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Karki, Shyam D., and J. M. C. Holden. "Appropriateness of the Use of Serum Lithium Assays." Drug Intelligence & Clinical Pharmacy 22, no. 2 (February 1988): 151–53. http://dx.doi.org/10.1177/106002808802200213.
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The performance of 222 lithium assays was studied in a psychiatric hospital to determine if their use was appropriate and therapeutically beneficial. Charts of all patients whose serum lithium levels were measured in a month were reviewed to determine whether the assays were indicated, whether they were performed correctly, and whether the dosage was adjusted appropriately. Of the assays reviewed, 16 percent were performed for inappropriate indications and 98 percent were drawn at correct times. Of 157 assays that should not have resulted in a dosage change, 8 changes were made; of 63 assays that should have resulted in a dosage change, only 23 changes were made. Inappropriate orders for assays cost the hospital $5016 per year. If routine serum lithium assay monitoring is changed to a three-month frequency, the total cost savings would be $16 632 per year. Clinical pharmacists with specialized knowledge of clinical pharmacokinetics should work with physicians and treatment teams in monitoring serum drug assays to ensure appropriateness of assay request, more complete interpretation of results, and proper follow-up.
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Webber, Charles F. "Educational Change in Alberta, Canada." education policy analysis archives 3 (July 9, 1995): 12. http://dx.doi.org/10.14507/epaa.v3n12.1995.
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Alberta, Canada, is the site of large-scale educational change initiatives legislated by the provincial government. The mandates have sparked heated public debate over the appropriateness, wisdom, and utility of the reforms. This article summarizes the views of representatives of several educational interest groups and offers suggestions for making change more meaningful and successful.
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ENTWISTLE, TOM. "FOR APPROPRIATENESS OR CONSEQUENCES? EXPLAINING ORGANIZATIONAL CHANGE IN ENGLISH LOCAL GOVERNMENT." Public Administration 89, no. 2 (October 25, 2010): 661–80. http://dx.doi.org/10.1111/j.1467-9299.2010.01850.x.
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Cole, Michael S., Stanley G. Harris, and Jeremy B. Bernerth. "Exploring the implications of vision, appropriateness, and execution of organizational change." Leadership & Organization Development Journal 27, no. 5 (July 2006): 352–67. http://dx.doi.org/10.1108/01437730610677963.
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Yang, Jesse Xiaolong, Margaret J. Stevenson, Linda Valsdottir, Kalon Ho, John A. Spertus, Robert W. Yeh, and Jordan B. Strom. "Association between procedure appropriateness and patient-reported outcomes after percutaneous coronary intervention." Heart 106, no. 6 (December 19, 2019): 441–46. http://dx.doi.org/10.1136/heartjnl-2019-315835.
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ObjectiveThe Appropriate Use Criteria (AUC) has been used to identify individuals who are likely to benefit from percutaneous coronary intervention (PCI) for stable ischaemic heart disease. However, whether physicians reliably grade PCI appropriateness and whether AUC categories stratify symptomatic improvement in real-world practice are unclear.MethodsPatient-reported outcomes measures (PROMs) for angina (Seattle Angina Questionnaire (SAQ-7)), dyspnoea (Rose Dyspnea Scale (RDS)) and depression (Patient Health Questionnaire-2 (PHQ-2)) were collected on patients undergoing elective coronary angiography at an academic medical centre. Retrospectively, two physicians independently determined PCI appropriateness by the AUC criteria.ResultsInter-rater agreement on appropriateness was moderate (κ=0.48, 95% CI 0.32 to 0.63). Of PCI procedures evaluated, 57 (47.1%) were appropriate (A-PCI), 62 (51.2%) were maybe appropriate (MA-PCI) and 2 (1.6%) were rarely appropriate. At baseline, A-PCI compared with MA-PCI patients had worse RDS scores (2.0 vs 1.2, p=0.01). At 30 days, the change in SAQ-7 summary score was similar between groups (A-PCI vs MA-PCI, +27.1 vs +20.7, p=0.11). The mean change in RDS score was greater in A-PCI than MA-PCI (−1.0 vs −0.5, p for group by time interaction=0.03). PHQ-2 scores were similar and did not improve at 30 days.ConclusionIn patients undergoing PCI with PROMs collected before and 30 days after PCI, similar improvements in angina were observed regardless of appropriateness. Inter-rater agreement on PCI appropriateness was only moderate. Use of PROMs may improve reliability of physician assessments of PCI appropriateness.
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Chepelev, Leonid L., Xuan Wang, Benjamin Gold, Clara-Lea Bonzel, Frank Rybicki Jr, Jennifer W. Uyeda, Adnan Sheikh, et al. "Improved Appropriateness of Advanced Diagnostic Imaging After Implementation of Clinical Decision Support Mechanism." Journal of Digital Imaging 34, no. 2 (February 25, 2021): 397–403. http://dx.doi.org/10.1007/s10278-021-00433-6.
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AbstractThe Protecting Access to Medicare Act (PAMA) mandates clinical decision support mechanism (CDSM) consultation for all advanced imaging. There are a growing number of studies examining the association of CDSM use with imaging appropriateness, but a paucity of multicenter data. This observational study evaluates the association between changes in advanced imaging appropriateness scores with increasing provider exposure to CDSM. Each provider’s first 200 consecutive anonymized requisitions for advanced imaging (CT, MRI, ultrasound, nuclear medicine) using a single CDSM (CareSelect, Change Healthcare) between January 1, 2017 and December 31, 2019 were collected from 288 US institutions. Changes in imaging requisition proportions among four appropriateness categories (“usually appropriate” [green], “may be appropriate” [yellow], “usually not appropriate” [red], and unmapped [gray]) were evaluated in relation to the chronological order of the requisition for each provider and total provider exposure to CDSM using logistic regression fits and Wald tests. The number of providers and requisitions included was 244,158 and 7,345,437, respectively. For 10,123 providers with ≥ 200 requisitions (2,024,600 total requisitions), the fraction of green, yellow, and red requisitions among the last 10 requisitions changed by +3.0% (95% confidence interval +2.6% to +3.4%), −0.8% (95% CI −0.5% to −1.1%), and −3.0% (95% CI 3.3% to −2.7%) in comparison with the first 10, respectively. Providers with > 190 requisitions had 8.5% (95% CI 6.3% to 10.7%) more green requisitions, 2.3% (0.7% to 3.9%) fewer yellow requisitions, and 0.5% (95% CI −1.0% to 2.0%) fewer red (not statistically significant) requisitions relative to providers with ≤ 10 requisitions. Increasing provider exposure to CDSM is associated with improved appropriateness scores for advanced imaging requisitions.
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Lim, Morgan E., Simona C. Minotti, Chelsea D’Silva, Robert J. Reid, Matthew B. Schlenker, and Iqbal K. Ahmed. "Predicting changes in cataract surgery health outcomes using a cataract surgery appropriateness and prioritization instrument." PLOS ONE 16, no. 1 (January 28, 2021): e0246104. http://dx.doi.org/10.1371/journal.pone.0246104.
