Hvordan oppnå markedsmakt i Personal Health Record-bransjen : bransjeutvikling i grenselandet mellom stat og det private næringslivet

I denne oppgaven har vi sett på utviklingen av bransjer innenfor elektronisk utveksling av helseinformasjon. Dette er relativt nye bransjer som har det interessante ved seg at de ligger i grenselandet mellom det offentlige og private næringsliv. Vi har i denne oppgaven mer spesifikt fokusert en bransje som ikke er direkte knyttet til helsevesenet, men fokuserer på individets rett til å ha kontroll på sin egen helseinformasjon, den såkalte Personal Health Record- bransjen (PHR- bransjen). I de siste årene har PHR- bransjen fått stor oppmerksomhet verden over og da spesielt i USA, og mange mener at dette kan bli en av de største nye bransjene i tiden fremover. Det som har medført at en denne bransjen har blitt interessant, er at helsesektorene verden over ikke fullt ut har dratt nytte av den raske utviklingen som har skjedd ellers i samfunnet når det gjelder bruk av ny teknologi. Dette gjelder både i forhold til informasjonsflyt og informasjonskontroll, og da i første rekke gjennom nye medier som mobil, Internett og nyere intelligente systemer. I denne oppgaven har vi sett på hvordan dagens teorier kan benyttes i forhold til denne nye bransjen, og videre hvordan disse teoriene kan videreutvikles for å forstå bransjen bedre. Mer konkret har vi vurdert utviklingen i forhold til en dominant design i bransjen, og i den forbindelse hvordan aktører i bransjen kan påvirke at deres løsning enten blir den dominante designen eller i alle fall er kompatibel med det. I tillegg har vi valgt å inkorporere Michael E. Porter(1980) sin femfaktormodell i et annet analyseverktøy for å beskrive utviklingen mot fastsettelsen av en dominant design. Vi har imidlertid vært nødt til å foreta noen modifikasjoner for at Porters femfaktormodell skal passe til denne bransjen. Samlet sett mener vi at denne gjennomgangen av teoretiske modeller i forhold til PHRbransjen vil gi aktørene mulighet til å kunne analysere markedet og med det bedre posisjonere seg for å oppnå markedsmakt

Explaining variation in perceived team effectiveness: Results from eleven quality improvement collaboratives

Aims and objectives. Explore effectiveness of 11 collaboratives focusing on 11 different topics, as perceived by local improvement teams and to explore associations with collaborative-, organisational- and team-level factors. Background. Evidence underlying the effectiveness of quality improvement collaboratives is inconclusive and few studies investigated determinants of implementation success. Moreover, most evaluation studies on quality improvement collaboratives are based on one specific topic or quality problem, making it hard to compare across collaboratives addressing different topics. Design. A multiple-case cross-sectional study. Methods. Quality improvement teams in 11 quality improvement collaboratives focusing on 11 different topics. Team members received a postal questionnaire at the end of each collaborative. Of the 283 improvement teams, 151 project leaders and 362 team members returned the questionnaire. Results. Analysis of variance revealed that teams varied widely on perceived effectiveness. Especially, members in the Prevention of Malnutrition and Prevention of Medication Errors collaboratives perceived a higher effectiveness than other groups. Multilevel regression analyses showed that educational level of professionals, innovation attributes, organisational support, innovative culture and commitment to change were all significant predictors of perceived effectiveness. In total, 27·9% of the individual-level variance, 57·6% of the team-level variance and 80% of the collaborative-level variance could be explained. Conclusion. The innovation's attributes, organisational support, an innovative team culture and professionals' commitment to change are instrumental to perceived effectiveness. The results support the notion that a layered approach is necessary to achieve improvements in quality of care and provides further insight in the determinants of success of quality improvement collaboratives. Relevance to clinical practice. Understanding which factors enhance the impact of quality improvement initiatives can help professionals to achieve breakthrough improvement in care delivery to patients on a wide variety of quality problems

Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination

Background An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care. Methods Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care. Results Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care

Can there be two speeds in a clean peloton? Performance strategies in modern road cycling

In the history of professional cycling, riders have always sought competitive advantages. Throughout 20th century, many relied on performance-enhancing drugs (PEDs) which gave rise to a phenomenon called “two-speed cycling”. Throughout its modern era, professional cycling has seen anti-doping efforts repeatedly intensify on the heels of several large doping scandals. Over the past decade, the sport appears to have transitioned away from large-scale systematic doping and towards novel, legal performance-enhancing strategies, facilitated by a close relationship with scientific, technological, and engineering communities. The tools and technologies available to assess the demands of the sport, the capabilities of the riders, and the role of environmental factors such as wind resistance, altitude, and heat are more refined and comprehensive than ever. Teams and riders are now able to leverage these to improve training, recovery, equipment, race tactics and more, often from a very early age. This review explores several key developments in road cycling and their implications for the modern professional peloton.publishedVersio

The Quantified Caveman: A Yearlong Case Study of the Paleolithic Diet

This is a detailed study of nutritional and lifestyle data on a single individual who adhered to the Paleolithic diet (PD) for a full year. The dietary intake was compared with evidence-based guidelines and various PD iterations from the research literature and popular diet books. Although the subject's diet aligned with PD book recommendations, several nutrients differed markedly from estimations in the scientific literature, highlighting the importance of relying on evidence-based dietary advice. These findings provide insight into a contemporary PD in practice, the feasibility of nutrition tracking, and how self-tracked dietary data can inform health behavior.acceptedVersio

