Evidence-based practice, whose roots emanate from the mid-1960s, aims to provide fair, high-quality, and soundly researched health care with patients' best interests as a priority. Clinical practice guidelines are evidence-based and designed to assist clinicians with sound decision making. Despite the importance of evidence-based practice and the efforts invested into its development and dissemination, its uptake and implementation are poor. The disconnect between evidence-based practice and its translation into clinical practice was previously reported in low-to-middle income countries. This study investigated South African audiologists' and otorhinolaryngologists' (ear, nose and throat specialists') self-reported orientation to evidence-based practice. Second, adherence to evidence-based clinical practice guidelines was assessed with reference to the diagnosis and management of benign paroxysmal positional vertigo, a common vestibular condition for which a firm evidence base supporting treatment exists. A two-part quantitative approach was adopted. Part one surveyed South African audiologists and otorhinolaryngologists with the Evidence-Based Practice Profile Questionnaire and an additional researcher-developed questionnaire pertaining to the diagnosis and management of benign paroxysmal positional vertigo. A total of 130 survey responses were included in this study. Independent sample t-tests, one-way ANOVAs and Fisher's Exact tests were used to analyse the survey data. Part two used a retrospective record review at a tertiary academic hospital in the Western Cape of South Africa. Medical folders of patients diagnosed with benign paroxysmal positional vertigo, between 2010 – 2018 (n = 80), were analysed. The diagnosis and management strategies were recorded and compared against a gold standard evidence based guideline for congruence. Descriptive statistics were used to analyse and understand the data. Survey scores showed a positive association between increased years of experience and healthcare professionals' knowledge (p = .008) and confidence (p = .003) in evidence-based practice. Otorhinolaryngologists might be more knowledgeable than audiologists in evidence-based practice due to their increased training and exposure to evidence-based practice in their specialising years. Findings from the retrospective record review suggested adherence to the clinical practice guidelines in the diagnosis and management of posterior semi circular canal benign paroxysmal positional vertigo. The study outcomes propose that evidence-based clinical practice guidelines developed in the Global North may not be appropriate for the different health contexts that exist in low-to-middle income South Africa (e.g., rural settings). However, the benign paroxysmal positional vertigo clinical practice guidelines were adhered to at a tertiary, academic hospital in Cape Town. The results also support the notion that increased exposure to evidence-based practice reinforces its approach. Outcomes from this study raise implications for the development and dissemination of context-appropriate, evidence-based clinical practice guidelines.

This thesis examines how computer modelling matters for policy-making by looking at two case studies of European fisheries management. Based on documentary analysis and ethnographic interviews and observations, the main case is located within the European Union (EU) and centred around the flatfish fishery in the North Sea with a supplementary one from outside the EU and focused on the North East Arctic cod fishery in the Barents Sea. As in other much-contested areas of public policy, fisheries officials in the EU and neighbouring countries seek to develop a universalistic and objective ground by which to depoliticise management decisions. In this sense, modelling has long become their preferred approach to produce policy relevant representations of the otherwise hidden dynamics of a fishery. Social constructivists in the field of Science and Technology Studies (STS) studying the modelling used in areas of policy-making such as, for instance, climate change have questioned whether models are the right tools for this job given that the modelling may conceal large uncertainties about their accuracy and relevance to policy-making. Some of these scholars argue for producing ‘good’ models for policy-making, and thus more robust policies, by constructively engaging the non-modellers or non-specialists in the quality assurance of the modelling. ‘Fisheries Studies’ literature suggests, however, that modelling can contribute to policy resilience despite its well-known limitations to produce accurate fish counting. It follows that models are doing something else than providing policy-salient real-looking representations. How may modelling count differently for policy-making in fisheries and beyond? Drawing on the ‘co-production’ of science and social order framework from STS, the thesis puts forward three related arguments. First, that the technologies designed to depoliticise decision-making, including modelling, become spaces for political work by policy-makers, stakeholders and scientists. Second, that the role of computer modelling for policy stems from how representational validity and political usefulness are produced together. Third, that the role of modelling for policy is mediated by virtue of being assessed together with other technologies for depoliticising as part of a whole sociotechnical infrastructure to allow evidence-based decisions. As a distinctive contribution, this thesis thus questions the presumption in many social constructivist accounts that modelling alone becomes central to the policy process and its outcomes. The significance of modelling for policy-making should be understood in terms of its contribution to processes of sociotechnical framing. Narratives that foreground the former and background the latter show an analytical bias that needs turning around.

