<p>Ventilator-associerad pneumoni (VAP) är den vanligaste infektionen på intensivvårdsavdelningar. Det är en komplikation som orsakar stort lidande, ökad mortalitet och medför höga vårdkostnader. Det finns många evidensbaserade riktlinjer för att förhindra att VAP uppstår, där sjuksköterskan har en betydande roll. Flera studier har visat att det finns brister i sjuksköterskans kunskap att tillämpa de evidensbaserade riktlinjerna för att förhindra uppkomsten av VAP. Syftet med studien var att beskriva intensivvårdsjuksköterskors tillämpning av de evidensbaserade riktlinjerna för att förhindra uppkomsten av ventilatorassocierad pneumoni hos intensivvårdspatienter samt att jämföra tillämpningen av riktlinjer mellan subgrupper. En strukturerad enkät delades ut till alla intensivvårdsjuksköterskor (N=40) på en intensivvårdsavdelning i mellansverige, varav 30 besvarade enkäten. Resultatet visade att intensivvårdsjuksköterskorna tillämpar de evidensbaserade riktlinjerna i hög utsträckning utifrån självskattningar. Det framkom inga signifikanta skillnader mellan de med kort (0-5 år) och lång (>5 år) erfarenhet som intensivvårdsjuksköterska, vad gäller i vilken utsträckning de använder de evidensbaserade riktlinjerna för att förhindra uppkomsten av VAP. Kunskapen och tillämpningen av de evidensbaserade riktlinjerna kan anses vara god hos respondenterna i föreliggande studie utifrån självskattningar. I det närmaste alla respondenter hade fått utbildning/information om VAP vilket kan vara orsaken till det resultat som framkom. Många tidigare studier har visat att utbildning ökar tillämpningen av de evidensbaserade riktlinjerna.</p> / <p>Ventilator-associated pneumonia is the most common infection in the intensive care unit. It is a complication that causes major morbidity, increased mortality and growing healthcare costs. There are many evidence-based clinical practice guidelines in order to prevent that VAP arises, where the nurse has a significant role. Several studies have established that there is deficiencies in the nurse's knowledge to apply to the evidence-based guidelines in order to prevent the origin of VAP. The aim with the study was to describe intensive care unit nurses' application of the evidence-based guidelines in order to prevent the origin of VAP at intensive care patients and to compare the application of the evidence-based guidelines between subgroups. A structured questionnaire was distributed out to all intensive care nurses (N=40) on an intensive care unit in the middle of Sweden, of which 30 responded to the questionnaire. The result showed that the intensive care nurses apply to the evidence-based guidelines in a high extent on the basis of self-reports. There were no significant differences between they with short (0-5 year) and long (> 5 year) experience as an intensive care nurse, as regards in what extent they use the evidence-based guidelines in order to prevent the origin of VAP. The respondents knowledge and application of the evidence-based guidelines can be considered to be good in this study, on the basis of self-reports. Most of the respondents had got education/information about VAP, what can have caused the result that appeared. Many previous studies have shown that education increases the application of the evidence-based guidelines.</p>

