Factors facilitating a national quality registry to aid clinical quality improvement : findings of a national survey

Objectives: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement. Methods: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression. Results: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with ‘Colleagues’ call for local results’ (p=<0.001), ‘Management Request of Registry data’ (p=<0.001), and it was said to be ‘Simple to explain the results to colleagues’ (p=0.02). Using stepwise regression, ‘Colleagues’ call for local results’ was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results. Conclusions: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.

Energy performance comparison of three innovative HVAC systems for renovation through dynamic simulation

In this paper, dynamic simulation was used to compare the energy performance of three innovativeHVAC systems: (A) mechanical ventilation with heat recovery (MVHR) and micro heat pump, (B) exhaustventilation with exhaust air-to-water heat pump and ventilation radiators, and (C) exhaust ventilationwith air-to-water heat pump and ventilation radiators, to a reference system: (D) exhaust ventilation withair-to-water heat pump and panel radiators. System A was modelled in MATLAB Simulink and systems Band C in TRNSYS 17. The reference system was modelled in both tools, for comparison between the two.All systems were tested with a model of a renovated single family house for varying U-values, climates,infiltration and ventilation rates.It was found that A was the best system for lower heating demand, while for higher heating demandsystem B would be preferable. System C was better than the reference system, but not as good as A or B.The difference in energy consumption of the reference system was less than 2 kWh/(m2a) betweenSimulink and TRNSYS. This could be explained by the different ways of handling solar gains, but also bythe fact that the TRNSYS systems supplied slightly more than the ideal heating demand.

Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units : a register study over 10 years

Objective: There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants. Design, setting and participants: This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004–2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups. Results: From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22–27 weeks) from 55% to 16%, in very preterm (GA 28–31 weeks) from 41% to 34% and in moderately preterm infants (GA 32–36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants). Conclusions: In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding.

Leva som man lär? : En studie av spänningsfältet mellan genusvetande och genusgörande

Practice as you preach? Gender scholars’ reflections on practising gender theory Being a gender scholar – to what extent is it possible to practice as you preach? This study investigates how gender scholars relate to using and practicing theoretical knowledge on gender.Ten in-depth interviews are conducted with gender scholars at Swedish universities. A semi-structured interview guide, based on ambitions, possibilities and obstacles regarding using theoretical knowledge in practice, is used. The results indicate that being a gender scholar is a highly reflective project, since it involves turning your gender theoretical gaze towards yourself. Practicing as you preach seems to be interpreted as undoing gender. Attempts to undo gender are said to be hindered by gender normative structures rendering gender scholar women and gender scholar men different possibilities to practice the undoing of gender. The analysis show that gender scholars perform a balancing act by adding some expressions for the opposite gender to their everyday doings and their physical appearance, thus combining a doing with an undoing of gender. The pace and force of change in these doings and undoings are rather small. Nevertheless, small as they may be, these steps are interpreted as part of a strategy to change gender normative structures, making possible yet other and freer gender performances.

New graduate nurses' developmental trajectories for capability beliefs concerning core competencies for healthcare professionals : A national cohort study on patient-centered care, teamwork and evidence-based practice.

Background: This study aimed to describe the developmental trajectories of registered nurses' capability beliefs during their first 3 years of practice. The focus was on three core competencies for health professionals-patient-centered care, teamwork, and evidence-based practice. Methods: A national cohort of registered nurses (n = 1,205) was recruited during their nursing education and subsequently surveyed yearly during the first 3 years of working life. The survey included 16 items on capability beliefs divided into three subscales for the assessment of patient-centered care, teamwork, and evidence-based practice, and the data were analyzed with linear latent growth modeling. Results: The nurses' capability beliefs for patient-centered care increased over the three first years of working life, their capability beliefs for evidence-based practice were stable over the 3 years, and their capability beliefs for teamwork showed a downward trend. Linking evidence to action: Through collaboration between nursing education and clinical practice, the transition to work life could be supported and competence development in newly graduated nurses could be enhanced to help them master the core competencies. Future research should focus on determining which factors impact the development of capability beliefs in new nurses and how these factors can be developed by testing interventions.

Reindeer habitat selection under the risk of brown bear predation during calving season

The depredation of semi-domesticated reindeer by large carnivores reflects an important human-wildlife conflict in Fennoscandia. Recent studies have revealed that brown bears (Ursus arctos) may kill substantial numbers of reindeer calves (Rangifer tarandus tarandus) in forest areas in Sweden. Several authors have suggested that predation risk is an important driver of habitat selection in wild Rangifer populations where predation is a limiting factor, but little is known about these mechanisms in semi-domesticated populations. We examined the habitat selection of female reindeer in relation to spatial and temporal variations in brown bear predation risk on the reindeer calving grounds and evaluated the simultaneous responses of brown bears and reindeer to landscape characteristics. We used GPS data from 110 reindeer years (97 individuals) and 29 brown bear years (19 individuals), from two reindeer herding districts in the forest area of northern Sweden. Our results did not indicate that reindeer alter their behavior in response to spatiotemporal variation in brown bear predation risk, on the scale of the calving range. Instead, we suggest that spatiotemporal behavioral adjustments by brown bears were the main driver of prey-predator interactions in our study system. Contrasting responses by brown bears and reindeer to clear-cuts and young forest indicate that forestry can influence species interactions and possibly yield negative consequences for the reindeer herd. Even if clear-cuts may be beneficial in terms of calf survival, logging activity will eventually cause greater abundance of young regenerating forest, reducing available reindeer habitats and increasing habitat preferred by brown bears. Domestication may have made semi-domesticated reindeer in Fennoscandia less adapted to cope with predators. Areal restrictions, limiting the opportunity for dispersion and escape, possibly make the calves more susceptible to predation. Also, a generally higher population density in semi-domesticated herds compared to wild populations can make dispersion a less efficient strategy and the reindeer calves easier prey. Overall, the lack of ability of the reindeer females to reduce brown bear encounter risk on the scale of the calving range is probably an important reason for the high brown bear predation rates on reindeer calves documented in our study areas. 

Clinical interventions, implementation interventions, and the potential greyness in between - a discussion paper

Background: There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between 'intervention' and 'implementation', yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between. Discussion: To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively. Conclusion: Semantics provide opportunities for improved precision in depicting what is 'intervention' and what is 'implementation' in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse.

The effect on CO2 emissions of taxing truck distance in retail transports

To finance transportation infrastructure and to address social and environmental negative externalities of road transports, several countries have recently introduced or consider a distance based tax on trucks. In competitive retail and transportation markets, such tax can be expected to lower the demand and thereby reduce CO2 emissions of road transports. However, as we show in this paper, such tax might also slow down the transition towards e-tailing. Considering that previous research indicates that a consumer switching from brick-and-mortar shopping to e-tailing reduces her CO2 emissions substantially, the direction and magnitude of the environmental net effect of the tax is unclear. In this paper, we assess the net effect in a Swedish regional retail market where the tax not yet is in place. We predict the net effect on CO2 emissions to be positive, but off-set by about 50% because of a slower transition to e-tailing.