Søkelys på nye varslingsregler

Artikkelen drøfter om varslingsbestemmelsene i arbeidsmiljøloven er tilstrekkelige med hensyn til å bedre varslingsaktiviteten og til å gi varsleren vern. «Tilstrekkelig» belyses her både ved en gjennomgang av Varslingsutvalgets mandat om styrking av varslervernet, og empiri om hvordan varslingsbestemmelsene har fungert. Både bestemmelsene som trådte i kraft 1. januar 2020, herunder fjerning av forsvarlighetskravet, og de mindre materielle endringene som ble vedtatt, gjennomgås. Forslagene fra Varslingsutvalget som regjeringen valgte å ikke gå videre med, blir også kommentert.acceptedVersio

Digitalization in the Emergency Department—An Interview Study of Nurses’ Experiences in Norway

Emergency departments (EDs) are overcrowded and linked to an increased risk of mortality and morbidity. Digitalization in EDs has been shown to increase effectiveness, reduce wait times, and improve performance and patient experience. The purpose of this study was to explore ED nurses’ experiences with digitalization in the ED. Interviews were conducted with eight ED nurses in a Norwegian hospital. Data were analyzed using Braun and Clarke’s six-step thematic analysis. Through analysis, three themes were identified, namely (1) consequences for patient safety, (2) influencing communication in the ED, and (3) impacting acute nursing. ED nurses experienced that the digital tools had increased patient safety through accurate documentation and providing a quick overview of the patient. However, digital tools were also seen as a threat to patient safety due to taking focus away from the patient. Digital tools were experienced to have negatively changed the communication both between personnel and between personnel and patients. Also, digital tools impacted the ED nurses’ professional role to a more digitalization-focused approach rather than a patient-oriented approach. These aspects must be included when planning the implementation of new digital tools in EDs in the future.publishedVersio

Intensivsykepleieres erfaring med deliriumskartlegging i intensivavdelinger – en scoping review

Bakgrunn: Intensivpasienter er utsatt for delirium. Det er derfor anbefalt med rutinemessig kartlegging av delirium med bruk av kartleggingsverktøy. CAM-ICU er et validert kartleggingsverktøy for å identifisere delirium hos intensivpasienter. Forskning viser at deliriumskartlegging skjer sjeldnere enn anbefalt. Hensikt: Hensikten med studien var å samle eksisterende litteratur om sykepleieres erfaring med bruk av CAM-ICU. Metode: Det ble gjennomført en scoping review basert på Arksey og O’Malleys femtrinnsmodell. Det ble samlet kvalitativ og kvantitativ litteratur på forskningsområdet. Dette ble utført systematiske søk i databasene Embase, MEDLINE, CINAHL og Academic Search Elite. Etter utvalgsprosessen ble totalt 13 artikler inkludert i studien. Funnene ble bearbeidet i en numerisk og en tematisk analyse. Resultat: Flere studier viste at CAM-ICU ble nedprioritert, mens noen av sykepleierne opplevde at verktøyet bidro til bedre pasientvurdering. CAM-ICU kan bedre kommunikasjon og samarbeid når både sykepleiere og leger bruker det. Det er ingen klar enighet om at CAM-ICU er enkelt å administrere, og tilliten til verktøyet er også varierende. Sykepleierne opplevde at CAM-ICU var utfordrende i møte med mekanisk ventilerte og sederte pasienter. Mangel på tid blir også trukket frem, i tillegg til behov for økt kunnskap. Konklusjon: Studien viser varierte erfaringer med nytteverdien og tilliten til CAM-ICU. Tverrfaglig samarbeid ser ut til å være viktig for bruken av CAM-ICU. Det etterlyses mer kunnskap og opplæring i bruk av verktøyet. Studien kan være nyttig ved utarbeiding av implementeringsstrategier for nye kartleggingsverktøy.  ENGLISH ABSTRACT Intensive care nurses' experience with delirium assessment in intensive care units – a scoping review Background: Intensive care patients are at risk of delirium. Therefore, regular use of a delirium assessment tool is recommended. CAM-ICU is a validated assessment tool, developed for intensive care patients. Research shows that delirium assessment occurs less often than recommended. Objectives: The aim of this study was to collect existing literature on nurses’ experience using CAM-ICU. Method: A scoping review based on Arksey and O’Malley’s five-step model was utilized. Qualitative and quantitative research were collected. Systematic searches were conducted in the databases Embase, MEDLINE, CINAHL, and Academic Search Elite. The searches resulted in 13 articles that were included in the study. The findings were processed in a numerical and a thematic analysis. Results: Several studies showed that CAM-ICU was de-prioritized, while some of the nurses felt that CAM-ICU contributed to a better patient assessment. CAM-ICU can improve communication and collaboration when both nurses and doctors use it. There is no clear consensus that CAM-ICU is easy to administer, confidence in the tool is also variable. The nurses experienced that CAM-ICU was challenging when dealing with mechanically ventilated and sedated patients. Lack of time is also highlighted, in addition to the need for increased knowledge. Conclusion: This study shows varied experience with the utility of, and trust in, CAM-ICU. In particular, the implementation of CAM-ICU in sedated and mechanically ventilated patients is experienced as challenging. The findings point to the fact that interdisciplinary collaboration appears to be important for the use of CAM-ICU. More knowledge and training are requested. This study can be useful when drawing up implementation strategies for new mapping tools.

