Yes / A significant proportion of healthcare that is delivered is wasteful, harmful and not evidence based. There are many wound care related guidelines, but their implementation in practice is variable. The Society of Tissue Viability (SoTV) published updated seating guidelines in 2017, but there is a lack of theoretical and conceptual clarity about how these guidelines are being utilised to inform clinical practice. Therefore, the aim of this paper is to generate a theory that can be used to incorporate the SoTV seating guidelines into policy and clinical practice. Methods: We critically reflected on data from an evaluation study utilising systems-thinking approach, informed by implementation and safety science using wider literature as well as our expertise to generate a guideline implementation theory. Discussion: Factors that facilitate or hinder the incorporation of the SoTV guidelines into policy and practice were characterised. We conceptualised the implementation of these guidelines into policy and practice into a Translation or Implementation into Policy or Practice (TIPP) theory with distinct stages, that we called liminal spaces. Knowledge of the guidelines, and the agency or authority to effect change, are key factors in the translation of these guidelines into clinical practice. Conclusion: Our theory is that there are liminal spaces in the implementation trajectory of these guidelines into practice, which have their own characteristics. This theory provides a framework that can be used to underpin guidelines strategies to embed skin and wound care guidelines into policy and clinical practice in order to improve patient care.

The use of in-stream flow control structures for channel stabilization has become increasingly popular due to its potential cost-effectiveness and ecological benefits. These structures help to protect the bank from erosion and lateral migration. However, a large number of these projects fail due to inadequate design guidelines. This study aims to create authoritative design guidelines which are based on hydraulic and physical criteria attributed to the channel reach. In this report, some of the most common types of in-stream structures have been reviewed and results from a practitioner experience survey have been analyzed. This research has allowed for the selection of the most promising structures which will be studied later in the project. / Master of Science

This study retrospectively evaluated patient records from two cardiac rehabilitation (CR) service centers located in large urban hospitals using a Process Evaluation System (PES) recently developed through a collaborative project of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), Madison, WI, and the Center for Clinical Quality Evaluation (CCQE), Washington, DC. The major aims were to: 1) evaluate the utility of the PES as an audit instrument for assessment of adherence to the 24 quality process criteria that comprised the PES; and 2) determine whether adherence to the PES criteria resulted in different patient outcomes for those cases where intervention need was documented at patient admission. Using the data abstraction manual and audit procedures developed by AACVPR/CCQE, a trained medical technician audited 150 CR records for consecutively treated outpatients who typically received 36 sessions of treatment in either Moses H. Cone Memorial Hospital, N.C. Heart Institute, Greensboro, NC, or Carolinaà ­s Medical Center, Charlotte, NC, covering a calendar period between 1995-97. The data were pooled from both sites for analyses and included patients with one or more of the following diagnoses: MI (37%), angina (14%), coronary revascularization (76%), and other (18%). The cost of utilizing the PES was assessed by evaluating the technician time required to abstract a patient record and this was observed to improve over the course of the review period, i.e., mean abstraction time for initial versus final 20 records = 13.2 min. and 4.6 min., respectively. Experience with the PES suggested areas where instrument revision should be considered, e.g., the operational guidelines for extracting acceptable markers were not always clear enough or sufficiently flexible to allow determination of adherence of a record to the 24 quality process criteria. Adherence to the PES was determined, case by case, for each of the 24 criteria. In 129 cases (86% of the sample), complete adherence was found, i.e. 100% adherence to all 24 criteria that included indicators of key clinical steps for patient intake, treatment planning, and follow-up. The remaining 21 records (14%) showed adherence to at least 21 of the 24 criteria (87.5%). Given the uniformly high levels of adherence to the PES documented by these two program sites, the data could not resolve the question of whether patient outcome effects were different between cases of high versus low adherence to PES. Nonetheless, outcome data were examined to evaluate achievement levels in four different areas widely considered by clinicians as important to treatment success: blood cholesterol, smoking status, exercise tolerance, and body mass index (BMI). Of the study patients diagnosed with dyslipidemia 12 of 27 (44%) had levels < 200 mg/dl by exit. Seven of 14 documented smokers (50%) reported quitting at exit from treatment. Forty-nine patients of 117 (42%) who initially could only maintain treadmill walking for 10 min. at levels below 4 METs, were able to exceed this level by treatment end. Six of 104 (6%) with BMI values > 24.9 kg/m2 had a documented decrease in this indicator of overweight by treatment end. The threshold levels for outcome criteria used here to describe achievement levels in this data set are somewhat arbitrary. However, the criteria are reflective of the standards typically suggested as meaningful for effective secondary risk reduction in CR programs (Franklin et al., 1996). The PES system was developed to audit the quality of CR process in treatment centers, as standardized by a consensus panel to reflect the content of the evidenced-based CR guideline recently published by the US Agency for Health Care Policy and Research (Cardiac Rehabilitation as Secondary Prevention: #17, 1995). The findings of this study suggest that the content markers of quality process in the PES are relevant and the instrument is efficient to administer. When field tested against two urban centers in North Carolina where state statutes require program certification for CR treatment centers, these centers demonstrated uniformly high adherence to the PES and a pattern of good achievement for several patient outcome measures accepted as relevant to evaluation of treatment success for individual patients. / Master of Science

