Gemensam modell för professionella : E-klubb för närståendevårdare till personer med Multipel Skleros

Detta examensarbete är en del av ett projekt som Yrkeshögskolan Novia inledde redan våren 2016. Syftet med arbetet är främja hälsa och välbefinnande samt stöda och stärka närståendevårdarens egna resurser. Målet med arbetet är att skapa en gemensam modell för en e-klubb som skall användas av professionella. Grunden för arbetet har varit tjänstedesign och litteraturöversikt. Arbetet är uppdelat i två delar: en gemensam modell för uppbyggandet av en e klubb samt en målgruppsspecifik del. Den målgruppsspecifika delen utgår från skribenternas valda målgrupp, närståendevårdare till personer med multipel skleros. Inför detta arbete har frågeställningarna varit: Vad behöver den professionella ta i beaktande vid användning av en e klubb? Vilka behov av stöd har närståendevårdare till personer med MS? Metoden som använts i arbetet är tjänstedesign. Tjänstedesign utgår från användarens behov, förutsättningar och preferenser och det är även dessa som de professionella behöver ta i beaktande vid användningen av en e-klubb. För att få kunskap om närståendevårdarnas behov har litteraturöversikt använts. Behoven som närståendevårdare nämner är både av fysisk, psykisk och social karaktär. Detta har sedan sammanställts till en teoretisk sammanfattning. Utgående från behoven och den teoretiska sammanfattningen har olika förslag på träffar tagits fram, detta för att tillgodose den specifika målgruppens behov. Den teoretiska sammanfattningen har även stått som grund för den gemensamma modellen. Resultatet av detta har sedan visualiserats i form en hemsida. Planen är att denna hemsida och detta arbete skall vara en del i arbetet för att skapa en gemensam modell för professionella att utgå från vid skapandet av e klubbar.Tämä opinnäytetyö on osa Ammattikorkeakoulu Novian projektia, joka aloitettiin jo keväällä 2016. Työn tarkoituksena on edistää terveyttä ja hyvinvointia, sekä tukea ja vahvistaa omaishoitajien omia voimavaroja. Työn tavoitteena on luoda perusta ammattilaisten käyttämälle e kerholle. Työn perustana toimii palvelumuotoilu ja kirjallisuuskatsaus. Työ on jaettu kahteen osaan. Toinen osa keskittyy e-kerhon rakentamiseen, toinen kohderyhmäpainoitteiseen osaan joka muodostuu kirjoittajien valitsemasta, multipel sklerosia sairastavien henkilöiden omaishoitajista koostuvasta kohderyhmästä. Tässä työssä kysymyksenasettelussa ovat olleet: Mitä ammattilaisen täytyy ottaa huomioon käyttäessään e kerhoa? Minkälaisia tarpeita tuelle multipel skleroosia sairastavien henkilöiden omaishoitajilla on? Menetelmänä työssä on käytetty palvelumuotoilua. Palvelumuotoilu perustuu käyttäjän tarpeisiin, edellytyksiin sekä valintoihin. Nämä asiat ovat myös niitä, jotka ammattilaisen tulee ottaa huomioon käyttäessään e kerhoa. Omaishoitajien tarpeista on saatu tietoa käyttämällä kirjallisuuskatsausta. Tarpeita, joita omaishoitajilla on ovat sekä fyysisiä, psyykkisiä että sosiaalisia. Tämä on koottu sittemmin teoreettiseksi yhteenvedoksi. Tarpeiden ja teoreettisen yhteenvedon perusteella on tehty erilaisia ehdotuksia tapaamisille, jotta ne vastaavat ensisijaisen kohderyhmän tarpeisiin. Teoreettinen yhteenveto on myös toiminut perustana yhteiselle mallille. Tulos on havainnollistettu kotisivun avulla. Suunnitelmana on, että kotisivu ja tämä työ yhdessä luovat yhteisen mallin ammattilaisille e kerhon luomiseksi.This thesis is a part of a project by Novia University of Applied Sciences, which started in the spring 2016. The purpose of this thesis is health and wellbeing promotion, as well as creating a method to support and strengthen the clients’ own resources. The aim of this thesis is to create an example of an e club, which can be used by professionals within health and social care. The basis for this thesis is service design and review of existing literature. This thesis is divided into two parts. The first part describes the joint model for creating an e club and the second part is more specific for the target group of this thesis; Care givers for persons with multiple sclerosis. The research questions for this thesis are: What does the professional need to take into consideration while using an e club? What kind of needs do care givers for persons with MS have? The method that has been used for this thesis is service design. Service design is based on the needs of the customer. The professional need to take these needs of the customer into consideration while using an e club. To gain knowledge about the needs of the care givers, a literature review has been done. The needs of care givers are physical, psychological and social. This has then been compiled into a theoretical summary. Based on the needs of care givers and the theoretical summary, an e club has been developed. The result of this thesis has been visualized into a web page. This web page and thesis is a part of a joint model for professionals to use when creating an e club

