Dissertations / Theses: 'Evidence-based decisions'

1

Chin, Ryan C. C. 1974. "Smart customization : making evidence-based environmental decisions." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/78200.

Full text

Abstract:

Thesis (Ph. D.)--Massachusetts Institute of Technology, School of Architecture and Planning, Program in Media Arts and Sciences, 2012.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 177-179).
This thesis examines the environmental benefits created by the manufacture, distribution, and consumer use of products that are mass customized (MC) or produced "on-demand" and tailored to individual end-user preferences. Traditional mass production (MP) models take advantage of economies of scale by efficiently producing multiple copies of the same standard product. However, this also creates waste throughout the product life cycle. The waste of stocks, transportation, overproduction, and non-actuality (markdowns and disposal due to inability to move products in time) pose a problem for manufacturers to achieve financial and environmental sustainability. Studies have found that the textile industry can lose approximately one-third of total revenue ($300B) a year due to waste alone. The men's dress shirt industry serves as a comparative case study in this research, demonstrating the trade-offs between MC and MP methods and enabling evidence-based environmental decisions by manufacturers and consumers. In addition to an examination of the carbon footprint created by the manufacture and distribution of MC vs. MP men's dress shirts, this study includes experiments to understand, in detail, the environmental consequences of shirt acquisition and consumer use. Experiment participants are provided coupons to "purchase" two new dress shirts (one MC, one MP), which are embedded with washable and dry-clean proof RFID tags. A RFID tracking system deployed at the entrance and exit of the participants' offices collects data over a period of 60 working days to determine overall utilization patterns. Armed with this "post-transaction" information gathered by this tracking methodology and ethnographic findings (information that manufacturers often lack), this thesis provides an evidence-based guide that takes into account the environmental benefits of both MC and MP models to enable manufacturers to produce more sustainable products and consumers to practice "Responsible Consumerism."
by Ryan C. C. Chin.
Ph.D.

APA, Harvard, Vancouver, ISO, and other styles

2

Sansom, Rebecca Louise. "Understanding STEM Faculty Members' Decisions About Evidence-Based Instructional Practices." BYU ScholarsArchive, 2019. https://scholarsarchive.byu.edu/etd/9066.

Full text

Abstract:

Traditional teaching practices in undergraduate science, technology, engineering, and mathematics (STEM) courses have failed to support student success, causing many students to leave STEM fields and disproportionately affecting women and students of color. Although much is known about effective STEM teaching practices, many faculty continue to adhere to traditional methods, such as lecture. In this study, we investigated the factors that affect STEM faculty members' instructional decisions about evidence-based instructional practices (EBIPs). We performed a qualitative analysis of semistructured interviews with faculty members from the Colleges of Physical and Mathematical Sciences, Life Sciences, and Engineering who took part in the STEM Faculty Institute (STEMFI) professional development program at the university. We also observed the participants' teaching behaviors using the Classroom Observation Protocol for Undergraduate STEM (COPUS) and investigated the relationship between faculty teaching behaviors and the individual, social, and contextual factors identified from the interview data. We found that internal factors, including attitudes and self-efficacy, were significantly correlated with student-centered teaching behaviors, while social and contextual factors were not significantly correlated with teaching behaviors. This result suggests that in addition to promoting positive teaching cultures and reducing barriers, efforts to support faculty change should emphasize changing faculty attitudes.

APA, Harvard, Vancouver, ISO, and other styles

3

Stretch, Vincent. "The nature of the evidence evaluated in recognition memory decisions : familiarity-based versus retrieval-based models /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC IP addresses, 1997. http://wwwlib.umi.com/cr/ucsd/fullcit?p9732686.

Full text

APA, Harvard, Vancouver, ISO, and other styles

4

Turriff, Alison. "The effective evidence-based high school librarian : a journey to decision." Thesis, Robert Gordon University, 2008. http://hdl.handle.net/10059/375.

Full text

Abstract:

This thesis aims to establish how high school librarians in Scotland and America can become effective evidence-based decision-makers. Initial data collection consisted of written questionnaires to elicit background data from librarians on the extent of their evidence-based practice. Three main themes emerged: collaboration; interprofessional relationships and roles; and decision-making. These themes are discussed in more detail. A range of qualitative methodologies was designed and implemented to gain more in-depth information on practice and viewpoints, involving librarians and stakeholders. A draft model was created of the effective evidence-based practitioner in a high school library, based on an interpretation of findings and readings from the literature. After member-checking and validating by stakeholders, a final model was produced. This emergent model focuses not on the role of the school librarian in isolation, but stresses the importance of interrelationships involving the librarian. The study makes an original contribution to knowledge by giving a better understanding of the effective evidence-based high school librarian in the wider context of education. There is also a contribution to knowledge by adding to the general theory of workplace decision-making and evidence-based practice which is applicable outwith the school sector, and the pragmatic solution-driven model of decision-making is introduced. Key findings give an insight into the complexity of the school library situation, and highlights that ideally there will be positive relationships between school management, school librarian and collaboration. When these come together, it can mean an increase in student achievement, and more effective evidence-based decisions can be made. Findings also demonstrate links between these elements with evidence, national bodies and skills and qualities needed to be an effective evidence-based high school librarian, and identify how the new and complex expectations made of school librarians can be met. Recommendations are made to help stakeholders improve practice.

APA, Harvard, Vancouver, ISO, and other styles

5

Mutyala, Suhrullekha, and Shravani Nelapudi. "Assessing Barriers and Facilitators to Evidence Use in Decisions : A Tertiary and Interview Study." Thesis, Blekinge Tekniska Högskola, Institutionen för programvaruteknik, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-15457.

Full text

Abstract:

Context. Decision-making is a significant step in development process of software engineering. Evidence-based Software Engineering has been one of the strategies attempting to facilitate decision-making process. It follows process of gathering suitable evidence in the aim of making a viable use the evidence. Objectives. In this study, evidence use in practice was mainly focused as a part of which barriers and facilitators concerning it were aspired to be obtained from the practitioners. Concerning existing evidence, it was also aimed in finding out and gathering the existing evidence in software engineering, as a contribution to the evidence use in practice. Methods. To obtain the outcomes for the specified objectives, an extensive tertiary study and 18 interviews were conducted. The tertiary study was replication of study by Kitchenham et al. [1]. It was also an updated version for the years of 2010 to 2016. The interviews were conducted among the software practitioners from several types of industries and regions. Results. 67 SLRs were analysed and extracted to gather and obtain existing evidence. 18 interviews were conducted among software practitioners to assess barriers and facilitators to evidence use in making decisions. Conclusions. We conclude from results of tertiary study that the research studies in every sub-domain are available under software engineering and are even increasing year by year. From the analysed results of the semi-structured interviews, it was clear that the implementation of research results in practice is inter-dependant on many major as well as trivial factors concerning the practitioners. Reference [1] B. Kitchenham et al., “Systematic literature reviews in software engineering – A tertiary study,” Inf. Softw. Technol., vol. 52, no. 8, pp. 792–805, Aug. 2010.

APA, Harvard, Vancouver, ISO, and other styles

6

Gobbo, Andrea. "The making of consumer decisions : revisiting the notions of evaluation and choice by reconstructing consumer habits through subject evidence based ethnography." Thesis, London School of Economics and Political Science (University of London), 2014. http://etheses.lse.ac.uk/1066/.

Full text

Abstract:

This research is concerned with processes of choice in consumers and models of consumer behaviour. It also envisages a broader contribution towards economics in general to clarify how preferences in economic agents arise and change. The research question is: “are the models and factors of evaluation predicted by experts applicable to real cases?” Factors of value and evaluation processes will be observed in real world participants and in everyday behaviour. The results will be compared to models found in the consumer research literature. The fieldwork will focus on a single activity carried out by a sample of consumers: shoe buying behaviour. The first set of data is drawn from 11+11 open ended interviews of participants chosen in the two complementary groups of experts and consumers for the purpose of construal identification. The second stream of data relies on an ethnographic approach that involves recording first-person experiences by use of a miniature camera applied at eye-level, or “subcam” (17 participants). The recordings are analysed in order to reconstruct the choice processes through content analysis of events. The third stream of data in the research is produced by means of replay interviews conducted on those same participants who produced the subjective recordings (selection of 12 participants). Using a first-person ethnographic method allowed: (i) A more exact tracking of the actions involved in the choice process versus standard participant observation or in-shop surveillance cameras, (ii) intersubjective post-hoc account of the recorded activity and, (iii) elicitation of reflective rationalization from the participants in narrative form. The material collected at this step underwent a special kind of process analysis involving memory registers. Findings suggest the need to re-rank factors typically considered for choice in consumer behaviour. A fundamental rebalancing of weight must be attributed to habits versus rational evaluation as long-term factor of choice. Equally short-term factors, like emotions and attitudes, acquire distinctive significance in connection with environmental cues that are susceptible to trigger their repetition in future shopping episodes. The contribution to methodology is twofold. The empirical component extends the use of firstperson ethnographic methods to self-reporting of consumer activities in addition to introspective and survey methods. Activity reconstruction led to amending consumer behaviour models by including the influence of social environment found in installation theory.

APA, Harvard, Vancouver, ISO, and other styles

7

Syrowatka, Ania. "Understanding the Role of the Ottawa Ankle Rules in Physicians' Radiography Decisions: A Social Judgment Analysis Approach." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/22854.

Full text

Abstract:

Clinical decision rules improve health care fidelity, benefit patients, physicians and healthcare systems, without reducing patient safety or satisfaction, while promoting cost-effective practice standards. It is critical to appropriately and consistently apply clinical decision rules to realize these benefits. The objective of this thesis was to understand how physicians use the Ottawa Ankle Rules to guide radiography decision-making. The study employed a clinical judgment survey targeting members of the Canadian Association of Emergency Physicians. Statistical analyses were informed by the Brunswik Lens Model and Social Judgment Analysis. Physicians’ overall agreement with the ankle rule was high, but can be improved. Physicians placed greatest value on rule-based cues, while considering non-rule-based cues as moderately important. There is room to improve physician agreement with the ankle rule and use of rule-based cues through knowledge translation interventions. Further development of this Lens Modeling technique could lend itself to a valuable cognitive behavioral intervention.

APA, Harvard, Vancouver, ISO, and other styles

8

Vydrová, Rosa. "Evidence based management ve zdravotnictví." Master's thesis, Vysoká škola ekonomická v Praze, 2011. http://www.nusl.cz/ntk/nusl-72289.

Full text

Abstract:

Evidence-based management involves decision making based on the best available scientific knowledge about effective organization practice. This evidence can be obtained from internal or systematic external research. Analysis of measures to prevent infections in hemato-oncologic patients a Prague teaching hospital revealed, that current organization practices do not allow a high quality internal research assessing provided health care quality. Causes of barriers to practice evidence-based approach in the organization processes and potential solutions are debated. In healthcare, Evidence-based management has a significant impact on improving the quality of provided care via identification of the best processes of integrating the outcomes of evidence-based medicine into the routine clinical practice. The aim of this work was to fill in absent information about evidence-based management in Czech academic literature and to introduce the ideas, principles and tools of evidence-based practice, as well as information on available sources of scientific evidence and activities that help adopting the evidene-based approach to management.

