Diabetes type 2-The nurses guiding role

Bacheloroppgave i sykepleie, 2013Diabetes er en folkehelsesykdom, som er i økende vekst både i Norge og i resten av verden (Diabetesforbundet, 2012). Problemstillingen vår er hvordan vi som sykepleiere kan veilede pasienter med nyoppdaget diabetes type 2, for at pasienten skal mestre livsstilsendringer i hverdagen og leve godt på tross av sin diabetes? Vi har utført et litteraturstudie for å belyse og svare på vår problemstilling. Mennesker som blir diagnostisert med diabetes type 2 kan oppleve dette som en krise, en trussel i henhold til tidligere livsførsel. I forhold til sykdommen diabetes står begrepet brukermedvirkning sentralt, da det er helt nødvendig at pasienten selv tar grep om sin egen sykdom, og bidrar aktivt ved å ta sine egne beslutninger rundt egen helse og derved oppnå kontroll, som igjen vil gi større helsegevinst. Som sykepleiere er det vår jobb å gi veiledning, informasjon og undervisning alt etter hvor mottagelig pasienten er på det stadiet vi treffer ham. Vi skal inneha ferdigheter i kommunikasjon som gjør oss best mulig rustet til å møte pasienten, og som skal være med på å bidra til motivasjon til endring. Konklusjonen er at metoden motiverende intervju er et godt hjelpemiddel for oss sykepleiere i dialog med pasienten, det er også viktig at veiledningen blir individualisert og skreddersydd den enkelte, hans ressurser og personlige ståsted for å kunne oppnå mestring

Norwegian public health nurses’ competence areas

Objective: To explore the competence areas of public health nurses in Norway. Design: A qualitative and comparative design was employed. Sample: A purposive sample of 41 public health nurses participated. Measurements: Data were gathered from focus groups and individual interviews. The interviews centered around an open question about public health nurses’ knowledge. They also discussed 10 proposed competence areas for public health nursing, developed from the literature. A qualitative content analysis was conducted on the interview transcripts, followed by a synthesis of the data from the interviews and earlier developed competencies. The 10 competence areas for Norwegian public health nursing were then refined. Finally, we compared the affirmed competence areas with earlier developed cornerstones and the new educational guidelines. Results: The interviews revealed 10 competence areas. These 10 competence areas were synthesized with the 10 proposed competencies from literature. Ten affirmed competence areas, which mostly corresponded with the competences from literature, were developed. The affirmed competencies were supported by the previously developed cornerstones and new educational guidelines. Conclusions: The affirmed competencies will help promote and explain the content and focus of PHNs’ work in Norway and may have implications for education and international research.publishedVersio

Health-related quality of life in patients with advanced melanoma treated with ipilimumab: prognostic implications and changes during treatment

Background: We have previously reported that the safety and efficacy of ipilimumab in real-world patients with metastatic melanoma were comparable to clinical trials. Few studies have explored health-related quality of life (HRQL) in real-world populations receiving checkpoint inhibitors. This study reports HRQL in real-world patients receiving ipilimumab and assesses the prognostic value of patient-reported outcome measures. Patients and methods: Ipi4 (NCT02068196) was a prospective, multicentre, interventional phase IV trial. Real-world patients (N = 151) with metastatic melanoma were treated with ipilimumab 3 mg/kg intravenously as labelled. HRQL was assessed by the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire at baseline and after 10-12 weeks. Results: The European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire was completed by 93% (141/151 patients) at baseline, and by 82% at 10-12 weeks. Poor performance status and elevated C-reactive protein (CRP) were associated with worse baseline HRQL. Clinically relevant and statistically significant deteriorations in HRQL from baseline to weeks 10-12 were reported (P <0.05). Baseline physical functioning [hazard ratio (HR) 1.96, P = 0.016], role functioning (HR 2.15, P <0.001), fatigue (HR 1.60, P = 0.030), and appetite loss (HR 1.76, P = 0.012) were associated with poorer overall survival independent of performance status, lactate dehydrogenase (LDH), and CRP. We further developed a prognostic model, combining HRQL outcomes with performance status, LDH, and CRP. This model identified three groups with large and statistically significant differences in survival. Conclusions: Systemic inflammation is associated with impaired HRQL. During treatment with ipilimumab, HRQL deteriorated significantly. Combining HRQL outcomes with objective risk factors provided additional prognostic information that may aid clinical decision making.publishedVersio

Ipilimumab in a real-world population: A prospective Phase IV trial with long-term follow-up

Ipilimumab was the first treatment that improved survival in advanced melanoma. Efficacy and toxicity in a real-world setting may differ from clinical trials, due to more liberal eligibility criteria and less intensive monitoring. Moreover, high costs and lack of biomarkers have raised cost-benefit concerns about ipilimumab in national healthcare systems and limited its use. Here, we report the prospective, interventional study, Ipi4 (NCT02068196), which aimed to investigate the toxicity and efficacy of ipilimumab in a real-world population with advanced melanoma. This national, multicentre, phase IV trial included 151 patients. Patients received ipilimumab 3 mg/kg intravenously and were followed for at least 5 years or until death. Treatment interruption or cessation occurred in 38%, most frequently due to disease progression (19%). Treatment-associated grade 3 to 4 toxicity was observed in 28% of patients, and immune-related toxicity in 56%. The overall response rate was 9%. Median overall survival was 12.1 months (95% CI: 8.3-15.9); and progression-free survival 2.7 months (95% CI: 2.6-2.8). After 5 years, 20% of patients were alive. In a landmark analysis from 6 months, improved survival was associated with objective response (HR 0.16, P = .001) and stable disease (HR 0.49, P = .005) compared to progressive disease. Poor performance status, elevated lactate dehydrogenase and C-reactive protein were identified as biomarkers. This prospective trial represents the longest reported follow-up of a real-world melanoma population treated with ipilimumab. Results indicate safety and efficacy comparable to phase III trials and suggest that the use of ipilimumab can be based on current cost-benefit estimates.publishedVersio

Serving the Media Ministers: A Mixed Methods Study on the Personalization of Ministerial Communication

The personalization of politics has received much attention in both the political science and political communication literature, but the focus has almost entirely been on party leaders and prime ministers. This study investigates the personalization of ministerial communication in Norway, a type of decentralized personalization. It combines a survey of communication workers; in-depth interviews with politicians, communication workers, political reporters, and top-level civil servants; and ethnographic observation inside a ministry. The article goes beyond media-centered perspectives and identifies several potential drivers and barriers to personalization processes. Based on our mixed methods approach, we find that ministerial communication in Norway is strongly centered on the minister in both reactive media management and the proactive promotion of the minister and new policies. This decentralized personalization is driven by both demands from the media and the strategic adaptation by political and administrative actors within ministries. Based on the rich empirically grounded insights, the article discusses how the interplay between the logic of the contemporary commercial news media, political ambitions, internal administrative ambitions, and changes in executive government shapes the personalization of ministerial communication, and illuminates how these multiple drivers of personalization are mutually reinforcing.publishedVersionacceptedVersio

