Kompetanseutvikling og anvendelse av kompetanse hos sykepleiere på sengeposter : En kvantitativ studie om hvilke former for kompetanseutvikling sykepleiere på sengeposter deltar i, og hvorvidt kompetansen deres kommer til anvendelse

Formål: Hensikten med studien er å beskrive formelle og uformelle kompetanseutviklingstiltak sykepleiere på sengeposter deltar i. Videre er hensikten å beskrive om sykepleierne opplever at kompetansen deres kommer til anvendelse. Å bidra til en økt forståelse av disse to områdene er viktig da sykepleiere er aktive deltakere i forhold til deltakelse i kompetanseutvikling. Teoretisk forankring: Studien forankres i tidligere forskning og litteratur som tematiserer samspill av ulike kunnskapsformer og ulike former for kompetanse. Litteraturen belyser ulike arenaer for kompetanseutvikling og for anvendelse av kompetanse. Videre hvilken rolle dette har i forhold til generelle overordnede mål om å bidra til kvalitet i helsetjenesten. Metode: Studien er deskriptiv. Det er benyttet kvantitativ metode. Det ble utarbeidet et spørreskjema som er benyttet til datainnsamling. Spørreskjemaet er utviklet med forankring i oppgavens litteratur og tidligere forskning. Resultater: Det ble distribuert 76 spørreskjemaer til sykepleiere på to medisinske og to kirurgiske sengeposter ved et universitetssykehus. Totalt 60 sykepleiere besvarte spørreskjemaene.Disse utgjør til sammen en svarprosent på 79%. Resultatene viser at et fåtall av sykepleiere på sengepostene har videreutdanning. Mye av kompetanseutviklingen skjer "ad hoc" gjennom samhandling med kolleger. Sykepleierne har en opplevelse av at kompetansen deres kommer til anvendelse. Resultatene peker mot at avdelingssykepleierne er oppmerksomme på sykepleiernes kompetanse, halvparten av sykepleierne sier de opplever at avdelingssykepleier bruker kompetansen deres bevisst. Resultatene peker mot at liten tid i arbeidsdagen er en faktor som påvirker kompetanseutvikling og anvendelse av kompetanse, funnene gir også inntrykk av at det enten mangler strategisk plan for utvikling og anvendelse av kompetanse, eller så er en slik plan lite synlig blant sykepleierne. Konklusjon: I denne studien er det få respondenter som har formell videreutdanning, samtidig legges det lite til rette for videreutdanning på arbeidsplassen. Kompetanseutvikling og anvendelse av kompetanse foregår i stor grad gjennom samhandling med kolleger, fortløpende under arbeid og skjer ofte "ad hoc" når et behov oppstår. Nøkkelord: Kompetanse, kompetanseutvikling, anvendelse av kompetanse, erfaring, videreutdanning, læring på arbeidsplasse

De siste dager og timer: Hvordan kan sykepleieren gi bedre psykisk omsorg ved livets slutt

Vi har alle tre opplevd dødsfall i praksis, og har vært med pasienter de siste dager og timer før døden. To av oss har også hatt praksis på en avdeling for lindrende behandling/terminal pleie. Grunnen til at fokuset falt på de psykiske aspektene hos terminale pasienter er flere. Vi ønsket å få en økt forståelse for denne naturlige, men likevel på mange måter vanskelige delen av livet. Vi ville også lære mer om hvordan vi som sykepleiere kan bidra til at døende pasienter opplever den siste tiden best mulig. Samtidig lærer vi å sette ord på hva vi opplever som vanskelig når vi gir omsorg til døende pasienten, noe som kan bidra til en større forståelse og erkjennelse av egne følelser. Forskning viser at sykepleiere med kunnskap og erfaring innen palliativ omsorg er mindre usikre i møte med den terminale pasienten, noe som har innvirkning på pasientens trygghetsfølelse (Deffner og Bell, 2005, Eide og Eide, 2007)

A processual model for functional analyses of carcinogenesis in the prospective cohort design

