Background: Evidence-based medicine (EBM) receives significant attention worldwide. Many studies have used questionnaires to discuss the factors obstructing the practice of EBM. There has however been no large-scale data analysis on who and when to practice EBM. This study aims to fill this gap in research by applying nationally representative data to analyze EBM practice after the provision of new evidence regarding rosiglitazone prescription. Methods: We used the National Health Insurance Database in Taiwan to analyze the changes in the prescription of rosiglitazone after meta-analysis found the drug to increase the risk of myocardial infarction. The study period was 18 months from the second quarter of 2007 to the fourth quarter in 2008. Two models of doctors¡¦ prescription behaviors were analyzed in the study. We conducted univariate analyses to distinguish significant differences in the variable and applied multivariate logistic analyses to predict the probability of physicians ceasing to prescribe rosiglitazone. Results: We found a significant improvement in EBM practice from specialists and experienced physicians. When compared to other specialists, endocrinologists were four times more likely to change rosiglitazone prescription (OR: 4.129, 95% CI: 2.484-6.863). Doctors with more than 10 years of specialist experience performed better in EBM practice than younger doctors. The hospital level that a physician worked at was not a significant factor. Local urbanization and economic status did not affect the practice of EBM by physicians in clinics either. Conclusions: Our study found that the EBM was still not well practiced among doctors in Taiwan. The practice of new evidence depended on the specialty or professional experience. Younger doctors and doctors working in medical centers seemed not to practice EBM well. In clinics, patients did not have enough influence to modify the doctor¡¦s prescription behavior. There was a significant time lag between the EBM emergence and EBM practice. This suggests that setting up an authoritative organization to provide timely EBM recommendations is very important. Further improvements to the practice of EBM are still urgently needed within the medical community.

The objective of this research is to review the degree of United States Army compliance in the implementation of evidence-based design practices within the Military Health System construction cycle. This research looks at the impact of the 2007 Assistant Secretary of Defense for Health Affairs memorandum directing the use of evidence-based design within the Military Healthcare System construction process. The memorandum impacted the military medical construction process that includes over 6.2 billion dollars in government programmed military medical construction covering 9.2 million beneficiaries. An analysis of federal construction documents, interviews, and an online survey was conducted with 85 government and civilian healthcare facility planners to measure general evidence-based design knowledge, direct knowledge of medical construction policy requirements, and the level to which the Military Health System Evidence-based Design Principles matrix has been implemented within four selected military medical construction projects. Results of the review of construction publications show minimal evidence of evidence-based design incorporation with key federal regulatory documents. The results of an online survey conducted during the research had a 65.8% response rate (39 government personnel, 17 civilian personnel). The survey showed that basic knowledge of evidence-based design was present, but revealed severe deficiencies in specific knowledge and application of construction policies. Review of selected medical facilities demonstrated non-standardized incorporation of evidence-based design features. This research concludes that evidence-based design has achieved minimal integration into the Military Health System general knowledge base and project execution. Achieving compliance with the 2007 directive memorandum requires that significant efforts be made in personnel training and reconciliation with federal military medical construction documents.

Thesis (M.Sc.)--York University, 2007. Graduate Programme in Computer Science. / Typescript. Includes bibliographical references (leaves 112-117). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR38843

At the heart of this thesis research lies the theory of biophilia which describes the innate affinity that humans have for nature and suggests a scientific hypothesis for environmental behavioral responses within the creative fields of architecture and design. Natural environments afford healing and restorative benefits in the form of positive shifts in cognitive, physical, and social functioning. Stress relieving benefits of natural environments are also widely recognized for their ability to provide a sense of control or privacy, a means for social support and interaction, opportunities for physical exercise and movement, and positive distractions through connection to nature. By creating verdant environments that are sensory-rich and accommodate physical experiences with nature beyond the passive experience of simply viewing it from the interior, a garden can provide healing benefits that extend past the architectural walls of the healthcare building. Through the introduction of guidelines and considerations, the field of healing landscape architecture has been able to design for positive environmental responses to create successful exterior healing environments. However, the same supportive characteristics, preferences, and stress relieving benefits of a natural healing environment need to be considered for the interior healthcare environment. To further facilitate well-being, the built spaces need to be environments that reconnect the body and mind and foster a sense of place. These healing effects can be achieved through biophilic and sensory encounters within the facility. By focusing more on the human-environmental response research from environmental psychology, the methods for healing landscape architecture, and expanding on the principle of connection to nature in evidence-based healthcare design, healing interior environments can begin to be redefined. Using concepts of biophilic design to guide decisions for the built environment, spaces are designed to support healing through biophilic responses and connection to natural elements and systems. This thesis is meant to be viewed as a contribution towards developing evidence-based biophilic interior design solutions for healthcare environments. The interdisciplinary research and proposed guidelines are hypotheses for how to further design with nature for human well-being. They offer support and design considerations for psychological responses to nature within the interior healthcare environment. / text

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

Intimate partner violence (IPV) is a global public health problem and occurs in all countries including Hong Kong. Women are significantly more likely to report being victimized by intimate partner than men. IPV can result in high personal and social costs in terms of personal health consequences, burden on the medical care and loss productivity for the society. Early and effective interventions for women survivors of IPV are utmost importance. Increasing the safety behaviours education to abused women is one of the aims of advocacy interventions that may prevent further abuse and increase the safety and well-being of those women. It is crucial for nurses to assess the effectiveness of the advocacy intervention in order to apply the best evidence into practice in the local settings. However, there are no specific interventions or guidelines for women survivors of IPV are available in Hong Kong local healthcare system including the STD clinics or the Social Hygiene Clinics. In this dissertation, a translational nursing research related to an effective advocacy intervention for women survivors of IPV is described. The purposes of this study are (1) to conduct a systematic literature review on interventions to increase safety behaviours for women survivors of IPV; (2) to summarize and synthesize the data from the identified literatures; (3) to assess the implementation potential of the proposed innovation on advocacy intervention; (4) to develop an evidence-based practice guideline; (5) to develop an implementation plan; and (6) to develop an evaluation plan to assess the effectiveness of the proposed evidence-based guideline. A systematic literature search was conducted and a total of nine studies were identified in the review. The level of evidence and critical appraisal of each selected study was criticized by using the grading system of Scottish Intercollegiate Guideline Network (SIGN). After the integrative review, the implementation potential of the proposed innovation on advocacy intervention for women survivors of IPV was assessed in terms of different aspects, including target audience and setting, transferability, feasibility and cost-benefit ratio. Then an evidence-based guideline was developed based on the level of evidence with grades of recommendation stated. For the implementation plan was divided into two parts, the communication plan and the pilot study plan. After communicating with the different identified stakeholders and providing proper training programme to the innovators, a pilot study test was carried out for concrete information on the feasibility of the proposed innovation. Finally, an evaluation plan was designed to evaluate the effectiveness of the proposed innovation. The aim of this dissertation is to increase the safety behaviours of the target population and to reduce further abuse. With the implementation of the evidence-based advocacy intervention, the women client’s knowledge on safety-promoting behaviours should be improved significantly thus to improve their health and also to increase their safety. / published_or_final_version / Nursing Studies / Master / Master of Nursing