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Russo, Philip L. "Evidence based recommendations for national healthcare-associated infection surveillance." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/100034/1/Philip_Russo_Thesis.pdf.
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This thesis has provided new knowledge about the surveillance of healthcare associated infections both in Australia and internationally. Using a mixed methods approach, a series of evidence based and pragmatic recommendations for a national surveillance program in Australia have been generated. Gaps in current surveillance activities across Australia were identified, and findings from the novel application of a discrete choice experiment, have identified strong key stakeholder support for a preferred national program to reduce the burden of infections in Australian hospitals.
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Wanigarathna, Nadeeshani. "Evidence-based design for healthcare buildings in England and Wales." Thesis, Loughborough University, 2014. https://dspace.lboro.ac.uk/2134/16161.
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A substantial amount of credible evidence shows that properly designed healthcare built environments can positively impact upon the health outcomes of the building users. This offers an opportunity to improve the quality of healthcare through appropriately designed healthcare built environments. Evidence-based design (EBD) emerged within healthcare building design practice to enhance the process of designing with credible evidence. This research explored improvement opportunities for EBD in the UK which would subsequently improve the quality of healthcare through built environment interventions. Specifically, three key research gaps were addressed during this research. Firstly, this research explored current practices of evidence use during healthcare designing and opportunities to increase the direct use of research-based evidence and alternative ways of conveying research-based evidence into the design process through other source of generic evidence for design. Secondly, this research explored how evidence could be effectively expressed within healthcare design standards, guidance and tools (SGaTs) in the forms of performance and prescriptive specifications. Finally, considering the unique nature of built environment design, this research explored how project unique contextual circumstances impact EBD processes and how practitioners reflect on these circumstances. These challenges were then transformed into six objectives. Following a comprehensive literature review, this research was divided into four phases. First, a model of the sources and flows of evidence (SaFE) was developed to represent evidence for EBD within generic evidence for design. The initial conceptual model was developed through desk study, based on the literature review, self-experience and the experience. This model was then verified with the comments from five un-structured interviews conducted with lecturers and senior lecturers of the School of Civil and Building Engineering. Finally, the model was validated using 12 semi-structured interviews conducted with design practitioners from the industry. In addition to the validating the sources and flows of evidence these interviews revealed rationales behind design practitioners use of evidence from four types of evidence sources. These results revealed improvement opportunities to increase the intake of research-based evidence use during healthcare built environments designing. The main data collection method for this research was case studies. Eight exemplar design elements within three case studies were investigated to explore details of evidence use practices; practices of using performance and prescriptive specifications; and impact of project unique contextual circumstances for EBD process and how design practitioners reflect on these circumstances. Results of this research revealed that EBD needs to be supported by both externally published research evidence and through internally generated evidence. It was also identified that EBD could be significantly facilitated through research- evidence informed other generic design evidence sources. Healthcare design SGaTs provides a promising prospect to facilitate EBD. Performance specification driven healthcare design SGaTs supplemented by prescriptive specifications to define design outputs and design inputs could improve effective use of evidence-informed SGaTs. These results were incorporated into a framework to guide development of healthcare design SGaTs. Finally, by exploring how projects unique contextual circumstances impact EBD processes and how practitioners reflect on these circumstances, this research identified the need for procedural guidance for designers to guide evidence acquisition, evidence application and new evidence generation.
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Rexhepi, Hanife. "Improving healthcare information systems : A key to evidence based medicine." Licentiate thesis, Högskolan i Skövde, Institutionen för informationsteknologi, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-11019.
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Delivering good quality care is a complex endeavor that is highly dependent on patient information and medical knowledge. When decisions about the care of a patient are made, they must, as far as possible, be based on research-derived evidence rather than on clinical skills and experience alone. Evidence based medicine (EBM) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise as well as patient values and preferences to guide healthcare decisions. Following the principles of EBM, healthcare practitioners are required to formulate questions based on patients’ current clinical status, medical history, values and preferences, search the literature for answers, evaluate the evidence for its validity and usefulness, and finally apply the information to the patient. Information systems play a crucial role in the practice of evidence based medicine, by allowing healthcare practitioners to access clinical evidence and information about the patients’ health as they formulate their patient-care strategies. However, current information systems solutions are far from this perspective for various reasons. One of these reasons is that existing information systems do not support a seamless flow of patient information along the patient process. Due to interoperability issues, healthcare practitioners cannot easily exchange patient information from one information system to another and from one healthcare practitioner to another. Consequently, vital information that is stored in separate information systems and which could present a clear and complete picture of the patient cannot be easily accessed. All too often, units have to operate without knowledge of the problems addressed by other healthcare practitioners from other units, the services provided, medications prescribed, or preferences expressed in those previous situations. The practice of EBM is further complicated by current information systems that do not support practitioners in their search and evaluation of current evidence in everyday clinical care. Based on a qualitative approach, this work aims to find solutions for how future healthcare information systems can support the practice of EBM. By combining existing research on process orientation, knowledge management and evidence based medicine with empirical data, a number of recommendations have been initiated. These recommendations aim to support healthcare managers, IT–managers and system developers in the development of future healthcare information systems, from a process-oriented and knowledge management perspective. By following these recommendations, it is possible to develop information systems that facilitate the practice of evidence based medicine, and improve patient engagement.
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Whitaker, David S. "The Use of Evidence-Based Design in Hospital Renovation Projects." BYU ScholarsArchive, 2018. https://scholarsarchive.byu.edu/etd/6692.
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Since the 1960s, researchers have been exploring how the design of the built environment impacts the health and well-being of occupants and users. By the 1980s, further research began to focus on healthcare facilities in particular and how design could influence patient healing and medical staff performance (Alfonsi, 2014). Evidence-Based Design (EBD) is "the process of basing decisions about the built environment on credible research to achieve the best possible outcomes" (CHD, 2016). The desired outcomes of Evidence-Based Design recommendations include improvements in the following: patient healing, patient experience and comfort, medical staff performance, and medical staff job satisfaction (CHD, 2017). Extensive research has been done on the subject of EBD; however, the question remains whether or not the latest research findings are being utilized by the design and construction industries in practice. The purpose of this research is to determine whether or not the latest scientific knowledge and research findings are being implemented into hospital renovation projects by the healthcare design and construction industries. A list of recommendations from existing EBD literature was compiled. Construction documents from 30 recent healthcare facility renovation projects across the United States were then obtained and analyzed. The findings indicate that EBD recommendations are being adopted in practice at consistently high levels. These findings also reveal that there are still areas of potential improvement which could inform those who influence or determine building and design codes, standards, and guidelines. The results are instructive to owners, designers, and contractors by providing a glimpse into how well the industry is recognizing and implementing known best practices. The findings likewise open up new opportunities for further research which could lead to additional improvement in the healthcare facilities of the future.
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Okcu, Selen. "Developing evidence based design metrics and methods for improving healthcare soundscapes." Diss., Georgia Institute of Technology, 2011. http://hdl.handle.net/1853/43695.
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Healing and clinical work requires a complex choreography of architectural acoustic design in healthcare settings. In most healthcare settings, medical staff members conduct vital tasks that may have life-and-death implications. Patients visit the hospitals to heal. Their expectations include fast recovery, restful sleep, and privacy (i.e., speech privacy). However, sound environment qualities of the care settings often fall far from supporting the mission of hospitals. There is strong and growing evidence showing that effective soundscapes in healthcare settings potentially impact errors, healing and stress for patients, families and staff but it is still not clear what measures of the sound environment best predict key healthcare outcomes and what design strategies best impact those measures. By using a multi-method approach (i.e., objective and subjective noise level measurements, in-situ impulse response measurements, heuristic design analysis, theoretical studies, acoustic simulations and statistical analysis), this study aims to develop evidence based design strategies by statistically defining the relationships between three types of variables: (1) architectural floor-plate design metrics, (2) acoustic metrics, and (3) occupant response.
The research is conducted in three phases. The first phase of the study compared the objective and subjective qualities of the hospital sound environments with different architectural designs, assessed the effectiveness of a newer acoustic metrics in capturing caregiver perceptions, and evaluated the impact of particular noise sources on caregiver outcomes. The second phase of the study tested the validity of an acoustic simulation tool in estimating the acoustic qualities of the healthcare soundscapes. The third phase of the study systematically explored the relationship between floor-plate design and acoustics of complex inter-connected nursing unit corridors. Even though the relationship between design and acoustics of proportional spaces (a.k.a. rooms with more traditional dimensions) has been well documented, the number of studies linking design and acoustics of complex non-proportional spaces such as inter-connected corridors still remains limited.
The findings of the first phase show that critical care sound environments with different designs can vary drastically and impact caregivers` perceived wellbeing and task performance (e.g., patient auditory monitoring). Despite their extensive use, traditional noise metrics sometimes may not be effective in capturing unique characteristics of healthcare sound environments. This study validated the effectiveness of a new more detailed noise metric, "occurrence rate", in capturing the differences between acoustic characteristics of healthcare sound environments. Moreover, particular noise sources such as impulsive noises are likely to dominate the ICU sound environments and interfere with perceived caregiver health and performance. The findings of the second phase suggest the potential effectiveness of acoustic simulation tools (with hybrid prediction programs) in estimating the acoustic qualities of complex inter-connected hospital corridors. The findings of the third phase suggest the potential significant impact of design features of particular hallways (e.g., number of turns, corridor length, and number of branches) and overall floor-shape characteristics of inter-connected corridors (i.e., relative grid distance, and visual fragmentation) on reverberation time. Overall, in the units with shorter, more compact, fragmented corridors with multiple number of branching hallways, reverberation times are likely to be less. Moreover receivers located at the corridors with less number of turns from the sound source also potentially experience lower reverberation times. According to previous research, the human auditory system`s ability to monitor auditory cues is likely to be higher in the less reverberant sound environments.