APA, Harvard, Vancouver, ISO, and other styles

9

Yet, Barbaros. "Bayesian networks for evidence based clinical decision support." Thesis, Queen Mary, University of London, 2013. http://qmro.qmul.ac.uk/xmlui/handle/123456789/9096.

Full text

Abstract:

Evidence based medicine (EBM) is defined as the use of best available evidence for decision making, and it has been the predominant paradigm in clinical decision making for the last 20 years. EBM requires evidence from multiple sources to be combined, as published results may not be directly applicable to individual patients. For example, randomised controlled trials (RCT) often exclude patients with comorbidities, so a clinician has to combine the results of the RCT with evidence about comorbidities using his clinical knowledge of how disease, treatment and comorbidities interact with each other. Bayesian networks (BN) are well suited for assisting clinicians making evidence-based decisions as they can combine knowledge, data and other sources of evidence. The graphical structure of BN is suitable for representing knowledge about the mechanisms linking diseases, treatments and comorbidities and the strength of relations in this structure can be learned from data and published results. However, there is still a lack of techniques that systematically use knowledge, data and published results together to build BNs. This thesis advances techniques for using knowledge, data and published results to develop and refine BNs for assisting clinical decision-making. In particular, the thesis presents four novel contributions. First, it proposes a method of combining knowledge and data to build BNs that reason in a way that is consistent with knowledge and data by allowing the BN model to include variables that cannot be measured directly. Second, it proposes techniques to build BNs that provide decision support by combining the evidence from meta-analysis of published studies with clinical knowledge and data. Third, it presents an evidence framework that supplements clinical BNs by representing the description and source of medical evidence supporting each element of a BN. Fourth, it proposes a knowledge engineering method for abstracting a BN structure by showing how each abstraction operation changes knowledge encoded in the structure. These novel techniques are illustrated by a clinical case-study in trauma-care. The aim of the case-study is to provide decision support in treatment of mangled extremities by using clinical expertise, data and published evidence about the subject. The case study is done in collaboration with the trauma unit of the Royal London Hospital.

APA, Harvard, Vancouver, ISO, and other styles

10

Osop, Hamzah Bin. "A practice-based evidence approach for clinical decision support." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/123320/2/Hamzah%20Bin%20Osop%20Thesis.pdf.

Full text

Abstract:

This thesis studies the conceptualisation and evaluation of a Practice-Based Evidence approach to decision making in healthcare. It examines the existing ICT architecture of a public hospital in Singapore to design a decision support system that leverages practical clinical evidence meaningfully captured in electronic health records. In doing so, healthcare professionals are supported in decision making through findings from past similar patients that can be generalised to the current patient population.

APA, Harvard, Vancouver, ISO, and other styles

11

Lampi, Elina. "Individual preferences, choices, and risk perceptions - survey based evidence /." Göteborg : University of Gothenburg, 2008. http://catalog.hathitrust.org/api/volumes/oclc/235948582.html.

Full text

APA, Harvard, Vancouver, ISO, and other styles

12

Harris, Patricia Amanda. "Promoting research utilisation and evidence-based decision making amongst healthcare managers : utilising nonrecursive structural equation modelling to develop the theory of planned behaviour." n.p, 2005. http://ethos.bl.uk/.

Full text

APA, Harvard, Vancouver, ISO, and other styles

13

Miny, Marnie. "Evidenced based decision making in public policy for innovating firms." Diss., University of Pretoria, 2012. http://hdl.handle.net/2263/22769.

Full text

Abstract:

Firms require policies that are supportive to their operating environment and competiveness. Few firms, however, interact with policy makers and it is suggested in the literature that they do so in a self-interested manner. Policy makers are faced with the challenge of ensuring positive sum outcomes in a highly politicised process. Innovative firms could possible request more value creating policies with noninnovative firms requesting value capturing policies. A firm that is more networked is more innovative, but this also increases the management complexity of the firm. The purpose of this study was to enable policy makers to make more informed political decisions in the public policy process. A secondary dataset focused on firms in the innovation context. Groups of firms were categorised by their innovativeness, involvement with policy and network richness through Chi-square tests, Exploratory Factor Analysis and Cluster Analysis. The policy requests of these firms were analysed through the Kruskal-Wallis test, with post hoc analyses using Mann-Whitney U tests. The study found that firms could be categorised based on their innovativeness and involvement, but that network richness played an important role in increasing both. Innovative and non-innovative firms had similar needs in policies. It is suggested that richly networked firms are not independently rent seeking as they request policies that are to the benefit of the broader innovation network in order to sustain and grow the collaborative relationships. Policy makers are advised to ensure the inclusion of network rich firms in the policy process.
Dissertation (MBA)--University of Pretoria, 2012.
Gordon Institute of Business Science (GIBS)
unrestricted

APA, Harvard, Vancouver, ISO, and other styles

14

Koufogiannakis, Denise Ann. "How academic librarians use evidence in their decision making : reconsidering the evidence based practice model." Thesis, Aberystwyth University, 2013. http://hdl.handle.net/2160/ad53022d-b416-444d-987a-f584db4aeb6d.

Full text

Abstract:

The model for evidence based library and information practice makes assumptions about the way librarians should use evidence to inform decisions. This study explores how academic librarians actually use evidence in their practice, the types of evidence that are useful to them, and whether the decision making model upon which EBLIP is based fits with the ways academic librarians actually incorporate research. A grounded theory methodology was used, within a pragmatic philosophical approach. The 19 study participants were academic librarians in Canada. Data was gathered via online diaries and semi-structured interviews over a 6 month period in 2011. Findings encompass three main areas: 1) the concept of evidence and the sources of evidence that are used by academic librarians in their decision making; 2) how academic librarians use evidence, namely to convince in individual or group decision making; and 3) determinants of evidence use in decision making. Several elements of the existing EBLIP model were identified as being insufficient, and based on the findings, a revised model of EBLIP is proposed. The new model is more inclusive of different types of evidence that are important for librarians, explicitly includes the professional knowledge of librarians, and accounts for the context in which decision making occurs. This study is the first to focus on how academic librarians use evidence in their decision making; to determine what types of evidence they use; and to consider whether the existing EBLIP model is one that is applicable for academic librarians. The findings highlight the impact of collaboration and organisational dynamics upon decision making and evidence use. Convincing emerged as the main theoretical concept in relation to how evidence is used. The new model proposed in this thesis is grounded in the research data from this study and is more applicable to the needs and realities of academic librarians than the current model that was adopted from medicine.

APA, Harvard, Vancouver, ISO, and other styles

15

Versteeg, Cynthia Elaine. "Fostering collaborative evidence-based decision-making: The public health nurse's role." Thesis, University of Ottawa (Canada), 2002. http://hdl.handle.net/10393/6360.

Full text

Abstract:

The Canadian Nursing Association promotes the use of evidence-based decision-making (EBDM) as a component of quality nursing care. A shift to a population health approach encourages public participation in health-related decision-making. Public health nurses (PHNs) participate in joint health-related decision-making with community partners. The purpose of this exploratory and descriptive study was to gain an in-depth understanding of EBDM from the perspective of the PHN. The meaning of EBDM, the perceived barriers and facilitators of using evidence, and the role of the PHN in bringing evidence to the joint decision-making process that they share with community partners was explored. A qualitative methodology known as ethnography was used and data were collected from two sources: observations at team meetings and semi-structured interviews with PHNs. Analysis of the data led to the identification of three sub-themes: holistically knowing the community, bridging 'evidence' to context, and actively managing information. All three sub-themes contribute to the main theme: the PHNs' role in fostering collaborative 'evidence-based' decision-making in the community. The PHNs' holistic view of evidence, which includes hard and soft data, contextual data and professional experience, is discussed. Basic steps in a shared EBDM process are described and dimensions of the context in which PHNs practice are explored. Implications for education, practice, research, and policy are discussed.

APA, Harvard, Vancouver, ISO, and other styles

16

Mt-Isa, Shahrul Hisham. "Improving evidence-based risk-benefit decision-making of medicines for children." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/9049.

Full text

Abstract:

Risk-benefit assessment for decision-making based on evidence is a subject of continuing interest. However, randomised clinical trials evidence of risks and benefits are not always available especially for drugs used in children mainly due to ethical concern of children being subjects of clinical trials. This thesis appraises risk-benefit evidence from published trials in children for the case study; assesses the risk-benefit balance of drugs, proposes a framework for risk-benefit evidence synthesis, and demonstrates the extent of its contribution. The review shows trial designs lack safety planning leading to inconsistency safety reporting, and lack of efficacy evidence. The General Practice Research Database (GPRD) data was exploited to synthesise evidence of risks of cisapride and domperidone in children with gastro-oesophageal reflux as a case study. Efficacy data are only available through review evidence. Analysis of prescribing trends does not identify further risk-benefit issues but suggest the lack of evidence has led to inappropriate prescribing in children. Known adverse events are defined from the British National Formulary and quantified. Proportional reporting ratio technique is applied to other clinical events to generate potential safety signals. Signals are validated; and analysed for confirmatory association through covariates adjustment in regressions. The degree of associations between signals and drugs are assessed using Bradford Hill’s criteria for causation. Verified risks are known adverse events with 95% statistical significance, and signals in abdominal pain group and bronchitis and bronchiolitis group. The drugs’ risk-benefit profiles are illustrated using the two verified signals and an efficacy outcome. Sensitivity of input parameters is studied via simulations. The findings are used to hypothetically advise risk-benefit aspects of trial designs. The value of information from this study varies between stakeholders and the keys to communicating risks and benefits lie in presentation and understanding. The generalisability and scope of the proposed methods are discussed.

APA, Harvard, Vancouver, ISO, and other styles

17

Southwick, Jason Scott. "Therapist Utilization of Evidence-Based Treatment Monitoring." BYU ScholarsArchive, 2011. https://scholarsarchive.byu.edu/etd/3080.

Full text

Abstract:

The early identification of non-responding psychotherapy clients and reducing their treatment failure rates are the principal functions of Clinical Support Tools (CST). Nearly two decades of patient-focused research have produced several "evidence-based treatment monitoring" (EBTM) practices, that measure individual patients' responses to theory-guided treatments and alert therapists of clients who are at risk of eventual treatment failure. Clinical Support Tools are a quality management program that bundle several EBTM practices, and have been shown to improve outcomes in failing clients (Shimokawa, Lambert & Smart, 2010). Appropriately, EBTM has generated significant interest as it expands notions of what constitutes evidence-based practice with non-responding patients (APA, 2006). There is a practical need to disseminate Clinical Support Tools to a wider audience of clinicians and practice environments. The current study was designed to advance understanding of CST mechanisms by providing detailed, qualitative data that demonstrate how CST procedures are utilized in routine practice. Eleven doctoral-level psychologists experienced in using Clinical Support Tools at a university counseling center were interviewed about their use of Clinical Support Tools with a recent non-responding client and about their general experiences with past non-responding clients. Clinicians' responses were categorized as Actions, Decisions, or Attitudes, and were subjected to inductive, thematic content analysis. Results were interpreted to indicate which CST functions were active or inactive in the therapists' routine care. Findings indicated that therapists utilized CST resources to monitor patient status, to identify problems that may have explained therapy non-response, and to initiate corrective interventions. Although it was clear that therapists used the CST signal-alarm system to initiate a problem assessment and corrective intervention, it was less clear whether therapists used CST's to determine significance of client change or to determine the client's prognosis. This observation needs to be confirmed through further investigation. Future research that quantifies CST utilization and investigates implementation-outcome relationships is recommended. Finally, practical avenues for increasing the influence and prevalence of EBTM practices in behavioral healthcare are discussed.

