Preliminary research exists indicating the importance of counselor attitudes and organizational features as influencing use of evidence-based practices (EBPs). Conceptual models of evidence-based practice implementation posit relationships among factors theoretically associated with use of an EBP, yet little research exists that explores how a constellation of counselor characteristics relate to counselors’ use of evidence-based practices. Research is also lacking on the role of counselor characteristics in use of motivational interviewing, a specific evidence-based practice. In addition to identifying counselor characteristics associated with use of MI, this study explores how counselor characteristics directly and indirectly affect implementation relationships for MI. The study sample comes from a larger study testing how organizational facilitation influences outpatient substance abuse counselors’ use of MI, and client outcomes. Multiple regression was used to explore the contribution of counselor characteristics (amount of MI training, MI skill level, motivation to use MI, supportive attitudes toward MI, perception of organizational climate and MI skill level) on reported use of MI. Analyses with each dependent variable had different sample sizes: N=76 for relationships tested between counselor characteristics and use of MI and N=46 for relationships tested between counselor characteristics and MI skill level. Results suggest that among these characteristics, supportive attitudes related to MI and motivation to use MI significantly contribute to counselors’ use of MI with clients. Further, supportive attitudes related to MI and motivation to use MI each partially mediates the relationship between amount of MI training and counselor use of MI. But, findings are tempered by a sample comprised of relatively low levels of training and low MI skill level. Despite having very little training, and low skill levels, high usage of MI was reported by counselors. More empirical research utilizing larger samples with higher training levels is needed to better understand how counselor characteristics may affect EBPs implementation in order to promote the effective use of evidence-based practices. / text

Fibromyalgia syndrome (FMS) is a chronic pain condition with significant societal and personal burdens of illness. Chronic opioid therapy in the treatment of chronic nonmalignant pain has increased drastically over the past decade. This is a worrisome trend in general, but specifically, given the pathophysiologic characteristics seen in fibromyalgia syndrome patients, the use of this class of medication deserves special scrutiny. Although the theoretical case against this therapy choice is strong, little empirical evidence exists. In order to supplement this literature, retrospective analysis methods are utilized to examine the association of state-, provider-, and patient level characteristics with the prevalence of chronic opioid use in this disease state. Data gathered through this analysis is then used to develop a propensity index for the identification of an appropriate control group for fibromyalgia patients, a task that has proven difficult in the literature to date. Using propensity stratification and matching techniques analysis of the impact of fibromyalgia, chronic opioid use, and the interaction of these two variables are undertaken. Several key findings and updates to the understanding of chronic opioid use and fibromyalgia syndrome are reported. Wide geographic variation in chronic opioid utilization between states is seen. The role of diagnosing provider type in the rate of chronic opioid prescribing is significant and can be aggregated at various levels. Demographic characteristics, comorbid conditions, and concurrent medication use are all important associates of chronic opioid use in fibromyalgia syndrome. Additionally, chronic opioid use in fibromyalgia patients, independent of propensity to receive that therapy choice is a significant correlate with healthcare costs. A diagnosis of fibromyalgia is a statistically significant source of healthcare costs, though the clinical significance of its impact when compared to a closely matched control group is minimized. Despite the minimization of the role of this diagnosis the impact of the interaction of chronic opioid use with fibromyalgia, despite control for myriad regressors, is significant both statistically and clinically.

The purpose of this project is to examine how the factors of gender, placement status, type of treatment, the number of different types of trauma experienced, and a child’s age at the start of treatment may influence end of treatment symptom severity scores for children ages 2-12 years who received trauma-informed evidence-based treatment for trauma. Method: Caregivers and children receiving outpatient services (N=134) completed the Child Behavioral Checklist, Trauma Symptom Checklist for Young Children, and the Trauma Symptom Checklist for Children-Alternate Version at baseline and end of treatment. Hypotheses were tested with a series of ANCOVA analyses, Independent t-Tests, and a Paired Samples t-Test. Results: While statistically significant improvements were found between baseline and termination outcome scores regardless of treatment type, TF-CBT was found to more successfully reduce externalizing and total problem scores at termination compared to PCIT. Despite the relatively young age of this sample, significant differences in externalizing and total problem scores on the CBCL were found for older children at the end of treatment. No significant differences were found between pre-and post-test internalizing and externalizing scale scores for either TF-CBT or PCIT. Additionally, examination of caregiver and child daily functioning scale scores indicated improved ratings of daily functioning from baseline to the end of treatment. Implications: Behavior problems stemming from traumatic exposure may resolve differently from behaviors that result from environmental factors apart from trauma. Trauma recovery is dependent upon successful matching of client characteristics and need to treatment type. Practitioners are encouraged to be mindful of the specialized needs of older children who are seeking treatment. Research that focuses on clarifying the factors that differentiate symptom resolution can inform treatment selection decisions. Social work educators are encouraged to design curriculum that is trauma-informed with an emphasis on helping students learn how to think critically about a child’s needs and to integrate this knowledge into treatment decisions. The development of policies that incentivize agencies to provide evidence-based care can increase the availability of research-supported care for trauma exposed youth.

