Det ständigt ökande trycket på minskande utsläpp och effektivare energianvändning driver utvecklingen av Scanias produkter. För att varakonkurrenskraftiga på marknaden behöver man leverera lastbilar med högre kvalitet och lägre bränsleförbrukning, det vill säga sänka transportkostnaderna förkunden. Ett steg i detta är att utveckla komponenter i fordonet som är optimerade iförsta hand med avseende på hållfasthet men även mot vikt och pris. En betydande andel av lastbilens komponenter är plåtfästen som ofta underprioriteras i produktutvecklingen. Examensarbetet fokuserade därför på att utveckla metoder för konstruktion av plåtfästen. En metod för att förbättra konstruktionerna är att arbeta med simuleringsdriven konstruktion. Simuleringsdriven konstruktion innebär att man inför simuleringar tidigt i konstruktionsprocessen och låter dessa bestämma utformningen av komponenten. Simuleringarna kan bestå av FEM-beräkningar så som egenfrekvensanalys och frekvensresponsanalys. Genom att iterativt arbeta med simuleringsdriven konstruktion kan man erhålla kortare ledtider och lägre produktionskostnader samt robustare och lättare komponenter. Scania eftersträvar att simuleringsdriven konstruktion ska vara ett standardiserat arbetssätt för konstruktörer. Examensarbetet har resulterat i en metodbeskrivning för konstruktörer som fokuserar på ämnet simuleringsdriven konstruktion. Metodbeskrivningen innefattar stora delar av konstruktionsprocessen och beskriver metoder och integrerade verktyg i CATIA V5 som är nödvändiga för att arbeta med simuleringsdriven konstruktion. För att metodbeskrivningen skulle testas samt få en pedagogisk följd konstruerades ett plåtfäste till en laddluftrörsinstallation från ett verklighetsbaserat problem på Scania. Med hjälp av metodbeskrivningen erhölls ett optimerat plåtfäste med avseende på hållfasthet, vikt och pris. Iterationsprocessen för det optimerade plåtfästet presenteras i metodbeskrivningen. / The ever increasing pressure on reducing emissions and improving energy efficiency is driving the development of the products at Scania. To be competitive in the market the company needs to deliver trucks with higher quality and lower fuel consumption in order to reduce transportation costs for the customer. One step in this is to develop vehicle components that are optimized primarily for strength but also towards weight and price. A significant portion of the truck's components are sheet metal brackets and these are often not prioritized in the product development. This thesis focuses on developing methods for the design of sheet metal brackets. Simulation driven design is a method for improving the components. Simulationdriven design implies that simulations are introduced early in the design process and the simulations determine the design of the component. The simulations may consist of FEM calculations such as natural frequency analysis and frequency response analysis. By iteratively work with simulation driven design the company can achieve shorter lead times and lower production costs as well as lighter and more robust components. Scania strives to make simulation driven design as the standardized approach for designers. This thesis has resulted in a guideline for designers who focus on the subject simulation driven design. The guideline includes most parts of the construction process and discloses methods and integrated tools in CATIA V5 that are necessary when developing sheet metal brackets with simulation driven design. For testing as well as getting an educational structure for the guideline, a sheetmetal bracket from a reality-based problem was constructed. By using the guideline an optimized sheet metal bracket, in terms of strength, weight and price,was obtained. The iteration process of the optimized sheet metal bracket is presented in the guideline.

Guidelines focusing on web interface design allow for the dissemination of complex and multidisciplinary research to communities of practice. Motivated by the desire to better understand how research evidence canbe shared with the web design community, this dissertation investigates the role guidelines play in the design process, the attitudes designers hold regarding guidelines, and whether evidence based guidelines can be consistently interpreted by designers. Guidelines are a potential means to address the knowledge gap between research and practice, yet we do not have a clear understanding of the relationship between research evidence, guideline sets and web design practitioners. In order to better understand how design guidelines are used by designers in the practice of web interface design, four sequential studies were designed; the application of a guideline subset to a design project by 16 students, the assessment of ten health information websites by eight designers using a guideline subset, a web based survey of 116 designers, and interviews with 20 designers. The studies reveal that guideline use is dependent on the perceived trustworthiness of the guideline, its source and the alignment between guideline advice and designer experience. The first two studies found that guidelines are inconsistently interpreted. One third of the guidelines used in the second study were interpreted differently by participants, an inconsistency which represents a critical problem in guideline use. Findings showed no difference in the characteristics of guidelines which were consistently interpreted and those for which interpretation was the most inconsistent. Further, research evidence was not a factor in guideline use, less than half the designers are aware of evidence-based guideline sets, and guidelines are predominantly used as memory aids. Ultimately alternatives to guidelines, such as checklists or pattern libraries, may yield the best results in our efforts to share research knowledge with communities of practice.

Guidelines focusing on web interface design allow for the dissemination of complex and multidisciplinary research to communities of practice. Motivated by the desire to better understand how research evidence canbe shared with the web design community, this dissertation investigates the role guidelines play in the design process, the attitudes designers hold regarding guidelines, and whether evidence based guidelines can be consistently interpreted by designers. Guidelines are a potential means to address the knowledge gap between research and practice, yet we do not have a clear understanding of the relationship between research evidence, guideline sets and web design practitioners. In order to better understand how design guidelines are used by designers in the practice of web interface design, four sequential studies were designed; the application of a guideline subset to a design project by 16 students, the assessment of ten health information websites by eight designers using a guideline subset, a web based survey of 116 designers, and interviews with 20 designers. The studies reveal that guideline use is dependent on the perceived trustworthiness of the guideline, its source and the alignment between guideline advice and designer experience. The first two studies found that guidelines are inconsistently interpreted. One third of the guidelines used in the second study were interpreted differently by participants, an inconsistency which represents a critical problem in guideline use. Findings showed no difference in the characteristics of guidelines which were consistently interpreted and those for which interpretation was the most inconsistent. Further, research evidence was not a factor in guideline use, less than half the designers are aware of evidence-based guideline sets, and guidelines are predominantly used as memory aids. Ultimately alternatives to guidelines, such as checklists or pattern libraries, may yield the best results in our efforts to share research knowledge with communities of practice.

Background: Clinical practice guidelines are a common and efficient approach to facilitate the transfer and use of scientific evidence into clinical practice. However, despite the increasing body of evidence about relevant differences between women and men for healthcare, differences are only rarely explicitly and systematically addressed in guidelines. This suggests that at some point of the guideline development process the integration of sex/gender factors into clinical practice guidelines gets impeded. The study aimed at evaluating the consideration given to sex/gender factors in guideline method reports and their current uptake in guidelines, using the example of National Disease Management Guidelines (NDMG) in Germany. Furthermore, the study was directed at identifying barriers and facilitators for the systematic consideration and integration of sex/gender differences in the guideline development process to finally formulate recommendations for the development of sex/gender sensitive guidelines. Methods: Through document analyses of NDMG program method reports and guidelines the current uptake and the representation of sex/gender differences were assessed. Furthermore, barriers and facilitators for the development of sex/gender sensitive guidelines were identified and supporting measures discussed by means of semi-structured interviews with twelve guideline developers (f = 66.7%). The interview data was analyzed using qualitative content structuring methods according to Mayring. To assure a theoretically sound analysis of the interview data, a theoretical framework model was developed based on existing literature. The pre-determined categories were open for adjustment and alterations during the whole analysis. Results: The evaluation of the current representation of sex/gender revealed that generally sex/gender factors are seldom stated in the method report of the NDMG program and accordingly also in the evaluated guidelines. An underrepresentation of women was found in most of the guideline development groups and little attention was paid to sex/gender factors during the formulation of key questions, the definition of the target population, the literature searches, and the evidence appraisal. On average only 6.5% of the recommendations in the identified guidelines referred to sex/gender differences. The statements in the interviews on barriers and facilitators were allocated to the main categories Innovation, Individual/Professional, Social, Organizational, and Political Context and summarized in ten subcategories. The identified barriers mainly addressed the increasing complexity of guidelines, the lack of availability and quality of sex/gender sensitive evidence, and the shortage of resources. Furthermore, barriers were identified in an individual/professional context, such as deficiencies in awareness/knowledge about relevant sex/gender differences. The results of facilitating factors showed that experts see the support of policies and standards from guideline organizations as facilitating factors for the consideration of sex/gender factors in guideline development. In this context, the experts emphasized the need for specific measures and tools for successful implementation. To begin to address the described challenges, supporting measures were discussed with the experts, e.g., focus groups and sex/gender sensitive search strategies. Based on the results of the present study fifteen recommendations for the development of sex/gender sensitive guidelines were formulated. Conclusion: The development of sex/gender sensitive guidelines will contribute to the transfer of sex/gender sensitive evidence into clinical practice, thereby supporting the prevention of inadequate and inappropriate treatment and the improvement of health outcomes for both women and men. The recommendations developed in the present study can be taken as a first step to enhance the identified facilitators and diminish the barriers. The objective of the formulated recommendations is not to replace existing standards or checklists, but instead to supplement and complete existing structures of guideline developing organizations. Yet, to achieve optimal healthcare for women and men further research and interventions are needed to reach consideration of sex/gender factors in all areas of healthcare, including basic and clinical research, knowledge transition, and medical education and training, to have a positive effect on healthcare practice.

This work consists in proposing a methodology to improve automated evaluation of the ergonomic quality of web sites (with special focus on usability and accessibility) by static analysis of HTML code of their pages using the evaluation technique called guideline review. This methodology will be articulated around: - A framework that defines a systematic and consistent way for structuring guidelines in order to enable their automatic evaluation; - A guideline definition language (GDL) able to express guideline information in a sufficiently rich manner to enable an evaluation engine to perform automated evaluation of any GDL-compliant guideline; - Tools to support the proposed methodology. The tools are (1) a structuring tool (editor) to enable the specification and manipulation of guidelines structures (structured following the framework and expressed in a GDL-compliant form) and (2) an evaluation tool which uses the guidelines to conduct the evaluation of Web sites.

Background: Healthcare-associated pneumonia (HCAP) guidelines were first proposed in 2005 but have not yet been validated. The objective of this study was to compare 30-day mortality and length of stay (LOS) in HCAP patients treated with either guideline-concordant HCAP (GC-HCAP) therapy or guideline-concordant community-acquired pneumonia (GC-CAP) therapy. Methods: We performed a retrospective cohort study of >150 hospitals in the Veterans Health Administration. Patients were included if they had ≥1 HCAP risk factor and received antibiotic therapy within 48 hours of admission. Patients were excluded if they received ICU care, had cardiovascular or respiratory organ failure, or received invasive mechanical ventilation and/or vasopressors. We determined independent risk factors for 30-day mortality with a multivariable logistic regression model including baseline characteristics, individual HCAP risk factors, comorbidities, and organ failure as dichotomous covariates. Propensity scores were calculated for the probability to receive GC-HCAP therapy and incorporated into a second logistic regression model. Results: A total of 15,071 patients met study criteria and received GC-HCAP therapy (8.0%), GC-CAP therapy (75.7%), or non-guideline-concordant therapy (16.3%). GC-HCAP patients were more likely to have neoplastic disease; whereas, GC-CAP patients had a higher prevalence of other comorbidities, tobacco use, and recent medication use. In multivariable regression, recent hospital admission (OR 2.47, 95% CI 2.10-2.91) and GC-HCAP therapy (2.13, 1.82-2.48) were the strongest predictors of 30-day mortality. Hematologic organ failure, non-invasive mechanical ventilation, neoplastic disease, renal organ failure, and cerebrovascular disease were also independent risk factors. Use of cardiovascular medications, inhaled corticosteroids, and tobacco were protective. GC-HCAP therapy continued to be an independent risk factor for 30-day mortality (OR 2.12, 95% CI 1.82-2.48) in the propensity score analysis. Conclusions: GC-HCAP therapy is not associated with improved survival in HCAP patients. / text

Background: Moving the latest evidence from research into nursing practice remains a challenge. We are only beginning to recognize the processes involved and little is known as to which approaches are effective in different contexts. Facilitation is an intervention that involves helping practitioners recognize what it is they need to change in practice and how to make these changes to incorporate evidence into practice. Objective: To describe the role, function, and practice of facilitation in moving evidence into nursing practice. A secondary element is to determine if a provisional facilitation framework, developed to reflect the concept in guideline adaptation and the early stages of implementation, accurately depicts facilitation in the context of actual implementation. Methods: The thesis employs an emergent mixed-methods design and is composed of two phases each with multiple components. The first phase explores the conceptual, theoretical, and experiential foundations of facilitation and examines: (1) how the concept has evolved over 16 years in a comprehensive literature review, (2) facilitation as described by experienced nurses in guideline implementation, and (3) how facilitation relates to other guideline implementation interventions in a review of studies included in an existing systematic review. The second phase describes the practical foundations of facilitation and follows the facilitation occurring naturally over time in a guideline implementation involving front-line nurses at the point of care. Results: The comprehensive review provides a description of how facilitation has evolved and presents a current synopsis of the state of knowledge regarding facilitation. The conceptual, theoretical, and empirical understandings of the concept were integrated with the practical foundations to confirm and refine the framework to reflect facilitation across the continuum from guideline adaptation to implementation. The revised framework is displayed and represents a comprehensive view and understanding of facilitation of evidence-based practice in nursing from multiple perspectives. Conclusions: The detail in the revised framework provides a useful guide for practitioners and organizations in planning for change. Further testing is required to determine its applicability and usability in the practice setting. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-09-29 23:34:20.869

Introduction and Rationale: Concussions account for the majority of traumatic brain injuries in children. Currently there more than 500,000 pediatric concussions per year and that number is likely low due to under-reporting (Rose, Weber, Collen,& Heyer, 2015). Most symptoms of concussion are easily recognized to the trained pediatric primary care provider. Yet, symptom management and recommendations for rest, exercise, specialty care referral, and return to normal activities can be challenging for many providers, due to the lack of evidence and lack of formal recommendations by any organization (Rose et al., 2015; Silverberg & Iverson, 2013). Purpose and Objective: The main purpose of this Doctor of Nursing Practice (DNP) project is to develop evidence-based clinical practice guidelines (CPG) for pediatric primary care providers. The objective is to provide a CPG that offers clinical guidance when managing pediatric concussion patients in the primary care setting. This CPG will also provide clarity for pediatric primary care providers (PCP) when determining what options are available in treatment for pediatric concussions. Methods: The working framework of this project was The Appraisal of Guidelines for Research & Evaluation II (AGREE II). The American Academy of Pediatrics (AAP) procedure for reporting clinical guidelines, in the form of key action statements, was used as the model for development of the CPG. Results: The CPG was appraised using the AGREE II instrument, which provides valid and reliable scores and data used in the evaluation of CPG's. Six domains were evaluated, and the CPG yielded scores above 80% for all categories. The overall standard deviation was 0, which indicts a very low level of discrepancy between users of the instrument. Conclusion: This DNP project addresses an evidence and primary care practice gap. With a large number of pediatric concussions, a consistent management approach will ensure a safe and therapeutic recovery. A CPG was developed and evaluated using the AGREE II instrument. The CPG was found to meet the standards for general recommended use in pediatric primary care.

Faculty of Health Sciences School of Pharmacy 0107750d VANNIEKERKD@mweb.co.za / The prescription habits of general practitioners are continually under the scrutiny of ethical critics. There are numerous factors that influence a practitioner’s decision as to which antihypertensive agents to prescribe for the treatment of hypertension. As outlined in various international and national guidelines for the management of hypertension, the recommended treatment depends on ethnicity, current life-style, diet, smoking, age, gender, family history and possible underlying or secondary conditions such as diabetes mellitus, heart failure, isolated systolic hypertension, myocardial infarction, pregnancy, and evidence of coronary artery disease (CAD), stroke or peripheral vascular disease. Currently the control of blood pressure in patients with hypertension is far from optimal with over 70% of hypertensive patients being reported as having imperfect control. A number of factors related to the patient, the practitioner or the medication may explain the high incidence of inadequate blood pressure control. One possible explanation for the poor control of blood pressure may be that practitioners fail to comply with the guidelines. Hence the aim of my study was firstly to determine whether a practitioner’s decision as to which medication to prescribe in the treatment of hypertension is influenced by the Southern African Hypertension Society Guidelines. Secondly, in an attempt to assess the validity of the results of the primary analysis, the actual prescription habits (MediCross® database) were assessed and compared to the general practitioner’s recall of their prescription habits. Questionnaires were distributed to 320 MediCross® practitioners and prescription habits were identified and substantiated by the screening of an existing MediCross® database. I chose as my sample MediCross® general practitioners, as they are demographically representative of all major urban areas in South Africa; likely to be open-minded to supporting research and answering questionnaires (as MediCross® is part of a Clinical Research Site Management Organisation); and I had access to the database of the prescriptions made by MediCross® practitioners hence enabling me to fulfil my second objective. However, it must be kept in mind that these practitioners are representative of general practitioners in urban areas only (as the title of my research report indicates). My results show that 33.1% adhere to the guidelines (when a non-conservative definition of diuretics is used); 27% have heard of the guidelines and have a copy of them. When asked to give their own opinion however, 39% thought they adhered to the guidelines. The results also show that ACE inhibitors are the most commonly prescribed drug class for uncomplicated hypertension but a comparison to a MediCross® database, of which the quality is questionable, does not support this. As the response rate to the questionnaires was only 24.7%, these results are only a pilot study; however they suggest that few general practitioners use the guidelines or even have a copy of the guidelines. This pilot study suggests that the guidelines need to be distributed more widely. Furthermore the general practitioners that responded to the questionnaire indicated that the management of hypertension is difficult in that there is no single treatment regimen appropriate for all populations and each different patient. It was also their view that clinical guidelines for the management of hypertension should more accurately reflect the uncertainty of when to initiate treatment and individual variation if they are going to take these guidelines seriously and comply with them.

Childhood obesity is a national problem in the United States and has known implications as a potential cause of chronic illnesses as the child transitions into adulthood. A primary care clinic in the southwestern United States had a high percentage of obese Hispanic children within its population; therefore, the nurses and the pediatrician needed an evidence-based clinical practice guideline (CPG) to manage Hispanic children with a body mass index greater than the 95th percentile for their age. The purpose of the project was to develop a culturally competent CPG to manage childhood obesity in this primary care practice. The social cognitive theory provided the framework to develop the CPG. The final project resulted in an evidence-based CPG that was validated by an expert physician panel. The implication of this project is that nurses and providers can provide culturally competent education to the parent and child to reduce obesity among the pediatric Hispanic population. This project may create positive social change by modifying unhealthy cultural practices and behaviors, preventing chronic diseases, and reducing health care costs for the children within the selected practice.