Etterlevelse av sjekklisten Trygg Kirurgi - Operasjonssykepleiernes erfaringer

Bakgrunn: I 2008 utviklet Verdens helseorganisasjon (WHO) en sjekkliste for trygg kirurgi på bakgrunn av tilbakemeldinger om pasientskader og utilstrekkelig pasientsikkerhet ved kirurgiske inngrep. Sjekklisten sin intensjon er å øke pasientsikkerheten på operasjonsavdelingen ved å forbedre sikkerhetsrutiner og kvalitetssikre alle prosesser ved et kirurgisk inngrep, samt styrke teamsamarbeid og kommunikasjon. Formål og problemstilling: Formålet med denne studien var å undersøke hvilke erfaringer operasjonssykepleieren har med gjennomgangen og bruken av sjekklisten Trygg Kirurgi. I denne studien ble følgende problemstilling besvart: “Hvordan opplever og erfarer operasjonssykepleierne gjennomgangen og bruken av sjekklisten Trygg Kirurgi?” Metode: Vi har brukt kvalitativ metode for å besvare studiens problemstilling. Det er gjennomført 8 semistrukturerte intervjuer med operasjonssykepleiere ved et universitetssykehus i Norge. Datamaterialet ble transkribert og analysert etter Graneheim & Lundman’s kvalitative innholdsanalyse. Funn: Funnene viser at operasjonssykepleierne erfarer at sjekklisten Trygg Kirurgi skaper en individuell pasientbehandling samt forbedrer sikkerhetsrutinene på operasjonsstuen. Sjekklisten samler teamet ved å gi alle en felles forståelse for hva som skal skje, men det kommer frem utfordringer relatert til bruken og gjennomføringen av sjekklisten. Det kommer også frem utfordringer knyttet til holdninger og respekt for operasjonssykepleiernes arbeidsoppgaver. Konklusjon: Sjekklisten Trygg Kirurgi er et viktig verktøy som bidrar til å øke pasientsikkerheten. Bruken av sjekklisten har forbedringspotensial og det bør rettes mer oppmerksomhet på korrekt gjennomførelse av alle tre delene. I tillegg er det et behov for en evaluering av sjekklisten for å forbedre etterlevelsen. Nøkkelord: Operasjonssykepleie, sjekklisten Trygg Kirurgi, kommunikasjon, tverrfaglig teamsamarbeid, pasientsikkerhet, holdninger.Background: In 2008 World Health Organization (WHO) developed a checklist for safe surgery based on feedbacks about patient injuries and inadequate patient safety in surgery. The intention of the Surgical Safety Checklist is to increase patient safety by improving safety practice and ensure quality in every surgcial prosess, and strengthen the teamwork and communication. Purpose and research question: The purpose of this study was to examine the operating room nurse`s experiences in how the Surgical Safety Checklist are used and executed. The research question for this study was: “How does the operating room nurse`s experience the use and execution of the Surgical Safety Checklist?» Method: A qualitative method was used to find answers to our research question. The data collection was conducted by 8 semi-structured individual interviews on operating room nurses in a hospital in Norway. The data material was transcribed and analyzed using Lundman & Graneheims qualitative content analysis. Findings: The findings show that operating room nurse`s experience that the Surgical Safety Checklist creates an individual patient treatment and improves the saftey routines in the operating room. The checklist gather the team together by giving everyone a common understanding, but there are also challenges related to the use and execution of the Surgical Safety Checklist. There are also some challenges related to attitudes and respect for the operating room nurses work tasks. Conclusion: The Surgical Safety Checklist is an important tool that contributes to focus on patientsafety. The use of the Surgical Saftey Checklist has potential for improvement and it should be more focus on correct excecution of all three parts of the checklist. In addition, there is a need for an evaluation of the checklist to improve compliance. Keywords: Operating room nursing, surgical safety checklist, communication, multidisciplinary teamwork, patientsafety, attitude