This thesis examines the construction of forensic medical evidence in penetrative sexual assault cases and the procedures that Forensic Medical Examiners (FMEs) employ in order to ensure the authority of that evidence. Drawing upon interviews and on the texts and artefacts that FMEs use in their work, the thesis employs the concept of “meaning finitism” to analyse how FMEs perform forensic examinations for evidential purposes. The thesis starts with an exploration of how medical practitioners are taught to identify and classify injuries of medico-legal significance, culminating in their being judged “safe” to provide expert testimony by other members of the clinical forensic medical community. The thesis next addresses the construction of what I call the “morphological account”: a set of judgements about the nature of a case based upon a combination of the observed injuries, the FME’s training and their previous experience of cases. While there is considerable agreement amongst practitioners about how to interpret injuries (a result of their training), because the morphological account involves personal judgement, there is also scope for differences of opinion. The thesis therefore explores the methods that FMEs employ to limit the risk of being seen to disagree with one another during trials. The thesis also examines the role that guidelines play in the forensic medical examination. The thesis argues that standardised medical kits and associated guidance documents were originally introduced in the early 1980s in response to sustained criticism of FMEs’ practices, and further developed in the late 1990s and early 2000s with the rise of Evidence-Based Medicine. Kits and guidance documents provide a means for FMEs to legitimate and explain their work to others, particularly during trials: they codify collective practice and provide FMEs with an aide memoire of the requisite procedures, without overly determining or constraining practice. Finally, I will argue that FMEs’ concern to ensure the authority of their evidence may sometimes limit the value of that evidence. Caution over drawing inferences that might be challenged in court, and a concern not to be seen as “prosecution-minded”, commonly leads FME to compose so-called “Neutral Reports” which neither confirm nor deny the complainer’s allegations. As Scottish Procedural Law makes provision for non-contentious evidence to be removed from trial, such neutral reports are likely to be dismissed from consideration.

Percy Barnevik is one example of a renowned leader publishing a book, “Leadership- 200 advice”, on his experiences as a manager. The overall quantity of this so called Guru Literature on the market demonstrate that it exist a great interest in advice from business leaders but further raise a question of soundness of the advice. The aim with the thesis is to generate a picture of how well Guru Theory in general and Percy Barnevik specifically is connected to management research and practice. What constitute evidence is often debated within the management research field and scholars mean that one cannot assume a fact without any evidence created from research. This leads to a discussion about rigor and relevance and how management research should be designed to create a rigorous study, without overshadowing its practical relevance to the operating business. To answer the research question, interviews were executed with complementary questionnaires. In order to create a picture of what kind of anchoring Barnevik’s advice have in management theory a literature review was conducted. It is possible to see that the majority of the practitioners compared to research have a different level of cohesiveness with Barnevik regarding the studied advice. Practitioners, tend to a high level agree with Barnevik although management research stand for a more hesitant approach. Our conclusions are that management researchers should consider Guru Theory to a greater extent rather than discard it. This we believe could generate relevant research contributions to practitioners and add rigor to an unscientific field of theories

