<p>Det har länge varit känt att patientens perioperativa position kan orsaka symtom som förmodas uppstå genom tryck och sträckningar. Positionen vid laparosko-piska operationer anses öka risken för symtom och därför är perioperativ om-vårdnad av betydelse. Syftet var därför att undersöka hur frekvent positions- relaterade symtom förekommer vid laparoskopiska ingrepp och vilken betydelse de har för patienten. Studien genomfördes som en deskriptiv tvärsnittstudie och datainsamlingen gjordes med hjälp av symtomskattning och semistrukturerade intervjuer. Totalt 60 respondenter i åldern 19 till 75 år deltog i studien som pågick under åtta månader. Resultatet visade att en fjärdedel av respondenterna drab-bades av nytillkomna eller förvärrade symtom. Dessa uppmärksammades postoperativt eller några dagar efter operationen och var oberoende av ingrepp, perioperativ tid eller armarnas position. Några av respondenterna upplevde smärta och domningar i nacke, axlar och händer som ledde till inskränkningar i det dagliga livet och krävde hjälp av närstående. Det är viktigt att fortsätta arbetet med att förebygga positionsrelaterade skador, för att förhindra postoperativa symtom, genom att placera patienten så nära ett neutralläge som möjligt och ge denne möjlighet att känna efter hur det känns före nedsövning.</p> / <p>It has long been assumed that a patient’s perioperative position can cause symp-toms which appear from pressure and strains on the body. The position in lapa-roscopic surgery is considered to increase the risk of symptoms, perioperative care is therefore important. The scope of this study was therefore to survey how frequent symptoms associated with the patient’s position occur and why they are important to the patient. The survey was made as a descriptive cross-section study. The data collection was made by way of patients own estimates of their symptoms and by semistructured interviews. 60 respondents aged between 19 and 75 took part in the study. The result showed that a fourth of the respondents experienced new or aggravated symptoms. These were observed postoperatively or a few days after surgery and were independent of operations, perioperative time or position of the arms. Some of the respondents felt pain and numbness in the neck, shoulders and hands which led to restrictions in their daily life and required help from someone close. It is important to continue working with preventing postoperative symptoms, by placing the patient as close to a neutral position as possible and give her the possibility to feel comfortable before the anesthetization.</p>

Invasive procedures are often painful and distressing for children and disturbing for their parents. The purpose of this study was to develop a substantive theory of parental perceptions of their school-aged child's responses to an outpatient minor surgical procedure with nitrous oxide. The sample included 22 parents of 21 children who underwent a nitrous procedure. Participants were recruited from the pediatric surgery department at a children's hospital. Semi-structured, audio-recorded interviews were conducted with each participant. Grounded theory method was used to simultaneously collect and analyze the data using the constant comparative method. The findings of the study revealed parental impressions involving a process of various emotions and behaviors. The identified process began at procedural scheduling, progressing through the procedure, and terminated going home. The core category derived from the data was Weathering the Storm before the Calm by Securing Connections. This core category describes the complexity of parental impressions and all categories subsumed by the core category. Six major categories and seven subcategories derived from the data represent parental impressions. Parental feelings of anxiety and fear arose during initial phases of the process. Parents attempted to deal with these stormy feelings in several ways. Parents experienced a sense of calmness after the procedure upon realizing their child was safe. The theme that weaves through the entire process is the parental-child connection and parental presence during the nitrous procedure. Parents also identified barriers and facilitators they faced during this process. The substantive theory that emerged provides nurses with an understanding of the stormy and subsequent calm phases parents endured. This information offers clinicians unique interventions to help parents get through this process. Future research needs extension to other settings such as radiology and other specialties such as plastic surgery and urology. Further research warrants investigating children's perceptions to their procedure with nitrous oxide.

The purpose of this study is to find out what working procedures are used in Nepalese schools. We have also investegated teachers'views on how schools are organised and how the school system is structured in Nepal. Furthermore, we studied what kind of National Curriculum and other official documents that existed in Nepal, to support teachers when planning their teaching. In our study we used an ethnographic approach. The literature review and our results show that the teachers in Nepal face several challenges in their profession. We believe that the central power of the government can in a future development be discussed in terms of de-centralisation of the school system. If so, it could be problematised how and what the teachers should teach and how the pupils'final School Leaving Certificate exam should look like.

