Background: The treatment outcome of temporomandibular disorders (TMD) can be assessed with Symptom Severity Index (SSI). In addition to this self-report measure, Patients’ Global Impression of Change (PGIC) provides information about the overall impression of change. The use of SSI and PGIC when assessing treatment outcome in the field of TMD, and their correlation, has not previously been reviewed. Aim: The aims of this study were to investigate the correlation between the scales SSI and PGIC, to gain knowledge about which factors that contribute to the impression of change and to identify the diagnoses that have the most improvement. Methods: Data from 193 patients was analyzed. The percentage change in symptoms between baseline and follow up was compared to PGIC. The patients were divided into three groups based on main diagnoses, for further analysis. PGIC categories “much improved” and “very much improved” were set as successful treatment outcome. Different factors impact on PGIC were analyzed.  Results: Majority of the patients had a successful treatment outcome. A higher mean percentage change correlated with a better PGIC value. Patients with articular related diagnoses needed a greater reduction in SSI to rate the impression of change as improved. According to the regression analysis, diagnosis group, age, number of treatment visits and SSI-baseline were associated with treatment outcome. Conclusions: The present study supports the use of both SSI and PGIC for assessment of the treatment outcome when treating TMD. However, a possible discrepancy between the scales addresses the need for further examination and change of treatment approach.

Introduktion: Psoriasis är en autoimmun hudsjukdom som orsakar fjällande, erytematösa plack på huden. Sjukdomen orsakas av genetiska och miljömässiga faktorer och den är kopplad till andra sjukdomar som psoriasisartrit. Immunceller i kroppen spelar en viktig roll i bildandet av psoriasis, så som T-celler och olika cytokiner, inklusive interleukin-23 (IL-23), IL-12, IL-6 och tyrosine kinase 2 (TYK2). Dessa inflammatoriska faktorer leder till överdriven tillväxt av keratinocyter i huden och bidrar till bildandet av psoriasis. Plackpsoriasis är den vanligaste typen av psoriasis där den uppträder symmetriskt i kroppen. Den kan orsaka torra fjäll och smärtsamma sprickor vilket försämrar patientens livskvalitet. Forskning pågår fortfarande i strävan efter nya läkemedel medbättre effekt och färre biverkningar. Det finns olika orala behandlingar som riktar sig mot immunmolekyler i kroppen och hämmar deras verkan för att lindra symptomen på plackpsoriasis. Apremilast, en oral fosfodiesteras 4 (PDE4) hämmare, har visat en god terapeutisk effekt och säkerhet medan deucravacitinib är en ny oral selektiv TYK2-hämmare som har en god effekt och bra säkerhetsprofil. Syfte: Syftet var att hitta och analysera kliniska studier för att ta reda på om oral behandling med deucravacitinib har bättre effekt och säkerhet än apremilast vid behandling av patienter med medelsvår till svår plackpsoriasis. Metod: Databasen PubMed användes för att hitta fem vetenskapliga artiklar som undersökte effekt och säkerhet på de två läkemedlen i fråga. Studierna analyserades och utifrån analyserna drogs slutaster som besvarar syftet med arbetet. Resultat: De två första studierna hade till syfte att jämföra deucravacitinib med apremilast genom en så kallad ”head to head”. De visade en signifikant överlägsenhet av deucravacitinib över apremilast för att uppnå 75 % förbättring av Psoriasis Area and Severity Index (PASI 75) och Static Physician's Global Assessment score of 0 (clear) or 1 (almost clear) (sPGA 0/1) samt en bra säkerhetsprofil. Medan den tredje och fjärde studien visade att apremilast hade en överlägsen terapeutisk effekt jämfört med placebo. Patienterna nådde PASI 75 och sPGA-värden signifikant med en bra säkerhetsprofil. När det gäller den femte studien så jämförde den deucravacitinib med placebo. Dess resultat överensstämde med resultaten av de två första studierna. Diskussion: De fem artiklarna som analyserades var randomiserade kliniska studier på patienter med plackpsoriasis vilket gav tillförlitliga slutsatser. Det fanns felkällor så som det lilla antalet deltagare i den tredje och femte studien och bristen på tillräcklig etnisk mångfald. Vid jämförelse av PASI-värdena för de fem studierna så hade deucravacitinib bättre terapeutiska värden än apremilast. När det gäller säkerhetsprofilen så minskade kardiovaskulära biverkningar signifikant vid behandling med deucravacitinib. Slutsats: Deucravacitinib har en bättre effekt än apremilast samt bättre säkerhetsprofil vid behandling av patienter med medelsvår till svår plackpsoriasis

