Should I stay or should I go – Factors associated with hospitalization risk among older persons in Sweden

An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences. Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital. Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care. Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients. Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.

Utveckling av programvara för läsning och skrivning till iButton

Dagens dataloggare har många funktioner vilket avspeglas i programvaran som används för att kommunicera med dem. De har fler funktioner än vad enskilda företag och privatpersoner behöver vilket gör programvaran onödigt komplicerad. Genom att minska antalet inställningsmöjligheter kan programvaran göras mindre, snabbare och lättare att lära sig. Arbetet utfördes hos Inventech Europe AB som tillhandahöll dataloggare för temperatur- och fuktighetsmätning. De ville undersöka möjligheterna att utveckla ett program som personer med begränsad datorvana snabbt kunde lära sig att använda. Därför var syftet med detta arbete att utreda hur ett sådant program kunde se ut. Arbetets fokus låg på designprocessen. Genom olika UML-diagram visualiserades de olika momenten i processen. Då projektet var relativt litet valdes en utvecklingsprocess som följer vattenfallsmodellen där de olika stegen (specifikation, design, implementation, test) utförs i följd. Det förutsätter att ett steg är färdigt innan nästa steg påbörjas. Modellen fungerar bäst när projektet är mindre och väldefinierat. Tyvärr ändrades företagets krav på hur programmet skulle fungera flera gånger under arbetets gång. Därmed borde en mer flexibel utvecklingsprocess ha valts för att ge utrymme för förändringar som kunde uppkomma under projektets gång. Slutresultatet blev en funktionsprototyp som var lätt att använda och inte hade fler inställningsmöjligheter än nödvändigt. Funktionsprototyp kan användas som bas för att lägga till egen skräddarsydd funktionalitet. För att visa detta inkluderades ytterligare två funktioner. En av funktionerna var möjligheten att kunna spara insamlad data till en extern databas som sedan kunde användas som källa till andra program vilka exempelvis skulle kunna visualisera data med hjälp av olika grafer. För att lätt kunna identifiera olika inkopplade dataloggare inkluderades även möjligheten att namnge de olika enheterna.

Skapandet av ett webbaserat ärendehanteringssystem för affärssystemet Pyramid med Scrum : Creation of a web based case management system for the business system Pyramid with Scrum

The business system known as Pyramid does today not provide its user with a reasonable system regarding case management for support issues. The current system in place requires the customer to contact its provider via telephone to register new cases. In addition to this, current system doesn’t include any way for the user to view any of their current cases without contacting the provider.A solution to this issue is to migrate the current case management system from a telephone contact to a web based platform, where customers could easier access their current cases, but also directly through the website create new cases. This new system would reduce the time required to manually manage each individual case, for both customer and provider, resulting in an overall reduction in cost for both parties.The result is a system divided into two different sections, the first one is an API created in Pyramid that acts as a web service, and the second one a website which customers can connect to. The website will allow users to overview their current cases, but also the option to create new cases directly through the site. All the information used to the website is obtained through the web service inside Pyramid. Analyzing the final design of the system, the developers where able to conclude both positive and negative aspects of the systems’ final design. If the platform chosen was the optimal choice or not, and also what can be include if the system is further developed, will be discussed.The development process and the method used during development will also be analyzed and discussed, what positive and negative aspects that where encountered. In addition to this the cause and effect of a development team smaller than the suggested size will also be analyzed. Lastly an analysis of actions that could’ve been made in order to prevent certain issues from occurring will.