Introduction: There has been increasing interest in evidence from pragmatic trials as healthcare providers and decision makers must determine if available evidence can be translated and used in real world practice. As a result, a number of tools have been developed to help researchers design and appraise randomized controlled trials (RCTs) within the pragmatic-explanatory continuum. It is unclear what role pragmatism plays in heterogeneity and if pragmatic and explanatory trials should be pooled in meta-analyses of systematic reviews. Objectives: Our primary objective was to explore the role of pragmatism (based on the Pragmatic-Explanatory Continuum Indicator Summary-2 [PRECIS-2] score) as a source of heterogeneity in Cochrane systematic reviews with at least substantial heterogeneity (I2≥ 50%). Our secondary objective was to compare and contrast the application of the established PRECIS-2 tool to the newly developed Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool. Methods: We conducted a cross-sectional methodological review on systematic reviews of RCTs published in the Cochrane Library from January 1, 2014 to January 1, 2017. Included systematic reviews had a minimum of 10 RCTs in the meta-analysis of the primary outcome and at least moderate heterogeneity (I2≥ 50%). Of the eligible systematic reviews, a random selection of 10 were included for quantitative evaluation. In each systematic review, RCTs were scored using the PRECIS-2 and RITES tools, in duplicate, to determine the amount of pragmatism. Meta-regression modelling was performed to evaluate how much variability in heterogeneity (quantified by I2) was due to pragmatism. Inter-rater reliability of both PRECIS-2 and RITES was measured using the intraclass correlation coefficient and Spearman’s correlation coefficient was used to determine the strength of the relation between PRECIS-2 and RITES. Results: Ten systematic reviews from nine Cochrane Review Groups were included in the quantitative analysis. The reviews included an average of 13 RCTs (standard deviation=2.6) for a total of 132 RCTs of which 128 could be obtained. When the PRECIS-2 summary score was entered as a covariate in random effects meta-regression models for each systematic review, there were minimal changes in heterogeneity. The changes in I2 ranged from 0.2% to 13.3%. Conclusion: Based on these findings it appears pragmatism as measured by PRECIS-2 does not explain heterogeneity in systematic reviews, therefore pooling of pragmatic and explanatory RCTs is unlikely to be detrimental to meta-analyses. / Thesis / Master of Science (MSc) / Systematic reviews and meta-analyses of randomized controlled trials (RCTs) are an important scientific activity that can lead to changes in health care. However, there is concern whether it is appropriate to meta-analyze data from RCTs that are performed under more controlled conditions (explanatory RCTs) and RCTs that are performed under more real world conditions (pragmatic RCTs) since there may be variability between them. The purpose of this research was to explore how much these trial types affect variability, otherwise known as heterogeneity, in systematic reviews. We applied a scoring tool called the Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) to RCTs within 10 systematic reviews with at least moderate heterogeneity and performed statistical modelling to determine how much heterogeneity could be explained by a trial being more or less pragmatic. Results showed that trial type did not explain heterogeneity therefore it is probably reasonable to meta-analyze data from pragmatic and explanatory RCTs.

The purpose of this thesis was to determine the relationships between gender or sex with mobility in middle aged and older community-dwelling adults with chronic conditions. Study one was a systematic review of published literature on whether gender or sex predict mobility in middle aged and older adults with chronic conditions in community-dwelling setting. Study two was a secondary analysis study (data from a randomized controlled trial where there were no statistically significant differences between rehabilitation intervention group and control group) to determine whether age and sex predict self-reported and performance-based mobility-related outcomes in community-dwelling middle and older aged adults with chronic conditions. This relationship was also examined in the context of sociodemographic and comorbidity variables. The information gained from these studies could be used to inform and guide future research and prevention intervention programs for people with risk of mobility limitation. / Thesis / Master of Science (MSc)

In deciding whether to use a particular treatment for conditions such as depression, arthritis, or heart disease, clinicians and patients must balance the benefits against the side effects and burden. To make this trade-off, they must understand the likely degree of benefit in patients’ symptoms and perceived wellbeing, best undertaken using patient-reported outcomes (PROs). PROs are measures of any aspect of a patients’ health status that are obtained from direct patient inquiry without interpretation by a clinician or anyone else. PRO measures (PROMs) are increasingly used in clinical trials and systematic reviews to evaluate health care interventions, and information obtained from PROMs can guide clinical decisions and inform shared-decision making. The use of PROMs, however, involves challenges, the most important of which is deciding if a particular treatment effect is trivial, small but important, moderate or large. One way to make this judgment is to consider the minimal important difference (MID), the smallest change in a PROM score that is important enough that patients would consider a change in treatment to achieve that benefit. The number of published studies providing anchor-based MIDs for PROMs has grown rapidly over the last three decades, and researchers have proposed several anchor-based methods to derive MID estimates, each with its own merits and limitations. This thesis begins with the development of a framework to determine the extent to which the design and conduct of studies measuring anchor-based MIDs are likely to have protected against misleading estimates. Subsequently, this thesis presents a comprehensive inventory of empirically estimated anchor-based MIDs and their associated credibility for all PROMs published in the medical literature. Further, this thesis highlights critical issues that key stakeholders should consider, and demonstrates how the use of credible MIDs may inform the development of a clinical practice guideline in which PROs were identified as critically important. Finally, this thesis concludes with insights to improve the methodological quality and transparency for researchers in the PRO and MID field. / Thesis / Doctor of Philosophy (PhD)

