The refugee crisis in the world, specifically after 2015, which came as a result of the repercussions of the war in Syria and the absence of the right political vision in Iraq and Libya. This migration has led to increased pressures on many countries in the European Union, as a result of the influx of more immigrants from the Middle East and North Africa. The purpose of this research for the bachelor's degree in POLITICAL SCIENCE, is to reveal the impact of the political integration process on solving the refugee crisis that plagued Europe in 2015, with a close focus on the asylum policy adopted by the EU during the refugee crisis in 2015.   The method used in this research is a qualitative case study in order to get an in depth understanding of the selected case and with the help of the data material obtained from the sources used. Through the method, materials and theoretical and empirical analysis, the purpose and questions posed within the research were answered. In this thesis, two theories were used in the research topic, namely, the theory of integration and the constructivist theory in international relations.  The results were as follows. Europe was seeking for solidarity among their countries in solving the refugee crisis that occurred in 2015. Further that solidarity could provide solutions that contribute to the distribution of burdens among the countries of the European Union. Solidarity means establishing compatible solutions among the countries of the Union. The result also showed that the 2013 Dublin III Regulation and European Asylum Policy need to be reformed because they do not work effectively during times of crisis and exceptional events.

Contexte : La pression croissante sur les soins primaires nécessite de développer des approches adaptées pour apprécier la valeur des innovations dans ce domaine et identifier les conditions favorables à leur diffusion, ce qui peut s'avérer difficile, puisque ces innovations sont souvent complexes et de nature organisationnelle. Objectifs : Explorer les arguments de valeur de 10 innovations identifiées comme prometteuses lors des symposiums sur les innovations du Collège québécois des médecins de famille et proposer des pistes pour leur bonification et diffusion. Méthodes : Approche délibérative multidimensionnelle avec un panel diversifié de 12 cliniciens, gestionnaires, patients et citoyens. À partir de données synthétisées par dimension, chaque participant a apprécié le potentiel de valeur des innovations par un score et des arguments justificatifs pour chaque dimension individuellement et suite à une délibération. Le potentiel de valeur moyen a été calculé par innovation, les arguments ont fait l’objet d’une synthèse qualitative. Ces résultats ont informé une seconde délibération visant à identifier des pistes d’amélioration et diffusion qui ont été organisées par analyse thématique. Résultats : Les innovations d’adaptation de l'organisation des soins aux populations vulnérables ont été considérées comme ayant le plus grand potentiel de valeur dans l’ensemble. Les innovations visant l’optimisation des processus cliniques et d’amélioration continue ont reçu des appréciations plus variables. 460 pistes ont été classées en six catégories : objectifs, modalités d’accès, fonctionnement, impacts, gouvernance et contexte externe. Conclusions : L’exploration du potentiel de valeur d’innovations complexes avec une approche délibérative multidimensionnelle permet d’identifier, pour certaines catégories d’innovations en soins primaires, des arguments de valeur communs, et facilite l’identification de pistes d’amélioration et diffusion. / Context: The increasing pressure on primary care calls for the development of appropriate approaches to assess the value of innovations in this field and identify the conditions for their diffusion, which can be difficult, as these innovations are often complex and organizational in nature. Objectives: To explore the value arguments of 10 innovations identified as promising during the Quebec College of Family Physicians' Innovation Symposia and to propose avenues for their improvement and diffusion. Methods: Multidimensional deliberative approach with a diverse panel of 12 clinicians, managers, patients and citizens. Using data synthesized by dimension, each participant assessed the value potential of the innovations by providing a score and supporting arguments for each dimension individually, and following group deliberation. The average value potential was calculated per innovation, and the arguments were qualitatively synthesized. These results informed a second deliberation aimed at identifying avenues for improvement and deployment that were organized by thematic analysis. Results: Innovations aimed at adapting the organization of care for vulnerable populations were considered to have the greatest value potential overall, while interventions aimed at optimizing clinical processes and continuous improvement received more variable appraisals. 460 avenues were categorized into six areas: objectives, access modalities, operations, impacts, governance, and external context. Conclusions: Exploring the value potential of complex innovations with a multidimensional deliberative approach allowed the identification of common value arguments for certain categories of primary care innovations and facilitated the identification of pathways for their improvement and dissemination.

Background: The care for the older adults is facing major challenges with the growing proportion of older people. This entails a need to find new ways to cope with the tasks of elderly care, and digitalization is seen as part of the solution. In order to succeed with digitalizing, the first-line managers in elderly care needs knowledge of change management and digitalization. That knowledge needs to be obtained via educational efforts. Aim: The aim of the study was to examine the experiences of first-line managers within elderly care after they recieved training in change management and digitalization. The aim was further to examine their perspectives on the influencing factors when it comes to leading change management in digitalization. Method: The method was a qualitative interview study with an inductive research approach and the sample consisted of first-line managers within elderly care in a medium-sized Swedish municipality. Semi-structured interviews were conducted which were analyzed by qualitative inductive content analysis.  Results: Four main categories emerged; perspectives on implemented educational efforts; identified potential, barriers and needs in change management and digitalization; responsibilities and roles in change management and digitalization; and perspectives on care users when using health and welfare technology. Potential and barriers included assent from management, cooperation between colleagues, influence of the first-line managers' level of interest, resources, goals and strategies. It also included prioritization of daily operations, employee needs, resistance and information about purpose, implementation process and technology. In order for the first-line managers in elderly care to achieve the expected benefit with training on change management and digitalization, the expectations needs to be well defined. Conclusion: Educational efforts in change management and digitalization alone are not enough to achieve a successful implementation of health and welfare technology in municipal care for the elderly. Digitalization is an ongoing process of changes and the first-line managers can-not do it by themselves. The preferred practice is to be able to create the conditions for interested employees to drive the work of digitalization within their respective operation.

Införandet av New Public Management i den offentliga sektorn har för första linjens chefer,benämnda som enhetschefer i denna studie, inneburit en ökad byråkrati och minskad kunskap inom hantering av olika arbetsuppgifter. Detta bland annat inom arbetet kopplat till personalärenden. På så sätt ökar värdet av ett gott samarbete och en god relation med HR-avdelningen och dess HR-partners. Studiens syfte avser att skapa förståelse kring enhetschefers upplevelse av relationen till sin HR-partner och vilka faktorer som ligger till grund för en högkvalitativ arbetsrelation. Studien ämnar att ta reda på vilka kriterier enhetschefer anser bör finnas i en högkvalitativ arbetsrelation samt på vilket sätt relationen mellan enhetschefer och deras HR-partners kan definieras som en högkvalitativ arbetsrelation. Alternativt vad som behöver utvecklas för att relationen skall definieras som en högkvalitativ relation. Genom en kvalitativ metod intervjuades enhetschefer inom en offentlig verksamhet. Semi-struktureradeintervjuer användes för att undersöka deras upplevelser av relationen till deras HR-partners. Genom en tematisk analys kunde ett resultat presenteras. Resultat visade att relationen idag ärgod, men är inte av en högkvalitativ karaktär. Relationen innehåller ömsesidig respekt ochempati som ger psykologisk trygghet till medlemmarna i den men det finns hinder för utvecklingen av relationen. Det handlar om att fylla ett behov för ett individ- och verksamhetsanpassat arbete som i dag saknas i relationen. Då relationer är dynamiska och en uppfattning om vad god kvalité innebär är individuellt kan relationer lätt få fel förutsättningar för att fungera. Genom att arbeta mot en tydligare målbild för vad arbetet skall bidra till samt vad relationen betyder för de olika parterna kan en högkvalitativ relation lättare uppnås. / The introduction of New Public Management in the public sector has meant increased bureaucracy and reduced knowledge in handling various tasks for first-line managers referred to as unit managers in this study. This, among other things, in work linked to personnel matters. In this way, the value of good collaboration and a good relationship with the HR department and its HR partners increases. The purpose of the study is to create an understanding of unit managers' experience of the relationship with their HR partner and the factors that form the basis for a high-quality working relationship. The study aims to find out what criteria unit managers believe should exist in a high-quality working relationship and in what way the relationship between unit managers and their HR partners can be defined as a high-quality working relationship. Alternatively, what needs to be developed for the relationship to be defined as a high-quality relationship. Through a qualitative method, unit managers in thepublic sector were interviewed. Semi-structured interviews were used to examine their experiences of the relationship with their HR partners. Through a thematic analysis, a result could be presented. Results showed that the relationship today is good, but is not of high-quality nature. The relationship contains mutual respect and empathy that gives psychological security to its member. There are obstacles to the development of the relationship that is about filling a need for individual and business-adapted work that is currently lacking in the relationship. As relationships are dynamic and perception of what good quality means is individual, relationships can easily have the wrong conditions to function. By working towards a clearer goal picture for what the work is to contribute to and what the relationship means for the various parties, a high-quality relationship can be more easily achieved.

