Do managed clinical networks improve quality of diabetes care? : Evidence from a retrospective mixed methods evaluation

Peer reviewedPostprin

Bulletin No. 15: Integration in DPMP: An organising principle and an expanded set of tools

DPMP involves various levels of integration: • across law enforcement, treatment, harm reduction and prevention, as both approaches and sectors; • across global, national, state and local scales; • between research, policy and other practice; and • across an array of disciplinary and epistemological research approaches. Although the need for integration to better deal with complex problems, like illicit drug use, is now widely recognised and discussed, formalised processes for achieving this have been slow to develop. A unique aspect of DPMP is its close link with the new cross-cutting specialisation of Integration and Implementation Sciences. The specialisation draws from a range of disciplines, such as political science, systems thinking, complexity science, participatory methods, management, and information science, and aims to help make better-founded decisions on complex social problems by applying integrative methods to: • tackling problems systemically; • deepening understanding of problems based on all the relevant disciplines and interests; • applying knowledge management strategies to cope with both information overload and diverse epistemologies; and • applying understanding of how action occurs, in other words how policy is made, how business operates, how activism succeeds; as well as how action can be influenced by evidence. Thus the new specialisation provides theory, methods and skills to facilitate comprehensive examination of issues and problems, as well as effective mobilisation to action. Integration and Implementation Sciences also seeks to incorporate the effective use of research-based knowledge to help bring about change. Specifically, Integration and Implementation Sciences is developing theory and methods for: 1. Comprehensive scoping of problems and issues. 2. Application of appropriate integrative concepts and methods. 3. Involvement of the strengths of different research epistemologies. 4. Attention to emergent properties, i.e. to identifying and understanding properties that disappear when a system is studied in disaggregated segments. 5. Understanding of policy, product development and action and how these can be influenced by research. 6. Application of knowledge management concepts and tools. 7. Development and application of expanded ways of taking uncertainty into account. 8. Managing the inevitability of less than perfect outcomes. 9. Application of concepts and methods from change management and innovation, including developing new roles such as boundary spanners and knowledge brokers to apply research to changed practice. 10. Development and application of collaborative processes. DPMP has built on the insights gained as Integration and Implementation Sciences have developed. This has allowed some of the best leading edge ideas and methods developed in other areas to be introduced to the illicit drugs field

The translation research in a dental setting (TRiaDS) programme protocol

Background: It is well documented that the translation of knowledge into clinical practice is a slow and haphazard process. This is no less true for dental healthcare than other types of healthcare. One common policy strategy to help promote knowledge translation is the production of clinical guidance, but it has been demonstrated that the simple publication of guidance is unlikely to optimise practice. Additional knowledge translation interventions have been shown to be effective, but effectiveness varies and much of this variation is unexplained. The need for researchers to move beyond single studies to develop a generalisable, theory based, knowledge translation framework has been identified.For dentistry in Scotland, the production of clinical guidance is the responsibility of the Scottish Dental Clinical Effectiveness Programme (SDCEP). TRiaDS (Translation Research in a Dental Setting) is a multidisciplinary research collaboration, embedded within the SDCEP guidance development process, which aims to establish a practical evaluative framework for the translation of guidance and to conduct and evaluate a programme of integrated, multi-disciplinary research to enhance the science of knowledge translation.Methods: Set in General Dental Practice the TRiaDS programmatic evaluation employs a standardised process using optimal methods and theory. For each SDCEP guidance document a diagnostic analysis is undertaken alongside the guidance development process. Information is gathered about current dental care activities. Key recommendations and their required behaviours are identified and prioritised. Stakeholder questionnaires and interviews are used to identify and elicit salient beliefs regarding potential barriers and enablers towards the key recommendations and behaviours. Where possible routinely collected data are used to measure compliance with the guidance and to inform decisions about whether a knowledge translation intervention is required. Interventions are theory based and informed by evidence gathered during the diagnostic phase and by prior published evidence. They are evaluated using a range of experimental and quasi-experimental study designs, and data collection continues beyond the end of the intervention to investigate the sustainability of an intervention effect.Discussion: The TRiaDS programmatic approach is a significant step forward towards the development of a practical, generalisable framework for knowledge translation research. The multidisciplinary composition of the TRiaDS team enables consideration of the individual, organisational and system determinants of professional behaviour change. In addition the embedding of TRiaDS within a national programme of guidance development offers a unique opportunity to inform and influence the guidance development process, and enables TRiaDS to inform dental services practitioners, policy makers and patients on how best to translate national recommendations into routine clinical activities

How Will Comparative Effectiveness Research Affect the Quality of Health Care?

