The 2024 revision of the Norwegian standard for the safe practice of anaesthesia.

The Norwegian standard for the safe practice of anaesthesia was first published in 1991, and revised in 1994, 1998, 2005, 2010 and 2016 respectively. The 1998 version was published in English for the first time in Acta Anaesthesiologica Scandinavica in 2002. It must be noted that this is a national standard, reflecting the specific opportunities and challenges in a Norwegian setting, which may be different from other countries in some respects. A feature of the Norwegian healthcare system is the availability, on a national basis, of specifically highly trained and qualified nurse anaesthetists. Another feature is the geography, with parts of the population living in remote areas. These may be served by small, local emergency hospitals. Emergency transport of patients to larger hospitals is not always achievable when weather conditions are rough. These features and challenges were considered important when designing a balanced and consensus-based national standard for the safe practice of anaesthesia, across Norwegian clinical settings. In this article, we present the 2024 revision of the document. This article presents a direct translation of the complete document from the Norwegian original.

A quantitative, multicentre, longitudinal study of patient experiences after gynaecological day surgery.

AIM: The aim of this study was to explore patients' experiences after gynaecological day surgery one and 30 days postoperatively, as well as potential factors influencing these experiences. DESIGN: The study had a multicentre, quantitative, longitudinal design. METHODS: The study was conducted in three different hospitals' day surgical unit and included patients undergoing gynaecological surgery in general anaesthesia. We used a questionnaire including the European Quality of Life tool (EQ5D3L), the Quality-of-Recovery-15 questionnaire (QoR-15) and items relating to patient experiences, the first day (T1, n = 444) and 30 days (T2, n = 193) after surgery. Data were collected in the period March 2019 to March 2020. RESULTS: Results show that patients mainly had positive experiences and ranged quality of recovery high, even though some areas needed improvement. Patient scores on the QoR-15 relating to their experiences 24 h postoperative were rated higher at T1 than at T2. Twenty per cent of the respondents experienced complications such as infection, haemorrhage and pain. About 1/5 of these contacted healthcare services, and three per cent was hospitalized. EQ5D score was the only factor that made an statistically significant impact on patients' experiences with quality of recovery (R2 .169, F = 82.87). However, this effect was weak.

Anaesthesia personnels' perspectives on digital anaesthesia information management systems - a qualitative study.

BACKGROUND: In Norway, the anaesthesia team normally consists of a nurse anaesthetist and an anaesthetist. Digital anesthesia information management systems (AIMS) that collect patient information directly from the anaesthesia workstation, and transmit the data into documentation systems have recently been implemented in Norway. Earlier studies have indicated that implementation of digital AIMS impacts the clinical workflow patterns and distracts the anaesthesia providers. These studies have mainly had a quantitative design and focused on functionality, installation designs, benefits and challenges associated with implementing and using AIMS. Hence, the aim of this study was to qualitatively explore anaesthesia personnel's perspectives on implementing and using digital AIMS. METHODS: The study had an exploratory and descriptive design. The study was conducted within three non-university hospitals in Southern Norway. Qualitative, individual interviews with nurse anaesthetists (n = 9) and anaesthetists (n = 9) were conducted in the period September to December 2020. Data were analysed using qualitative content analysis according to the recommendations of Graneheim and Lundman. RESULTS: Four categories were identified: 1) Balance between clinical assessment and monitoring, 2) Vigilance in relation to the patient, 3) The nurse-physician collaboration, and 4) Software issues. Participants described that anaesthesia included a continuous balance between clinical assessment and monitoring. They experienced that the digital AIMS had an impact on their vigilance in relation to the patient during anaesthesia. The digital AIMS affected the nurse-physician collaboration. Moreover, participants emphasised a lack of user participation and aspects of user-friendliness regarding the implementation of digital AIMS. CONCLUSION: Digital AIMS impacts vigilance in relation to the patient. Hence, collaboration and acceptance of the mutual responsibility between nurse anaesthetists and anaesthetists for both clinical observation and digital AIMS administration is essential. Anaesthesia personnel should be included in development and implementation processes to facilitate implementation.