Framtid, samspill og skaperglede : Betydningen av studentbedrift for senere entreprenøriell aktivitet

Ungt Entreprenørskap sine programmer bidrar til at mange tusen barn og unge blir introdusert for entreprenørskap i utdanning, der de får muligheten til å utvikle sine entreprenørielle ferdigheter gjennom en teoretisk og praktisk tilnærming. Vi synes dette arbeidet er viktig fordi det er disse som skal bidra til fremtidig økonomisk vekst og verdiskapning i Norge. Vi har selv hatt glede av organisasjonen gjennom studieløpet, og ønsket derfor å se nærmere på deres arbeid med å forme fremtidens entreprenører og arbeidstakere. Etter dialog med Ungt Entreprenørskap kom vi frem til følgende problemstilling: Hvilken betydning har deltakelse i studentbedrift hatt for entreprenøriell aktivitet 3-5 år etter endt program? Vi har med denne problemstillingen sett nærmere på hvor tidligere studentbedriftsdeltakere befinner seg i dag, og hvilket utbytte studentbedriften har dem gitt i ettertid. I vår oppgave har vi hovedsakelig benyttet Theresa M. Amabile sin teori om kreativitet og innovasjon. Ut i fra vårt perspektiv lagde vi en noe tilpasset og forenklet variant av hennes komponentmodell. Sammen med annen relevant forskning, og analysen av vårt forskningsmateriale, utgjør dette det teoretiske rammeverket for oppgaven. Vi har benyttet en kvalitativ tilnærming for å samle inn egen data. Som del av dette arbeidet gjennomførte vi semistrukturerte dybdeintervju er med åtte informanter, som deltok i Ungt Entreprenørskap sitt studentbedriftsprogram for 3-5 år siden. Som et resultat av kodingsarbeidet kategoriserte vi informantene basert på entreprenøriell aktivitet etter studentbedriftdeltakelsen. Analysearbeidet viste at det er karakteristiske forskjeller mellom kategoriene, som kalles entreprenørene, de kreative og rådgiverne. Vi har ikke kunnet fastslå en direkte sammenheng mellom deltakelse i studentbedriftsprogrammet til Ungt Entreprenørskap og senere entreprenøriell aktivitet, men vi ser indikasjoner på at alle informantene har hatt en eller annen form for utbytte av deltakelsen

Location of the southern edge of the Gorda slab and evidence for an adjacent asthenospheric window: Results from seismic profiling and gravity

