The public health care sector has come under increasing pressure to cut down costs, maximize productivity and satisfy patients' needs during the 1990s and onwards. As a way of "getting more for less" quality management has been introduced. Originating in the private manufacturing industry, quality management has a strong focus on productivity and efficiency, aspects which are measured in quantitative terms. However, there are strong concerns that quality management is a means of speeding up the marketization of public health care by introducing core values much different from the ethic and medical norms that traditionally underpin health care organizations.This essay focuses on how quality management has been introduced to, and transformed by, public health care. A theoretical framework based on new institutionalism is constructed, and translation theories are used as a way of illustrating how the medical institutional environment, in fact, changes the concept of quality management.

ABSTRACTAim: The aim of this study was to examine differences in the documentation of the case incident reports, before (FRP) and after (FRE) the introduction of a quality standard for fall prevention in the geriatric departments at a Swedish University hospital. Method: 51 fall incident reports were collected before the introduction of quality standards for fall prevention and 63 after. Differences in documentation between the fall incident reports were analyzed with a Chi-2 test. Results: Number of case incidents in which the use of the alarm mat was documented increased after the introduction of quality standards for fall prevention and documented use of shoes and walker decreased. The majority of all documented case incidents occurred inside the patient room according to both FRP and FRE.

Hos patient med inflammatory bowel diseases (IBD) har nutrition en central betydelse. Nutrition ska betraktas som en medicinsk behandling samtidigt som nutrition är ett av sjuksköterskans omvårdnadsansvar. Syftet var att belysa nutritionsbehovet hos patient med inflammatory bowel diseases. Resultatet baseras på 15 vetenskapliga artiklar. Resultatet visar att patient med IBD lider av malnutrition eller ligger i riskzon för att bli malnutrierad.

Bakgrund: Övervikt och fetma är den största folkhälsosjukdomen i dagens samhälle. Överviktiga patienter blir allt vanligare i hälso- och sjukvården och vårdpersonal upplever det svårt att behandla dem korrekt. Sjuksköterskor använder sig av olika strategier för att nå dessa patienter men är osäkra på hur patienterna uppfattar deras råd. Patienter med övervikt står inför allvarliga hälsorisker. Syfte: Syftet med studien är att belysa överviktiga patienters upplevelser av mötet med vården.

Den sociala och fysiska miljö som omger måltiden är av stor betydelse för den äldre patienten. Syftet med studien var att beskriva äldre patienters måltidsmiljö och dess effekter ur ett omvårdnadsperspektiv. Metoden som användes var en litteraturstudie. Litteratursökningen har skett i databaserna CINAHL och Medline. Efter urval och granskning återstod 12 artiklar som var publicerade mellan åren 1994-2005, åtta kvalitativa och fyra kvantitativa artiklar.

Celiac disease (CD) is an autoimmune disease, induced by an immune mediated reaction in the small intestine after ingestion of gluten and related prolamines. There is a strong genetic linkage and most important are the genes that encodes for HLA-DQ2 and HLA-DQ8. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has developed new guidelines for investigation of CD in children and adolescents, which include genotyping for HLA-DQ2 and HLA-DQ8. Therefore, the clinical microbiological laboratory in Västmanland wants to introduce a method for analysis of these genes. Microarray is a newly developed method for determination of the alleles HLA-DQA1 and HLA-DQB1 that encodes for the ?- and ?-subunits of the HLA-molecules.

During one week (9-13 May, 2005) the use of veterinary diets for the hospitalised patients att the University clinic was registered. The animal owners were interviewed by telephone six months later about the feeding after coming home. Four out of ten animal owners answered yes to the question if the veterinarian had asked what food their animal normally consumed. Out of 35 animals, 15 (43%) were prescribed to a veterinary diet. Among cats it was 8 out of 14 (57%) and among dogs it was 7 out of 21 (33%). Four animals out of ten were recommended a veterinary diet when going home, but 20% did not follow the recommendation all the way through and stopped feeding their animal the veterinary diet. Reasons that were given was that the diet didn't last the entire period, that the animal didn't need the diet anymore according to the owner and one dog that became to lean when fed the diet. The diagnosis for these three dogs was vomiting, foreign body in the digestive system and bloody diarrhoea.

Aim: The aim of the study was to examine the effects of ?Rehabilitation with psychotherapy and yoga in group? with cancer patients, regarding physical, social, emotional and functional wellbeing. The participants? health and satisfaction with the project were also evaluated. Method: The evaluation was made with quantitative method and descriptive, longitudinal design.

