Adopting Proactive Knowledge Use as an Innovation: The Case of a Knowledge Management System in Rheumatology

The aim of the study is to present a tentative framework to explore and investigate the drivers and barriers of adoption of the innovation of proactive knowledge use in connection to a knowledge management system (KMS) in health care. Semi-structured interviews were performed with champion implementers and physicians using the KMS along with a document analysis depicting significant events of the implementation process. The findings from the study suggested that drivers of the innovation were the characteristics of change agents, quality improvement, budget control and knowledge brought to the physician-patient dialogue by the KMS. In particular, there were indications of the KMS facilitating the process of making tacit knowledge explicit in the physician-patient dialogue. Identified barriers towards the innovation were resistance from clinical management, lack of motivation to share knowledge, lack of time and perceived flaws in the interface and compilation of data in the KMS

Innovations in Health Care: Design Theory and Realist Evaluation Combined

Innovations in health care are often characterized by complexity and fuzzy boundaries, involving both the elements of the innovation and the organizational structure required for a full implementation. Evaluation in health care is traditionally based on the collection and dissemination of evidence-based knowledge stating the randomized controlled trial, and the quasi-experimental study design as the most rigorous and ideal approaches. These evaluation approaches capture neither the complexity of innovations in health care, nor the characteristics of the organizational structure of the innovation. As a result, the reasons for innovations in health care not being disseminated are not fully explained. The aim of the paper is to present a design-evaluation framework for complex innovations in health care in order to understand what works for whom under what circumstances combining design theory and realist evaluation. The framework is based on research findings of a case study of a complex innovation, a health care quality register, in order to understand underlying assumptions behind the design of the innovation, as well as the characteristics of the implementation process. The design-evaluation cycle is hypothesized to improve the design and implementation of complex innovation by using program/kernel theories to develop design principles, which are evaluated by realistic evaluation, resulting in further refinement of program/kernel theories. The goal of the design-evaluation cycle is to provide support to implementers and practitioners designing and implementing complex innovations in health care, for improving dissemination of complex innovations

Balanced scorecard i sjukvården - en jämförelse

Problemformulering: Vi vill först och främst på grund av vikten av effektiv styrning inom offentlig förvaltning undersöka hur olika sjukvårdsenheter inom Region Skåne rent praktiskt arbetar med balanced scorecard (BSC) i olika kontexter. Vi ställer oss följande frågor: -Vilka motiv låg till grund för införandet av verktyget BSC? -Hur såg framtagningsprocess och implementering av BSC ut? -Hur ser tillämpningen av BSC ut? -Vad är de viktigaste skälen till användandet av BSC? Syfte: Uppsatsens syfte är att undersöka motiven bakom införandet av balanced scorecard inom sjukvården, beskriva och analysera framtagningsprocesser samt tillämpning av och skäl till användning av verktyget. Metod: Vi har valt att göra en kvalitativ undersökning på tre separata sjukvårdsenheter i Skåne. Denna undersökningsansats grundar sig främst på vårt behov av att nå en djupare insikt om bredden och helheten i arbetet med BSC. Den insamlade informationen sammanställdes och analyserades. I analysen gjordes kopplingar till valda teoridelar samt jämförelser mellan verksamheterna. Slutsatser: Våra fallstudier har haft olika motiv till införandet av BSC; sammanslagningen av flera avdelningar till en enhet, utvärdera och följa upp en entreprenör respektive styra organisation med många enheter. Genom att utveckla och låta BSC mogna fram samt använda sig av de anställdas erfarenheter och kunskap är det möjligt att implementera ett verktyg som når hög acceptans inom organisationen. Härigenom ökar också förståelsen för verksamhetens strategiska mål. BSC i kombination med IT-stöd är en optimal lösning för insamlandet av information samt hålla densamma lättillgänglig. BSC är ett effektivt, flexibelt och mångsidigt instrument som detaljerat återger en bra helhetsbild av organisationens verksamhet

Atheroprotective natural anti-phosphorylcholine antibodies of IgM subclass are decreased in Swedish controls as compared to non-westernized individuals from New Guinea

OBJECTIVE: To determine the importance of IgM antibodies against phosphorylcholine (aPC), a novel protective factor for cardiovascular disease (CVD), in a population with a non-western life style as compared with a Swedish control group. METHODS AND RESULTS: Risk factors for cardiovascular disease were determined in a group of 108 individuals aged 40–86 years from New Guinea and 108 age-and sex-matched individuals from a population based study in Sweden. Antibodies were tested by ELISA. aPC IgM levels were significantly higher among New Guineans than among Swedish controls (p < 0.0001). This difference remained significant among both men and women when controlled for LDL and blood pressure which were lower and smoking which was more prevalent in New Guineans as compared to Swedish controls (p < 0.0001). aPC IgM was significantly and negatively associated with age and systolic blood pressure among Swedish controls and with waist circumference among New Guineans. aPC IgM levels were significantly higher among women than men in both groups. The proportion of the saturated fatty acid (FA) myristic acid in serum cholesterol esters was negatively but polyunsaturated eicosapentaenoic acid and also lipoprotein (a) were positively associated with aPC IgM levels. CONCLUSION: IgM-antibodies against PC, which have atheroprotective properties, are higher in a population from Kitava, New Guinea with a traditional lifestyle, than in Swedish Controls, and higher among women than men in both populations tested. Such antibodies could contribute to the low incidence of cardiovascular disease reported from Kitava and could also provide an explanation as to why women have a later onset of CVD than men

Analysis of Neuropeptide S Receptor Gene (NPSR1) Polymorphism in Rheumatoid Arthritis

Polymorphism in the neuropeptide S receptor gene NPSR1 is associated with asthma and inflammatory bowel disease. NPSR1 is expressed in the brain, where it modulates anxiety and responses to stress, but also in other tissues and cell types including lymphocytes, the lungs, and the intestine, where it appears to be up-regulated in inflammation. We sought to determine whether genetic variability at the NPSR1 locus influences the susceptibility and clinical manifestation of rheumatoid arthritis (RA).From the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) case-control study, 1,888 rheumatoid arthritis patients and 888 controls were genotyped for 19 single-nucleotide polymorphisms (SNPs) spanning the entire NPSR1 gene and 220 KB of DNA on chromosome 7p14. The association between individual genetic markers and their haplotypic combinations, respectively, and diagnosis of RA, presence of autoantibodies to citrullinated proteins (ACPA), and disease activity score based on 28 joints (DAS28) was tested. There was no association between diagnosis of RA and NPSR1 variants. However, several associations of nominal significance were detected concerning susceptibility to ACPA-negative RA and disease activity measures (DAS28). Among these, the association of SNP rs324987 with ACPA-negative RA [(p=0.004, OR=0.674 (95% CI 0.512-0.888)] and that of SNP rs10263447 with DAS28 [p=0.0002, OR=0.380 (95% CI 0.227-0.635)] remained significant after correction for multiple comparisons.NPSR1 polymorphism may be relevant to RA susceptibility and its clinical manifestation. Specific alleles at the NPSR1 locus may represent common risk factors for chronic inflammatory diseases, including RA

Patient focused registries can improve health, care, and science.

Eugene Nelson and colleagues call for registries of care data to be transformed into patient centred interactive learning systemsThis work is supported by funding from the Robert Wood Johnson Foundation (Grants: #71211 and 72313), the Cystic Fibrosis Foundation (Grant #OCONNO04Q10), and the Crohn’s and Colitis Foundation of America Quality of Care Initiative (Grant #3372). TSM was funded by the Multidisciplinary Clinical Research Center for Musculoskeletal Diseases at Dartmouth (P60 AR-062799, A. Tosteson, PI), sponsored by the National Institute for Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health. EE was funded by The Swedish Research Council for Health, Work Life and Welfare (#2014-4238). MDW is supported by a Wellcome Trust Senior Investigator award (WT09789).This is the final version of the article. It first appeared from BMJ Group via https://doi.org/10.1136/bmj.i331