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Fingerhut, Henry Alan. "Individual and organizational Uses of Evidence-Based Practice in healthcare settings." Thesis, Massachusetts Institute of Technology, 2020. https://hdl.handle.net/1721.1/128641.
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Thesis: Ph. D. in Engineering Systems: Technology, Management, and Policy, Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Society, February, 2020Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 135-145).
In the three decades since its introduction, Evidence-Based Practice (EBP) has become standard clinical practice and the subject of targeted interventions at all levels of the health system. Despite its prevalence, EBP is frequently challenged on philosophical, practical, empirical, and normative grounds. And EBP is often underused in practice relative to the considerable investment in training and sophisticated organizational interventions to implement EBP. In this dissertation, I identify what the concept of EBP means to health system stakeholders as a partial explanation for this persistent gap in EBP use and implementation outcomes. Through interviews with clinicians and healthcare administrators, I identify how providers and organizations use EBP in practice to clinical ends and in inter-professional relationships. First, I find that in contrast to the theoretical model, stakeholders vary in how they operationalize EBP for individual-level clinical use.
Stakeholders endorse a range of what I call implicit mental models of EBP that imply different approaches to clinical decision-making. Respondents' implicit mental models of EBP each emphasize an incomplete aspect of the full EBP model: Resource-Based EBP emphasizes specific evidence artifacts, Decision-Making EBP emphasizes the decision-making process, and EBT-Based EBP emphasizes specific Evidence-Based Treatments. These implicit models represent the decision inputs, process, and outputs, respectively. Second, I describe how and why healthcare organizations conduct EBP interventions, despite its initial design as an individual-level clinical decision-making model. I document a range of different organizational EBP activities and interventions, including disseminating resources, training providers, and implementing local standards. These organizational EBP activities both support individual EBP use and address broader organizational ends, which may conflict.
Finally, EBP takes on social and inter-professional meanings beyond its intended scope as a clinical decision-making model, which emerge in context and affect how providers understand and use EBP. Specifically, providers may renounce their standing to evaluate evidence, demonstratively use EBP, and administrators claim standing to evaluate evidence. This dissertation therefore demonstrates the varied uses of EBP that emerge in practice, contributing to our understanding of the challenges and contradictions that arise in applying general knowledge to individual cases and systematizing strategies for the same at the organization level.
by Henry Alan Fingerhut.
Ph. D. in Engineering Systems: Technology, Management, and Policy
Ph.D.inEngineeringSystems:Technology,Management,andPolicy Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Society
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Kasali, Altug. "An ethnographic study of the role of evidence in problem-solving practices of healthcare facilities design teams." Diss., Georgia Institute of Technology, 2013. http://hdl.handle.net/1853/52918.
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Progressive efforts within the healthcare design community have led to a call for architects to use relevant scientific research in design decision making in order to provide facilities that are safe, efficient, and flexible enough to accommodate evolving care processes. Interdisciplinary design project teams comprising architects, interior designers, engineers, and a variety of consultants struggle to find ways to deal with the challenge of incorporating the evidence base into the projects at hand. To date there has been little research into how these interdisciplinary teams operate in the real world and especially how they communicate and attempt to integrate evidence coming from different sources into the architectural design that is delivered. This study presents an investigation of a healthcare design project in situ by using methods of ethnographic inquiry, with the aim of developing an enhanced understanding of actual collaborative healthcare design practices. A major finding is that ‘evidence’, as used in practice is a richly textured notion extending beyond just the scientific research base. The description and analysis of the observed practices is presented around two core chapters involving the design process of 1) the emergency department and 2) the inpatient unit. Each design episode, which depicts the complex socio-cognitive landscape of architectural practice, introduces how evidence, with its various types and representational forms, was generated, represented, evaluated, and translated within the interdisciplinary design team. Strategically utilizing various design media, including layout drawings and mock-ups, the architects represented and negotiated a set of physical design attributes which were supported by differing levels of scientific research findings, anecdotes, successful precedents, in-house experimental findings, and intuition, each having different affordances and constraints in solving design problems over time. Individually, or combined into larger “stories” which were collectively generated, the set of relevant evidence provided a basis for decision making at various scales, ranging from minor details within rooms to broader principles to guide design work over the course of the project. Emphasizing the role of the architects in translation of evidence, the design episodes provide vivid examples of how various forms of evidence shape the design of healthcare environments. The case observed in this research demonstrated that the participants formulated and explained their design ideas in terms of mechanistic arguments where scientific research, best practices, and anecdotal evidence were integrated into segments that formed causal links. These mechanistic models, as repositories of trans-disciplinary knowledge involving design, medicine, epidemiology, nursing, and engineering, expand the scope of traditional understanding of evidence in healthcare design. In facilitating design processes architects are required not only to become knowledgeable about the available evidence on healthcare, but also to use their meta-expertise to interpret, translate (re-present), and produce evidence in order to meaningfully engage in interdisciplinary exchanges. In re-presenting causal models through layouts or mock-ups, architects play a critical role in evidence-based design processes through creating a platform that displays shortcomings of available evidence and shows where evidence needs to be created in situ.
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Zhao, Yisong. "Evidence based design in healthcare : integrating user perception in automated space layout planning." Thesis, Loughborough University, 2013. https://dspace.lboro.ac.uk/2134/12621.
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Despite significant technological and scientific advances in healthcare provision and treatment in past decades, economies are struggling to address increasing costs while enhancing accessibility to quality health and care services. Globally, around 8.4% of gross domestic product (GDP) is spent on healthcare, with United States spending 17.4% of its GDP. There is, therefore, a growing interest in reducing healthcare costs and improving quality of care in terms of patients outcomes and their perception. Research has found strong association between physical environments and patient outcomes and staff and patient wellbeing. The acknowledgement of this link has led to the postulation of the idea of evidence based design (EBD) of healthcare facilities, in which design decisions are based on the evidence of the impact of environment on healthcare indicators. The key challenges for integrating EBD in healthcare design are the difficulty in disaggregating past research findings (i.e. evidence) from the context and the use of these findings, often hidden behind several behavioural and demographic variables or of the form of multi-dimensional indices, in design decision-making. Another recent development in healthcare is the patient-centred approach of care, in which patients perceptions and needs take the centre-stage in the planning and delivery of their care. Local and regional healthcare authorities are, therefore, interested in incorporating patients views in all aspects of care, including the design and operation of health and care facilities. Considering the gaps in knowledge, this research was aimed at investigating: users perception of physical environment indicators that had the potential for influencing their wellbeing and care outcomes, and the integration of their perception in the design of healthcare facilities through automated space layout planning. Perceptions of physical environment indicators were investigated using structured questionnaires among three user groups: inpatients, outpatients and healthcare providers. Resulting perception indicators were then used in a prototype automated space layout planning system, developed as part of this research, to aid the optimization process. The research has identified significant differences in perception between different user groups, in particular between males and females. Analyses of scaled responses indicate that environmental design (e.g. lighting and thermal comfort) and maintenance (e.g. cleanliness) related factors are more important to users than abstract architectural design factors (e.g. aesthetics). Accommodating the variation in perception would require individual approaches for the design of constituent spaces in a healthcare facility. With regard to the integration of user perception in design, the research demonstrates that qualitative indicators such as perception can be integrated in automated design frameworks and, therefore, design decisions can be based on a mix of quantitative and qualitative evidence. The application of automated layout planning system in the design of healthcare space layouts also demonstrates that computer-mediated systems and frameworks are a promising alternative to traditional manual design, if increasing number of design factors and objectives are to be reconciled for decision making.
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Geist, Thomas. "A Survey of Healthcare Providers’ Attitudes and Knowledge on E-cigarettes Based On Evidence-Based Practice." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1533656577013985.
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Reid, Benet. "The discourse of evidence-based healthcare (1992-2012) : power in dialogue, embodiment and emotion." Thesis, University of Newcastle upon Tyne, 2014. http://hdl.handle.net/10443/2491.
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The topic of this thesis is evidence-based healthcare, EBHC. The thesis has two key aims: to undertake an empirical exploration and analysis of debates around EBHC; and to develop a conceptual theorisation of these debates in terms of power. To fulfil the empirical aim I conduct a reading and analytic re-reading of EBHC-literature from the disciplines of medicine, physiotherapy and sociology. To fulfil the conceptual aim I draw upon the work of Foucault, Bakhtin and Barbalet to produce a ‘dialogical’ model of power. Treating debates around EBHC as ‘EB-discourse’, this thesis follows the tradition of discourse analysis; but breaks ground by deploying writing as a research method and applying ethnographic ideas to discursive study. This novel approach I call ‘literary ethnography’. Being a literary ethnography of EB-discourse, the thesis begins with a descriptive overview of the chosen disciplinary literatures. A methodological section explains the rationale for proceeding along the analytic path of dialogue; and then the thesis becomes gradually more analytical through progressively deeper readings of the same literatures. The thesis is structured into these three levels of review, methodology and analysis; and in each level, the three strands of literary context (medicine, physiotherapy and sociology) run in parallel as comparators for each other. EBHC began in medicine (as EBM), but following its course in other disciplines allows discursive similarities and differences to be explicated. The initially descriptive and gradually more analytical approach reveals the dialogical structure of the discourse, and discovers embodiment and emotion as ideas which, across all three contexts, trouble the terms of the discourse. The key findings of the thesis are that in EB-discourse, power operates through dialogue, by being split into different forms which interact to reinforce each other. Specifically, EB-discourse is built upon dialogical distinctions between mind and body, and between emotion and reason. These are dialogues which powerfully re-produce particular kinds of rationality. They are also in dialogue with each other; embodiment for the repressive aspects, and emotion for the productive aspects of power. The thesis also raises questions relating to the predicament of the patient in contemporary healthcare, and relating to the role of philosophical argumentation in social theory. It finishes with some suggestions for investigating the dialogical-power model in other areas of social life.
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Harris, Patricia Amanda. "Promoting research utilisation and evidence-based decision making amongst healthcare managers : utilising nonrecursive structural equation modelling to develop the theory of planned behaviour." n.p, 2005. http://ethos.bl.uk/.
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Ring, Nicola A. "A critical analysis of evidence-based practice in healthcare : the case of asthma action plans." Thesis, University of Stirling, 2013. http://hdl.handle.net/1893/13061.
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Evidence-based practice is an integral part of multi-disciplinary healthcare, but its routine clinical implementation remains a challenge internationally. Written asthma action plans are an example of sub-optimal evidence-based practice because, despite being recommended, these plans are under-issued by health professionals and under-used by patients/carers. This thesis is a critical analysis of the generation and implementation of evidence in this area and provides fresh insight into this specific theory/practice gap. This submission brings together, in five published papers, a body of work conducted by the candidate. Findings report that known barriers to action plan use (such as a lack of practitioner time) are symptomatic of deeper and more complex underlying factors. In particular, over-reliance on knowledge derived from randomised controlled trials and their systematic review, as the primary and sole source of evidence for healthcare practice, hindered the implementation of these plans. A lack of evidence reflecting the personal experience of using these plans in the real world, rather than in trial settings, contributed to a mismatch between what patients/carers want from asthma action plans and what they are currently being provided with by professionals. This submission illustrates the benefits of utilising a broader range of knowledge as a basis for clinical practice. The presented papers report how new and innovative research methodologies (including meta-ethnography and cross-study synthesis) can be used to synthesise individual studies reporting the personal experiences of patients and professionals and how such findings can then be used to better understand why interventions can be implemented in trial settings rather than everyday practice. Whilst these emerging approaches have great potential to contribute to evidence-based practice by, for example, strengthening the ‘weight’ of experiential knowledge, there are methodological challenges which, whilst acknowledged, have yet to be fully addressed.
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Ona, Samsiya. "Evidence-Based Preventive Healthcare in the CWB Family Support Homes: The Healthy Learners Pilot Program." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295881.
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Zambia is one of the poorest countries in the world. The school aged population experiences high mortality and morbidity rates from malnutrition, chronic and acute infections. Our long-term goal is to develop an ongoing preventive health program to supplement the CWB educational mission. The pilot program included health screenings, detailed health status and needs survey, interviewing local experts and key stakeholders and a health promotion workshop for the schoolteachers. Follow-up screenings were also conducted in Summer 2013. We screened 455 children and surveyed 223 children with their guardians during the pilot study. The most common diagnoses were GU infections, URTIs, diarrhea and fungal infections. Among the 455 children screened, there were 51 cases of S. haematobium infection. A striking finding from the health status survey is the lack of knowledge on health and sanitation topics and the urgent need to integrate health and nutrition education in the school curriculum. The teachers’ health promotion workshop was effective in increasing teachers’ health literacy. The HLP pilot helped initiate a program to provide school-based healthcare to children with otherwise minimal access to care and to train their teachers in important basic public health topics.
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Wood, Anne Akins. "School Nursing and Asthma the relationship between evidence-based practice, best practice and individualized healthcare plans /." Lynchburg, Va. : Liberty University, 2009. http://digitalcommons.liberty.edu.
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Plummer, Kristin. "Sustainable Healing: Rethinking Cancer Center Design." University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1522341437826741.
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Cheng, Chih-Wen. "Development of integrated informatics analytics for improved evidence-based, personalized, and predictive health." Diss., Georgia Institute of Technology, 2015. http://hdl.handle.net/1853/54872.
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Advanced information technologies promise a massive influx of individual-specific medical data. These rich sources offer great potential for an increased understanding of disease mechanisms and for providing evidence-based and personalized clinical decision support. However, the size, complexity, and biases of the data pose new challenges, which make it difficult to transform the data to useful and actionable knowledge using conventional statistical analysis. The so-called “Big Data” era has created an emerging and urgent need for scalable, computer-based data mining methods that can turn data into useful, personalized decision support knowledge in a flexible, cost-effective, and productive way. The goal of my Ph.D. research is to address some key challenges in current clinical deci-sion support, including (1) the lack of a flexible, evidence-based, and personalized data mining tool, (2) the need for interactive interfaces and visualization to deliver the decision support knowledge in an accurate and effective way, (3) the ability to generate temporal rules based on patient-centric chronological events, and (4) the need for quantitative and progressive clinical predictions to investigate the causality of targeted clinical outcomes. The problem statement of this dissertation is that the size, complexity, and biases of the current clinical data make it very difficult for current informatics technologies to extract individual-specific knowledge for clinical decision support. This dissertation addresses these challenges with four overall specific aims: Evidence-Based and Personalized Decision Support: To develop clinical decision support systems that can generate evidence-based rules based on personalized clinical conditions. The systems should also show flexibility by using data from different clinical settings. Interactive Knowledge Delivery: To develop an interactive graphical user interface that expedites the delivery of discovered decision support knowledge and to propose a new visualiza-tion technique to improve the accuracy and efficiency of knowledge search. Temporal Knowledge Discovery: To improve conventional rule mining techniques for the discovery of relationships among temporal clinical events and to use case-based reasoning to evaluate the quality of discovered rules.
Clinical Casual Analysis: To expand temporal rules with casual and time-after-cause analyses to provide progressive clinical prognostications without prediction time constraints. The research of this dissertation was conducted with frequent collaboration with Children’s Healthcare of Atlanta, Emory Hospital, and Georgia Institute of Technology. It resulted in the development and adoption of concrete application deliverables in different medical settings, including: the neuroARM system in pediatric neuropsychology, the PHARM system in predictive health, and the icuARM, icuARM-II, and icuARM-KM systems in intensive care. The case studies for the evaluation of these systems and the discovered knowledge demonstrate the scope of this research and its potential for future evidence-based and personalized clinical decision support.
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Spaeth, Christine Grey. "Evidence for and Barriers to a Team-Based Approach for Genetic Services in Pediatric Healthcare Specialty Settings." University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1211913285.
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Mirzaei, Narek. "Healing By Design: Evidence-Based Approach in Designing Brain & Spinal Cord Injury Rehabilitation Center." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491315343286767.
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Gout, Marine. "Technicisation du raisonnement médical : une approche communicationnelle des pratiques délibératives et interprétatives en cancérologie." Thesis, Toulouse 3, 2015. http://www.theses.fr/2015TOU30301/document.
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La thèse se positionne dans un ensemble de travaux portant sur les rationalisations contemporaines des organisations de santé, et se focalise sur les pratiques des médecins hospitaliers au sein de réunions de concertation pluridisciplinaire en cancérologie. Nous développons une hypothése selon laquelle la dimen- sion prudentielle, conjecturale de l'activité médicale est en tension avec les dynamiques de rationalisation qui traversent l'organisation. En étudiant les techniques qui structurent les savoirs médicaux et qui équipent les pratiques délibératives et interprétatives des médecins, nous analysons une tension spécifique qui se produit au cœur des pratiques conjecturales ethnographiées. La thése expose les différentes conceptions de l'incerti- tude qui sont formalisées dans les dispositifs techniques qui équipent les savoirs et les pratiques médicales, où les prises de position objectiviste et épistémique divergent et doivent être articulées au sein de processus communicationnels, délibératifs et interprétatifsThis thesis belongs to the field of rationalization studies in healthcare organizations. Its focus is on medical practices observed in multi-disciplinary meetings in the oncology ward of a hospital in South West France. We hypothesize that tension exists between the prudential and conjectural dimension of medical activity and the rationalization dynamics present across the organization. Technologies exist that structure medical knowledge and practices. They equip deliberative and interpretative medical practices. By studying these technologies, we can analyze a specific tension that exists in the depths of the observed conjectural practices. The thesis shows the different conceptions of uncertainty that are formalized in the technological dispositifs equiping medical knowledge and practice. It highlights those areas where objective and epistemic positions differ, and which therefore require articulation inside communicational, deliberative and interpretative processes
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Sharp, D. "Exploring evidence based management in the National Health Service : if doctors in the NHS use evidence based medicine, why don't managers in the NHS use evidence based healthcare management? : can this paradox be explained and is the paradox true?" Thesis, Nottingham Trent University, 2010. http://irep.ntu.ac.uk/id/eprint/191/.
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Purpose and aims of the study: To contribute to the on-going debate over whether the use of evidence could and should improve organisational effectiveness. This is especially important in the context of the health service that has, since (May 1997) enthusiastically adopted evidence based medicine as its method of health delivery. To develop a practical explanation for policy makers and managers on how and where evidence based management is used appropriately. Justification: Kovner and Rundall (2006 p3) said “the sense of urgency associated with improving the quality of medical care does not exist with respect to improving the quality of management decision making. A more evidence based approach would improve the competence of the decision makers and their motivation to use more scientific methods when making a decision”. The paper reviews the conclusion of Kovner and Rundall (2006) (an American study) within the context of the UK National Health Service. There is a need to develop a theoretical framework of how and why evidence is (or is not) used by managers in the NHS. Motivation: The author holds a senior management position in the National Health Service. The author has performed the role of Director and Chief Executive in NHS organisations since 2000. These organisations have been surplus making, target hitting, award winning, credited by the auditors and successful in the eyes of the regulators. Unfortunately over the last few years the author has been in a quandary about something. Are NHS managers as a group of professionals, using policies that solved the wrong problem or solving the right problem, but still in the wrong way? Following this line of thought, the author wanted to ask "why don’t executives in the NHS make evidence based decisions? Methodology: A survey was conducted of the most senior NHS managers in the East Midlands. A set of interviews and participant observations of senior managers when making key decisions around current policy initiatives was recorded. This explored how the concept of evidence based management is perceived by the managers. The studied group were taken to have had career success and to be taken to be leaders in their field. The researcher was a senior manager within the same region of the NHS. The method additionally studied the effect of a discrete, but accepted piece of data upon the NHS as it struggled to adopt an evidence based response to the operational issue the data highlighted. The researcher was a planner within the same region that this data was being used and was responsible for responding to the data. The ontology used Bryman (2004) and Morgan (2007) to attach meaning to the views that members of that part of the NHS had of their world. Methods: Through taped recordings of meetings and verbatim transcripts of 1 to 1 interviews with senior managers the study recorded the awareness of a need for evidence (or not) and also analysed the collection and evaluation of evidence where such awareness did exist. Using a model developed by Rousseau (2006) the study classified the responses. Interpretation of the responses was shared with the participant and conclusions drawn against the Rousseau based model. Findings: Senior managers approve of evidence as it gives them a systematic view of what their staff are qualified to do and a requirement for evidence based decision making is part of the scheme of delegation. Adoption of innovation and research is a complex and often drawn out process. The adoption of research evidence is not a single discrete event. Managers will only use research if it improves the organisations standing. Finally, it is shown that there are credible and complex reasons for the failure in NHS managers to use evidence very often, despite the prevailing orthodoxy of evidence based medicine. The researcher agrees with McDaniel (2009) that evidence should be used to start new creative methods of working. Although Arndt and Bigelow (2009) raise objections against evidence based decision making as “decisions do not necessarily lead to expected outcomes” The researcher finds their work cautionary rather than impeding to what Banaszak-Holl says are “compelling arguments for moving forward with developing EBM".
