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  • 1.
    Gartlehner, Gerald
    et al.
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Hansen, Richard A
    Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, 207 Dunstan Hall, Auburn, AL 36849.
    Morgan, Laura C
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Thaler, Kylie
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Lux, Linda
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Van Noord, Megan
    Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27599.
    Mager, Ursula
    Ludwig Boltzmann Institute for Health Promotion Research, Vienna, Austria. .
    Gaynes, Bradley N
    Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC.
    Thieda, Patricia
    226 Barclay Road, Chapel Hill, NC 27516.
    Strobelberger, Michaela
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Lloyd, Stacey
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Reichenpfader, Ursula
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Lohr, Kathleen N
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression: An Update of the 2007 Comparative Effectiveness Review [Internet]2011Report (Other academic)
    Abstract [en]

    BACKGROUND: 

    Depressive disorders such as major depressive disorder (MDD), dysthymia, and subsyndromal depression may be serious disabling illnesses. MDD affects more than 16 percent of adults at some point during their lifetimes. Second-generation antidepressants dominate the medical management of depressive disorders. These drugs include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other drugs with related mechanisms of action that selectively target neurotransmitters.

    OBJECTIVES: 

    The objective of this report was to compare the benefits and harms of bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine for the treatment of depressive disorders, including variations of effects in patients with accompanying symptoms and patient subgroups.

    DATA SOURCES: 

    We updated a comparative effectiveness review published in 2007 by the Agency for Healthcare Research and Quality searching PubMed, Embase, The Cochrane Library, and International Pharmaceutical Abstracts up to January 2011.

    REVIEW METHODS: 

    Two people independently reviewed the literature, abstracted data, and rated the risk of bias. If data were sufficient, we conducted meta-analyses of head-to-head trials of the relative benefit of response to treatment. In addition, we conducted mixed treatment comparisons to derive indirect estimates of the comparative efficacy among all second-generation antidepressants.

    RESULTS: 

    From a total of 3,722 citations, we identified 248 studies of good or fair quality. Overall, no substantial differences in efficacy could be detected among second-generation antidepressants for the treatment of acute-phase MDD. Statistically significant differences in response rates between some drugs are small and likely not clinically relevant. No differences in efficacy were apparent in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbidities, although evidence within these subpopulations was limited. Differences exist in the incidence of specific adverse events and the onset of action. Venlafaxine leads to higher rates of nausea and vomiting, sertraline to higher rates of diarrhea, and mirtazapine to higher rates of weight gain than comparator drugs. Bupropion causes lower rates of sexual dysfunction than other antidepressants. The evidence is insufficient to draw conclusions about the comparative efficacy and effectiveness for the treatment of dysthymia and subsyndromal depression.

    CONCLUSIONS: 

    Our findings indicate that the existing evidence does not warrant the choice of one second-generation antidepressant over another based on greater efficacy and effectiveness. Differences with respect to onset of action and adverse events may be taken into consideration for the choice of a medication.

  • 2.
    Gartlehner, Gerald
    et al.
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Hansen, Richard A
    Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, 207 Dunstan Hall, Auburn, AL 36849.
    Morgan, Laura C
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Thaler, Kylie
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Lux, Linda
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Van Noord, Megan
    Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27599.
    Mager, Ursula
    Ludwig Boltzmann Institute for Health Promotion Research, Vienna, Austria. .
    Thieda, Patricia
    226 Barclay Road, Chapel Hill, NC 27516.
    Gaynes, Bradley N
    Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC.
    Wilkins, Tania
    Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27599.
    Strobelberger, Michaela
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Lloyd, Stacey
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Reichenpfader, Ursula
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Lohr, Kathleen N
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis.2011In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 155, no 11, p. 772-785Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Second-generation antidepressants dominate the management of major depressive disorder (MDD), but evidence on the comparative benefits and harms of these agents is contradictory.

    PURPOSE: To compare the benefits and harms of second-generation antidepressants for treating MDD in adults.

