Ellinge castle : the history of the garden and parks at one of the oldest manors in Scania

Den här rapporten om Ellinge slott är en produkt inom kursen ”Bevarande, vård och restaurering av historiska trädgårdsanläggningar”. Arbetet har skett i en grupp bestående av Karin Henriksson, Karin Ingemansson och Eva-Marie Samuelson. Syftet med rapporten är att teckna Ellinge slotts landskapliga omgivningar, trädgårdar och parks historia. Syftet har även varit att inventera dagsläget, samt föra en diskussion med utgångspunkt i detta om hur anläggningen långsiktigt kan vårdas, skötas och bevaras. Sökandet kring Ellinge slotts historia har skett främst genom arkivstudier, kontakter med en rad olika personer samt genom besök på platsen. Vi har även gjort en kortare kartläggning av Ellinges mer allmänna historia. I resultatdelen har vi kartlagt historien, kronologiskt indelad: tidig historia, 1700-, 1800- och 1900-talet. Den tidiga historieskrivningen utgår från tidigare tryckta historiesamman-fattningar och avbildningar. Från 1760 och framåt finns kartmaterial av olika slag att tillgå samt samtida beskrivningar. Från 1897 och framåt finns fotografier bevarade vilka har varit en viktig källa för att fastställa hur delar i parken och trädgården har utvecklats. Det skrivna materialet vi funnit kring Ellinge handlar främst om en allmän historia kring slottet, där vi dock funnit en del nedtecknat om parken och trädgården. Ur våra arkivstudier har vi även funnit en del protokoll och listor som ytterligare hjälpt oss kartlägga trädgårdshistorien. För att kartlägga dagsläget på Ellinges park, trädgårdar samt närmaste omgivningar har en omfattande inventering gjorts. Till denna inventering hör uppritning av kartor, fotografering och upprättande av växtlistor. Utifrån historieskrivningen och inventeringen av Ellinge slotts omgivningar idag förs en diskussion om hur denna anläggning med anor redan från 1200-talet kan bevaras och utvecklas. Slutsatser som dragits är vikten av att bevara de stora övergripande strukturerna i en anläggning som kontinuerligt har utvecklats och anpassats till de rådande stilidealen. Det är viktigt att behålla de axlar som löper i anläggningen, samt att bevara vallgraven kring slottet. Det är även viktigt att försöka behålla den lummiga och grönskade karaktären på Ellinge, främst i from av de stora och ibland även mycket gamla träd som växer där. Vissa idéer för hur en eventuell återplantering av träd har gjorts. Till sist dras slutsatser kring hur Ellinge skall kunna utvecklas i framtiden, kopplat till dagens verksamheter, för att skapa en levande miljö som är anpassad efter sina brukare.This report on Ellinge castle is a product in the course ”Garden Conservation”. The work has been carried out in a group consisting of Karin Henriksson, Karin Ingemansson and Eva-Marie Samuelson. The purpose of this report is to describe Ellinge castle’s history, including its designed landscape surroundings, gardens and parks. The aim was also to make an inventory of the current situation and have a discussion, based on our results, on how the long term care, management and preservation can be carried out. The search concerning Ellinge castle’s history has primarily been carried out through archival studies, contact with people and visits to the site to find traces of previous garden designs. We have also made a short summary of Ellinges broader history. In the result chapter, we have divided the history into chronological order: Early History, 18th, 19th and 20th century history. The early history is based on previously printed historical summaries. From 1760 onwards there are maps of various kinds’ available and also contemporary descriptions. From 1897 onwards there are photographs preserved which has been an important source for determining how parts of the park has developed trough the years. The written material we have found about Ellinge focuses mainly on a general history about the castle but has also sometimes mentioned the park and garden. From our archival studies, we have also found some protocols and lists, which have further helped us identify the park and gardens history. To identify the current state of Ellinges Park gardens and near surroundings has a comprehensive inventory been carried out. This inventory included drawing of maps, photographing and the making of an inventory list containing findings like plants, constructions and traces of previous garden management and designs. Based on history and the inventory of Ellinge castles surroundings, a discussion are being held on how this site, dating from the 1200-century, can be preserved and further developed. Conclusions drawn are the importance of preserving the large structures in a park that have been continuously developed and adapted to the prevailing style ideals. It is important to keep the two dominating axises and to preserve the moat around the castle. It is also important to keep the lush and green nature at Ellinge, mainly the large and old trees and the tree rows that are leading out into the landscape. Some ideas for a possible future replanting of trees has been described Finally, conclusions about how Ellinge is to be developed in the future, linked to today’s activities, and how to create an outdoor environment suitable for its future use are being drawn

