DOCSLIB.ORG

Are Frail Elderly Patients Treated in a CGA Unit More Satisfied with Their Hospital Care Than Those Treated in Conventional Acute Medical Care?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Are Frail Elderly Patients Treated in a CGA Unit More Satisfied with Their Hospital Care Than Those Treated in Conventional Acute Medical Care? Journal name: Patient Preference and Adherence Article Designation: Original Research Year: 2018 Volume: 12 Patient Preference and Adherence Dovepress Running head verso: Ekerstad et al Running head recto: Comparison of acute treatment in CGA units and in conventional wards open access to scientific and medical research DOI: http://dx.doi.org/10.2147/PPA.S154658 Open Access Full Text Article ORIGINAL RESEARCH Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care? Niklas Ekerstad1,2 Objectives: Our aim was to study whether the acute care of frail elderly patients directly Göran Östberg3 admitted to a comprehensive geriatric assessment (CGA) unit is superior to the care in a con- Maria Johansson3 ventional acute medical care unit in terms of patient satisfaction. Björn W Karlson3,4 Design: TREEE (Is the TReatment of frail Elderly patients Effective in an Elderly care unit?) is a clinical, prospective, controlled, one-center intervention trial comparing acute treatment in 1Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, CGA units and in conventional wards. Trollhättan-Uddevalla-Vänersborg, Setting: This study was conducted in the NÄL-Uddevalla county hospital in western Sweden. 2 Department of Medical and Health Participants: In this follow-up to the TREEE study, 229 frail patients, aged $75 years, in need Sciences, Division of Health Care Analysis, Linköping University, of acute in-hospital treatment, were eligible. Of these patients, 139 patients were included in 3 For personal use only. Linköping, Division of Internal and the analysis, 72 allocated to the CGA unit group and 67 to the conventional care group. Mean Acute Medicine, NU Hospital Group, age was 85 years and 65% were female. Trollhättan-Uddevalla-Vänersborg, 4Department of Molecular and Clinical Intervention: Direct admittance to an acute elderly care unit with structured, systematic Medicine, Institute of Medicine, interdisciplinary CGA-based care, compared to conventional acute medical care via the emer- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden gency room. Measurements: The primary outcome was the satisfaction reported by the patients shortly after discharge from hospital. A four-item confidential questionnaire was used. Responses were given on a 4-graded scale. Results: The response rate was 61%. In unadjusted analyses, significantly more patients in the intervention group responded positively to the following three questions about the hospitalization: “Did you get the nursing from the ward staff that you needed?” ( p=0.003), “Are you satisfied with the information you received on your diseases and medication?” ( p=0.016), and “Are Patient Preference and Adherence downloaded from https://www.dovepress.com/ by 54.70.40.11 on 31-Dec-2018 you satisfied with the planning before discharge from the hospital?” ( p=0.032). After adjusted analyses by multiple regression, a significant difference in favor of the intervention remained for the first question ( p=0.027). Conclusion: Acute care in a CGA unit with direct admission was associated with higher levels of patient satisfaction compared with conventional acute care via the emergency room. Keywords: frailty, elderly, comprehensive geriatric assessment, acute care, patient satisfaction, direct admission Correspondence: Niklas Ekerstad Introduction Department of Cardiology, Background NU (NAL-Uddevalla) Hospital Frailty is a biological syndrome reflecting vulnerability to stressors and reduced Group, Lärketorpsvägen, 46100 Trollhättan, Sweden physiological reserves.1 It is associated with functional decline, activity limitations, Tel +46 736 249 652 prolonged recovery, and a high risk of being institutionalized and dying.2–5 Among older Fax +46 104 357 129 Email [email protected] persons, the prevalence of frailty is estimated to be 10%–60%, depending on the frailty submit your manuscript | www.dovepress.com Patient Preference and Adherence 2018:12 233–240 233 Dovepress © 2018 Ekerstad et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you http://dx.doi.org/10.2147/PPA.S154658 hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Powered by TCPDF (www.tcpdf.org) 1 / 1 Ekerstad et al Dovepress assessment instrument used and the population studied.6,7 admitted to a CGA unit is superior to conventional acute Most of these patients have multiple chronic diseases and medical care in terms of patient satisfaction. We hypothesized recurring episodes of acute illness. that a higher proportion of patients