GP's Adherence to Guidelines for Cardiovascular Disease among Elderly: A Quality Development Study

Background. Evidence-based guidelines should in most cases be followed also in the treatment of elderly. Older people are often suboptimally treated with the recommended drugs. Objectives. To describe how well general practitioners adhere to current guidelines in the treatment of elderly with cardiovascular disease and evaluate local education as a tool for improvement. Method. Data was collected from the medical records of patients aged ≥65, who visited a primary health care center in Sweden 2006 and had one or more of the following diagnoses: hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation, or prior stroke. Local education was organized and included feed-back to the patient's doctor and discussion about regional guidelines. Repeated measurements were performed in 2008. Results and Conclusion. The adherence to guidelines was low. Approximately one-third of the patients with hypertension reached target blood pressure, stroke patients more often. More patients with heart failure were treated with angiotensin converting enzyme inhibitor than in other European countries, but still only 60%. Half of the patients with chronic atrial fibrillation were treated with Warfarin, although more than two-thirds had a CHADS2 score indicating the need. Educational efforts appeared to increase the adherence and hence should be encouraged

The assessment of renal function in relation to the use of drugs in elderly in nursing homes; a cohort study

Background Renal function decreases with age. Dosage adjustment according to renal function is   indicated for many drugs, in order to avoid adverse reactions of medications and/or   aggravation of renal impairment. There are several ways to assess renal function in   the elderly, but no way is ideal. The aim of the study was to explore renal function   in elderly subjects in nursing homes and the use of pharmaceuticals that may be harmful   to patients with renal impairment. Methods 243 elderly subjects living in nursing homes were included. S-creatinine and s-cystatin   c were analysed. Renal function was estimated using Cockcroft-Gault formula, Modification   of Diet in Renal Disease (MDRD) and cystatin C-estimated glomerular filtration rate   (GFR). Concomitant medication was registered and four groups of renal risk drugs were   identified: metformin, nonsteroidal anti-inflammatory drugs (NSAID), angiotensin-converting   enzyme -inhibitors/angiotensin receptor blockers and digoxin. Descriptive statistics   and the Kappa test for concordance were used. Results Reduced renal function (cystatin C-estimated GFR < 60 ml/min) was seen in 53%. Normal   s-creatinine was seen in 41% of those with renal impairment. Renal risk drugs were   rather rarely prescribed, with exception for ACE-inhibitors. Poor concordance was   seen between the GFR estimates as concluded by other studies. Conclusions The physician has to be observant on renal function when prescribing medications to   the elderly patient and not only rely on s-creatinine level. GFR has to be estimated   before prescribing renal risk drugs, but using different estimates may give divergence   in the results

Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE)

n/

Polychaete invader enhances resource utilization in a species-poor system

Ecosystem consequences of biodiversity change are often studied from a species loss perspective, while the effects of invasive species on ecosystem functions are rarely quantified. In this experimental study, we used isotope tracers to measure the incorporation and burial of carbon and nitrogen from a simulated spring phytoplankton bloom by communities of one to four species of deposit-feeding macrofauna found in the species-poor Baltic Sea. The recently invading polychaete Marenzelleriaarctia, which has spread throughout the Baltic Sea, grows more rapidly than the native species Monoporeia affinis, Pontoporeia femorata (both amphipods) and Macoma balthica (a bivalve), resulting in higher biomass increase (biomass production) in treatments including the polychaete. Marenzelleria incorporated and buried bloom material at rates similar to the native species. Multi-species treatments generally had higher isotope incorporation, indicative of utilization of bloom material, than expected from monoculture yields of the respective species. The mechanism behind this observed over-yielding was mainly niche complementarity in utilization of the bloom input, and was more evident in communities including the invader. In contrast, multi-species treatments had generally lower biomass increase than expected. This contrasting pattern suggests that there is little overlap in resource use of freshly deposited bloom material between Marenzelleria and the native species but it is likely that interference competition acts to dampen resulting community biomass. In conclusion, an invasive species can enhance incorporation and burial of organic matter from settled phytoplankton blooms, two processes fundamental for marine productivity

Lekande lätt? – en studie kring hur pedagoger i förskola ser på lek- och samspelssvårigheter