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Objective Determine whether items in a cataract surgery appropriateness and prioritization questionnaire can predict change in best corrected visual acuity (BCVA) and health related quality of life (HRQOL) following cataract surgery. Methods 313 patients with a cataract in Ontario, Canada were recruited to participate. BCVA was measured using the Snellen chart. HRQOL was measured using a generic instrument (EQ5D), a visual functioning instrument (Catquest-9SF), and an appropriateness and prioritization instrument (17 items). Outcomes were measured preoperatively and 3–6 months postoperatively. Descriptive statistics were used to describe demographics and outcomes. For each appropriateness and prioritization questionnaire item, a one-way ANOVA was used to compare group means of the change in BCVA, EQ5D, and Catquest-9SF. Results Participants had a mean age of 69 years and were 56% female. BCVA improved in 81%, EQ5D in 49.6%, and Catquest-9SF score in 84% of patients. Improvement in both BCVA and Catquest-9SF scores were found in 68.5% of patients. The ANOVA showed a statistically significant association between a change in BCVA and the ability to participate in social life, and a statistically significant association between a change in Catquest-9SF and glare, extent of impairment in visual function, safety and injury concerns, ability to work and care for dependents, ability to take care of local errands, ability to assist others and ability to participate in social life. Conclusions Almost all patients had improved BCVA and/or visual functioning after surgery. Seven variables from the cataract appropriateness and prioritization instrument were found to be predictors of improvement in Catquest-9SF measuring visual functioning.
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Ridenour, Marcella V. "Children's Snow Sleds: Age Appropriateness and Safety." Perceptual and Motor Skills 68, no. 3 (June 1989): 883–90. http://dx.doi.org/10.2466/pms.1989.68.3.883.
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The guidelines for age-labeling children's toys are summarized. Publications relating to the safe use of snow sleds by children are reviewed. The patent history of sled runners and steering is described. 140 children between the ages of 6 and 12 yr. old participated in the assessment of four different styles of snow sleds, using a downhill course which required a very small directional change. Sled style influenced the children's steering success. A traditional sled with a wooden platform and flexible metal runners provided the best steering for all age groups between 6 and 12 yr. old. Recommendations for parents, park managers, and manufacturers regarding the safety of children's sleds are provided.
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Widanta, I. Made Rai Jaya, Ni Putu Somawati, and I. Wayan Dana Ardika. "Students’ L2 Refusal Appropriateness and Accuracy." Journal of Language Teaching and Research 10, no. 2 (March 1, 2019): 294. http://dx.doi.org/10.17507/jltr.1002.11.
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The study aimed at investigating refusal strategies performed by foreign learners of Indonesian language. Specifically, it was focused on researching strategies of refusal used by the participant, emerging frequency of each strategies, as well as appropriateness and accuracy of each strategy used. Sixty students majoring in Tourism were involved in the project. Discourse completion task (DCT) containing an invitation using three sociocultural aspects of low power (-P), low distance (-D), and low rank of imposition (-R) was used to elicit participants’ refusal strategies. Taxonomy of refusal proposed by Beebe, Takahashi, and Uliss-Weltz (1990) was applied to recognize refusal strategies used by participants. Result of the study revealed that there were three strategies of ‘direct, indirect, and adjunct to refusal’ used by participants in responding the invitation. However, two new sub-strategies found to enrich indirect strategies, they are ‘alternative (change subject)’ and ‘telling wish’. Dealing with participants’ appropriateness and accuracy, it could be concluded that their appropriateness in producing semantic formulas were higher than their accuracy (96,55% and 40,83%) respectively. In addition, there were two contradictive propositions finally underscored upon analysis of appropriateness and accuracy. In term of appropriateness, it is implied that L2 proficiency does not guarantee learners’ high appropriateness, which is in contrast with the Cordina-Espurz’s (2013) finding. However, in term of accuracy, it implied that the lower learners’ L2 proficiency is the lower accuracy level they are in, which is in line with Cordina-Espurz’s (2013) finding.
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Mitchell, Ronald B., and Charli Carpenter. "Norms for the Earth: Changing the Climate on “Climate Change”." Journal of Global Security Studies 4, no. 4 (April 2, 2019): 413–29. http://dx.doi.org/10.1093/jogss/ogz006.
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AbstractClimate change poses a grave security threat to national borders, habitats, and vulnerable people. Plagued by asymmetries in both states' vulnerability to climate impacts and their capacity to mitigate them, climate change presents states with a “wicked” problem that poses significant obstacles to interest-based solutions. Yet, most global climate change policy involves rationales and mechanisms grounded in an interest-based logic of consequences: information-sharing, reciprocity, and exchange. We argue that strategies that promote ethics-based discourse and policies offer considerable promise for hastening stronger global climate governance. We argue that successes in human security norm-building, including bans on land mines, cluster munitions, and nuclear weapons, provide climate scholars and practitioners with alternative governance models that rely on activating a logic of appropriateness and spearhead faster, more effective climate action. We identify five strategies that previous scholars have shown fostered efforts to promote a logic of appropriateness in human rights, humanitarian law, and disarmament. We examine the empirical experience of those strategies and particularly highlight the recent success of efforts to negotiate a treaty banning nuclear weapons. Given the success of these strategies in other issue areas, we argue scholars of climate change could fruitfully focus greater attention on political efforts that promote strong global ethical norms for climate action.
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Bateman, Brooke L., Helen T. Murphy, April E. Reside, Karel Mokany, and Jeremy VanDerWal. "Appropriateness of full-, partial- and no-dispersal scenarios in climate change impact modelling." Diversity and Distributions 19, no. 10 (June 22, 2013): 1224–34. http://dx.doi.org/10.1111/ddi.12107.
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Luttrull, Michael D., Daniel J. Boulter, Claudia F. E. Kirsch, Joseph M. Aulino, Joshua S. Broder, Santanu Chakraborty, Asim F. Choudhri, et al. "ACR Appropriateness Criteria® Acute Mental Status Change, Delirium, and New Onset Psychosis." Journal of the American College of Radiology 16, no. 5 (May 2019): S26—S37. http://dx.doi.org/10.1016/j.jacr.2019.02.024.
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Fonseca, Ricardo, Kazuaki Negishi, Petr Otahal, and Thomas H. Marwick. "Temporal Changes in Appropriateness of Cardiac Imaging." Journal of the American College of Cardiology 65, no. 8 (March 2015): 763–73. http://dx.doi.org/10.1016/j.jacc.2014.11.057.
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Cavezzi, Attilio. "Medicine and Phlebolymphology: Time to Change?" Journal of Clinical Medicine 9, no. 12 (December 18, 2020): 4091. http://dx.doi.org/10.3390/jcm9124091.
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Biomedical science is undergoing a reappraisal of its scientific advancement process and of the related healthcare management. Progress in medicine should combine improvements of knowledge, efficacy, and safety of diagnostic/therapeutic procedures, with adequate cost-effectiveness profiles. This narrative review is aimed at assessing in medicine, more specifically in phlebology and lymphology: (a) scientific literature possible biases, (b) the level of evidence, comprehensiveness, and cost-effectiveness of the main therapeutic options, and (c) the possible contribution of integrative and translational medicine. Current medical research may have cognitive biases, or industry-tied influences, which impacts clinical practice. Some reductionism, with an increasing use of drugs and technology, often neglecting the understanding and care of the root causative pathways of the diseases, is affecting biomedical science as well. Aging brings a relevant burden of chronic degenerative diseases and disabilities, with relevant socio-economic repercussions; thus, a major attention to cost-effectiveness and appropriateness of healthcare is warranted. In this scenario, costly and innovative but relatively validated therapies may tend to be adopted in venous and lymphatic diseases, such as varicose veins, leg venous ulcer, post-thrombotic syndrome, pelvic congestion syndrome, and lymphedema. Conversely, a more comprehensive approach to the basic pathophysiology of chronic venous and lymphatic insufficiency and the inclusion of pharmacoeconomics analyses would benefit overall patients’ management. Erroneous lifestyle and nutrition, together with chronic stress-induced syndromes, significantly influence chronic degenerative phlebo-lymphatic diseases. The main active epigenetic socio-biologic factors are obesity, dysfunctions of musculo-respiratory-vascular pumps, pro-inflammatory nutrition, hyperactivation of stress axis, and sedentarism. An overall critical view of the scientific evidence and innovations in phebolymphology could be of help to improve efficacy, safety, and sustainability of current practice. Translational and integrative medicine may contribute to a patient-centered approach. Conversely, reductionism, eminence/reimbursement-based decisional processes, patients’ lack of education, industry-influenced science, and physician’s improvable awareness, may compromise efficacy, safety, appropriateness, and cost-effectiveness of future diagnostic and therapeutic patterns of phlebology and lymphology.
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Bertsch, Andy, M. Saeed, and James Ondracek. "Responses to Changes in the Downtown Area of a Booming Midwest City." JOURNAL OF INTERNATIONAL BUSINESS RESEARCH AND MARKETING 3, no. 1 (2017): 19–24. http://dx.doi.org/10.18775/jibrm.1849-8558.2015.31.3003.
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Borrowing the “Organizational Change Recipients’ Belief Scale” instrument developed by Armenakis, Bernserth, Pitts, and Walker, employees and owners of businesses in a quickly changing downtown environment were surveyed to assess similarities and differences in their readiness to change. In addition to added demographic variables, the constructs included from the Armenakis et al. Instrument were valence, principal support, efficacy, appropriateness, and discrepancy. Results were mixed. There were no significant differences across industries nor employees vs supervisors/owners. However, significant differences were found across sex, age, and level of education.
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Mulas, M.F. "How not to waste: appropriateness in medicine." Journal of AMD 22, no. 4 (November 2019): 254. http://dx.doi.org/10.36171/jamd19.22.4.12.
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The idea that the author promotes is that the term waste amounts to inappropriateness whatever the economic environment referred to. The hope is that it can act as a prod for those people who wish to make more rational and economically more convenient work choices by reducing the opportunities for conflict, the loss of time, the legal disputes, the bottlenecks, the incompetence. Two possible approaches to waste are presented. The first represents the point of view of the industry, it is only apparently distant. Thought, the lean organization requires an effort of reading and perhaps greater analysis but, mutatis mutandis, the areas of waste, that is of inappropriateness, are perfectly adaptable to the health world. The second was born in the health world, originates from a work of an important author in the world of quality in medicine, identifies six categories of waste and was taken up in our country by the GIMBE Foundation, giving inspiration or a strong debate. Reflection on each category allows the expert physician to translate his content into his everyday life and draw hypotheses and stimuli for a possible change in clinical organizational practice, in a vision of contrasting inappropriateness. Homo medicus continually needs to be solicited and have elements of reflection to make choices that minimize, in this case, the behavior of inappropriateness (waste) prescriptive and organizational. KEY WORDS waste; appropriateness; lean production.
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Johnson, Scott M., Troy Hutchins, Miriam Peckham, Yoshimi Anzai, Elizabeth Ryals, H. Christian Davidson, and Lubdha Shah. "Effects of implementing evidence-based appropriateness guidelines for epidural steroid injection in chronic low back pain: the EAGER (Esi Appropriateness GuidElines pRotocol) study." BMJ Open Quality 8, no. 4 (December 2019): e000772. http://dx.doi.org/10.1136/bmjoq-2019-000772.
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ObjectiveChronic low back pain is very common and often treated with epidural steroid injections (ESIs). As ESI referrals had been rapidly increasing at our Veterans’ Administration hospital, we were concerned that they were supplanting more comprehensive care. The objective was to determine how referral patterns and multidisciplinary care might change with the implementation of evidence-based guidelines.MethodsIn this retrospective observational study, multidisciplinary evidence-based guidelines were implemented in 2014 (EAGER: Esi Appropriateness GuidElines pRotocol) as part of the ordering process for an ESI. Time series analysis was performed to assess the primary outcome of subspecialty referral pattern, that is, the number of patients receiving referrals to ancillary services which might serve to provide a more comprehensive approach to their back pain. Secondary outcomes included patient-level changes (ie, body mass index, number of injections, opioid use), which were compared before and after protocol implementation.ResultsComparing preimplementation and postimplementation protocol periods, referrals to physical medicine/rehabilitation increased 11.7% (p=0.003) per year and integrative health increased 2.1% (p<0.001) per year among the 2294 individual patients who received ESI through the neurointerventional radiology service. Of 100 randomly selected patients for patient-level analysis, the median body mass index decreased from 31.57 to 30.22 (p=<0.001) and the mean number of injections decreased from 1.76 to 0.73 (p<0.001). The percentage of patients using oral opioid analgesics decreased from 72% to 49% (p=<0.001).ConclusionImplementation of evidence-based guidelines for ESI referral helps guide patients into a more comprehensive care pathway for chronic low back pain and is correlated with patient-level changes such as decreased body mass index and decreased opioid usage.
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Schunk, Dale H. "Peer Models and Children’s Behavioral Change." Review of Educational Research 57, no. 2 (June 1987): 149–74. http://dx.doi.org/10.3102/00346543057002149.
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This article critically reviews the research literature on peer modeling among children as a function of model attributes. Peer modeling is hypothesized to depend in part on perceived similarity between model and observer. Similarity serves as an important source of information for gauging behavioral appropriateness, formulating outcome expectations, and assessing one’s self efficacy for learning or performing tasks. Research is reviewed on the effects of model age, model sex, model competence, number of models, and model background. Peer models can foster diverse types of behavioral change in children, but attribute similarity does not automatically enhance modeling. The conditions under which similarity promotes behavioral change are discussed. Future research needs to assess children’s self-perceptions, as well as maintenance and generalization of behavioral changes. It is suggested that classroom peers can help train social skills, enhance self-efficacy, and remedy skill deficiencies.
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Taguchi, Naoko, Shuai Li, and Feng Xiao. "Production of formulaic expressions in L2 Chinese: A developmental investigation in a study abroad context." Chinese as a Second Language Research 2, no. 1 (June 24, 2013): 23–58. http://dx.doi.org/10.1515/caslar-2013-0021.
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AbstractThis study investigated the development of L2 Chinese formulaic competence in a study abroad context. Participants were 31 American students studying Chinese in a university in China (intermediate-level). They completed a computerized speaking test consisting of 24 formulae-use situations twice during their semester-long study abroad in China. The learners produced a formulaic expression according to each situation, and their production was evaluated on appropriateness (rated on a four-point scale by native speakers) and planning time. In addition, a survey was administered to gather information about the learners' perceived frequency of encounter with formulae-use situations. The learners showed significant gains on appropriateness and fluency. Reported frequency of encounter with target formulae-use situations did not correlate with the gains in formulae production, except for the learners with lower pretest score. Qualitative analysis revealed four patterns of change: (1) change toward target formulae, (2) change toward target-like slot-and-frame patterns, (3) change toward non-target formulae; and (4) stabilized non-target formulae use.
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Kaplow, M., S. Charest, N. Mayo, and S. Benaroya. "Managing Patient Length of Stay Better Using an Appropriateness Tool." Healthcare Management Forum 11, no. 2 (July 1998): 13–16. http://dx.doi.org/10.1016/s0840-4704(10)60640-0.
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A multidisciplinary group from two medical floors at the Royal Victoria Hospital chose the Managed Care Appropriateness Program (MCAP) to evaluate the appropriateness of the days of stay for their patients. Of 100 charts of consecutive patients examined by the nurse reviewer (comprising 1,095 patient days), 33 percent of the days were deemed inappropriate. The reasons for each of these inappropriate days were documented, and strategies were implemented to address the issues. The major outcome of the study was a change in the culture of the health professionals to a more positive approach to defining and carrying out efficient patient care.
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Finnemore, Martha, and Kathryn Sikkink. "International Norm Dynamics and Political Change." International Organization 52, no. 4 (1998): 887–917. http://dx.doi.org/10.1162/002081898550789.
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Norms have never been absent from the study of international politics, but the sweeping “ideational turn” in the 1980s and 1990s brought them back as a central theoretical concern in the field. Much theorizing about norms has focused on how they create social structure, standards of appropriateness, and stability in international politics. Recent empirical research on norms, in contrast, has examined their role in creating political change, but change processes have been less well-theorized. We induce from this research a variety of theoretical arguments and testable hypotheses about the role of norms in political change. We argue that norms evolve in a three-stage “life cycle” of emergence, “norm cascades,” and internalization, and that each stage is governed by different motives, mechanisms, and behavioral logics. We also highlight the rational and strategic nature of many social construction processes and argue that theoretical progress will only be made by placing attention on the connections between norms and rationality rather than by opposing the two.
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Fitzpatrick, N. K., C. J. Thompson, H. Hemingway, T. R. E. Barnes, A. Higgitt, C. Molloy, and S. Hargreaves. "Acute mental health admissions in inner London: changes in patient characteristics and clinical admission thresholds between 1988 and 1998." Psychiatric Bulletin 27, no. 1 (January 2003): 7–11. http://dx.doi.org/10.1192/pb.27.1.7.
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Aims and MethodWe undertook a retrospective case-note review of three cohorts of mental health admissions to determine the extent to which patient and service characteristics changed between 1988 and 1998. Changes in clinical admission thresholds were investigated by a psychiatrists' review of handwritten medical admission assessments.ResultsPatients admitted in 1998 were demographically less stable and clinically more complex than those admitted 10 years earlier. Clinical admission thresholds remained consistent.Clinical ImplicationsOur findings suggest that the perceived increase in pressure on psychiatric services over this period was a response to a change in population need. This study highlights important questions about the clinical decision-making process leading to use of alternatives to admission and the appropriateness of acute admissions.
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Sargenti, Christine, Lawrence Zelman, Therese Beauclair, Elwyn Garrard, and Ralph Boehm. "Evaluation of Appropriateness and Interpretation of Serum Theophylline Assays." Drug Intelligence & Clinical Pharmacy 19, no. 5 (May 1985): 380–84. http://dx.doi.org/10.1177/106002808501900512.
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A drug utilization review of serum theophylline assays was undertaken to: (1) evaluate the prescriben' usage and interpretation of serum theophylline levels (STLs), and (2) calculate the cost of inappropriate assays. Criteria for appropriate use and interpretation were defined by an audit committee and approved by the chief medical resident. STLs were evaluated on medicine patients for a one-month period. Results of 102 levels ordered showed that 47 percent were inappropriate. The reasons cited most often for inappropriateness were: (1) previously-known STLs with no reason to expect a change in subsequent levels (26 percent); and (2) STLs drawn prior to steady state (12 percent). None of the levels evaluated had a request entered for the sampling time to be recorded. STLs were interpreted with the same degree of accuracy regardless of whether they were ordered appropriately. Results from this study suggest significant cost savings can be realized if physicians' ordering habits are corrected.
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Strathern, Marilyn. "Climate activism: afterword." Journal of the British Academy 9s5 (2021): 117–21. http://dx.doi.org/10.5871/jba/009s5.117.
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A short �Afterword� commenting on the multidisciplinary nature of the articles, and their appropriateness to the multi-purposed orientations to be found in climate change activism. It touches on the importance of diverse frames of thought: one crisis is also many crises.
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Pan, Xu, Xuan, Gu, and Bai. "Appropriateness of Potential Evapotranspiration Models for Climate Change Impact Analysis in Yarlung Zangbo River Basin, China." Atmosphere 10, no. 8 (August 8, 2019): 453. http://dx.doi.org/10.3390/atmos10080453.
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Evapotranspiration (ET) is an important element in the water and energy cycle. Potential evapotranspiration (PET) is an important measurement of ET. Its accuracy has significant influence on agricultural water management, irrigation planning, and hydrological modelling. However, whether current PET models are applicable under climate change or not, is still a question. In this study, five frequently used PET models were chosen, including one combination model (the FAO Penman-Monteith model, FAO-PM), two temperature-based models (the Blaney-Criddle and the Hargreaves models) and two radiation-based models (the Makkink and the Priestley-Taylor models), to estimate their appropriateness in the historical and future periods under climate change impact on the Yarlung Zangbo river basin, China. Bias correction methods were not only applied to the temperature output of Global Climate Models (GCMs), but also for radiation, humidity, and wind speed. It was demonstrated that the results from the Blaney-Criddle and Makkink models provided better agreement with the PET obtained by the FAO-PM model in the historical period. In the future period, monthly PET estimated by all five models show positive trends. The changes of PET under RCP8.5 are much higher than under RCP2.6. The radiation-based models show better appropriateness than the temperature-based models in the future, as the root mean square error (RMSE) value of the former models is almost half of the latter models. The radiation-based models are recommended for use to estimate PET under climate change in the Yarlung Zangbo river basin.
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Ronquillo, Charlene, Chris Roome, and Ken Stein. "VP113 Reframing “Disinvestment”: Appropriateness And Real-Time Data Capture." International Journal of Technology Assessment in Health Care 33, S1 (2017): 201–2. http://dx.doi.org/10.1017/s0266462317003713.
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INTRODUCTION:Disinvestment – stopping the use of health technologies with little or no clinical benefits – can reduce health system costs and change practice towards effective innovations. In England, efforts to support disinvestment have included the National Institute of Health and Care Excellence (NICE's) list of 900+ “Do Not Do (DND) technologies”. However, recent studies show ongoing, varying rates of DND technology, suggesting limited influence. In response, we propose a shift in perspective and reframing of the concept of ‘disinvestment’ to focus on ‘appropriateness’.METHODS:We have developed a two-pronged approach to ‘appropriateness’. The first develops local clinician agreements on specific, appropriate indications for a technology. The "RAND/UCLA Appropriateness Method” is being extended in this stage. This knowledge management process enables incorporation of local knowledge and practice via consensus development amongst local experts alongside scientific evidence. The second, and more novel, element is to specify and routinely collect data on technology use associated with these agreed indications. Shifting from cross-sectional clinical audits to real-time monitoring will highlight variation from the agreed indications, which can inform reimbursement policy and decisions. Evaluating the feasibility and sustainability of this approach will provide important lessons for scaling up.RESULTS:For clinicians, the reframing from disinvestment to appropriateness has important implications. The approach recognizes that there are very few technologies with absolutely no benefit. Framing the management of technology diffusion in terms of appropriateness emphasises benefits and maximises value for public health. Furthermore, combining local agreements on indications with real-time data capture facilitates intelligent, flexible commissioning and informs real-life evaluation.CONCLUSIONS:Shifting the perspective from disinvestment to appropriateness overcomes negative associations of stopping healthcare technologies. Linking clinically driven decisions on technology indications with routine data capture on use can transform clinical audit and healthcare commissioning. The combination of these approaches is, we believe, a novel approach on which more reflection and research will be valuable.