Driving is the preferred mode of transportation among community-dwelling older Canadians. Unfortunately, drivers aged 70+ have a high risk of being injured or killed in a collision. Many collisions are caused by poor driving habits, which could be avoided by improving their behind-the-wheel behaviours. The manuscripts in this thesis describe the development of an evidence-based and user-informed driver training program aimed at refreshing older adults’ driving skills. First, a systematic review of older driver training programs was undertaken to examine evidence specific to the impact of this training on improving road safety knowledge, self-perceived driving abilities, and on-road performance. Results highlighted the breadth of approaches used to train older drivers. Interventions were most effective when feedback was tailored to the specific needs of an aging driver. The second manuscript outlines a qualitative descriptive analysis exploring older adults’ motivations to participate in driver training with key stakeholders (i.e., older drivers and service delivery providers). Findings indicated having insight into one’s driving abilities, experiencing a near-miss or crash, as well as an openness to improving behind-the-wheel skills were factors that could influence seeking out and participating in such training. Stakeholders also emphasized considerations for educating older drivers. The final manuscript describes the design and evaluation of a driver training program. In this randomized controlled trial, older drivers watched either a video of tailored feedback on their driving or a generic video on aging-in-place. When the on-road performance was compared between treatment groups, those who received tailored feedback significantly reduced the number of errors they made behind-the-wheel. Ensuring driver training programs are designed to consider the specific needs and preferences of older adults is critical, which can lead to innovations that help maintain driving ability and community mobility in later life. / Thesis / Doctor of Philosophy (PhD) / Being able to drive is important to many older Canadians. Unfortunately, drivers aged 70+ have a high risk of being injured or killed in a car crash. Many crashes could be avoided by improving their driving skills. This thesis describes the development of an older driver training program. The first study examined research evidence on such programs where tailoring feedback was key to improving on-road performance. In the second study, older adults and other stakeholders identified what was important when designing training for aging drivers. They felt the focus should be on areas of improvement as well as strengths when behind-the-wheel. In the final study, older drivers underwent training where they watched either a video with feedback on their driving or a generic video on aging-in-place. Those who received feedback made fewer mistakes behind-the-wheel. Findings emphasize the importance of including older adults’ needs and preferences when designing driver training programs.

The demand for engineering graduates in the United States continues to grow, yet the number of students entering post-secondary education is declining, and graduation rates have seen little to no change over the last several decades. Engineering transfer students are a growing population and can help meet the nation's needs, however, there is little research on the persistence of this population after they transfer to the receiving institution. Student persistence is dependent on a complex set of interactions over time. Management systems engineering provides a framework for working with complex systems through system analysis and design, with a focus on the interactions of the system components. This research includes multiple management systems engineering analysis methods used to define and develop a systems view of engineering transfer student persistence. This work includes a comprehensive literature review to identify factors affecting engineering transfer student persistence, an empirical analysis of an institutional dataset, and development of a simulation model to demonstrate the throughput of engineering transfer student. Findings include 34 factors identified in the literature as affecting engineering student persistence. A review of the literature also highlighted two important gaps in the literature, including a focus on post-transfer success almost exclusively in the first post-transfer year and a significant interest in vertical transfer students, with little consideration given to lateral transfer students. The empirical analysis addressed the gaps found in the literature. Vertical and lateral engineering transfer students were found to experience different levels of transfer shock which also impacts their 4-year graduation rates. The analysis also found transfer shock was not unique to the first post-transfer term, it was also present in the second and third post-transfer terms, and reframed as transfer adjustment. The simulation model uncovers leaving patterns of engineering transfer students which include the students leaving engineering in the second year, as well as those graduating with an engineering degree in the third year. Overall this research identifies explicit factors that affect engineering transfer student persistence and suggests a new systems engineering approach for understanding student persistence and how institutions can affect change. / Doctor of Philosophy / The United States continues to need more students graduating with a bachelor's degree in engineering. To meet this demand, higher education institutions are investing more time to learn how to increase the number of engineering graduates. One method is through increasing the number of students that start and finish an engineering degree. There are two types of students enrolled in engineering degrees. The first type are students that begin a bachelor's degree at a 4year institution after completion of high school; these students are known as first-time, full-time (FTFT). The second type of student are transfer students who begin at one institution and move to another. The transfer students could have started at another 4-year institution, or they may begin at a 2-year community college. There has been a significant focus on increasing the number of FTFT students starting and finishing an engineering degree. However, there is little research on engineering transfer students and their ability to finish an engineering degree after transferring. The throughput of a student in the higher education system is a complex set of interaction over time that results in either the student earning a degree or not earning a degree. Systems engineering is a field of engineering that focuses of the design of complex system and is well-suited to be applied to better understanding student throughput. This purpose of this research is to introduce systems engineering methodologies to determine what affects the persistence of engineering transfer students, i.e., finishing an engineering degree. The research findings indicate more attention should be given to engineering transfer students in their second year of enrollment. Findings also suggest that engineering transfer students should not be considered as one population. There are several types of engineering transfer students and they each have different experiences during their transfer process which influence their ability to finish an engineering degree.

Yes / Purpose – The purpose of this paper is to perform a systematic review of articles that have used the unified theory of acceptance and use of technology (UTAUT). Design/methodology/approach – The results produced in this research are based on the literature analysis of 174 existing articles on the UTAUT model. This has been performed by collecting data including demographic details, methodological details, limitations, and significance of relationships between the constructs from the available articles based on the UTAUT. Findings – The findings indicated that general purpose systems and specialized business systems were examined in the majority of the articles using the UTAUT. The analysis also indicated that crosssectional approach, survey methods, and structural equation modelling analysis techniques were the most explored research methodologies whereas SPSS was found to be the largely used analysis tools. Moreover, the weight analysis of independent variables indicates that variables such as performance expectancy and behavioural intention qualified for the best predictor category. Moreover, the analysis also suggested that single subject or biased sample as the most explored limitation across all studies. Research limitations/implications – The search activities were centered on occurrences of keywords to avoid tracing a large number of publications where these keywords might have been used as casual words in the main text. However, we acknowledge that there may be a number of studies, which lack keywords in the title, but still focus upon UTAUT in some form. Originality/value – This is the first research of its type which has extensively examined the literature on the UTAUT and provided the researchers with the accumulative knowledge about the model.

Yes / The extended unified theory of acceptance and use of technology (UTAUT2) is less than ten years old and has already garnered more than 6,000 citations with extensive usage in information systems and beyond. This research employed cited reference search to systematically review studies that cited UTAUT2 originating article. Based on UTAUT2 usage, the downloaded articles were classified into four categories such as: 1) General citation, 2) UTAUT2 application, 3) UTAUT2 integration, and 4) UTAUT2 extensions. Weber's (2012) theory evaluation framework revealed UTAUT2 as a robust theory on most dimensions except for parsimony arising from the complex model. UTAUT2 extensions emerged as popular UTAUT2 utilization category as researchers extended the model with context specific variables. Finally, UTAUT2 extensions were mapped to Johns' (2006) context dimensions to identify various limitations of the existing technology adoption research and to provide multi-level framework for future researchers with libraries of context dimensions.

No / The objective of this article was to evaluate the effectiveness of pharmacist-led medication review in chronic pain management. Six electronic databases (Medline, Embase, PsycInfo, CINHAL, CENTRAL, International Pharmaceutical Abstracts) reference lists of retrieved articles and relevant websites were searched for randomized controlled trials published in the English language involving adults with chronic pain. Studies were included if one of the intervention arms had received pharmacist-led medication review independently or as part of a multidisciplinary intervention. Risk of bias was assessed for all the included studies. The search strategy yielded 583 unique articles including 5 randomized controlled trials. Compared with control, meta-analysis showed that participants in the intervention group had: a 0.8-point reduction in pain intensity on a 0 to 10 numerical rating scale at 3 months [95% confidence interval (CI), -1.28 to -0.36] and a 0.7-point reduction (95% CI, -1.19 to -0.20) at 6 months; a 4.84 point (95% CI, -7.38 to -2.29) and -3.82 point (95% CI, -6.49 to -1.14) improvement in physical functioning on a 0- to 68-point function subscale of Western Ontario and McMaster Universities Osteoarthritis Index at 3 and 6 months, respectively; and a significant improvement in patient satisfaction equivalent to a "small to moderate effect." Pharmacist-led medication review reduces pain intensity and improves physical functioning and patient satisfaction. However, the clinical significance of these findings remain uncertain due to small effect size and nature of reported data within clinical trials that limits recommendation of wider clinical role of pharmacist in chronic pain management.

