A cross-sectional evaluation of community pharmacists’ perceptions of intermediate care and medicines management across the healthcare interface

Background Despite the importance placed on the concept of the multidisciplinary team in relation to intermediate care (IC), little is known about community pharmacists’ (CPs) involvement. 
Objective To determine CPs’ awareness of and involvement with IC services, perceptions of the transfer of patients’ medication information between healthcare settings and views of the development of a CP–IC service. 
Setting Community pharmacies in Northern Ireland. 
Methods A postal questionnaire, informed by previous qualitative work was developed and piloted. 
Main outcome measure CPs’ awareness of and involvement with IC. Results The response rate was 35.3 % (190/539). Under half (47.4 %) of CPs ‘agreed/strongly agreed’ that they understood the term ‘intermediate care’. Three quarters of respondents were either not involved or unsure if they were involved with providing services to IC. A small minority (1.2 %) of CPs reported that they received communication regarding medication changes made in hospital or IC settings ‘all of the time’. Only 9.5 and 0.5 % of respondents ‘strongly agreed’ that communication from hospital and IC, respectively, was sufficiently detailed. In total, 155 (81.6 %) CPs indicated that they would like to have greater involvement with IC services. ‘Current workload’ was ranked as the most important barrier to service development.
Conclusion It was revealed that CPs had little awareness of, or involvement with, IC. Communication of information relating to patients’ medicines between settings was perceived as insufficient, especially between IC and community pharmacy settings. CPs demonstrated willingness to be involved with IC and services aimed at bridging the communication gap between healthcare settings.

Logghantering : En undersökning av logghantering och logghanteringssystem

This research includes a review of the log management of the company Telia. The research has also included a comparison of the two log management sys- tems Splunk and ELK. The review of the company’s log management shows that log messages are being stored in files on a hard drive that can be accessed through the network. The log messages are system-specific. ELK is able to fetch log messages of different formats simultaneously, but this feature is not possible in Splunk where the process of uploading log messages has to be re- peated for log messages that have different formats. Both systems store log messages through a file system on a hard drive, where the systems are installed. In networks that involve multiple servers, ELK is distributing the log messages between the servers. Thus, the workload to perform searches and storing large amounts of data is reduced. Using Splunk in networks can also reduce the workload. This is done by using forwarders that send the log messages to one or multiple central servers which stores the messages. Searches of log messages in Splunk are performed by using a graphical interface. Searches in ELK is done by using a REST-API which can be used by external systems as well, to retrieve search results. Splunk also has a REST-API that can be used by external sys- tems to receive search results. The research revealed that ELK had a lower search time than Splunk. However, no method was found that could be used to measure the indexing time of ELK, which meant that no comparison could be made with respect to the indexing time for Splunk. For future work there should be an investigation whether there is any possibility to measure the indexing time of ELK. Another recommendation is to include more log management sys- tem in the research to improve the results that may be suitable candidates for the company Telia. An improvement suggestion as well, is to do performance tests in a network with multiple servers and thereby draw conclusions how the performance is in practice.

