A substantial amount of credible evidence shows that properly designed healthcare built environments can positively impact upon the health outcomes of the building users. This offers an opportunity to improve the quality of healthcare through appropriately designed healthcare built environments. Evidence-based design (EBD) emerged within healthcare building design practice to enhance the process of designing with credible evidence. This research explored improvement opportunities for EBD in the UK which would subsequently improve the quality of healthcare through built environment interventions. Specifically, three key research gaps were addressed during this research. Firstly, this research explored current practices of evidence use during healthcare designing and opportunities to increase the direct use of research-based evidence and alternative ways of conveying research-based evidence into the design process through other source of generic evidence for design. Secondly, this research explored how evidence could be effectively expressed within healthcare design standards, guidance and tools (SGaTs) in the forms of performance and prescriptive specifications. Finally, considering the unique nature of built environment design, this research explored how project unique contextual circumstances impact EBD processes and how practitioners reflect on these circumstances. These challenges were then transformed into six objectives. Following a comprehensive literature review, this research was divided into four phases. First, a model of the sources and flows of evidence (SaFE) was developed to represent evidence for EBD within generic evidence for design. The initial conceptual model was developed through desk study, based on the literature review, self-experience and the experience. This model was then verified with the comments from five un-structured interviews conducted with lecturers and senior lecturers of the School of Civil and Building Engineering. Finally, the model was validated using 12 semi-structured interviews conducted with design practitioners from the industry. In addition to the validating the sources and flows of evidence these interviews revealed rationales behind design practitioners use of evidence from four types of evidence sources. These results revealed improvement opportunities to increase the intake of research-based evidence use during healthcare built environments designing. The main data collection method for this research was case studies. Eight exemplar design elements within three case studies were investigated to explore details of evidence use practices; practices of using performance and prescriptive specifications; and impact of project unique contextual circumstances for EBD process and how design practitioners reflect on these circumstances. Results of this research revealed that EBD needs to be supported by both externally published research evidence and through internally generated evidence. It was also identified that EBD could be significantly facilitated through research- evidence informed other generic design evidence sources. Healthcare design SGaTs provides a promising prospect to facilitate EBD. Performance specification driven healthcare design SGaTs supplemented by prescriptive specifications to define design outputs and design inputs could improve effective use of evidence-informed SGaTs. These results were incorporated into a framework to guide development of healthcare design SGaTs. Finally, by exploring how projects unique contextual circumstances impact EBD processes and how practitioners reflect on these circumstances, this research identified the need for procedural guidance for designers to guide evidence acquisition, evidence application and new evidence generation.

The use of research evidence to improve the practices of teachers is considered one of the ways of improving the educational outcomes for children. This study was focussed on determining how an online approach could be used to increase knowledge mobilisation in education, by giving teachers better access to research knowledge that they could use to support and develop their practices. This study had two aims. The first aim was to investigate what research knowledge and research practices teachers were using and what value they ascribed to those practices; the second was to explore teachers' views and opinions of a new online approach to the presentation of research knowledge. This was a mixed method study using questionnaires, interviews and focus groups to gather a range of both qualitative and quantitative data. The findings of this study show that practitioners value research practices more than they are able to participate in them, and that there is a consistent valuepractice gap across the range of research practices. Exploratory factor analysis revealed five underlying factors; engagement with research, engagement with the research community, promotes professional discussion of research, promotes teacher knowledge generation, and promotes wider engagement of the school with research and the research community. These factors showed that teachers and their schools want to engage both with research knowledge and with the wider research community so that the use of research knowledge can be enhanced in education. The findings also show that practitioners were receptive to the use of an online approach to the delivery of research knowledge and the piloted approach was accessible and intuitive. Practitioners exhibited interest in using the approach in a range of collaborative interactions with colleagues. Overall this study revealed that online approaches to knowledge mobilisation have potential but that teachers need to be supported in their engagement with research and the wider research community. This thesis is a contribution to the knowledge of how online approaches can be developed and deployed to enhance knowledge mobilisation towards teaching being an evidence informed profession. Equally school leaders and policy-makers need to create environments that are supportive of teachers' use of research, if they want teachers to use research knowledge to inform their practices.

