Tesis: "Evaluation of complex intervention"

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Theodoreli-Riga, C. V. "Evaluation of robotic catheter technology in complex endovascular intervention". Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/11627.

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The past four decades have witnessed tremendous strides in the evolution of endovascular devices and techniques. Catheter-based intervention has revolutionized the management of arterial disease allowing treatment of aortic and peripheral pathologies via a minimally invasive approach. Despite the exponential advances in endovascular equipment, devices and techniques, catheter-based endovascular intervention has certain morphological and technological constraints. Complex patient anatomy, technological impediments and suboptimal fluoroscopic imaging, can make endovascular intervention challenging using traditional endovascular means. Conventional endovascular catheters lack active manoeuvrability of the tip. Manual control can hinder overall stability and control at key target areas, leading to significantly prolonged overall procedure and fluoroscopic times. Repeated instrumentation increases the risk of vessel trauma and distal embolization. More importantly, guidewire-catheter skills are not necessarily intuitive but must be developed and are highly dependent on operator skill with long training pathways as a result. Recognizing the pressing need to address some of the limitations of standard catheter technology this thesis aims to evaluate the role of advanced robotic endovascular catheters in the aortic arch and the visceral segment. Clinical use of this technology is currently limited to transvenous cardiac mapping and ablation procedures. A comprehensive pre-clinical comparison and analysis of robotic versus manual catheter techniques is presented to reveal both their advantages and limitations, with particular emphasis on the potential of robotic catheter technology to reduce the manual skill required for complex tasks, improve stability at key target areas, reduce the risk of vessel trauma, embolization and radiation exposure, whilst improving overall operator performance. The worlds first clinical report of robot-assisted aortic aneurysm repair, a “proof - of - concept” resulting from this research, is also presented, and the potential for future advanced applications in order to increase the applicability of endovascular therapy to a larger cohort of patients discussed.

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Brown, C. T. "Self-management for men with uncomplicated lower urinary tract symptoms : evaluation of a complex intervention". Thesis, University of London, 2007. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.546711.

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Goldthorpe, Joanna. "Developing and evaluating a complex intervention to treat chronic orofacial pain". Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/developing-and-evaluating-a-complex-intervention-to-treat-chronic-orofacial-pain(29158f44-c916-41c4-a84f-c6481437dc9e).html.

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Introduction: Chronic orofacial pain (COFP) is distressing and disabling to sufferers and can be costly to patients, health services and society. Frequently, no underlying medical pathology can be found to account for the condition. Despite this, patients are treated according to a biomedical model, often by mechanistic and invasive procedures, which tend to be unsuccessful and not evidence based. Evidence suggests that cognitive behavioural therapy (CBT) based management may produce improved outcomes for patients. However, published studies can tell us little about which intervention components are effective, or recommend an optimum way for these components to be applied. Aim: To develop an evidence based intervention for the management of COFP that is feasible and acceptable to patients and practitioners. Method: The Medical Research Council’s guidelines for developing complex interventions were used as a framework for the research. Evidence from multiple sources was synthesised to produce the draft components of an intervention to manage COFP. An exploratory trial investigated preliminary outcomes, acceptability, feasibility and explored parameters for a full scale randomised control trial. Results: The intervention was acceptable to participants and could be feasibly implemented. No conclusions could be drawn relating to the effectiveness of the intervention. Participants were not affected at baseline for a number of outcomes, which implies that cut off points should be introduced into the inclusion and exclusion criteria of any future studies. Conclusion: The study produced an intervention which is acceptable and feasible to participants, however it is not known if it is effective. A number of recommendations are made for progression to a larger, definitive trial.

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Pinnock, Hilary. "Telephone consultations for the routine review of people with asthma in primary care : an evaluation of a complex intervention". Thesis, University of Aberdeen, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.430976.

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Introduction: Set within the Medical Research Council framework for the development and evaluation of complex interventions, this thesis describes the evaluation of telephone consultations for the routine review of people with asthma in primary care. Objectives: 1. To critically review the evidence for regular review of people with asthma. 2. To develop an intervention, underpinned by existing theoretical and empirical evidence on telephone consulting, to improve access to asthma care. 3. To test the hypotheses that telephone consultations improve access and are an acceptable, clinically effective and cost-effective alternative to face-to-face consultations for the provision of routine asthma care. 4. To design a telephone asthma review service for ‘real-world’ implementation. Methods: Literature review and a randomised controlled trial comparing nurse-led telephone with face-to-face asthma reviews in four UK general practices. Results: 1) Despite the evidence for proactive asthma care, attendance at routine clinics remains poor. 2) Convenience for patients and the potential for opportunistic calls, suggest that telephone consultations might increase the proportion of patients reviewed. 3) 101/137 (74%) of people randomised to telephone consultations were reviewed compared with 68/141 (48%) in the surgery group (p<0.001). Asthma-related quality-of-life was comparable in the two groups (risk difference -0.07 (95%Cl -0.40 to 0.27) p=0.69). The shorter duration of telephone consultations resulted in a mean cost saving per consultation achieved of £3.92 (95%Cl £3.01 to £4.84), p<0.001). Patients appreciated the convenience of telephone reviews. 4) Building on these results, a telephone asthma review service is described for testing in an on-going implementation trial.

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McCall, MacBain Marcy C. "Yoga as a complex intervention and its development for health-related quality of life in adult cancer". Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:c7259cbe-b6c0-42f8-b893-79306cdccdfa.

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The aim of this thesis was to develop yoga as a complex intervention in health care for the improvement of health-related quality of life (HRQoL) in adult cancer. As the Indian tradition of practising yoga increases in popularity worldwide, populations in the West are beginning to see yoga as an opportunity to prevent and treat health conditions. The Medical Research Council’s framework has provided a methodology to address a paucity of coherent evidence for the myriad of unsupported health claims made by yoga enthusiasts. The thesis structure included a step-by-step approach to investigate biomedical theories of how yoga might work to improve health, to synthesise evidence of yoga interventions, to model their process and outcomes, and to test evaluation procedures in the context of a randomised controlled trial (RCT). The results of a bibliometric analysis indicated an overall increase in the publication rate of yoga research in health care, and in 2005 this research began to focus on cancer. A component analysis, semi-structured patient interviews (n=10) and oncologist surveys (n=29) were successively designed, implemented and analysed to advance a model of yoga intervention specific to adult cancer. The cumulative results were applied to design three yoga interventions randomly allocated to men and women receiving treatment for cancer (n=15). Outcomes of the feasibility study demonstrated that yoga intervention is appropriate for adult patients and can be administered safely in a clinical setting. In its conclusion, this thesis produces evidence-based support for the optimisation of yoga intervention in the context of a large-scale RCT for HRQoL in adult cancer, and it provides recommendations to improve research methodology and reporting of complex interventions in health care.

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Kanthabalan, Ana Abhiramy. "The evaluation of a novel imaging-based complex diagnostic and therapeutic pathway intervention for men who fail radiotherapy for prostate cancer". Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10057034/.

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Background: One-third of men may experience biochemical failure by 8 years following radical radiotherapy for prostate cancer. Focal salvage therapy (FST) may offer further curative treatment. Before FST, distant disease must be ruled-out and intra-prostatic disease must be accurately detected and characterised. Aim: The aim of this thesis was to evaluate novel diagnostic and staging techniques and outcomes of focal salvage treatments for radiorecurrent prostate cancer. Methods: Both retrospective and prospective data will be presented. A retrospective analysis was conducted to compare a) Bone scan with Choline PET/CT in the detection of distant metastases b) Accuracy of MRI-Targeted Biopsy (MRI-TB) with whole-gland template mapping biopsy (TPM) c) the outcomes of focal salvage HIFU (FS-HIFU). These retrospective analyses provided important inputs into the design and conduct of the prospective trial FORECAST - Focal RECurrent Assessment and Salvage Treatment. Key trial outcomes were a) detection rate of distant metastatic disease of Whole Body MRI compared to other staging scans b) detection rate of MRI for clinically significant prostate cancer and c) Short-term outcomes of focal salvage therapies. Outcomes: Within the retrospective analyses, there was poor concordance with bone scan and Choline PET/CT in the detection of metastatic disease (kappa value 0.024). MRI-TB had lower detection rates of clinically significant cancer compared with TPM biopsy; 77.9% vs. 85.7% (p=0.146). The b-DFS rate post FS-HIFU was 48% (95% CI 39–59) and composite end free survival was 40% (95% CI 31–50). In the prospective analyses, there was moderate agreement between WB-MRI and Choline PET/CT for bony metastatic disease (Kappa=0.411 (p < 0.0001)). MRI (PIRADS 4) had a high sensitivity, specificity, PPV and NPV for the detection of clinically significant cancer 90%, 81.3%, 85.7% and 86.7%. b-DFS rates post FS-HIFU and FS-cryotherapy was 73% (95% CI 51-100) and 67% (95% CI 30-100) at 12 months (p=0.95).

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Craig, Louise Eisten. "Developing and evaluating a complex intervention in stroke : using very early mobilisation as an example". Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4294/.

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Background: Complex interventions, those that incorporate multiple interacting components, are difficult to define, measure and implement. The aim of this research was to develop and evaluate the complex intervention, very early mobilisation (VEM) in acute stroke care. The clinical effectiveness and cost-effectiveness of VEM were evaluated whilst simultaneously considering the implications for future implementation. Methods: A mixed methods approach was used: systematic review, predictive modelling, observational study design, individual patient data meta-analysis, qualitative methods and economic evaluation. Statistical models to accurately predict mobility post-stroke were developed. A multicentre observational study was conducted to establish pre-implementation activity levels of acute stroke patients. Data from two completed and comparable feasibility trials were used to estimate the clinical and economic impact of VEM. A qualitative process evaluation was conducted to identify the barriers and facilitators to implementing VEM, if shown to be effective. Results: Two predictive models were developed with age and stroke type common factors to both. Pre-implementation activity levels were low. Patients who underwent VEM were 3-times more likely to be independent at 3 months than were standard care (SC) patients. The incremental cost-effectiveness ratio associated with VEM in comparison to SC indicated VEM to be potentially cost-effective from a societal perspective. Barriers and facilitators identified for each stage of the stroke pathway and a set of HCPs’ beliefs towards VEM were formulated. Conclusions: This research has adhered to current guidance provided by the Medical Research Council to develop and evaluate VEM. The clinical effectiveness and cost-effectiveness of VEM were estimated. The ongoing A Very Early Rehabilitation Trial phase III will provide definitive evidence for the effectiveness of VEM and the wider consequences for stroke care. This research has provided the support and the foundations for the development of a clear implementation strategy for VEM.