Generations and intention to leave current job : Belgian nurses in the workplace

This master thesis aims to identify work-related factors making Belgian nurses consider leaving their job voluntary and to compare the work-related factors across different generations. The purpose of this master thesis has a descriptive nature of research. The research approach chosen is a deductive approach and the research design chosen is a quantitative research design. Cluster sampling in combination with simple random sampling was used as sampling technique. 128 nurses were surveyed from April to May 2016. Nurses who reported to leave the organization due to retirement reasons, temporary employment contract or maternity leave were excluded from the study as this study investigates the voluntary turnover intention. A total of 68 nurses were included in the study which indicates an overall response rate of 53 %. Numerous of the findings in this master thesis are consistent with previous studies on turnover intention of different generations in other western-countries than Belgium. The work-related factor workload was most often reported by Belgian nurses with no intention to leave their job. Belgian nurses with an intention to leave their job indicated most often the work-related factor (non-)financial benefits. The generation-specific findings indicated both similarities and differences between the work-related factors selected. It was observed that Baby Boomers with an intention to leave their job selected most often variables related to the work-related factors (non-)financial benefits, supportive organization and workload. The variable lack of recognition appeared among Baby Boomers with an intention and no intention to leave their job. Surprisingly was the often selected variables lack of direct and/clear feedback on performances and unsupportive supervisor among Baby Boomers with professional turnover intention. Further, it was observed that Generation Xers with an intention to leave their job selected most often variables related to the work-related factors supportive organization, communication, (non-)financial benefits, work content and workload. The variables inadequate opportunity for advancement/professional growth and imbalance work-life appeared among Generation Xers with an intention and no intention to leave their job. Generation Yers with an intention to leave their job selected most frequently variables related to the work-related factors (non-)financial benefits, workload and commitment. The variables inadequate salary and opportunities elsewhere appeared among nurses with an intention and no intention to leave their job. Surprisingly was the often selected variable inadequate salary among Generation Yers with professional turnover intention.

Vad ska vi göra med den psykosociala arbetsmiljön? : En undersökning av den psykosociala arbetsmiljön och hur vi kan arbeta för att förbättra den.

Denna uppsats baseras på en undersökning inom en global organisation. Syftet med undersökningen är att tydliggöra och beskriva en HR-avdelnings upplevelse av sin egen psykosociala arbetsmiljö. Utgångspunkten är att det finns givna faktorer som påverkar den psykosociala arbetsmiljön. Vidare syftar undersökningen till att motivera organisationen att arbeta vidare med detta. Teorin som dessa faktorer utgår från är att den psykosociala arbetsmiljön påverkas av för stor arbetsbelastning, bristande kontroll, brist på erkänsla, gemenskapen på arbetet, rollkonflikter och värderingskonflikter (Åsberg, Grape, Nygren, Rohde, Wahlberg, & Währborg, 2010; Thylefors, 2011). Även kompetens och möjligheten att påverka arbetsplatsen utgör faktorer (Wreder, 2007). Kunskap, kommunikation och ett gott ledarskap är grunden för att ha en fungerande psykosocial arbetsmiljö. Undersökningen grundas i en deduktiv ansats, där deltagarna inledningsvis skattar faktorer genom en kvantitativ enkät, för att några veckor senare diskutera faktorerna i kvalitativa fokusgrupper. Syftet med enkäten var att erhålla en anonym och individuell skattning av upplevelsen, medan syftet med fokusgrupperna var att erhålla en djupare information om upplevelsen och hur arbetstagarna upplever att den psykosociala arbetsmiljön kan förbättras. Resultatet tolkades utifrån teorin och flertalet faktorer hade potential att åtgärdas. För att kunna bedriva ett adekvat arbetsmiljöarbete är det viktigt för samtliga organisationer att identifiera dessa och arbeta med de faktorer som arbetstagarna upplever aktuella. Vidare är det viktigt att arbeta med den psykosociala arbetsmiljön utifrån ett organisationsperspektiv, än endast det individuella perspektivet.

