No description available.

BACKGROUND: Antibiotics are essential medicines and their effectiveness is under threat due to antimicrobial resistance. Guidelines are one way to conserve antibiotic effectiveness given that they are intended to modify clinician prescribing. Guidelines that provide antibiotic recommendations should make explicit contextual considerations that influence antimicrobial resistance and their downstream effects on resistance emergence. METHODS: We conducted a systematic review of tuberculosis, gonorrhoea, and respiratory tract infection guidelines and recommendations to examine how and to what extent they are considering contextual factors that influence antimicrobial resistance. We also investigated whether there are guidelines and recommendations that can be adopted or adapted to local contexts. RESULTS: We found that within 74 included guidelines, two thirds of recommendations considered antimicrobial resistance. Of which only five guidelines considered all factors required to consider local aspects such as values, resource use, acceptability, feasibility, and equity. As such, these five guidelines can be either adopted or adapted to Canadian and other contexts. We also found that 39% of guidelines met credibility scores of 60% or greater in AGREE II domains: scope and purpose, rigor of development, and editorial independence. CLINCAL IMPLICATIONS: There are very few Infectious disease guidelines for highly prevalent diseases that do not consider all important contextual factors may influence antimicrobial resistance. Our findings can support societies and organizations, public health policy, and health care stakeholders to develop and implement guidelines that are applicable to local contexts efficiently and resourcefully. Our antimicrobial resistance recommendation framework, used in addition to GRADE Evidence to Decision frameworks, is a start to having this come to fruition. / Thesis / Master of Public Health (MPH)

Published Article / The declaration of eleven languages as the official languages of South Africa brought about an increased need for translation and language planning in South Africa. However, many students of translation experience difficulty to produce quality translations, even after completing a course in translation. The purpose of this article is to report the findings of the original research on an investigation of the possible cause of this problem, as well as to find a possible solution to the problem. The results of the study show that the reason for this problem might be the training of translation students by using foreign textbooks and the lack of a South African textbook of translation. The findings further suggest that a translation textbook true to the South African context might be the solution to this problem. This study focuses on developing guidelines for the compilation of such a textbook.

"Guidelines for Transcribing Baroque Lute Music for the Modern Guitar, Using Silvius Leopold Weiss's Sonata 36 (from the Dresden Manuscript) as a Model" analyzes the process of creating guitar transcriptions of Weiss's music. The methodology unfolds through three steps: 1) rendering the tablature into modern guitar notation, 2) analyses of stylistic issues for the definition of fingerings on the guitar, and 3) two categories of ornamental practices—essential embellishments and diminutions. In addition, the study includes a discussion about an alternative tuning and presents a suggested prelude for Sonata 36 from the Dresden manuscript. The purpose of this research is twofold: first, to create a new guitar transcription of a sonata by Weiss, analyzing the challenges inherent in this process, and second, to train intermediate and advanced guitar students to develop their own original transcriptions following the model presented in this study.

Background: The challenges in the utilization of scientific findings in the fields of prevention and mental health are well documented. Scholars have found significant gaps between the knowledge available and the knowledge applied in healthcare. Studies have suggested that about half of the patients receive the recommended care for their medical condition. In order to address this gap, health systems at global, national, regional and local levels have made diverse efforts to facilitate the uptake of research for example through evidence-based health policy processes. In Sweden, government agencies and health policy actors such as the National Board of Health and Welfare support and control the health care system through evidence-based policies amongst other steering tools. The overall aim of this thesis is to explore evidence-based policy processes, and to further understand barriers to implementation of policies in the fields of preventive and mental health services. Methods: A multiple case study approach was used, and data were collected from several sources. Qualitative content analysis methodology was used. Case 1 comprises the development and early implementation of national guidelines for methods of preventing disease managed by the National Board of Health and Welfare during 2007–2014. Case 2 covers the effort to improve health care for the older population that was undertaken through an agreement between the Swedish government and the Swedish Association of Local Authorities and Regions during 2009–2014. Case 3 involves an effort to implement an adapted version of a systematic review from the Swedish agency for health technology assessment and assessment of social services on treatment of depression in primary health care. Data was collected between 2007 and 2010. In Paper 1, the policies from Case 1 and 2 were studied using a longitudinal, comparative case study approach. Data were collected through interviews, documents and observations. A conceptual model was developed based on prior frameworks. The model was used to organize and analyse the data. In Paper 2, the guideline development process (Case 1) was studied through interviews and the collection of documents. A prior framework on guideline quality was used in order to organize the data. Paper 3 investigated decision-making processes during guideline development using a longitudinal approach. Qualitative data were collected from questionnaires, documents and observations and analysed using conventional and summative content analysis. In Paper 4, the barriers to implementation were investigated through interviews and the collection of documents. Data were analysed using qualitative content analysis with a conceptual model to structure the analysis. Results: The sources and procedures for policy formulation differed in Case 1 and 2, as did the approaches to promote the implementation of the policies. The policy processes were cyclical, and phases overlapped to a large degree. The policy actors intended to promote implementation, both during and after the policy formulation process. The thesis shows variation in how the key policy actors defined and used research evidence in the policy processes. In addition, other types of knowledge (e.g. politics, context, experience) served as alternative or multiple sources to inform the health policies. The composition of sources that informed the policies changed over time in Cases 1 and B. During the policy formulation and implementation process, efforts to integrate research evidence with clinical experiences and values were associated with tension and recurrent dilemmas. On the local level (i.e. primary health care centres), barriers to implementation were found related to the innovation and among health professionals, patients, in social networks as well as in the organizational, economic and political contexts. Conclusion: The concept of evidence holds a key position in terms of goals and means for knowledge based policymaking in the Swedish health system. Broad definitions of evidence – including research and non-research evidence - were requested and to various extents utilized by the policy actors in the studied cases. An explicit terminology and systematic, transparent methodology to define, identify, and assess also non-research evidence in policy processes would potentially strengthen the clarity and validity of these processes and also enhance policy implementation. Particular determinants to implementation, such as the interventions characteristic, are to a considerable degree established early in the policy process, during agenda setting and policy formulation. This early phase offers unique opportunities to assess and build capacity, initiate and facilitate implementation. Early analysis and considerations of target populations and contexts and other implementation determinants related to the specific policy scope (e.g. disease preventive guidelines) could enhance the forth-coming implementation of the policy.

