Konflikthantering inom sjukvården : erfarenheter från ett chefsperspektiv på två akutsjukhus i Mellansverige

Destructive conflicts in a workplace can be harmful. It is important that an organization through guidelines, training, distributed accountability and established external contacts quickly discovers and manages such conflicts. The purpose of this study was from a manager's perspective identify typical conflict situations and conflict resolution strategies at two hospitals in central Sweden, to increase knowledge about how conflicts are handled in hospitals and identify any problems in the conflict management. A qualitative approach with semi-structured individual interviews was chosen. Interviews were conducted with two staff specialists and six department heads about workplace procedures for conflict management and their experience of the conflict management of typical conflict situations. The interviews were condensed to structured summaries that were categorized and analyzed. Although respondents were generally quite satisfied with the current practice, a recurring complaint was that department heads often felt trapped in their role as a link between the upper management of the hospital and their employees. This became sometimes a cause of conflict. Another problem identified in the study concerns the role of the department head as a conflict manager. The analysis shows that problems in this role can be referred to the unequal relation between the department head and the employee, as well as the varying competence among department heads when it comes to conflict management. The study shows that this may be especially problematic when the manager is personally involved in the conflict, as was the case in a clear majority of the conflict situations described in the interviews.Destruktiva konflikter på en arbetsplats kan vara förödande. Det är viktigt att man i en organisation genom riktlinjer, utbildning, ansvarsfördelning och etablerade externa kontakter snabbt upptäcker och hanterar sådana konflikter. Syftet med denna studie var att utifrån ett chefsperspektiv identifiera typiska konfliktsituationer och konfliktlösningsstrategier på två sjukhus i Mellansverige, för att öka kunskapen om hur konflikter i sjukhusmiljö hanteras och identifiera eventuella problem i konflikthanteringen. En kvalitativ ansats med semistrukturerade individuella intervjuer valdes som metod. Intervjuer gjordes med två personalspecialister och sex enhetschefer om arbetsplatsens rutiner för konflikthantering och deras erfarenheter av hur konflikthanteringen fungerar i praktiken vid typiska konfliktsituationer. Intervjuerna kondenserades till strukturerade referat som kategoriserades och analyserades. Även om intervjupersonerna överlag var relativt nöjda med nuvarande rutiner var ett återkommande klagomål att enhetscheferna ofta kände sig klämda i sin roll som länk mellan ledning och medarbetare. Detta ledde ibland till konflikter. Ett annat problem som identifieras i studien är chefens roll som konflikthanterare. Beroendeställningen mellan chef och anställd kan här utgöra ett problem liksom chefers varierande kompetens när det gäller konflikthantering. Studien visar att detta är speciellt problematiskt när chefen själv är inblandat i konflikten vilket var fallet i en klar majoritet av de i intervjuerna beskrivna konfliktsituationerna

Methamphetamine Abuse Retinopathy: a Case Report

Methamphetamine is one of the most addictive drugs and its usage has spread all over the world in recent decades. Methamphetamine abuse causes mental and physical problems such as psychosis and stroke and also can cause perpetual and temporal ocular diseases like episcleritis, scleritis, retinopathy, retinal vasculitis, endophthalmitis and panophthalmitis. A few cases of ocular involvement caused by amphetamines abuse have been reported. Here we present a case of retinopathy caused by inhaling methamphetamine in a 46 years old male.Keywords:Methamphetamine; Drug-related sude effects and adverse reactions; Inhalant abuse; Retinopathy.

Effects of adjuvant omega-3 fatty acid supplementation on dry eye syndrome following cataract surgery: A randomized clinical trial

