Bakgrund: Den intensivvårdskrävande patienten är många gånger i behov av transport utanför intensivvårdsavdelningen för diagnostiserande undersökning eller behandling. Transporten är riskfylld då patienten kräver komplicerad utrustning och avancerad medicinsk behandling. Studier visar att patientsäkerheten ökar om policydokument används vid transportprocessen. Syfte: Studiens syfte var att kartlägga antalet policydokument som reglerar intrahospital transport i Stockholms län och jämföra dem med en guideline. Metod: Urvalet bestod av policydokument från 11 intensivvårdsavdelningar i Stockholms län. Metoden utgjordes av deskriptiv dokumentinnehållsanalys. Resultat: Sex av elva intensivvårdsavdelningar i Stockholms län hade policydokument som reglerar intrahospital transport. Policydokumenten hade fem gemensamma huvudämnen: Riskbedömning, bemanning, förberedelse, övervakning och utrustning vilka överensstämde med dem i guidelinen. Detaljnivån avseende utrustning skiljde sig dock policydokumenten emellan. Ett policydokument, som bestod av både riktlinje och checklista, utmärkte sig då det bäst överensstämde med innehållet i guidelinen. Slutsats: Studien visar att många intensivvårdsavdelningar i Stockholms Län saknar policydokument vid intrahospital transport. Existerande policydokument varierar i omfång, utformning och till viss del även avseende innehåll. Klinisk betydelse: Förhoppningen är att studien kan ligga till grund för omarbetning av befintliga riktlinjer och checklistor eller utformning av nya. Ytterst avser studien med detta förbättra patientsäkerheten. / Background: The intensive care patient often needs transportation outside the intensive care unit for diagnostic examination or treatment. Transports are associated with major risks due to critically ill patient requirements of complex equipment and advanced medical treatment. Studies show that the use of protocols in intrahospital transports increases patient safety. Objective: The study aimed to examine protocols that regulate intrahospital transport of patients in intensive care units in Stockholm County and compare them with a guideline. Method: The sample consisted of protocols from 11 intensive care units in Stockholm County. The method used was a document content analysis. Results: Six out of eleven intensive care units in Sweden possessed a protocol governing the intrahospital transport. The protocols had five main topics in common: Risk assessment, staffing, preparation, supervision and equipment, which were consistent with the guideline. The level of detail regarding equipment differed between them. Protocols containing both a guideline and checklist, stood out as the most integrated document. Conclusion: The result of the study shows that several intensive care units in Stockholm County are missing protocols regarding intrahospital transport. Existing protocols vary in size, design, and to some extent also in content. Clinical significance: This study has a goal to provide a basis for revision of existing guidelines and checklists or for designing new ones. Furthermost the aim of this study is to improve patient safety.

Bakgrund Antalet kirurgiska ingrepp förväntas öka, och därmed ökar även den totala risken för komplikationer. Världshälsoorganisationen, World Health Organization, WHO, har tagit fram en Checklista att använda i samband med kirurgiska ingrepp för att minska komplikationer och öka patientsäkerheten. Syftet med föreliggande studie är att undersöka operationssjuksköterskors erfarenheter av Checklistan. Metod En pilotstudie genomfördes och fem operationssjuksköterskor intervjuades. Intervjuerna transkriberades ordagrant och en manifest kvalitativ innehållsanalys gjordes med induktiv ansats. Resultatet visar att det fanns hinder vid användning av Checklistan, det fanns en ovana vid de nya rutiner som Checklistan innebär, arbetslagets attityder påverkar användningen och att vissa i operationsteamet visade oförståelse för Checklistans syfte. Osäkerhet rådde bland operationssjuksköterskorna för när Checklistans olika faser skulle utföras samt vem som ska initiera Checklistan. Användning av Checklistan medförde trygghet för så väl patient som personal, liksom en ökad handlingsberedskap för operationssjuksköterskan. Presentation av personalen på operationssalen ansågs vara positiv för ny personal, och negativ då detta tar tid och innebär upprepning. Slutsats WHO:s Checklista är ett bra verktyg för att öka kommunikationen och därmed öka patientsäkerheten. Det fanns ett behov av att anpassa Checklistan till den egna kliniken. / Background The number of surgical procedures is expected to increase, and thus also the total number of complications might increase. World Health Organization, WHO, has developed a Checklist for use in connection with surgical procedures to minimize the risk of errors and to enhance patient safety. The aim of this study was to investigate the theatre nurses' experiences of this Checklist. Method A pilot study was performed and five theatre nurses were interviewed. The interviews were transcribed verbatim, and a qualitative manifest content analysis was conducted with an inductive approach. The result shows that there were obstacles in the use of the Checklist, the staff was unaccustomed to the new procedures the Checklist had led to, the surgical team’s attitudes affected the use of the Checklist, and some in the surgical team showed lack of understanding of the purpose of the Checklist. Uncertainty prevailed among theatre nurses when to perform the different phases of the Checklist, and who should be initiating the Checklist. The use of the Checklist led to increased safety for the patients as well as for the staff, and also led to an increased preparedness for theatre nurses. The presentation of the staff in the theatre room was considered to be positive for new staff, and negative since this took time and involved repetition. Conclusion The WHO's Checklist is a useful tool to increase communication and thereby increase patient safety. There was a need to adapt the Checklist to the own clinics.

