Aim: The purpose of this study was to highlight in what forms and manifestations spirituality emerges in medical patients whether they consider themselves believers or not. The other aim was to analyse spiritual ideas of nursing scientists – authors of the patients’ oriented studies to come to the better understanding of the situation with spirituality in caring. Method: Descriptive meta-synthesis was chosen, in which 12 nursing studies were analyzed and compiled in a new integrity. Results: The analysis shows that caregivers must be ready to meet and confirm the spiritual dimension consisting of Faith, Meaning, Relationship and Questions without answers in the various forms and expressions they emerge in patient’s experience. Nursing scientists showed ideas broad enough to confirm patients’ experience. Relevance for clinical practice: By include spirituality only to religion and culture the dimension are easily forgotten, it can also in those forms mean that caregivers doesn’t see it as theirs to confirm. Nursing science do not with hold that small view of spirituality, instead the science presents a broad spectra of forms in which patients spirituality can appear. New insights about patients’ spirituality can be used by health care professionals to improve the care of patients as multidimensional human beings.

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease that has a highly variable disease course. Three biologic agents, adalimumab, etanercept, and infliximab, have been developed for the treatment of AS. We conducted three studies: 1) an exploratory analysis of a year-long longitudinal dataset to gain insight into the variability of disease activity, physical function, and well-being and to explore the relationship between these outcome measures; 2) a systematic review of the available evidence for the efficacy of biologic treatment; 3) a systematic review of potential adverse effects of this treatment. We found that repeated measures of disease activity, function and well-being fluctuate considerably between patients, with complex patterns occurring over time within patients. There was mostly high quality evidence that these biologics are efficacious against placebo. We did not find evidence of an increase in serious adverse events or serious infections from short-term randomized controlled trials.

Background: Teleradiology is currently being explored to enhance services for patients seeking emergency neurosurgical diagnoses in Ontario, Canada. Design: Systematic review of literature and cost-consequence analysis. Data sources: Medline, Embase, Cochrane, and Database of Abstracts of Reviews of Effects. Methods: Studies published between 1950 and 2008 describing remote consultations for neurosurgical assessments were retrieved. Two reviewers selected studies through multi-staged content screening and extracted data. Results 12 of 3765 studies met the inclusion criteria: two were randomized controlled trials and ten were case series. Teleradiology [88% (207/236)] and video-conferencing [89% (213/239] consultations produced higher diagnostic accuracy than telephone consultations [64% (150/235), p<0.001]. Savings varied by location and were based on avoided costs for ground and air transportation and hospitalization. Conclusions: There is limited evidence of clinical benefit of teleradiology. Savings associated with reduction in patient transfer rates depend on transportation mode and may be attenuated by higher operational costs.

Background: Systematic reviews (SRs) should be kept up-to-date to maintain importance in informing health care policy and practice. However, updating policies and practices of health care organizations (HCOs) that fund or conduct SRs are either unclear or non-existent. Objective: To examine updating policies and practices of relevant HCOs. Primary Research Design: An exploratory Internet survey of 195 HCOs within the international SR community. Results: The completed response rate was 58% (n=114) across 26 countries. Although 57% of organizations reported to have a formal updating policy, 59% reported updating practices as irregular. Moreover, 54% estimated more than half of their respective SRs were likely out dated. Resource constraints were a prominent barrier. Most (70%) supported centralizing updating efforts across institutions or agencies. Significance: This research provides a baseline glimpse of the state of updating among HCOs globally involved in evidence synthesis and therefore adds to a limited body of knowledge.

