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

Thesis(Ph.D.(Medical Science)) -- University of Limpopo, 2016 / Background: Chronic disease management (CDM) is an approach to health care that keeps people as healthy as possible through the prevention, early detection and management of chronic diseases. This approach offers holistic and comprehensive care, with a focus on rehabilitation, to achieve the highest level of independence possible for individuals.The aim of this study was to develop an integrated, evidence-based model for the management of chronic non-communicable diseases in a rural community of the Limpopo Province, South Africa. Methods: The study was conducted at Dikgale Health and Demographic Surveillance System (HDSS) site is situated in Capricorn District of Limpopo Province in South Africa. This study followed mixed methods methodology with an aim on integrating quantitative and qualitative data collection and analysis in a single study to develop an intervention program in a form of model to improve management of chronic diseases in a rural area. Therefore, this included literature review and WHO STEPwise approach to surveillance of NCD risk factors for quantitative techniques and focus group discussions, semi-structures interviews and quality circles for qualitative techniques. In the surveillance of NCD risk factors standardised international protocols were used to assess behavioural risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity) and physical characteristics (weight, height, waist and hip circumferences, and blood pressure). A purposive sampling method was used for qualitative research to determine knowledge, experience and barriers to chronic disease management in respect of patients, nurses, community health workers (CHWs), traditional health practitioners (THPs) and managers of chronic disease programmes. Data were analysed using STATA 12 for Windows, INVIVO and Excel Spreadsheets. Results: The study revealed that epidemiological transition is occurring in Dikgale HDSS. This rural area already demonstrates a high burden of risk factors for non-communicable diseases, especially smoking, alcohol consumption, low fruit and vegetable intake, physical inactivity, overweight and obesity, hypertension and dyslipidaemia, which can lead to cardiovascular diseases. The barriers mostly mentioned by the nurses, patients with chronic disease, CHWs and THPs include lack of knowledge of NCDs, shortages of medication and shortages of nurses in the clinics which cause patients to stay for long periods of time in a clinic. Lack of training on the management of chronic diseases, supervision by the district and provincial health managers, together with poor dissemination of guidelines, were contributing factors to lack of knowledge of NCDs management among nurses and CHWs. THPs revealed that cultural insensitivity on the part of nurses (disrespect) makes them unwilling to collaborate with the nurses in health service delivery. x The model developed in this study which was the main aim of the study describes four interacting system components which are health care providers, health care system, community partners and patients with their families. The main feature of this model is the integration of services from nurses, CHWs and THPs including a well-established clinical information system for health care providers to have better informed patient care. The developed model also has an intervention such as establishment of community ambassadors. Conclusion: Substantially high levels of the various risk factors for NCDs among adults in the Dikgale HDSS suggest an urgent need for adopting healthy life style modifications and the development of an integrated chronic care model. This highlights the need for health interventions that are aimed at controling risk factors at the population level in order to slow the progress of the coming non-communicable disease epidemic. Our study highlights the need for health interventions that aim to control risk factors at the population level, the need for availability of NCD-trained nurses, functional equipment and medication and a need to improve the link with traditional healers and integrate their services in order to facilitate early detection and management of chronic diseases in the community. The developed model will serve as a contribution to the improvement of NCD management in rural areas. Lastly, concerted action is needed to strengthen the delivery of essential health services in a health care system based on this model which will be tasked to organize health care in the rural area to improve management and prevention of chronic illnesses. Support systems in a form of supervisory visits to clinics, provision of medical equipments and training of health care providers should be provided. Contribution from community partners in a form of better leadership to mobilise and coordinate resources for chronic care is emphasized in the model. This productive interaction will be supported by the district and provincial Health Departments through re-organization of health services to give traditional leaders a role to take part in leadership to improve community participation. / Medical Science Department, University of Limpopo in South Africa,International Health Unit, and Antwerp University