cared for in a CGA unit Frail elderly individuals constitute a high percentage of would report satisfaction compared with patients treated in emergency patients in every hospital. The current organiza- a conventional care unit. tion of acute care is often poorly adapted to the specific needs of these patients. To meet these needs, in 2008, the NU (NÄL- Patients and methods Uddevalla) hospital group in the Västra Götaland Region of Study design and setting Sweden introduced two acute elderly care comprehensive This study on patient satisfaction used data from the TREEE 8 geriatric assessment (CGA) units (MÄVAs). The basic aims study, a clinical, prospective, controlled intervention trial were to optimize the clinical treatment and thereby utilize with two parallel groups performed at the NU hospital group health care resources in the best way. This form of care is between March 2013 and July 2015. Details of TREEE have characterized by direct admission and a structured, systematic been described earlier.14 The total primary population of the multi- and interdisciplinary CGA and care performed in the NU health care system is 280,000 inhabitants. The TREEE ward, including an early rehabilitation strategy involving study was approved by the Independent Ethics Committee at physicians, occupational therapists, physiotherapists, and the Sahlgrenska University Hospital in Gothenburg (8883-12, nurses as active team members. 20121212) and registered at the Swedish National Database Previous clinical studies have indicated that frail elderly of Research and Development (identifier: 113021). Written 9–14 patients could benefit from a CGA. informed consent was obtained from the patients or from Patient satisfaction is an important patient-reported a member of their next of kin. All data were computerized experience measure, and it can also be seen as an outcome and handled in accordance with legislation and Good in itself and as an integrated part of the results of every type Clinical Practice. of health care organization. It has been described as crucial For personal use only. 15,16 for the evaluation of health care quality. In accordance Selection of participants with the consumer model, satisfaction can be regarded as a TREEE included patients aged $75 years, in need of in- difference between expectations and assessed performance.17 hospital treatment, and who fulfilled the foundation of frailty On the other hand, it has been argued that it might be prob- in accordance with the recently validated FRESH (FRail lematic to treat elderly patients as consumers.18 Patient Elderly Support researcH group) screening instrument,22 satisfaction can also be defined as measuring the needs that is, two or more of the following criteria: tiredness from and wants,19 and it influences patient compliance as well as a short walk, general fatigue, frequent falls/anticipation of continuity of care.20,21 falls, dependence in shopping, and three or more visits to the emergency ward during the last 12 months. Patients were Importance excluded if they were clearly suited for care in a conven- Patient Preference and Adherence downloaded from https://www.dovepress.com/ by 54.70.40.11 on 31-Dec-2018 In acute care settings, there is, however, a lack of knowledge tional acute medical care unit due to the type or severity of regarding the effects of CGA on health-related quality of the acute illness. life (HRQoL) and even more so on patient satisfaction. When the ambulance nurse, or the primary care physician, In the TREEE study (Is the TReatment of frail Elderly had identified a patient who could fulfill the inclusion criteria, patients Effective in an Elderly care unit?), the results on a MÄVA doctor was contacted via telephone. If he/she HRQoL, activities of daily living (ADLs), mortality, and agreed, and there was a bed available at MÄVA, the patient re-hospitalizations were favorable for the CGA units as was allocated to the intervention group and admitted directly 14 described previously. to MÄVA. If bed was not available, the patient was allocated In severely frail elderly patients with poor prognosis to the control group and admitted to a conventional acute who need emergency care, the satisfaction with the received medical care unit through the emergency room. hospital care may be particularly important. In the TREEE study, 408 patients were included between March 2013 and July 2015. For practical and
Load more

Recommended publications
  • Uddevalla a Safe Community
