Individuell utprovning av inkontinenshjälpmedel i kommunala särskilda boenden

The purpose of this study was to examine the extent to which incontinence aids, used in local authority/municipal nursing homes, were adapted to the resident’s urine-leakage volume and to find out how nurses perceived the current situation concerning individual testing of incontinence aids in municipal nursing homes. The study method was a quantitative empirical study and was carried out in two phases. The first phase was a weighing test, carried out in three nursing homes, whereby the incontinence aids used by 25 residents during a 48 hour period were weighed. The second phase was the completion of a questionnaire by the municipal nurses working in the same local authority. The questionnaire covered: the division of responsibilities; routines for testing incontinence aids, and the level of knowledge concerning individual incontinence aid testing. Only 22 % of the pads used during the observation were properly adapted to the patients’ urinary leakage volume, while 76 % of incontinence aids were larger than necessary in relation to the real volume of urinary leakage. The municipal nurses, who have a key role and formal responsibility for individual incontinence aid testing, considered that there was insufficient knowledge within the organisation concerning individual incontinence aid testing, and that the division of responsibilities in this area was unclear. There were great variations relating to the extent of the nurses’ involvement in individual incontinence aid testing, and the nurses stated that increased involvement in individual incontinence aid testing was dependent on more time being made available for this task. Only a minority of the nurses thought that the requisitioning of incontinence aids was preceded by individual testing of the incontinence pads within the organisation. The majority of nurses considered that this was not the case or were unsure of the situation.

Energieffektivisering av klimatskal med hänsyn till kulturhistorisk värdering : Fallstudier av tre befintliga småhus från 1900-talet ur bevarandesynpunkt

Allt hårdare lagkrav gör att det är svårt att energieffektivisera befintliga byggnader utan att förändra deras utseende. Syftet med examensarbetet är att utreda hur stor energieffektivisering, för tre befintliga småhus uppförda under 1900-talet, som är möjlig att uppnå genom förbättring av byggnadernas klimatskal, det vill säga tak, väggar, golv, fönster och dörrar, utan att förvanska byggnadernas utseende och samtidigt bevara deras kulturhistoriska värden. Arbetet bestod av en förstudie där tre byggnader identifierades, ett undersökningsskede där information om byggnaderna togs fram och ett slutsatsskede där energibesparande åtgärdsförslag togs fram och utvärderades. Byggnader som var goda representanter för sin tid och stil söktes. Byggnader från 1910-talet, 1930-talet och 1970-talet, lokaliserades. Sedan gjordes det fallstudier med intervjuer och inventeringar. För att utreda byggnadens klimatskal utfördes u-värdesberäkningar och energiberäkningar av befintliga byggander och byggnader baserade på föreslagna åtgärdsförslag. Ingen av byggnaderna nådde efter föreslagna åtgärder ner till passivhuskravet 59 kWh/år/m2 Atemp eller BBR-kravet 110 kWh/år/m2 Atemp för en byggnads specifika energianvändning. Den största möjliga energieffektivisering för de tre byggnaderna uppförda under 1900-talet, som är möjlig att uppnå utan att förvanska byggnadernas utseende och samtidigt bevara deras kulturhistoriska värden är 13,0 kWh/år/m2 Atemp, 49,7 kWh/år/m2 Atemp respektive 64,8 kWh/år/m2 Atemp. Slutsatser från arbetet är att byggnader från 1910-tal kan åtgärdas genom att isolera fönstren, sätta dit en extra dörr på insidan av ytterdörren samt tilläggsisolera snedtaket. Byggnader från 1930-tal kan åtgärdas genom att isolera fönstren med en isolerruta på insidan av fönstret och dörrarna med en extra dörr på insidan av ytterdörren. Byggnader från 1970-tal kan åtgärda fönstren genom att byta ut dem till energifönster, ingen åtgärd för golvet men fasaden isoleras utvändigt med vakuumisolering. Byggnaden från 1970-talet klarade sig bäst i jämförelsen eftersom den var i autentiskt skick från början vilket gjorde att förbättringen blev större än för till exempel byggnaden från 1910-talet som redan var ombyggd innan åtgärder föreslogs.

