- og så fikk dem se en rein! Ulike tilnærminger til hverdagslig pedagogisk virksomhet i barnehager i samisk-lulesamisk område i Norge.

Det er nødvendig å få mer kunnskap om hva barnehagene og personalet i samisk-lulesamisk område gjør for å håndtere pålegg og intensjoner i styringsdokumentene om samisk innhold i barnehagehverdagen. Forskningsarbeidet som er bakgrunn for denne artikkelen tar utgangspunkt i et sosiokulturelt perspektiv og en institusjonell etnografisk tilnærming. Barnehagens styringsdokumenter og personalets beretninger om tanker og erfaringer med å iverksette og utvikle det pedagogiske innholdet og arbeidet i barnehagens hverdagsliv er sentrale i datamaterialet. Analysene gav mulighet for å peke på kjennetegn for og egenskaper ved faglig innhold og kvalitet i arbeidet med samiske tema. Det fremkommer momenter for videre utvikling og mulige valg for kompetanse og føringer for området samiske språk og kultur i enhver barnehage. Det er åpenbart at det må gjøres en innsats på alle nivå for å ta vare på og utvikle lulesamisk kultur og språk så vel innen- som utenfor forvaltningsområdet. It is necessary to gain more knowledge about what the barnehage and its staff in the Pite- and Lule-Sami region in Norway do to meet the requirements and fulfill the intentions of the curriculum when it comes to Sami content in the everyday life of the barnehage. The research reported on in this article has its departure point in a sociocultural perspective and uses institutional ethnography as one of its approaches. The barnehage curricula and the staffs narratives, thoughts and experiences are central in the data. The analysis gave the possibility to point out some central features and traits of the content and quality of the work on Sami topics. Areas for further development and possible choices concerning competence and guidelines for the area of Sami language and culture in all barnehager were found. It is obvious that stronger efforts are needed on all levels to sustain and to develop the Lule-Sami culture and language both within the Sami language municipalities and other municipalities

- og så fikk dem se en rein! Ulike tilnærminger til hverdagslig pedagogisk virksomhet i barnehager i samisk-lulesamisk område i Norge

Det er nødvendig å få mer kunnskap om hva barnehagene og personalet i samisk-lulesamisk område gjør for å håndtere pålegg og intensjoner i styringsdokumentene om samisk innhold i barnehagehverdagen. Forskningsarbeidet som er bakgrunn for denne artikkelen tar utgangspunkt i et sosiokulturelt perspektiv og en institusjonell etnografisk tilnærming. Barnehagens styringsdokumenter og personalets beretninger om tanker og erfaringer med å iverksette og utvikle det pedagogiske innholdet og arbeidet i barnehagens hverdagsliv er sentrale i datamaterialet. Analysene gav mulighet for å peke på kjennetegn for og egenskaper ved faglig innhold og kvalitet i arbeidet med samiske tema. Det fremkommer momenter for videre utvikling og mulige valg for kompetanse og føringer for området samiske språk og kultur i enhver barnehage. Det er åpenbart at det må gjøres en innsats på alle nivå for å ta vare på og utvikle lulesamisk kultur og språk så vel innen- som utenfor forvaltningsområdet. It is necessary to gain more knowledge about what the barnehage and its staff in the Pite- and Lule-Sami region in Norway do to meet the requirements and fulfill the intentions of the curriculum when it comes to Sami content in the everyday life of the barnehage. The research reported on in this article has its departure point in a sociocultural perspective and uses institutional ethnography as one of its approaches. The barnehage curricula and the staffs narratives, thoughts and experiences are central in the data. The analysis gave the possibility to point out some central features and traits of the content and quality of the work on Sami topics. Areas for further development and possible choices concerning competence and guidelines for the area of Sami language and culture in all barnehager were found. It is obvious that stronger efforts are needed on all levels to sustain and to develop the Lule-Sami culture and language both within the Sami language municipalities and other municipalities

Concurrent palliative chemoradiation leads to survival and quality of life benefits in poor prognosis stage III non-small-cell lung cancer: a randomised trial by the Norwegian Lung Cancer Study Group