Ventilator-associerad pneumoni (VAP) är den vanligaste infektionen på intensivvårdsavdelningar. Det är en komplikation som orsakar stort lidande, ökad mortalitet och medför höga vårdkostnader. Det finns många evidensbaserade riktlinjer för att förhindra att VAP uppstår, där sjuksköterskan har en betydande roll. Flera studier har visat att det finns brister i sjuksköterskans kunskap att tillämpa de evidensbaserade riktlinjerna för att förhindra uppkomsten av VAP. Syftet med studien var att beskriva intensivvårdsjuksköterskors tillämpning av de evidensbaserade riktlinjerna för att förhindra uppkomsten av ventilatorassocierad pneumoni hos intensivvårdspatienter samt att jämföra tillämpningen av riktlinjer mellan subgrupper. En strukturerad enkät delades ut till alla intensivvårdsjuksköterskor (N=40) på en intensivvårdsavdelning i mellansverige, varav 30 besvarade enkäten. Resultatet visade att intensivvårdsjuksköterskorna tillämpar de evidensbaserade riktlinjerna i hög utsträckning utifrån självskattningar. Det framkom inga signifikanta skillnader mellan de med kort (0-5 år) och lång (&gt;5 år) erfarenhet som intensivvårdsjuksköterska, vad gäller i vilken utsträckning de använder de evidensbaserade riktlinjerna för att förhindra uppkomsten av VAP. Kunskapen och tillämpningen av de evidensbaserade riktlinjerna kan anses vara god hos respondenterna i föreliggande studie utifrån självskattningar. I det närmaste alla respondenter hade fått utbildning/information om VAP vilket kan vara orsaken till det resultat som framkom. Många tidigare studier har visat att utbildning ökar tillämpningen av de evidensbaserade riktlinjerna. / Ventilator-associated pneumonia is the most common infection in the intensive care unit. It is a complication that causes major morbidity, increased mortality and growing healthcare costs. There are many evidence-based clinical practice guidelines in order to prevent that VAP arises, where the nurse has a significant role. Several studies have established that there is deficiencies in the nurse's knowledge to apply to the evidence-based guidelines in order to prevent the origin of VAP. The aim with the study was to describe intensive care unit nurses' application of the evidence-based guidelines in order to prevent the origin of VAP at intensive care patients and to compare the application of the evidence-based guidelines between subgroups. A structured questionnaire was distributed out to all intensive care nurses (N=40) on an intensive care unit in the middle of Sweden, of which 30 responded to the questionnaire. The result showed that the intensive care nurses apply to the evidence-based guidelines in a high extent on the basis of self-reports. There were no significant differences between they with short (0-5 year) and long (&gt; 5 year) experience as an intensive care nurse, as regards in what extent they use the evidence-based guidelines in order to prevent the origin of VAP. The respondents knowledge and application of the evidence-based guidelines can be considered to be good in this study, on the basis of self-reports. Most of the respondents had got education/information about VAP, what can have caused the result that appeared. Many previous studies have shown that education increases the application of the evidence-based guidelines.

Bakgrund: Vårdrelaterade infektioner skapar stora påfrestningar i vården på samhälls-,organisations och individnivå. Vårdpersonalens tillämpning och följsamhet tillbefintliga evidensbaserade riktlinjer är det mest effektiva sättet att förbygga VRI. För attsjuksköterskor skall kunna bedriva ett preventivt arbete och möjliggöra en patientsäkervård är det av vikt att undersöka de faktorer som påverkar följsamheten till dessariktlinjer.Syfte: Syftet med litteraturstudien var att beskriva faktorer som kan leda till attsjuksköterskor inte följer evidensbaserade riktlinjer för att förebygga vårdrelateradeinfektioner. Vidare har syftet varit att granska artiklarna avseende dess datainsamlingsmetod.Metod: En deskriptiv litteraturstudie med fjorton artiklar som underlag. Artiklarna haräven granskats utifrån dess datainsamlingsmetodHuvudresultat: Flera olika faktorer samverkar till varför sjuksköterskor inte följerevidensbaserade riktlinjer, där både inre och yttrefaktorer ingår. Tydligt framkommer attsjuksköterskor saknar kunskap och praktiska färdigheter. Sjuksköterskansföreställningar om den egna kapaciteten och den faktiska tillämpningen av riktlinjernaöverensstämmer med verkligheten. Vidare framkom att sjuksköterskornasföreställningar om konsekvenser, där sjuksköterskan har en tendens att minimeraomfattningen av de konsekvenser, som deras handlande eller underlåtelse av handlande,kan medföra.Slutsats: Sjuksköterskor saknar kunskap kring evidensbaserade riktlinjer för attförebygga vårdrelaterade infektioner. Dock finns det flera faktorer som kan förklaravarför inte riktlinjerna efterföljs. / Background: Healthcare associated infections creates great strains in healthcare at asocietal-, organizational- and individual level. Healthcare workers implementation andadherence to existing evidence-based guidelines is the most effective way to preventnosocomial infections. For nurses to conduct preventive work and enabling a safe carefor patients, it is important to examine the cause of deficiencies in adherence to theseguidelines.Aim: The aim of this survey was to describe factors that can explain why nurses do notfollow evidence-based guidelines for preventing healthcare-associated infections.Furthermore, the aim has been to examine the articles regarding the data collection method.Method: A descriptive literature survey based on fourteen articles. Articles have beenexamined in terms of the data collection method.Main result: Several different factors contribute to why nurses do not follow evidence-based guidelines, where both internal and external factors interact. It’s clearly revealedthat nurses lack knowledge and practical skills. Nurses' beliefs about their own capacityand actual application of the guidelines correspond poorly with reality. It has alsoemerged that according to the nurses' beliefs about consequences, the nurse has atendency to minimize the extent of the consequences of their act or omission of action. Conclusion: Nurses lack knowledge about evidence-based guidelines for preventinghealthcare-associated infections. However, there are several factors that could explainwhy the guidelines are not applied.

