Health-Related Quality of Life (HRQOL) is an important outcomes measure in cancer and there are specific issues depending on the site, stage, treatment and patient age. Although numerous instruments are available for cancer HRQOL, most are designed for adults, some for children, but none for adolescents and young adults (AYA) who have special age-specific concerns and poor improvement in survival compared with other age groups. An existing HRQOL instrument was modified to ensure its suitability for AYA, its validity, reliability and sensitivity were tested in Australians aged 16 to 25 years old diagnosed with cancer or a blood disorder. Varni’s PedsQLTM Measurement Model (13-18 year olds) was selected, modified then administered to families recruited from haematology/oncology clinics and wards at three Sydney Metropolitan Hospitals in person or by telephone. The Memorial Symptom Assessment Scale was used to categorise participants into groups reflecting sensitivity of symptom severity (slight, moderate and severe). The instruments demonstrated excellent internal consistency reliability, making them suitable for both group and individual comparisons. Clinical validity, construct validity, and discriminant validity were demonstrated by “known-groups” analysis, exploratory factor analysis and correlations, respectively. These new versions of the PedsQL Generic Core and Cancer Module are reliable, valid and sensitive measures of HRQOL in patients aged 16-25 years diagnosed with cancer or a blood disorder. The measures will soon be available for use as outcome measures in clinical trials and clinical practice with this age cohort in Australasia and internationally.

Research Doctorate - Doctor of Philosophy (PhD) / Despite the emergence of smoking care guidelines and best practice recommendations over the past 13 years, it has been suggested that smoking care is not routinely provided in hospitals. Although there is a relatively large body of evidence regarding the prevalence of patient smoking cessation after hospitalisation and the effectiveness of interventions to increase cessation levels, much less is known regarding the prevalence of best practice smoking care routinely provided in hospitals or the effectiveness of interventions to increase such care provision. This thesis seeks to address these deficiencies in the evidence base. In particular this thesis aimed to: 1. Examine the prevalence of hospital smoking care in the international and Australian contexts. This is addressed via a literature review of studies that have reported the level of smoking care delivered routinely in hospitals and a survey of hospital managers in New South Wales, Australia. 2. Examine the effectiveness of interventions to increase the routine delivery of smoking care in hospitals. This is addressed via a literature review of studies that have reported the effect of an intervention on smoking care levels, and via the implementation of a quasi-experimental study that was designed to increase the hospital-wide delivery of a broad range of smoking care elements. 3. Propose recommendations for future practice and research regarding the routine provision of hospital smoking care. This thesis consists of six chapters that address the above aims. Each of the chapters has been written as a relatively distinct report in the style of a journal article. The approach has been adopted to facilitate the reading of the thesis, and results in some repetition in some chapters. At the time of submission, two papers based on the chapters of this thesis have been published in peer-reviewed journals. A further two papers are under editorial review.

Objective. To translate and cross-cultural adapt the Lumbar Spine Instability Questionnaire (LSIQ) into Swedish and to test its validity and reliability on patients with non-specific lowback pain in primary health care. Methods. The LSIQ was translated and cross-culturally adapted into Swedish language according to accepted guidelines. Data from 15 patients were collected through a ”thinkaloud” process to test the face validity of the instrument. Together with an additional 35 patients, data from a total of 50 participants (27 men and 23 women) were thereafter subsequently collected to assess test-retest reliability and construct validity. Data were collected through the Lumbar Spine Instability Questionnaire, and the Roland Morris Disability Questionnaire. Results. The Lumbar Spine Instability Questionnaire was successfully adapted into Swedish language according to recommended guidelines. The result demonstrated high test-retest reliability, and the analysis of construct validity showed consistency with the hypothesis, proving a moderate positive correlation with the Roland Morris Disability Questionnaire. No floor or ceiling effects were detected. Conclusion. The Swedish version of the Lumbar Spine Instability Questionnaire (LSIQ-S) shows good psychometric properties regarding reliability and validity. To further study the usefulness of the instrument, the dimensionality also need to be investigated.

