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Waters, Donna. "Evidence : the knowledge of most worth." University of Sydney, 2006. http://hdl.handle.net/2123/1903.
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Doctor of PhilosophySimilar to their colleagues throughout the world, nurses and midwives in New South Wales (NSW), Australia, welcome evidencebased practice (EBP) as a means to improve patient or client outcomes. This thesis explores the way nurses and midwives understand evidence for EBP and aims to determine whether members of these professions currently have the knowledge and skills necessary to implement evidence‐based care. Three separate studies were conducted to explore NSW nurses’ readiness for EBP. Attitudes, knowledge and skill were investigated using an EBP questionnaire returned by 383 nurses. The views of 23 nursing opinion leaders were elicited during qualitative in‐depth interviews, and their ideas on maximising the potential for future nurses to confidently engage in EBP were explored. Current approaches to teaching EBP in undergraduate nursing programs were investigated by examining documents issued by NSW nursing education providers. The results demonstrate many differences between the ways NSW nurses currently understand evidence for EBP, and a range of approaches to teaching EBP in undergraduate nursing programs. Under current conditions, nurses graduating from universities in NSW commence practice with varying levels of preparation for EBP and enter into a professional arena that is itself struggling to cope with the concepts and language of this approach to improving healthcare. v Evidence for the effectiveness of EBP is slowly accumulating and despite some small positive signs, the collective results of this thesis suggest that current educational approaches are not capable of producing the kind of results that are both necessary and desirable for the promotion of evidence‐based nursing practice in NSW. Articulating a commitment to EBP, using a common language and a consistent approach are among the recommendations made for the future promotion of EBP in nursing education.
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Kruger, Mariana. "Ethics education in a problem-based medical curriculum." Thesis, Stellenbosch : Stellenbosch University, 2005. http://hdl.handle.net/10019.1/50339.
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Thesis (MPhil)--Stellenbosch University, 2005.ENGLISH ABSTRACT: The complex ethical dilemmas created by advanced technological medicine and problematic doctor-patient relationships have lead to an increasing interest in medical ethics education since the 1980's. The Medical School of the University of Pretoria has embarked on a new undergraduate medical curriculum in 1997. Ethics is educated in a longitudinal fashion over the six years of the medical curriculum and has focussed largely on the principal-based approach as described by Beauchamp and Childress. The research participants were the first final year class of this new curriculum, while the facilitators were medical educators or philosophers. The major finding was that the students were not yet able to identify ethical dilemmas with ease, although they were successful in the application of the principal-based approach to the vignettes of the study. The students did not cope well with the uncertainty created by ethical dilemmas and sought to solve the situation by creating boundaries provided by medical law. Therecommendations of the study are that the theoretical component of the ethics curriculum should: 1) include more approaches to ethics, than only the principal-based approach; 2) address daily experienced ethical dilemmas during the study years in small group discussions; 3) and implement a portfolio assessment which can serve as a tool for students to track their own development in reflection on ethical dilemmas. In conclusion, the question remains whether we are currently ready to come ""face to face" with the "other" as Levinas argues or are we still divided into "only two classes of mankind in the world - doctors and patients" as remarked by Kipling in the 19th century.
AFRIKAANSE OPSOMMING: Die komplekse etiese dilemmas, veroorsaak deur hoogs gespesialiseerde tegnologiese medisyne en die problematiese dokter-pasiënt verhouding, het gelei tot 'n verhoogde belangstelling in mediese etiekonderrig sedert die 1980's. Die Mediese Skool van die Universiteit van Pretoria het in 1997 'n nuwe voorgraadse mediese kurrikulum geïmplimenteer. Etiek is op 'n longitudinale manier onderrig oor ses jaar in die mediese kurrikulum en het gefokus op die beginsel-benadering soos beskryf deur Beauchamp en Childress. Die navorsingsdeelnemers was die eerste finale-jaar klas van die nuwe kurrikulum, terwyl die fasiliteerders mediese dosente of filosowe was. Die hoofbevinding van die kurrikulum was dat die studente nie die etiese dilemmas met gemak kon identifiseer nie, alhowel hulle suksesvol die beginsel-benadering kon toepas op die gevallestudies. Die studente hanteer nie onsekerheid, veroorsaak deur die etiese dilemmas, met gemak nie en probeer om die saak op te los deur die skep van grense verskaf deur mediese reg. Die aanbevelings van die studie is dat die teoretiese komponent van die etiekkurrikulum die volgende moet bevat: 1) bekendstelling aan meerdere benaderings tot die etiek, bo en behalwe die beginsel-gebaseerde benadering; 2) aanspreek van die daaglikse etiese dilemmas gedurende die studiejare in kleingroepbesprekings; 3) en die implementering van 'n portfolio-evaluasie, wat kan dien as 'n instrument vir die studente om hul eie ontwikkeling aangaande nadenke oor etiese dilemmas na te gaan. Opsommend, die vraag is steeds of ons tans gereed is om "aangesig-tot-aangesig" te verkeer met die "ander" soos Levinas redeneer of is ons steeds verdeel in "slegs twee klasse van menswees in die wêreld - dokters en pasiënte" soos opgemerk deur Kipling in die 19deeeu.
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Buser, Stacey. "A CASE STUDY ON CRITICAL THINKING SKILLS AND PROBLEM-BASED LEARNING IN ATHLETIC TRAINING EDUCATION." University of Akron / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=akron1491588873882199.
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White, Elizabeth, Brandon Mizell, Jodi Polaha, Leigh Johnson, David W. Stewart, Patricia Jessee, and G. Zimmer. "Evidence-Based Heart Failure Management Process Implementation at a Residency Teaching Family Medicine Clinic." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6567.
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Background/Purpose: The American College of Cardiology/American Heart Association/Heart Failure Society of America guidelines for management of heart failure were recently updated to include use of sacubitril/valsartan due to its ability to reduce mortality and hospitalizations over the current standard of therapy. Based on these guideline updates, a champion research team at East Tennessee State University (ETSU) Family Medicine Associates worked to create and implement a process that identified patients with systolic heart failure and provided access to medications with mortality and morbidity benefits. The objective of this study is to improve provider knowledge of evidence-based heart failure pharmacotherapy and to assess provider acceptability of a process implemented at ETSU Family Medicine Associates.
Methodology: This study was approved by the Institutional Review Board. On December 21, 2016 the champion research team presented a didactic session to all providers at ETSU Family Medicine Associates. Immediately prior to the education session, providers completed a pre-education clinical knowledge assessment on heart failure pharmacotherapy. A one-hour didactic session then followed focusing on evidence-based medication management of systolic heart failure and introduction of the new process being implemented. Following the presentation, providers completed a post-education clinical knowledge assessment and a pre-implementation process acceptability survey. Providers were then scheduled to complete a post-implementation process acceptability survey at two months post-process implementation and quarterly thereafter. A McNemars Test will be used to determine if statistically significant differences exist among pre- and post-education clinical knowledge assessments and pre- and post-implementation process acceptability surveys.
Presentation Objective: Discuss the process implemented to improve provider knowledge of heart failure pharmacotherapy and improve patient access to evidence-based pharmacotherapy options.
Self-Assessment: Did the one-hour didactic session improve provider knowledge of heart failure pharmacotherapy?
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Smith, Amy L. "Evidence-Based Practice Self-Efficacy and Outcome Expectancy in the Nurse Resident." Otterbein University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1596206174965756.
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Beniuk, Kathleen. "Integrating evidence-based medicine and service design : a study of emergency department crowding." Thesis, University of Cambridge, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.610514.
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Fennessy, Gabrielle Ann 1968. "Knowledge management in evidence based practice : study of a community of practice." Monash University, School of Information Management and Systems, 2002. http://arrow.monash.edu.au/hdl/1959.1/8023.
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Breytenbach, Cecile. "A best practice guideline for evidence based teaching strategies for nurse educators." Thesis, Nelson Mandela Metropolitan University, 2015. http://hdl.handle.net/10948/4831.
