Medical students’ views of clinical environments.

Background: Monitoring the quality of clinical learning environments (CLEs) is immensely important in medical education. Objective indicators of the quality of the CLE can be used to measure learner perceptions and to inform educational improvements; however, many established tools were not designed for use in clinical settings and are not theoretically grounded. Our aim was to apply a new tool to the new context of a UK setting to explore the perceptions of senior medical students in a number of different CLEs. “Monitoring the quality of clinical learning environments is immensely important in medical education”. Methods: The four-factor Undergraduate Clinical Education Environment Measure (UCEEM) was translated into English, and used to gather fina-year medical students’ perceptions of four different specialties they had rotated through: Emergency Medicine (EM), General Surgery (GS), Medicine for the Elderly (ME), and Obstetrics and Gynaecology (O&G). The UCEEM was distributed in paper form. Students were asked to complete it in relation to two of the four specialties. Results/findings: Year-5 medical students (n = 132) returned a completed UCEEM. For opportunities to learn in and through work experience EM was reported the most positively. ME was perceived to be the most prepared for student entry. Students reported being well received by staff and made to feel part of the team within GS, EM and ME, but less so in O&G. Discussion: UCEEM appears to be a useful tool for evaluating medical student perceptions of CLEs. Theoretically robust, UCEEM is straightforward to administer and to score. It has the potential to be used by time-pressured educators to collect baseline and comparative data for evaluation and improvement purposes

The invasive Pacific oyster, Crassostrea gigas, in Scandinavia coastal waters:A risk assessment on the impact in different habitats and climate conditions

A massive invasion of the Pacific oyster, Crassostrea gigas, has occurred in Scandinavia during the last decade. The introduction and dispersal was described through collaboration between scientists from Sweden, Denmark and Norway. This work has been followed up by national activities that clearly visualized the need for a continued collaboration between scientists in the Scandinavian countries, as the bio-invasion is a cross-border issue and management actions then have to be synchronized, and based on a “state of the art” knowledge of the Scandinavian bio-invasion of the species. The risk assessment presented in this report is based on available scientific literature, expert judgments and data collected during a Nordic collaboration project on Pacific oysters in 2011 – 2013

Tradeoffs and synergies in wetland multifunctionality: A scaling issue

Wetland area in agricultural landscapes has been heavily reduced to gain land for crop production, but in recent years there is increased societal recognition of the negative consequences from wetland loss on nutrient retention, biodiversity and a range of other benefits to humans. The current trend is therefore to re-establish wetlands, often with an aim to achieve the simultaneous delivery of multiple ecosystem services, i.e., multifunctionality. Here we review the literature on key objectives used to motivate wetland re-establishment in temperate agricultural landscapes (provision of flow regulation, nutrient retention, climate mitigation, biodiversity conservation and cultural ecosystem services), and their relationships to environmental properties, in order to identify potential for tradeoffs and synergies concerning the development of multifunctional wetlands. Through this process, we find that there is a need for a change in scale from a focus on single wetlands to wetlandscapes (multiple neighboring wetlands including their catchments and surrounding landscape features) if multiple societal and environmental goals are to be achieved. Finally, we discuss the key factors to be considered when planning for re-establishment of wetlands that can support achievement of a wide range of objectives at the landscape scale

Impact of an icy winter on the Pacific oyster (Crassostrea gigas Thunberg, 1793) populations in Scandinavia

The Pacific oyster (Crassostrea gigas) is an invasive species that has dispersed into Scandinavia during the last few decades. The objective of this study was to evaluate the effects of extreme winter conditions on the mortality of the Pacific oyster in Scandinavia. The study was done by compiling mortality data from independent surveys in Denmark, Sweden and Norway. Winter mortality of the oysters increased with latitude, which can be explained by the colder climate experienced at higher latitudes. Mortality was also found to be affected by site specific conditions such as water depth at the sampling sites of oyster populations. Despite the severe winter conditions of 2009/2010 causing high mortality, the Pacific oyster still exists in large numbers in Scandinavia. The present investigation indicates that extreme winter onditions may result in a temporary reduction of the density of the Pacific oyster, but that the species can be expected to continue its invasion of Scandinavian coastal areas.publishedVersio

