Background: Human 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. Objective: To document the current level of simulation-based training and assessment of seven generic NTSs in crew members in the Norwegian HEMS. Methods: A 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. Results: The 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. Conclusions: Our 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.

AIMS AND OBJECTIVES: To explore patient perceptions of chronic obstructive pulmonary disease exacerbation and the patients' experiences of their relations with health personnel during care and treatment.

BACKGROUND: Patients 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.

DESIGN: Narrative research design was chosen.

METHODS: Ten 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.

RESULTS: Because 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.

CONCLUSIONS: This 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 PRACTICE: The findings give nurses insight into building trust and a good relationship between patient and caregiver during an acute exacerbation of chronic obstructive lung disease.

Although methadone maintenance treatment (MMT) has been shown to be effective, poor compliance is always a threat. It has often been pointed out that one variable that inevitably reduces adherence to treatment regimes is the negative side-effects of the treatment. This study examines seventeen known side-effects in a sample of 110 former opiate addicts consecutively admitted to methadone maintenance treatment. Self-reported side-effects were collected through a questionnaire. Despite the considerable increase, from 23 to 74% of the sample, in the proportion that reported individual side-effects between the period of opiate use and that of methadone treatment, the overall result was a significant decrease in eleven symptoms, no change in four and a substantial increase in only two. In some individuals a symptom that is liable to be problematic actually does become problematic, while the same symptom becomes less frequent in the group as a whole. Weight gain is the symptom that increases most in the whole group and needs to be constantly monitored. Other side-effects that remain high and need to be kept under review in clinical practice are nervousness, decreased libido, daytime drowsiness, constipation and perspiration.

Numerous reports of the effectiveness of methadone in reducing opiate use as well as mortality, criminality, prostitution and the risk for HIV-infection have been published during the last forty years. However, poor adherence to treatment, continuing drug use and increasing rate of premature termination may lead to less than optimal outcome results or in too many cases death. The aim of this paper is to investigate which of the background variables, collected at the admission procedure, that can be used to tell which type of patient will adhere to the treatment regime and succeed or who will fail and who either need special considerations or ought not to be accepted for a methadone treatment (MMT). As much as 86 percent of the compliers in this study did benefit from the treatment and were rated as medium to very much improved according to CGI-I. The group not improved or worse had significantly more background problems such as school problems, a history of non-opioid abuse, many non-MMT treatment episodes, low age at drug debut and opioid debut than the group much or very much improved. Those moderately improved is usually situated somewhere in between the others.

The aim of this article is to describe the drug career of 71 severely opioid-dependent women who had a history of selling sex and were enrolled in methadone maintenance treatment. Data were collected through semi-structured interviews, from medical records and reports from social agencies and correctional institutions. The sequential pattern could be described in the following order: initiation of the first drug of abuse, opioid onset, initiation of selling sex, first non-methadone treatment episode, first sentence and, finally, methadone maintenance treatment. There were significant age differences and correlations between most of the events. The main correlation (r = 0.70) was the one between debut of opioid use and selling sex, which was confirmed in a stepwise multiple regression analysis. In addition, a history of running away from home advanced the age at which the women started selling sex for those with an onset of opioid use at an older age than the mean of 18.4 years.

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.

The aim of the present study is to examine whether the established fact that men by far outnumber women in leading positions is an inherent unintentional characteristic of a hierarchy where appointments happen one by one on an individual basis, as opposed to boards where the members are appointed as a group. The sample consists of those appointed to the hierarchies as well as the boards of 36 state universities in Sweden. The main finding is that significantly more men are appointed in hierarchies than to group-composed boards. When the gendered distribution of those in leading positions becomes fully apparent, the last and final position in the hierarchy is significantly more often given to a woman. However, these women are much older than their male counterparts, a fact that makes it harder for them to reach the final step of the ladder. The article concludes with a discussion of whether the higher probability of appointing a woman as vice-president when both chair and president are men is a fair acknowledgement of an unfair gender distribution, or if there are other possible explanations.

Objective: to explore what information and knowledge the labour admission test is perceived to provide and what meaning the test carries in the daily work of practising midwives. Design: in-depth interviews transcribed verbatim and analysed using the grounded theory technique. Setting: four different labour wards in Norway. Participants: a theoretical sample of 12 practising midwives. Findings: the core category "experiencing contradictions" was identified during the analyses, indicating that the midwives found conflicting interests within themselves, or between themselves and others when using the labour admission test. They experienced contradictions between professional identity and the increasing use of technology, between feeling safe and feeling unsafe and between having power and being powerless. Key conclusions: the labour admission traces could be difficult to interpret, especially for newly qualified midwives. Some midwives thought that a labour admission trace could protect them in case of litigation. The hierarchy of power in the labour ward influences the use and interpretation of the labour admission test. Some midwives felt their professional identity threatened and that midwives in general are losing their traditional skills because of the increasing use of obstetric technology. Implications for practice: the findings of the present study should be taken into consideration when changing practice to not routinely perform the labour admission test. There is also a need for further research on what effect the increasing use of obstetric technology has on traditional midwifery skills.