Introduction: Early detection and case management remain the main strategies in malaria control programme (MCP) in a low endemic area such as in Java Island, Indonesia. These strategies require an understanding of the community’s care-seeking behaviour in relation to the various health services. Since most malaria cases in Java are diagnosed at home by the village malaria workers (VMWs), this study aimed to examine the user-provider interface in early detection and case management of malaria, particularly the interaction between the clinical malaria patients and the VMWs. Methods: The number of blood slides examined and the laboratory results over a 20-year period were retrieved from the routine malaria surveillance system. The population at risk of malaria and the rainfall data were obtained from secondary sources. In addition, age, sex, malaria species, types of drugs, drug and dosage and time lapse between slides taken and examined were recorded from the malaria registers at the three endemic health centres from 1994-1998. The quality of diagnosis was examined by re-reading 153 slides at the Faculty of Medicine, Gadjah Mada University. Prior to using rapid assessment procedures (RAP), we proposed 11 criteria and applied these to 15 published RAP studies in health. For each of the papers, two authors assessed the adequacy of information provided independently. Using the criteria as a guideline for developing a protocol, a RAP study of malaria was thereafter carried out. Data were retrieved from 38 free-listings, 28 in-depth interviews, seven focus group discussions and unstructured observation. A qualitative thematic content analysis was applied. Finally, based on the RAP results, a one-year longitudinal study of care-seeking behaviour of all clinical malaria cases treated by the VMWs was conducted in Mlonggo II area. Age, sex, daily actions and date of consultations were recorded by all VMWs in a diary that covered prior all contacts between the patients and the VMWs. Also, 24 interactions between the VMWs and the patients were audiotaped. Results: The incidence of malaria during the 1990s fluctuated, albeit at the lower level than that of the 1980s, and it reached a peak (3.5/1000 population) during an outbreak in 1996-97. There was no clear association between the El Nino phenomenon and incidence of malaria. The incidence was almost twice as high in children &lt;15 years than in adults (15+ years). In &lt;5 year old children the risk of P. vivax malaria was higher than the risk of P. falciparum. Comparisons between active and passive case detection (ACD and PCD) showed that almost 60% of 10, 493 confirmed malaria cases in Jepara were identified from ACD. ACD also detected significantly higher percentage of P. falciparum gametocyte infections than PCD (14.7% vs. 5.7%). The duration between slides taken to examination was however longer for ACD than for PCD (2.3 vs. 1.1 days). Applying the criteria to the published RAP studies, it was found that information was limited to address subjectivity, staff and ethics criteria. In Jepara, malaria (known as katisen or panas tis) was considered a common but minor illness. This was also reflected by the most common action taken by the patients, i.e. not doing anything. However, when the illness was perceived as important, the community had a good access to different health care providers. Eighty seven percent of cases had been treated by the VMWs on day four of the illness period. On day two, the proportion not treated was significantly higher in male than in female cases (60.7% and 54.6%; p 0.01) and in those &lt;15 years of age compared with those 15+ years (71.3% and 56.9%; p&lt;0.001). Insufficient understanding of malaria signs and symptoms likely leads to delay in illness recognition and treatment. Interactions between the VMWs and the patients were mostly focused on medical tasks, and low compliance with treatment was a common concern of the VMWs in the interaction. Conclusion: El Nino phenomenon was not associated with an epidemic in Jepara. A possible association between age and the risk of P. vivax malaria needs further investigation. In this decentralised health care system, ACD should be continued in a focus endemic area and therefore, efforts to retain the VMWs should be considered. This research showed similar findings between the RAP study and the longitudinal study. A consistent gap was found between the common understanding and the biomedical description of malaria. The performance of the VMWs supports the MCP through early contact with clinical malaria patients. Visits of VMWs within four days of symptom recognition appear to be the ideal situation for both the programme and the community. If case management continues to be the main strategy in MCP in this low endemic area, the emic perspective of the people must be well integrated to improve home treatment. Likewise, simple interventions to strengthen the role of VMWs in home management should be conducted.