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Patricia, Nesa Lydia, Zamralita Zamralita, and Rita Markus Idulfilastri. "APAKAH PEMBERDAYAAN PSIKOLOGIS DAN PERSEPSI DUKUNGAN ORGANISASI MENDUKUNG KESIAPAN UNTUK BERUBAH ?" Jurnal Muara Ilmu Sosial, Humaniora, dan Seni 4, no. 1 (April 30, 2020): 245. http://dx.doi.org/10.24912/jmishumsen.v4i1.7706.2020.
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Facing the demands of economic change in global competition which creates an increasingly fierce competition climate, an organization must make changes as an adjustment in order to exist and develop. Increasing readiness for change in all employees is one of the most effective interventions an organization can undertake so that the change process can achieve the expected goals. This aim of this study is to identify the role of psychological empowerment and perceived of organizational on the readiness for change. The readiness for change is an employee's belief that they are capable for implementing the proposed change (change efficacy), the proposed changes are appropriate for the organization (appropriateness), the leader is committed to the proposed change (management support), and proposed changes will benefit the members of the organization personal benefit). The study was conducted on 53 employees of Airline X used populated samples and analyzed using linear regression by SPSS. The results showed that psychological empowerment had positive and significant influence on readiness for change Perceived of organizational support had positive and significant influence on readiness for change Both psychological empowerment and perceived of organizational support have positive and significant influence on readiness for change. The findings may serve as a reference for the improvement of the change strategy. Sebagai penyesuaian diri dalam menghadapi tuntutan perubahan ekonomi dalam persaingan global, suatu organisasi harus melakukan perubahan agar dapat eksis dan berkembang. Salah satu intervensi paling efektif yang dapat dilakukan oleh organisasi agar proses perubahan dapat mencapai tujuan yang diharapkan adalah dengan meningkatkan kesiapan terhadap perubahan pada seluruh karyawan. Penelitian ini bertujuan untuk melihat peran pemberdayaan psikologis dan persepsi dukungan organisasi terhadap kesiapan untuk berubah. Kesiapan untuk berubah merupakan kepercayaan karyawan bahwa mereka mampu melaksanakan perubahan yang diusulkan (change efficacy), perubahan yang diusulkan tepat untuk dilakukan organisasi (appropriateness), pemimpin berkomitmen dalam perubahan (management support), dan perubahan akan memberikan keuntungan bagi anggota organisasi (personal benefit). Penelitian dilakukan terhadap 53 orang karyawan maskapai penerbangan X menggunakan sampel jenuh. Analisis dilakukan menggunakan regresi linear dengan program SPSS. Hasil penelitian menunjukkan pemberdayaan psikologis memengaruhi kesiapan untuk berubah. Persepsi dukungan organisasi memengaruhi kesiapan untuk berubah. Pemberdayaan psikologis dan Persepsi dukungan organisasi secara simultan memengaruhi kesiapan untuk berubah. Temuan penelitian ini diharapkan menjadi referensi penyempurnaan strategi perubahan dengan intervensi peningkatan kesejahteraan karyawan dan mempertahankan keberlanjutan pemberdayaan psikologis karyawan dengan memfasilitasi mereka untuk berkinerja optimal melalui program-program pengembangan yang terarah.
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Colwell, Peter F., and Catherine Jackson. "Modelling rental change across key retail investment markets in Britain." Journal of Property Investment & Finance 22, no. 5 (October 1, 2004): 354–85. http://dx.doi.org/10.1108/14635780410556861.
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Models of the commercial property market have become increasingly sophisticated in recent years. However, the retail sector and, more specifically, analysis of retail markets at the local level, have been comparatively neglected. This paper makes inroads into this gap in property research. Retail rental change at the local level is explored, focusing on consumer expenditure as the key determinant of change. The appropriateness of proxy variables is investigated and the mechanisms of rental change are examined. This highlights issues and difficulties unique to local level analysis. Following this, the relationship between rental change and underlying changes in consumer expenditure is investigated. The stability of a panel model of rental change is examined, with differences in market functioning identified across diverse groups of key local retail investment markets. These differences highlight the re‐emergence of northern markets during both the economic decline and recovery phases of the last decade of the 20th century. Rental levels in larger and smaller markets are also seen to respond to changes in consumer expenditure to significantly different degrees, in periods of both decline and recovery.
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Ung, Chhun-Huor, and Sylvain Végiard. "Problèmes d'inférence statistique reliés à la transformation logarithmique en régression." Canadian Journal of Forest Research 18, no. 6 (June 1, 1988): 733–38. http://dx.doi.org/10.1139/x88-112.
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In regression calculations, a return to the original scale after logarithmic transformation constitutes a bias. This paper analyses three methods of bias correction for point estimation of the mean and four methods of bias correction for the interval estimation of the mean; some details about the interval prediction of a new observation are given. The appropriateness of using the methods reviewed in various circumstances is also discussed.
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SENDING, OLE JACOB. "Constitution, Choice and Change: Problems with the `Logic of Appropriateness' and its Use in Constructivist Theory." European Journal of International Relations 8, no. 4 (December 2002): 443–70. http://dx.doi.org/10.1177/1354066102008004001.
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Zhao, Jing, Jie Cao, Siquan Tian, Yong Chen, and Shouyu Zhang. "Evaluating Sampling Designs for Demersal Fish Communities." Sustainability 10, no. 8 (July 24, 2018): 2585. http://dx.doi.org/10.3390/su10082585.
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Fish communities play an important role in determining the dynamics of marine ecosystems, while the evaluation and formulation of protective measures for these fish communities depends on the quality and quantity of data collected from well-designed sampling programs. The ecological model was used first to predict the distribution of the demersal fish community as the “true” population for the sampling design. Four sampling designs, including simple random sampling, systematic sampling, and stratified sampling with two sampling effort allocations (proportional allocation and Neyman allocation), were compared to evaluate their performance in estimating the richness and biodiversity indices of the demersal fish community. The impacts of two different temperature change scenarios, uniform temperature and non-uniform temperature increase on the performance of the sampling designs, were also evaluated. The proportional allocation yielded the best estimates of fish community richness and biodiversity relative to a synthetic baseline. However, its performance was not always robust relative to the simulated temperature change. When the water temperature changed unevenly, systematic sampling tended to perform the best. Thus, it is important to adjust the strata for a stratified sampling when the habitat experiences large changes. This suggests that we need to carefully evaluate the appropriateness of stratification when temperature change-induced habitat changes are large enough to result in substantial changes in the fish community.
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Sailor, David J., and Xiangshang Li. "A Semiempirical Downscaling Approach for Predicting Regional Temperature Impacts Associated with Climatic Change." Journal of Climate 12, no. 1 (January 1, 1999): 103–14. http://dx.doi.org/10.1175/1520-0442-12.1.103.
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Abstract A statistical downscaling approach is developed for generating regional temperature change predictions from GCM results. The approach utilizes GCM free atmosphere output and surface observations in a framework conceptually similar to the model output statistics approach common in the forecasting community. The appropriateness of this approach is demonstrated through a comparison of GCM and observed free atmosphere variables. Seasonal downscaling models are presented for eight sites within four community climate model (CCM) grid cells in the United States. The majority of these models are capable of explaining more than 90% of the variance in the temperature time series. The results indicate a wide range of differences between downscaled climate change predictions and grid cell–level CCM predictions.
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Burke, Jessica Griffin, Patricia Mahoney, Andrea Gielen, Karen A. McDonnell, and Patricia O’Campo. "Defining Appropriate Stages of Change for Intimate Partner Violence Survivors." Violence and Victims 24, no. 1 (February 2009): 36–51. http://dx.doi.org/10.1891/0886-6708.24.1.36.
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Recent research suggests that the transtheoretical model of behavior change is a promising approach for interventions addressing women’s experiences of intimate partner violence. This study explores the distribution of abused women across the stages of change for (a) staying safe from intimate partner violence and (b) leaving an abusive relationship. It explores the relationship between stage assignment and other indicators of a woman’s stage (i.e., safety behaviors and desire for services). Quantitative surveys were conducted with 96 low-income, urban abused women recruited from six health care clinics. The findings call into question the appropriateness of using a staging algorithm that uses one “global” question about keeping safe and suggest that staging questions focused on a single action stage (e.g., leaving) are also problematic. In conclusion, additional work remains to be done to develop and validate quantitative measures of stages of change for survivors of intimate partner violence and to design, implement, and evaluated stage-based, tailored intimate partner violence interventions.
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Ben Lahouel, Béchir, and Nathalie Montargot. "Exploring change conversations through the rhetoric of French leaders." European Business Review 28, no. 4 (June 13, 2016): 486–502. http://dx.doi.org/10.1108/ebr-11-2015-0130.
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Purpose This paper aims to capitalize on a linguistic perspective to analyze the rhetoric of French leaders about organizational change. Design/methodology/approach To address the research questions, the authors opted for a lexical content analysis. They use Ford and Ford’s (1995) change conversational framework and the speech act theory to analyze French CEOs’ letters to stakeholders, over the period 2007-2012. Findings The authors find that leaders’ rhetoric consists of three types of change conversations, namely, initiative, for understanding and for performance, that were underpinned by a network of assertive, expressive and commissive speech acts. Practical implications The results reveal that the communication of change to external stakeholders can be characterized as supportive change conversations, offering assurance on the necessity, appropriateness and expected benefits of change. Originality/value This paper is the first work, in the French context, which integrates change conversations and speech act perspectives to examine the way leaders communicate with external stakeholders through CEOs letters. Previous research focused specially on communicating change with internal stakeholders.
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Krisch, Laura, Angelika Mahlknecht, Ulrike Bauer, Nadja Nestler, Georg Hempel, Jürgen Osterbrink, and Maria Flamm. "The challenge to define a relevant change in medication appropriateness index score in older adults – An approach." British Journal of Clinical Pharmacology 86, no. 2 (January 12, 2020): 398–99. http://dx.doi.org/10.1111/bcp.14167.
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Anemone, Susan, and Tasneem Lalani. "Patient Friendly Summary of the ACR Appropriateness Criteria: Acute Mental Status Change, Delirium, and New Onset Psychosis." Journal of the American College of Radiology 17, no. 9 (September 2020): e50. http://dx.doi.org/10.1016/j.jacr.2020.04.011.
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Heo, Jun-Haeng, Hyunjun Ahn, Ju-Young Shin, Thomas Rodding Kjeldsen, and Changsam Jeong. "Probability Distributions for a Quantile Mapping Technique for a Bias Correction of Precipitation Data: A Case Study to Precipitation Data Under Climate Change." Water 11, no. 7 (July 16, 2019): 1475. http://dx.doi.org/10.3390/w11071475.
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The quantile mapping method is a bias correction method that leads to a good performance in terms of precipitation. Selecting an appropriate probability distribution model is essential for the successful implementation of quantile mapping. Probability distribution models with two shape parameters have proved that they are fit for precipitation modeling because of their flexibility. Hence, the application of a two-shape parameter distribution will improve the performance of the quantile mapping method in the bias correction of precipitation data. In this study, the applicability and appropriateness of two-shape parameter distribution models are examined in quantile mapping, for a bias correction of simulated precipitation data from a climate model under a climate change scenario. Additionally, the impacts of distribution selection on the frequency analysis of future extreme precipitation from climate are investigated. Generalized Lindley, Burr XII, and Kappa distributions are used, and their fits and appropriateness are compared to those of conventional distributions in a case study. Applications of two-shape parameter distributions do lead to better performances in reproducing the statistical characteristics of observed precipitation, compared to those of conventional distributions. The Kappa distribution is considered the best distribution model, as it can reproduce reliable spatial dependences of the quantile corresponding to a 100-year return period, unlike the gamma distribution.
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Villevalde, S., A. Safarova, M. Vorobyeva, and Z. Kobalava. "CHANGES OF APPROPRIATENESS OF LEFT VENTRICULAR MASS DURING ANTIHYPERTENSIVE TREATMENT." Journal of Hypertension 29 (June 2011): e358-e359. http://dx.doi.org/10.1097/00004872-201106001-01048.
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Chartrand, Larry. "The Appropriateness of the Lawyer as Advocate in Contemporary Aboriginal Justice Initiatives." Alberta Law Review 33, no. 4 (August 1, 1995): 874. http://dx.doi.org/10.29173/alr1123.
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This article discusses circle sentencing as a means of addressing the high proportion of aboriginal offenders in the prison system and allowing aboriginal communities greater participation in sentencing decisions. The difficulties of continuing the lawyer's role as advocate, a primary duty of lawyers in this process, is also explored. Ultimately, it is the clients decision whether to allow community participation in sentencing. The article queries whether by allowing community involvement in decision-making, the lawyer is disregarding a commitment to act in the client's interests. For circle sentencing to be effective, not only must the lawyer relinquish the role of advocate, but equally importantly, the client must accept this non-adversarial role. Similarly, the function of the judge must change from passive neutrality to mediation. Until there is legislative reform, the extent to which aboriginal communities may be involved in the sentencing process rests within the judge's discretion.
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Madakasira, Suohakar, and T. Kenneth Taylor. "Misuse of the Dexamethasone Suppression Test as a Diagnostic Tool." International Journal of Psychiatry in Medicine 16, no. 1 (March 1987): 77–84. http://dx.doi.org/10.2190/cn9k-jdy2-2ygh-phaq.
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The diagnostic reliability and appropriateness of use of the Dexamethasone Suppression Test (DST) were assessed by a retrospective chart survey of ninety-nine psychiatric admissions to a community hospital. A change in psychiatric diagnosis between admission and discharge occurred in one-third of the patients. The diagnostic change appeared to be associated with the DST result more than the clinical findings. Such reliance on the test was not justified as the observed diagnostic confidence of the DST in supporting a diagnosis of major depression was only 38 percent. These findings suggest a misuse of the test as a diagnostic tool in routine practice.
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Sathyapalan, Dipu T., Jini James, Sangita Sudhir, Vrinda Nampoothiri, Praveena N. Bhaskaran, Nandita Shashindran, Jisha Thomas, et al. "Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting." Antibiotics 10, no. 5 (April 21, 2021): 470. http://dx.doi.org/10.3390/antibiotics10050470.