    Uddevalla En säker och trygg kommun Uddevalla Ansökan om fortsatt status/utmärkelse inom Räddningsverkets nationella och A SafeWHO:s globala Community program för En säker och trygg kommun/Safe Communitie Framsida Application document 2007/2008 Table of Contents 1. Introduction 3 2. Uddevalla Municipality 3 3. A safe community 4 4. From Safe Uddevalla to A Safe Community – a short history 5 4.1 Project Safe Uddevalla 5 4.2 Uddevalla - A Safe Community 6 5. Indicator 1: An infrastructure based on the participation and collaboration of community residents, governed by a cross-sectional group responsible for promoting safety in the community 7 5.1 Infrastructure 7 5.2 Control documents 9 5.3 Economic Aspects 9 5.4 Collaboration 9 5.5 Residents’ participation 10 6. Indicator 2: Long-term, sustainable programmes involving both sexes and all ages, environments and situations 10 6.1 Information 11 6.2 Training 12 6.3 Measures 12 6.4 Follow-up 12 7. Indicator 3: Programmes targeting high-risk groups and environments, and programmes aimed at promoting the safety of vulnerable groups 13 7.1 Child safety 13 7.1.1. Infants and children of school age 13 7.1.2 A safe Association 14 7.2. Safety of the elderly 15 7.3 Crime, violence and drugs 15 7.4 Violence against women 17 7.5. Traffic safety 18 7.6 Promoting psychological health 18 8. Indicator 4: Programmes documenting the frequency and causes of injuries 19 9. Indicator 5: Evaluation to assess the processes of the programme and the effects of change 20 10.
    [Show full text]
  • First-Year Experience of Medical Emergency Care, a New Healthcare Chain for Acute Life-Threatening Medical Conditions at the ED
    Research Article Published: 13 Dec, 2018 Journal of Cardiology Forecast First-Year Experience of Medical Emergency Care, a New Healthcare Chain for Acute Life-Threatening Medical Conditions at the ED Bergh N2,3*, Hellberg J1,3, Rehnström K1, Karlsson T4, Ekerstad N5,6 and Karlson BW1,2 1Department of Acute and Internal Medicine, NU (NÄL-Uddevalla) Hospital Group, Trollhättan-Uddevalla- Vänersborg, Sweden 2Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3Department of Cardiology, Sahlgrenska University Hospital, Sahlgrenska, Gothenburg, Sweden 4Health Metrics Unit, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 5Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhättan-Uddevalla-Vänersborg, Sweden 6Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden Abstract Background: There is a high inflow of patients at most medical emergency departments (ED). In 2013 the Medical Emergency Care (MEC) healthcare chain was introduced at the NU-hospital group, Sweden, in order to better identify, alerting and treat the critically ill adult medical patients. Aim: The primary aim of this retrospective study was to characterize medical patients who were judged and handled as critically ill according to the concept of MEC during the first year following its introduction. OPEN ACCESS Methods: This is a single-center, consecutive cohort study of all patients initially taken care of at the ED using the concept of MEC at the NU Hospital group, Västra Götaland health care region, * Correspondence: Sweden, between February 26 2013 and February 28 2014. Niklas Bergh, Department of Molecular and Clinical Medicine, Department Results: A total of 856 patients were registered as MEC patients, representing 3.2% of all adult medical ED patients.
    [Show full text]
  • The Dark Unknown History
    Ds 2014:8 The Dark Unknown History White Paper on Abuses and Rights Violations Against Roma in the 20th Century Ds 2014:8 The Dark Unknown History White Paper on Abuses and Rights Violations Against Roma in the 20th Century 2 Swedish Government Official Reports (SOU) and Ministry Publications Series (Ds) can be purchased from Fritzes' customer service. Fritzes Offentliga Publikationer are responsible for distributing copies of Swedish Government Official Reports (SOU) and Ministry publications series (Ds) for referral purposes when commissioned to do so by the Government Offices' Office for Administrative Affairs. Address for orders: Fritzes customer service 106 47 Stockholm Fax orders to: +46 (0)8-598 191 91 Order by phone: +46 (0)8-598 191 90 Email: [email protected] Internet: www.fritzes.se Svara på remiss – hur och varför. [Respond to a proposal referred for consideration – how and why.] Prime Minister's Office (SB PM 2003:2, revised 02/05/2009) – A small booklet that makes it easier for those who have to respond to a proposal referred for consideration. The booklet is free and can be downloaded or ordered from http://www.regeringen.se/ (only available in Swedish) Cover: Blomquist Annonsbyrå AB. Printed by Elanders Sverige AB Stockholm 2015 ISBN 978-91-38-24266-7 ISSN 0284-6012 3 Preface In March 2014, the then Minister for Integration Erik Ullenhag presented a White Paper entitled ‘The Dark Unknown History’. It describes an important part of Swedish history that had previously been little known. The White Paper has been very well received. Both Roma people and the majority population have shown great interest in it, as have public bodies, central government agencies and local authorities.
