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Treatment of enterococcal endocarditis requires up to 6 weeks of intravenous (IV) antimicrobial therapy. When susceptible, an ampicillin-based regimen is preferred. Studies evaluating ampicillin stability utilizing high-pressure liquid chromatography have indicated enhanced stability (greater than 24 hours at room temperature), supporting outpatient administration. Thus, we report the successful treatment of a 30-year-old male with tricuspid valve enterococcal endocarditis in an outpatient setting using continuous infusion ampicillin via an ambulatory infusion pump. The patient received daily gentamicin at an outpatient infusion center with the ampicillin dose to be infused over the next 24 hours. Outpatient ambulatory infusion pumps allow for delivery of ampicillin via continuous infusion or pump-programmed pulse dosing. Preparation and administration in an outpatient infusion center may be a viable option to circumvent stability and delivery issues. Furthermore, 81% (34/42) of treatment days were completed outpatient, supporting that this approach may increase access to treatment and help reduce the economic burden to health care.

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Bakgrund: Psykisk ohälsa ökar i Sverige. Rapporter visar att patienter med psykisk ohälsa utsätts för stigmatiserande attityder och bristande vård. Att belysa omvårdnadspersonals erfarenheter kan leda till en djupare förståelse för vården av patienter med psykisk ohälsa. Syfte: Att belysa omvårdnadspersonals erfarenheter av att vårda patienter med psykisk ohälsa inom öppenvården i Sverige. Metod: Litteraturstudien baserades på åtta kvalitativa artiklar. Sökningar genomfördes i databaserna CINAHL och Pubmed. Analysen baserades på Graneheim och Lundmans (2004) artikel. Resultat: Analysen resulterade i tre huvudteman: "behovet av mer resurser”, “vikten av kompetens” och "en krävande professionell roll". Konklusion: Vården av patienter med psykisk ohälsa är komplex och det finns ett behov av mer resurser i form av tid, utbildning och interprofessionellt samarbete för att göra omvårdnadspersonal mer trygga och mötet mer givande. I dagsläget orsakar dessa möten omvårdnadspersonal stress och känslor av otillräcklighet. / Background: The frequency of mental illness is increasing in Sweden. Reports show that patients with mental illness are exposed to stigmatizing attitudes and lack of care in healthcare. Highlighting the experiences of nursing staff can lead to a deeper understanding of the care of patients with mental illness. Aim: To illuminate nursing staff’s experiences of caring for patients with mental illness in outpatient care in Sweden. Methods: Qualitative literature study based on eight articles. Searches were conducted in Cinahl and Pubmed. The analysis was conducted based on a model by Graneheim and Lundman (2004).   Results: The analysis resulted in three themes; “the need for more resources”, “the importance of competence” and “a demanding professional role”. Conclusion: Caring for patients with mental illness is a complex matter and there is a need for additional resources in the shape of time, education and interprofessional collaboration. This in order to make nursing staff more comfortable and the meetings more rewarding. At present these meetings cause stress and feelings of inadequacy in nursing staff.

