Quality in palliative care from the patient perspective : Instrument development, perceptions of care received and the importance of care

The overall aim was to investigate the quality of palliative care from the patient perspective, to adapt and psychometrically evaluate the Quality from Patients’ Perspective instrument specific to palliative care (QPP-PC) and investigate the relationship between the combination of person- and organization-related conditions and patients’ perceptions of care quality. Methods: In the systematic literature review (I), 23 studies from 6 databases and reference lists in 2014 were synthesized by integrative thematic analysis. The quantitative studies (II–IV) had cross-sectional designs including 191 patients (73% RR) from hospice inpatient care, hospice day care, palliative units in nursing homes and home care in 2013–2014. A modified version of QPP was used. Additionally, person- and organization-related conditions were assessed. Psychometric evaluation, descriptive and inferential statistics were used. Main findings: Patients’ preferences for palliative care included living a meaningful life and responsive healthcare personnel, care environment and organization of care (I). The QPP-PC was developed, comprising 12 factors (49 items), 3 single items and 4 dimensions: medical–technical competence, physical–technical conditions, identity–oriented approach, and socio-cultural atmosphere (II). QPP-PC measured patients’ perceived reality (PR) and subjective importance (SI) of care quality. PR differed across settings, but SI did not (III). All settings exhibited areas of strength and for improvement (II, III). Person-related conditions seemed to be related to SI, and person- and organization-related conditions to PR, explaining 18–30 and 22-29% respectively of the variance (IV). Conclusions: The patient perspective of care quality (SI and PR) should be integrated into daily care and improvement initiatives in palliative care. The QPP-PC can measure patients’ perceptions of care quality. Registered nurses and other healthcare personnel need awareness of person- and organization-related conditions to provide high-quality person-centred care.

Genus i ensemble : En intervjustudie om lärares syn på genusuppdraget och dess innebörd för ensembleämnet

Syftet med undersökningen är att med avseende på skolans genusuppdrag studera musiklärares förhållningsätt i ensembleundervisning på gymnasieskolan. För att uppnå detta har kvalitativa, semistrukturerade intervjuer genomförts med lärare i gymnasiekursen ensemble, följt av diskursanalys på transkriberingar av dessa intervjuer. De teoretiska utgångspunkterna är genusteorier och diskursteorier. I resultatet framkommer lärarnas syn på genusbegreppet och genusuppdraget. Bland de genusdiskurser som presenteras finns synen på genus som rutin, som sidoeffekt på annat arbete och som medvetenhet. Gällande elevsyn visar sig diskurser om eleven som platstagare, som normbrytare och vikten av att eleven känner sig som en synbar individ. Slutledningarna, liksom diskussionskapitlet, rör sig kring genusarbetets framgångar, vilka faktorer som kan ha orsakat dessa, och hur arbetet förändrats på skolorna utifrån dessa framgångar. Genomgående har ett individfokus framkommit, där eleverna inte ses som en grupp, utan som enskilda individer, vilka alla måste mötas personligt.

Organisering av tid och emotioner i psykiatrin

Att arbeta med migranter i psykiatrin innebär ett krävande emotionsarbete som tar tid och reflektion i anspråk. I en organisation där produktionen ständigt förväntas öka kan patient och lidande bli en marknadsekonomisk entitet som behandlare ska hantera i ett ökande tempo. Som följd av denna acceleration måste behandlare hitta strategier för att undvika att dräneras på emotionell energi.

Regulation, stability and change: Reflections on the UK and Sweden

Despite the impact of neo-liberal agendas, the issue of regulation remains central to our understanding of economic processes, and particularly employment. The concept of regulation is often reduced to a narrowly defined set of functions performed by the state. However, processes of regulation involve a much wider range of sites and actors, within and beyond the boundaries of the state. This paper presents a framework for the analysis of the panoply of regulatory actors and the complex relations between them, including the shifting boundaries between regulatory spaces. The paper concludes with some illustrative examples of shifting regulatory structures within Sweden.

Att avslöja sina dolda funktionsnedsättningar i arbetslivet

Artikeln handlar om hur personer med dolda funktionsnedsättningar, som omgivningen inte direkt kan se, befinner sig i en sårbar situation. Om de är helt öppna med sina funktionsnedsättningar riskerar de, trots en positiv norm om öppenhet, att bemötas eller behandlas som annorlunda av andra på sina arbetsplatser. Artikeln visar hur personer med dolda funktionsnedsättningar pressar sig hårt för att inte avvika från den normalitet som deltagande i arbetslivet innebär.

