Antihypertensive treatment in people with dementia

Introduction The range and magnitude of potential benefits and harms of antihypertensive treatment in people with dementia has not been previously established. Method A scoping review to identify potential domains of benefits and harms of antihypertensive therapy in people with dementia was undertaken. Systematic reviews of these domains were undertaken to examine the magnitude of the benefits or harms. Results Potential outcome domains identified in the 155 papers in the scoping review were cardio-vascular events, falls, fractures and syncope, depression, orthostatic hypotension, behavioural disturbances, polypharmacy risks, kidney problems, sleep problems, interactions with cholinesterase inhibitors and pain. The systematic reviews across these domains identified relatively few studies done in people with dementia, and no convincing evidence of safety, benefit or harm across any of them. Discussion There is no justification for materially different guidance for the treatment of hypertension in people with dementia, but sufficient evidence to warrant particular caution and further research into treatment in this group of patients

Effect of learning to use a mobility aid on gait and cognitive demands in people with mild to moderate Alzheimer’s dementia: Part II – 4-Wheeled walker

Background: Cognitive deficits and gait problems are common and progressive in Alzheimer’s disease (AD). Prescription of a 4-wheeled walker is a common intervention to improve stability and independence, yet can be associated with an increased falls risk. Objectives: 1) To examine changes in spatial-temporal gait parameters while using a 4-wheeled walker under different walking conditions, and 2) to determine the cognitive and gait task costs of walking with the aid in adults with AD and healthy older adults. Methods: Twenty participants with AD (age 79.1±7.1 years) and 22 controls (age 68.5±10.7 years) walked using a 4-wheeled walker in a straight (6 m) and Figure of 8 path under three task conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones). Results: Gait velocity was statistically slower in adults with AD than the controls across all conditions (all p values <0.025). Stride time variability was significantly different between groups for straight path single task (p = 0.045), straight path multi-task (p = 0.031), and Figure of 8 multi-task (0.036). Gait and cognitive task costs increased while multi-tasking, with performance decrement greater for people with AD. None of the people with AD self-prioritized gait over the cognitive task while walking in a straight path, yet 75% were able to shift prioritization to gait in the complex walking path. Conclusion: Learning to use a 4-wheeled walker is cognitively demanding and any additional tasks increases the demands, further adversely affecting gait. The increased cognitive demands result in a decrease in gait velocity that is greatest in adults with AD. Future research needs to investigate the effects of mobility aid training on gait performance

Withdrawal of antihypertensive therapy in people with dementia: feasibility study

Background: This study explored the feasibility of a randomised controlled withdrawal trial of antihypertensive medication in normotensive people with dementia. Feasibility aspects included response, recruitment, exclusion and drop-out rates, suitability of outcome measures, acceptability of study procedures and an indicative economic evaluation for a randomised controlled trial. Methods: A cohort study attempting the withdrawal of antihypertensive drugs where appropriate and a feasibility study of home-based blood pressure monitoring, in people with dementia treated for hypertension, was undertaken. Interviews with participants and carers and an indicative economic evaluation were also undertaken. Results: Three hundred and sixty-two primary care practices in the East Midlands were contacted of which only 41 (11% (95%CI 8–15%)) agreed to support the study. These 41 practices posted 940 letters to potential participants. Thirty participants were enrolled in the cohort study of whom 9 were eligible for the antihypertensive withdrawal programme, 20 participated in a home blood pressure monitoring sub-group analysis and 12 took part in an interview study. Twenty-two of those enrolled in the cohort study were followed up at 6 months. The withdrawal programme was acceptable to participants and general practitioners (GPs). The study procedures including assessments and home blood pressure monitoring were acceptable to the participants and their carers. The economic evaluation was not possible. Conclusion: A withdrawal trial of antihypertensive medication in normotensive people with dementia may not be feasible in the UK because of low recruitment rates

Physical restraint use and falls in institutional care of old people : effects of a restraint minimization program

