A medical procedure is a threatening and stressful experience for many children. The consequent increased feelings of anxiety in hospitalized children can negatively affect their healing process, their psychological health, and their behavioural, cognitive, emotional and academic development. To limit these negative results, knowledge about interventions that could contribute to a decrease in anxiety in hospitalized children is needed. The aim of this review was to examine interventions aiming at reducing anxiety in hospitalized children that undergo a medical procedure. A systematic literature was conducted in three databases that has resulted in 10 articles that met the inclusion criteria. The 10 selected articles included a total of 11 interventions for this review. The results showed that the intervention technique Distraction was effective in reducing anxiety for most hospitalized children. The intervention technique Information provision showed both significance and non-significance and the intervention techniques Medication and Modelling showed a non-significant change in anxiety. Besides, an active distraction form and a longer duration of the intervention might contribute to the effectiveness in reducing the hospitalized child’s anxiety level. Future research needs to focus on the anxiety level of both children and their parents, in addition to the upcoming intervention use of multimedia applications. Furthermore, the characteristics of the hospitalized child and the collaboration with the child and parents should be taken into account before applying interventions aiming at reducing anxiety in hospitalized children.

Bakgrund: Det framkommer centrala aspekter vid omvårdnaden av patienter som skadar sig själva som i sin tur ställer krav på vårdpersonalens förmåga att förhålla sig till mötet med dessa patienter. Syfte: Syftet med litteraturstudien var att belysa psykiatrisk vårdpersonals upplevelser i mötet med patienter som skadar sig själva. Metod: En systematisk litteraturstudie baserad på Evans analysmetod och resultatet grundar sig på 22 artiklar av kvalitativ ansats. Resultat: Vårdpersonalens möten med patienter som skadar sig själva redovisas sex teman; Att utmanas av negativa känslor, Att stänga av sin empatiska förmåga, Att vara osäker på vad som komma skall, En svår balansgång, Ett gynnsamt möte och Professionell utveckling. Slutsats: Resultatet visade på att vårdpersonal i psykiatrisk vård har att hantera flera negativa känslor i sina möten med patienter som skadar sig själva. Kontinuerlig fortbildning och handledning framstår som nödvändiga förutsättningar för att möjliggöra gynnsamma möten med patientgruppen. / Background: It appears to be central aspects regarding the care of patients who self-harm and these aspects set requirements on psychiatric health care personnel's ability to relate to the meeting with the patients. Aim: To illustrate psychiatric health care personnel's experiences of meeting with patients who self-harm. Method: A systematic literature review based on a method described by Evans with a result based on 22 articles of qualitative design. Result: To meet patients who self-harm can be seen out of the six themes described in the result of the present study; To be challenged by negative emotions, To disconnect from your empathic ability, To be unsure of what´s to come, A difficult balancing act, A favorably meeting and Professional development. Conclusion: The result of the present study shows that the negative emotions were prominent. Continuous further training and tutorial appears necessary conditions to enable favorable meetings with the patient group.

Bakgrund: Att genomgå hjärtkirurgi kan rädda en patients liv men det kan även leda till en ökad risk att drabbas av en komplikation som postoperativt delirium. Delirium är inte ett sjukdomstillstånd utan ett tillstånd av mental förvirring som påverkar patientens uppmärksamhet, medvetenhet och kognitiva förmåga. Postoperativt delirium kan leda till många negativa konsekvenser vilket kan medföra lidande för patienten. Vården ska ha som mål att lindra patientens lidande genom att se till hela patienten i den vårdande relationen, det är det som är kärnan i vårdvetenskap. Forskning har visat att det är viktigt för patientens postoperativa återhämtning att tidigt kunna upptäcka och förebygga postoperativt delirium. Det har framkommit att intensivvårdssjuksköterskor behöver ha ökad förståelse och kunskap om ämnet för att kunna upptäcka och förebygga postoperativt delirium efter hjärtkirurgi. Syfte: Syftet med studien är att identifiera riskfaktorer som kan påverka utvecklingen av postoperativt delirium bland intensivvårdspatienter efter hjärtkirurgi. Metod: En systematisk litteraturstudie där kvantitativa artiklar har analyserats efter Bettany-Saltikov och McSherry (2016) analysmetod. Resultat: Analysen resulterade i fyra kategorier: Patientens bakgrund, Tiden i hjärt-lungmaskin, Längden av respiratorbehandling samt Komplikationer till följd av hjärtkirurgi som är riskfaktorer som visade sig påverka utvecklingen av postoperativt delirium. Slutsats: Den