Tidigare forskning inom intensivvårdsområdet har visat att ej adekvat utförd munvård kan leda till allvarliga livshotande sjukdomar. Det är av därför av vikt att munvård utförs enligt gällande rekommendationer och följer evidensbaserad forskning. Syftet var att identifiera intensivvårdssjuksköterskans beskrivning av tillvägagångssätt, delaktighet och dokumentation vid utförande av munvård hos patienter inneliggande på IVA. En kvantitativ ansats valdes med målsättning att göra en undersökning med hjälp av enkätfrågor. Inklusionskriterier var specialistutbildade sjuksköterskor inom intensivvård som tjänstgjorde på tre intensivvårdsavdelningar i västra Sverige under aktuell studieperiod. Sammanlagt distribuerades 182 enkäter och 103 svar erhölls vilket gav en svarsfrekvens på 60 %. Resultatet visade att munvård var en prioriterad omvårdnadsåtgärd på avdelningarna och tillvägagångssättet följde till stor del fastställda riktlinjer. Det framkom att i begreppet munvård ingick huvudsakligen inspektion av munhålan, mekanisk rengöring, fuktning av slemhinna och läppar, inspektion av tänder och tandkött samt sugning av munhåla och svalg. De verktyg som huvudsakligen användes var tandborste, muntork eller liknande samt antibakteriellt medel. Ett signifikant samband förekom vad gäller sjuksköterskans delaktighet vid utförande av munvård hos intuberade patienter jämfört med övriga patienter (p=0,02). Detta ansågs vara en mer komplex omvårdnadsåtgärd vilken krävde samarbete med övriga medarbetare. Munvård delegerades ofta till undersköterskor men det är dock sjuksköterskans uppgift att leda och ansvara för omvårdnaden.  Dokumentation vad gäller munvård utfördes i de flesta fall på en observationskurva. Ett mindre antal sjuksköterskor angav att dokumentation även utfördes i datajournal. Ett flertal sjuksköterskor angav att dokumentation dessutom utfördes på interna checklistor. Det framkom att flera sjuksköterskor dokumenterade i datajournal enbart vid avvikelser eller om komplikationer tillstött. / Previous studies in the intensive care areas have shown that inadequate oral care may predispose patients to life-threatening diseases and conditions. The role of oral hygiene in maintaining the health of patients in the ICU is indisputable and therefore the importance of oral care evidence-based clinical recommendations. The purpose of this study was to identify the intensive care nurses description of the conducting, participation and documentation of oral care performed by nurses on patients in ICUs. A quantitative study with a describing design has been used which is based on the statistical analysis of data collected by structured questionnaires. The inclusion criteria were nurses working in three ICUs located in West Sweden during the study period. One hundred eighty-two questionnaires were distributed and replies were received from 103 nurses which gave a response rate of 60%. The result showed that the oral care conducted followed the evidence-based clinical recommendations and was given a high priority. The majority of the nurses performed an oral assessment before beginning oral care which included inspection of the oral cavity and inspection of teeth and gum. Oropharyngeal suction and moisturizing of lips and the mucosal membrane was also included. The most common used equipment was toothbrushes and foam swabs. Chlorhexidine was the most common solution used. A significant correlation was observed regarding nurse participation when conducting oral care for an intubated patient compared to other patients (p=0,02). Intubated patients were considered having more complex oral care needs which were associated with the demand of more than one person providing oral care. In practice, nurses frequently delegate the conducting of oral hygiene to nursing assistants, but the law clearly describes the role of the nurse as responsible and the leader of care practices. Oral care was in most cases documented on the unit’s flow sheet. A fewer number of nurses commented on that oral care was documented in the electronical clinical journal. A considerable   number of nurses also indicated that oral care in addition was documented on the unit’s internal checklists. It appeared that several nurses used the electronical clinical journal in cases only when abnormalities or complications had occurred.

published_or_final_version / Education / Master / Master of Education

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Language Studies / Master / Master of Arts

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

No description available.

Open access to scientific literature on Internet is a concept which is supposed to change librarians' work. The aim of the thesis was to examine librarians' perception of Open access. A questionnaire survey was conducted among librarians at libraries with specialisation in technique, natural sciences, medicine and pharmacy in Sweden. Even though Open access can be regarded as an alarming for librarians' work, the results of the survey showed that the future of the librarians' profession can be positive if they flexibly adopt their work routines according to changes in publication forms and library users' needs.

This thesis presents the results from a survey of transit agencies on web-based feedback tools and their role in enabling communication between agencies and riders. Motivation for the survey stems from the growing importance of web-based feedback tools in improving transit services. Web-based feedback can improve transit agencies' knowledge of issues relating to their systems while enhancing the transit riding experience. As the availability of Internet and smartphones increases among transit users, the tools available to gather feedback have grown in response. Web- and smartphone-based tools are instrumental in collecting a wide range of feedback, including commendations and complaints, maintenance issues, transit services, safety and security, long-term planning and other transit operations related issues. At the same time, transit agencies must determine how to best respond and manage the growing presence of information on the web relating to their agencies performance. Through a web-based survey administered to 130 transit agencies in the United States and Canada, information was gathered on the current and planned use of web-based tools by transit agencies. The overall survey results show that most transit agencies focus on sorting and responding to unsolicited feedback being collected primarily through social media, email, and online forms. Additionally, transit agencies see the benefits of web-based customer feedback, noting that the key to managing their systems into the future will involve developing agency-wide digital feedback plans that allow automation and integration across all feedback channels. Finally, transit agencies also noted that the primary downside to web-based feedback involved a lack of staff resources to support their systems. This thesis provides further analysis focusing on three questions regarding the survey results: - How can agency size, based on unlinked trips, influence the survey responses collected from agencies regarding their use of web-based feedback tools? - What variables from the survey can influence a transit agencies ability to provide web-based feedback tools to their riders? - What factors might contribute to differences in transit agencies rider access estimates to Internet and smartphones? While the results show that larger agencies are able to offer more web-based feedback tools to their riders, there were problems with transit agencies incorrectly estimating their riders’ access to Internet and smartphones. This could cause issues regarding agencies ability to understand which web-based tools they should implement to engage their riders. This thesis details one portion of an overall project, which will provide framework for agencies to assess their needs and resources to determine how to create their own effective customer feedback systems in relation to what web-based feedback tools will most benefit themselves and their riders.

BACKGROUND: In children, sleep-related airway obstruction by large tonsils and adenoids can cause obstructive sleep apnea (OSA). OSA may lead to poor growth, developmental delay, behaviour or learning problems. Recent evidence also suggests that children with OSA may develop cardiovascular complications, the mechanisms perhaps involving hypoxemia, the autonomic nervous system, apneas, and arousals. Surgical removal of tonsils and adenoids (adenotonsillectomy (T&A)) usually cures pediatric OSA. To diagnose OSA at all levels of severity, polysomnography is currently the best approach. The McGill Oximetry Score (MOS) is a validated measure based on nocturnal pulse oximetry. An abnormal MOS has a 97% positive predictive value at detecting moderate-severe OSA. Because the MOS was devised by measuring frequency of desaturations (<90%) and numbers of clusters of desaturations, it is not accurate at detecting OSA in children who do not have such drops in oxygen saturation. Accordingly, other measures applicable to a wider spectrum of children should be assessed. These measures should be simpler, less cumbersome, cheaper, and more accessible than polysomnography. / OBJECTIVES: To study alternative approaches that may be used to identify moderate-severe OSA in children, two studies were conducted. We examined one subjective measure - the OSA-18 parent questionnaire - and two objective measures - pulse rate and pulse rate variability. For the OSA-18 study, the goal was to determine whether it would accurately detect children with moderate-severe OSA as indicated by an abnormal MOS. For the pulse rate and pulse rate variability study, the goal was to determine if either or both would decrease after treatment with T&A for children with moderate-severe OSA. / METHODS: For the OSA-18 study, we used a cross-sectional design that included children 1-18 years old referred to a pediatric sleep laboratory for evaluation of suspected OSA. Alongside data from the OSA-18, we analyzed demographic and medical data (from a parent questionnaire) and information regarding adenotonsillar hypertrophy. We estimated sensitivity, specificity, positive and negative predictive values as well as receiver operating curves of the OSA-18 in detecting an abnormal MOS. We also conducted univariate and multivariate logistic regression analyses, using the MOS as the dependent variable and the OSA-18 score and others (age, gender, comorbidities, race) as independent variables. For the second study, we used a retrospective before-after design to compare pulse rate and pulse rate variability as measured by nocturnal pulse oximetry pre- and post-T&A of otherwise healthy children 1-18 years old with moderate-to-severe OSA. / RESULTS: For the OSA-18 study, we studied 334 children (58% male, mean age 4.6 +/- 2.2 years). The OSA-18 had a sensitivity of 40% and a negative predictive value of 73% for detecting an abnormal MOS. In addition, the area under the receiver operating curve was 0.611. While controlling for other independent variables in the logistic regression model, for each unit increase in the OSA-18 Score, the odds of having an abnormal MOS were increased by 2%. However, for each increase in age of 1 year, the odds of having an abnormal MOS were decreased by 17%. In the pulse rate and pulse rate variability study, 25 subjects (88% male; mean age 4.3 +/- 3.6 years) were enrolled. Following T&A, pulse rate and pulse rate variability decreased in 21 of 25 and 23 of 25 children, respectively. Mean pulse rate dropped from 99.7+/-11.2 to 90.1+/-10.7 bpm, p<0.001; age-standardized pulse rate (z-score) from 0.8 (0.4, 1.5) to 0.4 (0, 0.9), p=0.04). Pulse rate variability, as measured by the standard deviation of the pulse rate decreased from 10.3 +/- 2.1 to 8.2 +/- 1.6 bpm, p<0.001. As well, OSA symptomatology, parental concern about breathing during sleep and the MOS all improved. / CONCLUSIONS: Based on the first study we conclude that among children referred to a sleep laboratory, the OSA-18 does not accurately detect which children will have an abnormal MOS. The OSA-18 should not be used in place of objective testing to identify moderate-severe OSA in children. However, from the second study we conclude that measures of the autonomic nervous system such as pulse rate and pulse rate variability, as measured by pulse oximetry, decreased following surgical treatment of moderate-severe OSA. The results of this study potentially serve as important data for further work that would determine the accuracy of pulse rate and pulse rate variability measures and their diagnostic usefulness for OSA at all levels of severity.

The main goal of this study was to evaluate the utility of physical activity (PA) measurement in an Inuit population with a self-administered questionnaire. The objective was to validate a culturally relevant physical activity questionnaire that measures Inuit PA levels. To do this, the International Physical Activity Questionnaire (IPAQ) was evaluated against the Caltrac accelerometer and anthropometric/physiologic measurements. / There were a number of compliance problems encountered when implementing the Caltrac in the pilot community which resulted in too few Caltrac scores available for analyses. However, IPAQ PA score (N=44) was significantly inversely related to Body Mass Index (p≤0.05) and positively related to high-density lipoprotein cholesterol (p≤0.03). / The results indicate that the IPAQ has potential but needs further refinements to be acceptable to Inuit populations and needs re-evaluation in a larger sample. The participants found it very difficult to remember the time spent performing each activity and, in general, the IPAQ was not well received.