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Polymyxins being last resort drugs to treat infections triggered by multidrug-resistant pathogens necessitates the implementation of antimicrobial stewardship program (ASP) initiatives to support its rational prescription across healthcare settings. Our study aims to describe the change in the epidemiology of polymyxins and patient outcomes following the implementation of ASP at our institution. The antimicrobial stewardship program initiated in February 2016 at our 1300 bed tertiary care center involved post-prescriptive audits tracking polymyxin consumption and evaluating prescription appropriateness in terms of the right indication, right frequency, right drug, right duration of therapy and administration of the right loading dose (LD) and maintenance dose (MD). Among the 2442 polymyxin prescriptions tracked over the entire study period ranging from February 2016 to January 2020, the number of prescriptions dropped from 772 prescriptions in the pre-implementation period to an average of 417 per year during the post-implementation period, recording a 45% reduction. The quarterly patient survival rates had a significant positive correlation with the quarterly prescription appropriateness rates (r = 0.4774, p = 0.02), right loading dose (r = 0.5228, p = 0.015) and right duration (r = 0.4361, p = 0.04). Our study on the epidemiology of polymyxin use demonstrated favorable effects on the appropriateness of prescriptions and mortality benefits after successful implementation of antimicrobial stewardship in a real-world setting.
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Nampoothiri, Vrinda, Akkulath Sangita Sudhir, Mariam Varsha Joseph, Zubair Mohamed, Vidya Menon, Esmita Charani, and Sanjeev Singh. "Mapping the Implementation of a Clinical Pharmacist-Driven Antimicrobial Stewardship Programme at a Tertiary Care Centre in South India." Antibiotics 10, no. 2 (February 23, 2021): 220. http://dx.doi.org/10.3390/antibiotics10020220.
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In many parts of the world, including in India, pharmacist roles in antimicrobial stewardship (AMS) programmes remain unexplored. We describe the evolution and effect of the role of adding clinical pharmacists to a multidisciplinary AMS at a tertiary care teaching hospital in Kerala, India. Through effective leadership, multidisciplinary AMS (February 2016) and antitubercular therapy (ATT) stewardship programmes (June 2017) were established. Clinical pharmacists were introduced as core members of the programmes, responsible for the operational delivery of key stewardship interventions. Pharmacy-led audit and feedback monitored the appropriateness of antimicrobial prescriptions and compliance to AMS/ATT recommendations. Between February 2016 and January 2017, 56% (742/1326) of antimicrobial prescriptions were appropriate, and 54% (318/584) of recommendations showed compliance. By the third year of the AMS, appropriateness increased to 80% (1752/2190), and compliance to the AMS recommendations to 70% (227/325). The appropriateness of ATT prescriptions increased from a baseline of 61% (95/157) in the first year, to 72% (62/86, June 2018–February 2019). The compliance to ATT recommendations increased from 42% (25/60) to 58% (14/24). Such a model can be effective in implementing sustainable change in low- and middle-income countries (LMICs) such as India, where the shortage of infectious disease physicians is a major impediment to the implementation and sustainability of AMS programmes.
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Nasution, Febriani Hastini, and Dedes Asriani Siregar. "VALIDITAS BAHAN AJAR FISIKA SISWA SMA/MA BERBASIS CONCEPTUAL CHANGE." JURNAL EDUCATION AND DEVELOPMENT 7, no. 3 (July 27, 2019): 75. http://dx.doi.org/10.37081/ed.v7i3.1169.
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This article was contained about analyzing the validity of students’ teaching module based on conceptual change. Students’ teaching module based on conceptual change was the module which is arranged based on the indicator of conceptual change, they are elicit and confirm current ideas, exposure to conflicting evidence, construct new explanation, apply and evaluate new explanation, and the last is review change in ideas and explanations. This module was validated by three validators. There were four components which was validated, they were about content validity which is consist of the components of module and the appropriateness of module’s contents, construct validity, language validity, and the suitability with the learning used conceptual change. Based on analysis data obtained: The average value of validity of students’ teaching module by three validators was 91.11 was in very valid category. Furthermore, the value of each components were 94.90 in content validity, 90.97 in construct validity, 86.90 in language validity, and 91.67 in the suitability with the learning used conceptual change. Four of the components were in very valid category.
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Collins, Paul E., Jon R. Skafel, David I. Atkinson, and Sandra Jenkins. "Continuum: Measuring and Managing the Patient Care Process." Healthcare Management Forum 7, no. 3 (October 1994): 27–40. http://dx.doi.org/10.1016/s0840-4704(10)61065-4.
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The authors describe the CONTINUUM project which was initiated in a community hospital to manage the appropriateness, timeliness and acceptability of the patient care process on a concurrent or day-to-day basis. CONTINUUM is a quality and data-driven approach to continuous improvement of the patient care process. The St. Thomas-Elgin General Hospital researched “appropriateness of care” measurements and adapted their use for the CONTINUUM project. A concurrent care plan evaluation tool is applied to every care every day. This intensity of service (needs-based) strategy is called the ACTIVITY index. Patients are categorized ACTIV (appropriate) or non-ACTIV (perhaps inappropriate). Non-ACTIV patients are further subdivided into various “barriers to care,” from which service, hospital or physician-related factors can be stratified. Practice patterns and hospital resource use are then rapidly identified. The operational dimensions of the project (bedside, organization and community) are described as well as the inhibitors and enablers of this change process.
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Nordhauser, Jennifer, and Jason Rosenfeld. "Adapting a water, sanitation, and hygiene picture-based curriculum in the Dominican Republic." Global Health Promotion 27, no. 3 (November 17, 2019): 6–14. http://dx.doi.org/10.1177/1757975919848111.
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Water, sanitation, and hygiene issues present barriers to health in rural Dominican Republic. Limited access to adequate water, sanitation, and hygiene accompanies a prevalence of water, sanitation, and hygiene-related diseases. To address these issues, an education and behavior change program using community health clubs has been adapted for areas at greatest risk of water, sanitation, and hygiene disease transmission. To support this initiative, a protocol was created to evaluate 147 images from a community health clubs toolkit for Dominican agricultural communities, or bateyes, to determine image comprehension and cultural appropriateness, as well as the demographic variables associated with visual literacy. A total of 112 interviews were completed across seven bateyes located near the city of La Romana; 60 images were determined to require additional adaptation. Further analyses demonstrated that age and education were significantly associated with greater visual literacy. These results reinforce that educational visual aids require testing for cultural appropriateness and that future work should be conducted to investigate factors that contribute to visual literacy.
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Hutchison, Andrew J., Jeff D. Breckon, and Lynne H. Johnston. "Physical Activity Behavior Change Interventions Based on the Transtheoretical Model: A Systematic Review." Health Education & Behavior 36, no. 5 (July 7, 2008): 829–45. http://dx.doi.org/10.1177/1090198108318491.
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This review critically examines Transtheoretical Model (TTM)—based interventions for physical activity (PA) behavior change. It has been suggested that the TTM may not be the most appropriate theoretical model for applications to PA behavior change. However, previous reviews have paid little or no attention to how accurately each intervention represents the TTM. Findings comprise two sections: sample characteristics of each intervention reviewed and a summary outlining the use of the TTM to develop the interventions. Results reveal numerous inconsistencies regarding the development and implementation/application of TTM-based interventions. Specifically, the majority of interventions reported to be based on the TTM fail to accurately represent all dimensions of the model. Therefore, until interventions are developed to accurately represent the TTM, the efficacy of these approaches and the appropriateness of the underpinning theoretical model cannot be determined.
