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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.

Bakgrund: Antalet personer med multisjuklighet och polyfarmaci ökar i samhället. Läkemedelsrelaterade vårdskador och problem är vanligt förekommande i vården och polyfarmaci ökar risken. Läkemedelsgenomgångar är viktiga för att främja en säker läkemedelsanvändning och förebygga vårdskador. WHO beskriver läkemedelsgenomgångar som ett interprofessionellt teamarbete där ansvaret är delat mellan yrkesutövarna. Sjuksköterskor beskrivs kunna ha en egen och viktig roll i arbetet med läkemedelsgenomgångar. Syfte: Syftet med denna systematiska litteraturgranskning är att belysa sjuksköterskors erfarenheter av att utföra läkemedelsgenomgångar.  Metod: Studien är en systematisk litteraturgranskning och bygger på 16 kvalitativa vetenskapliga artiklar. Datainsamlingen genomfördes genom strukturerade databassökningar i Cinahl, Pubmed och Web of Science. Dataanalysen genomfördes enligt tematisk syntes av Thomas & Harden. Tillförlitligheten av sammanvägningen bedömdes enligt CERQual. Resultat: Två tredje nivå teman utgör resultatet med underliggande andra nivå teman. Utmaningar och brister vid läkemedelsgenomgångar: resursbrister vid genomförande av läkemedelsgenomgångar, brist på kompetens hos sjuksköterskor vid genomförande av läkemedelsgenomgångar, utmaningar i det professionella samarbetet vid läkemedelsgenomgångar, utmaningar vid läkemedelsgenomgångar i vårdens övergångar, organisatoriska utmaningar och brister vid läkemedelsgenomgångar, bristande delaktighet och kunskap hos patienter vid läkemedelsgenomgångar. Underlättande faktorer vid läkemedelsgenomgångar: fördelar med samarbete vid läkemedelsgenomgångar samt fördelaktiga utfall och gynnsamma faktorer vid läkemedelsgenomgångar.   Konklusion: Förekomsten av utmaningar och fördelaktiga utfall vid läkemedelsgenomgångar bland sjuksköterskors erfarenheter belyser behovet av patientens delaktighet, kompetensutvecklingen hos sjuksköterskor och att utveckla riktlinjer och den organisatoriska strukturen kring arbetet med läkemedelsgenomgångar. Genom att studera sjuksköterskors bidragande roll vid läkemedelsgenomgångar kan sjuksköterskans roll i arbetet formaliseras. / Background: The number of people living with multimorbidity and polypharmacy increases in society. Drug-related health care misses and problems are common and the risk increases with polypharmacy. Medication reviews are important to facilitate safe drug use and to prevent medical errors. WHO describes medication reviews as a multiprofessional teamwork where response is shared between the professionals. Nurses are described to be able to have their own important role within the work of medication reviews.    Aim: The aim of this systematic literature review is to illustrate nurses experiences of performing medication reviews. Method: The study is a systematic literature review and is constructed of 16 qualitative scientific articles. Data collection was made through structured database searches in Cinahl, Pubmed and Web of Science. For the data analysis a thematic synthesis of Thomas and Harden was performed. To evaluate the confidence in the evidence CERQual was performed. Result: Two third level themes constitute the result with underlying second level themes. Barriers and deficits in medication reviews: resource shortages while performing medication reviews, lack of competence among nurses performing medication reviews, barriers within the interprofessional teamwork while performing medication reviews, barriers in medication reviews at care transitions, organizational barriers and deficits in medication reviews and lack of participation and knowledge in patintens while performing medication reviews. Facilitators in medication reviews: apportioning with teamwork in medication reviews and facilitating outcomes and factors of medication reviews.   Conclusion: The presence of challenges and beneficial outcomes in medication reviews among nurses' experiences highlights the need for patient involvement, the development of nurses' skills, and the development of guidelines and the organizational structure around the work of medication reviews. By studying the contributing role of nurses in medication reviews, the role of the nurse can be clarified and formalized.

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.

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Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 274-292).

Magister Curationis - MCur / Background and Problem Statement: Maternal mortality is a global health issue, which mostly affects the developing countries. The United Nations (UN) member states have made a commitment to reduce maternal mortality by 75% by 2015. However, one of the biggest challenges in monitoring maternal deaths in Sub-Sahara Africa including Ghana, is the lack of adequate information for the accurate estimation of the maternal mortality rate (MMRate), and to identify causes of death. The World Health Organization (WHO) developed strategies and guidelines to assist countries to generate accurate information regarding maternal deaths. Maternal death review is one such strategy that was implemented in Ghana. Midwives are among the health workers who participate in the implementation of this strategy in different health facilities.However, what is not well understood is the role that midwives play in the implementation of Maternal Death Review (MDR).The purpose of the study: To explore and describe the roles that midwives play in the implementation of MDR in selected health facilities in Ghana‟s Ashanti Region.Methodology: A qualitative descriptive design was used to guide the research.Purposive sampling was conducted to select midwives who have been involved in maternal death review from the teaching, regional and district referral hospitals. Data was collected by conducting semi-structured individual interviews. Data saturation was reached after twenty interviews. Thematic Content Analysis was used to manage and analyse data. The Facility-based maternal death review model was used to assist the researcher to identify and organize the emerged themes. Ethical clearance was obtained from the University, as well as approval from the management of the health facilities prior to approaching the informants.Main findings: The results of this study indicate that midwives in Ghana‟s Ashanti Region are undertaking various activities and duties in all the stages of the Facilitybased maternal review model. The type of activities and duties undertaken by midwives varied according to their seniority and the level of the health facilities.Conclusion and recommendation: The findings of this study bring insight into the roles played by midwives in the implementation of the Facility-based maternal death review process in the health facilities in Ghana‟s Ashanti Region. These findings have a direct implication for the training and education of midwives. It is recommended that issues related to maternal death review methods and processes be included in the formal and continuing training and education of midwives. However, further research considering the training and practice development needs of midwives in respect of implementation of maternal death review is required.