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Evidence based practice (EBP) is a worldwide phenomena defined as the “conscientious explicit and judicious use of current best evidence in making decisions about the patient’s care”. The evidence based practice concept’s aim is to effectively guide health care professionals to build knowledge that will be supported by evidence. Evidence based practice must be supported by evidence based teaching. Nurse educators must be up to date with evidence based teaching as well as the latest evidence based teaching strategies, in order to teach the new millennial nursing students and for the new qualifications structure. Teaching the concept of evidence based practice by implementing evidence based teaching to nursing students will enable them to transform the future of healthcare by delivering high quality care practice. A paucity of evidence is available on evidence based teaching and teaching strategies in the South African context. Therefore the researcher used a systematic review methodology to explore and describe the best available evidence based teaching strategies and to develop a guideline on evidence based teaching strategies for nurse educators. The data bases searched included: MEDLINE, CINAHL, PubMed and Google Scholar. Manual searches were done and completed with the assistance of librarians. A total number of n=50 studies were identified as potentially relevant to the study. The number or articles included for critical appraisal were 20. On completion of the critical appraisal n=17 articles were identified for the review. The included studies for the review were n=7 Level 1, systematic reviews and n=10 Level 2, quasi-experimental studies. Three studies were excluded after critical appraisal from two reviewers, appraisal was done independently, and consensuses were reached between the two reviewers. The Joanna Briggs Institutes critical appraisal and data extraction instruments were used for the study. The descriptive data synthesis was done of the included studies as well as a comparison of teaching strategies to determine which one to better than the other one. Although n = 4 of the teaching strategies (concept mapping, internet-based learning, evidence based interactive strategy and cultural competence) significantly increased knowledge, the overall results found that a variety of teaching strategies to be implemented to increase the knowledge outcomes of the nursing students. The different teaching strategies found were: e-learning, concept mapping, internet-based learning, web-based learning, gaming, problem-based learning, and case studies, evidence based learning and cultural competence. However, more research is needed to investigate the best use of the different teaching strategies and compare the impact of a variety of teaching strategies on increasing knowledge of the nursing student.
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Sin, Lok-man Raymond, and 冼樂文. "Simulation for training of clinical anaesthesia : is it an evidence-based or a fashionable practice?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193781.
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Introduction
Simulation training is widely adopted in clinical medicine. Simulated environment provides a safe condition for participants to practice without any harm inflicted on patients. Within the spectrum of clinical anaesthesia, simulation mannequin was first developed in 1960. The first journal article with description about the use of simulator to teach intubation to anaesthesia residents occurred in 1969. The first report about simulated anaesthesia training was in 1988. Since then, there has been a flourishing trend of adopting this simulation training in clinical anaesthesia, across various subspecialties including obstetric anaesthesia, cardiac anaesthesia. For individual perspective, simulation training expanded beyond skill development into non technical skill training.
This article is to review the impact of simulation training for individual development for anaesthesia residents or trainees. The aim is to evaluate the evidence of simulation training on individual anaesthesia resident performance and improvement on patient outcome. As a result, more vigorous use of simulation is adopted in modular subspecialty anaesthesia and also non-technical skill training for residents.
Methods
A search of literatures through search engines of Pubmed, Google Scholars, EMBASE, Cochrane library for ‘Simulation for training of clinical anaesthesia’ was done. After limit the search for English language and past 10 years, there are 223 articles. With appropriate exclusion criteria, 25 articles are selected for detail evaluation.
Results
Simulation has good effects in various aspects. For various anaesthesia subspecialties, simulation-based training can improve trainees’ confidence and capability in handling rare but life-threatening peri-operative crises. For assessments, simulation is an essential part of Israeli Board Examination in Anesthesia with good discriminating power. For technical skill development, simulation-based training can reduce residents’ time requirement to perform cricothyroidotomy and improve successful rate of central line insertion. The specific skill developed can retain for long period of time such as 12 months. For non-technical skills, there are conflicting results in behavioural scores. For patient safety and outcome perspective, there lacks the result from individual simulation-based training study.
Conclusions
Simulation in anaesthesia residents training is a worldwide practice. These simulation training allow residents to have exposure in various anesthesia subspecialty including cardiac, obstetrics, liver transplant. There are specific technical and non-technical skill development. Individual performance particularly time to complete cricothyroidotomy and confidence, understanding of procedures and anatomy by residents are also enhanced. Thus, simulation should be allocated more proportion of anaesthesia resident training in Hong Kong. Although there remains no study showing better patient outcome after simulation-based individual training, future studies should be done to confirm such presence and degree of association with simulation training.published_or_final_version
Community Medicine
Master
Master of Public Health
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Dandees, Husam. "Evidence-based physiotherapeutic management for knee osteoarthritis: A knowledge translation study." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/20161.
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Thesis (MScPhysio)--Stellenbosch University, 2012.Background: Evidence for the effectiveness of physiotherapeutic interventions in the management of knee osteoarthritis (OA) is synthesised in the current clinical guidelines (CGs), providing clinicians with readily accessible and interpretable practice guidelines. However, CGs are often not specific to the local context of the target users, therefore hindering successful implementation of evidence into clinical practice. Formulating succinct and composite recommendations by synthesising the current CGs reporting on the evidence-based (EB) management of knee OA may assure contextual relevance and facilitate implementation of evidence into clinical practice. In addition, multifaceted interventions, such as evidence-based practice (EBP) workshops, are also postulated to promote the implementation of guideline recommendations, thereby enhancing clinical outcomes. Objectives: The primary objectives of this study were to: 1) describe the range of EB physiotherapeutic interventions in the management of knee OA as documented in the current CGs; and 2) develop composite clinical recommendations for a specific group of users working in Jerusalem. A secondary study objective was to ascertain the effect of translating the knowledge through a specifically-designed EBP workshop on the uptake of knowledge and implementation of EBP into clinical practice by physiotherapists working in Jerusalem. The EBP workshop was aimed at educating physiotherapists about the EB physiotherapeutic techniques for knee OA management. Study design: Two studies were conducted. A systematic review (SR) into EB clinical guidelines was conducted to describe and synthesise the available evidence and formulate composite recommendations for knee OA. The results of the SR were used to design an EBP workshop aimed at educating physiotherapists about EB physiotherapeutic techniques for treating knee OA patients. A pre-post quasi-experimental design was then conducted to assess the effect of this EBP workshop on the uptake and implementation of EBP into clinical practice amongst public sector physiotherapists working in Jerusalem. Methodology for quasi experimental study: Physiotherapists who regularly treat knee OA patients were recruited from a list of members registered with the Palestinian Physiotherapy Association Jerusalem. A three-month retrospective audit (initial audit) of knee OA patients’ physiotherapy records kept by the participating physiotherapists was conducted to establish current management patterns. EB strategies for knee OA was presented to the participating physiotherapists during a one-day workshop. A second audit of physiotherapy records was conducted three months after the EBP workshop to establish changes in the selection of physiotherapeutic management techniques for knee OA. Results: The initial audit revealed that the participating physiotherapists utilized one high EB modality namely, exercises, as a core management strategy in knee OA, but did not frequently implement other high EB modalities such as self-management and weight-loss programs. Following the EBP workshop, a statistically significant increase (p=0.008) in the implementation of weight-loss and self-management strategies in the management of knee OA was noted. Conversely, a statistically significant decrease was noticed in using patellar taping (low EB modality) in the management of knee OA (p=0.04). No significant changes were noticed in the utilization of other physiotherapy modalities supported by weak or modest EB recommendations. Conclusion: The study concluded that physiotherapists inherently prescribed exercise as a core management strategy for knee OA. Modalities supported by modest levels of evidence were used as adjunct treatments. The EBP workshop facilitated the increased application of high EB modalities such as weight-loss and self-management programs. The results of this study illustrate that an EBP workshop may be effective in promoting the implementation of EB physiotherapeutic modalities in the management of knee OA. However, larger studies with longer follow-up periods are required.
No Afrikaans abstract available
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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.
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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.
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Chung, Lisa. "AN EXPLORATION OF SELECTED CHARACTERISTICS OF REGISTERED NURSES AND THEIR USE OF EVIDENCE-BASED PRACTICE IN ACUTE CARE SETTINGS." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1430143066.
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Kasch, Cindy [Verfasser]. "Teaching Evidence-Based Veterinary Medicine – New insights into critical thinking, implementation of writing of knowledge synthesis and use of mobile devices by students / Cindy Kasch." Berlin : Freie Universität Berlin, 2019. http://d-nb.info/1176634712/34.
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Cooper, Heather L. "Evidence-based practice and asthma guideline adherence and barriers a study of a university family practice clinic /." Laramie, Wyo. : University of Wyoming, 2007. http://proquest.umi.com/pqdweb?did=1400966251&sid=1&Fmt=2&clientId=18949&RQT=309&VName=PQD.
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Snyder, Nichole M. "An Examination of Coalition Functioning and Use of Evidence-Based Practices: A Case Study of Four Community Substance Abuse Coalitions." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5393.
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There has been a recent expansion of community-based coalitions to address issues related to youth substance use. Research on their overall effectiveness, however, has produced mixed results. Recommendations to improve coalition success have emphasized the high-quality implementation of evidence-based programs targeting specific community needs. Coalitions vary extensively, however, in their organization and functioning. In addition, the lack of a universally accepted theoretical framework to understand coalition functioning has led to inconsistencies in the coalition research and the specific constructs used to describe coalition functioning.
Purpose of the Study: To address these gaps, the current study used a case study approach to describe the organization and functioning of four local substance abuse coalitions and to identify factors related to coalition high-quality implementation of evidence-based programs.