    [Show full text]
  • Turning Point on Climate Change? Emergent Municipal Response in Sweden: Pilot Study
    Turning Point on Climate Change? Emergent Municipal Response in Sweden: Pilot Study Turning Point on Climate Change? Emergent Municipal Response in Sweden: Pilot Study Richard Langlais, Per Francke, Johan Nilsson & Fredrik Ernborg NORDREGIO 2007 Nordregio Working Paper 2007:3 ISSN 1403-2511 Nordregio P.O. Box 1658 SE-111 86 Stockholm, Sweden [email protected] www.nordregio.se www.norden.org Nordic co-operation takes place among the countries of Denmark, Finland, Iceland, Norway and Sweden, as well as the autonomous territories of the Faroe Islands, Greenland and Åland. The Nordic Council is a forum for co-operation between the Nordic parliaments and governments. The Council consists of 87 parliamentarians form the Nordic countries. The Nordic Council takes policy initiatives and monitors Nordic co-operation. Founded in 1952. The Nordic Council of Ministers is a forum of co-operation between the Nordic governments. The Nordic Council of Ministers implements Nordic co-operation. The prime ministers have the overall responsibility. Its activities are co-ordinated by the Nordic ministers for co-operation, the Nordic Committee for co-operation and portfolio ministers. Founded in 1971. Stockholm, Sweden 2007 Table of Contents Summary ............................................................................................................................... 7 Acknowledgements .............................................................................................................. 8 1. Introduction.....................................................................................................................
    [Show full text]
  • Landskapsanalys.Pdf
    Landskapsanalys Vindbruk - tematiskt tillägg till Översiktsplanen, Lysekils kommun Antagandehandling 2012-05-18 Dnr: LKS 10-4-375 Vindbruk - tematiskt tillägg till översiktsplanen. Beställare: Lysekil kommun Konsult: Vectura Planchef: Josefin Kaldo, Lysekils kommun Uppdragsledare: Lena Lundkvist, Vectura Landskapsarkitekter: Ann Henrikson och Sara Tärk, Vectura GIS och kartor: Anders Ala-Häivälä och Ola Rosenqvist, Vectura Foton tagna av Vectura. Framsida: Vindkraftverket Elvira i Lysekils kommun. 2 Landskapsanalys Innehåll Metod 5 Landskapskaraktärsanalys 5 Landskapets förutsättningar 5 Naturgeografiska strukturer 6 Kulturgeografiska strukturer 8 Sociala strukturer 10 Naturvärden och ekologiska samband 10 Landskapskaraktärer 13 1. Kust och skärgård 14 2. Kala höjdplatåer 15 3. Mosaiklandskap 16 4. Fjordlandskap 17 5. Delvis skogiga höjdplatåer 18 Slutsatser 19 Källor 20 3 Vindbruk - tematiskt tillägg till översiktsplanen. DINGLE MUNKEDALS KOMMUN BOVALLSTRAND MUNKEDAL ULEBERGSHAMN F ä r TORREBY l HUNNEBOSTRAND e v f j o r d e n BRODALEN BARKEDAL GÅRVIK SOTENÄS KOMMUN s ä s n ä e n t r n e ä So d VÄJERN r H BRASTAD o fj Fågelviken y b HOVENÄSET Å RIXÖ Brofjorden BÖRSÅS KUNGSHAMN s PREEMRAFF ä MALMÖN n rn e a g m n ll å u G St KOLVIK KRISTEVIK KOLLERÖD UDDEVALLA KOMMUN s nä LYSEKIL ke Bo KAVLANDA GÅRE LYSEKILS KOMMUN RÖRBÄCK FISKEBÄCKSKIL SÖDRA MUNKEBY - t HENÅN ftö e a nd Sk la GRUNDSUND Islandsberg ORUSTS KOMMUN Jonsborg ELLÖS 0 2 4 6 km © Lantmäteriet MS2009/09632 Karta 1. Översikt över Lysekils kommun 4 Landskapsanalys Metod Landskapskaraktärsanalys I denna landskapsanalys har metoden landskapskaraktärsanalys använts. Kommunens yta har analyserats med avseende på natur, kultur och upplevelse. Vid en analys av land- skapskaraktärer undersöks och beskrivs olika områdens platskänsla och skillnaderna mellan dessa.