Recent research has challenged the long-standing hypothesis that forests in the Upper Midwest of the United States developed during wetter periods and retreated during dry periods. We explored this debate by examining patterns of tree establishment on an oak savanna in east-central Minnesota within the context of variable moisture availability and fire suppression. We used superposed epoch analyses (SEA) to evaluate the mean moisture conditions for a 21-year window surrounding tree establishment dates. Before effective fire suppression (1809–1939), 24 of 42 trees with pith dates (62%) grew to 30-cm height during dry years (Palmer Drought Severity Index < -1), versus only 5 of 42 (12%) that established in wet years (PDSI > 1). Significantly more trees established during dry periods (negative PDSI values) than would be expected with the proportion of wet-to-dry years (x²= 10.738, df = 1, p-value = 0.001). Twenty of the complete sample of 74 trees with pith dates (27%) established during drought in the 1930s. We hypothesize that dry conditions limited plant productivity, which in turn decreased competition between grasses and tree seedlings and reduced rates of accumulation of fine fuels, enabling seedlings to grow tall enough to resist subsequent fires. We recommend SEA as a methodological approach to compare historical climate conditions with the timing of regeneration success in other regions of forest expansion.

La mesure traditionnelle de la criminalité (taux pour 100 000 habitants) pose problème dans l'analyse des variations de la criminalité dans le temps ou l'espace. Le problème est dû au fait que le taux de criminalité est essentiellement déterminé par des infractions moins graves et très fréquentes. La présente étude a permis de tester l’utilité du nouvel outil développé par Statistique Canada qui procure un index de « gravité de la criminalité » dans lequel chaque crime est pondéré par son score de gravité (basé sur les décisions sentencielles moyennes au Canada de 2002 à 2007 pour chaque forme de crime). Appliquées aux statistiques officielles du Québec de 1977 à 2008, nos analyses montrent que l’indice de gravité s’avère une mesure utile pour dresser un portrait plus juste des tendances des crimes violents d’une année à l’autre. Plus exactement, l’indice de gravité montre que le taux de crimes violents est demeuré stable de 1977 à 1992 contrairement à l'image fournie par le taux traditionnel qui montre plutôt une montée fulgurante durant cette période. L’indice de gravité peut également être utile à l’égard des crimes violents pour comparer plus adéquatement les territoires entre eux afin d’établir ceux qui présentent une criminalité plus grave. Cependant, à l’égard de la criminalité globale et des crimes sans violence, l’indice de gravité n’est d’aucune utilité et présente la même lecture de la criminalité que la mesure traditionnelle. Cela s’explique par le fait que ce sont toujours les mêmes infractions (les vols, les méfaits et les introductions par effraction) qui contribuent majoritairement à chacune des deux mesures de la criminalité. / The traditional measure of the criminality (rate for 100 000 inhabitants) raises problem in the analysis of the variations of the criminality in time or space. The problem is due to the fact that the rate of criminality is essentially determined by less serious and very frequent crimes. The present study allowed testing the utility of a new tool developed by Statistics Canada which gets an index of "severity of criminality" in which every crime is weighted by its score of severity (based on the sentencielles decisions average in Canada from 2002 till 2007 for every kind of crime. Applied to the official statistics of Quebec from 1977 till 2008, our analyses show that the indication of gravity turns out to be a useful measure to draw up a more realistic portrait of the trends of violent crimes from one year to the next. More precisely, the crime seriousness index shows that the rate of violent crimes remained stable from 1977 till 1992, on contradiction to what is shown by traditional rate which rather demonstrates a huge rise during this period. Crime seriousness index can also be used towards violent crimes, in order to compare more adequately territories, to establish those who show more serious crimes. However, among global criminality and crimes without violence, the indication of gravity is of no utility and presents the same reading of the criminality as traditional measures. It explains that it is always the same crimes (thefts, mischief and breaking and entering) that contribute mainly to each of both measures of the criminality.

