PURPOSE: Retinal and choroidal ischemic retinopathies such as retinal-vein occlusion (RVO), diabetic retinopathy (DR), and age-related macular degeneration (AMD) are ocular diseases caused by abnormal changes in the microvasculature. The ischemia can lead to macular edema or neovascularization, which can affect vision. Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) can help to reduce macular edema and improve visual acuity. Lost to follow-up (LTFU) after anti-VEGF injections increases the risk of vision loss in patients with RVO, DR, and AMD. METHODS: Patients scheduled for an IVI of anti-VEGF between September 2009 and September 2019 with either RVO, DR, or AMD were included in the analysis. LTFU was defined as missing an appointment without another evaluation for at least one interval exceeding 180 days. All patients were seen by a single provider at an urban, hospital-based, single-site retina practice in Boston, MA. RESULTS: Among the 698 patients (mean [SD] age, 70.23 [14.2] years; 373 [53.4%] female) identified as receiving an IVI, 121 (17.3%) were LTFU. Age was not found to be statistically different between the LTFU and not LTFU groups (mean difference, -1.67; 95% CI, -4.66¬–1.32; P=.27). Odds of LTFU was lower among patients with AMD (odds ratio [OR], 0.57; 95% CI, 0.36-0.92; P=.02). Odds of LTFU was greater among patients with Medicaid insurance (OR, 2.31; 95% CI, 1.22-4.33; P=.01), compared with patients with Medicare insurance. A trend towards higher risk of LTFU was seen in patients with DR (OR, 1.42; 95% CI, 0.94-2.15; P=.09) and a toward lower risk in patients with two or more eye diseases (OR, 0.53; 95% CI, 0.24-1.15; P=.10). Medicaid insurance was the only significant (P=.02) independent risk factor of LTFU in the multivariate regression. CONCLUSION: We found a high rate of LTFU after anti-VEGF injections among patients with RVO, DR, AMD, and identified risk and protective factors associated with LTFU among this population. Although our results may not be generalizable, data on LTFU in a clinical practice setting are needed to understand the scope of the problem so that interventions may be designed to improve outcomes.

No description available.

A studies carries for the last twenty years accumulated data that show two different etiology of head and neck squamous cell carcinoma. Tumors located in the oral cavity are often independent of the viral infection and is associated with tobacco and alcohol use. Approximately 26 % of all HNC and more than 50 % of tonsillar cancers are associated with the presence of high risk human papillomavirus (HR HPV). The purpose of this study was to determine whether changes in HPV DNA prevalence in oral rinses and/ or HPV - specific antibody levels in sera of patients with head and neck carcinoma (HNC) have prognostic significance. Patients with HNC were enrolled (N=142). The presence of HPV DNA was assayed in tumor tissue and oral rinses, and HPV-specific antibodies were assessed in sera. Sera were drawn one month and one year after the end of treatment. One year after treatment, oral rinses were collected. Altogether, 59.2 % tumors were HPV positive. Initially, the presence of HPV DNA in the tumors strongly correlated with HPV DNA positivity in oral rinses as well as with the presence of HPV- specific antibodies in sera. Out of 66 patients with HPV positive oral rinses at enrollment, 84.8 % became negative at one-year follow up. The mean titres of HPV 16 E6 and E7 antibodies at follow- up were lower in...

[pt] No percurso desta tese buscamos analisar a prática do acompanhamento terapêutico, visando investigar as especificidades que compõem este dispositivo clínico. Para tanto, nos empenhamos em refletir acerca da relação estabelecida entre acompanhante e sujeito acompanhado, tendo-se a cidade como cenário. O AT desponta como estratégia de intervenção eminentemente clínico-política, a qual reúne, em uma mesma abordagem, questões relacionadas tanto aos processos de subjetivação, quanto ao domínio mais amplo da cultura. A sua potência interventiva reside em compor novas modalidades relacionais pautadas por uma política da amizade, a partir das possibilidades abertas pelos espaços públicos. / [en] In the course of this thesis, we seek to analyze the practice of therapeutic follow-up care, aiming to investigate the specificities that compose this clinical device. For this purpose, we aspire to reflect on the relationship established between the carer and the person being cared, having the city as a scenario. The therapeutic follow-up care emerges as a highly clinical-political strategy of intervention, which gathers, in a single approach, questions related to subjectification processes and to a wider cultural domain. Its interventional potency lies in composing new relationship modalities guided by a friendship policy, originated by the possibilities opened by the public spaces.