Self-reported symptoms and motor tests via telemetry in a 36-month levodopa-carbidopa intestinal gel infusion trial

Objective To investigate if a home environment test battery can be used to measure effects of Parkinson’s disease (PD) treatment intervention and disease progression. Background Seventy-seven patients diagnosed with advanced PD were recruited in an open longitudinal 36-month study at 10 clinics in Sweden and Norway; 40 of them were treated with levodopa-carbidopa intestinal gel (LCIG) and 37 patients were candidates for switching from oral PD treatment to LCIG. They utilized a mobile device test battery, consisting of self-assessments of symptoms and objective measures of motor function through a set of fine motor tests (tapping and spiral drawings), in their homes. Both the LCIG-naïve and LCIG-non-naïve patients used the test battery four times per day during week-long test periods. Methods Assessments The LCIG-naïve patients used the test battery at baseline (before LCIG), month 0 (first visit; at least 3 months after intraduodenal LCIG), and thereafter quarterly for the first year and biannually for the second and third years. The LCIG-non-naïve patients used the test battery from the first visit, i.e. month 0. Out of the 77 patients, only 65 utilized the test battery; 35 were LCIG-non-naïve and 30 LCIG-naïve. In 20 of the LCIG-naïve patients, assessments with the test battery were available during oral treatment and at least one test period after having started infusion treatment. Three LCIG-naïve patients did not use the test battery at baseline but had at least one test period of assessments thereafter. Hence, n=23 in the LCIG-naïve group. In total, symptom assessments in the full sample (including both patient groups) were collected during 379 test periods and 10079 test occasions. For 369 of these test periods, clinical assessments including UPDRS and PDQ-39 were performed in afternoons at the start of the test periods. The repeated measurements of the test battery were processed and summarized into scores representing patients’ symptom severities over a test period, using statistical methods. Six conceptual dimensions were defined; four subjectively-reported: ‘walking’, ‘satisfied’, ‘dyskinesia’, and ‘off’ and two objectively-measured: ‘tapping’ and ‘spiral’. In addition, an ‘overall test score’ (OTS) was defined to represent the global health condition of the patient during a test period. Statistical methods Change in the test battery scores over time, that is at baseline and follow-up test periods, was assessed with linear mixed-effects models with patient ID as a random effect and test period as a fixed effect of interest. The within-patient variability of OTS was assessed using intra-class correlation coefficient (ICC), for the two patient groups. Correlations between clinical rating scores and test battery scores were assessed using Spearman’s rank correlations (rho). Results In LCIG-naïve patients, mean OTS compared to baseline was significantly improved from the first test period on LCIG treatment until month 24. However, there were no significant changes in mean OTS scores of LCIG-non-naïve patients, except for worse mean OTS at month 36 (p<0.01, n=16). The mean scores of all subjectively-reported dimensions improved significantly throughout the course of the study, except ‘walking’ at month 36 (p=0.41, n=4). However, there were no significant differences in mean scores of objectively-measured dimensions between baseline and other test periods, except improved ‘tapping’ at month 6 and month 36, and ‘spiral’ at month 3 (p<0.05). The LCIG-naïve patients had a higher within-subject variability in their OTS scores (ICC=0.67) compared to LCIG-non-naïve patients (ICC=0.71). The OTS correlated adequately with total UPDRS (rho=0.59) and total PDQ-39 (rho=0.59). Conclusions In this 3-year follow-up study of advanced PD patients treated with LCIG we found that it is possible to monitor PD progression over time using a home environment test battery. The significant improvements in the mean OTS scores indicate that the test battery is able to measure functional improvement with LCIG sustained over at least 24 months.