    DATA SOURCES: English-language studies from PubMed, Embase, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to August 2011 and reference lists of pertinent review articles and gray literature.

    STUDY SELECTION: 2 independent reviewers identified randomized trials of at least 6 weeks' duration to evaluate efficacy and observational studies with at least 1000 participants to assess harm.

    DATA EXTRACTION: Reviewers abstracted data about study design and conduct, participants, and interventions and outcomes and rated study quality. A senior reviewer checked and confirmed extracted data and quality ratings.

    DATA SYNTHESIS: Meta-analyses and mixed-treatment comparisons of response to treatment and weighted mean differences were conducted on specific scales to rate depression. On the basis of 234 studies, no clinically relevant differences in efficacy or effectiveness were detected for the treatment of acute, continuation, and maintenance phases of MDD. No differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbid conditions. Individual drugs differed in onset of action, adverse events, and some measures of health-related quality of life.

    LIMITATIONS: Most trials were conducted in highly selected populations. Publication bias might affect the estimates of some comparisons. Mixed-treatment comparisons cannot conclusively exclude differences in efficacy. Evidence within subgroups was limited.

    CONCLUSION: Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy. Differences in onset of action and adverse events may be considered when choosing a medication.

    PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

  • 3.
    Gartlehner, Gerald
    et al.
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Hansen, Richard A
    Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, 207 Dunstan Hall, Auburn, AL 36849.
    Reichenpfader, Ursula
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Kaminski, A
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Kien, C
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Strobelberger, Michaela
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Van Noord, Megan
    Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27599.
    Thieda, Patricia
    226 Barclay Road, Chapel Hill, NC 27516.
    Thaler, Kylie
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Gaynes, Bradley N
    Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC.
    Drug Class Review: Second-Generation Antidepressants: Final Update 5 Report [Internet].2011Report (Refereed)
    Abstract [en]

    PURPOSE: 

    We compared the effectiveness and harms of second-generation antidepressants in the treatment of major depressive disorder (MDD), dysthymia, subsyndromal depression, seasonal affective disorder, generalized anxiety disorder, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder.

    DATA SOURCES: 

    We searched PubMed, Embase, PsycINFO, the Cochrane Library, and the International Pharmaceutical Abstracts until September 2010. For additional data we also hand searched reference lists, US Food and Drug Administration medical and statistical reviews and dossiers submitted by pharmaceutical companies.

    REVIEW METHODS: 

    Study selection, data abstraction, validity assessment, grading the strength of the evidence, and data synthesis were all carried out according to standard Drug Effectiveness Review Project review methods.

    RESULTS AND CONCLUSIONS: 

    Overall, we found no substantial differences in comparative efficacy and effectiveness of second-generation antidepressants for the treatment of depressive or anxiety disorders. Differences exist in the incidence of specific adverse events and the onset of action. Except for MDD, the evidence is limited to few direct comparisons for most indications. No head-to-head evidence is available for MDD in pediatric populations, dysthymia, subsyndromal depression, seasonal affective disorder, and premenstrual dysphoric disorder.

  • 4.
    Kien, Christina
    et al.
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Reichenpfader, Ursula
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Nußbaumer, Barbara
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Rohleder, Sonja
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Punz, Petra
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Christof, Claudia
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Gartlehner, Gerald
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    [Comparative effectiveness and safety of screening and counselling interventions conducted by non-physicians and physicians: A systematic review].2015In: Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, ISSN 2212-0289, Vol. 109, no 1, p. 18-27Article in journal (Refereed)
    Abstract [de]

    BACKGROUND: Current forecasts project a future shortage of physicians which might compromise the quality of health care if not addressed adequately by health policy decisions. One proposed measure is to shift selected tasks and responsibilities from physicians to other medical staff, a strategy that has proven successful in some areas (e. g., chronic disease management). To date, no studies have systematically and objectively assessed whether the application of a similar strategy to screening and counselling in preventive medicine compromises patients' health outcomes and experiences.

    METHODS: A systematic search was conducted in MEDLINE, the Cochrane Library, CINAHL, and EMBASE (January 2000 - June 2014). We dually reviewed articles and assessed the risk of bias.

    RESULTS: 3,315 citations were identified and five relevant articles located. Overall, the available evidence indicated that there were no substantial differences in benefits and harms of screening (colon cancer screening, sexual transmitted diseases, and mammography) and counselling (genetic breast cancer risk) between non-physicians and physicians. The quality of evidence, however, is very low for most comparisons. Reported statistically significant differences for some outcomes need to be viewed cautiously.

    CONCLUSION: Shifting tasks from physicians to other medical staff for screening and counselling could be a viable strategy to address the shortage of practicing physicians. Adequate training by a physician, however, is a prerequisite for the safe and beneficial screening and counselling conducted by non-physicians.

  • 5.
    Nussbaumer, Barbara
    et al.
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Morgan, Laura C.
    Research Triangle Institute Int, NC 27709 USA.
    Reichenpfader, Ursula
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Greenblatt, Amy
    Research Triangle Institute Int, NC 27709 USA.
    Hansen, Richard A.
    Auburn University, AL 36849 USA.
    Van Noord, Megan
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Lux, Linda
    Research Triangle Institute Int, NC 27709 USA.
    Gaynes, Bradley N.
    University of N Carolina, NC 27599 USA.
    Gartlehner, Gerald
    Danube University of Krems, Austria; Research Triangle Institute Int, NC 27709 USA.
    Comparative Efficacy and Risk of Harms of Immediate- versus Extended-Release Second-Generation Antidepressants: A Systematic Review with Network Meta-Analysis2014In: CNS Drugs, ISSN 1172-7047, E-ISSN 1179-1934, Vol. 28, no 8, p. 699-712Article, review/survey (Refereed)
    Abstract [en]

    Major depressive disorder (MDD) has detrimental effects on an individuals personal life, leads to increased risk of comorbidities, and places an enormous economic burden on society. Several second-generation antidepressants are available as both immediate-release (IR) and extended-release formulations. The advantage of extended-release formulations may be the potentially improved adherence and a lower risk of adverse events. We conducted a systematic review to assess the comparative efficacy, risk of harms, and patients adherence of IR and extended-release antidepressants for the treatment of MDD. English-language abstracts were retrieved from PubMed, EMBASE, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to October 2012, as well as from reference lists of pertinent review articles and grey literature searches. We included head-to-head randomized controlled trials (RCTs) of at least 6 weeks duration that compared an IR formulation with an extended-release formulation of the same antidepressant in adult patients with MDD. We also included placebo-controlled trials to conduct a network meta-analysis. To assess harms and adherence, in addition to RCTs, we searched for observational studies with a parts per thousand yen1,000 participants and a follow-up of a parts per thousand yen12 weeks. We dually reviewed abstracts and full texts and assessed quality ratings. Lacking head-to-head evidence for many comparisons of interest, we conducted network meta-analyses using Bayesian methods. Our outcome measure of choice was response on the Hamilton Depression Rating Scale. We located seven head-to-head trials and 94 placebo- and active-controlled trials for network meta-analysis. Overall, our analyses indicate that IR and extended-release formulations do not differ substantially with respect to efficacy and risk of harms. The evidence is mixed with respect to differences in adherence, indicating lower adherence for IR formulations. The lack of head-to-head comparisons for many drugs compromises our conclusions. Network meta-analyses have methodological limitations that need to be taken into consideration when interpreting findings. Available evidence currently shows no clear differences between the two formulations and therefore we cannot recommend a first choice. However, if adherence or compliance with one medication is an issue, then clinicians and patients should consider the alternative medication. If adherence or costs are a problem with one formulation, consideration of the other formulation to provide an adequate treatment trial is reasonable.

