Bedre nytteverdi av blodkultur ved sepsis

Tema/problemstilling: Vårt kvalitetsforbedringsprosjekt er rettet mot behandling av pasienter med sepsis ved en indremedisinsk avdeling. Målet er å øke nytteverdien av blodkultur for å redusere bredspektret antibiotikabehandling. Kunnskapsgrunnlag: Det er sammenheng mellom bruk av bredspektrede antibiotika og resistensutvikling. Deeskalering, endring av antibiotikabehandlingen til et mer smalspektret regime etter blodkultursvar, er en strategi for å redusere bruk av bredspektrede antibiotika. Deeskalering hos sepsispasienter der blodkultursvaret med resistensbestemmelse tillater det er trygg praksis og anbefales i nasjonale retningslinjer for antibiotikabehandling i sykehus. Tiltak/kvalitetsindikator: Samtaler med leger på Diakonhjemmet og Ullevål sykehus bekrefter at flere pasienter blir stående unødvendig på bredspektret antibiotikabehandling etter at man har blodkultursvar, og at det kan være potensial for å sette i gang forbedringstiltak. Vi innfører et tiltak som sikrer direkte kontakt mellom mikrobiolog og aktuell kliniker. Vi har valgt indikatorer for å vurdere i hvor stor grad tiltak gjennomføres og positive og negative effekter av tiltaket. Ledelse/organisering: Vi har brukt PUKK-sirkelen og Kotters åtte punkter som verktøy for å strukturere prosjektperioden. Slik kan vi sette fokus på de delene av prosjektet som trenger ekstra oppmerksomhet. Vi vil forankre prosjektet i ledelsen gjennom god informasjon og forankring i sykehusets strategiplan. For å oppnå varig endring i praksis, vil vi blant annet gjennomføre halvårlige målinger etter at prosjektperioden er avsluttet. Konklusjon: Tiltaket vi foreslår bygger på allerede gjeldende systemer og vil kreve lite opplæring og ressurser. Effekten er lett målbar. Kunnskapsgrunnlaget viser også at intervensjoner for formidling av dyrkningssvar ved sepsis kan redusere bruken av bredspektret antibiotika uten skadelige bieffekter. Med bakgrunn i dette vil vi anbefale at tiltaket gjennomføres

L’inviolabilité de la maternité

Parmi les différents aspects de la loi norvégienne régulant l’utilisation de la biotechnologie à des fins médicales, un en particulier attire l’attention. Le paragraphe 2-15 concernant l’usage et la réimplantation d’ovocytes fertilisés stipule : « Les ovules fertilisés ne peuvent être utilisés que pour la réimplantation chez les femmes à qui ils ont été prélevés. » Le paragraphe 2-18 au sujet de l’interdiction du don d’ovules énonce quant à lui : « Le don d’une femme à une autre d’un ovocyte ..

Chapitre 11. L’enfant illégitime. Les enjeux de la législation et des pratiques de procréation assistée en Norvège

Introduction En 2003, la Norvège a adopté une nouvelle loi relative aux biotechnologies (loi du 5 décembre 2003), qui a la particularité d’être la plus restrictive des pays nordiques, et l’une des plus restrictives dans l’Europe tout entière. Elle réglemente la procréation médicalement assistée, la recherche sur l’embryon et le clonage, le diagnostic prénatal, l’examen génétique du nouveau-né et la thérapie génique (article 1-2). Elle interdit entre autres le don d’ovocyte (voir infra). En ce..

Medborgerutdanning gjennom dialog og kunnskap - En flernivåanalyse av demokratiske verdier og holdninger blant 8.klassinger i 38 land

Over the last years there has been an increasing emphasis on democracy and citizenship education in both national and international education policies. International organizations, such as the UN and EU, explicitly agree that one of the school’s primary tasks is to promote democratic values and principles that can ensure a more just, peaceful, tolerant and including world. This thesis investigates the factors that explain variation in students’ democratic values and attitudes, as well as how civic education can ensure support for these values and attitudes. The analysis uses data from the International Civic and Citizenship Education Study from 2009, a study conducted among 8th graders in 38 countries. Four multilevel analyses are conducted to examine how variables on individual-, class- and country level affect students’ democratic values and their attitudes towards gender equality, immigrants and ethnic groups. This research shows that characteristics on individual level are more important for democratic attitudes and values than class and country characteristics, but it also states that characteristics of the students' teaching environment and the country from which they come from are significant. At the individual level, high socioeconomic background and strong democratic knowledge and skills have a positive effect on attitudes and values. At the class level, the models show that both an open discussion environment and the students’ experience of the opportunity to participate in decision-making processes in school life have a positive correlation with attitudes and values. In addition, students from countries where citizenship education is a separate subject in school, show higher support for democratic values and attitudes than students from countries where citizenship education is integrated in other subjects. This indicates that education policy and school leadership should emphasize on teaching democratic knowledge and skills, a democratic school community and teachers who are conscious of their role as dialogue facilitators in citizenship education. Finally, the implementation of a separate citizenship subject should be considered

Recapturing the household: reflections on labour, productive relations, and economic value

Labour regimes organize the economy; they also organize lives. With the continued deregulation of the labour market and the simultaneous drive to cut labour costs, there lies a challenge to grasp not only the workings of capital but also the way such processes impact on the organization of everyday labouring lives. This implies a focus that is attentive to value, combining political economy with moral economy. I suggest that household analysis represents one way to address such issues. Household analysis provides a means of ethnographic access to a particular temporal dynamic that is revealing of a layered texture of precariousness, capturing at one and the same time the material realities and the intimate relations of living. Regimes of labour and regimes of value can thus be brought into the same frame, indicating relational dependencies as well as structures of social inequality. Drawing on earlier ethnography amongst landless tobacco growers in Corrientes, Argentina, I draw attention to the potentials of a particular perspective, all the while paying attention to the specific historical and political context. Anthropology is well placed to grasp contemporary configurations of labour and how these both are framed by and contribute towards reproducing social and economic inequalities, not only locally but also at a more global scale

Ethnographic practice in the present

In its assessment of the current 'state of play' of ethnographic practice in social anthropology, this volume explores the challenges that changing social forms and changing understandings of 'the field'pose to contemporary ethnographic methods. These challenges include the implications of the remarkable impact social anthropology is having on neighboring disciplines such as history, sociology, cultural studies, human geography and linguistics, as well as the potential 'costs' of this success for the discipline. Contributors also discuss how the ethnographic method is influenced by current institutional contexts and historical 'traditions' across a range of settings. Here ethnography is featured less as a methodological 'tool-box' or technique but rather as a subject on which to reflect