The objective was to evaluate differences in the severity and symptoms of borderline personality disorder (BPD) according to sex and service context among adolescents involved with youth protection services (YPS) and first-line mental health services (FLMHS) in Quebec. A total of 45 adolescents (14 to 17 years old) with BPD traits were recruited from YPS (n=35) and CLSCs (n=10). The Borderline Symptom List (BSL-23) measured the severity of symptomatology while the Life Problems Inventory (LPI) evaluated the intensity of BPD. Independent samples t-tests and Mann-Whitney U tests were used to analyze group differences. Analyses revealed that girls had significantly higher mean symptom severity scores (BSL-23) than boys and a significantly higher interpersonal chaos score (LPI). No other significant differences emerged from the primary analyses. Supplementary item-by-item analyses of the BSL-23 and LPI, indicated that girls endorsed several internalizing behaviours, while boys endorsed numerous externalizing behaviours. In terms of service context, the YPS group scored higher on several externalizing behaviours, while the FLMHS group scored higher on many internalizing behaviours. The results of this study provide initial insights into BPD symptomatology and severity in these understudied service contexts and can guide early detection and intervention. / L’objectif était d’évaluer les différences de sévérité et de symptômes du trouble de personnalité limite (TPL) selon le sexe et le contexte de service chez les adolescents suivis en protection de la jeunesse (PJ) et dans les services de santé mentale de première ligne au Québec. Un total de 45 adolescents (14 à 17 ans) présentant des traits du TPL ont été recrutés en PJ (n=35) et en CLSC (n=10). Le Borderline Symptom List (BSL-23) a mesuré la sévérité de la symptomatologie et le Life Problems Inventory (LPI) a évalué l'intensité du TPL. Des tests t d'échantillons indépendants et des tests Mann-Whitney U ont été utilisés pour analyser les différences entre les groupes. Les analyses ont révélé que les filles présentaient des scores moyens de sévérité (BSL-23) significativement plus élevés que les garçons et un score significativement plus élevé pour le chaos interpersonnel (LPI). Aucune autre différence significative n'est ressortie des analyses primaires. Des analyses complémentaires item par item du BSL-23 et du LPI, ont indiqué que les filles endossaient plusieurs comportements internalisés, et les garçons des comportements externalisés. Au niveau du contexte de service, le groupe PJ a obtenu des résultats plus élevés pour nombreux comportements externalisés, tandis que le groupe en première ligne a obtenu des résultats plus élevés pour plusieurs comportements internalisés. Les résultats de cette étude fournissent un premier aperçu des symptômes et de la sévérité du TPL dans ces contextes de service peu étudiés permettant de guider la détection et l'intervention précoces.