Evidence-based practice (EBP) is recognized as a means for providing safe, cost-effective, and quality healthcare. Registered Nurses (RNs), like other disciplines, are accountable for providing patient care based on the best evidence. The greatest majority of RNs are employed within the acute care setting. Unknown is what type of organizational infrastructure is necessary to support RNs in EBP. The business community reports positive performance outcomes through development of learning organizations (LO). LOs are reputed to be high functioning, supportive, adaptive, and continuously learning systems, compatible with the needs reflected in today's complex, turbulent healthcare. This descriptive study used a survey methodology to identify relationships between the dimensions of a LO as perceived by RNs within the context of the acute care hospital and their beliefs about and implementation of EBP. Six hospitals, two magnet designated, two non-magnet, and two Veterans Administration Medical Centers in one southwestern state were invited to participate. Three established instruments were used. Distribution of questionnaires to 1750 RNs resulted in a return of 592, for a 34% response rate. Instruments demonstrated adequate reliability and validity for this sample. Psychometrics on the EBP Beliefs Scale resulted in the identification of four subscales that were subsequently included in the analyses. Descriptive statistics indicated differences in characteristics of nurses from the different types organizations. The VA nurse's average age was 48 years, worked 19 years as an RN and 64% reported their highest educational degree as bachelor or above. Nurses responding from the other two types of organizations, on the average, were 42 years old, had 14 years experience, and 52% reported an educational degree of bachelor or above. Relationships were identified between RNs' perceived beliefs about EBP and their reported frequency of EBP implementation. Regressing beliefs on the dependent variable of implementation with the full sample (n=543) resulted in R2=.23, p<.05. Slight variation was noted in the analysis per organizational type. Relationships among the dimensions of the learning organization and the subscales of the Belief scale were analyzed using regression analysis. Significant relationships were noted but were demonstrated differently among the three different types of organizations.

This study describes primary care nurse practitioner (PCNP) beliefs in, knowledge, implementation and utilization of evidence based practice (EBP). Research questions answered are: 1. What are the levels of belief, implementation, knowledge and utilization of EBP among PCNPs? 2. Is there a relationship with PCNP demographics (personal, professional, and practice), belief, knowledge, implementation and utilization of EBP? 3. Do PCNP demographics (personal, professional, and practice) and scores on belief, knowledge and implementation influence EBP utilization? EBP is considered a standard of care and essential to nurse practitioner practice. The primary advantages of EBP include improved quality of care through the utilization of patient resources, provider resources and experiences, current research and scientific information. However, few studies describe nurse practitioner beliefs, knowledge in EBP and the extent to which this may affect primary care nurse practitioners' (PCNP) utilization of EBP in their practice. Four questionnaires incorporated into one survey were used to examine PCNP beliefs, knowledge, implementation and utilization of EBP. JNC7 guideline knowledge and self-reported use was used to measure EBP utilization. A convenience sample of 202 FNPs, ANPs and GNPs were obtained during the American Academy of Nurse Practitioners National Conference 2011 in Las Vegas, Nevada. PCNPs surveyed were found to have a high level of belief in EBP but did not report implementing EBP more than 3 times in the past 8 weeks. Belief was statistically higher in doctorally prepared PCNPs. Ninety-five percent of the participants were familiar with the JNC7 guideline but the group scored a mean of 69% on knowledge of JNC7 guideline specifics. Only 25% of respondents indicated they utilized guidelines in hypertension management. Future studies should include quantitative and qualitative evaluation of EBP implementation facilitators and obstacles. Findings in this study have provided initial information to better understand PCNPs and EBP.

Title: Analysis of Pharmacotherapy by patients with diagnosis of COPD Student: Marilena Kartali-Kaouni Tutor: Prof. RNDr. Jiri Vlcek, CSc Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove Background: " Chronic Obstructive Pulmonary Disease (COPD) is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases". Tobacco smoking is the major risk factor in the development of COPD. COPD is a leading cause of morbidity and mortality worldwide. Aim: 1st from the current literature to understand the nature of COPD and obtain information about the aetiopathogenesis of the disease, diagnosis options and summarize the current view of strategies for achieving the goals of treatment. 2nd in a pilot study to analyze drug therapy in COPD patients visiting a pharmacy in Greece. Methods: 56 prescriptions with the diagnosis of COPD were collected during a period of 8 months from a Greek pharmacy. Information from the prescriptions with regard to COPD medications prescribed (active substances, trade names, strength, dosage scheme, pack size), patients characteristics (age and gender) and prescribing...

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Title: Evidence based practice within social work in Sweden: a systematic literature study Aim: The aim of this study was to investigate the research concerning EBP in a Swedish context. Method: a systematic literature study, wherein 16 articles were used and assessed using thematic analysis. Results: the study further clarifies the vagueness concerning the term EBP and what it contains. The results point to several factors which facilitate as well as inhibit the implementation of EBP, and that organization and leadership pose a significant role in the development of social workers organizations. Further findings are the gap between theory and practice and the lack of research of EBP in a Swedish context. / <p>2019-06-04</p>

There is broad agreement that medicine ought to be `evidence based' and `personalized' and that data should play a large role in achieving both these goals. But the path from data to improved medical decision making is not clear. This thesis presents three methods that hopefully help in small ways to clear the path. Personalized medicine depends almost entirely on understanding variation in treatment effect. Chapter 1 describes latent class mixture models for treatment effect heterogeneity that distinguish between continuous and discrete heterogeneity, use hierarchical shrinkage priors to mitigate overfitting and multiple comparisons concerns, and employ flexible error distributions to improve robustness. We apply different versions of these models to reanalyze a clinical trial comparing HIV treatments and a natural experiment on the effect of Medicaid on emergency department utilization. Medical decisions often depend on observational studies performed on large longitudinal health insurance claims databases. These studies usually claim to identify a causal effect, but empirical evaluations have demonstrated that standard methods for causal discovery perform poorly in this context, most likely in large part due to the presence of unobserved confounding. Chapter 2 proposes an algorithm called Ensembles of Granger Graphs (EGG) that does not rely on the assumption that unobserved confounding is absent. In a simulation and experiments on a real claims database, EGG is robust to confounding, has high positive predictive value, and has high power to detect strong causal effects. While decision making inherently involves causal inference, purely predictive models aid many medical decisions in practice. Predictions from health histories are challenging because the space of possible predictors is so vast. Not only are there thousands of health events to consider, but also their temporal interactions. In Chapter 3, we adapt a method originally developed for speech recognition that greedily constructs informative labeled graphs representing temporal relations between multiple health events at the nodes of randomized decision trees. We use this method to predict strokes in patients with atrial fibrillation using data from a Medicaid claims database. I hope the ideas illustrated in these three projects inspire work that someday genuinely improves healthcare. I also include a short `bonus' chapter on an improved estimate of effective sample size in importance sampling. This chapter is not directly related to medicine, but finds a home in this thesis nonetheless.

This exploratory study describes the variation in how evidence-based practice is understood in educational psychology. The study is comprised of two phases, which were both designed, analysed and interpreted using qualitative methodology. In phase one, twenty-two semi-structured interviews were conducted with educational psychologists from eight services in England. A phenomenographic approach to analysis was applied, resulting in a conceptual framework, representing the variation in understandings of evidence-based practice of a group of educational psychologists. In phase two, two focus groups were conducted with a subset of participants from phase one to elucidate the influence of evidence-based practice on decision-making in practice. A framework approach to thematic analysis showed that practice decisions of educational psychologists are influenced by evidence-based practice according to contextual factors, training and practice experiences and personal characteristics. This study gives insight as to how educational psychologists experience and account for the role of evidence and evidence-based practice in their practice and informs how evidence-based practice might be conceptualised in educational psychology. The findings suggest that evidence-based practice is grounded on personal, internalised beliefs while being contextualised by the demands of specific circumstances. The findings have implications for providers of educational psychology training in terms of the curriculum for evidence-based practice and associated learning outcomes.

Neighbourhood design is a part of sustainable development, and attempts to create better places for people by reflecting residents' values, as well as coordinating powers, resources, and actions between stakeholders. This research aims to investigate neighbourhood regeneration plans using an activity-based approach. It explores how daily social activities can be modelled using the case study of Brunswick, to develop the analytical and decision-support roles of modelling in the urban design process. The literature about the role of design in urban development argues that the designers' attempts to predict how new environments will actually be used have not often been successful. It is assumed that if the design process incorporates human-centred activities in creating and maintaining neighbourhood places, the certainty and reliability of any future vision will be enhanced. Following a critical review of the concept of activity in urban design and urban modelling, the daily activities of Brunswick residents are investigated through the residents' completion of daily diaries. This data contributes to an analytical activity-based approach. The outcomes provide the analyses of the following areas: the activity choices of individuals and how these choices are linked with the socio-demographics of residents, how current local agencies and the existing physical environment provide opportunities and restrict residents' participation in local activities, and the future activity-based scenarios of change as a result of the neighbourhood regeneration proposal submitted to the Manchester City Council. Ultimately, an activity-based framework is proposed which enables the qualitative analysis of regeneration planning statements, community consultation reports, institutional programmes, and policy documents. The framework then outlines the method of integrating the three above mentioned quantitative results with the qualitative data, and the formation of activity scenarios. This thesis demonstrates how this framework assists local agencies, authorities, service providers, and regeneration teams with regard to improving their services, promoting social integration of residents in neighbourhoods, and linking neighbourhoods to their wider contexts. The modelling results reveal that the elderly residents of Brunswick are isolated, the Brunswick spaces are not frequently used in the evenings, and the existing activities are not popular for male, employed and highly qualified residents. Although Brunswick Church attempts to be the community centre of the Brunswick neighbourhood, the provision of activities in this place is via other organisations. Medlock School and the Sure Start Children's Centre are the community hubs for parents and children to socially interact with other members. In addition, the new layout of the Brunswick neighbourhood after the regeneration scheme will improve the safety level of the Brunswick spaces, but will partially link Brunswick to Manchester. There is the lack of exchanging data as well as the absence of the indication of the reasons and processes that have contributed to the current challenges in Brunswick. Hence, there is inconsistency between the stakeholders' views towards the neighbourhood issues, and limited evidence is available for stakeholders to have a robust future outlook to the regeneration plan.