  • 6.
    Reichenpfader, Ursula
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Embedding Medication Review in Clinical Practice: Reconceptualising Implementation Using a Practice Theory Perspective2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The hospital is a critical setting with respect to medication safety and quality of medication therapy. Medication review, the structured assessment of an individual patient’s medications with the aim of improving therapy, has been advocated as a strategy to reduce medication-related harm. Although programs of medication review have been widely introduced, its implementation has encountered difficulties. While seemingly a rather straightforward concept, processes to identify current medication use and reconcile different medication lists have been complicated by organizational, interprofessional, or technical factors. There is, thus, a need to better understand medication review implementation. However, it is also important to critically consider how the implementation of healthcare interventions is generally understood, and what theoretical or conceptual considerations inform implementation efforts. Studying organizational and social phenomena as they unfold in practice has the potential to shed light on how these everyday activities are generated, how they are adapted over time, and what consequences this has on social and organizational processes.

    The purpose of this thesis is to develop an alternative perspective on studying the implementation of a healthcare intervention in routine care. More specifically, this thesis aims to theorize the embedding and practicing of medication review in routine hospital work. Theorizing, here, refers to empirically and theoretically exploring phenomena based on cases of local medication review implementation.

    Drawing on empirical case examples of medication review implementation in southeast Sweden, an ethnographic approach is employed conducting participant observation, informal conversations and semi-structured interviews with different healthcare professionals in two hospital settings, as well as semi-structured interviews with patients from three different hospital settings. A so-called toolkit approach for practice theory is employed, using a range of different practice-theoretical concepts to empirically study practice.

    The empirical findings point to the centrality of dealing with medication-related problems when conducting and embedding medication review. Both practicing and embedding medication review were shaped by how medication-related problems and potential medication harms were constructed, contested, and negotiated in practice. Practitioners’ everyday actions and practices revealed different meanings attached to the concept of medication-related problem bringing to the fore the contested and conflictual nature of the practice. Also, insight was provided into how practices to embed medication review in routine hospital work unfolded, revealing material-discursive and reflective practices, but also silent modes of legitimizing the ‘non-practicing’ of medication review in a highly structured way.

    This thesis provides an alternative perspective on studying the implementation of a healthcare intervention and challenges various assumptions underpinning implementation research. Instead, a broadened perspective is suggested directing attention to the practical and situated knowing involved, the local processes of negotiating objectives in practice, as well as to the meaning-making required when practitioners engage with a practice. Finally, there are opportunities to learn from implementation processes, when frontline practitioners involved in embedding medication review are able to reflect on adapting medication review to make routines better fit the local context.

    List of papers
    1. Our surgeons want this to be short and simple: practices of in-hospital medication review as coordinated sociomaterial actions
    Open this publication in new window or tab >>Our surgeons want this to be short and simple: practices of in-hospital medication review as coordinated sociomaterial actions
    Show others...
    2018 (English)In: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 40, no 3, p. 323-336Article in journal (Refereed) Published
    Abstract [en]

    Medication review, a systematic assessment of a patients medicines by a health care professional, is intended to prevent medication-related harms. A critical element of medication review concerns whether medication review is conducted in a coordinated way. This article draws from a case example of implementing medication review in two surgical wards of a Swedish regional hospital and aims to analyse how medication review is being accomplished with respect to the coordination of its actions. Using a practice-based ethnographic approach, we present several coordination mechanisms by illustrating how practices are connected to materials involved in medication review. Also, we show how common orientations, ends, and understandings expressed in different medication review practices contribute to the coordination of the practices. In conclusion, this article highlights the complexity of establishing and sustaining medication review as a coordinated practice in routine health care. By closely examining sociomaterial connections, this article sheds new light on the neglected issue of artefacts and arrangements in constituting and transforming a highly complex medication practice.