samlade kunskapen som föreliggande studie har givit kan ligga till grund för intensivvårdssjuksköterskor i vården av patienter med postoperativt delirium. Intensivvårdssjuksköterskor ska ha med sig i den vårdande relationen att patientens situation är komplex och att det de utsätts för kan bidra till ökat lidande för patienten. Mer forskning behövs kring riskfaktorer för postoperativt delirium och hur den mentala förvirringen påverkar patienten och dess anhöriga. / Background: Heart surgery can save a patient's life but can also lead to an increased risk of suffering from a complication such as postoperative delirium. Delirium is not an illness but a state of mental confusion that affects the patient's attention, awareness and cognitive ability. Postoperative delirium can lead to many negative consequences which can cause patient suffering. Nursing care has aimed to alleviate a patient's suffering by seeing the entire patient in the caring relationship. This is the core in nursing science. Research has shown that it is important for the patient's postoperative recovery to be able to detect and prevent postoperative delirium in an early stage. It has appeared that intensive care nurses need more education and knowledge in this area in order to be able to detect and prevent postoperative delirium after heart surgery. Aim: The aim of the study is to identify risk factors that are associated with the development of postoperative delirium after heart surgery within patients in the intensive care unit. Method: A systematic literature review that analyzed quantitative articles according to a method of analysis by Bettany-Saltikov and McSherry (2016). Result: Four categories emerged from the analysis: Patients background, length of mechanical ventilation, Heart- and lung machine duration and Complications after heart surgery that were risk factors which affected the development of postoperative delirium. Conclusion: The overall knowledge that the study has provided can form a basis for intensive care nurses in the care of patients with postoperative delirium. Further research is needed on risk factors for postoperative delirium and how the mental confusion affects both the patient and relatives. More research is also needed about how postoperative delirium can be prevented.

A utilização de uma gestão de portfólio de projetos permite que as empresas possam se adaptar rapidamente frente as turbulências advindas do ambiente interno e externo e com isso, possam rearranjar os projetos para que estes estejam alinhados com estratégia da organização. Entretanto, o modelo tradicional de gerenciamento de portfólio possui procedimentos que não seguem necessariamente essa característica de agilidade e adaptação. Na maioria das vezes os procedimentos são pouco visíveis, extensos e poucas vezes são interativos ou divulgados por todos os níveis hierárquicos das organizações. Dessa maneira o propósito deste trabalho é a aplicação de práticas, métodos e ferramentas ágeis na gestão de portfólio de projetos. Para isto, foi realizada uma revisão sistemática da literatura, a análise crítica do modelo tradicional por 7 especialistas da área e desenvolvimento de um modelo com base na análise das respostas das entrevistas por três especialistas sendo 2 da área acadêmica e 1 profissional da área. Os principais resultados revelam, que a existe uma escassez de trabalhos referentes a utilização de ferramentas ágeis em gestão de portfólio de projetos e na percepção dos entrevistados, a aplicação de práticas, métodos e ferramentas ágeis atende o quesito de gestão visual, melhor interação entre as equipes de trabalho, democratização da informação relativa à tomada de decisão e ferramentas alinhadas com a proposição ágil. / The use of project portfolio management allows companies to adapt quickly to the turbulence arising from the internal and external environment and with that, can rearrange the projects so that they are aligned with the organization's strategy. However, the traditional portfolio management model has procedures that do not necessarily follow this characteristic of agility and adaptation. Most of the time the procedures are barely visible, extensive and are rarely interactive or disseminated by all hierarchical levels of organizations. In this way, the purpose of this work is the incorporation of agile practices, methods and tools in project portfolio management. For this, a systematic review of the literature, the critical analysis of the traditional model by 7 specialists of the area and the development of a model based on the analysis of the answers of the interviews by three specialists were carried out, being 2 of the academic area and 1 professional of the area. The main results show that there is a shortage of work related to the use of agile tools in project portfolio management and the perception of the interviewees, the incorporation of agile practices, methods and tools attends to the question of visual management, better interaction between work teams, democratization of decision-making information and tools aligned with the agile proposition.

