| 41. |
- Frykman, M., et al.
(författare)
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Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department : A comparative case study
- 2014
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Ingår i: BMC Health Services Research. - : BioMed Central Ltd.. - 1472-6963. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- While there is strong support for the benefits of working in multi-professional teams in health care, the implementation of multi-professional teamwork is reported to be complex and challenging. Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited. There is a lack of studies focusing on the functions of different behavior change interventions and the mechanisms driving behavior change. In this study, applied behavior analysis is used to analyze the function and impact of different behavior change interventions when implementing multi-professional teamwork. Methods. A comparative case study design was applied. Two sections of an emergency department implemented multi-professional teamwork involving changes in work processes, aimed at increasing inter-professional collaboration. Behavior change interventions and staff behavior change were studied using observations, interviews and document analysis. Using a hybrid thematic analysis, the behavior change interventions were categorized according to the DCOM® model. The functions of the behavior change interventions were then analyzed using applied behavior analysis. Results: The two sections used different behavior change interventions, resulting in a large difference in the degree of staff behavior change. The successful section enabled staff performance of teamwork behaviors with a strategy based on ongoing problem-solving and frequent clarification of directions. Managerial feedback initially played an important role in motivating teamwork behaviors. Gradually, as staff started to experience positive outcomes of the intervention, motivation for teamwork behaviors was replaced by positive task-generated feedback. Conclusions: The functional perspective of applied behavior analysis offers insight into the behavioral mechanisms that describe how and why behavior change interventions influence staff behavior. The analysis demonstrates how enabling behavior change interventions, managerial feedback and task-related feedback interact in their influence on behavior and have complementary functions during different stages of implementation.
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| 42. |
- Frykman, M., et al.
(författare)
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Line managers’ influence on employee usage of a web-based system for occupational health management
- 2018
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Ingår i: International Journal of Workplace Health Management. - : Emerald Group Publishing Ltd.. - 1753-8351 .- 1753-836X. ; 11:4, s. 193-209
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this paper is to investigate line managers’ influence on employee usage of a web-based system for occupational health management. Design/methodology/approach: Questionnaires were used to measure line managers’ transformational leadership at baseline and their change-supportive managerial activities during weeks 16–52. Employee initial (weeks 16–52) and sustained (weeks 53–144) use of the web-based system was measured by extracting their frequency of logins to the system from electronic records. Data were collected from six white-collar organizations from 2011 through 2013. Mixed Poisson regressions were used to analyze the influence of transformational leadership and change-supportive managerial activities on employee usage. Findings: As predicted, line managers’ change-supportive activities influenced the employees’ initial and sustained use of the system. Line managers’ transformational leadership had no direct effect on employees’ use of the system, however transformational leadership was indirectly associated with employees’ initial and sustained use of the system through line managers’ change-supportive activities. Originality/value: The study adds to the understanding of the role line managers’ play during the implementation of occupational health interventions. The findings suggest that the line managers’ change-supportive activities directed toward the intervention are important for employees’ initial and sustained use of the system. The influence of transformational leadership was indirect, suggesting that line managers may need to direct their leadership behaviors toward the intervention to facilitate implementation. © 2018, Emerald Publishing Limited.
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| 43. |
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| 44. |
- Günther, B., et al.
(författare)
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Control of Separation on the Flap of a Three-Element High-Lift Configuration
- 2007
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Ingår i: 45th AIAA Aerospace Sciences Meeting and Exhibit. - : AIAA. - 9781563478901
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Konferensbidrag (refereegranskat)abstract
- This paper describes a joint experimental and numerical investigation of the control of the flow over the flap of a three-element high-lift configuration by means of periodic excitation. At Reynolds numbers between 0.3 ￜ 106 and 1 ￜ 106 the flow is influenced by periodic blowing or periodic blowing/suction through slots near the flap leading edge. The delay of flow separation by periodic vertical excitation could be identified in the experiments as well as numerical simulations based on the Unsteady Reynolds-averaged Navier-Stokes equations (URANS). As a result, the mean aerodynamic lift of this practically relevant wing configuration could be significantly enhanced. By investigating different excitation frequencies and intensities optimum control parameters could be found. The behaviour of the aerodynamic forces with varying flap deflection angle are measured on a finite swept wing. Scientific visualisation of the numerical simulations of an infinite swept wing allows a detailed analysis of the structures in this complex flow field and the effect of flow control on these.
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| 45. |
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| 46. |
- Hasson, H., et al.
(författare)
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A typology of useful evidence : Approaches to increase the practical value of intervention research
- 2020
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Ingår i: BMC Medical Research Methodology. - : BioMed Central Ltd.. - 1471-2288. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Too often, studies of evidence-based interventions (EBIs) in preventive, community, and health care are not sufficiently useful to end users (typically practitioners, patients, policymakers, or other researchers). The ways in which intervention studies are conventionally conducted and reported mean that there is often a shortage of information when an EBI is used in practice. The paper aims to invite the research community to consider ways to optimize not only the trustworthiness but also the research's usefulness in intervention studies. This is done by proposing a typology that provides some approaches to useful EBIs for intervention researchers. The approaches originate from different research fields and are summarized to highlight their potential benefits from a usefulness perspective. Main message: The typology consists of research approaches to increase the usefulness of EBIs by improving the reporting of four features in intervention studies: (1) the interventions themselves, including core components and appropriate adaptations; (2) strategies to support-high-quality implementation of the interventions; (3) generalizations about the evidence in a variety of contexts; and (4) outcomes based on end users' preferences and knowledge. The research approaches fall into three levels: Description, Analysis, and Design. The first level, Description, outlines what types of information about the intervention and its implementation, context, and outcomes can be helpful for end users. Research approaches under analysis offers alternative ways of analyzing data, increasing the precision of information provided to end users. Approaches summarized under design involve more radical changes and far-reaching implications for how research can provide more useful information. These approaches partly flip the order of efficacy and effectiveness, focusing not on whether an intervention works in highly controlled and optimal circumstances, but first and foremost whether an intervention can be implemented and lead to anticipated outcomes in everyday practice. Conclusions: The research community, as well as the end users of research, are invited to consider ways to optimize research's usefulness as well as its trustworthiness. Many of the research approaches in the typology are not new, and their contributions to quality have been described for generations - but their contributions to useful knowledge need more attention.