    Place, publisher, year, edition, pages
    ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2018
    Keywords
    Ethnography; practice theory; sociomateriality; coordination; medication safety; implementation
    National Category
    Pedagogy
    Identifiers
    urn:nbn:se:liu:diva-151230 (URN)10.1080/0158037X.2018.1458710 (DOI)000442433800007 ()
    Note

    Funding Agencies|Swedish Research Council for Health, Working Life and Welfare (Forte) [2014-4657]; Medical Research Council of Southeast Sweden (FORSS) [FORSS-476971, FORSS-568651]; County Council of Ostergotlands patient safety research fund (Region Ostergotlands Medel for Patientsakerhetsforskning) [LIO-533151, LIO-626451]

    Available from: 2018-09-13 Created: 2018-09-13 Last updated: 2019-04-10
    2. Medi(c)ation work in the emergency department: Making standardized practice work
    Open this publication in new window or tab >>Medi(c)ation work in the emergency department: Making standardized practice work
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    2018 (English)In: Professions & Professionalism, ISSN 1893-1049, E-ISSN 1893-1049, Vol. 8, no 2, article id e2298Article in journal (Refereed) Published
    Abstract [en]

    Medication review, the systematic examination of an individual patient’s medicines in order to improve medication therapy, has been advocated as an important patient safety measure. Despite widespread use, little is known about how medication review is conducted when implemented in routine health care. Drawing from an ethnographic case study in a Swedish emergency department and using a practice-based approach, we examine how medication review is practically accomplished and how knowledge is mobilized in everyday practice. We show how physicians construct and negotiate medication safety through situated practices and thereby generate knowledge through mundane activities. We illustrate the centrality of practitioners’ collective reflexive work when co-constructing meaning and argue here that practitioners’ local adaptations can serve as important prerequisites to make “standardized” practice function in everyday work. Organizations need to build a practical capacity to support practitioners’ work-based learning in messy and time-pressured  health care  settings.

    Keywords
    practice-based study, ethnography, practical knowledge, professional practice, medication review, implementation, patient safety
    National Category
    Other Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-151815 (URN)10.7577/pp.2298 (DOI)
    Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2019-05-01
    3. Embedding hospital-based medication review: The conflictual and developmental potential of a practice
    Open this publication in new window or tab >>Embedding hospital-based medication review: The conflictual and developmental potential of a practice
    2019 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 33, no 3, p. 339-352Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The purpose of this paper is to explore the embedding of hospital-based medication review attending to the conflictual and developmental nature of practice. Specifically, this paper examines manifestations of contradictions and how they play out in professional practices and local embedding processes.

    Design/methodology/approach: Using ethnographic methods, this paper employs the activity-theoretic notion of contradictions for analyzing the embedding of medication review. Data from participant observation (in total 290?h over 48 different workdays) and 31 semi-structured interviews with different healthcare professionals in two Swedish hospital-based settings (emergency department, department of surgery) are utilized.

    Findings: The conflictual and developmental potential related to three interrelated characteristics (contested, fragmented and distributed) of the activity object is shown. The contested nature is illustrated showing different conceptualizations, interests and positions both within and across different professional groups. The fragmented character of medication review is shown by tensions related to the appraisal of the utility of the newly introduced practice. Finally, the distributed character is exemplified through tensions between individual and collective responsibility when engaging in multi-site work. Overall, the need for ongoing ᅵrepairᅵ work is demonstrated.

    Originality/value: By using a practice-theoretical approach and ethnographic methods, this paper presents a novel perspective for studying local embedding processes. Following the day-to-day work of frontline clinicians captures the ongoing processes of embedding medication review and highlights the opportunities to learn from contradictions inherent in routine work practices.

    Place, publisher, year, edition, pages
    Emerald Group Publishing Limited, 2019
    Keywords
    Patient safety, Qualitative research, Implementation, Medical professions, Ethnographic methods, Medical practice
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Nursing
    Identifiers
    urn:nbn:se:liu:diva-156644 (URN)10.1108/JHOM-09-2018-0268 (DOI)000471054500005 ()2-s2.0-85064750614 (Scopus ID)
    Note

    Funding agencies:  Swedish Research Council for Health, Working Life and Welfare (Forte) [2014-4657]; Medical Research Council of Southeast Sweden (FORSS) [FORSS-476971, FORSS-568651]; County Council of ostergotland patient safety research fund (Region ostergotlands Medel f

    Available from: 2019-05-02 Created: 2019-05-02 Last updated: 2019-07-15Bibliographically approved
  • 7.
    Reichenpfader, Ursula
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Leadership in evidence-based practice: a systematic review2015In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 28, no 4, p. 298-316Article in journal (Refereed)
    Abstract [en]

    Purpose: We aimed to systematically review published empirical research on leadership as a determinant for the implementation of evidence-based practice (EBP) and to investigate leadership conceptualization and operationalization in this field.

    Design/methodology/approach: A systematic review with narrative synthesis was conducted. Relevant bibliographic databases and reference lists of pertinent review articles were searched. To be included, a study had to involve empirical research and refer to both leadership and EBP in health care. Study quality was assessed with a structured instrument based on study design.

    Findings: A total of 17 studies were included. Leadership was mostly viewed as a modifier for implementation success, acting through leadership support. Yet, there was definitional imprecision as well as conceptual inconsistency and studies seemed to inadequately address situational and contextual factors. Although referring to an organizational factor, the concept was mostly analysed at the individual or group level.

    Research limitations/implications: The concept of leadership in implementation science seems to be not fully developed. It is unclear whether attempts to tap the concept of leadership in available instruments truly capture and measure the full range of the diverse leadership elements at various levels. Research in implementation science would benefit from a better integration of research findings from other disciplinary fields. Once a more mature concept has been established, researchers in implementation science could proceed to further elaborate operationalization and measurement.

    Originality/value. Although the relevance of leadership in implementation science has been acknowledged, the conceptual base of leadership in this field has received only limited attention.

  • 8.
    Reichenpfader, Ursula
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Gartlehner, Gerald
    Danube University of Krems, Austria RTI Int, NC 27709 USA .
    Morgan, Laura C.
    RTI Int, NC 27709 USA .
    Greenblatt, Amy
    RTI Int, NC 27709 USA .
    Nussbaumer, Barbara
    Danube University of Krems, Austria .
    Hansen, Richard A.
    Auburn University, AL 36849 USA .
    Van Noord, Megan
    Danube University of Krems, Austria RTI Int, NC 27709 USA .
    Lux, Linda
    RTI Int, NC 27709 USA .
    Gaynes, Bradley N.
    University of N Carolina, NC 27599 USA .
    Sexual Dysfunction associated with Second-Generation Antidepressants in Patients with Major Depressive Disorder: Results from a Systematic Review with Network Meta-Analysis2014In: Drug Safety, ISSN 0114-5916, E-ISSN 1179-1942, Vol. 37, no 1, p. 19-31Article in journal (Refereed)
    Abstract [en]

    Sexual dysfunction (SD) is prevalent in patients with major depressive disorder (MDD) and is also associated with second-generation antidepressants (SGADs) that are commonly used to treat the condition. Evidence indicates under-reporting of SD in efficacy studies. SD associated with antidepressant treatment is a serious side effect that may lead to early termination of treatment and worsening of quality of life. Our objective was to systematically assess the harms of SD associated with SGADs in adult patients with MDD by drug type. We retrieved English-language abstracts from PubMed, EMBASE, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to October 2012 as well as from reference lists of pertinent review articles and grey literature searches. Two independent reviewers identified randomized controlled trials (RCTs) of at least 6 weeks duration and observational studies with at least 1,000 participants. Reviewers abstracted data on study design, conduct, participants, interventions, outcomes and method of SD ascertainment, and rated risk of bias. A senior reviewer checked and confirmed extracted data and risk-of-bias ratings. Random effects network meta-analysis using Bayesian methods for data from head-to-head trials and placebo-controlled comparisons; descriptive analyses calculating weighted mean rates from individual trials and observational studies. Data from 63 studies of low and moderate risk of bias (58 RCTs, five observational studies) with more than 26,000 patients treated with SGADs were included. Based on network meta-analyses of 66 pairwise comparisons from 37 RCTs, most comparisons showed a similar risk of SD among included SGADs. However, credible intervals were wide and included differences that would be considered clinically relevant. We observed three main patterns: bupropion had a statistically significantly lower risk of SD than some other SGADs, and both escitalopram and paroxetine showed a statistically significantly higher risk of SD than some other SGADs. We found reporting of harms related to SD inconsistent and insufficient in some trials. Most trials were conducted in highly selected populations. Search was restricted to English-language only. Because of the indirect nature of the comparisons, the often wide credible intervals, and the high variation in magnitude of outcome, we rated the overall strength of evidence with respect to our findings as low. The current degree of evidence does not allow a precise estimate of comparative risk of SD associated with a specific antidepressant. In the absence of such evidence, clinicians need to be aware of SD as a common adverse event and should discuss patients preferences before initiating antidepressant therapy.

  • 9.
    Reichenpfader, Ursula
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Noack, Horst
    Developing an analytical framework for categorising the knowledge base of European public health: content analysis of selected presentations at the "EUPHA 2005 Conference"2006In: Promoting The Public's Health: EUPHA 2005 Conference Book / [ed] Noack, Horst; Kahr-Gottlieb, Dorothea;, Gamburg, Germany: Verlag fuer Gesundheitsförderung , 2006, p. 203-220Chapter in book (Other academic)
  • 10.
    Reichenpfader, Ursula
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Department for Evidence-Based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria.
    Thaler, Kylie
    Department for Evidence-Based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria.
    Richter, Anke
    Naval Postgraduate School, Monterey, CA 93943, USA.
    Thieda, Patricia
    RTI Health Solutions, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA.
    Gartlehner, Gerald
    Department for Evidence-Based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria .
    [Clinical outcomes, health-related quality of life, and cost-effectiveness of a 6-month community- based lifestyle program for adults at increased cardiovascular risk in lower Austria].2012In: Wiener Medizinische Wochenschrift, ISSN 0043-5341, E-ISSN 1563-258X, Vol. 162, no 15-16, p. 321-329Article in journal (Refereed)
    Abstract [de]

    AIM: To investigate lifestyle intervention effects and cost-effectiveness of a structured 6-month exercise and nutrition program for individuals at high risk for cardiovascular disease.

    METHODS: Uncontrolled before and after study with assessments at baseline and six months. Adults without existing cardiovascular disease (CVD) but at increased CVD risk were eligible. The analysis was done by intention-to-treat (last-observation-carried-forward). Incremental cost-effectiveness analysis was performed. Main outcome measures were changes in cardiovascular risk-factors (blood pressure, weight, body-mass index, serum lipids, blood glucose, smoking cessation, and exercise) and health-related quality of life.

    RESULTS: A total of 356 adults (70.5% female; mean age 48.9 years; mean body mass index 32.4; drop-out 10.4%) participated. At 6 months significant favorable effects were observed in several cardiovascular risk outcomes, exercise behaviour and health related quality of life. At an average incremental cost per life year saved for the ITT-population of <euro> 22.474 the program can be considered cost-effective.

  • 11.
    Reichenpfader, Ursula
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Wickström, Anette
    Linköping University, Department of Thematic Studies, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Embedding hospital-based medication review: The conflictual and developmental potential of a practice2019In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 33, no 3, p. 339-352Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to explore the embedding of hospital-based medication review attending to the conflictual and developmental nature of practice. Specifically, this paper examines manifestations of contradictions and how they play out in professional practices and local embedding processes.

    Design/methodology/approach: Using ethnographic methods, this paper employs the activity-theoretic notion of contradictions for analyzing the embedding of medication review. Data from participant observation (in total 290?h over 48 different workdays) and 31 semi-structured interviews with different healthcare professionals in two Swedish hospital-based settings (emergency department, department of surgery) are utilized.

    Findings: The conflictual and developmental potential related to three interrelated characteristics (contested, fragmented and distributed) of the activity object is shown. The contested nature is illustrated showing different conceptualizations, interests and positions both within and across different professional groups. The fragmented character of medication review is shown by tensions related to the appraisal of the utility of the newly introduced practice. Finally, the distributed character is exemplified through tensions between individual and collective responsibility when engaging in multi-site work. Overall, the need for ongoing ᅵrepairᅵ work is demonstrated.

    Originality/value: By using a practice-theoretical approach and ethnographic methods, this paper presents a novel perspective for studying local embedding processes. Following the day-to-day work of frontline clinicians captures the ongoing processes of embedding medication review and highlights the opportunities to learn from contradictions inherent in routine work practices.

  • 12.
    Reichenpfader, Ursula
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Wickström, Anette
    Linköping University, Department of Thematic Studies, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    'In the hospital all is taken care of': A practice-theoretical approach to understand patients' medication use2019In: Sociology of Health and Illness, ISSN 0141-9889, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Drawing from case examples of medication review implementation in three hospital settings in Sweden, this article examines patients’ medication use. Based on a practice theory approach and utilising data from interviews with patients and participant observation, we reconstruct three practices of everyday medication use centring on accepting, challenging or appropriating medication orders. This article argues that patients’ medication practices are embedded in wider practice arrangements that afford different modes of agency. Reconceptualising patients’ medication use from a practice‐based perspective revealed the meaning‐making, order‐producing and identity‐forming features of these practices. Also, we illustrated how different modes of agency were achieved in patients’ medication practices, suggesting a fluidity of both the meanings attached to and the identities related to medication use. Our findings have practical implications as these practices of medication use can be transformed when altering the arrangements they are embedded in, thus going beyond the clinical encounter.

  • 13.
    Reichenpfader, Ursula
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Wickström, Anette
    Linköping University, Department of Thematic Studies, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Our surgeons want this to be short and simple: practices of in-hospital medication review as coordinated sociomaterial actions2018In: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 40, no 3, p. 323-336Article in journal (Refereed)
    Abstract [en]

    Medication review, a systematic assessment of a patients medicines by a health care professional, is intended to prevent medication-related harms. A critical element of medication review concerns whether medication review is conducted in a coordinated way. This article draws from a case example of implementing medication review in two surgical wards of a Swedish regional hospital and aims to analyse how medication review is being accomplished with respect to the coordination of its actions. Using a practice-based ethnographic approach, we present several coordination mechanisms by illustrating how practices are connected to materials involved in medication review. Also, we show how common orientations, ends, and understandings expressed in different medication review practices contribute to the coordination of the practices. In conclusion, this article highlights the complexity of establishing and sustaining medication review as a coordinated practice in routine health care. By closely examining sociomaterial connections, this article sheds new light on the neglected issue of artefacts and arrangements in constituting and transforming a highly complex medication practice.

  • 14.
    Reichenpfader, Ursula
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Wickström, Anette
    Linköping University, Department of Thematic Studies, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Medi(c)ation work in the emergency department: Making standardized practice work2018In: Professions & Professionalism, ISSN 1893-1049, E-ISSN 1893-1049, Vol. 8, no 2, article id e2298Article in journal (Refereed)
    Abstract [en]

    Medication review, the systematic examination of an individual patient’s medicines in order to improve medication therapy, has been advocated as an important patient safety measure. Despite widespread use, little is known about how medication review is conducted when implemented in routine health care. Drawing from an ethnographic case study in a Swedish emergency department and using a practice-based approach, we examine how medication review is practically accomplished and how knowledge is mobilized in everyday practice. We show how physicians construct and negotiate medication safety through situated practices and thereby generate knowledge through mundane activities. We illustrate the centrality of practitioners’ collective reflexive work when co-constructing meaning and argue here that practitioners’ local adaptations can serve as important prerequisites to make “standardized” practice function in everyday work. Organizations need to build a practical capacity to support practitioners’ work-based learning in messy and time-pressured  health care  settings.

1 - 14 of 14
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