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Taylor, Ellen. "Anticipate to participate to integrate : bridging evidence-based design and human factors ergonomics to advance safer healthcare facility design." Thesis, Loughborough University, 2016. https://dspace.lboro.ac.uk/2134/21154.
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Objective: The primary objective of the thesis is to advance proactive thinking in designing healthcare facilities for safety by constructing theory to bridge gaps between evidence-based design (EBD) and human factors/ergonomics (HF/E). Background: Adverse events are a pervasive issue in healthcare, with causes and prevention measures under increased scrutiny for the past 15 years. The physical environment can be an underlying condition of safety and healthcare (HC) facility design can be seen as a layer of defense in accident causation theory. However, HC facility design is complicated and complex, and the implications of decisions can be felt for decades. While architects excel at problem solving, they are not fully versed in healthcare work tasks, flow, and function, resulting in complex system interactions. Evidence-based design (EBD) is a process that uses research as a foundation for decision-making in HC facility design. While the EBD process acknowledges the importance of system factors, its focus is on understanding specific facility design interventions on outcomes such as safety, efficiency, quality of care, and satisfaction. HF/E focuses on humans interacting with a system with a goal of optimizing human well-being and overall system performance. Although HF/E recognizes the physical environment as a system component, the ergonomic definition of the environment lacks clarity and influences are frequently considered at a microergonomic level. In summary, EBD supports desired outcomes of a system through building design, while HF/E more often supports desired outcomes of the system through work design. Methods: The thesis leverages a grant to create a Safety Risk Assessment (SRA) toolkit for HC facility design using: (1) consensus-based methods to develop built-environment considerations for falls in HC facility design, (2) a mixed methods approach to test the SRA in hypothetical scenarios, (3) a mixed methods approach to test the SRA in real-world scenarios, (4) quantitative and qualitative analysis using an inductive and abductive approach to construct grounded theory to develop a core theme and a theoretical framework for proactively considering safety in HC facility design, (5) an extended systematic literature review to identify additional system considerations of the organization and people, and (6) established thinking to advance new theoretical frameworks to achieve the thesis objectives. Results: Two theoretical frameworks are proposed. The first framework, Safety as Complexity of the Organization, People and Environment (SCOPE) is based on the Dial-F systems model (Hignett 2013). The evolution includes: the definition of the ergonomic environment using building design as the most stable element of the system, identifying built environment interventions to mitigate the risk of falls (SCOPE 1.0); the addition of non-building design interventions of the system such as organizational and people-based conditions (SCOPE 2.0); and the integration of HF/E design principles to reframe thinking about hospital falls (DEEP SCOPE). The second framework evolves from grounded theory constructed through data from SRA testing proposing safe design as a participatory process to anticipate, participate, and integrate solutions. A participatory ergonomics framework (Haines and Wilson 1998) is integrated with a mesoergonomic framework of inquiry (Karsh, Waterson, and Holden 2014, Karsh 2006) to advance a theoretical framework of participatory mesoergonomics using the SRA and SCOPE content as inputs over the course of a HC facility design project to achieve safety. Conclusion: The gap between EBD and HF/E can be bridged using safety (falls) as a proactive consideration during HC facility design using theoretical frameworks. These frameworks address (1) the definition of building design and design considerations in the HF/E context and (2) integration of the EBD process with HF/E methods to understand interactions of the system.
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Rahman, Aurin, Kate Beatty, Amal Khoury, Michael Smith, Liane Ventura, Oluwatosin Ariyo, and Deborah L. Slawson. "Perceived Impact of Contraceptive Trainings on Performance and Patient Care Among Safety Net Clinics in South Carolina." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/asrf/2021/presentations/8.
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Objective
Safety-net clinics such as health department family planning (HD) and federally qualified health centers (FQHCs) provide free or low-cost contraceptive care to low-income and uninsured populations. Integration of contraceptive focused training within safety-net clinics is essential to deliver comprehensive, patient-centered contraceptive care. In SC, HDs receive Title X funding, which requires providing training to staff. However, due to different funding policies, trainings may be less available to FQHC staff which creates gap in care. This study examined perceptions of impact of trainings on overall performance and patient care among safety-net clinics in South Carolina (SC) that received externally funded contraceptive trainings for healthcare providers and clinic staff. The key focus of this study was to identify the perceptions of training among clinical staff and providers in HDs and FQHCs in SC. Our study showed that when equal funding opportunities were provided, it expanded the opportunity of positive impact.
Method
Key informant interviews were conducted among 58 individuals, 31 HD and 27 FQHC clinic staff and system leaders in 2019. Interview questions assessed the respondent’s perception of trainings on overall performance and patient care. Formal informed consent was obtained before the interview and participation was voluntary. Interviews were conducted privately via phone by study staff at East Tennessee State University. The interview recordings were transcribed and coded with QSR International’s NVivo 12 qualitative data analysis software. A codebook was developed, and inter-rater reliability and consensus coding methodologies were utilized to ensure consistency of coding.
Results
The majority of HD and FQHC respondents identified improved quality of services and infrastructure as positive impacts of provided trainings (N=14 and N=12, respectively). Additionally, four respondents from FQHC sectors mentioned that training increased capacity for contraceptive provision. Challenges with staffing capacity such as not having time for training were mentioned as a negative perception among both sectors.
Perception of impact of training on patient care were positive among most respondents (N=44). Most respondents from both sectors indicated improved capacity for patient counseling as a positive impact of training (N=26). Two FQHC respondents mentioned that training led to implementing best practices.
Conclusion
Positive perception of contraceptive training on overall performance and patient care have been identified throughout this study. Federal funding provides support for training implementation but restrictions in funding due to policy changes and different funding mechanisms limit some clinics. Although external funding provides support; this does not ensure the sustainability of trainings after completion of the funding period which can create gaps in care and contraceptive provision. Future research should focus on training sustainability models such as Train-the-Trainer to ensure continuity of positive impact in local and state levels.
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Boström, Anne-Marie. "Evidence-based care of older people - utopia or reality? : healthcare personnel's perceptions of using research in their daily practice /." Stockholm : Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-385-6/.
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Henry, Glynis. "An exploration of the use of evidence-based healthcare interventions in the care of stroke patients by hospital-based nurses in Northern Ireland." Thesis, University of Ulster, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.415872.
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Jones, Georden. "Untangling and Addressing Cancer-Related Fatigue Guidelines Implementation Gaps: A Knowledge Translation Perspective." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/41459.
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Cancer-related fatigue (CRF) as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer and cancer treatment that is not proportional to recent activity, such as physical activity, that interferes with usual functioning (Howell et al., 2015; National Comprehensive Cancer Network, 2020). CRF is one of the most common symptoms experienced by cancer patients at all stages of the cancer trajectory which significantly impacts patient’s quality of life, return to work, mental health, and can lead to disability (Bower, 2014b; Jones et al., 2016). Much research has focused on the development of CRF assessment and intervention strategies which have promoted the development of comprehensive evidence-based guidelines (Howell et al., 2015; National Comprehensive Cancer Network, 2020). However, previous research has identified many practice gaps in their implementation (Berger et al., 2015; Borneman et al., 2007; Pearson et al., 2015a, 2017b). This thesis’ objectives were to gain a deeper understanding of potential barriers to CRF clinical guideline implementation to identify potential knowledge translation strategies of CRF guidelines into practice following a Knowledge-To-Action (KTA) framework perspective (Graham et al., 2006; Straus et al., 2013).
In Study 1, a qualitative research design was used to recruit a total of 62 participants—16 patients, 32 healthcare providers (HCPs), and 15 community support providers (CSPs). Drawing on the KTA model, the goal of the study was to explore key stakeholders’ (patients, HCPs, CSPs) experiences and opinions on CRF assessment and management and to explore underlying causes of CRF treatment gaps. No specific hypothesis were determined given the exploratory nature of the study. The results of this study highlight CRF guideline implementation gaps, patient dissatisfaction with CRF care, and challenges contributing to CRF assessment and management gaps. The results also suggested the presence of two underlying mechanisms contributing to treatment gaps: A Perfect Storm and Patient-Provider Communication Gaps. Understanding these mechanisms provides clarity on the potential causes maintaining CRF treatment gaps and can help direct targeted knowledge translation strategies to improve the implementation of CAPO CRF guidelines into practice. Consistent with a recent Delphi study (Pearson et al., 2017b), the results supported the need for professionals’ training on CRF guidelines to fill knowledge gaps.
