Quality of radiotherapy care by development of e-feedback knowledge

The aim of this three phase study was to develop quality of radiotherapy care by the e-Feedback knowledge of radiotherapy -intervention (e-Re-Know). In Phase I, the purpose was to describe the quality of radiotherapy care and its deficits experienced by cancer patients. Based on the deficits in patient education in Phase II, the purpose was to describe cancer patients’ e-knowledge expectations in radiotherapy. In Phase III, the purpose was to develop and evaluate the outcomes of the e-Re-Know among breast cancer patients. The ultimate aim was to develop radiotherapy care to support patients’ empowerment with patient e-education. In Phase I (2004-2005), the descriptive design was used, and 134 radiotherapy patients evaluated their experiences by Good Nursing Care Scale for Patients (GNCS-P) in the middle of RT period. In Phase II (2006-2008), the descriptive longitudinal design was used and 100 radiotherapy patients’ e-knowledge expectations of RT were evaluated using open-ended questionnaire developed for this study before commencing first RT, in the middle of the treatment, and concluding RT period. In Phase III, firstly (2009-2010), the e-Re-Know intervention, i.e. knowledge test and feedback, was developed in terms of empowering knowledge and implemented with e-feedback approach based on literature and expert reviews. Secondly (2011-2014), the randomized controlled study was used to evaluate the e-Re-Know. Breast cancer patients randomized to either the intervention group (n=65) receiving the e-Re-Know by e-mail before commencing first RT and standard education or the control group (n=63) receiving standard education. The data were collected before commencing first RT, concluding last RT and 3 months after last RT using RT Knowledge Test, Spielberger’s State Trait Inventory (STAI) and Functional Assessment of Cancer Therapy - Breast (FACT-B) –instruments. Data were analyzed using statistical methods and content analysis. The study showed radiotherapy patients experienced quality of care high. However, there were deficits in patient education. Furthermore, radiotherapy patients’ multidimensional e-knowledge expectations through Internet covered mainly bio-physiological and functional knowledge. Thus, the e-Re-Know was developed and evaluated. The study showed when breast cancer patients’ carried out the e-Re-Know their knowledge of side effects self-care was significantly increased and quality of life (QOL) significantly improved in line with decrease in anxiety from time before radiotherapy period to three months after. In addition, the e-Re-Know has potential to have positive effects on anxiety and QOL, regardless of patient characteristics or knowledge level. The results support the theory of empowering patient education suggesting that empowerment can be supported by confirming patients’ understanding of own knowledge level. In summary, the e-Feedback knowledge of radiotherapy (e-Re-Know) intervention can be recommended in development of quality of radiotherapy care experienced by breast cancer patients. Further research is needed to assess and develop patient-centred quality of care by patient education among cancer patients.

Organizing for Systemic Innovations – Research on Knowledge, Interaction and Organizational Interdependencies

Systemic innovation has emerged as an important topic due to the interconnected technological and sociotechnical change of our current complex world. This study approaches the phenomenon from an organizing perspective, by analyzing the various actors, collaborative activities and resources available in innovation systems. It presents knowledge production for innovation and discusses the organizational challenges of shared innovation activities from a dynamic perspective. Knowledge, interaction, and organizational interdependencies are seen as the core elements of organizing for systemic innovations. This dissertation is divided into two parts. The first part introduces the focus of the study and the relevant literature and summarizes conclusions. The second part includes seven publications, each reporting on an important aspect of the phenomenon studied. Each of the in-depth single-case studies takes a distinct and complementary systems approach to innovation activities – linking the refining of knowledge to the enabling of organizations to participate in shared innovation processes. These aspects are summarized as theoretical and practical implications for recognizing innovation opportunities and turning ideas into innovations by means of using information and organizing activities in an efficient manner. Through its investigation of the existing literature and empirical case studies, this study makes three main contributions. First, it describes the challenges inherent in utilizing information and transforming it into innovation knowledge. Secondly, it presents the role of interaction and organizational interdependencies in innovation activities from various novel perspectives. Third, it highlights the interconnection between innovations and organizations, and the related path dependency and anticipatory aspects in innovation activities. In general, the thesis adds to our knowledge of how different aspects of systems form innovations through interaction and organizational interdependencies. It highlights the continuous need to redefine information and adjust organizations and networks based on ongoing activities – stressing the emergent, systemic nature of innovation.

Translation, adaptation and validation of the Roland-Morris questionnaire - Brazil Roland-Morris

The purpose of the present study was to translate the Roland-Morris (RM) questionnaire into Brazilian-Portuguese and adapt and validate it. First 3 English teachers independently translated the original questionnaire into Brazilian-Portuguese and a consensus version was generated. Later, 3 other translators, blind to the original questionnaire, performed a back translation. This version was then compared with the original English questionnaire. Discrepancies were discussed and solved by a panel of 3 rheumatologists and the final Brazilian version was established (Brazil-RM). This version was then pretested on 30 chronic low back pain patients consecutively selected from the spine disorders outpatient clinic. In addition to the traditional clinical outcome measures, the Brazil-RM, a 6-point pain scale (from no pain to unbearable pain), and its numerical pain rating scale (PS) (0 to 5) and a visual analog scale (VAS) (0 to 10) were administered twice by one interviewer (1 week apart) and once by one independent interviewer. Spearman's correlation coefficient (SCC) and intraclass correlation coefficient (ICC) were computed to assess test-retest and interobserver reliability. Cross-sectional construct validity was evaluated using the SCC. In the pretesting session, all questions were well understood by the patients. The mean time of questionnaire administration was 4 min and 53 s. The SCC and ICC were 0.88 (P<0.01) and 0.94, respectively, for the test-retest reliability and 0.86 (P<0.01) and 0.95, respectively, for interobserver reliability. The correlation coefficient was 0.80 (P<0.01) between the PS and Brazil-RM score and 0.79 (P<0.01) between the VAS and Brazil-RM score. We conclude that the Brazil-RM was successfully translated and adapted for application to Brazilian patients, with satisfactory reliability and cross-sectional construct validity.

Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire

The objective of the present study was to translate, adapt and validate a Brazilian Portuguese version of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. The study was carried out in two steps. The first was to translate the DASH into Portuguese and to perform cultural adaptation and the second involved the determination of the reliability and validity of the DASH for the Brazilian population. For this purpose, 65 rheumatoid arthritis patients of either sex (according to the classification criteria of the American College of Rheumatology), ranging in age from 18 to 60 years and presenting no other diseases involving the upper limbs, were interviewed. The patients were selected consecutively at the rheumatology outpatient clinic of UNIFESP. The following results were obtained: in the first step (translation and cultural adaptation), all patients answered the questions. In the second step, Spearman's correlation coefficients for interobserver evaluation ranged from 0.762 to 0.995, values considered to be highly reliable. In addition, intraclass correlation coefficients ranged from 0.97 to 0.99, also highly reliable values. Spearman's correlation coefficients and the intraclass correlation coefficients obtained during intra-observer evaluation ranged from 0.731 to 0.937 and from 0.90 to 0.96, respectively, being highly reliable values. The Ritchie Index showed a weak correlation with Brazilian DASH scores, while the visual analog scale of pain showed a good correlation with DASH score. We conclude that the Portuguese version of the DASH is a reliable instrument.

The RNA interference revolution

The discovery of double-stranded RNA-mediated gene silencing has rapidly led to its use as a method of choice for blocking a gene, and has turned it into one of the most discussed topics in cell biology. Although still in its infancy, the field of RNA interference has already produced a vast array of results, mainly in Caenorhabditis elegans, but recently also in mammalian systems. Micro-RNAs are short hairpins of RNA capable of blocking translation, which are transcribed from genomic DNA and are implicated in several aspects from development to cell signaling. The present review discusses the main methods used for gene silencing in cell culture and animal models, including the selection of target sequences, delivery methods and strategies for a successful silencing. Expected developments are briefly discussed, ranging from reverse genetics to therapeutics. Thus, the development of the new paradigm of RNA-mediated gene silencing has produced two important advances: knowledge of a basic cellular mechanism present in the majority of eukaryotic cells and access to a potent and specific new method for gene silencing.

Liber fostering Open Science and Knowledge Discovery

Presentation of Kristiina Hormia-Poutanen at the 25th Anniversary Conference of The National Repository Library of Finland, Kuopio 22th of May 2015.

Evaluating the Strategic Objectives of Cameroonian Higher Education: An application of the Balanced Scorecard

Contemporary higher education operates in an environment of dwindling and parsimonious resources; the increasing need for accountability and relevance to varying stakeholders with differing expectations. These relatively new trends in higher education have been faced by business organizations which have developed different ways of operating in response. This study outlines one way by which business organizations have addressed similar circumstances to show how the Cameroon higher education (HE) could learn from business organizations to manage strategic objectives. The balanced scorecard (BSC) has been used by business organizations to address similar trends. This study evaluates the strategic objectives of Cameroonian higher education using the balanced scorecard. The system level is used to identify the general strategic objectives and one state university is used to represent the translation and implementation of the objectives at the institution level. The BSC principles used include: operational strategic objectives; organizational alignment to the strategy; making strategy everyone’s everyday job; making strategy continual and; mobilizing the leadership for change. The underlying concepts in these principles are communication, consensus, relevance, and a participatory approach. The study employs data from policy documents, relevant literature, websites and semi-structured interviews. The research approach is qualitative and the analyses are done by making meaning of phenomena in their natural contexts. The results show that there is a general knowledge of the strategic objectives but there is disagreement on the relevance of these objectives to HE and on the type of approaches used in implementing the objectives. It was also found that the relevant stakeholders are known, but not all the respondents agree on the importance of these stakeholders. All stakeholders do not have the same level of influence-the state is the most influential. Reporting is sufficiently done but there are insufficient provisions for feedback from stakeholders. The study concludes that the BSC principles can be applied to the management of strategic objectives in Cameroon HE. For Cameroonian higher education, it is recommended that the focus should be first, on developing tools for strategy before the strategy itself. Even though the need for the BSC is confirmed the context does not seem sufficiently ready to implement the BSC as a strategic management tool. The proposed BSC framework can only be used as a communication tool. The barriers to managing strategic objectives in Cameroon HE are related to the communication, consensus, clarity and relevance. However, the system has prospects for improved management and eventual adoption of the BSC as both a strategic management and communication tool. In line with other BSC applications to higher education, this study concluded that it is more feasible to apply the balanced scorecard to a single higher education institution than to a higher education system. The study makes a contribution to the BSC by showing how its principles can be used in a non-business context. The study also opens up possibilities for future research on the same topic in a different context or the same context with a wider scope (more institutions and respondents); the same study with a deeper focus on the interrelationships between the different strategic objectives (strategy maps). The study could also be extended by including the perspectives of the identified stakeholders who are not directly part of the higher education system but constitute the environment in which higher education operates.

The northern provinces of Sweden and Norway with part I, of Russia / published under the superintendence of the Society for the Diffusion of Useful Knowledge.

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Effect of the Knowledge Representation Form on the Efficiency of Knowledge Sharing

The goal of this thesis is to estimate the effect of the form of knowledge representation on the efficiency of knowledge sharing. The objectives include the design of an experimental framework which would allow to establish this effect, data collection, and statistical analysis of the collected data. The study follows the experimental quantitative design. The experimental questionnaire features three sample forms of knowledge: text, mind maps, concept maps. In the interview, these forms are presented to an interviewee, afterwards the knowledge sharing time and knowledge sharing quality are measured. According to the statistical analysis of 76 interviews, text performs worse in both knowledge sharing time and quality compared to visualized forms of knowledge representation. However, mind maps and concept maps do not differ in knowledge sharing time and quality, since this difference is not statistically significant. Since visualized structured forms of knowledge perform better than unstructured text in knowledge sharing, it is advised for companies to foster the usage of these forms in knowledge sharing processes inside the company. Aside of performance in knowledge sharing, the visualized structured forms are preferable due the possibility of their usage in the system of ontological knowledge management within an enterprise.