The purpose of this study is to explore crowdsourcing as a research paradigm for creating evidence-based practice research in the field of speech pathology. Using an Internet survey, respondents provided de-identified information about one patient with aphasia they had treated in the previous year. The respondents were then asked to rate the success of treatment. Analysis and grading of the responses was performed to identify which responses were usable for the purpose of planning a treatment for a patient with similar demographics and diagnostic make-up. Results showed that crowdsourcing is a viable research method; however, further refinements to the collection and analysis are required before it can be an effectively used. / text

In 2001 the Institute of Medicine identified a significant gap between what is known about how we care for patients and the care that they receive. This identified gap renewed interest in the development and implementation of evidence-based practice (EBP). A number of research studies have evaluated barriers to EBP yet questions still arise as to why evidence is not routinely incorporated into practice. This led to a new field of inquiry called implementation science focused on methods for translating evidence into practice. The Promoting Action on Research Implementation in Health Services (PARiHS) framework purports that successful implementation of EBP is a function of the strength of the evidence to be implemented, the quality of the context into which it will be implemented and appropriate facilitation. There currently are levels of evidence and measures of context that can be utilized but no measures of appropriate facilitation. The purpose of this research was to develop an instrument (the Facilitation Assessment Index) to measure facilitation. This methodological study was conducted to determine the psychometric properties of an investigator-developed instrument to define and measure the concept of facilitation. The instrument was distributed to1025 Registered Nurses in an Academic Medical Center. The response rate was 28%. The majority of respondents were in a staff nurse role, over age 35 and had at least a Bachelor's degree. The Facilitation Assessment Index (FAI) demonstrated adequate psychometrics. Factor analysis delineated four subscales entitled Support, Leadership, Respect and Autonomy. The overall reliability of the scale was r = .93 and the range of reliability of the subscales was r = .85-.93. The test-retest correlation for the total scale was r = .85 (p<.001). Correlations for the subscales ranged from r = .61-.85 (p<.01).Relationships between demographic variables and facilitation were evaluated. Both unit and job title variables demonstrated relationships with scale scores but group sizes were not equal. Future research is needed to strengthen the psychometric properties of the FAI. Subsequent research could focus on use in strengthening the PARiHS framework and quantifying the amount of facilitation needed to implement EBP.

There are two main objectives of this thesis. First, to review the social science evidence on the extent to which different police practices have been proven to reduce crime, or not reduce crime, as well as those cases where the evidence is not clear. This thesis synthesizes crime reduction strategies to short-list those practices that are proven to reduce crime. Second, it uses the evidence collected to facilitate an exploratory case study with three key informants from the Ottawa Police Service (OPS). The case study examines the current use and perceived future role of the police in evidence-based crime prevention efforts. Overall, the research study seeks to answer the following four research questions: 1. What sources of literature provide well-researched and reliable data on effectiveness of policing in crime reduction? 2. In this literature, what policing strategies/practices are shown to reduce crime, not reduce crime or are promising in reducing crime? 3. To what extent is the OPS using evidence-based knowledge to guide their policing strategy/practices? 4. To what extent is the OPS open to using evidence-based knowledge to guide their policing strategy/practices in the future?

Since its addition to the medical lexicon in 1992, the concept of ‘evidence-based medicine’ (EBM) has captured the imagination of the medical world, attracting both passionate advocates and ardent opponents. EBM is defined clinically as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Yet, its boldest claim is an ethical one: that EBM, rather than any other method, is the most effective way to fulfill our moral duty to help patients achieve better health. Academic debate on this point has been deeply polarized, from those who assert that ethical practice is evidence-based practice to those who argue that evidence-based practice impoverishes practice and robs it of ethical substance. Mainstream psychiatrists have endorsed EBM which holds out the promise of greater ethical legitimacy for psychiatric disorders and treatments through improved scientific substantiation. Evidence-based psychiatry arises through the straightforward application of EBM to the practice of psychiatry and thus shares the same ethical goal of EBM, to improve patients’ health. Given the ethical debates that have framed psychiatry since its inception as a medical specialty, and the particular nature of mental disorders and their treatments, it is unclear if EBM can be applied to psychiatry, and therefore, whether it can deliver on its ethical promises. This thesis project involved two phases. The first, a conceptual phase, included an analysis of EBM’s ethical commitments as they are represented in its two authoritative textbooks (‘literal’ EBM). This provisional analysis was then extended by a qualitative analysis of the views of three groups of participants concerning the ethics of EBM: 1) EBM developers; 2) mental health practitioners; and 3) philosophers or bioethicists. Combining the analyses from both phases, a more complete depiction of the ethics of EBM was developed in order to address the main thesis question. Evidence-based psychiatric practice cannot be ethical practice by itself. Instead, it can play a small ethical role in clinical practice, only if it is situated within the larger value structure of contemporary medicine and psychiatry.