Bakgrund: Bristande kommunikation mellan vårdpersonal är en av de vanligaste orsakerna till de skador och avvikelserapporter som årligen uppstår inom hälso- och sjukvården. Vid ett överrapporteringstillfälle finns risk att information missförstås eller att information inte överlämnas vilket därmed kan äventyra patientsäkerheten och en god vård. Eftersom användandet av kommunikationsverktyg förespråkas fanns det skäl att beskriva betydelsen av kommunikationsverktyg vid överrapportering. Syfte: Syftet var att beskriva betydelsen av att använda kommunikationsverktyg vid överrapportering från anestesipersonal till postoperativ avdelning. Metod: En systematisk litteraturstudie med kvantitativ ansats användes. Sökningarna genomfördes i två vetenskapliga databaser, Cinahl och Pubmed. Totalt elva artiklar identifierades och data extraherades genom en dataextraktionsmall. Resultat: Resultatet sammanfattas i tre kategorier; förändrad tid för överrapportering, minskad informationsförlust och förändringar i teamet. Genom användandet av kommunikationsverktyg ökade eller minskade tiden för överrapportering. Informationsförlusten minskade då det blev minskat antal fel, lättare att komma ihåg detaljer samt antalet mellanhänder minskade. Förändringar i teamet kunde ses utifrån att användandet av kommunikationsverktyg skapade förutsättningar för ett förbättrat samarbete i teamet samtidigt som det fanns en del svårigheter med rutinförändringar i samband med introduktionen av ett kommunikationsverktyg. Slutsats: Resultatet visar på flertalet fördelar med användandet av kommunikationsverktyg men även utmaningar i det. Vidare forskning inom området behövs för att utvärdera kommunikationsverktygets inverkan på patientens säkerhet. / Background: Lack of communication between healthcare professionals is one of the most common causes of the injuries and deviation reports that occur annually in the healthcare system. In the event of a handover, there is a risk that information will be misunderstood or that information will not be submitted, which may compromise patient safety. Because the use of communication tools is advocated, there was reason to describe the importance of communication tools in handover. Purpose: The purpose was to describe the importance of using communication tools in handover from anesthetic staff to post-operative department. Methods: A systematic literature review with quantitative approach was used. Searches were conducted in Cinahl and Pubmed. A total of eleven articles were identified and data extracted by an extraction template. Results: The result is summarized in three categories; changed time for over-reporting, reduced information loss and changes in the team. The use of communication tools increased or decreased the time for over-reporting. The information loss decreased as the number of errors decreased, the details were easier to remember and the number of intermediaries decreased. Changes in the team could be seen from the view that the use of communication tools created the conditions for improved collaboration in the team, while there were some difficulties with routine changes in connection with the introduction of a communication tool. Conclusion: The result shows the many advantages of using communication tools but also challenges in it. Further research in the field is needed to evaluate the impact of the communication tool on the patient's safety.

Bakgrund: Idag utförs åtskilliga pediatriska operationer – i Sverige opererades omkring 90 000 barn mellan noll till fjorton år 2017. Att sövas och opereras är förmodligen bland det mest oroväckande ett barn kan vara med om inom sjukvården. Oro påträffas hos 50-75% av de barn som ska genomgå operation. Oro kan bland annat försvåra anestesin, ge ökat medicinskt behov och orsaka postoperativa komplikationer. Syfte: Syftet var att genom en systematisk litteraturstudie belysa strategier som förebygger och reducerar barns perioperativa oro. Metod: Systematisk litteraturstudie med kvantitativ ansats. Barn två till tolv år som skagenomgå eller har genomgått anestesi och operation. Artikelsökningar genomfördes i tre, för ämnesområdet, relevanta databaser. Resultat: Studien omfattar 25 resultatartiklar som visar på varierande strategier för att hantera barns perioperativa oro. Fem av dessa visade inte på någon överlägsen ororeducerande effekt i jämförelse med sedvanliga eller jämförande strategier. Information och distraktion utkristalliserades som huvudkategorier med tillhörande underkategorier. Multimedia var en framträdande underkategori som innefattade flera olika strategier. Några utstickande strategier var bland annat doftande inhalationsmasker och teaterframträdanden. Slutsats: Studien påvisar att det finns en variation i hur oro kan hanteras för att förebyggas och reduceras inom den pediatriska perioperativa vården. Strategierna inom underkategorin multimedia ter sig i denna studie mer framträdande vilket kan tyda på att de förekommer i större utsträckning inom denna vårdform. Det tydliggjordes dock att det inte finns en enda enskild strategi som anses vara vedertagen eller överlägsen andra. En icke-farmakologisk strategi skulle kunna föredras då den kan anses vara ett säkert, icke-invasivt och således behagligt alternativ till sedvanliga farmakologiska strategier såsom premedicinering. / Background: Today numerous paediatric surgeries are performed – In Sweden, 2017, approximately 90 000 children from zero to fourteen years of age underwent surgery/were operated on. To receive anaesthesia and have an operation is probably among the most disturbing and stressful a child can experience. Anxiety is found in 50-75% of children undergoing surgery. Anxiety can, among other things, complicate anesthesia, increase medical need and cause postoperative complications. Purpose: The aim was to elucidate strategies to prevent and reduce children’s perioperative anxiety through a systematic literature review. Method: A systematic literature review with quantitative approach. Children two to twelwe years of age who are to undergo or have undergone anesthesia and surgery. Article searches were carried out in three, for the subject area, relevant databases. Result: The study comprises 25 result articles that show varying strategies for dealing with children's perioperative anxiety. Five of these did not show any superior or reducing effect compared to conventional or comparative strategies. Information and distraction were distinguished as main categories. Multimedia was a prominent subcategory that included several different strategies. Some protruding strategies included scented inhalation masks and theater performances. Conclusion: There is a variation in how anxiety can be managed to be prevented and reduced in pediatric perioperative care. The strategies in the sub-category multimedia appear prominent in this study, which may indicate that these strategies occur to a greater extent within this form of care. It was made clear that there is no single individual strategy considered to be accepted or superior to others. A nonpharmacological strategy might be preferred as it can be considered a safe, non-invasive and thus pleasant alternative to conventional pharmacological strategies such as premedication.

This thesis explores the relationship between motor difficulties and wider educational, social and emotional outcomes. The first two sections have been prepared in accordance with author guidelines of the journals proposed for submission. The first paper presents a systematic review of the literature examining the effects of poor motor skills on self-esteem (global and/or domain specific) in children and adolescents. Four databases were searched for articles focusing on motor skills and self-esteem in children and adolescents. 26 potentially relevant studies were identified and from the 26, eight studies met the inclusion criteria. A synthesis of the studies reveals that there appears to be a relationship between motor skills and self-esteem, however this relationship is complex and likely to vary depending on age, gender and co-morbidity. Implications for EP practice are discussed. The second paper is an exploratory product evaluation of the Manchester Motor Skills Programme (MMSP). A mixed methodology was used to explore outcomes for four KS2 children with motor skills difficulties who participated in the MMSP. The children's motor skills, social skills, academic outcomes and self-esteem were assessed using standardized measures pre and post intervention and at follow up. Semi-structured interviews and a focus group were used to elicit the views of pupils, the class teacher and the group leader. Results indicated improvements in some motor skill domains which were sustained at follow up. Qualitative data highlights perceived improvement in children's social skills, confidence, and use of meta-cognitive strategies. Further research is needed into outcomes of the MMSP on children's social skills and self-esteem. The third paper discusses the dissemination of the research, providing a summary of the research development implications from the research at, the research site and at a wider Local Authority level. A strategy for promoting the dissemination and impact of the research will be discussed.