In Study 2, a mixed-methods pilot study with 18 HCPs and CSPs was used to develop and evaluate the acceptability and feasibility of a one-time training session for HCPs and CSPs on CAPO CRF guidelines, once again flowing the KTA framework (Graham et al., 2006; Straus, 2011). A secondary objective was to evaluate the learning outcomes of the training session including CAPO CRF guidelines knowledge, self-efficacy, and intent to apply CAPO CRF guidelines in practice. Overall, results suggest that offering a brief one-time training for HCPs and CSPs on CRF guidelines may be effective in increasing knowledge, self-efficacy, and intent to apply guidelines into practice. Similarly, that KT tools are appreciated by HCPs/CSPs and may be used in practice to supplement and sustain the knowledge and skills gained in training.
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Muntlin, Åsa. "Identifying and Improving Quality of Care at an Emergency Department : Patient and healthcare professional perspectives." Doctoral thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-110260.
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Background: Patients in the emergency department are not always satisfied with the care received and the nursing care in the emergency department is sometimes described as instrumental and non-holistic. Structured quality improvement work and evidence-based practice are needed. Aim: The overall aim was to emphasize general patients in the emergency department to enhance the knowledge on how they perceive the quality of care and how the care could be improved through collaboration with the healthcare professionals. Methods: Four studies, with quantitative and qualitative designs, were conducted in a Swedish emergency department. Two hundred patients answered a questionnaire, after which 22 healthcare professionals comprising five focus groups were interviewed, and finally 200 patients were included in an intervention study. Results: The following five areas for improvement were identified: “information, respect and empathy”, “pain relief”, “nutrition”, “waiting time” and “general atmosphere”. Of these areas, the healthcare professionals prioritized “information, respect and empathy”, “waiting time” and “pain relief” to be highlighted in the quality improvement work. Although goals and suggestions for changes were stated, barriers to quality improvement at different levels in the health care were detected. The results of the intervention study showed that structured nursing assessment of the patients’ abdominal status and nurse-initiated intravenous opioid analgesic could increase frequency of analgesic and reduce time to analgesic in the emergency department. Patients perceived lower pain intensity and improved quality of care in pain management. Conclusions: An uncomplicated nursing intervention, related to pain management, based on the results from a patient questionnaire and interviews with healthcare professionals, can improve the care process and pain management in the emergency department, as well as patients’ perceptions of the quality of care in pain management. To succeed with continuous quality improvement work, barriers to change should be addressed.
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September, Gail. "Exploring mental healthcare provider attitudes towards evidence-based practice in the treatment of post-traumatic stress disorder (PTSD) in South Africa." University of the Western Cape, 2018. http://hdl.handle.net/11394/6052.
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Magister Psychologiae - MPsych (Psychology)Evidence-based practice (EBP) is the responsive process of making clinical decisions on behalf of the individual patient based on the best available research evidence, the clinician's expertise, as well as the context and characteristics of the patient. As stipulated in the 2011 scope of practice for the Psychology Profession (Government Gazette, 2011), offering evidence-based interventions to people with psychological and psychiatric conditions has become a legal requirement in South Africa. However, the adoption of EBP within the profession of Psychology has been slow, which has raised concerns. Related to this, numerous barriers have been identified as hindering the adoption of EBP in the field of Psychology, central among these being mental healthcare provider attitudes. The current study focused on investigating mental healthcare providers' attitudes to EBP in the treatment of Post-Traumatic Stress Disorder (PTSD) in South Africa and utilised a cross-sectional, descriptive, survey design using two self-reporting online questionnaires, namely the Evidence-Based Practice Attitude Scale (EBPAS) and a demographic questionnaire. Participants included registered clinical and counselling psychologists, social workers, and counsellors in South Africa and were recruited from various websites through purposive sampling. Findings indicated that participants generally held positive attitudes towards EBP in the treatment of PTSD and demographic characteristics, specifically age and race, had a significant impact on participants' attitudes toward EBP. Ethical approval was obtained by the Senate Higher Degrees Committee of the University of the Western Cape.
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Harris, Patricia A. "Promoting research utilisation and evidence-based decision making amongst healthcare managers : utilising nonrecursive structural equation modelling to develop the theory of planned behaviour." Thesis, Open University, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424678.
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Martin, Elizabeth Kate. "A cost-effectiveness modelling study of strategies to prevent post-caesarian surgical site infection." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/115015/1/115015_8913773_elizabeth_martin_thesis.pdf.
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In this thesis, the best ways of preventing surgical site infection following caesarean section were identified. A cost-effectiveness analysis was conducted to inform clinical decision makers of whether moving to evidence-based practice was value for money. The research was an important step in raising the profile of surgical site infections following caesarean section, and identifying the large and unwarranted variation in surgical practice at caesarean section in Australia. The research also introduced an economic evaluation framework to maternity health care, which is a service that continues to be costly and high-volume.
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Rejzer, Courtney Brynne. "The influence of the acute care nurse practitioner on healthcare delivery outcomes : a systematic review /." Full-text of dissertation on the Internet (211 KB), 2009. http://www.lib.jmu.edu/general/etd/2009/Honors/Rejzer_CourtneyB/rejzercb_honors_11-11-2009.pdf.
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Jerndahl, Fineide Mona. "Controlled by Knowledge : A Study of two Clinical pathways in Mental Healthcare." Doctoral thesis, Karlstads universitet, Fakulteten för ekonomi, kommunikation och IT, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-12937.
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Standardisation of professional work is a major policy concern to ensure quality and efficiency of services and a number of hospitals are now focusing on the use of clinical pathways as an important tool to standardise their work. This study sheds light on the processes set in motion when notions of standardisation meet local practice. In order to gain insight into what clinical pathways mean for professional work in mental health care, the focus of the study was to explore the contexts in which standardisation by “rule production” takes place. Two empirical cases from Norwegian mental health care show how dedicated professionals are in charge of carrying out the standardisation work, strongly influenced by a steering framework of defined governmental policies where employee involvement and responsibility ensured loyalty to the idea. Along with a “package” of ideas, new bodies and techniques, clinical pathways contribute to the institutionalisation of prima facie knowledge in demonstrating that evidence basing is linked to steering and control of employees. Thus, professional autonomy is threatened in an insidious way: through the institutionalisation of evidence-based knowledge as ‘prima facie’ knowledge in combination with professionals who standardise and control their own work. The thesis therefore concludes that the control of professional work has now become a complex and sophisticated process where professional work is “controlled by knowledge”.
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Sarala, A. V. "Development of a Smartphone-enabled hypertension and diabetes management package to facilitate evidence-based care delivery in primary healthcare facilities in India : a formative research to inform intervention design." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2014. http://researchonline.lshtm.ac.uk/2021055/.
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Background. Hypertension and diabetes have become a major public health challenge in India. This research work aims to develop a feasible and scalable intervention for hypertension and diabetes, tailored to primary care settings in India. Objectives. To conduct a healthcare facility assessment to inform the development of a Smartphone-enabled intervention package for hypertension and diabetes at primary healthcare facilities in India. To pilot the Smartphone-enabled hypertension and diabetes intervention package at primary healthcare facilities in India in order to identify the barriers, synergies and health system strengthening requirements for the feasibility and scalability of such an intervention. Methodology. This research work was carried out in five Community Health Centres (CHCs) in Solan, Himachal Pradesh. The implementation and evaluation of the piloting, guided by a conceptual framework1, was carried out using mixed methods, following implementation science principles. Results. In this research work, a six component intervention was developed comprising a Nurse Care Coordinator (NCC), a structured training programme, clinical management guidelines, a Smartphone-based clinical decision-support system, counselling services and follow-up plan for patients. During piloting, NCCs detected that 37% of the out-patient clinic attendees had hypertension/diabetes. At three months of follow-up, systolic blood pressure had a mean reduction of 10.9+/-13.1 mmHg (p<0.001) in 2974 participants while fasting glucose level had a mean reduction of 26.4+/-49.0 mg/dl (p<0.001) in 717 subjects. Discussion. This research work demonstrated that a six component intervention for hypertension and diabetes care is feasible. However, barriers such as inadequate manpower, insufficient drug supply and inadequate lab facilities need to be addressed for optimal intervention delivery. Conclusion. A Smartphone decision-support-enabled, NCC-facilitated intervention for hypertension and diabetes is feasible for primary care settings in India.
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Santos, Patrícia Alexandra Teixeira da Costa. "Arquitetura para a doença de Parkinson." Master's thesis, Universidade de Lisboa, Faculdade de Arquitetura, 2019. http://hdl.handle.net/10400.5/18361.
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Dissertação de Mestrado Integrado em Arquitetura, com a especialização em Arquitetura apresentada na Faculdade de Arquitetura da Universidade de Lisboa para obtenção do grau de Mestre.Com o aumento da esperança média de vida e envelhecimento da população portuguesa, o risco de contrair doenças cresce. São as doenças do foro neurológico que surgem com a idade, como é o caso da doença de Parkinson. O papel da arquitectura torna-se fundamental no desenho de espaços associados à saúde, contribuindo assim para a criação de ambientes que promovem a saúde, a segurança e o bem-estar de todos os seus utilizadores. A Unidade de Cuidados Especializados em Alburrica vem responder a esta problemática mas também preencher um vazio urbano presente na cidade do Barreiro, fruto do processo de desindustrialização que sofreu. Este equipamento contempla características ambientais arquitectónicas que colaboram e contribuem para uma melhor qualidade de vida e bem-estar dos doentes, atendendo às suas necessidades. É através da selecção dos comportamentos próprios da doença de Parkinson, de conversas e convívio com os doentes que o projecto sintetiza e apresenta os objectivos estimuladores. Estes objectivos surgem como linhas orientadoras centradas nos doentes, que através da arquitectura pretendem incentivar uma atitude positiva face às limitações próprias da doença e estimular capacidades físicas, cognitivas e sociais de um doente com Parkinson.
ABSTRACT: With the increase in average life expectancy and the ageing of the Portuguese population, the risk of contracting the disease increases. It is the neurological diseases that appear with the age, as it is the case of the Parkinson disease. Architecture plays a major role at designing health related spaces, creating environments that promote health, security and well-being of all its users. The specialized care facilities in Alburrica not only comes up as a solution to this issue, but also fills in an empty urban space triggered by the de-industrialisation process. This equipment takes into account architectonic environmental characteristics that contribute to a better quality of life and patients well-being, meeting their needs. It is through patient’s behaviours, talks and interactions with the patients that the project presents its stimulating objectives. These objectives appear as guidelines focused on the patients, which pretend to encourage positive stances against their physical barriers and stimulate their physical, cognitive and social skills.
N/A
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Palm, Adam, and Veera Kokko. "Visual comfort in nursing rooms, from a patient’s perspective." Thesis, Tekniska Högskolan, Högskolan i Jönköping, JTH, Byggnadsteknik och belysningsvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-40696.
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The awareness regarding important aspects of how to plan and design healthcare environments is something that is constantly progressing. Even though these environments can be seen as complex, the knowledge and understanding of its many different users is often taken into consideration in today’s planning. Several studies have shown positive effects on the visual performance among the hospital staff but also positive effects regarding visual comfort that facilitates recovery and well-being among patients. However, when planning lighting in healthcare environments today, the focus often lies on providing good lighting qualities regarding the visual performance of the hospital staff and the patients are, by that, not taken in consideration to the same level of extent. Therefore this study was focused on analyzing if certain demands could be set on lighting in a nursing room, to improve the experience of visual comfort, from a patient perspective, while using two different lighting scenarios. The thesis has been conducted using an already approved and widely used method Evidence based design (EBD) through a literature study, a pre-study, and an experiment. This to evaluate and develop an innovative design to facilitate visual comfort from a patient's perspective. The visual parameters that the experiment has been focusing on are glare, luminance, contrasts, shadows, lighting principles, and the perception of objects. These parameters have been evaluated from a sitting, standing and lying position in two different lighting scenarios, developed from the hypothesis, without access to daylight. A healthcare environment has a number of different users, that all use the facilities in different ways. Therefore it was important that the innovative design, constructed for the experiment, did not compromise the visual comfort or need of light for the other users. A questionnaire was created, based on the visual parameters, to help answer the research questions. The experiment had a total of 30 participants, where each participant answered the questionnaire six times, one for each position and a total of three times in each lighting scenario. The results were compiled and the mean values were analyzed to evaluate differences and similarities between the two lighting scenarios and between the positions. The results of the experiment show that there are certain demands that can be set on the artificial lighting in a nursing room, and it also shows that it is of great importance to plan for a various lighting environment since it can enhance the experience of visual comfort. Despite this, it is important for a lighting designer to carefully analyze and evaluate the patient's need for light in the specific ward that is being designed. To achieve a sustainable lighting solution it is important to remember that all the sustainability factors, such as the social, economic and environmental factors, are equally important to create a sustainable development.Medvetenheten gällande viktiga aspekter av hur man planerar och utformar vårdmiljöer är något som ständigt ökar. Trots att dessa miljöer kan ses som komplexa, tas ofta kunskap och förståelse i beaktning för miljöernas många olika användare vid dagens planering. Flera studier har visat positiva effekter på visuell prestanda hos sjukhuspersonalen, men även positiva effekter gällande visuell komfort som påskyndar återhämtning och ökar välbefinnande bland patienter. När belysningsplanering idag utförs i vårdmiljöer ligger fokuset ofta på att tillgodose ljuskvaliteter med avseende för sjukhuspersonalens visuella prestanda och patienterna beaktas därmed inte i samma omfattning. Därför har denna studie fokuserats på att analysera om vissa krav kan ställas på artificiell belysning i ett vårdrum, för att förbättra upplevelsen av visuell komfort utifrån en patients perspektiv, vid utvärdering av två olika belysningsscenarion. Studien har genomförts med hjälp av en redan beprövad och allmänt använd metod Evidensbaserad design (EBD), genom en litteraturstudie, en förstudie och ett experiment. Detta för att utvärdera och utveckla en innovativ design med fokus på att underlätta visuell komfort från patientens perspektiv. De visuella parametrar som experimentet har fokuserat på är bländning, luminans, kontraster, skuggor, olika belysningsprinciper samt uppfattningen av objekt. Dessa parametrar har utvärderats från en sittande, stående och liggande position, vid två olika belysningsscenarion med enbart artificiell belysning, utvecklad utifrån hypotesen. I en vårdmiljö vistas ett antal olika användare som alla använder anläggningarna på olika sätt. Det ansågs därför viktigt att den innovativa designen, som konstruerats för experimentet, inte påverkade den visuella komfort eller behovet av ljus för övriga användare. Ett frågeformulär skapades, baserat på de visuella parametrarna, för att besvara frågeställningen. Experimentet hade totalt 30 deltagare, där varje deltagare besvarade frågeformuläret sex gånger, ett formulär per position och totalt tre gånger vid varje ljusscenario. Resultaten sammanställdes och medelvärden analyserades för att utvärdera skillnader och likheter mellan de två belysningsscenarierna samt mellan positionerna. Resultaten av experimentet visar att det finns särskilda krav att ställa på den artificiella belysningen i ett vårdrum. Resultatet visar även att det är av stor betydelse att planera in en varierad ljusmiljö då det kan förbättra upplevelsen av den visuella komforten. Utöver detta är det även viktigt för en ljusdesigner att noggrant analysera och utvärdera patientens behov av ljuset i den specifika avdelningen som utformas. För att uppnå en hållbar belysningslösning är det viktigt att ha i åtanke att alla hållbarhetsfaktorer, såsom de sociala, ekonomiska och ekologiska, är lika viktiga att ta hänsyn till för att skapa en hållbar utveckling.
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Mauck, Erin E. "Oregon's Death with Dignity Act: An Evidenced-Based Approach to Improving End-of-Life Healthcare in Tennessee." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/26.
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Oregon’s Death with Dignity Act: An Evidenced-Based Approach to Improving End-of-Life Healthcare in Tennessee
Erin E. Mauck, MA
Community and Behavioral Health, College of Public Health
East Tennessee State University
Johnson City, TN
The legalization of physician-assisted death has been shown to improve the quality of end-of-life healthcare in the states that have passed Death with Dignity or End-of-Life Care Acts. The state of Oregon passed its Death with Dignity Act in 1994, and it is a model that has been replicated in Washington, Vermont, California, Colorado, and Washington D.C. In a national ranking of states in the areas of long-term services and supports for end-of-life care, five of the top nine were states with either a Death with Dignity or End-of-Life Care Act. This is not merely a coincidence. This data is a clear reflection that having legislation which clarifies the rights of a dying individual, impacts end-of-life healthcare in a positive way. Tennessee is currently ranked 47th nationally based on the following criteria: affordability and access, choice of settings and provider, quality of life and quality of care, support for family caregivers, and effective transitions. There are three major determinants that impact Tennessee’s poorly rated end-of-life health care. The first determinant is the limited use of advanced directives, living wills and patient-physician discussions about death, dying, and end-of-life healthcare choices. The second determinant is lack of coverage for the uninsured and less affluent. End-of-life healthcare is not strictly for individuals over the age of 65, terminal illness can impact the life of someone, regardless of age, income, or health insurance status. The third major determinant that is negatively impacting Tennessee’s end-of-life health care, is the lack of a Death with Dignity or End-of-Life Care Act. Data has been collected over the past 36 months, including data from secondary sources and field research data collected in Oregon, including 14 in-depth interviews with volunteers, employees, and the directors of two advocacy organizations at the center of Oregon’s Death with Dignity Act. The analysis of this data shows that states which have enacted Death with Dignity Acts, have better end-of-life care than states that have not. This includes the use of hospice and palliative care at the end of life, and the percentage of people who die at home. When a law that legalizes physician-assisted death is being considered, everyone, including citizens of the state, state policy makers, and healthcare professionals take notice. This encourages the public education of end-of-life healthcare options, as well as promotes further education in end-of-life care for all health professionals. In Tennessee, efficient and regulated end-of-life care is becoming more essential as the population increases, and life expectancy is extended.
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Nguyen, Hoa L. "Age and Sex Differences in Duration of Pre-Hospital Delay, Hospital Treatment Practices, and Short-Term Outcomes in Patients Hospitalized with an Acute Coronary Syndrome/Acute Myocardial Infarction: A Dissertation." eScholarship@UMMS, 2010. https://escholarship.umassmed.edu/gsbs_diss/471.
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BackgroundThe prompt seeking of medical care after the onset of symptoms suggestive of acute coronary syndromes (ACS)/acute myocardial infarction (AMI) is associated with the receipt of coronary reperfusion therapy, and effective cardiac medications in patients with an ACS/AMI and is crucial to reducing mortality and the risk of serious clinical complications in these patients. Despite declines in important hospital complications and short-term death rates in patients hospitalized with an ACS/AMI, several patient groups remain at increased risk for these adverse outcomes, including women and the elderly. However, recent trends in age and sex differences in extent of pre-hospital delay, hospital management practices, and short-term outcomes associated with ACS/AMI remain unexplored.
The objectives of this study were to examine the overall magnitude, and changing trends therein, of age and sex differences in duration of pre-hospital delay (1986-2005), hospital management practices (1999-2007), and short-terms outcomes (1975-2005) in patients hospitalized with ACS/AMI.
MethodsData from 13,663 residents of the Worcester, MA, metropolitan area hospitalized at all greater Worcester medical centers for AMI 15 biennial periods between 1975 and 2005 (Worcester Heart Attack Study), and from 50,096 patients hospitalized with an ACS in 106 medical centers in 14 countries participating in the Global Registry of Acute Coronary Events (GRACE) between 2000 and 2007 were used for this investigation.
