Pain is a common problem for cancer patients at home and when hospitalized. Pain interferes with all aspects of a patient's life including sleep, appetite, sexual desire, emotion and productivity. The under-prescribing of opioids can lead to uncontrolled pain in cancer patients. This study examined nursing advocacy related to pain management and the accuracy of the intravenous (IV) to oral (PO) opioid conversion at discharge in cancer patients. Retrospective chart audits were done on 50 cancer patients. The physicians in the charts surveyed who prescribed the discharge medications consisted of a mix of hematologist/oncologists, surgeons and internists/hospitalists in a southwest Florida community. Fifty nurses were also surveyed and asked how comfortable they are in advocating for their patient's pain control and how often they actually advocate for proper pain management. This was done in the same southwest Florida hospital. The most common cancer diagnoses of the patient subjects were colorectal cancer and esophageal/lung cancer. The results of this study show that an overwhelming majority of cancer patients (47 of 50), received doses that were not accurately converted from intravenous to oral opioids at the time of discharge from the hospital. This conversion was based on the Johns Hopkins Opioid Conversion Tool. Nurses in general reported that they are comfortable in advocating for their patients' pain control, but more so in more autonomous areas of practice such as intensive care. The results were overwhelming in the direction of poor control of patient pain. This study leads to the need for further research in the important area of pain control for cancer patients. It also indicates the need for additional education for physicians and nurses about pain control and opioid conversion.

Declining bat populations necessitates a need to understand how different land management techniques influence bat activity. This study assessed the influences of different coastal upland habitat management techniques, such as mulching, prescribed fire, and select cut, on forest bat activity within the Grand Bay National Wildlife Refuge and National Estuarine Research Reserve. Acoustic recorders were used to monitor bat activity and insect and vegetation surveys were used to assess influences on bat activity across different land management techniques. Results demonstrate that overall bat activity was similar across different land management techniques, however larger species adapted for open-space flying were shown to be less active within dense forest such as the select cut technique areas. Findings from this study suggest that various land management techniques can influence bat activity differently.

Dagens hälso- och sjukvård står inför utmaningar när det kommer till effektiv, hållbar och tillgänglig primärvård, vilket reformen god och nära vård skall verka för. Målet är en personcentrerad vård med hälsofrämjande och förebyggande insatser i fokus. Distriktssköterskan har en betydande roll i omställningen och studier visar att distriktssköterskans förskrivningsrätt leder till en möjlig personcentrering. Syftet med denna studie är att undersöka i vilken utsträckning som distriktssköterskor använder sin förskrivningsrätt och om de känner sig trygga i att använda den. Studien genomfördes med kvantitativ ansats och är en icke experimentell tvärsnittsstudie. En enkät besvarades vid ett tillfälle, av 36 distriktssköterskor verksamma på antingen vårdcentral, hemsjukvård eller barnavårdscentral. Resultatet visar att alla distriktssköterskor verksamma på vårdcentral och i hemsjukvård använder sin förskrivningsrätt för hjälpmedel och förskriver detta vid fler tillfällen, i jämförelse med deras läkemedelsförskrivning. Däremot visas att färre distriktssköterskor vid dessa verksamheter använder sin förskrivningsrätt för läkemedel och läkemedelsförskrivningar sker till färre antal tillfällen. Vidare visar resultatet att alla distriktssköterskor på barnavårdscentral använder sin förskrivningsrätt för läkemedel, men inte alls för hjälpmedel. Resultatet visar också att det finns en korrelation mellan hur trygga distriktssköterskorna känner sig med att använda sin förskrivningsrätt och hur länge de haft den inom samtliga tre verksamheter. Mer trygghet upplevs hos de distriktssköterskor som haft sin förskrivningsrätt mer än två år. När distriktssköterskan känner sig trygg så ökar förutsättningen för en effektiv och personcentrerad vård som främjar hälsa och lindrar lidande genom förskrivning. / Today's healthcare system faces challenges when it comes to effective, sustainable, and accessible primary care. The reform of integrated care will work for such a health care system. The goal is person centered care with a focus on health promotion and prevention. The district nurse has a significant role in the required conversion and studies show that the district nurse's right to prescribe leads to a possible person-centered care. More knowledge about how the district nurses administers their prescribing rights is needed. The purpose of this study is to investigate to what extent district nurses use their right to prescribe and whether they feel safe to use it. The study was conducted with a quantitative approach and is a non-experimental cross-sectional study. A total of 36 district nurses working at either community health centers, home care services or child health centers participated by answering a questionnaire on one occasion. The results show that all district nurses working at health centers and in home care prescribe medical equipment and supplies and on more occasions in comparison with their pharmaceuticals prescriptions. It shows that fewer district nurses at these operations use their right to prescribe pharmaceuticals and prescriptions are made on fewer occasions. Furthermore, the results show that all district nurses at child health care centers use their right to prescribe pharmaceuticals, but not at all for medical equipment and supplies. The results also show that there is a correlation between how safe district nurses feel to use their right to prescribe and for how long time they have had the right to prescribe in all three operations. More security is experienced by the district nurses who have had their right to prescribe for more than two years. When the district nurse feels safe, the prerequisite for an effective and person-centered care that promotes health and relieves suffering through prescription increases.

Increased possibilities during the last decades for early detection of prostate cancer have sparked research on preventable or treatable risk factors and on improvements in therapy. Treatments of the disease still entail significant side effects potentially affecting men during the rest of their lives. The studies of the present thesis concern different aspects of prostate cancer from etiological risk factors and factors influencing treatment to an improved methodology for the detection of treatment side effects. Papers I, II, both based in the population based cohort ULSAM (Uppsala Longitudinal Study of Adult Men), investigate possible risk factors of prostate cancer with options for intervention: selenium levels and the metabolic syndrome. The phenomenon of competing risk of death from other causes than prostate cancer and its impact on and importance for choice of statistical methods is also exemplified and discussed for the first time in prostate cancer research. -Smokers with low selenium status have an increased future risk of later development of prostate cancer. Influence of genetic variability appears plausible. -The metabolic syndrome and especially its increased waist circumference component are associated with later development of prostate cancer – taking competing risks of death from other causes into account. Papers III and IV using pharmacoepidemiological methods investigate aspects of drug utilisation in prostate cancer using nationwide and international databases. In Paper III factors influencing anti-androgen use in prostate cancer are investigated, both from a prescriber- and patient perspective.  The age and disease risk group of the patient, unsupported scientifically, influence both the prescribers’ choice of dose and the patients’ adherence to treatment. -Adherence, not previously investigated in male cancer patients, was considerably higher than reported for adjuvant breast cancer treatment. Subgroups of men suitable for intervention to increase adherence were identified. Paper IV, investigates the feasibility of improving an established method for screening large adverse drug reactions databases, the proportional reporting ratio (PRR), this by using restricted sub-databases according to treatment area (TA), introducing the concept of PRR-TA. -The PRR-TA method increases the signal-noise relationship of analyses; a finding highly relevant for possibly conserving manual resources in Pharmacovigilance work in a drug-authority setting.