File sharing is a significant activity of enterprise computer use. In organizations, files are usually shared using e-mail attachments. However, large media files cannot be shared using e-mail, due to file size limitations. Instead, different external file sharing systems are used to share large files. The use and size of media files will continue to increase, which requires file sharing mechanisms that can handle this. For organizations today, it is difficult to find a file sharing application that fulfills all requirements and needs of the users. Especially for large media rich organizations, where the file sharing scenarios are many and files can be shared internally and externally with dissimilar feature and security requirements. An example of such an organization is Baggie, a fashion company where large media files are shared daily, using various file sharing systems. The inconsistency of what system to use, leads to confusion and frustration among its users. Additionally, their current file sharing systems do not fulfill all of Baggie’s users’ requirements and no system is integrated with their media asset management system. This master thesis aims to solve the challenges of file sharing within large organizations, particularly media rich organizations such as Baggie by centralize file sharing to one application. By performing a theoretical study and user studies, thirteen design guidelines for file sharing applications have been established. The guidelines focuses on usability, security and users’ requirements regarding media file sharing. Based on the studies, a prototype have been designed for a new file sharing application: BShare. BShare aims to replace Baggie’s current file sharing systems and the application fulfills all requirements of Baggie users. The BShare prototype can be seen as a reference design for file sharing applications.

Background: Healthcare-associated pneumonia (HCAP) guidelines were first proposed in 2005 but have not yet been validated. The objective of this study was to compare 30-day mortality and length of stay (LOS) in HCAP patients treated with either guideline-concordant HCAP (GC-HCAP) therapy or guideline-concordant community-acquired pneumonia (GC-CAP) therapy. Methods: We performed a retrospective cohort study of >150 hospitals in the Veterans Health Administration. Patients were included if they had ≥1 HCAP risk factor and received antibiotic therapy within 48 hours of admission. Patients were excluded if they received ICU care, had cardiovascular or respiratory organ failure, or received invasive mechanical ventilation and/or vasopressors. We determined independent risk factors for 30-day mortality with a multivariable logistic regression model including baseline characteristics, individual HCAP risk factors, comorbidities, and organ failure as dichotomous covariates. Propensity scores were calculated for the probability to receive GC-HCAP therapy and incorporated into a second logistic regression model. Results: A total of 15,071 patients met study criteria and received GC-HCAP therapy (8.0%), GC-CAP therapy (75.7%), or non-guideline-concordant therapy (16.3%). GC-HCAP patients were more likely to have neoplastic disease; whereas, GC-CAP patients had a higher prevalence of other comorbidities, tobacco use, and recent medication use. In multivariable regression, recent hospital admission (OR 2.47, 95% CI 2.10-2.91) and GC-HCAP therapy (2.13, 1.82-2.48) were the strongest predictors of 30-day mortality. Hematologic organ failure, non-invasive mechanical ventilation, neoplastic disease, renal organ failure, and cerebrovascular disease were also independent risk factors. Use of cardiovascular medications, inhaled corticosteroids, and tobacco were protective. GC-HCAP therapy continued to be an independent risk factor for 30-day mortality (OR 2.12, 95% CI 1.82-2.48) in the propensity score analysis. Conclusions: GC-HCAP therapy is not associated with improved survival in HCAP patients. / text