Cancer-related fatigue (CRF) as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer and cancer treatment that is not proportional to recent activity, such as physical activity, that interferes with usual functioning (Howell et al., 2015; National Comprehensive Cancer Network, 2020). CRF is one of the most common symptoms experienced by cancer patients at all stages of the cancer trajectory which significantly impacts patient’s quality of life, return to work, mental health, and can lead to disability (Bower, 2014b; Jones et al., 2016). Much research has focused on the development of CRF assessment and intervention strategies which have promoted the development of comprehensive evidence-based guidelines (Howell et al., 2015; National Comprehensive Cancer Network, 2020). However, previous research has identified many practice gaps in their implementation (Berger et al., 2015; Borneman et al., 2007; Pearson et al., 2015a, 2017b). This thesis’ objectives were to gain a deeper understanding of potential barriers to CRF clinical guideline implementation to identify potential knowledge translation strategies of CRF guidelines into practice following a Knowledge-To-Action (KTA) framework perspective (Graham et al., 2006; Straus et al., 2013). In Study 1, a qualitative research design was used to recruit a total of 62 participants—16 patients, 32 healthcare providers (HCPs), and 15 community support providers (CSPs). Drawing on the KTA model, the goal of the study was to explore key stakeholders’ (patients, HCPs, CSPs) experiences and opinions on CRF assessment and management and to explore underlying causes of CRF treatment gaps. No specific hypothesis were determined given the exploratory nature of the study. The results of this study highlight CRF guideline implementation gaps, patient dissatisfaction with CRF care, and challenges contributing to CRF assessment and management gaps. The results also suggested the presence of two underlying mechanisms contributing to treatment gaps: A Perfect Storm and Patient-Provider Communication Gaps. Understanding these mechanisms provides clarity on the potential causes maintaining CRF treatment gaps and can help direct targeted knowledge translation strategies to improve the implementation of CAPO CRF guidelines into practice. Consistent with a recent Delphi study (Pearson et al., 2017b), the results supported the need for professionals’ training on CRF guidelines to fill knowledge gaps. In Study 2, a mixed-methods pilot study with 18 HCPs and CSPs was used to develop and evaluate the acceptability and feasibility of a one-time training session for HCPs and CSPs on CAPO CRF guidelines, once again flowing the KTA framework (Graham et al., 2006; Straus, 2011). A secondary objective was to evaluate the learning outcomes of the training session including CAPO CRF guidelines knowledge, self-efficacy, and intent to apply CAPO CRF guidelines in practice. Overall, results suggest that offering a brief one-time training for HCPs and CSPs on CRF guidelines may be effective in increasing knowledge, self-efficacy, and intent to apply guidelines into practice. Similarly, that KT tools are appreciated by HCPs/CSPs and may be used in practice to supplement and sustain the knowledge and skills gained in training.