The aim of this dissertation is to examine empirically what Evidence-based practice (EBP) and its standardized procedures become when put into practice in social work. EBP builds on the idea that professional practice should be based on systematic and reliable knowledge of the interventions and instruments used in this work. This implies a standardization of both research and practice that has been highly contested. Inspired by works within science and technology studies (STS), this dissertation analyses the actual content of the standardized procedures and their uses in social work practice. The dissertation examines a ‘critical case’, a substance abuse social services agency that has worked extensively for several years at implementing EBP, and consists of four papers focusing on three standardized procedures used by the agency in order to enact EBP: 1) the Addiction severity index (ASI) assessment instrument; 2) the psychosocial intervention Motivational interviewing, and 3) the decision-making model Critical appraisal (CA). Ethnographic methods were employed to study the agency’s concrete uses of the standardized procedures in daily practice. MI was also followed in the research literature as it became established as an ‘evidence-based’ intervention. Fundamentally, the development of the standards of EBP can be a messy and paradoxical process. In the stabilization of MI, its differences and ‘fluidity’ have eventually been made to disappear and left a stable ‘evidence-based’ object. Findings from the ethnographic studies show that EBP, as enacted in the agency’s daily practice, is a bureaucratic project where the agency’s managers have decided on and control the use of a set of standards. Thus, what constitutes relevant evidence is based not on professional discussion within the agency but is ultimately determined by the managers. In practice, the standards introduce new logics that cause tensions within the agency, tensions which the social workers are left to handle. Main conflicts concern how the client work is ordered and contradictory organizational rationales. The three standards are used to varying extent, which can be understood by examining what they seek to standardize and how they are put to work. CA was not used at all, mainly due to its design. Disregarding organizational rationales that are unavoidable within the social services, it could not be adapted to the agency’s work. With ASI and MI the situation was different, mostly because of their organizational adaptability. ASI could be implemented in several phases of the agency’s work flow resulting in adjustments of both the instrument and the work flow. As a ‘fluid intervention’, MI was constrained by, but also adjustable to the organization. It was thus possible for both ASI and MI to transform and be transformed by pre-existing practices, in effect creating new practices. A major conclusion is that EBP and its standardized procedures is a more dynamic and multifaceted process than previously acknowledged in social work. Rather than a deterministic one-way path, there are different kinds, degrees, and mutual transformations of standardization processes, which must be appreciated in research and in practical efforts to implement EBP. Given the importance of the organization in professional social work, there is a need to move away from individualistic conceptions of EBP and to consider what evidence use might mean from an organizational perspective. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Manuscript.</p>

<p> </p><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><p><!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-name:"Normal\,Normal1\,Normal11\,Normal111\,Normal1111\, webb2"; mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:70.85pt 70.85pt 70.85pt 70.85pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --></p><!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normal tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} --><p> </p><!--[endif]--><p>Vilka bedömningsinstrument som används inom missbruks- och beroendevården och hur Sveriges kommuner använder instrumenten är ett outforskat område. Socialstyrelsen publicerade år 2007 nationella riktlinjer för missbruks- och beroendevård där man förespråkar användandet av bedömningsinstrument. Studien har granskat i vilken utsträckning och i vilket syfte bedömningsinstrument används och hur förutsättningarna ser ut för användningen av bedömningsinstrument inom socialtjänstens arbete med missbruks- och beroendevård. Hur frekvent är användningen av bedömningsinstrument och vilka för- och nackdelar framkommer i bruket av dessa? Uppsatsen har en kvantitativansats med kvalitativa inslag och utgår från telefonintervjuer med tio respondenter. Dessa arbetar som handläggare inom missbruks- och beroendevården för vuxna och har tillgång till bedömningsinstrument. Studien visade att åtta av tio arbetsplatser (80 %) som har tillgång till olika bedömningsinstrument använder dem. Främsta syftet är att tydliggöra klientens problematik, se insatsbehovet, få ett helhetsperspektiv och att skapa ett aktivt deltagande från klienten. Förutsättningarna för att använda bedömningsinstrument finns i form av utbildning och stöd från organisationen, men det saknas tid, kunskap och utrustning för att använda dessa fullt ut. Den statliga intentionen med en evidensbaserad praktik är att skapa en evidensbaserad kunskapsbank. Trots detta visar undersökningen att utvärdering och statistik är två eftersatta områden gällande hanteringen av bedömningsinstrument.