    [Show full text]
  • Preserved Physical Fitness Is Associated with Lower 1-Year Mortality in Frail Elderly Patients with a Severe Comorbidity Burden
    Journal name: Clinical Interventions in Aging Article Designation: Original Research Year: 2019 Volume: 14 Clinical Interventions in Aging Dovepress Running head verso: Åhlund et al Running head recto: Åhlund et al open access to scientific and medical research DOI: 198591 Open Access Full Text Article ORIGINAL RESEARCH Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden This article was published in the following Dove Medical Press journal: Clinical Interventions in Aging Kristina Åhlund1,2 Introduction: Physical deterioration in connection with a care episode is common. The aim Niklas Ekerstad3,4 of this study was, in frail elderly patients with a severe comorbidity burden, to analyze 1) the Maria Bäck2,5 association between physical fitness measurements and 1-year mortality and 2) the association Björn W Karlson6,7 between preserved physical fitness during the first three months after discharge from emergency Birgitta Öberg2 hospital care and 1-year prognosis. Methods: Frail elderly patients ($75 years) in need of inpatient emergency medical care were 1Department of Physiotherapy, NU included. Aerobic capacity (six-minute walk test, 6MWT) and muscle strength (handgrip strength Hospital Group, Trollhättan, Sweden; 2Department of Medical and Health test, HS) were assessed during the hospital stay and at a three-month follow-up. The results Sciences, Division of Physiotherapy, were analyzed using multivariate Cox regression; 1) 0–12-month analysis and 2) 0–3-month Linköping University, Linköping, For personal use only. Sweden; 3Department of Research and change in physical fitness in relation to 1-year mortality. The analyses were adjusted for age, Development, NU Hospital Group, gender, comorbidity and frailty.
    [Show full text]
  • Maritime Businesses in the Gothenburg Region 2020
    Interview Study - Maritime businesses in the Gothenburg Region, Orust and Uddevalla The Gothenburg Region 29/05/2020 Contents 1. Introduction ....................................................................................................................................... 4 2. Background ........................................................................................................................................ 6 1.2. Purpose ........................................................................................................................................... 8 3. Implementation ................................................................................................................................ 9 3.1 Method ....................................................................................................................................... 9 3.2 Participating companies ........................................................................................................ 11 3.3 Division into sectors ............................................................................................................... 12 4. Results of the interview study ..................................................................................................... 16 4.1 The companies’ most important markets ........................................................................ 16 4.2 The development and supply of competence ............................................................... 17 4.3 Local collaboration...............................................................................................................
