It is conventional to argue that the autonomy and reputation of regulatory agencies depend on their expertise. Yet the studies on how independent regulatory agencies (IRAs) create and deploy their knowledge capacity are few and far apart. Normatively, the justification for delegating decision-making powers to IRAs is that they operate by using technical analysis and expertise rather than political considerations. But yet again, although delegation has been discussed as a design principle, systematic evidence on the conditions under which IRAs make use of knowledge and how is still scarce. The literature on knowledge utilization portrays a rather complex link between expertise and policy, where relevant knowledge is not always reflected in policy outcomes and plays several functions besides facilitating the solution of policy problems. Unfortunately, scholars of IRAs have not exploited the insights of this literature yet. This dissertation addresses the under-explored question of the usage of economic knowledge by IRAs. We identify four possible uses of expertise: instrumental (i.e., to solve problems); strategic (e.g. to advocate a position); symbolic (e.g., to gain legitimacy), and non-use. Our aim is to explain under which conditions a certain usage is more likely to occur. To do so, we draw on the methodological device of explanatory typologies (Elman 2005). Specifically, we select two explanatory dimensions that reflect both the context and the content of policy: the level of conflict in the policy arena, and the degree problem tractability. We use different combinations of these two dimensions to derive four hypotheses on the possible uses of expertise mentioned above. The elusive nature of knowledge utilization makes the identification and measurement of these different usages highly dependent on an in-depth understanding of the institutional, organisational, and political context in which a regulatory decision is taken. We have thus opted for a qualitative approach based on case studies and process tracing (Bennett 2010; Brady 2010; Freedman 2010) to appraise the four hypotheses. Empirically, we performed three case studies on regulatory policy decisions taken by the UK Office of Communications (Ofcom) between 2005 and 2010. We find that, given certain scope conditions, the prevalent use of economic analysis is instrumental - a finding that contradicts previous research that labelled instrumental learning as extremely rare, if not a sort of technocratic utopia. Other uses still exist however, and given other scope conditions regulators can be strategic and symbolic in their approach to knowledge and expertise. This is not surprising if we accept the notion that regulators operate in a policy environment that is eminently but not exclusively technical: to survive in a (at least partially) political environment, regulators have to deploy usages of knowledge that deviate from the instrumental type.

Coronary heart disease is the leading cause of premature death in the UK. Chest pain, the most common symptoms associated with this disease, accounts for 1% of all primary care consultations, 5% of visits to emergency departments, and up to 40% of emergency admissions to hospital. When people experience acute coronary symptoms such as chest pain, or other symptoms such as pain in the arms, back or shoulder pain and pain in the jaw and neck, we know that prompt diagnosis and treatment of heart disease can significantly reduce mortality. However, we also know that when people experience these symptoms they can wait sometime before seeking medical help. Part of the problem may be that people do not attribute their symptoms a serious problem such as heart disease. Whilst several campaigns have been aimed at the general population there is no information resource targeted at people who may be at risk of heart disease to help them understand and evaluate their symptoms and take prompt action. The overall aim of this thesis is to fill this gap by producing a piloted draft information resource which aims to help people to respond effectively to symptoms that might be attributable to heart disease for people at high risk of heart disease. Using focus group discussions and individual interviews with people who had experienced symptoms that might be attributable to heart disease or might be at high risk of heart disease experiential data about their response to symptoms were gathered. Participants were also asked their views on what an information resource should be like and their experiences and views formed the basis of the content of the first draft of the information resource. In making sense of their symptom the participants drew upon a range of past experiences and the experiences of others to help them; participants who experienced severe symptoms sought help quickly; those whose symptoms were mild or transient waited, in some cases a considerable time, before seeking help. Previous personal experience may be the factor that helped those who acted quickly. Whereas the experience of others, evident in many of the accounts of those who waited, may not be sufficient to help people interpret and make sense of their own symptom experiences. The information resource incorporated the experiences of people with symptoms that ended up being attributable to heart disease and included examples of the range of symptoms that can be encountered to illustrate the different ways in which heart disease can be manifested as well as information drawn from best practice resources in the management of heart disease. Participants in the original focus group discussions and interviews were asked to be involved in the development of the resource and seventeen agreed. The information resource went through three drafts; at each stage changes were made to incorporate respondent views; at the penultimate draft health professionals’ views were also sought and used to inform the final draft which is now ready for further evaluation.

<b>Introduction</b>: Kinesiology-style manual muscle testing (kMMT) is a non-invasive assessment method used by various types of practitioners to detect a wide range of target conditions. It is distinctly different from the muscle testing performed in orthopaedic/neurological settings and from Applied kinesiology. Despite being estimated to be used by over 1 million people worldwide, the usefulness of kMMT has not yet been established. The aim of this thesis was to assess the validity of kMMT by examining its accuracy and precision. <b>Methods</b>: A series of 5 diagnostic test accuracy studies were undertaken. In the first study, the index test was kMMT, and the target condition was deceit in verbal statements spoken by Test Patients (TPs). The comparator reference standard was a true gold standard: the actual verity of the spoken statement. The outcomes of the muscle tests were interpreted consistently: a weak result indicated a Lie and a strong result indicated a Truth. A secondary index test was included as a comparator: Intuition, where Practitioners used intuition (without using kMMT) to ascertain if a Lie or Truth was spoken. Forty-eight Practitioners were recruited and paired with 48 unique kMMT-naïve TPs. Each Pair performed 60 kMMTs broken up into 6 blocks of 10, which alternated with blocks of 10 Intuitions. For each Pair, an overall percent correct was calculated for both kMMT and Intuition, and their means were compared. Also calculated for both tests were sensitivity, specificity, positive predictive value and negative predictive value. The second study was a replication of the first, using a sample size of 20 Pairs and a less complex procedure. In the third study, grip strength dynamometry replaced kMMT as the primary index test. In the fourth study, the reproducibility and repeatability of kMMT were examined. In the final study, TPs were presented with emotionally-arousing stimuli in addition to the affect-neutral stimuli used in previous studies, to assess if stimuli valence impacted kMMT accuracy. <b>Results</b>: Throughout this series of studies, mean kMMT accuracies (95% Confidence Intervals; CIs) ranged from 0.594 (0.541 – 0.647) to 0.659 (0.623 - 0.695) and mean Intuition accuracies, from 0.481 (0.456 - 0.506) to 0.526 (0.488 - 0.564). In all studies, mean kMMT accuracies were found to be significantly different from mean Intuition accuracies (p ≤ 0.01), and from Chance (p < 0.01). On the other hand, no difference was found between grip strength following False statements compared to grip strength following True statements (p = 0.61). In addition, the Practitioner-TP complex accounted for 57% of the variation in kMMT accuracy, with 43% unaccounted for. Also, there was no difference in the mean kMMT accuracy when using emotionally-arousing stimuli compared to when using affect-neutral stimuli (p = 0.35). Mean sensitivities (95% CI) ranged from 0.503 (0.421 - 0.584) to 0.659 (0.612 - 0.706) while mean specificities (95% CI) ranged from 0.638 (0.430 - 0.486) to 0.685 (0.616 - 0.754). Finally, while a number of participant characteristic seemed to influence kMMT accuracy during one study or another, no one specific characteristic was found to influence kMMT accuracy consistently (i.e. across the series of studies). <b>Discussion</b>: This series of studies has shown that kMMT can be investigated using rigorous evidence-based health care methods. Furthermore, for distinguishing lies from truths, kMMT has repeatedly been found to be significantly more accurate than both Intuition and Chance. Practitioners appear to be an integral part of the kMMT dynamic because when replaced by a mechanical device (i.e. a grip strength dynamometer), distinguishing Lies from Truth was not possible. In addition, since specificities seemed to be greater than sensitivities, Truths may have been easier to detect than Lies. A limitation of this series of studies is that I have a potential conflict of interest, in that I am a practitioner of kMMT who gets paid to perform kMMT. Another limitation is these results are not generalisable to other applications of kMMT, such as its use in other paradigms or using muscles other than the deltoid. Also, these results suggest that kMMT may be about 60&percnt; accurate, which is statistically different from Intuition and Chance; however it has not been established if 60&percnt; correct is "good enough" in a clinical context. As such, further research is needed to assess its clinical utility, such as randomised controlled trials investigating the effectiveness of whole kMMT technique systems. Also, future investigators may want to explore what factors, such as specific Practitioner and TP characteristics, influence kMMT accuracy, and to investigate the validity of using kMMT to detect other target conditions, using other reference standards and muscles other than the deltoid. <b>Summary</b>: This series of diagnostic test accuracy studies has found that kMMT can be investigated using rigorous methods, and that kMMT used to distinguish Lies from Truths is significantly more accurate that both Intuition and Chance. Further research is needed to assess kMMT’s clinical utility.

No description available.

Bakgrund Utveckling av evidensbaserad omvårdnad i klinisk praxis innebär förbättring av kvalitén inom vården. Sjuksköterskestudenter påbörjar förberedelserna för evidensbaserad omvårdnad redan under sin utbildningsperiod, och nyexaminerade sjuksköterskor förväntas i hög grad tillämpa evidensbaserad omvårdnad i klinisk praxis. Syfte Syftet med denna litteraturöversikt är att beskriva nyexaminerade sjuksköterskors användning av evidensbaserad omvårdnad och vilka faktorer som har betydelse för sjuksköterskors tillämpning av evidensbaserad omvårdnad. Metod En litteraturöversikt baserad på 16 vetenskapliga artiklar som inkluderar både kvalitativa och kvantitativa studier. Resultat Utvecklingen i tillämpning av evidensbaserad omvårdnad bland nyexaminerade sjuksköterskor förefaller oförändrad eller avtagande under senaste decenniet. Mest tillämpad evidensbaserad omvårdnad är Instrumentell forskningsanvändning. Faktorer som har betydelse för sjuksköterskors tillämpning av evidensbaserad omvårdnad är: utbildning, oerfarenhet, stressiga arbetssituationer och stöd i arbetsmiljön. Slutsats Att granska i vilken utsträckning nyexaminerade sjuksköterskor tillämpar evidensbaserad omvårdnad är svårt då begreppet kan tolkas på olika sätt och det är enligt min kunskap fortfarande ett outforskat område. Nyexaminerade sjuksköterskor behöver mer stöd både före och efter examen för att utveckla sin tillämpning av evidensbaserad omvårdnad. De behöver mer stöd av lärare under utbildningsperioden och av erfarna seniora kollegor på arbetsplatsen. Därutöver krävs ett aktivt ledarskap. / Background Development of evidence-based nursing leads to improvement of the quality of care in clinical practice. Nursing students begin the preparations for evidencebased nursing already during their training period, and newly graduated nurses are highly expected to apply evidence-based nursing in clinical practice. Aim The aim of this review is to describe the newly graduated nurses' use of evidencebased nursing and the factors which are significant for the nurse´s application of evidence-based nursing. Method A literature review based on 16 articles that included both qualitative and quantitative studies. Result The development of application of evidence-based nursing among newly graduated nurses seems unchanged or decreasing in the last decade. The most applied implementation of evidence-based nursing among newly graduated nurses is Instrumental research use. The influential factors are: education, inexperience, stressful work situations and the support they perceive at their workplace. Conclusion In conclusion, this review emerged to that the whole situation of how and which extent newly graduated nurses apply evidence-based nursing is difficult to grasp within my comprehension. Since the apprehension of the concept of applying evidence-based nursing is complex, it is still an unexplored subject. Newly graduated nurses require further extensive support through their pregraduate to the post- graduate period to develop their application of evidencebased nursing. They need more guiding by the teachers, experienced senior colleagues and administrative support at their workplaces.

Tort laws aim to deter risky medical practices and increase accountability for harm. This research examines their effects on deterrence of a high-risk obstetric practice in the United States: elective early-term (37-38 weeks gestation) induction of labor. Using birth certificate data from the Natality Detail Files and state-level data from publicly available sources, this study analyzes the effects of tort laws on labor induction with multilevel models (MLM) of 665,491 early-term births nested in states. Results reveal that caps on damages are associated with significantly higher odds of early-term induction and Proportionate Liability (PL) is associated with significantly lower odds compared to Joint and Several Liability (JSL). The findings suggest that clinicians are more likely to engage in practices that defy professional guidelines in tort environments with lower legal burdens. I discuss the implications of the findings for patient safety and the deterrence of high-risk practices.

Given the importance of client characteristics and preferences, and therapist expertise to evidence-based practice in psychology, the current study sought to contribute to the literature concerning the role of values in psychotherapy. Personal values of clients and trainee therapists in 29 dyads were examined for relationships between client and therapist values and associations with working alliance and outcomes. Although previous literature in this area has suggested that successful therapy is characterized by an increase in similarity of client and therapist values, the current study did not replicate this finding. However, client perceptions of therapist values were found to be important to working alliance and outcome. Findings are discussed in terms of suggestions for future research as well as implications for clinical practice, including the importance of discussing expectations and preferences with clients.

Syftet med studien var att undersöka hur socialsekreterare arbetar med barnavårdsärenden där en förälder har intellektuellt funktionshinder. Studien utgick från två frågeställningar; hur socialsekreterarna upplever mötet med dessa föräldrar och var de hämtar kunskapen inom detta område. En fokusgruppsintervju genomfördes med sex deltagare. Studiens resultat visade att socialsekreterarna upplevde osäkerhet i bemötande och bedömning av familjer med intellektuellt funktionshinder. Denna studie visade också att det finns brister i samverkan och osäkerhet mellan myndigheter, och att socialsekreterarens kunskapsbas främst är erfarenhetsbaserad. Slutsatsen är att det saknas evidensbaserade metoder och att kunskapsområdet präglas av osäkerhet. / The aim of the study was to investigate how social workers, within the social child care, work with parents with intellectual disability. Two questions were investigated: how the social workers experienced meeting the parents and what was their knowledge base. A focus group interview was conducted with six participants. The results of the study showed that social workers experienced uncertainty in meeting and assessment the families with intellectual disability. Further, the study showed that there were weaknesses and uncertainty in cooperation between authorities, and that the knowledge used by the professionals was mainly experience based. The conclusion is that there is a lack of evidence based methods and the field is characterised by uncertainty.

ABSTRACT Introduction and Rationale: Atopic Dermatitis (AD) is a common skin condition, characterized by markedly pruritic eczematous lesions, that most often presents in childhood. The majority of children diagnosed with AD will have mild disease and will first present with symptoms to a primary care provider (PCP), however approximately 85% of pediatricians only provide limited initial care followed by a referral to dermatology (Eichenfield et al., 2015). While there are specialty care based treatment guidelines for childhood AD, there are no guidelines available that specifically address primary care management of childhood AD. Purpose and Objective: The primary purpose of this DNP project is to develop an evidence-based clinical practice guideline (CPG) for pediatric PCPs. The secondary purpose is to develop a corresponding atopic dermatitis action plan (ADAP) to be used by children and parents. The objective is to equip PCPs to better manage children with AD in the primary care setting and to guide patients and parents in the importance of daily control measures and in the individualized treatment plan prescribed by the PCP. Methods: The Appraisal of Guidelines for Research & Evaluation II (AGREE II) framework and Social Cognitive Theory (SCT) serve as the theoretical frameworks for CPG and ADAP development. The American Academy of Pediatrics (AAP) process for evidence based policy setting is used as a model for key action statement development. Results: Evaluation of the CPG was completed using the AGREE II tool, a reliable and validated tool for evaluating CPGs. Five of the six domains evaluated, yielded combined scores of at least 90%, with one domain a combined score of 63%. The overall standard deviation was 0.58, indicating an overall low level of user discrepancy Additions and revisions were made based on the results of the AGREE II evaluation scores with specific emphasis on the lowest scoring domain. Conclusion: This DNP Project identified the need for a CPG specific to pediatric primary care. A CPG with accompanying ADAP was developed and evaluated using the AGREE II tool. The CPG was found to meet the recommended standards and recommended for use in pediatric primary care.

The need to provide effective Cognitive Behavioural Therapy (CBT) treatments in routine clinical practice necessitates effective methods of CBT training, which are scalable and can be disseminated in populations without ready access to specialist trainers or large scale funding. This thesis seeks to add theoretical and empirical guidance to the development of evidence-based CBT training. The first chapter reviews the current literature on effective CBT training, and suggests theoretical and methodological guidance for future research on evidence-based training practices. Cohort studies (Chapters 2 – 4) examine data from former trainees for guidance on accurate CBT competence measurement and effective CBT training components. The fifth and sixth chapters report randomised-controlled trials examining the effects of internet-based training (IBT) on therapists’ competence and patient outcomes (Chapter 6). Findings from the literature review (Chapter 1) and Chapter 2 suggested the need for training effectiveness trials using treatment trial methodology, which includes ‘blind’ observer ratings of therapist behaviour as the measure of competence. Chapter 3 found that extensive training led to significant improvement in competence for trainees with a range of individual baseline characteristics. Since such extensive training is not accessible to the majority of practicing therapists, Chapter 4 examined which elements of extensive training were perceived by trainees as having the greatest positive effect on competence; thus providing empirical guidance in planning more scalable forms of training, such as IBT. Findings from the first four chapters provided guidance in planning the two randomised controlled trials outlined in Chapters 5 and 6, resulting in rigorous empirical data showing significant positive effects of IBT on therapists’ competence and on their patients’ clinical outcomes. Finally, the results of this thesis are related to the framework for developing evidence-based training, which was suggested in Chapter 1 and suggestions for future research are made.