ADHD has for a long time been perceived as something that affects children and grows away with time. American psychiatric association state that ADHD may appear differently with adolescences and adults than with children. That could lead to misunderstandings and exclusion by adults and adolescences with ADHD at work life amongst other situations. This report investigates that exclusion and tries to find what information that needs to reach certain target groups to prevent it from happen. The works focus is text design, a part of information design, and looks firstly at the factors that make good information material. Then I investigate if there is a need for more information about ADHD within working life and if so what it would contain. The next part brings up what criteria it takes to be diagnosed with ADHD and different kinds of support; such as administrative, economical or cognitive. The goal of the report is to form information, mostly with text. Therefore the theoretical part ends with factors connected to information design followed by the design development. / ADHD har länge uppfattats som något som drabbar barn och växer bort med tiden. American psychiatric association uppger att ADHD kan uppträda annorlunda hos ungdomar och vuxna än hos barn. Något som kan leda till missförstånd och exkludering av vuxna och ungdomar med ADHD på bland annat arbetsmarknaden. Denna rapport undersöker den exkluderingen och söker vilken information som behöver nå vilka målgrupper för att förebygga den. Arbetets inriktning är textdesign, en del av informationsdesign, och fokuserar inledningsvis på de faktorer som bygger effektiv informationsmaterial. Sedan undersöks om det finns behov av mer information om ADHD inom yrkeslivet och vad den i så fall ska innehålla. Nästa del tar upp vilka kriterier som ska uppfyllas för att diagnostiseras med ADHD och vilken typ av stöd som då går att få; det kan handla om administrativ, ekonomisk eller kognitiv. Rapportens mål är att gestalta information och det är i första hand med hjälp av text. Därför avslutas den teoretiska delen med faktorer kopplade till informationsdesign och följs av designarbetets utveckling.

Background: Pre-eclampsia (PET) is one of the major causes of maternal and neonatal morbidity and mortality1. Misclassification of PET can lead to biased or erroneous results in epidemiologic studies resulting in false conclusions. Objectives: The objectives of this thesis are to determine the validity of PET diagnosis in pregnant women in administrative database using the ICD-10-CA codes, to explore the nature of misclassification, and to estimate whether misclassification of PET diagnosis in administrative database may result in biased conclusions. Methods: Pregnant women who participated in the Ottawa and Kingston (OaK) Birth Cohort study and delivered in the Ottawa Hospital were included in the study. All cases with hypertensive disorder of pregnancy in the study population were adjudicated to confirm diagnosis of PET. This adjudicated dataset was used as a reference standard. The PET incidence in hospital discharge database was compared with PET incidence calculated from the reference standard database. Results: 2887 of the requested charts were available for review. The PET incidence was much lower in administrative database (1.47%) than in the OaK Birth Cohort Study (3.6%). The results of the study demonstrated that hospital discharge database via ICD-10-CA was not very sensitive to determine incidence of PET since sensitivity of ICD-10-CA diagnostic codes for PET was low (35.92% with 95% Confidence Intervals (CI): 26.7; 45.9) but specificity, PPV, and NPV were high. The majority of misclassified cases belonged to the category (according to the proposed classification) “PET pregnancies coded with incorrect ICD-10-CA code” (78.88%) followed by the category “Pregnancies affected by PET coded as normal” (14.08%). Conclusion: Using hospital discharge database and ICD-10-CA coding to determine incidence of PET in certain settings may yield low sensitivity. Researchers should validate the results when using the hospital discharge database for PET research to ensure that the findings based on analyses of such data demonstrate what they claimed to demonstrate.

In dieser Arbeit soll auf das gesellschaftliche Problem der Altersgebrechlichkeit (Frailty) aufmerksam gemacht werden. Die Bedeutung für jedes Individuum, gebrechlich, frail zu altern und damit den Verlust an Lebensqualität und eine vorzeitige Mortalität zu riskieren wird deutlich gemacht. Das Alterssyndrom wäre einfach zu diagnostizieren, fällt aber dennoch zurzeit durch ein Raster. Deshalb wird ein Kodierungsvorschlag für Frailty entworfen, aus dem sich gezielte individuelle Therapie- und Rehabilitationsmaßnahmen ableiten lassen. Der Zusammenhang von altersphysiologischen immuno-neuro-endokrinen Veränderungen und der Frailty bilden die Grundlage für eine Präventionskaskade: F1, F2; F3 in Anlehnung der „U“-Untersuchungen für Kinder.

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No description available.

