The Canadian C-Spine (CS) and CT-Head (CT) Rules are tools aimed at improving the accuracy and efficiency of radiography use in emergency departments. This study evaluated whether the Theory of Planned Behaviour (TPB) could explain the inconsistent results from implementation studies of these two rules at 12 Canadian hospitals, where the same intervention resulted in a significant reduction in CS radiography but not CT radiography. It was demonstrated that the TPB model’s proposed relationships between constructs and behaviour could explain the ordering of CS but not CT radiography. However, after examining longitudinal changes of the TPB constructs, it was clear that these changes could not explain the changes in CS radiography ordering. Overall, TPB is unlikely to suggest important ways by which to improve radiography use, for CT because its constructs are not related to radiography ordering, and for CS because of high baseline levels of intention to clinically clear.

The Canadian C-Spine (CS) and CT-Head (CT) Rules are tools aimed at improving the accuracy and efficiency of radiography use in emergency departments. This study evaluated whether the Theory of Planned Behaviour (TPB) could explain the inconsistent results from implementation studies of these two rules at 12 Canadian hospitals, where the same intervention resulted in a significant reduction in CS radiography but not CT radiography. It was demonstrated that the TPB model’s proposed relationships between constructs and behaviour could explain the ordering of CS but not CT radiography. However, after examining longitudinal changes of the TPB constructs, it was clear that these changes could not explain the changes in CS radiography ordering. Overall, TPB is unlikely to suggest important ways by which to improve radiography use, for CT because its constructs are not related to radiography ordering, and for CS because of high baseline levels of intention to clinically clear.

The Canadian C-Spine (CS) and CT-Head (CT) Rules are tools aimed at improving the accuracy and efficiency of radiography use in emergency departments. This study evaluated whether the Theory of Planned Behaviour (TPB) could explain the inconsistent results from implementation studies of these two rules at 12 Canadian hospitals, where the same intervention resulted in a significant reduction in CS radiography but not CT radiography. It was demonstrated that the TPB model’s proposed relationships between constructs and behaviour could explain the ordering of CS but not CT radiography. However, after examining longitudinal changes of the TPB constructs, it was clear that these changes could not explain the changes in CS radiography ordering. Overall, TPB is unlikely to suggest important ways by which to improve radiography use, for CT because its constructs are not related to radiography ordering, and for CS because of high baseline levels of intention to clinically clear.

The Canadian C-Spine (CS) and CT-Head (CT) Rules are tools aimed at improving the accuracy and efficiency of radiography use in emergency departments. This study evaluated whether the Theory of Planned Behaviour (TPB) could explain the inconsistent results from implementation studies of these two rules at 12 Canadian hospitals, where the same intervention resulted in a significant reduction in CS radiography but not CT radiography. It was demonstrated that the TPB model’s proposed relationships between constructs and behaviour could explain the ordering of CS but not CT radiography. However, after examining longitudinal changes of the TPB constructs, it was clear that these changes could not explain the changes in CS radiography ordering. Overall, TPB is unlikely to suggest important ways by which to improve radiography use, for CT because its constructs are not related to radiography ordering, and for CS because of high baseline levels of intention to clinically clear.

No description available.

In this essay a quantitative empirical study with qualitative elements is performed. The purposeof the paper is to investigate whether public procurement can be applied as a political instrument. The empirical data consists of a selection of government agencies and how well these government's governing documents have implemented the current government's National Public Procurement Strategy. In order to analyze the degree of implementation, three different implementation theories are applied. The theories applied are implementation from an upside down perspective, implementation from a bottom and up perspective and implementation based on ability, will and understanding. In order to delimit the essay to a reasonable extent, the study aims to focus on how socially responsible public procurement have been included in the governing documents. The question that is aimed to be answered is: to what extent has the objective of socially responsible in public procurement been implemented in the governing documents? The second question is: Is social responsibility more prominent in governing documents that were updated after launching the national public procurement strategy. the third question is: what possible implementation barriers can be identified when implementing the national procurement strategy. The method used in the essay is essentially a quantitative content analysis that is complemented by a qualitative interview survey. The results of the empirical study show shortcomings in the implementation of the selected authorities, which indicates that the national strategy have a weak effect as a political instrument.

In this essay a quantitative empirical study with additional qualitative studies are performed. The purpose of this essay is to study how public procurement is used as a political instrument through the national procurement strategy. Swedish procurement legislation is based on EU directives since January 1, 1994 when the 1992 Act: 1,528 entered into force. The purpose of the provisions was to ensure legal certainty in the purchasing and commercial practices of public authorities. Public authorities spend about 17% of EU gross domestic product on public procurement. The value of purchases covered by procurement laws is estimated at approximately SEK 625 billion, which corresponds to 25% of GDP excluding VAT. This represents just over one-sixth of gross domestic product. Swedish procurement law is based on EU law and lies between administrative and civil law and is often described as commercial administrative law, as public procurement concerns how the public sector will act in commercial transactions. Public procurement has in recent years been the subject of political focus and a way to achieve political goals. The conclusions of this essay are that it is mainly time and human resources that causes a deficient implementation of the national procurement strategy. According to the top-down perspective, there are a number of possible obstacles to the implementation of a policy, lack of time and resources in the state authorities may have contributed to the national procurement strategy not being implemented to the extent that the government probably hoped. The national procurement strategy has had a direct effect on 5 authorities regarding social sustainability. The authorities that have given social sustainability their own heading in the governing documents can, from the top-down perspective, be considered to have had sufficient time to implement the concepts.

