Sjuksköterskors erfarenhet av förebyggandeomvårdnadsåtgärder mot trycksår och undernäring: - En litteraturöversikt

Background: There is an established correlation between malnutrition and development of pressure ulcers. The incidence of malnutrition among patients has increased in recent years despite that risk assessment instruments exist in the organisations. Pressure ulcers remain one of the most common adverse event with a negative impact on the patients’ quality of life and lack of patient-safety. Aim: The aim of this study was to describe nurses’ work on preventive measures against pressure ulcers and malnutrition. Method: The study was conducted as a literature review including 19 articles, published between 2008-2018, with quantitative, qualitative and mixed-methods approaches. Searches were made in the PubMed and CINAHL databases. The articles were quality-reviewed, analyzed and compiled into a result. Results: Nurses appear to have positive attitudes to preventive measures towards pressure ulcers and malnutrition while the level of knowledge was generally low. Nurses valued their own clinical judgement high and felt that lack of time, high workload and severely ill patients constituted obstacles to adequate application of preventive measures. Organisational shortcomings emerged for the adequate use and implementation of risk assessment instruments. Lack of guidelines and work routines for preventive work could result in a deficient patient safety. Conclusion: The results show that the majority of nurses value nutrition in the preventive work but the level of knowledge and the application of measures were generally low. Introduction of guidelines could lead to increased knowledge and implementation of pressure ulcers and nutritional treatment in clinical work

Anchorage effectiveness of orthodontic miniscrews compared to headgear and transpalatal arches:a systematic review and meta-analysis

Background: Anchorage in orthodontics can be provided through several extra- and intra-oral sources including headgear, teeth, cortical bone and soft tissue. Objective: The aim of this review was to systematically review the effectiveness of miniscrews in reinforcing anchorage during en-masse retraction of anterior teeth in comparison to conventional anchorage appliances. Search method: Comprehensive searching of the electronic databases was undertaken up to March 2018 in the Cochrane Database of Systematic review, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed and Scopus databases. Additional searching for on-going and unpublished data and hand search of relevant journals were also undertaken, authors were contacted, and reference lists screened. Eligibility criteria: Searches were restricted to randomized clinical trials (RCTs) published in English, which compared anchorage reinforcement using mechanically-retained miniscrews (diameter of 2 mm or less) to conventional anchorage appliances during en-masse retraction of anterior teeth in participants of any age treated with fixed appliances combined with extraction of maxillary premolars. Data collection and analysis: Blind and induplicate study selection, data extraction and risk of bias assessment were undertaken. The primary outcome was the amount of mesial movement of the upper first permanent molar (anchorage loss) while secondary outcomes included treatment duration, number of visits, adverse effects and patient-centered outcomes. The risk of bias was assessed using Cochrane risk of bias tool. A random-effects model with its corresponding 95% confidence interval (CI) were generated for comparable outcomes. Statistical heterogeneity across the studies were assessed using the I2 and Chi2 test. Additional sensitivity tests were implemented. Results: Seven RCTs met the inclusion criteria, however, data of 241 participants from 6 RCTs (250 miniscrews and 134 conventional anchorage appliances) were meta-analyzed. Qualities of the included RCTs varied from low to high. The standardized mean difference (SMD) of the anchrage loss between the two intervention groups was 2.07 mm ((95% CI (–3.05) to (–1.08), p I2 = 88%, 6 RCTs)) in favour of miniscrews, which was also preserved after excluding the high risk of bias studies (SMD 1.94 mm, 95% CI (–2.46) to (–0.42) p I2 = 93%, 3 RCTs)). Information on overall treatment duration, space closure duration, quality of treatment, patient-reported outcomes, adverse effects and number of visit were limited. Conclusion: The result of the meta-analysis suggested that there is moderate quality of evidence that miniscrews are clinically and statistically more effective in preserving orthodontic anchorage than conventional appliances. However, this conclusion is supported by a small number of studies with variable qualities. High-quality RCTs would give a better understanding of miniscrews effectiveness in providing orthodontic anchorage.</p

Current constraints on Cosmological Parameters from Microwave Background Anisotropies

We compare the latest observations of Cosmic Microwave Background (CMB) Anisotropies with the theoretical predictions of the standard scenario of structure formation. Assuming a primordial power spectrum of adiabatic perturbations we found that the total energy density is constrained to be $\Omega_{tot}=1.03\pm0.06$ while the energy density in baryon and Cold Dark Matter (CDM) are $\Omega_bh^2=0.021\pm0.003$ and $\Omega_{cdm}h^2=0.12\pm0.02$, (all at 68% C.L.) respectively. The primordial spectrum is consistent with scale invariance, ($n_s=0.97\pm0.04$) and the age of the universe is $t_0=14.6\pm0.9$ Gyrs. Adding informations from Large Scale Structure and Supernovae, we found a strong evidence for a cosmological constant $\Omega_{\Lambda}=0.70_{-0.05}^{+0.07}$ and a value of the Hubble parameter $h=0.69\pm0.07$. Restricting this combined analysis to flat universes, we put constraints on possible 'extensions' of the standard scenario. A gravity waves contribution to the quadrupole anisotropy is limited to be $r \le 0.42$ (95% c.l.). A constant equation of state for the dark energy component is bound to be $w_Q \le -0.74$ (95% c.l.). We constrain the effective relativistic degrees of freedom $N_\nu \leq 6.2$ and the neutrino chemical potential $-0.01 \leq \xi_e \leq 0.18$ and $|\xi_{\mu,\tau}|\leq 2.3$ (massless neutrinos).Comment: The status of cosmological parameters before WMAP. In press on Phys. Rev. D., Rapid Communication, 6 pages, 5 figure

High sensitivity measurements of the CMB power spectrum with the extended Very Small Array

We present deep Ka-band ($\nu \approx 33$ GHz) observations of the CMB made with the extended Very Small Array (VSA). This configuration produces a naturally weighted synthesized FWHM beamwidth of $\sim 11$ arcmin which covers an $\ell$-range of 300 to 1500. On these scales, foreground extragalactic sources can be a major source of contamination to the CMB anisotropy. This problem has been alleviated by identifying sources at 15 GHz with the Ryle Telescope and then monitoring these sources at 33 GHz using a single baseline interferometer co-located with the VSA. Sources with flux densities \gtsim 20 mJy at 33 GHz are subtracted from the data. In addition, we calculate a statistical correction for the small residual contribution from weaker sources that are below the detection limit of the survey. The CMB power spectrum corrected for Galactic foregrounds and extragalactic point sources is presented. A total $\ell$-range of 150-1500 is achieved by combining the complete extended array data with earlier VSA data in a compact configuration. Our resolution of $\Delta \ell \approx 60$ allows the first 3 acoustic peaks to be clearly delineated. The is achieved by using mosaiced observations in 7 regions covering a total area of 82 sq. degrees. There is good agreement with WMAP data up to $\ell=700$ where WMAP data run out of resolution. For higher $\ell$-values out to $\ell = 1500$, the agreement in power spectrum amplitudes with other experiments is also very good despite differences in frequency and observing technique.Comment: 16 pages. Accepted in MNRAS (minor revisions

Facilitators and Pitfalls in the Use of Consultation Strategies : Prospective Special Educators’ Self-Reflections on Audio-recorded Consultation Sessions

acceptedVersio

To be an immigrant and a patient in Sweden: A study with an individualised perspective

The aim is to describe how experiences of being an immigrant can influence the situation when becoming a patient in Swedish health care. A hermeneutic approach was used. Sixteen persons born in non-Nordic countries were interviewed. The data was analysed with an empirical hermeneutical method. The findings indicate that positive experiences (i.e., establishing oneself in a new home country) enhance the possibilities of taking part in caring situations and vice versa. Hence, there is a need for individually adapted care that takes one's whole life situation into consideration. Consequently, it is suggested that the concept, “cultural competence” merely serves the purpose of illuminating caregivers' need for categorisation. It does not illuminate individual needs in a caring situation

The State of the Dark Energy Equation of State

By combining data from seven cosmic microwave background experiments (including the latest WMAP results) with large scale structure data, the Hubble parameter measurement from the Hubble Space Telescope and luminosity measurements of Type Ia supernovae we demonstrate the bounds on the dark energy equation of state $w_Q$ to be $-1.38< w_Q <-0.82$ at the 95% confidence level. Although our limit on $w_Q$ is improved with respect to previous analyses, cosmological data does not rule out the possibility that the equation of state parameter $w_Q$ of the dark energy $Q$ is less than -1. We present a tracking model that ensures $w_Q \le -1$ at recent times and discuss the observational consequences.Comment: 7 pages, 4 figures, added a referenc

Constraining the shape of the CMB: a Peak-by-Peak analysis

The recent measurements of the power spectrum of Cosmic Microwave Background anisotropies are consistent with the simplest inflationary scenario and big bang nucleosynthesis constraints. However, these results rely on the assumption of a class of models based on primordial adiabatic perturbations, cold dark matter and a cosmological constant. In this paper we investigate the need for deviations from the $\Lambda$-CDM scenario by first characterizing the spectrum using a phenomenological function in a 15 dimensional parameter space. Using a Monte Carlo Markov chain approach to Bayesian inference and a low curvature model template we then check for the presence of new physics and/or systematics in the CMB data. We find an almost perfect consistency between the phenomenological fits and the standard $\Lambda$-CDM models. The improved spectral resolution expected from future satellite experiments is warranted for a definitive test of the scenario.Comment: 11 pages, 9 figures. Revised version with results from latest Cosmic Microwave Background experiments. Version with High-Res figures from http://www.mrao.cam.ac.uk/~cjo2