Outlines how the use of comparative effectiveness research on the relative merits of a healthcare intervention compared with others could improve quality of care and outcomes. Presents challenges in enhancing CE research and expanding its adoption

Key Factors for Effective Organisation of e-Assessment

The benefits of e-assessment are widely documented (Bull and McKenna 2004). However, instances of good practice have not been systematically reported. Recognising and acknowledging this gap in the research, the JISC Organisational Committee has funded a number of projects on e-assessment practice: 'E-Assessment Glossary?, 'The Roadmap to E-Assessment? together with a set of case studies of innovative and effective practice. This paper is based on the findings of the JISC Case Study Project 'The innovative and effective use of E-Assessment'. Members of the project team conducted over 90 interviews with teaching staff, senior management, developers and students to showcase all aspects of e-assessment. The project offered a unique opportunity to observe different organisational structures and gain inside-information about the effectiveness of a number of different applications. The 17 case studies and their follow-up surveys have been studied to identify the facilitating factors for the introduction of e-assessment and the organisational structures supporting e-assessment have also been investigated. The focus of this analysis was to study the different organisational structures and to identify patterns herein. We suggest that the key characteristics for the typology are the position of the e-assessment within the organisational structure and the support from the senior management. Three types of organisational structures are identified by the study, which support innovative practice. These are the Central Team, the Faculty based Team and the Departmental Champion. The Central Team offers e-assessment support and, in some cases, production services to all academics on a university-wide basis whilst the Faculty Based Team provides a more limited discipline-related service. The Departmental Champion usually implements e-assessment within his/her specific discipline and may be an early adopter or have a special interest in this area

Interaction Design: Foundations, Experiments

Interaction Design: Foundations, Experiments is the result of a series of projects, experiments and curricula aimed at investigating the foundations of interaction design in particular and design research in general. The first part of the book - Foundations - deals with foundational theoretical issues in interaction design. An analysis of two categorical mistakes -the empirical and interactive fallacies- forms a background to a discussion of interaction design as act design and of computational technology as material in design. The second part of the book - Experiments - describes a range of design methods, programs and examples that have been used to probe foundational issues through systematic questioning of what is given. Based on experimental design work such as Slow Technology, Abstract Information Displays, Design for Sound Hiders, Zero Expression Fashion, and IT+Textiles, this section also explores how design experiments can play a central role when developing new design theory

Managing direct energy use now and in the future

[Background and Introduction]: Agricultural producers are currently aware of increasing energy costs. This has occurred before the scientific and political debate on climate change has been resolved and a decision made on the best policy instruments to be used to respond. In parallel to this discussion, the on farm assessment of direct energy inputs (i.e. diesel and electricity) enables farmers to react positively to the potential of rising energy costs while contributing to a reduction in greenhouse gasses (GHGs) regardless of the scientific and policy debate surrounding climate change and emissions reduction. Previous work undertaken by the National Centre for Engineering in Agriculture (NCEA) has studied direct on farm energy use involving a number of case study cotton farms to understand the range, costs and contributions of energy use to cotton production and greenhouse gas emissions. The results from this work showed that energy use varies depending on the cropping enterprise and the farming system and that there are significant opportunities to reduce energy and costs. In comparison the greenhouse gas emissions (GHGs) from direct energy use can be similar and in fact greater than the GHGs generated by soil / fertiliser / water interactions. Improving on farm energy use would appear to be as important as improving nitrogen efficiency. A more detailed study undertaken by the NCEA on a large cotton farm in the Gwydir Valley (reference) identified significant reductions in energy resulting from the adoption of reduced tillage systems. The study showed that the adoption of a minimum tillage system had reduced energy costs (and greenhouse emissions) by 12% since 2000 and developing a 'near zero till' system had the potential to reduce this to 24% less than 2000 energy costs. It is evident from this work that there is substantial scope to improve energy use efficiency in cotton production systems, but to enable more growers to identify where they can improve, further development of tools, processes and human capacity is required. In the cropping sector a number of practice changes and technology developments have been, or are being, adopted which can be expected to reduce fuel / energy use or energy use intensity. Examples include minimum / zero tillage, controlled traffic, a range of precision ag technologies, planting of GM crops, some water use efficiency measures and use of legumes in crop rotations. Unfortunately, because the primary driver for the adoption of these practices and technologies has not been energy costs or efficiency, relatively few studies have considered the energy savings or efficiencies associated with them. Within highly mechanised agricultural productions systems such as the Australian Cotton Industry direct energy inputs (i.e. diesel and electricity) represent a major cost to the grower and potentially a significant proportion of the total green house gas (GHG) emissions. Previous studies by Baillie and Chen (2008) have reported significant savings in energy for both a refinement in current practices (i.e. up to 30 % for individual operations) and a change in practice (10 – 20% across the farming system) through energy assessment