This thesis deals with the legal procedures indicated forchanges in land-related rights, i.e. land use planning andproperty acquisitions. The rules of procedure in this field oflaw are extensive and complicated. As a first step, the rules of procedure are structured intoa number of procedural types: administrative, cadastral andjudicial. The procedural characteristics and the substantivelegal character of the decisions are clarified andcompared. In a second step an institutional perspective is adopted,based on economic theory. The different types of procedure areperceived as alternative institutional solutions to the problemof transaction costs in transformations of land-related rightstructures. An economic analysis is made of the transactioncosts arising in the different types of procedure in connectionwith, respectively, permissibility assessment and propertyacquisition assessment. The administrative procedures present distinct comparativeadvantages in the assessment of permissibility questions, e.g.utility concessions or permits for environmentally hazardousactivity. In these questions, an extensive, heterogeneouscollective of individuals is made subject to external effects.Those effects are divided into smaller value fragments. Throughthe publicity and ready availability of the administrativeprocedures, coupled with the system of politicalaccountability, important information about the preferences ofthe collective concerned can be produced and made to form thebasis of the decision. The cadastral and judicial procedures present comparativeadvantages in connection with property acquisition assessments,such as compulsory purchase of land or exaction of utilityeasements. For the limited collective of individuals involved,the right of negotiating and concluding agreements willeffectively utilise the high degree of information and thestronger economic incentives for action. The negotiation phasebecomes a low-cost procedure which at the same time acts as aselective mechanism for transactions not requiring the coerciveand more expensive procedure of official assessment. Theself-containment of cadastral and judicial procedures and theirisolation from political influences benefit the quality andcontrol of the documentation on which decisions arefounded. / QC 20100528

Det har länge varit känt att patientens perioperativa position kan orsaka symtom som förmodas uppstå genom tryck och sträckningar. Positionen vid laparosko-piska operationer anses öka risken för symtom och därför är perioperativ om-vårdnad av betydelse. Syftet var därför att undersöka hur frekvent positions- relaterade symtom förekommer vid laparoskopiska ingrepp och vilken betydelse de har för patienten. Studien genomfördes som en deskriptiv tvärsnittstudie och datainsamlingen gjordes med hjälp av symtomskattning och semistrukturerade intervjuer. Totalt 60 respondenter i åldern 19 till 75 år deltog i studien som pågick under åtta månader. Resultatet visade att en fjärdedel av respondenterna drab-bades av nytillkomna eller förvärrade symtom. Dessa uppmärksammades postoperativt eller några dagar efter operationen och var oberoende av ingrepp, perioperativ tid eller armarnas position. Några av respondenterna upplevde smärta och domningar i nacke, axlar och händer som ledde till inskränkningar i det dagliga livet och krävde hjälp av närstående. Det är viktigt att fortsätta arbetet med att förebygga positionsrelaterade skador, för att förhindra postoperativa symtom, genom att placera patienten så nära ett neutralläge som möjligt och ge denne möjlighet att känna efter hur det känns före nedsövning. / It has long been assumed that a patient’s perioperative position can cause symp-toms which appear from pressure and strains on the body. The position in lapa-roscopic surgery is considered to increase the risk of symptoms, perioperative care is therefore important. The scope of this study was therefore to survey how frequent symptoms associated with the patient’s position occur and why they are important to the patient. The survey was made as a descriptive cross-section study. The data collection was made by way of patients own estimates of their symptoms and by semistructured interviews. 60 respondents aged between 19 and 75 took part in the study. The result showed that a fourth of the respondents experienced new or aggravated symptoms. These were observed postoperatively or a few days after surgery and were independent of operations, perioperative time or position of the arms. Some of the respondents felt pain and numbness in the neck, shoulders and hands which led to restrictions in their daily life and required help from someone close. It is important to continue working with preventing postoperative symptoms, by placing the patient as close to a neutral position as possible and give her the possibility to feel comfortable before the anesthetization.

Syftet med studien var att beskriva icke farmakologiska metoder för att reducera barns rädsla och smärta inför cancerrelaterade behandlingar och undersökningar. Studien genomfördes som en litteraturstudie med beskrivande design. 21 vetenskapliga artiklar inkluderades, analyserades och lades som grund för resultatet. Resultatet visade att distraktion var den vanligaste förekommande icke farmakologiska omvårdnadsåtgärden för att minska barns rädsla och smärta inför smärtsamma cancerrelaterade behandlingar och undersökningar. Distraktion i form av kommunikation, beröring och hjälpmedel distraherar, lugnar, ökar smärttoleransen, förbättrar vårdresultatet och ger positiva vårderfarenheter. Barn som själva fick välja distraktionsmedel visade mindre rädsla, smärta och obehag vid smärtsamma behandlingar och undersökningar. Som distraktion används kommunikation, beröring, elektroniska leksaker, såpbubblor, clowner, virtuell verklighet, filmer, musik och kalejdoskop. Kognitiv beteendeterapi (KBT) visade sig vara bra för att hjälpa barn att hantera rädslan inför provtagningar. Hypnos visade sig vara användbart till rädda och oroliga barn med tidigare vårderfarenhet för att inge trygghet och förebygga ångest. Slutsatsen är att kommunikation, åldersadekvata distraktionsmedel och mänsklig närvaro är ett billigt och effektivt komplement för sjuksköterskan att reducera barns smärta och rädsla under smärtsamma procedurer. Vidare forskning inom området behövs för att utvärdera sjuksköterskornas kunskaper om kommunikation och distraktion. / The aim with the study was to describe non pharmacologic methods in order to reduce children's dread and pain before cancer related treatments and surveys. The study was implemented as a literature study with descriptive design. In the study 21 scientific articles was analyzed for the result. The result showed that distraction was the most common non pharmacologic method in order to decrease children's dread and pain before painful cancer related treatments and surveys. Distraction in the form of communication, touch and accessibility distract, reassuring, increases pain tolerance, improve care results and provides positive care experience. Children who elect distracters funds showed less fear, pain and discomfort at painful treatments and surveys. As distraction was communication, contact, electronic toys, soft soap bubbles, clowns, virtual reality, films, musical and kaleidoscope used. Cognitive behavior therapy (KBT) was found to help children to handle the dread before treatments. Hypnos showed to be useful to cautious and anxious children with earlier care experience stem to submit safety and to prevent anxiety. The authors drew the conclusion that communication, age adequate distraction and human presence is a cheap and effective complements for the nurse to reduce children's pain and dread during painful procedures. Further research within the area is needed in order to evaluate the nurses' knowledge about communication and distraction.

