Management challenges for future digitalization of healthcare services

eHealth is considered a solution to current challenges in healthcare. However, its use is not very well developed, and its potential has been little exploited. There are many reasons for the limited diffusion of eHealth. Knowledge, opportunities for training and collaborative activities are examples of factors that influence diffusion. Managerial responsibility is decisive in transforming healthcare. This paper aims at exploring middle management strategies that can facilitate workplace learning when introducing eHealth and new ways of providing healthcare. Introduction of eHealth will imply new and innovative working processes, where both employees and managers need to be aware that their work will change fundamentally, from routine work to work that involves learning, skills development and continuous changes in work practice. This study takes a qualitative approach by analysing data collected through focus group interviews. The findings indicate a necessity for a shift towards learning-oriented leadership and adaptive management that emphasizes employee involvement and opportunities for learning. Helping employees make sense of the complexities associated with continuously changing work practices is another identified middle management strategy. Scenario planning and backcasting stand out as suitable tools for sensemaking in complex organizations and as techniques that can promote workplace learning.publishedVersio

Vilka egenskaper hos elcykeln attraherar dess användare och hur kan denna kunskap användas för en ökad spridning?

I flera andra europeiska länder har antalet elektriska cyklar ökat kraftigt de senaste åren. En liknande ökning förväntas också i Sverige. Hittills har kunskapen om attityder hos elcyklister i Sverige varit begränsade. Denna studie består av intervjuer med 39 personer från hela Sverige för att få en bättre förståelse för varför de har valt att cykla en elcykel, och vad de tror kan göras för att få fler människor att välja elcykel. Dessutom genomfördes en webbenkät med 41 kommuner för att se hur förberedda de är på en ökning av elcyklar. Resultatet av intervjustudien pekar på att de som inledningsvis kan gå före och göra elcykling mer populärt är människor som älskar att cykla. Elcyklisterna i studien lyfte fram hur roligt de tyckte det var att cykla elcykel. De uppskattade att det var ett snabbt och smidigt transportmedel, samtidigt som de fick bättre kondition och gjorde en insats för miljön. En avgörande förutsättning för att kunna cykla elcykel var sammanhängande cykelvägar utan ojämnheter och tvära kurvor som inte delades med långsammare cyklister och gående. Många valde av den anledningen att cykla på bilvägen i stället. Bättre parkeringar nämndes också, framför allt cykelställ där ramen kunde låsas fast. Av webbenkätens resultat gick det också att se att kommunerna genomgående hade höga ambitioner för att förbättra infrastrukturen för cyklar, men det gick inte att läsa ut hur långt det arbetet hade kommit. Ungefär hälften av kommunerna i studien hade haft kampanjer för att öka elcykling. Slutsatsen av studien är att det krävs en kombination av insatser för att nå en ökad användning av elcyklar, och att det allra viktigaste är att förbättra cykelvägnätet. En lösning som föreslås är en breddning av vägrenen till avgränsade cykelfält på bilvägar

Arbeidsmiljøets betydning for sykepleierstudenters valg av arbeidsgiver En kvalitativ studie med søkelys på rekruttering av sykepleiere til kommunale helse- og omsorgstjenester

Det er behov for at flere sykepleiere vil jobbe i kommunehelsetjenesten. En spørreundersøkelse blant tredjeårsstudenter fra et årskull i bachelorprogram sykepleie (n=101) synliggjorde arbeidsmiljø som den viktigste faktoren for valg av arbeidsgiver som nyutdannede sykepleiere. Denne artikkelen omhandler en oppfølgingsstudie, hvor hensikten var å få økt innsikt i hva sykepleierstudenter forbinder med et godt arbeidsmiljø. Studien hadde et kvalitativt design, med semistrukturerte individuelle intervjuer av 15 studenter rekruttert fra samme kull som spørreundersøkelsen. Datamaterialet ble analysert tematisk, og vi fant at studentene beskrev et godt arbeidsmiljø som spennende, støttende og levelig. Funnene indikerer at tilrettelegging for et godt arbeidsmiljø for sykepleierstudenter i praksis og nyutdannede sykepleiere kan ha betydning for rekrutteringen til kommunale helse- og omsorgstjenester.publishedVersio

Integrated cost and environmental impact assessment of management options for dredged sediment

Large quantities of sediment must be dredged regularly to enable marine transport and trade. The sediments are often polluted, with e.g. metals, which limits the management options. The aim of this study has been to assess costs and environmental impacts (impact on climate, marine organisms, etc.) of different management options for polluted dredged sediment, by combining life-cycle assessment (LCA) of the climate impact, scoring of other environmental aspects and a cost evaluation. This approach has been used to study both traditional and new management alternatives for a real port case. The studied options include landfilling, deep-sea disposal, construction of a port area using a stabilization and solidification (S/S) method, and a combination of the aforementioned methods with the innovative option of metal recovery through sediment electrolysis. The LCA showed that deep-sea disposal had the lowest climate impact. The assessment of the other environmental impacts showed that the result varied depending on the pollution level and the time perspective used (short or long-term). Using sediment for construction had the highest climate impact, although other environmental impacts were comparably low. Electrolysis was found to be suitable for highly polluted sediments, as it left the sediment cleaner and enabled recovery of precious metals, however the costs were high. The results highlight the complexity of comparing different environmental impacts and the benefits of using integrated assessments to provide clarity, and to evaluate both the synergetic and counteracting effects associated with the investigated scenarios and may aid early-stage decision making