Syfte: Syftet med studien är att undersöka hur pedagoger i förskola ser på lek- och samspelssvårigheter hos barn samt hur de arbetar för att skapa möjligheter till lek och samspel i barngruppen. Metod och genomförande: Studien har gjorts genom en kvalitativ metod. Genom samtalsintervjuer har fyra förskollärare fått ge uttryck för sin syn på lek- och samspelssvårigheter samt attityder och förhållningssätt kring hur lek och samspel kan stimuleras. Resultat: Resultatet visar att pedagogerna i studien uttrycker att barn i lek- och samspelssvårigheter har mindre gynnsamma förutsättningar för utveckling och lärande. Detta menar pedagogerna då de uttrycker att lek och samspel med andra har stor betydelse för barnets utveckling. Pedagogerna visar på skilda sätt att se på hur lek- och samspelssvårigheter kan ta sig uttryck. Resultatet visar även att samtliga pedagoger uttrycker att barn i lek- och samspelsvårigheter behöver stöd och stimulans för att utveckla sin lekförmåga. Pedagogerna uttrycker olika sätt att ge barnet detta stöd. Resultatet visar att lek- och samspelssvårigheter påverkar den pedagogiska verksamheten. Denna påverkan sker på tre nivåer; individ-, grupp- samt organisationsnivå. Resultatet visar att denna påverkan är ömsesidig då gruppen och organisationen påverkar lek och samspel. Slutsatser med betydelse för läraryrket: För att barn i lek- och samspelssvårigheter ska få gynnsamma förutsättningar till utveckling och lärande genom lek och samspel är det av stor vikt att möta varje barn. Detta möte bör ske utifrån det enskilda barnets erfarenheter, förutsättningar och behov. Verksamheten bör utformas efter gruppen, samt varje enskilt barns behov för att skapa möjligheter till lek och samspel i gruppen

MANAGING DRUG USE IN THE ELDERLY. General practitioners’ adherence to guidelines and patients’ conceptions of medication

Introduction: Older patients’ knowledge about their medicines is generally poor. Patients are entitled to be informed on an individual and adequate level. Evidence-based guidelines should, in most cases, be followed also in the treatment of elderly to avoid suboptimal treatment, for example for cardiovascular conditions, or risky prescriptions in the case of renal impairment. Objectives: 1. To describe frail elderly patients’ knowledge about and attitudes towards their medicines and to explore their experiences of receiving information about their medications. 2. To describe how well general practitioners (GPs) adhere to guidelines when using renal risk drugs in frail elderly patients and when treating elderly with cardio¬¬vascular disease and to evaluate local education of GPs as a tool for improvement. Methods: (Paper I, IV) For each prescribed medicine, the patient was asked about the indication and possible adverse effects. Attitudes were investigated with the Beliefs about Medicines Questionnaire. Semi-structured interviews covering questions on information about medication were analysed qualitatively. (Paper II) Medications for elderly patients in nursing homes were registered and the use of renal risk drugs was compared to renal function, estimated from s-creatinine and s-cystatin C. (Paper III) Data about GPs adherence to guidelines was collected from the medical records of patients aged ≥ 65 with a cardiovascular diagnosis. Local education was organized, followed by repeated measurements. Results: The knowledge about indication was satisfying but the knowledge about possible adverse effects was poor. The patients believed strongly in the benefits of their medication. The elderly felt comfortable with information when they trusted their physician or their medication, when they received enough information from the prescriber or when they knew how to find out sufficient information by themselves. They felt insecure if they were anxious, if the availability of medical care was poor or if they did not receive enough information. Reduced renal function was common (53%) in nursing home patients but s-creatinine was often normal. Renal risk drugs were rarely prescribed. The adherence to guidelines about cardiovascular diseases was low among GPs, but educational efforts appeared to increase the adherence. Conclusions: To receive an adequate drug therapy in the elderly, GPs should pay attention to patients’ need for suitable information on their medication and follow evidence-based guidelines about when to initiate and when to avoid certain drugs

DEN SOCIALA SITUATIONEN OCH RELATIONERS BETYDELSE FÖR ÅTERHÄMTNING : - En kvalitativ litteraturstudie om upplevelser hos personer med allvarlig psykisk störning

Bakgrund: Genom historien har personer med allvarlig psykisk störning ofta tvingats leva avskilda och utstötta från samhället, en stigmatisering som finns kvar än idag. Syfte: Syftet med litteraturstudien var att belysa hur personer med allvarlig psykisk störning upplever sin sociala situation samt hur dessa personer upplever att sociala relationer påverkar återhämtningen från allvarlig psykisk störning. Metod: Till studien eftersöktes kvalitativa artiklar i relevanta databaser, nio stycken artiklar som passade studiens syfte valdes ut. Artiklarna genomgick manifest innehållsanalys, två huvudkategorier och ett flertal underkategorier kunde urskiljas. Resultat: I litteraturstudien framgick att personer med allvarlig psykisk störning känner sig utstötta från samhället och upplever fördomar riktade mot sig. Svårigheter med sociala kontakter leder till ensamhet. Önskan om meningsfulla aktiviteter fanns för att få en mer meningsfull vardag och lättare kunna knyta kontakter med andra. De sociala relationernas betydelse för återhämtningen från allvarlig psykisk störning framkom tydligt i litteraturstudien. Familj, vänner och vårdare bidrog samtliga till återhämtningsprocessen. Slutsats: Personerna upplevde en stigmatisering som bidrog till att försämra deras sociala situation, vilket bidrar till ökat lidande. Alla inom vården är en viktig del för att minska detta. Sociala relationer som medför att bli sedd och bekräftad som människa är viktigt för återhämtningen från allvarlig psykisk störning

