Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care : a cluster randomised study

BACKGROUND: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44819426.

Developing leadership in managers to facilitate the implementation of national guideline recommendations : a process evaluation of feasibility and usefulness

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.

Grafisk profil till ett företag som tillverkar handgjorda textilprodukter av naturmaterial : Hur kan en hemsida kommunicera ett varumärke?

Målet med detta examensarbete var att skapa en grafisk profil till företaget Lyst Form AB som bedriver större delen av sin affärsverksamhet via en hemsida. Företaget säljer handgjorda kläder och accessoarer i lintyg. En teoretisk del i arbetet tar upp hur varumärket kan kommuniceras genom hemsidan. Den grafiska profilen utformades utifrån företagets identitet. Det är viktigt att företaget speglas på ett korrekt sätt. Ett företags identitet kan beskrivas som organisationens själ och den visas utåt i form av bland annat den grafiska profilen. Denna ses därför som en viktig identitetsbärare och den kan kallas för den visuella identiteten. En grafisk profil innehåller bland annat logotyp, profilfärger samt typografi. Företagets målgrupp ansågs vara en viktig del i hela processen eftersom de i slutändan ska tilltalas av den grafiska profilen. Först gjordes en grundlig undersökning och research av företaget för att få en god uppfattning av dess identitet. Även konkurrenterna granskades. En enkätundersökning gjordes för att kunna samla information utifrån målgruppens perspektiv. Denna informationsinsamling gav ett bra underlag och en riktlinje i framtagningen av den grafiska profilen.   Under designprocessens gång diskuterades de logotypförslag som togs fram med hjälp av en sammansatt fokusgrupp. Diskussionen var givande och var till stor nytta i designprocessen. Baserat på den grafiska profilen skapades en layout för hemsidan samt exempel på trycksaker för att visa hur den kan användas. En enklare grafisk manual skapades för att företaget ska kunna synas utåt på ett enhetligt sätt. En sista enkätundersökning gjordes för att se om målet uppnåtts. Resultatet visade att den nya framtagna grafiska profilen var en klar förbättring jämfört mot den nuvarande sett utifrån företagets identitet. I slutändan valde dock företaget en annan logotyp. Detta påvisar svårigheterna i processen att ta fram en grafisk profil. Alla delar i processen är viktiga och undersökningarna är bland annat en av de väsentliga delarna vilka bidrar med en större chans till ett bra slutresultat som tar hänsyn till både företagets och målgruppens åsikter.  

Granskning av riktlinjer vid Sveriges förlossningskliniker gällande sfinkterskada i samband med förlossning : Innehållsanalys med en kombination av en deduktiv och induktiv ansats

Background: Sphincter injury is serious complication in connection to vaginal childbirth. Desire to avoid vaginal birth again is seen in women who previously suffered from a sphincter injury. Objective: To identify and evaluate obstetric guidelines in Sweden regarding sphincter injury in relation to childbirth Method: Content analysis with a combination of a deductive and inductive approach. Results: The most frequently occurring risk factors and prevention with help of perineal protection were described in the guidelines. The physician made diagnosis and repaired the sphincter injury at the theatre.  Complications such as coital pain and anal incontinence were described in the guidelines. Paracetamol and diclofenac was most common analgesic regimen given for pain. Prophylaxis such as antibiotic treatment and laxative were common. Information given to women was described. Follow-up by physician, midwife and physiotherapist was recommended after four weeks to six months. For future birth a cesarean section was recommended. Conclusion: The guidelines were constructed in the same way and had to a large extent similar content. The authors of the present work recommend a national guideline.

A user guide to simple monitoring and sustainable operation of PV-diesel hybrid systems : Handbook for system users and operators

This report contains a suggestion for a simple monitoring and evaluation guideline for PV-diesel hybrid systems. It offers system users a way to better understand if their system is operated in a way that will make it last for a long time. It also gives suggestions on how to act if there are signs of unfavourable use or failure. The application of the guide requires little technical equipment, but daily manual measurements. For the most part, it can be managed by pen and paper, by people with no earlier experience of power systems.The guide is structured and expressed in a way that targets PV-diesel hybrid system users with no, or limited, earlier experience of power engineering. It is less detailed in terms of motivations for certain choices and limitations, but rich in details concerning calculations, evaluation procedures and maintenance routines. A more scientific description of the guide can be found in a related journal article.

Standardisation of the Selling Process in Franchising : A Take on Sales Funnel Management

This paper addresses the two opposing extremes of standardisation in franchising and the dynamics of sales in search of a juncture point in order to reduce franchisees’ uncertainties in sales and improve sales performance. A conceptual framework is developed based on both theory and practice in order to investigate the sales process of a specific franchise network. The research is conducted over a period of six weeks in form of a customised sales report considering the sales funnel concept and performance indicators along the sales process. The received quantitative data is analysed through descriptive statistics and logistic regressions in respect to what variations in the sales process can be discovered and what practices yield higher performance. The results indicate an advantage of a prioritisation guideline regarding the activities and choices to make as a salesperson over strict standardisation. Defining the sales funnel plus engaging in the process of monitoring sales in itself has proven to be a way of reducing uncertainty as the franchisor and franchisees alike inherently gain a greater understanding of the process. The extended knowledge gained from this research allowed for both practical as well as theoretical implications and expands the knowledge on standardisation of sales and the appropriateness of the sales funnel and its management for dealing with the dilemma between standardisation and flexibility of sales in franchising contexts.