Magistro baigiamąjį darbą sudaro 4 skyriai. Pirmajame skyriuje nagrinėta įrodymais grįstos politikos teorinė prieiga. Antrajame – įrodymų naudojimas sveikatos priežiūros srityje. Tuo tarpu trečiasis skyrius skirtas sveikatos priežiūros įstaigų bei paslaugų restruktūrizacijos analizei akcentuojant trečiojo restruktūrizacijos etapo pasiekimus. Galiausiai paskutiniame skyriuje koncentruojamasi į empirinę darbo dalį, išryškinant sveikatos priežiūros specialistų, sveikatos politikos formuotojų požiūrį į trečiojo restruktūrizacijos etapo rezultatus sveikatos priežiūros paslaugų bei trečiosios programos įgyvendinimo kontekste. Užsibrėžtas darbo tikslas: išanalizuoti trečiojo sveikatos priežiūros įstaigų ir paslaugų restruktūrizavimo etapo rezultatus remiantis įrodymais grįstos politikos teorine prieiga. Darbo uždaviniai: išanalizuoti įrodymais grįstos politikos teorinę koncepciją bei jos taikymą sveikatos priežiūros srityje; pasitelkus Lietuvos sveikatos ekspertų vertinimus, teisinį reglamentavimą, išnagrinėti sveikatos priežiūros įstaigų ir paslaugų restruktūrizacijos etapų pasiekimus; atskleisti paslaugų prieinamumo, kokybės ir saugumo pokyčius trečiojo restruktūrizacijos etapo kontekste; išanalizuoti stacionarinių paslaugų, finansavimo bei įstaigų tinklo optimizacijos rezultatus ir jų poveikį sveikatos priežiūrai; atskleisti trečiosios restruktūrizacijos programos tikslo bei uždavinių įgyvendinimo problemas; išnagrinėti trečiojo restruktūrizacijos etapo rezultatų... [toliau žr. visą tekstą] / The M.A. thesis consists of four chapters. In the first chapter the evidence-based theoretical approach to the political theory is analyzed. In the second chapter the use of evidence in the area of health care is discussed. The third chapter deals with the analysis of the restructuring of health care system, emphasizing results of the third stage of the restructuring. In the last chapter the empirical part of the research is presented. It shows the approaches of health care specialists and creators of health politics concerning the results of the third stage of restructuring in the context of health care delivery system and implementation of the third stage programme. The aim of the M.A. thesis is to analyze the results of the third stage of health care delivery system restructuring regarding the evidence-based theoretical approach to the political theory. In order to achieve the aim the following objectives have been set out: to review the thoretical conception of the evidence-based theoretical approach to the political theory and its application in the area of health care; to analyze the results of the stages of health care delivery system restructuring regarding the evaluation of Lithuanian health care experts and legal regulation; to show the changes in accessibility, quality and safety of health care delivery services in the context of the third stage of restructuring; to analyze the results of health care stationery services, financing and optimization of institution... [to full text]

This thesis explores the statement that the health information needs and behaviour of the general public, namely health information consumers are comparable with those of academics, health and social care professionals. The research has been conducted in the broad Interpretist tradition, seeking to understand rather than merely explain human behaviour. A model depicting the health information and knowledge environment has been developed to show the how the infonnation behaviour of the various populations in the research are interpreted and where they are placed. The provision, access and use of health information by consumers is the focus of the inner core of the model and is the first theme of the thesis. Several discrete groups of the information poor are investigated to explore their information needs and behaviour. The middle layer of the model depicts the second theme of this thesis focusing on the attitudes of academics, health and social care professionals in their use and access of health information and IT in everyday practice. The information behaviour of the health information and library professional is the focus of the third theme of the thesis and is represented by the outer layer of the model. This theme explores the detail and the contribution of the role to the clinical team, the use of Evidence Based Medicine and Clinical Governance. Conclusions support the opening statement that the health information needs and behaviour of the general public, namely health information consumers are comparable with those of academics, health and social care professionals. Recommendations are made to promote better and more frequent use of health information and health information professionals in the everyday practice of health and social care; to improve the access and provision of health information for consumers.

The aim of this study was to determine the information-seeking behaviour, needs and preferences of doctors, specifically with reference to Evidence Based Medicine (EBM) in the UK. This is particularly relevant during the current IT and resource development currently being undertaken in the NHS. Mixed methods research techniques were utilised to gather and analyse the data collected to meet the aims and objectives of this study. Three data collection methods have been utilised. The first utilised Clinical Librarians to count the information needs (questions) of doctors (Clinical Librarians Logs). The second data collection method gathered clinical questions from clinical librarians (specialists), medical librarians (generalists) and from websites hosting clinical questions (such as http://www.attract.wales.nhs.uk). These were analysed using the taxonomy developed by Ely et al. 2000. Finally an online questionnaire was used to gather data on doctors' awareness and use of electronic EBM resources. The major finding is that research undertaken on the information needs in the healthcare sector in the USA cannot be readily utilised in the NHS. This research utilised a unique data collection technique, the Clinical Librarian as a data collector. This enabled the quantification of doctors unperceived information needs. This research identified that doctors in the UK asked roughly one question for every four patients seen. Despite the advances and ease of use of electronic resources, the preferred information source was colleagues. Time continues to be the major barrier for accessinge lectronici nformation to aid clinical decision making.