    [Show full text]
  • UDDEVALLA LYSEKIL VÄSTERGÖTLAND Uddevalla SKAFTÖ It’S No Coincidence That Lysekil Is Most Often Known As the Town by the Sea
    WEST SWEDEN SWEDEN NORWAY Oslo 3 Stockholm DAYS DALSLAND Copenhagen Family BOHUSLÄN island-hopping from Lysekil to UDDEVALLA LYSEKIL VÄSTERGÖTLAND Uddevalla SKAFTÖ It’s no coincidence that Lysekil is most often known as the town by the sea. GOTHENBURG Whether you are in Lysekil itself, or take the boat over the Gullmar Fjord to Skaftö, Fiskebäckskil and Grundsund, a distinctly maritime feel pervades the N air. In Lysekil and its surroundings you can enjoy salty swims, go crab fishing and explore narrow alleyways and winding streets a stone’s throw from the W E water. Take a boat trip on to Uddevalla and you’ll find more fun experiences and activities suitable for the whole family. S DAY 1 Monday: Havets Hus IT ONLY TAKES A COUPLE OF HOURS to get to Lysekil from Gothenburg on the 841, Västtrafik’s direct bus route. When you’re there you can choose whether to stay in Lysekil itself, or take the 15 minute boat ride over Gullmarsfjorden and stay in Fiskebäckskil, or somewhere else on the island of Skaftö. The ferry runs every day, all year round, from Lysekil’s South Harbour. There is a variety of accommodation in Lysekil, including Strandflickornas hotel, offering a charming 19th century setting with hotel and youth hostel standard accommodation. If you book its family package, Salt & Wild, family en- try to Havets Hus aquarium and Nordens Ark Zoo is included. Gullmarsstrand and Slipens Hotell in Fiskebäckskil offer comfortable accommodation close to the sea. Lysekil is often called ‘the town by the sea’. At the tip of the archipelago is the Stångehuvud nature reserve and the Pinneviksbadet bathing area, with smooth granite rocks.
    [Show full text]
  • A Roadmap for Improving Wikipedia 29/08 2017
    Embargo Tuesday 29th August at 00:05 [UK time] Press release 29/08 A roadmap for improving Wikipedia The evolution of Wikipedia’s medical content: past, present and future 2017 Shafee T, Masukume G, Kipersztok L, Das D, Häggström M, Heilman J. (2017) Journal of Epidemiology & Community Health 71(10) Wikipedia is a key source of public health information Wikipedia needs expert input Health professionals need Wikipedia’s reach Image: Blausen medical CC BY-SA, via WikiJournal of Medicine (full res version) doi:10.15347/wjm/2014.010. Given its prominence as a source of scientific and medical information, improving Wikipedia is a public health “Wikipedia has over 44 million necessity. How can the medical and scientific community articles across 295 languages work towards enhancing the quality and quantity of its and climbing, but contributor medical articles? An international group of doctors and numbers are pretty flat.” researchers have outlined their recommendations in the Journal of Epidemiology and Community Health. The encyclopedia’s content, community and collaborations have changed a lot over the last 16 years. Now is also the time to plan improvements for its future. The Wikimedia Foundation, the charity that supports Wikipedia, is currently updating their strategy through to 2030. It’s therefore an ideal “At 16 years old, Wikipedia is opportunity for those with an interest in disseminating a teenager, and going through biomedical information to become involved in some changes.” Wikipedia. The authors identify four main areas that can be used to improve the encyclopedia. doi.org/10.1136/jech-2016-208601 Embargo Tuesday 29th August at 00:05 [UK time] Individual Wikipedia is built entirely by volunteers.
    [Show full text]
  • Invitation to Acquire Shares in Fortinova Fastigheter Ab (Publ)
    INVITATION TO ACQUIRE SHARES IN FORTINOVA FASTIGHETER AB (PUBL) Distribution of this Prospectus and subscription of new shares are subject to restrictions in some jurisdictions, see “Important Information to Investors”. THE PROSPECTUS WAS APPROVED BY THE FINANCIAL SUPERVISORY Global Coordinator and Joint Bookrunner AUTHORITY ON 6 NOVEMBER 2020. The period of validity of the Prospectus expires on 6 November 2021. The obligation to provide supplements to the Prospectus in the event of new circumstances of significance, factual errors or material inaccuracies will not apply once the Prospectus is no longer valid. Retail Manager IMPORTANT INFORMATION TO INVESTORS This prospectus (the “Prospectus”) has been prepared in connection with the STABILIZATION offering to the public in Sweden of Class B shares in Fortinova Fastigheter In connection with the Offering, SEB may carry out transactions aimed at AB (publ) (a Swedish public limited company) (the “Offering”) and the listing supporting the market price of the shares at levels above those which might of the Class B shares for trading on Nasdaq First North Premier Growth Mar- otherwise prevail in the open market. Such stabilization transactions may ket. In the Prospectus, “Fortinova”, the “Company” or the “Group” refers to be effected on Nasdaq First North Premier Growth Market, in the over-the- Fortinova Fastigheter AB (publ), the group of which Fortinova Fastigheter counter market or otherwise, at any time during the period starting on the AB (publ) is the parent company, or a subsidiary of the Group, depending date of commencement of trading in the shares on Nasdaq First North Pre- on the context.