As large displays become more affordable, researchers investigate their effects on productivity and try to develop techniques for making the large display user experience more effective. Recent work has demonstrated significant productivity benefits, but has also identified numerous usability issues with current software design not scaling well. Studies show that large displays enable users to create and manage more windows, as well as to engage in more complex multitasking behavior. In this thesis, we developed some user interface design guidelines for large shared displays. Specifically, empirical studies to compare the effects of using large shared displays against personal displays when each of them is used as a secondary display are presented, showing that large shared display impose higher interruption and comprehension to the user. Empirical and qualitative studies are designed to develop two user interface design guidelines for large shared displays. We designed a system called SuperTrack that uses LSD along with the guidelines to further enhance and improve team efficiency and productivity in collaborative software development environments. Finally, an in-situ evaluation assesses the benefits of SuperTrack based on our developed design guidelines in terms of improving software development efficiency and productivity. Results show that by exposing software development team members to a large shared display, a system that follows our developed user interface guidelines leads to higher communication among the team members and improved group awareness, leading to higher productivity and efficiency. / Master of Science

No / Alopecia areata is an immunologically mediated disease characterized by extreme variability not only in the time of initial onset of hair loss but in the duration, extent and pattern of hair loss during any given episode of active loss. These variables, as well as the unpredictable nature of spontaneous regrowth and lack of a uniform response to various therapies, has made clinical trials in alopecia areata difficult to plan and implement. In fact, there are currently no drugs FDA-approved specifically for the indication of alopecia areata. To help facilitate well-controlled clinical trials for alopecia areata, this National Alopecia Areata Foundation (NAAF) sponsored subgroup of investigators/clinicians experienced in clinical trials and/or in the clinical care of patients with alopecia areata has outlined some general principles and potential endpoints for clinical studies in alopecia areata. These guidelines build on the Alopecia Areata Investigational Assessment Guidelines published in 1991 which established baseline clinical staging and background information important to gather on any alopecia areata patient involved in clinical research.

No / Purpose: The European Academy of Allergy and Clinical Immunology (EAACI) has produced Guidelines on Allergen Immunotherapy (AIT). We sought to gauge the preparedness of primary care to participate in the delivery of AIT in Europe. Methods: We undertook a mixed‐methods, situational analysis. This involved a purposeful literature search and two surveys: one to primary care clinicians and the other to a wider group of stakeholders across Europe. Results: The 10 papers identified all pointed out gaps or deficiencies in allergy care provision in primary care. The surveys also highlighted similar concerns, particularly in relation to concerns about lack of knowledge, skills, infrastructural weaknesses, reimbursement policies and communication with specialists as barriers to evidence‐based care. Almost all countries (92%) reported the availability of AIT. In spite of that, only 28% and 44% of the countries reported the availability of guidelines for primary care physicians and specialists, respectively. Agreed pathways between specialists and primary care physicians were reported as existing in 32%‐48% of countries. Reimbursement appeared to be an important barrier as AIT was only fully reimbursed in 32% of countries. Additionally, 44% of respondents considered accessibility to AIT and 36% stating patient costs were barriers. Conclusions: Successful working with primary care providers is essential to scaling‐up AIT provision in Europe, but to achieve this, the identified barriers must be overcome. Development of primary care interpretation of guidelines to aid patient selection, establishment of disease management pathways and collaboration with specialist groups are required as a matter of urgency.

