No description available.

Bakgrund: Ett palliativt förhållningssätt är en förutsättning för att kunna ge palliativ vård där behov finns och ska underlätta de utmaningar som personer och deras närstående möter i samband med allvarlig sjukdom. Att vårda utifrån ett palliativt förhållningssätt tydliggör patienternas behov av åtgärder som ger ökad livskvalitet och minskar lidandet för svårt sjuka personer. Sjuksköterskans omvårdnads kompetens utgör en betydande del i den palliativa vården. Många allvarligt kroniskt sjuka lever längre i dag och får vård i hemmet via kommunala hemsjukvårdssjuksköterskor. Syfte: Syftet var att beskriva kommunala hemsjukvårdssjuksköterskors erfarenheter av att integrera ett palliativt förhållningssätt för personer med allvarlig kronisk sjukdom i hemmet. Metod: En litteraturöversikt där 13 originalartiklar analyserades med en strukturerad tematisk analys enligt Bettany-Saltikov och McSherry (2016). Resultat: Resultatet sammanställdes i tre huvudteman med totalt åtta underteman. Att leda var det första huvudtemat och innefattade tre underteman: ansvar, kunskap och påfrestningar. Miljö var det andra huvudtemat och innefattade tre underteman: vårdens uppbyggnad, samarbete och hemmet. Det tredje temat var Att närvara och innefattade två underteman: kommunikation samt stöd och relation. Slutsats: Kommunala hemsjukvårdssjuksköterskor har en betydande roll i integrering av ett palliativt förhållningssätt där kommunikationen utgör en viktig del. Det finns behov av kompetensutveckling och handledning inom palliativ vård för sjuksköterskor i kommunal hemsjukvård och behov av ett förbättrat samarbete mellan olika vårdgivare. / Background: A palliative approach is a requirement for being able to provide palliative care where there is a need and should facilitate the challenges that the people and their relatives confronts with serious illness. Nursing based on a palliative approach clarifies the patients need for actions that increases their quality of life and reduce suffering of seriously ill people. Nurses´ nursing competence is a significant part of palliative care. Chronical seriously ill people live longer today and receive care at home thru the community home healthcare nurses.  Aim: The aim was to describe the community home healthcare nurses´ experiences of integration of a palliative approach for people with serious chronic illness in their home. Method: A literature review in which 13 original articles were analyzed using a structured thematic analysis according to Bettany-Saltikov and McSherry (2016). Results: The results were compiled into three main themes with sub-themes. Leading was the first theme and included three sub-themes: responsibility, knowledge and stress. Environment was the second main theme and included three sub-themes: the structure of care, collaboration and the home. The third theme was Being present and included two sub-themes: communication and support and relationship.  Conclusion: Community nurses in home healthcare have a significant role in integrating a palliative approach where good communication is necessary. There is a need for competence development and supervision in palliative care for nurses in community home healthcare and a need for improved cooperation between different care providers.

No description available.

No description available.

Bakgrund: Ett palliativt förhållningssätt är en förutsättning för att kunna ge palliativ vård där behov finns och ska underlätta de utmaningar som personer och deras närstående möter i samband med allvarlig sjukdom. Att vårda utifrån ett palliativt förhållningssätt tydliggör patienternas behov av åtgärder som ger ökad livskvalitet och minskar lidandet för svårt sjuka personer. Sjuksköterskans omvårdnads kompetens utgör en betydande del i den palliativa vården. Många allvarligt kroniskt sjuka lever längre i dag och får vård i hemmet via kommunala hemsjukvårdssjuksköterskor. Syfte: Syftet var att beskriva kommunala hemsjukvårdssjuksköterskors erfarenheter av att integrera ett palliativt förhållningssätt för personer med allvarlig kronisk sjukdom i hemmet. Metod: En litteraturöversikt där 13 originalartiklar analyserades med en strukturerad tematisk analys enligt Bettany-Saltikov och McSherry (2016). Resultat: Resultatet sammanställdes i tre huvudteman med totalt åtta underteman. Att leda var det första huvudtemat och innefattade tre underteman: ansvar, kunskap och påfrestningar. Miljö var det andra huvudtemat och innefattade tre underteman: vårdens uppbyggnad, samarbete och hemmet. Det tredje temat var Att närvara och innefattade två underteman: kommunikation samt stöd och relation. Slutsats: Kommunala hemsjukvårdssjuksköterskor har en betydande roll i integrering av ett palliativt förhållningssätt där kommunikationen utgör en viktig del. Det finns behov av kompetensutveckling och handledning inom palliativ vård för sjuksköterskor i kommunal hemsjukvård och behov av ett förbättrat samarbete mellan olika vårdgivare. / Background: A palliative approach is a requirement for being able to provide palliative care where there is a need and should facilitate the challenges that the people and their relatives confronts with serious illness. Nursing based on a palliative approach clarifies the patients need for actions that increases their quality of life and reduce suffering of seriously ill people. Nurses´ nursing competence is a significant part of palliative care. Chronical seriously ill people live longer today and receive care at home thru the community home healthcare nurses.  Aim: The aim was to describe the community home healthcare nurses´ experiences of integration of a palliative approach for people with serious chronic illness in their home. Method:A literature review in which 13 original articles were analyzed using a structured thematic analysis according to Bettany-Saltikov and McSherry (2016). Results: The results were compiled into three main themes with sub-themes. Leading was the first theme and included three sub-themes: responsibility, knowledge and stress. Environment was the second main theme and included three sub-themes: the structure of care, collaboration and the home. The third theme was Being present and included two sub-themes: communication and support and relationship.  Conclusion: Community nurses in home healthcare have a significant role in integrating a palliative approach where good communication is necessary. There is a need for competence development and supervision in palliative care for nurses in community home healthcare and a need for improved cooperation between different care providers.