</p> / <p><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-name:"Normal\,Normal1\,Normal11\,Normal111\,Normal1111\, webb2"; mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:70.85pt 70.85pt 70.85pt 70.85pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normal tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} --> <!--[endif]--></p><p>What assessment instruments used in drug and dependent care, and the extent to which the Swedish municipalities are using these instruments is an unexplored area. Socialstyrelsen published in 2007, national guidelines for drug and dependent care which advocates the use of assessment instruments. The study aim is to examine the extent to which, for what purpose and how conditions look for the use of assessment instruments in the social service work with drug and dependent care. How frequent is the use of assessment instruments and the advantages and disadvantages apparent in the use of these? The essay has a rate of quantitative and qualitative elements based on telephone interviews with ten respondents. Those working as administrators in the drug and dependent care for adults and have access to assessment instruments. The results showed that eight out of ten sites (80%) use different assessment instruments. Main purpose is to clarify the client's problem, see the effort need, have a global perspective and to create the active participation of the client. The conditions for the use of assessment instruments are in the form of training and support from the organization, but the absence still time, knowledge and equipment to use them fully. The government intends to evidence-based practice is to create an evidence-based knowledge. Although this study shows that the evaluation and statistics are two areas in the existing management of the assessment instrument.<strong></strong></p><p> </p>

<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-name:"Normal\,Normal1\,Normal11\,Normal111\,Normal1111\, webb2"; mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:70.85pt 70.85pt 70.85pt 70.85pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normal tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} -->  <!--[endif]-->Vilka bedömningsinstrument som används inom missbruks- och beroendevården och hur Sveriges kommuner använder instrumenten är ett outforskat område. Socialstyrelsen publicerade år 2007 nationella riktlinjer för missbruks- och beroendevård där man förespråkar användandet av bedömningsinstrument. Studien har granskat i vilken utsträckning och i vilket syfte bedömningsinstrument används och hur förutsättningarna ser ut för användningen av bedömningsinstrument inom socialtjänstens arbete med missbruks- och beroendevård. Hur frekvent är användningen av bedömningsinstrument och vilka för- och nackdelar framkommer i bruket av dessa? Uppsatsen har en kvantitativansats med kvalitativa inslag och utgår från telefonintervjuer med tio respondenter. Dessa arbetar som handläggare inom missbruks- och beroendevården för vuxna och har tillgång till bedömningsinstrument. Studien visade att åtta av tio arbetsplatser (80 %) som har tillgång till olika bedömningsinstrument använder dem. Främsta syftet är att tydliggöra klientens problematik, se insatsbehovet, få ett helhetsperspektiv och att skapa ett aktivt deltagande från klienten. Förutsättningarna för att använda bedömningsinstrument finns i form av utbildning och stöd från organisationen, men det saknas tid, kunskap och utrustning för att använda dessa fullt ut. Den statliga intentionen med en evidensbaserad praktik är att skapa en evidensbaserad kunskapsbank. Trots detta visar undersökningen att utvärdering och statistik är två eftersatta områden gällande hanteringen av bedömningsinstrument. / <!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-name:"Normal\,Normal1\,Normal11\,Normal111\,Normal1111\, webb2"; mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:70.85pt 70.85pt 70.85pt 70.85pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normal tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} --> <!--[endif]--> What assessment instruments used in drug and dependent care, and the extent to which the Swedish municipalities are using these instruments is an unexplored area. Socialstyrelsen published in 2007, national guidelines for drug and dependent care which advocates the use of assessment instruments. The study aim is to examine the extent to which, for what purpose and how conditions look for the use of assessment instruments in the social service work with drug and dependent care. How frequent is the use of assessment instruments and the advantages and disadvantages apparent in the use of these? The essay has a rate of quantitative and qualitative elements based on telephone interviews with ten respondents. Those working as administrators in the drug and dependent care for adults and have access to assessment instruments. The results showed that eight out of ten sites (80%) use different assessment instruments. Main purpose is to clarify the client's problem, see the effort need, have a global perspective and to create the active participation of the client. The conditions for the use of assessment instruments are in the form of training and support from the organization, but the absence still time, knowledge and equipment to use them fully. The government intends to evidence-based practice is to create an evidence-based knowledge. Although this study shows that the evaluation and statistics are two areas in the existing management of the assessment instrument.