Under de senaste åren har det gjorts flertalet ansatser till att skapa etiska koder som ska bidra till att öka det etiska handlandet i organisationer. Etik kan kommuniceras och tolkas på olika sätt, och forskningslitteraturen har beskrivit olika perspektiv och förklaringar till varför medarbetarnas förhållningssätt till ett företags etiska riktlinjer är som det är. Tidigare forskning inom frikopplingsteorin har i stor utsträckning åskådliggjort både orsaker och konsekvenser av frikoppling på organisationsnivå. Men det finns en brist på forskning som undersöker hur enskilda organisationsmedlemmars förhållningsätt påverkar frikopplingen. Det deskriptiva syftet är att undersöka skillnader mellan bankers etiska riktlinjer och medarbetarnas förhållningssätt. Det teoretiska syftet med uppsatsen är att identifiera möjliga förklaringar till varför förhållningssättet är som det är. Undersökningen har en kvalitativ kundskapsansats där insamlad data består av primär data ifrån intervjuer och sekundär data ifrån bankernas etiska riktlinjer. Empirin visar på att det finns skillnader i de anställdas förhållningssätt till de etiska riktlinjerna, och resultaten visar att det förekommer frikoppling i alla tre banker. De skillnader som studien påvisar är att medarbetarnas förhållningssätt till de etiska riktlinjerna skiljer sig beroende på de etiska riktlinjernas struktur. Olika perspektiv på strukturen ger olika faktorer som påverkar de anställdas förhållningssätt och ger en frikoppling mellan handling och de etiska riktlinjerna. Studien har begränsningar då resultatet inte kan generaliseras, detta på grund av att forskningsmetoden är en kvalitativ fallstudie samt att urvalet av respondenter är relativt lågt. Tidigare forskning inom frikopplingsteori har fokuserat på hur organisationen väljer att frikoppla struktur och handling, medan vår studie beskriver hur frikoppling uppstår på mikronivå, individnivå där de anställda frikopplar de etiska riktlinjerna olika beroende på riktlinjens struktur. Detta förklarar den variation som finns i frikopplingen och som ger olika orsaker till att frikoppling sker. Vi har i denna studie visat på att tidigare forskning med motstridiga studier har haft rätt i sina argument, men att detta beror på i vilken struktur av de etiska riktlinjer som studierna applicerats på. / In recent years, several efforts have been made to create ethical codes that will help to increase ethical behavior in organizations. Ethics can be communicated and interpreted differently and previously research literature has described different perspectives and explanations as to why employees' approach to corporate ethical guidelines is as it is. Previous research in decoupling theory has largely given significant light on both causes and results of decoupling at the organization level, but there is a lack of research that investigates individual organizational members and how their approaches affect the decoupling. The descriptive purpose is to study differences between banks' ethical guidelines and employee approaches. The theoretical purpose of the paper is to identify possible explanations as to why the attitude is as it is. The research method of the study has a qualitative approach where data consists of primary data from interviews and secondary data from the banks' ethical guidelines. The empirical data shows that there are differences in employee approach to the ethical guidelines, and the results show that there are decoupling in all three banks. The differences that the study shows is that employees' approach to the ethical guidelines differs depending on the structure of ethical guidelines. Different perspectives on the structure provide different factors that affect employee approaches and provide a decoupling between action and the ethical guidelines. The study has limitations as the result cannot be generalized, due to the fact that the research method is a qualitative case study and that the sample of respondents is relatively low. Previous research in decoupling theory has focused on how the organization chooses to decouple structure and action while our study describes how decoupling occurs at the micro level, individual level, where employees decouple the ethical guidelines depending on the structure of the guideline. This explains the variation in the decoupling and the causes for decoupling. We have shown in this study that previous research with contradictory studies is all right in their arguments but which of the study that can be applied depends on the structure of the ethical guidelines that the studies apply to.