Peritoneal Dialysis is a treatment for patients suffering from renal failure thatallows out-patient care. This means that the patient only needs to visit the hospital forconsultation and not for treatment, increasing considerably the comfort of the patient,while reducing remarkably the cost per patient.In order to increase the level of medical supervision obtained with the periodicvisits to the clinic, televisit has been put into practice in some hospitals. But thesetelevisits are based on indirect and qualitative indicators of renal failure, and thereforethey are just valid for detection of situations near limit cases, such as well over-hydratedor dehydrated.Electrical Bioimpedance Measurements have been proved to constitute anappropriate method for assessment of body composition, and therefore they can providewith direct indicators of body fluid distribution. Such ability of EBI technology allowsthe detection of body fluid unbalance caused by renal dysfunction, and therefore,nephrology televisits would benefit tremendously from EBI measurements.This project is based on the AD5933 Impedance Network Analyzer of AnalogDevices, and the main task is to develop a software application that controls theevaluation board in which it is implemented, and allows the storage of the EBImeasurements in EDF+ files that will facilitate the management of medical data whenapplied to televisit. These files are uploaded to XML format in order to be sent to aremote server, where a software application will have been implemented for medicalconsultation. / Uppsatsnivå: D

La recherche opérationnelle (RO) joue un rôle important dans les systèmes de santé. Au cours des dernières années, l'hospitalisation à domicile comme les hôpitaux de réhabilitation ont émergé pour pallier aux coûts du système de santé et à la qualité de vie des patients. Dans les secteurs de la réhabilitation, la gestion des soins de santé est sous-développée et la plupart des hôpitaux de réhabilitation sont gérés uniquement par l’expérience. Dans cette thèse, nous traitons d'abord le problème de la planification des traitements dans les hôpitaux de réhabilitation afin de les optimiser. Notre travail vise à réduire le temps d’attente des patients hospitalisés et ainsi améliorer leur satisfaction. Afin de résoudre efficacement ce problème de planification de traitements complexes, nous proposons une approche basée sur un algorithme de recherche hybride de coucou qui est testée et validée dans un cas réel. Nous nous intéressons ensuite à l'hospitalisation à domicile qui constitue un autre problème réel compte tenu du vieillissement de la population. Dans la plupart des régions, un nombre croissant d’organisations à but lucratif et à but non lucratif s’associent pour offrir des soins aux patients. Elles ont tendance à atteindre un niveau hospitalier tant en quantité et qu'en qualité avec une flexibilité accrue par rapport aux services hospitaliers. Nous étudions les problèmes de planification et d'acheminement des soins à domicile en tenant compte de nombreuses contraintes liées à la fois aux patients et aux soignants. Le problème est un scénario pratique motivé et vise à minimiser les coûts d'exploitation totaux. Nous utilisons le solveur commercial Gurobi pour résoudre et valider le modèle avec des données réelles. / Operations research (OR) plays an important role in healthcare system. In recent years, rehabilitation hospitals have been emerging to meet the increasing needs for rehabilitation services due to the ageing population trend. However, the healthcare management in rehabilitation sectors is undeveloped and most of the rehabilitation hospitals (departments) are managed by experience. In this thesis, we deal with a treatment scheduling problem in rehabilitation hospitals. The objective is to facilitate the scheduling process. More importantly, our work aims at reducing the waiting time of inpatients so as to improve inpatients’ satisfactions. In order to solve the complex treatment scheduling problem efficiently, we propose an approach based on a hybrid cuckoo search algorithm which is tested and validated in a real case. Moreover, home healthcare (HHC) is another real-world issue considering the aggravating trend of ageing population. In most areas, an increasing number of social-profit & non-profit organizations are joining in providing healthcare services to patients at their homes and it has a tendency to reach the hospital-level in both quantity and quality for the added flexibility than hospital's service. We investigate home healthcare scheduling and routing problem with consideration of many real-life factors, especially lunch break requirement. The problem is practical scenario motivated and aims at minimizing the total operating cost. We use the commercial solver Gurobi to solve and validate the model with real data.