During the past decade, consumer health information-centers have been developed at the hospital libraries in Sweden in order to meet the increasing demand from patients and their relatives concerning consumer health information. In 1993, the hospital libraries in Falun, Västervik and Karlstad launched a consumer health information database called PION. The aim of this Master's thesis is two-fold. My first aim is to describe and discuss the principles of user-oriented evaluation. In my attempt to convey the theoretical discussion into the everyday life of librarianship, my second and most important aim is to conduct a user-oriented evaluation of the database PION.

The main objective of this study is to divide a number of colorectal cancer cases into subgroups based on their molecular features using cluster analysis. The data used is supplied by a research group at Pathology, the Department of Medical Biosciences, Umeå University, and consists, after some preparation, of 455 observations which is a larger data set than many similar studies. The molecular variables that the clustering is based on are CIMP (CpG Island Methylator Phenotype), MSI (Micro Satellite Instability), BRAF- and KRAS-mutations. These are categorical variables and consequently the clustering method used is PAM (Partitioning Around Medoids) which is particularly useful with data on diverse variable level. The final analysis results in four subgroups that are represented by different combinations of attributes on the aforementioned variables.

SammanfattningBakgrund:Tidigare litteratur beskriver att sjuksköterskor frekvent blir utsatta för våld på sin arbetsplats. Våldshandlingar orsakar spänningar i förhållandet mellan sjuksköterskor och patienter, vilket har negativa effekter på omvårdnaden.Syfte: Syftet med föreliggande studie var att beskriva bakgrundsfaktorer till att patienter och anhöriga utövar våld mot sjuksköterskor och annan vårdpersonal på sjukhus.Metod: En litteraturstudie med deskriptiv design, som inkluderade 15 artiklar. Artiklarna hittades i databaserna PubMed och Cinahl, sökorden som användes var Nurses, Patients, Hospitals, Workplace, Violence och Factors.Resultat: Huvudresultatet från denna studie var att bakgrundsfaktorer till våldshandlingar var höga arbetskrav på personal, långa väntetider, tid på dygnet, demografiska faktorer, substanspåverkan, påverkan av hälsotillstånd och inställning till sjukvården.Slutsats: Författaren till föreliggande litteraturstudie fann att de bakgrundsfaktorer som beskrevs till att patienter och anhöriga utövade våldshandlingar mot sjuksköterskor grundade sig i missnöje över vården eller att patienter och anhörigas beteenden påverkades av tillfälliga omständigheter. Det är av vikt att lyfta fram detta forskningsområde då det har en direkt påverkan på omvårdnad..

Objective: To investigate the experiences of ambulance nurses when using Boussignac CPAPcompared to their previous model, and their suggestions for possible improvements in the use of CPAP in the care of patients with pulmonary oedema. Method: A qualitative study with a descriptive and exploratory approach. Data was collected through ten semi-structured interviews with ambulance nurses, seven men and three women. The analysis was conducted using Lundman and Graneheim?s content analysis.

Syftet med litteraturstudien var att beskriva vilka faktorer som i omvårdnadsforskningen beskrivs som bidragande faktorer till akut delirium. Syftet var vidare att beskriva vilka omvårdnadsåtgärder som omvårdnadsforskningen tar upp som kan minska risken för uppkomst av akut delirium. Resultatet baserades på vetenskapliga artiklar som söktes i följande databaser: Elin@dalarna, BlackwellSynergy, PubMed och EBSCO host. Följande sökord användes: delirium, acute, elderly, nursing, patients, caring, management, confusional state, needs. Artiklarna granskades enligt en granskningsmall med avseende på vetenskaplig kvalité.

ABSTRACTAim: The aim of this study is to chart the experiences of Swedish general psychiatric care on a Swedish University hospital from a relative?s point of view. The study focus on how they are meet, satisfaction with and participation in the care. The study is done as an improvement project.Methods: The study was conducted by performing semi-structured interviews with eight close relatives to patients on a general psychiatric ward. The interviews lasted for 20-40 minutes.Results: The result shows that relatives are satisfied with the way they are meet by the staff on the ward, that they appreciate staff that are open, down to earth and are inviting to form a good relationship.

Aim: The aim of this qualitative interview study was to describe the nurse's professional role and the role as a patient during different time periods. Data were collected through semi-structured interviews, where respondents had a link to the nursing profession, either as a student, now working nurse or retired nurse. Method: The data were analyzed using a content analysis. Result: The older nurses believe that nurses today has a high status and is seen as a well-read and well informed person. Most respondents believe that collaboration between nurses and doctors has improved since past.