A study on effects of safety checklists emphasizing quality of complication data

Introduction: Despite increased focus on patient safety, complication rates in hospitals have remained unchanged with reports ranging between one out of twenty patients and one out of four patients, often related to surgery. However, half of the complications may be prevented throughout the surgical pathway. To inform and study effects of targeted patient safety interventions requires patient outcome data of high accuracy. Introduction of the World Health Organization surgical safety checklists (WHO SSC) has been reported to increase safety, also in our hospital. Aims: The overall objective for the study was to investigate effects of using safety checklists on patient outcomes in medicine. Further, to evaluate effects of adding a validated Norwegian version of the pre- and postoperative parts of the SURPASS checklists in combination with the established WHO SSC on emergency reoperations, 30-day unplanned readmissions, 30-day mortality and length of hospital stay, in addition to verified in-hospital complications using a reliable and validated method. Methods: In the first study, we conducted a systematic literature search in Cochrane Library, MEDLINE, EMBASE and Web of Science on effects on patient outcomes of using safety checklists in medicine. Following the PRISMA guidelines ensured transparency of reporting. The studies were eligible if they quantitatively reported possible effects of using safety checklists. In the second study, validation of a Norwegian version of the pre- and postoperative SURPASS checklists in combination with the established WHO SSC was performed in one neurosurgical department. Adaptation and validation of the new checklists were in accordance to guidelines from the WHO included forth- and back translation, testing the content in clinical practice, focus groups, expert panels, and final approval of the checklists. The third study used a prospective observational design to investigate complications in surgical admissions using two different methods. Utilising the Global Trigger Tool (GTT) and the International Classification of Diseases 10th version (ICD-10) identified and verified in-hospital complications in the same admissions with GTT appointed as the reference standard. Tests were performed to investigate strength of method agreement of estimating complications. In the fourth study, the validated pre- and postoperative SURPASS checklists were implemented as an add-on to the established WHO SSC using a Stepped Wedge Cluster Controlled Trial (SWCCT) design in three surgical clusters, each serving as their own controls (neurosurgery, orthopaedics and gynaecology) in one hospital. One separate department in the intervention hospital and two external hospitals without new checklists constituted parallel controls. Effects on verified in-hospital complications, emergency reoperations, 30-day readmissions, 30-day mortality and length of hospital stay were investigated over 29 months from November 2012 through March 2015. Results: Thirty-four studies met the inclusion criteria of the systematic review of the literature showing improvements in four groups of patient outcomes: morbidity and mortality; adherence to guidelines; human factors; and adverse events. None of the included studies reported on checklist use resulting in decreased patient safety (Study I). Translation of the pre- and postoperative SURPASS checklists in combination with the WHO SSC was completed and reached face validity. Testing of the content was performed for 29 neurosurgical procedures with all checklist users (ward nurse and physicians, surgeons, anaesthesiologists, operating theatre nurses, post-anaesthetic care unit nurses, and discharging physicians and nurses). Focus groups revealed that wording needed to be adapted to clinical practice and that checklist items challenged existing workflow. The expert panels scored content validity to > 80 %. All the steps involved adjustments to the checklist content. The final back translated SURPASS checklist version was approved by the Dutch copyright holder (Study II). In 700 random surgical admissions complications were identified in 30.3 % (298/700) using the GTT method. Extracted ICD-10 codes indicating a complication yielded a rate of 47.4 % (332/700) in the same admissions. However, when excluding ICD-10 codes representing conditions present on admission, in-hospital complications were verified for 20.1 % (141/700) of the admissions. After the verification procedure, agreement of complications between findings using both methods increased from 68.3 % to 83.3 % (Study III). The fourth study compared 3,892 before and 5,117 procedures after the pre- and postoperative SURPASS checklists implementation in intervention clusters. In addition, investigations of 9,678 surgical procedures in parallel control hospitals were performed. Crude analysis of in-hospital complications showed an increase of complications from 14.7 % to 16.5 % (p=0.025). However, in-hospital complications decreased in adjusted intention to treat analyses (Odds Ratio (OR): 0.73; 95% Confidence Interval (CI): 0.54 to 0.98; p = 0.035). Logistic regression on effects of the SURPASS checklists, show a significant decrease in in-hospital complications (OR: 0.70; 95% CI: 0.50 to 0.98; p = 0.036) and emergency reoperations (OR: 0.42; 95% CI: 0.23 to 0.76; p = 0.004) with full compliance to the preoperative SURPASS checklist in adjusted analysis. With obtained full compliance to the postoperative SURPASS checklists 30-day readmissions were decreased (OR: 0.32; 95% CI: 0.16 to 0.64; p = 0.001) in adjusted analysis. Thirty-day mortality and length of hospital stay remained unchanged. For parallel control hospitals, the in-hospital complications increased, whereas emergency reoperations, 30-day readmissions and 30-day mortality were unchanged. Conclusions The systematic review of the literature concluded that use of safety checklists may have positive impact on patient outcomes as more clinicians adhere to standardised guidelines and procedures; improve human factors; and reduce adverse events, morbidity and mortality. We need more studies with strong study designs investigating effects of checklists used throughout the surgical pathway. The first Norwegian version of the pre- and postoperative SURPASS checklists in combination with the already established WHO SSC was validated following guidelines on translation and adaptation from the WHO. Using ICD-10 codes to monitor complications increased accuracy significantly when codes indicating complications were verified to have emerged in-hospital. Full compliance with the pre- and postoperative SURPASS checklists were associated with reduced in-hospital complications, emergency reoperations and 30-day readmissions when added to the already established intraoperative WHO SSC

Treatment Planning Adaptations for Hypoxia in Proton Therapy for Head and Neck Cancer

Aim: Perform treatment planning adaptations for proton therapy to correct for hypoxia in head and neck cancer (HNC). Material and methods: Hypoxic subvolumes were defined using three pO2 (oxygen partial pressure) thresholds, 5 mmHg, 7.5 mmHg and 10 mmHg, using [18F]EF5 PET/CT images for a HNC patient. FLUKA Monte Carlo simulations were then performed to calculate the oxygen enhancement ratio (OER) and relative biological effectiveness (RBE) weighted dose. Three additional treatment plans were made, one for each pO2 threshold, before OER adapting the dose objectives for the hypoxic subvolumes using Eclipse treatment planning system. Results: the method successfully defined and increased the biological dose for three pO2 threshold defined hypoxic regions. However, the dose to the surrounding normoxic tumour tissue was also increased.Masteroppgave i fysikkPHYS399MAMN-PHY

Open-source Branding: How consumers develop a Corporate Brand Image through Instagram- An Exploratory Single-Case Study

Title: Open-source Branding: How consumers develop a Corporate Brand Image through Instagram- An Exploratory Single-Case Study. Research problem: The research problem originates from the shifted power balance through the rise of social media. Whereby, organizational control of the brand image is starting to fade. Thus, further research is needed, whether an open-source branding strategy truly affects consumers’ perceptions of a brand. Thesis purpose: The purpose of this research is to analyze how consumers experience a brand through social media and what implications the interaction between consumer-consumers and consumer-brands have on the company's brand image. By mediating and illuminating the importance of involving the consumers into the ‘open-source’ branding process on social media, through the concept of co-creation of value. Theoretical framework: The framework consists of three interrelated concepts, open-source branding, co-creation and brand image. Methodology: The research emphasizes an exploratory single-case study with a qualitative and multisided approach, consisting of semi-structured in-depth interviews with one IKEA representative as key informant and seven consumer interviews. In addition, a virtual observation on the focal channel of Instagram has been conducted. Findings: The main findings gathered underline the evolvement of IKEA’s brand image from a consumer perceptive. From a company perspective, the open-source paradigm has been enhanced, in greater extent.Title: Open-source Branding: How consumers develop a Corporate Brand Image through Instagram- An Exploratory Single-Case Study. Research problem: The research problem originates from the shifted power balance through the rise of social media. Whereby, organizational control of the brand image is starting to fade. Thus, further research is needed, whether an open-source branding strategy truly affects consumers’ perceptions of a brand. Thesis purpose: The purpose of this research is to analyze how consumers experience a brand through social media and what implications the interaction between consumer-consumers and consumer-brands have on the company's brand image. By mediating and illuminating the importance of involving the consumers into the ‘open-source’ branding process on social media, through the concept of co-creation of value. Theoretical framework: The framework consists of three interrelated concepts, open-source branding, co-creation and brand image. Methodology: The research emphasizes an exploratory single-case study with a qualitative and multisided approach, consisting of semi-structured in-depth interviews with one IKEA representative as key informant and seven consumer interviews. In addition, a virtual observation on the focal channel of Instagram has been conducted. Findings: The main findings gathered underline the evolvement of IKEA’s brand image from a consumer perceptive. From a company perspective, the open-source paradigm has been enhanced, in greater extent