Background: Systematic reviews (SRs) should be kept up-to-date to maintain importance in informing health care policy and practice. However, updating policies and practices of health care organizations (HCOs) that fund or conduct SRs are either unclear or non-existent. Objective: To examine updating policies and practices of relevant HCOs. Primary Research Design: An exploratory Internet survey of 195 HCOs within the international SR community. Results: The completed response rate was 58% (n=114) across 26 countries. Although 57% of organizations reported to have a formal updating policy, 59% reported updating practices as irregular. Moreover, 54% estimated more than half of their respective SRs were likely out dated. Resource constraints were a prominent barrier. Most (70%) supported centralizing updating efforts across institutions or agencies. Significance: This research provides a baseline glimpse of the state of updating among HCOs globally involved in evidence synthesis and therefore adds to a limited body of knowledge.

Background: Teleradiology is currently being explored to enhance services for patients seeking emergency neurosurgical diagnoses in Ontario, Canada. Design: Systematic review of literature and cost-consequence analysis. Data sources: Medline, Embase, Cochrane, and Database of Abstracts of Reviews of Effects. Methods: Studies published between 1950 and 2008 describing remote consultations for neurosurgical assessments were retrieved. Two reviewers selected studies through multi-staged content screening and extracted data. Results 12 of 3765 studies met the inclusion criteria: two were randomized controlled trials and ten were case series. Teleradiology [88% (207/236)] and video-conferencing [89% (213/239] consultations produced higher diagnostic accuracy than telephone consultations [64% (150/235), p<0.001]. Savings varied by location and were based on avoided costs for ground and air transportation and hospitalization. Conclusions: There is limited evidence of clinical benefit of teleradiology. Savings associated with reduction in patient transfer rates depend on transportation mode and may be attenuated by higher operational costs.

This thesis presents the results of three complementary studies which were carried out to evaluate the accuracy of diagnostic tests for Salmonella in pigs. First, a research synthesis method approach, which included a systematic review, meta-analysis and meta-regression, was used to map out existing primary research investigating the accuracy of bacterial culture, antibody or antigen -capture ELISA, and PCR for Salmonella in pigs under field conditions.. Large statistical variability, limited methodological soundness and reporting precluded a quantitative synthesis of findings from multiple studies. The meta-regression identified significant factors, such as variations in test protocols, which explained much of the variability of reported estimates of test accuracy. The need for consistent use of a standard reference test is essential to ensure comparability of results generated in future studies.<p> In the second study, the accuracy of a bacterial culture, real-time (RT) PCR, and a mix-ELISA for Salmonella in were evaluated in western Canadian nursery and grow-finish pigs using traditional and Bayesian statistical methods. Ten farrow-to-finish pig farms from Alberta and Saskatchewan were purposively selected based on their presumptive Salmonella status. Bacteriological culture, RT-PCR and a mix-ELISA were performed on feces and blood samples collected from grow-finish (n=294) pigs and pens. Bayesian estimates of test sensitivity (Se) and specificity (Sp) at the individual pig level were similar to traditional statistical estimates. Sensitivity of culture and RT-PCR ranged from 65-75%, PCR Sp was 98-99% and ELISA Se and Sp at a cutoff of OD¡Ý20% ranged from 59-63% and 84-87%, respectively. In the third study, Salmonella serovar distribution and risk factors for Salmonella shedding were investigated in breeding, nursery, and grow-finish pigs using the same 10 herds. Among 418 Salmonella isolates, most common serovars were Derby (28.5%), Typhimurium, var. Copenhagen (19.1%), and Putten (11.8%). More Salmonella were detected in pooled pen than individual pig samples, confirming that the use of pooled samples is more effective for detecting the full range of serovars that may be present on Canadian pig farms. Sows shed significantly more Salmonella than nursery or grow to finish pigs, suggesting that the breeding herd is an important source of Salmonella persistence. Pelleted feed and nose-to-nose pig contact through pens were also associated with increased Salmonella prevalence, indicating that these factors are relevant as control targets.<p> The main advantages of research synthesis methods are increased power and precision in effect estimates and identification knowledge gaps and areas requiring further research. Bayesian methods for evaluating test accuracy are useful when there is no known "gold standard", which is often the case for zoonotic and food-borne pathogens. Both research synthesis and Bayesian methods are valuable tools for evaluating diagnostic test accuracy and should be more frequently used when developing monitoring and control programs in food safety.