Background: The palliative role of chemoradiation in the treatment of patients with locally advanced, inoperable non-small-cell lung cancer stage III and negative prognostic factors remains unresolved. Methods: Patients not eligible for curative radiotherapy were randomised to receive either chemoradiation or chemotherapy alone. Four courses of intravenous carboplatin on day 1 and oral vinorelbin on days 1 and 8 were given with 3-week intervals. Patients in the chemoradiation arm also received radiotherapy with fractionation 42 Gy/15, starting at the second chemotherapy course. The primary end point was overall survival; secondary end points were health-related quality of life (HRQOL) and toxicity. Results: Enrolment was terminated due to slow accrual after 191 patients from 25 Norwegian hospitals were randomised. Median age was 67 years and 21% had PS 2. In the chemotherapy versus the chemoradiation arm, the median overall survival was 9.7 and 12.6 months, respectively (Po0.01). One-year survival was 34.0% and 53.2% (Po0.01). Following a minor decline during treatment, HRQOL remained unchanged in the chemoradiation arm. The patients in the chemotherapy arm reported gradual deterioration during the subsequent months. In the chemoradiation arm, there were more hospital admissions related to side effects (Po0.05). Conclusion: Chemoradiation was superior to chemotherapy alone with respect to survival and HRQoL at the expense of more hospital admissions due to toxicity

“The challenge is the complexity” – A qualitative study about decision-making in advanced lung cancer treatment

Introduction The value of shared decision-making and decision aids (DA) has been well documented yet remain difficult to integrate into clinical practice. We wanted to investigate needs and challenges regarding decision-making about advanced lung cancer treatment after first-line therapy, focusing on DA applicability. Methods Qualitative data from separate, semi-structured focus groups with patients/relatives and healthcare professionals were analysed using systematic text condensation. 12 patients with incurable lung cancer, seven relatives, 12 nurses and 18 doctors were recruited from four different hospitals in Norway. Results The participants described the following needs and challenges affecting treatment decisions: 1) Continuity of clinician-patient-relationships as a basic framework for decision-making; 2) barriers to information exchange; 3) negotiation of autonomy; and 4) assessment of uncertainty and how to deal with it. Some clinicians feared DA would steal valuable time and disrupt consultations, arguing that such tools could not incorporate the complexity and uncertainty of decision-making. Patients and relatives reported a need for more information and the possibility both to decline or continue burdensome therapy. Participants welcomed interventions supporting information exchange, like communicative techniques and organizational changes ensuring continuity and more time for dialogue. Doctors called for tools decreasing uncertainty about treatment tolerance and futile therapy. Conclusion Our study suggests it is difficult to develop an applicable DA for advanced lung cancer after first-line therapy that meets the composite requirements of stakeholders. Comprehensive decision support interventions are needed to address organizational structures, communication training including scientific and existential uncertainty, and assessment of frailty and treatment toxicity.publishedVersio

Minnebok som et hjelpemiddel i reminisensarbeidet med den eldre, markasamiske pasienten med demens

Rapport fra fagutviklingsprosjekt. Delprosjekt i Helsedirektoratets "Treårige satsinger". Omhandler bruk av minnebok i reminisensarbeid med markesamiske pasienter med demens.Personalets fokus i omsorgstjenesten for å finne tilnærmingsmåter som ivaretar individet i den daglige driften, er absolutt den viktigste faktor for å lykkes. Den samiske kulturen er en minoritet i forhold til den norske. Mange kulturmarkører gjelder for begge kulturer, men det er en vesentlig fare for at minoritetens særpreg blir borte i det daglige. Med dette utgangspunkt kan fagutviklingsprosjektet forbedre praksis i vår avdeling. Vi har også en formening om at dette arbeidet kan være til hjelp i andre kommuner der det gis helse- og omsorgstjenester til samiske pasienter. Hensikten med prosjektet er å tilpasse ”minneboken” slik at den samiske pasienten med demens gjennom reminisensarbeidet får bekreftelse på sin identitet.Helsedirektorate

Systematic evaluation of pembrolizumab dosing in patients with advanced non-small cell lung cancer

