Hur AI-verktyget ChatGPT klarar en hemtentamen i palliativ vård

Dataprogrammet ChatGPT är en bott som utför automatiska uppgifter. Denna chattbott skapade rubriker under hösten på grund av dess förmåga att med artificiell intelligens (AI) skapa svar på riktade frågor och texter utifrån ett beskrivet syfte. I slutet av december 2022 lades 16 frågor från en hemtentamen i palliativ vård vid sjuksköterskeprogrammet in i AI-botten för att få dem besvarade och testa bottens förmåga att besvara frågorna korrekt. Vi ville även testa om man kunde se någon skillnad på svaren i rättningsmallen och på studenternas svar och på de svar som genererats från AI-botten. En bedömning av bottens svar visade på att den hade klarat examinationen. Somliga svar var mycket bra och resonerande till sin natur, något gav reducerade poäng pga. bristande innehåll och ett par svar felaktiga. Ett svar stack ut då det var på engelska. Svaren hade ibland smärre grammatiska fel, men var främst betydligt längre och bättre strukturerade än studerandes. Möjligheten att upptäcka försök till vilseledande i examination hade varit liten. Det finns skillnad i svarens diskurs, där svaren från botten har en mer amerikansk stil i sin formulering.  ENGLSIH ABSTRACT How the AI tool ChatGPT passes a home exam in palliative care The ChatGPT computer program is a bot that performs automatic tasks. This chatbot made headlines during the fall due to its ability to use Artificial Intelligence (AI) to create answers to targeted questions and texts based on a described purpose. At the end of December 2022, 16 questions from a home exam in palliative care at the nursing program were put into the AI bot to get them answered and test its ability to answer the questions correctly but also an assessment of whether the answers could be detected. An evaluation of the bot’s answers showed it had passed the examination. Some answers were excellent and reasoned, some gave reduced points due to lack of content, and some were incorrect. One answer stood out as it was in English. The answers sometimes had minor grammatical errors but were significantly more prolonged and better structured than the students’ answers. The possibility of detecting attempts at deception in the examination had been limited. There is a difference in discourse in the answers, with the answers from the bot having a more American style

Wound Infection Following Coronary Artery Bypass Graft Surgery : Risk Factors and the Experiences of Patients

The primary aim was to register the incidence of surgical wound infections (SWI) in sternotomy and leg incisions and potential risk factors for SWI following coronary artery by-pass graft (CAGB) procedures. Patients’ perspectives of SWI and the subsequent treatment were also considered. Risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed according to a questionnaire about symptoms and signs of wound infections. SWI was defined according to The Centers for Disease Control. Patients with mediastinitis were also interviewed within four months about how they experienced care, how they coped and how they thought the mediastinitis would influence their future life. SWIs were diagnosed in 30 % of the patients. Seventy-three percent of the SWIs of the leg were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days. Female gender and use of a monofilament suture for skin closure were the most important risk factors for SWI of the leg. Low preoperative haemoglobin concentration was the most important risk factor for sternal SWI. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day 2 or later than those without infections. Patients without a diagnosis of diabetes who had increased blood glucose concentrations during the intermediate postoperative period had an increased risk of mediastinitis. It was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia as such. Patients’ experiences were influenced by the staffs’ medical knowledge, how care was given and how well information was provided. Perceived danger and stress influenced how they coped with the situation. The patients believed that the mediastinitis would not affect the final outcome of the CABG procedure, even though their confidence in this was influenced by uncertainties about the rehabilitation process

Perioperative dialogue on postoperative recovery measured by the use of painmedication, psychopharmaceutic agents and length of hospital stay.