Moral Courage: Student Registered Nurse Anesthetist Experiences on the Operating Team.

Lack of moral courage may lead to moral stress for healthcare personnel and to unethical behavior or adverse events for patients. Hospital operating room (OR) teams include surgeons, OR nurses, Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, and student registered nurse anesthetists (SRNAs). Due to the multidisciplinary work in a stressful, high-technology and high-risk environment, the OR is the context for most of the unethical behavior reported in hospitals. The purpose of this study was to explore SRNA experiences of moral courage in the OR. We used a critical incident technique, utilizing 40 SRNA narratives of situations including moral courage/lack of moral courage. The narratives were analyzed using thematic analysis. Findings indicate that unethical behavior potentially leading to patient safety or work environment issues could be avoided when OR personnel showed moral courage by speaking up for patients or for colleagues. Lack of moral courage was indicated by tacit acceptance of unethical behavior or lack of collaboration. SRNAs need not only to learn about the CRNAs' professional obligations and tasks but also to develop moral courage to be able to respond to unethical behavior or communication in the OR. Hence, students should be introduced to such issues during their education.

Anesthesia Personnel's Experiences With Digital Anesthesia Information Management Systems: A Literature Review.

Traditionally, anesthetic records were in paper format. An increasing volume of complex data, legislation, and quality improvement initiatives related to clinical documentation have promoted the transition to digital records. Anesthesia information management systems (AIMS) have been designed to directly extract patient information from the anesthesia workstation and transmit the data into documentation systems and databases. The purpose of this review was to explore existing literature on anesthesia personnel's experiences with digital AIMS. Literature searches were conducted in PubMed, Cumulative Index to Nursing & Allied Health Literature, Embase, and The Cochrane Database of Systematic Reviews. A total of 473 records were identified, of which 40 records were read in full-text. Seven records underwent quality appraisal, representing research from 1991 to 2018, all with a quantitative design. In total, 379 anesthesia personnel were included. Five studies were conducted in the United States; 1, in Korea; and 1, in Germany. Results were collated into the themes user satisfaction, technical aspects, physical placement of the system, paper-based vs electronic data entry, quality of care, and suggestions for improvement. Findings indicate both positive and negative effects of AIMS. Anesthesia personnel's experiences should be included in the planning, development, and implementation of digital data entry systems.

Competence evaluation processes for nursing students abroad: Findings from an international case study.

BACKGROUND: Assessing clinical competence in nursing students abroad is a challenge, and requires both methods and instruments capable of capturing the multidimensional nature of the clinical competences acquired. OBJECTIVES: The aim of the study was to compare the clinical competence assessment processes and instruments adopted for nursing students during their clinical placement abroad. DESIGN: A case study design was adopted in 2015. SETTING AND PARTICIPANTS: A purposeful sample of eight nursing programmes located in seven countries (Belgium, Denmark, Greece, Norway, Poland, Portugal and Italy) were approached. METHODS: Tools as instruments for evaluating competences developed in clinical training by international nursing students, and written procedures aimed at guiding the evaluation process, were scrutinised through a content analysis method. FINDINGS: All clinical competence evaluation procedures and instruments used in the nursing programmes involved were provided in English. A final evaluation of the competences was expected by all nursing programmes at the end of the clinical placement, while only four provided an intermediate evaluation. Great variability emerged in the tools, with between five and 88 items included. Through content analysis, 196 items emerged, classified into 12 different core competence categories, the majority were categorised as 'Technical skills' (=60), 'Self-learning and critical thinking' (=27) and 'Nursing care process' (=25) competences. Little emphasis was given in the tools to competences involving 'Self-adaptation', 'Inter-professional skills', 'Clinical documentation', 'Managing nursing care', 'Patient communication', and 'Theory and practice integration'. CONCLUSIONS: Institutions signing Bilateral Agreements should agree upon the competences expected from students during their clinical education abroad. The tools used in the process, as well as the role expected by the student, should also be agreed upon. Intercultural competences should be further addressed in the process of evaluation, in addition to adaptation to different settings. There is also a need to establish those competences achievable or not in the host country, aiming at increasing transparency in learning expectations and evaluation.

Benefits of Group Living Include Increased Feeding Efficiency and Lower Mass Loss during Desiccation in the Social and Inbreeding Spider Stegodyphus dumicola.

Group living carries a price: it inherently entails increased competition for resources and reproduction, and may also be associated with mating among relatives, which carries costs of inbreeding. Nonetheless, group living and sociality is found in many animals, and understanding the direct and indirect benefits of cooperation that override the inherent costs remains a challenge in evolutionary ecology. Individuals in groups may benefit from more efficient management of energy or water reserves, for example in the form of reduced water or heat loss from groups of animals huddling, or through reduced energy demands afforded by shared participation in tasks. We investigated the putative benefits of group living in the permanently social spider Stegodyphus dumicola by comparing the effect of group size on standard metabolic rate, lipid/protein content as a body condition measure, feeding efficiency, per capita web investment, and weight/water loss and survival during desiccation. Because energetic expenditure is temperature sensitive, some assays were performed under varying temperature conditions. We found that feeding efficiency increased with group size, and the rate of weight loss was higher in solitary individuals than in animals in groups of various sizes during desiccation. Interestingly, this was not translated into differences in survival or in standard metabolic rate. We did not detect any group size effects for other parameters, and group size effects did not co-vary with experimental temperature in a predictive manner. Both feeding efficiency and mass loss during desiccation are relevant ecological factors as the former results in lowered predator exposure time, and the latter benefits social spiders which occupy arid, hot environments.

Competitive HIF Prolyl Hydroxylase Inhibitors Show Protection against Oxidative Stress by a Mechanism Partially Dependent on Glycolysis.

The hypoxia inducible factor 1 (HIF-1) is a central transcription factor involved in the cellular and molecular adaptation to hypoxia and low glucose supply. The level of HIF-1 is to a large degree regulated by the HIF prolyl hydroxylase enzymes (HPHs) belonging to the Fe(II) and 2-oxoglutarate-dependent dioxygenase superfamily. In the present study, we compared competitive and noncompetitive HPH-inhibitor compounds in two different cell types (SH-SY5Y and PC12). Although the competitive HPH-inhibitor compounds were found to be pharmacologically more potent than the non-competitive compounds at inhibiting HPH2 and HPH1, this was not translated into the cellular effects of the compounds, where the non-competitive inhibitors were actually more potent than the competitive in stabilizing and translocatingHIF1 α to the nucleus (quantified with Cellomics ArrayScan technology). This could be explained by the high cellular concentrations of the cofactor 2-oxoglutarate (2-OG) as the competitive inhibitors act by binding to the 2-OG site of the HPH enzymes. Both competitive and non-competitive HPH inhibitors protected the cells against 6-OHDA induced oxidative stress. In addition, the protective effect of a specific HPH inhibitor was partially preserved when the cells were serum starved and exposed to 2-deoxyglucose, an inhibitor of glycolysis, indicating that other processes than restoring energy supply could be important for the HIF-mediated cytoprotection.

Negative modulation of GABAA α5 receptors by RO4938581 attenuates discrete sub-chronic and early postnatal phencyclidine (PCP)-induced cognitive deficits in rats.