International audienceBACKGROUND: In the phase I KEYNOTE-001 study, pembrolizumab demonstrated durable antitumor activity in patients with advanced non-small cell lung cancer (NSCLC). We sought to characterize the relationship between pembrolizumab dose, exposure, and response to define an effective dose for these patients. METHODS: Patients received pembrolizumab 2 mg/kg every 3 weeks (Q3W) (n=55), 10 mg/kg Q3W (n=238), or 10 mg/kg Q2W (n=156). Response (RECIST v1.1) was assessed every 9 weeks. The relationship between the estimated pembrolizumab area under the concentration-time curve at steady-state over 6 weeks (AUCss-6weeks) and the longitudinal change in tumor size (sum of longest diameters) was analyzed by regression and nonlinear mixed effects modeling. This model was simultaneously fit to all tumor size data, then used to simulate response rates, normalizing the trial data across dose for prognostic covariates (tumor PD-L1 expression and EGFR mutation status). The exposure-safety relationship was assessed by logistic regression of pembrolizumab AUCss-6weeks versus occurrence of adverse events of interest based on their immune etiology. RESULTS: Overall response rates were 15% (95% confidence interval [CI] 7%-28%) at 2 Q3W, 25% (18%-33%) at 10 Q3W, and 21% (95% CI 14% to 30%) at 10 Q2W. Regression analyses of percentage change from baseline in tumor size versus AUCss-6week indicated a flat relationship (regression slope P\textgreater0.05). Simulations showed the exposure-response relationship to be similarly flat, thus indicating that the lowest evaluated dose of 2 mg/kg Q3W to likely be at or near the efficacy plateau. Exposure-safety analysis showed the adverse event incidence to be similar among the clinically tested doses. CONCLUSIONS: No significant exposure dependency on efficacy or safety was identified for pembrolizumab across doses of 2 mg/kg to 10 mg/kg. These results support the use of a 2-mg/kg Q3W dosage in patients with previously treated, advanced NSCLC.ClinicalTrials.gov registry: NCT0129582

Can body composition be used to optimize the dose of platinum chemotherapy in lung cancer? A feasibility study

Purpose Current methods of dosing platinum-based chemotherapy are suboptimal. Potentially, taking lean body mass into account may help. To inform the design of a future study, we first examined the feasibility and acceptability of such an approach using dual-energy X-ray absorptiometry (DEXA) and explored aspects suggestive of over- and under-dosing. Methods Patients with lung cancer offered platinum-based chemotherapy over 1 year were identified and, if eligible, invited to take part in a prospective feasibility study. Questionnaires examined acceptability of the DEXA scan and of a future study that randomized between traditional dosing and one adjusted according to body composition. Dose-limiting toxicity (DLT) and a lack of neutropenia explored potential over- and under-dosing, respectively. Results Of the 173 patients offered chemotherapy, 123 (71%) were ineligible, mostly because of failing entry criteria (84, 49%). Of the 50 approached, 18 (36%) participated, most receiving carboplatin, with 17 providing data. All found a DEXA scan acceptable; other assessments were fully completed, except nadir and pre-chemotherapy blood counts. Most (94%) were prepared to take part in a future study, although the additional hospital visits for a nadir blood count were unpopular with some. Five (29%) patients experienced six episodes of DLT which resulted in discontinuation (3), dose reduction (2) or change to a less toxic regimen (1). Nine (60%) patients experienced either no (2) or inconsistent (7) neutropenia. Conclusions A randomized trial appears acceptable and feasible in patients receiving carboplatin. Adjustment of our entry criteria and avoiding a hospital visit for a nadir blood count should aid recruitment

En bekymringsfull tilstand? En analyse av risikostyring og internkontroll i norske stiftelser.

I denne oppgaven har vi drøftet begrepet corporate governance (CG) i norske stiftelser. En rekke oppslag i media de siste årene har gitt utrykk for at det har forekommet alvorlige styringsproblemer i mange stiftelser. Siden stiftelser per definisjon eier seg selv, er gode systemer for internkontroll helt nødvendig. Stiftelsestilsynet gjennomførte et tematilsyn i 2009 for å beskrive internkontrollen i norske stiftelser. Tilsynet betraktet resultatet som bekymringsfullt. Mangelfulle systemer for risikostyring og internkontroll ble avdekket. I denne oppgaven tar vi opp flere av temaene fra Stiftelsestilsynets undersøkelse. Primært ønsker vi å belyse følgende problemstilling: Har norske stiftelser i dag et hensiktsmessig fokus på risikostyring og internkontroll? Stiftelsesloven setter de overordnede rammene for risikostyring og internkontroll. Loven stiller generelle krav til stiftelsens styre og daglig ledelse, men sier lite om hvordan de skal opptre i praksis. Stiftelser er i utgangspunktet ikke så spesielle og særegne. Vår oppfatning er derfor at de kan tilegne seg mye lærdom fra flere allmenne rettskilder som omfatter virksomhetsstyring. En stor del av vår oppgave har derfor vært å utarbeide et rammeverk basert på blant annet aksjelovgivingen, NUES, COSO-rammeverkene, kapitalforvaltningsforskriften og internkontrollforskriften. Med dette som utgangspunkt har vi utarbeidet et eget forslag til ”beste praksis” for styring og kontroll i norske stiftelser. Dette utgjør en vesentlig del av vår oppgave. Kartleggingen er strukturert i henholdsvis overordnet styring og kontroll, kapitalforvaltning og utdeling av midler. Vår undersøkelse har en deskriptiv tilnærming, og bygger på en spørreundersøkelse blant såkalte alminnelige stiftelser med bokført egenkapital på 10-100 mill. NOK per 31.12.2010. Analyseresultatene viser at stiftelsene mener å være tilstrekkelig uavhengig av stiftelsens oppretter og at formalisert internkontroll vektlegges fremfor tillit. En stor andel av stiftelsene foretar årlige vurderinger av risikosituasjonen og tilhørende internkontroll. Våre funn indikerer videre at flere stiftelser har en passiv holdning til sin kapitalforvaltning, selv om svært mange stiftelser synes å ha en bevisst tilnærming til forvaltningen av stiftelsens midler. Et oppsiktsvekkende funn er manglende benyttelse av og kjennskapen til fundamentale forskrifter blant flere styreledere. Utdeling av stiftelsens midler er et bredt begrep, og det synes som om mange ikke helt har forstått betydningen av dette. Flere har tilfredsstillende kontroll med sin utdeling, men ideelt sett burde denne andelen vært høyere. In this master thesis we discussthe term Corporate Governance (CG) in Norwegian foundations. In recent years, the media have implied that serious problems concerning governance have occurred in a number of foundations. Because of the nature of such foundations, in that they are self‐owned, it is vital for them to have sufficient systems for internal control. In 2009 the Norwegian Foundation Authority made it a focal area to investigate the internal control of such foundations. They found the results to be worrying, uncovering that system for risk management and internal control were unsatisfactory. Thus, the main question in our thesis will be: To what degrees do Norwegian foundations have a sufficient focus on risk management and internal control

Simplifying Treatment of Advanced Non-small Cell Lung Cancer : Regimen, Route of Administration, and Patients' Preferences

Lung cancer is the cancer disease that takes the most lives. Non-small cell lung cancer (NSCLC) is the most common type, and more than half have an incurable disease at the time of diagnosis. Chemotherapy can halt the disease but is only moderately effective, has some side effects and requires regular hospital visits for intravenous infusions. The aim of the current work was to find a more tolerable treatment that is easier to administer and to explore how patients balance the benefits and disadvantages of treatment. We conducted a national study comparing a chemotherapy combination with fewer side effects (vinorelbine and gemcitabine; VG) with the most commonly used combination in Norway (vinorelbine and carboplatin; VC). Both regimens had a 3-week cycle, with carboplatin given on day 8 and the other drugs on days 1 and 8. The patients went through three cycles. We used vinorelbine in capsule form (oral vinorelbine). This allowed comparison with previous studies in Norway that used intravenous vinorelbine. We also interviewed patients about how large the treatment effect should be to accept treatment. The VG combination was no better than VC, in terms of overall survival and health related quality of life (HRQoL), and VC remained the preferred regimen for most patients. Oral vinorelbine had a favourable toxicity profile without compromising survival outcomes. Oral vinorelbine have replaced intravenous vinorelbine on day 8, which allow for home treatment and simplifying the treatment. Studying patients’ attitudes to treatment at the time of diagnosis was complicated. This study suggested that most patients accepted the planned treatment even if the benefits were minimal