This thesis explores the transformations of evidence in health research synthesis studies – studies that bring together evidence from a number of research reports on the same/ similar topic. It argues that health research synthesis is a broad and intriguing field in a state of pre-formation, in spite of the fact that it may appear well established if equated with its exemplar method – the systematic review inclusive of meta-analysis. Transformations of evidence are processes by which pieces of evidence are modified from what they are in the primary study report into what is needed in the synthesis study while, supposedly, having their integrity fully preserved. Such processes have received no focused attention in the literature. Yet they are key to the validity and reliability of synthesis studies. This work begins to describe them and explore their frequency, scope and drivers. A ‘meta-scientific’ perspective is taken, where ‘meta-scientific’ is understood to include primarily ideas from the philosophy of science and methodological texts in health research, and, to a lesser extent, social studies of science and psychology of science thinking. A range of meta-scientific ideas on evidence and factors that shape it guide the analysis of processes of “data extraction” and “coding” during which much evidence is transformed. The core of the analysis involves the application of an extensive Analysis Framework to 17 highly heterogeneous research papers on cancer. Five non-standard ‘injunctions’ complement the Analysis Framework – for comprehensiveness, extensive multiple coding, extreme transparency, combination of critical appraisal and critique, and for first coding as close as possible to the original and then extending towards larger transformations. Findings suggest even lower credibility of the current overall model of health research synthesis than initially expected. Implications are discussed and a radical vision for the future proposed.

This article is about social workers that assess disabled people’s needs and their abilities to implement a new way of working. The National Board of Health and Welfare (Socialstyrelsen) in Sweden are developing a new way of working in these cases and it’s supposed to make the social work more evidence based. The National Board of Health and Welfare has already developed this kind of instrument for the social workers who assess needs of children and elderly people and now it’s time for those who work with disabled people. Therefore, I have chosen to study which possibilities these social workers have to implement this new method called IBIC (Individens Behov I Centrum - The individual’s needs in focus, my translation). I have based my study on three factors that are important that the persons involved in an implementation have in order for the implementation to succeed. They are: comprehension, capability and willingness. The aim was to get an understanding based on the three factors comprehend, capability and willingness of which abilities the assessment workers have to implement IBIC and how this would affect the profession. To reach that aim I have interviewed six social workers who assess the needs of disabled persons. The social workers were chosen because of their work title and after approval by their managers. I was able to get one who has worked 22 years, two who has worked around 10 years and three who has just started working. This meant that I got a good distribution in length of experience. In my sample there is also one who has worked with the standardized work method for children that I mentioned earlier. The results show that most of the social workers comprehend IBIC but it is doubtful whether or not they have the capability and the willingness to implement it. The result also shows that an implementation of IBIC most likely would mean that the profession which now is based on occupational values would move towards organizational professionalism.

Bakgrund Evidensbaserad vård (EBV) är ett välkänt begrepp som används för att tillförsäkra patienter en säker vård som vilar på bästa tillgängliga bevis, beprövad erfarenhet och patientens individuella preferenser. Många studier har tidigare undersökt hinder för sjuksköterskor att bedriva och/eller implementera EBV för att förklara gapet som kan uppstå mellan teori och praktik. Färre studier har undersökt vilka faktorer som främjar sjuksköterskors användande av EBV. Syfte Att genom en litteraturöversikt beskriva vilka faktorer som främjar sjuksköterskors möjligheter att bedriva en evidensbaserad vård. Metod Studien genomfördes som en litteraturöversikt. Databaserna CINAHL, PubMed och Web of Science genomsöktes och 15 artiklar valdes ut (8 kvalitativa, 4 kvantitativa och 3 mixedmethod). Resultat Fem kategorier identifierades som främjande faktorer för sjuksköterskor att bedriva och/eller implementera EBV; arbetsmiljö, stöd, kunskap, sjuksköterskans inställning och organisation. Stöd i form utav underlättare var den mest framträdande faktorn. Slutsats Sjuksköterskan har ett individuellt ansvar att bedriva EBV och kan genom sin egen inställning påverka att en sådan vård bedrivs. De flesta främjande faktorer som framkom var dock tydligare kopplade till ledningen och chefens del i att främja användandet av EBV. / Background Evidence-based practice (EBP) is a well-known term used to ensure that patients receive a safe care based on the best research evidence, clinical expertise and patient individual preferences. A variety of studies have examined the barriers for nurses to conduct and/or implement EBP to explain the gap that can occur between theory and practice. Fewer studies have examined the factors facilitating nurses’ use of EBP. Aim Was to describe the factors facilitating nurses’ use of evidence-based practice through a literature review. Methods The study was conducted as a literature review. The databases searched were CINAHL, PubMed and Web of Science and 15 articles were chosen for the result (8 qualitative, 4 quantitative and 3 mixed-method). Results Five categories were identified as facilitating factors for nurses to conduct and/or implement EBP; work environment, support, knowledge, nurses’ attitude and organization. Support from facilitators were the most emerging factor. Conclusion Nurses have individual responsibility to conduct EBP and can through their attitude influence that it’s being used, though a majority of the facilitating factors identified were more direct connected to the leadership and managerial part in facilitating the use of EBP.

