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Masteroppgave i tilpassa opplæring - 201

Cervical chondroid chordoma in a standard dachshund: a case report

A ten-year-old male standard dachshund was presented with a history of neck pain and progressive gait disturbances. Following a neurological examination and diagnostic imaging, including CT, a neoplastic lesion involving the third and fourth cervical vertebrae was suspected. The lesion included an extradural mass on the right side of the spinal canal causing a local compression of the cervical cord. Surgery, using a modified dorsal laminectomy procedure, was performed in order to decompress the cervical spinal cord. Histopathological examination of the extradural mass indicated that the tumour was a chondroid chordoma. Following discharge, the quality of life for the dog was very good for a sustained period, but clinical signs recurred at 22 months. The dog was euthanased 25 months post-surgery. On post-mortem examination, a regrowth of neoplastic tissue was found to have infiltrated the bone and spinal cord at C3-C4. This is the first report to show that palliative surgery can offer successful long-lasting treatment of chondroid chordoma of the cervical spine in the dog

Early recurrence of thoracolumbar intervertebral disc extrusion after surgical decompression: a report of three cases

Thoracolumbar disc extrusions were diagnosed in three chondrodystrophic dogs with paraparesis of up to three days duration. All cases were managed by hemilaminectomy and removal of extruded disc material. In one dog, fenestration of the herniated disc space was also performed. Initially neurological function improved or was unchanged, but from two to ten days postoperatively clinical signs of deterioration became apparent. In all the dogs, recurrence of disc extrusion at the same location as the initial extrusion was diagnosed by computer tomography and at a second surgery abundant disc material was found at the hemilaminectomy site between the dura and an implanted graft of autogenous fat

Gastrointestinal stromal tumour and hypoglycemia in a Fjord pony: Case report

<p>Abstract</p> <p>Background</p> <p>Neoplasia may cause hypoglycemia in different species including the horse, but hypoglycemia has not previously been reported in the horse associated with gastrointestinal stromal tumours.</p> <p>Case presentation</p> <p>A case of a gastrointestinal stromal tumour in a Fjord pony with severe recurrent hypoglycemia is presented. The mechanism causing the hypoglycemia was not established.</p> <p>Conclusion</p> <p>This case indicates that a gastrointestinal stromal tumour may cause hypoglycemia also in the horse.</p

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Undersøkelse i barnevernet. En kvalitativ studie om saksbehandleres arbeid i undersøkelsesfasen.

Barneverntjenestene i Norge har myndighet til å gjøre store inngrep i private folks liv. Vurderinger og beslutninger som fattes, kan få konsekvenser for de enkelte barn og familier som kommer i kontakt med tjenesten, som kan oppleves både positivt og negativ. Intensjonen bak og grunnlaget for at vi en skal ha en slik tjeneste er å ivareta barns rettigheter, samt for å sikre gode nok oppvekstvillkår og god nok omsorg. For å ivareta utsatte barn, eller bistå familier og foreldre som har behov for hjelp, er barneverntjenesten en nødvendig og viktig funksjon å ha i et moderne samfunn. Barneverntjenestene har et bredt arbeidsfelt med blant annet myndighet og plikt til å undersøke, iverksette og gjennomføre tiltak, dette vil også innebære tverrfaglig samarbeid med ulike instanser og familiene det gjelder. Dette arbeidsfeltet er komplekst, og det vil naturligvis stille krav til god faglig kompetanse og praksis for å kunne forvalte tjenestens funksjon og oppgaver tilfredsstillende. For å forvalte denne tjenesten har vi egen lovgivning, retningslinjer og egen barnevernspedagogutdanning, slik at det i så måte ligger til rette for god praksisutøving. Imidlertid mangler vi i Norge tilstrekkelig oppdatert forskningsbasert kunnskap i forhold til barneverntjenestens undersøkelsesarbeid. Dette er betenkelig fordi undersøkelsesarbeidet barneverntjenesten gjør, er grunnlaget for vurderinger og beslutninger som tas. For denne studien er tema undersøkelse i barnevernet, der jeg ser nærmere på system for praksis, samt kvalitet og kompetanse for arbeidet. I min studie har jeg benyttet kvalitativt forskningsdesign, med semistrukturerte intervju som datainnsamlingsmetode. Utvalget består av saksbehandlere i den kommunale barneverntjeneste, fra ulike kommuner. Analyse av datamaterialet er utført med systematisk tekstkondensering. I mitt arbeid med denne studien har jeg identifisert to hovedområder, som viser behov for økt kompetanse og økt kvalitet. Resultater i studien viste at det er ulik praksis i hvordan undersøkelsesarbeid gjennomføres, og det fremkom ønske og behov for bedre system/struktur for arbeidet som foreligger per i dag. Teoretisk perspektiv for studien er Bronnfenbrenners økologiske teori om barns utvikling, og det er benyttet ulik relevant teori og litteratur for oppgavens diskusjon av funn. Mine informanter synliggjorde gjennom sine beskrivelser flere felles utfordringer i gjennomføring av sitt arbeid. Blant annet ble det trukket frem malverktøy som er for omfattende og tidskrevende å bruke, og det ble gjort tilfeldig utvalg av malens elementer som ble benyttet i arbeidet. Videre ytret de ønske om en bedre struktur og kompetanse for å benytte slik type verktøy. Det ble også vist til utfordringer i forhold til informasjonsinnhenting, der det ble påpekt at innhenting av opplysninger kunne ta for lang tid, og kan være mangelfull. Funnene viste videre at majoriteten av informantene vektla og var opptatt av samtaler med barna og deres medvirkning, dette gjaldt også i forhold til familier, og det ble uttrykt behov for økt kompetanse i forhold til området.

Uveal myxoid leiomyosarcoma in a horse

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