[pt] A prática do Planejamento, Previsão e Reabastecimento Colaborativo (em inglês, Collaborative Planning, Forecasting and Replenishment – CPFR) é um tema recente de integração de cadeias de suprimento que tem sido amplamente abordado na literatura acadêmica. O CPFR é considerado, para muitos pesquisadores, uma iniciativa mais completa e avançada que outros métodos de colaboração na cadeia, sendo, em alguns casos, uma extensão ou aprimoramento dos mesmos. O amadurecimento do tema é representado pela existência de revisões sistemáticas na literatura. Contudo, por ser o CPFR ainda um tema recente com acentuado crescimento de estudos na literatura, esta dissertação tem como objetivo realizar uma atualização destas revisões sistemáticas para verificar novos avanços no assunto, se lacunas ressaltadas já foram pelo menos parcialmente endereçadas e se tendências estão se consolidando. Mais ainda, em função da dificuldade de se implementar o CPFR na prática, um enfoque maior na análise dos estudos empíricos existentes com o objetivo de ir além de resultados parciais e particulares oferecidos na literatura é contemplado nesta dissertação, expandindo assim o escopo das revisões existentes com o foco específico em estudos empíricos. A dissertação apresenta seus resultados guiados em um framework de síntese para integração de cadeias focado em CPFR, tendo como base os passos para a condução de uma pesquisa empírica em gerência de operações, os blocos conceituais do CPFR e a contribuição dos estudos empíricos. Uma agenda para pesquisas futuras finaliza a dissertação. / [en] The practice of Collaborative Planning, Forecasting and Replenishment (CPFR) is a recent topic of supply chain integration that has been extensively covered in academic literature. The CPFR is considered by several researchers a more complete and advanced initiative than other methods of collaboration in the chain, being in some cases an extension or improvement of them. The maturation of the theme is represented by the existence of systematic reviews in the literature. However, since CPFR is still a recent topic with a strong growth of studies in the literature, this dissertation aims to carry out an update of these systematic reviews in order to verify new advances in the subject, if highlighted gaps have been at least partially addressed, and also if trends have been consolidating. Moreover, due to the difficulty of implementing CPFR in practice, a greater focus on the analysis of existing empirical studies with the objective of going beyond partial and particular results offered in the literature is contemplated in this dissertation, thus expanding the scope of the existing reviews with specific focus on empirical studies. The dissertation presents its results guided by a synthesis framework for supply chain integration focused on CPFR, based on the steps for conducting an empirical research in operations management, the conceptual building blocks for CPFR and the contribution of the empirical studies. An agenda for future research concludes the dissertation.

[pt] O número de publicações sobre Eficiência Técnica (TE) de explorações leiteiras vem crescendo nos últimos tempos devido à relevância política, econômica e social do tema, bem como ao seu apelo acadêmico. O objetivo desta tese é duplo: apresentar uma síntese de pesquisa sobre a TE em explorações leiteiras, desenvolvendo tanto uma análise de meta-síntese quanto uma análise de meta-regressão; apresentar um estudo empírico com o objetivo de mensurar e compreender os fatores que afetam a TE em propriedades leiteiras nos municípios selecionados no Sul do Brasil. A síntese de pesquisa (análise de meta-síntese e análise de meta-regressão) abrange 103 artigos publicados entre 1987 e 2014 em 54 fontes diferentes usando uma abordagem rigorosa e reprodutível para selecionar estudos. Esta síntese complementa e amplia as revisões de literatura anteriores apresentando um quadro de síntese (contexto e determinantes, entradas, saídas e técnicas de mensuração da TE) por meio da análise de conteúdo. Em seguida, a meta-regressão foi aplicada para analisar os efeitos que as diferentes metodologias e que as características específicas de cada estudo têm sobre a média da TE (modelos I ao IV – subseção 3.1.3). Os resultados da análise de meta-síntese indicam que não há um acordo entre os autores sobre o contexto e os determinantes da TE. A análise dos determinantes levou a proposições de pesquisa verificáveis. Os principais determinantes da TE são: a localização geográfica (altitude, qualidade do solo, clima), o tamanho da propriedade, os investimentos em cuidados veterinários, alimentação e práticas de ordenha, modelo de estimativa da TE, políticas públicas, e gestão relacionada com as variáveis. Os resultados da análise de meta-regressão (total de 531 distribuições do índice de TE em explorações leiteiras baseado nos 103 artigos da amostra) são discutidos e têm-se duas contribuições importantes: (i) o estudo atualiza e compara trabalhos anteriores sobre a TE em fazendas leiteiras e (ii) acrescenta duas dimensões das explorações leiteiras: tamanho (número de vacas e hectares de terra) e o desenvolvimento econômico. A variação nos índices de TE relatados na literatura pode ser explicada pela metodologia das estimativas (método de estimação, forma funcional, dimensionalidade do modelo), pela localização geográfica das fazendas e pelo tamanho da propriedade. Além