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| 47. |
- Hijazi, Ziad, et al.
(författare)
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Apixaban or Vitamin K Antagonists and Aspirin or Placebo According to Kidney Function in Patients With Atrial Fibrillation After Acute Coronary Syndrome or Percutaneous Coronary Intervention : Insights From the AUGUSTUS Trial
- 2021
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Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 0009-7322 .- 1524-4539. ; 143:12, s. 1215-1223
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the AUGUSTUS trial (An Open-Label, 2x2 Factorial, Randomized Controlled, Clinical Trial to Evaluate the Safety of Apixaban Versus Vitamin K Antagonist and Aspirin Versus Aspirin Placebo in Patients With Atrial Fibrillation and Acute Coronary Syndrome or Percutaneous Coronary Intervention), apixaban resulted in less bleeding and fewer hospitalizations than vitamin K antagonists, and aspirin caused more bleeding than placebo in patients with atrial fibrillation and acute coronary syndrome or percutaneous coronary intervention treated with a P2Y(12) inhibitor. We evaluated the risk-benefit balance of antithrombotic therapy according to kidney function.Methods: In 4456 patients, the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula was used to calculate baseline estimated glomerular filtration rate (eGFR). The effect of apixaban versus vitamin K antagonists and aspirin versus placebo was assessed across kidney function categories by using Cox models. The primary outcome was International Society on Thrombosis and Haemostasis major or clinically relevant nonmajor bleeding. Secondary outcomes included death or hospitalization and ischemic events (death, stroke, myocardial infarction, stent thrombosis [definite or probable], or urgent revascularization). Creatinine clearanceResults: Overall, 30%, 52%, and 19% had an eGFR of >80, >50 to 80, and 30 to 50 mL.min(-1).1.73 m(-2), respectively. At the 6-month follow-up, a total of 543 primary outcomes of bleeding, 1125 death or hospitalizations, and 282 ischemic events occurred. Compared with vitamin K antagonists, patients assigned apixaban had lower rates for all 3 outcomes across most eGFR categories without significant interaction. The absolute risk reduction with apixaban was most pronounced in those with an eGFR of 30 to 50 mL.min(-1).1.73 m(-2) for bleeding events with rates of 13.1% versus 21.3% (hazard ratio, 0.59; 95% CI, 0.41-0.84). Patients assigned aspirin had a higher risk of bleeding in all eGFR categories with an even greater increase among those with eGFR >80 mL.min(-1).1.73 m(-2): 16.6% versus 5.6% (hazard ratio, 3.22; 95% CI, 2.19-4.74; P for interaction=0.007). The risk of death or hospitalization and ischemic events were comparable to aspirin and placebo across eGFR categories with hazard ratios ranging from 0.97 (95% CI, 0.76-1.23) to 1.28 (95% CI, 1.02-1.59) and from 0.75 (95% CI, 0.48-1.17) to 1.34 (95% CI, 0.81-2.22), respectively.Conclusions: The safety and efficacy of apixaban was consistent irrespective of kidney function, compared with warfarin, and in accordance with the overall trial results. The risk of bleeding with aspirin was consistently higher across all kidney function categories.
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| 48. |
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| 49. |
- Ingvarsson, Sara, et al.
(författare)
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Strategies for de-implementation of low-value care—a scoping review
- 2022
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Ingår i: Implementation Science. - : BioMed Central Ltd. - 1748-5908. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of low-value care (LVC) is a persistent problem that calls for knowledge about strategies for de-implementation. However, studies are dispersed across many clinical fields, and there is no overview of strategies that can be used to support the de-implementation of LVC. The extent to which strategies used for implementation are also used in de-implementing LVC is unknown. The aim of this scoping review is to (1) identify strategies for the de-implementation of LVC described in the scientific literature and (2) compare de-implementation strategies to implementation strategies as specified in the Expert Recommendation for Implementing Change (ERIC) and strategies added by Perry et al. Method: A scoping review was conducted according to recommendations outlined by Arksey and O’Malley. Four scientific databases were searched, relevant articles were snowball searched, and the journal Implementation Science was searched manually for peer-reviewed journal articles in English. Articles were included if they were empirical studies of strategies designed to reduce the use of LVC. Two reviewers conducted all abstract and full-text reviews, and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data-charting form. The strategies were first coded inductively and then mapped onto the ERIC compilation of implementation strategies. Results: The scoping review identified a total of 71 unique de-implementation strategies described in the literature. Of these, 62 strategies could be mapped onto ERIC strategies, and four strategies onto one added category. Half (50%) of the 73 ERIC implementation strategies were used for de-implementation purposes. Five identified de-implementation strategies could not be mapped onto any of the existing strategies in ERIC. Conclusions: Similar strategies are used for de-implementation and implementation. However, only a half of the implementation strategies included in the ERIC compilation were represented in the de-implementation studies, which may imply that some strategies are being underused or that they are not applicable for de-implementation purposes. The strategies assess and redesign workflow (a strategy previously suggested to be added to ERIC), accountability tool, and communication tool (unique new strategies for de-implementation) could complement the existing ERIC compilation when used for de-implementation purposes.
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