Diabetes mellitus (DM) is one of the most common chronic diseases affecting children under the age of 20, and it often leads to serious complications. In recent decades, there has been an increase in incidence of both types of DM among U.S. children. Having this chronic condition not only negatively impacts the health of these children but also their academic achievements. School health nurses struggle to manage these children appropriately and safely. The purpose of this project was to develop an evidence- based guideline for a standardized process in which school nurses coordinate the school and student health care teams to ensure a safe school environment for diabetic children. The Stevens star model of knowledge transformation was used to frame the development of this guideline. A team of experts, consisting of 10 ten school nurses, was assembled to provide formative and summative evaluations of the guidelines. Nine nurses completed and returned the questionnaires within the allotted time. The formative group feedback resulted in the revision of the guideline prior to distribution for the summative evaluation. The experts then participated in a summative evaluation using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. The revised guideline was approved and recommended for use by all of the experts without additional modification. Implementation of the guideline will result in social change by improving outcomes in students' health and academic achievement and in strengthening the role and autonomy of the school nurse. Dissemination will occur first in the school district through presentation and then to a larger audience through publication in journals focused on school nursing.

Introduction: The increase in the number of patients presenting with osteoarthritis in the past decade has led to a 32% increase in knee replacement surgeries designed to reduce restrictions on patient movement and improve their quality of life. Patient satisfaction is becoming an increasingly important indicator of quality of care. This study was designed to identify predictors of various service components in the treatment process and hospital key performance indicators significantly associated with patient satisfaction. Materials and methods: A multicenter cross-sectional study was conducted with 856 patients having their primary total knee replacements at 41 hospitals. Patient satisfaction was queried via a validated, multidimensional questionnaire mainly using a six-point scale. In addition to bivariate calculations, patient satisfaction was the dependent variable in a binary logistic regression model. Results: The bivariate analysis showed a strong association between satisfaction and sex (male or female), the patients’ health before admission, and the length of stay. The number of cases treated at each hospital did not reveal any impact on satisfaction. The multivariate analysis identified three predictors associated with overall satisfaction. The strongest factor was the treatment outcome and the weakest was the quality of food. It became apparent that the statutory procedure minimums were not being met. Conclusions: The relevant factors influencing patient satisfaction were partially the same as previous study results and allowed more detailed conclusions. The results provide suggestions across hospitals that could help health care providers better meet needs of patients after knee arthroplasties.

Submitted to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy. / M

Submitted to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy. / M

Introduction: The increase in the number of patients presenting with osteoarthritis in the past decade has led to a 32% increase in knee replacement surgeries designed to reduce restrictions on patient movement and improve their quality of life. Patient satisfaction is becoming an increasingly important indicator of quality of care. This study was designed to identify predictors of various service components in the treatment process and hospital key performance indicators significantly associated with patient satisfaction. Materials and methods: A multicenter cross-sectional study was conducted with 856 patients having their primary total knee replacements at 41 hospitals. Patient satisfaction was queried via a validated, multidimensional questionnaire mainly using a six-point scale. In addition to bivariate calculations, patient satisfaction was the dependent variable in a binary logistic regression model. Results: The bivariate analysis showed a strong association between satisfaction and sex (male or female), the patients’ health before admission, and the length of stay. The number of cases treated at each hospital did not reveal any impact on satisfaction. The multivariate analysis identified three predictors associated with overall satisfaction. The strongest factor was the treatment outcome and the weakest was the quality of food. It became apparent that the statutory procedure minimums were not being met. Conclusions: The relevant factors influencing patient satisfaction were partially the same as previous study results and allowed more detailed conclusions. The results provide suggestions across hospitals that could help health care providers better meet needs of patients after knee arthroplasties.

These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.