Diabetes type 2 – Sykepleierens veiledende rolle

Diabetes er en folkehelsesykdom, som er i økende vekst både i Norge og i resten av verden (Diabetesforbundet, 2012). Problemstillingen vår er hvordan vi som sykepleiere kan veilede pasienter med nyoppdaget diabetes type 2, for at pasienten skal mestre livsstilsendringer i hverdagen og leve godt på tross av sin diabetes? Vi har utført et litteraturstudie for å belyse og svare på vår problemstilling. Mennesker som blir diagnostisert med diabetes type 2 kan oppleve dette som en krise, en trussel i henhold til tidligere livsførsel. I forhold til sykdommen diabetes står begrepet brukermedvirkning sentralt, da det er helt nødvendig at pasienten selv tar grep om sin egen sykdom, og bidrar aktivt ved å ta sine egne beslutninger rundt egen helse og derved oppnå kontroll, som igjen vil gi større helsegevinst. Som sykepleiere er det vår jobb å gi veiledning, informasjon og undervisning alt etter hvor mottagelig pasienten er på det stadiet vi treffer ham. Vi skal inneha ferdigheter i kommunikasjon som gjør oss best mulig rustet til å møte pasienten, og som skal være med på å bidra til motivasjon til endring. Konklusjonen er at metoden motiverende intervju er et godt hjelpemiddel for oss sykepleiere i dialog med pasienten, det er også viktig at veiledningen blir individualisert og skreddersydd den enkelte, hans ressurser og personlige ståsted for å kunne oppnå mestring

Air quality in Ny-Ålesund. Monitoring of local air quality 2014-2015.

The concentrations of the measured components are generally low and below national limit values for the protection of human health and critical levels for the protection of vegetation. Wind from northern sectors gave the highest average concentrations of nitrogen oxides, which indicates the power station and the harbour as possible sources. From September 2014 to February 2015, volcanic eruptions at Iceland emitted large volumes of SO2, which gave episodes of elevated concentrations in Ny-Ålesund. The measurement results for CO2 show an annual variation with higher concentrations in the winter and lower in summer. Measured concentrations of CO were most likely caused by local snowmobile traffic and long-range transport of emissions from wildfires in North America

Air quality in Ny-Ålesund. Monitoring of local air quality 2016-2017.

The concentrations of the measured components are generally low and below national limit values for the protection of human health and critical levels for the protection of vegetation. Wind from northern sectors gave the highest average concentrations of nitrogen oxides and sulphur dioxide, which indicates the power station and the harbour as possible sources. The measurement results for CO2 show an annual variation with higher concentrations in the winter and lower in summer. Measured concentrations of CO were most likely caused by local snowmobile traffic

Media and Bureaucracy: Investigating Media Awareness Amongst Civil Servants

Scholars claim that civil servants are increasingly having to engage in media management and be aware of how events are presented in the press, with this media awareness being said to threaten civil servants’ traditional bureaucratic values. In this article, we argue that media awareness is unevenly spread in public bureaucracies, and rather is contingent on individual and organizational characteristics. More specifically, we present the hypotheses that media awareness depends on the amount of media related work, the amount of media attention on the organization in which they work, as well as the civil servants’ fundamental views on the role of the media in society. To test the hypotheses, the article utilizes a large-N survey of civil servants in Norwegian ministries and agencies. The results show that the vast majority of civil servants care about how issues appear in the press. Further on, we find that civil servants’ media awareness coexists with traditional bureaucratic values, offering some relief to scholars who fear the disruptive effects of the media in public administration. As the hypotheses suggest, we find that this media awareness is linked to civil servants’ actual media-related work. However, the analysis shows that civil servants working in organizations with a lot of media attention are, in fact, are less aware of the media

Kartlegging av lokal luftkvalitet i Hønefoss. Målinger 2018-2019.

NILU - Norsk institutt for luftforskning har på oppdrag fra Ringerike kommune gjennomført kartlegging av lokal luftkvalitet i Hønefoss. Måleprogrammet startet juni 2018 og ble avsluttet i mai 2019. Målingene ble gjennomført for å framskaffe kunnskapsgrunnlag for ny byplan i Hønefoss. Måleprogrammet inneholdt måling av svevestøv og nitrogendioksid samt meteorologiske parametre som temperatur, trykk, relativ fuktighet og vind. Årsmiddelkonsentrasjonen av PM2,5 lå under øvre, men over nedre vurderingsterskel. Årsmiddelverdiene av NO2 og PM10 lå ikke over nedre vurderingsterskel. Døgnmiddelverdier av PM10 og timemiddelkonsentrasjon av NO2 lå under øvre, men over nedre vurderingsterskel