What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register

OBJECTIVES: There is a growing emphasis on the perspective of individuals living with diabetes and the need for a more person-centred diabetes care. At present, the Swedish National Diabetes Register (NDR) lacks patient-reported outcome measures (PROMs) based on the perspective of the patient. As a basis for a new PROM, the aim of this study was to describe important aspects in life for adult individuals with diabetes. DESIGN: Semistructured qualitative interviews analysed using content analysis. SETTING: Hospital-based outpatient clinics and primary healthcare clinics in Sweden. PARTICIPANTS: 29 adults with type 1 diabetes mellitus (DM) (n=15) and type 2 DM (n=14). INCLUSION CRITERIA: Swedish adults (≥18 years) living with type 1 DM or type 2 DM (duration ≥5 years) able to describe their situation in Swedish. Purposive sampling generated heterogeneous characteristics. RESULTS: To live a good life with diabetes is demanding for the individual, but experienced barriers can be eased by support from others in the personal sphere, and by professional support from diabetes care. Diabetes care was a crucial resource to nurture the individual's ability and knowledge to manage diabetes, and to facilitate life with diabetes by supplying support, guidance, medical treatment and technical devices tailored to individual needs. The analysis resulted in the overarching theme 'To live a good life with diabetes' constituting the two main categories 'How I feel and how things are going with my diabetes' and 'Support from diabetes care in managing diabetes' including five different categories. CONCLUSIONS: Common aspects were identified including the experience of living with diabetes and support from diabetes care. These will be used to establish a basis for a tailored PROM for the NDR.

Experimentell studie på kostnadseffektiva inkjetbestrykningspigment

The objective of this study was to evaluate and compare the print performance of some of the new most promising, cost effective absorbent pigments specialised for inkjet coatings on the market in a continuous drive to find an alternative to silica. The target was a lower production cost for ArjoWiggins inkjet products, OMD 01 and OMD 02. Five absorbent pigments are being evaluated through measuring the qualities of the coating mix itself, visual evaluations of print performance and physical testing of the coated paper. Pigments 1,2 and 3, which all are said to be tailored for inkjet coatings, did not reach the print performance needed for an OMD 01 and OMD 02 equal, due to severe bleed and feathering identified especially on the Epson 950 printer. They are therefore currently not seen as viable formulations. A blend of 50% pigment 5 and 50% silica had excellent print performance as OMD 01 and OMD 02 equivalents and is therefore recommended as a potential alternative to 100% silica. It is of the company’s interest to find a more cost effective solution to their inkjet coatings, and a 50/50 blend of Pigment 5 will save the company more than 35 000 euro per year.

Bättre utnyttjande av nya och befintliga förrådslokaler på SSAB Tunnplåt

The purpose of this assignment at SSAB Tunnplåt in Borlänge was mainly to investigate and describe the circumstances for the spare parts stored in storage facilities within the area of operation. Even new facilities which could serve as storage rooms and their opportunities for storing spare parts were an important part of the investigation. This because of the need for improved storing of spare parts. Furthermore, market offers where reviewed for storage of spare parts in more tailored designs. The work will culminate in proposals for improvement which is of importance for the development surrounding the storage and handling of spare parts. This is since the design and management of existing storage facilities is not perceived as satisfactory with regards to spare parts characteristics. Moreover, the amount of stock locations is too few in relation to the actual need. The approach used to achieve objectives of the work was an advanced mapping for collection of vital data. The mapping consisted of interviews with involved parties, both internal and external, for the most comprehensive picture of the problems as possible. In addition, a literature survey was conducted to identify possible options for the objectives of the work as well as a personal study of existing and new storage facilities. Furthermore, the market offers for improved conditions in storage rooms were examined. A clear picture of internal logistics and warehouse activities for spare parts at SSAB Tunnplåt has been obtained during this work. From this picture, it is concluded that work in and around storage facilities can be made more efficient. SSAB Tunnplåt should additionally make efforts in the storage facilities for better use of the available storage space. A number of proposals for improvement for each studied storage facility and spare parts management in general have been conducted. These proposals for improvement include presentations to improve the design of the studied storage facilities towards enabling more stock locations. The proposals also include additional equipment for handling spare parts, scrap handling, as well as expansions of the maintenance system which supports activities in the spare parts management.

Discourse strategies and power roles in student-led distance learning

The assertion of identity and power via computer-mediated communication in the context of distance or web-based learning presents challenges to both teachers and students. When regular, face-to-face classroom interaction is replaced by online chat or group discussion forums, participants must avail themselves of new techniques and tactics for contributing to and furthering interaction, discussion, and learning. During student-only chat sessions, the absence of teacher-led, face-to-face classroom activities requires the students to assume leadership roles and responsibilities normally associated with the teacher. This situation raises the questions of who teaches and who learns; how students discursively negotiate power roles; and whether power emerges as a function of displayed expertise and knowledge or rather the use of authoritative language. This descriptive study represents an examination of a corpus of task-based discussion logs among Vietnamese students of distance learning courses in English linguistics. The data reveal recurring discourse strategies for 1) negotiating the progression of the discussion sessions, 2) asserting and questioning knowledge, and 3) assuming or delegating responsibility. Power is defined ad hoc as the ability to successfully perform these strategies. The data analysis contributes to a better understanding of how working methods and materials can be tailored to students in distance learning courses, and how such students can be empowered by being afforded opportunities and effectively encouraged to assert their knowledge and authority.