Konkurrens och styrning : Privata utförare inom kommunal verksamhet

Kommuner, regioner och landsting utgör en betydande del av den svenska offentliga sektorn och tillhandahåller tjänster som är betydelsefulla för landets medborgare. Några exempel är vård av äldre och funktionshindrade, utbildning samt hälso- och sjukvård. Under senare år har den andel av verksamheten som tillhandahålls direkt av kommuner, regioner och landsting minskat. Istället har förekomsten av privata utförare ökat inom många områden. Eftersom den upphandlade verksamheten motsvarar stora belopp och omfattningen kontinuerligt ökar är det viktigt att dessa beställare ser till att de privata utförarna levererar verksamhet på överenskommet sätt och med utlovat resultat. Denna forskningsrapport syftar till att beskriva och förklara hur offentliga beställare styr privata utförare i olika styrsituationer avseende konkurrenssituationen och vilken verksamhet som upphandlas. Det empiriska materialet är insamlat genom intervjuer både med kommuner och med privata utförare.

Initiation and early crack growth in VHCF of stainless steels : Experimental and theoretical analysis

Mechanical fatigue is a failure phenomenon that occurs due to repeated application of mechanical loads. Very High Cycle Fatigue (VHCF) is considered as the domain of fatigue life greater than 10 million load cycles. Increasing numbers of structural components have service life in the VHCF regime, for instance in automotive and high speed train transportation, gas turbine disks, and components of paper production machinery. Safe and reliable operation of these components depends on the knowledge of their VHCF properties. In this thesis both experimental tools and theoretical modelling were utilized to develop better understanding of the VHCF phenomena. In the experimental part, ultrasonic fatigue testing at 20 kHz of cold rolled and hot rolled stainless steel grades was conducted and fatigue strengths in the VHCF regime were obtained. The mechanisms for fatigue crack initiation and short crack growth were investigated using electron microscopes. For the cold rolled stainless steels crack initiation and early growth occurred through the formation of the Fine Granular Area (FGA) observed on the fracture surface and in TEM observations of cross-sections. The crack growth in the FGA seems to control more than 90% of the total fatigue life. For the hot rolled duplex stainless steels fatigue crack initiation occurred due to accumulation of plastic fatigue damage at the external surface, and early crack growth proceeded through a crystallographic growth mechanism. Theoretical modelling of complex cracks involving kinks and branches in an elastic half-plane under static loading was carried out by using the Distributed Dislocation Dipole Technique (DDDT). The technique was implemented for 2D crack problems. Both fully open and partially closed crack cases were analyzed. The main aim of the development of the DDDT was to compute the stress intensity factors. Accuracy of 2% in the computations was attainable compared to the solutions obtained by the Finite Element Method.

Perceived Accessibility of Public Transport as a Potential Indicator of Social Inclusion

Perceived accessibility has been acknowledged as an important aspect of transport policy since the 70s. Nevertheless, very few empirical studies have been conducted in this field. When aiming to improve social inclusion, by making sus-tainable transport modes accessible to all, it is important to understand the factors driving perceived accessibility. Un-like conventional accessibility measures, perceived accessibility focuses on the perceived possibilities and ease of en-gaging in preferred activities using different transport modes. We define perceived accessibility in terms of how easy it is to live a satisfactory life with the help of the transport system, which is not necessarily the same thing as the objec-tive standard of the system. According to previous research, perceived accessibility varies with the subjectively-rated quality of the mode of transport. Thus, improvements in quality (e.g. trip planning, comfort, or safety) increase the per-ceived accessibility and make life easier to live using the chosen mode of transport. This study (n=750) focuses on the perceived accessibility of public transport, captured using the Perceived Accessibility Scale PAC (Lättman, Olsson, & Fri-man, 2015). More specifically, this study aims to determine how level of quality affects the perceived accessibility in public transport. A Conditional Process Model shows that, in addition to quality, feeling safe and frequency of travel are important predictors of perceived accessibility. Furthermore, elderly and those in their thirties report a lower level of perceived accessibility to their day-to-day activities using public transport. The basic premise of this study is that sub-jective experiences may be as important as objective indicators when planning and designing for socially inclusive transport systems.

On the Cost of Using Happy Eyeballs for Transport Protocol Selection

Concerns have been raised in the past several years that introducing new transport protocols on the Internet has be- come increasingly difficult, not least because there is no agreed-upon way for a source end host to find out if a trans- port protocol is supported all the way to a destination peer. A solution to a similar problem—finding out support for IPv6—has been proposed and is currently being deployed: the Happy Eyeballs (HE) mechanism. HE has also been proposed as an efficient way for an application to select an appropriate transport protocol. Still, there are few, if any, performance evaluations of transport HE. This paper demonstrates that transport HE could indeed be a feasible solution to the transport support problem. The paper evaluates HE between TCP and SCTP using TLS encrypted and unencrypted traffic, and shows that although there is indeed a cost in terms of CPU load to introduce HE, the cost is rel- atively small, especially in comparison with the cost of using TLS encryption. Moreover, our results suggest that HE has a marginal impact on memory usage. Finally, by introduc- ing caching of previous connection attempts, the additional cost of transport HE could be significantly reduced.