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Walker, Jane. "Evaluation of a complex intervention for depression in patients with lung cancer : the design, execution and results of a randomised controlled trial". Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/9560.

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The aim of this thesis was to develop and evaluate a complex intervention for major depression in patients with lung cancer. Major depression is a leading cause of disease burden worldwide and is particularly important in patients with lung cancer, not only because it is common in this poor prognosis cancer group but also because it substantially reduces the quality of the often short period of time that patients have left to live. The thesis describes a systematic review of the relevant research literature, the development of a complex intervention and a multi-centre randomised controlled trial. I found no trials, in my systematic review, that had evaluated the effectiveness of treatments for depression in patients with lung cancer. I did, however, find six trials of interventions intended to improve symptoms or quality of life in this patient group, the findings of which suggested that enhanced care approaches were more effective in reducing depressive symptoms than standard medical care. I developed the complex intervention ‘Depression Care for People with Lung Cancer’ (DCPLC) with 12 patients who had major depression and lung cancer. DCPLC was delivered by a team of cancer nurses and psychiatrists in collaboration with the patient’s GP. It included education about depression, antidepressant medication, psychological treatments (behavioural activation and problem solving therapy) and systematic progress monitoring. The trial comparing DCPLC with usual care included 142 patients. Patients who received DCPLC reported significantly lower average depression severity during their time in the trial, and better self-rated depression improvement, anxiety, quality of life, role functioning and perceived quality of depression care. The methodological limitations, relevant literature and implications of these findings for future research and for clinical practice are discussed.

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Scobbie, Lesley. "The development and initial evaluation of a Goal setting and Action Planning (G-AP) framework for use in community based stroke rehabilitation". Thesis, University of Stirling, 2015. http://hdl.handle.net/1893/21909.

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Background: Goal setting is accepted ‘best practice’ in stroke rehabilitation however, there is no consensus about what the key components of goal setting interventions are, how they should be optimally delivered in practice and how best to involve stroke survivors in the process. This PhD by publication describes the development and initial evaluation of a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice in community based stroke rehabilitation settings. Included studies: The Medical Research Council (MRC) framework for developing and evaluating complex interventions guided the development and conduct of a programme of research which included the following studies: (i) a review of the literature to identify theories of behaviour change with most potential to inform goal setting practice (Paper 1) (ii) a causal modelling exercise to map identified theoretical constructs onto a goal setting process and convening of a multi-disciplinary task group to develop the theoretical process into a Goal setting and Action Planning (G-AP) practice framework (Paper 2) (iii) a process evaluation of the G-AP framework in one community rehabilitation team (Paper 3) (iv) a United Kingdom (UK) wide survey to investigate the nature of services providing community based stroke rehabilitation across the UK and what goal setting practice is in these settings in order to understand the context into which an evaluation of the G-AP framework could be introduced (Paper 4) Main Findings: The review of the literature identified three theories of behaviour change that offered most potential to inform goal setting practice: Social Cognitive Theory, Health Action Process Approach and Goal Setting Theory. These theories contained constructs directly relevant to the goal setting practice: self-efficacy, outcome expectancies, goal attributes, action planning, coping planning and appraisal and feedback. The causal modelling and Task group exercise: (i) Informed development of the G-AP framework into a four stage, cyclical process that included (i) goal negotiation and setting (ii) planning and measuring confidence (iii) action and (iv) appraisal, feedback and decision making. (ii) Proposed mechanisms of action: successful completion of action plans resulting in incremental improvements in goal sub-skills and self-efficacy. (iii) Predicted outcomes G-AP was likely to impact on: goal attainment and improved rehabilitation outcomes. The process evaluation suggested that each stage of the G-AP framework had a distinct purpose and made a useful contribution to the overall process. Overall, G-AP was acceptable and feasible to use but implementation of novel aspects of the framework (coping planning and measuring confidence) was inconsistent and health professionals had concerns about the potential impact of unmet goals on patients’ wellbeing. Patient reports suggested that (i) the experience of goal non-attainment could facilitate adjustment to limitations resulting from stroke and (ii) feeling involved in the goal setting process can incorporate both patient-led and professional-led approaches. The survey findings highlighted the variability that exists in community based stroke rehabilitation services in the UK (e.g. the patients they see; the input they provide). Goal setting is reportedly used with all or most stroke survivors in these services; however, practice is variable and may be sub-optimal. Conclusions: G-AP is the first practice framework which has been explicitly developed to guide health professionals through a systematic, theoretically based and patient centred goal setting process in community based stroke rehabilitation. G-AP is a cyclical process that that has four key stages, proposed mechanisms of action and has shown promise as an acceptable, feasible and effective framework to guide goal setting practice. The complexity that exists within community based stroke rehabilitation services, and the variability in usual goal setting practice used within them, should be considered when designing a study to evaluate the effectiveness of G-AP in routine practice.

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Appel, Caroline. "Development, evaluation and measurement of a complex intervention : a preliminary investigation of shoulder strapping used as an adjunct therapy to conventional stroke rehabilitation". Thesis, St George's, University of London, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.604012.

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Development, evaluation and measurement of a complex intervention; a preliminary investigation of shoulder strapping used as an adjunct therapy to conventional stroke rehabilitation Some therapeutic treatments show promise for improving upper limb motor recovery after stroke, especially those with a focus on high-intensity task-specific practice. However, application of such treatments poses a problem in those patients with insufficient joint stability and weakness of the shoulder complex. Intensive exercise might be possible if the shoulder complex were supported during exercise by, for example, shoulder strapping. Whilst studies indicate an interest in shoulder strapping for stroke patients, evidence for its use is not strong. To establish an evidence base for shoulder strapping, clarification is needed on: underlying mechanisms of any action; strapping methods used; which patients benefit; what effect is achieved; what outcome measures should be used; and patient and staff experience. To develop, evaluate and measure shoulder strapping as a complex intervention within the updated MRC framework, four preliminary studies were completed. A systematic review of shoulder movement impairments suggested that in the early aftermath of stroke, shoulder weakness was severe. Another systematic review indicated that few studies have investigated shoulder strapping and focused on treatment of paralysis. The feasibility of a strapping protocol was, therefore, examined in participants with paresis. This indicated that strapping has potential beneficial effects on upper limb function with minimal adverse skin reactions. Strapping was accepted by staff and stroke participants as feasible. Findings of these studies directed the development and preliminary testing of a new tool for measuring shoulder movement in participants with paresis. Results indicated reliable assessment of video footage by neurophysiotherapists and informed further development of the tool. Findings of these four studies will inform development of a future randomised controlled trial to test the efficacy of shoulder strapping on motor recovery after stroke.

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Litmanovitz, Yael D. "Moving towards an evidence-base of democratic police training : the development and evaluation of a complex social intervention in the Israeli Border Police". Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:168d66e3-5a50-4e85-bde6-577fe6ffe23e.

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The centrality of the police in everyday life means police officers are in position of power to actively support or threaten democratic activities (Sklansky, 2008) for example during protests. In democracies, policing duties should be performed in ways that sustain democratic values, rather than undermine them (Loader, 2006), yet that is not always the reality. Police training is one of the tools for aligning officers' behaviour with societal norms; it is considered a protection against the possibility that police officers abuse the wide-ranging powers they hold (Manning, 2010). Training programs are therefore a basic feature of all police forces' organizational approach. Despite its centrality, training has not received extensive academic attention; there is a pressing need to understand the impact of training on police behaviour and the mechanisms thorough which it operates (Skogan & Frydl, 2004). This thesis attempts to advance the evidence-base of democratic police training following the Medical Research Council's framework for the development and evaluation of complex social interventions (Craig et al., 2008). The Israeli Border Police was chosen as the context to examine the potential of training to advance democratic norms. The three stages of the research project included: theoretical modelling of the existing complex training intervention to assess its alignment with existing evidence; participatory development and piloting of a training curriculum on policing of protests in a democracy that used an Adult Education approach and introduced Procedural Justice-related components; and a pilot quasi-randomised study to evaluate this training. Analysis and reporting are carried out in a way that allows assessment of prospective scale-up and generalisability. Flowing from the empirical work, four strands of theoretical contributions are put forward. First, a theoretical model of police training is proposed, drawing on social psychology constructs. Second, contact theory, which originates in peace education, is proposed as a possible platform for designing both police training and their evaluation studies. Third, four factors limiting the efficacy of Procedural Justice & Legitimacy based training interventions in deeply divided societies are outlined. Fourth, the Border Police case study is used to substantiate the value of participatory research methods for advancing knowledge translation and evidence-based policing.

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Frey, Katherine Parris. "A Qualitative Analysis of the Implementation of a Complex Intervention| Evaluating Implementation of the Trauma Survivors Network". Thesis, University of Maryland, Baltimore, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10275517.

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Background: Annually, two million adults are admitted to US hospitals due to traumatic injury. The trauma recovery process often brings physical and psychological challenges. The Trauma Survivors Network (TSN) is a multimodal program designed to improve outcomes for this population. However, despite early efforts at dissemination, widespread adoption of the program remains low. Understanding barriers and facilitators to adoption and implementation is a common challenge in intervention development and dissemination generally, representing a knowledge gap in planning for the implementation of complex, behavior change interventions more specifically.

Purpose: The purpose of this project was to qualitatively assess the implementation of the TSN at 6 trauma centers using a combination of prospective documentation and retrospective interviews. The implementation process at each of the participating centers was analyzed and compared to rate implementation strength. Specific barriers and facilitators to program implementation were identified.

Methods: In this qualitative multiple case study, data sources included implementation logs (6), diary entries (147), and semi-structured interviews with key informants (37). Each of the centers was considered an analytic case. Data analysis followed a primarily deductive approach, using a coding framework based on the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Matrices of themes and cases were constructed, allowing the evaluation constructs at the case and study level.

Results: The result of this research is the development of a model of program implementation proposing the factors most likely to result in successful implementation of the TSN. Implementation requires leaders at local centers to recognize the need for the program, and working with a dedicated coordinator and engaged opinion leaders, provide the time, support, and resources necessary to demonstrate program continuity and value to staff. This process is facilitated by external, national level support for the program, including the potential incorporation of the TSN into guidelines for trauma center verification, as well as the design of internal processes intended to integrate the program into the center, ensuring acceptance and longevity for the program. The results of this study can assist future adopters of the TSN, improving the likelihood of successful program implementation.

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Mas, Bergas Miquel Àngel. "Hospital-at-home complex intervention tailored to older patients with disabling acute processes: evaluation of clinical factors for effectiveness on early discharge and admission avoidance strategies". Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/665873.

