Factors influencing the use of evidence based practice among physiotherapists and occupational therapists in their clinical work

Background: Evidence-based practice (EBP) is a process through which research is applied in daily clinical practice. Occupational therapists (OTs) and physiotherapists (PTs) are expected to work in line with EBP in order to optimise health care resources. This expectation is too seldom fulfilled. Consequently, research findings may not be implemented in clinical practice in a timely manner, or at all. To remedy this situation, additional knowledge is needed regarding what factors influence the process of EBP among practitioners. The purpose of the present study was to identify factors that influence the use of EBP and the experienced effects of the use of EBP among PTs and OTs in their clinical work. Method: This was a qualitative interview study that consisted of six group interviews involving either OTs or PTs employed by the Jönköping County Council in the South of Sweden. Resulting data were analysed using content analysis. Results: The analysis resulted in the following categories: “definition of evidence and EBP”, “sources of evidence”, “barriers to acquiring evidence and to using evidence in clinical work”, “factors that facilitate the acquisition of evidence and the use of evidence in clinical work”, and “personal experiences of using EBP”. Basing clinical practice on scientific evidence evoked positive experiences, although an ambivalent view towards acting on clinical experience was evident. Participants reported that time for and increased knowledge about searching for, evaluating, and implementing EBP were needed. Conclusion: Because OTs are more oriented towards professional theories and models, and PTs are more focused on randomised controlled trials of interventions, different strategies appear to be needed to increase EBP in these two professions. Management support was considered vital to the implementation of EBP. However, the personal obligation to work in line with EBP must also be emphasised; the participants apparently underestimate its importance.

Personcentrerad omvårdnad vid demens : En deskriptiv kvalitativ studie

Bakgrund: Demens är en av de stora folksjukdomarna och vårdpersonal möter dessa personer med demens både inom akutsjukvård och kommunal vård. På slutet av sitt liv bor de flesta personer som drabbats av demens på institution. Personcentrerad vård beskrivs vara gynnsamt i vården av personer med demens och personalens erfarenhet av detta har stor betydelse. Syfte: Syftet var att studera sjuksköterskors, enhetschefers och undersköterskors erfarenhet av personcentrerad omvårdnad inom kommunal hälso och sjukvård. Metod: Designen var en deskriptiv studie med kvalitativ ansats som har analyserats med hjälp av en induktiv innehållsanalys. Deltagarna som inkluderades i intervjustudien kom från samma kommun. Det var tio personer och bestod av fyra sjuksköterskor, fyra undersköterskor och två enhetschefer. De valdes ut av verksamhetschefen där inklusionskriteriet var att ha arbetat med personer med demens i minst fem år. Resultat: I resultatet framkom fyra kategorier och 12 subkategorier. Personcentrerad omvårdnad ansågs relevant i samband med god omvårdnad av personer med demens. I arbetet med personcentrerad vård var fokus att; anpassa sig till personen med demens, att se till dennes identitet och personlighet. Vidare lades vikt vid anhörigas deltagande, bemötande och ett gemensamt arbetssätt, vilket bestod av att identifiera behov och se personen bakom sjukdomen. Slutsats: Resultatet visade att de flesta intervjupersonerna hade liknande erfarenheter i att arbeta med personer med demens. Det framkom i studien att bemötandet hade stor betydelse i omvårdnaden. Fokus i personcentrerad omvårdnad var de redovisade kategorierna och dess innehåll och ansågs betydelsefull och nödvändig för att personer med demens får ett så bra och värdigt liv som möjligt efter sjukdomsdebuten.

Äldre invandrares från före detta Jugoslaviens förväntningar i mötet med sjuksköterskor i Sverige : -En kvalitativ intervjustudie

Dagens samhälle blir allt mer mångkulturellt. Det ställer högre krav på både omvårdnaden och sjuksköterskan. Sjuksköterskans eventuella brist på kompetens om kulturskillnader kan skapa kulturkrockar, missförstånd och felaktig omvårdnad. Syftet med studien var att undersöka vilka förväntningar äldre invandrare från förre detta Jugoslavien har i möten med sjuksköterskan i Sverige samt hur sjuksköterskans kompetens kan skiljas från undersköterskor, sjukgymnaster och arbetsterapeuter. Metod: Studien är kvalitativ med en induktiv ansats och baseras på sex intervjuer med äldre invandrare som ursprungligen kom från fd. Jugoslavien. Personlig kontakt togs med informanterna om deltagande i undersökningen genom serbiska/bosniska/kroatiska/makedoniska. Författaren informerade om studien och att de som ville delta kontaktade författaren. Insamlat material analyserades systematiskt med innehållsanalys. Resultat: Det som framkom att de äldre invandrarna förväntade sig i mötet med sjuksköterskan presenteras i följande fem kategorier; Att få bekräftelse för uttalade behov; Empatisk kontakt; Kommunikation och dialog i mötet; Respekt för sina värderingar och syn på hälsa och Trygghet. Slutsatsen: omvårdnad av äldre patienter med en annan kulturell bakgrund kräver båda kulturell kompetens och professionellt förhållningssätt. Sjuksköterskan behöver kunna identifiera patientens vårdbehov och i detta fallet även övergå de språkliga barriärer och nå patienten och förstå deras behov.