Sex timmars arbetsdag –ett modigt beslut : För att bli en attraktiv arbetsgivare

I studien undersöks hur arbetstagarnas arbetstillfredsställelse förändrats vis en arbetstidsförkortning. Arbetstidsförkortningens art är i form av en övergång ifrån åtta timmars arbetsdag till sex timmars arbetsdag med bibehållen heltidslön. Studien har genomförts vid ett mindre privat tjänsteföretag. Studiens syfte är att undersöka hur denna typ av arbetstidsförkortning förhåller sig till arbetstagarnas arbetstillfredsställelse och därmed öka förståelsen för de båda fenomenen. Det framkommer att arbetstagarnas arbetstillfredsställelse har förändrats sedan arbetstidsförkortningen. Gällande enskilda faktorer i arbetet har somliga faktorer minskat medan somliga faktorer ökat. I diskussionen framkommer att det föreligger en risk för ohälsa för arbetstagarna då det råder brist på stöd, minskad kontroll och ökade krav sedan arbetstidsförkortningen införts. Den föreliggande risken för ohälsa kan dock ses som acceptabel med tanke på den varierande arbetsbelastningen vilket innebär att arbetstagarna under perioder får tid för återhämtning. Trots omständigheterna råder en hög global arbetstillfredsställelse vilket i sin tur borde innebära att teorierna som brukats innehåller vissa brister då hänsyn till svängningar i arbetsbelastningen inte tagits. I resultatanalysen framkom tre teman vilka sågs relevanta för arbetstagarna och dess arbetstillfredsställelse. Dessa teman bestod av förändringar i relationer, förändringar i arbetet och förändringar i belöningar. Den teoretiska referensramen för studien innehåller förväntningsteorin, tvåfaktor teorin, kravkontroll- stödmodellen samt ansträngning- belöning- obalansmodellen. Datainsamling har skett med hjälp av fyra semistrukturerade intervjuer då respondenterna bestått av arbetstagare på det valda fallet som studerats. Studien är uppbyggt efter kvalitativ metod och har en fenomenologisk ansats. Studien har utformats i form av en fallstudie.

Den offentliga sektorns komplexa adaptiva system : En kvalitativ studie om medarbetarpolicys i praktiken

Intresset för hur HR och ledning kan påverka medarbetarnas beteendemönster och den sociala strukturen inom organisationer har gett upphov till denna undersökning. Med utgångspunkt i teorier om komplexa adaptiva system som perspektiv har jag försökt fånga medarbetarnas förutsättningar att nå organisationers vision och därmed förverkliga medarbetarpolicyn i praktiken. Tillsammans med kontaktpersoner från den undersökta kommunen har jag gjort en djupdykning i en offentlig organisation i syfte att förklara byråkratins inverkan på beteendemönstret hos medarbetarna och hur de tillsammans skapar en social struktur vilken speglar organisationens vision. Syftet med studien är att undersöka hur det adaptiva systemet fungerar i en byråkratisk organisation och vad det betyder för medarbetarnas möjligheter att förverkliga organisationens vision och medarbetarpolicy. Undersökningen har genomförts på en socialförvaltning i en kommun i mellan Sverige och med en kvalitativ metod och semistrukturerade intervjuer har sex respondenter deltagit i undersökningen. Samtliga respondenter har olika befattningar inom organisationen och bidrar därmed med olika perspektiv på samma fenomen. Undersökningens resultat visar att den offentliga verksamhetens byråkratiska organisationsstruktur bidrar till att det bildas olika adaptiva system inom organisationen, där medarbetarnas beteendemönster bildar en social struktur som leder till att visionen och medarbetarpolicyn inte förverkligas. Undersökningen visar även att de adaptiva systemen inom organisationen inte påverkar varandra, då de inte interagerar med varandra inom organisationen. Det som ligger till grund för hur medarbetarnas beteendemönster etableras inom organisationen är kraven från omvärlden, hög arbetsbelastning och avsaknaden av stabilitet i den organisatoriska och sociala arbetsmiljön och inte vad tidigare forskning visat; att det skulle vara hög regelstyrning som ligger till grund för beteendemönstret inom den offentliga sektorn. Slutsatsen är att för att medarbetarna ska kunna förverkliga organisationens vision och medarbetarpolicy kräver det att HR, ledning och medarbetare alla ingår i samma adaptiva system. För att det ska vara möjligt behöver HR upprätta strategier för hur samtliga inom organisationen ska interagera med varandra i det dagliga arbetet. Ledningen och medarbetarna behöver även ha goda möjligheter att kommunicera med varandra regelbundet i en större omfattning än vad de gör idag. Konkreta åtgärder för hur det lämpligen bör genomföras presenteras under diskussionen.