As the Mendocino Triple Junction migrates northward along the California margin it is widely presumed to leave a "slab-free" or "asthenospheric" window in its wake. A 250-km-long south-north seismic refraction-reflection profile crossing the transition from transform to subduction regimes allows us to compare and contrast crust and upper mantle of the North American margin before and after it is modified by passage of the Mendocino Triple Junction. From the seismic data we have determined that (1) the crust is laterally homogeneous in velocity to a depth of 20 km (interpreted by us as Franciscan complex), (2) below 20 km depth the crust is characterized by velocities of ≥7.0 km/s for the southern half of the profile and by velocities of ≤7.0 km/s for the northern half, (3) regions of high reflectivity in the crust occur below ~20 km depth throughout the profile, and (4) the North American crust is thickest (~35) in the center of the profile and thins to ~25 km at either end. From the gravity data we have determined that (1) asthenospheric densities (3.2 g/cm³) occur subjacent to the North American crust in the center of the profile, and (2) a wedge of lithospheric mantle density material (≥3.2 g/cm³) is required on the southern end of the profile. We interpret these combined results to indicate that out profile crosses the southern edge of the Gorda plate and that directly adjacent to this edge is an asthenospheric window with overlying mafic rocks in the crust. These mafic rocks and a reforming lithospheric mantle increase in thickness southward.Copyrighted by American Geophysical Union

Systemic immune response induced by oxaliplatin-based neoadjuvant therapy favours survival without metastatic progression in high-risk rectal cancer

Background Systemic failure remains a challenge in rectal cancer. We investigated the possible systemic anti-tumour immune activity invoked within oxaliplatin-based neoadjuvant therapy. Methods In two high-risk patient cohorts, we assessed the circulating levels of the fms-like tyrosine kinase 3 ligand (Flt3L), a factor reflecting both therapy-induced myelosuppression and activation of tumour antigen-presenting dendritic cells, at baseline and following induction chemotherapy and sequential chemoradiotherapy, both modalities containing oxaliplatin. The primary end point was progression-free survival (PFS). Results In both cohorts, the median Flt3L level was significantly higher at completion of each sequential modality than at baseline. The 5-year PFS (most events being metastatic progression) was 68% and 71% in the two cohorts consisting of 33% and 52% T4 cases. In the principal cohort, a high Flt3L level following the induction chemotherapy was associated with low risk for a PFS event (HR: 0.15; P < 0.01). These patients also had available dose scheduling and toxicity data, revealing that oxaliplatin dose reduction during chemoradiotherapy, undertaken to maintain compliance to the radiotherapy protocol, was associated with advantageous PFS (HR: 0.47; P = 0.046). Conclusion In high-risk rectal cancer, oxaliplatin-containing neoadjuvant therapy may promote an immune response that favours survival without metastatic progression

The benefits of collaboration:The Nordic Arthroplasty Register Association

□ The Nordic Arthroplasty Register Association (NARA) was established in 2007 by arthroplasty register representatives from Sweden, Norway and Denmark with the overall aim to improve the quality of research and thereby enhance the possibility for quality improvement with arthroplasty surgery. Finland joined the NARA collaboration in 2010. □ NARA minimal hip, knee and shoulder datasets were created with variables that all countries can deliver. They are dynamic datasets, currently with 25 variables for hip arthroplasty, 20 for knee arthroplasty and 20 for shoulder arthroplasty. □ NARA has published statistical guidelines for the analysis of arthroplasty register data. The association is continuously working on the improvement of statistical methods and the application of new ones. □ There are 31 published peer-reviewed papers based on the NARA databases and 20 ongoing projects in different phases. Several NARA publications have significantly affected clinical practice. For example, metal-on-metal total hip arthroplasty and resurfacing arthroplasty have been abandoned due to increased revision risk based on i.a. NARA reports. Further, the use of uncemented total hip arthroplasty in elderly patients has decreased significantly, especially in Finland, based on the NARA data. □ The NARA collaboration has been successful because the countries were able to agree on a common dataset and variable definitions. The collaboration was also successful because the group was able to initiate a number of research projects and provide answers to clinically relevant questions. A number of specific goals, set up in 2007, have been achieved and new one has emerged in the process