Since its addition to the medical lexicon in 1992, the concept of ‘evidence-based medicine’ (EBM) has captured the imagination of the medical world, attracting both passionate advocates and ardent opponents. EBM is defined clinically as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Yet, its boldest claim is an ethical one: that EBM, rather than any other method, is the most effective way to fulfill our moral duty to help patients achieve better health. Academic debate on this point has been deeply polarized, from those who assert that ethical practice is evidence-based practice to those who argue that evidence-based practice impoverishes practice and robs it of ethical substance. Mainstream psychiatrists have endorsed EBM which holds out the promise of greater ethical legitimacy for psychiatric disorders and treatments through improved scientific substantiation. Evidence-based psychiatry arises through the straightforward application of EBM to the practice of psychiatry and thus shares the same ethical goal of EBM, to improve patients’ health. Given the ethical debates that have framed psychiatry since its inception as a medical specialty, and the particular nature of mental disorders and their treatments, it is unclear if EBM can be applied to psychiatry, and therefore, whether it can deliver on its ethical promises. This thesis project involved two phases. The first, a conceptual phase, included an analysis of EBM’s ethical commitments as they are represented in its two authoritative textbooks (‘literal’ EBM). This provisional analysis was then extended by a qualitative analysis of the views of three groups of participants concerning the ethics of EBM: 1) EBM developers; 2) mental health practitioners; and 3) philosophers or bioethicists. Combining the analyses from both phases, a more complete depiction of the ethics of EBM was developed in order to address the main thesis question. Evidence-based psychiatric practice cannot be ethical practice by itself. Instead, it can play a small ethical role in clinical practice, only if it is situated within the larger value structure of contemporary medicine and psychiatry.

The purposes of this study were to understand emergency physicians¡¦ perception, attitude and application of evidence-based medicine(EBM). This cross-sectional study employed quantitative methods. Regarding the quantitative method, the study population included emergency physicians in southern Taiwan of 32 participating hospitals. Structured questionnaires were sent to emergency physicians, a total of 214 questionnaires were distributed with 189 questionnaires being returned. The response rate was 88.32%. Descriptive statistics was used in data analysis. The major findings were: 1. Emergency physician¡¦s perception of EBM: The average score in Physicians¡¦ understanding EBM terminologies were from 1.88 to 2.79(score ranged from 1 to 4, 1 represented fully understand). 2. Emergency physician¡¦s attitude of EBM: a. There were over a half (57.7%) emergency physicians had taken EBM training courses, while 93.1% expressed their willingness to attend EBM activities in the future. b. Most emergency physicians(86.7%) agreed that application of EBM was useful in clinical practice. c. The major barriers of emergency physicians to apply EBM were lack of time(57.1%), lack of EBM knowledge(50.3%), lack of research methodology knowledge(45.5%) and hardness of critical appraisal(40.7%). d. In general, emergency physicians hold positive attitudes toward EBM, the average score was from 1.79 to 3.09 (score ranged from 1 to 5, 1 represented the most agree). 3. Emergency physician¡¦s application of EBM: a. The average proportion of EBM application in emergency physicians¡¦ clinical practice was 54.42% . b. Emergency physician¡¦s choice of clinical problem-treating was diverse, only little clinical problem may have uniform opinions.