Etterlevelse av sjekklisten Trygg Kirurgi - Operasjonssykepleiernes erfaringer

Bakgrunn: I 2008 utviklet Verdens helseorganisasjon (WHO) en sjekkliste for trygg kirurgi på bakgrunn av tilbakemeldinger om pasientskader og utilstrekkelig pasientsikkerhet ved kirurgiske inngrep. Sjekklisten sin intensjon er å øke pasientsikkerheten på operasjonsavdelingen ved å forbedre sikkerhetsrutiner og kvalitetssikre alle prosesser ved et kirurgisk inngrep, samt styrke teamsamarbeid og kommunikasjon. Formål og problemstilling: Formålet med denne studien var å undersøke hvilke erfaringer operasjonssykepleieren har med gjennomgangen og bruken av sjekklisten Trygg Kirurgi. I denne studien ble følgende problemstilling besvart: “Hvordan opplever og erfarer operasjonssykepleierne gjennomgangen og bruken av sjekklisten Trygg Kirurgi?” Metode: Vi har brukt kvalitativ metode for å besvare studiens problemstilling. Det er gjennomført 8 semistrukturerte intervjuer med operasjonssykepleiere ved et universitetssykehus i Norge. Datamaterialet ble transkribert og analysert etter Graneheim & Lundman’s kvalitative innholdsanalyse. Funn: Funnene viser at operasjonssykepleierne erfarer at sjekklisten Trygg Kirurgi skaper en individuell pasientbehandling samt forbedrer sikkerhetsrutinene på operasjonsstuen. Sjekklisten samler teamet ved å gi alle en felles forståelse for hva som skal skje, men det kommer frem utfordringer relatert til bruken og gjennomføringen av sjekklisten. Det kommer også frem utfordringer knyttet til holdninger og respekt for operasjonssykepleiernes arbeidsoppgaver. Konklusjon: Sjekklisten Trygg Kirurgi er et viktig verktøy som bidrar til å øke pasientsikkerheten. Bruken av sjekklisten har forbedringspotensial og det bør rettes mer oppmerksomhet på korrekt gjennomførelse av alle tre delene. I tillegg er det et behov for en evaluering av sjekklisten for å forbedre etterlevelsen. Nøkkelord: Operasjonssykepleie, sjekklisten Trygg Kirurgi, kommunikasjon, tverrfaglig teamsamarbeid, pasientsikkerhet, holdninger.Background: In 2008 World Health Organization (WHO) developed a checklist for safe surgery based on feedbacks about patient injuries and inadequate patient safety in surgery. The intention of the Surgical Safety Checklist is to increase patient safety by improving safety practice and ensure quality in every surgcial prosess, and strengthen the teamwork and communication. Purpose and research question: The purpose of this study was to examine the operating room nurse`s experiences in how the Surgical Safety Checklist are used and executed. The research question for this study was: “How does the operating room nurse`s experience the use and execution of the Surgical Safety Checklist?» Method: A qualitative method was used to find answers to our research question. The data collection was conducted by 8 semi-structured individual interviews on operating room nurses in a hospital in Norway. The data material was transcribed and analyzed using Lundman & Graneheims qualitative content analysis. Findings: The findings show that operating room nurse`s experience that the Surgical Safety Checklist creates an individual patient treatment and improves the saftey routines in the operating room. The checklist gather the team together by giving everyone a common understanding, but there are also challenges related to the use and execution of the Surgical Safety Checklist. There are also some challenges related to attitudes and respect for the operating room nurses work tasks. Conclusion: The Surgical Safety Checklist is an important tool that contributes to focus on patientsafety. The use of the Surgical Saftey Checklist has potential for improvement and it should be more focus on correct excecution of all three parts of the checklist. In addition, there is a need for an evaluation of the checklist to improve compliance. Keywords: Operating room nursing, surgical safety checklist, communication, multidisciplinary teamwork, patientsafety, attitude

The Use and Productivity of Visual Aids as Retrieval Support in Police Interviews of Preschool-Aged Victims of Abuse

Professional use of external retrieval cues, such as various types of visual aids, has been utilized in investigative interviews of children for decades based on the assumption that aids can facilitate children’s recollection of abusive incidents. Although analog studies and surveys have provided insight into various aspects of visual aid utilization, there is a scarcity of field studies that addresses the use of visual aids in large samples of authentic investigative interviews of preschool-aged children. In the present study, the use and productivity of visual aids were examined in 140 investigative interviews of 3- to 6-year-old children, all of whom disclosed abuse in cases that progressed to prosecution. The exploratory analyses focused on the overall use of visual aids, the types of questions posed along with visual aids when the interviewer directly asks questions regarding the investigated incident(s), and the extent to which the children provided forensically relevant information in response to questions used along with visual aids. It was found that visual aids were utilized to elicit information regarding the investigated incident(s) in 92% (n = 129) of the interviews, with emotion cards and drawing materials being the most common aids used. The highest proportion of questions asked alongside visual aids were directive (41.6%) and option-posing (37.3%) questions, followed by suggestive questions (17.9%), and a rather low proportion of open-ended invitations (3.2%). In addition to visual aids, open-ended invitations elicited the most forensically relevant information from the interviewees. The need for standardized guidelines and specialized training for the use of visual aids in investigative interviews of young children is discussed.publishedVersio