APA, Harvard, Vancouver, ISO, and other styles

18

Schrefler, Lorna Sarah. "The role of economic analysis in the decision-making process of Independent Regulatory Agencies." Thesis, University of Exeter, 2011. http://hdl.handle.net/10036/3393.

Full text

Abstract:

It is conventional to argue that the autonomy and reputation of regulatory agencies depend on their expertise. Yet the studies on how independent regulatory agencies (IRAs) create and deploy their knowledge capacity are few and far apart. Normatively, the justification for delegating decision-making powers to IRAs is that they operate by using technical analysis and expertise rather than political considerations. But yet again, although delegation has been discussed as a design principle, systematic evidence on the conditions under which IRAs make use of knowledge and how is still scarce. The literature on knowledge utilization portrays a rather complex link between expertise and policy, where relevant knowledge is not always reflected in policy outcomes and plays several functions besides facilitating the solution of policy problems. Unfortunately, scholars of IRAs have not exploited the insights of this literature yet. This dissertation addresses the under-explored question of the usage of economic knowledge by IRAs. We identify four possible uses of expertise: instrumental (i.e., to solve problems); strategic (e.g. to advocate a position); symbolic (e.g., to gain legitimacy), and non-use. Our aim is to explain under which conditions a certain usage is more likely to occur. To do so, we draw on the methodological device of explanatory typologies (Elman 2005). Specifically, we select two explanatory dimensions that reflect both the context and the content of policy: the level of conflict in the policy arena, and the degree problem tractability. We use different combinations of these two dimensions to derive four hypotheses on the possible uses of expertise mentioned above. The elusive nature of knowledge utilization makes the identification and measurement of these different usages highly dependent on an in-depth understanding of the institutional, organisational, and political context in which a regulatory decision is taken. We have thus opted for a qualitative approach based on case studies and process tracing (Bennett 2010; Brady 2010; Freedman 2010) to appraise the four hypotheses. Empirically, we performed three case studies on regulatory policy decisions taken by the UK Office of Communications (Ofcom) between 2005 and 2010. We find that, given certain scope conditions, the prevalent use of economic analysis is instrumental - a finding that contradicts previous research that labelled instrumental learning as extremely rare, if not a sort of technocratic utopia. Other uses still exist however, and given other scope conditions regulators can be strategic and symbolic in their approach to knowledge and expertise. This is not surprising if we accept the notion that regulators operate in a policy environment that is eminently but not exclusively technical: to survive in a (at least partially) political environment, regulators have to deploy usages of knowledge that deviate from the instrumental type.

APA, Harvard, Vancouver, ISO, and other styles

19

Rowe, Erin T. "Clinical decision-making in aphasia therapy: A survey of perceived levels of evidence for common treatment approaches." Scholar Commons, 2010. http://scholarcommons.usf.edu/etd/1755.

Full text

Abstract:

The past three decades have produced a surge of interest in the role of evidence-based practice (EBP) in the clinical decision-making of speech-language pathologists and other healthcare professionals in delivering optimally effective patient care. A review of the literature revealed several studies investigating potential barriers to EBP implementation and attitudes toward EBP. However, few studies have been designed to probe what treatment approaches to neurogenic communication disorders clinicians are currently implementing and the rationales behind their use. Furthermore, a review of the literature failed to reveal any surveys designed to probe the correlation between what clinicians perceive to be evidence based and what truly is evidence based as outlined in current practice guidelines. The primary aim of this study was to examine potential trends within the field of speech-language pathology relating to the role of EBP in the clinical decision-making of aphasia therapy and the quality of evidentiary support for these decisions. Launching both Web-based and hard copy versions of an 18-question survey, questions probed clinicians' perceptions of the evidence level, primary sources of information, and timeframe of implementation related to various traditional treatment approaches for aphasia. Analysis of the 104 survey responses revealed a disconnect between the implementation of aphasia treatments and the research behind their use. Results indicate that many of the common treatment approaches for aphasia currently in practice are evidence based. However, a research-to-practice gap exists as many treatment approaches that clinicians are not reportedly using are also supported by evidence. Similarly, clinicians' perceptions of what is evidence based are not always in accordance with current practice guidelines. Clinicians appear to rely on professional journals, graduate school training, and professional conferences as their primary sources of evidence-based information. It does not appear as though advertising significantly affects clinicians' decision making in treatment selection. Furthermore, clinicians tend to implement new or alternative treatment approaches rather quickly after exposure to the treatment. Although participants reportedly acknowledge the importance of EBP, further research is needed to investigate causes of and ways to eliminate the research-to-practice gap in the treatment of neurological communication disorders.

APA, Harvard, Vancouver, ISO, and other styles

20

Nannoolal, Shanitha. "Impact of organisational structure on evidence-based decision making : the matrix versus hierarchical." Diss., University of Pretoria, 2015. http://hdl.handle.net/2263/52274.

Full text

Abstract:

Leaders of organisations are faced with a challenging, rapidly changing business environment that results in increasing complexities. To deal with these complex environments the matrix structure, even though problematic, is often cited as the preferred structure to leverage from the efficient information flow. Organisational structure should facilitate strategy implementation and is often referred to as strategy-structure paradigm. The concept of organisational structure has been extensively researched. However there exists a gap in determining and relating the factors that influence the flow of information through organisational structure. Therefore further research into organisational structure is needed. This study contributed to the field of organisational structure by comparing matrix structure with hierarchical structure in an effort to determine the impact on evidence-based decision making. The research method adopted for this study was a quantitative cross-sectional study. Data was collected through a self-administered questionnaire that was adapted from constructs presented in the literature review. The questionnaire was distributed employing convenience and snowballing sampling which resulted in 189 responses from 16 diverse industry sectors. The pertinent findings of the study were that organisational structure has no impact on evidence-based decision making when comparing matrix organisations to hierarchical organisations. The comparison revealed that there is no significant relationship regarding information flow and evidence-based cultures. The study found that organisational culture is the main driver of evidence-based decision making.
Mini Dissertation (MBA)--University of Pretoria, 2015.
vn2016
Gordon Institute of Business Science (GIBS)
MBA
Unrestricted

APA, Harvard, Vancouver, ISO, and other styles

21

Momoti, Nikiwe Gloria. "A model to foster the use of records for evidence-based decision-making by senior managers in western cape governmental bodies, South Africa." University of the Western Cape, 2021. http://hdl.handle.net/11394/8118.

Full text

Abstract:

Philosophiae Doctor - PhD
South Africa has placed emphasis on evidence-based decision-making for justifying service delivery improvement decisions. Evidence-based decision-making entails decisions made by referring to verifiable facts and figures available from a variety of sources of evidence such as organizational records. Records are created or received during the conduct of business and contain evidence of organizational activities. Their use as sources of evidence is continuous. Most records management scholars hypothesize that the use of records as sources of evidence for decision-making contributes to improved service delivery. In the same breath, some scholars lament their minimal use as sources of evidence for decision-making in the South African public sector due to poor records management. This descriptive, positivist quantitative study used a cross-sectional survey to determine the extent to which records as sources of evidence were used for evidence-based decision-making by senior managers in Western Cape governmental bodies,

APA, Harvard, Vancouver, ISO, and other styles

22

Al-Baghdadi, Mohammed Khalil Shaker. "Evidence-based management and clinical decision-making in temporomandibular joint disc displacement without reduction." Thesis, University of Newcastle upon Tyne, 2015. http://hdl.handle.net/10443/3204.

Full text

Abstract:

Disc displacement without reduction (DDwoR), also known as “closed lock” (CL), is a temporomandibular disorder that may cause painful and limited mouth opening. Patients with DDwoR may present to any clinician in practice, but in the acute phase, patients often seek care immediately from clinicians at the frontline in emergency or primary care. There is, however, a lack of understanding on how frontline clinicians behave and what decisions they make when initially presented with a DDwoR patient. The suggested therapeutic interventions for DDwoR vary considerably in invasiveness with contradictory opinions about the appropriate conservative or surgical intervention, and their timing, for managing DDwoR. This may cause confusion for clinicians and lead management of DDwoR to become based more on experience than evidence. The aim of this project is to inform and facilitate the development of a virtually delivered, evidence-informed, behavioural intervention for clinicians to aid management of DDwoR, through the identification of: the best available evidence for timing of intervention, and the intervention itself, for DDwoR; the influences on clinicians’ decision-making processes in the management of DDwoR. This project involved three separate, but sequential, studies. The first study was a systematic review of closed lock studies to investigate the effects of locking duration on DDwoR management. The second study was a systematic review of randomised trials to examine the therapeutic effects of interventions on DDwoR. The third study was a qualitative study interviewing clinicians at the frontline and specialist services in order to understand the decision-making processes in DDwoR management. The two systematic reviews suggest that the best available evidence for managing DDwoR is by intervening early with the simplest and least invasive intervention. The qualitative data suggest that the main behavioural influences on frontline clinicians’ decision to refer DDwoR early were their lack of condition-specific knowledge, skills, and experience which represent the theoretically-based core targets for a future intervention to support their decisions.

APA, Harvard, Vancouver, ISO, and other styles

23

Esfandiari, Mahsa. "Can oral health technology assessment promote evidence-based decision making in undergraduate dental faculties?" Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=114518.

Full text

Abstract:

Objectives: To investigate the effect of Oral Health Technology Assessment (OHTA) on Evidence-Based Decision Making (EBDM) in the undergraduate dental curriculum. Methods: This study was performed at two levels; 1) the literature review where electronic data bases including PUBMED, MEDLINE, EMBASE, COCHRANE LIBRARY, and CINHAL were searched, and 2) A need assessment by means of interviewing a few faculty members and graduating trainees for systematic evaluation of dental technologies was performed at the McGill University, faculty of Dentistry. Results: Our preliminary evaluation of assessing dental technologies in Canadian faculties reveals a random decision making pattern with no regards to adoption and utilisation of EBDM in undergraduate curriculum. There is also no evidence of either integrating EBDM or systematic evaluation of dental technologies in dental faculties. Conclusion: Within the limitation of this study our findings suggest that the systematic assessment of dental technologies may help faculties to integrate EBDM in their curriculum and that technology assessment committees could provide faculty members and students with the latest developments in dental technologies that are suitable for university dental clinics.
Objectifs: Pour étudier l'effet de Oral Health Technology Assessment (OHTA) sur Evidence-Based Decision Making (EBDM) dans le programme de premier cycle de médecine dentaire. Méthodes: Cette étude a été réalisée à deux niveaux: 1) la revue de la littérature où les bases de données électroniques, y compris PubMed, MEDLINE, EMBASE, Cochrane Library, et CINHAL ont été fouillés, et 2) Une évaluation des besoins au moyen des entrevues avec des membres du corps professoral et diplômés stagiaires pour une évaluation systématique des technologies dentaires a été réalisée à l'Université McGill, faculté de médecine dentaire. Résultats: Notre évaluation préliminaire de l'évaluation des technologies dentaires dans les facultés canadiennes révèle un modèle de décisions prises au hasard, sans concerne envers l'adoption et l'utilisation de EBDM dans les programmes de premier cycle des facultés médecine dentaire. En plus, il n'y a aucune preuve de intégration de EBDM ou l'évaluation systématique des technologies dentaires dans les facultés dentaires. Conclusion: Dans la limite de cette étude, nos résultats suggèrent que l'évaluation systématique des technologies dentaires peuvent aider les facultés de médecine dentaire à intégrer EBDM dans leur curriculum et que les comités d'évaluation des technologies pourrait fournir aux membres du corps professoral et les étudiants les derniers développements dans les technologies dentaires qui peuvent être adaptés dans les curriculum dentaires.

APA, Harvard, Vancouver, ISO, and other styles

24

Stevenson, Paul. "Increasing evidence informed decision making practices among senior non-clinical NHS managers." Thesis, Robert Gordon University, 2017. http://hdl.handle.net/10059/2452.

Full text

Abstract:

There is limited engagement with research based evidence among senior managers within the NHS, and a failure to consistently integrate research findings into the decision making process. While much is known about the decision making and information behaviour of clinical staff and policy makers, there is little knowledge of this for senior non-clinical managers within the NHS. There is also a lack of clarity on how best to facilitate and integrate research evidence into the decision making process and a lack of research regarding the context of non-clinical healthcare managers working in the NHS. This study addresses these shortcomings through in-depth analysis in a case study approach. Data was collected through semi-structured interview, questionnaire and observed scenario work. This data was analysed to increase knowledge and understanding of the current information behaviour and decision making practices of non-medical senior management staff working within the NHS in England. Several key barriers to research utilisation were identified in the analysis of the data. These barriers included insufficient information literacy skills in the cohort, shortcomings with the published research papers, a culture which was focused on achieving politically set targets, and a lack of defined processes to decision making. To address these barriers an embedded librarian and a SharePoint based knowledge management system were implemented and evaluated. Evaluation of these interventions concluded that an embedded librarian was effective in increasing and supporting evidence informed decision making. This provides a practical example of an effective service development which should be considered for implementation across the NHS and wider healthcare community. The study also recommends that, to increase use of their output, researchers need to include more explicit information on the implementation and financial elements of their findings rather than a narrow focus on the intervention outcome. In addition, findings showed the target driven culture of the NHS create an environment that stifles evidence informed decision making. To address this barrier the study recommends that the NHS adopts methods of quality assurance and metrics which place an emphasis on measures of process. This study contributes to theory by exploring the information behaviour of a specific group which have been overlooked in previous research, and contributes new understanding of mechanisms for knowledge translation and interactions between the research based evidence and decision making processes in the context of NHS non-clinical management.

APA, Harvard, Vancouver, ISO, and other styles

25

Rushing, Jessica L. "EVIDENCE-BASED MUSIC THERAPY TREATMENT TO ELEVATE MOOD DURING ACUTE STROKE CARE." UKnowledge, 2019. https://uknowledge.uky.edu/rehabsci_etds/54.

Full text

Abstract:

Stroke is the fifth leading cause of death in the U.S. with approximately 795,000 Americans experiencing a stroke each year. In addition to common difficulties with communication and physical impairments following stroke, psychosocial impacts warrant assessment and treatment. Experiencing a stroke can lead to depression, mood disorders, and difficulties with emotion regulation. It is well documented that post-stroke depression (PSD) affects a third of stroke survivors. Higher levels of depression and depressive symptoms are associated with a less efficient use of rehabilitation services, poor functional outcomes, greater odds of hospital readmission, negative impacts on social participation, and increased mortality. The acute phase of stroke recovery may be a key factor in influencing the depression trajectory with early depression predicting poor longitudinal outcomes. The current approach to treating PSD is medication. However, psychotherapy approaches have demonstrated more promise in preventing PSD. Investigations into music-based treatments have shown encouraging results following acquired brain injuries with active music therapy interventions demonstrating large effect sizes for mood improvement. Therefore, the purpose of this three-part dissertation was to examine the effects of active music therapy on mood and describe the clinical decision making process of using music therapy to target mood elevation for hospitalized adults following a first-time acute ischemic stroke. The first study examined the effect of one treatment of active music therapy on mood following a first-time ischemic stroke during acute hospitalization. Active music therapy was defined as music making interventions that elicit and encourage active participation from participants. The Faces Scale was used to assess mood immediately prior to and following treatment. Forty-four adults received at least one treatment. A significant change in mood was found following one treatment. Comment analysis indicated that participants viewed music therapy as a positive experience. The second study investigated the impact of receiving two treatments of active music therapy on mood as compared to one. No significant difference was found between those who received one treatment and those who received two. Both dosing groups demonstrated significant mood improvement; however Group 2 (two treatments) had more severe strokes and did not improve until the second session. The purpose of the third study was to describe the clinical decision-making (CDM) process of a music therapist targeting mood elevation for hospitalized patients following a first-time acute ischemic stroke. The Three Phase Process Model of Collaborative Self-Study was selected as a guiding qualitative methodological framework. Data was collected from four sources: (a) electronic medical records, (b) audio recordings of eight music therapy treatments, (c) a researcher journal, and (d) patient and caregiver/visitor comments. Results indicate that factors influencing CDM included progression through a four-stage treatment process, use of a variety of music-based and therapy-based techniques, and the monitoring and influencing of participant levels of arousal, affect, salience, and engagement. In conclusion, active music therapy during acute hospitalization following a first-time ischemic stroke is effective in significantly improving mood. Components of clinical decision making to elevate mood are illustrated in a provided conceptual framework. Continued investigation is warranted with consideration of stroke severity, dosing amounts, and additional outcomes of interest. Longitudinal investigation is needed to evaluate the impact of treatment on the trajectory of post-stroke depression.

APA, Harvard, Vancouver, ISO, and other styles

26

Barron-Kagan, Rene Norene. "An Evidence-Based Educational Intervention to Improve Nursing Staff's Critical Thinking and Decision-Making Skills." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2786.

Full text

Abstract:

An Evidence-Based Educational Intervention to Improve Nursing Staff's Critical Thinking and Decision-Making Skills by Rene N. Kagan MSN, University of New Mexico, 2009 BS, University of Phoenix, 2000 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University September 2016 Hospitalized patients in acute care settings are at a high risk of developing health complications that can eventually lead to failure to rescue (FTR) situations. The aim of this project was to deliver a structured comprehensive medical-surgical competency plan for acute care nurses to detect deterioration in a patient's condition through the triad of assessment model to promote clinical reasoning among acute care nurses. Data were collected using pretest surveys, a demographic sheet, and an evaluation survey. A convenient sample of between 22 and 29 nursing staff was recruited from three medical-surgical inpatient units at a VA Hospital. The pretest survey, administered simultaneously with the educational modules, assessed participants' baseline knowledge on components of the triad of assessment model and the processes involved in the prevention of FTR. The pretest scores for modules 1 to 6 were 2, 3, 3, 3, 2, and 3 respectively. The posttests scores for modules 1 to 6 were 4, 5, 5, 5, 4, and 5 respectively. The nurse's aides also recorded posttest scores of 4.6 for both Pulse Oximetry and orthostatic hypotension modules. The t-test (p<0.00) showed a significant difference between the pre and posttests scores, thus, indicating an improvement in nursing staff's knowledge regarding the triad of assessment model. Thus, it is important to adopt a comprehensive medical-surgical plan for acute care nurses institutional-wide. This project contributes to social change through identification of a medical-surgical intervention that improves nurses' critical thinking skills, thereby promoting patient satisfaction and safety. Because nurses play a significant role at the bedside, improved critical thinking skills will facilitate a significant reduction in FTR rates, heighten patient satisfaction, and enhance the nurse-patient relationship.

APA, Harvard, Vancouver, ISO, and other styles

27

Gwinn, Rachael E. "The role of attention in preference-based choice: Evidence from behavioral, neural, and auditorydomains." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1555404091329415.

Full text

APA, Harvard, Vancouver, ISO, and other styles

28

Cheng, Chih-Wen. "Development of integrated informatics analytics for improved evidence-based, personalized, and predictive health." Diss., Georgia Institute of Technology, 2015. http://hdl.handle.net/1853/54872.

Full text

Abstract:

Advanced information technologies promise a massive influx of individual-specific medical data. These rich sources offer great potential for an increased understanding of disease mechanisms and for providing evidence-based and personalized clinical decision support. However, the size, complexity, and biases of the data pose new challenges, which make it difficult to transform the data to useful and actionable knowledge using conventional statistical analysis. The so-called “Big Data” era has created an emerging and urgent need for scalable, computer-based data mining methods that can turn data into useful, personalized decision support knowledge in a flexible, cost-effective, and productive way. The goal of my Ph.D. research is to address some key challenges in current clinical deci-sion support, including (1) the lack of a flexible, evidence-based, and personalized data mining tool, (2) the need for interactive interfaces and visualization to deliver the decision support knowledge in an accurate and effective way, (3) the ability to generate temporal rules based on patient-centric chronological events, and (4) the need for quantitative and progressive clinical predictions to investigate the causality of targeted clinical outcomes. The problem statement of this dissertation is that the size, complexity, and biases of the current clinical data make it very difficult for current informatics technologies to extract individual-specific knowledge for clinical decision support. This dissertation addresses these challenges with four overall specific aims: Evidence-Based and Personalized Decision Support: To develop clinical decision support systems that can generate evidence-based rules based on personalized clinical conditions. The systems should also show flexibility by using data from different clinical settings. Interactive Knowledge Delivery: To develop an interactive graphical user interface that expedites the delivery of discovered decision support knowledge and to propose a new visualiza-tion technique to improve the accuracy and efficiency of knowledge search. Temporal Knowledge Discovery: To improve conventional rule mining techniques for the discovery of relationships among temporal clinical events and to use case-based reasoning to evaluate the quality of discovered rules. Clinical Casual Analysis: To expand temporal rules with casual and time-after-cause analyses to provide progressive clinical prognostications without prediction time constraints. The research of this dissertation was conducted with frequent collaboration with Children’s Healthcare of Atlanta, Emory Hospital, and Georgia Institute of Technology. It resulted in the development and adoption of concrete application deliverables in different medical settings, including: the neuroARM system in pediatric neuropsychology, the PHARM system in predictive health, and the icuARM, icuARM-II, and icuARM-KM systems in intensive care. The case studies for the evaluation of these systems and the discovered knowledge demonstrate the scope of this research and its potential for future evidence-based and personalized clinical decision support.