The rising population of older people in the UK (Office for National Statistics 2010) and pressure on healthcare services to reduce costs indicate the necessity of developing strategies that enable coping and independence. Loss through death of close family members, partners and friends is a key factor that inhibits physical, emotional and social well being of older people. The research carried out for this thesis explored bereavement in healthcare settings where contacts with bereaved older people commonly occur, and used data collected to develop guidelines for practice. The guidelines provide research informed enhancement to bereavement care and develop opportunities for meaningful interactions. They complement current policy development work on bereavement in healthcare settings (The Scottish Government 2011). A qualitative design drawing on phenomenological methodology was used to explore healthcare staffs’ experiences of caring for bereaved older people, and older people’s experiences of being bereaved and bereavement care. Theoretical sampling took place to recruit staff from a range of roles in general practice and community nursing, hospital wards and care homes, as well as a small sample of bereaved older people. Thirty nine participants took part in in-depth interviews that yielded four key themes: bereavement care depends on a relationship between healthcare staff and relatives; preparation for a relative’s death may not equate to preparedness for bereavement; the ‘Open Door’ to bereavement care is only slightly ajar, and bereavement care supports progression of the ‘Rolling Ball’ of life. The themes informed development of the guidelines in terms of structure and content. Recommendation statements consider bereavement care before the death; at the time of the death; and follow up in the weeks and months afterwards. Criteria in the recommendations provide suggestions for enhancements to practice that facilitate appropriate response to bereavement in older people. Consultation on the guidelines provided positive feedback that identified the potential to promote consistent interactions with bereaved older people, respond to needs and support coping.

Systematic reviews and meta-analyses have been a central pillar of evidence-based practice and policy-making in healthcare over recent years. Traditionally, this has focused on effectiveness evidence from trials.. There is increasing understanding, however, that other study designs also provide essential information and this has led to interest in developing ways to review and synthesis such evidence. Qualitative research has unique potential to illuminate the patient experience. This research has three aims: 1) To review and compare the proposed methods of systematic review and synthesis of qualitative research. 2) To develop and assess two methods of systematic review and synthesis of qualitative research. 3) To compare these two methods and suggest how they might be used in a policy-making context. In addressing these aims, this thesis substantially contributes to debates about the purpose and practice of systematic review and synthesis of qualitative research, particularly in the context of health technology assessment and related pOlicy-making. I undertake a unique critical comparison of the methods suggested for reviewing and synthesising qualitative research, based on their approach to key stages of systematic review. This is used to produce a comprehensive framework for good practice~ I use the framework in two systematic reviews, one about heavy menstrual bleeding using meta-ethnography, and one about hysterectomy using meta-study. These two reviews allow a comparison of the two methods, and in particular explore the impact of expanding the meta-ethnography approach through meta-study, which adds explicit steps to assess the impact of study methodology and theory on findings. The ability of meta-study to unpack the procedures and theories that produce particular findings is key and illuminates the importance of theory in systematic reviews of qualitative research. Through the two systematic reviews, my thesis also contributes to understanding of these reproductive health topic areas through the creation of new insights and concepts from the synthesis. The synthesis of heavy menstrual bleeding studies produced a detailed patient illness model based on women's experiences. In addition, it allowed an understanding of elements that contribute to women's certainty or uncertainty about whether or not their periods could be seen as problematic and requiring medical help. This helps to establish the limitations of the medical model for doctors, as well as women who suffer from heavy menstrual bleeding. The synthesis of hysterectomy studies produced a detailed description of the journey that women make to, and through, hysterectomy, based on their experiences. I also created a theoretical framework, which shows that hysterectomy needs to be understood in the context of personal, physical experiences, together with sociocultural forces that affect the way in which hysterectomy is experienced, and that the interaction of these micro- and macro-concerns mediate through, and affect, relationships with key other people. Methodology affected the research questions posed and the conclusions of research. Comparing the two methods of review and synthesis showed the importance of taking account of the methods and theories that produce research findings. However this additional detail may be at the expense of certainty and requires additional resources.