abstract: There are federal mandates attached to funding for behavioral health programs that require the use of evidence-based treatments (EBTs) to treat mental health disorders in order to improve clinical outcomes. However, these EBTs have not been constructed with American Indian/Alaskan Native (AI/AN) populations. There are over 340 EBTs, and only two outcome controlled studies have demonstrated effectiveness with AI/AN populations to treat mental health disorders. AI/AN communities often have to select an EBT that is not reflective of their culture, language, and traditions. Although EBTs are frequently used in AI/AN communities, little is known about the adaptation process of these interventions with the AI/AN population. For this study, a qualitative design was used to explore how American Indian behavioral health (AIBH) organizations in the Southwest adapted EBTs for cultural relevancy and cultural appropriateness. One urban and two tribal AIBH programs were recruited for the study. Over a six-week period, 24 respondents (practitioners and cultural experts) participated in a semi-structured interview. Transcripts were analyzed using the constant comparative analysis approach. As a result, four themes emerged: 1) attitudes towards EBTs, 2) how to build culturally competent clinical skills, 3) steps to adapt EBTs, and 4) internal and external organizational factors required to adopt EBTs. The four themes identify how to build a culturally responsive behavioral health program in Indian country and are the purview of this dissertation. / Dissertation/Thesis / Doctoral Dissertation Social Work 2020

Background: It has been proven to be a challenge for physiotherapists to utilize evidence within their practice. Conducting evidence-based care is a requirement for providing good care and a requirement in the legitimation for Swedish physiotherapists. Aim: To explore physiotherapists experiences of their possibilities and challenges in implementing prevailing evidence in their practice. Method: A qualitative method was applied with a semi-structured interview guide. A choice of convenience sampling was made with 5 physiotherapists from a region in Sweden with the aim of getting as wide a sample as possible. The analysis of the data was done through a qualitative content analysis. Results: Physiotherapists felt that the challenges were based on their work environment and that the Swedish care structure  measures quantity over quality. Other contributing challenging factors mentioned where lack of time, low interest from managers, lack of training and difficulties in understanding and evaluating the different parts of the evidence model. Opportunities that were raised were the mutual learning among colleagues in the workplace and that research is easily accessible with today's technology. Conclusion: This study shows that in order for physiotherapists to feel that they have good opportunities to implement evidence, one needs to try to eliminate the various challenges that arise within their work environment. This can enable organizations in which physiotherapists work to gain an understanding of what needs to be focused on and improved in order for physiotherapists to be able to implement evidence-based care and therefore increase the quality of care for patients. / Bakgrund: Det har visat sig vara en utmaning för fysioterapeuter att använda sig av evidens inom sitt verksamhetsområde. Att bedriva en evidensbaserad vård är en nödvändighet för att bedriva en god vård och ett krav i legitimationen för svenska fysioterapeuter. Syfte: Att utforska fysioterapeuters upplevelser av sina möjligheter och utmaningar med att implementera rådande evidens inom sitt verksamhetsområde. Metod: En kvalitativ metod tillämpades med en semistrukturerad intervjuguide. Ett bekvämlighetsval användes där 5 fysioterapeuter valdes från en region i Sverige och med syfte att få så brett urval som möjligt. Analysen av data gjordes genom en kvalitativ innehållsanalys. Resultat: Fysioterapeuterna upplevde att utmaningarna främst grundade sig i deras arbetsmiljö och att den svenska vårdstrukturen är mer uppbyggd för att mäta kvantitet och inte kvalité. Andra nämnda bidragande utmanande faktorer var tidsbrist, lågt intresse från chefer, brist på utbildning och svårigheter med att förstå och värdera evidensmodellens olika delar. Möjligheter som togs upp var det gemensamma lärandet bland kollegor på arbetsplatsen och att forskningen är lättillgänglig med dagens teknik. Konklusion: Den här studien visar att om fysioterapeuter ska uppleva att de har goda möjligheter att implementera evidens så behöver man försöka eliminera de olika utmaningar som finns inom deras arbetsmiljö. Detta kan möjliggöra att organisationer som fysioterapeuter jobbar inom kan få en förståelse för vad man behöver fokusera på och förbättra för att fysioterapeuter ska kunna implementera en evidensbaserad vård och därmed öka vårdkvalitén för patienter.

No description available.

To address students’ academic and behavioral needs, schools are held accountable for implementing effective evidence–based interventions. An important relationship exists between implementation fidelity and the effectiveness of interventions. The purpose of this systematic review was to identify and evaluate the evidence of interventions to improve the implementation fidelity of academic interventions and to evaluate the quality of the existing research with a focus on the quality of the research on the most successful interventions. A total of 13 studies met the inclusion criteria. Each study was coded based on a quality of evidence coding protocol and the findings were then reviewed and synthesized. The results show that performance feedback was the most used and successful intervention for increasing implementation fidelity of an academic intervention. Professional development and teacher training were other interventions that were implemented to improve implementation fidelity. These results are summarized and implications for school-based practice are discussed. With such few studies that met the inclusion criteria, there is a need for more research in this area.