Miljöbedömning med dess tillhörande dokument, miljökonsekvensbeskrivning (MKB), genomförs för att minska negativ miljöpåverkan från projekt och används som beslutsunderlag. Trafikverket som statlig myndighet gör MKB:er för många av sina projekt. Om utfallet blir så som det står i MKB:erna eller inte, vad det beror på, samt hur avvikelser påverkar miljön har undersökts i det här examensarbetet. Undersökningen har skett genom fallstudier av fyra olika Trafikverksprojekt. Dessa har varit vägprojekten Västra länken; bro över Umeälven, Östra länken; E4 syd – Östteg och Puckdalen; riskobjekt. Det fjärde fallet är ett järnvägsprojekt, Åmsele station; ny mötesdriftplats. För att kunna besvara frågeställningarna har intervjuer, dokumentgranskning, platsbesök och litteraturstudier genomförts. För varje fall har ett antal påverkanskategorier med betydelse för projektet valts ut för fördjupad granskning. Resultatet visar att avvikelser har förekommit mellan det som stått i MKB:erna och faktiskt resultat i alla fyra fallen, men inte i något fall har avvikelserna varit fler än överensstämmelserna. De flesta kontrollpunkter från MKB:erna har därmed stämt med faktiskt resultat, sammanlagt har 76 % stämt. I ett av fallen, Östra länken, har större andel avvikelser upptäckts än i övriga. Här blev resultatet 63 % överensstämmelse, i jämförelse med Västra länkens 77 %, Puckdalen 88 % och Åmsele stations 73 %. Avvikelserna som har upptäckts har gett både positiv, negativ och insignifikant miljöpåverkan, men majoriteten har varit negativ. Orsakerna till avvikelserna har varierat stort för de olika granskade kontrollpunkterna, men för vissa är otillräcklig uppföljning en möjlig orsak. Som resultat av detta arbete föreslås mer uppföljningsarbete med hjälp av Trafikverkets redan befintliga metoder, för att minska avvikelser mellan MKB och verklighet i framtiden. / Environmental impact assessment, with the document environmental impact statement (EIS), are produced to limit the negative environmental impact of projects, and as a base for decision-making. Trafikverket (Swedish Transport Administration) is a public authority that produce EIS for many of their projects. This study has examined if the statements made in the EIS are actually done in practise or not, why eventual deviations may occur and what effects these deviations gives to the environment. The method used have been case studies of four projects performed by Trafikverket. Those are three road projects, The Western link; bridge over Umeälven, The Eastern Link; E4 south – Östteg and Puckdalen; risk object. The fourth project is a railroad project named Åmsele station, new passing place and service site. To answer the research questions also interviews, document studies, field trips and literature studies have been performed. For each of the cases a number of important categories for the project have been selected for further investigations. The result show that in all cases there have been deviations. In summary of the four cases 76 % of the checkpoints have been congruent. In all cases the congruence has been greater than the deviations. In one case, The Eastern Link, more deviations than in the other projects have been noted. In this case the result showed 63 % congruence, compared to 77 % at The Western Link, 88 % at Puckdalen and 73 % at Åmsele station. The deviations found have both given positive, negative, or insignificant environmental impacts, but the majority have been negative. The causes of the deviations have varied between the different checkpoints examined. One reason that is possible for some of the deviations are lack in follow-up. As a result of this study more extensive follow-up in the future, with use of already existing tools in the organisation of Swedish Transport Administration, are suggested to reduce the deviations between EIS and reality.