Mortality and HRQoL in ICU patients with delirium : Protocol for 1-year follow-up of AID-ICU trial

Background Intensive care unit (ICU)-acquired delirium is frequent and associated with poor short- and long-term outcomes for patients in ICUs. It therefore constitutes a major healthcare problem. Despite limited evidence, haloperidol is the most frequently used pharmacological intervention against ICU-acquired delirium. Agents intervening against Delirium in the ICU (AID-ICU) is an international, multicentre, randomised, blinded, placebo-controlled trial investigates benefits and harms of treatment with haloperidol in patients with ICU-acquired delirium. The current pre-planned one-year follow-up study of the AID-ICU trial population aims to explore the effects of haloperidol on one-year mortality and health related quality of life (HRQoL). Methods The AID-ICU trial will include 1000 participants. One-year mortality will be obtained from the trial sites; we will validate the vital status of Danish participants using the Danish National Health Data Registers. Mortality will be analysed by Cox-regression and visualized by Kaplan-Meier curves tested for significance using the log-rank test. We will obtain HRQoL data using the EQ-5D instrument. HRQoL analysis will be performed using a general linear model adjusted for stratification variables. Deceased participants will be designated the worst possible value. Results We expect to publish results of this study in 2022. Conclusion We expect that this one-year follow-up study of participants with ICU-acquired delirium allocated to haloperidol vs. placebo will provide important information on the long-term consequences of delirium including the effects of haloperidol. We expect that our results will improve the care of this vulnerable patient group.Peer reviewe

Sedation during mechanical ventilation in intensive care - Sedation practices and patients' memories, stressful experiences and psychological distress

The overall aim of this thesis was to describe and determine intensive care sedation in adult mechanically ventilated patients with the emphasis on patients? memory, stressful experiences and psychological distress. The results are based on a nationwide postal survey (Paper I) including 89 Swedish intensive care units (ICUs) followed by a prospective cohort study (Papers II?IV) conducted over 18 months in 2 ICUs including 313 mechanically ventilated adults admitted for more than 24 hours. In Papers II?IV, the patients were interviewed 5 days and 2 months post ICU using established instruments concerning patients? memory, stressful experiences, anxiety, depression and acute posttraumatic stress disorder (PTSD) related symptoms. Patient characteristics, doses of sedatives and depth of sedation as measured by a scoring system during the ICU stay were collected from hospital records after the interviews. Sedation practices in Swedish ICUs in 2000 varied, with a preference for heavy sedation with little use of sedation guidelines and scoring systems, and indicated the need of research concerning patient comfort in relation to sedation. Among the 250 patients interviewed, amnesia of the ICU (18%) and of the endotracheal tube (54%) was associated with deeper levels of sedation, and long-term heavy sedation increased the risk of having delusional memories without factual recall. Bothersome stressful experiences of the ICU were common (68%) and associated with lighter levels of sedation by means of more periods of wakefulness, and with longer ICU stay. The lighter the sedation practised, the higher the probability of having recall and stressful memories of the ICU. The best predictor of delusional memories in general and of having bothersome nightmares was increasing length of ICU stay. Psychological distress 2 months post ICU was associated with experiences of the ICU perceived as extremely stressful, but not with amnesia or having delusional memories without factual recall of the ICU. Female sex, signs of agitation, administration of midazolam and feelings of extreme fear during the ICU stay, and high levels of anxiety 5 days post ICU, increased the risk of developing high levels of acute PTSD-related symptoms 2 months post ICU. In conclusion, the results of this thesis indicate that some ICUs presumably could benefit from reviewing their sedation practice. Regular sedation assessment should be a priority of all ICU staff and the use of sedatives adapted to the individual requirements of the patient. Having memories of the ICU appears to be common and long-term critically ill patients seem to need special attention and support due to the increased risk of having bothersome stressful experiences of the ICU and of the endotracheal tube. Efforts to reduce stressful memories and to facilitate care by sedating patients more deeply for a longer period of time may interfere with the chance of a rapid and complication-free recovery. Consequently, the ICU staff needs to consider non-pharmacological means of improving patient comfort in addition to sedation. Early follow-up visits at the general ward, including assessment of patients? subjective status, and further follow-up support services after hospital discharge may be beneficial for the patients. Due to limitations in study design and measurement quality further research is needed to confirm the associations suggested in this thesis

Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patients-Findings from 250 interviews.

AIM: In order to improve the patients' comfort and well-being during and after a stay in the intensive care unit (ICU), the patients' perspective on the intensive care experience in terms of memories is essential. The aim of this study was to describe unpleasant and pleasant memories of the ICU stay in adult mechanically ventilated patients. METHOD: Mechanically ventilated adults admitted for more than 24hours from two Swedish general ICUs were included and interviewed 5 days after ICU discharge using two open-ended questions. The data were analysed exploring the manifest content. FINDINGS: Of the 250 patients interviewed, 81% remembered the ICU stay, 71% described unpleasant memories and 59% pleasant. Ten categories emerged from the content analyses (five from unpleasant and five from pleasant memories), contrasting with each other: physical distress and relief of physical distress, emotional distress and emotional well-being, perceptual distress and perceptual well-being, environmental distress and environmental comfort, and stress-inducing care and caring service. CONCLUSION: Most critical care patients have both unpleasant and pleasant memories of their ICU stay. Pleasant memories such as support and caring service are important to relief the stress and may balance the impact of the distressing memories of the ICU stay

Adult intensive care patients' perception of endotracheal tube-related discomforts: A prospective evaluation.

OBJECTIVE: This study was designed to investigate adult patients' perceptions of endotracheal tube (ETT)-related discomfort at 5 days and 2 months after discharge from the intensive care unit (ICU). METHODS: This prospective cohort study in 2 general ICUs included 250 intubated, mechanically ventilated adults admitted for more than 24 hours. Patients were interviewed 5 days and 2 months after discharge from the ICU about their ETT-related discomfort, using a modified Swedish ETT version of the ICU Stressful Experience Questionnaire that comprises 14 items. RESULTS: Of 116 patients describing their ETT experience during their ICU stay, 88% rated their discomfort as moderately to extremely stressful. At 2 months after discharge from the ICU, 23% (51/226) reported bothersome discomfort, vs. 46% (104/226) 5 days after discharge from the ICU, and 10 patients suffered from severe, persistent hoarseness. CONCLUSION: The incidence of bothersome subjective complaints after tracheal intubation in the intensive-care setting is high, and severe ETT-related problems may persist several months after extubation

The Stressful Memory Assessment Checklist for the Intensive Care Unit (SMAC-ICU) : Development and Testing

Stressful or traumatic memories of an intensive care stay may lead to long-term psychological morbidity. Memory assessment is therefore essential to aid in the patients’ recovery process. Acknowledging the large cohort of post ICU patients during the SARS-CoV-2 pandemic, a simple tool for the evaluation of ICU memories is needed. The aim of this study was, therefore, to develop and test the validity and reliability of a short stressful memory assessment checklist, including a distress intensity rating scale, for intensive care survivors. The consecutive sample consisted of 309 patients attending an intensive care follow-up consultation in Sweden. A methodological design was used consisting of four phases. The first three concerned construct and content validity and resulted in a 15-item checklist of potential stressful memories with a Likert-type scale including five response categories for distress intensity rating. To fill out the checklist, a median of 3 (2–3) minutes was needed. A test–retest approach yielded weighted kappa values between 0.419 and 0.821 for 12 of the single items and just below 0.4 for the remaining three. In conclusion, the stressful memory assessment checklist seems to be valid and reliable and can be used as a simple tool to evaluate the impact of stressful ICU memories

