Postoperativ sårinfektion är en komplikation som var tionde patient drabbas av efter ett kirurgiskt ingrepp. Det medför inte bara lidande och förlängd vårdtid för patienten utan kan även vara direkt livshotande. Den förlängda vårdtiden medför dessutom kostnader för samhället, och resurser skulle kunna användas till annan vård. Syftet med litteraturstudien var att beskriva sådana omvårdnadsåtgärder som sjuksköterskan kan vidta för att förebygga postoperativa sårinfektioner. Evidensbaserade omvårdnadsåtgärder som, var för sig minskar risken för att patienten ska drabbas av en postoperativ sårinfektion, och tillsammans utgör grunden för en säker vård. Databassökning av vetenskapligt material inom området ligger till grund för resultatet. Genom aktuell forskning presenteras och lyfts olika omvårdnadsåtgärder som reducerar risken för patienten att drabbas av en postoperativ sårinfektion. Viktiga omvårdnadsåtgärder är: korrekt hårborttagning, bibehållen normotermi, dusch med desinfektion, glukoskontroll, administrering av antibiotikaprofylax och postoperativ sårvård. Ny forskning inom området efterfrågas för att kunna följa utvecklingen, eftersom den befintliga är publicerad för många år sedan. För att patienten ska kunna erbjudas en säker vård behövs kontinuerlig utbildning under sjuksköterskeutbildningen men även i den kliniska verksamheten. Regelbunden uppföljning och utvärdering bör också ske i den kliniska verksamheten för att omvårdnadsåtgärderna ska vara effektiva. / Postoperative surgical wound infection is a complication that every tenth patient suffering after a surgical procedure. The consequences are the suffering and prolonged length of stay for the patient and can also be directly fatal. The prolonged duration of treatment is a high cost in society and resources could be used for other care. The purpose of literature review was to describe nurse’s interventions, which can be taken to prevent postoperative surgical wound infections. Evidence-based care interventions which reduce the risk of the patients suffering a postoperative surgical wound infection and together they represent a safe care. The result is based on search in databases for scientific materials in the subject area. Through current research highlights interventions which reduce the risk of the patient suffering a postoperative wound infection. Essential nursing interventions which are identified as: Hair removal, warming, shower with disinfectant, glucose monitoring, administration of antibiotic prophylaxis and wound care. New research in this area is requested to follow the developments since the current research is getting old. If the care should be safe for patient there must be education in nursing training as well as in the clinical work. Continuous follow-up should also occur in the clinical work in order to get feedback if the nursing interventions are effective.

Bien que les règles de droits et des directives administratives dictent leur conduite, les policiers jouissent d’une latitude considérable dans la manière d’appliquer la loi et de dispenser des services. Puisque l’exercice efficient de toute forme d’autorité nécessite la reconnaissance de sa légitimité (Tyler, 2004), plus l’application de leurs pouvoirs discrétionnaires est jugée arbitraire ou excessive, plus les citoyens risquent d’utiliser des mécanismes normaux d’opposition ou de riposte. Dans cette optique, la présente étude cherche à départager les causes des 15 023 épisodes de voie de fait, menace, harcèlement, entrave et intimidation, qualifiés de défiance, dont les policiers du Service de police de la ville de Montréal (SPVM) ont été la cible entre 1998-2008 selon leur registre des événements (Module d’information policière – MIP). Elle présume qu’à interactions constantes entre la police et les citoyens, les comportements de défiance policière seront fonction du niveau de désordre du quartier et des caractéristiques des personnes impliquées. Plus les policiers interceptent de jeunes, de minorités ethniques et d’individus associés aux gangs de rue, plus ils risquent d’être défiés. Elle suppose également que la probabilité qu’une intervention soit défiée dépend de l’excessivité des activités policières menées dans le quartier. Plus un quartier est sur-contrôlé par rapport à son volume de crimes (overpoliced), plus le climat local est tendu, plus les policiers sont perçus comme étant illégitimes et plus ils risquent d’être défiés lorsqu’ils procèdent à une intervention. Enfin, les comportements de défiance sont peut-être simplement fonction du niveau d’interactions entre les policiers et les citoyens, à conditions sociales et criminogènes des quartiers tenues constantes. Une série d’analyses de corrélation tend à confirmer que les comportements de défiance varient en fonction de l’âge, de l’ethnicité et de l’appartenance à un gang de rue de l’auteur. Par contre, les conditions sociales et criminogènes des quartiers paraissent être des causes antécédentes à la défiance puisqu’elles encouragent un volume plus élevé d’interventions dans les quartiers désorganisés, lequel influe sur le nombre d’incidents de défiance. Contrairement à notre hypothèse, les résultats tendent à démontrer que les policiers risquent davantage d’être défiés dans les quartiers sous-contrôlés (underpoliced). Quant à elles, les analyses multiniveaux suggèrent que le nombre d’incidents de défiance augmente à chaque fois qu’une intervention policière est effectuée, mais que cette augmentation est influencée par les quartiers propices aux activités criminelles des gangs de rue. En ce sens, il est probable que l’approche policière dans les quartiers d’activités « gangs de rue » soit différente, par souci de protection ou par anticipation de problèmes, résultant plus fréquemment en des actes de défiance à l’égard des policiers. / Although the rules of law and administrative directives dictate their conduct, police officers have considerable discretion in how to apply the law and provide services. Since the efficient conduct of all forms of authority requires the awareness of its legitimacy (Tyler, 2004), the more their discretionary powers is deemed arbitrary or excessive, the more citizens are likely to use normal objection or opposition mechanisms. In this context, this study seeks to disentangle the causes of the 15 023 cases of assaults, threats, harassment, obstruction and intimidation, described as defiance, which the police officers of the Service de police de la ville de Montréal (SPVM) were the target of between 1998-2008 according to their register of events (Module d’information policière - MIP). It presumes that with constant interactions level between police and citizens, behaviors of police mistrust will depend on the level of neighborhood disorder and the characteristics of the persons involved. The more the police intercept youths, ethnic minorities and individuals associated with street gangs, the more they are likely to be challenged. It also assumes that the probability that a police intervention be challenged depends on the excessiveness of police activities conducted in the district. The more the neighborhood is overpoliced versus the volume of crimes, the more the local climate is tense, the more the police officers are perceived as being unlawful and they are more likely to be challenged when making an intervention. Finally, defiant behavior may just depend on the level of interaction between police officers and citizens, social and criminogenic conditions of neighborhoods being consistent. A series of correlation analysis tends to confirm that defiant behavior vary according to age, ethnicity and belonging to a street gang of the author. However, the social and criminogenic conditions of neighborhoods appear to be caused by prior defiant behavior because they encourage a higher volume of interventions in the disorganized neighborhoods, which affects the number defiant behavior incidents. Contrary to our hypothesis, the results suggest that police officers are more likely to be challenged in underpoliced neighborhoods. In turn, the multilevel analysis suggests that the number of defiant behavior incidents increases each time a police intervention is performed, but this increase is influenced by neighborhoods conducive to street gang criminal activities. To this effort, it is likely that the police approach in the street gang’s neighborhood activities is different, for the sake of protection or in anticipation of problems, resulting more frequently in defiant behavior acts against police officers.

Le but de cette étude est d’adopter une intervention systémique visant à faciliter la communication entre les infirmières1 et les familles2 dans un contexte de soins intensifs (SI) en traumatologie. Cette recherche prend en compte la réalité et les besoins du milieu à l’étude grâce au devis participatif retenu. Le cadre de référence est composé de l’approche systémique familiale de Wright et Leahey (2005) ainsi que de la théorie du caring de Jean Watson (1979). La collecte des données a été inspirée du parcours de recherche en spirale de Lehoux, Levy et Rodrigue (1995). Cinq entrevues ont été menées auprès de membres de familles ainsi que trois groupes de discussion (focus groups) auprès d’infirmières. L’analyse des données a été effectuée selon le Modèle de Huberman et Miles (2003) qui préconise une démarche analytique continue et interactive. Les résultats obtenus révèlent un changement de pratique selon dix interventions systémiques infirmières spécifiques permettant de faciliter la communication avec les familles aux soins intensifs en traumatologie et soulignent l’importance d’agir sur le plan du contexte, de la relation et du contenu liés au processus de communication. De plus, ils permettent de démontrer un réel changement de pratique dans le milieu retenu pour l’étude. / Abstract The purpose on this study was to adopt systemic nursing interventions to enhance communication with families in a context of traumatology intensive cares. This participative study has the benefit of reflecting the real needs expressed by the persons concerned. The terms of reference for this study comprised the conceptual model as well as Wright and Leahey’s (2005) family systems nursing approach and the caring theory of Jean Watson (1979). The data collection was inspired by Lehoux, Levy and Rodrigue (1995) over five family interviews and three nurses’ meetings. The data collection was performed over a period of seven months. All of the interviews and meetings were recorded on audio tape and the verbatim’s were fully transcripted. The data analysis was done according to Huberman and Miles’ (2003) model, where analytical activities and data collection establish a continuous and interactive approach. The results obtained revealed ten specific systemic nursing interventions to enhance communication with families in this context and revealed the importance of the three levels of communication: cognitive, affective and behavioral. Moreover, the results are used to identify well-established interventions and recommend those who have to be improved.

Magister Scientiae Dentium - MSc(Dent) / AIM:The aim of this study was to review the data available from the Department of Health(DOH), on pre-school paediatric patients treated under Dental General Anaesthesia(DGA), at public health facilities in the Western Cape (WC) in order to ascertain the type and nature of treatment provided.METHODOLOGY:This retrospective descriptive study reviewed the records on the Department of Health(DoH) Database of 16 732 pre-school patients treated under dental general anaesthesia in the period 1 January 2005 until 31 December 2007. A questionnaire was also completed telephonically with 22 dentists from the district dental health clinics.Summary descriptive statistics were calculated from data collected and comparisons were drawn between services available at the health districts and academic hospitals.RESULTS:Of the 58 255 procedures recorded for pre-school patients in the district health clinics in the Western Cape, 99.94% were for extractions provided and 0.5% for restorations.The average number of teeth extracted was 10.4 (SD ±3.9).The average rate of DGA per 1000 of the population was 1.06. Only 9% (2) of dentists at district clinics reported that pre-DGA prevention was provided and 5% (1) reported including post-DGA prevention. The Academic Hospital at Tygerberg Oral Health Centre was the only facility in the Western Cape that provided comprehensive dental treatment for pre-school patients which included restorations, extractions, pre and post DGA prevention. Red Cross Children’s Hospital provided treatment for pre-school patients under DGA that included extractions, pre- and post DGA, but no restorative treatment. CONCLUSION:The demand for DGA in pre-school patients in the WC was high. The lack of prevention associated with DGA in the public health service is the most likely reason the retreatment rate under DGA was reported by dentists as being 77%. There was an absence of protocol regarding DGA for pre-school patients in the public health service.RECOMMENDATIONS:Guidelines formulated were recommended for use in the public service for pre-school patients being treated under DGA and includes the provision of preventive interventions such as regular topical fluoride applications, oral hygiene instruction and dietary advice.

Magister Educationis - MEd / In this study I researched the effectiveness of a ‘Thinking Schools’ initiative at a local primary school between April 2010 and September 2011. I looked at how the school began the journey, what has changed in the school, the contextual factors that have influenced the process and what has sustained the school’s progress. As background to the study I discuss the importance and relevance of learned intelligence as explained by Vygotsky, thinking skills and cognitive education, and the whole school approach as opposed to individual teacher initiatives, as introduced by Burden in the United Kingdom. A local adaptation of Lipman’s ‘Philosophy for Children’ was the focus of this study, as it was chosen by the school as the starting point on their road to becoming a Thinking School. A qualitative research approach was used, using a constructivist paradigm and case study methodology, following the guidelines established by Stake (1995) and Yin (2003). The participants included the principal, together with selected teachers and learners and a curriculum advisor. Data collection took the form of interviews and a rating scale. The study found positive changes in teacher and learner thinking, supported by the ethos and stability of the school environment. The major challenge was that not all stakeholders were involved.