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Code review is a recurring activity at software companies where the source code, orparts of it, undergoes an inspection where the aim is to detect possible errors beforethe code is released for production. A variation of code review that is common today iscalled modern code review and is more lightweight practise than formal code review. Inmodern code review, the developers participate and continuously revise their colleagues’code.At a financial technology company in Stockholm, modern code review is applied. Thecompany has expressed a need to implement a tool that can facilitate the code reviewprocess. One suggestion from the company was to implement high-level conceptual codereview (HCCR), an idea of a tool where code changes are sorted automatically intodifferent commits with a specific message.In order to implement the tool, HCCR needs to be defined and concretised since it haspreviously existed solely as an idea. As a first step of the project, developers’ view ofwhat information is desirable in a commit needed to be examined. The project addressedthe following research questions: What information is desirable and needed by the developers of a medium-sizedcompany, to help them do code reviews in a pull-based environment?– What should the information consist of?– How should the information be presented?To answer these questions, interviews were conducted with software developers at thecompany, together with observations where the developers had to try out a first iterationof HCCR. The first iteration was developed using the company’s guidelines on howdevelopers contribute to code changes together with our company supervisor’s viewson how the tool can work. The interviews were recorded and transcribed, whereafteriia thematic analysis was applied. From the analysis, 13 concepts emerged, which weredivided into five categories. The developers wanted the commits to be atomic, compilableand testable in order to facilitate debugging. The developers also expressed a need toget clear information about both pull-requests (PRs) and commit messages. In theinterviews, a theme emerged that the messages should consist of: what has changed andwhy it has changed. Differences were also observed in the code review process as differentdevelopers use different strategies when reviewing code.Based on the information that emerged from the interviews and observations along withprevious research, a second iteration of HCCR was prepared. The report concludes bydiscussing possible implementations of the tool. / Kodgranskning är en vanligt förekommande aktivitet hos mjukvaruföretag där källkoden,eller delar av den, genomgår en granskning för att upptäcka möjliga fel innan kodensläpps till produktion. En variation av kodgranskning som är vanlig idag kallas modernkodgranskning och är en mindre formell kodgranskning där utvecklarna själva är medoch kontinuerligt reviderar sina kollegors kod.Ett finansiellt teknikbolag i Stockholm tillämpar modern kodgranskning. Företagethar uttryckt ett behov av att implementera ett verktyg som kan underlättakodgranskningsprocessen. Ett förslag från företaget var att implementera HCCR, enidé om ett verktyg där kodändringar automatiskt sorteras till olika, så kallade, commits1med ett specifikt meddelande.För att implementera verktyget behöver HCCR definieras och konkretiseras. Som ettförsta steg i projektet behövde vi undersöka utvecklarnas önskvärda information av huren commit bör utformas. Projektet behandlar följande forskningsfrågor: Vilken information är önskvärd och behövs av utvecklarna på ett medelstort företag,för att hjälpa dem att göra kodgranskningar i en pull-based miljö?– Vad ska informationen bestå av?– Hur skall informationen presenteras?För att svara på frågorna gjordes intervjuer med mjukvaruutvecklarna på företagettillsammans med observationer där utvecklarna fick prova på en första iteration avHCCR. Den första iterationen togs fram genom att använda företagets riktlinjer gällandehur utvecklare bidrar med kodändringar tillsammans med åsikter från handledaren påföretaget om hur verktyget kan fungera. Intervjuerna spelades in och transkriberades1När det kommer till ord och uttryck inom Git, (exempelvis commits, pull-request, push, pull) finnsdet ingen standardiserad översättning till svenska. Därför kommer dessa ord skrivas på engelska isammanfattningen.ivvarpå en tematisk analys genomfördes. Från analysen framträdde 13 koncept kringkodgranskning vilka delades in i fem kategorier. Utvecklarna önskade att varje commitskulle vara atomisk, kompilerbar samt testbar för att underlätta felsökning av buggar.Utvecklarna uttryckte också ett behov av att få tydlig information om både PR ochcommit-meddelanden. I intervjuerna framkom det att meddelandena borde bestå av:vad som har ändrats och varför det har ändrats. Det observerades även skillnader ikodgranskningsprocessen då olika utvecklare använder olika strategier när de granskarkod.Baserat på den information som framträdde från intervjuerna och observationernatillsammans med tidigare forskning utarbetades en andra iteration av HCCR. Rapportenavslutas med att diskutera möjliga implementationer av verktyget.