AbstractPurposeTo investigate the effect of omega-3 polyunsaturated fatty acid supplement on qualitative and quantitative subjective (ocular surface disease index: OSDI) and objective (Schirmer's test, tear break up time [TBUT], and tear osmolarity) dry eye indices after cataract surgery.MethodsIn this randomized clinical study, 61 eyes of 48 patients complaining of new onset dry eye symptoms after phacoemulsification were enrolled. Subjects were randomly allocated into two groups using urn randomization. Controls received conventional treatment. The treatment group received omega-3 dietary supplement in addition to conventional therapy.ResultsThere was no significant difference between the control and treatment groups in pre-treatment indices of Schirmer (3.50 ± 3.13and 2.96 ± 3.39, respectively, P = 0.582), TBUT (6.67 ± 1.36 and 4.87 ± 2.22, respectively, P = 0.687), osmolarity (316.66 ± 8.50 and 315.4 ± 17.06, respectively, P = 0.906), and OSDI (32.99 ± 19.03 and 35.32 ± 18.99, respectively, P = 0.635).Mean pre-treatment OSDI in the control group was 32.99 ± 19.03, which improved significantly after treatment to 25.43 ± 14.49 (P = 0.003). The mean pre-treatment OSDI in the treatment group was 35.32 ± 18.99 (range: 7.5–77.77), which improved significantly after treatment to 16.31 ± 13.72 (range: 2.77–47.22) (P < 0.001). OSDI improvement was significantly higher in the treatment group than the control group (P = 0.026).TBUT improved in both the control and treatment groups after treatment (P < 0.001). However, TBUT was affected significantly more in the treatment group compared with the control group (P = 0.038).Mean tear film osmolarity in the control group was 316.67 ± 8.50 (range: 308–325), which improved insignificantly after treatment to 311.33 ± 6.35 (range: 304–315) (P = 0.157). Mean pre-treatment tear film osmolarity in the treatment group was 315.40 ± 17.06 (range: 279–340), which improved significantly after treatment to 296.90 ± 14.39 (range: 260–310) (P < 0.001). Also, post-treatment Schirmer results between the two groups were not statistically significant (P = 0.155).ConclusionOmega-3 dietary supplements have an additive effect on tear film indices of patients with dry eye syndrome after phacoemulsification

Acridinium 2-hy­droxy­benzoate

In the title compound, C13H10N+·C7H5O3 − or (acrH)+(Hsal)−, the asymmetric unit contains one acridinium cation and one salicylate anion. The acridinium N atom is protonated and the carb­oxy­lic acid group of salicylic acid is deprotonated. Both moieties are planar, with an r.m.s. deviation of 0.0127 Å for the acr cation and 0.0235 ° for the sal anion. They are aligned with a dihedral angle of 71.68 (3)° between them. The crystal structure is stabilized by a network of inter­molecular N—H⋯O, O—H⋯O and C—H⋯O hydrogen bonds. C—H⋯π inter­actions are also present

Photopigment Bleaching Phenomenon on Fluorescein Angiography in a Patient with Impending Central Retinal Vein Occlusion

Purpose: To present the second case of photopigment bleaching phenomenon in fluorescein angiography (FA) and the first case of this phenomenon due to impending central retinal vein occlusion (CRVO). Case Report: A 32-year-old healthy female noticed blurred vision in her right eye one day before presentation. Despite the 20/20 visual acuity at presentation, mild increased retinal vascular tortuosity and unilateral photopigment bleaching phenomenon in FA was observed in the right eye. Three weeks later, she developed a complete CRVO with visual acuity reduction to 20/40 that responded well to the intravitreal injection of aflibercept. Conclusion: Impending CRVO can cause unilateral photopigment bleaching phenomenon in FA that may be due to retinal ischemia

Bis(2,4,6-triamino-1,3,5-triazin-1-ium) pyrazine-2,3-dicarboxyl­ate tetra­hydrate: a synchrotron radiation study

The title compound, 2C3H7N6 +·C6H2N2O4 2−·4H2O or (tataH)2(pzdc)·4H2O, was synthesised by a reaction between pyrazine-2,3-dicarboxylic acid (H2pzdc) as a proton donor and 2,4,6-triamino-1,3,5-triazin (tata) as a proton acceptor. In the crystal structure, an extensive series of O—H⋯O, O—H⋯N, N—H⋯O and N—H⋯N hydrogen bonds generates a three-dimensional framework with the hydrogen bonding involving most donor and acceptor centers. π–π stacking inter­actions are also observed between adjacent triazine rings, with centroid–centroid distances of 3.4994 (8) and 3.5922 (7) Å