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En les últimes dècades un moviment internacional provinent de diversos països ha desenvolupat diferents recursos comunitaris per l’atenció de persones grans amb crisis complexes de salut a partir d’intervencions complexes. En la primera part de la tesi s’ha realitzat una revisió de la literatura per tal d’analitzar les principals característiques de diversos models d’hospitalització domiciliària en les persones grans, basada en dues modalitats/estratègies principals: Evitació d’Ingrés (per tal de proveir atenció substitutiva a l’hospitalització i prevenir complicacions relacionades amb l’hospitalització) i Facilitació d’Alta (per tal d’escurçar la durada de l’hospitalització i facilitar la reinserció comunitària després d’un ingrés hospitalari agut). Després de comprovar que disposem de sòlides evidències en intervencions d’hospitalització domiciliària en poblacions d’edat avançada, tant per la modalitat de Facilitació d’Alta com per la d’Evitació d’Ingrés, es va dissenyar, en base a la literatura revisada, una intervenció complexa centrada en la persona a partir de l’Avaluació Geriàtrica Integral (AGI), per a la provisió d’atenció de crisis de salut en persones grans vulnerables que necessitin atenció hospitalària. Un programa integrat d’atenció, anomenat d’Hospitalització Domiciliària Integral (HDI), es va pilotar i avaluar en una àrea urbana del nord del Barcelona, per un equip multidisciplinari de base geriàtrica. El programa va ser analitzat per mitjà d’un disseny quasi experimental, amb comparació dels resultats de la intervenció realitzada en una unitat d’hospitalització domiciliària vinculada a un servei de geriatria, amb els dels pacients aparellats atesos contemporàniament pel mateix servei en la trajectòria convencional d’hospitalització, en diferents processos de salut (mèdics, ortopèdics i ictus). En les dues modalitats, Facilitació d’Alta i Evitació d’Ingrés, el programa domiciliari es va comprovar que era eficient en la consecució de resultats clínics de resolució de crisis i de recuperació funcional, per les diferents trajectòries (mèdica, ortopèdica i ictus). Globalment, els resultats clínics foren comparables als de la trajectòria d’hospitalització convencional. En rehabilitació de processos aguts discapacitants la intervenció s’associà a favorable resolució de la crisi, comparant-la amb l’atenció habitual. En la modalitat de Facilitació d’Alta, en crisis mèdiques i ortopèdiques, la intervenció es va associar amb una estada hospitalària més curta. En la modalitat d’Evitació d’Ingrés en crisis mèdiques, es van evidenciar millors resultats al finalitzar la intervenció, a més d’una tendència no significativa a tenir taxes més reduïdes de reingrés als 30 dies. En l’atenció dels processos ortopèdics, es va evidenciar una reducció significativa en els costos directes de l’atenció. La creació del programa integrat d’HDI va suposar l’adaptació dels models d’hospitalització domiciliària geriàtrics a una població local adulta en el Sud d’Europa. Van identificar-se diversos factors clínics, provinents de l’AGI feta a l’ingrés a la unitat d’hospitalització domiciliària, com a relacionats amb resolució favorable de les crisis de salut ateses, com ara que el diagnòstic principal sigui ortopèdic, presentar una puntuació de més de 40 en l’índex de Barthel d’ingrés, o no presentar nafres per pressió. La recerca clínica presentada en aquesta tesi pretén contribuir a la implementació d’un model d’hospitalització domiciliària geriàtric, adaptat al sistema d’atenció integrat català, a partir de diferents consideracions de recerca futures que es descriuen en la discussió.
In the last decades, an international movement worldwide has developed different schemes in the community to provide care to older adults in complex health crises based on complex interventions. In the first part of this thesis, a literature review was done in order to analyse the main characteristics of several models of hospital-at-home care in older adults, based on two main modalities/strategies: Admission Avoidance (for providing hospital admission substitution and preventing hospital-related morbidities) and Early Supported Discharge (for shortening length of hospitalisation and facilitating community reinsertion after an acute admission). After knowing that there is a strong international evidence on hospital-at-home interventions for several processes of care in older populations, both on Early Supported Discharge and Admission Avoidance modalities, we designed a patientcentred complex intervention, by using Comprehensive Geriatric Assessment (CGA), based on the reviewed literature, to provide care of health crises in vulnerable older patients in need of hospital care. The Hospital-at-Home Integrated Care Programme (HaH-ICP) was piloted and evaluated in an urban area in the north of Barcelona, by a geriatrician-led multidisciplinary team. The programme was analysed using a quasi-experimental design, by comparing the results of the intervention provided in a hospital-at-home unit, linked to a department of geriatrics, with the results of contemporary matched patients that were attended by the same department in a hospital-based trajectory for several disabling health processes (medical, orthopaedics and stroke). In both, Early Supported Discharge and Admission Avoidance modalities, the homebased scheme was found efficient based on clinical outcomes of health crisis resolution and functional resolution, in several trajectories (medical, orthopaedic and stroke processes). Overall, the clinical results were comparable to the hospital-based trajectory. In the rehabilitation process of the disabling health crises, the intervention was found associated with favourable crisis resolution, compared to usual care. In the Early Supported Discharge trajectory, in medical and orthopaedics crises, the intervention led to shortening of acute stay. In Admission Avoidance in medical crises, better functional results at discharge were evidenced, and a non significant trend in lower readmission rates up to 30-day follow-up was observed. In orthopaedic processes, a significant reduction in direct costs was evidenced. The HaH-ICP was an adaptation of geriatrician-led hospital-at-home models of care to a local older adult population in Southern Europe. Several clinical factors from CGA at admission, such as suffering an orthopaedic process, having Barthel Index score higher than 40 points at admission, and not having pressure ulcers at admission, were found factors related with favourable crisis resolution. The clinical research presented in this Doctoral Thesis pretends to contribute to future implementation of the geriatrician-led multidisciplinary hospital-at-home model in the Catalan integrated care system, based on future research lines summarised in the discussion section.

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Decroix, Charlotte. "Du développement d’une intervention complexe en santé des populations à sa mise à l’échelle : aspects conceptuels et méthodologiques des études de viabilité, applications dans le champ de la petite enfance". Electronic Thesis or Diss., Bordeaux, 2024. http://www.theses.fr/2024BORD0007.

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Les enjeux de santé publique auxquels nos systèmes de santé et éducatif ont à faire face nécessitent des transformations qui passent notamment par le développement d’interventions en santé des populations (actions, programmes, organisations, politiques). Ces interventions sont généralement considérées comme complexes. La complexité est un enjeu majeur pour l’évaluation des interventions. Si les devis expérimentaux sont les références pour la recherche clinique, leur contrôle des facteurs contextuels pour renforcer la validité interne des études, obère la validité externe de ces recherches. Il convient d’aller au-delà de ces designs centrés sur l’efficacité, afin de comprendre les mécanismes et processus de l’intervention. Cette approche doit permettre d’examiner la mise en oeuvre et les conditions de routinisation, de transférabilité et de mise à l’échelle de l’intervention, dans le monde réel. Dans cette perspective, Chen a proposé un changement de paradigme en développant le modèle de la validité intégrative. Dans une approche ascendante, celui-ci reconnait 3 types de validité : la validité interne, la validité externe et la validité viable. La validité viable s’intéresse à l’intégration des interventions dans le système dans lequel elle vise à être déployées, hors d’un contexte de recherche. La validité viable correspond à la perception des parties prenantes quant à savoir si une intervention est utile, appropriée, faisable, abordable, adaptée et évaluable, dans le monde réel (Chen, 2010). Cette thèse s’intéressait à la pertinence de l’approche ascendante pour les interventions en santé des populations et au concept de viabilité : Quelle est la place de la viabilité dans le développement et l’évaluation d’interventions complexes en santé des populations ? En quoi l’étude de la viabilité est un préalable pour envisager la pérennisation, le transfert et la mise à l’échelle de l’intervention ? Quels sont les critères (et dimensions) à considérer pour analyser la viabilité ? L’objectif était d’analyser la viabilité d’interventions innovantes à partir du vécu de l’intervention par les parties prenantes. Une stratégie d’étude de cas multiples, mobilisant des méthodes qualitatives, suivant plusieurs niveaux d’analyse imbriqués a été choisie. Les trois cas ont été sélectionnés au regard de points de similitudes (ex : intervention dans le champ de la petite enfance) et de contrastes. Les résultats étaient en convergence avec les postulats de Chen quant à la pertinence d’adopter une approche ascendante en recherche et de s’intéresser à la validité viable. Elle proposait de décrire la viabilité comme le potentiel d’une intervention innovante : (i) à s’intégrer dans les projets, programmes, organisations, politiques existantes afin de former un tout cohérent en termes d’objectif, de missions des parties prenantes, de leviers d’interventions et de moyens ; et (ii) à faire sens pour les parties prenantes de l’intervention dans le monde réel. Ce « faire sens » dépendait de l’adéquation entre la perception des parties prenantes de l’intervention innovante et du système dans lequel elles évoluent. Les résultats ont permis d’éprouver les critères de viabilité tels que mis à jour par Chen en 2023 et de les décliner en dimensions. Ils ont mis en avant l’interdépendance de la perception de ces critères par les parties prenantes qu’ils soient liés à la nature ou à la faisabilité de l’intervention. En outre la viabilité est située : il s’agissait de s’intéresser aux conditions de viabilité plus que de proposer une vision binaire de la viabilité. Différents déterminants de la viabilité ont été identifiés : les composantes du changement organisationnel et les niveaux de l’approche socio-écologique. Finalement, cette thèse a permis d’interroger la définition d’une intervention probante sous le prisme de la viabilité. Des recherches complémentaires sont en cours pour interroger le concept dans une perspective interdisciplinaire
Public health challenges facing our healthcare and education systems call for transformations that include the development of population health interventions (actions, programs, organizations, policies). These interventions are generally considered to be complex. Complexity is a major issue for the evaluation of interventions. While experimental designs are the gold standard for clinical research, their control of contextual factors to reinforce the internal validity of studies obviates the external validity of such research. It's essential to go beyond these efficacy-focused designs, in order to understand the mechanisms and processes of the intervention. This approach should make it possible to examine the implementation and conditions of routinization, transferability and scaling-up of the intervention, in the real world. To this end, Chen proposed a paradigm shift by developing the integrative validity model. This bottom-up approach recognizes 3 types of validity: internal validity, external validity and viable validity. Viable validity concerns the integration of interventions into the system in which they are to be deployed, outside a research context. Viable validity corresponds to stakeholders' perception of whether an intervention is useful, suitable, practical, affordable and evaluable, in the real world (Chen, 2010). This PhD explored the relevance of the bottom-up approach to population health interventions and the concept of viability: What is the place of viability in the development and evaluation of complex population health interventions? In what way is the study of viability a prerequisite for considering the sustainability, transfer and scaling-up of interventions? What criteria (and dimensions) should be considered when analyzing viability? The aim was to analyze the viability of innovative interventions based on stakeholders' experience of the intervention. A multiple-case study strategy, mobilizing qualitative methods and following several interlocking levels of analysis, was chosen. The three cases were selected on the basis of similarities (e.g.: intervention in the field of early childhood) and contrasts. The results converged with Chen's postulates on the relevance of adopting a bottom-up approach to research and focusing on viable validity. They suggested describing viability as the potential of an innovative intervention: (i) to integrate with existing projects, programs, organizations and policies to form a coherent whole in terms of objective, stakeholder missions, intervention levers and inputs; and (ii) to make sense to the intervention's stakeholders in the real world. This "making sense" depended on the fit between the stakeholders' perception of the innovative intervention and the system in which they are evolving. The results made it possible to test the viability criteria as updated by Chen in 2023 and to decline them into dimensions. They highlighted the interdependence of stakeholders' perceptions of these criteria, whether related to the substance or feasibility of the intervention. Moreover, viability is situated: the aim was to focus on the conditions of viability rather than to propose a binary vision of viability. Various determinants of viability were identified: the components of organizational change, the interlocking levels of the socio-ecological approach. Finally, this research questioned the definition of a evidence-based intervention through the prism of viability. Further research is underway to examine the concept from an interdisciplinary perspective