Problématique: Le partenariat de soins est un concept qui s’avère prometteur pour améliorer la qualité des soins de santé offerts à la population. Les gestionnaires de proximité détiennent un rôle-clé dans son intégration en raison de leurs fonctions d’organisation des soins et de gouvernance, ainsi que de leur proximité avec les patients. But: Le but de cette étude est d’explorer l’intégration du partenariat de soins en administration des services infirmiers auprès de gestionnaires de proximité, de coordonnateurs de programme et de patients partenaires de trois unités de soins d’un centre hospitalier de la région de Montréal. D’une part, l’étude vise à explorer les perceptions des parties prenantes quant au rôle du gestionnaire de proximité dans l’intégration du partenariat de soins et, d’autre part, identifier les barrières, les facilitateurs et les compétences y étant associées. Méthodologie: Pour réaliser cette étude exploratoire descriptive, une entrevue semi-dirigée a été conduite auprès de chacun des huit participants : trois coordonnateurs de programme, deux gestionnaires de proximité et trois patients partenaires. Une analyse de contenu a été effectuée et guidée par le référentiel de compétences de pratique collaborative et partenariat patient en santé et services sociaux. Résultats: Le rôle du gestionnaire de proximité dans l’intégration du partenariat de soins en administration des services infirmiers concerne plusieurs thématiques, dont la gestion de projets, la valorisation du patient partenaire et la représentativité de la clientèle. Les principales barrières à l’intégration du partenariat de soins en administration des services infirmiers identifiées sont l’organisation des soins et la disponibilité des ressources. À l’inverse, le principal facilitateur est la gestion de projets. Les habiletés des parties prenantes peuvent être tant une barrière qu’un facilitateur. La communication, la clarification des rôles et des responsabilités et le leadership collaboratif sont des compétences-clé à maîtriser par les gestionnaires de proximité, selon les participants. Discussion/Conclusion: La variabilité dans l’intégration du partenariat de soins et l’importance de l’exercice du leadership dans la gestion des projets réalisés en partenariat sont constatées par l’étudiante-chercheure. Le rôle et le positionnement hiérarchique des coordonnateurs de programme semblent faciliter davantage l’intégration du partenariat de soins en administration des services infirmiers que ceux des gestionnaires de proximité. Un besoin de soutien en ce qui a trait à la compréhension de l’approche, au développement des compétences requises et à l’accès aux ressources en facilitant l’intégration demeure à combler. / Background: The patient partnership is a concept that appears to be promising for the improvement of the quality of care delivered to the population. The first-line managers play a key role in its integration because of their functions in care organization and governance and their proximity with the patients. Objective: The aim of this study is to explore the integration of the patient partnership in nursing administration in three units of a hospital of the greater Montreal area. On the one hand, the study will allow to explore the perceptions of the stakeholders related to the role of the first-line manager in the integration of patient partnership in nursing administration and, on the other, to identify the associated facilitators, barriers and competencies. Methods: A semi-directed interview has been conducted with each of the eight participants: three program coordinators, two unit head nurses and five patient partners. This descriptive exploratory study then included a content analysis guided by the competency framework for collaborative practice and patient partnership in health and social services. Findings: The first-line manager’s role regarding patient partnership integration in nursing administration is related to several themes including project management, valuing the patient partner and users’ representativeness. The main barriers documented regarding patient partnership integration in nursing administration are the organization of care and the availability of resources. The main facilitator relates to project management. The skills of the stakeholders are a common theme of the barriers and facilitators. According to the participants, communication, responsibilities and roles’ clarification, as well as collaborative leadership are key competencies that first-line managers need to master. Discussion/Conclusion: Variability in the integration of the patient partnership and the importance of leadership in project management regarding patient partnership were noted by the student-researcher. The role and hierarchical positioning of program coordinators seem to facilitate the integration of the patient partnership in nursing administration more than those of the first-line managers. Furthermore, support regarding understanding of the approach, competencies development and access to resources facilitating the integration is still required.

