Guidelines for rating Global Assessment of Functioning (GAF)

<p>Abstract</p> <p>Background</p> <p>Global Assessment of Functioning (GAF) is a scoring system for the severity of illness in psychiatry. It is used clinically in many countries, as well as in research, but studies have shown several problems with GAF, for example concerning its validity and reliability. Guidelines for rating are important. The present study aimed to identify the current status of guidelines for rating GAF, and relevant factors and gaps in knowledge for the development of improved guidelines.</p> <p>Methods</p> <p>A thorough literature search was conducted.</p> <p>Results</p> <p>Few studies of existing guidelines have been conducted; existing guidelines are short; and rating has a subjective element. Seven main categories were identified as being important in relation to further development of guidelines: (1) general points about guidelines for rating GAF; (2) introduction to guidelines, with ground rules; (3) starting scoring at the top, middle or bottom level of the scale; (4) scoring for different time periods and of different values (highest, lowest or average); (5) the finer grading of the scale; (6) different guidelines for different conditions; and (7) different languages and cultures. Little information is available about how rules for rating are understood by different raters: the final score may be affected by whether the rater starts at the top, middle or bottom of the scale; there is little data on which value/combination of GAF values to record; guidelines for scoring within 10-point intervals are limited; there is little empirical information concerning the suitability of existing guidelines for different conditions and patient characteristics; and little is known about the effects of translation into different languages or of different cultural understanding.</p> <p>Conclusions</p> <p>Few studies have dealt specifically with guidelines for rating GAF. Current guidelines for rating GAF are not comprehensive, and relevant points for new guidelines are presented. Theoretical and empirical studies, and international expert panels would be valuable, as well as production of a manual with more information about scoring. Computerised assessment may well be the future.</p

Global Assessment of Functioning (GAF): properties and frontier of current knowledge

ABSTRACT: BACKGROUND: Global Assessment of Functioning (GAF) is well known internationally and widely used for scoring the severity of illness in psychiatry. Problems with GAF show a need for its further development (for example validity and reliability problems). The aim of the present study was to identify gaps in current knowledge about properties of GAF that are of interest for further development. Properties of GAF are defined as characteristic traits or attributes that serve to define GAF (or may have a role to define a future updated GAF). METHODS: A thorough literature search was conducted. RESULTS: A number of gaps in knowledge about the properties of GAF were identified: for example, the current GAF has a continuous scale, but is a continuous or categorical scale better? Scoring is not performed by setting a mark directly on a visual scale, but could this improve scoring? Would new anchor points, including key words and examples, improve GAF (anchor points for symptoms, functioning, positive mental health, prognosis, improvement of generic properties, exclusion criteria for scoring in 10-point intervals, and anchor points at the endpoints of the scale)? Is a change in the number of anchor points and their distribution over the total scale important? Could better instructions for scoring within 10-point intervals improve scoring? Internationally, both single and dual scales for GAF are used, but what is the advantage of having separate symptom and functioning scales? Symptom (GAF-S) and functioning (GAF-F) scales should score different dimensions and still be correlated, but what is the best combination of definitions for GAF-S and GAF-F? For GAF with more than two scales there is limited empirical testing, but what is gained or lost by using more than two scales? CONCLUSIONS: In the history of GAF, its basic properties have undergone limited changes. Problems with GAF may, in part, be due to lack of a research programme testing the effects of different changes in basic properties. Given the widespread use, research-based development of GAF has not been especially strong. Further research could improve GAF

The organizational challenge for health care

New technology has been proposed to Brattbakk, Ingarg great changes for our societies. In health care telemedicine was met with great enthusiasm and considered an enabler to overcome distance barriers. It is now clear that telemedicine does not spread like fire in dry Grimsmo, Asbjørns. A more extensive use of telemedicine can imply advantages, and some countries have invested much in technology. The present book shows organizational problems to be crucial for the future of telemedicine, and has two main points: identification of organizational problems and design of solutions to organizational problems. For telemedicine we find many organizational consequences and many types of consequences, but it is not just so that implementing technology has organizational consequences. Organizational changes can be performed first and increased use of telemedicine will follow. Measures of collaboration are important to make telemedicine distance collaboration work, and health care organizations should consider a number of such measures for implementation. Reorganization of where to perform work can result in more telemedicine. A new concept for centralization and decentralization in regions (or large health enterprises) simplifies analysis of where to locate telemedicine. Research on general network organization is well known from the history of organization theory. To work with telemedicine means having a virtual organization. Health care has something to learn from general network research and from research on virtual organizations for other sectors of society than health care. Internal organizational changes are very common when telemedicine is implemented. Forecasting future development for telemedicine is difficult. If health care tackles the situation correctly organizations can be changed to facilitators for telemedicine. Time has come for work with the organizational problems

GrowPro Växthusautomation

With food shortage becoming a growing problem at the same time as the world population increases and cities become more densely populated than ever before, resource efficiency has become a more dire issue than ever. One major problem in food production today is that production efficiency is very weather dependent, transportation is also a big factor in environmental impact and almost half the world's landmass is used for farming, meaning that cultivation of new land is under more pressure than ever. Furthermore pesticides have become commonly used to increase productivity and minimize waste while in recent years it has been proven that these methods can cause health issues. This is where indoor farming has become a growing trend in densely populated areas and it’s proving to be a financially feasible way to meet growing food production demand. Some vertical farms proving to be 100 times more efficient per square meter compared to traditional methods, with 40% less power consumption, 80% less food waste and 99% less water usage compared to outdoor fields. Furthermore the indoor environment can be kept sanitary and therefore the usage of pesticides can be kept at a minimum. With this as a background this project aims to design and build an automated indoor growing environment. An iterative approach will be taken and several prototypes will be constructed, one after another, in order to end up with a small-scale indoor farming setup, also known as a GrowPro

Electrifying Fishing for Rural Electrification

Electrification is a known precondition for development and is still lacking in rural and inaccessible parts of the world. Electric conversion of small coastal fishing boats can be an economical driver for small coastal villages in addition to providing environmental benefits. With local standalone solar photovoltaic mini-grids, the system can be fully renewable while still being economically viable. This study shows that such a system could be feasible to build in the Kelan village, Bali, Indonesia. Benefits of modern and smart grid technologies can further increase the economic and environmental benefits. It is also shown that if multiple fishing boat owners join forces to invest in Li-ion batteries the benefit of the even greater

Munnkurv og varsling

Arbeidsforskningsinstituttet har i denne studien sett nærmere på sykepleiernes muligheter og begrensninger for å ytre seg både internt og eksternt om kritikkverdige forhold ved arbeidssituasjonen, og hvorvidt den ansatte ilegges munnkurv eller forbud mot å ytre seg internt eller eksternt. Helseinstitusjonene har vært gjennom en rekke reformer og endringsprosesser de senere år, og dilemmaer i krysnings¬punktet mellom økonomiske hensyn og kvalitetshensyn oppleves som vanskelige både av tillitsvalgte, ansatte og ledelse. I en slik arbeidsvirkelighet er behovet for å melde avvik ofte stort, samtidig som det viser seg at svært mange lar være å melde fra. Denne undersøkelsen viser at årsakskjeden som bidrar til munnkurv er svært kompleks. En hovedkonklusjon er likevel at intern kritikk oppfattes som farlig i organisasjonen, ikke som en kilde til læring og forbedring. Det ser ut til å være en tendens til at organisasjonsproblemer individualiseres ved at motstanden mot å erkjenne systemkarakteren av enkelthendelser er stor. I tillegg bekreftes sykepleierne i sin frykt for sanksjoner ved at de selv eller kolleger har opplevd negative reaksjoner eller sanksjoner, for eksempel fortielse og trenering, utstøtning fra kollegafellesskapet, å bli ”kalt inn på teppet”, eller mer alvorlige reaksjoner