Kvinnlig Könsstympning : Litteraturstudie om praktisk handläggning och komplikationsrisker vid förlossning

Today around 28 000 women originally from countries where FGM is practised, are living in Sweden. Many of them are at childbearing age which means that knowledge about FGM and its consequences is of outmost importance during delivery. The aim of this study is to describe current research on how to manage the delivery, regarding deinfibulation and the following stitching as well as the risk of complications when the labouring woman is mutilated. This review of literature is based on 12 scientific articles published between years 1989 – 2005. Five different databases have been searched with use of a large number of keywords.The review found that no scientific research has been carried out that describes how deinfibulation and following stitching should be managed when the woman is mutilated. All available articles within this area are referring to best practice only. The review also found that the conclusions of the studies are contradictory. The majority, however, show an increased frequency for prolonged labour that could be related to FGM. The three largest studies also show an increased rate of caesarean section among mutilated women. In the few studies that examine haemorrhage, the majorities show an increased tendency to bleed, that could be related to FGM. Several articles emphasize the importance of good routines for deinfibulation to reduce the risk for complications.In summary it can be established that due to methodological problems in many studies, no reliable conclusion can be made that the researched complications exists to a greater extent when the woman is mutilated

The Quest for CSR in Closedowns

This paper focuses on analysis of and suggestions for Corporate Social Responsibility (CSR) orienta- tion during the closedown process.The article addresses CSR considerations that adjust business strategies, which in turn change the Human Resource Management (HRM) focus. Our study fo- cuses on four best practice cases in Sweden, which are compared with three reported cases in the literature.All four best practice cases had a long notice period and socially responsible coordination of management and employees, which created adjusted corporate strategies.Three cases had the CSR orientation in the earliest stage, while the fourth case had this coordination during a later stage of the closedown process. We develop a model where we show that the scope for action increases if the CSR orientation and coordination of actions come early in the closedown process, due to the increased ability to adjust the business strategy and create a plan for outreach HRM activities and local community activities. 

Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care : a cluster randomised study

BACKGROUND: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44819426.