Er det mulig å yte faglig forsvarlig sykepleie i sykehus hvor økonomistyring og effektivitet er sentrale faktorer?

Gjennom vår sykepleiepraksis har vi erfart at arbeidslivet kan være krevende og belastende. Vi har opplevd korridorpasienter, tidsmangel og arbeidspress. Vi har fått inntrykk av at mange sykepleiere sliter med følelsen av å ikke ha nok tid til hver enkelt pasient. De kjenner på at de ikke får utført jobben slik de ideelt sett skulle ønske. Mange føler også at de har et stort ansvar og er redde for å gjøre feil som kan skade pasientene. Media gir oss et bilde av stadige omorganiseringer og effektiviseringsprosesser. Roness (2004) skriver at det offentlige i tillegg er rammet av harde nedskjæringer og et hektisk arbeidstempo der flere pasienter per sykepleier ofte er en realitet. Vi har en formening om at helseøkonomien og effektiviseringen kan være årsaken til forholdene som Roness (2004) beskriver, og at dette kan påvirke den faglige forsvarligheten. Problemstillingen er dagsaktuell og temaet er viktig å rette fokus på, for oss som framtidige sykepleiere og for pasientenes framtid. 1.

Long-Term Followup with Evaluation of the Surgical and Functional Results of the Ileal Pouch Reservoir in Restorative Proctocolectomy for Ulcerative Colitis

Aims. Evaluate the early and long term surgical and functional results of the ileal pouch-reservoir (IPAA) in patients with intractable ulcerative colitis. Material and Methods. Followup of 134 consecutive patients with W-or J-ileal pouch by diseases-specific and general health (SF-36) questionnaire. In the first 44 patients, early and late followup was performed. Results. Followup was performed 7.4 years (0.5–17 years) after construction of W (n = 9) and J (n = 125) ileal pouch, which had similar results. There were 14.9% early and 43.6% late complications with 12.7% early and 19.5% late reoperations. Protecting loop-ileostomy used in 54 patients (43.9%), did not protect against complications. Thirteen reservoirs (9.8%) were resected (n = 8) or deactivated (n = 5) due to functional failure. Operation time, postoperative complications and pouchitis were determinators for reservoir failure and reduced quality of life. The functional results at followup of 44 patients at 2.5 years (0.8–6.7 years) and 11.5 years (8.2–19.2 years) were remarkably similar. Conclusions. IPAA is a good option for most patients when medication fails. 10% experience failure with inferior quality of life. Protective stoma will not reduce failure rates. After an initial time period, reservoir function will not change over time

Dietary patterns related to biological mechanisms and survival after breast cancer diagnosis: results from a cohort study

BackgroundInflammatory, insulin and oestrogenic pathways have been linked to breast cancer (BC). We aimed to examine the relationship between pre-diagnostic dietary patterns related to these mechanisms and BC survival.MethodsThe diabetes risk reduction diet (DRRD), inflammatory score of diet (ISD) and oestrogen-related dietary pattern (ERDP) were calculated using dietary data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Cox proportional hazards models were used to assess associations between dietary patterns and overall mortality and competing risk models for associations with BC-specific mortality.ResultsWe included 13,270 BC cases with a mean follow-up after diagnosis of 8.6 years, representing 2340 total deaths, including 1475 BC deaths. Higher adherence to the DRRD score was associated with lower overall mortality (HR1-SD 0.92; 95%CI 0.87-0.96). Greater adherence to pro-inflammatory diets was borderline associated with 6% higher mortality HR1-SD 1.06; 95%CI 1.00-1.12. No significant association with the oestrogen-related dietary pattern was observed. None of the dietary patterns were associated with BC-specific mortality.ConclusionsGreater adherence to an anti-diabetic and anti-inflammatory diet prior to diagnosis is associated with lower overall mortality among BC survivors. Long-term adherence to these dietary patterns could be a means to improve the prognosis of BC survivors

Timing of eating across ten European countries - results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study

Objective To examine timing of eating across ten European countries. Design Cross-sectional analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study using standardized 24 h diet recalls collected during 1995-2000. Eleven predefined food consumption occasions were assessed during the recall interview. We present time of consumption of meals and snacks as well as the later:earlier energy intake ratio, with earlier and later intakes defined as 06.00-14.00 and 15.00-24.00 hours, respectively. Type III tests were used to examine associations of sociodemographic, lifestyle and health variables with timing of energy intake. Setting Ten Western European countries. Subjects In total, 22 985 women and 13 035 men aged 35-74 years (n 36 020). Results A south-north gradient was observed for timing of eating, with later consumption of meals and snacks in Mediterranean countries compared with Central and Northern European countries. However, the energy load was reversed, with the later:earlier energy intake ratio ranging from 0 center dot 68 (France) to 1 center dot 39 (Norway) among women, and from 0 center dot 71 (Greece) to 1 center dot 35 (the Netherlands) among men. Among women, country, age, education, marital status, smoking, day of recall and season were all independently associated with timing of energy intake (all PPeer reviewe

Associations between dietary inflammatory scores and biomarkers of inflammation in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Background: Since the first version of the dietary inflammatory index (DII & REG;) developed in the past decade, several other versions have been developed. However, to date no study has attempted to compare these versions with respect to their associations with biomarkers of inflammation. Objective: We aimed to investigate the relationship between four dietary inflammatory scores [DII, two energy-adjusted derivatives (E-DII and E-DIIr), and the Inflammatory Score of the Diet (ISD)], and circulating levels of several inflammatory markers and adipokines. Methods: This study included 17 637 participants from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort with at least one marker of inflammation measured in blood. Associations between the four scores and C-reactive protein (CRP), interleukin (IL)6, IL10, IL1RA, tumor necrosis factor-a (TNFa), soluble tumor necrosis factor receptor-1 (sTNFR1), sTNFR2, leptin, soluble leptin receptor (sLeptin R), adiponectin, and High Molecular Weight (HMW) adiponectin were evaluated using multivariable linear regressions adjusted for potential confounders. Results: Positive associations were observed between the four dietary inflammatory scores and levels of CRP, IL6, sTNFR1, sTNFR2 and leptin. However, only the DII and the ISD were positively associated with IL1RA levels and only the DII and the E-DIIr were positively associated with TNFa levels. The proportion of variance of each biomarker explained by the scores was lower than 2%, which was equivalent to the Conclusions: Our results suggest that the four dietary inflammatory scores were associated with some biomarkers of inflammation and could be used to assess the inflammatory potential of diet in European adults but are not sufficient to capture the inflammatory status of an individual. These findings can help to better understand the inflammatory potential of diet, but they need to be replicated in studies with repeated dietary measurements. Crown Copyright & COPY; 2023 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-N

A Framework for the Development, Design and Implementation of a Sustained Arctic Ocean Observing System

Rapid Arctic warming drives profound change in the marine environment that have significant socio-economic impacts within the Arctic and beyond, including climate and weather hazards, food security, transportation, infrastructure planning and resource extraction. These concerns drive efforts to understand and predict Arctic environmental change and motivate development of an Arctic Region Component of the Global Ocean Observing System (ARCGOOS) capable of collecting the broad, sustained observations needed to support these endeavors. This paper provides a roadmap for establishing the ARCGOOS. ARCGOOS development must be underpinned by a broadly-endorsed framework grounded in high-level policy drivers and the scientific and operational objectives that stem from them. This should be guided by a transparent, internationally accepted governance structure with recognized authority and organizational relationships with the national agencies that ultimately execute network plans. A governance model for ARCGOOS must guide selection of objectives, assess performance and fitness-to-purpose, and advocate for resources. A requirements-based framework for an ARCGOOS begins with the Societal Benefit Areas (SBAs) that underpin the system. SBAs motivate investments and define the system's science and operational objectives. Objectives can then be used to identify key observables and their scope. The domains of planning/policy, strategy, and tactics define scope ranging from decades and basins to focused observing with near real time data delivery. Patterns emerge when this analysis is integrated across an appropriate set of SBAs and science/operational objectives, identifying impactful variables and the scope of the measurements. When weighted for technological readiness and logistical feasibility, this can be used to select Essential ARCGOOS Variables, analogous to Essential Ocean Variables of the Global Ocean Observing System. The Arctic presents distinct needs and challenges, demanding novel observing strategies. Cost, traceability and ability to integrate region-specific knowledge have to be balanced, in an approach that builds on existing and new observing infrastructure. ARCGOOS should benefit from established data infrastructures following the Findable, Accessible, Interoperable, Reuseable Principles to ensure preservation and sharing of data and derived products. Linking to the Sustaining Arctic Observing Networks (SAON) process and involving Arctic stakeholders, for example through liaison with the International Arctic Science Committee (IASC), can help ensure success

A new model of patient-reported outcome monitoring with a clinical feedback system in ostomy care: rationale, description and evaluation protocol

Background Living with an ostomy can be challenging and adapting to life with an ostomy can be particularly complex, with regard to both the physical and psychosocial aspects. Follow-up with a stoma care nurse (SCN) is usually performed after surgery to support the adaptation process. In the present paper, we describe a new model of ostomy care, where a clinical feedback system (CFS) is implemented in order to improve the adaption process of patients with an ostomy. We also present a plan for evaluating patients experience with the CFS and their clinical outcomes. Methods In this study, we include patients who had recently performed colostomy, ileostomy, or urostomy surgery. The intervention includes self-reported measures for adaptation to life with an ostomy and health-related quality of life (HRQoL), as well as patient experiences and satisfaction recorded by the clinical feedback system. The measures are electronically assessed before each clinical consultation at 3, 6, and 12 months after surgery. The scores are instantly analysed and graphically presented for use during the consultation and the patient and the SCN can discuss the findings. Patient experiences and satisfaction with care will be measured with the Generic Short Patient Experiences Questionnaire. Adaptation to the life with ostomy will be measured with the Ostomy Adjustment Scale, and HRQoL with the Short Form 36. Discussion This study presents a novel approach that could lead to improved consultation, more patient involvement, and better adaptation to life with an ostomy

Psychometric Properties of New Subscales of the Ostomy Adjustment Scale: A Cross-Sectional Study

Background: The Ostomy Adjustment Scale (OAS), which consists of an overall sum score along with 34 single-item scores, has been frequently used to measure self-reported adjustment to life with an ostomy. However, it is unknown whether the OAS can be divided into meaningful thematic subscales that may make it easier to administer and to apply in a clinical feedback system. Purpose: The purpose of this study was to specify thematic OAS subscales and evaluate their psychometric properties. Patients and Methods: A cross-sectional study was conducted with 302 patients across Norway having colostomy, ileostomy, or urostomy. The OAS items were divided into different subscales by expert nurses and patients based on clinical and theoretical considerations. The overall structural validity of this analysis of the OAS was examined using robust confirmatory factor analysis. We evaluated the overall goodness of fit using the root mean square error of approximation (RMSEA), the comparative fit index (CFI) and the Tucker–Lewis index (TLI). Factor loadings from the confirmatory factor analysis were used to calculate composite reliability values for the new OAS scales. Results: The OAS was divided into seven subscales. The overall structure validity was acceptable with RMSEA = 0.053 (90% CI, 0.045– 0.060), CFI = 0.913 and TLI = 0.904. The composite reliability values of all scales were > 0.70. Conclusions: The OAS can be divided into seven clinically meaningful subscales with acceptable psychometric properties. Trial Register: ClinicalTrials.gov Registration Number: NCT03841071. Date 18. February 2019 retrospectively registered