Syftet med föreliggande studie är att fördjupa kunskapen om vilka svårigheter som kan uppstå vid problemlösning i matematikundervisningen och hur lärare förebygger och följer upp elevernas svårigheter. Vi har använt oss av en kvalitativ ansats och ett ramverk hämtat ur Mölleheds (2001) avhandling. Vi har genomfört observationer av elever och lärare och semistrukturerade intervjuer med lärarna. Resultatet visar vilka svårigheter elever har i problemlösningsuppgifter samt hur lärare förebygger och följer upp elevernas svårigheter. Elever visar svårigheter med att kombinera föremål, motivera sina lösningar, förstå matematiska begrepp, förstå texten, separera räknesätten, att ha fokus på rätt detaljer och att de gjorde slarvfel. Lärares förebyggande och uppföljande arbete inkluderade varierande introduktioner, förklaring av begrepp, kartläggande av elevers svårigheter, erbjuda individuellt stöd, och använda helklassdiskussionen som ett sätt att reda ut befintliga svårigheter som uppkommit, genom att lyfta olika strategier. Slutsatsen är att elevers svårigheter är att kombinera föremål, textförståelse, matematiska begrepp, att motivera sina lösningar, räkneförmåga och att behålla fokus på uppgiften. Lärare förebygger elevers svårigheter i problemlösning genom varierande introduktioner, genomgångar, att förklara begrepp och genom att kartlägga elevers svårigheter. Lärare följer upp elevers svårigheter genom att erbjuda individuellt stöd både i och utanför undervisningen i klassrummet och diskutera elevers svårigheter, möjliga lösningar och möjliga strategier i helklassdiskussioner. / The purpose of this study is to deepen the knowledge of the difficulties that can arise in problem solving in mathematics teaching and how teachers prevent and follow up students' difficulties. We have used a qualitative approach and a framework derived from Möllehed's (2001) thesis. We conducted observations of students and teachers and semi-structured interviews with the teachers. The result shows what difficulties students have in problem solving tasks as well as how teachers prevent and follow up students' difficulties. Pupils show difficulty combining objects, motivating their solutions, understanding mathematical concepts, understanding the text, separating the calculations, focusing on the right details and making mistakes. Teacher prevention and follow-up work included varied introductions, explanation of concepts, mapping of student difficulties, offering individual support, and using the whole-class discussion as a way to identify existing difficulties that arose, by highlighting different strategies. The conclusion is that pupils’ difficulties are to combine objects, textual understanding, mathematical concepts, to justify their solutions, calculating ability and to keep focus on the task. Teachers prevent pupils’ difficulties in problem solving through various different introductions, reviews, explaining concepts and by charting lifting difficulties. Teachers follow up pupils difficulties by offering individual support both inside and outside the classroom and discussing the pupils’ difficulties, possible solutions and possible strategies in whole class discussions.

The purpose of the master thesis is to find a way to plan activities, visualize them and follow-up on these activities. The Visual Planning method is used at Scania Production, R&D and at Scania Purchasing. However, the method doesn‟t fit the purchasers‟ communication and coordination needs. Furthermore, a majority of purchasing activities is disrupted due to unexpected events or deviations, which may cause delays.Hence, the thesis will result in a proposal of an effective planning and follow-up method that fits the need of the purchasing environment in general and more specifically in the purchasing group SGC. The proposing solution should handle deviations, be easy to use and visualize activities on an individual and aggregated department level.To find the best solution, an internal benchmarking and a review of best practice literature was carried out during the thesis. Observations at Scania Production, R&D and purchasing department were also carried out along with external interviews.Key findings included that handling deviances have a higher priority than commercial activities such as cost saving activities. Additionally, there is no standardize way of activity planning at SGC, cost has higher than quality and delivery and the Visual Planning method does not fit Scania‟s purchasing organization due to different needs of communication and coordination.Hence, the proposal included recommendations to introduce two milestones to the planned activities, collect all performance measurements in a balanced scorecard and an improved way of handling deviations. Furthermore, recommendations regarding the Visual Planning method included that the method should be used daily, where an agenda should structure the communication and the method should be adapted to fit the group‟s need of communication and coordination. / Syftet med examensarbetet var att finna ett sätt att planera aktiviteter, visualisera samt följa upp dem. Visuell planering används på Scanias produktionsanläggningar, forskning och utveckling samt på deras inköpsavdelning. Dock passar inte metoden inköparnas behov av kommunikation och koordination. Vidare blir inköparnas aktiviteter avbrutna av störningar som resulterar i förseningar.Detta examensarbete kommer därför att föreslå en effektiv planerings- och uppföljningsmetod som passar inköparnas behov, specifikt inköparna på gruppen SGC. Lösningen skall hantera störningar, vara enkel och använda samt visualisera aktiviteter på individuell och gruppnivå.För att finna bästa lösningen genomfördes en intern benchmarking och en litteraturstudie. Observationer på Scanias produktionsanläggningar, forskning och utveckling samt inköpsavdelning genomfördes tillsammans med intervjuer med externa respondenter.Från empirin framgick det att hantera störningar har högre prioritet än kommersiella aktiviteter så som kostnadsbesparingsaktiviteter. Vidare finns inget standardiserat sätt att planera aktiviteter hos SGC, kostnad har högre fokus än kvalitet och leverans samt att visuell planering inte passar inköpsorganisationens behov av kommunikation och koordination.Lösningsförslaget inkluderar förslag till att införa delmål till de planerade aktiviteterna, att alla mätetal samlas ihop till ett balanserat styrkort samt ett förbättrat sätt att hantera störningar. Vidare ges förslag att visuell planering skall fortsätta att användas dagligen, med en agenda som strukturerar kommunikationen för att passa gruppens behov för kommunikation och koordination.