China and France have both adopted the International Standards on Auditing (ISA). Thelargest firms in auditing and accounting in the world, known as Big Four, are established inFrance as well as in China. Auditors from those firms apply procedures that have beenharmonized worldwide within Deloitte, PricewaterhouseCoopers, KPMG, and Ernst &amp;Young. When it comes to audit, French auditor and Chinese auditor talk the same language,use the same software, boundaries seem to be knocked over. On the other hand, what BigFour firms are not able to standardize is the culture of their auditors. Does auditor’s culturemay shatter all efforts that have been put to deliver the same services throughout the world?Does auditor’s culture may call the work of the International Auditing and AssuranceStandards Board (IAASB) into question? Do either French or Chinese auditors enable ahigher audit risk to the audited client? Many other questions could be raised about the effectof cultures on the audit process. The purpose of this research is to explore, measure and analyse the cultural impact on theaudit process. In order to highlight the difference(s) of the audit outcome due to culture,countries have to exemplify a certain numbers of cultural differences. China and France havebeen chosen because their belonging to the Eastern and Western clusters, and as we know,Eastern and Western countries have substantial cultural differences (Hofstede, 2001).According to Hofstede’s cultural dimensions, Individualism (versus Collectivism) andUncertainty Avoidance are the two dimensions that get the higher cultural differences whenhe compares Chinese and French Culture. We want to discover how Chinese and Frenchauditors rely on analytical procedures and assess audit evidence and internal controlenvironment. We want to study if their audit results reflect the cultural differences betweenChina and France based on the two cultural dimensions. In order to manage our empirical research, we use a sample of 28 Chinese auditors and 14French auditors. We use primary data collection through our design questionnaire. Theauditors’ answers were analysed using a quantitative approach to reveal the eventual existenceof a connection between the auditor’s cultural background and how the audit process iscarried out. Our findings about cultural differences within Big Four companies are not so categorical. We did not find significant differences regarding Chinese and French auditors’ culture. However,Chinese auditors appear to have a higher willingness to refuse a misstatement in the client’s financial statements, due to collectivism cultural dimension, than French auditors. Auditors from both countries assess in similar way audit evidence, but they do not consider of the same importance some components of the internal control environment. French auditors considerof greater importance components that can directly influenced the accuracy of the accountingreporting process, because an individualism society as France tends to “encourage”accounting and cut-off errors within organizations.