Multi-Disciplinary Experts Supporting Graduate Medical Education through Participation in COMPLETE Chart Rounds

Learning Objective: As a result of this presentation, attendees will learn skills that they can use to implement collaborative graduate medical education learning experiences using a community of multi-disciplinary professionals within their own institutions. Background: Inter-professional Chart Rounds were implemented to provide residents an opportunity to review and present patient cases utilizing “COMPLETE” guidelines developed by residency leadership as the result of a “Regional Medicine – Public Health Education Centers” grant. COMPLETE guidelines explicitly direct residents to include consideration of: - Context – Culture of context – who is the patient? - Outside Visitors/Resources – incorporate visitors/experts such as librarians, pharmacists and psychologists and utilize their resources - Mental Health – assess behavioral health aspects of the case - Population Perspective – address prevalence of the condition in the community - Learn From Others – consider specialists, home care, and complementary therapies - Expectations – clear goals set between physician and patient - Time – Start on time, end on time. Respect everyone’s time. - End with “Culture of Continuity” – what are the key lessons? Is there a follow-up plan? Through the attendance of librarians, psychologists, pharmacologists, medical students and other faculty, discussion ensues which leads to continued resident education and support. Methods: Chart Rounds are held daily at each residency practice site. Residents are required to attend along with medical and pharmacy students rotating at the centers. The preceptor leads Chart Rounds and other faculty physicians join as they are able. Residents present cases while maintaining patient confidentiality. The preceptor leads the group discussion of the case. Faculty members discuss clinical and administrative implications, the psychologist addresses potential behavioral aspects of the case, the librarian searches for Evidence-Based information to support decisions and the pharmacologist advises on medication management. The group also discusses how individual patient care reflects the public health needs and profile of the community. Residents (n=32) were invited to complete a survey asking them to evaluate their experience with multi-disciplinary COMPLETE Chart Rounds. Results: Survey results as well as observational analysis will be used to improve the resident’s experience at Chart Rounds with the goal of making this experience an even more rewarding collaborative educational experience. Some sample findings include: - 66% of residents report satisfaction of Chart Rounds challenging the academic aspects of their work - 100% of residents in the early portion of their program report that Chart Rounds assists them in building collaborative relationships with faculty and other providers/experts - Residents report the greatest satisfaction (92% overall) with pharmacist participation in Chart Rounds across all Post Graduate Years - Satisfaction with librarian participation increases through each year (from only 10% in PGY1 to over 60% in PGY3) , possibly due to limited exposure early in the program Although these guidelines were developed for use in a Family Medicine Graduate Medical Education program and fit well into this practice model, the findings can be utilized in other resident training programs. Presented at the Patients and Populations: Public Health in Medical Education conference sponsored by the Association of American Medical Colleges (AAMC) and the Centers for Disease Control and Prevention (CDC), held September 14-15, 2010, in Cleveland, OH

Relation between dietary cadmium intake and biomarkers of cadmium exposure in premenopausal women accounting for body iron stores

<p>Abstract</p> <p>Background</p> <p>Cadmium is a widespread environmental pollutant with adverse effects on kidneys and bone, but with insufficiently elucidated public health consequences such as risk of end-stage renal diseases, fractures and cancer. Urinary cadmium is considered a valid biomarker of lifetime kidney accumulation from overall cadmium exposure and thus used in the assessment of cadmium-induced health effects. We aimed to assess the relationship between dietary cadmium intake assessed by analyses of duplicate food portions and cadmium concentrations in urine and blood, taking the toxicokinetics of cadmium into consideration.</p> <p>Methods</p> <p>In a sample of 57 non-smoking Swedish women aged 20-50 years, we assessed Pearson's correlation coefficients between: 1) Dietary intake of cadmium assessed by analyses of cadmium in duplicate food portions collected during four consecutive days and cadmium concentrations in urine, 2) Partial correlations between the duplicate food portions and urinary and blood cadmium concentrations, respectively, and 3) Model-predicted urinary cadmium concentration predicted from the dietary intake using a one-compartment toxicokinetic model (with individual data on age, weight and gastrointestinal cadmium absorption) and urinary cadmium concentration.</p> <p>Results</p> <p>The mean concentration of cadmium in urine was 0.18 (+/- s.d.0.12) μg/g creatinine and the model-predicted urinary cadmium concentration was 0.19 (+/- s.d.0.15) μg/g creatinine. The partial Pearson correlations between analyzed dietary cadmium intake and urinary cadmium or blood concentrations were r = 0.43 and 0.42, respectively. The correlation between diet and urinary cadmium increased to r = 0.54 when using a one-compartment model with individual gastrointestinal cadmium absorption coefficients based on the women's iron status.</p> <p>Conclusions</p> <p>Our results indicate that measured dietary cadmium intake can reasonably well predict biomarkers of both long-term kidney accumulation (urine) and short-term exposure (blood). The predictions are improved when taking data on the iron status into account.</p