Thesis (MPH.) -- University of Limpopo, 2021 / Background: The provision and success of Antiretroviral therapy (ART) depend on monitoring and evaluation of treatment programmes which should be assessed during regular patient follow-ups. The treatment of HIV infection can only be effective if patients are retained in care and programme monitoring is adequately undertaken to understand the effectiveness of the emerging treatment. The outcome of patients lost to follow-up (LTFU) has received relatively little attention and it is predicted that these patients may have stopped taking antiretroviral drugs, resulting in high morbidity and mortality. The provision of ART was introduced into South African public health facilities in 2003 and therefore, attention has shifted from the immediate need to get patients into care, to the long-term challenges of keeping patients in care and on treatment. The objective of the current study was to determine the trends at which HIV-positive patients become LTFU on the ART programme at Shiluvana Local Area’s six clinics in the Greater Tzaneen Sub-District, Limpopo Province, South Africa. Methods: A retrospective cohort study approach was used and data was collected from the database of patients who were LTFU from 2012 – 2017 in the electronic data management system of the District Health Information System. Data was collected from 1161 patients. Data analysis was done using SPSS version 25, in which categorical data was presented using frequencies and percentages and comparisons between groups was done using Chi-square test for categorical data, and Student’s t-test for continuous data. A p-value of <0.05 was considered statistically significant. Univariate regression analysis was done to determine the contributory factors to LTFU for a period of more than 3 months. Results: The mean age of the study population was 36.5 years old ranging from 16 years to 87 years old and the age distribution of people who were LTFU for ART showed a significant association (p = 0.001). The study participants’ distribution by gender revealed that majority were females at 71.4%. The study findings also revealed there was a statistically significance difference in health status of the study population and majority of the LTFU were in the younger age group. The CD4 count of LTFU patients showed a statistically significance difference and majority of the LTFU in patients with a CD4 count of less than 200 were in younger age group also. The TB/HIV co-infection in the study population showed a statistically significance difference and majority of LTFU in the study did not have TB/HIV co-infection. The WHO clinical HIV staging in the study population did not show a statistically significance difference. Marital status, TB/HIV co-infection and WHO clinical staging were found to be a strong predictor of LTFU of more than 3 months. Conclusion: The study findings bring with them a number of recommendations such as there is a need to have a standardised tracking method of patients who migrate to other health facilities for their ART treatment. This will provide more accurate information regarding LTFU levels and reduce the misclassification of patients. The age group which is affected by LTFU in all variables was in the 20 – 34 years’ age group. This is of great concern, as this is the age group who are economically active and should contribute to the future economy of the country. It is therefore recommended that a greater focus should be placed in this age group, with policies and programmes that bring them into ART and retain them there. Lastly, educational campaigns, in a form of pamphlets and posters to emphasize adherence to ART and the importance of remaining on ART within designated health facilities. In conclusion, patients should be retained in care for as long as possible to prevent the prevalence of the ARV resistant virus that can impact negatively on the ART programme. Keywords: Antiretroviral treatment. Human immunodeficiency virus, Loss to follow-up, socio-demographic.