En utvärderings inflytande - mer än bara ord

This thesis is a meta-evaluation of a specific evaluation; "Demokrati och delaktighet? Delrapport om Storstadssatsningen i Fosie, Hyllie och Södra Innerstaden" . My thesis concerns two of the three district city councils mentioned in the title, in the City of Malmö, and their way of handling the government initiative Storstadssatsningen. The initiative is aiming to promote strategies to improve the conditions in socially disadvantaged neighborhoods in Sweden. The evaluation in question has evaluated the effects the different local strategies have had on the neighborhoods regarding democracy and participation among the marginalized population. The local city councils are Fosie and Södra Innerstaden. Meta-evaluation is a branch of the evaluation-discipline which is studying the role played by an evaluation's design, function and user-context. This thesis is a case study, focused on the dimension of use in two local contexts. My study is therefore based in a local policy context. The aim of my study was to inquire, through interviews, into how the evaluation results were received in the district city councils and among the civil servants, and if the evaluation had any consequences and/or effects. I was using Carol H. Weiss perspective on evaluation use in a policy context as a starting point. The initial question I based my inquiry on was if her perspective was applicable on a Swedish evaluation context. I also asked whether the evaluation design developed by the evaluators and the presentation had any effects on the dimension of use. I also tried to ascertain if the conception of use in the two districts were different and if differences in the organizational make-up and attitude influenced the likelihood that the evaluation would be used. Finally, I also inquired into the different challenges there are in implementing policies and programs with a democracy and participation aim in the districts. I found that Weiss perspective was very much applicable on a Swedish evaluation context. Combined with Karen E. Kirkharts' analytical framework it became even more useable. The design of the evaluation and the presentation was important aspects as well. My findings did not say much about the role the organizational make-up played. What I did find however was that the attitudes to evaluation in general among the civil servants had a great influence on the possibility for an evaluation to influence an organizations learning trajectory. There were differences between the two districts in this. I mostly found evidence of enlightenment use of the evaluation results, but there were indications on more instrumental models of use in one of the districts. In addition I found that the relationship and co-operation between the evaluators and the program or project was important for the reception and the possibility of use of the evaluation results when the report was published

A nurse-led intensive care after-care programme - development, experiences and preliminary evaluation.

BACKGROUND: The benefits of critical care follow-up services include increased understanding of the long-term consequences of intensive care and entail helping patients and their next of kin to come to terms with their problems and distress following critical illness and intensive care treatment. AIMS: To establish an intensive care after-care programme and to conduct a preliminary evaluation of the follow-up service from the patients' and relatives' perspectives in a general intensive care unit (ICU) in Sweden. DESIGN: A descriptive and evaluative design was used, and data from the first year of the after-care programme were collected. The final programme was nurse led and included five main points; a patient diary with colour photographs, ward visits, a patient information pamphlet, a follow-up consultation 2-3 months after intensive care discharge and feedback to the ICU staff. An evaluation questionnaire was handed out to patients and next of kin attending the follow-up clinic, e.g. asking the respondents to rate their satisfaction of the consultation on a visual analogue scale (VAS). RESULTS: The first year of after-care statistics showed that 170 survivors with a stay of 48 h or more were discharged from the ICU, resulting in 190 ward visits and 79 follow-up consultations. The preliminary evaluation revealed that the 2-month follow-up consultation achieved a median VAS rating of 9.8 (ranging from 1 to 10, poor to excellent) from both patients and next of kin. CONCLUSION: The development and preliminary evaluation of this nurse-led intensive care programme resulted in a feasible programme, requiring modest resources, with a high level of patient and relative satisfaction. RELEVANCE TO CLINICAL PRACTICE: This paper attempts to share with professional colleagues important steps during the developmental process of establishing an intensive care follow-up service and presents the content and preliminary evaluation of a nurse-led intensive care after-care programme focusing on the patients' and relatives' perspectives