Conventional and Pattern Scanning Pan-Retinal Photocoagulation Laser in Diabetic Patients’ Visual Field

Background: We aimed to compare visual field defects in two different methods of laser in patients with proliferative diabetic or very severe non- proliferative diabetic retinopathy: conventional pan retinal photocoagulation (PRP) and Pattern Scanning PRP. &nbsp; Study design: Non-randomized, single-blind, prospective clinical trial in which fellow eye of each patient served as control. Materials and Methods: Twenty patients with proliferative or very severe non-proliferative diabetic retinopathy were enrolled. Only patients with same severity score in both eyes were included.&nbsp; One eye underwent the Conventional PRP laser and the other eye pattern scanning PRP laser simultaneously. SITA Standard perimetry was done one month after the initial PRP and evaluated for visual field defects. Results: Pattern standard deviation (PSD) significantly increased in both pattern and conventional PRP laser groups within one month after PRP. There was no significant difference between the mean PSD values of the two groups before PRP and after one month of the follow-up. The mean deviation (MD) level significantly decreased in the conventional group after 1 month. Conclusion: Changes in visual acuity and visual field of patients between the two Pattern and conventional PRP laser methods did not show a significant difference but pattern PRP method causes less reduction of the overall sensitivity in the patient's visual field

Uveitis-induced Refractory Ocular Hypotony Managed with High-dose Latanoprost

Purpose: To report a case of refractory ocular hypotony due to chronic Behcet’s disease with good response to high-dose topical latanoprost. Case Report: We present a 26-year-old man with a known history of Behcet’s disease who developed decreasing vision and severe ocular hypotony that was refractory to multiple treatment modalities including subtenon triamcinolone acetonide, ibopamine, pars plana vitrectomy, and silicone oil injection. We decided to try high-dose topical latanoprost for the management of ocular hypotony based on recent reports. After six months, intraocular pressure (IOP) increased by 5 mm Hg, became stable at 7 mm Hg, and remained unchanged at month 24. Conclusion: High-dose topical latanoprost could lead to significant increase in IOP in uveitis-induced refractory ocular hypotony

Influence of nano wollastonite on physical, mechanical and morphological properties of gypsum composites manufactured from bagasse

We investigated the effect of adding nano-wollastonite on the physical, mechanical and morphological properties of gypsum Composites. The ratio percentage of bagasse mixing as lignocellulosic material with gypsum at three levels (85:15; 75:25; 65:35) and nano-wollastonite at three levels of 0 %, 5 % and 10 %. Specimens were prepared according to the ISO 11925 specifications for the fire resistance (weight loss) properties and according to the DIN EN 634-1: 1195-04 specifications for the mechanical and physical properties. Scanning Electron Microscopy (SEM) were also used to study the properties of composite morphology and distribution of samples. The results showed that by increasing the amount of nano wollastonite, physical and mechanical properties improved. The MOR, MOE and IB of boards decreased with increased bagasse usage amount, and its maximum value was obtained in using 15 % bagasse. The results also showed that increasing the amount of bagasse in boards caused a significant increase in the TS of the boards. The results from microscopic images showed that the optimal level of nano-wollastonite can fill the empty holes and create a uniform structure, thereby improving the properties of the boards

Spontaneous retrobulbar hemorrhage in a patient with breast cancer: A case report

AbstractPurposeWe present spontaneous retrobulbar hemorrhage in a 52-year-old woman with history of breast cancer and tamoxifen intake which was first thought to be an orbital metastasis.Case reportA 52-year-old woman with history of breast cancer and tamoxifen intake was referred due to severe proptosis and visual loss. Orbital imaging showed an intra-conal mass. After exploration, multiple fragments of dark brown mass in the retrobulbar area were excised. Microscopic diagnosis was blood clot. All of clinical signs and symptoms were improved 1 week after operation.ConclusionSpontaneous retrobulbar hemorrhage is a rare condition that may have unknown etiologies, and its symptoms may mimic orbital metastasis. Since both breast cancer and tamoxifen intake can cause coagulation disorders, they might be possible causes for retrobulbar hemorrhage in this case