Introduction There is a need in palliative care for development of structured methods to assess quality and support improvement. This need is present both within and outside specialised palliative care. Honest information from physicians is regarded as an important part of palliative care. Information about the transition to end-of-life care (ITEOL), conveyed by physicians to patients, has also been described as a ‘breakpoint conversation’. Quality registers enable monitoring and improvement of quality of care, and clinical research. The Swedish Register of Palliative Care (SRPC) is a Swedish national quality register that collects data from hospitals, hospices, nursing homes and home care, with an end-of-life questionnaire (ELQ) about palliative care content focusing on the last week of life. Aims Study I – The aim was to examine the validity of the ELQ from the SRPC. Study II – The aim was to examine whether participation in the SRPC increases the quality of palliative care over a three-year period regarding eight items in the ELQ. Study III – The aim was to examine whether an educational intervention for physicians and nurses in nursing homes and hospitals increases the proportion of patients who receive ITEOL. Study IV – The aim was to describe how patients with cancer perceive the information they receive from physicians during palliative chemotherapy. Methods Study I – Data from 100 medical records and data from the paper versions of the ELQ filled in at a specialised palliative unit were compared with data reported to the SRPC. Study II – Data from eight items in the ELQ reported to the SRPC from all healthcare units that had reported patients continuously during a three-year period were compared year-by-year with logistic regression. Study III – Two municipalities (in charge of nursing homes) and two hospitals were randomised to receive an interactive half-day course about ITEOL for physicians and nurses. Four hospitals and four municipalities were assigned matched controls. The proportion of patients who received ITEOL before and after the intervention was measured with the ELQ. The effect of the intervention was analysed with a multivariable logistic regression model. Study IV – Fifteen semi-structured interviews with patients with incurable cancer were conducted, transcribed verbatim and analysed with qualitative content analysis. Results Study I – The questions in the ELQ showed a congruity of 22% to 100% when comparing data from medical records with data reported to the SRPC. Eight questions fell below 80%. The paper versions filled in at the unit and the data reported to the SRPC showed a congruity of between 91% and 100%. Study II – The prevalence of six symptoms decreased. The prescription of PRN (pro re nata – ‘as needed’) medications for pain, nausea, anxiety and death rattle increased. A higher proportion of patients died in their place of preference. The patient’s next of kin was more often offered a follow-up appointment after the patient’s death. There was no change in the proportion of patients or next of kin who received ITEOL. Study III – The proportion of patients in the intervention group who received ITEOL increased from 35.1% (during a six-month period before the intervention) to 42.0% (during a six-month period after the intervention). The proportion in the control group increased from 30.4% to 33.7%. The effect of the intervention was significant (p=0.005) in the multivariable model. Study IV – Three categories were disclosed during the analytical process: ‘living with a death sentence’, ‘depending on chemotherapy’, and ‘living with uncertainty’. Conclusions A national quality register has the potential of contributing to quality improvement in palliative care. Study I showed varied validity in the ELQ, implying a need to modify the questionnaire. Study II showed that participation in the SRPC was covariant with quality improvements in end-of-life care over time. Study III showed that more patients received ITEOL after an educative half-day intervention directed to physicians and nurses. Study IV showed that patients undergoing palliative chemotherapy perceived that their disease was incurable and deadly, and that conditions for future treatment and survival were uncertain.

<p>Diss. (sammanfattning) Umeå : Umeå universitet, 2003</p> / digitalisering@umu

Outcome after traumatic brain injury (TBI) depends on the extent of primary cell death and on the development of secondary brain injury. The general aim of this thesis was to find strategies and quality systems to minimize the extent of secondary insults in neurointensive care (NIC). An established standardized management protocol system, multimodality monitoring and computerized data collection, and analysis systems were used. The Uppsala TBI register was established for regular monitoring of NIC quality indexes. For 2008-2010 the proportion of patients improving during NIC was 60-80%, whereas 10% deteriorated. The percentage of ‘talk and die’ cases was &lt; 1%. The occurrences of secondary insults were less than 5% of good monitoring time (GMT) for intracranial pressure (ICP) &gt; 25 mmHg, cerebral perfusion pressure (CPP) &lt; 50 mmHg and systolic blood pressure &lt; 100 mmHg. Favorable outcome was achieved by 64% of adults. Nurse checklists of secondary insult occurrence were introduced. Evaluation of the use of nursing checklists showed that the nurses documented their assessments in 84-85% of the shifts and duration of monitoring time at insult level was significantly longer when secondary insults were reported regarding ICP, CPP and temperature. The use of nurse checklist was found to be feasible and accurate.  A clinical tool to avoid secondary insults related to nursing interventions was developed. Secondary brain insults occurred in about 10% of nursing interventions. There were substantial variations between patients. The risk ratios of developing an ICP insult were 4.7 when baseline ICP ≥ 15 mmHg, 2.9 when ICP amplitude ≥ 6 mmHg and 1.7 when pressure autoregulation ≥ 0.3. Hyperthermia, which is a known frequent secondary insult, was studied. Hyperthermia was most common on Day 7 after admission and 90% of the TBI patients had hyperthermia during the first 10 days at the NIC unit. The effects of hyperthermia on intracranial dynamics (ICP, brain energy metabolism and BtipO2) were small but individual differences were observed. Hyperthermia increased ICP slightly more when temperature increased in the groups with low compliance and impaired pressure autoregulation. Ischemic pattern was never observed in the microdialysis samples. The treatment of hyperthermia may be individualized and guided by multimodality monitoring.