Kvinnors behov av stöd vid bröstcancer : - En litteraturöversikt

Bakgrund Bröstcancer är den vanligaste typen av cancer hos kvinnor över hela världen. De som drabbas av bröstcancer har olika förutsättningar att hantera sin situation. Många av kvinnorna upplever en emotionell kris i samband med diagnosen och med hjälp av stöd från sjukvården kan patienten finna mening i sin situation. Syfte Syftet är att sammanställa aktuell forskning om bröstcancerdrabbade kvinnors effekter av stöd under diagnosperioden. Metod En litteraturöversikt som sammanställer aktuell forskning inom det valda omvårdnadsområdet. Resultat I resultatet framkom att kvinnorna behöver ett stöd i form av kommunikation, information samt ett emotionellt stöd från vårdpersonal. Stödet ska utformas efter patientens unika situation och när sjukvården är tillgänglig för patienterna minskas deras stress. Patienterna upplevde stöd under diagnosperioden då sjuksköterskan erhöll god förmåga att bemöta och kommunicera på ett adekvat sätt. Slutsats Studien visar att det krävs en god relation mellan bröstcancer drabbade kvinnor och vårdaren för att kvinnorna ska känna stöd.

Outdoor performance of forest seedlings pre-cultivated under artificial lights : effects of the light spectra used for pre-cultivation on the future establishment and development

Forest nurseries are essential for producing good quality seedlings, thus being a key element in the reforestation process. With increasing climate change awareness, nursery managers are looking for new tools that can help reduce the effects of their operations on the environment. The ZEPHYR project, funded by the European Commission under the Seventh Framework Programme (FP7), has the objective of finding new alternatives for nurseries by developing innovative zero-impact technologies for forest plant production. Due to their direct relationship to the energy consumption of the nurseries, one of the main elements addressed are the grow lights used for the pre-cultivation. New LED luminaires with a light spectrum tailored to the seedlings’ needs are being studied and compared against the traditional fluorescent lamps. Seedlings of Picea abies and Pinus sylvestris were grown under five different light spectra (one fluorescent and 4 LED) during 5 weeks with a photoperiod of 16 hours at 100 μmol∙m-2∙s-1 and 60% humidity. In order to evaluate if these seedlings were able cope with real field stress conditions, a forest field trial was also designed. The terrain chosen was a typical planting site in mid-Sweden after clear-cutting. Two vegetation periods after the outplanting, the seedlings that were pre-cultivated under the LED lamps have performed at least as well as those that were grown under fluorescent lights. These results show that there is a good  potential for lightning substitution in forestry nurseries.

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.

The fall descriptions and health characteristics of older adults with hip fracture : a mixed methods study

Background: In light of the multifactorial etiology of fall-related hip fracture, knowledge of fall circumstances may be especially valuable when placed in the context of the health of the person who falls. We aimed to investigate the circumstances surrounding fall-related hip fractures and to describe fall circumstances in relation to participants' health and functional characteristics. Methods: The fall circumstances of 125 individuals (age >= 50 years) with hip fracture were investigated using semi-structured interviews. Data concerning participants' health (comorbidities and medications) and function (self-reported performance of mobility, balance, personal activities of daily living and physical activity, previous falls and hand grip strength) were collected via medical records, questionnaires and dynamometry. Using a mixed methods design, both data sets were analysed separately and then merged in order to provide a comprehensive description of fall events and identify eventual patterns in the data. Results: Fall circumstances were described as i) Activity at the time of the fall: Positional change (n = 24, 19%); Standing (n = 16, 13%); Walking (n = 71, 57%); Balance challenging (n = 14, 11%) and ii) Nature of the fall: Environmental (n = 32, 26%); Physiological (n = 35, 28%); Activity-related indoor (n = 8, 6%) and outdoor (n = 8, 6%); Trips and slips on snow (n = 20, 16%) and in snow-free conditions (n = 12, 10%) and Unknown (n = 10, 8%). We observed the following patterns regarding fall circumstances and participants' health: those who fell i) during positional change had the poorest functional status; ii) due to environmental reasons (indoors) had moderate physical function, but high levels of comorbidity and fall risk increasing medications; iii) in snow-free environments (outdoors) appeared to have a poorer health and functional status than other outdoor groups. Conclusions: Our findings indicate that patterns exist in relation to the falls circumstances and health characteristics of people with hip fracture which build upon that previously reported. These patterns, when verified, can provide useful information as to the ways in which fall prevention strategies can be tailored to individuals of varying levels of health and function who are at risk for falls and hip fracture.