disso, os resultados sugerem que, dado o estado da tecnologia predominante em cada região no momento em que os estudos sobre TE foram realizados, os produtores de leite na amostra poderiam aumentar a sua produção de leite em 20,1 porcento (nível de ineficiência), em média, se eles produzirem em suas fronteiras de eficiência. Implicações para os produtores de leite e para pesquisas futuras é validar essa síntese de pesquisa. A partir dessa síntese de pesquisa, algumas proposições e hipóteses que emergiram foram testadas usando os dados obtidos em uma pesquisa realizada em municípios selecionados no Sul do Brasil. Este estudo empírico mensurou a TE para cada propriedade de leite e identificou aquelas que apresentam as melhores práticas (benchmarks). A mensuração do nível de TE combinada com a análise das melhores práticas auxilia os produtores a melhorar seu grau de eficiência. Em seguida, utilizando outros dois modelos de meta-regressão (V e VI – subseção 3.2.3), o estudo empírico auxiliou no entendimento dos principais fatores que afetam essa TE, derramando novas luzes empíricas na literatura acadêmica. / [en] There is a growing number of publications on Technical Efficiency (TE) of dairy farms, due to the political, economic and social relevance of the theme as well as to its academic appeal. The goal of this thesis is two fold: first, it presents a research synthesis on TE in dairy farms conducting both a meta-synthesis and a meta-regression analysis and, second, an empirical study aiming at measuring and understanding the factors affecting the TE in dairy farms of selected municipalities in the South of Brazil. The research synthesis embraces 103 papers published between 1987 and 2014 in 54 sources using a rigorous and reproducible approach to select studies. This synthesis complements and extends previous literature reviews on TE in dairy farms, offering a synthesis framework (i.e., context and determinants, inputs, outputs and measurement techniques of TE) and analysing the effects of different methodologies and study-specific characteristics on Mean TE (MTE) through meta-regression. Findings point to no agreement among authors on context and determinants of TE. The analysis of determinants led to verifiable research propositions: the main determinants of TE are geographical location (altitude, quality of the soil, climate), farm size, investments in veterinary care, feeding and milking practice, TE model estimation techniques, public policy, and management-related variables. Results from the meta-regression analysis of the gathered papers totalling 531 TE observations in dairy farms worldwide are discussed and makes two important contributions: (i) it updates and compares previous works on frontier estimation of TE in dairy farms and (ii) it adds two dimensions of dairy farms, size (herd and land area) and economic development, to the known differentials of TE measurement. The variation in the MTE indexes reported in the literature can be explained by the methodology of estimations (method of estimation, functional form of frontier models, model dimensionality), farms geographical location and farm size. Additionally, the results suggest that, given the state of technology prevailing in each region at the time that the studies on TE were conducted, dairy farmers in the sample could increase milk output by 20.1 percent (level of inefficiency), on average, if they produce on their frontiers. Implications for dairy farmers and for future research close the research synthesis. The propositions and hypotheses emerged from the research synthesis and were tested using data obtained in a survey conducted in selected municipalities in the South of Brazil. The mensuration of level TE combined with benchmark analysis helps the producers improve the degree of efficiency. This empirical study measured and helped in the understanding of the main factors affecting the TE in dairy farms from these municipalities, shedding new empirical lights in the academic literature.

Every day, a new publication on information systems highlights about Cloud of Things (CoT) vulnerabilities; in most of these publications, vulnerability is quoted as the most substantial barrier for CoT realization. However, formulating a justifiable appraisement of the actual vulnerability impact on CoT is difficult because in many of these publications, the term security “vulnerability” is stated incorrectly as a threat or the publication does not discuss CoT-specific vulnerabilities. To achieve a well-founded understanding of CoT vulnerabilities, this literature review identifies the major vulnerabilities and their security controls and to identify any gaps for future research. A systematic literature review (SLR) approach using 58 articles is considered for this review. Based on this review, a taxonomy is created to classify the existing CoT vulnerabilities and security controls. This literature review identifies and discusses similarities and differences among various vulnerability issues and solutions. Most reviews previously performed were limited to the threats to the application interface and virtualization level, whereas this SLR thesis expand to the vulnerabilities in connectivity and things level of CoT. This study emphasize the importance of a clear definition of cloud of things vulnerabilities and to facilitate better understanding and assessment of CoT vulnerabilities to build more secure systems.