Bakgrund: Palliativ vård omfattar inte bara vård av patienten utan innefattar även stöd till närstående, både under vårdtiden och efter dödens faktiska inträffande. Ett efterlevandesamtal är en möjlighet för distriktssköterskan att följa upp hur de närstående mår en tid efter dödsfallet och hur de upplevde vården under sjukdomstiden. Syfte: Att beskriva distriktssköterskors och sjuksköterskors erfarenheter av efterlevandesamtal inom kommunal hemsjukvård. Metod: Studien hade en kvalitativ deskriptiv design med en induktiv ansats. Åtta individuella semi-strukturerade intervjuer genomfördes via videomöte. Insamlat material analyserades genom en kvalitativ innehållsanalys med fokus på det manifesta innehållet. Resultat: I resultatet framkom att efterlevandesamtal erbjöds efter alla dödsfall. Arbetsuppgiften beskrevs vara värdefull och mångsidig samt något som distriktssköterskan fått lära sig på egen hand. Efterlevandesamtalet hade en avslutande funktion från både distriktssköterskans och de närståendes perspektiv. Efterlevandesamtalets syfte ansågs vara att identifiera de närstående som var i behov av stöd samt ta emot synpunkter ifrån de närstående och reda ut eventuella frågor. Synpunkterna ansågs viktiga att ta vara på för att kunna kvalitetsutveckla vården. Slutsats: Betydelsen av efterlevandesamtalet var utifrån distriktssköterskornas perspektiv viktig för både distriktssköterskorna och de närstående. Distriktssköterskornas inställning till att genomföra efterlevandesamtal varierade. Framförallt ansågs det vara en värdefull arbetsuppgift men beskrevs även kunna vara svår och krävande. Vår studie skulle kunna hjälpa distriktssköterskor som känner en oro inför efterlevandesamtalet att se på det ur ett annat perspektiv. / Background: Palliative care includes not only the care of the patient, but also support for family members, both during the period of care and after the actual occurrence of death. A bereavement follow-up is an opportunity for the community health nurse to follow up on how the family members feel some time after the death and how they experienced the care during the illness. Aim: To describe the community health nurses experiences of bereavement follow-up in home care services. Method: The study had a qualitative descriptive design with an inductive approach. Eight individual semi-structured interviews were conducted via video meeting. The collected material was analyzed through a qualitative content analysis with a focus on the manifested content. Findings: The results revealed that bereavement follow-up are offered after all deaths. The task was perceived to be valuable and versatile, as well as something that the community health nurse had to learn on their own. The bereavement follow-up had an ending function from both the community health nurses and the family members perspective. The purpose of the bereavement follow-up was to identify the family members in need of support and to receive comments from the family members and sort out any issues. The comments were considered important to take advantage of to improve the quality of the care. Conclusion: From the perspective of the community health nurses the bereavement follow-up was important for both community health nurses and family members. Among the community health nurses the attitude to have bereavement follow-up varied. Above all, it was considered a valuable task but could also be difficult and demanding. Our study could be helpful to those who are anxious about the bereavement follow-up, to look at it from a different perspective.

Medellivslängden i den svenska befolkningen har successivt ökat och kroniska sjukdomar har blivit fler bland de äldre. Potentiella medicinska behandlingar har också blivit fler och det är inte ovanligt att den äldre patienten behandlas med många olika läkemedel samtidigt, så kallat polyfarmaci. Polyfarmaci innebär en ökad risk för läkemedelsbiverkningar och läkemedelsinteraktioner. Uppföljning av läkemedelsbehandlingar är därför en viktig uppgift för sjuksköterskan. Syftet med litteraturstudien var att beskriva sjuksköterskans erfarenheter av läkemedelsuppföljning hos äldre patienter inom kommunal hälso- och sjukvård. I litteraturstudien ingår tio vetenskapliga artiklar varav sex med kvalitativ metod, tre med kvantitativ metod och en mixad metod. Resultatet visar sjuksköterskans erfarenheter av läkemedelsuppföljning i två huvudkategorier: risker och samverkan. Under dessa återfinns sju kategorier, tre kategorier var särskilt återkommande i inkluderade artiklar: osäkerhet i ansvarsfördelning kring läkemedelsuppföljning, brist på kunskap och ansvar för att sammanställa läkemedelsinformation. Den sistnämnda kategorin framträdde som ett markant problem för sjuksköterskan varför vi föreslår forskning på ett gemensamt journalsystem för region och kommun beträffande patientens läkemedelslista. Förhoppningsvis kan en sådan studie leda till resultat som i framtiden kan användas till ett förbättrat journalsystem och ökad patientsäkerhet. / Life expectancy in the Swedish population has gradually increased and chronic diseases have increased among the elderly. Potential medical treatments have also increased and it is not uncommon for the elderly patient to be treated with many different drugs at the same time, denoted polypharmacy. Polypharmacy involves an increased risk of drug side effects and drug interactions. Follow-up of drug treatments is therefore an important task for the nurse. The purpose of the literature study was to describe the nurse's experiences of drug follow-up in elderly patients in municipal health care. The literature study includes ten articles, of which six with a qualitative method, three with a quantitative method and one mixed method. The results show the nurse's experiences of drug follow-up in two main categories: risks and collaboration. Under these are seven categories, three categories were particularly recurring in included articles: uncertainty in the division of responsibilities regarding drug follow-up, lack of knowledge and responsibility for compiling drug information. The latter category emerged as a significant problem for the nurse, which is why we propose research on a common record system for region and municipality regarding the patient's drug list. Hopefully, such a study can lead to results that in the future can be used for an improved medical record system and increased patient safety.