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15

Cambon, Linda. "Étude de la transférabilité des interventions de promotion de la santé dans une perspective de promotion des démarches "evidence based health promotion" : développement d'un outil d'analyse de la transférabilité des interventions". Thesis, Université de Lorraine, 2012. http://www.theses.fr/2012LORR0276/document.

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Contexte : Les interventions de promotion de la santé agissent sur l'ensemble des déterminants de la santé. Cette caractéristique en fait le levier nécessaire à la lutte contre les inégalités sociales de santé mais rendent ces dernières complexes à mettre en oeuvre, à évaluer et à transférer. Il y a un enjeu à développer en France la promotion de la santé fondée sur les preuves et donc à favoriser le transfert d'interventions. La question de la transférabilité, c'est-à-dire la mesure dans laquelle l'effet d'une intervention dans un contexte donné peut être atteint dans un autre contexte, devient alors cruciale à étudier. Objectif : Les objectifs de ce travail étaient : définir le concept de la transférabilité dans le champ de la promotion de la santé ; développer un outil d'analyse de la transférabilité et d'accompagnement au transfert d'intervention de promotion de la santé. Méthodes : Pour répondre à ces objectifs, nous avons mis en oeuvre un projet, EVATRAPS (EVAluation de la TRAnsférabilité des interventions en Promotion de la Santé). Ce projet s'est déroulé en deux étapes. La première consistait en une revue de la littérature qui visait notamment à définir le concept de transférabilité, en déterminer les facteurs d'influence, repérer s'il existait des outils permettant d'analyser la transférabilité des interventions. La deuxième étape a été réalisée grâce à une méthode de concept mapping qui permettait de faire générer par un groupe d'experts une liste de critères de transférabilité des interventions en promotion de la santé, de les organiser en catégories et de coter leur pertinence. Ces critères ont ensuite été organisés en un outil d'analyse de la transférabilité et testé à deux reprises sur le terrain par des chefs de projets et experts. Résultats : L'outil conçu, nommé ASTAIRE (outil d'AnalySe de la Transférabilité et d'Accompagnement à l'adaptation des InteRventions en promotion de la santE), est organisé en deux grilles, l'une de 18 critères et 56 sous-critères destinée aux producteurs d'interventions nouvelles afin qu'ils intègrent, dès la conception de leur intervention, des paramètres de transférabilité ; une deuxième grille de 23 critères et 69 sous-critères, destinée aux acteurs de terrain et visant à analyser la transférabilité d'une intervention de promotion de la santé et accompagner son adaptation dans un nouveau contexte. Discussion : Ce travail a permis de proposer des perspectives concernant l'utilisation d'ASTAIRE, l'intégration de la démarche fondée sur les preuves dans la conduite de projets en promotion de la santé et plus globalement, le développement du transfert de connaissances en France. Enfin, nous avons poursuivi nos réflexions sur les modalités de recherche prenant davantage en compte la complexité des interventions de promotion de la santé
Context: Health promotion interventions influence all health determinants and contribute to reduce social inequities in health. So, interventions in this field are considered complex, both to implement, to evaluate and consequently to transfer in another setting. That is why, it is difficult to develop, in France, evidence-based health promotion and, consequently, to transfer health promotion intervention experimented in another setting. Transferability, that is the extent to which the result of one intervention in a given setting can be achieved in another setting, becomes an important subject to study. Objective: The objectives were: (1) to define the concept of transferability in health promotion; (2) to develop a tool to analyze transferability and to support the adaptation of health promotion interventions to new setting. Methods: We implemented a project named, EVATRAPS (EVAluation of TRAnsferabilty of health Promotion interventionS). The project developed in two steps. The first step was an review of international literature intended to define factors that influence transferability and tools and criteria available to assess transferability. The second step used a concept mapping method that allowed to a group of experts, to generate a list of ideas associated with a concept, to group them statistically into categories and to score them for their relevance. From the final list of criteria thus structured, a tool to analyze transferability was created. This tool was subsequently tested by stakeholders and experts. Results: After testing, a tool, named ASTAIRE (for ASsessment of Transferability and Adaptation of health promotion InteRvEntions), contained 23 criteria structured into four categories. It consists of two grids?one for reporting data from primary interventions and one for analyzing transferability of intervention and supporting their adaptation to the new setting. Discussion: This project contributed to develop perspectives to facilitate the transfer of health promotion interventions, leverage evidence-based practices and more globally develop a knowledge transfer system in France. Finally, we have suggested reflexions about research methodologies in health promotion in order that they take into account of complexity of health promotion intervention, notably in evidence based practices perspective

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Mutale, W. "Evaluation of a complex health intervention in Zambia : the case of the Better Health Outcome through Mentorship and Assessment (BHOMA) applying system wide approaches to measuring health system strengthening : essential markers and impact pathway". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2014. http://researchonline.lshtm.ac.uk/1917782/.

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Introduction: In many low income countries the delivery of quality health services is hampered by health system-wide barriers which are often interlinked, however empirical evidence on how to assess the level and scope of these barriers is scarce. It has been recognised that taking a more comprehensive approach to assessing these barriers is more likely to provide lessons on what works and why. WHO has been advocating the use of systems wide approaches such as systems thinking to guide intervention design and evaluation. This thesis reports system-wide assessment of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality at the health facility and influence service demand from the community. Methodology: This study is nested within a cluster randomised trial of the BHOMA intervention that aims to strengthen the health system in three rural districts covering 42 health facilities in Zambia. The main trial has a stepped wedge design where the intervention is being rolled-out to all the 42 health facilities over a period of 4 years. A baseline health facility survey was done in 2011. This was followed by a 12 months post-intervention evaluation survey. At the time of the follow up survey 24 health facilities had received the intervention while 18 had not. Data collection used both quantitative and qualitative methods. The study was guided by a systems thinking theoretical framework which was inspired by the WHO building blocks for health system strengthening. Results: The baseline survey validated tools and indicators for assessing health system building blocks. Research paper 2 applied an innovative measure of health worker motivation which was initially applied in Kenya. The results showed that this simple tool was reliable with cronbach’s alpha of 0.73 for the 21 item measures of health workers’ motivation. Baseline assessment of health worker motivation showed variation in motivation score based on gender and access to training. Research paper 3 tested and applied a new tool for measuring health systems governance at health facility level. The new tool for measuring governance was reliable with the 16 item one side cronbach’s alpha ranging between 0.69-0.74.The tool was simple to use and found to be applicable in the Zambian health care setting. A balanced scorecard approach was applied to measure the baseline health system characteristics for the target districts. Differences in performance were noted by district and residence in most domains with finance and service delivery domains performing poorly in all study districts. Regression modelling showed that children’s clinical observation scores were negatively correlated with drug availability (coeff 20.40, p = 0.02) while Adult clinical observation scores were positively association with adult service satisfaction score (coeff 0.82, p = 0.04) Baseline qualitative results are presented in paper 5. The results showed close linkages between health system building blocks. Challenges noted in service delivery were linked to human resources, medical supplies, information flow, governance and finance building blocks either directly or indirectly. The 12 months post intervention survey applied both quantitative and qualitative methods. Research paper 6 presents 12 months post intervention quantitative results applying the balanced scorecard approach as at baseline. Comparison was made between the control and intervention health facilities. The results showed significant mean differences between intervention (I) and control (C) sites in the following domains: Training domain (Mean I:C;87.5.vs 61.1, mean difference 23.3,p=0.031),adult clinical observation domain (mean I:C;73.3 vs.58.0, mean difference 10.9,p=0.02 ). The 12 months post intervention qualitative evaluation applied systems thinking approach and the conceptual framework developed before the intervention. The findings are presented in research paper 7. The overall results showed that the community had accepted the intervention with increasing demand for services reported in all sites where the BHOMA intervention was implemented. The indications were that in the short term there was increased demand for services but the health workers’ capacity was not severely affected. However, from a systems thinking perspective, it was clear that several unintended consequences also occurred during the implementation of the BHOMA. Conclusion: In evaluation of complex interventions such as the BHOMA attention should be paid to context. Using system wide approaches and triangulating data collection methods seems to be important to successful evaluation of such complex intervention.

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Cravo, Oliveira Tiago. "Accounting for behaviours and context in evaluations of complex health interventions". Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/24687.

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Health care systems across developed countries face a perfect storm of rising demand and constrained funding. Systems have relied so far on short-term fixes but the time for incremental piecemeal solutions is passing. To achieve transformational change and fundamental service redesign, policy makers are resorting to ever more complex interventions. Evaluating their effects is far from trivial. From public health programmes, to integrated and community care services, to electronic health technologies, complex health interventions typically exhibit a large number of components and interactions among them and other parts of the system; involve numerous intricate behaviours by those delivering and receiving the intervention; engage multiple and diverse groups, organisational levels and populations; result in many outcomes, typically with a high degree of variability; and are extensively tailored to local settings and circumstances. Evaluating such interventions is as much about whether they work, as how and why. In this research, I examine the difficulties in using standard economic evaluation methods to assess complex interventions in the outpatient setting, and develop an approach to evaluation which uses methods and techniques that can explicitly address complexity, incorporate preferences and behaviours of patients and carers, and account for wider contextual influences. I apply the suggested approach to the evaluation of teleconsultation in Alentejo, drawing on insights from previous theoretical and empirical research, new econometric and statistical studies, and simulation modelling. The application makes contributions to extant research on behaviour and decision making, and has implications for the evaluation of teleconsultation, as well as for broader discussions of how to assess complex interventions. Complex health interventions have the potential to deliver a revolution in health care, but to achieve it we must be able to identify those that truly work, how and why. It is hoped the approach suggested here will contribute to that objective.

