad ansåg att de med sitt konsumentbeteende kan påverka sin omgivning drar vi slutsatsen att studenter kan vara en bra målgrupp för elbolagen med grön marknadsföring. Dock bör det primära fokuset för elbolagen i deras marknadskommunikation ligga på priset, då informanterna uppgett att de skulle föredrar grön el om priset var detsamma som de mindre miljövänliga alternativen. Vidare forskning inom detta problemområde krävas för att fastställa om så verkligen är fallet. Vi rekommenderar att framtid forskning bör använda sig av ett sannolikhetsurval, vilket skulle möjliggöra en generalisering av resultaten.

“Take me seriously and do something!” - a qualitative study exploring patients’ perceptions and expectations of an upcoming orthopaedic consultation

Abstract Background Patients’ perceptions of care is an important factor in evaluation of health care, in quality assessment, and in improvement efforts. Expectations of assessments or procedures such as surgery have been found to be related to perceptions of outcome as well as satisfaction, and are therefore of interest to both clinicians and researchers. Increased understanding of these patient views is important so that orthopaedic assessments, regardless of who performs them, can be further developed and patient-centred to better meet patients’ needs. The purpose of this study was therefore to explore patients’ perceptions and expectations of an upcoming orthopaedic consultation. Methods This was an explorative qualitative study with an inductive approach. Thirteen patients who were referred for orthopaedic consultation were included using a purposeful sampling strategy. Patients participated in individual, semi-structured interviews that were recorded, transcribed verbatim and analysed with qualitative content analysis. Results The participants’ expressed perceptions and expectations of the upcoming orthopaedic surgeon consultation were classified into 5 categories: Hoping for action, Meeting an expert, A respectful meeting, Participating in the consultation, and A belief that hard facts make evidence. Across the categories, an overarching theme was formulated: Take me seriously and do something! The participants emphasised a desire to be taken seriously and for something to happen, both during the consultation itself and as a result of the orthopaedic consultation. They described a trust in the expertise of the orthopaedic surgeon and stressed the importance of the surgeon’s attitude, but still expected to participate in the consultation as well as in the decision-making process. Conclusions The study findings illuminate aspects that are important for patients in an orthopaedic consultation. The descriptions of patients’ perceptions and expectations can serve to improve patient–clinician relationships as well as to inform the development of new models of care, and a greater understanding of these aspects may improve the patient experience

Identifying young people exposed to or at risk of sexual ill health: pilot implementation of an evidence-informed toolkit (SEXIT) at Swedish youth clinics

Objectives: We aimed to develop and pilot-implement an evidence-informed toolkit (SEXual health Identification Tool; SEXIT) for identifying young people exposed to or at risk of sexual ill health, at Swedish youth clinics, and to investigate SEXITs potential to identify young people in need of special care and monitoring. Methods: The SEXIT toolkit was developed, validated and pilot-implemented at three Swedish youth clinics. Pre-implementation staff readiness was assessed and youth clinic visitors responses to SEXIT were analysed. Results: All staff perceived a need for screening for sexual risk-taking and exposure. The response rate from 268 youth clinic visitors (aged 15-24 years) was 86%. Half of the visitors had one or no variable associated with sexual ill health, a third had two or three, and 15% reported between four and seven variables. The most common variables were alcohol use, three or more sexual partners in the past year and previous chlamydia. Visitors rated SEXIT as important and not uncomfortable or difficult to answer. Conclusions: The SEXIT toolkit was found to be feasible and highly acceptable in a clinical setting. The use of SEXIT may facilitate important questions on sexual risk-taking and sexual ill health to be raised with youth clinic visitors.Funding Agencies|Public Health Agency of Sweden [03393-2015]; Healthcare Board, Region Vastra Gotaland, Sweden [VGFOUREG-573441]; Medical Research Council of Southeast Sweden [FORSS-664621]</p