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Der ambulante Versorgungssektor hat in den letzten Jahren einen strukturellen Wandel der Angebotsformen hin zu Kooperationsmodellen erfahren. Ein Beispiel dafür sind Medizinischen Versorgungszentren (MVZ). MVZ sind auf städtische Gebiete konzentriert. Welche Kriterien für die Ansiedlung von MVZ entscheidend sind und inwiefern sie die ambulante Versorgungsstruktur beein-flussen, ist bisher nicht umfassend wissenschaftlich untersucht worden. Im Rahmen der Studie wurden Standortfaktoren von MVZ, deren raum-zeitliche Ausbreitung und ihr Einfluss auf die Sicherstellung der ambulanten Versorgung untersucht. Als Untersuchungsgebiet dient Mecklenburg-Vorpommern. Es wurde ein mehrstufiger Analyseansatz umgesetzt, der aus qualitativen und quantitativen Methoden besteht: einer systematischen Literaturrecherche, einer Bestandsanalyse inklusive einer Erreichbarkeitsmodellierung, einer GIS-gestützten Analyse der Standortfaktoren, einer Analyse raum-zeitlicher Ausbreitungsmuster, einer Ärztebefragung sowie Experteninterviews. Die Ergebnisse der Studie zeigen, dass auch in Mecklenburg-Vorpommern eine verstärkte Ansiedlung von MVZ in Städten stattfindet, jedoch im Laufe der Zeit zunehmend dezentrale Regionen gewählt werden. Dabei wurde in raum-zeitlicher Hinsicht eine signifikante Zunahme an MVZ in der Nähe zu Mittelzentren nachgewiesen. Die Standortanalyse konnte belegen, dass bei der Ansiedlung von MVZ weiche personenbezogene und harte Standortfaktoren entscheidend sind. Die Auswertungen von Behandlungsfällen und Bedarfsplanungsanteilen konnte aufzeigen, dass der Einfluss von MVZ auf die Sicherstellung in mittel-/großstädtischen Regionen am geringsten ist, während er mit zunehmender Ländlichkeit steigt. Jedoch wurde anhand der Ärztebefragung eine reduzierte Arbeits-stundenzahl für MVZ-Ärzte nachgewiesen. Insgesamt konnte die Studie den Mehrwert eines mehrstufigen Analyseansatzes sowie die Notwendigkeit der weiterführenden Forschung und der Bedeutung von MVZ im Bundesland aufzeigen. / The outpatient care sector has experienced changes of the supply structure in recent years towards cooperation models. One example of this are Medical Care Centres (MVZ). MVZs are concentrated in urban areas. Which criteria are crucial for the settlement of MVZs and how this form of operation influences the structure of outpatient care has not yet been scientifically investigated. The study therefore aimed to identify location factors, to analyse their spatio-temporal spread and to examine their influence on the assurance of outpatient care. The analyses were performed using the example of Mecklenburg-Western Pomerania. A multi-level analysis approach was implemented, consisting of various qualitative and quantitative methods: a systematic literature research, an analysis of the existing situation including accessibility modelling, a GIS-based analysis of location factors, an analysis of spatio-temporal dispersion patterns, a survey of doctors as well as expert interviews. The results of the study show that in the study area, MVZs are more frequently located in towns and cities, but that decentralised regions are increasingly being chosen over time. In this context, a significant increase in MVZ locations in the vicinity of medium-sized centres was demonstrated in spatial-temporal respect. The location analysis was able to show that soft person-related and hard location factors play a significant role in the settlement of MVZs. The evaluations of treatment cases and demand planning proportions were able to demonstrate that the influence of MVZs on ensuring outpatient care is lowest in medium-sized/large urban regions, while there is an increasing influence with greater rurality. However, a reduced number of working hours for MVZ physicians was demonstrated based on the physician survey. Overall, the study was able to show the added value of a multi-level analysis approach as well as the need for further research and the relevance of MVZs in the federal state.

When adults with neurological conditions can access occupational therapy (OT) services, they have better outcomes. Unfortunately, many people who are living in the community with these conditions do not participate in OT services. This can compound deficits, lead to re-hospitalization, and negatively impact independence and quality of life. The issues with access for this population, specifically adults aged 18-65, can largely be attributed to lack of awareness of the role and scope of OT, lack of availability of specialized services, and issues with affordability. Evolve Occupational Therapy (Evolve OT) is a program designed specifically for this group, adults with neurological conditions aged 18-65 who have difficulty accessing OT services. This innovative approach to service delivery provides an alternative access pathway, treatment, and payment models that are intentionally designed to increase participation in and utilization of OT services. With this program, it is expected that patients will report increased satisfaction with participation, increased quality of life, and outcomes will hopefully effect change amongst policymakers.

Abstrakt Bakgrund. Aggressivt beteende är vanligt inom hälso- och sjukvården, med konsekvenser som försämrad arbetstillfredsställelse och burnout. Syftet med studien är att undersöka samband mellan egenskattad utsatthet för aggressivt samt våldsamt beteende och arbetstillfredsställelse, burnout samt sjukskrivning inom den psykiatriska öppenvården. Design. Tvärsnittsstudie med kvantitativ ansats. Metod. Analys av data, insamlat hösten 2014, från totalt 129 respondenter har utförts i SPSS. Resultatet visar att 20,6 % av respondenterna ofta är utsatt för aggressivt beteende samt att 7,3 % ofta är utsatt för våldsamt beteende. Inget samband sågs mellan att vara utsatt och dess inverkan på arbetstillfredsställelse samt burnout. Däremot ses en signifikant skillnad vad gäller utsatthet mellan de undersökta orterna. Slutsats. Den undersökta gruppen är sällan utsatt för våldsamt beteende, men däremot hög förekomst av aggressivt beteende. Trots utsattheten skattades arbetstillfredsställelsen högt. Nyckelord: Aggressivt beteende, våldsamt beteende, arbetstillfredsställelse, burnout, psykiatrisk öppenvård. / Abstract Background. Aggressive behavior is common in health care, with consequences such as impaired job satisfaction and burnout. The aim of the study is to investigate the relationship between self-rated exposure to aggressive and violent behavior, and job satisfaction, burnout and sick-leave in psychiatric outpatient care. Design. Cross-sectional study with a quantitative approach. Method. Analysis of data collected in autumn 2014 from a total of 129 respondents was performed in SPSS. The result shows that 20.6% of respondents are often exposed to aggressive behavior and 7.3% are often exposed to violent behavior. No association between being exposed and its impact on job satisfaction and burnout. In contrast the results show significance difference in terms of exposure between studied cities. Conclusion The examined groups are rarely exposed to violent behavior, however, there is a high incidence of aggressive behavior. The job satisfaction were estimated high despite the exposure. Keywords:Aggressive behavior, violent behavior, job satisfaction, burnout, psychiatric outpatient.