Results In comparison with men years, patients in other age-sex strata exhibited significantly longer pre-hospital delay, with the exception of women < 65 years; had a significantly lower odds of receiving aspirin, angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta blockers, statins, and undergoing coronary artery bypass graft surgery (CABG) surgery or percutaneous coronary intervention (PCI), and were significantly more likely to develop atrial fibrillation, cardiogenic shock, heart failure, and to die during hospitalization and in the first 30 days after admission. There was a significant interaction between age and sex in relation to the use of several medications and the development of several of these outcomes; in patients Conclusions Our results suggest that the elderly were more likely to experience longer prehospital delay, were less likely to be treated with evidence-based treatments during hospitalization for acute coronary syndrome, and were more likely to develop adverse outcomes compared to younger persons. Younger women were less likely to be treated with effective treatments and were more likely to develop adverse outcomes compared with younger men while there was no sex difference in these outcomes. Interventions targeted at older patients, in particular, are needed to encourage these high-risk patients to seek medical care promptly to maximize the benefits of currently available treatment modalities. More targeted treatment approaches during hospitalization for ACS/AMI for younger women and older patients are needed to improve their hospital prognosis.
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Rodrigues, Hugo André Amaral. "Clinical protocols enabling evidence based medicine practice in healthcare software solutions." Master's thesis, 2008. http://hdl.handle.net/10216/61633.
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Rodrigues, Hugo André Amaral. "Clinical protocols enabling evidence based medicine practice in healthcare software solutions." Dissertação, 2008. http://hdl.handle.net/10216/61633.
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Locklear, Kendra Michele. "Guidelines and considerations for biophilic interior design in healthcare environments." Thesis, 2012. http://hdl.handle.net/2152/ETD-UT-2012-05-5643.
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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
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Hu, Hao. "Evidence and value based healthcare decision making for chronic disease in China." Thesis, 2017. http://hdl.handle.net/1959.13/1349948.
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Research Doctorate - Doctor of Philosophy (PhD)Different with the western developed countries, the current healthcare reimbursement system in China is not to maximize cost-effectiveness, but rather to provide basic drug coverage and to contain costs. As a consequence, the current system provides limited coverage for drugs under patent, even when these drugs are clinically more effective than cheaper alternatives already reimbursed. With the rapid economy developments in the past three decades, the Chinese government has the intention to include more innovative drugs in healthcare reimbursement coverage to satisfy public healthcare needs. In order to implement this effectively, China is moving towards evidence and value-based healthcare decision making. Among various techniques of health economics evaluations, the cost-utility analysis with quality adjusted life years derived from preference based generic health related quality of life instruments was particularly endorsed by the Chinese health economics guidelines. However, when conducting these kinds of analyses, one of the most obvious barriers for researchers and decision makers is the availability of evidence; typically either cost or utility data were unavailable from existing studies. A fundamental question could be easily asked: how to implement the evidence and value based healthcare decision making in China in the context of lack of health economics evidences? In this thesis we attempted to answer this question systematically, taking rheumatoid arthritis as the example indication. First, for utility and quality of life, we conducted a systematic review on the use of quality of life instruments in published studies, having identified the gap in quality of life research in China and the need to validate the quality of life instruments in Chinese settings. Based on this finding, we validated the most commonly used but not yet validated HRQL instruments and investigated the quality of life of Chinese patients from physical and mental perspectives respectively. In these studies, the validated instruments demonstrated good acceptability and psychometric properties in Chinese patients, which would provide the basis to justify the use of these instruments in not only future quality of life research in China, but also provide evidence to support the results of the historical ones. Then through modelling, we built up the mapping relationship between the most commonly used disease specific instruments and the most commonly used generic one, which would be important for deriving utility values in the case of unavailability of evidence with generic instruments. Second, to quantify the costs of chronic disease management, the economic burden of rheumatoid arthritis in China was researched through a cost of illness cross sectional study. In this study, besides the substantial burden in terms of direct medical cost and productivity lost, notable intangible costs were observed, especially among the older patients. Third, to verify whether these findings can be applied in other countries, the transferability of direct cost of chronic disease across different countries was then further researched. Using the approach by converting the raw cost data into percentage of GDP/capita of individual country, our results showed that it would be feasible to transfer the direct medical cost across countries. Hence, the approach could be potentially useful for a quick check on the economic burden of particular disease for countries without the information, using cost data from other jurisdiction. This would contribute to facilitate informed decision making in health care resource allocation. In conclusion, this thesis has systematically contributed new knowledge to the feasibility of technical implementing economic evaluations for chronic disease using rheumatoid arthritis as an illustrative example in China. With the validated HRQL instruments, the new mapping algorithm to derive utility values, the real world cost of illness and the approach to facilitate cost transferability from the studies of this thesis, we would arrive at a conclusion that researchers can embrace a more rational evidence and value based healthcare decision making process for managing RA in China. Furthermore, this information would not only be useful for clinicians and healthcare administrators in China, but other countries with similar stage of economic development. In addition, we would state that the same approach can be applied in a similar manner to study other chronic diseases in China and other developing countries.
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Bloomquist, Samuel W. "Web-based geotemporal visualization of healthcare data." Thesis, 2014. http://hdl.handle.net/1805/6188.
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Indiana University-Purdue University Indianapolis (IUPUI)Healthcare data visualization presents challenges due to its non-standard organizational structure and disparate record formats. Epidemiologists and clinicians currently lack the tools to discern patterns in large-scale data that would reveal valuable healthcare information at the granular level of individual patients and populations. Integrating geospatial and temporal healthcare data within a common visual context provides a twofold benefit: it allows clinicians to synthesize large-scale healthcare data to provide a context for local patient care decisions, and it better informs epidemiologists in making public health recommendations. Advanced implementations of the Scalable Vector Graphic (SVG), HyperText Markup Language version 5 (HTML5), and Cascading Style Sheets version 3 (CSS3) specifications in the latest versions of most major Web browsers brought hardware-accelerated graphics to the Web and opened the door for more intricate and interactive visualization techniques than have previously been possible. We developed a series of new geotemporal visualization techniques under a general healthcare data visualization framework in order to provide a real-time dashboard for analysis and exploration of complex healthcare data. This visualization framework, HealthTerrain, is a concept space constructed using text and data mining techniques, extracted concepts, and attributes associated with geographical locations. HealthTerrain's association graph serves two purposes. First, it is a powerful interactive visualization of the relationships among concept terms, allowing users to explore the concept space, discover correlations, and generate novel hypotheses. Second, it functions as a user interface, allowing selection of concept terms for further visual analysis. In addition to the association graph, concept terms can be compared across time and location using several new visualization techniques. A spatial-temporal choropleth map projection embeds rich textures to generate an integrated, two-dimensional visualization. Its key feature is a new offset contour method to visualize multidimensional and time-series data associated with different geographical regions. Additionally, a ring graph reveals patterns at the fine granularity of patient occurrences using a new radial coordinate-based time-series visualization technique.
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Tzeng, Pei-Chuan, and 曾珮娟. "Impacts of Evidence-based Medicine Workshop Participation on Related Knowledge and Attitudes of Healthcare Professionals." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/26776484929083797620.
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Kok, Victor C., and 郭集慶. "Integrating Evidence-based Medicine and Population-wide Disease Informatics in E-Research Using Administrative Healthcare Databases." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/66921792669833903392.
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博士亞洲大學
生物與醫學資訊學系
102
This thesis presents insights on integrating evidence-based medicine research methodology and core methods of clinical epidemiology into population-based disease informatics (PbDI) forming a novel research methodology to facilitate administrative healthcare database observational epidemiologic research. Background: A group of interdisciplinary researchers that consist of medical informatics specialists, information technology specialists, and physician informaticians focus their work and electronic research on public health and population-wide disease informatics by using Taiwan’s national administrative claim database, commonly known as the National Health Insurance Research Database (NHIRD). PbDI is defined as the field of information science within the scope of biomedical informatics that deals with patient information at the level of an entire community or certain groups of a population whose treatment records, in the form of computable electronic data, are shared. The data are obtained through data-mining and/or other information science technology and analyzed to better understand the disease and improve its treatment outcome. PbDI in electronic research (e-research) is abbreviated as PbDIR in the dissertation. This thesis would like to recognize and promote population-wide disease informatics as a branch of knowledge in the rapidly evolving field of medical informatics. Motivation of Research: 1. Population-based observational epidemiologic research involves physicians, clinicians, academicians, epidemiologists, information scientists and informaticians. 2. To establish a novel methodology in the population-based informatics research that incorporates evidence-based methods so that the research outcomes (manuscripts) contain high-quality results. The Rationale for Integrating EBM and PbDIR: Scientifically, after a thorough literature review, the development of a novel methodological approach combing EBM and PbDIR using healthcare databases is required to ascertain a quality research outcome. Ethical-legally, we should responsibly conduct epidemiologic research. Methods: PbDIR can be implemented by using a healthcare or claim database. After full literature search using MeSH terms and Boolean logics, an answerable research question can then be selected. Research-based PECOTS framework was introduced. After gaining an approval (mostly exemption from full review) from an IRB, PbDIR can be carried out. Evidence-based methods to incorporate into PbDIR include at least the followings: Search strategy, Study design (descriptive & analytic) (observational designs: cohort, case-control, hybrid), Calculation of risk, odds, and rate (eg., incidence rate), Minimizing bias, Matching (propensity score matching), Immortal time exclusion, Regression coefficient (ß1) interpretation. Data management involves utilization of coding book, data tables (flat files), data dictionary (meta-data), normalization (referential integrity) and validation rules for value, relational database, table-lookup function and complex programming may sometimes be needed. Linkage databases research such as merging data between NHIRD and National Death Registry or Taiwan Cancer Database (TCDB) shall be planned at the outset. Early self-application and self-evaluation with STROBE checklist shall be performed. The outcomes (endpoints) adopted specifically for this integration research were determined as follows: 1. Quality research outcome which is measured by the acceptance of the PbDIR manuscript submitted to a quarter 1 ranked biomedical journal or cited by a quarter 1 ranked journal. 2. Steady pace of manuscript completion and acceptance gained from the successful establishment of the integrated research methodology in PbDIR. Results: Realization of the implementation of the incorporation of evidence-based medicine into PbDIR and the depth of this integration was demonstrated by three successful research projects that were association studies. Conclusion and Recommendation: A novel research methodology in population-based disease informatics incorporating evidence-based methods can help population-based investigators to produce high-quality research outcome. For a multidisciplinary PbDIR collaborative team, adoption of this novel research methodology may further improve the evidence-based foundation of a quality research.