RATIONALE: A growing body of evidence suggests that negative modulation of γ-aminobutyric acid (GABA) GABA(A) α5 receptors may be a promising strategy for the treatment of certain facets of cognitive impairment; however, selective modulators of GABA(A) α5 receptors have not yet been tested in "schizophrenia-relevant" cognitive assay/model systems in animals. OBJECTIVES: The objectives of this study were to investigate the potential of RO4938581, a negative modulator of GABA(A) α5 receptors, and to attenuate cognitive impairments induced following sub-chronic (sub-PCP) and early postnatal PCP (neo-PCP) administration in the novel object recognition (NOR) and intra-extradimensional shift (ID/ED) paradigms in rats. Complementary in vitro, ex vivo and in vivo studies were performed to confirm negative modulatory activity of RO4938581 and to investigate animal model validity, concept validity and potential side effect issues, respectively. RESULTS: In vitro studies confirmed the reported negative modulatory activity of RO4938581, whilst immunohistochemical analyses revealed significantly reduced parvalbumin-positive cells in the prefrontal cortex of sub-PCP- and neo-PCP-treated rats. RO4938581 (1 mg/kg) ameliorated both sub-PCP- and neo-PCP-induced cognitive deficits in NOR and ID/ED performance, respectively. In contrast, QH-II-066 (1 and 3 mg/kg), a GABA(A) α5 receptor positive modulator, impaired cognitive performance in the NOR task when administered to vehicle-treated animals. Additional studies revealed that both RO4938581 (1 mg/kg) and QH-II-066 (1 and 3 mg/kg) attenuated amphetamine-induced hyperactivity in rats. CONCLUSIONS: Taken together, these novel findings suggest that negative modulation of GABA(A) α5 receptors may represent an attractive treatment option for the cognitive impairments, and potentially positive symptoms, associated with schizophrenia.

New insights into the GABA(A) receptor structure and orthosteric ligand binding: receptor modeling guided by experimental data.

GABA(A) receptors (GABA(A)Rs) are ligand gated chloride ion channels that mediate overall inhibitory signaling in the CNS. A detailed understanding of their structure is important to gain insights in, e.g., ligand binding and functional properties of this pharmaceutically important target. Homology modeling is a necessary tool in this regard because experimentally determined structures are lacking. Here we present an exhaustive approach for creating a high quality model of the α(1)ß(2)γ(2) subtype of the GABA(A)R ligand binding domain, and we demonstrate its usefulness in understanding details of orthosteric ligand binding. The model was constructed by using multiple templates and by incorporation of knowledge from biochemical/pharmacological experiments. It was validated on the basis of objective energy functions, its ability to account for available residue specific information, and its stability in molecular dynamics (MD) compared with that of the two homologous crystal structures. We then combined the model with extensive structure-activity relationships available from two homologous series of orthosteric GABA(A)R antagonists to create a detailed hypothesis for their binding modes. Excellent agreement with key experimental data was found, including the ability of the model to accommodate and explain a previously developed pharmacophore model. A coupling to agonist binding was thereby established and discussed in relation to activation mechanisms. Our results highlight the importance of critical evaluation and optimization of each step in the homology modeling process. The approach taken here can greatly aid in increasing the understanding of GABA(A)Rs and related receptors where structural insight is limited and reliable models are difficult to obtain.

Docking to flexible nicotinic acetylcholine receptors: a validation study using the acetylcholine binding protein.

Computational docking to nicotinic acetylcholine receptors (nAChRs) and other members of the Cys-loop receptor family is complicated by the flexibility of the so-called C-loop. As observed in the large number of published crystal structures of the acetylcholine binding protein (AChBP), a structural surrogate and homology modeling template for the nAChRs, the conformation of this loop is controlled by the ligand present in the binding pocket. As part of the development of a protocol for unbiased docking to the nAChRs, we here present the results of docking of ligands with known binding modes to an AChBP ensemble with systematic variations in C-loop closure generated via a series of targeted geometry optimizations. We demonstrate the ability to correctly predict binding modes for 12 out of 15 ligands and induced degrees of C-loop closure for 14 out of 15 ligands. Our approach holds a promising potential for structure based drug discovery within nAChRs and related receptors.