Equilíbrios Difíceis: stress laboral, equilíbrio trabalho/família e diferenças de género entre os colaboradores de uma empresa de tecnologias da informação

O stress é não apenas inerente para o ser humano, como indispensável para a sua sobrevivência. À medida que as sociedades humanas evoluíram, assim também se alteraram as principais fontes de stress. Actualmente o stress organizacional é uma das principais áreas de investigação, bem como as suas relações com a família e a vida pessoal. Em foco estão ainda as variáveis individuais que servem como moderadoras da experiência de stress, como o coping e o suporte social. Neste trabalho procurou-se conhecer os níveis de stress experienciados pelos colaboradores da Cisco Systems Lda, identificando diferenças de género e entre os tipos de trabalho. Pretendeu-se ainda relacionar o stress no trabalho com o equilíbrio trabalho/família, equlíbrio vida pessoal/trabalho, suporte social e coping. Através de um estudo não experimental transversal, descritivo/descritivo correlacional, com 42 sujeitos, utilizando o PMI – Pressure Management Indicator, foi possível identificar quatro factores, com α a partir de 0,531 para as variáveis moderadoras ate 0,904 para as variáveis stressoras. Os trabalhadores da amostra trabalham em média 49,7 horas por semana, apontando como principal razão “para que o trabalho seja feito”; 31,7% consideram estar a sofrer de pressão negativa iniciada há mais de 3 meses. Estão muito satisfeitos com a organização, mas sentem pressão devido ao volume de trabalho, ao relacionamento interpessoal e às dificuldades em desligar do trabalho quando em casa, fazendo uso de estratégias focadas no problema e de suporte social. Existem diferenças estatisticamente significativas entre homens e mulheres nas subescalas “Estado de espírito” e “Nível de confiança”, indicando níveis mais altos de segurança e satisfação com o seu estado mental para o grupo dos homens. No que respeita aos tipos de trabalho, foi possível identificar diferenças entre as categorias Sénior gerência/profissional e Manual/hábil nas subescalas “Nível de energia”, “Volume de trabalho” e “Equilíbrio vida/trabalho”. Existe correlação positiva entre as variáveis stressoras e a subescala “Equilíbrio trabalho/família” (r=0,890; p<0,000) e entre as variáveis stressoras e a escala de Coping (r=0,748; p<0,000), sugerindo que níveis de stress elevados interferem com a vida familiar e conduzem a maior utilização das estratégias de coping. Apesar das políticas de recursos humanos da empresa no sentido de promover a conciliação entre trabalho e vida pessoal e familiar, há ainda margem para intervir e melhorar. / Stress is not only inherent to the human being, it’s essential to survival. As the humans societies evolved, so did the major sources of stress. These days, organizational stress is one of the main areas of research, as it is it’s relation with family and personal life. Under the spotlight are also individual variables that moderate the stress experience, such as coping and social support. With this paper, we intended to know the levels of stress experienced by the workers of Cisco Systems Lda, identifying gender and work type differences. We were also intending to relate work stress with home/work balance, life/work balance, social support and coping. Using a cross sectional correlational study, with n=42, using the PMI, we were able to identify four factors, with α starting on 0,531 for moderator variables to 0,904 for stressor variables. The workers on this sample work an average of 49,7 hours per week, naming “to get the job done” as the main reason for it. 31,7% consider to be suffering from negative pressure that started more than 3 months ago. They are very satisfied with the organization, but feel pressure due to workload, interpersonal relationship and the difficulties in switching off from work when at home. They use mostly Problem focus strategies and social support.There are statically significative differences between men and women in the subscales “State of mind” and “Confidence level”, which indicate higher levels of security and satisfaction with their state of mind for men. Regarding work types, we were able to identify differences between senior Management and Manual categories on subscales “Energy level”, “Workload” and “Life/work balance”. There is a positive correlation between stressor variables and the subscales “Home/work balance” (r=0,890; p<0,000) and between stressor variables and Coping scale (r=0,748; p<0,000), suggesting that high levels of stress interfere with family life and lead to higher use of coping mechanisms. Despite the company’s human resources policies to promote the balance between work and personal and family life, there is still place to intervene and improve.

Causes of teachers’ turnover intentions in Swedish schools : A qualitative research

Purpose – The purpose of this paper is to explore the causes of teachers' turnover intentions in selected Swedish schools. Research methodology – This research took the form of a qualitative research. Semi-structured interviews were used to explore the causes of teachers' turnover intentions within the schools selected for this study. The sample was composed by 9 teachers that work in Säter. In order to provide a different yet meaningful perspective, a further interview with the Säter school department has been conducted. Results – Several of the results were coherent with the literature: elements such as motivations to teach, administrative support, workload, class size and collaboration were found to be related to teachers’ turnover intentions and therefore confirmed the previous studies. However, factors like salary, mentoring, autonomy, physical conditions and orderly environment were not found to have a connection with the respondents’ turnover intentions, hence constituting a result that did not confirm the literature. Originality – This thesis extended the previous research related to the causes of teachers’ turnover intentions by focusing on Sweden, which had not been investigated yet to that matter. The Swedish context appears particularly worth researching because of both the particularity of its decentralized educational system and the widespread turnover intentions of teachers.

Parallel dynamic load-balancing for adaptive unstructured meshes

This chapter describes a parallel optimization technique that incorporates a distributed load-balancing algorithm and provides an extremely fast solution to the problem of load-balancing adaptive unstructured meshes. Moreover, a parallel graph contraction technique can be employed to enhance the partition quality and the resulting strategy outperforms or matches results from existing state-of-the-art static mesh partitioning algorithms. The strategy can also be applied to static partitioning problems. Dynamic procedures have been found to be much faster than static techniques, to provide partitions of similar or higher quality and, in comparison, involve the migration of a fraction of the data. The method employs a new iterative optimization technique that balances the workload and attempts to minimize the interprocessor communications overhead. Experiments on a series of adaptively refined meshes indicate that the algorithm provides partitions of an equivalent or higher quality to static partitioners (which do not reuse the existing partition) and much more quickly. The dynamic evolution of load has three major influences on possible partitioning techniques; cost, reuse, and parallelism. The unstructured mesh may be modified every few time-steps and so the load-balancing must have a low cost relative to that of the solution algorithm in between remeshing.

Biståndshandläggare inom äldreomsorgens upplevelse av sin arbetssituation : En kvalitativ studie ur ett salutogent perspektiv

Syftet med denna uppsats var att genom ett salutogent perspektiv få en ökad förståelse för, inom äldreomsorgen verksamma, biståndshandläggares arbetssituation samt att undersöka vad som kan bidra till att biståndshandläggares arbetssituation upplevs som lättare och mindre påfrestande. Metoden som använts är kvalitativa intervjuer där sex biståndshandläggare verksamma i Värmland har intervjuats. Intervjuerna analyserades genom teman ur KASAM och resulterade i kategorier under varje tema. Under temat begriplighet framkom att biståndshandläggare får stöd från sina kollegor men att de också önskar att det fanns mer resurser för handledning. Biståndshandläggare utför mer än vad som ingår i arbetsbeskrivningen. Under temat hanterbarhet framgår att hög arbetsbelastning hanteras genom att biståndshandläggarna måste planera, strukturera och prioritera. Kollegornas stöd gör arbetet lättare att hantera då de genom att prata med varandra bearbetar känslomässigt påfrestande delar av arbetet. De uttryckte olika behov av att reflektera över sitt arbete. Biståndshandläggare har en stor frihet att planera sin egen arbetsdag och de samverkar med andra professioner. Under temat meningsfullhet framgår att biståndshandläggare finner mening i att göra skillnad för den enskilde. Vårt resultat visar att biståndshandläggarna är utsatta för stress i sitt arbete och att de också har förmåga att möta stressen, men förmågan att möta stressen minskar när arbetsbelastningen blir för hög. 

Dynamic load-balancing for parallel adaptive unstructured meshes

A parallel method for dynamic partitioning of unstructured meshes is described. The method employs a new iterative optimisation technique which both balances the workload and attempts to minimise the interprocessor communications overhead. Experiments on a series of adaptively refined meshes indicate that the algorithm provides partitions of an equivalent or higher quality to static partitioners (which do not reuse the existing partition) and much more quickly. Perhaps more importantly, the algorithm results in only a small fraction of the amount of data migration compared to the static partitioners.

Parallel partitioning of unstructured meshes

A method is outlined for optimising graph partitions which arise in mapping un- structured mesh calculations to parallel computers. The method employs a combination of iterative techniques to both evenly balance the workload and minimise the number and volume of interprocessor communications. They are designed to work efficiently in parallel as well as sequentially and when combined with a fast direct partitioning technique (such as the Greedy algorithm) to give an initial partition, the resulting two-stage process proves itself to be both a powerful and flexible solution to the static graph-partitioning problem. The algorithms can also be used for dynamic load-balancing and a clustering technique can additionally be employed to speed up the whole process. Experiments indicate that the resulting parallel code can provide high quality partitions, independent of the initial partition, within a few seconds.

Dynamic load balancing of distributed memory parallel computational mechanics using unstructured meshes for multi-physical modelling

As the complexity of parallel applications increase, the performance limitations resulting from computational load imbalance become dominant. Mapping the problem space to the processors in a parallel machine in a manner that balances the workload of each processors will typically reduce the run-time. In many cases the computation time required for a given calculation cannot be predetermined even at run-time and so static partition of the problem returns poor performance. For problems in which the computational load across the discretisation is dynamic and inhomogeneous, for example multi-physics problems involving fluid and solid mechanics with phase changes, the workload for a static subdomain will change over the course of a computation and cannot be estimated beforehand. For such applications the mapping of loads to process is required to change dynamically, at run-time in order to maintain reasonable efficiency. The issue of dynamic load balancing are examined in the context of PHYSICA, a three dimensional unstructured mesh multi-physics continuum mechanics computational modelling code.

Mesh partitioning and load balancing for distributed memory parallel systems

A method is outlined for optimising graph partitions which arise in mapping unstructured mesh calculations to parallel computers. The method employs a relative gain iterative technique to both evenly balance the workload and minimise the number and volume of interprocessor communications. A parallel graph reduction technique is also briefly described and can be used to give a global perspective to the optimisation. The algorithms work efficiently in parallel as well as sequentially and when combined with a fast direct partitioning technique (such as the Greedy algorithm) to give an initial partition, the resulting two-stage process proves itself to be both a powerful and flexible solution to the static graph-partitioning problem. Experiments indicate that the resulting parallel code can provide high quality partitions, independent of the initial partition, within a few seconds. The algorithms can also be used for dynamic load-balancing, reusing existing partitions and in this case the procedures are much faster than static techniques, provide partitions of similar or higher quality and, in comparison, involve the migration of a fraction of the data.

Parallel dynamic graph-partitioning for unstructured meshes

A parallel method for the dynamic partitioning of unstructured meshes is described. The method introduces a new iterative optimisation technique known as relative gain optimisation which both balances the workload and attempts to minimise the interprocessor communications overhead. Experiments on a series of adaptively refined meshes indicate that the algorithm provides partitions of an equivalent or higher quality to static partitioners (which do not reuse the existing partition) and much more rapidly. Perhaps more importantly, the algorithm results in only a small fraction of the amount of data migration compared to the static partitioners.