Introduction: Like many other countries, Norway has seen a shift from inpatient to outpatient cancer care, with pathways aimed at improving the integration and coordination of health services. This ...study explores the perspectives of seven patients and their family members in light of this change. We focus on one particular phase of the pathway: the first encounter. Our interviews were set in the period from referral until the start of treatment.
Methods: Nineteen individual in-depth interviews were conducted in seven families. Seven patients with cancer and 12 family members were interviewed.
Results: Three categories of experiences stood out in the empirical material: ‘Being in between different health professionals’, ‘Overwhelmed by written and oral informationʼ and ‘Lack of involvement’.
Conclusion: This study provides insight into families’ experiences with cancer care from referral until the start of treatment. Our findings indicate that families often experience cancer care as fragmented and confusing. Although evaluations have shown that the introduction of cancer pathways seems to have a positive effect on waiting times and standardization of examinations across hospitals and regions, there is still potential for improvement in coordination between services, family involvement, and emotional and practical support. We argue that our findings highlight the tension between two ideals of professional care: standardization and patient-centredness. The study illustrates shortcomings in translating the ideal of patient-centredness into professional practice.
The Impact of Telementoring Andreassen, Hege Kristin; Warth, Line Lundvoll
Studies in health technology and informatics,
2018, Letnik:
255
Journal Article
Recenzirano
Telementoring is a well-known practice in surgical training, and its impact is traditionally related to individual surgeons' performance and the quality of the procedure. The objective of this study ...was to explore telementoring in a wider organisational context. This paper reports on an ethnographic study carried out during 2014-2016 in Norway, combining observations, interviews, focus groups and field notes. We followed the surgical training of a specialist candidate at a medium-sized surgical ward. The training successfully took place through the use of telementoring, comprising updated standards for a surgical procedure that ensured minimum invasive surgery for a vulnerable patient group. We observed that telementoring was a necessary and important element in ongoing quality improvement processes at the ward, and its impact at the organisational level was important. In fact, a series of co-existing interwoven elements was necessary to normalise the new procedure in question. We conclude that the use of telementoring linking international expertise to local contexts is one of the factors that can facilitate and speed up quality improvement processes in small- to medium-sized surgical wards.
Background
Norway has a long coastline, steep mountains, and wide fjords, which presents some challenges to the prehospital emergency healthcare system. In recent years, the prehospital emergency ...medical services (EMS) have undergone significant changes, structurally, in terms of professionalisation of the services and in the education level of the personnel. In this article, we aim to describe the current structure for handling prehospital medical emergencies.
Methods
For healthcare, Norway is divided into four Regional Health Authorities, consisting of 19 Health Trusts, where 18 have an EMS. There is a dedicated medical emergency number, 113, that terminates in 16 emergency medical communication centres. The use of air and boat ambulances, in addition to traditional ambulances, seeks to meet the challenges in the EMS system.
Strengths and limitations
The Norwegian EMS is an advanced system with highly educated staff; however, this level of care comes with an equally high cost.
Conclusion
The Norwegian EMS can handle emergencies nationwide, providing advanced care at the scene and during transport. The geography and demography challenge the idea of equal care, but the open publishing of data from national quality registries seeks to identify and address potential differences.
•Interprofessional simulation-based learning (ISBL) can strongly affect student self-efficacy contribution.•Students’ experiences with how ISBL contributes to self-efficacy is described.•In ISBL, all ...of Bandura's sources for the development of self-efficacy can be identified.•To positively affect students’ self-efficacy, ISBL needs to be well-designed/prepared.
Self-efficacy is an essential concept regarding academic performance and persistence in higher education. Research indicates that interprofessional simulation-based learning influences participants’ self-efficacy and points to a need for more research on self-efficacy and its development. This study describes perioperative nursing students’ experiences with how interprofessional simulation-based learning contributes to self-efficacy in communication, interdisciplinary collaboration, and prioritising tasks in acute situations. Six qualitative focus group interviews were conducted with thirty-four perioperative nursing students from four universities and university colleges in Norway. Qualitative directed content analysis was applied in accordance with Bandura's social cognitive theory which specifies four sources influencing self-efficacy. Results showed that well-designed/prepared interprofessional simulation-based learning can develop self-efficacy concerning communication, interdisciplinary collaboration, and prioritising tasks in acute situations.
DNA-dependent protein kinase catalytic subunit (DNA-PK) is a pleiotropic kinase involved in DNA repair and transcriptional regulation. DNA-PK is deregulated in selected cancer types and is strongly ...associated with poor outcome. The underlying mechanisms by which DNA-PK promotes aggressive tumor phenotypes are not well understood. Here, unbiased molecular investigation in clinically relevant tumor models reveals novel functions of DNA-PK in cancer.
DNA-PK function was modulated using both genetic and pharmacologic methods in a series of
models,
xenografts, and patient-derived explants (PDE), and the impact on the downstream signaling and cellular cancer phenotypes was discerned. Data obtained were used to develop novel strategies for combinatorial targeting of DNA-PK and hormone signaling pathways.