Physical restraint use and falls are common in institutional care of old people and various attempts have been made to reduce their occurrence. Falls and concomitant injuries are a major problem due to their negative effect on morbidity and mortality. Prevention of falls and injuries is the most common reason for physically restraining old people in institutional care. Its use has, however, been questioned both from an ethical perspective, since restraints can be perceived as coercive and also because of the lack of sound evidence of their effectiveness in preventing falls, as well as the adverse effects associated with their use. The main purposes of this thesis were to investigate differences in the us of physical restraints over time, to identifify risk factors for falls among people with dementia, to evaluate the effects of a restraint minimization program on staff knowledge, attitudes, and work environment and use of physical restraints and the quality of care. The present thesis is based on three main data collections, two census surveys conducted within institutional care for old people in the county of Västerbotten in 2000 (n=3,804) and 2007 (n=2,970) and one cluster-Randomized Controlled Trial (RCT) including 40 group dwellings for people suffering from dementia where the intervention consisted of staff education. The use of physical restraints increased slightly between 2000 and 2007 (16.2% to 18.4%, p=0.016). Analyses suggest that the increase might be independent of any change in resident characteristics. Restrained residents were also subjected to restraints for longer times in 2007. During a six-month follow-up 64/160 (40.0%) residents in group dwellings for those with dementia sustained at least one fall. Independent risk factors for falls were ‘requiring help with hygiene’, ‘displaying verbally disruptive/attention-seeking behavior’, ‘able to rise from a chair’, ‘walking with assistive devices’, and ‘participating in outdoor walks’, which explained 36.1% of the falls. The majority of the 191 falls were un-witnessed, 35% occurred during the night and anxiety and confusion were the most common symptoms preceding the falls. A six-month restraint minimization program showed a positive impact on staff knowledge, attitudes and work environment as well as on the use of physical restraints and subjectively estimated quality of care. Residents in the intervention group present throughout the entire study period had lower odds, relative to the residents in the control group of being physically restrained at follow-up (OR= 0.21, CI 95%=0.08-0.57) after controlling for potential confounders and the cluster effect. Adjusted analyses including all residents present at either baseline or follow-up also showed that the use of physical restraints was less in the intervention group relative to the control group at follow-up. There was no change in the occurrence of falls or use of psychoactive drugs. The intervention also reduced stress of conscience, job demands and strain in the staff, and improved their job control and the caring climate. Subgroup analysis indicated a greater effect in units where the use of physical restraints had been reduced or remained constant. In conclusion, physical restraint use and falls remains common in institutional care of old people. The practice of physical restraint seems to have changed. In the RCT it was found that it is possible to change restraint practice and also to improve staff work environment. Falls among residents with dementia require a certain mobility function and anxiety and confusion are common symptoms preceding falls

SUSPLAB : A suspension component simulation tool for MATLAB

A GUI-assisted (Graphical User Interface) suspension component simulation tool has been developed in the computer package MATLAB. The purpose is to provide an example of a lightweight and expandable platform for educational use in the field of vehicle dynamics and suspension components. In this first version the program focused on passive rail vehicle components and their mechanical behaviour during harmonic displacement excitation. The simulation is however fairly general and may be used for describing suspension components in road vehicles and a range of other engineering applications after some modification. Thus the software and this report also emphasizes on the modular approach of the software and how it can be expanded and tailored by individual users. Calculations are based on linear and non-linear, one-dimensional models with a relation between force and motion. The simulation tool is mainly developed for educational purposes and is therefore, in its current state, subject to compromises between accuracy, model complexity and computational effort.Ett simuleringspaket med grafiskt användargränssnitt har programmerats för MATLAB. Syftet är att exemplifiera hur en lätthanterlig och utbyggbar datorplattformar kan utvecklas och implementeras för utbildningsändamål inom fordonsdynamik samt införskaffa djupare kunskaper i komponent- och simuleringsteknik. Den version av programmet som beskrivs i denna rapport är också den första och tungvikten ligger på passiva fjädringskomponenter för spårfordon och hur dessa beter sig under harmonisk förskjutningsexcitering. Programmets struktur och utbyggbarhet är också en viktig del i detta utvecklingsarbete. Beräkning och simulering är baserad på endimensionella, linjära modeler byggda på relationen kraft – förskjutning. Simuleringspaketet är utvecklat i utbildningsyfte och därför också begränsat beträffande noggrannhet, modellkomplexitet och krav på beräkningskapacitet

The Students’, in Social Work, views on professionalization in Social Work : A Quantitative Study About the Attitudes of Students’, in Social Work, Towards Professionalization and Legitimation in Social Work

Professionaliseringen av socialt arbete påbörjades i mitten av 1900-talet och har bland annat medfört en akademisk utbildning och forskning inom området. Professionaliseringen är fortgående och de senaste årtiondena har diskussionen om ett införande av en socionomlegitimation pågått och det är därför av intresse att undersöka socionomstudenters syn på professionalisering och socionomlegitimation. Studien syftar till att undersöka hur socionomstudenter ser på professionaliseringen inom socialt arbete och en yrkeslegitimation för socionomer. Följande forskningsfrågor har legat till grund för studien: Hur skattar socionomstuderande på professionalisering av socialt arbete och socionomlegitimation?  På vilket sätt påverkar kön, ålder, tidigare arbetslivserfarenheter och längd på genomförd utbildning attityden gentemot socionomlegitimation och professionalisering?    Studien har haft en kvantitativ forskningsansats och enkät har använts som datainsamlingsmetod. Enkäten skickades ut till alla socionomstudenter på Hälsohögskolan i Jönköping. Resultatet analyserades i SPSS 28.0 och visade att socionomstudenter är positiva till professionaliseringen inom socialt arbete och en socionomlegitimation. En viktig slutsats som framkommer är att professionaliseringen är obalanserad. Det innebär att områden inom det sociala arbetet är olika professionaliserade, exempelvis har hälso- och sjukvårdskuratorer fått möjligheten till en legitimation medan en allmän socionomlegitimation avslås. Obalansen driver utveckling av socialt arbete framåt genom att professioner konkurrerar med varandra och i den aktuella studien ses obalansen som positiv. En annan slutsats är att socionomstudenternas attityder är viktiga för den fortsatta professionaliseringen av socialt arbete.At the beginning of the 20th century, the professionalization of social work began and contributed, among other things, to academic education and research in social work. The professionalization is continuous, and a discussion about the imposition of legitimation in social work has lasted for several decades. Thus, it is interesting to learn what students in social work think about professionalization and legitimation in social work. The study aims to examine how students in social work view professionalization and legitimation in social work. The following research questions formed the study's basis: How do social work students view professionalization in social work and legitimation in social work? How do gender, age, previous work experience, and length of completed education affect the attitudes towards legitimation in social work and professionalization?   The study used a quantitative research approach, and a survey was used to collect data. The survey was sent out to all students in social work at the School of Health and Welfare in Jönköping. The results were analyzed using SPSS 28.0 and showed that the students in social work are positive towards professionalization and legitimation in social work. An important conclusion is that professionalization is unbalanced. This means that areas within social work are not evenly professionalized. For example, counselors in health care have a legitimation, while the proposal for legitimation in social work is denied. The imbalance drives the development of social work through competition between professions, and in this study, we view the imbalance as positive. Another conclusion is that students' attitudes in social work are essential for continuing professionalization in social work

The Students’, in Social Work, views on professionalization in Social Work : A Quantitative Study About the Attitudes of Students’, in Social Work, Towards Professionalization and Legitimation in Social Work

Professionaliseringen av socialt arbete påbörjades i mitten av 1900-talet och har bland annat medfört en akademisk utbildning och forskning inom området. Professionaliseringen är fortgående och de senaste årtiondena har diskussionen om ett införande av en socionomlegitimation pågått och det är därför av intresse att undersöka socionomstudenters syn på professionalisering och socionomlegitimation. Studien syftar till att undersöka hur socionomstudenter ser på professionaliseringen inom socialt arbete och en yrkeslegitimation för socionomer. Följande forskningsfrågor har legat till grund för studien: Hur skattar socionomstuderande på professionalisering av socialt arbete och socionomlegitimation?  På vilket sätt påverkar kön, ålder, tidigare arbetslivserfarenheter och längd på genomförd utbildning attityden gentemot socionomlegitimation och professionalisering?    Studien har haft en kvantitativ forskningsansats och enkät har använts som datainsamlingsmetod. Enkäten skickades ut till alla socionomstudenter på Hälsohögskolan i Jönköping. Resultatet analyserades i SPSS 28.0 och visade att socionomstudenter är positiva till professionaliseringen inom socialt arbete och en socionomlegitimation. En viktig slutsats som framkommer är att professionaliseringen är obalanserad. Det innebär att områden inom det sociala arbetet är olika professionaliserade, exempelvis har hälso- och sjukvårdskuratorer fått möjligheten till en legitimation medan en allmän socionomlegitimation avslås. Obalansen driver utveckling av socialt arbete framåt genom att professioner konkurrerar med varandra och i den aktuella studien ses obalansen som positiv. En annan slutsats är att socionomstudenternas attityder är viktiga för den fortsatta professionaliseringen av socialt arbete.At the beginning of the 20th century, the professionalization of social work began and contributed, among other things, to academic education and research in social work. The professionalization is continuous, and a discussion about the imposition of legitimation in social work has lasted for several decades. Thus, it is interesting to learn what students in social work think about professionalization and legitimation in social work. The study aims to examine how students in social work view professionalization and legitimation in social work. The following research questions formed the study's basis: How do social work students view professionalization in social work and legitimation in social work? How do gender, age, previous work experience, and length of completed education affect the attitudes towards legitimation in social work and professionalization?   The study used a quantitative research approach, and a survey was used to collect data. The survey was sent out to all students in social work at the School of Health and Welfare in Jönköping. The results were analyzed using SPSS 28.0 and showed that the students in social work are positive towards professionalization and legitimation in social work. An important conclusion is that professionalization is unbalanced. This means that areas within social work are not evenly professionalized. For example, counselors in health care have a legitimation, while the proposal for legitimation in social work is denied. The imbalance drives the development of social work through competition between professions, and in this study, we view the imbalance as positive. Another conclusion is that students' attitudes in social work are essential for continuing professionalization in social work

Managing to Adapt: Analysing adaptive management for planning, monitoring, evaluation, and learning

Adaptive management is at the heart of 'Doing Development Differently'. It emerges from stakeholders' calls for development programmes to be more flexible and responsive to their contexts. Whether it becomes a mainstreamed practice depends on how much it is embraced by donors and implementers alike, especially in funding, design, monitoring, evaluation, and learning cycles.This report was developed by a group of students from the London School of Economics as part of their Master's degree programme, in partnership with Oxfam Great Britain. It presents a collection of case studies from Oxfam and other agencies to illustrate concrete examples of how programmes can incorporate adaptive practices at different stages of the planning cycle. It also offers practical suggestions to development actors to support adaptive practices. It argues that PMEL for adaptive management entails flexible funding mechanisms; iterative design processes; developing locally owned approaches; and creating an enabling environment for learning