Η διαλογή (Triage) των ασθενών, που προσέρχονται στο Τμήμα Επειγόντων Περιστατικών (ΤΕΠ), αποτελεί μια διαδικασία, η οποία εφαρμόζεται όταν ο αριθμός των προσερχόμενων πασχόντων είναι μεγαλύτερος από την δυνατότητα του προσωπικού και των διαθέσιμων πόρων του εκάστοτε φορέα. Στην Ελλάδα, η οικονομική ύφεση φαίνεται να έχει επηρεάσει την επισκεψιμότητα στα ΤΕΠ, καθώς υπάρχει ένα τεράστιο ποσοστό του πληθυσμού, που είναι ανασφάλιστοι και που για οποιοδήποτε πρόβλημα υγείας, απευθύνονται στα ΤΕΠ τριτοβάθμιων νοσοκομείων. Ωστόσο, αν και οι ανάγκες απαιτούν ένα πιο ολοκληρωμένο σύστημα ΤΕΠ, τα αποτελέσματα είναι δυσμενή. Η Επείγουσα Ιατρική, αν και είναι νομικά κατοχυρωμένη ειδικότητα σε >54 χώρες παγκοσμίως και σε 19/27 χώρες-μέλη της Ε.Ε., στην Ελλάδα ακόμη δεν είναι αναγνωρισμένη ως ειδικότητα ή εξειδίκευση. Επιπροσθέτως, η διαλογή των ασθενών, δεν είναι οργανωμένη και δεν ακολουθεί τις κατευθυντήριες οδηγίες.. Μόνη εξαίρεση αποτελεί το Γ.Ν. Θεσσαλονίκης ‘Παπαγεωργίου’, στο οποίο εφαρμόζεται διαλογή με 5-level σύστημα, κάνοντας χρήση του αλγορίθμου ESI (Emergency Severity Index). Σκοπός της εργασίας αυτής, αποτελεί αφ' ενός μεν η δημιουργία ενός ευφυούς συστήματος διαλογής και κατηγοριοποίησης των ασθενών, που προσέρχονται στο Τμήμα Επειγόντων Περιστατικών, αφ' ετέρου δε η σύγκριση διαφόρων μεθόδων δημιουργίας του πυρήνα του ευφυούς συστήματος. Στόχος του συστήματος είναι να αποτελέσει ένα χρήσιμο εργαλείο για την αποτελεσματικότερη και ταχύτερη διαλογή των ασθενών. Αρχικά, πραγματοποιήθηκε η συλλογή ενός σημαντικού αριθμού δεδομένων ασθενών, οι οποίοι προσήλθαν στα ΤΕΠ του ΠΓΝ Πατρών. Τα δεδομένα αυτά, τα οποία και συλλέχθηκαν ανώνυμα, περιλαμβάνουν δημογραφικά στοιχεία, το κύριο σύμπτωμα του ασθενή, την αξιολόγηση TRIAGE, τον τρόπο άφιξης στα ΤΕΠ καθώς και ένα σύνολο από χαρακτηριστικά γνωρίσματα για κάθε ξεχωριστό οργανικό σύστημα. Παράλληλα, πραγματοποιήθηκαν συνεντεύξεις με εμπειρογνώμονες (ιατρούς-νοσηλευτές). Η γνώση, η οποία πάρθηκε από τα δεδομένα, τις συνεντεύξεις και την βιβλιογραφία αποτέλεσαν την πηγή για την παραγωγή των κανόνων του συστήματος. Η κατηγοριοποίηση των ασθενών, η οποία και στηρίζεται στο σύστημα διαλογής ESI, γίνεται σε κλάσεις εξόδου. Ο αριθμός των κλάσεων εξόδου, είναι 5πλάσιος του αριθμού των ιατρικών ειδικοτήτων. Η αποτελεσματικότητα του συστήματος, αξιολογείται με βάση διεθνώς χρησιμοποιούμενες μετρικές. / The screening (Triage) of patients attending the Emergency Department (ED) is a process which applies when the number of the arriving patients is greater than the ability of the staff and of the resources of each institution. In Greece, the economic downturn seems to have affected the traffic in ED, as there is a huge percentage of the population, who are uninsured and who for any health problem, addressed to the tertiary hospital. However, although needs require a more integrated system of ED, the results are unfavourable. The Emergency Medicine, although legally patented specialty in > 54 countries around the world and in 19/27 countries-members of the EU, in Greece is still not recognized as a specialty or specialization. In addition, the ED-Triage, is not organized and does not follow the guidelines. The only exception is the General Hospital ‘Papageorgiou’ at Thessaloniki, which uses for ED-Triage a 5-level system, using the algorithm ESI (Emergency Severity Index). The purpose of this work is on the one hand, the creation of an intelligent system for sorting and categorization of patients who come to the Emergency Department, and a comparison of various methods of creating the core of intelligent system. The aim of the system is to be a useful tool for better and faster triage of patients. Initially, the collection was a considerable quantity of data by patients who came to the ED of the Universal Hospital of Patras. These data, which were collected anonymously, include demographics, the main symptom of the patient, the evaluation of TRIAGE, how the patient arrival in the ED and a set of features for each separate organic system. At the same time, made interviews with experts (doctors-nurses). Knowledge, which was taken by the data, interviews and literature became the source for the production of the rules of the system. The categorization of patients, which is based on the sorting system, ESI is to output classes. The number of output classes, is 5 times the number of medical specialties. The effectiveness of the system, evaluated by internationally-used metrics.