    [Show full text]
  • Polymyalgia Rheumatica Mimicking an Iliopsoas Abscess
    Central Annals of Orthopedics & Rheumatology Case Report *Corresponding author Lennart Dimberg, Department of Public Health and Community Medicine, the Sahlgrenska Academy, University of Gothenburg, Box 454, SE-405 30 Polymyalgia Rheumatica Gothenburg, Sweden, Email: [email protected] Submitted: 30 November 2020 Mimicking an Iliopsoas Abscess Accepted: 12 December 2020 Published: 15 December 2020 Lennart Dimberg1* and Fredrik Wennerberg2 Copyright 1Department of Public Health and Community Medicine, the Sahlgrenska Academy, © 2020 Dimberg L, et al. University of Gothenburg, Sweden OPEN ACCESS 2Radiology Resident Physician/MD, NU Hospital Group/NU-sjukvården, Sweden Keywords • Case report Abstract • Polymyalgia rheumatic Background: Polymyalgia Rheumatica (PMR) is a clinical condition characterized • Iliopsoas abscess by pain and stiffness of proximal muscles of shoulders and hips. We here present an unusual case initially believed to be an abscess of the iliopsoas muscle. Case presentation: An elderly man visited our clinic with symptoms of left hip pain and stiffness and an elevated erythrocyte sedimentation rate (ESR) at 96 mm/h, but no fever. An MRI of the left hip and proximal femur suggested an iliopsoas abscess, which was aspirated with clear yellow fluid and no bacteria. A few weeks later, additional pain and stiffness of the muscles of both shoulders made a diagnosis of PMR suspicious. A prompt response to high doses of Prednisolone confirmed the diagnosis. Conclusion: PMR may present with hip-pain due to a unilateral iliopsoas bursitis. BACKGROUND An iliopsoas abscess is a rare condition, often appearing with vague clinical features. In a review article by Lee et al, during 1988-1998 a major Taiwanese hospital registered about one case per year Lee et al, [1] The affected individual typically presents with fever, back-pain and limp.
    [Show full text]
  • Communicative Interfaces for Planning
    THESIS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY Communicative Interfaces for Planning Social learning in participatory local networks in a Swedish context LISA BOMBLE DRAFT DRAFT 1 Communicative Interfaces for Planning - Social learning in participatory local networks in a Swedish context LISA BOMBLE ISBN 978-91-7597-416-3 © LISA BOMBLE, 2016. Doktorsavhandlingar vid Chalmers tekniska högskola Ny serie nr 4097 ISSN 0346-718X Department of Architecture Chalmers University of Technology SE-412 96 Gothenburg Sweden Telephone + 46 (0)31-772 1000 Cover: [Participation takes place between and among all stakeholders. I visualize it as a plane on which communication takes place. See fg. 2 page 14] Chalmers Reproservice Gothenburg, Sweden 2016 DRAFT DRAFT 2 Communicative Interfaces for Planning - Social learning in participatory local networks in a Swedish context LISA BOMBLE Department of Architecture Chalmers University of Technology ABSTRACT Swedish municipalities connect participation strategies to objectives concerning sustainable development, as we all need to be part of the solution when it comes to climate change and resource scarcity. The manda- tory participatory meetings in municipal planning are criticized for being slow and ineffcient and alterna- tive, parallel methods of participation are called for. After having followed two municipalities’ efforts in trying their hand at such alternative methods, conclu- sions have been drawn about participation in municipal planning in general. The frst case study in the mu- nicipality of Uddevalla (2009-2011) dealt with specifc participatory methods in practice, while the second case study in the municipality of Lerum (2011-2014) focused on organizational changes. A vast empirical material has been collected in interviews, workshops and meetings, most of which have been audio-recorded.
    [Show full text]