Kindlin-3–mediated signaling from multiple integrin classes is required for osteoclast-mediated bone resorption

Loss of kindlin-3 impairs activation of β1, β2, and β3 integrin classes, resulting in osteopetrotic defects in osteoclast adhesion and spreading

Skogens helsetilstand i Norge. Resultater fra skogskadeovervåkingen i 2022

Skogens helsetilstand påvirkes i stor grad av klima og værforhold, enten direkte ved tørke, frost og vind, eller indirekte ved at klimaet påvirker omfanget av soppsykdommer og insektangrep. Klimaendringene og den forventede økningen i klimarelaterte skogskader gir store utfordringer for forvaltningen av framtidas skogressurser. Det samme gjør invaderende skadegjørere, både allerede etablerte arter og nye som kan komme til Norge i nær framtid. I denne rapporten presenteres resultater fra skogskadeovervåkingen i Norge i 2022 og trender over tid for følgende temaer: (i) Landsrepresentativ skogovervåking; (ii) Intensiv skogovervåking; (iii) Overvåking av bjørkemålere i Troms og Finnmark; (iv) Barkbilleovervåkingen; (v) Furuvednematode; (vi) Askeskuddsyke; (vii) Andre spesielle skogskader i 2022

R-Flurbiprofen Reduces Neuropathic Pain in Rodents by Restoring Endogenous Cannabinoids

Background: R-flurbiprofen, one of the enantiomers of flurbiprofen racemate, is inactive with respect to cyclooxygenase inhibition, but shows analgesic properties without relevant toxicity. Its mode of action is still unclear. Methodology/Principal Findings: We show that R-flurbiprofen reduces glutamate release in the dorsal horn of the spinal cord evoked by sciatic nerve injury and thereby alleviates pain in sciatic nerve injury models of neuropathic pain in rats and mice. This is mediated by restoring the balance of endocannabinoids (eCB), which is disturbed following peripheral nerve injury in the DRGs, spinal cord and forebrain. The imbalance results from transcriptional adaptations of fatty acid amide hydrolase (FAAH) and NAPE-phospholipase D, i.e. the major enzymes involved in anandamide metabolism and synthesis, respectively. R-flurbiprofen inhibits FAAH activity and normalizes NAPE-PLD expression. As a consequence, R-Flurbiprofen improves endogenous cannabinoid mediated effects, indicated by the reduction of glutamate release, increased activity of the anti-inflammatory transcription factor PPAR gamma and attenuation of microglia activation. Antinociceptive effects are lost by combined inhibition of CB1 and CB2 receptors and partially abolished in CB1 receptor deficient mice. R-flurbiprofen does however not cause changes of core body temperature which is a typical indicator of central effects of cannabinoid-1 receptor agonists. Conclusion: Our results suggest that R-flurbiprofen improves the endogenous mechanisms to regain stability after axonal injury and to fend off chronic neuropathic pain by modulating the endocannabinoid system and thus constitutes an attractive, novel therapeutic agent in the treatment of chronic, intractable pain

Implantable cardioverter defibrillator use in arrhythmogenic right ventricular cardiomyopathy in North America and Europe

Background and aims: Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death (SCD) in arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to identify cross-continental differences in utilization of primary prevention ICDs and survival free from sustained ventricular arrhythmia (VA) in ARVC. Methods: This was a retrospective analysis of ARVC patients without prior VA enrolled in clinical registries from 11 countries throughout Europe and North America. Patients were classified according to whether they received treatment in North America or Europe and were further stratified by baseline predicted VA risk into low- (25%/5 years) groups. Differences in ICD implantation and survival free from sustained VA events (including appropriate ICD therapy) were assessed. Results: One thousand ninety-eight patients were followed for a median of 5.1 years; 554 (50.5%) received a primary prevention ICD, and 286 (26.0%) experienced a first VA event. After adjusting for baseline risk factors, North Americans were more than three times as likely to receive ICDs {hazard ratio (HR) 3.1 [95% confidence interval (CI) 2.5, 3.8]} but had only mildly increased risk for incident sustained VA [HR 1.4 (95% CI 1.1, 1.8)]. North Americans without ICDs were at higher risk for incident sustained VA [HR 2.1 (95% CI 1.3, 3.4)] than Europeans. Conclusions: North American ARVC patients were substantially more likely than Europeans to receive primary prevention ICDs across all arrhythmic risk strata. A lower rate of ICD implantation in Europe was not associated with a higher rate of VA events in those without ICDs