Introduktion: Barncancer är ett samlingsnamn på en grupp av cancerformer som drabbar barn och ungdomar. Varje år drabbas ungefär 350 barn i Sverige. Att drabbas av cancer som barn är en traumatisk upplevelse som påverkar alla aspekter av livet. Sjukdomen påverkar inte bara barnet, utan familjen som helhet drabbas. För föräldrarna innebär det en omställning med emotionella och sociala anpassningar. Sjuksköterskan har en viktig roll i omhändertagandet av hela familjen. Syfte: Syftet är att undersöka föräldrars upplevelser av att ha ett barn med en cancersjukdom som genomgår behandling. Metod: En litteraturstudie med deskriptiv design användes. Tolv kvalitativa studier från PubMed eller CINAHL har granskats. Studierna analyserades med utgångspunkt i en artikel av Popenoe och medarbetare.   Resultat: Av analysen framkom tre kategorier: När världen vänds upp och ner, Obalans i vardagen och Någonting gott av det tillslut samt nio underkategorier. Föräldrarna beskrev en känslomässig påverkan som innefattade chock, rädsla, oro, ångest, skuld och hjälplöshet under barnets behandling. Då sjukdomen resulterade i ensamhet, oro för ekonomin och svåra påfrestningar upplevdes även en obalans i vardagen. Trots utmaningar och känslomässiga svårigheter beskrev föräldrarna även positiva upplevelser av sjukdomen. Detta beskrevs som trygghet i form av stöd, förbättrade relationer eller ny syn på livet. Slutsats: Föräldrarna till barn med en cancersjukdom upplever förändringar i livet, från chock och rädsla till obalans och påfrestningar i vardagen. Trots utmaningarna kan de uppleva trygghet, nya perspektiv eller förbättrade relationer. Examensarbetet belyser vikten av att arbeta familjefokuserat och att sjuksköterskans har en betydande roll gällande stöd till familjen. / Introduction: Childhood cancer is a collective name for a group of cancer forms that affect children and adolescents. Approximately 350 children in Sweden are diagnosed each year. Being diagnosed with cancer as a child is a traumatic experience that affects all aspects of life. The disease not only affects the child, but also has an impact on the entire family. For the parents, it means significant adjustments with emotional and social adaptations. The nurse has an important role in caring for the whole family.  Aim: The aim is to investigate parents' experiences of having a child with a cancer disease undergoing treatment. Method: A literature review with descriptive design was used. Twelve qualitative studies from PubMed or CINAHL have been reviewed for the results. The studies were analyzed based on an article by Popenoe and colleagues. Results: Three categories emerged from the analysis: when the world turns upside down, imbalance in everyday life and finding something good in it eventually, along with nine subcategories. The parents experienced a significant emotional impact such as shock, fear, worry, anxiety, guilt and helplessness during their child's treatment. An imbalance in everyday life was also experienced as the disease resulted in loneliness, financial worries and severe strains. Despite challenges and emotional difficulties, a number of parents also experienced positive aspects of the disease. This was described as security in form of support, improved relationships and a new outlook on life.  Conclusion: The parents of children with a cancer disease experienced a variety of changes in life, from shock and fear to imbalance and stress in everyday life. Despite many challenges, they experienced safety, new perspectives, and improved relationships. The thesis emphasizes the importance of working with a family-focused view and the nurse's significant role in supporting the family.

Reliability generalization (RG) is a method for meta-analysis of reliability coefficients to estimate average score reliability across studies, determine variation in reliability, and identify study-level moderator variables influencing score reliability. A total of 107 peer-reviewed RG studies published from 1998 to 2013 were systematically reviewed to characterize the meta-analytic methods employed and to evaluate quality of reporting practice against standards for transparency in meta-analysis reporting. Most commonly, RG studies meta-analyzed alpha coefficients, which were synthesized using an unweighted, fixed-effects model applied to untransformed coefficients. Moderator analyses most frequently included multiple regression and bivariate correlations employing a fixed-effects model on untransformed, unweighted coefficients. Based on a unit-weighted scoring system, mean reporting quality for RG studies was statistically less than that for a comparison study of 198 meta-analyses in the organizational sciences across 42 indicators; however, means were not statistically significantly different between the two studies when evaluating reporting quality on 18 indicators deemed essential to ethical reporting practice in meta-analyses. Since its inception a wide variety of statistical methods have been applied to RG, and meta-analysis of reliability coefficients has extended to fields outside of psychological measurement, such as medicine and business. A set of guidelines for conducting and reporting RG studies is provided.