Resistenta bakterier är ett växande problem inom den svenska sjukvården. Extended spectrum ß-lactamases (ESBL) är bakterier som kan bilda enzymer som bryter ned antibiotika så att den på så sätt blir resistent. En av de stora anledningarna till spridning av resistenta bakterier är personalens brist på korrekt utförande av basala hygienrutiner. Syftet med studien var att undersöka hur sjukvårdspersonal på en infektionsavdelning tillämpar de riktlinjer för basala hygienrutiner som finns fastställda för personal inom hälso- och sjukvården. Data samlades in genom observationer på en infektionsavdelning på ett sjukhus i Mellansverige. Resultatet visade att följsamheten till basala hygienrutiner var mindre än hälften bland de två jämförda personalgrupperna. Resultatet visade hög följsamhet till handskanvändning vid vård av patienter som inte var ESBL-bärare, medan följsamheten var sämre vid vård av patienter med ESBL. Detta resultat visade på en signifikant skillnad, dvs. att personalen var bättre på att använda handskar vid vård av patienter som inte var bärare av ESBL. Resultatet visade att nära hälften av de observerade inte spritar händerna innan patientkontakt, vare sig det rör sig om en patient som är bärare av ESBL-bakterier eller inte. Det tyder på stora brister i följsamheten till hygienrutiner på den observerade infektionsavdelningen. / Resistant bacteria are an increasingly large problem within the Swedish health care system. Extended spectrum ß-lactamases (ESBL) are bacteria that produce enzymes capable of breaking down antibiotics, a characteristic which renders them resistant to antibiotics. One of the main causes for the spreading of resistant bacteria is low compliance to hand hygiene procedures. The aim of this study was to examine how the health care workers of an infectious disease ward apply the hygiene guidelines that have been established for health care staff. Data was collected through observations in an infectious disease ward in Central Sweden. The results showed that compliance towards hand hygiene procedures was less than 50% within the two staff groups compared. It also showed good compliance to the guidelines for glove use when caring for patients not carrying ESBL, but less compliance when caring for patients with the infection. The difference was statistically significant, i.e. health care staff used gloves more often when caring for patients not carrying ESBL than they did with patients who were carriers. The results showed that that almost 50% of the observed health care workers did not use hand disinfection before contact with patients, whether these were ESBL carriers or not. This indicates that compliance to hand hygiene procedures is not as good as one could hope for.

Skolverket skickade ut ett pressmeddelande som ifrågasätter kvaliteten inom undervisningen av ämnet svenska som andraspråk i grundskolan. Skolverket ville belysa den koppling som finns mellan modersmålsundervisning och goda resultat i svenskundervisning. I den här studien studerades erfarna lärares förhållnings- och tillvägagångssätt i undervisningen av flerspråkiga elever. Lärarna studerades för att ta reda på vad som kännetecknar och stimulerar undervisning av flerspråkiga elever. I studien användes kvalitativa intervjuer och observationer i kombination. Erfarna lärare fick möjligheten att beskriva undervisningen av flerspråkiga elever. Lärarna observerades också för att kunna studera de beteenden som lärarna visade i de förhållnings- och tillvägagångssätt de använde i sin undervisning. Det framkom i studien att kommunikationen är en viktig och central del i lärarnas undervisning av flerspråkiga elever. Lärarna i studien arbetade med sitt förhållningssätt gentemot flerspråkighet och kunde därmed skapades möjligheter till samarbete och valfrihet i undervisningen som gynnade den flerspråkiga eleven. Samspelet var ett tillvägagångssätt som lärarna i studien använde i sin undervisning av flerspråkiga elever. Samspelet byggde på lärarnas förhållningssätt, arbetsglädje och erfarenhet i yrket. Enligt studien gynnades samspelet av samarbete med elevernas föräldrar och med modersmålslärarna. Lärarna i studien ville också påvisa ordförståelsens betydelse i undervisningen av flerspråkiga elever. Förberedelserna för mottagandet av flerspråkiga elever är enligt studien komplex för lärare då elevernas behov varierar. Avslutningsvis diskuterades vilka förhållnings- och tillvägagångssätt som lärarna i studien upplevde som rätt för flerspråkiga elever. / The National Agency for Education has sent out a message which questions the quality of teaching Swedish as a second language in the compulsory-school. The National Agency for Education wanted to illustrate the connection between mother tongue teaching and good results in teaching of the Swedish language. In this study experienced teachers´ attitudes and procedures where investigated. The teachers where studied to found out what illustrates and stimulates teaching multilingual pupils. In the study qualitative interviews and observations where used in a combination. Experienced teachers were given the opportunity to describe the teaching of multilingual pupils. The teachers has also been observed to examine the behaviours they showed in their attitudes and procedures which they used in their teaching. It emerges in the study that the communication is an important and central part of the teachers´ teaching of multilingual pupils. The teachers in the study worked with their attitude against multilingualism and could because of that make opportunities for cooperation and freedom in choices of teaching which encouraged the multilingual pupil. Interaction was a procedure which teachers in the study use in their teaching of multilingual pupils. Interaction was built on the teachers´ attitudes, work satisfaction and experience of teaching. According to the study the interaction was encouraged by cooperation between the pupil’s parents and mother tongue teachers. The teachers in the study wanted to point out the importance of word comprehension in teaching of multilingual pupils. The preparations for the reception of multilingual pupils are according to the study complex because the pupil’s need varies. In conclusion there was a discussion over which attitudes and procedures the teachers in the study experienced as the right ones for multilingual pupils.