INTRODUCTION: The burden of child maltreatment is substantial, highlighting the importance of identifying effective prevention programs in reducing occurrence and costs. The SafeCare® model was developed as a home-based service for high-risk parents in child protective services for child maltreatment. Although limited, studies that evaluate interventions for child maltreatment through a public health strategy can be achieved through administrative data and have a positive impact on population level reduction of abuse and neglect. AIM: This current secondary analysis examines the effect of the statewide implementation of SafeCare compared to services as usual on the likelihood of out-of-home placement. The research question is “are there differences in out-of-home placement among families referred to SafeCare compared to families who received services as usual?” METHOD: The original study was a cluster-randomized research design was implemented to evaluate SafeCare verses services as usual at the agency/region level including two urban and four rural child protective services administrative regions of Oklahoma. The secondary analysis sample included 2,175 families, prioritizing the primary caregiver for intervention. The Cox proportional-hazards regression model was used to estimate the relative risk for an out-of-home placement and participants were categorized according to intervention type group. RESULTS: By the end of the 2.9-year follow-up, there were 283 first time occurrences of out-of-home placement. Families randomized to receive services as usual had no effect compared to families receiving SafeCare on the likelihood of out-of-home placement after adjusting for baseline family covariates. DISCUSSION: These findings suggest that many chronic cases in the child welfare system may show limited change with services and may suggest a different service approach for reducing recidivism in out-of-home placement outcomes. Although limited, evaluating interventions for child maltreatment by using administrative data can be achieved through administrative data and have a positive impact on establishing effective prevention programs in reducing occurrence of abuse and neglect on a population level.

Öppenvinkelglaukom är en kronisk sjukdom, cirka 100 000 personer i Sverige är drabbade. Den viktigaste riskfaktorn är förhöjt intraokulärt tryck. Egenvård är avgörande, därför är en korrekt förståelse av sjukdomen och dess förlopp en förutsättning för att kunna genomföra behandlingen på rätt sätt. Syftet med litteraturstudien var att undersöka vilken evidensbaserad kunskap om glaukominformation det finns för patienter med öppenvinkelglaukom. Studien genomfördes som en integrativ litteraturstudie. Patienterna berättar om svårigheter att både administrera ögondroppar samt att komma ihåg att ta dem. Synen på information om glaukom samt hur informationen ges varierar kraftigt. Den bästa tiden att ge informationen är i början av sjukdomen när diagnosen ställs, dessutom är det viktigt att denna undervisning upprepas. Många patienter uppger att de tycker att skriven information ska kompletteras med verbal information. För att söka information om sjukdomen går patienter med i föreningar, läser broschyrer, litteratur, artiklar och internet. Alla patienter, även de med god läskunnighet, upplever att broschyrer gjorda med en lägre läsbarhetsindex är lättare att förstå. Undervisningsprogram behöver inkludera information angående innebörden av ögondroppar, dess biverkningar samt hur recept förnyas. Sjuksköterskornas stöd består i att diskutera om glaukom, dess behandling och hur patienterna kan hantera sjukdomen. Fler kvalitativa studier behövs om patienternas önskemål om glaukomundervisningens innehåll. / Open angle glaucoma is a chronic disease, about 100 000 people in Sweden are affected. The main risk factor is increased intraocular pressure. Self-care is essential, therefore, a correct understanding of the disease and its course is provided to carry through the processing correctly. The aim of this study was to examine which evidence-based knowledge about glaucoma information existed for patients with open-angle glaucoma. The study was conducted as an integrative literature review. Patients talk about difficulties both with administering eye drops as well as remembering to take them. The view of the information about glaucoma and how the information is provided varies considerably. The best time to give the information is at the initial stages of the disease when the diagnosis is made, additionally, it is important that this training is repeated. Many patients report that written information shall be supplemented by verbal information. To seek information about the disease patients join associations, read brochures, books, articles and the internet. All patients, even those with good literacy, experience brochures made with a lower readability index easier to understand. Education programs need to include information regarding the significance of eye drops, its side effects and how prescription is renewed. The nurses´ support consists in discussing glaucoma, its treatment and how patients can manage the disease. More qualitative studies are needed on the patients´ requests for the content of glaucoma teaching.

