12 research outputs found

    Medline search validity for randomised controlled trials in different areas of dental research

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    OBJECTIVE: To determine the validity of Medline searches for randomised controlled trials in dental research (RCT-Ds), using the medical subject headings (MeSH-terms). DESIGN: The Medline database was searched for randomised controlled trials in dental research (RCT-Ds) published in 1999 and with MeSH-terms corresponding to different areas of dental research. All RCT-Ds were manually examined for relevance to the different areas of dental research and cross-tabulated against the Medline search results. The sensitivity, specificity, positive (precision) and negative predictive values, as well as the accuracy of the search results were calculated. RESULTS: The highest validity in the Medline searches for RCT-Ds was seen for endodontics, followed by orthodontics, whereas the lowest validity was seen for pediatric dentistry and public health dentistry. For pediatric dentistry the MeSH-term searches had too low a sensitivity for adequate location of RCT-Ds. CONCLUSIONS: MeSH-term searches on Medline are a useful tool for rapid location of RCT-Ds in most areas of dental research. However, there is a vast variation in the search validity. More refined search strategies are required to locate RCT-Ds in areas of dental research with low search validity

    Strategies to facilitate implementation and sustainability of large system transformations : a case study of a national program for improving quality of care for elderly people

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    BACKGROUND: Large-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies. METHODS: A longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries. RESULTS: This study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care. CONCLUSIONS: There is no blue-print on how to approach the challenging task of leading large scale change programs in complex contexts, but our conclusion is that more attention has to be given to the multidimensional strategies that program management need to consider. This multidimensionality comprises different strategies depending on types of actors, system levels, contextual factors, program progress over time, program content, types of learning and change processes, and the conditions for sustainability
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