Aim To assess the clinical outcomes of zirconia implants, namely survival rate and the prevalence of fracture, based on a systematic review of the literature. Material and method An electronic search was conducted in three databases (PubMed, Web of Science, Science Direct), last updated in October 2022. Inclusion criteria were clinical human studies providing information on implant failure rates in any group of patients receiving zirconia dental implants. Log-rank test was used to compare the survival distributions of implants between some groups of variables. Interval survival rate (ISR) and cumulative survival rate (CSR) were calculated. Results Thirty-seven publications were included in the review, with 2941 zirconia implants in 1766 patients, with a mean follow-up of 36.3 ± 22.7 months. There were 182 implant failures, with the great majority of them occurring within the first year after implant installation. Twenty-four implant fractures were reported, most of them in implants of narrow diameter. There was no statistically significant difference of implant failure between the anterior and posterior regions (p = 0.798), nor between maxilla and mandible (p = 0.341), nor between one- and two-piece implants (p = 0.787). The CSR after 10 years was 88.1 %. Conclusion Clinical studies assessing clinical outcomes of zirconia implants in humans have a relatively short mean follow-up time. Zirconia implants present a CSR of 88.1% after 10 years, with most failures happening within the first year after implant installation. Implants of narrow diameter present higher risk of fractures than implants of wider diameter. / Syfte Att bedöma de kliniska resultaten av zirkonia implantat, överlevnadsgrad och förekomst av frakturer, baserat på en systematisk översikt av litteraturen. Material och metod En elektronisk sökning gjordes i tre olika databaser (PubMed, Web of Science, Science Direct), senast uppdaterad i oktober 2022. Inklusions kriterier var kliniska humanstudier som gav information om frekvensen av implantatfel hos vilken grupp patienter som helst som fick zirkonia tandimplantat. Log-rank test användes för att jämföra överlevnadsfördelningen av implantat mellan vissa grupper av variabler. Intervallöverlevnadsfrekvens (ISR) och kumulativ överlevnadsfrekvens (CSR) beräknades. Resultat Trettio-sju publikationer inkluderades i granskningen, med 2941 zirkonia implantat hos 1766 patienter, med en genomsnittlig uppföljning på 36,3 ± 22,7 månader. Det förekom 182 implantatfel, varav den stora majoriteten inträffades under det första året efter implantatinstallationen. Tjugo-fyra implantatfrakturer rapporterades, de flesta i implantat med smal diameter. Det fanns ingen statistiskt signifikant skillnad av implantatfel mellan de främre och bakre områdena (p = 0,798), inte heller mellan maxilla och underkäken (p = 0,341), inte heller mellan implantat i ett och två delar (p = 0,787). CSR efter 10 år var 88,1 %. Slutsats Kliniska studier som bedömer kliniska resultat av zirkonia implantat hos människor har en relativt kort genomsnittlig uppföljningstid. Zirkonia implantat uppvisar en CSR på 88,1 % efter 10 år, med de flesta fel som inträffar inom det första året efter implantatinstallationen. Implantat med smal diameter ger högre risk för frakturer än implantat med bredare diameter.

Software intensive systems are developed to provide solutions in some problem domain and software engineering principles are employed to develop and implement that system. Software engineering principles should enhance the development and production of software artifacts and yet the artifacts often lack in quality. Crucial in the development process are requirements engineering activities and methods for software documentation. This research focused on requirements engineering activities, software requirements documentation and employed a new approach in these activities that incorporated ontology engineering principles. Ontology engineering refers to the set of activities concerned with the ontology development process, the ontology life cycle, the methods for building ontologies, and the tool suites and languages that support them. Ontologies facilitate domain knowledge reuse and sharing and provides a common vocabulary to system developers. The motivation of this research came from Ambr´osio and Kaiya, advocating the definition of the Software Requirements Knowledge Area of the Software Engineering Body of Knowledge (SWEBOK ) within an ontology system. The resulting system utilized the benefits of intelligent reasoning to elicit, automatically verify, extract and document software requirements. The requirements engineering process was modeled in an ontology. An ontology is a machine-readable data structure that distinctly defines concepts and describes relationships among those concepts. The requirements engineering process and ontology were the focal points in this research. A baseline ontology for software requirements engineering was created. The following are contributions of this research. A methodology was designed to enhance the software documentation production process. An initial ontology model of SWEBOK recommended data items was created. A method was provided to verify software requirements as they were elicited, entered and maintained in an ontology. A method was created that electronically provided provenance of software requirements. Software was created to automatically extract the software requirements from within an ontology.

Background Opioid use has become a huge public health crisis and opioids are now one of the leading causes of deaths related to drugs worldwide. Identifying differences in predictors and treatment outcomes for people with opioid use disorder (OUD) that were introduced by prescription versus other means is important. It is also vital to understand what the goals are and needs that patients want to achieve out of OUD treatment. Methods We used systematic review methodology to first examine any adverse outcomes that may be associated with prescribing opioids for acute low back pain. We also conducted a systematic review and meta-analysis examining what are the differences in patients with OUD that were initially introduced to opioids by prescription in comparison to those introduced by recreational means. We then conducted an observational study using data obtained from the GENetics of Opioid Addiction (GENOA) research collaborative. We examined treatment outcome differences between individuals introduced to opioids through a licit prescription and those introduced through illicit means. We conducted a mixed-methods study asking what the desired goals of patients with OUD from the Pharmacogenetics of Opioid Substitution Treatment (POST) project are. Using data from POST, we also examined the treatment outcome differences between those that were receiving methadone treatment in comparison to those that were on buprenorphine. Results The systematic review examining adverse outcomes of prescribing opioids for acute low back pain found that prescribing opioids for ALBP was significantly associated with long-term continued opioid use (1.57, 95% CI 1.06,2.33). The second systematic review found that those who were introduced to opioids through a legitimate prescription were significantly less likely to have illicit opioid use (0.70, 95% CI 0.50, 0.99) while in treatment. Our results from GENOA also showed that those introduced to opioids by prescription were more likely to have chronic pain, an older age of onset of opioid use, less likely to have hepatitis C and use cannabis. When we asked patients what goals they desired out of treatment, we found that the most frequently reported patient important outcomes were to stop treatment (39%) and avoid all drugs (25%). When comparing OUD patients by treatment we discovered that those receiving buprenorphine were less likely to consume illicit opioids and amphetamines but more likely to have used alcohol in comparison to those on methadone. Conclusion With this knowledge, we can recognize unique risk factors for each patient and provide more tailored treatment that can incorporate this into clinical practice to address specific concerns in various cohorts of OUD patients. Additionally, the variation in the selection of outcomes demand the need for further research to establish a set of outcomes that considers patients’ goals and preferences for OUD treatment. / Thesis / Candidate in Philosophy

Background: Analytical frameworks (AF) are graphical representation of the key questions answered by a systematic review and can support the development of guideline recommendations. Our objectives are to a) conduct a systematic review to identify, describe and compare all AFs published as part of a systematic and guideline development process related to colorectal cancer (CRC); and b) to use this case study to develop guidance on how to conduct systematic reviews of AFs. Methods: We conducted a systematic review and searched Medline and Embase from 1996 until December 2020. We also manually searched guideline databases and websites. We identified all guidelines in CRC that utilized an AFs and all systematic reviews in primary prevention, screening, and diagnosis of CRC that used AFs. We assessed quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool. The systematic review was registered in PROSPERO, registration CRD42020172117. Results: We screened 34,505 records and identified 1166 guidelines on CRC and 3127 systematic reviews, of which 5 met our inclusion criteria identifying a total of 4 AFs in colorectal cancer. We describe our search strategy and methods for conducting systematic reviews for AFs. Conclusion: Few guidelines and systematic reviews are utilizing AFs in the development of recommendations. We developed methods for conducting a systematic review on AF / Thesis / Master of Science (MSc) / Analytical frameworks are graphical diagrams that represent key questions with flow of resining from population to outcome. We conducted a systematic review to identify all analytical frameworks in colorectal cancer and in the process we developed guidance on how to conduct a systematic review for analytical frameworks. We identified four analytical frameworks, one in primary prevention, and three in screening of colorectal cancer. We found only a few clinical practice guidelines that utilized analytical frameworks in the development of the recommendations. We developed methods for conducting a systematic review of analytical frameworks.

The overarching theme of this thesis is to discuss the research to date on intimate partner violence (IPV) in orthopaedic surgery and to begin to study selected issues that have been understudied in orthopaedic surgery and IPV. This thesis outlines the current state of knowledge in the field of IPV and orthopaedic surgery and provides some insight into three selected “emerging issues” in the field which warrant future research including: education of orthopaedic surgeons and residents to reduce barriers and improve perceptions; IPV perpetrators; and outcomes for victims of IPV. The findings demonstrate that a short course on IPV for orthopaedic trainees led to an improvement and retention of knowledge three months after the course. IPV education should be integrated into training programs for orthopaedic surgeons. Our systematic review on IPV perpetrator factors indicates that using alcohol or drugs, experiencing child abuse, witnessing interparental aggression, low socioeconomic status, and psychological conditions like depression and anxiety were commonly associated with IPV perpetration. Perpetrator treatment programs should take into consideration modifiable and preventable factors that are associated with IPV perpetration. This thesis proposes a pilot prospective cohort study as the first step toward determining how experiences of IPV affect orthopaedic outcomes such as injury-related complications. The proposed study will determine feasibility and assist in the development a larger-scale multinational prospective cohort study that will engage health care professionals from around the world to increase awareness of how IPV affects patients’ musculoskeletal outcomes. In the past decade, the field of orthopaedic surgery has become more aware of the issue of IPV, but there are many questions that remain. Future research into the above issues will be an excellent first step to fully understanding the issue of IPV in orthopaedic patients, and may lead to improved support of victims of IPV in the future. / Thesis / Master of Science (MSc)

Begreppet akut coronart syndrom (ACS) används för tillstånd som orsakar syrebrist i hjärtmuskeln genom förträngning av kranskärlen. I Sverige sker ca 42 % av alla dödsfall hos både kvinnor och män till följd av hjärtkärlsjukdom. Riskfaktorer utgörs av kön, ålder och ärftlighet samt relateras till livsstils faktorer såsom rökning, förhöjda blodfetter, hypertoni, diabetes, stress och låg fysisk aktivitet. För personen som insjuknar i en hjärtinfarkt kan upplevelsen innebära en kris och sjuksköterskan har en central roll som rådgivare och vägledare för patienter under deras sjukhusvistelse och i eftervården.Syfte med denna litteratursammanställning var att beskriva sjuksköterskans omvårdnadsåtgärder som kan stödja patienter med ACS.Studien utgörs av en systematisk litteraturssammanställning och resulterade i sex kvalitativa och fem kvantitativa vetenskapliga artiklar.Resultatet belyser två teman som betydelsefulla omvårdnadsåtgärder sjuksköterskan kan stödja patienter med vid ACS. Dessa teman presenteras som information/utbildning och skapande av relationen mellan sjuksköterska och patient. Sjuksköterskans kompetens och professionalitet samt förmågan att möta patienten på ett bekräftande sätt leder till trygg relation mellan sjuksköterska och patient. En god relationen och information förefaller påverka patienten till att förstå och förbättra sin hälsa. Det är viktigt att få tid till att etablera en relation med patienten. Inom området bemötande och kommunikation ses flera framtida forskningsfrågor. / Acute coronary syndrome (ACS) is used to describe conditions that causes lack of oxygen to the heartmuscle due to a stenosis in the coronary arteries. The death rate in coronary heart disease is 42% in Sweden in both females and males and is the most common course of death. Risk factors are gender, age and heredity as well as lifestyle factors as smoking, hyperlipidemia, hypertonia, diabetes, stress and low fysical activity. The person that experience a heart failure might get into a crisis and nurses has an important role as a guide and councillor during the stay in hospital and in the aftercare.The aim of this systematic litterature review was to describe nursing interventions to support the patients with ACS. The study includes six qualitative and five quantitative articles. The result highlights two themes as important nursing interventions to support patients with ACS. These themes are presented as information/education and the establishment of a nurse-patient relation. The nurse’s competence and professionality and her capacity to confirm the patient leads to a confident relation between the nurse and the patient. A good relation and information seems to affect the patients understanding of, and improving of his/hers health. It seems to be of importance to obtain time to enable the possibility to establish the relation with the patient. In the domain of how the patient is approached and communicated with, future research is recommended.

Background: Nearly 750,000 adolescents and emerging adults with special health care needs (AEA-SHCN) enter into adulthood annually. The linkages to ensure the seamless transfer of care from pediatric to adult care and transition to adulthood for AEA-SHCN have yet to be realized. Purpose: The purpose of this systematic review was to investigate the state of the science of health care transition (HCT) service models as described in quantitative investigations. Methods: A four-tier screening approach was used to obtain reviewed articles published from 2004 to 2013. A total of 17 articles were included in this review. Discussion: Transfer of care was the most prominent intervention feature. Overall, using the Effective Public Health Practice Project criteria, the studies were rated as weak. Limitations included lack of control groups, rigorous designs and methodology, and incomplete intervention descriptions. Conclusion: As the findings indicate, HCT is an emerging field of practice that is largely in the exploratory stage of model development.

Background: Health care transition (HCT) for adolescents and emerging adults (AEA) with special health care needs is an emerging field of interdisciplinary field of practice and research that is based upon an intergenerational approach involving care coordination between pediatric and adult systems of health care. Informed understanding of the state of the HCT science pertaining to this group of providers is needed in order to develop and implement service programs that will meet the comprehensive needs of AEA with special health care needs. Methods: The authors conducted a systematic review of the literature on the transition from child to adult care for adolescents and emerging adults (AEA) with special health care needs from 2004 to 2013. Fifty-five articles were selected for this review. An adaptation of the PRISMA guidelines was applied because all studies in this review used descriptive designs. Results: Findings revealed lack of evidence due to the limitations of the research designs and methodology of the studies included in this systematic review. Study findings were categorized the following four types: adult provider competency, provider perspectives, provider attitudes, and HCT service models. The discipline of medicine was predominant; interdisciplinary frameworks based upon integrated care were not reported. Few studies included samples of adult providers. Conclusions: Empirical-based data are lacking pertaining to the role of providers involved in this specialty area of practice. Evidence is hampered by the limitations of the lack of rigorous research designs and methodology.

Background: A better understanding of the needs of adolescents and emerging adults with special health care needs (AEA-SHCNs) is essential to provide health care transition services that represent best practices. The purpose of this systematic review was to evaluate the research on health care transition for AEA-SHCNs from their perspectives. Methods: A comprehensive literature review of research publications since 2005 was performed using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and EBSCO databases. Thirty-five studies met the final review criteria. Results: The process of transition from child to adult for AEA-SHCNs is complex. Individuals experiencing the transition desire to be a part of the process and want providers who will listen and be sensitive to their needs, which are often different from others receiving health care at the same facility. Conclusions: More research that considers the voice of the AEA-SHCNs related to transition from pediatric to adult care is needed.

Purpose  To evaluate the impact of implant length on failure rates between short (<10 mm) and long (≥10 mm) dental implants.   Materials and methods A search was undertaken in three electronic databases, complemented by manual search of some journals. Implant failure was the outcome evaluated, with the estimate of relative effect expressed in risk ratio (RR). Heterogeneity among studies was evaluated by I2statistic. Inverse variance method was used for random- or fixed-effects models. Quality assessment of the studies was performed, and a funnel plot was drawn. A meta-regression was performed in order to verify how the RR was associated with the follow-up time.   Results The reviews included 353 publications. Altogether, there were 25,490 short implants and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher risk of failure than long implants (RR 2.437, p<0.001). The meta-regression observed that the follow-up time did not have any effect of the RR of failure between short and long implants. A sensitivity analysis plotting together only the studies with follow-up up until 7 years, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up.   Conclusion Short implants showed (< 10 mm) a 2.5 times higher risk of failure than long implants (≥ 10 mm). Implant failure is multifactorial and the implant length is only one of the many factors contributing to the loss of implant. A good treatment plan and the patient’s general health should be taken into account when planning for an implant treatment.       Keywords: dental implant, failure, implant length, systematic review, meta-analysis