Det nøtte itj å vårrå flink ålein : innføring av telemedisinsk samhandling i norske kommuner

Innledning Innføring av telemedisinske tjenester har vist seg å være komplekse, fordi det i en telemedisinsk innovasjon utvikles nye tjenester, prosesser og organisasjonsformer. Det er forsket mye på slike innføringer på sykehus, men vi vet lite om hvordan dette foregår i norske kommuner. Derfor har vår problemstilling vært: Hvordan foregår innføring av telemedisinske tjenester i norske kommuner? Materiale og metode For å besvare problemstillingen har vi brukte en kvalitativ metode med fire fokusgruppeintervju med 24 informanter fra 21 kommuner i tre helseregioner. Vi har brukt implementeringsmodellene Normalization Process Theory og FITT- Framework for å belyse våre funn. Resultater Helsemyndighetenes føringer og finansiering har hatt innflytelse på utviklingen. Alle hadde en grundig sosiologisk forankringsprosess. Prosessene har bestått av ildsjeler, pådrivere, bred involvering, kartlegging, markedsføring og systematisk tjenesteutvikling. Videre fant vi at det er utfordringer i samarbeid med HF. Deres rolle som samhandlingsaktør er betydningsfull og deres manglende deltakelse gir stagnert tjenesteutvikling. De tekniske utfordringer har vært mange. Kommuner har for lite båndbredde, og behovet for tilpasning av nettverk, teknologi, opplæring i bruk av videokonferanse og tjenesteutførelser er stort. Konklusjon Klare anbefalinger har kommet fram i løpet av studien. Disse omfatter bl.a. at man må støtte opp om lokale ildsjeler og pådrivere, sørge for bred involvering på alle nivå, gjøre en nøye behovskartlegging både av samhandlingsbehov og tekniske behov og sørge for en interkommunal teknisk tilrettelegging i samarbeid med Helsenettet. Nøkkelord: Telemedisin, innføringsprosesser, kommuner, samhandlin

Dette nummers samlede anmeldelser

I dette nummer er følgende blevet anmeldt: "Krop og æstetik. Tekster om krop og køn i moderniteten" (Rune Gade og Marianne Raakilde Jespersen (red.)), "Med kjønnsperspektiv på norsk historie. Fra vikingetiden til 2000-årsskiftet" (Ida Blom og Sølvi Sogner (red.)), "Højskolekvinden - mor, søster og datter. Højskolekvindens kulturelle status og livsvilkår 1870-1902" (Inger Hartby)

Perfluoroalkyl Acid Concentrations in Blood Samples Subjected to Transportation and Processing Delay

In studies of perfluoroalkyl acids, the validity and comparability of measured concentrations may be affected by differences in the handling of biospecimens. We aimed to investigate whether measured plasma levels of perfluoroalkyl acids differed between blood samples subjected to delay and transportation prior to processing and samples with immediate processing and freezing.Pregnant women recruited at Aarhus University Hospital, Denmark, (n = 88) provided paired blood samples. For each pair of samples, one was immediately processed and plasma was frozen, and the other was delayed and transported as whole blood before processing and freezing of plasma (similar to the Danish National Birth Cohort). We measured 12 perfluoroalkyl acids and present results for compounds with more than 50% of samples above the lower limit of quantification.For samples taken in the winter, relative differences between the paired samples ranged between -77 and +38% for individual perfluoroalkyl acids. In most cases concentrations were lower in the delayed and transported samples, e.g. the relative difference was -29% (95% confidence interval -30; -27) for perfluorooctane sulfonate. For perfluorooctanoate there was no difference between the two setups [corresponding estimate 1% (0, 3)]. Differences were negligible in the summer for all compounds.Transport of blood samples and processing delay, similar to conditions applied in some large, population-based studies, may affect measured perfluoroalkyl acid concentrations, mainly when outdoor temperatures are low. Attention to processing conditions is needed in studies of perfluoroalkyl acid exposure in humans

Bland Altman plot for perfluorooctane sulfonate after transformation by the natural logarithm, stratified by season.

<p>The first plot represents samples from the winter, while the second plot represents samples from the summer. The average lnPFOS is the average of the natural log-transformed concentrations of perfluorooctane sulfonate (PFOS) in the transported and delayed samples and the immediately processed samples. The difference is the difference between the two natural log-transformed concentrations.</p

Perfluoroalkyl acids abbreviations, method detection limits, and limits of quantification.

<p>PFAA: Perfluoroalkyl acid</p><p>MDL: Method detection limit</p><p>LOQ: Limit of quantification.</p><p>n (%) below the LOQ applies to the immediately processed samples.</p><p>Perfluoroalkyl acids abbreviations, method detection limits, and limits of quantification.</p

Illustration of the three designs applied to paired blood samples from pregnant women.

<p>Each woman donated two (n = 67) or three (n = 21) blood samples. For all women (n = 88), blood sample 1 and 2 were treated as displayed in the Fig. For the 21 women that provided a third blood sample this sample was treated as displayed for blood sample 3.</p

Relative differences between PFAA concentrations in 88 paired blood samples that were immediately processed or transported with a processing delay, stratified by the season of sampling.

<p>PFAA: Perfluoroalkyl acid</p><p>IQR: interquartile range</p><p>95% confidence interval (95% CI).</p><p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0137768#pone.0137768.t001" target="_blank">Table 1</a> for specific PFAA abbreviations. Medians are not log-transformed.</p><p>Median₁ refers to immediately processed samples. Median₂ corresponds to samples that were delayed and transported and processing. 36 samples were sampled in the winter, and 52 in the summer.</p><p>Relative differences between PFAA concentrations in 88 paired blood samples that were immediately processed or transported with a processing delay, stratified by the season of sampling.</p