Skatterettslig håndtering av utenlandsk foretak som etablerer seg i Norge, med fokus på fast driftssted, dobbeltbeskatning og internprising

Selskaper som etablerer virksomhet i Norge står overfor faren for å bli dobbelt beskattet. Slik dobbeltbeskatning utgjør et problem for investorer og eiere. Det som kan avgjøre slik problematikk er bestemmelser om virksomhetssted og fast driftssted. Hvor virksomheten er lokalisert avgjør skatteplikten. Selskaper må også forholde seg til internprising når de skal etablere virksomhet i Norge. Målet med oppgaven er å se på hvilke regler som gjelder for fast driftssted, dobbeltbeskatningstilfeller og internprising. Juridisk metode er metoden jeg bruker gjennom oppgaven. I oppgaven går jeg gjennom hvordan et utenlandsk selskap kan etablere seg i Norge med tanke på relevant selskapsform. I oppgavens hovedkapitler går jeg gjennom fast driftssted, dobbeltbeskatning og internprising. Jeg kommer med eksempler underveis som belyser temaene. Til slutt nevner jeg kort om arbeidsutleie til Norge

Techlash

Technology has made human lives incomparably better. Civilization as we know it would utterly collapse without it. However, if not properly managed, technology can and will be systematically abused and misuse and thereby become one of the biggest threats to humankind. This open access book applies proactive crisis management to the management of technology organizations to make them more sustainable and socially responsible for the betterment of humankind. It forecasts the unintended consequences of technology and offers methods to counteract it

Techlash

Technology has made human lives incomparably better. Civilization as we know it would utterly collapse without it. However, if not properly managed, technology can and will be systematically abused and misuse and thereby become one of the biggest threats to humankind. This open access book applies proactive crisis management to the management of technology organizations to make them more sustainable and socially responsible for the betterment of humankind. It forecasts the unintended consequences of technology and offers methods to counteract it

The Technology of Ethnography. An empirical argument against the repatriation of historical accounts

Based on experiences from a longitudinal fieldwork engagement on Mota island in north Vanuatu, this article challenges the established opinion that old ethnographies shall be repatriated as a matter-of-course. Firstly, because they are far from factual but nevertheless are treated as such, since books are a different technology of knowledge from the orally transmitted versions of the past and consequently have a different sociocultural impact; secondly, because they in most cases will be an asset mainly to the educated elite; and thirdly, because reintroducing histories disturbs the distribution of knowledge in knowledge-based societies and could cause further social instability. I do not claim that the situation on Mota has a general validity throughout Melanesia. However, I remain unconvinced by one of the premises for the categorical repatriation argument: that the disputes over control over, and validity of, knowledge that characterise most Melanesian societies, on this particular point for some reason should be suspended. Basé sur les observations longitudinales d’un long travail de terrain dans l’île de Mota au nord du Vanuatu, cet article conteste l’opinion établie considérant le rapatriement des données ethnographiques anciennes comme allant de soi. D’abord parce qu’elles sont loin d’être factuelles, mais sont néanmoins traitées comme telles, puisque les livres sont une technologie de connaissance différente des versions du passé transmises oralement et ont par conséquent un impact socioculturel différent  ; ensuite, parce qu’ils seront dans la plupart des cas un atout principalement pour l’élite instruite  ; et enfin, parce que la réintroduction d’histoires trouble la répartition des connaissances dans des sociétés basées sur la connaissance et pourrait aggraver l’instabilité sociale. Je ne prétends pas que la situation sur Mota a une validité générale partout en Mélanésie. Cependant, je reste dubitatif à l’égard d’un des présupposés fondant la thèse du rapatriement systématique : que les disputes portant sur le contrôle et la validité de la connaissance qui caractérisent la plupart des sociétés mélanésiennes, s’en trouvent, sur ce point particulier, suspendues pour une raison ou une autre

Listeria monocytogenes in salmonid slaughter facilities - Screening program for the Norwegian Food Safety Authority

