This qualitative study used a phenomenological approach to understand the experiences of seven parenting coordinators in using parenting coordination practices that they have found to be effective and would recommend to other parenting coordinators to achieve the following goals: educating parents, increasing the quality of parenting and co-parenting, managing conflict, and involving children and other family members in the process of parenting coordination. Data were collected with semi-structured interviews and analyzed using thematic coding. Initial findings suggest that there exists useful practice techniques toward achieving these goals, and supports a practice model informed by the evaluation by parenting coordinators of the efficacy of their chosen methods in the context of their practices. Participants report promoting cooperative co-parenting, stress parental autonomy, and supported parental decision making over parenting coordinator recommendations. Practical implications are discussed. / Master of Science

Les recommandations de bonne pratique, issues de la médecine des preuves, s’insèrent dans un processus ancien visant à asseoir la légitimité médicale sur la science et se sont déployées en tant qu’instrument politique de rationalisation des pratiques.Comment rencontrent-elles les valeurs professionnelles et l’exercice de la médecine ?La question est traitée dans le cadre de la médecine générale et de l’hypertension artérielle (HTA) dont la mise en recommandations est exemplaire de la construction d’un risque en santé publique.La première partie s’intéresse à l’origine de la médecine des preuves et en quoi ce mouvement est porteur de continuité et de modification dans les relations entre Médecine et État, au sein de la profession, entre médecin et patient.La seconde partie, centrée sur une microsociologie des consultations de patients hypertendus, montre que les recommandations constituent un appui pour le travail médical de prise de conscience par le patient de la réalité pathologique de l’HTA et des risques cardiovasculaires associés. Mais le généraliste inscrit son action dans la durée et, sous influence du patient, négocie et fait des compromis voire déroge aux « bonnes pratiques », considérant que ce qui n’est pas réalisable aujourd’hui le sera demain.Les recommandations sont intégrées dans les pratiques sous forme d’un modèle hybride associant la référence aux données scientifiques et l’adaptation à la singularité de la situation. La figure du patient statistique porté par la médecine des preuves est confrontée à la réalité sociale de l’individu plus ou moins doté d’autonomie et de ressources dont il s’agit pour le médecin d’acquérir la confiance et de la conserver. / Best practice recommendations, stemming from evidence based medicine, are part of a well versed process aiming to claim medical legitimacy based on science and are used as policy tools in practice. How do they relate to professional values, and to the practice of medicine?This question is examined within the framework of recommendations regarding the treatment, control and prevention of arterial hypertension (AH) in general practice which can be said to exemplify the construction of a public health risk.The first part of this work is centred on the origins of evidence based medicine, and the way in which it brings continuity as well as change to the relationships between: medical professionals; the institution of medicine and the state; doctors and patients.The second part, a microsociological study of GP consultations with hypertensive patients, shows that recommendations are used to reinforce the doctor’s efforts to increase patients’ awareness of AH and the ensuing cardiovascular risks. However, GPs use their influence over a long time period and, influenced by their patients, they negotiate, compromise and even disregard some of the best practice recommendations, considering that what may not be achievable in the present, may be achievable in the long term. Recommendations are therefore used in practice in hybrid form, where science is merged with an adaptation to each unique situation. The ‘average patient’ as the basic unit of evidence based medicine is opposed with the social reality of an individual with a certain level of autonomy and resources whose trust the doctor needs to gain and maintain.

Die vorliegende Arbeit untersucht die aktuelle wissenschaftliche Evidenz zur Diagnostik und Therapie neuropsychologischer Störungen nach Hirnschädigung, wie sie bis 2020 in Leitlinien publiziert wurde. Deren Umsetzung ist nur möglich, wenn die institutionellen Rahmenbedingungen dies erlauben. Unter Einbezug der klinischen Erfahrung wurden daher auf Basis der Leitlinien Standards für eine wissenschaftlich fundierte neuropsychologische Diagnostik und Therapie erarbeitet. Es entstanden Best-Practice-Empfehlungen zu Strukturund Prozessqualität, insbesondere zu Intensität und Häufigkeit der Interventionen. Diese werden für die wichtigsten neuropsychologischen Funktionsbereiche vorgestellt. Sowohl die Deutsche Gesellschaft für Neuropsychologie e. V. (GNP) als auch die Deutsche Gesellschaft für Neurologie e. V. (DGN) unterstützen diese Empfehlungen. Sie richten sich an Neuropsycholog_innen sowie an Einrichtungsleitende und Sozialversicherungsträger und definieren die Rahmenbedingungen für eine auf den individuellen Fall angepasste leitliniengerechte neuropsychologische Behandlung. / Recent years have seen the establishment of evidence-based guidelines for neuropsychological diagnostics and therapy; however, implementing these guidelines depends on structures and processes necessary to enable essential aspects like therapy frequency and intensity. The present work examines the current scientific evidence for the neuropsychological treatment of traumatic and nontraumatic brain injury, as published in guidelines up to 2020. Standards for evidence-based neuropsychological diagnostics and therapy were developed on this basis, including clinical experience and additional literature research. Best-practice recommendations on both general and specific structural and process quality emerged, especially on the intensity and frequency of interventions. These are presented for the most important neuropsychological functional areas. The German Neuropsychological Society (GNP) and the German Society for Neurology (DGN) support these recommendations. They are aimed at neuropsychologists as well as facility managers and social insurance providers, and they define the framework for guideline-based neuropsychological treatment adapted to individual cases.

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