Underlättad omvårdnad med hjälp av fyra tassar : Vårdpersonalens upplevelse av vårdhundens betydelse för personer med demenssjukdom som bor på särskilt boenden- En empirisk intervjustudie

Bakgrund: Antalet personer med demenssjukdom ökar i Sverige på grund av den åldrande befolkningen. Demenssjukdomar är kroniska och påverkar hela individens livssituation. Utöver farmakologisk behandling används komplementära terapier med syfte att öka personens upplevelse av välbefinnande och livskvalité, exempelvis genom hundassisterad-terapi. Svenska riktlinjer understryker vikten av att omvårdnaden vid demenssjukdom utgår från ett personcentrerat förhållningssätt. Syfte: Att beskriva vårdpersonalens upplevelse av vårdhundens betydelse för personer med demenssjukdom som bor på särskilt boende. Metod: En kvalitativ intervjustudie, där åtta semistrukturerade intervjuer gjordes och analyserades. Resultat: Vårdhunden upplevdes vara en motivationsfaktor för personer med demenssjukdom och motiverade dem till att delta i fysiska aktiviteter, uppehålla samtal och att samarbeta med vårdpersonalen. Vårdhunden upplevdes ha förmåga att lindra symtom som oro, ångest och aggressivitet, vilket hade en positiv inverkan på omvårdnaden av personerna med demenssjukdom. Utöver det så upplevde vårdpersonalen att vårdhunden var en begränsad tillgänglighet och inte något som alla personer med demenssjukdom kunde dra nytta av. Slutsats: Vårdpersonalen upplever att vårdhunden har en övergripande positiv inverkan på personer med demenssjukdom som bor på särskilt boende och kan underlätta att uppnå en personcentrerad omvårdnad. Mer forskning krävs för att nå ökad kunskap om vårdhundens effekt på personer med demenssjukdom. Nyckelord: Demens, Personcentrerad omvårdnad, Upplevelser, Vårdhund, Vårdpersonal.Background: The number of people with dementia is increasing in Sweden due to the aging population. Dementia is a chronic disease that affects the whole life situation of the person. Beside pharmacological treatment there are complementary therapies which are used to increase the person's experience of well-being and life quality, for example through dog-assisted therapy. Swedish guidelines underline the importance of person centred approach in the nursing of people with dementia. Aim: To describe healthcare staff's experience of therapy dog's significance for people with dementia living in a nursing home. Method: A qualitative interview study, in which eight semi-structured interviews were conducted and analysed. Results: The healthcare staff perceived that the therapy dog became a motivational factor for persons living with dementia, leading to increase their will to participate in physical activity, maintain conversations with others and to cooperate with the healthcare staff. The therapy dog contributed to encrichment of nursing of the care environment at the nursing home. The therapy dog seem like to alleviate symptoms such as worry, anxiety and aggressiveness. Which had a positive effect on the nursing of persons with dementia. Further the staff experienced that the therapy dog currently had a limited availability and was something not all people with dementia could make use of. Conclusion: The healthcare staff experiences that the therapy dog has an overall positive impact on people with dementia living in a nursing home and that it supports the ability to accomplish person-centered nursing. More research needs to be done in order to increase the knowledge of the therapy dog’s effect on people with dementia. Keywords: Dementia, Experiences, Healthcare staff, Person-centered care, Therapy dog

Pneumocystis jirovecii pneumonia in intensive care units: a multicenter study by ESGCIP and EFISG

Abstract Background Pneumocystis jirovecii pneumonia (PJP) is an opportunistic, life-threatening disease commonly affecting immunocompromised patients. The distribution of predisposing diseases or conditions in critically ill patients admitted to intensive care unit (ICU) and subjected to diagnostic work-up for PJP has seldom been explored. Materials and methods The primary objective of the study was to describe the characteristics of ICU patients subjected to diagnostic workup for PJP. The secondary objectives were: (i) to assess demographic and clinical variables associated with PJP; (ii) to assess the performance of Pneumocystis PCR on respiratory specimens and serum BDG for the diagnosis of PJP; (iii) to describe 30-day and 90-day mortality in the study population. Results Overall, 600 patients were included in the study, of whom 115 had presumptive/proven PJP (19.2%). Only 8.8% of ICU patients subjected to diagnostic workup for PJP had HIV infection, whereas hematological malignancy, solid tumor, inflammatory diseases, and solid organ transplants were present in 23.2%, 16.2%, 15.5%, and 10.0% of tested patients, respectively. In multivariable analysis, AIDS (odds ratio [OR] 3.31; 95% confidence interval [CI] 1.13–9.64, p = 0.029), non-Hodgkin lymphoma (OR 3.71; 95% CI 1.23–11.18, p = 0.020), vasculitis (OR 5.95; 95% CI 1.07–33.22, p = 0.042), metastatic solid tumor (OR 4.31; 95% CI 1.76–10.53, p = 0.001), and bilateral ground glass on CT scan (OR 2.19; 95% CI 1.01–4.78, p = 0.048) were associated with PJP, whereas an inverse association was observed for increasing lymphocyte cell count (OR 0.64; 95% CI 0.42–1.00, p = 0.049). For the diagnosis of PJP, higher positive predictive value (PPV) was observed when both respiratory Pneumocystis PCR and serum BDG were positive compared to individual assay positivity (72% for the combination vs. 63% for PCR and 39% for BDG). Cumulative 30-day mortality and 90-day mortality in patients with presumptive/proven PJP were 52% and 67%, respectively. Conclusion PJP in critically ill patients admitted to ICU is nowadays most encountered in non-HIV patients. Serum BDG when used in combination with respiratory Pneumocystis PCR could help improve the certainty of PJP diagnosis