Published version also available at http://dx.doi.org/10.1016/j.mehy.2015.07.006Traditionally, the prospective design has been chosen for risk factor analyses of lifestyle and cancer using mainly estimation by survival analysis methods. With new technologies, epidemiologists can expand their prospective studies to include functional genomics given either as transcriptomics, mRNA and microRNA, or epigenetics in blood or other biological materials. The novel functional analyses should not be assessed using classical survival analyses since the main goal is not risk estimation, but the analysis of functional genomics as part of the dynamic carcinogenic process over time, i.e., a ‘‘processual’’ approach. In the risk factor model, time to event is analysed as a function of exposure variables known at start of follow-up (fixed covariates) or changing over the follow-up period (time-dependent covariates). In the processual model, transcriptomics or epigenetics is considered as functions of time and exposures. The success of this novel approach depends on the development of new statistical methods with the capacity of describing and analysing the time-dependent curves or trajectories for tens of thousands of genes simultaneously. This approach also focuses on multilevel or integrative analyses introducing novel statistical methods in epidemiology. The processual approach as part of systems epidemiology might represent in a near future an alternative to human in vitro studies using human biological material for understanding the mechanisms and pathways involved in carcinogenesis

‘I want to get back!’ A qualitative study of long-term critically ill patients’ inner strength and willpower : Back home after long-term intensive care

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NKp46 defines ovine cells that have characteristics corresponding to NK cells

Natural killer (NK) cells are well recognized as playing a key role in innate immune defence through cytokine production and cytotoxic activity; additionally recent studies have identified several novel NK cell functions. The ability to study NK cells in the sheep has been restricted due to a lack of specific reagents. We report the generation of a monoclonal antibody specific for ovine NKp46, a receptor which in a number of mammals is expressed exclusively in NK cells. Ovine NKp46+ cells represent a population that is distinct from CD4+ and γδ+ T-cells, B-cells and cells of the monocytic lineage. The NKp46+ cells are heterogenous with respect to expression of CD2 and CD8 and most, but not all, express CD16 - characteristics consistent with NK cell populations in other species. We demonstrate that in addition to populations in peripheral blood and secondary lymphoid organs, ovine NKp46+ populations are also situated at the mucosal surfaces of the lung, gastro-intestinal tract and non-gravid uterus. Furthermore, we show that purified ovine NKp46+ populations cultured in IL-2 and IL-15 have cytotoxic activity that could be enhanced by ligation of NKp46 in re-directed lysis assays. Therefore we conclude that ovine NKp46+ cells represent a population that by phenotype, tissue distribution and function correspond to NK cells and that NKp46 is an activating receptor in sheep as in other species

Evaluation of Immune Status in Two Cohorts of Atlantic Salmon Raised in Different Aquaculture Systems (Case Study)

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Professorkvalifiseringens affektive økonomi. Styring, følelser og motstand

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A new statistical method for curve group analysis of longitudinal gene expression data illustrated for breast cancer in the NOWAC postgenome cohort as a proof of principle

International audienceA new statistical method for curve group analysis of longitudinal gene expression data illustrated for breast cancer in the NOWAC postgenome cohort as a proof of principle Abstract Background: The understanding of changes in temporal processes related to human carcinogenesis is limited. One approach for prospective functional genomic studies is to compile trajectories of differential expression of genes, based on measurements from many case-control pairs. We propose a new statistical method that does not assume any parametric shape for the gene trajectories. Methods: The trajectory of a gene is defined as the curve representing the changes in gene expression levels in the blood as a function of time to cancer diagnosis. In a nested case–control design it consists of differences in gene expression levels between cases and controls. Genes can be grouped into curve groups, each curve group corresponding to genes with a similar development over time. The proposed new statistical approach is based on a set of hypothesis testing that can determine whether or not there is development in gene expression levels over time, and whether this development varies among different strata. Curve group analysis may reveal significant differences in gene expression levels over time among the different strata considered. This new method was applied as a " proof of concept " to breast cancer in the Norwegian Women and Cancer (NOWAC) postgenome cohort, using blood samples collected prospectively that were specifically preserved for transcriptomic analyses (PAX tube). Cohort members diagnosed with invasive breast cancer through 2009 were identified through linkage to the Cancer Registry of Norway, and for each case a random control from the postgenome cohort was also selected, matched by birth year and time of blood sampling, to create a case-control pair. After exclusions, 441 case-control pairs were available for analyses, in which we considered strata of lymph node status at time of diagnosis and time of diagnosis with respect to breast cancer screening visits. Results: The development of gene expression levels in the NOWAC postgenome cohort varied in the last years before breast cancer diagnosis, and this development differed by lymph node status and participation in the Norwegian Breast Cancer Screening Program. The differences among the investigated strata appeared larger in the year before breast cancer diagnosis compared to earlier years.ConclusionsThis approach shows good properties in term of statistical power and type 1 error under minimal assumptions. When applied to a real data set it was able to discriminate between groups of genes with non-linear similar patterns before diagnosis

