Skin and mucosa care in systemic sclerosis - patients' and family caregivers' experiences and expectations of a specific education programme: a qualitative study

BACKGROUND Skin and mucosal manifestations such as skin thickening, pruritus, reduced microvascular circulation, digital lesions, appearance-related changes, and dryness of the eyes and mucosa are common in systemic sclerosis (SSc). A specific skin and mucosa care education programme for patients and their family caregivers should increase their self-efficacy and improve coping strategies. AIMS The aims of this qualitative study were to explore the participants' experiences of both everyday life with skin and mucosal manifestations and the programme itself, while identifying unmet needs for programme development. METHODS Narrative interviews were conducted with eight SSc patients and two family caregivers of individuals with SSc. Using qualitative content analysis techniques, the transcribed interviews were systematically summarized and categories inductively developed. RESULTS The findings illustrated participants' experiences of skin and mucosal symptoms and revealed them to be experts in finding the right therapy mix alone (before diagnosis) and also in collaboration with health professionals (after diagnosis). Participants emphasized that the programme gave them useful education on skin and mucosa care. They described how they had to cope alone with the lack of information on pathophysiology, people's reactions, and the impact on their family and working lives. Nevertheless, participants said that they maintained a positive attitude by not dwelling on future disabilities. CONCLUSIONS Patients and family caregivers benefited from the individualized and SSc-specific education on skin and mucosa care. Future improvements to the programme should focus on imparting understandable information on SSc pathophysiology, dealing with disfigurement and seeking reliable disease information, as well as facilitating peer support.

Systemic Determinants of the Information Systems Outsourcing Decision: A Comparative Study of German and United States Firms

The practice of information systems (IS) outsourcing is widely established among organizations. Nonetheless, evidence suggests that organizations differ considerably in the extent to which they deploy IS outsourcing. This variation has motivated research into the determinants of the IS outsourcing decision. Most of this research is based on the assumption that a decision on the outsourcing of a particular IS function is made independently of other IS functions. This modular view ignores the systemic nature of the IS function, which posits that IS effectiveness depends on how the various IS functions work together effectively. This study proposes that systemic influences are important criteria in evaluating the outsourcing option. It further proposes that the recognition of systemic influences in outsourcing decisions is culturally sensitive. Specifically, we provide evidence that systemic effects are factored into the IS outsourcing decision differently in more individualist cultures than in collectivist ones. Our results of a survey of United States and German firms indicate that perceived in-house advantages in the systemic impact of an IS function are, indeed, a significant determinant of IS outsourcing in a moderately individualist country (i.e., Germany), whereas insignificant in a strongly individualist country (i.e., the United States). The country differences are even stronger with regard to perceived in-house advantages in the systemic view of IS professionals. In fact, the direction of this impact is reversed in the United States sample. Other IS outsourcing determinants that were included as controls, such as cost efficiency, did not show significant country differences.

Patient Expectations in Internet-Based Self-Help for Social Anxiety

A number of controlled trials have demonstrated the efficacy of Internet-based cognitive-behaviour therapy for treating social anxiety disorder (SAD). However, little is known about what makes those interventions work. The current trial focuses on patient expectations as one common mechanism of change. The study examines whether patients' expectancy predicts outcome, adherence, and dropout in an unguided Internet-based self-help programme for SAD. Data of 109 participants in a 10-week self-help programme for SAD were analysed. Social anxiety measures were administered prior to the intervention, at week 2, and after the intervention. Expectancy was assessed at week 2. Patient expectations were a significant predictor of change in social anxiety (β = - .35 to - .40, all p < .003). Patient expectations also predicted treatment adherence (β = .27, p = .02). Patients with higher expectations showed more adherence and better outcome. Dropout was not predicted by expectations. The effect of positive expectations on outcome was mediated by early symptom change (from week 0 to week 2). Results suggest that positive outcome expectations have a beneficial effect on outcome in Internet-based self-help for SAD. Furthermore, patient expectations as early process predictors could be used to inform therapeutic decisions such as stepping up patients to guided or face-to-face treatment options

A Process Model of Complementarity and Substitution of Contractual and Relational Governance in IS Outsourcing

This paper develops a process model of how and why complementarity and substitution form over time between contractual and relational governance in the context of information systems outsourcing. Our analysis identifies four distinct process patterns that explain this formation as the outcome of interaction processes between key elements of both contractual and relational governance. These patterns unveil the dynamic nature of complementarity and substitution. In particular, we show that the relationship between contractual and relational governance oscillates between complementarity and substitution. Those oscillations are triggered mainly by three types of contextual events (goal fuzziness, goal conflict, and goal misalignment). Surprisingly, substitution of informal control did not occur as an immediate reaction to external events but emerged as a consequence of preceding complementarity. Thus, our study challenges the prevailing view of an either/or dichotomy of complementarity and substitution by showing that they are causally connected over time.

European veterinary public health specialization: post-graduate training and expectations of potential employers

Residents of the European College of Veterinary Public Health (ECVPH) carried out a survey to explore the expectations and needs of potential employers of ECVPH diplomates and to assess the extent to which the ECVPH post-graduate training program meets those requirements. An online questionnaire was sent to 707 individuals working for universities, government organizations, and private companies active in the field of public health in 16 countries. Details on the structure and activities of the participants' organizations, their current knowledge of the ECVPH, and potential interest in employing veterinary public health (VPH) experts or hosting internships were collected. Participants were requested to rate 22 relevant competencies according to their importance for VPH professionals exiting the ECVPH training. A total of 138 completed questionnaires were included in the analysis. While generic skills such as "problem solving" and "broad horizon and inter-/multidisciplinary thinking" were consistently given high grades by all participants, the importance ascribed to more specialized skills was less homogeneous. The current ECVPH training more closely complies with the profile sought in academia, which may partly explain the lower employment rate of residents and diplomates within government and industry sectors. The study revealed a lack of awareness of the ECVPH among public health institutions and demonstrated the need for greater promotion of this veterinary specialization within Europe, both in terms of its training capacity and the professional skill-set of its diplomates. This study provides input for a critical revision of the ECVPH curriculum and the design of post-graduate training programs in VPH.