Background World Alliance for Patient Safety, launched by the WHO, has created a Surgical Safety Checklist. It was first published in 2008 and has been translated and modified in Sweden by Landstingens Ömsesidiga Försäkringsbolag, LÖF. The use of the WHO Surgical Safety Checklist has been shown to reduce the number of complications and deaths related to surgery. Aim The aim of this study is to describe the Theatre Nurse’s participation in in the use of a modified version of the WHO Surgical Safety Checklist intraoperatively in two Theatres in a hospital in the centre of Sweden. Method This study has a quantitative descriptive approach. A direct observational study was carried out in two Theatres and the participants were asked a few complementary questions after the observations. A total of 16 Theatre Nurses participated in this study. Results None of the Theatre Nurses confirmed all the steps in all phases of the checklists during an operation. However one Theatre Nurse confirmed all the steps in the Sign Out phase at one occasion. There was no team member in either Theatre allocated to read out all the steps in the checklist and to make sure that all the steps were completed. Conclusion Insufficient compliance to the checklist prevails in both Theatres and they need to improve quality measures in order to increase adherence to the checklists to promote patient safety. Clinical significance This study describes the Theatre Nurses’ participation in performing the checklists in the two Theatres were the observations were carried out. The study may inspire improvement measures and provide inspiration for further research. / Bakgrund Världsalliansen för patientsäkerhet, som är en del av WHO, har skapat en checklista för säker kirurgi. Den publicerades för första gången år 2008 och i Sverige har Landstingens Ömsesidiga Försäkringsbolag, LÖF, översatt och bearbetat checklistan för svenskt bruk. Användandet av WHO:s checklista för säker kirurgi har visats minska antalet komplikationer och dödsfall i samband med operationer. Syfte Syftet med studien var att beskriva operationssjuksköterskans medverkan i användandet av WHO:s modifierade checklista för säker kirurgi intraoperativt på två operationsavdelningar på ett sjukhus i Mellansverige. Metod Denna studie har en kvantitativ deskriptiv ansats. En direkt observationsstudie genomfördes och därefter ställdes frågor utifrån en frågeguide. Totalt 16 operationssjuksköterskor deltog i studien. Resultat Ingen operationssjuksköterska medverkade i eller tog upp samtliga punkter i checklistans alla tre faser under en operation. En operationssjuksköterska tog däremot upp alla punkter i avslutningsfasen vid ett tillfälle. Det fanns ingen checklisteansvarig personal som läste upp checklistans alla punkter för operationslaget och som såg till att alla punkterna genomfördes på de båda avdelningarna. Slutsats Bristande följsamhet till checklistorna råder på båda avdelningarna. Avdelningarna är i behov av kvalitetsförbättrande åtgärder för att öka följsamheten till checklistorna för att främja patientsäkerheten. Klinisk betydelse Studien är en beskrivning av hur operationssjuksköterskor arbetar med checklistorna på de två avdelningarna där observationerna utfördes. Den utgör en grund för fortsatt förbättringsarbete på avdelningarna samt ger inspiration till fortsatt forskning.

The Master’s thesis addresses the issue of ergonomics. The aim of the diploma thesis is to analyze the current ergonomic state of the production line with the subsequent detection of ergonomic risks, the use of various assessment methods and comparison with legislative requirements. After defining the deficiencies, corrective actions are proposed, leading to their elimination and reduction of work intensity. The ergonomic analysis was performed within Tyco Electronics Czech s.r.o. The analytical part follows up on, in depth, the theoretical part of the work, where all its aspects are listed in addition to the introduction of ergonomics as a scientific discipline.

Introductory computer programming course is one of the fundamental courses in computer science. Students enrolled in computer science courses at the college or university have been reported to lack motivation, and engagement when learning introductory programming (CS1). Traditional classrooms with lecture-based delivery of content do not meet the needs of the students that are being exposed to programming courses for the first time. Students enrolled in first year programming courses are better served with a platform that can provide them with a self-paced learning environment, quicker feedback, easier access to information and different level of learning content/assessment that can keep them motivated and engaged. Introductory programming courses (hereafter referred to as CS1 and CS2 courses) also include students from non-STEM majors who struggle at learning basic programming concepts. Studies report that CS1 courses nationally have high dropout rates, ranging from anywhere between 30-40% on an average. Some of the reasons cited by researchers for high dropout rate are lack of resource support, motivation, lack of engagement, lack of motivation, lack of practice and feedback, and confidence. Although the interest to address these issues in computing is expanding, the dropout rate for CS1/CS2 courses remains high. The software engineering industry often believes that the academic community is missing the mark in the education of computer science students. Employers recognize that students entering the workforce directly from university training often do not have the complete set of software development skills that they will need to be productive, especially in large software development companies.

abstract: Language Textbooks often play a major role in English for speakers of other languages (ESOL) classrooms, not only to provide information but also to help students construct their identities. Several studies showed that identity and language learning are inseparable, due to the simple fact that every learner has his/her own identity aspects like race, gender, social class, and speaker status (i.e., native speaker vs. non-native speaker of the target language). These aspects should be acknowledged because providing the students with limited identity options might cause the students to resist learning the language or be less invested in this practice (Norton & Toohey,2011). However, there is limited support for teachers who wish to examine identity in ESOL textbooks. Several scholars attempted to evaluate the range of identity options offered in ESOL textbooks, but they all used either Critical Discourse Analysis or Content Analysis which can be effective; however, these procedures require training and can take a long time, so they may not be practical for teachers. This suggests that there is a need for a less complicated evaluation tool that can be easily used by teachers. The purpose of this thesis is to develop a teacher-friendly identity-focused checklist for ESOL textbooks, and the thesis is guided by the following questions: (a) what would an evaluation checklist for identity in ESOL textbooks look like?; (b) what can this checklist reveal about ESOL textbooks? The purpose of this thesis was achieved by developing a qualitative checklist that covers, race, gender, social class, and speaker status, and demonstrating how to use it on a collection of five adult ESOL textbooks. The checklist revealed similarities and differences between the textbooks, including important shortcomings, and that kind of information can be useful for the teacher to make decisions about the textbook he/she uses. / Dissertation/Thesis / Masters Thesis Applied Linguistics 2019

Detta examensarbete kommer att handla om planering och projektering av Finplanering. Med Finplanering menas den sista ”finishen” på byggarbetsplatsen dvs. innegårdar, uteplatser, kringliggande gågator och cykelbanor. Det är en etapp i byggproduktionen som börjar bli betydligt mer krävande vad gäller ekonomi och resursåtgång, då det ställs större krav på snabb inflyttning samt att efterfrågan på större och finare uteplatser ökar. Vi har försökt att belysa olika problem man ställs inför under detta skede av byggproduktionen. Vart man kan arbeta för att minska olika problem såsom förseningar och extra kostnader, men framförallt försöka hitta de kritiska skedena där Finplaneringen oftast glöms bort. Samt försöka hitta lämpliga sätt att redan i projekteringsstadiet försöka att planera och strukturera upp förebyggande arbeten så att allting fungerar som det ska när det väl är dags att sätta igång. / This thesis will describe and tell about planning and projecting of “Detailed planning”. “Detailed planning” is the last finish of the construction site i.e. courtyards, patios, surrounding pedestrian streets and bicycle paths. This is a stage in the overall process that is starting to get more demanding in terms of economy and resources. This because today, the demands for speedier housewarming and requirements for bigger and more fancy patios are higher.   We will highlight the different problems that you will encounter during this production stage. We will also pin point the areas where effort is needed in order to lessen problems like delays and extra costs, but most importantly try to find the critical stages during production where “Detailed planning” frequently is “forgotten”. The key, as we will try to show, is to find suitable ways in the early project planning stage to prepare and structure the preventive planning so that all is in place and has a chance to run smoothly when it is time to start the project.

SAMMANFATTNING  Bakgrund: Sjuksköterskor inom akutsjukvård ska enligt gällande kompetensbeskrivning främja och utveckla former för hållbar, säker, personcentrerad och evidensbaserad vård. Risk för vårdskador som drabbar patienten är särskilt hög på akutmottagningar på grund av en oförutsägbar arbetsbelastning, komplicerade arbetsuppgifter och att snabba beslut måste tas för att tidigt inleda livräddande åtgärder. Bristande kompetens och utbildning är ytterligare bidragande orsaker. Checklistor har länge nyttjats i flygbranschen för att öka säkerheten och minska risken för olyckor. Misstag uppstår lätt i akuta situationer och checklistor har på senare år även visats gynnsamt för att öka patientsäkerheten inom operationssjukvård. Kan checklistor inom akutsjukvård påverka patientsäkerheten? Syfte: Syftet var att undersöka hur checklistor påverkar patientsäkerheten utifrån ett omvårdnadsperspektiv inom akutsjukvård. Metod: Artikeln är en litteraturöversikt. Databaserna CINAHL och PubMed användes för att söka artiklar. Arton primära vetenskapliga artiklar inkluderades i studien efter genomförd kvalitetsgranskning. Artiklarna analyserades och ett resultat formades. Resultat: I resultatet framkom två teman som svarade på syftet: checklistans påverkan på patientsäkerheten vid kommunikation och checklistans påverkan på patientsäkerheten vid vård. Checklistans påverkan på patientsäkerheten vid kommunikation delades in i tre underkategorier: I teamet, vid personcentrerad vård och vid dokumentation. Checklistans påverkan på patientsäkerheten vid vård utgjordes av medicinska åtgärder och omvårdnadsåtgärder. Slutsats: En väl utformad evidensbaserad checklista kan inverka positivt på patientsäkerheten utifrån ett omvårdnadsperspektiv både i det akuta skedet och i det vardagliga arbetet på akutmottagningen. Förbättringar sågs vid kommunikation både mellan vårdpersonal och med patienten. En positiv påverkan på patientsäkerheten vid vissa omvårdnads- och medicinska åtgärder observerades. En del checklistor visades inverka negativt på patientsäkerheten, det är därför viktigt att undersöka checklistors effektivitet innan implementering. / Background: According to the current description of competence, nurses in the emergency room department must encourage and develop forms of sustainable, safe, person-centered, and evidence-based care. The risk of healthcare injuries which affect the patient is particularly high in emergency departments due to an unpredictable workload, complicated tasks and fast decisions must be taken to initiate life-saving measures. Besides the workload, additional contributing factors are lack of competence and education. Checklists have long been used in the aviation industry to increase safety and reduce the risk of accidents. Mistakes easily occur in emergency situations and checklists have in recent years also shown to be useful in surgical care. Can checklists influence patient safety in emergency care? Aim: The aim was to investigate how checklists for healthcare professionals influence patient safety from a nursing perspective within emergency care. Method: The article is a literature review. The CINAHL and PubMed databases were used to search for articles. Eighteen primary scientific articles were included in the study after assessment of the article’s quality. The articles were analyzed, and a result was formed. Results: The results revealed two themes who responded to the aim; the checklists effect on patient safety in communication and the checklists effect on patient safety in care. The checklists effect on patient safety in communication was divided into three subcategories: in the team, in person-centered care, and in documentation. The checklists effect on patient safety in care consisted of medical interventions and nursing interventions. Conclusion: A well-designed evidence-based checklist may positively influence patient safety from a nursing perspective both in the acute situation and in everyday work at the emergency department. Improvements were seen in communication both between staff and with the patient. A positive impact on patient safety was observed during certain nursing interventions and medical interventions. Some checklists were shown to have a negative effect on patient safety, therefore it’s important to thoroughly examine if a checklist is effective before implementation.

Objective: The concurrence of prenatal alcohol exposure with other drug exposure, low socioeconomic status and environmental risk factors may obscure associations, if any, between prenatal cocaine exposure and child outcomes. This study evaluates the effects of prenatal cocaine exposure on child behavior in analyses stratified by gender and prenatal alcohol exposure status. Methods: Maternal alcohol, cigarette, and illicit drug use were prospectively assessed by interview during pregnancy and postnatally. Maternal and neonatal urine were tested for drug exposure as clinically indicated. Caregiver report of child behavior was assessed with the Achenbach Child Behavior Checklist (CBCL). Dichotomous cocaine exposure was characterized as no (negative history and biologic markers), and any (positive history and/or biologic markers during pregnancy and/or positive urine screen at delivery from either mother or infant). Results: Prenatal cocaine exposure was associated with adverse effects on offspring behavior that were moderated by the gender of the offspring as well as prenatal alcohol exposure. For girls without prenatal alcohol exposure, 6.5% of the unique variance in behavior was related to prenatal cocaine exposure. For these girls, the odds of scoring in the abnormal range for Aggression was 17 times control levels (95% confidence limits 1.4 to 203). These findings, though significant, have wide confidence intervals and need to be replicated in larger cohorts and on longitudinal follow-up.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18201号 / 人健博第18号 / 新制||人健||2(附属図書館) / 31059 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 二木 淑子, 教授 坪山 直生, 教授 桂 敏樹 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM