Magister Public Health - MPH / Primary Health Care (PHC) services in Namibia are based on the principles of equity,availability, accessibility, affordability of services, and community participation and empowerment. According to the Namibian Constitution and the National Health Policy,all Namibians should have equal access to public health services at no cost to the patient.The government places a high premium on the involvement of communities in PHC through communication, consultation and respectful interaction between health workers and patients and communities in the interests of quality service delivery. Services provided at PHC facilities include immunisations, antenatal care, post-natal care, family planning, health education, tuberculosis and malaria treatment, outreach services, antiretroviral treatment (ART), and the Prevention of Mother to Child Transmission(PMTCT) programme. Numerous complaints have been received from patients relating to patients' admissions at clinics, long waiting hours, over-crowded facilities, poor communication between patients and nurses, and non-availability of some medications and medical officers at some of the PHC facilities.This study investigated patient satisfaction and the reasons for reported poor nursepatient relations at PHC facilities in Khomas region in Namibia. The objectives of the study were to describe patient’s perceptions concerning quality of service delivery at PHC clinics, to explore factors related to the clinic environment that might influence perceived quality of care and to describe the nature of nurse-patient relations. Methodology A descriptive, qualitative study was conducted among randomly selected patients (15) and registered nurses (5) at five purposively selected PHC clinics in Khomas region, in the Windhoek district. Five sisters-in-charge from the designated facilities were interviewed as key informants.Data was collected through key informant interviews and focused interviews with nurses and patients, respectively. Data on the participants’ experiences and perceptions of using the health services, as well as factors influencing nurse-patient relations and patient satisfaction was collected. Interview data was recorded on audiotape and transcribed verbatim. Data from key informants was captured in field notes. Thematic analysis of transcribed data was conducted.Results Low patient satisfaction with services was confirmed as a key problem facing four out of the five health facilities visited in Khomas region. Patient dissatisfaction was mostly related to the long waiting times, which in turn, was caused by increased patient numbers as a result of the escalating HIV/AIDS and tuberculosis (TB) epidemics, ART roll out and increased immigration to Windhoek. Other factors attributed to low patient satisfaction were poor communication between health providers and patients, nonavailability of family planning and immunisation services, and frequent stock-outs of some prescribed medicines.ConclusionsThe findings of this study support the need to rethink nurse-patient relations for greater patient satisfaction and quality of service delivery in the public Primary Health Care facilities in Khomas region. Greater care should be taken to inform patients about service days and the staffing limitations at health facilities, and to educate and empower patients for self-care. Communication strategies should target negative perceptions about service delivery at PHC clinics in the communities. In-service training in areas like case management, different PHC disciplines and communication skills are needed to improve the competency of nurses. In addition, motivation of nurses needs to be addressed through recognition and appreciation from management in order to avoid frustrations and negative attitudes towards patients. Motivation of nurses can be improved by paying attention to their work environment and the physical structure of health facilities.

Bakgrund: Allt fler patienter med palliativt vårdbehov vårdas i hemmet. Detta kan skapa en komplex situation för den närstående då det kan upplevas betungande att vårda en svårt sjuk familjemedlem. Det är därmed värdefullt att vårdpersonal har kunskap om bemötandet av närståendes behov för att kunna ge anpassat stöd att hantera sin och den sjuke familjemedlemmens situation. Detta gör det betydelsefullt att undersöka närståendes upplevelser av vilka åtgärder och insatser denne är i behov av.  Syfte: Att beskriva närståendes behov av stöd när en familjemedlem vårdas med palliativ vård i hemmet. Metod: Studien genomfördes som en litteraturöversikt. En deduktiv analysprocess genomfördes där kodningen skedde utefter ett befintligt teoretiskt ramverk av Andershed och Ternestedt (1999) som sedan prövades gentemot aktuell forskning. Resultat: Att närstående kunde få möjlighet att förbereda sig genom information kring palliativ vård men också kring praktiska åtgärder och sjukdomsförlopp möjliggjorde en ökad trygghet hos närstående. Att få bekräftelse och bli sedd var något närstående ansåg som betydande. Vårdpersonalens tillgänglighet under dygnets alla timmar var av vikt men även att de tog tid för patient och närstående. Hjälp med praktiska göromål var av vikt då närståendes möjlighet att få tid för sig själv och avlastning visade sig vara en bärande punkt. Även samordning med andra professioner och vårdgivare ansågs värdefullt, liksom optimering av hemmiljön för att underlätta vården. Slutsats: Om de närstående får stöd anpassat efter deras behov underlättas deras situation och känsla av utsatthet kan minska. Generellt behöver närstående kunskap, trygghet och avlastning. Palliativ vård ställer krav på vårdpersonals förmåga att möta de närstående på en individanpassad nivå där denne befinner sig för att kunna möta de närstående med insatser efter deras behov.

Yes / This paper aims to evaluate the implementation of innovative programmes within the downstream domain of the pharmaceutical supply chain (PSC), with the aim of informing improved service provision. A mixed-method approach was used to assess to what extent innovation could be adopted by hospital and community pharmacies to improve the delivery process of pharmaceutical products. Unstructured interviews and 130 questionnaires were collected and analysed to identify factors that facilitate or prevent innovation within PSC processes. The analysis led to the creation of the innovative pharmaceutical supply chain framework (IPSCF) that provides guidance to health-care organisations about how supply chain management problems could be addressed by implementing innovative approaches. The results also indicated that the implementation of Lean and Reverse Logistics (RL) practices, supported by integrated information technology systems, can help health-care organisations to enhance their delivery in terms of quality (products and service quality), visibility (knowledge and information sharing), speed (response to customers and suppliers needs) and cost (minimisation of cost and waste). The study’s recommendations have potential implications for supply chain theory and practice, particularly for pharmacies in terms of innovation adoption. The IPSCF provides guidance to pharmacies and health-care organisations to develop more efficient and effective supply chain strategies. This research contributes to the academic literature as it adds novel theoretical insights to highly complex delivery process innovation.

Det svenska välfärdssamhället har sedan länge värnat om alla likas rätt att få sina levnadsbehov tillgodosedda. I de fall där äldre blivit inkapabla att själva ta hand om sina behov kan plats till särskilt boende sökas där den äldre får assistans i sin livsföring. Biståndsansökningar till dessa boenden hanteras av kommunala tjänstemän och ska enligt lag hanteras lika för alla, oavsett kommunal utförare.Studien undersöker och analyserar huruvida det råder skillnader mellan större kommuner i Sverige vad gäller planering av- och placering till särskilt boende.Slutsatsen är att skillnader föreligger då vissa kommunerna utformat en reaktiv strategi där en uppbyggnad av ej verkställda beslut rättas till i efterhand och som inte tar hänsyn till behov utan endast ålder. De kommuner som lyckats väga in hälsa och behov i sin planering och i förväg försökt skatta den framtida efterfrågan på särskilt boende har lyckats bättre. Studiens resultat är att det råder kommunala skillnader kopplade till planering och placering till särskilda boende / The swedish welfare state has a history of equal rights for living needs. In cases whereolder people become incapable to take care of their needs, there are specialaccommodations where the elderly can receive all forms of assistance. Theapplication to these special accommodations are managed by the municipal officialsand must be handled equal by law, regardless of local performers.This study examines and analyzes whether there are differences between the largermunicipalities in Sweden in terms of planning and placement to specialaccommodations.The conclusion is that differences exist because some municipalities have designed areactive strategy in which a buildup of unexecuted decisions has to be correctedretrospectively and does not take needs but age into to account. The municipalitiesthat managed to weigh health and needs in their planning and tried to estimate thefuture in advance regarding demand for special accommodations has been moresuccessful. The result of this study is that there are municipal differences in planningand placement for special accommodations

Drug interactions of gastrointestinal remedies Author: Marek Lapka Tutor: Josef Malý1 1 Department of Clinical and Social Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Background: Drug interactions may be a serious cause of toxicity and undesirable drug effects. There is a direct proportion to side effect incidence caused by drug interactions and number of used drugs. The issue is a significant constituent of pharmaceutical care. The aim of dissertation: The aim of the thesis was to process available information, suggest a posible solution and create compact overview which can be taken into consideration by pharmacist in order to achieve optimal pharmacotherapy. Methods: Drug combinations, which interactions had clinical evaluation from "moderate severity" to "major severity" were collected from the fundamental information source, Vademecum infopharm aplication. Only currently registered drugs to 1st September 2013 by State Institute for Drug Controle were chosen and then medicinal products of which route of administration enables systemic effect. Furthermore the combination was compared with Micromedex database or Stockley's Drug Interactions Pharmaceutical Press, or both. Pubmed database (www.pubmed.gov) with entering key words "drug interaction", "basic drug" and...

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Introduktion: Våld i nära relationer är ett globalt fenomen och utgör ettåterkommande inslag i arbetet inom hälso- och sjukvården, polismyndigheten ochsocialtjänsten. Våld i nära relationer förekommer i alla samhällsklasser, åldrar,oavsett sexuell läggning och är inte relaterad till vare sig etnicitet, kulturell ellerreligiös bakgrund. Det finns flertal myndigheter som ger skydd och stöd tillvåldsutsatta. För att säkerställa ett professionellt omhändertagande av denvåldsutsatta måste de olika myndigheterna samverka. Forskning visar dock attsamverkan ofta brister vilket kan resultera i ett försämrat omhändertagande av dendrabbade individen.Syfte: Att undersöka vilka faktorer som är av betydelse för myndigheterssamverkan vid vuxnas utsatthet för våld i nära relationer, utifrån hälso- ochsjukvårdens, polismyndighetens, och socialtjänstens perspektiv.Metod: Studien är en integrativ litteraturstudie. Litteratursökningarna eftervetenskapliga artiklar genomfördes i databaserna Cinahl, Pubmed, Criminal justiceabstracts, Social services abstracts, Psycinfo och Social science premium collection.De för studien relevanta artiklarna har kvalitetsgranskats, kodats, kategoriserats ochanalyserats enligt gällande metod.Resultat: Resultatet baseras på tio vetenskapliga artiklar och visar att det finns ettflertal faktorer som har betydelse för myndigheters samverkan vid våld i närarelationer. Faktorer som kunskap, organisation, kommunikation och kultur har idenna studie visat sig vara särskilt utmärkande. Dessa faktorer kan verka bådehämmande och främjande beroende på rådande omständigheter inom respektivemyndighetSlutsats: Samverkan mellan myndigheter är en absolut förutsättning för ett adekvatomhändertagande av den individ som utsatts för våld i en nära relation. Fenomenetmedför en komplex problematik. Det finns ett uppenbart utbildningsbehov för flerayrkeskategorier, främst gällande identifikation och bemötande av den våldsutsattasamt klargörande kring de olika myndigheternas olika ansvarsområden ochbefogenheter. Arbetet bör i framtiden organiseras utifrån den drabbades behov avolika hjälpinsatser istället för att som idag utgå från de olika myndigheternasrespektive kompetensområde.

The rising complexity in healthcare, exacerbated by an ageing population, results in ineffective decision-making leading to detrimental effects on care quality and escalates care costs. Consequently, there is a need for smart decision support systems that can empower clinician's to make better informed care decisions. Decisions, which are not only based on general clinical knowledge and personal experience, but also rest on personalised and precise insights about future patient outcomes. A promising approach is to leverage the ongoing digitization of healthcare that generates unprecedented amounts of clinical data stored in Electronic Health Records (EHRs) and couple it with modern Machine Learning (ML) toolset for clinical decision support, and simultaneously, expand the evidence base of medicine. As promising as it sounds, assimilating complete clinical data that provides a rich perspective of the patient's health state comes with a multitude of data-science challenges that impede efficient learning of ML models. This thesis primarily focuses on learning comprehensive patient representations from EHRs. The key challenges of heterogeneity and temporality in EHR data are addressed using human-derived features appended to contextual embeddings of clinical concepts and Long-Short-Term-Memory networks, respectively. The developed models are empirically evaluated in the context of predicting adverse clinical outcomes such as mortality or hospital readmissions. We also present evidence that, surprisingly, different ML models primarily designed for non-EHR analysis (like language processing and time-series prediction) can be combined and adapted into a single framework to efficiently represent EHR data and predict patient outcomes.

Among workers from four Southeast Asian countries in Taiwan, Indonesian workers constitute of the biggest group, especially those working in the care service sector. The trend of these workers has been associated with the growing number of the older population in Taiwan. As an Indonesian student studying in Taiwan, I took this opportunity to conduct research on the Indonesian care workers in Taiwan. This study tries to search whether the Indonesian workers are satisfied with their job as caretakers. It includes an overview of their job content, wage, personality job fitness, and supportive work condition. Data was collected by using survey and interviews, with a result of 42 respondents living in Taipei City by using a snowball approach, as well as interviews with an Indonesian representative and Taiwanese government officer. The data collected was analyzed by using cross tabulation and organizational behavior approaches. The study found some relationships between job satisfaction and other variables: i.e.: job contents or characteristics of the caretaking job (such as spends much energy, aggravates health condition, stressful, and restricts social contact with outside of the home), wage (expectation, regularity payment), personality job fit and supportive working condition (no days off and separated room). This study is very comprehensive. The interview results enriched the analyses. It will give much information not only to students, but also to lecturers, researchers and scholars who are interested in the field. It is also a useful resource for the Indonesian and Taiwanese governments to improve working conditions and worker satisfaction. / Among workers from four Southeast Asian countries in Taiwan, Indonesian workers constitute of the biggest group, especially those working in the care service sector. The trend of these workers has been associated with the growing number of the older population in Taiwan. As an Indonesian student studying in Taiwan, I took this opportunity to conduct research on the Indonesian care workers in Taiwan. This study tries to search whether the Indonesian workers are satisfied with their job as caretakers. It includes an overview of their job content, wage, personality job fitness, and supportive work condition. Data was collected by using survey and interviews, with a result of 42 respondents living in Taipei City by using a snowball approach, as well as interviews with an Indonesian representative and Taiwanese government officer. The data collected was analyzed by using cross tabulation and organizational behavior approaches. The study found some relationships between job satisfaction and other variables: i.e.: job contents or characteristics of the caretaking job (such as spends much energy, aggravates health condition, stressful, and restricts social contact with outside of the home), wage (expectation, regularity payment), personality job fit and supportive working condition (no days off and separated room). This study is very comprehensive. The interview results enriched the analyses. It will give much information not only to students, but also to lecturers, researchers and scholars who are interested in the field. It is also a useful resource for the Indonesian and Taiwanese governments to improve working conditions and worker satisfaction.

<p>Gruppen äldre kommer att öka i antal och då smärta ökar med ålder kommer fler individer att ha ont. Fler äldre med smärta ställer större krav på hälso- och sjukvården. Studiers visar att sjuksköterskors bild och de äldres upplevelser av smärta inte alltid stämmer överens samt att det finns brister i smärtdokumentation. Syftet med studien var att belysa smärtdokumentation hos en grupp äldre i särskilt boende eller med hemsjukvård. Materialet analyserades med en kvantitativ beskrivande metod och en kvalitativ innehållsanalys. Urvalet bestod av individer med smärta 65 år och äldre. Resultatet visade att många äldre hade ont vid vila och aktivitet. De valde vila framför aktivitet som smärtlindrande åtgärd, trots att fanns nackdelar med vila. Resultatet visade även på brister i sjuksköterskors dokumentation av smärtan. Ett hinder för dokumentation var att en grupp äldre inte berättade om sin smärta vilket kunde bero på att de äldre bland annat inte ville vara till besvär eller att de ansåg att smärta var en del av att bli gammal.</p> / <p>An increasing elderly population coupled with an increasing likelihood of pain in oldage means more individuals will be in pain, thus making larger demands on the healthcare system. Studies show that nurses can’t describe the elder’s experience of pain andthere is insufficiency in pain documentation. The aim was to describe paindocumentation in a group of elderly people living in sheltered accommodations or withhome care services. The material was analysed with a quantitative descriptive method aswell as a qualitative content analysis. The inclusion criteria were elderly with pain,above the age of 65. The results showed that many elderly people had pain during restand activity. The elderly more often choose rest than mobility as an activity to reliefpain. The results also showed insufficiency in pain documentation. One obstacle forpain documentation was when the elderly did not tell the nurses about their pain. Therewere several reasons for this, for example that the elderly did not want to be a burden tothe nurses or that they simply accepting that pain were a part of being old.</p>