Key findings reveal that (i) DNA-PK regulates tumor cell proliferation; (ii) pharmacologic targeting of DNA-PK suppresses tumor growth both
, and
; (iii) DNA-PK transcriptionally regulates the known DNA-PK-mediated functions as well as novel cancer-related pathways that promote tumor growth; (iv) dual targeting of DNA-PK/TOR kinase (TORK) transcriptionally upregulates androgen signaling, which can be mitigated using the androgen receptor (AR) antagonist enzalutamide; (v) cotargeting AR and DNA-PK/TORK leads to the expansion of antitumor effects, uncovering the modulation of novel, highly relevant protumorigenic cancer pathways; and (viii) cotargeting DNA-PK/TORK and AR has cooperative growth inhibitory effects
and
.
These findings uncovered novel DNA-PK transcriptional regulatory functions and led to the development of a combinatorial therapeutic strategy for patients with advanced prostate cancer, currently being tested in the clinical setting.
DIFFERENCES AND INEQUALITIES IN HEALTH Andreassen, Hege Kristin; Dyb, Kari
Information, communication & society,
10/2010, Letnik:
13, Številka:
7
Journal Article
Recenzirano
The potential for information technologies (ITs) to contribute to a struggle against social inequalities in health is discussed in contemporary policy and research. Expectations are on IT to ...facilitate access to health expertise and knowledge, and hence result in improved health practices and outcomes for individuals. In this article, the authors argue that this currently dominant understanding of the relation between IT and social inequalities in health is constraining as well as insufficient to explain the persistence of health inequalities in digitalized western societies. Human action is reduced to be about rational choice, and technology is expected to be a passive tool to be employed by implementers and policy-makers. Drawing on case studies from two telemedicine projects in Norway, this analysis combines perspectives from sociology concerned with structural inequalities on the one hand, with science technology studies on the other. It reveals how the practice and performance of IT is tied to the practice and performance of local differences, and this might be important to a discussion of the social distribution of health. Combining these two perspectives allows for an alternative understanding of how IT and social inequalities in health interact.
Simulation-based learning has been extensively explored, especially in baccalaureate nursing programmes. Recently, simulation-based learning has been introduced in perioperative nursing. The aim of ...this scoping review is to investigate work published on the use of simulation-based learning in the field of perioperative nursing.
A scoping review was conducted using the methodological framework of Arksey and O'Malley to identify a broad range of relevant literature, regardless of study design. A comprehensive and systematic search was performed using Medline, CINAHL, Eric, Svemed+, PsychINFO and Embase in May 2016 and then was updated in February 2018. Each database was searched for literature published between 1st January 2005 and 8th February 2018.
Two authors independently assessed literature eligibility and extracted data to answer our research question ‘What is known about the use of simulation-based learning in the field of perioperative nursing?’
Nine articles and one doctoral thesis were included in the review. There appears to be a paucity of research or results-oriented evidence regarding the use of simulation-based learning in the field of perioperative nursing. Different goals of simulation-based learning were reported. It was difficult to confirm whether these goals had been reached as none of the articles included control groups, and no evaluations had been undertaken against Kirkpatrick's level 3 to see changes in participants' behaviours, and level 4, to determine whether the training had a positive impact on, for example, patient outcomes.
Owing to the lack of research and the inadequate descriptions of design and method in simulation-based learning in most of the articles included, there is little evidence in the existing literature to guide practitioners of this learning in the field of perioperative nursing. This indicates a need for further research in this area.
A highly positive intraoperative fluid balance should be prevented as it negatively impacts patient outcome. Analysis of volume-kinetics has identified an increase in interstitial fluid volume after ...crystalloid fluid loading during isoflurane anesthesia. Isoflurane has also been associated with postoperative hypoxemia and may be associated with an increase in alveolar epithelial permeability, edema formation, and hindered oxygen exchange. In this article, the authors compare fluid extravasation rates before and during cardiopulmonary bypass (CPB) with isoflurane- versus propofol-based anesthesia.
Fourteen pigs underwent 2 h of tepid CPB with propofol (P-group; n = 7) or isoflurane anesthesia (I-group; n = 7). Fluid requirements, plasma volume, colloid osmotic pressures in plasma and interstitial fluid, hematocrit levels, and total tissue water content were recorded, and fluid extravasation rates calculated.
Fluid extravasation rates increased in the I-group from the pre-CPB level of 0.27 (0.13) to 0.92 (0.36) ml·kg·min, but remained essentially unchanged in the P-group with significant between-group differences during CPB (pb = 0.002). The results are supported by corresponding changes in interstitial colloid osmotic pressure and total tissue water content.
During CPB, isoflurane, in contrast to propofol, significantly contributes to a general increase in fluid shifts from the intravascular to the interstitial space with edema formation and a possible negative impact on postoperative organ function.
Abstract
The aim of this qualitative interview study was to explore the specific expectations that N = 29 Jehovah's Witnesses (JWs) had of end times and paradise using an emotion regulation ...perspective. Beyond the general eschatological doctrine of JWs, the participants were encouraged to report their individual beliefs and connected emotions. Thematic analysis identified forecasting of life in paradise in the form of a continuation of physical life but with an overall positive emotional atmosphere. Emotionally, paradise was often contrasted with the present time, as negative emotions and the downregulation of strong positive emotions dominate the current end time. As an emotion regulation strategy between current end times and future paradise, emotional forecasting, i.e., predicting which emotions would arise in the future to regulate present-day emotions, is used. The results are discussed in the frame of positive and negative psychological implications of JWs' eschatological beliefs and emotional forecasting.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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