La gestion des symptômes comportementaux et psychologiques de la démence [SCPD] est une thématique d’actualité, car la démence affecte 7,1 % des Canadiens (Agence de la santé publique du Canada, 2017). Parmi ceux-ci, environ 40 à 60 % présentent des symptômes tels que l’errance, l’agressivité, l’agitation verbale, etc. (Ministère de la Santé et des services sociaux [MSSS], 2012). Plusieurs publications récentes, basées sur un consensus d’experts, suggèrent les bonnes pratiques à privilégier au sujet de cette problématique (MSSS, 2014), cependant la mise en application de leur contenu est peu documentée à ce jour. Les objectifs du présent mémoire sont, dans un premier temps, de décrire la pratique des ergothérapeutes au Québec auprès des personnes présentant des SCPD. Le second objectif est de décrire comment les ergothérapeutes intègrent les résultats probants dans la pratique auprès de cette clientèle. Une étude de devis mixte simultané avec triangulation (Briand & Larivière, 2014) a été réalisée. Un questionnaire en ligne abordant la pratique des ergothérapeutes auprès des personnes présentant des SCPD a été complété par 86 ergothérapeutes. Également, 12 ergothérapeutes ont participé à des entrevues semi-dirigées, pour enrichir les données sur l’intégration des résultats probants dans leur pratique. Les résultats de l’étude mettent en lumière l’importance qu’accordent les ergothérapeutes à l’évaluation du fonctionnement dans les activités de la vie quotidienne en ayant recours à des observations ou des mises en situation. Les interventions privilégiées concernent principalement les modifications de l’environnement. Les résultats indiquent que les interventions préconisées par les répondants sont celles jugées comme étant les moins efficaces, tel que le fait valoir la recension des écrits. Les résultats montrent que les ergothérapeutes ont recours à des interventions pour lesquelles ils perçoivent qu’ils sont compétents. Les ergothérapeutes privilégient l’expérience clinique et les formations antérieures pour guider leur pratique plutôt que la consultation d’écrits scientifiques. Les résultats de ce mémoire fournissent des pistes de réflexion utiles pour guider la pratique des ergothérapeutes pour la gestion des SCPD. Comprendre les facteurs influençant les ergothérapeutes dans leur choix d’intervention à privilégier permet de proposer des solutions pour optimiser l’intégration des résultats probants dans la pratique. / The management of behavioural and psychological symptoms of dementia [BPSD] is a hot topic as dementia affects 7.1% of Canadians (Public Health Agency of Canada, 2017). Of these, approximately 40-60% experience symptoms such as wandering, aggression, verbal agitation, etc. (Public Health Agency of Canada, 2017). (MSSS, 2012). Several recent publications, based on a consensus of experts, suggest good practices to be favoured regarding this problem (MSSS, 2014), however, implementation is poorly documented to date. The objectives of this master’s thesis are, first, to describe the practice of occupational therapists in Quebec with people with BPSD. The second objective is to describe how occupational therapists integrate evidence-based results into their practice with this clientele. A simultaneous mixed quote study (Briand & Larivière, 2014) was carried out. An online questionnaire addressing occupational therapist practice with individuals with BPSD was completed by 86 occupational therapists. As well, 12 occupational therapists participated in semi-structured interviews to provide additional information on the integration of evidence-based outcomes into their practice. The results of the study highlight the importance that occupational therapists place on assessing functioning in activities of daily living through observation or role-playing. The preferred interventions mainly concern changes in the environment. The results indicate that the interventions advocated by the respondents are those that were considered least effective as indicated by the literature review. The results show that occupational therapists use interventions for which they perceive they are competent. Occupational therapists favour prior clinical experience and training to guide their practice over consulting scientific literature. The results of this master’s thesis provide useful insights to guide the practice of occupational therapists in the management of BPSD. Understanding the factors influencing occupational therapists in their choice of preferred intervention allows us to propose solutions to optimize the integration of evidence-based results in practice.