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18

Colombani, Françoise. "Modélisation de la coordination des soins infirmière en cancérologie : de l’analyse conceptuelle au transfert vers les décideurs". Electronic Thesis or Diss., Bordeaux, 2024. http://www.theses.fr/2024BORD0113.

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Face aux mutations démographiques, à la progression des maladies chroniques dont le cancer, et en réponse à la fragmentation des systèmes de santé actuels, la coordination des soins est devenue une priorité de Santé publique mondiale. Les patients atteints de cancer sont particulièrement à risque de recevoir des soins mal organisés en raison de la complexité de leur prise en charge, impliquant de multiples équipes médicales, infirmières, médico-sociales et sociales sur une durée prolongée. Ce défaut de coordination se fait au détriment de la qualité et de l’efficience des soins. Les progrès en matière de coordination des soins ont été limités par l'absence de définition commune et un manque de précision sur les modalités de sa mise en œuvre. En France, de nouvelles fonctions de coordination infirmière en cancérologie ont été introduites, sans conceptualisation préalable, conduisant à une grande diversité d'actions et d’intitulés de poste. Cette hétérogénéité entrave la reconnaissance, la compréhension de leurs actions et l'évaluation de leur performance. Face à l’absence d’analyse fine du périmètre d’action de ces professionnels et de cadre théorique de la coordination des soins, ce projet de thèse vise, en trois volets, à modéliser l’intervention infirmière de coordination des soins en cancérologie et trouver les leviers pour une prise en compte de ces résultats dans la politique nationale de coordination des soins en France. Le premier volet, conceptuel, a permis de développer un cadre de référence innovant centré sur les activités de coordination au moyen d’une scoping review et d’une méthode de consensus structurée (groupe nominal) ayant inclus des décideurs, des organisateurs et des patients partenaires. Le deuxième volet centré sur les pratiques, a produit un modèle opérationnel de l’intervention infirmière de coordination des soins en cancérologie exerçant en établissement de santé, en confrontant les attendus théoriques (cadre du volet 1) aux pratiques et aux représentations que ces infirmiers, leurs patients, aidants et partenaires professionnels avaient de cette intervention de coordination. L’enquête de terrain a consisté en une étude mixte multicentrique nationale par triangulation d’informations qualitatives (observations, entretiens, focus groups), et quantitatives (échelles validées) des pratiques, contextes, perceptions et attitude au travail des infirmiers de coordination en cancérologie en France. Le troisième volet a été dédié au transfert des résultats vers les décideurs via l’organisation d’un séminaire national de travail impliquant l’ensemble des acteurs du champ (régulateurs, administrateurs d’hôpitaux, associations professionnelles, chercheurs, infirmiers, patients partenaires). Son objectif était de présenter en avant-première les résultats de la modélisation, partager les expériences d’autres équipes de recherche sur le sujet, et décliner le modèle opérationnel en actions concrètes, par la construction par consensus d’une fiche de poste et la définition des éléments minimaux d’accompagnement managérial et prérequis à la prise de fonctions de ces infirmiers. Ce projet de thèse a produit des connaissances nouvelles sur la coordination des soins, en général et plus spécifiquement en cancérologie, sur le plan conceptuel (cadre de référence), interventionnel (modèle opérationnel) et translationnel (fiche de poste). Les travaux présentés dans cette thèse ouvrent ainsi la voie à un déploiement optimal de ces fonctions pour la décision publique en santé à l’évaluation de l’impact de ces interventions
Faced with demographic changes, the rise of chronic diseases including cancer, and in response to the fragmentation of current healthcare systems, care coordination has become a priority in global public health. Cancer patients are particularly at risk of receiving poorly organized care due to the complex nature of the disease and its management, which involves multiple medical, nursing, socio-medical, and social teams operating at different levels of the healthcare system over an extended period. This lack of coordination affects the quality and efficiency of care. Progress in care coordination has been hindered by the lack of a common definition and precision on how it should be implemented. In France, new nursing coordination functions in oncology have been introduced without prior conceptualisation, leading to a wide variety of actions and job titles. This heterogeneity hampers the recognition, understanding of their actions, and the evaluation of their performance. In the absence of a detailed analysis of the scope of action of these professionals and a theoretical framework for care coordination, this thesis project aims, in three parts, to model nursing care coordination intervention in oncology and to identify ways to implement these results into the national health policy of care coordination in France. The first part (conceptual) allowed the development of an innovative reference framework focused on coordination activities through a scoping review and a structured consensus method (nominal group technique) involving decision-makers, organizers, and patient partners. The second part, focusing on practices, produced an operational model of hospital-based cancer coordination nurses’ intervention, by comparing theoretical expectations (framework from part 1) with the practices and perceptions that these nurses, their patients, caregivers, and professional partners had of this coordination intervention. The field survey consisted of a national multicenter mixed-method study through a triangulation of qualitative (observations, interviews, focus groups) and quantitative (validated scales) information on practices, contexts, perceptions, and attitudes towards work among oncology care coordination nurses in France. The third part was dedicated to transferring results to decision-makers through the organisation of a national workshop involving all stakeholders in the field (regulators, hospital administrators, professional associations, researchers, nurses, patient partners). Its objective was to present the modelling results, share experiences from other research teams on the subject, and translate the operational model into concrete actions through consensus-building of a job description, and defining the minimum elements of managerial support and prerequisites for these nurses' functions. This thesis project has generated new knowledge on care coordination, both in general and more specifically in oncology, at a conceptual level (reference framework), interventional level (operational model), and translational level (job description). The work presented in this thesis thus paves the way for optimal deployment of these functions for public health decision-making (implementation of the job description, standardisation of training), and research evaluation of the effects and impact of these interventions

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LIU, HUEIMING. "Strengthening health systems through the use of process evaluations of complex interventions". Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/19603.

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Strengthening health systems to provide affordable, effective and accessible care in a lifecourse approach is necessary to address the growing global burden from non-communicable diseases (NCD). To address deficiencies in the health system, researchers have designed and trialled ‘complex interventions’ which are defined as interventions with multiple interacting components, and complexity in its implementation. Process evaluations alongside randomised controlled trials (RCT) of complex interventions are highly valuable. They explore implementation and different stakeholders’ perspectives as to for whom, how and why a complex intervention has an impact.

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20

Hoyland, Philip. "Computer-assisted electrophysiological intervention treating complex ventricular arrhythmias". Electronic Thesis or Diss., Université de Lorraine, 2021. http://www.theses.fr/2021LORR0271.

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Depuis le début des années 1990 et l'utilisation de l'énergie de radiofréquence pour l'ablation par voie endocavitaire des troubles du rythme rapide, les rythmologues interventionnels prennent en charge des troubles du rythme de plus en plus complexe. Des systèmes de cartographie 3D permettent une représentation précise dans l'espace du positionnement du cathéter et constituent donc un outil très important pour le rythmologue interventionnel. L’identification des zones d’intérêts reste néanmoins longue et sujet à des nombreuses étapes reposant sur des analyses indirectes des propriétés électriques du cœur. L’objectif principal de la thèse est le développement de nouveaux outils afin de localiser l’isthme critique des tachycardies ventriculaires après infarctus du myocarde. L’identification précise des composantes du circuit de la tachycardie ventriculaire permet la mise en place d’une stratégie d’ablation pour traiter le patient. Les méthodes étudiées ne nécessitent pas un électrocardiogramme (ECG) à 12 dérivations de la tachycardie ventriculaire et présentent donc l’avantage de pouvoir être utilisées même en cas d’échec de déclenchement de la tachycardie pendant la procédure. Un axe majeur de recherche est le développement d’un algorithme qui permet d’extraire de façon automatique les données pertinentes obtenus lors de la topo-stimulation. Cela permet de faciliter l’affichage des cartes multi paramétriques mettant en avant les circuits de réentrée. Un autre axe de recherche est l’étude des variations des propriétés électriques du ventricule sous forme de graphe. Les points de stimulations sont considérés comme l’ensemble des sommets du graphe. Chaque arrête est associé à un poids et trouver le chemin entre deux sommets de poids minimum permet d’analyser les circuits de réentrée possibles
Since the beginning of the nineties and the use of radiofrequency to ablate cardiac arrhythmias, electrophysiologists treat rhythm disorders of increasing complexity. 3D mapping systems enable catheter locations to be determined with high precision and therefore are very important tools for cardiac electrophysiologists. Identifying zones of interest remains long and involves a great number of steps based on indirect analyses of the heart's electrical properties. The main objective of the thesis is the development of new tools to locate the critical isthmus in patients who have ventricular tachycardia after myocardial infarction. The clear identification of the circuit components of the ventricular tachycardia enables the implementation of an ablation strategy to treat the patient. The studied methods do not require a 12-lead electrocardiogram (ECG) of the ventricular tachycardia and therefore have the advantage of being able to be used even if the ventricular tachycardia cannot be initiated during the procedure. Pace mapping consists of stimulating the myocardium and analyzing the induced signal, the 12-lead morphology and the S-QRS interval. A major area of research is the development of an algorithm that automatically extracts the relevant data obtained during pace mapping. This facilitates the display of multi-parametric maps highlighting potential reentry circuits. Another area of research is the development of a graph-based method to study the variations of the electrical properties of the ventricle. The paced points are considered as vertices of a graph. Each edge is given a weight and finding the path between two vertices of minimum weight allows the analysis of potential reentry circuits

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21

Raab, Markus. "Techniktraining im Tischtennis Intervention und Evaluation /". [S.l. : s.n.], 2004. http://deposit.ddb.de/cgi-bin/dokserv?idn=97467222X.

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Nelson, J. Ron. "Evaluation of Utah's Prereferral Intervention Mandate". DigitalCommons@USU, 1990. https://digitalcommons.usu.edu/etd/6855.