Class of 2010 Abstract / OBJECTIVES: The purpose of this study was to determine the relative amount of time committed to each content area of the ACPE guidelines for curricular content and the three “outcomes expected of graduates” domains of the University of Arizona College of Pharmacy and to identify potential areas of weakness within the current curriculum. METHODS: Course coordinators were emailed and asked to fill out a questionnaire that addressed the amount of time that was spent on a given topic during lectures. The questionnaire included all topics necessary for the education of all pharmacists according to the ACPE guidelines. Questionnaires were collected from all required courses in the Doctor of Pharmacy program curriculum. Each course coordinator was asked to respond to every section with a numerical value of 0-3, indicating the amount of time spent on each topic. RESULTS: Surveys were completed by all 37 course coordinators for required courses. 42 subsections were recommended to be reviewed by the curriculum committee. CONCLUSIONS: There is a need for revision to the ACPE guidelines. A detailed description of the time and depth of each content area that should be covered within the curriculum would provide further guidance to colleges of pharmacy. Since this is not currently available, the data collected should be used as a tool to determine possible areas of deficiency within the University of Arizona Doctorate of Pharmacy curriculum. These areas need to be addressed by the curriculum committee.

Introduction: The number of older adults (≥ 65 years) is increasing in Sweden. At the same time, the elderly care system is being restructured with an increased care burden in nursing homes (NHs). Several studies report a high prevalence of malnutrition among older adults. In recent years public awareness about malnutrition has increased and collective initiatives have been undertaken. However, we lack knowledge regarding how to implement these initiatives to achieve real improvements in practice. Aims: The overall aims of the thesis are to update our knowledge of the nutritional situation in municipal elderly care and to evaluate different implementation strategies (external facilitation and educational outreach visits) for implementing nutritional guidelines in the NH setting. Methods: Residents and staff of altogether eight NH units participated in the studies. The two implementation strategies were external facilitation (EF) and educational outreach visits (EOV). The EF strategy was a one-year, multifaceted intervention that included support, guidance, practice audits and feedback in four NH units. The EOV strategy comprised one three-hour lecture about the nutritional guidelines in four other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5-10 care staff. Results: In paper I, the prevalence of malnutrition in the NH setting remained high, i.e., 30% were malnourished and 63% at risk of malnutrition, and malnutrition was associated with deterioration in function and cognition and one-year mortality. However, possible improvements in nutritional status among NH residents over time (from 1996 to 2010) were observed. In paper II, the EF strategy improved mealtime ambience compared to the EOV strategy with respect to arranging the table, offering a choice of beverage and more to drink, serving the meal, increasing social interactions between staff and residents, decreasing social interactions among staff and reducing noise from the kitchen. In paper III, the EF strategy may have been related to a delay in cognitive deterioration in a sub-sample of communicative NH residents. In paper IV, the EF strategy improved, on average, the ability and willingness of the staff to implement the guidelines, i.e., the staff experienced a clearer assignment of responsibilities regarding nutritional procedures and that they had more time, tools and support from leadership. Moreover, the staff felt that they experienced less resistance from work colleagues, that their knowledge and experience were valued, that the guidelines worked in practice and that the implementation of guidelines was not labourious.  Conclusions: Malnutrition is prevalent in Swedish nursing homes. Implementation of nutritional guidelines by an external facilitator, as compared to traditional methods, may be more effective on mealtime ambience, provide better preconditions for change among the staff, and may have positive effects on cognition among residents.

Title: Analysis of Pharmacotherapy by patients with diagnosis of arterial hypertension Student: Vasiliki Kontou Tutor: Prof. RNDr. Jiri Vlcek, CSs Department of Social and Clinical Pharmacy, Charles University of Prague, Faculty of Pharmacy in Hradec Kralove Introduction: Arterial Hypertension (AH) is characterized by elevated blood pressure, which often leads to increased morbidity and mortality. AH divided into primary and secondary. Aim: In the theoretical part the aim is to analyse the etiopathogenesis, methods of diagnosis and the treatment strategies of arterial hypertension in the recent literature. In the experimental part the aim is to analyse the provisions of the above diagnosis of arterial hypertension. Method: During a six month period were collected 58 prescriptions with the diagnosis of arterial hypertension from a pharmacy that provided pharmaceutical care in the Greek village, Mytikas. Only one prescription for one patient was analysed. In the prescriptions were collected data on drugs, patients and physicians. Results: The pilot study included 58 prescriptions. Most patients were elderly, over 65 years old and 30% were in age 71 - 80 years. General practitioners prescribed 65% of the medical prescriptions. Most frequently prescribed ARBs with hydrochlorothiazide drugs (27%) and...