APA, Harvard, Vancouver, ISO, and other styles

29

Jennings, Elizabeth M. "Matters of life and death : rationalizing medical decision-making in a managed care nation /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC IP addresses, 2002. http://wwwlib.umi.com/cr/ucsd/fullcit?p3049667.

Full text

APA, Harvard, Vancouver, ISO, and other styles

30

Lukeman, Sionnach. "Understanding Evidence-Informed Decision-Making in a Community-Based Network Working Towards the Baby Friendly Initiative." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/24401.

Full text

Abstract:

Objective: To understand the use of evidence-informed decision-making within an interorganizational network, and identify the facilitators and barriers to achieving network goals. Design: Case study. Setting: Rural health district in Nova Scotia, Canada (2006 to 2011). Participants: Members from 4 organizations representing community and hospital groups participating in a regional Baby Friendly Initiative network. Methods: A descriptive mixed methods study using focus group and questionnaire methodology. Data were analyzed using framework analysis and social network analysis (SNA). Results: The SNA results highlighted the role that relationships have on the sharing of knowledge among network members. The findings highlight the need for leadership at multiple levels (community, network members, primary organizations, and the provincial government). A lack of resources to achieve the network’s goals was a key barrier. Conclusions: The role of multi-level leadership is important for future network development and community consideration. The case study methodology facilitated momentum towards the network’s goals.

APA, Harvard, Vancouver, ISO, and other styles

31

Alyami, Mohammed Abdulkareem. "Toward Patient-Centered Personal Health Records Systems to Promote Evidence-Based Decision-Making and Information Sharing." Thesis, Towson University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10745897.

Full text

Abstract:

Personal health record (PHR) is considered a crucial part in improving patient outcomes by ensuring important aspects in treatment such as continuity of care (COC), evidence- based treatment (EBT) and most importantly prevent medical errors (PME). Recently there has been more focus on preventive care or monitoring and control of patients symptoms than treatment itself. Nowadays, there are many mobile health applications and sensors such as blood pressure sensors, electrocardiogram sensors, blood glucose measuring devices, and others that are used by the patients who monitor and control their health. These apps and sensors produce personal health data that can be used for treatment purposes. If managed and handled properly, it can be considered patient-generated data. There are other types of personal health data that are available from various sources such as hospitals, doctors offices, clinics, radiology centers or any other caregivers.

Aforementioned health documents are deemed as a PHR. However, personal health data is difficult to collect and manage due to the fact that they are distributed over multiple sources (e.g. caregivers, patients themselves, clinical devices, and others) and each may describe patient problems in their own way. Such inconsistencies could lead to medical mistakes when it comes to the treatment of the patient. In case of emergency, this situation makes timely retrieval of necessary personal clinical data difficult. In addition, since the amount and types of personal clinical data continue to grow, finding relevant clinical data when needed is getting more difficult if no actions are taken to resolve such issue. Having complete and accurate patient medical history available at the time of need can improve patient outcomes by ensuring important aspects such as COC, EBT, and PME. Despite the importance of PHR, the adoption rate by the general public in the U.S. still remains low. In this study we attempt to use Personal Health Record System (PHRS) as a central point to aggregate health records of a patient from multiple sources (e.g. caregivers, patients themselves, clinical devices, and others) and to standardize personal health records (e.g. use of International Classification of Diseases (ICD- 10) and Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT)) through our proof-of-concept model: Health Decision Support System (HDSS).

We started out by exploring the barriers in adopting PHRs and proposed a few approaches that can promote the adoption of PHRS by the general public so it is possible to implement continuity of care in community settings, evidence-based care, and also prevent potential medical errors. To uncover the barriers in adopting PHR, we have surveyed articles related to PHRS from 2008 to 2017 and categorized them into 6 different categories: motivation, usability, ownerships, interoperability, privacy, and security and portability.

We incorporated the survey results into our proposed PHRS, so it can help overcome some of the barriers and motivate people to adopt PHRS. In Our proposed PHRS, we aimed to manage personal health data by utilizing metadata for organizing and retrieval of clinical data. Cloud storage was chosen for easy access and sharing of health data with relevant caregivers to implement the continuity of care and evidence-based treatment. In our study, we have used Dropbox as storage for testing purposes. However, for practical use, secure cloud storage services that are Health Insurance Portability and Accountability Act (HIPAA) complaint can be used for privacy and security purposes, such as Dropbox (Business), Box, Google Drive,Microsoft OneDrive, and Carbonite. In case of emergency, we make critical medical information such as current medication and allergies available to relevant caregivers with valid license numbers only. In addition, to standardize PHR and improve health knowledge, we provide semantic guidance for using SNOMED CT to describe patient problems and for mapping SNOMED CT codes to ICD-10-CM to uncover potential diseases. As a proof of concept, we have developed two systems (prototypes): first, my clinical record system (MCRS) for organizing, managing, storing, sharing and retrieving personal health records in a timely manner; second, a health decision support system (HDSS) that can help users to use SNOMED CT codes and potential disease(s) as a diagnosis result.

APA, Harvard, Vancouver, ISO, and other styles

32

Sutcliffe, Katy. "Shared decision-making : an evidence-based approach for supporting children, parents and practitioners to manage chronic conditions." Thesis, UCL Institute of Education (IOE), 2010. http://eprints.ioe.ac.uk/6509/.

Full text

APA, Harvard, Vancouver, ISO, and other styles

33

Ruppert, Tobias Verfasser], Dieter W. [Akademischer Betreuer] [Fellner, Jörn [Akademischer Betreuer] Kohlhammer, and Silvia [Akademischer Betreuer] Miksch. "Visual Analytics to Support Evidence-Based Decision Making / Tobias Ruppert ; Dieter W. Fellner, Jörn Kohlhammer, Silvia Miksch." Darmstadt : Universitäts- und Landesbibliothek Darmstadt, 2018. http://d-nb.info/1149824336/34.

Full text

APA, Harvard, Vancouver, ISO, and other styles

34

Walker, Alice Jessica. "Procedural Rationality as a Means for Evidence-Based Management in Conflicted Decision-Making: A Mixed-Methods Study." Case Western Reserve University School of Graduate Studies / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=case1427835243.

Full text

APA, Harvard, Vancouver, ISO, and other styles

35

Ruppert, Tobias [Verfasser], Dieter W. [Akademischer Betreuer] Fellner, Jörn [Akademischer Betreuer] Kohlhammer, and Silvia [Akademischer Betreuer] Miksch. "Visual Analytics to Support Evidence-Based Decision Making / Tobias Ruppert ; Dieter W. Fellner, Jörn Kohlhammer, Silvia Miksch." Darmstadt : Universitäts- und Landesbibliothek Darmstadt, 2018. http://d-nb.info/1149824336/34.

Full text

APA, Harvard, Vancouver, ISO, and other styles

36

Chong, Natalie. "Beyond Evidence-Based Decision Support : Exploring the Multi-Dimensional Functionality of Environmental Modelling Tools. Comparative Analysis of Tool." Thesis, Paris Est, 2019. http://www.theses.fr/2019PESC1005.

Full text

Abstract:

À l’heure où les horizons d’une croissance et d’une consommation infinies sont remis en cause, les appels aux développements de solutions de plus en plus robustes, flexibles et intégrées pour gérer les problèmes environnementaux inédits ont conduit à l’avènement d’un nouveau paradigme, transformant de manière radicale les pratiques de la science et de la gestion. L’importance accrue accordée aux approches collaboratives, intégrées et participatives a soutenu l’essor d’arrangements entre science, pratique et politique, tout en rendant nécessaire la création de nouveaux outils pour accompagner la mise en œuvre d’une réglementation de plus en plus exigeante. Dans le contexte de la gestion des ressources en eau, les modèles sont apparus comme des outils cruciaux, plébiscités par des scientifiques et des praticiens, pour leur capacité à faire avancer la compréhension scientifique du fonctionnement des systèmes hydrologiques à renseigner les politiques publiques et la planification de l’eau dans les bassins versants. Une grande diversité d’outils de modélisation a été développée pour analyser les processus physiques, chimiques et biologiques à l’œuvre, à des échelles spatiales et temporelles diverses et avec des degrés de complexité variés. Par ailleurs, les modèles sont censés fournir aux praticiens des outils concrets au service de politiques fondées sur des faits scientifiques (‘evidence-based policy’), en permettant de transposer des problèmes complexes en solutions techniques « gérables ». Pour autant, leur application pratique est loin d’être proportionnelle à l’investissement en temps et en ressources dédié à leur développement. Cette thèse vise à éclairer le fossé persistant entre science, pratique et politique dans le contexte d’un nouveau paradigme pour la science et la gestion, à travers le prisme des outils de modélisation et de leur rôle à l’interface science-pratique-politique. Nous utilisons une approche qualitative et nous nous appuyons sur deux exemples empiriques : le PIREN-Seine en France et le CRC for Water Sensitive Cities en Australie. Bien que les deux exemples partagent des défis, des méthodes et des objectifs similaires, la richesse de leur comparaison repose sur la différence fondamentale dans leurs approches et leurs stratégies.Ce faisant, nous explorons les moteurs, implications et conséquences potentielles des changements de paradigme parallèles à l’œuvre de la science et la gestion, en nous concentrant sur trois aspects : 1/ l’utilisation et l’utilité des outils de modélisation pour soutenir la gestion, la planification et les politiques publiques concernant les ressources en eau ; 2/ les différentes modalités qui permettent d’aborder l’incertitude dans l’aide à la décision reposant sur des modèles ; 3/ la signification ou la portée de nouveaux arrangements entre science, pratique et politique. En retraçant l’histoire de la production et de l’utilisation des outils de modélisation dans les deux exemples, nous cherchons tout d’abord à comprendre la relation nuancée entre « utilisation » et « utilité », en offrant un aperçu des facteurs qui les influencent. Nous nous intéressons ensuite à la question de l’incertitude en analysant la manière dont chercheurs et praticiens affrontent le défi fondamental de l’incertitude dans l’aide à la décision fondée sur les modèles. En considérant les processus complexes, socialement négociés, qui s’inscrivent dans le contexte de la prise de décision, nous nous concentrons sur la construction sociale de l’ignorance et sur sa fonction. Nous examinons enfin, à un niveau macro socio-économique, l’évolution des pratiques engendrée par le changement de paradigme dans la science et la gestion. Parmi ces changements, nous proposons une interprétation de l’émergence et des fonctions des « organisations frontières », et le rôle qu’elles sont amenées à jouer dans la recherche de solutions robustes, flexibles et durables
As the sun sets on the age of unlimited growth and consumption, the call for progressively robust, adaptive and integrated solutions to address ‘wicked’ environmental problems has ushered in a new paradigm that has fundamentally changed the practices of both science and management. Emphasis on collaborative, integrative and participative approaches has given rise to burgeoning science-practice-policy arrangements while necessitating new tools to support the implementation of increasingly demanding regulation. In the context of water resources, models have emerged as fundamental tools favoured by scientists and practitioners alike, owing to their ability to advance scientific understanding of water systems functioning, while at the same time supporting key decisions in the management, policy and planning of river basins. A wide range of modelling tools have been developed to study the numerous physical, chemical, and biological processes at work, on different spatial and temporal scales, with varying levels of complexity. At the same time, models provide practitioners with a practical tool for supporting ‘evidence-based’ policy by transposing complex problems into technical, ‘manageable’ solutions. Yet, their application in practice has proven far from proportional to the amount of time and resources that have been invested in their development.This thesis aims to elucidate the enduring divide between science, practice and policy in the context of a new paradigm of science and management through the lens of modelling tools and their role at the science-practice-policy interface. Using a qualitative approach, we draw from two empirical examples: the PIREN-Seine in France and the CRC for Water Sensitive Cities in Australia. While both share similar challenges, methods and objectives, the fundamental difference in their strategies and approaches offers a rich foundation for comparison. In doing so, we explore the driving forces, implications and potential consequences of the parallel paradigm shifts in science and management, focusing on three main aspects: 1/ the use and utility of modelling tools to support water management, policy and planning; 2/ the different modalities of addressing uncertainty in model-based decision support, and; 3/ the role of new science-practice-policy arrangements. By first retracing the history of production and use of modelling tools in both examples, we seek to understand the nuanced relationship between ‘use’ and ‘utility’, offering insight into influencing factors. Next, we turn to the question of uncertainty by analysing how researchers and practitioners reconcile the fundamental challenge of uncertainty in model-based decision support. Delving deeper into the complex, negotiated social process that comprises the decision-making context, we focus on the social construction of ignorance and its role in decision-making. Finally, we examine the macro-level changes brought about by the paradigm shift in science and management. Amidst these changes, we seek to understand the emergence and functions of ‘boundary organisations’ in this new epoch, and their role in the quest for robust, adaptive and sustainable solutions