Knowledge access is crucial for firms, especially those with resource constraints facing the rapid change in technology. This systematic review attempts to provide an understanding on how technology-based small and medium-sized enterprises (SMEs) source external knowledge. With the extant literature pointing to the spatial characteristics as the central theme, I identify four generic conditional dimensions that shape the overall geographical pattern of knowledge sourcing. The industrial knowledge base, the market, the local conditions, and the institutional environment influence from whom and where firms source knowledge. The empirical evidence leads to my contention that the conditional dimensions presented are far from being straightforward. Points of caution that should be incorporated when interpreting general patterns are discussed. The main argument is that further understanding of the geography of knowledge sourcing may start from generic external factors but contextual sensitivity and analytical interpretations are invariably essential. Further research opportunities call for more understanding on a) the relationship between private firms and the institutional environment, b) how an individual firm builds and develops own network, and c) how relational asset and different types of knowledge interact.

Limited English Proficient (LEP) patients are subject to low patient health outcomes due to limited health literacy. Cultural and linguistic barriers prohibit the obtainment and comprehension of health information and services. This systematic review will present the complications of healthcare experienced by LEP patients and will provide an analysis of interventions and policies that will be a gateway to better health outcomes for the LEP patient population.

This thesis presents the results of three complementary studies which were carried out to evaluate the accuracy of diagnostic tests for Salmonella in pigs. First, a research synthesis method approach, which included a systematic review, meta-analysis and meta-regression, was used to map out existing primary research investigating the accuracy of bacterial culture, antibody or antigen -capture ELISA, and PCR for Salmonella in pigs under field conditions.. Large statistical variability, limited methodological soundness and reporting precluded a quantitative synthesis of findings from multiple studies. The meta-regression identified significant factors, such as variations in test protocols, which explained much of the variability of reported estimates of test accuracy. The need for consistent use of a standard reference test is essential to ensure comparability of results generated in future studies.<p> In the second study, the accuracy of a bacterial culture, real-time (RT) PCR, and a mix-ELISA for Salmonella in were evaluated in western Canadian nursery and grow-finish pigs using traditional and Bayesian statistical methods. Ten farrow-to-finish pig farms from Alberta and Saskatchewan were purposively selected based on their presumptive Salmonella status. Bacteriological culture, RT-PCR and a mix-ELISA were performed on feces and blood samples collected from grow-finish (n=294) pigs and pens. Bayesian estimates of test sensitivity (Se) and specificity (Sp) at the individual pig level were similar to traditional statistical estimates. Sensitivity of culture and RT-PCR ranged from 65-75%, PCR Sp was 98-99% and ELISA Se and Sp at a cutoff of OD¡Ý20% ranged from 59-63% and 84-87%, respectively. In the third study, Salmonella serovar distribution and risk factors for Salmonella shedding were investigated in breeding, nursery, and grow-finish pigs using the same 10 herds. Among 418 Salmonella isolates, most common serovars were Derby (28.5%), Typhimurium, var. Copenhagen (19.1%), and Putten (11.8%). More Salmonella were detected in pooled pen than individual pig samples, confirming that the use of pooled samples is more effective for detecting the full range of serovars that may be present on Canadian pig farms. Sows shed significantly more Salmonella than nursery or grow to finish pigs, suggesting that the breeding herd is an important source of Salmonella persistence. Pelleted feed and nose-to-nose pig contact through pens were also associated with increased Salmonella prevalence, indicating that these factors are relevant as control targets.<p> The main advantages of research synthesis methods are increased power and precision in effect estimates and identification knowledge gaps and areas requiring further research. Bayesian methods for evaluating test accuracy are useful when there is no known "gold standard", which is often the case for zoonotic and food-borne pathogens. Both research synthesis and Bayesian methods are valuable tools for evaluating diagnostic test accuracy and should be more frequently used when developing monitoring and control programs in food safety.