Goal directed fluid removal with furosemide versus placebo in intensive care patients with fluid overload:A trial protocol for a randomised, blinded trial (GODIF trial)

Funding Information: SW has received a grant from Merchant Jakob Ehrenreich and wife Grete Ehrenreich's Foundation to production of trial drug for the GODIF trial. AP has received research funding from the Novo Nordisk Foundation, Health Insurance Denmark (Sygeforsikringen Danmark), Fresenius Kabi, Denmark, and Pfizer, Denmark. MO has received research funding from Fresenius Medical Care, Baxter and Biomerieux. MHB has received research funding for the GODIF trial from Novo Nordisk Foundation, Jakob Madsen's and wife Olga Madsen's Foundation, Svend Andersen's Foundation, and Health Insurance Denmark (Sygeforsikringen Danmark). No authors received any financial gain. All other authors declared no conflicts of interest. Publisher Copyright: © 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.Background: Fluid overload is a risk factor for mortality in intensive care unit (ICU) patients. Administration of loop diuretics is the predominant treatment of fluid overload, but evidence for its benefit is very uncertain when assessed in a systematic review of randomised clinical trials. The GODIF trial will assess the benefits and harms of goal directed fluid removal with furosemide versus placebo in ICU patients with fluid overload. Methods: An investigator-initiated, international, randomised, stratified, blinded, parallel-group trial allocating 1000 adult ICU patients with fluid overload to infusion of furosemide versus placebo. The goal is to achieve a neutral fluid balance. The primary outcome is days alive and out of hospital 90 days after randomisation. Secondary outcomes are all-cause mortality at day 90 and 1-year after randomisation; days alive at day 90 without life support; number of participants with one or more serious adverse events or reactions; health-related quality of life and cognitive function at 1-year follow-up. A sample size of 1000 participants is required to detect an improvement of 8% in days alive and out of hospital 90 days after randomisation with a power of 90% and a risk of type 1 error of 5%. The conclusion of the trial will be based on the point estimate and 95% confidence interval; dichotomisation will not be used. ClinicalTrials.gov identifier: NCT04180397. Perspective: The GODIF trial will provide important evidence of possible benefits and harms of fluid removal with furosemide in adult ICU patients with fluid overload.Peer reviewe

Å rette feil : Gjennomføring av likelønnsregelen når kollektive avtaler diskriminerer

Oppgaven tar utgangspunkt i at timelønnsforskjellene mellom kvinner og menn i dag er på omtrent 15 %, og at en av årsakene til at det ikke er faktisk likelønn i Norge er at systemet for lønnsdannelse viderefører etablerte lønnsforskjeller. Det følger av norsk rett og Norges internasjonale forpliktelser at retten til å ikke bli diskriminert gjennom den kollektive lønnsdannelsen skal sikres, noe som blant annet innebærer at det skal være mulig å kjenne tariffavtaler ugyldig dersom de er i strid med preseptoriske likelønnsbestemmelser. Oppgaven viser at det norske systemet for håndheving av disse spørsmålene ikke er egnet til å oppfylle disse kravene. Videre vurderes mulige tiltak og forslag til endringer i systemet som kan bidra til et tilstrekkelig vern av retten til å ikke bli diskriminert på strukturelt grunnlag i lønnsdannelsen

Kommunikationskompetens – att skifta perspektiv

ST-boken Denna lärobok är den första som sätter hela specialiseringstjänstgöringen för läkare (ST) i fokus. Tongivande och utbildningsaktiva medförfattare från hela landet bidrar till ST-bokens mångfald, som inkluderar fakta om ST 2008 och den nya ST som gäller från 2015. I den första delen av ST-boken reflekterar läkare om sina personliga erfarenheter av ST. Övriga kapitel är inriktade på gemensamma specialitetsövergripande ämnen

Being and becoming a teacher in medical education

Recension av doktorsavhandling, Karolinska Intitutet, Stockhol