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George, Emily Rebecca. "Exploring and characterizing healthcare champions who have successfully promoted adoption of new initiatives within the healthcare delivery system to promote and enhance uptake of evidence-based interventions." Thesis, 2021. https://hdl.handle.net/2144/43006.
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BACKGROUND: Champions are widely recognized as playing a key role in the successful implementation of evidence-based interventions within the healthcare sector; however, little is known about which characteristics and skills enable them to play that role. Furthermore, previous studies have measured only individual champion’s responses to personal attributes without incorporating input from other observers. A mixed methods study was conducted to 1) identify, analyze, and group the characteristics of champions who have successfully promoted adoption of new initiatives within the healthcare delivery system, 2) understand when and how champion-like characteristics emerge during the implementation process, and 3) describe how these characteristics are developed to more quickly advance champions within the healthcare setting. METHODS: Data were collected and analyzed from healthcare champions (n=30) and their colleagues (n=58) from eleven countries using a survey. Every champion and a subset of colleagues (n=14) also participated in in-depth
interviews. Correlation coefficients and descriptive statistics were used to explore the relationship between responses to survey items; Chi-squared tests and Kruskal-Wallis tests were used to compare the differences. Thematic content analysis of qualitative data explored champion-like characteristics, their emergence, and how their skills were developed. Once results emerged, characteristics of champions were categorized using the Transformational Leadership Theory framework.
RESULTS: Champions tend to inspire their clinical teams to adopt new interventions within healthcare using a leadership style that naturally facilitates trust, as well as motivation to work towards common goals. This leadership style is similar to what is exhibited by transformational leaders; therefore, champions can be identified, categorized, and developed using transformational leadership theory. Champion emergence within the implementation process is facilitated by supportive leadership and high levels of autonomy. Additionally, there was a high proportion of agreement between champion and colleague survey responses; however, champions were more likely to underrate their skills and abilities to instigate change.
CONCLUSION: Champions exhibit the same characteristics as transformational leaders; therefore, transformational leadership theory — its frameworks and associated tools — is useful for identifying and developing champions. Future work should focus on how organizational leaders can facilitate the growth of emerging champions, as this enabling environment determines the fate of both the champion and the evidence-based intervention.
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Tsai, Jung-Mei, and 蔡榮美. "Study on the factors facilitating the application of evidence-based healthcare among physicians and nurses: based on the Decomposed Theory of Planned Behavior." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/97824799155926238827.
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博士國立陽明大學
護理學系
105
Physicians and nurses performing clinical application based on the evidence-based healthcare (EBHC) to improve quality of patient care is an important issue. In particular, the physicians and nurses of EBHC competitions are already competent with specific EBHC practices and aware of EBHC clinical application. Whether the clinical application of these EBHC practices reaches the ‘adhered to’ stage is a critical issue requires further investigation. This study was first to understand the distribution of the EBHC clinical application in seven action stages, then to explore factors influencing the behavior of EBHC clinical application by adopting the Decomposed Theory of Planned Behavior (DTPB), and finally to identify factors predicting the ‘adhered to’ stage of EBHC clinical application. Methods: The study employed a cross-sectional study design. The total population of physicians and nurses of EBHC competitions was 631. A survey was conducted using a structural questionnaire. Data was collected from 312 of the population; the returning rate 49.45%. The overall model of the study was analyzed using the structural equation modeling. Results: In the distribution of seven action stages (7As), 33.3% of the survey reported the ‘adhered to’ stage. In DTPB model testing revealed that all hypotheses, except for the association between ease of use and attitude and the association between technology facilitating condition and perceived behavioral control, were supported by the data with good overall model fit. The influences of behavioral intention and perceived behavioral control on the behavior of EBHC clinical application was positive with 37% variance of the behavior explained. As for predicting the ‘adhered to’ stage of EBHC clinical application, the odds for supervisory vs. nonsupervisory was 2.03 (OR=2.03, CI=1.10-3.77) resource facilitating condition, perceived behavioral control, and behavioral intention each incremental point the odds increased by 1.06 (OR=1.06, CI=1.01-1.11), 2.21 (OR=2.21, CI=1.47-3.32) and 1.96 (OR=1.96, CI=1.40-2.73) times respectively. Conclusion and recommendation: The study found that: perceived usefulness, compatibility, peer and superior influences, self-effcacy, resource facilitating condition, attitude, subjective norm, perceived behavioral control, and behavioral intention influencing EBHC clinical application; supervisory duties, resource facilitating condition, perceived behavioral control, and behavioral intention predicting the ‘adhered to’ stage of EBHC clinical application. Therefore, we recommend as follows: promoting continuing education for nonsupervisory physicians and nurses to improve knowledge and skill related to EBHC clinical application; installing databases and equipments necessary for EBHC clinical application as well as encouraging involvement of EBHC competitions. The study model based on the DTPB model revealed a good fit and the questionnaire was valid and reliable hence suitable for measuring the behavior of EBHC clinical application and exploring other relevant factors facilitating the behavior of EBHC clinical application in future studies.
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"A Post Occupancy Evaluation of the Education Spaces at the Ngeruka Health Center in Rwanda: Can the Design of the Built Environment Effect Healing?" Master's thesis, 2015. http://hdl.handle.net/2286/R.I.36380.
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abstract: A post occupancy evaluation (POE) was conducted at the Ngeruka Health Center (NHC) in the Bugesera District of Rwanda. The POE was limited to the education spaces within the health center, its participants, and staff. A POE is a combination of methods both quantitative and qualitative to determine user satisfaction and whether the design intent of the built environment was met.
In rural Rwanda where healthcare facilities are scarce and people become seriously ill from preventable diseases, help is needed. The smallest injuries become life threatening. Healthcare facilities and providers must develop approaches that stop these minor illnesses and diseases from costing further problems.
The healthcare facility is a healing environment. Healing environments nurture health and provide a sense of safety and security. The Ngeruka facility has incorporated education spaces within their facility to teach the community ways to prevent minor health problems from becoming major ones.
The research that was conducted at this healthcare facility sought to answer the main questions: Does the built environment of the NHC contribute to healing by engaging education program attendees to learn about preventing illness and disease and other health promotion strategies? In addition, can you measure healing effects of the built environment?
The research took measurements of the built environment and combined them with user satisfaction questionnaires. Site observations and a participant engagement questionnaire were used to determine the amount of engagement the participants put forth into the education programs within the designated design space. Measuring engagement is a tool schools use to find out if their facilities are producing their intended results. This same thought process was incorporated into this research. The participants did prove to be engaged, but it is not definitive that the built environment was responsible. It was a combination of many factors.Dissertation/Thesis
Masters Thesis Design 2015
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Gajic, Sanela. "Outlining Healthcare Utilization in Order to Develop Evidence Based Data Collection Tools for Prospective Evaluation of the Economic Burden Due to Invasive Meningococcal Disease (IMD) in Canada." 2013. http://hdl.handle.net/10222/21448.
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Defining health and economic burden of Invasive Meningococcal Disease (IMD) in Canada is critical to inform Public Health Policy around immunization programs. A comprehensive literature review was conducted to assess available studies, a lack of comprehensive Canadian data to allow evaluation of total economic burden of IMD was identified in Canada. Thus, this dissertation proposes a prospective cost collection methodology tailored to Canadian data and healthcare utilization (HCU). All patient-related HCU is considered and outlined. HCU is then categorized as direct or indirect and relevant direct and indirect healthcare costs are detailed. Intangible costs are described and methodology for capturing these costs using validated quality of life instruments is proposed. As all published economic evaluations of this disease lack prospective collection of data, this study proposes the use of a patient diary to serve as a memory aid during patient cost-collection interviews.
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Váchová, Veronika. "Informační podpora medicíny založené na důkazu na Psychiatrické klinice 1. Lékařské fakulty Univerzity Karlovy a Všeobecné fakultní nemocnice v Praze." Master's thesis, 2019. http://www.nusl.cz/ntk/nusl-404745.
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The thesis focuses on the use of Evidence Based Medicine (EBM) methods and principles at the Psychiatric Clinic of the First Faculty of Medicine of Charles University and the General University Hospital in Prague. There is a theoretical introduction to EBM - its origin and development, EBM information resources as well as general basic principles of this approach to work with clinical evidence. Part of this work introduces the history and current activities of the Psychiatric Clinic and the related Psychiatric Association of the Czech Medical Association of J. E. Purkyně. The practical part of the thesis describes the preparation of research and its results. Based on semi-structured interviews with physicians of the Psychiatric Clinic, the results of this research represents their current attitude towards EBM and use of EBM methods in their daily work. The aim of the thesis is also a proposal to raise awareness of EBM information sources in the form of information materials and educational seminars.
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Horne, Maria, G. McCracken, A. Walls, P. J. Tyrrell, and C. J. Smith. "Organisation, practice and experiences of mouth hygiene in stroke unit care: a mixed methods study." 2015. http://hdl.handle.net/10454/7373.
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noAims and objectives To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. Background Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. Design Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. Methods A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. Results Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. Conclusion Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice.