The mortality within a cohort of 115 street heroin addicts was studied for 5-8 years using the Kaplan-Meier survival estimate technique. This differed markedly from the relatively low mortality of 166 comparable heroin addicts given methadone maintenance treatment (MT). The street addicts' mortality rate was 63 times that expected, compared with official statistics for a group of this age and sex distribution. When 53 patients in MT were involuntarily expelled from treatment, due to violation of programme rules, they returned to the high mortality of street addicts (55 times that expected). A group of 34 rehabilitated patients who left MT with medical consent retained the low mortality of MT patients (their mortality rate was 4 times that expected). Despite this great improvement in survival, even patients in MT showed a moderately elevated mortality (8 times that expected), mainly due to diseases acquired before entering the treatment programme. It is concluded that MT exerts a major improvement in the survival of heroin addicts.

The hypothesis that electrodermal nonresponsiveness to orienting stimuli delineates a core group of "Kraepelinian" type schizophrenics was tested by following up social functioning outcome over a 2-year period in 37 schizophrenics. Good social functioning outcome required both some self-supporting ability in the job market and a minimal social life. The prior assessments included monitoring of electrodermal responses to a series of moderately intense tones, ratings of reported and observed symptoms during an interview, and ratings of premorbid adjustment on the basis of an interview with a close relative. Electrodermal nonresponding, poor premorbid adjustment, and negative symptomatology predicted poor social functioning during the second follow-up year, but the relationship to nonresponding pertained exclusively to a group of 15 first-episode patients. Discriminant analysis showed that electrodermal nonresponding and symptoms were the only independent predictors of outcome.

The health of an individual depends on how well he or she can handle various stressors in his or her environment. One vulnerable period occurs during the transition from child to adult. The overall aim of this research project was to determine whether differences in the ability to deal with stress are related to various health indicators, aggression, and school marks during primary and upper secondary school. Data were collected class-wise and 253 Swedish upper secondary school pupils participated. Three well-established questionnaires [Sense of Coherence (SOC), Coping Resources Inventory (CRI) and Aggression Questionnaire (AQ)] were used. In addition, blood pressure, teacher evaluation and school marks were collected. Some demographic data such as gender, age and type of study programme were also collected. Both SOC and Coping Resources Inventory correlated significantly positively with many of the primary and upper secondary marks, while the AQ had significantly negative correlations with the mark. Females obtained higher values than males in Coping Resources Inventory, but lower in SOC and AQ.

AimTo report a study conducted to explore intensive care unit nurses’ perceptions of patient participation in the acute phase of chronic obstructive pulmonary disease exacerbation.BackgroundAn acute exacerbation is a life-threatening situation, which patients often consider to be extremely frightening. Healthcare personnel exercise considerable power in this situation, which challenges general professional notions of patient participation.DesignCritical discourse analysis.MethodsIn the autumn of 2009, three focus group interviews with experienced intensive care nurses were conducted at two hospitals in western Norway. Two groups had six participants each, and one group had five (N = 17). The transcribed interviews were analysed by means of critical discourse analysis.FindingsThe intensive care nurses said that an exacerbation is often an extreme situation in which healthcare personnel are exercising a high degree of control and power over patients. Patient participation during exacerbation often takes the form of non-involvement. The participating nurses attached great importance to taking a sensitive approach when meeting patients. The nurses experienced challenging ethical dilemmas.ConclusionThis study shows that patient participation should not be understood in universal terms, but rather in relation to a specific setting and the interactions that occur in this setting. Healthcare personnel must develop skill, understanding, and competence to meet these challenging ethical dilemmas. A collaborative inter-professional approach between physicians and nurses is needed to meet the patients’ demand for involvement.

Research concerning the supervisor role in separate educational programmes has been undertaken, but cross-professional studies are few. The aim of this study was to explore the lived experience of supervising mentors in Sweden during the practice-based, off-campus sections of the education in teaching, nursing, and social care. The study used a participatory phenomenological approach in which four researchers and nineteen supervising mentors worked together in the research process which was accomplished in four different phases. The data collecting method used was interview. The results constituted a main essence entitled ''Struggle of power and control of professional quality enhancement'' built upon four themes: ''Constitutes a motivating force'', ''Feelings of responsibility'', ''Feelings of frustration'' and ''Wishes for alteration''. Conclusions from the study are that communication, information and contact between the professionals in the fields and university teachers need to be strengthen to keep up supervising mentors' motivating force and to give them support.

Aims and objectivesTo explore patient perceptions of chronic obstructive pulmonary disease exacerbation and the patients’ experiences of their relations with health personnel during care and treatment.BackgroundPatients suffering from acute exacerbation of chronic obstructive pulmonary disease often experience life-threatening situations and undergo noninvasive positive-pressure ventilation via bi-level positive airway pressure in a hospital setting. Theory on trust, which often overlaps with the issue of power, can shed light on patient’s experiences during an acute exacerbation.DesignNarrative research design was chosen.MethodsTen in-depth qualitative interviews (n = 10) were conducted with patients who had been admitted to two intensive care units in Western Norway during the autumn of 2009 and the spring of 2010. Narrative analysis and theories on trust and power were used to analyse the interviews.ResultsBecause of their breathlessness, the patients perceived that they were completely dependent on others during the acute phase. Some stated that they had experienced an altered perception of reality and had not understood how serious their situation was. Although the patients trusted the health personnel in helping them breathe, they also told stories about care deficiencies and situations in which they felt neglected.ConclusionsThis study shows that patients with an acute exacerbation of chronic obstructive pulmonary disease often feel wholly dependent on health personnel during the exacerbation and, as a result, experience extreme vulnerability.Relevance to clinical practiceThe findings give nurses insight into building trust and a good relationship between patient and caregiver during an acute exacerbation of chronic obstructive lung disease.

BackgroundHuman error and deficient non-technical skills (NTSs) among providers of ALS in helicopter emergency medical services (HEMS) is a threat to patient and operational safety. Skills can be improved through simulation-based training and assessment.ObjectiveTo document the current level of simulation-based training and assessment of seven generic NTSs in crew members in the Norwegian HEMS.MethodsA cross-sectional survey, either electronic or paper-based, of all 207 physicians, HEMS crew members (HCMs) and pilots working in the civilian Norwegian HEMS (11 bases), between 8 May and 25 July 2012.ResultsThe response rate was 82% (n=193). A large proportion of each of the professional groups lacked simulation-based training and assessment of their NTSs. Compared with pilots and HCMs, physicians undergo statistically significantly less frequent simulation-based training and assessment of their NTSs. Fifty out of 82 (61%) physicians were on call for more than 72 consecutive hours on a regular basis. Of these, 79% did not have any training in coping with fatigue. In contrast, 72 out of 73 (99%) pilots and HCMs were on call for more than 3 days in a row. Of these, 54% did not have any training in coping with fatigue.ConclusionsOur study indicates a lack of simulation-based training and assessment. Pilots and HCMs train and are assessed more frequently than physicians. All professional groups are on call for extended hours, but receive limited training in how to cope with fatigue.

No abstract