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Effectiveness of occupational therapy intervention for people with Parkinson’s disease: Systematic review
Get PDFOccupational therapists commonly provide intervention that promotes quality of life in people with Parkinson’s disease. Existing research supports the effects of multidisciplinary and motor intervention for people with Parkinson’s disease. However, few studies have identified the effectiveness of occupational therapy intervention alone. The aim of this review was to examine the efficacy of interventions provided by occupational therapists for people with Parkinson’s disease.
Methods
A comprehensive database search of the literature was performed using Medline, EMBASE, PsycInfo and CINAHL between 2003 and January 2018. There were no restrictions on study design and studies with or without a control group were selected for review. Studies were included if intervention consisted of at least 50% of occupational therapy intervention for Parkinson’s disease. Two independent reviewers extracted and synthesised data from relevant articles.
Results
In all, 10 studies representing data from 1343 people with Parkinson’s disease and 180 caregivers were included in this review. Occupational therapy interventions focussing on meaningful activities were shown to improve perceived occupational performance. Upper limb therapy programmes were shown to improve upper limb function in the short term though longer‐term effects are unclear.
Conclusion
Current research supports interventions which are intermittent, short term and intensive, and involve tailored therapy plans working towards an individual’s goals. Occupational therapists should implement goal‐oriented intervention programmes in conjunction with following the guidance of existing best practice guidelines.måsjekke
Social integration and alcohol consumption among older people: A four-year follow-up of a Swedish national sample
Get PDFBackground
Today’s older people drink more alcohol than earlier cohorts of older people. Social integration has been identified as an important factor for older people’s drinking, but the association is complex. This study investigates both high and low levels of social integration and their associations with longitudinal patterns of alcohol consumption among older women and men.
Methods
Longitudinal nationally representative data of older Swedish women and men aged over 65 – the Swedish Level of Living Survey (LNU) and Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) – from 2010/2011 and 2014 (n = 1048). Associations between social contacts and social activities at baseline and longitudinal patterns of drinking frequency were examined with multinomial logistic regression analyses.
Results
Men reported drinking alcohol more often than women, but the most common drinking frequency among both women and men was to drink monthly or less. Drinking habits were generally stable over time. People with high levels of social activity at baseline were more likely to have a stable daily or weekly drinking frequency or increased drinking frequency over the four-year follow-up period, particularly women. People with low levels of social contacts and/or social activities were less likely to have a stable daily or weekly drinking frequency, compared to people in the low and stable drinking frequency group.
Conclusions
Alcohol consumption is embedded in a social context, older people drink in social situations and social integration predicts continued drinking patterns.måsjekke
Digital oppfølging og støtte for personer med multippel sklerose. Erfaringer fra prosjektet MS-DOS
Get PDFMS-DOS er et forprosjekt som undersøker muligheter for at personer med multippel sklerose (MS) og relevante helseaktører kan ta i bruk digitale hjelpemidler for bedre oppfølging, behandling og mestring av sykdommen. Målet for MS-DOS er å samle informasjon om hvilke utfordringer personer med MS opplever på grunn av sin sykdom, og vurdere i hvilken grad digitale verktøy kan gjøre livet bedre for denne gruppen. Denne rapporten gir et overblikk over helsetilbudet til personer med MS. Deretter presenteres resultater fra en dybdestudie hvor vi følger tre personer med MS over en periode på seks uker. Metoden vi har brukt er observasjon og intervjuer, samt kartlegging av planlagte og reelle pasientforløp ved hjelp av Customer Journey Modelling Language. Rapporten presenterer til slutt muligheter for bruk av digitale støtteverktøy, og forslag til videre studier Oppdragsgiver: Helsedirektoratet ved Innome
Velferdsteknologi i Stord kommune
Get PDFRegjeringa Solberg har i regjeringserklæringa sett fokus på Velferdsteknologi, og følgjer soleis opp NOU 2011: 11 og Meld. St. 29 Morgendagens omsorg. Målet er meir bruk av velferdsteknologi i helse- og omsorgstenestene for å bedre brukaren sin muligheit til å mestre eigen kvardag, auke brukar og pårørande sin tryggleik og auke brukaren og pårørande si deltaking i brukarnettverk og muligheit til å halde kontakt med kvarandre.
Stord kommune har i sin plan for rehabilitering, helse og omsorg (RHO) 2012 – 2021, pkt. 3.7 fokusområde: Velferdsteknologi som kan bidra til betre tenester. Målet er at teknologi skal styrkja omsorgstenestene og gje brukaren mogleik til sjølv å klara eigen kvardag. Kommunen ynskjer og å gje både brukarar og pårørande større tryggleik gjennom bruk av teknologi for sporing og observasjon, alarmar og sensorar. Eit prioritert mål i perioden 2012 – 2015 er å tileigna seg kunnskap om og prøve ut ulike teknologiske løysingar, samt samarbeide med frivillige og næringsliv om velferdsteknologi. Målet skal vera å halde oppe/auke funksjonsnivå, gje tryggleik og størst grad av sjølvstende hjå brukarane.
Det har i fleire år vore fokus i kommunen på å få ei betre organisering av tenesta og innføre bruk av teknologi for å lette tenestevegane og auke kvaliteten av tenesta til det beste for brukarar og personale. Heimetenestene nyttar i dag mobile løysingar (PDA) for tilgang til fagsystem der ein til ei kvar tid har tilgang til naudsynt informasjon om brukar. I 2011 tok kommunen i bruk elektroniske, sporbare nøkkelskap. Dette gjer til at me til ei kvar tid har betre kontroll over nøklar som er i bruk. Dersom me saknar nøklar, veit me kven som har brukt dei sist, og kan gå direkte til den aktuelle tilsette. Erfaringsvis finn me nøklane. Kommunen har sidan 2014 nytta elektronisk meldingsutveksling for kommunikasjon mellom fastlege og kommune, og kommune og spesialisthelsetenestene.
Fram til 2020 har Helsedirektoratet ansvar for eit program som skal prøve ut velferdsteknologiske løysingar i kommunane og gjennom tenesteinnovasjon utvikle gode tenestemodellar. Målet er at velferdsteknologiske løysingar er blitt ein integrert del av omsorgstenestene i 2020. Stord kommune søkte saman med Bergen og Lindås kommunar, og vart valt ut til å vera 1 av 34 kommunar frå heile landet til å delta i det nasjonale Velferdsteknologiprogrammet. Prosjektet starta opp i januar 2014 og er gått over i drift frå januar 2017.måsjekke
Older patients with late‐stage COPD: Their illness experiences and involvement in decision‐making regarding mechanical ventilation and noninvasive ventilation
Get PDFAims and objectives
To explore the illness experiences of older patients with late‐stage chronic obstructive pulmonary disease and to develop knowledge about how patients perceive their preferences to be taken into account in decision‐making processes concerning mechanical ventilation and/or noninvasive ventilation.
Background
Decisions about whether older patients with late‐stage chronic obstructive pulmonary disease will benefit from noninvasive ventilation treatment or whether the time has come for palliative treatment are complicated, both medically and ethically. Knowledge regarding patients' values and preferences concerning ventilation support is crucial yet often lacking.
Design
Qualitative design with a hermeneutic–phenomenological approach.
Methods
The data consist of qualitative in‐depth interviews with 12 patients from Norway diagnosed with late‐stage chronic obstructive pulmonary disease. The data were analysed within the three interpretative contexts described by Kvale and Brinkmann.
Results
The participants described their lives as fragile and burdensome, frequently interrupted by unpredictable and frightening exacerbations. They lacked information about their diagnosis and prognosis and were often not included in decisions about noninvasive ventilation or mechanical ventilation.
Conclusion
Findings indicate that these patients are highly vulnerable and have complex needs in terms of nursing care and medical treatment. Moreover, they need access to proactive advanced care planning and an opportunity to discuss their wishes for treatment and care.
Relevance to clinical practice
To provide competent care for these patients, healthcare personnel must be aware of how patients experience being seriously ill. Advanced care planning and shared decision‐making should be initiated alongside the curative treatment.måsjekke
Managing collaborative innovation in public bureaucracies
Get PDFPublic planners are increasingly recruited to manage collaborative innovation processes, but there is hardly any research on how they deal with the tensions they encounter in managing collaborative innovation in the institutional context of a public bureaucracy. Drawing on emerging theories of collaborative planning, network management and public innovation, the article develops a taxonomy of tasks related to managing collaborative innovation, identifies potential tensions between these tasks and the institutional logic of public bureaucracies and investigates how these tensions are experienced by frontline planners who remain involved in face-to-face interaction with citizens while managing collaborative innovation processes within urban regeneration projects in Copenhagen.måsjekke
Antall kroniske sykdommer og persontilpasning bør ligge til grunn for prioriteringer i kommunale helse- og omsorgstjenester
Get PDFUtvalget for prioritering i helse- og omsorgstjenestene i kommunene (Blankholmutvalget) har i sitt mandat fått i oppgave å vurdere om prioriteringskriteriene som ble fremlagt i Meld. St. 34 (2015−2016) for spesialisthelsetjenesten (Helse- og omsorgsdepartementet, 2016), også kan anvendes i kommunale helse- og sosialtjenester. Meldingen setter opp tre hovedkriterier for prioriteringer: nyttekriteriet, ressurskriteriet og alvorlighetskriteriet. I prinsippet kan man anvende de samme kriteriene for kommunale helse- og omsorgstjenester (videre omtalt som primærhelsetjenesten). Like fullt vil andre faglige målsettinger og rammer (se Tabell 1) (Rosstad, Garasen, Steinsbekk, Sletvold & Grimsmo, 2013) samt regulerende betingelser (eierskap, regelverk, styring og finansiering) påvirke innholdet og gjennomføringen i primærhelsetjenesten
Barriers and facilitators for guideline adherence in diagnostic imaging: An explorative study of GPs’ and radiologists’ perspectives
Get PDFBackground
Diagnostic imaging has been a part of medicine for the last century. It has been difficult to implement guidelines in this field, and unwarranted imaging has been a frequent problem. Some work has been done to explain these phenomena separately. Identifying the barriers to and facilitators of guideline use has been one strategy. The aim of this study is to offer a more comprehensive explanation of deviations from the guideline by studying the two phenomena together.
Methods
Eight general practitioners and 10 radiologists from two counties in Norway agreed to semi-structured interviews. Topics covered in the interviews were knowledge of the guideline, barriers to and facilitators of guideline use, implementation of guidelines and factors that influence unwarranted imaging.
Results
Several barriers to and facilitators of guideline use were identified. Among these are lack of time, pressure from patients, and guidelines being too long, rigid or unclear. Facilitators of guideline use were easy accessibility and having the guidelines adapted to the target group. Some of the factors that influence unwarranted imaging are lack of time, pressure from patients and availability of imaging services.
Conclusion
There are similarities between the perceived barriers for guideline adherence and the perceived factors that influence unwarranted imaging. There may be a few reasons that explains the deviation from guidelines, and the amount of unwarranted imaging
Advance Care Planning in Nursing Homes – Improving the Communication Among Patient, Family, and Staff: Results From a Cluster Randomized Controlled Trial (COSMOS)
Get PDFIntroduction: The majority of nursing home (NH) patients suffer from complex diseases, including dementia. This makes advance care planning (ACP) particularly important.
Objectives: The aim was to investigate the effect of an ACP intervention on communication among NH staff, patient, and family. We further investigated whether the intervention affected nursing staff distress.
Methods: The ACP intervention was a part of the 4-month cluster randomized controlled COSMOS trial with a 9-month follow-up. Norwegian NH units (n = 72), with 765 patients were invited, and eligible units were cluster randomized to usual care or the intervention group. The ACP intervention consisted of an education program targeting all NH staff (nurses and physicians) and managers. Implementation was supported by a train-the-trainer approach, with regular phone calls from the researchers. The effect of the intervention was assessed by a data collection form and questionnaires. Nursing staff distress was assessed by the Neuropsychiatric Inventory -Nursing Home version.
Results: Five hundred and forty five patients from 67 NH units were included and randomized to the intervention (N = 297; 36 units) and control group (N = 248; 31 units). Organized meetings between the family, patient, and nurses were conducted more frequently in the intervention compared to the control group at month 4 (OR = 3.9, 95% CI = 1.6 to 9.4, p = 0.002). Monthly contact between family and nurses was also more frequent in the intervention group (OR = 6.5, 95% CI = 1.6 to 3.5, p = 0.010). Nurses and families were more satisfied with their communication in the intervention compared to the control group. Staff distress was reduced in the intervention group at month 4 (B = -1.8, 95% CI = -3.1 to -0.4, p = 0.012). The intervention effect at month 4 did not persist during follow-up at month 9.
Conclusion: Compared to control, the ACP intervention improved the communication, and family and staff satisfaction as well as reduced staff distress. However, during the follow-up period these positive effects were not persistent. Indicating the necessity for ongoing staff support regarding ACP
Experiences and challenges of home care nurses and general practitioners in home-based palliative care – a qualitative study
Get PDFBackground
Norway has one of the lowest home death rates in Europe. However, it is the health authorities´ ambition to increase this by facilitating palliative care at home. The aim of this study was to achieve more insight, through home care nurses and general practitioners, of conditions that facilitate or hamper more time at home and more home deaths for patients with terminal disease and short life expectancy.
Methods
We used a qualitative research design with four focus groups with a total of 19 participants, of either home care nurses or general practitioners, using semi-structured question guides. The data were processed by systematic text condensation and encompassed thematic analysis of meaning and content of data across cases, which included four steps of analysis.
Results
Three main themes were identified: 1) The importance of a good start for the patient and family with five sub-themes, 2) ‘Passing the baton’ – the importance of collaboration across the health system with four sub-themes, and 3) Avoiding new hospitalization by establishing collaboration and competence within primary health care with four sub-themes.
Conclusions
This study demonstrates that optimum palliative care at home depends on close collaboration and dialogue between the patient, family, home care nurses and general practitioner. It suggests the need for safer discharge routines and planning when hospitals transfer patients with terminal disease to their homes. A good start for the patient and family, where the initial interdisciplinary collaboration meeting takes place in the patient’s home, is crucial for a good result. The general practitioners’ perception of their ‘disconnection’ during hospitalization and prior to discharge has the potential to reduce patient safety. The family seems to be fundamental in gaining more time at home for the patient and supporting the patient to eventually die at home. Home-based palliative care demands experience and competence as well as regular supportive mentoring