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Kirton, John, and Brittaney Warren. "From Silos to Synergies: G20 Governance of the SDGs, Climate Change & Digitalization." International Organisations Research Journal 16, no. 2 (June 30, 2021): 20–54. http://dx.doi.org/10.17323/1996-7845-2021-02-03.
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How well and why have Group of 20 (G20) summits advanced Agenda 2030’s sustainable development goals (SDGs) in a synergistic way, with climate change and digitization at the core? An answer to this urgent, indeed existential, question comes from a systematic analysis of G20 summit governance of the SDGs, climate change and digitization to assess the ambition and appropriateness of advances within each pillar and the synergistic links among them. This analysis examines G20 governance of the SDGs, sustainable development, climate change and digitization across the major dimensions of performance and evaluates how performance has changed and become synergistic with the advent of the SDGs in 2015 and the shock of the COVID-19 crisis in 2020. The latter has shown the need to prevent global ecological crises and spurred the digitization of the economy, society and health. Yet, G20 summit governance has largely remained in separate silos, doing little to use the digital revolution to address climate change or reach the SDGs. This highlights the need for G20 leaders to forge links at their future summits by mainstreaming the SDGs and mobilizing the digital revolution and climate action for future health and well-being.
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Umer, Ummara Siddique, Aruba Nawaz Khattak, Aman Nawaz Khan, Shahjehan Alam, Hadia Abid, Mahwish Jabeen, Faria Maqsood, Abdullah Safi, and Anisa Sundal. "Audit of CT head request appropriateness for patients referred from emergency department." Journal of Rehman Medical Institute 6, no. 2 (July 10, 2020): 21–23. http://dx.doi.org/10.52442/jrmi.v6i2.178.
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Introduction: Considering the usefulness and relative ease of Computerized Tomography (CT) based diagnosis, the propensity to request it in the Emergency Room setting when at times it is not really indicated can become an issue.
Objective: To audit use of CT imaging in the emergency department of Rehman Medical Institute by evaluating the clinical practice for CT referral and compliance with clinical guidelines by NICE (National Institute for Health and Care Excellence).
Materials & Methods: This study was conducted at Radiology Department of Rehman Medical institute Peshawar in Oct-Dec 2019 on 100 patients referred for computed tomography (CT) head scans from the emergency department (ED), mostly performed outside normal working hours. Clinical record and CT reports of patients who had their CT head scans done between 1 January 2018 and September 2019 were reviewed. The imaging record of included patients was reproduced from the Picture Archiving and Communication system (PACS) and laboratory data were reviewed through the Hospital Management Information System (HMIS). Clinical details were reviewed to assess risk factors satisfying NICE criteria for a CT scan in those with head injuries. An urgent CT head scan request was deemed appropriate if it led to an immediate change in patient management. Appropriateness of the requests according to the various guidelines was also evaluated. The NICE guideline 176 was used as a standard of care. Data were entered and analyzed using Microsoft Excel.
Results: For suspected brain injuries at least one of the NICE criteria was fulfilled by 84 patients, and 3 or more criteria by 16 patients with a history of head injury; 81% scans were both requested and performed in afternoon and night (between 1700 hrs and 0800 hrs). Most (70) patients were males; ages of patients were from 1- 90 years, most being 51-60 years. Most common presenting complaint was altered consciousness (85%); 51% of the advised CT scans were reported normal, 10% had skull fractures (base 2%, vault 8%), 13% extra-axial hemorrhages, 7% contusions, 7% only scalp hematoma, 6% intracerebral hemorrhages. 2% had infarcts and 2% were cerebral abscesses. Common change in patient management included intracranial bleed requiring urgent neurosurgical intervention and hemorrhagic stroke being ruled out. CT head scans also facilitated early discharge of the patients with head injuries and headache from the hospital.
Conclusion: All (100%) patients had CT head in compliance with NICE guidelines and 81% of these were performed in off hours.
Keywords: Head; Tomography; Craniocerebral Trauma.
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Chynoweth, Jennifer, Meaghan M. McCambridge, Helen M. Zorbas, Jacinta K. Elston, Robert J. S. Thomas, William J. H. Glasson, Joanna M. Coutts, Barbara A. Daveson, and Kathryn M. Whitfield. "Optimal Cancer Care for Aboriginal and Torres Strait Islander People: A Shared Approach to System Level Change." JCO Global Oncology, no. 6 (September 2020): 108–14. http://dx.doi.org/10.1200/jgo.19.00076.
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PURPOSE To improve cancer outcomes for Aboriginal and Torres Strait Islander people through the development and national endorsement of the first population-specific optimal care pathway (OCP) to guide the delivery of high-quality, culturally appropriate, and evidence-based cancer care. METHODS An iterative methodology was undertaken over a 2-year period, and more than 70 organizations and individuals from diverse cultural, geographic, and sectorial backgrounds provided input. Cancer Australia reviewed experiences of care and the evidence base and undertook national public consultation with the Indigenous health sector and community, health professionals, and professional colleges. Critical to the OCP development was the leadership of Aboriginal and Torres Strait Islander health experts and consumers. RESULTS The OCP received unanimous endorsement by all federal, state, and territory health ministers. Key elements of the OCP include attention to the cultural appropriateness of the health care environment; improvement in cross-cultural communication; relationship building with local community; optimization of health literacy; recognition of men’s and women’s business; and the need to use culturally appropriate resources. The OCP can be used as a tool for health services and health professionals to identify gaps in current cancer services and to inform quality improvement initiatives across all aspects of the care pathway. CONCLUSION The development of the OCP identified a number of areas that require prioritization. Ensuring culturally safe and accessible health services is essential to support early presentation and diagnosis. Multidisciplinary treatment planning and patient-centered care are required for all Aboriginal and Torres Strait Islander people, irrespective of location. Health planners and governments acknowledge the imperative for change and have expressed strong commitment to work with Indigenous Australians to improve the accessibility, cultural appropriateness, and quality of cancer care.
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Sayl, Khamis Naba, Sadeq Oleiwi Sulaiman, Ammar Hatem Kamel, Nur Shazwani Muhammad, Jazuri Abdullah, and Nadhir Al-Ansari. "Minimizing the Impacts of Desertification in an Arid Region: A Case Study of the West Desert of Iraq." Advances in Civil Engineering 2021 (June 21, 2021): 1–12. http://dx.doi.org/10.1155/2021/5580286.
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Currently, desertification is a major problem in the western desert of Iraq. The harsh nature, remoteness, and size of the desert make it difficult and expensive to monitor and mitigate desertification. Therefore, this study proposed a comprehensive and cost-effective method, via the integration of geographic information systems (GISs) and remote sensing (RS) techniques to estimate the potential risk of desertification, to identify the most vulnerable areas and determine the most appropriate sites for rainwater conservation. Two indices, namely, the Normalized Differential Vegetation Index (NDVI) and Land Degradation Index (LDI), were used for a cadastral assessment of land degradation. The findings of the combined rainwater harvesting appropriateness map, and the maps of NDVI and LDI changes found that 65% of highly suitable land for rainwater harvesting lies in the large change and 35% lies in the small change of NDVI, and 85% of highly suitable land lies in areas with a moderate change and 12% lies in strong change of LDI. The adoption of the weighted linear combination (WLC) and Boolean methods within the GIS environment, and the analysis of NDVI with LDI changes can allow hydrologists, decision-makers, and planners to quickly determine and minimize the risk of desertification and to prioritize the determination of suitable sites for rainwater harvesting.