La réalisation de gestes percutanés dans l’IRM ouvre la voie à des pratiques médicales prometteuses. En revanche, l’utilisation de l’IRM reste à ce jour limitée, et ce malgré l’intérêt en terme de qualité d’image. Cela est dû principalement à l’étroitesse du tunnel et à la complexité des gestes réalisés. Pour rendre accessibles de telles pratiques, une assistance robotique semble très pertinente. Pour le concepteur, la réalisation d’un système robotisé compatible IRM n’est pas une tâche facile, étant donné l’espace disponible et la présence d’un champ magnétique intense. C'est dans ce contexte que nous avons développé un assistant robotique, MRGuide, dédié aux traitements du cancer de la prostate dans l’IRM. Il s'agit d'un manipulateur à câbles avec un actionnement déporté. Dans ce travail, de nombreuses contributions menant à la réalisation de ce prototypes ont présentées. Parmi celles‐ci, une instrumentation originale pour estimer la tension des câbles est proposée. Cette instrumentation est basée sur l’utilisation d’une structure en treillis, de mécanismes compliants et de capteurs de déplacement à technologie optique pour assurer la compatibilité avec le scanner. Pour optimiser la géométrie du robot et faciliter son intégration dans l'IRM, une démarche de conception des robots à câbles instrumentés est développée. Cette démarche est basée sur une approche par intervalles. D'autres contributions relatives à la caractérisation de l'espace de travail des robots à câbles instrumentés, à l'étalonnage des capteurs de tension et au développement d'une stratégie de commande adaptée au dispositif sont décrites. / Performing medical gestures under MRI is a promising medical approach. Todate, using MRI for interventions is still limited, despite the quality of the provided images. This limitation is mainly due to the confined physical space inside the tunnel and the complexity of the gestures. To make accessible such practices, a robotic assistance seems very relevant. However, it’s a challenge for the designer, given the limited space and the strong magnetic field inside the bore. In this context, we have developed an MR-‐compatible robotic assistant, named MRGuide, for prostate interventions. The robot is based on an original cable-­‐ driven manipulator with a remote actuation. In this work, many contributions leading to the development of MRGuide are presented. One of these contributions lies in the use of an original instrumented structure to evaluate the cables tensions. This instrumentation is based on the use of a truss structure, compliant mechanisms and optical displacement sensors for MRcompatibility. In order to optimize the size of the robot and facilitate its integration in the scanner, a new design methodology using interval analysis has been developed. Other contributions related to the workspace characterization of instrumented cable-­‐driven robots, the tension sensor calibration and the development of a new control strategy adapted to the device are described.

A l'adolescence, les patients porteurs de maladie chronique depuis l'enfance passent une étape de transition des soins, qui implique la sortie des services pédiatriques et l'entrée dans les services pour adultes. Cette étape pose de nombreux défis et elle est reconnue comme une période à risque de rupture de soins. Pour éviter ces situations, des recommandations internationales et des programmes variés ont été proposées. En France, il n'existe pas de recommandation générique pour la transition. Notre objectif était de proposer un programme générique, pertinent et faisable pour la transition des jeunes porteurs de maladies chroniques variées dans un grand nombre de services en France. Pour cela nous avons employé une méthode mixte : 1) Revue systématique des études interventionnelles au niveau international ; 2) Enquête qualitative des pratiques de transition existantes dans un ensemble de services hospitaliers d'Ile de France ; 3) Enquête de consensus national pour l'élaboration d'un programme de transition pertinent et faisable par la méthode Delphi. Nous avons observé que l'existence de programmes de transition était très dépendante des services : certains ne proposant pratiquement aucune adaptation de la prise en charge, d'autres proposant des programmes très structurés. Globalement, les programmes sont peu spécifiques des pathologies. A l'issue de ce travail de thèse, nous avons proposé un programme générique qui peut être considéré comme un tronc commun. Il pourra notamment permettre aux professionnels impliqués dans le suivi de pathologies peu étudiées dans le contexte de la transition de proposer des pratiques essentielles et minimales aux patients concernés. / At the end of their adolescence, patients with chronic disease since childhood go through a phase of healthcare transition, which involves the discharge of pediatric services and the entry into adult care services. This step poses many challenges and is recognised as a high risk period of discontinuity in care pathway. To avoid these situations, international recommendations and various programs have been proposed. In France, there is no generic recommendation for transition to adult care.The final goal of this thesis work was to propose a generic, relevant and feasible program for the transition of young people with varied chronic diseases into a large number of services in France.For this purpose, we used a mixed method research including: 1) Systematic review of intervention studies at the international level; 2) Qualitative study of existing transition practices in a set of hospital services in the Ile de France region (including Paris and its surroundings); 3) National consensus survey for the development of a relevant and feasible transition program using the Delphi method.We observed that the existence of transition programs was highly dependent on services: some offering almost no adaptation of care during this process, others offering highly structured programs. Overall, the programs were not really specific to pathologies.At the end of this thesis work, we proposed a generic program which can be considered as a common core of transition practices. Among other thing, it will allow professionals involved in the follow-up of pathologies that are under-studied in the context of the transition to propose essential and minimal practices to their patients.

Researchers have found an overlap of psychological symptoms in victims of Post-Traumatic Stress Disorder and Continuous Traumatic Stress. Although the circumstances inducing the psychological reactions are different, the symptoms mimic one another without a clear cut demarcation, calling for practitioners to be cautious of contexts inducing psychopathology that is triggered through re-experiencing of past trauma when they are assessing and intervening with ongoing trauma-exposed communities. This study explored the subjective experiences of 15 local Non-Governmental Organization (NGO) administrators in Nigeria across 5 states, including the federal capital Abuja, about the intersectionality of their clients' persistent trauma experiences and their program planning and intervention strategies. The study leveraged complexity and organizational change models, using qualitative inquiry with open ended interview questions and purposive sampling. Questions probed administrators' modalities, orientations, and perceptions that inform organizational planning and interventions. Open-ended interviews of top local NGO administrators provided contrasting insights on current interventions. Data were collected and analyzed using constant comparative content analysis. Findings suggest that local NGO administrators currently lack the awareness and capacity to address their clients' psychosocial, behavioral, and mental health issues that are related to continuous, direct, and indirect violence. The study impacts social change by identifying gaps in current NGO administrators' efforts to reduce effects of violence and support peace in affected communities.

The current international system with its emphasis on state sovereignty was designed to restrain interference in domestic affairs by other states. However, this notion has been repeatedly challenged throughout the past 70 years by states intervening with military instruments in internal armed conflicts. Possible motives that led states to jeopardize the lives of their soldiers and convinced them to bear the costs of interventions have engendered a rich debate in the studies of International Relations and Peace and Conflict Studies. In this dissertation, two arguments based on the logic of the realist theory of international relations are brought forward to augment our understanding of factors contributing to military interventionism. First, it is shown that economic linkages between states transcend the debate on trade and include the effects of foreign direct investment on their willingness to intervene by force. Corporate investment is shown to significantly raise the willingness of states to intervene when existing FDI is endangered by the dynamics unfolding during internal armed conflicts. Second, great powers are apt to harness other states to alter the conflict dynamics in civil wars. Applying the principal-agent framework in combination with the logic of arms trade allows identifying unequal...

Bakgrund: Forskning visar att människor i stor utsträckning påverkas positivt av interaktion med djur. Då hälsa är ett mångdimensionellt begrepp är det viktigt för psykiatrisjuksköterskan att ha kunskap om omvårdande insatser som främjar upplevelsen av välbefinnande och skapar mening i tillvaron. Djurens betydelse vid behandling av psykisk ohälsa är således viktig att belysa. Syfte: Syftet var att undersöka hur personer med psykisk ohälsa beskriver att interaktion med djur kan påverka deras psykiska hälsa. Metod: En litteraturöversikt med systematiskt tillvägagångssätt valdes som metod. Litteratursökningen genomfördes i tre olika databaser och 11 vetenskapliga originalartiklar inkluderades i resultatet. Resultatartiklarna analyserades med en tematisk innehållsanalys. Resultat: Deltagarnas erfarenheter av interaktion med djur beskrevs genom tre huvudteman. Dessa var; En meningsfull relation, Att få må bra och En förändringsprocess. Sju underteman framkom, dessa var; En källa till värme, kärlek och stöd, Accepterad som den man är, Förtroende och ansvar, En upplevelse av glädje och välmående, Att kunna hantera symtom vid psykisk ohälsa, Utveckling av identitet och självkännedom och Ökad förmåga och funktion i vardagen. Slutsats: Interaktion med djur kan ha flera hälsofrämjande effekter för personer med psykisk ohälsa, såsom att minska självstigma, lindra symtom, bidra till personlig utveckling och upplevelse av välmående. En ökad integrering av djurunderstödd behandling skulle därför kunna vara värdefullt inom psykiatrisk vård. / Background: Research shows that people are essentially positively affected by interactions with animals. As health is a multidimensional concept, it is important for the psychiatric nurse to have knowledge of nursing interventions that promote the experience of well-being and create meaning in life. Thus, it is important to shed light on the value of animals in mental health treatment. Aim: The aim was to investigate how people with mental illness described their mental health being affected by interactions with animals. Method: A literature review with a systematic approach was chosen as method. The literature search was performed in three databases and 11 original scientific articles were included. The result articles were analysed with a thematic content analysis. Results: The participants' experiences of interaction with animals were described through three main themes. These were: A meaningful relationship, To feel good and A process of change. Seven sub-themes emerged, these were: A source of warmth, love and support, Accepted as you are, Trust and responsibility, An experience of joy and well-being, Being able to manage symptoms of mental illness, Development of identity and self-awareness and Increased ability and function in everyday life. Conclusion: Interaction with animals has several health-promoting effects for people with mental illness, such as reducing self-stigma, reducing symptoms, contributing to personal development, and experiencing well-being. Increased integration of animal-assisted treatment could therefore be valuable in psychiatric care.