Motivationsarbete med missbrukare - inom socialtjänst, sjukvårdens beroendevård och den gemensamma motivationsprocessen

Motivational work is a complex subject as well as being an extensive part of the modern addiction treatment. A national survey from 2001 report that motivational work is a necessity in a successful addiction treatment. On the other hand the same survey also identifies a lack of evidence-based methods. The purpose of this essay was to examine the motivational work within the social services and healthcare addiction treatment from a professionals perspective. Furthermore we have done this by isolating the four different areas; method, resources, attitude and responsibility. The empirical material from our eight semistructured interviews has been analyzed on the basis of theories concerning practice and method within motivational work. As a frame of reference we have Per Revstedt and his thoughts concerning motivational work, Håkan Jenner and his interpretation of both the attribution theory and the pygmalion effect, William Miller and his motivational interview as well as James Prochaska and Carlo DiClementes stages of change. Some of our conclusions drawn includes the fact that a successful motivational work is built upon a numerous important factors such as access to vital resources and a functional cooperation between the social services and the healthcare addiction treatment, a good knowledge concerning addiction and motivation, theories and methods, as well as an ability of turning them into practice

Socionomers förutsättningar för ett systematiskt arbetssätt? Organisatoriska hinder i arbetet med ASI Uppföljning

In the systematic work of following up on the needs of individuals with alcohol or drug related problems, the Addiction Severity Index follow-up interview plays a central role. In this descriptive cross-sectional study, we investigate how demographic, occupational, and organizational factors are related to the propensity of professional social workers to work with the ASI follow-up interview. The study includes 135 professional social workers who work to assess and follow up on the needs of individuals with alcohol or drug related problems. Lack of competence emerges as being associated with a lower likelihood of working with the ASI follow-up interview. To increase the propensity of employees to work with ASI follow-up, managers and other people in leadership positions should facilitate continued learning.I det systematiserade arbetet med att följa upp hjälpbehov för personer med alkohol- eller narkotikaproblem har Addiction Severity Index uppföljningsintervju (ASI U) en central funktion. I den här deskriptiva tvärsnittsstudien undersöker vi närmare hur demografiska, yrkesrelaterade och organisatoriska faktorer är relaterade till yrkesverksamma socionomers benägenhet att arbeta med ASI uppföljning. Studien omfattar 135 yrkesverksamma socionomer som arbetar med att utreda och följa upp hjälpbehov för personer med skadligt bruk eller beroende av alkohol eller narkotika. Bristande kompetens framträder som förenat med en lägre sannolikhet att arbeta med ASU uppföljning. För att öka medarbetares benägenhet att arbeta med ASU U bör chefer och andra personer i arbetsledande position ge medarbetare reella förutsättningar till fortbildning och vidareutbildning

Socionomers förutsättningar för ett systematiskt arbetssätt? : Organisatoriska hinder i arbetet med ASI Uppföljning

I det systematiserade arbetet med att följa upp hjälpbehov för personer med alkohol- eller narkotikaproblem har Addiction Severity Index uppföljnings-intervju (ASI U) en central funktion. I den här deskriptiva tvärsnittsstudien undersöker vi närmare hur demografiska, yrkesrelaterade och organisato-riska faktorer är relaterade till yrkesverksamma socionomers benägenhet att arbeta med ASI uppföljning. Studien omfattar 135 yrkesverksamma socionomer som arbetar med att utreda och följa upp hjälpbehov för personer med skadligt bruk eller beroende av alkohol eller narkotika. Bristande kompetens framträder som förenat med en lägre sannolikhet att arbeta med ASU upp-följning. För att öka medarbetares benägenhet att arbeta med ASU U bör chefer och andra personer i arbetsledande position ge medarbetare reella förutsättningar till fortbildning och vidareutbildning.In the systematic work of following up on the needs of individuals with alco-hol or drug related problems, the Addiction Severity Index follow-up interview plays a central role. In this descriptive cross-sectional study, we investigate how demographic, occupational, and organizational factors are related to the propensity of professional social workers to work with the ASI follow-up interview. The study includes 135 professional social workers who work to assess and follow up on the needs of individuals with alcohol or drug related problems. Lack of competence emerges as being associated with a lower likelihood of working with the ASI follow-up interview. To increase the pro-pensity of employees to work with ASI follow-up, managers and other people in leadership positions should facilitate continued learning. </p

Gulliver Simulation - En systemarkitektur f or n atverkssimulering av

Nowadays, a lot of resources are spent on developing systems that will make it possible for vehicles to act autonomously, and make them more effective. One of the projects that is working on this is the Gulliver Project. Gulliver has constructed a number of miniature vehicles equipped with various sensors, to use as a physical testbed for autonomous driving. One big disadvantage with this method is the long iteration time that occurs during the development and testing of a new software. This project has improved this process by developing a system architecture of a virtual testbed where it is possible to simulate autonomus vehicles that communicates through any type of wireless network. The testbed has made it possible to simulate autonomus vehicle systems that with a reasonable margin of error, acts like the system would act in a physical test. This testbed will save a lot of time for future projects, since it is now possible to develop autonomus systems virtually, and upload them to the physical testbed when it has been con rmed that the system works ok, instead of having to work with the physical testbed during the whole development period

Combining GFR estimates from cystatin C and creatinine—what is the optimal mix?

Background: Combining estimated glomerular filtration rate (eGFR) equations based on creatinine and cystatin C has been shown to improve the accuracy of GFR estimation. This study aims to optimize this strategy for height-independent GFR estimation in children. Methods: Retrospective study of 408 inulin clearance tests with simultaneous International Federation of Clinical Chemistry-calibrated measurements of creatinine, cystatin C, and urea in children (mean age 12.5 years, GFR 91.2 ml/min/1.73m2) comparing the arithmetic (meanarith) and geometric means (meangeom) of a height-independent creatinine-based (full age spectrum, based on age (FASage)) and a cystatin C-based equation (FAScys), with the complex height-dependent CKiD3 equation incorporating gender, height, cystatin C, creatinine, and urea. Results: Meangeom had a P30 accuracy of 89.2% compared to meanarith 87.7% (p = 0.030) as well as lower bias and %precision error and performed almost as well as CKiD3 (P30 accuracy 90.9%). Modifying the weight of FASage and FAScys when calculating the means showed that an equal contribution was most accurate in most patients. In spina bifida patients, FAScys alone outperformed any combination. Malignancy or nephritis patients had slightly higher accuracy with weighted means favoring cystatin C or creatinine, respectively. Disagreement between FAScys and FASage was inversely correlated with the accuracy of meangeom. When disagreement exceeded 40%, application of weighted means based on diagnosis improved the performance of eGFR. Conclusions: In the absence of height data, the optimal strategy for estimating GFR in children is by using the geometric mean of FASage and FAScys. When there is large disagreement between the two, weighted means based on diagnosis improve accuracy

Accurate eGFR reporting for children without anthropometric data

Introduction Reporting estimated glomerular filtration rate (eGFR) instead of serum concentrations is advised in current guidelines. Most creatinine-based eGFR equations for children require height, a parameter not readily available to laboratories. Combining height-dependent creatinine- and cystatin C-based eGFR improves performance. Recently, a height-independent creatinine-based eGFR equation has been developed. Aim To compare the combination of height-independent creatinine- and cystatin C-based equations with a combination of equations using anthropometric data. Methods Retrospective analysis of 408 pediatric inulin clearance studies with simultaneous height, creatinine, cystatin C and urea measurements. eGFR calculation using the recalibrated Schwartzcrea (height-dependent), FASage (height-independent) and the Schwartzcys equation. The means (Schwartzcrea + Schwartzcys) / 2 and (FASage + Schwartzcys) / 2 were compared with the CKiD3 equation incorporating cystatin C, creatinine, urea, height and gender in terms of %prediction error and accuracy. Results All three single parameter equations performed similarly (P30 accuracy around 80%). (FASage + Schwartzcys) / 2 (P30 89.2%) and (Schwartzcrea + Schwartzcys) / 2 (P30 89.0%), performed comparably to CKiD3 (P30 90.0%). If the difference between the creatinine- and the cystatine C based eGFR was < 40%, P30 accuracy of the mean exceeded 90%. Conclusion Combining the height-independent FASage and SchwartzCys equations substantially improves accuracy and performs comparably to height-dependent equations. This allows laboratories to directly report eGFR in children

Estimation of GFR in children using rescaled beta-trace protein

INTRODUCTION: Beta-trace protein (BTP) is a low molecular weight protein, produced mainly in the cerebrospinal fluid. It has been proposed as a marker for kidney function. Recently, a new method for GFR estimation using mean normal values to rescale GFR marker concentrations has been described for creatinine and cystatin C, two commonly used endogenous markers for kidney function. The aim of this study is to apply this approach to BTP in children. METHOD: We retrospectively analyzed serum concentrations of creatinine, cystatin C and BTP measured during inulin clearance tests in children. BTP was measured using a particle-enhanced immunonephelometric assay (Siemens Healthcare). A novel BTP-based eGFR equation was developed using published normal values for children: eGFRBTP[ml/min/1.73m2] = 107.3/BTP/QBTP with QBTP = 0.69. Performance of this equation was compared to the established creatinine-based full age spectrum equation FASage and the cystatin C-based FAScys equations as well as the BTP-based Benlamri equation in terms of bias, % prediction error and P30 and P10 accuracy rates. RESULTS: 322 inulin clearance tests were studied. Overall, our novel equation performed comparably to the creatinine-based FASage and the BTP-based Benlamri equations but was less accurate than FAScys (P30: 79.2 vs 86.3%, p = .008). Combining markers significantly enhanced performance compared to the single marker equations, with the exception of FAScys. CONCLUSION: Rescaled BTP concentrations are a simple method for estimating GFR in children. However, the additional value of BTP for the estimation of GFR compared to rescaled creatinine and cystatin C still remains to be demonstrated.status: publishe