The project was aimed at describing the mixing phenomena relevant for both safety analysis, particularly in steam line break and boron dilution scenarios, and mixing phenomena of interest for economical operation and the structural integrity. Measurement data from a set of mixing experiments, gained by using advanced measurement techniques with enhanced resolution in time and space help to improve the basic understanding of turbulent mixing and to provide data for Computational Fluid Dynamics (CFD) code validation. Slug mixing tests simulating the start-up of the first main circulation pump are performed with two 1:5 scaled facilities: The Rossendorf coolant mixing model ROCOM and the VATTENFALL test facility, modelling a German Konvoi type and a Westinghouse type three-loop PWR, respectively. Additional data on slug mixing in a VVER-1000 type reactor gained at a 1:5 scaled metal mock-up at EDO Gidropress are provided. Experimental results on mixing of fluids with density differences obtained at ROCOM and the FORTUM PTS test facility are made available. Concerning mixing phenomena of interest for operational issues and thermal fatigue, flow distribution data available from commissioning tests (Sizewell-B for PWRs, Loviisa and Paks for VVERs) are used together with the data from the ROCOM facility as a basis for the flow distribution studies. The test matrix on flow distribution and steady state mixing performed at ROCOM comprises experiments with various combinations of running pumps and various mass flow rates in the working loops. Computational fluid dynamics calculations are accomplished for selected experiments with two different CFD codes (CFX-5, FLUENT). Best practice guidelines (BPG) are applied in all CFD work when choosing computational grid, time step, turbulence models, modelling of internal geometry, boundary conditions, numerical schemes and convergence criteria. The BPG contain a set of systematic procedures for quantifying and reducing numerical errors. The knowledge of these numerical errors is a prerequisite for the proper judgement of model errors. The strategy of code validation based on the BPG and a matrix of CFD code validation calculations have been elaborated. Besides of the benchmark cases, additional experiments were calculated by new partners and observers, joining the project later. Based on the "best practice solutions", conclusions on the applicability of CFD for turbulent mixing problems in PWR were drawn and recommendations on CFD modelling were given. The high importance of proper grid generation was outlined. In general, second order discretization schemes should be used to minimise numerical diffusion. First order schemes can provide physically wrong results. With optimised "production meshes" reasonable results were obtained, but due to the complex geometry of the flow domains, no fully grid independent solutions were achieved. Therefore, with respect to turbulence models, no final conclusions can be given. However, first order turbulence models like K-e or SST K-w are suitable for momentum driven slug mixing. For buoyancy driven mixing (PTS scenarios), Reynolds stress models provide better results.

Management of Acute Coronary Syndrome (ACS) in an emergency department setting is challenging due to the complexity of the disease and the multi-disciplinary care environment, leading to the need for standardized protocols to ensure patient safety and care quality. Clinical Practice Guidelines (CPG) for ACS are prevalent but they are not directly applicable in the ED setting due to their complex narrative nature. In this thesis we present a knowledge modeling solution, using semantic web technologies, to computerize the ACS CPG published by the American Heart Association. Our knowledge modeling approach provides a modular characterization of the CPG knowledge and offers unique mechanisms to (a) update the knowledge model in response to periodic CPG updates; and (b) streamline the ACS management clinical pathway in response to resource constraints at an institution. The computerized CPG will serve as an ACS management decision support system, targeting tertiary hospitals in Saudi Arabia.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 7 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 2 uppsatser.

Problem: With an increasing aging Canadian population with chronic diseases such as arthritis, there is an urgent need for health professionals to promote evidence-based arthritis self-management support to their patients. Objective: The overall objective of this thesis was to determine the feasibility of using Facebook as a dissemination strategy for an online evidence-based arthritis self-management program, People Getting a Grip on Arthritis (PGrip), by arthritis health professionals with their patients. Methods: To identify the current evidence and knowledge gaps in regards to the use of innovative dissemination strategies for clinical practice guidelines (CPGs) and social media use for chronic disease self-management among health professionals, two systematic reviews of the literature were conducted. The first systematic review identified research on health professionals’ perceived usability and practice behaviour change of information and communication technologies (ICTs) for the dissemination of CPGs. The second identified research on the perceived usability of social media by health professionals to facilitate chronic disease self-management with their patients. To engage potential knowledge users in the research process, an advisory committee consisting of six arthritis health professional users (two registered nurses, two physiotherapists, and two occupational therapists) was convened to identify barriers and facilitators of using and accessing Facebook as a dissemination strategy for PGrip. The advisory committee was also convened to identify how the PGrip Facebook group page could be tailored to improve usability among arthritis health professionals. A feasibility study of 78 arthritis health professionals was then conducted to determine the feasibility of using Facebook as a dissemination strategy for PGrip among arthritis health professionals to their patients. To guide future research, a protocol for a pilot randomized controlled trial (RCT) was developed that will compare Facebook with an educational website and email to determine which strategy will demonstrate greater perceived usefulness among arthritis health professionals to disseminate the PGrip program with their patients. Results: The findings of the first systematic review revealed that health professionals’ perceived usability and practice behaviour change varies by type of ICT and the heterogeneity and paucity of properly conducted studies did not allow for a clear comparison between studies. The second systematic review revealed that health professionals perceived discussion forums and collaborative projects to be useful social media platforms to facilitate chronic disease self-management with patients. The feasibility study suggested that a Facebook group page can be used as a dissemination strategy for the PGrip program by arthritis health professionals. The Facebook group page was perceived to be usable with patients after two weeks and three months in regards its ease of use and high output quality. Conclusion: The overall research of this thesis provides advanced knowledge on how a Facebook group page as a dissemination strategy for an evidence-based self-management program for patients is perceived by arthritis health professionals. Facebook may provide arthritis health professionals with an additional option of how to best share evidence-based information to allow their patients to successfully self-manage their arthritis. A future pilot RCT is needed to determine whether Facebook is superior to other ICT intervention in regards its perceived usefulness among arthritis health professionals to disseminate the PGrip program with their patients.