Effect of two constant light regimens on antibody profiles and immune gene expression in Atlantic salmon following vaccination and experimental challenge with salmonid alphavirus

Before seawater transfer, farmed Atlantic salmon are subjected to treatments that may affect the immune system and susceptibility to pathogens. E.g., exposure to constant light (CL) stimulates smoltification, which prepares salmon to life in sea water, but endocrine changes in this period are associated with suppression of immune genes. Salmon are vaccinated towards end of the freshwater period to safeguard that adequate vaccine efficacy is achieved by the time the fish is transferred to sea. In the present study, we investigated how the responses to vaccination and viral infection varied depending on the time of CL onset relative to vaccination. The salmon were either exposed to CL two weeks prior to vaccination (2-PRI) or exposed to CL at the time of vaccination (0-PRI). A cohabitant challenge with salmonid alphavirus, the causative agent of pancreatic disease, was performed 9 weeks post vaccination. The immunological effects of the different light manipulation were examined at 0- and 6-weeks post vaccination, and 6 weeks post challenge. Antibody levels in serum were measured using a serological bead-based multiplex panel as well as ELISA, and 92 immune genes in heart and spleen were measured using an integrated fluidic circuit-based qPCR array for multiple gene expression. The 2-PRI group showed a moderate transcript down-regulation of genes in the heart at the time of vaccination, which were restored 6 weeks after vaccination (WPV). Conversely, at 6WPV a down-regulation was seen for the 0-PRI fish. Moreover, the 2-PRI group had significantly higher levels of antibodies binding to three of the vaccine components at 6WPV, compared to 0-PRI. In response to SAV challenge, transcription of immune genes between 2-PRI and 0-PRI was markedly dissimilar in the heart and spleen of control fish, but no difference was found between vaccinated salmon from the two CL regimens. Thus, by using labor-saving high throughput detection methods, we demonstrated that light regimens affected antibody production and transcription of immune genes in non-vaccinated and virus challenged salmon, but the differences between the light treatment groups appeared eliminated by vaccination.publishedVersio

Development of Atlantic Salmon (Salmo salar L.) Under Hypoxic Conditions Induced Sustained Changes in Expression of Immune Genes and Reduced Resistance to Moritella viscosa

Atlantic salmon is characterized with high sensitivity to low dissolved oxygen (DO) levels. Hypoxia can affect diverse biological processes with consequences that can be manifested immediately or with delay. Effects of hypoxia on the immune system and the resistance to a bacterial pathogen were investigated. Two groups were reared at, respectively, normal (NO, 80–100%) and low (LO, 60%) levels of DO over 10 months after which both groups were reared at NO. Smoltification was initiated after 13 months by a winter signal for 6 weeks, followed by constant light for 6 weeks. Samples were collected at the start and end of the constant light period. Expression of 92 immune and stress genes was analyzed in the gill, head kidney, and spleen using a Biomark HD. Most of differentially expressed genes showed higher levels in LO fish compared to NO fish; many immune genes were downregulated during smoltification and these changes were stronger in NO fish. A notable exception was pro-inflammatory genes upregulated in gill of NO fish. Further, salmon were challenged with Moritella viscosa, the causative agent of winter ulcer. Mortality was registered from 5 days post infection (dpi) to the end of trial at 36 dpi. Survival was consistently higher in NO than LO fish, reaching a maximum difference of 18% at 21–23 dpi that reduced to 10% at the end. Analyses with a genome-wide microarray at 36 dpi showed strong responses to the pathogen in gill and spleen. Notable features were the stimulation of eicosanoid metabolism, suggesting an important role of lipid mediators of inflammation, and the downregulation of chemokines. Many immune effectors were activated, including multiple lectins and acute phase proteins, enzymes producing free radicals, and matrix metalloproteinases. The transcriptomic changes induced with a bacterial challenge were similar in NO and LO. After the challenge, interferons a and g and panel of genes of innate antiviral immunity showed higher expression in LO, especially in the gill. The results from the present study suggest that chronic hypoxia in early life stimulated immune genes and attenuated their downregulation associated with smoltification. However, these changes did not improve protection against a bacterial pathogen of major concern in salmon aquaculture