APA, Harvard, Vancouver, ISO, and other styles

37

De, Beer Jessica. "Competing Values in the Integrated Environmental Management Process ~ Understanding the Dynamics Between Evidence Versus Value-Based Decision-Making." Diss., University of Pretoria, 2018. http://hdl.handle.net/2263/65176.

Full text

Abstract:

Within the Integrated Environmental Management (IEM) process, Environmental Assessment Practitioners are expected to gather information or evidence in order to formulate decisions on the suitability of development projects as it relates to the environment which takes the form of an Environmental Impact Assessment. The EIA decision-making framework relies mainly on a technocratic-, rationalist or technical-rational approach, which is based largely on cognitive or scientific knowledge. This over-reliance on scientific evidence (evidence-based knowledge) limits the level to which non-scientific evidence (value-based knowledge) is incorporated into the EIA decision-making framework. There is a concern that an over-reliance on evidence-based decision-making will lead to valuable information being overlooked or ignored, resulting in a skewed and fragmented process which could fail in ensuring environmental justice for the citizens of South Africa. The overall methodological approach that was used to achieve the aim and objectives of this study was of a qualitative nature, relying on three main methods, including document analysis, expert interviews and focus group meetings. The literature review provided six thematic areas of interest which was further elaborated during the thematic analysis of the data. One of the key findings of this research was that although the South African legislative framework makes provision for value-based decision-making processes, the EIA decision-making framework in particular is too rigid to incorporate non-scientific knowledge or value-based evidence. The need to shorten the EIA decision-making timeframes to allow for social and economic development in addition other challenges facing the IEM field can also attributed to an over-reliance on a formulaic tick-box approach which limits the incorporation of value-based decision-making in the EIA decision-making process.
Mini Dissertation (MA) University of Pretoria, 2018.
Geography, Geoinformatics and Meteorology
MA
Unrestricted

APA, Harvard, Vancouver, ISO, and other styles

38

Faverjon, Céline. "Risk based surveillance for vector-borne diseases in horses : combining multiple sources of evidence to improve decision making." Thesis, Clermont-Ferrand 2, 2015. http://www.theses.fr/2015CLF22604/document.

Full text

Abstract:

Les maladies émergentes à transmission vectorielle sont une préoccupation croissante et particulièrement lorsqu’elles affectent les chevaux, une population spécifiquement à risque vis-à-vis de la propagation de maladies. En effet, les chevaux voyagent fréquemment et, malgré l’impact sanitaire et économique des maladies équines, les règlementations sanitaires et les principes de biosécurité et de traçabilité censés assurer la sécurité des mouvements d'équidés ne sont pas toujours en place. Notre travail propose d'améliorer la surveillance des maladies à transmission vectorielle chez les chevaux en utilisant différentes méthodes pour estimer la probabilité d'émergence d'une maladie. Tout d'abord, nous avons développé un modèle quantitatif et spatio-temporel combinant différentes probabilités pour estimer les risques d'introduction de la peste équine et de l’encéphalose équine. Ces combinaisons permettent d’obtenir une image plus détaillée du risque posé par ces agents pathogènes. Nous avons ensuite évalué des systèmes de surveillance syndromique par deux approches méthodologiques: l'approche classique avec un seuil d'alarme basé sur un multiple de l'erreur standard de prédiction, et l'approche bayésienne basée sur le rapport de vraisemblance. Nous avons travaillé ici principalement sur la détection précoce du virus West Nile en utilisant les symptômes nerveux des chevaux. Les deux approches ont fourni des résultats prometteurs, mais l’approche bayésienne était particulièrement intéressante pour obtenir un résultat quantitatif et pour combiner différentes informations épidémiologiques. Pour finir, l'approche bayésienne a été utilisée pour combiner quantitativement différentes sources d'estimation du risque : surveillance syndromique multivariée, et combinaison de la surveillance syndromique avec les résultats d’analyses de risques. Ces combinaisons ont données des résultats prometteurs. Ce travail, basé sur des estimations de risque, contribue à améliorer la surveillance des maladies à transmission vectorielle chez les chevaux et facilite la prise de décision. Les principales perspectives de ce travail sont d'améliorer la collecte et le partage de données, de mettre en oeuvre une évaluation complète des performances des systèmes de surveillance multivariés, et de favoriser l'adoption de ce genre d’approche par les décideurs en utilisant une interface conviviale et en mettant en place un transfert de connaissance
Emerging vector-borne diseases are a growing concern, especially for horse populations, which are at particular risk for disease spread. In general, horses travel widely and frequently and, despite the health and economic impacts of equine diseases, effective health regulations and biosecurity systems to ensure safe equine movements are not always in place. The present work proposes to improve the surveillance of vector-borne diseases in horses through the use of different approaches that assess the probability of occurrence of a newly introduced epidemic. First, we developed a spatiotemporal quantitative model which combined various probabilities in order to estimate the risk of introduction of African horse sickness and equine encephalosis. Such combinations of risk provided more a detailed picture of the true risk posed by these pathogens. Second, we assessed syndromic surveillance systems using two approaches: a classical approach with the alarm threshold based on the standard error of prediction, and a Bayesian approach based on a likelihood ratio. We focused particularly on the early detection of West Nile virus using reports of nervous symptoms in horses. Both approaches provided interesting results but Bayes’ rule was especially useful as it provided a quantitative output and was able to combine different epidemiological information. Finally, a Bayesian approach was also used to quantitatively combine various sources of risk estimation in a multivariate syndromic surveillance system, as well as a combination of quantitative risk assessment with syndromic surveillance (applied to West Nile virus and equine encephalosis, respectively). Combining evidence provided promising results. This work, based on risk estimations, strengthens the surveillance of VBDs in horses and can support public health decision making. It also, however, highlights the need to improve data collection and data sharing, to implement full performance assessments of complex surveillance systems, and to use effective communication and training to promote the adoption of these approaches

APA, Harvard, Vancouver, ISO, and other styles

39

Rydvall, Anders. "Withhold or withdraw futile treatment in intensive care : arguments supported by physicians and the general public." Doctoral thesis, Umeå universitet, Anestesiologi och intensivvård, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-128863.

Full text

Abstract:

Background: Since the 60s and with increasing intensity a discussion have continued about balance between useful and useless/harmful treatment. Different attempts have been done to create sustainable criteria and recommendations to manage the situations of futile treatment near the end of life. Obviously, to be able to withhold (WH) or withdraw (WD) treatment which is no longer appropriate or even harmful and burdensome for the patient, other processes than strict medical (or physiological) assessments are necessary. Aim. To shed light on the arguments regarding to WH or WD futile treatment we performed two studies of physicians’ and the general populations’ choice and prioritized arguments in the treatment of a 72-year-old woman suffering from a large intra-cerebral bleeding with bad prognosis (Papers I and II) and a new born boy with postpartum anoxic brain damage (Papers III and IV). Methods. Postal questionnaires based on two cases presented above involving severely ill patients were used. Arguments for and against to WH or WD treatment, and providing treatment that might hasten death were presented. The respondents evaluated and prioritized arguments for and against withholding neurosurgery, withdrawing life-sustaining treatment and providing drugs to alleviate pain and distress. We also asked what would happen to physicians’ own trust if they took the action described, and what the physician estimated would happen to the general publics’ trust in health services (Paper IV). Results. Approximately 70% of the physicians and 46% of the general public responded in both surveys. The 72-year-old woman: A majority of doctors (82.3%) stated that they would withhold treatment, whereas a minority of the general public (40.2%) would do so; the arguments forwarded and considerations regarding quality of life differed significantly between the two groups. Quality-of-life aspects were stressed as an important argument by the majority of both neurosurgeons and ICU-physicians (76.8% vs. 54.0%); however, significantly more neurosurgeons regarded this argument as the most important. A minority in both groups, although more ICU-physicians, supported a patient’s previously expressed wish of not ending in a persistent vegetative state as the most important argument. As the case clinically progressed, a consensus evolved regarding the arguments for decision making. The new born child: A majority of both physicians [56 % (CI 50–62)] and the general population [53 % (CI 49–58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient’s symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. Conclusions. There are indeed considerable differences in how physicians and the general public assess and reason in critical care situations, but the more hopelessly ill the patient became the more the groups' assessments tended to converge, although they prioritized different arguments. In order to avoid unnecessary dispute and miscommunication, it is important that health care providers are aware of the public's views, expectations, and preferences. Our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making.

APA, Harvard, Vancouver, ISO, and other styles

40

Grove, Amy L. "A multicentre case study of evidence-based decision-making : exploring the process of knowledge mobilisation in NHS orthopaedic practice." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/99177/.

Full text

Abstract:

Background: Healthcare policy encourages the use of scientific evidence in clinical practice. The complex reality of practice means that dissemination of this evidence in clinical guidelines is insufficient to change behaviour and reduce variation. This study took a knowledge mobilisation perspective to assess the role of evidence- based medicine in orthopaedic practice decisions for hip replacement surgery. Objectives: The research sought to identify where, when and how evidence and knowledge were used in decision-making and how this contributed to variation in practice. It discovered factors which influenced orthopaedic surgery decision-making through an in-depth exploration of real life evidence use in practice. Methods: Three in-depth case studies were conducted at NHS hospitals over 12-months. Data collected included 64 interviews with surgeons and NHS staff, observations of day-to-day practice and the collection of 121 supplementary documents. A case study road map method was performed using thematic analysis to generate four themes: individuals, groups, organisations and regulation. Results: The findings combined individuals and groups, the organisational dynamics and environmental regulation to provide a nuanced understanding of knowledge mobilisation in orthopaedics. Group level knowledge was crucial in explaining variation to evidence based medicine, specifically how it influenced organisational capacity and the socialisation of medical professionals. The characteristics of surgeons also contributed to the wider definition of evidence which was important for clinical decisions. Conclusion: This empirical study of knowledge mobilisation demonstrated that orthopaedic practice was contingent and mediated at different levels, each of which contributed to variation. Decision-making was dependent on a range evidence and knowledge sources that were influential across the entire knowledge domain. A conceptual framework was produced to demonstrate how knowledge is mobilised in a highly professionalised organisationally regulated context.

APA, Harvard, Vancouver, ISO, and other styles

41

Shibu, Litty Mathew. "Examining the research-practice gap in Physical Therapy (PT) in the United States of America using knowledge translation interventions (KTIs) : a comparative study." Thesis, Brunel University, 2018. http://bura.brunel.ac.uk/handle/2438/17553.

Full text

Abstract:

This research was undertaken to study the impact of single and multicomponent knowledge translation interventions (KTIs) on barriers to the integration of Clinical Practice Guidelines (CPG) into Clinical Decision Making (CDM) in the context of physical therapists (PTs) and find out which of the two KTIs was more effective. A literature review showed that research knowledge (e.g. CPG) in the field of PT (Physical Therapy) is not being integrated in to clinical practice (e.g. CDM), thus leading to a research-practice (R-P) gap in other words CPG-CDM gap. It is suggested in the literature that the management and behavioural aspects of PTs might be acting as barriers hindering the integration of the research knowledge into clinical practice consequently affecting the delivery of optimum patientcare. Remedial measures, namely KTIs, are suggested to address those barriers and to bridge the R-P gap. However, the phenomenon of the R-P gap, the causes of it and the possible interventions are not well understood concepts in the literature, particularly in the context of PTs. CPG for Venous Thromboembolism (VTE) in PT was chosen as the example of research knowledge. It was argued that barriers have the potential to affect CDM which in turn can affect the CPG-CDM gap. Lack of knowledge about CPG-CDM gap is a major limitation in the literature that is affecting the integration of CPG into CDM. Other gaps found in the literature that have the potential to affect CPG-CDM gap include management and behavioural variables as probable causes of CPG-CDM gap (or barriers), use of KTIs to bridge the CPG-CDM gap and, KTIs. Furthermore, lack of knowledge about relationship between barriers and CPG-CDM gap, KTIs and barriers, KTIs and CPG-CDM gap and the impact of KTIs (effectiveness) in bridging CPG-CDM gap were the other gaps found in the literature that had potential implications to CPG-CDM gap. These gaps were addressed in this research to some extent. Relationships between the independent variables (lack of knowledge of PTs in CPG, lack of favourable attitude of PTs towards CPG and lack of self-efficacy and motivation of PTs to integrate CPG into CDM) and the dependent variables (CDM and CPG-CDM gap) were defined and models were proposed. Further, it was posited that KTIs could impact barriers based on theories and models found in the literature that provided some basis to create the linkage between KTIs and management and behavioural barriers. Education material (EM) and virtual communities of practice (VCoP) were chosen as of the KTIs in this study. The models of Cabana et al. (1999) and Fischer et al. (2016), primarily, were used to ground the conceptual models represented by figures and equations. Methodologically, a positivist approach with an objective ontological stance was employed and a deductive approach and quantitative research method were used to address the research gaps. The research design included a longitudinal element and survey questionnaire. The target population was licensed PTs in the USA. Random sampling was used. Two groups of PTs were identified namely EM-group and VCoP group. Data was collected from the groups before and after administering the KTIs. The results showed that single and multicomponent KTIs impacted barriers in different ways. EM impacted lack of favourable attitude of PTs towards CPG, and lack of self-efficacy and motivation of PTs to integrate CPG into CDM as barriers and narrow the CPG-CDM gap. VCoP was found to impact the combination of four barriers and narrow CPG-CDM gap. In addition, barriers in groups of two were also impacted by VCoP and narrowed the CPG-CDM gap. Furthermore, a CPG knowledge score card and a corresponding CDM score card developed by the researcher were used to test the change behaviour of PTs in integrating CPG into CDM. This experiment showed that barriers existed and caused CPG-CDM gap and KTIs could narrow the CPG-CDM gap. The findings indicate that this research has contributed to knowledge in many ways, including unearthing the relationship between CPG-CDM gap and barriers, better understanding of KTIs, their relationship with CPG-CDM gap and barriers, gaining knowledge about the impact of single and multicomponent KTIs on single and multiple barriers and identification of methods to bridge the CPG-CDM gap.

APA, Harvard, Vancouver, ISO, and other styles

42

Chandler, Erol. "Increasing Evidence Based Reasoning in an 8th Grade Classroom Through Explicit Instruction." PDXScholar, 2013. https://pdxscholar.library.pdx.edu/open_access_etds/1474.

Full text

Abstract:

This study investigates the effectiveness of an instructional strategy that uses students' prior understanding of informal evidence based reasoning (EBR) to build an understanding of scientific EBR. A pre and post instructional strategy survey revealed that students' understanding of EBR increased over the length of the study. Data collected from pre and post instructional discussions also showed increases in the amount of EBR students used.

APA, Harvard, Vancouver, ISO, and other styles

43

Denadija, Feda, and David Löfgren. "Revealing the Non-technical Side of Big Data Analytics : Evidence from Born analyticals and Big intelligent firms." Thesis, Uppsala universitet, Företagsekonomiska institutionen, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-298137.

Full text

Abstract:

This study aspired to gain a more a nuanced understanding of the emerging analytics technologies and the vital capabilities that ultimately drive evidence-based decision making. Big data technology is widely discussed by varying groups in society and believed to revolutionize corporate decision making. In spite of big data's promising possibilities only a trivial fraction of firms deploying big data analytics (BDA) have gained significant benefits from their initiatives. Trying to explain this inability we leaned back on prior IT literature suggesting that IT resources can only be successfully deployed when combined with organizational capabilities. We identified key theoretical components at an organizational, relational, and human level. The data collection included 20 interviews with decision makers and data scientist from four analytical leaders. Early on we distinguished the companies into two categories based on their empirical characteristics. The terms “Born analyticals” and “Big intelligent firms” were coined. The analysis concluded that social, non-technical elements play a crucial role in building BDA abilities. These capabilities differ among companies but can still enable BDA in different ways, indicating that organizations´ history and context seem to influence how firms deploy capabilities. Some capabilities have proven to be more important than others. The individual mindset towards data is seemingly the most determining capability in building BDA ability. Varying mindsets foster different BDA-environments in which other capabilities behave accordingly. Born analyticals seemed to display an environment benefitting evidence based decisions.

APA, Harvard, Vancouver, ISO, and other styles

44

Diskett, Patricia Muriel. "Evidence-based decision-making and managerial chaos in population displacement emergencies : a case study of Rohingya refugees in Bangladesh 1992-93." Thesis, University of Liverpool, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.243111.

Full text

Abstract:

The aim of the thesis is to explore (from a management perspective), the role, potential and limitations of evidence-basedd ecision-making in an acute population displacement emergency. Using an epidemiological approach, I evaluate its effectiveness in reducing and controlling mortality, malnutrition and disease outbreaks. Influences on the approach, blocks and facilitating factors are also identified. The difficulties associatedw ith using a rational approach in a chaotic setting are confronted. The literature review (Chapter 1) draws on lessons learnt from selectedp revious emergenciesa nd identifies opportunities and problem areas. This case study describes and analyzes the first year of an emergency relief programme for 250,000 Rohingya refugees in Bangladesh. The research is based on primary data collected using three main methods and verified through triangulation. These methods are participant observation, action research and epidemiological methods. Data are drawn from 20 refugee camps, 16 NGOs, selected UN agencies and government departments. The methods and context of the study are described in Chapters 2 and 3 respectivelThe emergency in Bangladesh is described from different viewpoints in order to analyze the chaotic conditions under which the epidemiological approach was tested. Models are developed showing emergency phases from four perspectives. The demographic and epidemiological paradigms are discussed in Chapter 4, while the political and managerial viewpoints are analyzed in Chapter 5. Similar to other emergencies, a sequence of events and trends can be identified. In the models these are shown as clear phases in the relief programme. Unlike some other emergencies, a number of the phases described occur concurrently rather than sequentially. For example, repatriation is an issue during the arrival (acute emergency) phase and acute crises occur in an apparently stable (continuation) phase. The relationships between crude mortality rates, malnutrition rates, disease outbreaks and the various factors affecting decisions, are examined in Chapter 6. When using an epidemiological approach, a number of limitations are noted. Rapid decisions need to be made during the acute emergency phase, but the data needed for decision-making are of poor quality and information is not available in a timely way. When useable information is available, political and organisational factors inhibit rational decision-making. These factors can have a negative effect on the health and nutritional status of the refugees. Political influences on decision-making are particularly strong. At times, political priorities take precedence over epidemiological evidenceEvidence-based decision-making can be used effectively by emergency managers to influence change. However managers and relief workers frequently lack the training and skills which are necessary to fully utilise such an approach. An analysis of political events, organisational factors and managerial chaos is of benefit (in support of evidence-based decision-making), as it facilitates a better understanding of constraints and opportunities (Chapter 7). Areas which require further research are summarised in Chapter

APA, Harvard, Vancouver, ISO, and other styles

45

Kvist, Linda, and Sara Gillhof. "Stödsystem/riktlinjer för riskbedömning av oral hälsa." Thesis, Malmö högskola, Odontologiska fakulteten (OD), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-19763.