The effects of perioperative dialogue have been studied using qualitative methods, describing patient satisfaction with their care.However, they have not been studied in patients with peritoneal carcinomatosis who undergo major surgery, nor with quan-titative variables. The aim was to study the use of pain medication and length of hospital stay following cytoreductive surgeryand hyperthermic intraperitoneal chemotherapy in patients who received, versus those who did not receive, perioperativedialogue. The study had a quantitative, retrospective and comparative design including 89 audits. Of these, 37 patients receivedperioperative dialogues, and 52 patients did not (the control group). The result showed that by postoperative day six, patientswho received a perioperative dialogue experienced pain less frequently than patients in the control group. However, no differ-ences between the groups were noted with regard to pain medication consumption and length of hospital stay. To ease theirworries, all patients in both groups used benzodiazepines. The perioperative dialogue may be studied quantitatively, but it mustinvolve the patient, who is an equal partner in the dialogue. Structured validated self-reporting measures may be used system-atically before and after surgery in order to evaluate the perioperative dialogue using quantitative measures

Compliance to intraoperative basic hygiene in the operating theatre and patient safety culture in Mozambique

Background: Surgical site infections are commonly occurring within healthcare, especially in Africa. Good hygiene is the most effective way in which to reduce and prevent infection. However, compliance is often low or insufficient. Objective: To assess intraoperative compliance to basic hygiene in the operating theatre and the staffs’ views on patient safety and to assess whether adherence to hand hygiene is related to patient safety culture in a developing country. Methods: The design was a structured observation in order to gathered information on compliance to basic intraoperative hygiene routines in operating theatres in Mozambique. Theatre staff was also asked to complete a survey on patient safety culture. Results: The study reveals that none of the work elements were performed in complete compliance to WHO’s guidelines at all times. The theatre staff’s views on patient safety culture showed the highest percentage of positive responses was within “Teamwork Within Hospital Units” and the dimensions with the least positive response was “Nonpunitive Response To Error” and “Staffing”. A medium relation was found between compliance to basic hygiene and the results of the patient safety culture survey. Conclusion: This study shows that compliance to basic hygiene during the intraoperative phase in theatre was insufficient. There was a medium relation between the views of the staff on patient safety and their compliance to basic hand hygiene. This implies that working with the attitudes of the staff concerning patient safety could be one way of improving hygiene compliance which would be expected to reduce the number of surgical site infections

Compliance to intraoperative basic hygiene in the operating theatre and patient safety culture in Mozambique

Background: Surgical site infections are commonly occurring within healthcare, especially in Africa. Good hygiene is the most effective way in which to reduce and prevent infection. However, compliance is often low or insufficient. Objective: To assess intraoperative compliance to basic hygiene in the operating theatre and the staffs’ views on patient safety and to assess whether adherence to hand hygiene is related to patient safety culture in a developing country. Methods: The design was a structured observation in order to gathered information on compliance to basic intraoperative hygiene routines in operating theatres in Mozambique. Theatre staff was also asked to complete a survey on patient safety culture. Results: The study reveals that none of the work elements were performed in complete compliance to WHO’s guidelines at all times. The theatre staff’s views on patient safety culture showed the highest percentage of positive responses was within “Teamwork Within Hospital Units” and the dimensions with the least positive response was “Nonpunitive Response To Error” and “Staffing”. A medium relation was found between compliance to basic hygiene and the results of the patient safety culture survey. Conclusion: This study shows that compliance to basic hygiene during the intraoperative phase in theatre was insufficient. There was a medium relation between the views of the staff on patient safety and their compliance to basic hand hygiene. This implies that working with the attitudes of the staff concerning patient safety could be one way of improving hygiene compliance which would be expected to reduce the number of surgical site infections

A peer learning intervention in workplace introduction - managers’ and new graduates’ perspectives