Le concept de structure clinique se réfère immédiatement à la classification d’une maladie mentale comme névrose, psychose ou perversion, mais aussi au sous-type nosographique la concernant. Actuellement, les développements de ce concept constituent la principale théorie psychopathologique de l’analyse lacanienne. Toutefois, il y a une disparité de jugement sur sa valeur : (1) quelques auteurs soutiennent une continuité naturelle entre cette théorie et la doctrine de Freud et Lacan ; (2) quelques autres proposent une réorganisation de la nosographie psychanalytique incluant des nouvelles pathologies ; (3) quelques autres, finalement, défendent la disparition complète de ces références théoriques dans la clinique.Cette disparité relève d’une lacune dans le savoir : les fondements des structures cliniques, ainsi que ses enjeux, n’ont pas été encore systématisés. L’objetctif général de ce travail fut de les restituer, afin de déterminer la légitimité de cette théorie en tant qu’interprétation de la pensée de Freud et Lacan, ainsi que sa pertinence dans les débats psychopathologiques actuels.Pour éclairer les filiations symboliques qui soutiennent le concept de structure clinique, une méthode généalogique a été employée. Les résultats démontrent que Freud a utilisé une notion de structure héritée de la science du XIX e siècle pour élaborer ses conceptions psychanalytiques. La référence minéralogique, fournie par son ancien professeur G. Tschermak, a notamment imprégné l’usage freudien de la structure en psychopathologie. Bien que les catégories de névrose, psychose et perversion n’arrivent pas chez lui à se constituer comme un triptyque, il y a dans ses textes une tendance à les considérer dans leurs rapports mutuels, en tant que perturbations de la vie sexuelle. Cette tendance a été récupérée par Lacan à partir de 1953, et déclinée sur son concept de structure – entendue alors comme un ensemble covariant de signifiants – et sur les registres du réel, du symbolique et de l’imaginaire. Les avancées de sa production intellectuelle, telles que l’invention de l’objet petit a et l’introduction des nœuds et des tresses en psychanalyse, auront apporté jusqu’à la fin de ses jours un approfondissement du triptyque freudien.La systématisation de la théorie des structures cliniques a proprement commencée en 1981, quand les membres du Champ freudien ont soudé cet ensemble d’éléments psychopathologiques avec le terme, homonyme et préexistant, de structure clinique. L’enjeu majeur de cette soudure a été de supporter la relation dialectique entre la théorie et la pratique analytique. À présent, le programme de recherche des structures cliniques porte sur les psychoses ordinaires et sur la spécificité de l’autisme. La psychopathologie lacanienne ainsi constitué est interrogée depuis nombreux angles : la proposition d’une structure psychosomatique, la promotion des pathologies borderline, la liquidation post-moderne de la structure perverse, la contrainte des nosographies opérationnalisées (CIM, DSM et PDM). Les conclusions de cette recherche qualifient la théorie des structures cliniques comme une interprétation légitime de la pensée de Freud et de Lacan. Elle est d’autant plus pertinente dans le contexte actuel qu’elle est d’une grande utilité pour l’établissement du diagnostic structural, pour la direction de la cure et pour la transmission du cas clinique. En tant que cartographie du malaise subjectif, la structure clinique signale la référence éthique du psychopathologique, et constitue une résistance et une subversion face à la défaillance contemporaine dans l’appréhension du réel clinique. / The concept of Clinical Structure concerns the classification of a mental disease as neurosis, psychosis or perversion, and its corresponding nosographic sub-type as well. Nowadays, the developments of this concept constitute the main psycho-pathological theory brought about by lacanian psychoanalysis. However, there is a disparity of judgment regarding its value: (1) some authors assert the natural continuity between that theory and the doctrine of Freud and Lacan; (2) some others propose a reorganization of psychoanalytic nosography which includes new pathologies; (3) some others finally advocate a complete disappearance of these theoretical references from clinical studies. This disparity takes on a lack of knowledge: the clinical structures’ foundations, and its stakes, have not yet been systematized. The main objective of this work was to restore them, in order to determine the legitimacy of this theory as an interpretation of Freud’s and Lacan’s thinking, and its appropriateness in contemporary psycho-pathological debates.For clarifying the symbolic filiations that support the concept, a genealogical method has been employed. The results demonstrate that Freud has used a notion of structure inherited from 19th century science to elaborate his psychoanalytical conceptions. The mineralogical reference, provided by his ancient Professor G. Tschermak, has notably permeated the freudien use of the structure in psychopathology. Although he did not constitute the categories of neurosis, psychosis and perversion as a triptych, there is in his textes a tendancy to consider them on their mutual connections, as disturbances of sexual life. This tendancy has been recovered by Lacan since 1953, and declined on his concept of structure (then understood as a co-variant set of signifiers) and on the registers of real, symbolic and imaginary. The advances of his intellectual production, like the invention of the Object petit a and the introduction of knots and braids in psychoanalysis, have brought until the end of his days a deepening of the freudien triptych.Systematization of the theory of clinical structures has properly started in 1981, when the members of the Freudien Field have welded this set of psycho-pathological items to the term, namesake and pre-existing, of clinical structure. The major stake of this welding has been to support the dialectical relationship between the psychoanalytic theory and the practice.Nowadays, the in-depth study of clinical structures is focused on the ordinary psychosis and the specificity of autism. The Lacanian psychopathology thus constituted is questioned from many angles: the proposition of a psychosomatic structure, the promotion of borderline pathology, the Postmodern liquidation of the perverse structure, the constraint of operationalized nosographies (ICD, DSM and PDM).In conclusion, this research confirms the theory of clinical structures as a legitimate interpretation of Freud’s and Lacan’s thinking. It is even more relevant in contemporary context that it has an important utility in order to the establishment of structural diagnose, to the direction of the cure and to the transmission of cases. As a cartography of subjective discomfort, the clinical structure points to the ethical reference of the psycho-pathological, and constitutes a resistance and a subversion facing the contemporary failure in the apprehension of clinical real.

Heart disease is one of the most prevalent diseases in the world. The survival chances for patients with ventricular fibrillation/ventricular tachycardia reduces significantly as time passes without treatment and even after getting timely treatment recurring episode are common. These patients can benefit from an Implantable Cardioverter Defibrillator (ICD) which can monitor heart rhythm and provide immediate treatment. Due to the ever changing physical conditions and disease progression, the ICD needs to collect diagnostic data as well as support programming by the physician. The ICD uses inductive telemetry and radio-frequency telemetry for the communication with the external devices such as a programmer or a monitor. Inductive telemetry uses less energy than RF telemetry but has a very short range of communication. In addition to inductive telemetry, the St. Jude Medical ICD supports 2.45 GHz band based asynchronized wakeup and 400 MHz MICS band based synchronized wakeup. The 2.45 GHz band based wakeup has limited wakeup range and the 400 MHz MICS based synchronized wakeup has limited availability for connection because it requires synchronization with the base station. The enhanced Medical Implant Communications Service (eMICS) algorithm is a firmware based algorithm which addresses the issues with other two wakeup schemes and provides fast, robust, and seamless wakeup. This thesis describes the design, implementation, and initial testing of eMICS algorithm on the Unity device platform in Technology Project Management (TPM) phase. The eMICS automated test tool developed at St. Jude Medical was used to test the eMICS algorithm under a controlled lab environment, typical home environment, typical hospital/clinic environment, and in the field. The project was successfully completed and transferred to Product Project Management (PPM) phase. However, the suggested duration of 60-90 seconds for sniff interval which will cause the least effect on the battery life was found unacceptable, and there is also a strong need for energy efficient hardware which draws minimal amount of current during each sniff. Therefore, St. Jude Medical is collaborating with the hardware vender to implement eMICS algorithm in the next version of hardware.

Background. In-hospital mortality is a measure recognized by US Agency for Healthcare Quality to represent quality of care within hospitals, that accounts for mortality based on three indicators: 1. select medical conditions and procedures; 2. procedures linked with questions of use (misuse, over/under use); 3. high volume procedures traditionally associated with lower mortality rates. Understanding how different comorbidity models measure in-hospital mortality is essential not only for determining patient health status in the hospital setting, but also help to regulating mortality risk and mortality risk predictions. One of the most widely used discriminatory models is the Charlson model, which predicts the risk of mortality within one year of hospitalization of patients with various comorbidities using CCSR codes for ICD-10 diagnoses which is quantified by the c-statistics, represented by the area under the curve (AUC). Objectives. To adapt a comorbidity index model to the National Inpatient Sample (NIS) database of 2020 to predict 1-year mortality for patients admitted with select ICD-10 codes of diagnoses. Methods Our study analysis examined mortality with comorbidity using the Charlson model in a sample population of estimated 5,533,477 adult inpatients (individuals ≥18 years of age). A multivariate logistic regression model was constructed with in-hospital mortality as the outcome variable and identifying predictor variables as defined by the Clinical Classifications Software Refined Variables (CCSR) codes for selected ICD-10 diagnoses (Table 3). Descriptive statistics and the base logistic regression analyses were conducted using SAS statistical software version 9.4. To avoid overpowering and avoid variables attaining statistical significance while only marginally changing the outcome, a subsample (n=100,000) was randomly selected from the original data set. Ultimately, 20 CCSR variables with p-values <0.20 from the base simple logistic regression models were included in the subsequent backward stepwise logistic regression analysis. Results Table 1 shows the prevalence of the selected diagnoses for our analysis. Anemia (28.32%), pulmonary disease (asthma, COPD, pneumoconiosis;21.88%), and diabetes without complications (19.47%) were the three most prevalent conditions among hospitalized patients. Table 2 shows the results of the base logistic regression analysis conducted, which excluded connective tissue/rheumatologic disorders, peptic ulcer disease, anemia, diabetes with complications, and human immunodeficiency as predictors of inpatient mortality. Results of the backward stepwise regression analysis revealed that severe liver disease/hepatic failure ([adjusted odds ratio (aOR): 10.50, (CI: 10.40-10.59)], acute myocardial infarction ([2.85, (2.83-2.87)] and malnutrition ([2.15, (2.14-2.16)] were three most important risk factors and had the highest impact on inpatient mortality (p-value <0.0001). However, smoking history, obesity, and liver disease were negatively associated with inpatient mortality. The c-statistic or the area under the curve (AUC) for the final model was 0.752. Conclusion Our findings, based on Charlson modeling procedures, indicate that independent variables representative of comorbidity with the strongest 1-year risk of mortality were among patients with ICD-10 codes relating to: severe liver disease/hepatic failure, acute myocardial infarction, and malnutrition. Hence, relevant stakeholders (patients, family members, and healthcare providers) can utilize this knowledge to advance models of care and prevention strategies that limit disease progression and improve patient outcomes.

Frailty is a multifaceted, geriatric syndrome that is associated with age-related declines in functional reserves resulting in increased risks of in-hospital death, readmissions and discharge to nursing homes. The risks associated with frailty highlights the need for providers to be able to quickly, and accurately, assess someone’s frailty level. Previous studies have shown that bedside clinician assessment is not a reliable or valid way to determine frailty, meaning that a more reliable, valid and concise method is needed. We developed a prediction model using discharge ICD-9/ICD-10 diagnostic codes and other demographic variables to predict Reported Edmonton Frail Scale scores. Participants were from the Baystate Frailty Study, a prospective cohort design study among elderly patients greater than 65 years old who were admitted to a single academic medical center between 2014 and 2016. Three different predictive models were completed utilizing the LASSO approach. The adjusted r-square increased across the three models indicating an increase in the predictive ability of the models. In this study of 762 hospitalized patients over the age of 65 years old, we found that a frailty prediction model that included ICD codes only had a poor prediction ability (adjusted r-square=0.10). The prediction ability improved 2-fold after adding demographic information, a comorbidity score and interaction terms (adjusted r-square=0.26). This study provided additional insights into the development of an automatic frailty assessment, something which is currently missing from clinical care.

En implanterbar defibrillator (ICD) är nuförtiden en väl beprövad behandlingsmetod för patienter som överlevt ett hjärtstopp eller har en avancerad hjärtsjukdom och därmed har ökad risk för ventrikulära arytmier. Syftet med vårt arbete var att beskriva ICD-patienters livskvalitet och de livsomställningar som en ICD-implantation medförde. Studien genomfördes som en litteraturöversikt enligt Willman et al. Resultat visade att livet med en ICD innebar omställningar och förändringar som många patienter inte var helt förberedda på. En defibrilleringschock visade sig inverka negativt på livskvaliteten. Professionell sjukvårdspersonal och anhöriga hade en viktig roll att spela vad gäller stöd, information och utbildning. Sjukvårdspersonal kan behöva ytterligare utbildning för att kunna ta hand om patienterna och möta dem i deras situation. Ytterligare forskning kan vara av värde för att se hur patienternas livskvalitet ser ut på längre sikt. / An implantable defibrillator is nowadays a well-known treatment for patients who survived a cardiac arrest or suffer from severe heart disease. The aim of our study was to describe ICD-patients quality of life and the life changes that come with the ICD-implantation. The study was conducted as a literature review pursuant to Willman et al. The result showed that patients living with an ICD needed to adapt to life changes that could occur. Defibrillation had a negative impact on quality of life. Medical staff and next of kin were important to provide support, information and education. All medical staff may need further education to properly manage the care of ICD-patients. Further research can be of value to evaluate patients’ quality of life in the long term.