Zur genauen Justage und objektiven Qualitätsprüfung von Druckmaschinen ist ein hochgenaues Messgerät zur Passermessung sinnvoll. Ein solches Messsystem wurde unter Verwendung konventioneller Videotechnik basierend auf Bildanalysetechnologien entwickelt. Speziell für das Messsystem entworfene Messelemente werden zur Passermessung gedruckt, mit Videotechnik digitalisiert und mit Hilfe von Bildanalysetechnologien erkannt, bewertet und vermessen. Auf dem Entwicklungsweg zu diesem Messsystem wurden verschiedene Problemkreise analysiert und gelöst. Dazu zählen beispielsweise Methoden zur Signalerfassung und zur Korrektur von Fehlern in optischen Abbildungssystemen. Ausgehend von einer Bewertung bekannter Lösungen zur Passermessung werden Technologien und Strategien für ein Messverfahren zur Passermessung mit konventioneller Videotechnik am Beispiel der Übergabepassermessung aufgezeigt. Nachweismöglichkeiten zur Prüfung der Technologie und Schlussfolgerungen wie wünschenswerte Forderungen für die Zukunft, beispielsweise für Folge- und Weiterentwicklungen, werden formuliert. / A high-precision instrument for register measurement is useful for the exact adjustment and quality control of printing presses. Such a measuring system has been developed on the basis of image analysis methods and the application of conventional video technology. Measuring elements specially designed for the measuring system are printed for register measurement, digitalized with video technology and recognized, evaluated and measured with the help of image analysis methods. On the way to the development of this measuring system various complexes of problems were analysed and solved, among them, for instance, methods of signal recognition and correction of errors in optical imaging systems. Proceeding from the evaluation of known solutions for register measurement, methods and strategies are demonstrated for a method of register measurement with conventional video technology using transfer register measurement as an example. Possibilities to proof the verification of the method, conclusions and desirable demands for the future, such as follow-up and further developments have been formulated.

Bakgrund: Kariessjukdomen hör till en av världens vanligaste sjukdomar med flertalet kända orsaks- och riskfaktorer. För att bevara en god oral hälsa utgör förebyggande tandvård en betydelsefull del bland äldre och kan ha en stor inverkan på en individs livskvalitet. Karies kan förebyggas och behandlas med stöd av patientutbildning och förebyggande tandvård, en hälsoinsats som främjar framförallt individen men även samhället med minskade resurs- och vårdkostnader. Syfte: Övergripande syftet med studien var att kartlägga förekomst och fördelning av registrerade förebyggande åtgärder i relation till karies bland individer 65 till 70 år, bofasta i Värmland 2017. Metod: Studiens design var en tvärsnittsstudie av individdata (n=2738) från 65- till 70-åriga individer bosatta i Värmland och undersökta i tandvården, Region Värmland 2017. Data baseras på Svenskt Kvalitetsregister för Karies och Parodontit (SKaPa) åren 2017 och 2018. Resultat: Närmare trefjärdedelar av individerna hade ingen tillståndskod för karies registrerad (72,1%). Det var ungefär dubbelt så vanligt med tillståndskoder för sekundärkaries jämfört med primärkaries, 684 respektive 291 registreringar. Totalt registrerades 742 sjukdomsförebyggande åtgärder (200-serien) och 3495 sjukdomsbehandlande åtgärder (300-serie). ”Icke-operativ behandling” var den åtgärd som starkast associerades till individer med kariestillstånd (OR 3,83; CI 3,04–4,83). ”Information vid risk för sjukdom” var starkast associerad till individer utan kariestillstånd.  Antalet erhållna förebyggande åtgärder var snedfördelad och kunde variera från en upp till nio behandlingar per individ. Konklusion: Resultatet i denna studie talar för betydelsen av ytterligare studier inom förebyggande tandvård som hälsofrämjande insats för att främja oral hälsa bland äldre individer med kariessjukdom. Beteendemedicinsk prevention är en underutnyttjad åtgärd som behöver övervägas inom den förebyggande tandvården. / Introduction: Dental caries is one of the most common diseases worldwide with well-known risk factors. In order to maintain a good oral health, preventive dental care is an important part for elderly people and impacts on an individual´s quality of life. Dental caries can be prevented and treated with patient support, education and preventive dental care. Health promotion activities within dental care contributes to the individual’s well-being and reduces costs for the society.   Aim: The overall aim was to identify the occurrence and distribution of registered preventive dental care in relation to caries, among individuals aged 65 to 70 years resident in the county of Värmland in 2017.  Method: A cross-sectional register-based study of individual data (n= 2738) from 65 to 70-year-old individuals resident and dental examined, in the county of Värmland in 2017. Data was obtained from The Swedish Quality Registry for Caries and Periodontal Diseases (SKaPa) from years 2017 and 2018.  Results: Nearly three-quarters of the individuals had no caries conditions registered (72,1%). Secondary caries-conditions were about twice as common compared to primary caries, 684 and 291 registrations, respectively.  A total of 742 preventive-treatments and 3495 preventive disease-treatments were registered. “Non-invasive treatment” had the strongest association to individuals with caries conditions (OR 3,83; CI 3,04-4,83). The treatment “information when risk for disease” had the strongest association to individuals without caries conditions. The number of obtained preventive treatments were skewed and could vary from one up to nine treatments per individual. Conclusion; The results of this study indicate the importance of further studies of preventive dental care as a health promotion achievement to promote oral health among older individuals with dental caries disease. Behavioral medical prevention is underused and needs to be considered in preventive dental care in the future.