published_or_final_version / Nursing Studies / Master / Master of Nursing

Asthma is a common chronic disease for children and is a leading cause for their hospitalization. Despite its negative health impact, a local survey has shown that children with asthma as well as their parents have a lack of understanding for asthma management (Wong, Wong, Chung & Lau, 2001). However, to help asthmatic children to better cope with their condition, it is important for health care professional such as nurses to enhance their knowledge in asthma management. Recent empirical research has shown that education promoting knowledge of asthma management can improve health outcomes in asthmatic children. Therefore, it is important to develop an evidence-based asthma education guideline for them. This dissertation aims to evaluate the empirical evidence of the education program for asthmatic children, with the age ranging from 5 to 18, and their parents. The goal of the proposed program is to reduce their re-hospitalization rate by enhancing their knowledge of asthma care. A translational nursing research was conducted and 10 studies focusing on asthma education program for children and their parents were identified from electronic databases. Critical appraisal was performed using the recognized assessment tool, named the Scottish Intercollegiate Guidelines Network (SIGN) (2008). Recommendations were developed based on the data extracted from the review. Based on the literatures reviewed, it was found that a 45-to-60 minute one-to-one educational intervention conducted by nurses using self-management plan is the most effective method for improving the health outcomes for asthmatic children. A plan of translating the empirical information extracted from the review into practice was developed and the potential of implementation was assessed. Based on the assessment, it was found that there is high transferability of the findings from the review and the proposed innovation is feasible in the selected clinical setting. In addition, the benefits generated from the proposed innovation also outweigh its cost. An evidence-based guideline was then developed based on the high and medium level of evidence. The grades of the recommendation were stated as well. A comprehensive communication plan targeting on various stakeholders was prepared. A pilot study was designed to examine the feasibility of the proposed innovation before the full-scale implementation. The outcomes of the proposed innovation include the re-hospitalization rate of asthmatic children, the patients’ and nurses’ level of knowledge in asthma care, the satisfactory level of patients and nurses towards the innovation, the competency of nurses in conducting the innovation, and the utilization rate and the cost of the innovation. They would be evaluated using appropriate methodologies. The proposed innovation would be considered as effective if the primary outcome, the re-hospitalization rate of asthmatic children is reduced. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Older adults are particularly vulnerable to the development of pressure ulcers (PUs) as a result of skin changes and reduced mobility (Knox, Anderson & Anderson, 1994; Russell et al., 2003). This is associated with diminished quality of life, longer hospitalisations and increased morbidity and mortality (Margolis et al., 2002).In view of the high incidence of PUs (grade 1-4) occurring in elderly patients in acute care, a systematic review of related studies was conducted in August 2011. The optimal frequency and methods of repositioning are described in the literature. With well-designed implementation and evaluation plans, the proposed repositioning guidelines are likely to reduce the incidence of PUs (grade 1-4), while in turn lessening the healthcare burden and preserving patients’ quality of life. Pilot testing, a trial run to test the feasibility of the innovation, will be carried out in the proposed medical ward, and training provided to all staff before the intervention. To proceed with the change, the intervention must be cost-effective and beneficial to all stakeholders. Outcome evaluation determines the number of goals achieved by the innovation and to what degree, and is very important (Melnyk & Fineout-Overholt, 2005).The PU incidence (grade 1-4) is expected to be different after the implementation of the innovation. / published_or_final_version / Nursing Studies / Master / Master of Nursing

The Issue: The integration of evidence into practice is a complex process. Facilitation is a strategy that may assist practitioners with enhancing evidence uptake in nursing practice. However, the concept is not well understood from a front-line nursing perspective. Thesis Objectives: To describe facilitation in moving evidence into nursing practice and determine the nature of the facilitator role and the process of facilitation in theory and from actual experience to develop a conceptual framework to guide practitioners. Methods: A descriptive design utilizing mixed methods was employed: 1) Focused review of the literature that synthesized the current state of knowledge on facilitation as role and process in the implementation of evidence-based practice (EBP) in nursing. 2) Case audit and focus group interview with facilitators of cases involved in adapting guidelines and planning for implementation. A provisional framework was developed based on the literature review which guided the case audit and focus group interview. The data from the literature was integrated with data from those actively involved in facilitation to refine the framework. Results: Focused literature review: A final set of 39 papers were identified. Facilitation is described as supporting and enabling practitioners to improve practice through evidence implementation. Certain aspects of the role and the strategies being employed to promote change are evident. Current literature reveals that facilitation is viewed as an individual role as well as a process involving individuals and groups. Case audit and focus group interview: Forty-six discrete, practical facilitation activities discovered in the literature were in large part found as occurring within the cases. An additional 5 new, distinct activities related to facilitation were found in the case documentation. Findings suggest that facilitation is a multifaceted process and a team effort. Communication and relationship-building are key elements. Conclusion: The transparency and detail displayed in the revised framework may contribute to systematically developing, implementing, and testing facilitation interventions in nursing contexts. Facilitation is clearly an important strategy to advance EBP and the improved understanding of facilitation offered in this thesis provides a guiding framework for future investigations of evidence implementation where facilitation is a key element. / Thesis (Master, Nursing) -- Queen's University, 2009-07-30 15:13:59.116