Hvordan kan den enkelte sykepleier bidra til trygg legemiddelhåndtering ved norske sykehus?

Bakgrunn Hver dag gjøres det feil i legemiddelhåndteringen ved norske sykehus. Gjennom årene på sykepleiestudiet, både i praksis og i jobb, har jeg observert og opplevd situasjoner der legemiddelhåndteringen utføres på måter som øker risikoen for feil. Dette har gjort at jeg har ønsket å undersøke hva sykepleiere kan gjøre for å bidra til trygg legemiddelhåndtering. Hensikt Hensikten med denne oppgaven er å belyse hvordan den enkelte sykepleier kan bidra til trygg håndtering av legemidler. Metode For å besvare denne oppgaven har jeg utført en litteraturstudie, der jeg har analysert fem forskningsartikler som omhandler sykepleieres oppfatninger og erfaringer knyttet til feil ved håndtering av legemidler. Resultater Resultatene viser at sykepleiere opplever at det er mange faktorer som påvirker tryggheten i legemiddelhåndteringen. Det kan knyttes til den enkelte sykepleieren, med faktorer knyttet til nøyaktighet, kunnskap og holdninger, til samarbeid, mellom sykepleiere, tverrfaglig eller med pasienten, og til strukturelle faktorer som arbeidsforhold, arbeidsbelastning og sikkerhetskultur. Jeg fant at travelhet kan knyttes til flere av disse faktorene. Travelheten påvirker hvordan den enkelte sykepleier møter oppgaven med istandgjøring, tilbereding og utdeling av legemidler, og hvor nøye sykepleier utfører kvalitetssikring og kontroll. I tillegg fant jeg at normer og holdninger bør få økt oppmerksomhet, og at sykepleier i større grad må sette spørsmålstegn ved eksisterende sikkerhetskultur i avdelingen

A Song of Ice and a Warm Southern Ocean: The paleoceanographic evolution of the Oligocene–Miocene Southern Ocean

The Oligocene-Miocene (~34-5 Ma) was likely characterized by globally relatively warm temperatures, high and variable CO2 levels (300-750 ppm) and fluctuating Antarctic ice volumes, and can thus function as a past analogues for future climates, considering the projected atmospheric CO2 concentrations for the end of this century and beyond. Yet, fundamental questions remain about the past Southern Ocean structure and its role in the (in)stability of Antarctic ice-sheets from this critical deep time slice. With my collaborators, in this thesis, I provide this context by reconstructing the latitudinal SST gradients, variability and position of ocean frontal systems and oceanic environmental conditions of Tasmanian Gateway and Drake Passage regions of the Southern Ocean from the Late Eocene until Late Miocene (37-5 Ma) using new TEX86-based SSTs and dinoflagellate cyst assemblage data. By quantifying Oligocene to Miocene oceanic conditions from critical locations around Antarctica we provide new insights for an improved mechanistic understanding of Southern Ocean paleoceanographic evolution. This involves new reconstructions of Southern Ocean circulation and frontal system migrations during past warm Oligocene and Miocene climates, which shows us how the southern polar ocean operates under warmer-than-present-day conditions. The information on Southern Ocean sea surface temperature and ecology/environment provided in this thesis can be used as fundamental boundary condition to improve model simulations and to test the fitness of models simulating past oceanographic conditions

Improving Safety by Learning from Automation in Transport Systems with a Focus on Sensemaking and Meaningful Human Control

Automated transport systems are deployed in many areas and transport modes. The predominant engineering perspective has been to automate as much as possible and minimize human interaction. However, a balanced integration between human factors and technology is often missing, as well as the “hand-over” process between humans and machine. The risks of automated and autonomous systems are emerging, and there is a need to explore how risks can be mitigated through design, focusing on sensemaking, meaningful human control and resilience engineering. This chapter presents key issues from an ongoing research project exploring safety, security and human control of autonomous transport systems in road, sea, rail and air. The chapter aims to answer: (1) What are the major safety and security challenges of autonomous industrial transport systems? (2) What can the various transport modes learn from each other? (3) What are suggested key measures related to organizational, technical and human issues? We have performed literature reviews, interviews and reviewed on-going automation projects. We see the importance of involving humans in the loop during design and operations, support sensemaking, focus on learning from projects through data gathering and risk-based regulation. Unanticipated deviations are key challenges in automated systems, together with how to design for human–automation interaction and meaningful user involvement. Limiting the operational envelope seems to be a key issue for successful implementation and operation of autonomous systems.publishedVersio

Probing for proof, plausibility, principle and possibility: a new approach to assessing evidence in a systematic evidence review

This article proposes a new approach to assessing evidence during a systematic evidence review aiming to inform international development policy. Drawing lessons from a number of social science systematic evidence reviews, the paper identifies how the method’s limiting perspective on evidence (including the exclusive focus on ‘golden standard’ empirical information) has serious disadvantages for the usability of evidence reviews for policy. This article aims to provide an alternative framework that allows for a less exclusionary, yet policy-practical way of assessing evidence. We propose four perspectives on evidence, appropriate for different stages in the policy process: principle when setting or prioritising broad policy goals, plausibility when assessing specific future policies, proof when evaluating past policies and possibility when striving for innovation and allowing exchange of ideas

Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries – Study protocol [version 1; referees: 2 approved]

Background. For the last two decades there has been growing interest in governmental and global health stakeholders about the role that performance measurement and management systems can play for the production of high-quality and safely delivered primary care services. Despite recognition and interest, the gaps in evidence in this field of research and practice in low- and middle-income countries remain poorly characterized. This study will develop an evidence gap map in the area of performance management in primary care delivery systems in low- and middle-income countries. Methods. The evidence gap map will follow the methodology developed by 3Ie, the International Initiative for Impact Evaluation, to systematically map evidence and research gaps. The process starts with the development of the scope by creating an evidence-informed framework that helps identify the interventions and outcomes of relevance as well as help define inclusion and exclusion criteria. A search strategy is then developed to guide the systematic search of the literature, covering the following databases: Medline (Ovid), Embase (Ovid), CAB Global Health (Ovid), CINAHL (Ebsco), Cochrane Library, Scopus (Elsevier), and Econlit (Ovid). Sources of grey literature are also searched. Studies that meet the inclusion criteria are systematically coded, extracting data on intervention, outcome, measures, context, geography, equity, and study design. Systematic reviews are also critically appraised using an existing standard checklist. Impact evaluations are not appraised but will be coded according to study design. The process of map-building ends with the creation of an evidence gap map graphic that displays the available evidence according to the intervention and outcome framework of interest. Discussion. Applications arising from the evidence map will be discussed in a separate paper that will summarize findings and make recommendations for the development of a prioritized research agenda

Strengthening women's empowerment and gender equality in fragile contexts towards peaceful and inclusive societies: A systematic review and meta-analysis

Background Across the globe, gender disparities still exist with regard to equitable access to resources, participation in decision-making processes, and gender and sexual-based violence. This is particularly true in fragile and conflict-affected settings, where women and girls are affected by both fragility and conflict in unique ways. While women have been acknowledged as key actors in peace processes and post-conflict reconstruction (e.g., through the United Nations Security Council Resolution 1325 and the Women, Peace and Security Agenda) evidence on the effectiveness of gender-specific and gender-transformative interventions to improve women's empowerment in fragile and conflict-affected states and situations (FCAS) remains understudied. Objectives The purpose of this review was to synthesize the body of evidence around gender-specific and gender-transformative interventions aimed at improving women's empowerment in fragile and conflict-affected settings with high levels of gender inequality. We also aimed to identify barriers and facilitators that could affect the effectiveness of these interventions and to provide implications for policy, practice and research designs within the field of transitional aid. Methods We searched for and screened over 100,000 experimental and quasi-experimental studies focused on FCAS at the individual and community levels. We used standard methodological procedures outlined by the Campbell Collaboration for the data collection and analysis, including quantitative and qualitative analyses, and completed the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology to assess the certainty around each body of evidence. Results We identified 104 impact evaluations (75% randomised controlled trials) assessing the effects of 14 different types of interventions in FCAS. About 28% of included studies were assessed as having a high risk of bias (45% among quasi-experimental designs). Interventions supporting women's empowerment and gender equality in FCAS produced positive effects on the outcomes related to the primary focus of the intervention. There are no significant negative effects of any included interventions. However, we observe smaller effects on behavioural outcomes further along the causal chain of empowerment. Qualitative syntheses indicated that gender norms and practices are potential barriers to intervention effectiveness, while working with local powers and institutions can facilitate the uptake and legitimacy of interventions. Conclusions We observe gaps of rigorous evidence in certain regions (notably MENA and Latin America) and in interventions specifically targeting women as actors of peacebuilding. Gender norms and practices are important elements to consider in programme design and implementation to maximise potential benefits: focusing on empowerment only might not be enough in the absence of targeting the restrictive gender norms and practices that may undermine intervention effectiveness. Lastly, programme designers and implementation should consider explicitly targeting specific empowerment outcomes, promoting social capital and exchange, and tailoring the intervention components to the desired empowerment-related outcomes