In this study, the aim is to review principals' data-based decision-making process, which is based on analysing the discourses that are expressed in the documentation of their decision-making process. There are 84 decisions reviewed which come from 12 different principals in 13 different schools (pre-school class and year 1 - 9 compulsory school).  The theoretical startingpoint for the study is organisational theory and a model for Critical discourse analysis (CDA), which consists of three interrelated processes of analysis. Four different decision discourses are identified, efficiency discourse, knowledge discourse, documentation discourse and problem-based discourse. Previous research in the same field are confirmed. However, it contradicts with the idea that data-based decision-making process is following certain steps and fixed order in this kind of decision process in school. The conclusions are that despite guidelines and a strong focus on assessing results, the decision-making process seems to take other directions than planned in policies. Some parts in the process seems to be particularly complicated, and schools would gain from clarifying a designed data-based decision process. / I den här studien är syftet att granska rektorers välgrundade eller databaserade beslutsprocess, vilket sker genom att analysera de diskurser som kommer till uttryck i rektorers dokumentation om analys av resultat och planerade åtgärder. Utifrån en flerdimensionell analysmodell granskas 84 planerade åtgärder, från 12 olika rektorer i 13 olika grundskolor. Den teoretiska och metodologiska utgångspunkten finns i kritisk diskursanalys och organisationsteori. Resultatet stämmer till viss del överens med och bekräftar tidigare forskningsresultat inom samma område, men det motsäger att den välgrundade beslutsprocessen går till i bestämda steg och i en viss ordning. I studien identifieras fyra beslutsdiskurser: effektivitetsdiskurs, kunskapsdiskurs, dokumentationsdiskurs och problembaserad diskurs. Slutsatserna är, att trots riktlinjer och ett starkt fokus på att bedöma resultat verkar beslutsprocessen ta andra vägar än det som planeras i direktiv och policys. Vissa delar är särskilt komplicerade och av den anledningen kan alla organisationsnivåer vinna på att ge en mer tydlig form till processen för de databaserade besluten.

School counsellors have been an occupation in Sweden since the 1940s but despite this, there is very little knowledge and research about school counsellors’ preconditions according to their work. This study aims to examine in what frequencies school counsellors’ use evidence-based methods in their work with students in senior high school. The result is based on a survey with N 215 respondents from all over Sweden and the analysis theoretical perspective is founded on evidence-based practice (EBP) and new institutional theory. The result indicates that school counsellors in Sweden do not use evidence-based methods to such an extent and that there are organisational and structural obstacles for school counsellors to base their work from evidence-based practice. There is a decoupling process where ideals of EBP do not match the reality as different kinds of logic appear and come into conflict with each other over whose legitimacy is the one that should dominate the organizational field. To increase the conditions, a school management that provides support and enables professional guidance and competence development is needed. The research field needs to start looking at the school counsellors’ practice from a bottom-up perspective to see what they do that works and develop EBP and the organizational field based on this. This is one way to give school counsellors’ more legitimacy.

The enactment of the NCLB Act of 2001 and its legislative mandates for accountability testing throughout the nation brought to the forefront the issue of data-driven decision making. This emphasis on improving education has been spurred due to the alleged failure of the public school system. As a result, the role of administrators has evolved to incorporate data-driven decision-making practices to help make educational choices. While the underlying assumption of implementing data-driven decision making is that it will lead to improvements in education, this has yet to be empirically proven. The purpose of the study was to analyze the relationships among school characteristics, principals' level of experience, principals' data-driven decision making practices, and student achievement. This census study addressed principals of k-5 public elementary schools. In this quantitative study, a web-based survey was used to measure principals' data-driven ion-making practices. The student achievement data examined were the California Standards Test results for English language arts and mathematics for the 2009–2010 and 2010–2011 school years. Through a series of multiple regression analyses, the study examined the relationships among school characteristics, principals' level of experience, principals' data-driven decision making practices, and student achievement. Specifically. this study explored the amount of variance in student achievement scores in language arts and mathematics that could be explained by school characteristics, principals' level of experience, and data-driven decision-making practices. The results showed principals are incorporating data-driven decision-making practices in k-5 public elementary schools in California. In addition, the results showed that principals believe the quality of their decision making has improved due to implementing data-driven decision making. Principals indicated they were incorporating practices identified in the four constructs used in the present study: (a) establishing a data-driven culture, (b) data-driven decision making by teachers to improve student achievement, (c) supporting systems for DDDM, and (d) collaboration among teachers using data-driven decision making. A strong negative correlation was found between the number of students on free and reduced lunch and student achievement.

No description available.