Introdução: Em muitos países, em especial naqueles pobres e de renda média, há dificuldades para melhorar os indicadores de morbi-mortalidade materna e neonatal, mesmo com a universalização do acesso à assistência, como no Brasil. Muitas vezes são as concepções de gênero que orientam a prática dos profissionais e a organização dos sistemas e serviços de saúde típicos, o que resulta em sobrevalorização da tecnologia e minimização ou mesmo invisibilidade de seus efeitos adversos. As narrativas sobre desrespeitos, abusos, e maus-tratos às mulheres evidenciam a ocorrência de uma modalidade específica de violência institucional, recentemente nomeada como violência obstétrica. Neste trabalho, o termo é entendido como o desrespeito aos direitos da mulher na assistência a sua saúde sexual e reprodutiva, tendo em vista seus direitos humanos básicos e inalienáveis. A Iniciativa Hospital Amigo da Mulher e da Criança (IHAMC) foi proposta em 2015 para superar esse quadro. Objetivos: Mapear os facilitadores e obstáculos de um piloto de implementação da IHAMC para a superação da violência obstétrica, em especial nos critérios \"liberdade de movimentação no trabalho de parto e parto\" e \"presença de acompanhante de escolha da mulher\". Métodos: Este trabalho integra um piloto de implementação da IHAMC em duas maternidades do SUS, com análise dos dados produzidos na etapa inicial no campo paulistano da pesquisa (2016-17). Foram realizadas entrevistas individuais e atividades em grupo com gestores, profissionais de saúde e usuárias do serviço; observação do serviço e análise dos dados do Sinasc da maternidade. Foi criado um grupo de trabalho com gestores, profissionais da assistência, pesquisadores e usuárias para analisar os problemas identificados e atuar sobre eles. Resultados: As visões de gestores e profissionais de saúde contrastam com a observação e os relatos das mulheres, com verificação de interdições ao exercício do direito a acompanhante e à liberdade de movimentação no trabalho de parto e parto. Também foram recorrentes as falas no sentido de responsabilizar as mulheres pelas dificuldades que elas enfrentam na internação para o parto. Os atores envolvidos mostram disposição para aprimorar a qualidade da assistência, e propuseram mudanças nesta direção, algumas já em andamento. Conclusão: A IHAMC pode ser uma boa estratégia para superar a violência obstétrica em contextos como o brasileiro, uma vez que coloca em debate a qualidade da assistência tendo em vista os direitos das mulheres e propicia a incorporação dos atores envolvidos na solução dos problemas, contribuindo para sua solidez e sustentabilidade. / Introduction: In many countries, especially in poor and middle-income ones, there are difficulties in improving maternal and neonatal morbidity and mortality, even with universal access to care, as in Brazil. Often it is the gender conceptions that guide professionals\' practices and the organization of typical health systems and services, which results in overvaluation of technology and minimization or even invisibility of its adverse effects. The narratives about disrespect, abuses, and mistreatment of women show the occurrence of a specific modality of institutional violence, recently named as obstetric violence. In this thesis, the term is understood as the disregard for women\'s rights while caring for their sexual and reproductive health, in view of their basic and inalienable human rights. The Mother-Baby Friendly Birthing Facilities Initiative (MBFBF) was proposed in 2015 to overcome this situation. Objectives: To map out the facilitators and obstacles of a MBFBF implementation pilot to overcoming obstetric violence, particularly with respect to the criteria \"freedom of movement in labor and birth\" and \"presence of women\'s companion of choice\". Methods: This study is part of a MBFBF implementation pilot in two SUS maternity hospitals, with an analysis of the data produced at the initial stage in the São Paulo site of research (2016-17). Individual interviews and group activities were conducted with managers, health professionals and users of the service; observation of the service and analysis of Sinasc maternity data. A working group was created with managers, health professionals, researchers and consumers to analyze and act on the problems identified. Results: The visions of managers and health professionals contrast with the observation and women\'s reports. It was verified that right to presence of a support person and freedom of movement in labor and birth were denied to women. There were recurrent statements blaming women for the difficulties they face during hospitalization. However, all actors involved showed a willingness to improve quality of care, and proposed changes in this direction, some already in progress. Conclusion: The MBFBF can be a good strategy to overcome obstetric violence in contexts such as Brazil, since it raises the issue of quality of care with regard to women\'s rights and allows the incorporation of the actors involved in the solution of the problems, contributing for its solidity and sustainability.