Philosophiae Doctor - PhD / The past decade has seen a growth in Physiotherapy schools offering postgraduate programmes in South Africa. The Republic of South Africa assists other African countries like Kenya, Malawi, Rwanda, Tanzania and Zambia in upgrading the education of diploma-trained physiotherapists (DTPs) to Bacherlor of Science (Honours) (BSc (Hons) and Master's Degrees respectively. The three institutions offering Physiotherapy training in Cape Town make it the largest training locality for Physiotherapy in South Africa. The University of Cape Town (UCT), University of the Western Cape (UWC) and Stellenbosch University are situated within a twenty kilometre radius from each other. These schools have taken a leading role in the postgraduate training of their own PTs, and those from other developing countries. In 2007, for example, about 20% of postgraduate students in Cape Town Physiotherapy schools were from other African countries. The Department of Physiotherapy at UWC in particular has been upgrading DTPs from other African countries to BSc (Hons) and Master's degrees for the last twenty years. However, compared to the wealth of educational literature on other healthcare professions, literature on the evaluation of postgraduate Physiotherapy programmes is scarce. Thus, the aim of this study was to evaluate the outcomes and impact of the UWC postgraduate Physiotherapy BSc (Hons) and Master's programme on clinical practice and research in East and Southern Africa. The dissertation used an explorative and descriptive theory-based evaluation approach using qualitative research methodology. The steps involved in the research process determined the choice and use of the qualitative methodology. The use of qualitative methods was undertaken to provide a comprehensive analysis of the research problem. The study had three main phases. Initially, administrative document reviews and in-depth interviews with UWC postgraduate Master's programme designers (PDs) were conducted to help develop and test the programme theory and measuring instruments (interview guides). Secondly, postgraduates were interviewed to establish and test the implementation process theory, as well as investigate perceived programme outcomes. Then focus group discussions with postgraduate students of UWC, and individual interviews with workplace supervisors of the UWC postgraduates were undertaken to investigate the perceived outcomes and impact of the UWC Master's programme. A variety of methods appropriate for the different steps or stages of the programme were employed, to ensure this evaluation exercise becomes an integrated function in which data are continuously collected and used for decision-making and programme improvement. Multiple types of data were collected to inform each phase. The researcher used purposive sampling technique to constitute the sample. The sampling technique yielded three official documents, three (3) PDs and two (2) implementers, 27 UWC postgraduates, seven (7) workplace supervisors and 30 students of UWC postgraduates. Data was collected via document analyses, in-depth interviews, telephonic in-depth interviews and focus group discussions. Qualitative data analysis occurred concurrently with data collection. Atlas Ti software version 10 was used to assist with data management. The UWC postgraduates reported acquiring knowledge of manual therapy, better management of musculo-skeletal conditions and enhanced clinical reasoning. Participants also reported career growth, pursuit of higher degrees such as PhDs, promotions, job changes from physiotherapy clinicians to educators, involvement in research and the introduction of BSc programmes in their respective countries. The current study demonstrates that the primary objective of the UWC BSc (Hons) and Master's programmes such as increasing access to physiotherapy training in Africa and empowering DTPs with research skills and knowledge of community-based rehabilitation was being realised. However, many postgraduate participants in all countries emphasised the need to include basic sciences, clinical practice and specialisation in the UWC BSc (Hons) and Master's programmes respectively. Furthermore, the participants reported that the programmes did not have much impact on management of conditions other than musculo-skeletal. On the other hand, the employers that participated in the current study identified that the UWC programmes had a positive impact on Physiotherapy education in their respective countries, producing a total of five Physiotherapy degree programmes between the year 2000 and 2014. Kenya, Rwanda, Tanzania and Zambia reported introducing two, one, one and two BSc Physiotherapy programmes respectively. The study also revealed moderate research activity among UWC postgraduates, a challenge most employers attributed to institutional research agendas, high patient work-load and personal strengths of postgraduate students. The students of UWC graduates who participated in the current study reported acquiring new assessment skills for musculo-skeletal conditions, enhanced treatment techniques for musculoskeletal conditions and use of evidence to guide their clinical practice. The participants also reported reduced hospital visits among patients with musculo-skeletal conditions and relatively short treatment durations. However, in all universities but one, students indicated that most lecturers had difficulty applying basic sciences during lectures. The participants also reported a lack of specialist lecturers in areas other than musculo-skeletal. This thesis focused on evaluation of the outcomes and impact of postgraduate BSc (Hons) and Master's programmes in Physiotherapy for DTPs in SADC and East Africa. While the thesis has highlighted many achievements, it has also identified training needs of DTPs that require attention. First, we recommend that the curriculum be reviewed to incorporate clinical practice and more theoretical content in the BSc (Hons) programme and that the UWC special BSc (Hons) programme be considered an RPL project to ensure the visible (documented) and nonvisible (undocumented) knowledge claimed by applicants are subjected to a form of assessment through the UWC RPL process, thus enabling the university to identify the knowledge gap that requires bridging among DTPs seeking admission to the degree programme. Second, we recommend a review of the Master's degree by coursework programme to include more theoretical and clinical practice components that would allow for specialisation. / National Research Foundation (NRF)

The spectrum of acute pancreatitis (AP) affects between 4.9 and 73.4 patients out of 100,000 worldwide annually (Tenner, Baillie, DeWitt, & Vege, 2013). AP uses the Atlanta classification system to establish a diagnosis of mild, moderate, or severe. The American College of Gastroenterology (ACG) has established comprehensive clinical practice guidelines (CPG) for the management of AP, the most recent version published in 2013 (Tenner et al., 2013). There have been similar CPGs published internationally that integrate current evidence-based research into recommendations for practice. These guidelines along with the ACG's guidelines recommend initiating a diet for mild acute pancreatitis patients due to research findings of improved patient outcomes (i.e. reduced length of hospital stay, decreased rate of infections, and reduced mortality) (Horibe et al., 2015; Lariño-Noia et al., 2014). There is an international awareness of the need for increased CPG nutrition recommendation compliance in the practice setting as many studies have found providers prefer to keep patients nil per os (NPO) and do not adhere to CPGs (Andersson, Andrén-Sandberg, Nilsson, & Andersson, 2012; Greenberg et al., 2016; Sun et al., 2013). The purpose of this doctor of nursing practice (DNP) project is to assess providers' current nutrition therapy practice and knowledge of the ACG’s CPG nutrition recommendations for mild AP patients. The researcher conducted the assessment with a hospitalist practice at Banner University Medical Center in Phoenix, Arizona. The results of the project contribute to the current body of research on national adherence to CPGs for AP and act as a needs assessment for future projects where a nutrition protocol order set may be established. The investigation of nutrition therapy for AP patients seeks to improve and standardize the care this patient population receives while in the acute care setting.

Osteoporosis is a common health problem and it is increasing in prevalence due to the increase in the aging population. The interest to treat osteoporosis has increased in recent years, due to availability of screening modalities, advances in medications that may prevent osteoporotic fractures. Many studies have showed the high medical and economic burden of the disease on the patients, their caregivers and on the health system. Clinical practice guidelines for management of osteoporosis varied nationally and internationally, and the adherence of physicians to guidelines were always reported as suboptimal, though most studies were for after fragility fracture care gap and vert few looked at the primary screening to identify patients at risk before the occurrence of fractures. This thesis is composed of two manuscripts research project assessing the development and impact of screening for osteoporosis guidelines. The first chapter is an overview of osteoporosis, definition, risk factors, diagnosis and treatment. A follow up discussion of the literature on adherence of physicians to the osteoporosis guidelines, which ends up with the rational for this thesis. The first paper is a systematic review to identify guidelines for screening for osteoporosis from 2002-2016 (Chapter 2). We assessed the quality of these guidelines using the AGREE II and IOM standards, compared between the two tools, and assessed if the quality has changed over time. We extracted recommendations in key areas with summary of the systems that were used to assign the level of evidence and strength of recommendations. We found that the quality of guidelines has varied greatly between different countries with no significant change over time. The recommendations and systems for level of evidence were variable and all this may create confusion to clinicians. In the second paper, we used an interrupted time series design to assess the effect of three clinical practice guidelines for screening for osteoporosis in Ontario on the baseline bone mineral density (BMD) testing for older adults 65 years of age and above using administrative data by ICES from 1998-2006. All three guidelines recommend baseline BMD testing for this age population. In addition, we analyzed the pattern of repeated testing in accordance with the latest guideline. We have found low rates of baseline BMD testing with a decreasing pattern of testing. The last guideline in 2010 had gradually increased the trend of BMD testing, though it was a very small change. Stratified analyses by sex showed that the decrease in the total BMD testing is due to decrease in the testing for female population while there is an increasing trend of BMD testing in male population. CPG by Osteoporosis Canada in 2010 caused an immediate reduction in the BMD testing for female, yet, over a period of time, the guideline increased the BMD testing. For male population; the 2002 CPG had immediately increased the BMD testing, while over time this trend has decreased. Despite the low baseline BMD testing by physicians, there is an over use of repeated BMD testing in the low risk population, especially the annual and the 2 yearly BMD repeats. In conclusion: This research project found a varied quality of guideline development and reporting of guidelines for osteoporosis screening, and no improvement in the quality over time (2002-2016). Several systems were used to assign the level of evidence and strength of recommendations with conflicting recommendations between different health organizations in the same country such as in Canada. Many tools are available to appraise the quality of guidelines, however, comparing between two tools (AGREE II & IOM standards) showed that they may give conflicting results for guidelines quality. There is no effect of guidelines for screening for osteoporosis on the ordering of BMD testing to screen adults 65 years and above living in Ontario between 1998- 2016. A small increase the rate of baseline BMD testing followed the release of the 2010 guideline. For male population the 2002 guideline showed an evident immediate and gradual effect over time on the rate of baseline BMD testing ordering for male population. Despite the low baseline BMD testing rates for adults 65 years and above, there is an unnecessary repeated BMD testing for low risk population in Ontario between 2011-2016 which is not in compliance to the latest guideline for screening for osteoporosis.

Beteendemedicin är ett paraplybegrepp där den fysioterapeutiska tillämpningen i praktik kan se ut på många olika sätt. Hur fysioterapeuter tillämpar beteendemedicin i praktiken och hur det avspeglas i den individanpassade behandlingsplanen råder det oklarheter kring. Syftet med denna studie var att undersöka fem fysioterapeuters upplevelser och erfarenheter av tillämpning av beteendemedicin inom sina respektive verksamheter i Uppsala län. Studien var av kvalitativ design. Enskilda semistrukturerade intervjuer avfem fysioterapeuter inom olika verksamheter utfördes. Databearbetning genomfördes i form av en kvalitativ innehållsanalys. Deltagarna tillämpade flertalet olika tekniker inom beteendemedicin. De upplevde även att det finns utmaningar som att det är tidskrävande, att patienten inte förstår konceptet och att teorin är lättare än tillämpningen i praktik. Alla deltagare var överens om att det finns en nytta med beteendemedicinsk tillämpning, som att bli en bättre fysioterapeut, att det ger vinst i långa loppet samt att teorin fyller en viktig funktion för praktisk tillämpning. Det föreföll sig som att fysioterapeuterna tillämpar beteendemedicin på ett annat sätt än vad de lärt sig från den teoretiska utbildningen. Fyra huvudkategorier identifierades under databearbetningen; Olika tekniker inom beteendemedicin, Utmaningar med att arbeta beteendemedicinskt, Förståelse av nyttan med beteendemedicin, Blivit en “tyst” kunskap. Deltagarna upplevde att beteendemedicin fyller en viktig funktion i den individualiserade behandlingsplanen för patienten, men upplevde även många utmaningar. Trots utmaningarna så var deltagarna överens om att beteendemedicin är ett vinnande behandlingskoncept inom fysioterapi. Detta examensarbete kan bidra till utvecklingsmöjligheter för grundutbildningen i fysioterapi. / Behavioral medicine is an umbrella concept where the physiotherapeutic application in practice can differ in many ways. There are uncertainties about how physiotherapists apply it in practice and how this is reflected in the individualized treatment plan. The aim of this study was to investigate five physiotherapists' experiences of applying behavioral medicine in clinical practice within each of their workplaces in Uppsala. This study is of a qualitative design. Individual semi-structured interviews offive physiotherapists were performed. Data processing was carried out in the form of a qualitative content analysis. The participants applied several different behavioral medicine techniques. They also experienced challenges; it is time consuming, the patient does not understand the concept and the theory is easier than the application in practice. All participants agreed that there are benefits to behavioral medicine application; becoming a better physiotherapist, it provides benefits in the long run and the theory fulfills an important function for practical application. It seemed that the physiotherapists apply behavioral medicine in a different way than what they have learned. Four main categories were identified; Different techniques in behavioral medicine, Challenges when working with behavioral medicine, Understanding the benefits of behavioral medicine, Has become a “silent” knowledge. The participants experienced that behavioral medicine fulfills an important function in individualized treatment plans for patients, but they also experienced many challenges. Despite the challenges, the participants agreed that behavioral medicine is a winning concept in physiotherapy. This degree project can contribute to development opportunities for the undergraduate education in physiotherapy.

No description available.

Childhood bullying can lead to adverse physical and mental health outcomes for both the victim and the bully. Risk factors for bullying can be related to gender, race, sexual preference, and having any type of disability. A pediatric primary care clinic in a large, metropolitan area, the focus for this project, did not have an evidenced-based clinical practice guideline (CPG) for providers to facilitate the management of children who presented with reported bullying. The project, guided by the Tanner'€™s integrated model of clinical judgement, addressed the question whether a CPG would facilitate the early recognition and treatment of bullying in the pediatric clinical site. Using a literature search, a CPG was developed with evidence that included 6 recommendations ranging from clinical assessment and screening to advocacy. The CPG was then evaluated by 4 expert panelists using the AGREE II tool. Panelists included 2 pediatric medical doctors, 1 pediatric school nurse, and 1 mental health nurse practitioner. The panel evaluation results revealed a score of 81 out of a possible 100, where a score of 71 was the standard for acceptable results for the 6 recommendations. Results from the expert panel were used to modify the CPG, after which the guideline was presented to the panel for final approval. One final recommendation of the panel was to include a provision for referral and follow up for children identified with bullying. The finalized CPG was presented to the medical director of the pediatric clinic for implementation. The implications of the project for positive social change include decreased variations in clinical practice, early detection and intervention of bullying, improved effectiveness and quality of care, and decreased costly and preventable adverse events.

Transition of care refers to the movement of patients between health care settings; it occurs each time patients move between providers within the same setting or between settings based on the patient's acute or chronic health care needs. Care transition includes the efficient and accurate exchange of information needed to provide high-quality continuity of care. A rural community hospital in in the northeastern region of the United States has a skilled nursing facility and an acute care hospital on one campus. This project focused on the development of a clinical practice guideline (CPG) for the hospital to improve communication during transitions of care. The Iowa model of evidence-based practice informed the development of the guideline. A project team developed the CPG. Five multidisciplinary experts reviewed the CPG using the appraisal of guidelines for research and evaluation (AGREE II) evaluative tool. Results for the 6 domains of the AGREE II tool showed experts' agreement greater than 90% with the guideline as developed. The creation of a CPG to improve communication during care transition could benefit nurses with improved clinical decision making and patients with improved outcomes. The CPG could impact social change by supporting the application of the principles of evidence-based nursing practice, which could result in improved care and patient outcomes.