Background Opioid use has become a huge public health crisis and opioids are now one of the leading causes of deaths related to drugs worldwide. Identifying differences in predictors and treatment outcomes for people with opioid use disorder (OUD) that were introduced by prescription versus other means is important. It is also vital to understand what the goals are and needs that patients want to achieve out of OUD treatment. Methods We used systematic review methodology to first examine any adverse outcomes that may be associated with prescribing opioids for acute low back pain. We also conducted a systematic review and meta-analysis examining what are the differences in patients with OUD that were initially introduced to opioids by prescription in comparison to those introduced by recreational means. We then conducted an observational study using data obtained from the GENetics of Opioid Addiction (GENOA) research collaborative. We examined treatment outcome differences between individuals introduced to opioids through a licit prescription and those introduced through illicit means. We conducted a mixed-methods study asking what the desired goals of patients with OUD from the Pharmacogenetics of Opioid Substitution Treatment (POST) project are. Using data from POST, we also examined the treatment outcome differences between those that were receiving methadone treatment in comparison to those that were on buprenorphine. Results The systematic review examining adverse outcomes of prescribing opioids for acute low back pain found that prescribing opioids for ALBP was significantly associated with long-term continued opioid use (1.57, 95% CI 1.06,2.33). The second systematic review found that those who were introduced to opioids through a legitimate prescription were significantly less likely to have illicit opioid use (0.70, 95% CI 0.50, 0.99) while in treatment. Our results from GENOA also showed that those introduced to opioids by prescription were more likely to have chronic pain, an older age of onset of opioid use, less likely to have hepatitis C and use cannabis. When we asked patients what goals they desired out of treatment, we found that the most frequently reported patient important outcomes were to stop treatment (39%) and avoid all drugs (25%). When comparing OUD patients by treatment we discovered that those receiving buprenorphine were less likely to consume illicit opioids and amphetamines but more likely to have used alcohol in comparison to those on methadone. Conclusion With this knowledge, we can recognize unique risk factors for each patient and provide more tailored treatment that can incorporate this into clinical practice to address specific concerns in various cohorts of OUD patients. Additionally, the variation in the selection of outcomes demand the need for further research to establish a set of outcomes that considers patients’ goals and preferences for OUD treatment. / Thesis / Candidate in Philosophy

Background: Analytical frameworks (AF) are graphical representation of the key questions answered by a systematic review and can support the development of guideline recommendations. Our objectives are to a) conduct a systematic review to identify, describe and compare all AFs published as part of a systematic and guideline development process related to colorectal cancer (CRC); and b) to use this case study to develop guidance on how to conduct systematic reviews of AFs. Methods: We conducted a systematic review and searched Medline and Embase from 1996 until December 2020. We also manually searched guideline databases and websites. We identified all guidelines in CRC that utilized an AFs and all systematic reviews in primary prevention, screening, and diagnosis of CRC that used AFs. We assessed quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool. The systematic review was registered in PROSPERO, registration CRD42020172117. Results: We screened 34,505 records and identified 1166 guidelines on CRC and 3127 systematic reviews, of which 5 met our inclusion criteria identifying a total of 4 AFs in colorectal cancer. We describe our search strategy and methods for conducting systematic reviews for AFs. Conclusion: Few guidelines and systematic reviews are utilizing AFs in the development of recommendations. We developed methods for conducting a systematic review on AF / Thesis / Master of Science (MSc) / Analytical frameworks are graphical diagrams that represent key questions with flow of resining from population to outcome. We conducted a systematic review to identify all analytical frameworks in colorectal cancer and in the process we developed guidance on how to conduct a systematic review for analytical frameworks. We identified four analytical frameworks, one in primary prevention, and three in screening of colorectal cancer. We found only a few clinical practice guidelines that utilized analytical frameworks in the development of the recommendations. We developed methods for conducting a systematic review of analytical frameworks.