EquiFACS: the Equine Facial Action Coding System

Although previous studies of horses have investigated their facial expressions in specific contexts, e.g. pain, until now there has been no methodology available that documents all the possible facial movements of the horse and provides a way to record all potential facial configurations. This is essential for an objective description of horse facial expressions across a range of contexts that reflect different emotional states. Facial Action Coding Systems (FACS) provide a systematic methodology of identifying and coding facial expressions on the basis of underlying facial musculature and muscle movement. FACS are anatomically based and document all possible facial movements rather than a configuration of movements associated with a particular situation. Consequently, FACS can be applied as a tool for a wide range of research questions. We developed FACS for the domestic horse (Equus caballus) through anatomical investigation of the underlying musculature and subsequent analysis of naturally occurring behaviour captured on high quality video. Discrete facial movements were identified and described in terms of the underlying muscle contractions, in correspondence with previous FACS systems. The reliability of others to be able to learn this system (EquiFACS) and consistently code behavioural sequences was high—and this included people with no previous experience of horses. A wide range of facial movements were identified, including many that are also seen in primates and other domestic animals (dogs and cats). EquiFACS provides a method that can now be used to document the facial movements associated with different social contexts and thus to address questions relevant to understanding social cognition and comparative psychology, as well as informing current veterinary and animal welfare practices

Genome wide single cell analysis of chemotherapy resistant metastatic cells in a case of gastroesophageal adenocarcinoma

<p>Abstract</p> <p>Background</p> <p>Metastatic progression due to development or enrichment of therapy-resistant tumor cells is eventually lethal. Molecular characterization of such chemotherapy resistant tumor cell clones may identify markers responsible for malignant progression and potential targets for new treatment. Here, in a case of stage IV adenocarcinoma of the gastroesophageal junction, we report the successful genome wide analysis using array comparative genomic hybridization (CGH) of DNA from only fourteen tumor cells using a bead-based single cell selection method from a bone metastasis progressing during chemotherapy.</p> <p>Case presentation</p> <p>In a case of metastatic adenocarcinoma of the gastroesophageal junction, the progression of bone metastasis was observed during a chemotherapy regimen of epirubicin, oxaliplatin and capecitabine, whereas lung-, liver and lymph node metastases as well as the primary tumor were regressing. A bone marrow aspirate sampled at the site of progressing metastasis in the right iliac bone was performed, and single cell molecular analysis using array-CGH of Epithelial Specific Antigen (ESA)-positive metastatic cells, and revealed two distinct regions of amplification, 12p12.1 and 17q12-q21.2 amplicons, containing the KRAS (12p) and ERBB2 (HER2/NEU) (17q) oncogenes. Further intrapatient tumor heterogeneity of these highlighted gene copy number changes was analyzed by fluorescence in situ hybridization (FISH) in all available primary and metastatic tumor biopsies, and ErbB2 protein expression was investigated by immunohistochemistry.</p> <p>ERBB2 was heterogeneously amplified by FISH analysis in the primary tumor, as well as liver and bone metastasis, but homogenously amplified in biopsy specimens from a progressing bone metastasis after three initial cycles of chemotherapy, indicating a possible enrichment of erbB2 positive tumor cells in the progressing bone marrow metastasis during chemotherapy. A similar amplification profile was detected for wild-type KRAS, although more heterogeneously expressed in the bone metastasis progressing on chemotherapy. Correspondingly, the erbB2 protein was found heterogeneously expressed by immunohistochemical staining of the primary tumor of the gastroesophageal junction, while negative in liver and bone metastases, but after three initial cycles of palliative chemotherapy with epirubicin, oxaliplatin and capecetabine, the representative bone metastasis stained strongly positive for erbB2.</p> <p>Conclusion</p> <p>Global analysis of genetic aberrations, as illustrated by performing array-CGH analysis on genomic DNA from only a few selected tumor cells of interest sampled from a progressing bone metastasis, can identify relevant therapeutic targets and genetic aberrations involved in malignant progression, thus emphasizing the importance and feasibility of this powerful tool on the road to more personalized cancer therapies in the future.</p