88 research outputs found
Improving quality of care through routine, successful implementation of evidence-based practice at the bedside: an organizational case study protocol using the Pettigrew and Whipp model of strategic change
BACKGROUND: Evidence-based practice (EBP) is an expected approach to improving the quality of patient care and service delivery in health care systems internationally that is yet to be realized. Given the current evidence-practice gap, numerous authors describe barriers to achieving EBP. One recurrently identified barrier is the setting or context of practice, which is likewise cited as a potential part of the solution to the gap. The purpose of this study is to identify key contextual elements and related strategic processes in organizations that find and use evidence at multiple levels, in an ongoing, integrated fashion, in contrast to those that do not. METHODS: The core theoretical framework for this multi-method explanatory case study is Pettigrew and Whipp's Content, Context, and Process model of strategic change. This framework focuses data collection on three entities: the Why of strategic change, the What of strategic change, and the How of strategic change, in this case related to implementation and normalization of EBP. The data collection plan, designed to capture relevant organizational context and related outcomes, focuses on eight interrelated factors said to characterize a receptive context. Selective, purposive sampling will provide contrasting results between two cases (departments of nursing) and three embedded units in each. Data collection methods will include quantitative tools (e.g., regarding culture) and qualitative approaches including focus groups, interviews, and documents review (e.g., regarding integration and “success”) relevant to the EBP initiative. DISCUSSION: This study should provide information regarding contextual elements and related strategic processes key to successful implementation and sustainability of EBP, specifically in terms of a pervasive pattern in an acute care hospital-based health care setting. Additionally, this study will identify key contextual elements that differentiate successful implementation and sustainability of EBP efforts, both within varying levels of a hospital-based clinical setting and across similar hospital settings interested in EBP
Effects of school-based interventions on mental health stigmatization: a systematic review
Stigmatizing, or discriminatory, perspectives and behaviour, which target individuals on the basis of their mental health, are observed in even the youngest school children. We conducted a systematic review of the published and unpublished, scientific literature concerning the benefits and harms of school-based interventions, which were directed at students 18 years of age or younger to prevent or eliminate such stigmatization. Forty relevant studies were identified, yet only a qualitative synthesis was deemed appropriate. Five limitations within the evidence base constituted barriers to drawing conclusive inferences about the effectiveness and harms of school-based interventions: poor reporting quality, a dearth of randomized controlled trial evidence, poor methods quality for all research designs, considerable clinical heterogeneity, and inconsistent or null results. Nevertheless, certain suggestive evidence derived both from within and beyond our evidence base has allowed us to recommend the development, implementation and evaluation of a curriculum, which fosters the development of empathy and, in turn, an orientation toward social inclusion and inclusiveness. These effects may be achieved largely by bringing especially but not exclusively the youngest children into direct, structured contact with an infant, and likely only the oldest children and youth into direct contact with individuals experiencing mental health difficulties. The possible value of using educational activities, materials and contents to enhance hypothesized benefits accruing to direct contact also requires investigation. Overall, the curriculum might serve as primary prevention for some students and as secondary prevention for others
Veto Players in Post-Conflict DDR Programs: Evidence from Nepal and the DRC
Under what conditions are Disarmament, Demobilization and Reintegration (DDR) programs successfully implemented following intrastate conflict? Previous research is dominated by under-theorized case studies that lack the ability to detect the precise factors and mechanisms that lead to successful DDR. In this article, we draw on game theory and ask how the number of veto players, their policy distance, and their internal cohesion impact DDR implementation. Using empirical evidence from Nepal and the Democratic Republic of Congo, we show that the number of veto players, rather than their distance and cohesion, explains the (lack of) implementation of DDR
Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula
IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.MethodsConsenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.ResultsOf 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.ConclusionEarly ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation
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Tamu Shamans' Books: The Challenges of Textualising the Pye-ta Lhu-ta
In this presentation, I discuss my ongoing work with the Tamu-mai, an ethnolinguistic community of central Nepal with whom I have been working collaboratively for two decades. I begin by reviewing a number of Tamu cultural preservation projects in which I have played a part, including the curation of sensitive material culture collections within museums in Europe and Nepal, an extensive video documentation project and studio recordings of traditional Tamu ritual chants and songs. Through these and other examples, I address the challenges of textualisation and the problems that are raised when delicate cultural materials are recorded, archived and disseminated to a wider audience
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Shamanic dialogue : history, representation and landscape in Nepal
This thesis was digitised by the British Library from microfilm. You can acquire a single copy of this thesis for research purposes by clicking on the padlock icon on the thesis file. Please be aware that the text in the supplied thesis pdf file may not be as clear as text in a thesis that was born digital or digitised directly from paper due to the conversion in format. However, all of the theses in Apollo that were digitised from microfilm are readable and have been processed by optical character recognition (OCR) technology which means the reader can search and find text within the document. If you are the author of this thesis and would like to make your work openly available, please contact us: [email protected]
Gurkhas’ in the town: migration, language, and healing
The serga pye1 recalls how a group of Tamu-mai2 (Gurung) came upon what is now
the ancestral village of Kohla, planted some grain, returned to find that it had produced
a high yield, and moved across the Lamjung Himal to settle in the forests
above their present villages. Many Tamu-mai consider the move across the Himalaya
to be the final stage in their migration, without realizing that they themselves
are engaged in an equally historic migration. This article examines the contemporary
rural-urban movement of the Tamu-mai, which is intimately tied to the experience
of service in the British army, and explores some of the associated social
and cultural changes. As people plot new urban geographies, and as the second
generation grow up as town-dwellers, a new Tamu social landscape is created and
the sense of what it means to be Tamu is shifting. In this new environment, the
cultural landscape is being re-drawn. As the map is reformulated, some knowledge
and practices have lost their cultural centrality. Language, for example, has been
displaced, and few of the second generation speak Tamu Kyui. In contrast, despite a
wide choice of alternative options, shamanic healing practices retain their cultural
salience
Observing the Elections in Central Nepal
no abstract availabl
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