Syftet med denna studien var att utforska den möjliga användningen av digitala inköpslistor i enfamiljekonstellation. Detta genomfördes genom kvalitativa metoder och insamlad empiri från dagböcker,intervjuer, observationer och en fokusgrupp. I studien deltog fyra medlemmar i en familj. Resultatet harsedan analyserats med hjälp av tidigare forskning och en del av analysen har omvandlats till tabeller.Resultatet visade att det finns ett behov av digitala inköpslistor i en familjekonstellation och funktionersom behöver uppfylla behoven. Studien avslutas genom att ge fem övergripande guidelines till design. / The purpose of this study was to explore the possible use of digital shopping lists in a family constellation.This was accomplished through qualitative methods and collected empirical data from diaries, interviews,observations and a focus group. The study involved four family members. The result has then beenanalyzed using previous research and parts of the analysis has been transformed into tables. The resultshowed that there is a need for digital shopping lists in a family constellation and features that need tomeet the needs of the family. The study concludes by giving five overall guidelines for design.

Bibliographic record: RYŠAVÁ, Markéta. Health professionals' beliefs concerning the non-specific back pain and their influence on following the recommended therapy procedures. Prague: Charles University, 2nd Faculty of Medicine, Department of Rehabilitation and Sports Medicine, 2021. 138 p., Appendixes, Supervisor of the work: Mgr. Tomáš Kavka Abstract: Nonspecific back pain (nonspecific LBP) is the most common reason for visiting a doctor and it is the leading cause of activity limitation and inability to work by patients. The theoretical part of this thesis describes the issue of LBP and related clinical guidelines. In addition, it summarizes current research results of the influence of health professionals' fear-avoidance beliefs (FA beliefs) on their clinical decision making for LBP patients. The practical part relates to the research of FA beliefs and non-adherence to clinical guidelines regarding care of individuals experiencing LBP among health professionals in the Czech Republic. The degree of FA beliefs was evaluated using a translated and cross-culturally adapted questionnaire "Fear- Avoidance Beliefs Tool", while the degree of non-adherence was evaluated using a self- reported questionnaire in connection to fictitious clinical vignette. A generalized linear model was used for data processing. The...

När förlossningsprogressen går långsamt fram eller stannar av helt kan barnmorskan använda sig av läkemedlet Oxytocin® för att framkalla tätare och mer intensiva värkar och på så sätt uppnå progress i förlossning. Oxytocin® är ett potent läkemedel som när det används felaktigt kan ge allvarliga komplikationer för mor och barn. I Sverige togs nationella riktlinjer för oxytocinbehandling vid värksvaghet fram år 2011. Barnmorskan har även lokala riktlinjer att förhålla sig till i sitt dagliga arbete. Studier har visat att oxytocinbehandling sker på ett ostrukturerat sätt i Sverige. Syftet med studien var att undersöka Sveriges förlossningsklinikers PM följsamhet till de nationella riktlinjerna framtagna år 2011 gällande oxytocinbehandling vid värksvaghet. Studien utgjordes av en kvantitativ, komparativ metod med en deskriptiv ansats, där urvalet resulterade i insamlade data från 43 av landets 44 förlossningskliniker. Ett instrument för dataanalys framtogs där samtliga PM jämfördes mot den text som var formulerad i de nationella riktlinjernas föreslagna PM och presenterades genom deskriptiv statistik. Resultatet visade på en variation i följsamhet i de lokala PM:en till de nationella riktlinjerna. Fem klinikers PM överensstämde med de nationella riktlinjernas PM på samtliga punkter. Ytterligare fyra klinikers PM överensstämde på alla punkter förutom gällande riktlinjer kring dokumentation. Knappt två tredjedelar av klinikerna överensstämde till 75 procent eller mer av de punkter som jämfördes i instrument för dataanalys. Ett fåtal klinikers följsamhet var 25 procent eller lägre. Vidare ansågs varken de nationella eller lokala riktlinjerna vara reviderade utifrån den senaste forskningen och evidensen. Studiens slutsats var att kliniker bör se över sina riktlinjer gällande oxytocinbehandling vid värksvaghet för att kunna erbjuda födande kvinnor i Sverige en jämlik och patientsäker vård.