Evaluation of arthroscopy and macroscopic scoring

INTRODUCTION: Arthroscopy is a minimally invasive technique for retrieving synovial biopsies in rheumatology during the past 20 years. Vital for its use is continual evaluation of its safety and efficacy. Important for sampling is the fact of intraarticular variation for synovial markers. For microscopic measurements scoring systems have been developed and validated, but for macroscopic evaluations there is a need for further comprehensive description and validation of equivalent scoring systems. METHODS: We studied the complication rate and yield of arthroscopies performed at our clinic between 1998 and 2005. We also created and evaluated a macroscopic score set of instructions for synovitis. RESULTS: Of 408 procedures, we had two major and one minor complication; two haemarthrosis and one wound infection, respectively. Pain was most often not a problem, but 12 procedures had to be prematurely ended due to pain. Yield of biopsies adequate for histology were 83% over all, 94% for knee joints and 34% for smaller joints. Video printer photographs of synovium taken during arthroscopy were jointly and individually reviewed by seven raters in several settings, and intra and inter rater variation was calculated. A macroscopic synovial scoring system for arthroscopy was created (Macro-score), based upon hypertrophy, vascularity and global synovitis. These written instructions were evaluated by five control-raters, and when evaluated individual parameters were without greater intra or inter rater variability, indicating that the score is reliable and easy to use. CONCLUSIONS: In our hands rheumatologic arthroscopy is a safe method with very few complications. For knee joints it is a reliable method to retrieve representative tissue in clinical longitudinal studies. We also created an easy to use macroscopic score, that needs to be validated against other methodologies. We hope it will be of value in further developing international standards in this area

Managing Knowledge across Boundaries in Healthcare when Innovation is Desired

The purpose of this study is to explore how knowledge can be managed across boundaries when implementing innovations in the healthcare sector is desired, in this specific case a healthcare quality register. The research is based on a qualitative, case study approach and comprises methodologies such as semi-structured interviews and document analysis. The findings of this study describe knowledge transferred across boundaries on a syntactic, semantic, and pragmatic level. On the syntactic level, knowledge of the innovation was transferred by training sessions for healthcare staff and through information to patients. On the semantic level, knowledge was transferred by knowledge brokering in the professional community of rheumatologists, and by creating collective stories and encouraging rheumatologists to “try” the innovation to find added value. On the pragmatic level, there were explicit conflicts of interest between physicians and healthcare authorities, as well as resistance from some rheumatologists to share knowledge of patients and treatment. The paper is concluded with implications for innovation practice in healthcare drawn from the study and ends with remarks about challenges ahead

Continuous glucose monitoring system during physical exercise in adolescents with type 1 diabetes

Aim: Continuous glucose monitoring system (CGMS) provides detailed information on glucose fluctuations. The aim was to establish whether CGMS could be used during physical exercise and whether it detects more episodes of hypoglycaemia and hyperglycaemia than frequent blood glucose measurements. Methods: Adolescents with type 1 diabetes (12 girls and 47 boys) participated in three annual sports camps that lasted for 3-4 days and included different types of exercise: soccer, floorball + cross-country skiing and golf. During the study, blood glucose values, mean 8.7 +/- 3.3 per day, were obtained with Hemocue in parallel with the CGMS. Results: Ninety-eight per cent of the participants used the sensor at all times during the camps. Eighty-seven per cent of the sensors gave adequate signals for 24 h and 66% for 48 h. Median durations of hypoglycaemia and hyperglycaemia were 1.7 h per day and 3.8 h per day, respectively. The CGMS identified significantly more episodes of hypoglycaemia (p < 0.005) and hyperglycaemia (p < 0.005) during the day and night than frequent blood glucose tests. Conclusion: We demonstrate that, even during days that included episodic strenuous physical exercise, CGMS could provide useful information on glucose fluctuations during day and night, albeit with significant failure rates