Innerhalb der Palliativmedizin - als multiprofessionellem Unterstützungskonzept für fortgeschritten unheilbar erkrankte Patienten – ist die SAPV als „relativ neue“ Versorgungsform seit 2007 eine gesetzlich festgelegte Struktur. Sie soll vor allem die bessere ambulante Versorgung von Patienten mit inkurablen Erkrankungen mit ausgeprägten komplexen Belastungen in den Bereichen körperlicher und psychosozialer Symptome sowie pflegerischen Hilfebedarfes, unter besonderer Berücksichtigung von Selbstbestimmung und Förderung von Lebensqualität, gewährleisten. In dieser Dissertation wird erstmalig ein Patientenkollektiv einer Universitätsklinik beschrieben, das durch die SAPV der Klinik für Palliativmedizin der UMG im Jahr 2011 behandelt wurde. Hierzu werden epidemiologische, klinische Symptome und Belastungen der Patienten, sowie deren Behandlungsintensität statistisch dargestellt, erläutert und schließlich im Kontext diskutiert.

Homes are a much discussed, but little empirically examined resource for action. Material stuff at home offer resources for social, organisational and individual activities that we routinely encounter and use on an everyday basis. Yet their purposes, storing and sharing practices of use and roles in social and organisational actions are hardly touched upon within Human Computer Interaction (HCI) and Computer Supported Cooperative Work (CSCW) academic literature. As a consequence of this, there are critical gaps in understanding home organisation and management methods as a means of informing the design of novel technologies. This thesis is an examination of everyday routines in home, paying particular attention to tidying, storing, retrieving and sharing practices. To examine these practices at home, this thesis presents a combination of two qualitative studies using ethnographically oriented methods. Study one (Home’s Tidying up, Storing and Retrieving) concerns the topic of home storage in practice; investigating how householders create and use domestic storage practices and the methods used to manage their storage at home. Study two (Social Interaction around Shared Resources) concerns social interaction around shared resources, and the methods used to manage sharing practices at home. Semi-structured interviews, fieldwork observation, tour around a home, and a photo diary were undertaken to produce a ‘rich’ description of how householders collaborate in storing and sharing set of practices to manage their everyday routines. Several key finding emerged from the research, that are used to identify important implications for design of home organisational technologies, for example to support effective lightweight interactions, providing user controlled mechanism to make different levels of privacy protection for family members, offering effective awareness of family communications and notifications of the activities of other people around these organisation systems, and making available a range of flexible options for family members to access a shared resource. The thesis make the case that flexible systems should be designed allowing people to categorise things in different ways, and have the values of home asserted in technologies, considering factors such as emotion around the use of space in home organisation to make homes become the unique places that they are understood to be.

Le sujet de thèse s’intéresse à la chimiothérapie à domicile qui est l’effet combiné de l’augmentation des patients atteints du cancer et du succès de l’hospitalisation à domicile. Nous proposons à travers ce mémoire de thèse des solutions appropriées au pilotage de la chaîne de prise en charge de la chimiothérapie à domicile permettant d’évaluer et d’améliorer la performance de celle-ci. La première partie présente le contexte socio-économique de la chimiothérapie à domicile, ainsi que les contraintes réglementaires et organisationnelles pour sa mise en œuvre. La deuxième partie précise les spécificités d’une chaîne de prise en charge de la chimiothérapie à domicile et les problématiques liées à cette chaîne basée sur une revue de la littérature. La troisième partie se focalise sur la modélisation des processus de prise en charge de la chimiothérapie à domicile à partir d’un important travail de terrain. Un modèle générique de la chimiothérapie à domicile est dégagé du travail de modélisation qui constitue le fondement d’une proposition de classification des pratiques de la chimiothérapie à domicile. Un diagnostic individuel et comparatif des différentes familles d’approches sont également présentés dans cette partie. La quatrième partie présente les différentes applications développées pour évaluer et améliorer la performance de la chaîne de prise en charge de la chimiothérapie à domicile. En conclusion, cette thèse apporte une première contribution à la généralisation de la pratique de la chimiothérapie à domicile et au développement d’outils d’aide aux pilotages destinés à l’amélioration de sa réalisation / This thesis deals with chemotherapy at home which is the fruit of increasing cancer patients and successful development of home care services. We present in this thesis appropriate solutions to evaluate and improve management performance of chemotherapy at home network. The first part concerns the socioeconomic context of chemotherapy at home, as well as its legal and organizational constraints. The second part outlines specificities and related issues of chemotherapy at home based on a literature review. The third part focuses on chemotherapy at home process modeling depending on an important field work. A generic model of chemotherapy at home is abstracted, which is the basis of a chemotherapy at home practices classification that we proposed. An individual analysis and a comparative analysis of chemotherapy at home approaches are also proposed in this part. The fourth part presents different solutions that we developed to evaluate and improve the management performance of chemotherapy at home network. In conclusion, this thesis provides an initial contribution to promote chemotherapy at home practices and to develop management support tools for its implementation

Zu Beginn des 20.Jahrhunderts fanden noch nahezu alle Geburten im privaten Hause statt. In der ersten Hälfte des Jahrhunderts begann der Übergang von der traditionellen Hausgeburtshilfe zur klinischen Geburtshilfe. Nach dem 2. Weltkrieg setzte sich diese Entwicklung fort und es vollzog sich in der DDR der vollständige Übergang zur klinischen Geburtshilfe. 1970 betrug der Anteil der Klinikentbindungen 99,1 %. Von staatlicher Seite wurde die Klinikentbindung eindeutig gefördert. Im "Gesetz über den Mutter- und Kinderschutz und die Rechte der Frau" (1950) wurde die Schaffung von Entbindungsbetten und der Ausbau der Schwangerenberatungsstellen, mit Registrierung aller schwangeren Frauen angeordnet. Die Beratungsstellen und die geburtshilflichen Kliniken bilden eine Einheit. Der Schwerpunkt der Hebammenausbildung wurde auf die Ausbildung zur Anstaltshebamme gelegt. Es wurden Niederlassungsbeschränkungen für Hebammen eingeführt, sodass es ab Ende der 60er Jahre praktisch keine selbständigen Hebammen mehr gab. Ein direktes Verbot der Hausgeburtshilfe in der DDR ist nicht nachzuweisen. In den 70er Jahren wurden neue Methoden (programmierte Geburt) und neue Technik (Kardiotokographie und Ultraschall) in den geburtshilflichen Abteilungen eingeführt. In den westeuropäischen Ländern, v. a. der Bundesrepublik kam es zu einer zunehmenden Kritik der Frauen an dieser Art der Geburtshilfe. Es wurde die "familienfreundliche Geburtshilfe" propagiert und die Hausgeburt wiederentdeckt. In der DDR blieben massive Forderungen nach familienfreundlicher Geburtshilfe aus. Ein Wiederaufleben der Hausgeburt war nicht zu verzeichnen. Andere soziale, gesellschaftliche und politische Gegebenheiten in der DDR als in der BRD könnten als Gründe vermutet werden. / At the beginning of the 20th century nearly all child births took place in private homes. In the first part of this century the transition from the traditional home deliveries to childbirth hospital began. This development continued after the second world war, and in the GDR there was a complete transition to childbirth taking place practically only in hospitals. In 1970 99,1% of all deliveries took place in the obstetrical department of a hospital. This Government policy was engendered in the law of 1950 "Gesetz über den Mutter- und Kinderschutz und die Rechte der Frau" (Law concerning the Rights of Women and Protection of Mothers and Children.). This law required the creation of obstetrical departments in hospitals and extension of information and antenatal care centres for pregnant women, with the aim of registering all pregnant women. The information and antenatal care centres and the obstetrical departments were to form a joint unit. The training of midwives assumed their working place to be the hospital. Midwives were no longer allowed to be self-employed, hence by the end of the sixties there no midwives practising privately, although there is no evidence of childbirth at home being forbidden. In the seventies new methods and technology: programmed births along with sonography and cardiotokography were introduced into antenatal care. In western European countries, notably The Federal Republic of Germany, women increasingly criticised these new methods as unnatural and as not family friendly. The demand for family friendly births arose, and with it for childbirth at home and domiciliary midwives. Childbirth at home had been rediscovered. In the GDR there was no increased demand for changes in antenatal or obstetrical care. A rediscovery of childbirth at home did not take place. A different social and political environment can be assumed as the reason for this.

La rééducation fonctionnelle classique comprend des séances thérapeutiques, des exercices à domicile et des mouvements avec ou sans l'aide de thérapeutes. Cette approche classique souffre de nombreuses limitations, en raison de l’incapacité de l’expert à suivre les séances à domicile du patient et du manque de motivation du patient pour répéter les exercices sans retour. Les jeux sérieux ont été présentés comme une solution à ces problèmes. Premièrement, des exergames ont été développés à l’aide d’une méthodologie de codesign, où patients, experts et développeurs ont pris part aux procédures de conception. Le capteur Kinect a été utilisé pour capturer la cinématique en temps réel au cours de l’exercice. Ensuite, une fusion de données a été étudier entre le capteur Kinect et les unités de mesure inertielles, afin d’augmenter la précision de l’estimation de l’angle des articulations, à l’aide d’une approche système de systèmes. Le système a été évalué par des patients avec différentes pathologies au cours de multiples campagnes d'évaluation. Les résultats obtenus montrent que les jeux sérieux peuvent être une solution pour des pathologies spécifiques. En outre, les experts ont été convaincus de la pertinence clinique de ce dispositif et ont estimé que les données proposées étaient suffisantes pour évaluer la situation du patient. La mise en place de tels systèmes maximiserait l’efficacité du programme de réadaptation. D'autre part, ce système permettrait également de réduire les limitations actuellement présentes dans les programmes de rééducation classiques, permettant aux patients de visualiser leurs mouvements et aux experts de suivre l'exécution de l'exercice à domicile. / Conventional musculoskeletal rehabilitation consists of therapeutic sessions, home exercise assignment, and movement execution with or without the assistance of therapists. This classical approach suffers from many limitations, due to the expert’s inability to follow the patient’s home sessions, and the patient’s lack of motivation to repeat the same exercises without feedback. Serious games have been presented as a possible solution for these problems. This thesis was carried out in the eBioMed experimental platform of the Université de technologie de Compiège, and in the framework of the Labex MS2T. The aim of this thesis is to develop a real-time, serious gaming system for home-based musculoskeletal rehabilitation. First, exergames were developed, using a codesign methodology, where the patients, experts and developers took part in the design and implementation procedures. The Kinect sensor was used to capture real-time kinematics during each exercise. Next, data fusion was implemented between the Kinect sensor and inertial measurement units, to increase the accuracy of joint angle estimation, using a system of systems approach. In addition, graphical user interfaces were developed, for experts and patients, to suit the needs of different end-users, based on the results of an end-user acceptability study. The system was evaluated by patients with different pathologies through multiple evaluation campaigns. Obtained results showed that serious games can be a good solution for specific types of pathologies. Moreover, experts were convinced of the clinical relevance of this device, and found that the estimated data was more than enough to assess the patient’s situation during their home-based exercise sessions. Finally, during these three years, we have set the base for a home-based rehabilitation system that can be deployed at home or in a clinical environment. The implementation of such systems would maximize the efficiency of rehabilitation program, while saving the patient’s and expert’s time and money. On the other hand, this system would also reduce the limitation that are currently present in classical rehabilitation programs, allowing the patients to visualize their movements, and the experts to follow the home exercise execution.

Neracionalus vaistų vartojimas yra viena svarbiausių problemų pasaulyje. PSO duomenimis, maždaug pusė visų pacientų medikamentus vartoja netinkamai ir nesilaiko gydytojo nurodymų. Ypač didelė problema yra netinkamas vaistų vartojimas namuose tiek pagal gydytojo paskyrimą, tiek savarankiškai. Iki šiol Lietuvoje dar nebuvo atliktas tyrimas, kokius vaistus žmonės turi savo namų vaistinėlėse ir ar tinkamai juos vartoja. Nežinoma, kokios yra racionaliai ar neracionaliai vaistus vartojančių Lietuvos žmonių savybės. Šiuo tyrimu buvo siekiama nustatyti galimus rizikos veiksnius, lemiančius neracionalų ambulatorinių vaistų vartojimą. Buvo atrinkti ir namuose apklausti 36 pacientai, kuriems KMUK buvo paskirtas antibiotikų kursas namuose. Su gautais duomenimis buvo atlikta aprašomoji ir lyginamoji statistinė analizė pagal Pirsono chi kvadrato kriterijų (statistiškai patikimu rezultatu laikoma reikšmė, kai chi kvadratas > 4, p < 0,05). Namų vaistinėlėse pacientai turėjo daugiau receptinių vaistų nei nereceptinių. Daugiausiai turima receptinių širdies ir kraujagyslių sistemą veikiančių vaistų. Savigydai dažniausiai naudojami nereceptiniai virškinimo sistemą ir metabolizmą veikiantys vaistai ir analgetikai. Nustatyta, kad 31 proc. pacientų paskirtuosius antimikrobinius vaistus vartojo nedrausmingai. Vartojimo drausmingumas gydymo atveju buvo geresnis nei profilaktikos atveju. Jei vaistus reikia vartoti ilgai, 48 proc. pacientų teigė esantys nedrausmingi. Taigi, trumpalaikės terapijos... [toliau žr. visą tekstą] / Irrational drug use is one of the biggest problems in the world. According to WHO, about half of all the patients don‘t use their medicine properly and fail to adhere to prescribed therapy. Irrational drug treatment at home (including use of prescribed medicines and self-medication) is a great problem. There have been no researches made in Lithuania up till now about what kind of drugs people have at home and if they use them properly. There was no information about characteristics of people who use drugs rationally or irrationally. So, the purpose of this research was to identify possible risk factors, which determine irrational drug treatment at home. There were chosen 36 patients who had got antimicrobial therapy at home after treatment or for prophylaxis in Clinics of Kaunas University of Medicine. Those patients had been questioned at home. Data were analyzed statistically (descriptive and comparative statistic analysis by parameter of Pearson’s chi square (statistically significant result was when chi square > 4, p < 0, 05)). At home people had more prescribed drugs than over the counter ones (mostly drugs acting on cardiovascular system). For self-medication the most popular are over the counter drugs acting on alimentary tract and metabolism and analgesics. It was determined that 31 percent of patients fail to adhere to prescribed antimicrobial therapy. Patients’ adherence was higher for treatment than for prophylaxis. 48 percent of the patients who used medicine for... [to full text]

This study on parent involvement in Early Childhood Development in KwaZulu Natal investigates the experiences of educators and parents of the different types of parent and community involvement as set out in the Epstein typology. In order to investigate this phenomenon a thorough background of the theory and practice of the Epstein model has been provided. In addition the work of other researchers that support the Epstein typology of parent involvement forms an integral part of the discussions. As parent involvement is the key focus of the study, parent involvement in education before and after 1994 are discussed. In this regard relevant educational policy and legislation that are designed to increase the role of parents and the community in Early Childhood Development are highlighted. Parents' role in the provision of Early Childhood Development is explored. The provision of Early Childhood Development in KwaZulu Natal, which provides a backdrop for the investigation, is exptained. In addition contextual factors that influence parent involvement in KwaZulu Natal are provided. The research methodology and the research design used in this study are described in detail. By means of a qualitative approach the experiences of a small sample of educators and parents in Early Childhood Development are explored using the six types of parent involvement that include parenting, communicating, volunteering, learning at home and collaborating with the community as set out in Epstein's comprehensive model. The experiences of educators and parents of Grade R learners of the six types of involvement have been included. Although all schools engage in some form of parent involvement, it is evident that not all schools involve parents in all types of parent involvement to the same extent. The study concludes with recommendations for developing strategies to involve parents more effectively in Early Childhood Development in KwaZulu Natal

Tema: Ikimokyklinio amžiaus vaikų saugumas namuose. Tikslas: Išanalizuoti ikimokyklinio amžiaus vaikų saugumą namuose. Tiriamieji: Tyrime dalyvavo 240 asmenų, kurių vaikai lanko ikimokyklinio ugdymo įstaigas Švenčionių rajone. Metodika: Pasirinkta atlikti kiekybinį tyrimą, kurio instrumentas – anketa, sudaryta iš 29 atvirų, pusiau atvirų ir uždarų klausimų. Atliekant tyrimą sudaryta atsitiktinė netikimybinė tyrimo imtis, apklausiant asmenis ikimokyklinio ugdymo įstaigose vykusio tėvų susirinkimo metu. Apklausa vykdyta 2014 m. sausio mėnesį. Tyrimo rezultatai: Tyrimo metu nustatyta, kad tiek fiziniai, tiek psichologiniai veiksniai įtakoja vaikų saugumą namuose. Rizika ikimokyklinio amžiaus vaikams patirti sužalojimus didėja gyvenamojoje zonoje, virtuvėje ir išorinėje aplinkoje. Pagrindinės priežastys, dėl kurių ikimokyklinio amžiaus vaikai patiria sužalojimus gyvenamojoje zonoje, virtuvėje ir vonios kambaryje yra aplinkos nepritaikymas ir neatsargus pačių vaikų elgesys, išorinėje aplinkoje – konfliktai su kitais vaikais. Dauguma tėvų stengiasi pasirūpinti ir užtikrinti ikimokyklinio amžiaus vaikų saugumą namuose nepalikdami jų vienų namuose, o vieniems namuose paliekamiems vaikams didėja rizika patirti sužalojimus vonios kambaryje. Pagrindinėmis vienų namuose paliekamų ikimokyklinio amžiaus vaikų patiriamų sužalojimų priežastys yra aplinkos nepritaikymas ir neatsargus vaikų elgesys. Namuose su seneliais ikimokyklinio amžiaus vaikai paliekami ženkliai dažniau nei su... [toliau žr. visą tekstą] / The theme: Preschool age Children Safety at Home. The objective: To analyze the preschool age children‘s safety at home. The subjects: This study involves 240 respondents who have child attending preschools in Švenčionys district. The methodology: It is the quantitative study which involves a questionnaire consisting of 29 opened, semi-opened and closed questions. Convenience nonprobability survey sample was concluded and the surveys was conducted on parents‘ meeting in prechools. The survey was carried out on January of 2014. The results: The study found that bouth physical and psychological factors has influence to children safety at home. The risk of injuries for preschool age children increases in living area, the kitchen or at the outside environment. The main reasons of preschool age children injuries that occur in the living area, the kitchen and the bathroom are poor adaptation of the environment and careless behavior of the children themselves. Injuries occurs at the external environment mostly because of conflicts with other children. Most parents try to take care and ensure the safety of preschool age children at home by avoiding to leave them alone at home and children who are left alone at home deals with higher risk of injuries in the bathroom. The main causes of injuries for one at home remained children are inadequate environmental adaptation and careless children behavior. Preschool aged children are remained at home significantly more often with... [to full text]

Denna studie fokuserar på villkor för lärande i arbete i samband med hemarbete på grund av den globala covid-19-pandemi som råder för tillfället. Syftet med studien är att undersöka hur konsulter upplever villkorenför lärande i arbete under hemarbetet. Studien utgår från ett arbetsplatslärandeperspektiv, vilket innebär att arbetsplatser ses som lärandemiljöer (Billett, 2001). Forskning om lärandet i arbetet delas ofta upp i formellt och informellt lärande (Tynjälä, 2008). Centralt för informellt lärande i arbetet är att kollegor lär sigtillsammans, vilket styrker arbetsgruppens betydelse (Cuel, 2020). Eftersom sociala relationer i arbetet ses som ett betydande villkor för informellt lärande, är det viktigt att arbetsplatser erbjuder diskussionsmöjligheter för kollegor emellan (Billett, 2001). Ellström (1996b) menar även att bland annat arbetsmässiga mål utgör viktiga villkor för lärande i arbetet vid sidan av delad kunskap.Studien baseras på intervjuer med sex konsulter som arbetar hemma under covid-19-pandemi. Intervjuerna har analyserats tematiskt för att kunna få fram en strukturerad förståelse av konsulternas upplevelser av villkor för lärande i arbete vid hemarbete. Studiens resultat visar att villkoren för sociala relationer i konsulternas arbete spelar en nyckelroll för lärande vid hemarbete. Kollegors närvaro är viktigt för att kunna dela arbetsrelaterad kunskap. Detta gör att fungerande digitala verktyg för kommunikation blir ett betydelsefullt lärandevillkor vid hemarbete. Att kunna pröva sig fram i arbetet visar sig också vara centralt för konsulters lärande vid hemarbete. Tydliga mål i arbetet formar i sin tur grunden för lärandet i dagliga arbetsuppgifter.Avsaknaden av en fysisk gemensam arbetsplats är däremot uppenbar bland konsulterna, vilket kan ses som en utmaning för lärande vid hemarbete. De möjligheter som studien specificerar för lärande vid hemarbetevisar hur möten kan hållas och kunskap delas platsoberoende. / This study focuses on conditions for learning in work associated with working at home due to the global covid-19-pandemic. The purpose of this study is to investigate how consultants experience conditions for learning in work during working at home. This study is based on the workplace learning perspective, which means that workplaces can be seen as environments for learning (Billett, 2001). Research about learning in work is often divided into formal and informal learning (Tynjälä, 2008). It is central for informal learning in work, that employees are learning with each other, which strengthens the meaning of the working group (Cuel, 2020). Because of social relations seem to be a considerable condition for informal learning in work, it isimportant that workplaces offer possibilities for discussions between coworkers (Billett, 2001). Ellström (1996b) means too that work goals constitute important conditions for learning in work beside shared knowledge. The study is based on interviews of six consultants who are working at homes during covid-19-pandemic. The interviews have been thematically analyzed to get a structured understanding of consultant’s experiencesof conditions for learning in work during work at home. Results in this study shows that conditions for social relations in consultants’ work are in a key role for learning while working at home. The presence of colleagues is significantly important in sharing of working related information. For this to be likely, functional digital tools for communication turned out to be particularly significant. To be able to try out in work seem also to be central for consultants learning in work at homes. Clear goals for its part form the ground for learning in daily working tasks. The lack of a physical common workplace, on the other hand, is obvious which points out obstacles that working at home results in learning. Possibilities that this study specifies for learning during work at home show how meetings can be hold and knowledge is shared independent of the location.

Bakgrund: Cancersmärta är ett växande problem för både vårdpersonal och patienter, eftersom cancer drabbar allt fler människor. Tidigare forskning visar att sjuksköterskor uttrycker en brist på kunskap och insikt i cancersmärta och patienters erfarenheter av cancersmärta, särskilt i eget hem. Syfte: Syftet med denna studie är att beskriva patienters upplevelser av cancersmärta i hemmet. Metod: En kvalitativ litteraturstudie, som inkluderar 13 artiklar analyserade utifrån Evans beskrivande syntes med en berättande sammanfattning. Resultat: Resultatet från den här studien består av tre huvudteman och sex subteman. Huvudteman inkluderar Upplevelser av att förlora kontroll, Upplevelser av oförståelse och Upplevelser av självstyre av smärtvården. Slutsats: Patienterna upplevde att cancersmärtan resulterade i en förlust av kontroll eftersom de upplevde att smärtan begränsade deras liv samt att vara hjälplös. De upplevde en oförståelse vilket omfattade att ha svårt att tala om och förstå smärtan. De uttryckte upplevelser av självstyre i smärtvården både genom att på egna sätt hantera och uthärda smärtan och att vara den som kontrollerar smärtbehandlingen. / Background: Cancer pain is a growing problem for both our personal and patients, where cancer affects more and more people. Previous research shows that nurses express a lack of knowledge and insight into cancer pain and patients' experiences of cancer pain, especially in their own homes. Aim: The aim of this study is to describe patients' experiences of cancer pain at home. Method: A qualitative literature study, using 13 articles analyzed based on Evans' description, appeared with a narrative summary. Results: The results of this study consist of three main themes and six sub-themes. Main themes include experiences of losing control, experiences of lack of understanding and experiences of autonomy in pain-care. Conclusion: The patients experienced that the cancer pain resulted in a loss of control when they experienced limitations of their lives, as well as a life of helplessness. They experienced a lack of understanding of their pain which included having difficulties in talking about and understanding the pain. They expressed experiences of autonomy in their pain-care by managing and enduring their pain in their own ways as well as being in control of their pain treatment.