Våld i nära relationer klassas som ett folkhälsoproblem och studier visar att arbetsplatsen kan ha en viktig funktion att hjälpa och stötta våldsutsatta personer (Charlott, Cleroux, Lopez & Scott, 2021; Holmgren & Grünbaum, 2021, s. 45; Strand, 2022, s. 51). Mäns våld mot kvinnor, våld i nära relationer och hedersrelaterat våld och förtryck innebär att våldet utövas av en person som finns i den utsatta personens närhet. Kvinnor är i högre grad utsatta för våld än män. Inom vård- och omsorgsverksamheten är cirka 80 procent av de anställda kvinnor (Strand, 2020, ss. 27-28; Hydén, Överlien, Ericson, Wiman & Grönberg Eskel, 2016, s. 3; SKR, 2016). Att vara utsatt för våld i nära relationer kan ha negativ inverkan på arbetsförmågan (Skoog Waller, 2022). Jämställdhetsmyndigheten (2022) uppmanar arbetsgivare att arbeta aktivt med att identifiera och förebygga våld i nära relationer hos medarbetare. Arbetsplatsen kan agera som en fristad för personer som är utsatta för våld i nära relationer vilket belyser arbetsplatsens viktiga funktion (Katula, 2012). Därav är det intressant att undersöka hur första linjens chefer inom den kommunala vård- och omsorgen arbetar med våld i nära relationer. Syftet med studien är att öka kunskapen om hur första linjens chefer inom kommunal vård- och omsorg arbetar med våld i nära relationer om medarbetaren är utsatt för våld. Studien har genomförts med en kvalitativ metod och urvalet bestod av tio första linjens chefer inom kommunal vård- och omsorgsverksamhet från nio olika kommuner i Sverige. Semistrukturerade intervjuer genomfördes och en kvalitativ innehållsanalys användes för att bearbeta texten. Utifrån studiens syfte att öka kunskapen om hur första linjens chefer arbetar samt vilka faktorer som kan påverkar första linjens chefers arbetssätt om medarbetare är utsatta för våld i nära relationer. Detta för att kunna ge stöd åt medarbetare som är utsatta för våld. Då det är arbetssätt som ska studeras förefaller det sig lämpligt att tolka innehållet i intervjuerna med hjälp av begreppen Förstå, Vilja och Kunna från Lundquist (1992, ss. 75-77) implementeringsteori. Dessa tre begrepp är en förutsättning för att införa arbetssätt därför har dessa begrepp använts som tolkningsstöd i analysarbetet. I resultatet visade det sig att ledarskapsstilen har betydelse i mötet med personer som är utsatt eller har varit utsatta för hot och våld i nära relationer. Ytterligare framkom att nio av tio chefer saknar rutiner kring stöd för medarbetare som är utsatta för våld i nära relationer. Några faktorer som framkom i studien var en rädsla för att fråga om våld i nära relationer, kunskapsbrist samt otillräckliga resurser. En annan faktor som framkom var att samtliga deltagare visar både på vilja och engagemang att lyfta frågeställningar om hot och våld i nära relationer i samtal med medarbetare. Resultatet visar att cheferna upplevde en kunskaps- och resursbrist inom verksamheterna kring frågan om våld i nära relationer. Studiens resultat indikerar att det finns förbättringsmöjligheter och att denna frågan borde vara högre prioriterad inom den kommunala vård- och omsorgen. / Domestic violence is classified as a public health problem, and studies show that the workplace can have an important function in helping and support people exposed to violence (Holmgren & Grünbaum, 2021, p. 45; Strand, 2022, p. 51; Charlott, Cleroux, Lopez & Scott , 2021). Men's violence against women and domestic violence means that the violence is perpetrated by a person who is in the victim's vicinity. Women are more exposed to violence than men. Health care is abusiness where approximately 80 percent of the employees are women (Strand, 2020, pp. 27-28; Hydén, Överlien, Ericson, Wiman & Grönberg Eskel, 2016, pp. 3; SKR, 2016). Being exposed to domestic violence can have a negative impact on the ability to work (Skoog Waller, 2022). Jämställdhetsmyndigheten (2022) calls on employers to work actively to identify and prevent domestic violence among employees. The workplace can act as a haven for people exposed to domestic violence, highlighting the important function of the workplace (Katula, 2012). Hence, it is interesting to examine how first-line managers in municipal health and social care work with domestic violence. The purpose of the study is to increase knowledge about how first-line managers in municipal health and care work with domestic violence if the employee is exposed to violence. The study was carried out using a qualitative method, and the sample consisted of ten first-line managers in municipal care and social care operations from nine different municipalities in Sweden. Semi-structured interviews were conducted, and a qualitative content analysis was used to process the text. Based on the purpose of the study to increase knowledge about how first-line managers work and which factors can affect the way first-line managers work if employees are exposed to domestic violence. This is to be able to provide support to employees who are exposed to violence. Since it is working methods that are to be studied, it seems appropriate to interpret the content of the interviews using the concepts of Understanding, Willing and Knowing from Lundquist's (1992, pp. 75-77) implementation theory. These three concepts are a prerequisite for introducing working methods since the purpose of the study is to investigate the working methods of first-line managers. These concepts were used as interpretation support in the analysis work. The results showed that the leadership style is important in meeting with people who are exposed or have been exposed to threats and domestic violence. Furthermore, it emerged that nine out of ten managers lack routines regarding support for employees who are exposed to domestic violence. Some factors that appeared in the study were a fear of asking about domestic violence, a lack of knowledge, and insufficient resources. Another factor that appeared was that all participants have both a willingness and commitment to raise questions about threats and domestic violence in conversations with employees. The results show that the managers experienced a lack of knowledge and resources within the operations regarding the issue of domestic violence. The results of the study indicate that there are opportunities for improvement and that this issue should be a higher priority within the municipal health and care system.

I Sverige finns ett gemensamt mål att bedriva en god och lika vård på lika villkor för alla. Vård- och omsorgssektorn står inför stora framtida utmaningar utifrån kompetensförsörjningen för att kunna bedriva en god vård. För att attrahera och behålla arbetskraft är det av stor vikt att prioritera arbetsmiljöarbetet och stärka ledarskapet. Organisationens syn på ledarskap påverkar vilka chefer som rekryteras och förutsättningarna för hur ledarskap skapas och utvecklas. Förstalinje chefer inom vård och omsorg har komplexa uppdrag i jämförelse med chefer inom andra branscher med tanke på storlek på arbetsgrupper, uppdragsbeskrivning, ekonomiska utmaningar och sämre organisatoriskt stöd. Organisationerna inom vård- och omsorg har färdigställd värdegrund som en del av marknadsföringsfilosofi och från ledning önskad organisationskultur, medan arbetsplatser har utvecklat egna kulturer och normer vilket leder till att förstalinje chefer hamnar i svår position då dem ska balansera mellan dessa kulturer. Tidigare forskning har påvisat att hållbart ledarskap har stor vikt för både organisationen, arbetsplatsen och förstalinjens chefer. Syftet med studien var att med fokus på vård och omsorg, undersöka huruvida det ömsesidiga förhållandet mellan ledarskap, psykologisk trygghet, mångfald organisationskultur och arbetsplatskultur främjar ett hållbart ledarskap. Metoden som använts är kvalitativ metod, där sex förstalinje chefer från olika delar av vård- och omsorg intervjuats då målet var att undersöka deras upplevelser och erfarenheter för att få en ökad förståelse hur organisationskultur och arbetsplatskultur påverkar och påverkas av ledarskapet. Intervjuerna har analyserats och sammanfattats utifrån följande kategorier: organisationskultur, arbetsplatskultur, psykologisk trygghet samt ledarskap och hållbart ledarskap. Resultatet har påvisat en betydlig skillnad mellan organisationskulturen och arbetsplatskulturen samt deras påverkan på förstalinje chefer och dennes ledarskap. Vidare, har det påvisat att förstalinje chefer upplever att ledarskapet blir mindre hållbart utifrån organisationskultur, medan mer hållbart utifrån arbetsplatskultur. Förstalinje chefer arbetar i hög grad att implementera en hållbar arbetsplatskultur där de poängterar vikten av ett närvarande och tillitsbaserat ledarskap. / In Sweden, there is a collective goal of providing high-quality and equitable care on equal terms for all. The health and social care sector faces significant future challenges in the area of competence maintenance in order to be able to provide high-quality care. To attract and retain a workforce, it is of great importance to prioritize work environment management and strengthen leadership. An organization’s perspective on leadership impacts which managers are recruited and the conditions for how leadership is created and developed. Taking into consideration the size of work groups, mission statement, economic challenges and comparatively weak organizational support, first line managers within health and social care have complex assignments in comparison with managers in other sectors. Organizations within the health and social care sector have finalized values as a part of their marketing philosophy and the organizational culture desired by leadership, while workplaces have developed their own cultures and norms, which leads to first line managers being placed in the difficult position of balancing between these cultures. Previous research has demonstrated that sustainable leadership is of great importance for organizations, workplaces, and first line managers.    The purpose of this study was to, with a focus on health and social care, investigate to what extent the reciprocal relationship between leadership, psychological security, diverse organizational cultures and work cultures promotes sustainable leadership.   The method of this study is a qualitative one, based on interviews conducted with six first line managers from different areas within the health and social care sector, with the goal of investigating their experiences in order to gain an increased understanding of how organizational culture and workplace culture affect and are affected by leadership. We have analyzed and summarized these interviews in relation to the following categories: organizational culture, workplace culture, psychological security, leadership and sustainable leadership.   The results demonstrate a significant distinction between organizational culture and workplace culture, as well as their impact on first line managers and their leadership. Furthermore, they demonstrate that first line managers feel that leadership becomes less sustainable in relation to organizational culture, but more sustainable in relation to workplace culture. First line managers work extensively with the implementation of sustainable workplace cultures, where they stress the importance of a present and trustbased leadership.

Background: The landmark EXTREME trial established cisplatin, 5-fluorouracil and cetuximab (PFE) as first-line chemotherapy (1L-ChT) for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). We were interested in outcome differences of R/M HNSCC in 1L-ChT and factors influencing outcome in certain subgroups, especially patients receiving PFE, and the value of PFE compared to other 1L-ChT regimens to provide real world evidence (RWE). Methods: For this retrospective monocentric study, 124 R/M HNSCC patients without curative surgical or radiotherapy options receiving at least one cycle of 1L-ChT were eligible. We analyzed their outcome using Kaplan-Meier plot and Cox regression to identify predictors for prolonged survival. Results: Subgroups benefiting significantly from PFE were patients suffering from an index HNSCC outside the oropharynx. The PFE regimen proved to be superior to all other 1L-ChT regimens in clinical routine. Significant outcome differences between PFE treatment within or outside controlled trials were not seen. Conclusion: This retrospective analysis provides RWE for factors linked to improved outcome. Subgroup analyses highlight the lasting value of PFE among the growing spectrum of 1L-ChT. Importantly, fit smokers with high level alcohol consumption benefit from PFE; considering the patient’s lifestyle factors, PFE should not be ignored in decision-making.

Gehaltediens lei tot effektiwiteit in enige organisasie. Die meting hiervan behoort 'n prioriteit te wees, maar geskikte, gevalideerde, wetenskaplike meetinstrumente hiervoor bestaan nie. Die algemene doel van die navorsing was die validering van 'n gerekenariseerde simulasietegniek ("Business Principles Orientation") vir die meting van klientediensvaardighede. In die literatuuroorsig is klientediens gedefinieer en vyf dimensies van gehaltediens gei:dentifiseer. Deur empiriese navorsing is die gerekenariseerde simulasietegniek ("Business Principles Orientation") se meting van klientediensvaardighede bepaal, deur dit afte neem op 'n steekproef van 28 kassiere in 'n supermark. Hierdie instrument is gekorreleer met die Servqual-vraelys. Die resultate dui op 'n swak verband tussen die veranderlikes van die Servqual-vraelys en gerekenariseerde simulasietegniek. Hiervolgens is die gerekenariseerde simulasietegniek en die ontwikkelingsverslag wat dit verskaf, nie geldig in die meting van klientdiensvaardighede nie. Aanbevelings ten opsigte van die instrument se verdere verfyning en navorsing word geformuleer. / Quality service leads to effectiveness in any organisation. The measurement of effectiveness should be a priority, but suitable, valid and scientific measurement instruments for this purpose does not exist. The general aim of the research was the validation of a computerized simulation technique ("Business Principles Orientation") for the measurement of client service skills. In the literature survey, quality service was defined and five dimensions of quality service identified. In the empirical research the measurement of client service skills through the use of the computerized technique ("Business Priciples Orientation"), was determined by testing it on a sample of 28 cashiers from a supermarket. This instrument was correlated with the Servqual-questionaire. The results show little correlation between the variables of the Servqual questionaire and computerized simulation technique. In terms hereof the computerized simulation technique and development report that it provides, is not valid in the measurement of client care skills. Recommendations for further refinement and research pertaining to this instrument is formulated. / Industrial & Organisational Psychology / M.A. (Bedryfsielkunde)