Introduktion: Hästunderstödd terapi (HUT) är ett växande kunskapsområde där studier visat välgörande effekter i flertalet patientgrupper. Att beskriva HUT generellt har försvårats av metodologiska orsaker. Eftersom HUT i klinisk praxis används som komplement till grundprofessioner, vill denna studie fördjupa kunskapen utifrån fysioterapeutiskt perspektiv. Därigenom kan HUT beskrivas med en tydlig koppling till klinisk användbarhet.  Syfte: Att undersöka OHI-certifierade fysioterapeuters erfarenheter av att arbeta med HUT utifrån ett perspektiv av rörelse. Metod: Kvalitativ studie med semistrukturerade intervjuer med elva OHI-certifierade fysioterapeuter. Materialet analyserades med kvalitativ innehållsanalys av Graneheim och Lundman. Som teoretiskt ramverk användes ”The movement continuum Theory of Physical Therapy”. Resultat: Temat ”Hästen och dess miljö berikar det fysioterapeutiska arbetssättet” byggs av fyra subteman och nio sub-subteman. HUT har potential att berika fysioterapeutiskt arbetssätt  genom inverkan på flera nivåer av rörelse samtidigt. Ridmomentet kan ge externa förutsättningar som verkar rörelsefrämjande, men innebär också ett professionellt omdöme i avvägningen mellan nytta och riskmomentet. Genom HUT upplevs resurser att stimulera interna faktorer såsom motivation och engagemang samt sociala faktorer i alliansen. HUT upplevs stötta ett resursfokuserat förhållningssätt till rörelse, där kropp, sinne och känsla har en given plats.   Slutsats: Hur HUT berikar professionen beror på fysioterapeutens val utifrån syfte, yrkeskunskap och personliga kompetens. Det breda användningsområdet ger möjligheter att använda HUT i mötet med olika målgrupper. När arbetssättet i HUT beskrivs i sammanhanget av fysioterapi kan komplexiteten i HUT förstås, och termer som evidensbaserad praktik kommer inom räckhåll. / Introduction: The knowledge of Equine Assisted Therapy (EAT) is growing, and studies describe beneficial effects in various groups of patients. Describing EAT in general has been difficult due to methodological reasons. Since EAT in clinical practice serves as a complement to professions, this study wants to deepen the knowledge from a physiotherapeutic perspective. EAT can thereby be described with a clear connection to clinical applicability. Aims: Investigate OHI-certified physiotherapists' experiences of working with EAT from a perspective of movement. Methods: Qualitative study with semi-structured interviews with eleven OHI-certified physiotherapists, using qualitative content analysis by Graneheim and Lundman. As theoretical framework "The movement continuum Theory of Physical Therapy" was used.. Results: The theme ”The horse and its environment enriches the physiotherapeutic practice” is based on four sub themes and nine sub-sub themes. EAT has potential to enrich physiotherapeutic practice by influencing several levels of movement simultaneously. Riding can provide external conditions promoting movement, also involving professional judgment between benefits and elements of risk.  Resources to stimulate internal factors as motivation, commitment, and social factors in the alliance were experienced. EAT is perceived to support a resource-focused approach to movement, where body, mind and emotion are involved.  Conclusion: How EAT enriches the profession depends on the physiotherapist's decisions based on purpose, professional knowledge, and personal competence. The versatility provides opportunities to use EAT with different populations. When clinical practice of EAT are described in context of physiotherapy, the complexity of EAT can be understood, and terms as evidence-based practice come within reach.

No description available.

Rural schools experience difficulty in filling teaching positions at higher rates than non-rural schools. Recruiting and retaining teachers are critical in these districts; however, because the term “rural” is variable, a one-size-fits-all response is not possible. Rural communities tend to be geographically remote, have a low critical mass of students with distinct disabilities, and have relatively few resources to provide differential support for students. In this context, special educators may find themselves in circumstances where they operate as general specialists who are responsible for addressing a broad range of student needs without the support of other related service providers (e.g., school psychologists, curriculum specialists, school counselors, speech and language pathologists). Garwood’s article provides a catalyst to consider ecological system factors that affect burnout, attrition, and, as a consequence, instruction, particularly for students with disabilities. In this response, we view this issue from a perspective of rural schools, where the system contexts are varied and directly impact teacher-level variables, such as the ability to implement evidence-based practices (EBPs) with fidelity. Taking a developmental systems approach, we describe what makes rural settings unique and how these characteristics interact with the critical features of EBPs, as well as suggest how preparation and induction programs might better prepare and sustain teachers to adapt instruction to these rural contexts. We conclude with implications for practice and policy.

Introduction: Quality improvement (QI) encompasses a wide range of healthcare studies and activities with the common goal of improving patient outcomes, healthcare system performance, and professional development. QI is characterized by a diversity of definitions, stakeholders, clinical fields and study designs, which creates challenges for rigorous reporting and evaluation of these studies. Understanding and addressing the methodological issues that arise from conducting QI studies from multiple clinical disciplines is critical for generating good evidence for healthcare improvement to tackle health system challenges. Objectives: This thesis addressed three independent objectives: (i) Determine the quality of reporting of QI studies in neonatology. (ii) Compare different statistical methods that can be used to analyze data from a cluster randomized controlled trial with repeated measures data and examine how the estimate of intervention effects varies between these approaches. (iii) Determine the cost-effectiveness of providing timely surgery or timely rehabilitation for patients with hip fracture. Methods: Objective 1: We conducted a systematic survey of quality improvement studies in neonatology to examine the extent to which these publications adhered to SQUIRE 2.0, the guidelines for reporting studies that sought to improve the quality, safety, and value of healthcare. Using the same set of articles, we examined how various methodological attributes, such as stakeholder engagement, outcome measures, and statistical process controls, are reported in these studies. Objective 2: To compare the differences in the statistical estimates of intervention effects between linear mixed models and Generalized Estimating Equations, for the CP@Clinic Program cluster randomized RCT, which contains routinely collected monthly outcome data aggregated at the cluster level. Objective 3: We constructed a Markov cohort model to estimate the cost-effectiveness of receiving timely surgery within 24 hours of admission to the emergency department, receiving immediate admission to inpatient rehabilitation following acute care discharge, receiving both, or none. Results: Objective 1: In our assessment of reporting quality, we found that adherence to SQUIRE 2.0 guidelines was inadequate and that journals should endorse the SQUIRE 2.0 guideline for improvement publications to alleviate this issue. We found that process measures was the most frequently reported methodological attribute (89%), while stakeholder engagement with leadership (32%) or caregivers (10%) were infrequently reported or conducted. Objective 2: In comparing statistical methods for analyzing a cluster randomized controlled trial with correlated data, we found that it was critical to apply a correction to the variance estimator of generalized estimating equations to produce robust estimates of the intervention effects. Objective 3: In our economic evaluation, both timely surgery alone and the combination of timely surgery and timely rehabilitation yielded cost-effective improvements in the quality-adjusted life-years of patients with hip fracture. However, the combination of receiving timely surgery and timely rehabilitation requires a high willingness-to-pay threshold, above $128,000 per quality-adjusted life-years, to be considered cost-effective. Conclusions: Overall, understanding the state of reporting and the broad spectrum of methods and methodologic issues for evaluating quality improvement initiatives will advance its rigorous research, evaluation, reporting, and contribution towards informed decision-making for tackling pressing healthcare issues. / Thesis / Doctor of Philosophy (PhD) / Quality improvement (QI) is a field of healthcare research that can be defined in many ways, and research in this field is conducted by researchers from various medical disciplines. Consequently, challenges may arise in reporting and evaluating QI interventions. Thus, it is important to examine how QI interventions are reported in academic literature and the methods used to evaluate their effectiveness in improving health. The current thesis aims to address these issues through three independent objectives: (1) examine the details reported in QI studies in neonatology, (2) compare different statistical methods that can be used to analyze data from a community paramedicine cluster randomized controlled trial, and (3) investigate whether providing timely surgery and timely hospital-based rehabilitation is a cost-effective way to improve the quality of life of patients who have experienced hip fracture. The findings of these studies will provide insights into the challenges of reporting and evaluating QI interventions, and suggest ways to improve them.

Evidence-Based Practice (EBP), the philosophy underpinning professional service in the health care industry in the U.S.A. and U.K., has been accepted as a paradigm for psychological practice by the American Psychological Association (APA). The APA recommends that professionals base their clinical decisions on scientifically supported research and an understanding of their clients' specific ecological disposition. Clients are considered to have a right to efficacious interventions based on objective research findings, effective service and a high standard of care. Sub-divisions of EBP are Evidence-Based Treatments (EBT) and Evidence-Based Assessment (EBA). . South African educational psychologists have a meagre assessment ‘toolkit’ - outdated, culturally insensitive, non-standardised tests for culturally and linguistically diverse clients. Children from diverse backgrounds would have higher standards of care and more efficacious interventions were psycho-educational assessments to be culturally-sensitive. Without such instruments, ethical management of interventions is questionable, although universally, psychologists have found innovative ways of adapting their praxis to the difficulty. However, all practices and/or interventions are not based on research evidence, nor can be necessarily considered good practice. In the U.S.A. with its abundance of assessment instruments, EBA is a means of ensuring the scientific foundation for professional practice, consequently reliable, valid, culturally-sensitive assessment instruments have been produced. Findings in this study, derived from conversations with a sample of educational psychologists, revealed they were already accommodating cultural and linguistic diversity. Awareness of the value of EBA would support educational psychologists, bring them on par with worldwide praxis and enhance their professionalism. / Teacher Education / D. Ed. (Psychology of Education)