Efterlevandesamtal i hemsjukvården : En intervjustudie baserad på distriktssköterskors och sjuksköterskors erfarenheter

Bakgrund: Palliativ vård omfattar inte bara vård av patienten utan innefattar även stöd till närstående, både under vårdtiden och efter dödens faktiska inträffande. Ett efterlevandesamtal är en möjlighet för distriktssköterskan att följa upp hur de närstående mår en tid efter dödsfallet och hur de upplevde vården under sjukdomstiden. Syfte: Att beskriva distriktssköterskors och sjuksköterskors erfarenheter av efterlevandesamtal inom kommunal hemsjukvård. Metod: Studien hade en kvalitativ deskriptiv design med en induktiv ansats. Åtta individuella semi-strukturerade intervjuer genomfördes via videomöte. Insamlat material analyserades genom en kvalitativ innehållsanalys med fokus på det manifesta innehållet. Resultat: I resultatet framkom att efterlevandesamtal erbjöds efter alla dödsfall. Arbetsuppgiften beskrevs vara värdefull och mångsidig samt något som distriktssköterskan fått lära sig på egen hand. Efterlevandesamtalet hade en avslutande funktion från både distriktssköterskans och de närståendes perspektiv. Efterlevandesamtalets syfte ansågs vara att identifiera de närstående som var i behov av stöd samt ta emot synpunkter ifrån de närstående och reda ut eventuella frågor. Synpunkterna ansågs viktiga att ta vara på för att kunna kvalitetsutveckla vården. Slutsats: Betydelsen av efterlevandesamtalet var utifrån distriktssköterskornas perspektiv viktig för både distriktssköterskorna och de närstående. Distriktssköterskornas inställning till att genomföra efterlevandesamtal varierade. Framförallt ansågs det vara en värdefull arbetsuppgift men beskrevs även kunna vara svår och krävande. Vår studie skulle kunna hjälpa distriktssköterskor som känner en oro inför efterlevandesamtalet att se på det ur ett annat perspektiv.Background: Palliative care includes not only the care of the patient, but also support for family members, both during the period of care and after the actual occurrence of death. A bereavement follow-up is an opportunity for the community health nurse to follow up on how the family members feel some time after the death and how they experienced the care during the illness. Aim: To describe the community health nurses experiences of bereavement follow-up in home care services. Method: The study had a qualitative descriptive design with an inductive approach. Eight individual semi-structured interviews were conducted via video meeting. The collected material was analyzed through a qualitative content analysis with a focus on the manifested content. Findings: The results revealed that bereavement follow-up are offered after all deaths. The task was perceived to be valuable and versatile, as well as something that the community health nurse had to learn on their own. The bereavement follow-up had an ending function from both the community health nurses and the family members perspective. The purpose of the bereavement follow-up was to identify the family members in need of support and to receive comments from the family members and sort out any issues. The comments were considered important to take advantage of to improve the quality of the care. Conclusion: From the perspective of the community health nurses the bereavement follow-up was important for both community health nurses and family members. Among the community health nurses the attitude to have bereavement follow-up varied. Above all, it was considered a valuable task but could also be difficult and demanding. Our study could be helpful to those who are anxious about the bereavement follow-up, to look at it from a different perspective

Kidney function and use of nonsteroidal anti-inflammatory drugs among elderly people : a cross-sectional study on potential hazards for an at risk population

Background Renal elimination normally decreases with age. Nonsteroidal antiinflammatory drugs (NSAIDs) carry a risk of additional kidney damage. Objective The aims of this study were to assess the prevalence of NSAIDs in the elderly (aged ≥ 65) population in Sweden, explore reasons for any possible differences in the level of use and assess their kidney functions. Setting Data were obtained from the cohort study Good Aging in Skåne, Sweden. Patients aged 65 or more were included. Methods Medication lists were collected as well as variables such as cognition and education levels. Glomerular filtration rate was estimated from creatinine and cystatin C. Descriptive statistics and multiple linear regression analysis were used. Main outcome measure: NSAID use among the general elderly population. Results A total of 1798 patients were included. Approximately six percent (n = 105) of the people in the study group were using NSAIDs and of those 82 (78%) bought NSAIDs over the counter (OTC). 42% of those buying NSAIDs OTC showed an estimated glomerular filtration rate below 60 ml/min/1.73 m2. Education level did not affect the use of nonsteroidal anti-inflammatory drugs, nor did age. NSAIDs were more commonly used than other recommended analgesics. Conclusion Many people are unaware of the risks associated with the use of NSAIDs. The findings imply that the frailest elderly use NSAIDs to the same extent as the younger elderly do. It is important that information about safety of these drugs be communicated to both patients and healthcare professionals