Background: Evaluation of a complex intervention are often described as being diminished by difficulties regarding acceptability, compliance, delivery of the intervention, recruitment and retention. Research of peer learning for nursing students have found several positive benefits while studies of peer learning for newly graduated nurses are lacking. This study aimed (1) to investigate the study process in terms of (a) first-line managers' perspectives on the intervention study, the difficulties they face and how they handle these and (b) new graduates' fidelity to the intervention and (2) to examine the effect of the peer learning intervention in workplace introduction for newly graduated nurses. Methods: A mixed-methods approach using semi-structured interviews with eight managers, repeated checklist for fidelity and questionnaires conducted with 35 new graduates from June 2015 and January 2018, whereof 21 in the intervention group. The peer learning intervention's central elements included pairs of new graduates starting their workplace introduction at the same time, working the same shift and sharing responsibility for a group of patients for 3 weeks. The intervention also included 3 months of regular peer reflection. Results: Managers offered mostly positive descriptions of using peer learning during workplace introduction. The intervention fidelity was generally good. Because of recruitment problems and thereby small sample size, it was difficult to draw conclusions about peer learning effects and, thus, the study hypothesis could either be accepted or rejected. Thereby, the study should be regarded as a pilot. Conclusions: The present study found positive experiences of, from managers, and fidelity to the peer learning intervention; regarding the experimental design, there were lessons learned.Title in dissertation list of papers: A PEER LEARNING INTERVENTION IN WORKPLACE INTRODUCTION - FIRST-LINE MANAGERS’ AND NEWLY GRADUATED NURSES’ PERSPECTIVES: A MIXED-METHODS STUDY GUIDED BY THE MEDICAL RESEARCH COUNCIL FRAMEWORK.</p

Att undervisa om mäns våld mot kvinnor och våld i nära relationer - Sjuksköterskeprogrammet vid Uppsala universitet

För att personer som utsatts för våld samt deras barn ska få skydd och stöd krävs att yrkesverksamma har evidensbaserad kunskap om våld. Idag är det obligatoriskt för studenterna på åtta utbildningsprogram att kunna visa på kunskap om ”Mäns våld mot kvinnor och våld i nära relationer”, sedan detta kunskapsmål införts i högskoleförordningen. Sjuksköterskeprogrammet vid Uppsala universitet undervisade tidigt om kunskapsområdet och har sedan 2006 utvecklat en sammanhållen undervisning fördelat på flera terminer, från 2019 med möjlighet till fördjupning genom en valbar kurs. Kunskapsmålet har brutits ned till mindre delar som exempelvis belyser särskilda sårbarheter för våld. En tvärvetenskaplig ansats, undervisning om lagstiftning och erfarenheter från praktisk verksamhet, kombinerat med reflektion ger studenterna förutsättningar att omsätta kunskapen i professionell praktik

The postoperative handover : a focus group interview study with nurse anaesthetists, anaesthesiologists and PACU nurses

OBJECTIVES: To investigate different professionals' (nurse anaesthetists', anaesthesiologists', and postanaesthesia care unit nurses') descriptions of and reflections on the postoperative handover. DESIGN: A focus group interview study with a descriptive design using qualitative content analysis of transcripts. SETTING: One anaesthetic clinic at two hospitals in Sweden. PARTICIPANTS: Six focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8). RESULTS: Patterns and five categories emerged: (1) having different temporal foci during handover, (2) insecurity when information is transferred from one team to another, (3) striving to ensure quality of the handover, (4) weighing the advantages and disadvantages of the bedside handover and (5) having different perspectives on the transfer of responsibility. The professionals' perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient but also that it could threaten the patient's privacy and that frequent interruptions could be disturbing. CONCLUSIONS: The present findings revealed variations in different professionals' views on the postoperative handover. Healthcare interventions are needed to minimise the gap between professionals' perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision makers need to pay attention to the environment and infrastructure in postanaesthesia care

Serum leptin is decreased thirty days after surgery

Background: Leptin plays an important role for the regulation of food intake, energy expenditure and glucose control. The aim of this study was to study the effect of surgery on circulating levels of human leptin in a human elective surgery model. Methods: A prospective observational study was conducted. Blood sampling was carried out prior to surgery and four and thirty days after elective surgery, respectively. Patients undergoing orthopedic surgery (n=29) and coronary bypass patients (n=21) were included in the study. Serum leptin levels were measured using sandwich ELISA. C-reactive protein (CRP) was analyzed by turbidimetry. Results: Leptin values was significantly decreased thirty days after surgery in both orthopedic (p=0.002) and coronary bypass patients (p=0.003) in comparison with presurgical values. Conclusion: Elective surgery is associated with decreased leptin levels in the late postsurgical phase