Full text

Abstract:

Riskbedömning är en väsentlig del av klinikerns vardag. Varje patient ska riskbedömas och riskgrupperas, vilket sedan utgör grund för val av behandling, behandlare och revisionsintervall. I tandvården i Sverige idag används det ett flertal olika stödsystem eller riktlinjer för riskbedömning av oral hälsa. Syftet med studien var att ta reda på vilka stödsystem/riktlinjer som finns för riskbedömning av oral hälsa i Sverige idag och ge en beskrivning av de mest frekvent använda systemen samt göra en jämförelse av dessa. Syftet var också att undersöka huruvida dessa system är evidensbaserade och utvärderade samt att kartlägga kunskapsläget, gällande evidensbasering och utvärdering av stödsystem/riktlinjer, för riskbedömning av oral hälsa. För att skapa oss en allmän bild av stödsystem/riktlinjer för riskbedömning inleddes vårt arbete med en litteraturgenomgång. För att svara på frågeställningen om kunskapsläget över stödsystemens/riktlinjernas evidens och utvärdering, gjordes en systematisk litteraturöversikt. En kartläggning över Folktandvården och kontakt med Praktikertjänst gav oss en bild över vilka system som är aktuella i Sverige idag. För information om de utvalda systemen kontaktades så kallade nyckelpersoner för intervju. Data från intervjuerna har sedan analyserats i relation till vår litteraturgenomgång. Resultaten visar att Beslutsstöd R2 är det system som används mest frekvent inom Folktandvården. Andra förekommande system är Datorstödd Riskbedömning Effica och DentiGroup. Inom Praktikertjänst finns ett system tillgängligt för alla som använder sig av Opus journalsystem. Vår slutsats är att det vetenskapliga underlaget, gällande evidensbasering och utvärdering av stödsystem/riktlinjer, är bristfälligt.
Risk assessment is an essential part of dental practice today. Each patient should be assessed and stratified into a well defined group according to risk. This risk assessment should then affect the choice of prevention and treatment, and intervals for recalls and appropriate level of care. Today, in Swedish dental healthcare, different guidelines are being used as support in the assessment of a patient’s oral health. The aim of this study was to find out, compare and describe the most frequent used guidelines/systems for risk assessment of oral health in Sweden today. A second aim was to examine whether these systems are evidence-based and evaluated, and to identify existing knowledge about evidence-based supporting systems for risk assessment of oral health. A systematic review was made where articles published more than 10 years ago and papers which didn’t involve risk assessment of the whole patient were excluded. The Public Dental Service and Praktikertjänst were contacted and enquired about which systems if any were in use. For more in depth information on these systems, persons with key knowledge were interviewed. The information received was then analyzed in relation to the literature review. The results show that the system most frequently used in the Public Dental Service today is Beslutsstöd R2. Other computerbased systems are Datorstödd riskgruppering Effica and DentiGroup. In Praktikertjänst a system is available for all users of Opus Dental practice management system. Our conclusion is that the scientific evidence, regarding evidence-based and evaluation of support / guidelines are inadequate.

APA, Harvard, Vancouver, ISO, and other styles

46

Harris, Patricia A. "Promoting research utilisation and evidence-based decision making amongst healthcare managers : utilising nonrecursive structural equation modelling to develop the theory of planned behaviour." Thesis, Open University, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424678.

Full text

APA, Harvard, Vancouver, ISO, and other styles

47

Macyk, Irene. "Staff Nurse Engagement, Decisional Involvement, Staff Nurse Participation in Shared Governance Councils and the Relationship to Evidence Based Practice Belief and Implementation." Thesis, Adelphi University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10610423.

Full text

Abstract:

A nurse's use of evidence-based practice (EBP) is imperative if the goal is for quality and safe care that is safe. Patient quality care is directly correlated to the degree to which hospital nurses are active participants in decision making. Nurses possess the skills that should promote their presence in decision-making forums using evidence-based strategies. Both evidence-based practice (EBP) and participatory Shared Governance Models, independently, have been found to promote improved patient outcomes (Kramer & Schmalenberg, 2004). Shared governance models include formal councils that address recruitment and retention, policy and procedure development, professional practice challenges, quality improvement initiatives and research opportunities. A nurses' Decisional Involvement (DI) and participation in a Shared Governance Council (SGC) may serve as a venue to best utilize Evidenced-Based Practice (EBP) skills with the overall goal of improving care outcomes.

The aim of this research was to determine the relationship of staff nurse engagement, DI and its impact on participation in a SGC and the relationship to EBP. A quantitative non-experimental correlational, on-line survey design was utilized. A total of 156 staff nurses from two (2) Magnet^® recognized hospitals in the Northeastern region of the United States was studied.

Results revealed a significant positive relationship between participation in a SGC and staff nurse engagement, actual DI, age, years of experience and professional certification. Additionally, nurses that participated in a SGC had a significantly higher self-reported EBP implementation. Exploratory logistic analysis revealed EBP implementation, staff nurse engagement, full time work status and participation in IDRs were significant predictors of participation in a SGC. A multiple regression analysis resulted in EBP belief, staff nurse engagement, and participation in a SGC explaining 34.5% of the variability of predicting EBP implementation. The findings give beginning support to the importance of creating an infrastructure that fosters staff nurse engagement and participation in a SGC to promote EBP implementation.

APA, Harvard, Vancouver, ISO, and other styles

48

Henriksson, Dorcus Kiwanuka. "Health systems bottlenecks and evidence-based district health planning : Experiences from the district health system in Uganda." Doctoral thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-329082.

Full text

Abstract:

In low-income countries where maternal and child mortality remains high, there is limited use of context-specific evidence for decision making and prioritization of interventions in the planning process at the sub-national level, such as the district level. Knowledge on the utility of tools and interventions to promote use of district-specific evidence in the planning process is limited, yet it could contribute to the prioritization of high-impact interventions for women and children. This thesis aims to investigate, in the planning process, the use of district-specific evidence to identify gaps in service delivery in the district health system in Uganda in order to contribute to improving health services for women and children. Study I evaluated the use of the modified Tanahashi model to identify bottlenecks for service delivery of maternal and newborn interventions. Study II and III used qualitative methods to document the experiences of district managers in adopting tools to facilitate the utilization of district-specific evidence, and the barriers and enablers to the use of these tools in the planning process. Study IV used qualitative methods, and analysis of district annual health work plans and reports. District managers were able to adopt tools for the utilization of district-specific evidence in the planning process. Governance and leadership were a major influence on the use of district-specific evidence. Limited decision space and fiscal space, and limited financial resources, and inadequate routine health information systems were also barriers to the utilization of district-specific evidence. Use of district-specific evidence in the planning process is not an end in itself but part of a process to improve the prioritization of interventions for women and children. In order to prioritize high impact interventions at the district level, a multifaceted approach needs to be taken that not only focuses on use of evidence, but also focuses on broader health system aspects like governance and leadership, the decision and fiscal space available to the district managers, limited resources, and inadequate routine health information systems.

APA, Harvard, Vancouver, ISO, and other styles

49

Risso, Ashley, and Ashley Risso. "Assessing The Clinical Utility of Non-Depolarizing Cardioplegia & The Challenge Of Evidence-Based Decision Making in an Anecdotal Age of Cardioplegia Comparative Research." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/620839.

Full text

Abstract:

PART I Background: For over forty years, depolarizing, hyperkalemic cardioplegia solutions have served as the standard of care for cardiac surgery. While effective in inducing cardiac arrest, potassium-based solutions are associated with an array of negative consequences, such as coagulopathies, conduction dysfunction, inflammation, coronary vasoconstriction, myocardial edema, and ischemic injury. Adenosine-lidocaine-magnesium, a non-depolarizing, non-potassium-containing solution, has recently entered the clinical arena. Animal research suggests that this agent may provide a method of diastolic arrest that is as effective as potassium-based cardioplegia but with improved protective benefits.Purpose: The aim is to assess the safety and efficacy of adenosine-lidocaine-magnesium as a cardioplegia solution in terms of overall patient outcomes.Methodology: In June 2014, Banner University Medical Center Tucson became the first American institution to adopt the use of PolarShot (ALM)--adenosine-lidocaine-magnesium - as a cardioplegia solution. This one-year, retrospective study compares patients receiving adenosine-lidocaine-magnesium to those receiving high-potassium/low-potassium cardioplegia during adult cardiac surgery. Cases compared in this study include isolated coronary artery bypass, isolated aortic/mitral valve repair/replacement, and combination coronary artery bypass/valve replacement surgery only. A propensity-weighted regression model was used for analysis to determine whether or not cardioplegia treatment affected clinical outcome. To assess overall clinical outcome, major morbidity and mortality and post-procedural length of stay were chosen as primary endpoints. Results: In terms of treatment (adenosine-magnesium-lidocaine vs. high-potassium/low-potassium), no statistically significant difference was found between groups in regard to major morbidity and mortality event occurrences nor was a significant difference found between post-procedural length of stay. Discussion: After comparing postoperative outcomes between cardioplegia treatment groups, PolarShot (ALM) cardioplegia produced postoperative outcomes that were statistically similar to those of high-potassium/low-potassium cardioplegia. The confidence in these results is limited by low case volume, surgical case variability, and retrospective nature of this study. Conclusion: According to this propensity-weighted regression model, PolarShot (ALM) cardioplegia appears to be a safe and effective alternative to traditional potassium-based cardioplegia for the purpose of adult cardiac surgery. More research, including prospective randomized trials, is necessary to confirm or deny the findings of this study. PART II Background: Historically, surgical cardioplegia compounding was accomplished by filling patient-tailored prescriptions on-demand. Modern day compounding has become a manufacturing process to improve quality and accommodate physician demand. Additionally, sterile compounding standards have become more stringent, further necessitating a standardized compounding approach. In 2013, scrutiny of sterile drug compounding increased with passage of the Drug Quality and Security Act (DQSA) and subsequent Federal Drug Administration oversight. This federal mandate requires all compounded sterile preparations distributed by 503B Outsourcing Facilities be tested for potency, stability, and sterility. To accomplish this, compounders must significantly reduce batched formula variability. Purpose: A review of 2014 sales data from a large 503B outsourcing facility and cardioplegia compounder will be conducted. The study will identify solution differences and detail its findings. The aim of this study is to assess cardioplegia variability on a national level. Methodology: Results will be summarized by cardioplegia strategy (Buckberg, high-potassium/low-potassium, crystalloid, del Nido, Adenocaine, and microplegia), dilution strategy (4:1 blood-crystalloid, 8:1 blood-crystalloid, 1:4 crystalloid-blood, all-blood, and all-crystalloid), formula constituents (base solutions, additives, buffers), potassium concentrations. Any observed patterns in formula usage will also be reported, geographical or otherwise. Results / Discussion: Based on institutional use, high-potassium/low-potassium (two-solution) multidose strategy was the most common. Based on solutions ordered, the most common cardioplegia ingredient was potassium chloride, present in almost ninety percent (89.64%) of all units sold. After looking at potassium content, extensive variability was noted in terms of potassium added to the bag (undiluted) and potassium to-be delivered (post-dilutional). Additionally, unique solution formulations identified in multiple institutions were often found in neighboring states or within a single state. Conclusion: The results of this analysis illustrate the extent to cardioplegia formula variability nationwide. Variability exists in both methodology and formulation on a state-to-state, institution-to-institution, even across-single-institution basis. This formula customization appears to be institution- and surgeon-specific, suggesting empirical influence in formula adaptation. Formula standardization may be necessary to combat the compounded issue of formula customization moving forward.

APA, Harvard, Vancouver, ISO, and other styles

50

King, Jason Maxwell. "Risk Quantification and Reliability Based Design Optimization in Reusable Launch Vehicles." Wright State University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=wright1291160215.

Full text

APA, Harvard, Vancouver, ISO, and other styles

Dissertations / Theses on the topic 'Evidence-based decisions'

Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles