Trycksår : preventiva omvårdnadsåtgärder och bedömningsinstrumentens effektivitet : en systematisk litteraturstudie

Syftet med denna litteraturstudie var att beskriva vilka omvårdnadsåtgärder som kan förebygga uppkomsten av trycksår samt vilken förmåga att identifiera patienter som riskerar att utveckla trycksår sjuksköterskan har med de bedömningsinstrument som finns. De vetenskapliga artiklarna (n = 20) som ingick i studien söktes via Högskolan Dalarnas databaser Blackwell Synergy, PubMed och ELIN@Dalarna. Sökorden som användes i olika kombinationer var pressure sore, pressure ulcers, nursing, routines, treatment, knowledge, methods, management, measures, risk assessment, scales, risk patients och prevention/preventing. Inklusionskriterierna var att de skulle vara empiriska, skrivna på svenska eller engelska samt vara publicerade efter 1997. Resultatet visade att det finns många olika förebyggande åtgärder som vidtas. I preventivt syfte var evidensbaserade bedömningsinstrument ett bra och användbart verktyg. Även tryckreducerande underlag som luft- eller trögskumsmadrasser, fårskinn eller vattenfyllda handskar användes som trycksårspreventiva åtgärder. Lägesändringar med hjälp av vändscheman samt tidig mobilisering var också förebyggande åtgärder som vidtogs. Patienternas näringsstatus har stor betydelse i det preventiva arbetet. Resultat visade att det förekommer näringstillägg som en förebyggande strategi. Kontinuerlig inspektion av hud samt noggrann hygien var även något som utfördes i preventivt syfte. Det finns en mängd olika bedömningsinstrument och resultatet av litteraturstudien visar att resultaten vad gällde skalornas förmåga att förutse trycksår varierade mellan olika studier. Uppsatsförfattarna anser att trycksårsprevention är viktigt då trycksår orsakar lidande för patienten och är kostsamma för samhället. Preventiva rutinmässiga åtgärder borde utföras inom de flesta patientgrupper och då är bedömningsinstrumenten en viktig del i det arbetet.

Energy efficient and economic renovation of residential buildings with low-temperature heating and air heat recovery

With the building sector accounting for around 40% of the total energy consumption in the EU, energy efficiency in buildings is and continues to be an important issue. Great progress has been made in reducing the energy consumption in new buildings, but the large stock of existing buildings with poor energy performance is probably an even more crucial area of focus. This thesis deals with energy efficiency measures that can be suitable for renovation of existing houses, particularly low-temperature heating systems and ventilation systems with heat recovery. The energy performance, environmental impact and costs are evaluated for a range of system combinations, for small and large houses with various heating demands and for different climates in Europe. The results were derived through simulation with energy calculation tools. Low-temperature heating and air heat recovery were both found to be promising with regard to increasing energy efficiency in European houses. These solutions proved particularly effective in Northern Europe as low-temperature heating and air heat recovery have a greater impact in cold climates and on houses with high heating demands. The performance of heat pumps, both with outdoor air and exhaust air, was seen to improve with low-temperature heating. The choice between an exhaust air heat pump and a ventilation system with heat recovery is likely to depend on case specific conditions, but both choices are more cost-effective and have a lower environmental impact than systems without heat recovery. The advantage of the heat pump is that it can be used all year round, given that it produces DHW. Economic and environmental aspects of energy efficiency measures do not always harmonize. On the one hand, lower costs can sometimes mean larger environmental impact; on the other hand there can be divergence between different environmental aspects. This makes it difficult to define financial subsidies to promote energy efficiency measures.

Techno-economic analysis of three HVAC retrofitting options

Accounting for around 40% of the total final energy consumption, the building stock is an important area of focus on the way to reaching the energy goals set for the European Union. The relatively small share of new buildings makes renovation of existing buildings possibly the most feasible way of improving the overall energy performance of the building stock. This of course involves improvements on the climate shell, for example by additional insulation or change of window glazing, but also installation of new heating systems, to increase the energy efficiency and to fit the new heat load after renovation. In the choice of systems for heating, ventilation and air conditioning (HVAC), it is important to consider their performance for space heating as well as for domestic hot water (DHW), especially for a renovated house where the DHW share of the total heating consumption is larger. The present study treats the retrofitting of a generic single family house, which was defined as a reference building in a European energy renovation project. Three HVAC retrofitting options were compared from a techno-economic point of view: A) Air-to-water heat pump (AWHP) and mechanical ventilation with heat recovery (MVHR), B) Exhaust air heat pump (EAHP) with low-temperature ventilation radiators, and C) Gas boiler and ventilation with MVHR. The systems were simulated for houses with two levels of heating demand and four different locations: Stockholm, Gdansk, Stuttgart and London. They were then evaluated by means of life cycle cost (LCC) and primary energy consumption. Dynamic simulations were done in TRNSYS 17. In most cases, system C with gas boiler and MVHR was found to be the cheapest retrofitting option from a life cycle perspective. The advantage over the heat pump systems was particularly clear for a house in Germany, due to the large discrepancy between national prices of natural gas and electricity. In Sweden, where the price difference is much smaller, the heat pump systems had almost as low or even lower life cycle costs than the gas boiler system. Considering the limited availability of natural gas in Sweden, systems A and B would be the better options. From a primary energy point of view system A was the best option throughout, while system B often had the highest primary energy consumption. The limited capacity of the EAHP forced it to use more auxiliary heating than the other systems did, which lowered its COP. The AWHP managed the DHW load better due to a higher capacity, but had a lower COP than the EAHP in space heating mode. Systems A and C were notably favoured by the air heat recovery, which significantly reduced the heating demand. It was also seen that the DHW share of the total heating consumption was, as expected, larger for the house with the lower space heating demand. This confirms the supposition that it is important to include DHW in the study of HVAC systems for retrofitting.