Home healthcare has been a growing sector of the economy over the last three decades with roughly 23,000 companies now doing business in the U.S. producing over $56 billion in combined annual revenue. As a highly fragmented market, profitability of individual companies depends on effective management and efficient operations. This dissertation aims at reducing costs and improving productivity for home healthcare companies. The first part of the research involves the development of a new formulation for the therapist routing and scheduling problem as a mixed integer program. Given the time horizon, a set of therapists and a group of geographically dispersed patients, the objective of the model is to minimize the total cost of providing service by assigning patients to therapists while satisfying a host of constraints concerning time windows, labor regulations and contractual agreements. This problem is NP-hard and proved to be beyond the capability of commercial solvers like CPLEX. To obtain good solutions quickly, three approaches have been developed that include two heuristics and a decomposition algorithm. The first approach is a parallel GRASP that assigns patients to multiple routes in a series of rounds. During the first round, the procedure optimizes the patient distribution among the available therapists, thus trying to reach a local optimum with respect to the combined cost of the routes. Computational results show that the parallel GRASP can reduce costs by 14.54% on average for real datasets, and works efficiently on randomly generated datasets. The second approach is a sequential GRASP that constructs one route at a time. When building a route, the procedure tracks the amount of time used by the therapists each day, giving it tight control over the treatment time distribution within a route. Computational results show that the sequential GRASP provides a cost savings of 18.09% on average for the same real datasets, but gets much better solutions with significantly less CPU for the same randomly generated datasets. The third approach is a branch and price algorithm, which is designed to find exact optima within an acceptable amount of time. By decomposing the full problem by therapist, we obtain a series of constrained shortest path problems, which, by comparison are relatively easy to solve. Computational results show that, this approach is not efficient here because: 1) convergence of Dantzig-Wolfe decomposition is not fast enough; and 2) subproblem is strongly NP-hard and cannot be solved efficiently. The last part of this research studies a simpler case in which all patients have fixed appointment times. The model takes the form of a large-scale mixed-integer program, and has different computational complexity when different features are considered. With the piece-wise linear cost structure, the problem is strongly NP-hard and not solvable with CPLEX for instances of realistic size. Subsequently, a rolling horizon algorithm, two relaxed mixed-integer models and a branch-and-price algorithm were developed. Computational results show that, both the rolling horizon algorithm and two relaxed mixed-integer models can solve the problem efficiently; the branch-and-price algorithm, however, is not practical again because the convergence of Dantzig-Wolfe decomposition is slow even when stabilization techniques are applied. / text

Bakgrund: Diabetes typ 2 är en sjukdom som ökar i samhället och bland de äldre. Många av dessa har ett behov av omvårdnadsinsatser i form av hemsjukvård. Hemsjukvården är en vårdform som ökar i takt med att sjukhusen får ett minskat antal vårdplatser. Detta innebär ett ökat krav på hemsjukvården och dess resurser. Egenvård är en central del inom diabetesvården och när den fungerar väl kan den minska risken för diabetesrelaterade komplikationer. Dock har äldre svårare att upprätthålla en god egenvårdsförmåga relaterat till det naturliga åldrandet och andra eventuella sjukdomar.Syfte: Syftet med studien var att belysa distriktssköterskornas erfarenheter av att främja egenvårdsförmågan hos äldre patienter med diabetes typ 2 i hemsjukvården.Metod: Data analyserades med en induktiv ansats utifrån en kvalitativ innehållsanalys. Datainsamlingen gjordes genom intervjuer med tio distriktssköterskor verksamma inom hemsjukvård.Resultat: Ur analysen framträdde temat Betydelsen av att möjliggöra för små diabetesrelaterade livsstilsförändringar, samt tre kategorier; Den äldres begränsningar för egenvård, Individanpassad egenvårdsrådgivning och Samverkan mellan olika yrkesgrupper med sju underkategorier.Konklusion: Studien påvisar att distriktssköterskorna har en stödjande roll i att främja patienternas egenvårdsförmåga. De tar hjälp av andra professioner för att förse patienterna med de verktyg och insatser som behövs för att på bästa sätt främja deras självständighet och möjlighet att utföra egenvård. / Background: Diabetes type 2 is a disease which is growing in the society and among elders. Many of these need care in the form of home healthcare. Home healthcare is a care form which is increasing as the hospitals have lesser hospital beds. This increases the demands of home healthcare and its resources. Self-care is a central part within the diabetes-care and when well-functioning it can reduce the risk of diabetes-related complications. Elderly though, have a more difficult time to maintain good self-care abilities due to the natural ageing and other possible diseases.Aim: The aim of this study was to illustrate district-nurses experiences of promoting self-care abilities among elderly patients with diabetes type 2 in home health-care settings. Method: Data were analyzed with an inductive approach by a qualitative content analysis. The data collection was made through interviews with ten district-nurses active in home health-careResults: From the analysis appeared a theme; the importance of enabling small diabetes-related lifestyle changes, and three categories; The elderlies limitations to self-care, Individualized self-care-guidance and Cooperation between different professions with seven subcategories.Conclusion: The study shows that the district-nurses have a supportive role in promoting patients self-care abilities. They cooperate with other professions to provide tools and measures needed for promoting their independency and opportunities for self-care.