Knowledge transfer in software-maintenance offshore outsourcing

Software-maintenance offshore outsourcing (SMOO) projects have been plagued by tedious knowledge transfer during the service transition to the vendor. Vendor engineers risk being over-strained by the high amounts of novel information, resulting in extra costs that may erode the business case behind offshoring. Although stakeholders may desire to avoid these extra costs by implementing appropriate knowledge transfer practices, little is known on how effective knowledge transfer can be designed and managed in light of the high cognitive loads in SMOO transitions. The dissertation at hand addresses this research gap by presenting and integrating four studies. The studies draw on cognitive load theory, attributional theory, and control theory and they apply qualitative, quantitative, and simulation methods to qualitative data from eight in-depth longitudinal cases. The results suggest that the choice of appropriate learning tasks may be more central to knowledge transfer than the amount of information shared with vendor engineers. Moreover, because vendor staff may not be able to and not dare to effectively self-manage learn-ing tasks during early transition, client-driven controls may be initially required and subsequently faded out. Collectively, the results call for people-based rather than codification-based knowledge management strategies in at least moderately specific and complex software environments.

Managing Knowledge Transfer in Software-Maintenance Outsourcing Transitions: A System-Dynamics Perspective

The existing literature suggests that transitions in software-maintenance offshore outsourcing projects are prone to knowledge transfer blockades, i.e. situations in which the activities that would yield effective knowledge transfer do not occur, and that client management involvement is central to overcome them. However, the theoretical understanding of the knowledge transfer blockade is limited, and the reactive management behavior reported in case studies suggests that practitioners may frequently be astonished by the dynamics that may give rise to the blockade. Drawing on recent research from offshore sourcing and reference theories, this study proposes a system dynamics framework that may explain why knowledge transfer blockades emerge and how and why client management can overcome the blockade. The results suggest that blockades may emerge from a vicious circle of weak learning due to cognitive overload of vendor staff and resulting negative ability attributions that result in reduced helping behavior and thus aggravate cognitive load. Client management may avoid these vicious circles by selecting vendor staff with strong prior related experience. Longer phases of coexistence of vendor staff and subject matter experts and high formal and clan controls may also mitigate vicious circles.

Explaining Emergence and Consequences of Specific Formal Controls in IS Outsourcing – A Process-View

IS outsourcing projects often fail to achieve project goals. To inhibit this failure, managers need to design formal controls that are tailored to the specific contextual demands. However, the dynamic and uncertain nature of IS outsourcing projects makes the design of such specific formal controls at the outset of a project challenging. Hence, the process of translating high-level project goals into specific formal controls becomes crucial for success or failure of IS outsourcing projects. Based on a comparative case study of four IS outsourcing projects, our study enhances current understanding of such translation processes and their consequences by developing a process model that explains the success or failure to achieve high-level project goals as an outcome of two unique translation patterns. This novel process-based explanation for how and why IS outsourcing projects succeed or fail has important implications for control theory and IS project escalation literature.

Knowledge in software-maintenance outsourcing projects: beyond integration of business and technical knowledge

Knowledge processes are critical to outsourced software projects. According to outsourcing research, outsourced software projects succeed if they manage to integrate the client’s business knowledge and the vendor’s technical knowledge. In this paper, we submit that this view may not be wrong, but incomplete in a significant part of outsourced software work, which is software maintenance. Data from six software-maintenance outsourcing transitions indicate that more important than business or technical knowledge can be application knowledge, which vendor engineers acquire over time during practice. Application knowledge was the dominant knowledge during knowledge transfer activities and its acquisition enabled vendor staff to solve maintenance tasks. We discuss implications for widespread assumptions in outsourcing research.

How expectations affect reference point formation: an experimental investigation

This paper addresses two major topics concerning the role of expectations in the formation of reference points. First, we show that when expectations are present, they have a significant impact on reference point formation. Second, we find that decision-makers employ expected values when forming reference points (integrated mechanism) as opposed to single possible outcomes (segregated mechanism). Despite the importance of reference points in prospect theory, to date, there is no standard method of examining these. We develop a new experimental design that employs an indirect approach and extends an existing direct approach. Our findings are consistent across the two approaches.

Information Technology Outsourcing: Towards Sustainable Business Value

This book attempts to synthesize research that contributes to a better understanding of how to reach sustainable business value through information systems (IS) outsourcing. Important topics in this realm are how IS outsourcing can contribute to innovation, how it can be dynamically governed, how to cope with its increasing complexity through multi-vendor arrangements, how service quality standards can be met, how corporate social responsibility can be upheld, and how to cope with increasing demands of internationalization and new sourcing models, such as crowdsourcing and platform-based cooperation. These issues are viewed from either the client or vendor perspective, or both. The book should be of interest to all academics and students in the fields of Information Systems, Management, and Organization as well as corporate executives and professionals who seek a more profound analysis and understanding of the underlying factors and mechanisms of outsourcing.