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The primary purpose of the present study was to evaluate the impact of Utah's prereferral intervention policy on the numbers of mildly handicapped students receiving special education services. Associated with this purpose, the study was also designed to identify the (a) types of prereferral intervention procedures available in school districts, (b) extent to which the procedures were implemented by schools, (c) effectiveness of the prereferral intervention procedures for maintaining students with handicaps in regular education, and (d) degree of prereferral intervention inservice training. In addition, LEA officials' perceptions regarding the prereferral intervention process were also examined. It was expected, in light of previous research, that the prereferral intervention mandate would decrease the numbers of students classified (a) mildly handicapped, (b) learning disabled, (c) behavior disordered, and (d) intellectually handicapped. Because there was no information to suggest otherwise, it was also expected that the mandate would fail to have a differential effect on rural and urban school districts and on the numbers of students classified as severely intellectually handicapped (control variable), whereas the degree of prereferral intervention inservice training provided teachers was expected to exert a systematic influence on the outcomes. Results of the evaluation showed that the prereferral intervention mandate failed to impact the numbers of students classified (a) mildly handicapped, (b) learning disabled, (c) behavior disordered, and (d) intellectually handicapped, and (e) severely intellectually handicapped (control variable). The mandate also failed to have a differential effect on rural and urban school districts. In addition, the results of the survey indicated that LEAs have implemented a variety of prereferral intervention procedures. However, within school districts, the number of schools implementing the procedures varied. LEA officials were uncertain whether the prereferral intervention procedures were effective or whether they should be maintained. LEA officials also indicated that teachers fail to benefit from their participation in the prereferral intervention process. Furthermore, they were uncertain whether the process is a bureaucratic hurdle and whether it should be maintained. (116 pages)

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23

Nattino, Giovanni. "Causal Inference in Observational Studies with Complex Design: Multiple Arms, Complex Sampling and Intervention Effects". The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1562582646286934.

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Redfern, Judith Marion. "Methods for developing and evaluating randomised controlled trials of complex interventions : case study of stroke secondary prevention". Thesis, King's College London (University of London), 2007. https://kclpure.kcl.ac.uk/portal/en/theses/methods-for-developing-and-evaluating-randomised-controlled-trials-of-complex-interventions--case-study-of-stroke-secondary-prevention(d0a616ac-5bce-4d9a-aea7-9ad88717990e).html.

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25

Siddiqi, Najma. "A complex intervention for delirium, preventing delirium in care homes". Thesis, University of Leeds, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.511151.

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26

Wylie, Richard William Jr. "Response to Intervention| A Study of Intervention Programs in Rural Secondary Schools". Thesis, Lindenwood University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10785181.

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During the late 20th and early 21st centuries, a trend developed for schools to meet the needs of struggling and at-risk learners through the implementation of multi-tiered response to intervention models (Apple, 2014). Response to intervention (RtI) is one of those frameworks and has been extensively researched from the perspective of those working in urban elementary schools (Burns & Gibbons, 2013). This research project was designed to allow for better understanding of the rural secondary perspective of RtI through investigation of the perceptions of administrators, counselors, and educators who have implemented RtI frameworks. This qualitative examination resulted in a narrative gathered through interviews with teachers, counselors, and administrators working in rural secondary schools of southwest Missouri about their experiences with academic intervention strategies and response to intervention. Data were gathered during the fall and spring of 2017. The purpose of this study was to add to the limited body of research about the implementation, operationalization, and improvement of RtI programs in rural secondary schools. Respondents identified difficulties and obstacles and illustrated how the implementation of RtI has affected their roles. Both similarities and differences were discovered between rural secondary-level staff and their urban elementary-level colleagues. Respondents explained how solutions addressed problems with their programs. The researcher noted how this process created one-of-a-kind multi-tiered intervention programs. Lastly, suggestions for additional research were offered.

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27

Song, Tao. "Colour difference evaluation for complex images". Thesis, University of Derby, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.443570.

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28

Deary, Vincent Aaron Vernon Adrian Hugo. "Cognitive behavioural therapy for functional dysphonia : development of a complex intervention". Thesis, University of Newcastle Upon Tyne, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.576979.

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Functional dysphonia, loss or alteration of voice in the absence of physical pathology, is the commonest presentation to speech and language therapists (SLTs) and accounts for up to 40,000 new cases every year in the UK. Besides its impact on personal and work life, functional dysphonia is also associated with increased levels of anxiety and depression and poor general health. Voice therapy delivered by SLTs improves voice but not these associated symptoms. The aim of this research project was therefore to develop an improved intervention. Method A broad cognitive behavioural model of medically unexplained symptoms (MUS) was researched and identified as a suitable theoretical basis for the intervention development process. This was then applied as an assessment format in a series of patient interviews. Data from this stage were used to design a cognitive behavioural therapy (CBT) intervention for a SLT to deliver in a small consecutive cohort study. Data and clinical insights from this study were used to further develop the CBT intervention, which was then trialled in an external pilot patient randomised trial. Following up findings from the consecutive cohort phase, particular attention was paid in the randomised trial to the process issues involved in the professional behaviour change of the SLT, and a questionnaire study to investigate fatigue and perfectionism in functional dysphonia patients was conducted. Results and conclusion It was acceptable and feasible for a SLT to deliver CBT and there was some evidence of clinical effectiveness. This data is used to discuss the power and design of a future definitive study. The focus on process illuminated the work that needed to be done to embed a complex intervention in clinical practice. Functional dysphonia was shown to resemble other MUS in ways that could significantly contribute to our understanding and treatment of this condition.

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29

Backhouse, Amy. "Developing a complex intervention to coordinate care for people with dementia". Thesis, University of Exeter, 2017. http://hdl.handle.net/10871/33267.

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The degenerative nature of dementia and its complexity of needs is becoming an increasing challenge to UK health and social care. Current care services have been reported as fragmented, providing poor quality of care and poor value for money. Coordinating interventions have shown a potential to improve outcomes for individuals living with dementia through the use of case managers who take responsibility for the provision of care through planning, facilitating and coordinating care. However, there is substantial variation across models including components, implementation methods and settings. The aim of this thesis was to explore these variations and develop a complex intervention to coordinate care for individuals living with dementia through a series of studies following the Medical Research Councils (MRC) framework. Two exploratory sequential systematic reviews were conducted to evaluate the evidence base for coordinating interventions in dementia. Firstly, thematic synthesis was conducted on data from seven papers from five independent studies evaluating qualitative evidence on the experience and perspectives of stakeholders and their views on key components of coordinating interventions. Synthesis identified five descriptive themes grouped from 32 codes: (1) Case Manager, (2) Communication, (3) Intervention, (4) Resources and (5) Support. The findings demonstrated stakeholders valued coordinating interventions in dementia care, and had clear preferences on the components, implementation methods and settings of interventions. The following systematic review synthesised evidence from 14 identified randomised controlled trials (RCTs) to evaluate the effectiveness of coordinating interventions and investigate associations between identified key components and intervention effects. Meta-analyses found individuals in coordinating interventions showed a significant improvement in caregiver burden and patient behaviour compared to individuals in usual care. Subgroup analyses found coordinating interventions using a case manager with a nursing background showed a greater positive effect on caregiver quality of life than those using case managers from other professions. Interventions that did not provide case managers with supervision showed a greater effectiveness of reducing rates of institutionalisation than interventions providing supervision. Evidence from the two systematic reviews were used to inform the development of a conceptual model of a coordinating intervention for dementia care. The conceptual model outlines the resources required for the intervention, intervention components including the activities and outputs required for each component, and the primary, intermediate and long-term outcomes of the interventions at a service user level and a system level. Following the modelling stage, a qualitative study was conducted using semi-structured interviews with 22 stakeholders including individuals with dementia, informal caregivers and a range of professionals from health care, social care and third sector organisation. Interviews were used to explore the perspectives and experiences of a range of stakeholders on the coordination of current services, and their views on the likely acceptability, utility and success of the conceptual model of care. Thematic analysis identified four overarching themes relating to stakeholder perspectives and experience of current care: (1) Societal Attitudes, (2) Care Conflict, (3) Disconnected Systems, and (4) Living Well with Dementia. A further three overarching themes were identified relating to stakeholders views on the conceptual model: (1) Barriers and Facilitators to Model Implementation, (2) Focus of the Intervention and Case Manager Role, and (3) Attributes of Case Manager. Both service users and professionals described a fractured system of care that they felt reflected existing discriminatory attitudes around dementia and the care of older adults. Participants felt a sense of hopelessness when it came to the treatment of dementia and a lack of accountability when it came to continued support. Many participants saw the value of having a case manager and felt the conceptual model for coordinating care could be effective for individuals living with dementia. However, stakeholders also identified potential barriers to implementation, namely funding, potential overlap with current services and roles, and workload of the case manager. The work in this thesis has identified a range of intervention components, implementation methods and settings of which stakeholders prefer, some of which have been proven to have associations with intervention effects. Incorporating these preferences into a conceptual model of a coordinating intervention in dementia care had a positive response with both service users and professionals who saw the model as a valuable tool in coordinating services, and a process that could fill a current gap in a fragmented care system.

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30

Gram, L. Z. "Women's empowerment in a complex public health intervention in rural Nepal". Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10043724/.

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This thesis presents a study of women’s empowerment in Nepal, a low-income country in South Asia with significant gender inequities across multiple dimensions. The thesis took place in the context of a cluster randomized controlled trial called the Low Birth Weight, South Asia Trial (LBW-SAT), which compared the impact of participatory women’s groups either alone or in combination with food or cash transfers on low birth weight. The thesis sought to understand the impacts of participatory women’s groups on women’s empowerment, as well as the role of agency in enabling or obstructing women’s use of cash transfers. First, a scale for measuring women’s agency freedom Deci and Ryan’s Self-Determination Theory [1] was validated and adapted for use in the local context. Second, the adapted tool was applied to evaluate the impact of LBW-SAT on women’s agency freedom. The results showed little evidence for an impact on women’s empowerment across a range of measures, except an improvement in women’s agency in group participation (p < 0.01). Third, a grounded theory study was conducted on women’s financial agency in the household. The results showed that daughters-in-law had severely restricted access to cash, while their mothers-in-law were recipients of household income and managers of savings, loans and expenditures. Fourth, results from the same grounded theory study showed that LBW-SAT trial staff put considerable pressure on beneficiary families to avoid non-recommended uses of their cash transfers. Thus, while daughters-in-law were often allowed to spend the cash transfer on food by their family members, daughters-in-law may have feared angering LBW-SAT staff if they spent the cash transfer on non-food items. Future researchers and policy-makers need to better integrate economic and gender considerations into health programming to achieve empowerment objectives.

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31

Steventon, A. "Evaluating complex interventions using routinely collected data : methods to improve the validity of randomised controlled trials and observational studies". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2015. http://researchonline.lshtm.ac.uk/2212900/.

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This thesis addresses the evaluation of complex interventions using routinely collected data, specifically the internal validity of observational studies and the generalisability of Randomised Controlled Trials (RCTs). Following a literature review, this thesis has four main objectives: to estimate the effect of telephone health coaching on hospital utilisation in an observational study; to assess optimal choices of control area in observational studies; to estimate the effect of telehealth within a large RCT; and to develop methods to assess aspects of the generalisability of RCTs empirically. The first paper compares health-coached patients with matched controls. Controls were selected from areas of England that were first matched to the characteristics of the intervention area. Health coaching did not reduce hospital admissions in this study. A second paper uses simulations to assess the relative bias and statistical precision in the treatment effects estimated under alternative approaches to selecting control areas. Lower bias is reported when using local controls than when selecting controls from matched areas, except when there is little unexplained area-level variation in outcomes, when the opposite is true. The third paper reports that, in the RCT, telehealth patients had fewer hospital admissions than controls, but admissions increased unexpectedly among controls after recruitment, leading to concerns about generalisability. Placebo tests find that control patients in the RCT experienced more admissions than matched non-participants receiving usual care. To address the concern that the control group did not receive ‘usual care’, sensitivity analyses are presented that contrast outcomes between the telehealth patients in the RCT and matched non-participants. In this comparison, telehealth is associated with a trend towards more admissions than usual care. The thesis concludes that careful control matching and placebo tests can address important aspects of the validity of observational studies and RCTs, but that further development of evaluation methods is warranted.

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32

Manzano, Castro Marc. "New robustness evaluation mechanism for complex networks". Doctoral thesis, Universitat de Girona, 2014. http://hdl.handle.net/10803/295713.

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Network science has significantly advanced in the last decade, providing insights into the underlying structure and dynamics of complex networks. Critical infrastructures such as telecommunication networks play a pivotal role in ensuring the smooth functioning of modern day living. These networks have to constantly deal with failures of their components. In multiple failure scenarios, where traditional protection and restoration schemes are not suitable because of the quantity of resources that would be required, the concept of robustness is used in order to quantify just how good a network is under such a large-scale failure scenario. The aim of this thesis is to, firstly, investigate the current challenges that might lead to multiple failure scenarios of present day networks and, secondly, to propose novel metrics able to quantify the network robustness.
La ciència de les xarxes (o network science) ha avançat significativament en l'última dècada, proporcionant coneixement sobre l'estructura subjacent i la dinàmica de les xarxes complexes (o complex networks). Infraestructures crítiques com xarxes de telecomunicacions, juguen un paper fonamental per garantir el bon funcionament de la vida moderna. Aquestes xarxes han de lidiar constantment amb fallades dels seus components. En escenaris de fallades múltiples, on els esquemes de protecció i restauració tradicionals no són adequats degut a la gran quantitat de recursos que serien necessaris, el concepte de robustesa (o robustness) s'utilitza per tal de quantificar com de bona és una xarxa quan es produeix una fallada a gran escala. L'objectiu d'aquesta tesi és, en primer lloc, investigar les amenaces actuals de les xarxes d'avui en dia que poden portar a escenaris de fallades múltiples i, en segon lloc, proposar nous indicadors capaços de quantificar la robustesa d'aquestes xarxes.

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33

Shepherd, Charles William. "A clinical evaluation of tuberous sclerosis complex". Thesis, Queen's University Belfast, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.282044.

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34

Slater, Graham. "Foreign Policy Evaluation and the Utility of Intervention". FIU Digital Commons, 2017. http://digitalcommons.fiu.edu/etd/3217.

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This dissertation identifies and explains the factors contributing to the presence and severity of U.S. foreign-policy blunders, or gross errors in strategic judgment resulting in significant harm to the national interest, since the Second World War. It hypothesizes that the grand strategy of preponderance and the overestimation of military power to transform the politics of other states have precipitated U.S. foreign-policy blunders since 1945. Examining the Vietnam War and Iraq War as case studies, it focuses on underlying conditions in the American national identity and the problematic foreign policy decision-making (FPDM) that corresponds to this bifurcated hypothesis, termed the overestimation/preponderance theoretical model (OPM). Four indicators operationalize the OPM: (1) how U.S. foreign policymakers estimated the capacity of military power to transform the political dynamics of the target state through intervention; (2) and (3) how U.S. actors and institutions affected the capacity of the partner state and hostile state and nonstate actors; and (4) how the foreign policy was justified and rationalized within the leadership of government and to the general public as it encountered disconfirming information. In each case, the grand strategy of preponderance instituted a bounded rationality of mission in the FPDM stage and the operationalization stage that precluded the inclusion of an unfavorable outcome. In each case, U.S. foreign policymakers greatly overestimated the capacity of the partner state to establish security and legitimacy and underestimated the capacity of hostile actors to mobilize and threaten the partner state. However, these preference-confirmation biases diametrically contradicted the assessment that victory would be easy to achieve; U.S. foreign policymakers promulgated this corresponding overestimation/underestimation even while inflating the threat far beyond what the actual threat to the national-security element of the national interest represented. The subsequent implementing of this inverted calculation created a national-security national interest where none was extant, then significantly harmed that new interest via intervention. This tactical application of the grand strategy of preponderance facilitated the strategic-tactical gap in U.S. foreign policy by creating monsters in order to have monsters to slay, consistent with the ideological tradition of the imperative of crusade in the modern history of American foreign relations.

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35

Steinmetz, Brigitte. "Stressmanagement für Führungskräfte : Entwicklung und Evaluation einer Intervention". Hamburg Kovač, 2006. http://www.verlagdrkovac.de/978-3-8300-2654-9.htm.

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36

Al-Samarrai, Lahab. "Evaluation of mythodrama intervention among middle school students". Thesis, Institute for Clinical Social Work (Chicago), 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3556973.

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This study utilizes Allan Guggenbuhl's seven-step Mythodrama method of resolving conflict and bullying in a school setting which has proven successful in Europe, applies this to a school setting in the United States, and measure that application to see if this intervention for addressing conflict and bullying is successful in a setting in the United States. Pre- and post-testing was conducted and some statistically significant improvement post-intervention was found. Study results suggest this methodology would have efficacy when applied broadly in US schools.

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37

Amphlett, Mary. "Sanctuary : the evaluation of a secondary school intervention". Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/3053/.

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This research is an evaluation of a Key Stage 3 intervention, Sanctuary, from its inception, through its evolution across nine years. The research explores the dichotomy related to achievement and inclusion and the conflicts that emerge when poor behaviour is involved. Pupils were identified in each of the three key stage 3 Year groups using criteria. These identified pupils were taken out of mainstream school into the resource base for a three week intensive course aimed at improving their basic numeracy and literacy skills whilst still ensuring provision of the core curriculum. Their adapted curriculum also included strategies to manage behaviour and anger and opportunities to develop self esteem, empathy, resilience and nurturing. The first research question was to investigate if the intervention provision answered the needs of the identified pupils. This justification was based on a formative evaluation of available literature and research. The second research question looking at the impact of the intervention required a summative evaluative methodological approach using documentation, questionnaires and interviews. Teachers, peer members, parents, employers, external inspectors and the young people themselves recognised improvements commensurate with other similar research as a result of the intervention.

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38

Sherrington, Anna. "Evaluation of an internet based weight loss intervention". Thesis, University of Newcastle upon Tyne, 2015. http://hdl.handle.net/10443/2840.

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Introduction: The increasing obesity epidemic requires investigation of the effectiveness, cost-effectiveness and scalability of alternative delivery methods for weight loss interventions, such as via the internet. Aims/objectives: To examine characteristics, feedback format, engagement levels, behaviour change techniques used and effectiveness of individualised feedback within internet based weight loss interventions to refine a pre-existing private sector web-based platform ‘My dietitian online’. To pilot test this refined platform, to investigate its feasibility and acceptability of this refined platform for delivery in primary care and to inform the design and conduct of a future definitive RCT. To describe website use and explore health professionals’ and participants’ views and perceptions of the intervention in terms of acceptability, feasibility and usability. Methods: (i) Systematic review of the components and effectiveness of individualised feedback within internet based weight loss interventions. (ii) A 12-month rehearsal pilot randomised controlled trial (RCT) of an internet based dietary and physical activity intervention in two population groups, with collection of data on anthropometric measures, diet, physical activity, quality of life and predictors of behaviour change. The main focus of the trial was on feasibility, including recruitment and retention rates. (iii) A mixed-methods qualitative process evaluation conducted alongside the pilot RCT comprising analysis of website usage and semi-structured interviews with participants and healthcare professionals to explore their experience of the intervention. Results The systematic review identified 14 studies. Interventions with individualised feedback led to more weight loss than those with no feedback. Studies examining different modalities of weight loss intervention were very limited. In the pilot trial 61 men with diabetes and 16 post-partum women were recruited. At 12 months retention rates for men were 61% in the intervention arm, 53% in the control arm, and for women were 53% in the intervention arm and 54% in the control arm. Website usage varied greatly between intervention participants, with 49% and 57% of men and women ii respectively ever using the website. The semi-structured interviews revealed that participants and health professionals saw an internet based intervention as an appropriate method to implement within the NHS for weight loss, with the suggestions made for integration with current services. Conclusion High attrition rates along with low adherence to the intervention were identified. Possible refinements to the website were suggested to reduce the burden and time requirements for users.

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39

Xie, Tianyi. "Responding to Microaggressions: Evaluation of Bystander Intervention Strategies". DigitalCommons@USU, 2019. https://digitalcommons.usu.edu/etd/7621.

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Ethnic minorities often experience microaggressions that cause psychological distress and increase health risks. Bystander interventions are good ways to intervene when microaggressions take place and provide emotional support for ethnic minority targets. White interveners and interventions that pose low threats to White aggressors are perceived more positively than ethnic minority interveners and interventions that are more confrontational and direct. Furthermore, a support-based intervention that validates White aggressors’ good intention and effort without judgement may help White aggressors feel less defensive and more receptive to the intervention. Asian Americans face unique microaggressive themes and their racial experiences are influenced by the stereotype that they are model minorities. Asian Americans may prefer the supportive interventions because they are congruent with Asian cultural values such as relational harmony. The current set of studies assessed the effect of different intervention formats (high threat, low threat, support based) and race of interveners (Asian vs. White) on Asian American targets and White witnesses’ emotional change, perceptions of the intervention, and willingness for future interracial interactions. Among three intervention formats, Asian American targets perceived the intervener and aggressor least negatively in the support intervention. Asian American targets perceived the intervener least positively, whereas White witnesses perceived intervener most negatively in the high-threat intervention. White witnesses perceived the intervener more positively and had more interests in making friends with them when they are White than Asian in high-threat and supportive interventions. White witnesses’ favorable perceptions of aggressor were only influenced by a high degree of racial colorblindness. Overall, the support approach seems to be the most socially appropriate and accepting bystander intervention strategy to intervene in microaggressions targeted at Asian Americans. The high-threat approach is likely to damage interveners’ social image, especially when the intervener is Asian.

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40

Rabier, Camille. "Evaluating Mending Mamre: An Animal Welfare Intervention". Master's thesis, Faculty of Commerce, 2019. http://hdl.handle.net/11427/31203.

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The need to improve animal welfare and control companion animal populations is necessary for South Africa, especially in impoverished communities lacking resources and education to care for their pets responsibly. These programmes are often multi-dimensional in nature and aim to improve animal welfare in different ways. Sterilisation is often the first step but is not enough. Consequently, education is often used in combination, to teach responsible pet care and ownership to pet owners. By increasing their understanding and knowledge of animals it is hoped that the pets’ overall quality of life and welfare improve. The following dissertation presents the findings of an evaluation conducted for the Mending Mamre Mass Education and Sterilisation Programme. This programme had four components: surgical sterilisation of pets and feral cats, basic veterinary care, education sessions and the rehoming of stray dogs. Three evaluations were performed (as requested by the clients): a programme theory evaluation of the education sessions, a process evaluation to understand why some residents refused sterilisation and an outcome evaluation to measure if the pets’ living conditions and body scores had changed 16 months after the programme. Overall, the results of the programme theory evaluation demonstrated that: the activities and outcomes of the education sessions were consistent with similar programmes but the two causal pathways underlying the programme are not plausible. The results of the process evaluation highlighted that the most common reason why pet owners refused sterilisation was due to fear. Finally, the results of the outcome evaluation indicated mixed results; with an increase observed in the pets’ physical wellbeing but an overall decrease observed in their quality of living conditions. With the results, the evaluator was able to make recommendations to the client and highlight considerations for programme improvement. Overall this study contributes to the paucity of research on evaluations of animal welfare interventions at the community level.

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41

Wyness, Laura A. "Assessing the need for humanitarian nutritional intervention for adults in complex emergencies". Thesis, University of Aberdeen, 2006. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU494631.

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This study aimed to identify methods to improve: 1) the assessment of the need for humanitarian nutritional intervention in adults in complex emergencies; and 2) the collection and quality of routine adult malnutrition data. A systematic literature review of methods for nutritional assessment of adults that could be used in complex emergencies was conducted. Hair pluckability was identified as a potential method, and empirical studies were conducted to investigate its reliability in healthy volunteers. A questionnaire was sent to NGOs to determine the most important context factors when considering adult nutritional status. Data were collected from three NGOs on the nutritional status of 13,599 adults from 33 feeding programmes in five different countries. As context data relevant to each feeding programme were unavailable, country-specific data were often used. Hair pluckability was significantly different between- and within-observers (p<0.001). In the feeding programmes, context factors were more significantly associated with Mid Upper Arm Circumference (MUAC) than Body Mass Index (BMI). Poor security and food security were also significantly associated with poorer nutritional status, but here was evidence that some of the associations were explained by differences in the type of feeding programme. Hair pluckability was found to be an unreliable indicator of nutritional status. MUAC may be a more useful method of assessing nutritional status in complex emergencies than BMI. The usefulness of the NGO data was limited due to bias and possible confounding, and the low number and spread of data points being compared. This highlights the need for standardised data collection methods, to enable comparison of nutritional needs between populations. Education and training of field workers in data collections methods is recommended.

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42

Bartlett, Scott W. "Nondestructive evaluation of complex geometry advanced material components". Thesis, Virginia Tech, 1989. http://hdl.handle.net/10919/43290.

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The potential of many nondestructive inspection methods and evaluation procedures are often demonstrated under rather pristine conditions. Considerable difficulty may result from attempting to apply such methodologies to actual components. This is further complicated if the material is inhomogeneous and anisotropic. Nevertheless with the use of advanced materials in complex geometry critical components, it is necessary to develop methods for assuring their quality during or upon completion of manufacture. This presentation will examine the challenges associated with this task and discuss the feasibility of the acousto-ultrasonic material characterization method for meeting these challenges. Particular attention will be given to implementing this methodology in an automated, cost effective manner. Work that is in progress involving laser in/out ultrasonic generation and detection technology, along with robotic sensor manipulation, and advanced computerized data acquisition and analysis will be discussed.
Master of Science

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43

Krasovskiy, V. R. y S. О. Kushnir. "Features of water management organizations activity complex evaluation". Thesis, Видавництво СумДУ, 2008. http://essuir.sumdu.edu.ua/handle/123456789/11726.

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Water management budgetary organizations carry out comprehensive activity in the field of water economy, earth’s land-reclamations, providing of population and national economy industries necessities in water resources. But unlike a self-supporting sphere, efficiency in which is determined objectively the level of profitability, the budgetary organizations and establishment’s activity estimation method in a considerable measure is indefinite and continues to have subjective character. The Ukraine statutory broker on a water economy conducts the organizations work indexes bulletin, which contains the large information array. It is enables to estimate organization after separate directions or works types, but does not allow to carry out general complex (or rating) organization activity description. Quite often the organization work general estimation from the side of higher establishment largely depends on leader ability to report about its activity. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/11726

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44

Dewey, J. L. "Activating children's thinking skills (ACTS) : an intervention evaluation study". Thesis, University College London (University of London), 2006. http://discovery.ucl.ac.uk/1444712/.

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This study investigated the impact of an infusion intervention on the cognitive, emotional and social development of Year 4 and Year 5 children across 10 schools in a large county. A two year intervention period was utilised to ascertain effects over time and contexts to monitor transfer and maintenance (Blagg, 1991 McGuinness, 1993 McKinstery & Topping, 2003). The project provided a unique contribution to the specialist sphere of thinking skills by using an experimental and matched waiting list control group to overcome limitations of earlier research design (Blagg, 1991 DfEE, 1999 Gorodetsky et al., 2002 Sternberg & Bhana, 1986). A multi-method pre, post and delayed post test using standardised measures across a range of learner outcomes developed research further in the domain of student effects in the primary age range (Coles, 1999 Nisbet, 1993 McKinstery & Topping, 2003 Watkins et al., 2001 Wilson, 2000). Furthermore, the research offered a distinctive insight into the perceptions of the key players involved through triangulated qualitative analysis which, unlike earlier studies examined the practicalities of the program in real life educational environments (Higgins et al., 2004 McGuinness, 2003 TES, 2002 Topping, 2002 Wilson, 2000). Key findings demonstrate the impact of the ACTS intervention on enhancing children's cognitive abilities over a two year as opposed to a one year intervention period. This resonates with similar studies in which such an extended time period is considered essential to generate cognitive change (Blagg, 1991 Feuerstein et al., 1980 Shayer & Adey, 1993). Correspondingly qualitative data from students and staff illustrate that children were not only able to detail the range of thinking skills taught but describe application. This evidenced transfer in both the near and far contexts an area ignored in prior work (Blagg, 1991 DfEE, 1999 McGuinness, 2003 Wilson, 2000). Additional effects linked the teaching of thinking to social and emotional gains of children in line with the evidence base (Blagg, 1991 Lipman et al., 1980 McKinstery & Topping, 2003). Considerable impact was, likewise, apparent in relation to the professional development of staff in terms of both skills and knowledge as paralleled in other studies (McGuinness et al., 1997 McKinstery & Topping, 2003 Munro, 1999 Stewart & Smardon, 2002). The research is of significance in strengthening both the empirical and theoretical evidence base in the teaching of thinking skills by evaluating infusion. Important implications for both the psychological knowledge base and educational psychology practice are made. Of particular significance are the application of such programmes within curriculum contexts alongside the professional artistry required to ensure effectiveness (McGuinness, 2003 McKinstery & Topping, 2003 Topping 2002). This will form the focus of future studies with evaluation necessitated to determine the relative value of core components within cognitive instruction. The growing interest in the area makes it of particular pertinence for ongoing EP scientific scrutiny. As McGuinness (1999) argues "The idea of thinking classrooms and schools as thinking communities, requires further articulation and interpretation, and the research base is in its infancy' (p.30). This is an area ripe for development and it is argued that educational psychologists should focus their efforts on helping teachers to translate theory into practice into the classroom.

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45

Malpass, Mark Casey. "An evaluation of microbiological intervention techniques within broiler production". Thesis, Bangor University, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.529743.

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46

Hayward, Sheila. "The design and evaluation of a stress management intervention". Thesis, University of Bristol, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299328.

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47

Routledge, Michael Henry Collis. "Organisation development: a formative evaluation of an OD intervention". Thesis, Rhodes University, 1999. http://hdl.handle.net/10962/d1002553.

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Rapid changes and increased competitiveness in business environments, together with greater demands by employees for improvements in the quality of their work lives, make it necessary for organisations to review their operating styles and functions. Many companies have found an answer in Organisation Development (OD) which focuses on ways in which people associated with organisations learn to diagnose and solve those problems which limit organisational effectiveness. The present study evaluates the progress of an OD intervention underway in an organisation in Zimbabwe. A formative evaluation is undertaken during an OD intervention. It is designed to assess the change effort's progress in such a way that steps can subsequently be taken to correct, modify or enhance such aspects of the intervention as may be determined by the evaluation. The study begins with a review of the company's original and revised Mission Statements as well as the present and last two sets of corporate three-year plans. These documents inform the construction of an interview guide. Individual interviews are then used to ascertain attitudes of respondents to the OD intervention and the changes it is bringing about. In addition the interviews are used to gauge the degree of commitment of respondents to the intervention. All the senior managers in the organisation are interviewed as well as the holding company's chief executive and the external consultant facilitating the intervention. The study records fundamental changes taking place in the attitudes of top managers and the first signs of an impact of these attitude changes on the formulation of company plans. Management styles and the culture of the organisation also show some change and influence on routine business operations. In addition there are early indications of an alteration of behaviour at other levels in the organisation. Business outcomes are improving and it is proposed that the benefits are due to fortuitous market developments assisted to an extent by the culture and attitude changes brought about by the OD intervention.

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Herman, Katharine Grace. "The evaluation of a Florida certified batterer intervention program". [Pensacola, Fla.] : University of West Florida, 2008. http://purl.fcla.edu/fcla/etd/WFE0000136.

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King, Kristine M. "An evaluation of a methamphetamine intervention on drug markets". abstract and full text PDF (UNR users only), 2009. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1464445.

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50

Barr-Cole, Dianne O. "An evaluation of an intense summer reading intervention program /". Thesis, Connect to this title online; UW restricted, 2004. http://hdl.handle.net/1773/7621.

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Tesis sobre el tema "Evaluation of complex intervention"

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