Sjuksköterskans roll i det multiprofessionella teamet - en litteraturstudie

Dagens hälso- och sjukvård fordrar en allt mer avancerad vårdform för att kunna tillgodose patienters behov. Det krävs en samverkan mellan professioner och svaret är ett välfungerande multiprofessionellt team som arbetar mot ett gemensamt mål, en personcentrerad och säker vård. Sjuksköterskan har i och med sin kompetens en central roll i det multiprofessionella teamet och ansvarar bland annat för att se till helheten samt föra patientens talan till teamet. Syftet med denna litteraturstudie var att undersöka vad som möjliggör respektive hindrar sjuksköterskan till att ha en tydlig roll i det multiprofessionella teamet. En litteraturstudie gjordes över åtta vetenskapliga artiklar. Resultatet visade att de fyra huvudsakliga faktorerna som möjliggör en tydlig roll för sjuksköterskan i det multiprofessionella teamet är en god kommunikation, en välfungerande organisation, personliga egenskaper och att det finns respekt och förtroende mellan teammedlemmarna. Om dessa faktorer inte finns eller fungerar blir det ett hinder. Det finns ett behov av att förtydliga sjuksköterskans roll i det multiprofessionella teamet vilket kräver ett engagemang som sträcker sig från en organisatorisk nivå till varje enskild individ i teamet

PeRL:A circum-Arctic Permafrost Region Pond and Lake database

Ponds and lakes are abundant in Arctic permafrost lowlands. They play an important role in Arctic wetland ecosystems by regulating carbon, water, and energy fluxes and providing freshwater habitats. However, ponds, i.e., waterbodies with surface areas smaller than 1. 0 × 104ĝ€m2, have not been inventoried on global and regional scales. The Permafrost Region Pond and Lake (PeRL) database presents the results of a circum-Arctic effort to map ponds and lakes from modern (2002-2013) high-resolution aerial and satellite imagery with a resolution of 5ĝ€m or better. The database also includes historical imagery from 1948 to 1965 with a resolution of 6ĝ€m or better. PeRL includes 69 maps covering a wide range of environmental conditions from tundra to boreal regions and from continuous to discontinuous permafrost zones. Waterbody maps are linked to regional permafrost landscape maps which provide information on permafrost extent, ground ice volume, geology, and lithology. This paper describes waterbody classification and accuracy, and presents statistics of waterbody distribution for each site. Maps of permafrost landscapes in Alaska, Canada, and Russia are used to extrapolate waterbody statistics from the site level to regional landscape units. PeRL presents pond and lake estimates for a total area of 1. 4 × 106ĝ€km2 across the Arctic, about 17ĝ€% of the Arctic lowland ( < ĝ€300ĝ€mĝ€a.s.l.) land surface area. PeRL waterbodies with sizes of 1. 0 × 106ĝ€m2 down to 1. 0 × 102ĝ€m2 contributed up to 21ĝ€% to the total water fraction. Waterbody density ranged from 1. 0 × 10 to 9. 4 × 101ĝ€kmĝ'2. Ponds are the dominant waterbody type by number in all landscapes representing 45-99ĝ€% of the total waterbody number. The implementation of PeRL size distributions in land surface models will greatly improve the investigation and projection of surface inundation and carbon fluxes in permafrost lowlands. Waterbody maps, study area boundaries, and maps of regional permafrost landscapes including detailed metadata are available at https://doi.pangaea.de/10.1594/PANGAEA.868349

Vrak och skeppsbrott

Vrak och skeppsbrott Innehållsförteckning – Inledaren: Idioti som kan föra skärgården på grund av Pia Prost och Nina Söderlund – Vrak i Finland Anna Moa Westerlund-Rönnberg – Vrak som hobby av Risto Sajaniemi – På dykresa i Skärgårdshavet av Pia Prost och Erik Saanila – Alfred – det kungliga vraket av Johnny Strömborg och Erik Saanila – Skeppsbrott och vrakplundring på medeltida Östersjön av Mikko Huhtamies – Vrak i åländska vatten av Marcus Lindholm – Champagnegaleasen av Kristin Ilves – Vrakturism inom projektet BALTACAR av Pernilla Flyg – Vrakpark vid Gråhara i Finska vikens stora grav av Thure Malmberg – Tsaren på grund av Anders Moliis-Mellberg – I Östersjöns stenigaste farvatten av Iris Sjöberg – Vraken ger platserna själ av Carola Sundqvist – Stolta minnen och förälskade sjömän av Cecilia Lundberg – Bomans på Tornskär av Pia Prost – Gustavsvärns historia av Thure Malmberg – Människan och havet av Anna Törnroos-Remes & Nina Tynkkynen – Vinden Drar – 34 år med nordiska allmogebåtar av Bosse Mellberg – Världsarvsporten har öppnats av Pia Prost – Skärinytt – Sista bilden av Julia Ajank

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

"Mamman är the good guy" : En kvalitativ studie om genusbias i barnhandläggares arbete med mammor och pappor

Studiens syfte var att undersöka hur barnhandläggares normer och föreställningar om föräldrarnas kön påverkar arbetet med barnärenden inom socialtjänsten. För att uppnå syftet genomfördes åtta enskilda intervjuer med yrkesverksamma barnhandläggare från sju olika kommuners socialtjänster i Mellansverige. Förväntningar på mammor respektive pappor undersöktes och dess eventuella påverkan på bemötandet, föräldrarnas delaktighet och bedömningen av föräldraförmågan. Intervjuerna baserades på vanliga intervjufrågor och två olika vinjetter där en familjesituation beskrevs, det som skiljde vinjetterna åt var att föräldrarna bytte roller. Empirin analyserades utifrån genusteorin som fördjupades i genussystemet och stereotyper. Resultatet påvisade genusbias existens gentemot föräldrar. Vinjetterna tolkades olika utifrån föräldrarnas kön. Vidare tillskrevs inte mammor och pappor samma krav, ansvar eller koll på barnen, då mammor framställdes som huvudsakliga omsorgsgivare. Mammortillskrevs högre krav på föräldraskapet och därmed döms hårdare vid misstag. De visade sig också mer involverade i arbetet, eftersom barnhandläggarna främst kontaktar dem eller att mammorna själva initierade mer kontakt. Arbetssätten för att uppnå en jämställd socialtjänst varierade. Fåtal arbetsplatser arbetade aktivt med detta, medan majoriteten lämnade ansvaret på barnhandläggarna själva. Slutsatsen visar att den traditionella bilden av mammor som primära omsorgsgivare fortfarande påverkar hur samhället och därigenom barnhandläggare ser föräldrarna. Jämställdhetsarbetet gentemot föräldrar är ett bortprioriterat fält som kräver förändringar om föräldrarna ska ses som jämlikar. The aim of the study was to investigate how child caseworkers' (CC) norms and perceptions of parents' gender influence their work with child cases within social services. To achieve this eight interviews were conducted with CC from the social services of seven different municipalities in central Sweden. Expectations of mothers and fathers were examined, along with their potential impact on interactions, parental involvement, and the assessment of parenting abilities. The interviews were based on standard questions and two vignettes describing a family situation, differing only in the parents’ swapping roles. The empirical data was analyzed using gender theory, delving into gender systems and stereotypes. The results indicated the existence of gender bias towards parents. The vignettes were interpreted differently based on the parents' gender. Furthermore, mothers and fathers were not held to the same standards, responsibilities, or level of awareness of their children, as mothers were portrayed as the primary caregivers. Mothers were subject to higher parenting expectations and thus faced harsher judgment for mistakes. Mothers were also more involved in the process, as CC primarily contacted them, or mothers themselves initiated more contact. Methods to achieve gender equality in social services varied. Few workplaces actively worked toward this goal,while the majority left the responsibility to the CC themselves. The conclusion highlights that the traditional image of mothers as primary caregivers still influences societal and professional perceptions of parents. Gender equality work towards parents is a neglected area that requires changes if parents are to be seen as equals