The overarching theme of this thesis is to discuss the research to date on intimate partner violence (IPV) in orthopaedic surgery and to begin to study selected issues that have been understudied in orthopaedic surgery and IPV. This thesis outlines the current state of knowledge in the field of IPV and orthopaedic surgery and provides some insight into three selected “emerging issues” in the field which warrant future research including: education of orthopaedic surgeons and residents to reduce barriers and improve perceptions; IPV perpetrators; and outcomes for victims of IPV. The findings demonstrate that a short course on IPV for orthopaedic trainees led to an improvement and retention of knowledge three months after the course. IPV education should be integrated into training programs for orthopaedic surgeons. Our systematic review on IPV perpetrator factors indicates that using alcohol or drugs, experiencing child abuse, witnessing interparental aggression, low socioeconomic status, and psychological conditions like depression and anxiety were commonly associated with IPV perpetration. Perpetrator treatment programs should take into consideration modifiable and preventable factors that are associated with IPV perpetration. This thesis proposes a pilot prospective cohort study as the first step toward determining how experiences of IPV affect orthopaedic outcomes such as injury-related complications. The proposed study will determine feasibility and assist in the development a larger-scale multinational prospective cohort study that will engage health care professionals from around the world to increase awareness of how IPV affects patients’ musculoskeletal outcomes. In the past decade, the field of orthopaedic surgery has become more aware of the issue of IPV, but there are many questions that remain. Future research into the above issues will be an excellent first step to fully understanding the issue of IPV in orthopaedic patients, and may lead to improved support of victims of IPV in the future. / Thesis / Master of Science (MSc)

Begreppet akut coronart syndrom (ACS) används för tillstånd som orsakar syrebrist i hjärtmuskeln genom förträngning av kranskärlen. I Sverige sker ca 42 % av alla dödsfall hos både kvinnor och män till följd av hjärtkärlsjukdom. Riskfaktorer utgörs av kön, ålder och ärftlighet samt relateras till livsstils faktorer såsom rökning, förhöjda blodfetter, hypertoni, diabetes, stress och låg fysisk aktivitet. För personen som insjuknar i en hjärtinfarkt kan upplevelsen innebära en kris och sjuksköterskan har en central roll som rådgivare och vägledare för patienter under deras sjukhusvistelse och i eftervården.Syfte med denna litteratursammanställning var att beskriva sjuksköterskans omvårdnadsåtgärder som kan stödja patienter med ACS.Studien utgörs av en systematisk litteraturssammanställning och resulterade i sex kvalitativa och fem kvantitativa vetenskapliga artiklar.Resultatet belyser två teman som betydelsefulla omvårdnadsåtgärder sjuksköterskan kan stödja patienter med vid ACS. Dessa teman presenteras som information/utbildning och skapande av relationen mellan sjuksköterska och patient. Sjuksköterskans kompetens och professionalitet samt förmågan att möta patienten på ett bekräftande sätt leder till trygg relation mellan sjuksköterska och patient. En god relationen och information förefaller påverka patienten till att förstå och förbättra sin hälsa. Det är viktigt att få tid till att etablera en relation med patienten. Inom området bemötande och kommunikation ses flera framtida forskningsfrågor. / Acute coronary syndrome (ACS) is used to describe conditions that causes lack of oxygen to the heartmuscle due to a stenosis in the coronary arteries. The death rate in coronary heart disease is 42% in Sweden in both females and males and is the most common course of death. Risk factors are gender, age and heredity as well as lifestyle factors as smoking, hyperlipidemia, hypertonia, diabetes, stress and low fysical activity. The person that experience a heart failure might get into a crisis and nurses has an important role as a guide and councillor during the stay in hospital and in the aftercare.The aim of this systematic litterature review was to describe nursing interventions to support the patients with ACS. The study includes six qualitative and five quantitative articles. The result highlights two themes as important nursing interventions to support patients with ACS. These themes are presented as information/education and the establishment of a nurse-patient relation. The nurse’s competence and professionality and her capacity to confirm the patient leads to a confident relation between the nurse and the patient. A good relation and information seems to affect the patients understanding of, and improving of his/hers health. It seems to be of importance to obtain time to enable the possibility to establish the relation with the patient. In the domain of how the patient is approached and communicated with, future research is recommended.

Background: Nearly 750,000 adolescents and emerging adults with special health care needs (AEA-SHCN) enter into adulthood annually. The linkages to ensure the seamless transfer of care from pediatric to adult care and transition to adulthood for AEA-SHCN have yet to be realized. Purpose: The purpose of this systematic review was to investigate the state of the science of health care transition (HCT) service models as described in quantitative investigations. Methods: A four-tier screening approach was used to obtain reviewed articles published from 2004 to 2013. A total of 17 articles were included in this review. Discussion: Transfer of care was the most prominent intervention feature. Overall, using the Effective Public Health Practice Project criteria, the studies were rated as weak. Limitations included lack of control groups, rigorous designs and methodology, and incomplete intervention descriptions. Conclusion: As the findings indicate, HCT is an emerging field of practice that is largely in the exploratory stage of model development.