Composition analysis and minimal treatments to solubilize polysaccharides from the brown seaweed Laminaria digitata for microbial growth of thermophiles

Publisher's version (útgefin grein)Brown macroalgae (Phaeophyta) hold high potential as feedstock for biorefineries due to high biomass productivity and carbohydrate content. They are, however, a challenging, unconventional feedstock for microbial refining and several processing problems need to be solved to make them a viable option. Pre-treatment is necessary to enhance accessibility and solubility of the biomass components but should be minimal and mild to assure sustainable and cost-effective processing. Here, two routes to pre-treatLaminaria digitata to release polysaccharides were investigated: hot water pre-treatment by autoclaving (121 °C, 20 min or 60 min) and a two-step extraction with mild acid (0.1 M HCl) followed by alkaline treatment. Hot water pre-treatment resulted in partial extraction of a mixture of polysaccharides consisting of alginate, fucoidan and laminarin. After mild acid pre-treatment, alginate was found in the remaining insoluble residues and was extracted in a second step via alkaline treatment using Na2CO3 (0.15 M) at 80 °C and CaCl2 (10%) for the precipitation. In addition to carbohydrates, a fraction of other components such as proteins, phenolic compounds, minerals and trace elements was detected in the extracts. Cultivation of the thermophilic bacterial strains Rhodothermus marinus DSM 16675 and Bacillus methanolicus MGA3 (ATCC 53907) in media supplemented with the respective extracts resulted in growth of both strains, indicating that they were able to utilize the available carbon source for growth. R. marinus displayed the highest cell density in the medium containing the extract from acid pre-treatment, whereas B. methanolicus growth was highest with the extract from hot water pre-treatment.Open access funding provided by Lund University. The authors received financial support for the projects Thermofactories, (Era-net MBT1, grant agreement No 604814), MacroVal (the Swedish research council Formas, grant 2015-769), Marine food resources for new markets (Formas, grant 2018-01863), Macro cascade (Bio-Based Industries Joint Undertaking under EU Horizon 2020, grant agreement No 720755), the Novo Nordisk foundation (grant agreement No NNF18OC00349792) and ProSeaFood, (Era-net SusFood2, grant agreement No 727473).Peer Reviewe

β-Amyloid 1-42 Oligomers Impair Function of Human Embryonic Stem Cell-Derived Forebrain Cholinergic Neurons

Cognitive impairment in Alzheimer's disease (AD) patients is associated with a decline in the levels of growth factors, impairment of axonal transport and marked degeneration of basal forebrain cholinergic neurons (BFCNs). Neurogenesis persists in the adult human brain, and the stimulation of regenerative processes in the CNS is an attractive prospect for neuroreplacement therapy in neurodegenerative diseases such as AD. Currently, it is still not clear how the pathophysiological environment in the AD brain affects stem cell biology. Previous studies investigating the effects of the β-amyloid (Aβ) peptide on neurogenesis have been inconclusive, since both neurogenic and neurotoxic effects on progenitor cell populations have been reported. In this study, we treated pluripotent human embryonic stem (hES) cells with nerve growth factor (NGF) as well as with fibrillar and oligomeric Aβ1-40 and Aβ1-42 (nM-µM concentrations) and thereafter studied the differentiation in vitro during 28-35 days. The process applied real time quantitative PCR, immunocytochemistry as well as functional studies of intracellular calcium signaling. Treatment with NGF promoted the differentiation into functionally mature BFCNs. In comparison to untreated cells, oligomeric Aβ1–40 increased the number of functional neurons, whereas oligomeric Aβ1–42 suppressed the number of functional neurons. Interestingly, oligomeric Aβ exposure did not influence the number of hES cell-derived neurons compared with untreated cells, while in contrast fibrillar Aβ1–40 and Aβ1–42 induced gliogenesis. These findings indicate that Aβ1–42 oligomers may impair the function of stem cell-derived neurons. We propose that it may be possible for future AD therapies to promote the maturation of functional stem cell-derived neurons by altering the brain microenvironment with trophic support and by targeting different aggregation forms of Aβ

Monitoring the referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the district hospital

BACKGROUND: The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger. METHODS: Strict and controlled application of existing clinical decision trees in a sample of rural health centres allowed the estimation of the corresponding need for and characteristics of curative referrals in rural Niger. Compliance of referral was monitored as well. Need was matched against actual referral in 11 rural districts. The referral patterns were registered so as to get an idea on the types of pathology referred. RESULTS: The referral rate benchmark was set at 2.5 % of patients consulting at the health centre for curative reasons. Niger's rural districts have a referral rate of less than half this benchmark. Acceptability of referrals is low for the population and is adding to the deficient referral system in Niger. Mortality because of under-referral is highest among young children. CONCLUSION: Referral patterns show that the present programme approach to deliver health care leaves a large amount of unmet need for which only comprehensive first and second line health services can provide a proper answer. On the other hand, the benchmark suggests that well functioning health centres can take care of the vast majority of problems patients present with