La mesure traditionnelle de la criminalité (taux pour 100 000 habitants) pose problème dans l'analyse des variations de la criminalité dans le temps ou l'espace. Le problème est dû au fait que le taux de criminalité est essentiellement déterminé par des infractions moins graves et très fréquentes. La présente étude a permis de tester l’utilité du nouvel outil développé par Statistique Canada qui procure un index de « gravité de la criminalité » dans lequel chaque crime est pondéré par son score de gravité (basé sur les décisions sentencielles moyennes au Canada de 2002 à 2007 pour chaque forme de crime). Appliquées aux statistiques officielles du Québec de 1977 à 2008, nos analyses montrent que l’indice de gravité s’avère une mesure utile pour dresser un portrait plus juste des tendances des crimes violents d’une année à l’autre. Plus exactement, l’indice de gravité montre que le taux de crimes violents est demeuré stable de 1977 à 1992 contrairement à l'image fournie par le taux traditionnel qui montre plutôt une montée fulgurante durant cette période. L’indice de gravité peut également être utile à l’égard des crimes violents pour comparer plus adéquatement les territoires entre eux afin d’établir ceux qui présentent une criminalité plus grave. Cependant, à l’égard de la criminalité globale et des crimes sans violence, l’indice de gravité n’est d’aucune utilité et présente la même lecture de la criminalité que la mesure traditionnelle. Cela s’explique par le fait que ce sont toujours les mêmes infractions (les vols, les méfaits et les introductions par effraction) qui contribuent majoritairement à chacune des deux mesures de la criminalité. / The traditional measure of the criminality (rate for 100 000 inhabitants) raises problem in the analysis of the variations of the criminality in time or space. The problem is due to the fact that the rate of criminality is essentially determined by less serious and very frequent crimes. The present study allowed testing the utility of a new tool developed by Statistics Canada which gets an index of "severity of criminality" in which every crime is weighted by its score of severity (based on the sentencielles decisions average in Canada from 2002 till 2007 for every kind of crime. Applied to the official statistics of Quebec from 1977 till 2008, our analyses show that the indication of gravity turns out to be a useful measure to draw up a more realistic portrait of the trends of violent crimes from one year to the next. More precisely, the crime seriousness index shows that the rate of violent crimes remained stable from 1977 till 1992, on contradiction to what is shown by traditional rate which rather demonstrates a huge rise during this period. Crime seriousness index can also be used towards violent crimes, in order to compare more adequately territories, to establish those who show more serious crimes. However, among global criminality and crimes without violence, the indication of gravity is of no utility and presents the same reading of the criminality as traditional measures. It explains that it is always the same crimes (thefts, mischief and breaking and entering) that contribute mainly to each of both measures of the criminality.

Background: Chronic plaque-type psoriasis is a major dermatosis, but a significant question is still unanswered: What defines severity in chronic plaque-type psoriasis? While objective assessments like the Psoriasis Area and Severity Index (PASI) have frequently been used in clinical trials, quality of life (QOL) questionnaires are currently becoming more and more popular. Objective: This article summarizes the most important objective and subjective measurements of severity in psoriasis. For every dermatologist it is critically important to distinguish between severe psoriasis and psoriasis that severely affects QOL. Even if the PASI also has disadvantages, it is the most adequate instrument available to evaluate severity in plaque-type psoriasis. Result: We provide reasons why PASI >12 defines severe, PASI 7–12 moderate and PASI <7 mild chronic plaque-type psoriasis. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.