Background Selective reporting of outcomes within a published study based on their nature or direction can result in systematic differences between reported and unreported data. Direct evidence of outcome reporting bias is limited to case reports. Objective To study empirically the nature of outcome reporting bias in randomised controlled trials (RCTs). Methods Three cohorts of RCTs were identified: PubMed-indexed RCTs published in December 2000; trial protocols approved by a Danish ethics committee from 1994-95; and trial protocols funded by a government agency in Canada from 1990-98. Data on reported and unreported outcomes were recorded from all trial publications and a survey of authors. An outcome was considered incompletely reported if insufficient data were presented for meta-analysis. Odds ratios relating the completeness of outcome reporting to statistical significance were calculated for each trial, and then pooled using a random effects meta-analysis. Protocols and publications were also reviewed for discrepancies in primary outcome reporting. Results 519 trials with 10,557 outcomes, 102 trials with 3613 outcomes, and 48 trials with 1390 outcomes were identified for the PubMed, ethics committee, and funding agency cohorts respectively. 22%-35% of outcomes per parallel group study were, on average, incompletely reported for meta-analysis. Fully reported outcomes had a two- to three-fold higher odds of being statistically significant compared to incompletely reported outcomes. The most common reasons given for omitting outcomes included a lack of clinical importance, lack of statistical significance, and space constraints. Major discrepancies between primary outcomes in protocols and publications were found in one half of trials. Discussion and conclusions The reporting of trial outcomes is frequently inadequate for meta-analysis; is biased to favour statistical significance; and is inconsistent with pre-specified protocol outcomes. Unacknowledged modifications to outcomes specified in trial protocols constitute scientific misconduct. Meta-analyses may therefore produce inflated and unreliable estimates of treatment effect.

Despite significant technological and scientific advances in healthcare provision and treatment in past decades, economies are struggling to address increasing costs while enhancing accessibility to quality health and care services. Globally, around 8.4% of gross domestic product (GDP) is spent on healthcare, with United States spending 17.4% of its GDP. There is, therefore, a growing interest in reducing healthcare costs and improving quality of care in terms of patients outcomes and their perception. Research has found strong association between physical environments and patient outcomes and staff and patient wellbeing. The acknowledgement of this link has led to the postulation of the idea of evidence based design (EBD) of healthcare facilities, in which design decisions are based on the evidence of the impact of environment on healthcare indicators. The key challenges for integrating EBD in healthcare design are the difficulty in disaggregating past research findings (i.e. evidence) from the context and the use of these findings, often hidden behind several behavioural and demographic variables or of the form of multi-dimensional indices, in design decision-making. Another recent development in healthcare is the patient-centred approach of care, in which patients perceptions and needs take the centre-stage in the planning and delivery of their care. Local and regional healthcare authorities are, therefore, interested in incorporating patients views in all aspects of care, including the design and operation of health and care facilities. Considering the gaps in knowledge, this research was aimed at investigating: users perception of physical environment indicators that had the potential for influencing their wellbeing and care outcomes, and the integration of their perception in the design of healthcare facilities through automated space layout planning. Perceptions of physical environment indicators were investigated using structured questionnaires among three user groups: inpatients, outpatients and healthcare providers. Resulting perception indicators were then used in a prototype automated space layout planning system, developed as part of this research, to aid the optimization process. The research has identified significant differences in perception between different user groups, in particular between males and females. Analyses of scaled responses indicate that environmental design (e.g. lighting and thermal comfort) and maintenance (e.g. cleanliness) related factors are more important to users than abstract architectural design factors (e.g. aesthetics). Accommodating the variation in perception would require individual approaches for the design of constituent spaces in a healthcare facility. With regard to the integration of user perception in design, the research demonstrates that qualitative indicators such as perception can be integrated in automated design frameworks and, therefore, design decisions can be based on a mix of quantitative and qualitative evidence. The application of automated layout planning system in the design of healthcare space layouts also demonstrates that computer-mediated systems and frameworks are a promising alternative to traditional manual design, if increasing number of design factors and objectives are to be reconciled for decision making.

OBJECTIVE: Hospital systems and regulating agencies enforce strict guidelines barring personal items from entering the operating room (OR) - touting surgical site infections (SSIs) and patient safety as the rationale. We sought to determine whether or not evidence supporting this recommendation exists by reviewing available literature. BACKGROUND DATA: Rules and guidelines that are not evidence based may lead to increased hospital expenses and limitations on healthcare provider autonomy. METHODS: PubMed, Embase, Scopus, Cochrane Library, Web of Science, and CINAHL were searched in order to find articles that correlated personal items in the OR to documented SSIs. Articles that satisfied the following criteria were included: (1) studies looking at personal items in the OR, such as handbags, purses, badges, pagers, backpacks, jewelry phones, and eyeglasses, but not just OR equipment; and (2) the primary outcome measure was infection at the surgical site. RESULTS: Seventeen articles met inclusion criteria and were evaluated. Of the 17, the majority did not determine if personal items increased risk for SSIs. Only one article examined the correlation between a personal item near the operative site and SSI, concluding that wedding rings worn in the OR had no impact on SSIs. Most studies examined colonization rates on personal items as potential infection risk; however, no personal items were causally linked to SSI in any of these studies. CONCLUSION: There is no objective evidence to suggest that personal items in the OR increase risk for SSIs.