Background: Health care transition (HCT) for adolescents and emerging adults (AEA) with special health care needs is an emerging field of interdisciplinary field of practice and research that is based upon an intergenerational approach involving care coordination between pediatric and adult systems of health care. Informed understanding of the state of the HCT science pertaining to this group of providers is needed in order to develop and implement service programs that will meet the comprehensive needs of AEA with special health care needs. Methods: The authors conducted a systematic review of the literature on the transition from child to adult care for adolescents and emerging adults (AEA) with special health care needs from 2004 to 2013. Fifty-five articles were selected for this review. An adaptation of the PRISMA guidelines was applied because all studies in this review used descriptive designs. Results: Findings revealed lack of evidence due to the limitations of the research designs and methodology of the studies included in this systematic review. Study findings were categorized the following four types: adult provider competency, provider perspectives, provider attitudes, and HCT service models. The discipline of medicine was predominant; interdisciplinary frameworks based upon integrated care were not reported. Few studies included samples of adult providers. Conclusions: Empirical-based data are lacking pertaining to the role of providers involved in this specialty area of practice. Evidence is hampered by the limitations of the lack of rigorous research designs and methodology.

Background: A better understanding of the needs of adolescents and emerging adults with special health care needs (AEA-SHCNs) is essential to provide health care transition services that represent best practices. The purpose of this systematic review was to evaluate the research on health care transition for AEA-SHCNs from their perspectives. Methods: A comprehensive literature review of research publications since 2005 was performed using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and EBSCO databases. Thirty-five studies met the final review criteria. Results: The process of transition from child to adult for AEA-SHCNs is complex. Individuals experiencing the transition desire to be a part of the process and want providers who will listen and be sensitive to their needs, which are often different from others receiving health care at the same facility. Conclusions: More research that considers the voice of the AEA-SHCNs related to transition from pediatric to adult care is needed.

Purpose  To evaluate the impact of implant length on failure rates between short (<10 mm) and long (≥10 mm) dental implants.   Materials and methods A search was undertaken in three electronic databases, complemented by manual search of some journals. Implant failure was the outcome evaluated, with the estimate of relative effect expressed in risk ratio (RR). Heterogeneity among studies was evaluated by I2statistic. Inverse variance method was used for random- or fixed-effects models. Quality assessment of the studies was performed, and a funnel plot was drawn. A meta-regression was performed in order to verify how the RR was associated with the follow-up time.   Results The reviews included 353 publications. Altogether, there were 25,490 short implants and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher risk of failure than long implants (RR 2.437, p<0.001). The meta-regression observed that the follow-up time did not have any effect of the RR of failure between short and long implants. A sensitivity analysis plotting together only the studies with follow-up up until 7 years, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up.   Conclusion Short implants showed (< 10 mm) a 2.5 times higher risk of failure than long implants (≥ 10 mm). Implant failure is multifactorial and the implant length is only one of the many factors contributing to the loss of implant. A good treatment plan and the patient’s general health should be taken into account when planning for an implant treatment.       Keywords: dental implant, failure, implant length, systematic review, meta-analysis

Wool is often being marketed as sustainable. However, when looking at LCA studies, results can be significantly different from one study to another and wool sometimes shows higher impacts than other fabrics. Based on a comprehensive literature review, this thesis aims at understanding the key environmental impacts of wool production and assessing the influence of main methodological choices on wool LCA results. In particular, the choice of the scope, allocation method and further considerations on water consumption and land use indicators have a great significance on the results of the studies. In order to provide with a fair representation of wool environmental impacts, the whole life-cycle should be taken into account, and methodological choices, such as the scope definition and allocation methods are to be clearly stated. The current tools that are the most widely used in the textile industry to rank fibres according to their sustainability performance are not suitable for wool due to unresolved methodological issues. Indeed, the impact categories that are taken into account in those tools are disadvantageous for wool compared to other alternative fibres, especially regarding water consumption and land use. This thesis also explores the construction of a single score based on the eco-costs of environmental impacts as a more suitable option to build a representative tool.

The research conducted was a systemic review of 88 action research masters theses from a teacher enhancement program for K-8 mathematics and science at the University of Central Florida and the teachers that performed the studies. The purpose of this study is to synthesize existing research results of a collection of master's theses from a teacher enhancement program for K-8 mathematics and science teachers in order to arrive at meaningful conclusions regarding teachers' research interests and classroom practices. Also, the study will help teacher educators who deliver the teacher enhancement program to improve the effectiveness of the program. A summary sheet was filled out for each thesis and teacher, and then entered into a spreadsheet that was later analyzed for reoccurring themes in the data. The results showed themes in topics of action research studies, questions in action research studies, and results of action research studies. There were no trends in characteristics of teachers performing the action research studies.