Methods: Using constructs based on Community Coalition Action Theory, the current study used coalition member surveys and key leadership interviews to produce separate case study descriptions of four participating community substance abuse coalitions. An exploratory factor analysis was conducted to examine the structure of the survey measure. Univariate statistics were used to describe coalition functioning and attitudes toward evidence-based practice and implementation. One-way analysis of variance tests were employed to examine differences across the coalitions and Pearson's product-moment correlations were used to identify coalition characteristics associated with attitudes toward evidence-based practice. A thematic analysis of interview data was conducted for an in-depth examination of coalition functioning and perceptions of evidence-based practice.
Results: Coalition members and leaders reported high levels of functioning across all of the included domains. However, several differences in coalition background and structure were discussed. Community support was described as a major functioning challenge across both surveys and interviews. Interview results also revealed several different coalition belief patterns surrounding evidence-based practice and quality implementation. Coalition members and leaders generally indicated positive attitudes toward the use of evidence-based prevention programs and strategies. However, varying levels of knowledge and experience with evidence-based practices was identified across interviews. Interviews also highlighted several factors that influence coalition decision-making and identified several perceived challenges associated with the use of evidence-based practices. Results include a discussion of coalition knowledge, perceptions, and experiences with program implementation.
Conclusions and Implications: Taken together, these findings form a basis for better understanding the current environment surrounding community substance abuse coalition functioning and implementation of evidence-based practices. Several factors were shown to influence coalition decision-making processes and overall functioning. In addition, the present study highlights strengths and gaps related to coalition leadership knowledge, attitudes, and implementation of evidence-based programs and strategies. These identified relationships can be used to guide future research and community practice. With their growing popularity, it is likely that community coalitions will take on a major role in future community-based prevention efforts across the country. As such, there is a need to design substance abuse prevention programming with coalitions in mind and to identify alternative avenues to disseminate information surrounding community-focused evidence-based practices. Identifying new ways to measure and build coalition processes, leadership skills, and structures could result in greater coalition capacity to plan for and support prevention activities, including use of evidence-based practices.
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Roberts, Lisa Jeanne. "Utilities for mental health outcomes among individuals with co-occurring substance use disorders and schizophrenia : a feasibility study /." Thesis, Connect to this title online; UW restricted, 2001. http://hdl.handle.net/1773/9146.
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Jerkert, Jesper. "Philosophical Issues in Medical Intervention Research." Licentiate thesis, KTH, Filosofi, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-163872.
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The thesis consists of an introduction and two papers. In the introduction a brief historical survey of empirical investigations into the effectiveness of medicinal interventions is given. Also, the main ideas of the EBM (evidence-based medicine) movement are presented. Both included papers can be viewed as investigations into the reasonableness of EBM and its hierarchies of evidence. Paper I: Typically, in a clinical trial patients with specified symptoms are given either of two or more predetermined treatments. Health endpoints in these groups are then compared using statistical methods. Concerns have been raised, not least from adherents of so-called alternative medicine, that clinical trials do not offer reliable evidence for some types of treatment, in particular for highly individualized treatments, for example traditional homeopathy. It is argued that such concerns are unfounded. There are two minimal conditions related to the nature of the treatments that must be fulfilled for evaluability in a clinical trial, namely (1) the proper distinction of the two treatment groups and (2) the elimination of confounding variables or variations. These are delineated, and a few misunderstandings are corrected. It is concluded that the conditions do not preclude the testing of alternative medicine, whether individualized or not. Paper II: Traditionally, mechanistic reasoning has been assigned a negligible role in standard EBM literature, although some recent authors have argued for an upgrading. Even so, mechanistic reasoning that has received attention has almost exclusively been positive -- both in an epistemic sense of claiming that there is a mechanistic chain and in a health-related sense of there being claimed benefits for the patient. Negative mechanistic reasoning has been neglected, both in the epistemic and in the health-related sense. I distinguish three main types of negative mechanistic reasoning and subsume them under a new definition of mechanistic reasoning in the context of assessing medical interventions. Although this definition is wider than a previous suggestion in the literature, there are still other instances of reasoning that concern mechanisms but do not (and should not) count as mechanistic reasoning. One of the three distinguished types, which is negative only in the health-related sense, has a corresponding positive counterpart, whereas the other two, which are epistemically negative, do not have such counterparts, at least not that are particularly interesting as evidence. Accounting for negative mechanistic reasoning in EBM is therefore partly different from accounting for positive mechanistic reasoning. Each negative type corresponds to a range of evidential strengths, and it is argued that there are differences with respect to the typical strengths. The variety of negative mechanistic reasoning should be acknowledged in EBM, and presents a serious challenge to proponents of so-called medical hierarchies of evidence.QC 20150413
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Mongeon, Mylène. "Improvising Knowledge: A Case Study of Practices in and Around World Spine Care's Evidence-based Clinics in Shoshong and Mahalapye, Botswana." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/34972.
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Global health organizations attend to populations around the world applying an evidence-based model of care that often does not correspond with local realities on the ground. My thesis provides an in-depth anthropological study of how this occurs within practices in and around World Spine Care's (WSC) clinics in Shoshong and Mahalapye, Botswana. More specifically I explore how knowledge is negotiated and improvised on the ground, paying particular attention to the ways WSC volunteers are (un)able to work with local health workers as they desire. I show the flows and counter-flows implicated in the difficult task of reconciling skills with standards. The study is based on a total of 15 months of participation with WSC's organization through attending meetings, activities and shadowing practitioners both in Ottawa and in Botswana. Expanding the scope of their creative improvisational skills beyond the closed settings of WSC clinics is proposed as a way to move forward.
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Ring, Nicola A. "A critical analysis of evidence-based practice in healthcare : the case of asthma action plans." Thesis, University of Stirling, 2013. http://hdl.handle.net/1893/13061.
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Evidence-based practice is an integral part of multi-disciplinary healthcare, but its routine clinical implementation remains a challenge internationally. Written asthma action plans are an example of sub-optimal evidence-based practice because, despite being recommended, these plans are under-issued by health professionals and under-used by patients/carers. This thesis is a critical analysis of the generation and implementation of evidence in this area and provides fresh insight into this specific theory/practice gap. This submission brings together, in five published papers, a body of work conducted by the candidate. Findings report that known barriers to action plan use (such as a lack of practitioner time) are symptomatic of deeper and more complex underlying factors. In particular, over-reliance on knowledge derived from randomised controlled trials and their systematic review, as the primary and sole source of evidence for healthcare practice, hindered the implementation of these plans. A lack of evidence reflecting the personal experience of using these plans in the real world, rather than in trial settings, contributed to a mismatch between what patients/carers want from asthma action plans and what they are currently being provided with by professionals. This submission illustrates the benefits of utilising a broader range of knowledge as a basis for clinical practice. The presented papers report how new and innovative research methodologies (including meta-ethnography and cross-study synthesis) can be used to synthesise individual studies reporting the personal experiences of patients and professionals and how such findings can then be used to better understand why interventions can be implemented in trial settings rather than everyday practice. Whilst these emerging approaches have great potential to contribute to evidence-based practice by, for example, strengthening the ‘weight’ of experiential knowledge, there are methodological challenges which, whilst acknowledged, have yet to be fully addressed.
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Dannapfel, Petra, Anneli Peolsson, and Per Nilsen. "What supports physiotherapists’ use of research in clinical practice? A qualitative study in Sweden." Linköpings universitet, Institutionen för medicin och hälsa, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-93865.
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Background Evidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circumstances that actually support use of research by physiotherapists. This study explores the conditions at different system levels that physiotherapists in Sweden perceive to be supportive of their use of research in clinical practice. Methods Patients in Sweden do not need a referral from a physician to consult a physiotherapist and physiotherapists are entitled to choose and perform any assessment and treatment technique they find suitable for each patient. Eleven focus group interviews were conducted with 45 physiotherapists, each lasting between 90 and 110 minutes. An inductive approach was applied, using topics rather than questions to allow the participants to generate their own questions and pursue their own priorities within the framework of the aim. The data were analyzed using qualitative content analysis. Results Analysis of the data yielded nine favorable conditions at three system levels supporting the participant’s use of research in clinical practice: two at the individual level (attitudes and motivation concerning research use; research-related knowledge and skills), four at the workplace level (leadership support; organizational culture; research-related resources; knowledge exchange) and three at the extra-organizational level (evidence-based practice guidelines; external meetings, networks, and conferences; academic research and education). Conclusions Supportive conditions for physiotherapists’ use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients.
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Costa, Luís Pedro Peres Dominguez Saraiva da. "Medicina baseada na evidência : proposta de modelo de classificação da investigação científica e de pirâmide da força de evidência. Mapeamento da evidência dos efeitos da gonadectomia em cães e cadelas : uma scoping review sistemática." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2020. http://hdl.handle.net/10400.5/20241.
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Dissertação de Mestrado Integrado em Medicina VeterináriaA Medicina Baseada na Evidência (EBM) constitui-se como um movimento que pretende impulsionar a qualidade da medicina, no sentido das suas práticas se basearem na mais recente e melhor evidência científica disponível. Reconhecendo importância à expressão do meio envolvente na saúde dos animais e na qualidade da relação dono-animal, propõe-se que a EBVM (Medicina Veterinária Baseada na Evidência) se conceba como confluência de 4 dimensões em vez de 3: experiência clínica individual; necessidades e expectativas do cliente/paciente; utilização das melhores evidências externas disponíveis; consideração das características do meio envolvente e respetiva influência sobre a relação paciente-dono. Para a concretização da EBM nas práticas médicas, é fundamental a aplicação de métodos para avaliação da força de evidência das investigações. Neste trabalho destacam-se dois: a “pirâmide da força de evidência” e a “avaliação do risco de enviesamentos nos estudos” (proposto pela Cochrane Collaboration). O método da “pirâmide da força de evidência” baseia-se na atribuição de um patamar hierárquico de força de evidência relativa das investigações, com base nas características intrínsecas dos diferentes “desenhos de estudo”. Existem vários formatos de “pirâmide de força de evidência” expressando entre si, diferenças e incoerências consideráveis. Existe também um grande desencontro na forma e método como os investigadores e comunidade científica classificam, designam e interpretam as formas de investigação em função dos seus desenhos de estudo. Todas estas divergências interferem na consistência da aplicação dos princípios da EBM, principalmente se utilizado o método da “pirâmide da força de evidência”. Com o intuito de resolver os problemas que as referidas divergências e inconsistências criam no âmbito da determinação da força de evidência das investigações, é proposto um método de sistematização, classificação e designação das diferentes formas de investigação científica quanto aos seus “desenhos de estudo”. No método proposto, as investigações científicas são enquadradas em 6 dimensões classificativas onde os estudos são classificados, categorizados e integrados numa matriz de classificação, designadamente: investigação primária ou investigação secundária; baseados em grupos ou no indivíduo; experimentais ou observacionais; analíticos ou descritivos; longitudinais ou não longitudinais; designação quanto ao seu desenho de estudo. Em função do sistema de classificação de estudos adotado, é também proposta uma adaptação do método de avaliação de força de evidência “pirâmide da força de evidência”. A aplicação prática do método estabelecido materializa-se na realização de uma scoping review sistemática. Nesta, realiza-se um mapeamento da evidência relativa aos efeitos da gonadectomia em cães e cadelas na base de dados Pubmed. Concluídos os processos de recolha e triagem, são exibidas 191 publicações onde: os 3 temas mais estudados são o sistema musculoesquelético, trato urinário e neoplasias; e os modelos de investigação mais frequentes consistem em estudos RCT e NRCT, na categoria da investigação experimental, e estudos full cohort analítico, caso-controlo e coorte analítico, na categoria de estudos observacionais.
ABSTRACT - Evidence based medicine is a movement which intends to increase quality in medicine, by advocating that clinical practice should be based on the most recent and best scientific evidence available. Acknowledging the importance of environmental factors in animal health, as well as in the relationship between pet and pet-owner, it is suggested that EBVM (Evidence Based Veterinary Medicine) may be conceived as the confluence of 4 dimensions, instead of 3, namely: individual clinical expertise; needs and expectations of the owner; use of the best external available evidence; environmental factors and their influence on pet-pet-owner relationship. In order to resort to EBM in clinical practice it is necessary to use methods which evaluate the strength of the evidence in each study. In this work, two methods are highlighted: the strength of evidence pyramid and the bias assessment risk (put forth by Cochrane Collaboration). The strength of evidence pyramid method is based on the hierarchization of the relative strength of evidence as assessed by studies’ design intrinsic characteristics. There are many different kinds of strength of evidence pyramids, but among them there are considerable contrasts and incoherencies. There are also disagreements among researchers and within the scientific community concerning the classification, the designation and the interpretation of study designs. All these divergences stand in the way of the sound use of EBM, mainly if the strength of evidence pyramid is to be used. In order to help solving the problems which arise from the abovementioned contrasts and inconsistencies when establishing the strength of evidence, a method of systematization, classification and denomination of different types of research according to study design is suggested. In the suggested method, the studies are framed into six classification dimensions in which they are categorized as: primary or secondary research; individual or group based; experimental or observational; analytical or descriptive; longitudinal or non-longitudinal; study design type. Abiding by the aforementioned classification system it is also suggested an adaptation of the strength of evidence pyramid method. The suggested classification method was used in a systematic scoping review in which, evidence about gonadectomy effects in dogs and bitches was mapped from the Pubmed database. After identification and exclusion phases, 191 studies were selected for analysis. The 3 most studied themes were the musculoskeletal system, urinary tract and neoplasms. The most frequent research methods were RCT and NRCT in the experimental category and analytical full cohort studies; case-control and analytical cohort in the observational studies category.
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Jerndahl, Fineide Mona. "Controlled by Knowledge : A Study of two Clinical pathways in Mental Healthcare." Doctoral thesis, Karlstads universitet, Fakulteten för ekonomi, kommunikation och IT, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-12937.
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Standardisation of professional work is a major policy concern to ensure quality and efficiency of services and a number of hospitals are now focusing on the use of clinical pathways as an important tool to standardise their work. This study sheds light on the processes set in motion when notions of standardisation meet local practice. In order to gain insight into what clinical pathways mean for professional work in mental health care, the focus of the study was to explore the contexts in which standardisation by “rule production” takes place. Two empirical cases from Norwegian mental health care show how dedicated professionals are in charge of carrying out the standardisation work, strongly influenced by a steering framework of defined governmental policies where employee involvement and responsibility ensured loyalty to the idea. Along with a “package” of ideas, new bodies and techniques, clinical pathways contribute to the institutionalisation of prima facie knowledge in demonstrating that evidence basing is linked to steering and control of employees. Thus, professional autonomy is threatened in an insidious way: through the institutionalisation of evidence-based knowledge as ‘prima facie’ knowledge in combination with professionals who standardise and control their own work. The thesis therefore concludes that the control of professional work has now become a complex and sophisticated process where professional work is “controlled by knowledge”.
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Starling, Roosevelt Riston. "Prática controlada: medidas continuadas e produção de evidências empíricas em terapias analítico-comportamentais." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/47/47133/tde-29032010-163308/.
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Buscando estabelecer controles públicos e empiricamente indexados para o comportamento verbal clínico do terapeuta de serviços, um modelo de Prática Psicológica por Evidências, chamado Prática Controlada, foi adaptado, testado e explorado quanto a algumas de suas possibilidades, em condições reais de aplicação. Esse modelo se fundamenta num arranjo específico dos procedimentos terapêuticos e em cinco instrumentos utilizados para a coleta de informações qualitativas e quantitativas pré-intervenção e na coleta continuada de dados empíricos referentes ao nível de perturbação psicológica do cliente, à qualidade da relação terapêutica e ao seu nível de engajamento nas tarefas terapêuticas, ao longo das primeiras 20 sessões de tratamentos de orientação analítico-comportamental para 34 clientes (10 homens, 33,3 ± 14,2 anos, e 24 mulheres, 35,6 ± 9,9 anos) em três cidades diferentes. As terapias foram conduzidas por três terapeutas experientes e quatro inexperientes. Os resultados indicaram que esse modelo de prática controlada produz indexadores empíricos que podem ancorar o comportamento verbal do terapeuta de serviços (suas interpretações e julgamentos teóricos e clínicos) e que são sensíveis à evolução de curto, médio e longo prazo da terapia, além de permitir a produção de evidências públicas clínica e socialmente relevantes dos resultados intermediários e finais do tratamento. Através da análise das séries temporais obtidas, os resultados também sugerem que a avaliação do cliente do seu nível de perturbação psicológica, do seu engajamento nas tarefas terapêuticas e na sua apreciação da qualidade da relação terapêutica pode responder a controles independentes e/ou a variáveis idiossincráticas. Apresenta-se uma discussão sobre teoria da mensuração, escalas de medidas e medidas em psicologia e em psicoterapia e algumas sugestões para pesquisas futuras são oferecidas.Aiming to establish public and empirically based controls for the therapist-practitioner\"s clinical verbal behavior, a model of Evidence Based Psychological Practice, called Controlled Practice, was adapted, tested and explored in real-world conditions of application. This model is based on a specific arrangement of the therapeutic procedures and on five instruments for collecting qualitative and quantitative pre-intervention information and empirical data and for collecting continued empirical data on the client\"s level of psychological distress, on the therapeutic relationship\"s quality and on the client\"s level of performance at therapeutic tasks along the first 20 sessions of behavior-analytic oriented psychological treatments of 34 clients (10 males, 33,3 ± 14,2 yrs., and 24 females, 35,6 ± 9,9 yrs.) in three different towns. The therapies were delivered by three experienced therapists and four inexperienced. Results indicates that this model of controlled practice may anchor the practitioner verbal behavior (his/her clinical and theoretical interpretations and judgments) on empirically based indexers that are, at the same time, sensitive to the short, medium and long-term evolution of the therapy and may provide clinically and socially relevant public evidences of the treatment\"s intermediate and outcome results. Through the analysis of the time-series collected results also suggested that the client\"s evaluation of his/her level of psychological distress, his/her engagement in the therapeutic tasks and his/her appraisal of the therapeutic relationship may respond to independent controls and/or to idiosyncratic variables. A discussion of the theory of measurement, measurement scales and measures in psychology and psychotherapy is presented and some suggestions for future researches are offered.
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Gaedke, Mari Ângela. "Uso de medicamentos recomendados na prevenção secundária da Síndrome Coronariana Aguda." Universidade do Vale do Rio dos Sinos, 2013. http://www.repositorio.jesuita.org.br/handle/UNISINOS/4256.
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Verificou-se a prevalência do uso de medicamentos recomendados na prevenção secundária da síndrome coronariana aguda na alta hospitalar e seguimentos de seis meses e de um ano. Utilizaram-se dados de estudo de coorte no qual se incluíram pacientes de 30 anos ou mais, de ambos os sexos, egressos de hospital da região sul do Brasil. Os desfechos foram o uso dos medicamentos recomendados para prevenção secundária: antiagregante plaquetário, betabloqueador, estatina e inibidor da enzima conversora de angiotensina ou bloqueador do receptor de angiotensina; e uso de bloqueio antiplaquetário duplo. Entre as 138 pessoas incluídas, 36,2% receberam os quatro medicamentos na alta, e 64,5% usaram bloqueio antiplaquetário. Na análise não se verificou associação entre exposições e o uso dos quatro medicamentos. Quanto ao uso de bloqueio antiplaquetário verificou-se diminuição nos seguimentos, porém ele foi mais frequente nos indivíduos que realizaram intervenção coronária percutânea. A prevalência de uso dos medicamentos na alta e nos seguimentos mostrou subutilização desta terapêutica na prática clínica.
We verify the prevalence of medication recommended in secondary prevention of Acute Coronary Syndrome in patient discharge and follow-up of a six months and one year period. We used data from a cohort study which included patients 30 years old or older, of both genders, discharged of hospital in southern Brazil. The outcome was the simultaneous use of drugs recommended by scientific evidence for secondary prevention: antiplatelet agents, beta-blocker, statin and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; and use of dual antiplatelet blockage. Among the 138 people included, 36.2% were prescribed the four drugs at discharge, and 64,5% and dual blockage. In the analysis there was no association between exposure and the use of the four drugs. Regarding the use of antiplatelet blockage there was a decrease in the follow-up, but he was more frequent in subjects who underwent percutaneous coronary intervention. The prevalence of drug use at discharge and follow-up showed underutilization of this therapy in clinical practice.
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Mthiyane, Gloria Nozipho. "The experiences of nurse educators in implementing the evidence-based practice in teaching and learning." Diss., 2018. http://hdl.handle.net/10500/24763.
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The purpose of this study was to determine the nurse educators’ experiences in implementing the evidence-based practice (EBP) in teaching and learning, and to describe the importance and benefits of EBP teaching and learning to the nursing profession, especially for nurse educators and student nurses. A qualitative research design and methods were followed in conducting the study. A non-probability purposive sampling technique was used to access the sample of twelve nurse educators from two nursing campuses under KwaZulu-Natal College of Nursing within Umgungundlovu Health District. Data were collected using semi-structured interviews, the interview guide, and the digital voice recorder. Data were analysed manually, following a content thematic data analysis approach. Two themes emerged as follows:
Challenges experienced by nurse educators with the implementation of EBP in teaching and learning.
Benefits/value of EBP in teaching and learning.
Findings revealed that, although most of the nurse educators are supportive and displayed a positive attitude towards implementing EBP in teaching and learning, the level of knowledge and skills was questionable. This was coupled with a lack of motivation and commitment towards research. Therefore, recommendations for nursing education, nursing practice, and future research were suggested, for successful implementation of EBP in teaching and learning.Health Studies
M.A. (Health Studies)
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Tseng, Pei-ching, and 曾佩菁. "Implementation of the Activity-Based Costing System－A Case Study of the Laboratory Medicine Department of Regional Teaching Hospital." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/52520749891908973305.
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碩士國立雲林科技大學
全球運籌管理研究所碩士班
99
Bureau of National Health Insurance limits the growth of the medical costs growth by means of the operation of piece rate, globe budget, case Payment and diagnosis related groups (DRGs) payment system. It will have a significant hospital impact on survival and profits so that the hospital has been increasing emphasis on cost analysis and control. Basis of apportionment of the traditional cost system does not reflect the actual cost of inspection services, with the help of its limited effectiveness of sector management, to be built for the department''s cost management system. Therefore, the laboratory medicine department should provide the correct, quick and effective test results and data, as a physician to determine the exact disease to patient important reference in order to enhance the operational efficiency of laboratory medicine department. To better understand the case of laboratory medicine department cost allocation methods currently used, and the implementation of ABC''s exclusion of this study to test the medical sector, for example, adopted "case study method" to study the application of activity based cost system architecture for the department features, build laboratory medicine department operations and product analysis mode. The results show that the current cost system, the biochemical test time test time operations center and emergency operations center costs are overestimated; In addition, ninety-nine in December to test the actual number of break-even point and required pieces number comparison, osmotic pressure test, urine routine examination, stool routine examination, pregnancy tests and body fluid analysis, five actual number of tests below the break-even point are the number, making the month showed a loss. After the final test operations process analysis and time consuming analysis of the results, some test items centrifugation time, the second operations center in order to improve the overall test time. ABC''s cost-sharing by way of step by step analysis of resource driver and activity driver, rationalize the cost of ownership of resources in the test operation, may assist the department to obtain more accurate cost information can also be a clear understanding of the human resources units, equipment and reagent supplies management situation, to assist the unit in charge of cost control, to improve the examination quality. Future development of new test project, ABC''s cost-sharing formula can also be purchased as a reference instrument and a basis for pricing decisions. ABC''s combination of cost-sharing approach if further performance management, financial indicators and use them effect, can really enhance the management efficiency.
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Van, Wyk Jacqueline Marina. "The progress examination as an assessment tool in a problem-based learning curriculum : a case study of the Nelson R. Mandela School of Medicine." Thesis, 2009. http://hdl.handle.net/10413/472.
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Medical schools have been reviewing their curricula to prepare caring and
competent health professionals in the midst of a knowledge and technology
explosion. The implementation of problem-based learning curricula signalled
attempts to make learning more significant, based on constructivist
perspectives that emphasise social interaction for meaning making and
understanding.
Available literature suggests that learning in PBL should be assessed by
authentic, contextual real-life tasks that support and encourage students’
learning. To this end, the Nelson R. Mandela School of Medicine
implemented the progress examination (PE) to complement the aims of
Curriculum 2001 (C2001). The potential formative function of the PE was
specifically appealing in terms of allowing for the development of reflective,
self-directed and deep learning. Early explorations revealed an apparent
mismatch between the aims of C2001, the expectations of stakeholders and
their experiences with the PE at the site and these resulted in a number of
adaptations to the examination.
Cognisant of the influence of assessment on students’ learning, this study
sought to examine whether the educational principles governing the
implementation of C2001 also informed the implementation and adaptations
of the PE. Using a qualitative case study methodology, the study investigated
stakeholders’ understandings of the PE and its goals and the lived
experiences of its implementation as a suitable tool to assess students’ cognitive learning. In addition, the study also investigated the possible factors
that influenced the reform.
Findings suggest that the PE was not suitable to assess students’ learning in
C2001. Despite the perceptions of a strong educational need for curriculum
reform and the apparent suitability of the PE, some members of staff lacked
understanding, skill and confidence to apply and implement its aims. Staff
failed to apply transformative practices of teaching and learning, while the
principles of the PE and C2001 were not well diffused through the
organisation. Members of staff expected the PE to differentiate between high
and low performing students, while students came to regard the examination
as just another hurdle in an already hostile learning environment. Factors
such as the unstable and poor leadership, the restructuring of the health and
education sectors, impacted on the implementation of the reform.
Curriculum and assessment reform is challenging for students and lecturers,
requiring the transforming institution to actively prepare and support
stakeholders in a conducive educational climate. This case study highlights
the need for comprehensive planning for effective and sustained curriculum
reform. Collaborative strategies and educational systems should be sought
and implemented to sustain conceptual and practical reform.Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.
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Reddy, Sarasvathie. "Experiences of clinical practice in a problem-based learning medical curriculum and subsequent clinical environments." Thesis, 2010. http://hdl.handle.net/10413/3224.
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The study traced the experiences of learning the clinical aspects of a problem-based learning
(PBL) medical curriculum and the participants’ construction of a relationship with the
subsequent clinical environments. In light of international and local medical and technological
changes, the Nelson R Mandela School of Medicine (NRMSM) changed its traditional
curriculum to a PBL curriculum in 2001. The participants were the first cohort to experience a
PBL pedagogy and graduated in 2005, subsequently undertaking two years of compulsory
internship and one year of community service within the South African health care system. It
was in the context of these changes and the present state of health care that such a study
sought to determine how a PBL pedagogy was experienced within the clinical environments
of South Africa.
Phenomenography was used as a methodology to describe and interpret the ‘qualitatively
different ways’ in which the participants’ experienced the phenomenon. Purposive sampling
reflecting the institution’s admission policy regarding race and gender demographics was
applied. In-depth interviews were conducted at the end of the community service experience.
Variation in the experiences was represented through logically related and hierarchical
categories of description resulting in the formulation of an outcome space.
The outcome space identified three categories of description: ‘The guinea pig identity’ which
found that the participants felt at the mercy of a curriculum experiment and felt discriminated
against by the hospital consultants who had negative views of PBL. The category of
‘knowledge construction’ saw the participants exploring issues of difference between the
knowledge and practices expected by the two different kinds of curricula. The category of
‘professional identity’ indicated an emerging sense of competence across a range of clinical
situations.
Critical discourse analysis (CDA) was used to augment the phenomenographic analysis and to
explore the ways in which the social structure of the clinical contexts related to the discourse
patterns emerging in the phenomenographic categories in the form of power relations and
ideological effects. CDA was used as an additional lens to develop theory and acquire deeper
knowledge about why the participants constructed a relationship with the phenomenon and
the subsequent clinical environments in the way that they did.
The thesis concludes with a proposal for an empirical model that illuminates resolutions from
the major findings in the study regarding medical knowledge construction in a PBL
curriculum. The model consists of a Y axis depicting the vertical spine of basic sciences
knowledge construction, a X axis depicting the horizontal nature of professional identity
construction and a spiral that indicates the simultaneous movement of clinical knowledge
construction along each axis. It is hoped that this model will serve as a future curriculum
innovation that will result in the production of professional medical practitioners that are
required for today’s South African communities. This study, however, revealed that despite
the hegemonic practices and the theoretical inadequacies that were reported by the
participants they finally felt like professional medical practitioners during their community
service experience.Thesis (Ph.D.) - University of KwaZulu-Natal, Durban, 2010.
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Sommerville, Thomas Edward. "People and pedagogy : problem-based learning in the MBChB curriculum at UKZN medical school." Thesis, 2012. http://hdl.handle.net/10413/9482.
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This study explores problem-based learning (PBL) as a form of pedagogy, and its interrelationships with the students, staff members and institution of the Medical Faculty at the University of KwaZulu-Natal. Little has been written previously about the interaction of student diversity and resource-constrained circumstances with PBL. I investigate perceptions and experiences of PBL as a pedagogic strategy, using Bernstein's theories of classification and framing as an organising framework. I draw also on his writings on discourses and knowledge structures and the pedagogic device.
Within an interpretive methodology, I use three methods to generate data. I analyse numerically the test marks of a cohort of 202 students over three years for demographic influences on pedagogic engagement. I explore in semi-structured interviews the perceptions and experiences of PBL of 19 students and 6 staff members, and relate these to Faculty documents; I analyse these sources thematically in order to describe the roles of student, teacher and institution. These perceptions and experiences I then examine according to the eight elements of Bernstein's classification and framing.
A number of contradictions emerge: between PBL theory, echoed by Faculty documents on one hand, and staff/student perceptions and experiences on the other; between staff members and students at some points but not at others; between high-achieving and low-achieving students; between different respondents' under-standings of "integration". Some demographic characteristics prove on analysis to be highly significant influences while others, counter-intuitively, are not.
Bernstein's theories about knowledge structures are pertinent to the tensions revealed. Medicine has thought of itself as akin to the pure sciences – implying a hierarchical structure in which all knowledge aggregates towards a point of abstraction. However, the structure and function revealed by respondents suggests a horizontal knowledge structure, in which disciplinary knowledge is kept distinct. Students and teachers thus struggle to integrate areas of knowledge that are inherently discrete. In terms of Bernstein's "pedagogic device", some students are able to discern PBL's implicit rules of engagement, while others are not. Consensus on medicine‟s knowledge structure might settle ambiguities and help PBL achieve its potential as a complex pedagogy in a complex field.Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.
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Lee, Shu-Ming, and 李淑敏. "The Study on the Application of Evidence-based Medicine." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/4g8n77.
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Tsai, Chien-Kuang, and 蔡健光. "A Study on Evidence-based Medicine Applied to Medical Civil Action." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/38003899952685030131.
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碩士國立高雄第一科技大學
科技法律研究所
101
In recent years, medical disputes emerge in an endless stream and high civil com-pensation, not only caused opposition intensifies between patient and doctor, also makes the medical profession was forced to take defensive medical behavior. The results of this vicious spiral, will lead to more rejected patients, higher medical costs as well as more unbalance medical specialist proportion, finally will seriously affect the medical quality and medical rights. In order to solve the problem to reduce litigation, the "medical dispute and medical accident compensation law" draft was adopted by the Executive Yuan in December 2012 to look forward to quickly resolve the dispute and promote harmonious doctor-patient relationship. However, the cause of the medical dispute was complex, although complete processing and compensation system, it is still hard to avoid lawsuit. So, the improvement of the proceedings is another important issue. For a long time, the proof of proceedings was regarded as the key to win. The medical appraisal report is the main source of evidence by the judge. In the past, the method of medical identification was according to the authority of an expert or doctor''s medical training. And the medical appraisal result was usually conducive to the health providers, so the patient or family does not trust the report. At present, evidence-based medicine promoted by medical community was based on medical literature, discussed in detail based on the medical evidence, combined with the opinion of patient and clinical experience of physician, in order to decide the direction of treatment. Therefore, in the process of medical litigation, if the court adopted the opinions of doctor, patient or appraisal, with empirical evidence-based medicine, it believed that this will enhance the trust of the report and promote the harmony between patient and doctor. The development of evidence-based medicine in our country has more than ten years, the importance of its role on litigation evidence, according to the questionnaire survey, was agreed with a high proportion of medical and legal profession. While the evidence-based medicine in practice situation, according to the results of our empirical research, the proportion of evidence-based medicine data cited in the lawsuit, the district court and the high court for a total of 54.5%, representing more than half of the parties and identification unit use the evidence-based medical data for attack, defense or identification tools. The identification unit accounted for the highest proportion, 18.4%；as far as on the regional differences, the north most, 54.4%. These results reflect evidence-based medicine for medical civil litigation in our country has gradually strengthened the influence in recent a decade. We believe that the medical treatment quality will be perfect and doctor-patient relationship more harmonious by the acceleration of "clinical guidelines" and improvement of medical identification system in the future.
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Huang, Ying-Ying, and 黃贏瑩. "A Study on Knowledge Flow of Medical Librarians Impelling Evidence-based Medicine." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/w4kef6.
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碩士國立臺灣師範大學
圖書資訊學研究所
96
This thesis is an exploratory study on knowledge flow of medical librarians participating work of evidence-based medicine. The main goals of this research are to describe styles of medical librarians’ knowledge flow at work and analyze knowledge flow elements of enhances and barriers base on the findings from this study. Eight medical librarians who have practical participated the work of impelling evidence-based medicine have been interviewed. Answers from the interviewers are examined and analyzed. The data are analyzed in three categories: current work situations, work knowledge with process of transformation, and elements of knowledge flow. Seven findings of this project are as following. First, the librarian’s professional position in the evidence-based medicine needs to be promoted. Second, the major difficulty for librarian participating evidence-based medicine is the lack of background knowledge, but the situational difficulty is more crucial and hard to solve. Third, three major patterns of knowledge flow for medical librarians participating evidence-based medicine are longitudinal, lateral and network knowledge flow. Fourth, often librarian plays the role as a knowledge receiver rather than a knowledge source. Fifth, there is more knowledge channels within the organization than outside the organization. Sixth, culture within organization and leadership are two factors affecting knowledge context. Finally, enhances and barriers of knowledge flow are closely related to social networks.
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Myers, Glenda Avrylle. "Attitudes of teaching staff at the Faculty of Health Sciences, University of the Witwatersrand towards embedding evidence-based information literacy skills programmes into the graduate entry medical programme 1 and 2 curriculum." Thesis, 2012. http://hdl.handle.net/10539/11547.
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Information literacy (IL) is recognized as the overall critical literacy for the 21st Century. Although large amounts of digital information are available, there is concern within higher education that students lack the competencies to assess and analyse sources in terms of relevance to their courses. Information literacy skills are of critical importance in teaching medical students to engage with evidence-based medicine (EBM), often within a problem-based learning (PBL) curriculum. Information practices that underpin academic and professional life should be embedded into the learning experience of the subject, and not taught extraneously in isolated silos. Attitudes of teaching staff at the Faculty of Health Sciences, University of the Witwatersrand towards embedding evidence-based information literacy skills into the Graduate Entry Medical Programme 1 and 2 curriculum were examined. Existing integration of IL skills into the curriculum was shown to be limited, and not as high as perceived by educators. Five barriers against the integration of IL skills, and six opportunities for embedding information literacy, were identified in the curriculum. Awareness of evidence-based practice was found to be high, and collaborative teaching of IL skills with librarians was accepted by a large majority of educators. Dynamic Purposeful Learning (DPL) was proposed as a constructivist framework into which collaborative teaching of IL skills could be placed. DPL draws on active and collaborative learning, as well as cognitive scaffolding and apprenticeship, and is suited to PBL in the context of medical education.
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Gupta, Mona. "Is Evidence-based Psychiatric Practice, Ethical Practice?: A Conceptual and Qualitative Study." Thesis, 2009. http://hdl.handle.net/1807/19274.
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Since its addition to the medical lexicon in 1992, the concept of ‘evidence-based medicine’ (EBM) has captured the imagination of the medical world, attracting both passionate advocates and ardent opponents. EBM is defined clinically as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Yet, its boldest claim is an ethical one: that EBM, rather than any other method, is the most effective way to fulfill our moral duty to help patients achieve better health. Academic debate on this point has been deeply polarized, from those who assert that ethical practice is evidence-based practice to those who argue that evidence-based practice impoverishes practice and robs it of ethical substance. Mainstream psychiatrists have endorsed EBM which holds out the promise of greater ethical legitimacy for psychiatric disorders and treatments through improved scientific substantiation. Evidence-based psychiatry arises through the straightforward application of EBM to the practice of psychiatry and thus shares the same ethical goal of EBM, to improve patients’ health. Given the ethical debates that have framed psychiatry since its inception as a medical specialty, and the particular nature of mental disorders and their treatments, it is unclear if EBM can be applied to psychiatry, and therefore, whether it can deliver on its ethical promises. This thesis project involved two phases. The first, a conceptual phase, included an analysis of EBM’s ethical commitments as they are represented in its two authoritative textbooks (‘literal’ EBM). This provisional analysis was then extended by a qualitative analysis of the views of three groups of participants concerning the ethics of EBM: 1) EBM developers; 2) mental health practitioners; and 3) philosophers or bioethicists. Combining the analyses from both phases, a more complete depiction of the ethics of EBM was developed in order to address the main thesis question. Evidence-based psychiatric practice cannot be ethical practice by itself. Instead, it can play a small ethical role in clinical practice, only if it is situated within the larger value structure of contemporary medicine and psychiatry.
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Yang, Meng-Yin, and 楊孟吟. "A Study of physicians’ Attitudes, Knowledge, Skills and Educational Needs in Evidence-based Medicine." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/78954285658706839476.
Full textAbstract:
碩士東海大學
工業工程與經營資訊學系
97
Objective: Evidence-based medicine (EBM) provides a route of scientific thinking for the doctor, so that the diagnosis and treatment of the disease could be more efficient, accurate and safe. The use of EBM indicates an important life long self-learning. In order to retrieve, appraise and clinically apply the current best evidence, the practitioner needs to possess special knowledge and skill. The objective of this study was to survey the attitudes, knowledge, skills and educational needs of the physicians regarding EBM. The research findings may be used as a guidance by the educator for EBM curriculum planning and EBM promotion. Method: The physicians of a medical center at the central Taiwan was surveyed, self-structured questionnaire was used. A total of 323 questionnaires were distributed, with 235 questionnaires being returned, the response rate was 72.75%. Results: 1.Most physicians had a positive attitude towards EBM. Among the statements, “I think that doctor should receive EBM education” got the highest score, while “I think that EBM is more important that personal clinical experience” got the lowest score. 2.Knowledge and skills of EBM: (1)The average score in physicians’ understanding of EBM terminology was 3.55 ± 0.80 (5 for fully understand, 1 for not understand at all). (2)The average score in physicians’ skills of EBM practice was 3.53 ± 0.63 (5 for very good skill, 1 for not familiar at all). Among that, appraisal of research article and clinical application of EBM got the lowest score. 3.The educational needs of EBM among physicians were high, the three most popular courses range in sequence were “statistics”, “efficacy evaluation” and “study design”. Workshop was the favorite way of teaching preferred by most physicians. 4.53.6% of the physicians in our study always find medical evidences. PubMed was the most frequent used resource while the usage of Cochrane, an EBM database, was low. 5.Compare to other department, the doctors in medical and surgical department had significant higher score in the attitudes, terminology and skills of EBM. Those who had publication as first or correspondent author also had significantly more positive attitudes towards EBM. Physicians with doctor degree had significant higher score than those with bachelor degree in the skills of EBM. 6.There were positive correlation between attitudes of EBM and terminology understanding, skills and educational needs of EBM. The correlation between EBM terminology and skills, educational needs of EBM were positive too. Conclusion and Suggestion: 1.The knowledge and skills of EBM among physicians are generally inadequate, there is still much to learn. 2.We should have more courses on “statistics”, “efficacy evaluation”, and “study design” since they are most needed by physicians. 3.In general, physicians still lack confidence in applying the EBM to their clinical practice. We suggested that EBM learning should be incorporated into daily ward round. 4.The attitudes, knowledge and skills of EBM among physicians other than medical and surgical department was poor, we should accent and promote the education of EBM more aggressively to the physicians in this field.
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Murphy, Matthew. "Assessing understanding of the principles of evidence-based practice and their application: a qualitative study of decision-making among Senior Management in Nova Scotia's addiction services." 2012. http://hdl.handle.net/10222/15359.
Full textAbstract:
Provision of a high standard of care in addiction treatment and prevention services is dependent upon knowledge of evidence-based practice (EBP) principles, and the skills needed to apply those principles, among the substance abuse workforce (SAW). Competency profiles for Canada’s SAW define the need for skill and knowledge of EBP. Within Canada’s SAW, persons within the Occupational Cluster Senior Management are ultimately responsible for decisions and therefore must possess a high level of proficiency in EBP. This proficiency has not been assessed in this group; the objective of this study was to conduct such an assessment on Senior Management from Nova Scotia’s Addiction Services. Eighteen Senior Managers completed semi-structured qualitative interviews. Interviews were analyzed using content analysis, five main themes emerged. It appears that Senior Management possess an understanding of the principles of EBP, but that their knowledge and use of the skills required for their application requires further development.
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-Mei, Yu, and 蔡玉梅. "The study of factors influencing staff nurses developing evidence-based practicein a southern regional teaching hospital." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/22476304564628349499.
Full textAbstract:
碩士輔英科技大學
護理系碩士班
97
Evidence-based practice originated from the territory of medicine. However, due to the limitations of literatures search and the lack of awareness in the early age, the results of scientific studies didn’t attract widespread attention. From the 1990s, with the rapid development of information technology and computers, concepts of evidence-based practice extended gradually from medical to nursing field. However, evidence-based practice implementation didn’t progress well in the clinical practice. Nurses are the key personnel to implement the evidence-based practice in the health care system. Did they encounter difficulties in the evidence-based practice? What factors may affect the development of evidence-based practice? Although the evidence-based practice gets more and more attention in Taiwan, the related researches are still rare. Therefore, the purpose of this study was to investigate the affecting factors in the development of evidence-based practice among the clinincal nursing staff, so as to submit effective suggestions and help the implementation of evidence-based practice. This study uses correlational research design, sampling the nursing staff in a regional teaching hospital in Taiwan. The research tool is "the development of evidence-based practice scale". The results found that staff nurses of the main sources of practical knowledge for the clinical study, work experience and the experience of care cases, the main source of empirical data to the Internet, but to comment on thestudy is lack of self-confidence and impede the reason comes from a lack of adequate resources, power, time and doctor’s support. In addition, the development of evidence-based practice is also subject to the frequency of reading journals, continuous education, job title, professional rank, working unit, awareness, seniority and age have impactson the development of evidence-based practice. The results showed that encourging journal reading, continuous education, upgrade in clinical practice, junior staff education and training and in the work of individual characteristics are important. Based on the results of the study, we proposed that school should start the courses of evidence-based nursing. Medical institutions simultaneously to promote evidence-based medicine and evidence-based nursing. Institutions and schools should provide appropriate literatures bank query services, to plan the staged on-the-job education and training to encourage the staff to read professional journals.
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Powell, Ryan. "A novel approach to support evidence-based medicine: should sulfonylureas remain an acceptable therapy for diabetes?" Thesis, 2017. https://hdl.handle.net/2144/23373.
Full textAbstract:
A key element in evidence-based medicine approaches is the ability for clinicians to evaluate the scientific rigor and relevance of research evidence. In the treatment of diabetes, clinicians make increasingly difficult decisions about which drug regimens are best for their patients with limited evidence-based information.
While the consensus is that metformin should be the initial drug treatment when diet and exercise are not sufficient, clinicians disagree on whether sulfonylureas should remain a suitable therapy after metformin. While this would be improved with further research investigating the comparative safety of therapeutic options, there is also need for better ways to synthesize available information to guide evidence-based decision-making in health services research.
Study 1 summarizes the pre-existing evidence on the long-term safety risks associated with sulfonylurea therapy relative to other drug classes. Results from a series of meta-analyses provide some evidence that sulfonylureas are associated with elevated all-cause mortality and cardiovascular risks relative to several other medications, either as a monotherapy or in combination with metformin.
Study 2 analyzes the comparative safety of second-line treatment in diabetic patients in the Veterans Health Administration to address gaps in the literature. Results suggest that second-line use of sulfonylureas is associated with increased risks compared to thiazolidinediones. Results also suggest that changes to existing metformin therapy may lead to differential hazards.
Clinicians may disagree about the quality of the evidence as well as the relevancy to their own treatment population. Improvements in methods for evidence-based medicine that take this into account are needed. Study 3 applies an underutilized research method that allows for a more thoughtful synthesis of all available evidence. This framework allows clinicians to incorporate the scientific rigor and relevancy of previous study results when integrating new data into their current knowledge base. Results suggest an elevated risk in all models for sulfonylureas compared to thiazolidinediones and highlight the need to design more focused research to support clinical decision-making around medication safety. This novel application to evidence synthesis shows promise as applied to a health services research problem and has potential as a useful framework in other health services research areas.2017-12-09T00:00:00Z
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Elshaug, Adam Grant. "Building the evidence base for disinvestment from ineffective health care practices: a case study in obstructive sleep apnoea syndrome." 2007. http://hdl.handle.net/2440/47974.
Full textAbstract:
In the early 1990s claims were made that in all areas of health care, “30-40% of patients do not receive treatments of proven effectiveness”, and, “20-25% of patients have treatments that are unnecessary or potentially harmful”. Many such practices were diffused prior to the acceptance of modern evidence-based standards of clinical- and cost-effectiveness. I define disinvestment in the context of health care as the processes of withdrawing (partially or completely) resources from any existing health care practices, procedures, technologies or pharmaceuticals that are deemed to deliver little or no health gain relative to their cost, and thus are not efficient health resource allocations. Arguably disinvestment has been central to Evidence-Based Medicine(EBM) for well over a decade yet despite general advances in EBM, this topic remains relatively unexplored. This thesis examines the ongoing challenges that exist within the Australian context relating to effective disinvestment. Upper airway surgical procedures for the treatment of adult Obstructive Sleep Apnoea Syndrome (OSA) are used as a case study to contextualise these challenges. This thesis has six sections: 1. A review of the literature outlines developments in EBM broadly and provides a detailed background to OSA, including the numerous treatment options for the condition. This review examines evidence that highlights the importance of ‘highly effective treatment’ over ‘subtherapeutic treatment’ as a necessity to confer improved health outcomes in OSA. It is argued that claims of surgical success inherent in most published results of surgery effectiveness fail to assimilate contemporary evidence for clinically significant indicators of success. 2. Section two comprises the first reported meta-analysis in this area. It presents the pooled success rates of surgery according to various definitions. Specifically, when the traditional ‘surgical’ definition of success is applied the pooled success rate for Phase I (i.e. soft palate) surgical procedures is 55% (that is 45% fail). However, using a more stringent definition (endorsed by the peak international sleep medicine body), success is reduced to 13% (that is 87% fail). Similarly for Phase II (i.e. hard palate) procedures success rates decrease from 86% to 43% respectively when moving from a surgical to a medical definition of success. That various medical specialties differentially define treatment success, I argue, creates uncertainty for observers and non-clinical participants in this debate (eg policy stakeholders and patients). This represents a barrier to disinvestment decisions. 3. Results are presented from a clinical audit of surgical cases conducted as a component of this thesis. Both clinical effectiveness and procedural variability of surgery are reported. A unique methodology was utilised to capture data from multiple centres. It is the first time such a methodology has been reported to measure procedural variability alongside clinical effectiveness (inclusive of a comparative treatment arm). The observed cohort (n=94) received 41 varying combinations of surgery in an attempt to treat OSA. Results on effectiveness demonstrate an overall physiological success rate of 13% (according to the most stringent definition; phases I and II combined). This demonstration of procedural variability combined with limited effectiveness highlights clinical uncertainty in the application of surgical procedures. 4. Section four outlines how a qualitative phase of enquiry, directed at exploring the perspectives and experiences of surgery recipients, was approved by three independent research ethics review boards but was not supported by a small group of surgeons, resulting in the project being canceled. Potential consequences of this for impeding health services research (HSR) are discussed. 5. Two sets of results are reported from a qualitative phase of enquiry (semi-structured interviews) involving senior Australian health policy stakeholders. The first results are of policy stakeholders’ perspectives on the surgical meta-analysis and clinical audit studies in 2 and 3 above. The second results are from an extended series of questions relating to challenges and direction for effecting disinvestment mechanisms in Australia. Stakeholder responses highlight that Australia currently has limited formal systems in place to support disinvestment. Themes include how defining and proving inferiority of health care practices is not only conceptually difficult but also is limited by data availability and interpretation. Also, as with any policy endeavour there is the ever-present need to balance multiple interests. Stakeholders pointed to a need, and a role, for health services and policy research to build methodological capacity and decision support tools to underpin disinvestment. 6. A final discussion piece is presented that builds on all previous sections and summarises the specific challenges that exist for disinvestment, including those methodological in nature. The thesis concludes with potential solutions to address these challenges within the Australian and international context. Systematic policy approaches to disinvestment represent one measure to further improve equity, efficiency, quality of care, as well as sustainability of resource allocation.http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297655
Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2007
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Jayasekara, Rasika Sirilal. "The development of an evidence-based conceptual framework for undergraduate nursing curricula in Sri Lanka." 2008. http://hdl.handle.net/2440/47521.
Full textAbstract:
Background In Sri Lanka, nursing education is moving from a 3-year general nursing certificate to a 4-year university bachelor degree. In this transitional stage, the development of a conceptual framework that uses evidence to underpin undergraduate nursing education is a crucially important step to improve nursing education and nursing service in Sri Lanka. However, there is no evidence to support the contention that existing and proposed undergraduate nursing curricula in Sri Lankan universities are based on a common philosophy or an acceptable needs assessment. Purpose The overall purpose of this study was to develop an evidence-based conceptual framework for undergraduate nursing curricula in Sri Lanka. Method This study has involved conducting critical reviews of literature, two systematic reviews, developing a draft conceptual framework, testing its appropriateness and feasibility with key stakeholders (nursing academics, administrators, clinicians) via focus group discussions in Sri Lanka, and formulating the final conceptual framework for nursing curricula in Sri Lanka. Findings The systematic reviews revealed that the evidence regarding the effectiveness and appropriateness of undergraduate nursing curricula is notably weak and direct transfer of the curriculum model from one country to another is not appropriate without first assessing the cultural context of both countries. The conceptual framework, which was developed using the finding of systematic reviews and literature reviews, consists of widely recognised nursing concepts in international and local contexts. However, some concepts can not be directly applicable because of cultural and economic impediments. Discussion The cultural, social, political and economic contexts of a country have a direct impact on its health and education systems. This study identified several factors that shape the approach to nursing curricula in Sri Lanka. These factors include: Western influence; Sri Lanka’s cultural influence; the current healthcare system and demand for healthcare; nursing systems and regulation; medical dominance; financial support; and Sri Lanka’s education system. All of these factors influence the conceptualisation of nursing and educational strategies needed to effectively and appropriately prepare nurses in Sri Lanka. I propose seven recommendations to support the implementation of the study findings into practice in Sri Lanka.http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1317073
Thesis(Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2008