Current use was established and Cochrane guidance on selection of social theories for systematic reviews of complex interventions was developed

Objective: To identify examples of how social theories are used in systematic reviews of complex interventions to inform production of Cochrane guidance. Study Design and Setting: Secondary analysis of published/unpublished examples of theories of social phenomena for use in reviews of complex interventions identified through scoping searches, engagement with key authors and methodologists supplemented by snowball- ing and reference searching. Theories were classified (low-level, mid-range, grand). Results: Over 100 theories were identified with evidence of proliferation over the last 5 years. New low-level theories (tools, taxon- omies, etc) have been developed for classifying and reporting complex interventions. Numerous mid-range theories are used; one example demonstrated how control theory had changed the review’s findings. Review-specific logic models are increasingly used, but these can be challenging to develop. New low-level and mid-range psychological theories of behavior change are evolving. No reviews using grand the- ory (e.g., feminist theory) were identified. We produced a searchable Wiki, Mendeley Inventory, and Cochrane guidance. Conclusions: Use of low-level theory is common and evolving; incorporation of mid-range theory is still the exception rather than the norm. Methodological work is needed to evaluate the contribution of theory. Choice of theory reflects personal preference; application of theory is a skilled endeavor

Identifying an essential package for school-age child health: economic analysis

This chapter presents the investment case for providing an integrated package of essential health services for children attending primary schools in low- and middle- income countries (LMICs). In doing so, it builds on chapter 20 in this volume (Bundy, Schultz, and others 2017), which presents a range of relevant health services for the school- age population and the economic rationale for adminis- tering them through educational systems. This chapter identifies a package of essential health services that low- and middle-income countries (LMICs) can aspire to implement through the primary and secondary school platforms. In addition, the chapter considers the design of such programs, including targeting strategies. Upper- middle-income countries and high-income countries (HICs) typically aim to implement such interventions on a larger scale and to include and promote additional health services relevant to their populations. Studies have docu- mented the contribution of school health interventions to a range of child health and educational outcomes, partic- ularly in the United States (Durlak and others 2011; Murray and others 2007; Shackleton and others 2016). Health services selected for the essential package are those that have demonstrated benefits and relevance for children in LMICs. The estimated costs of implementation are drawn from the academic literature. The concept of a package of essential school health interventions and its justification through a cost-benefit perspective was pioneered by Jamison and Leslie (1990). As chapter 20 notes, health services for school-age children can promote educational outcomes, including access, attendance, and academic achievement, by mitigat- ing earlier nutrition and health deprivations and by addressing current infections and nutritional deficiencies (Bundy, Schultz, and others 2017). This age group is partic- ularly at risk for parasitic helminth infections (Jukes, Drake, and Bundy 2008), and malaria has become prevalent in school-age populations as control for younger children delays the acquisition of immunity from early childhood to school age (Brooker and others 2017). Furthermore, school health services are commonly viewed as a means for build- ing and reinforcing healthy habits to lower the risk of non- communicable disease later in life (Bundy 2011). This chapter focuses on packages and programs to reach school-age children, while the previous chapter, chapter 24 (Horton and Black 2017), focuses on early childhood inter- ventions, and the next chapter, chapter 26 (Horton and others 2017), focuses on adolescent interventions. These packages are all part of the same continuum of care from age 5 years to early adulthood, as discussed in chapter 1 (Bundy, de Silva, and others 2017). A particular emphasis of the economic rationale for targeting school-age children is to promote their health and education while they are in the process of learning; many of the interventions that are part of the package have been shown to yield substantial benefits in educational outcomes (Bundy 2011; Jukes, Drake, and Bundy 2008). They might be viewed as health interventions that leverage the investment in education. Schools are an effective platform through which to deliver the essential package of health and nutrition ser- vices (Bundy, Schultz, and others 2017). Primary enroll- ment and attendance rates increased substantially during the Millennium Development Goals era, making schools a delivery platform with the potential to reach large num- bers of children equitably. Furthermore, unlike health centers, almost every community has a primary school, and teachers can be trained to deliver simple health inter- ventions, resulting in the potential for high returns for relatively low costs by using the existing infrastructure. This chapter identifies a core set of interventions for children ages 5–14 years that can be delivered effectively through schools. It then simulates the returns to health and education and benchmarks them against the costs of the intervention, drawing on published estimates. The invest- ment returns illustrate the scale of returns provided by school-based health interventions, highlighting the value of integrated health services and the parameters driving costs, benefits, and value for money (the ratio of benefits to costs). Countries seeking to introduce such a package need to undertake context-specific analyses of critical needs to ensure that the package responds to the specific local needs