<p>The standard of diagnosing and categorizing mental disorders in the United States has long been the Diagnostic and Statistical Manual of Mental Disorders (DSM), but the DSM has been criticized through evidence suggesting it lacks appropriate validity, reliability, and clinical utility. The Hierarchical Taxonomy of Psychopathology (HiTOP) has been offered as a solution to these criticisms. But the recommendation to replace the DSM and its categorical diagnostic system has been met with doubt and criticism by others in the field. A common sentiment in these critiques is a lack of evidence that the HiTOP dimensions are clinically useful or that clinicians would be open to applying them to their patients. The goal of the present study was to compare clinician perceptions of the HiTOP and DSM systems for the conceptualization of clinical cases. A sample of actively practicing clinicians (<i>n</i> = 143) rated one of three clinical vignettes using the HiTOP and DSM systems then rated the two approaches on seven indices of clinical utility. HiTOP was favored for overall clinical utility score as well as utility for formulating effective intervention, communicating clinical information to the client, comprehensively describing client psychopathology, describing global functioning, and ease of applying the system to the individual. There was no preference between HiTOP and the DSM for communicating with other mental health providers. The DSM was not favored for any clinical utility outcome. These results suggest interest in HiTOP and dissatisfaction with the DSM among clinicians.</p>

No description available.

The implementation of evidence-based practices has great potential to improve the quality of children’s services; however, with a large variety of available practices, it can be challenging to select targets for quality improvement in community-based treatment. This study used a method called relevance mapping to identify how thoroughly evidence-based programs could cover a specific population of children seeking services at a large public agency and identify practice elements relevant to these clients. A therapist survey was used to examine current practice at the agency. Eight therapists at the agency reported on their practice delivery for 141 clients. Results from relevance mapping and therapist surveys were combined to create practice profiles for two predominant diagnostic categories seen at the agency: substance use and depression. These practice profiles were used to identify three areas of interest for agency quality improvement with regard to practice element delivery: Agency Strengths, Opportunities, and Weaknesses. Results demonstrate a potential blueprint for tailoring specific feedback to an agency for use in quality improvement efforts.

Introduction: Fall risk, occurrence and injury is increasing as the world ages, and Africa and other emerging regions will not be spared. Similarly, the rise of noncommunicable diseases, compressed morbidity and lack of physical activity present major challenges. This novel feasibility study explored the use of an exergaming technology compared with a conventional, evidence-based exercise programme (Otago Exercise Programme) to reduce fall risk by improving balance, and to inform a large-scale randomised control trial. Methodology: Mixed methods study in independent older adults with established fall risk. The quantitative component employed feasibility RCT methodology. Cluster randomisation assigned interventions to sites. Single blinding was used. Both interventions were offered for six months. A variety of balance-related endpoints (e.g., Timed Up and Go, Dynamic Gait Index, Mini-BESTest) were used to find the most applicable. Patient-centred variables included questionnaires regarding depression, physical activity levels, quality of life and estimates of self-efficacy for exercise. Qualitative focus groups explored participants' experiences of falls and the exergaming intervention using a phenomenology lens. Results: Site and participant recruitment was simple and readily achievable, with low numbers need to screen required. Eligibility criteria were confirmed and more added. Adherence and attrition were major challenges. Cluster randomisation appeared to exacerbate between-group differences at baseline. The exergaming intervention produced preliminary evidence in its favour, with results approaching Minimal Clinically Important Difference compared with the evidence-based intervention. The experience of the exergaming intervention was regarded as positive by focus group participants. Barriers and facilitators are reported. Discussion: Methodological issues in the literature have prevented firm consensus on the use of exergaming in falls prevention, although studies are abundant. The current study used rigorous methodology in the novel context of a developing region, which offers numerous challenges for older adults. Implications for a large-scale, fully funded RCT are discussed. Lessons learned can be used to scale up service delivery for an under-served population; and promote the aim of well-being for all at all ages.