BACKGROUND: To evaluate whether a training programme is a feasible approach to facilitate occupational health professionals' (OHPs) use of knowledge and skills provided by a guideline.METHODS: Feasibility was evaluated by researching three aspects: 'acceptability', 'implementation' and 'limited efficacy'. Statements on acceptability and implementation were rated by OHPs on 10-point visual analogue scales after following the training programme (T2). Answers were analysed using descriptive statistics. Barriers to and facilitators of implementation were explored through open-ended questions at T2, which were qualitatively analysed. Limited efficacy was evaluated by measuring the level of knowledge and skills at baseline (T0), after reading the guideline (T1) and directly after completing the training programme (T2). Increase in knowledge and skills was analysed using a non-paramatric Friedman test and post-hoc Wilcoxon signed rank tests (two-tailed).RESULTS: The 38 OHPs found the training programme acceptable, judging that it was relevant (M: 8, SD: 1), increased their capability (M: 7, SD: 1), adhered to their daily practice (M: 8, SD: 1) and enhanced their guidance and assessment of people with a chronic disease (M: 8, SD: 1). OHPs found that it was feasible to implement the programme on a larger scale (M: 7, SD: 1) but foresaw barriers such as 'time', 'money' and organizational constraints. The reported facilitators were primarily related to the added value of the knowledge and skills to the OHPs' guidance and assessment, and that the programme taught them to apply the evidence in practice. Regarding limited efficacy, a significant increase was seen in OHPs' knowledge and skills over time (X2 (2) = 53.656, p < 0.001), with the median score improving from 6.3 (T0), 8.3 (T1) and 12.3 (T2). Post-hoc tests indicated a significant improvement between T0 and T1 (p < 0.001) and between T1 and T2 (p < 0.001).CONCLUSIONS: The training programme was found to be a feasible approach to facilitate OHPs' use of knowledge and skills provided by the guideline, from the perspective of OHPs generally (acceptability and implementation) and with respect to their increase in knowledge and skills in particular (limited efficacy).
Current guidelines on secondary prevention of cardiovascular disease recommend nurse-coordinated care (NCC) as an effective intervention. However, NCC programmes differ widely and the efficacy of NCC components has not been studied. To investigate the efficacy of NCC and its components in secondary prevention of coronary heart disease by means of a systematic review and meta-analysis of randomised controlled trials. 18 randomised trials (11 195 patients in total) using 15 components of NCC met the predefined inclusion criteria. These components were placed into three main intervention strategies: (1) risk factor management (13 studies); (2) multidisciplinary consultation (11 studies) and (3) shared decision making (10 studies). Six trials combined NCC components from all three strategies. In total, 30 outcomes were observed. We summarised observed outcomes in four outcome categories: (1) risk factor levels (16 studies); (2) clinical events (7 studies); (3) patient-perceived health (7 studies) and (4) guideline adherence (3 studies). Compared with usual care, NCC lowered systolic blood pressure (weighted mean difference (WMD) 2.96 mm Hg; 95% CI 1.53 to 4.40 mm Hg) and low-density lipoprotein cholesterol (WMD 0.23 mmol/L; 95% CI 0.10 to 0.36 mmol/L). NCC also improved smoking cessation rates by 25% (risk ratio 1.25; 95% CI 1.08 to 1.43). NCC demonstrated to have an effect on a small number of outcomes. NCC that incorporated blood pressure monitoring, cholesterol control and smoking cessation has an impact on the improvement of secondary prevention. Additionally, NCC is a heterogeneous concept. A shared definition of NCC may facilitate better comparisons of NCC content and outcomes.
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In the aftermath of the systemic financial crises of 2007-9, several scholars argued that the problem of systemic financial crises is not well understood. At the same time, the introduction of digital technologies led to new threats and opportunities for the design of the monetary and financial system. For example, thousands of private cryptocurrencies have been implemented and hundreds of research papers on the (possible) introduction of public digital currencies have been published. It is often not explained why these new forms of digital money are needed and which (systemic) problems they (can) solve. In addition, the literature does not provide requirements nor guidelines to shape the development of the monetary and financial system in the digital age. This thesis applies design science to the monetary and financial system as a whole. The application of this novel methodology offers new possibilities to examine this complex system. The contribution of this thesis is threefold. First, different theories on money, banking and systemic financial crises have been researched through an extensive literature review and balance sheets. Second, those theories have been used to develop design requirements and guidelines. Finally, the consensus and pivotal dissensions about the systemic problem(s) of the current monetary and financial system, requirements and guidelines among experts have been identified through semistructured interviews. This research process results in widely supported requirements that demarcate the design space and widely supported guidelines that aim to give direction within the design space, that is, to the future development of the monetary and financial system.
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