Understanding the conditions for improvement: research to discover which context influences affect improvement success

Context can be defined as all factors that are not part of a quality improvement intervention itself. More research indicates which aspects are ‘conditions for improvement’, which influence improvement success. However, little is known about which conditions are most important, whether these are different for different quality interventions or whether some become less or more important at different times in carrying out an improvement. Knowing more about these conditions could help speed up and spread improvements and develop the science. This paper proposes ways to build knowledge about the conditions needed for different changes, and to create conditional-attribution explanations to provide qualified generalisations. It describes theory-based, non-experimental research designs. It also suggests that ‘practical improvers’ can make their changes more effective by reflecting on and revising their own ‘assumption-theories’ about the conditions which will help and hinder the improvements they aim to implement

Aerobic interval training improves maximal oxygen uptake and reduces body fat in grapplers

BACKGROUND: Despite regularly engaging in high-intensity grappling, Brazilian jiu-jitsu (BJJ) athletes have a moderate maximal oxygen uptake (V̇O2max). The aim of this study was to evaluate the efficacy and feasibility of high-intensity aerobic interval training as an accessory to BJJ training for improvements in V̇O2max.METHODS: Twelve active male BJJ practitioners (age: 30.3±4.0 [SD] years; height: 183.0±5.3 cm; body mass: 82.7±8.3 kg; body fat: 11.9±3.8%) with 5.6±5.8 years of experience and a training volume of 9.9±4.6 hours·week-1 were randomly allocated to either a training group (TG) or control group (CG). The TG incorporated two high-intensity aerobic interval training sessions·week-1 comprising four 4-minute intervals at 85-95% of maximal heart rate (HRmax) separated by 3-minute active breaks at 70% of HRmax. RESULTS: After six weeks, the TG increased their V̇O2max by 8±3% (95% CI=3.84, 12.73; P=0.04; ES=0.64), from 52.7 to 56.8 mL·kg-1·min-1. This was accompanied by a 1±1% reduction in absolute body fat (95% CI=-0.13, -2.2; P=0.04; ES=0.64). No changes in V̇O2max (P=0.12) or body composition (P=0.34) were detected in the CG. CONCLUSIONS: These findings reveal compelling short-term effects of low-volume high-intensity aerobic interval training on V̇O2max and body composition in active BJJ athletes. There may be a ceiling effect in terms of developing V̇O2max in supine, intermittent grappling sports, making alternative approaches to aerobic conditioning particularly relevant for this athlete population.acceptedVersion© 2019. This is the authors' accepted and refereed manuscript to the chapter. Locked until 30.04.2020 due to copyright restrictions. The final authenticated version is available online at: 10.23736/S0022-4707.19.09584-

A reassuring presence: An evaluation of Bradford District Hospice at Home service

Within the United Kingdom, a developing role for primary care services in cancer and palliative care has resulted in an increase in palliative home care teams. The provision of professional care in the home setting seeks to provide necessary services and enhanced choice for patients whose preference is to die at home. A mismatch between patient preference for home death and the actual number of people who died at home was identified within Bradford, the locality of this study. In response to this mismatch, and reflecting the policy environment of wishing to enhance community service provision, the four Primary Care Trusts (PCTs) in the city sought to offer support to patients who wished to remain in their own homes through the final stages of a terminal illness. To offer this support they set up a dedicated hospice at home team. This would provide services and support for patients in achieving a dignified, symptom free and peaceful death, allowing families to maximise time spent together. The aim of the study was to evaluate the Bradford hospice at home service from the perspective of carers, nurses and General Practitioners. Postal questionnaires were sent to carers (n = 289), district nurses (n = 508) and GP's (n = 444) using Bradford's hospice at home service. Resulting quantitative data was analysed using the Statical Package for Social Sciences (SPSS) and qualitative data was analysed using grounded theory techniques. The data from carers, district nurses and GPs provide general support for the Bradford hospice at home service. Carers valued highly the opportunity to 'fulfil a promise' to the individual who wished to be cared for at home. District nurses and GPs cited the positive impact of access to specialist expertise. This was a 'reassuring presence' for primary healthcare teams and offered 'relief of carer anxiety' by providing prompt, accessible and sensitive care. Carers and health professionals welcomed the increased possibility of patients being cared for at home. The study identified the need to focus on improving skill levels of staff and on ensuring continuity of care

Exiting the Cave: Exploring the Transition From Paleolithic to Omnivorous Dieting

This is a follow-up of a recent case study of the Paleolithic diet that investigates dietary changes, including energy intake, food sources, and macronutrient and micronutrient distribution, associated with a transition from a Paleolithic diet toward a more omnivorous pattern. We observed a more than 40% increase in carbohydrate intake and a 10% decrease in fat intake, including 20% less energy from saturated fat, less intake of nearly all micronutrients, and a substantially greater energy contribution from nonpaleo sources, including ultraprocessed foods. This analysis of 2 full years of nutrition data provides a unique description of changing dietary patterns in a free-living individual.acceptedVersio