Listeria monocytogenes is a bacterium of special concern in the seafood industry beacuse it possesses several properties adapted for the food production environment and may cause severe disease in humans. The Institute of Marine Research has on behalf of the Norwegian Food Safety Authority conducted a screening program for L. monocytogens in salmonid slaughter facilities. In total, 358 samples from 60 slaugher facilities (49 slaughtering plants and 11 slaughtering vessels) were examined. Samples were collected from the production environment (n=108), from the surface of fish entering the facilities (n=47), and from the surface of fish (n=59) and raw material (n=144) at end point at the examined facility. None of the samples from the slaughtering vessels were positive for L. monocytogenes, whereas 22 positive samples were detected in nine different slaugtering plants. In five of these plants, several positive samples were found. Six of the slaughtering plants had positive samples at the end of the production line, where a higher prevalence was found when swabbing the fish skin and gills compared to the examined raw matierial. All the raw material samples contained low numbers of L. monocytogenes below the quatification limit (<10 CFU/g). However, this study found that L. monocytogenes can be present in both fish and the production environment, and that in some cases L. monocytogenes will be present in fish ready for furhter processing in the salmonid value chain.publishedVersio

Tidlig samarbeid med industrien i investeringsprosjekter – et uforløst potensial? En studie av forsvarssektorens konsept for tidlig samarbeid

Den siste forsvarsindustrielle strategien, Samarbeid for sikkerhet (Meld. St. 17 (2020–2021)) understreker viktigheten av å videreføre og videreutvikle samarbeid mellom norsk industri og forsvarsektoren i et hurtig skiftende internasjonalt sikkerhetspolitisk perspektiv. Et av fokusområdene er å øke tidlig samarbeid i trekantsamarbeidet mellom Forsvaret, industrien og Forsvarets forskningsinstitutt. Studiens formål er å bidra med empirisk forskning og kunnskap om forsvarets konsept for tidlig samarbeid (TISAM). Studien avdekket at det ble utviklet et konsept for TISAM i 2004, men forsvarssektoren lyktes ikke med konsept implementeringen. Dette var med å forme problemstillingen: I hvilken grad bør og kan TISAM-konseptet revitaliseres for fremtidig bruk i investeringsprosjekter mellom forsvarssektoren og norsk forsvarsindustri? For å besvare problemstillingen ble det utarbeidet tre forskningsspørsmål. Spørsmålenes hensikt var å belyse TISAMs opphav og historikk, samt forståelsen av begrepet. Videre har studien sett på dagens bruk og gir innspill til om og hvordan TISAM kan videreutvikles for fremtidig bruk. Studien har en kvalitativ tilnærming. Det empiriske datagrunnlaget baserer seg på dokumentstudier og muntlige kilder. Det ble gjennomført 12 semistrukturerte intervju og tre møter med personell som innehar kunnskap og erfaring med TISAM. Dataene er analysert ved hjelp av Braun og Clarkes (2006) sekstrinns tematiske analyse. Studiens funn viser at TISAM som begrep har eksistert i forsvarssektoren siden slutten av 1990-tallet. Selv om det forvitret i perioden fra 2007-2012 er begrepet igjen i bruk i dag. Forsvarssektoren er derimot ikke konsekvent i begrepsbruken og benytter ulike begrep for å omtale TISAM. Mangelen på en etablert beskrivelse eller definisjon av TISAM i forsvarssektoren medfører at prosjekter som får oppdrag om tidlig samarbeid opplever uklarhet rundt rammer, intensjon og målsetning. Likevel viser studien at forståelsen individuelt er omforent uavhengig av stilling i forsvarssektoren eller industrien. Grunnet en opplevd mangel på forankring og rammeverk utnyttes ikke fordelene TISAM kan gi. Det medfører også at utfordringer ikke mitigeres effektivt og helhetlig i trekantsamarbeidet. Spesielt opplever deltakere i studien at merkantilt fagfelt, per nå, ikke ser og forstår sin rolle i TISAM. Forsvarssektoren har ikke en oversikt over sine TISAM-prosjekter. Dette vanskeliggjør både organisatorisk og individuell læring, samt videreutvikling av TISAM i hele trekantmodellen. Studiens konklusjon tilsier at det er et uforløst potensialt i TISAM. Konseptet fra 2004 kan revitaliseres og bør videreutvikles gjennom en helhetlig tilnærming i forsvarssektoren