Bakgrund: Att vårdas palliativt i hemmet är en vårdform som ökar och utvecklas  hela tiden, detta då fler människor önskar att dö i sina egna hem. Syftet med  palliativ vård är att förbättra livskvalitén för patienter och de anhöriga, men även  att lindra patientens lidande. Symtomlindring, teamarbete, kommunikation och  relation samt stöd till de närstående, är de fyra hörnstenarna palliativ vård grundar  sig på. Sjuksköterskans roll är att bemöta patienten och närståendes fysiska,  psykiska, existentiella och sociala behov med värdighet. Syfte: Att beskriva  sjuksköterskors erfarenhet av palliativ vård i hemmet. Metod: Litteraturstudie  med kvalitativ ansats och material hämtad ur 12 artiklar från databaserna  CINAHL och PubMed. Artiklarna kvalitetsgranskades utifrån SBU:s mall för  kvalitativa studier och analyserades utifrån Forsberg och Wengström. Resultat:  Resultatet består av fem huvudkategorier, dessa är; närstående en del av vården,  vikten av att stödja patienten, organisationens betydelse, olikheter i  känslomässiga reaktioner och att skapa utrymme för medkänsla. Alla  huvudkategorier förutom att skapa utrymme för medkänsla och vikten av att  stödja patienten i hemmet har underkategorier. Det finns sammanlagt sju  underkategorier vilka är, kommunikation, frustration, konflikter och etiska  dilemman, teamets betydelse för en god vård, resurser stöd och utbildning,  positiva känslomässiga erfarenheter, negativa känslomässiga erfarenheter samt  känslomässig distansering vid palliativ vård i hemmet. Konklusion: Sjuksköterskors erfarenheter kan vara både positiva, negativa och neutrala. Från  dessa situationer och händelser kan lärdomar dras om omvårdnadens betydelse i  teamet, kommunikationens betydelse, närståendes inverkan på vården samt  symtomkontroll. Alla dessa aspekter är viktiga för den holistiska omvårdnaden  och vårdfilosofin som sjuksköterskan inom den palliativa vården i hemmet  arbetar efter. / Background: Palliative care in the home is a form of care that is a growing form  of care and is constantly evolving, as more people want to die in their own  homes. The purpose of palliative care is to improve the quality of life for patients  and their relatives, but also to ease the patient's suffering. Symptom relief,  teamwork, communication and relationships as well as support for those close to  you, are the four cornerstones on which palliative care is based on. The nurse's  role is to meet the patient's and relatives' physical, mental, existential and social  needs with dignity. Aim: To describe nurses` experiences of caring for patient’s  palliative care at home. Method: Literature study with qualitative approach and  material taken from CHINAL and PubMed. 12 articles were selected, quality  review with SBU: s template for qualitative studies and was analysed with  Forsberg and Wengström. Results: The results consist of five main categories  which are; close relations as part of the care, the importance of supporting the  patient, the importance of the organization, differences in emotional reactions and  creating space for compassion. All main categories except creating space for  compassion and the importance of supporting the patient have subcategories.  There is a total of seven subcategories which are, communication, frustration  conflicts and ethical dilemmas, the importance of the team for a good care,  resources support and education, positive emotional experiences, negative  emotional experiences and emotional distancing in palliative care in the home. Conclusion: Nurses' experiences can be both positive, negative and neutral. From  these situations and occurrences things can be learned about care, in the team,  with meaningful communication, through related parties and symptomcontrol. All  of these aspects are important for holistic care and carephilosophy and for the  nurse’s role in palliative care in the home.