Subclassification of patients with acute myelogenous leukemia based on chemokine responsiveness and constitutive chemokine release by their leukemic cells

Background and Objectives Chemokines are soluble mediators involved in angiogenesis, cellular growth control and immunomodulation. In the present study we investigated the effects of various chemokines on proliferation of acute myelogenous leukemia (AML) cells and constitutive chemokine release by primary AML cells.Design and Methods Native human AML cells derived from 68 consecutive patients were cultured in vitro. We investigated AML cell proliferation (3H-thymidine incorporation, colony formation), chemokine receptor expression, constitutive chemokine release and chemotaxis of normal peripheral blood mononuclear cells.Results Exogenous chemokines usually did not have any effect on AML blast proliferation in the absence of hematopoietic growth factors, but when investigating growth factor-dependent (interleukin 3 + granulocyte-macrophage colony-stimulating factor + stem cell factor) proliferation in suspension cultures the following patient subsets were identified: (i) patients whose cells showed chemokine-induced growth enhancement (8 patients); (ii) divergent effects on proliferation (15 patients); and (iii) no effect (most patients). These patient subsets did not differ in chemokine receptor expression, but, compared to CD34− AML cells, CD34+ cells showed higher expression of several receptors. Chemokines also increased the proliferation of clonogenic AML cells from the first subset of patients. Furthermore, a broad constitutive chemokine release profile was detected for most patients, and the following chemokine clusters could be identified: CCL2-4/CXCL1/8, CCL5/CXCL9-11 (possibly also CCL23) and CCL13/17/22/24/CXCL5 (possibly also CXCL6). Only the CCL2-4/CXCL1/8 cluster showed significant correlations between corresponding mRNA levels and NFκB levels/activation. The chemotaxis of normal immunocompetent cells for patients without constitutive chemokine release was observed to be decreased.Interpretation and Conclusions Differences in chemokine responsiveness as well as chemokine release contribute to patient heterogeneity in AML. Patients with AML can be classified into distinct subsets according to their chemokine responsiveness and chemokine release profile

Genes of cell-cell interactions, chemotherapy detoxification and apoptosis are induced during chemotherapy of acute myeloid leukemia

<p>Abstract</p> <p>Background</p> <p>The molecular changes <it>in vivo </it>in acute myeloid leukemia cells early after start of conventional genotoxic chemotherapy are incompletely understood, and it is not known if early molecular modulations reflect clinical response.</p> <p>Methods</p> <p>The gene expression was examined by whole genome 44 k oligo microarrays and 12 k cDNA microarrays in peripheral blood leukocytes collected from seven leukemia patients before treatment, 2–4 h and 18–24 h after start of chemotherapy and validated by real-time quantitative PCR. Statistically significantly upregulated genes were classified using gene ontology (GO) terms. Parallel samples were examined by flow cytometry for apoptosis by annexin V-binding and the expression of selected proteins were confirmed by immunoblotting.</p> <p>Results</p> <p>Significant differential modulation of 151 genes were found at 4 h after start of induction therapy with cytarabine and anthracycline, including significant overexpression of 31 genes associated with p53 regulation. Within 4 h of chemotherapy the BCL2/BAX and BCL2/PUMA ratio were attenuated in proapoptotic direction. FLT3 mutations indicated that non-responders (5/7 patients, 8 versus 49 months survival) are characterized by a unique gene response profile before and at 4 h. At 18–24 h after chemotherapy, the gene expression of p53 target genes was attenuated, while genes involved in chemoresistance, cytarabine detoxification, chemokine networks and T cell receptor were prominent. No signs of apoptosis were observed in the collected cells, suggesting the treated patients as a physiological source of pre-apoptotic cells.</p> <p>Conclusion</p> <p>Pre-apoptotic gene expression can be monitored within hours after start of chemotherapy in patients with acute myeloid leukemia, and may be useful in future determination of therapy responders. The low number of patients and the heterogeneity of acute myeloid leukemia limited the identification of gene expression predictive of therapy response. Therapy-induced gene expression reflects the complex biological processes involved in clinical cancer cell eradication and should be explored for future enhancement of therapy.</p