Prevalencia de síntomas de fatiga crónica / encefalomielitis miálgica (SFC/EM) y su relación con factores ocupacionales en trabajadores en una empresa de vigilancia en Bogotá, Colombia, 2016

Antecedentes: El síndrome de fatiga crónica/encefalomielitis miálgica (SFC/EM), un trastorno debilitante y complejo que se caracteriza por un cansancio intenso, ha sido estudiado en población general, sin embargo, su exploración en población trabajadora ha sido limitada. Objetivo: Determinar la prevalencia de síntomas asociados a SFC/EM y su relación con factores ocupacionales en personal de una empresa de vigilancia en Bogotá, durante el año 2016. Materiales y métodos: Estudio de corte transversal en una empresa de vigilancia, utilizando como instrumento para la recolección de datos la historia clínica-ocupacional. En las variables cualitativas se obtuvieron frecuencias simples y porcentajes y en las variables cuantitativas medidas de tendencia central y de dispersión. Se determinaron asociaciones entre variables (Ji-cuadrado de Pearson o test exacto de Fisher, valores esperados <5), (mann-whitney.y un modelo de regresión logística incondicional (p<0.05)). Resultados: Se evaluaron 162 trabajadores, los síntomas de SFC/EM con mayor prevalencia fueron sueño no reparador (38,3%) y dolor muscular (30,2%). Se encontró asociación estadísticamente significativa entre fatiga severa y crónica por al menos 6 meses con alteración en sistema nervioso (p=0,016) y consumo de medicamentos (p=0,043), así mismo entre el sueño no reparador con el número de horas de sueño de 5 a 7 horas (p=0,002). Conclusión: En los vigilantes el síntoma de SFC/EM más prevalente fue sueño no reparador y este se asoció con el número de horas de sueño de 5 a 7 horas. Con el estudio se pudieron determinar los casos probables de SFC/EM los cuales se beneficiarían de una valoración médica integral para un diagnóstico oportuno.

Changes in leisure time and occupational physical activity over 8 years: The Cornellà health Interview Survey Follow-Up Study

Aim: To describe changes in leisure time and occupational physical activity status in an urban Mediterranean population-based cohort, and to evaluate sociodemographic, health-related and lifestyle correlates of such changes. Methods: Data for this study come from the Cornellè Health Interview Survey Follow-Up Study, a prospective cohort study of a representative sample (n¿=¿2500) of the population. Participants in the analysis reported here include 1246 subjects (567 men and 679 women) who had complete data on physical activity at the 1994 baseline survey and at the 2002 follow-up. We fitted Breslow-Cox regression models to assess the association between correlates of interest and changes in physical activity. Results: Regarding leisure time physical activity, 61.6% of cohort members with ¿sedentary¿ habits in 1994 changed their status to ¿light/moderate¿ physical activity in 2002, and 70% who had ¿light/moderate¿ habits in 1994 did not change their activity level. Regarding occupational physical activity, 74.4% of cohort members who were ¿active¿ did not change their level of activity, and 64.3% of participants with ¿sedentary¿ habits in 1994 changed to ¿active¿ occupational physical activity. No clear correlates of change in physical activity were identified in multivariate analyses. Conclusion: While changes in physical activity are evident in this population-based cohort, no clear determinants of such changes were recognised. Further longitudinal studies including other potential individual and contextual determinants are needed to better understand determinants of changes in physical activity at the population level.

Rescuing a telecom giant from the jaws of bankruptcy: a case study and an interview with Sir Richard Lapthorne, chairman of Cable & Wireless

Purpose – The purpose of this paper is to demonstrate key strategic decisions involved in turning around a large multinational operating in a dynamic market. Design/methodology/approach – The paper is based on analysis of archival documents and a semi-structured interview with the chairman of the company credited with its rescue. Findings – Turnaround is complex and involves both planned and emergent strategies. The progress is non-linear requiring adjustment and change in direction of travel. Top management credibility and vision is critical to success. Rescue is only possible if the company has a strong cash generative business among its businesses. The speed of decision making, decisiveness and the ability to implement strategy are among the key ingredients of success. Originality/value – Turnaround is an under-researched area in strategy. This paper contributes to a better understanding in this important area and bridges the gap between theory and practice. It provides a practical view and demonstrates how a leading executive with significant expertise and successful turnaround track record deals with inherent dilemmas of turnaround

BSkyB transformation from a new loss-making venture to a successful organisation: case study and interview with Jeremy Darroch, Chief Executive of British Sky Broadcasting Group Plc

Purpose – This paper aims to articulate strategic dilemmas faced by a Chief Executive of a highly successful company and how such dilemmas were resolved. Design/methodology/approach – The case is based on a semi-structured interview with Mr Jeremy Darroch – Chief Executive of BSkyB – and analysis of documentary evidence. Findings – It is often difficult to implement strategies that simultaneously yield high organic growth rate, innovation, and a healthy balance-sheet. The paper sheds light on how Sky has met this challenge. Research limitations/implications – The research offers a unique insight into the views of a principal strategist and articulates the background to offer context, however, because of its design the findings are not generalisable. Originality/value – Very few articles offer insight into the thinking of those with principal responsibility for design and delivery of strategy. This paper offers such an insight based on a detailed interview with a highly successful Chief Executive.

Building from scratch a marketing services giant by acquisition: case study and interview with Sir Martin Sorrell, Chief Executive of WPP

Purpose – Mergers and acquisitions are among the most intensely used strategic decisions. Yet research by both academics and consulting groups suggests that many mergers and acquisitions fail to add value. On the other hand there are many companies that successfully use mergers and acquisition to grow and add shareholder value. One such company is WPP. The aim of this paper is to explore why WPP has been successful in its acquisition strategy while so many other companies fail. Design/methodology/approach – The paper draws on documentary evidence and a semi-structured interview with Sir Martin Sorrell – Chief Executive and founder of WPP. Research limitations/implications – The case study offers a unique insight into thinking of a successful acquirer and sheds light on how mergers and acquisitions are managed by WPP. However, because of its design the findings are not generalisable. Originality/value – This case study sheds light on how mergers and acquisitions can be used to create a £9 billion company from a standing start. Furthermore, very few case studies offer insight into the thinking of entrepreneurial Chief Executives who established the business, grew it to become the largest and most profitable marketing services company in the world and engineered close to 300 acquisitions.

Successful strategy making in Bupa not-for-profit provident: a case study and interview with Mr Ray King, chief executive of Bupa

Purpose – The focus of extant strategy literature is on for-profit organisations and within these group public organisations. There are other forms of organisations and following the deep recession of 2008 there is greater interest in other forms of organisation. In this case study and interview the aim is to examine strategy, strategic decisions and strategic management of a not-for-profit provident. Design/methodology/approach – The paper draws on documentary evidence and a semi-structured interview with Ray King, chief executive of Bupa. The perspective of CEO is key in strategy and such perspectives are relatively rarer. Findings – Bupa invests its surplus to provide better healthcare. Free from the pressures of quarterly reporting and shareholders it can pursue long-term value creation for members rather than short-term surpluses. Research limitations/implications – The case study and interview offers a unique insight into strategy-making within a successful mutual provident that has grown organically and externally becoming an international leader in health insurance. Originality/value – This case study sheds light on strategy-making within a not-for-profit provident that has diversified and grown significantly over the past six decades. Furthermore, very few case studies offer insight into the thinking of a chief executive who has successfully managed a business in a turbulent environment.

John Lewis Partnership lessons in logical incrementalism and organic growth: a case study and interview with the Chairman, Mr Charlie Mayfield

Purpose – The purpose of this paper is to demonstrate how strategy is developed and implemented in an organisation with an unusual ownership model. Partnerships are not a prevalent form of ownership but as this case demonstrates they can be extremely effective. Furthermore this case demonstrates how logical incrementalism can be used to implement major strategic decisions. Design/methodology/approach – The paper draws on company documentary evidence and a semi-structured interview with Mr Charlie Mayfield, Chairman of John Lewis Partnership. A chairman has a helicopter view of business whose perspectives are rarely captured by strategy researchers. This case study offers an insight into strategic thinking of a chairman and chief executive of a successful company. Research limitations/implications – The case study and interview offer a unique insight into the rationale behind strategic decisions within a successful partnership that has grown organically in a highly competitive retail market without high gearing. Originality/value – This case study sheds light on strategic moves within partnership. Furthermore, very few case studies offer insight into the thinking of a chief executive who has successfully managed a business in a turbulent environment.

A case study and interview with Jill McDonald CEO and President of McDonald's Northern Europe Division

Purpose – The purpose of this paper is to demonstrate how strategy is developed and implemented within a subsidiary of a global organization, the relationship between subsidiary and headquarters and the need for continuous change and adaption to remain relevant. Furthermore, this case study describes a successful process of invention and adoption. Design/methodology/approach – The paper draws on documentary evidence and a semistructured interview with Jill McDonald CEO and President of McDonald’s Northern Europe Division with responsibility for the UK, Sweden, Finland, Denmark, Norway and the Republic of Ireland. Management research rarely captures the views of the top executive, yet the top executives have a broad picture and are key strategic decision makers. Findings – The case study and interview offers a unique insight into factors contributing to McDonald’s unprecedented success (it has paid an increased dividend for the past 37 years). It also sheds light on its successful internationalization strategy. Originality/value – The case study draws on published material and augments this with an in-depth interview with the Chief Executive. Very few case studies offer insight into the thinking of a Chief Executive managing a subsidiary of a global organization. Its value lies in the lessons that managers and students of management can draw on the approach adopted by a highly successful global organization.

Small-Scale Farmers Land Use and Socioeconomic Situation in the Mount Elgon District in Northwestern Kenya : A Minor Field Study - Combined Field Mapping and Interview

This Minor Field Study was carried out during November and December in 2011 in the Mount Elgon District in Western Kenya. The objective was to examine nine small-scale farming household´s land use and socioeconomic situation when they have joined a non-governmental organization (NGO) project, which specifically targets small-scale farming households to improve land use system and socioeconomic situation by the extension of soil and water conservation measures. The survey has worked along three integral examinations methods which are mapping and processing data using GIS, semi structured interviews and literature studies.   This study has adopted a theoretical approach referred to as political ecology, in which landesque capital is a central concept. The result shows that all farmers, except one, have issues with land degradation. However, the extent of the problem and also implemented sustainable soil and water conservation measures were diverse among the farmers. The main causes of this can both be linked to how the farmers themselves utilized their farmland and how impacts from the climate change have modified the terms of the farmers working conditions. These factors have consequently resulted in impacts on the informants’ socioeconomic conditions. Furthermore it was also registered that social and economic elements, in some cases, were the causes of how the farmers manage their farmland. The farmer who had no significant problem with soil erosion had invested in trees and opportunities to irrigate the farmland. In addition, it was also recorded that certain farmers had invested in particular soil and water conservation measures without any significant result. This was probably due to the time span these land measures cover before they start to generate revenue.  The outcome of this study has traced how global, national and local elements exist in a context when it comes to the conditions of the farmers´ land use and their socioeconomic situation. The farmers atMt.Elgon are thereby a component of a wider context when they are both contributory to their socioeconomic situation, mainly due to their land management, and also exposed to core-periphery relationships on which the farmers themselves have no influence.

A multinational case-control study on childhood brain tumours, anthropogenic factors, birth characteristics and prenatal exposures: A validation of interview data.

Little is known about the aetiology of childhood brain tumours. We investigated anthropometric factors (birth weight, length, maternal age), birth characteristics (e.g. vacuum extraction, preterm delivery, birth order) and exposures during pregnancy (e.g. maternal: smoking, working, dietary supplement intake) in relation to risk of brain tumour diagnosis among 7-19 year olds. The multinational case-control study in Denmark, Sweden, Norway and Switzerland (CEFALO) included interviews with 352 (participation rate=83.2%) eligible cases and 646 (71.1%) population-based controls. Interview data were complemented with data from birth registries and validated by assessing agreement (Cohen's Kappa). We used conditional logistic regression models matched on age, sex and geographical region (adjusted for maternal age and parental education) to explore associations between birth factors and childhood brain tumour risk. Agreement between interview and birth registry data ranged from moderate (Kappa=0.54; worked during pregnancy) to almost perfect (Kappa=0.98; birth weight). Neither anthropogenic factors nor birth characteristics were associated with childhood brain tumour risk. Maternal vitamin intake during pregnancy was indicative of a protective effect (OR 0.75, 95%-CI: 0.56-1.01). No association was seen for maternal smoking during pregnancy or working during pregnancy. We found little evidence that the considered birth factors were related to brain tumour risk among children and adolescents.