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Common Barriers (common + barrier)
Selected AbstractsStretch Goals and Backcasting: Approaches for Overcoming Barriers to Large-Scale Ecological RestorationRESTORATION ECOLOGY, Issue 4 2006Adrian D. Manning Abstract The destruction and transformation of ecosystems by humans threatens biodiversity, ecosystem function, and vital ecosystem services. Ecological repair of ecosystems will be a major challenge over the next century and beyond. Restoration efforts to date have frequently been ad hoc, and site or situation specific. Although such small-scale efforts are vitally important, without large-scale visions and coordination, it is unlikely that large functioning ecosystems will ever be constructed by chance through the cumulative effects of small-scale projects. Although the problems of human-induced environmental degradation and the need for a solution are widely recognized, these issues have rarely been addressed on a sufficiently large-scale basis. There are numerous barriers that prevent large-scale ecological restoration projects from being proposed, initiated, or carried through. Common barriers include the "shifting baseline syndrome," the scale and complexity of restoration, the long-term and open-ended nature of restoration, funding challenges, and preemptive constraint of vision. Two potentially useful approaches that could help overcome these barriers are stretch goals and backcasting. Stretch goals are ambitious long-term goals used to inspire creativity and innovation to achieve outcomes that currently seem impossible. Backcasting is a technique where a desired end point is visualized, and then a pathway to that end point is worked out retrospectively. A case study from the Scottish Highlands is used to illustrate how stretch goals and backcasting could facilitate large-scale restoration. The combination of these approaches offers ways to evaluate and shape options for the future of ecosystems, rather than accepting that future ecosystems are victims of past and present political realities. [source] Perceived barriers to adherence among adolescent renal transplant candidatesPEDIATRIC TRANSPLANTATION, Issue 3 2008Nataliya Zelikovsky Abstract:, Non-adherence to medical regimens is a ubiquitous hindrance to quality health care among adolescent transplant recipients. Identification of potentially modifiable barriers to adherence when patients are listed for organ transplant would help with early intervention efforts to prepare adolescents for the stringent medication regimen post-transplant. Fifty-six adolescents listed for a kidney transplant, mean age 14.27 (s.d. = 2.2; range 11,18 yr), 73.2% male, 62.5% Caucasian participated in a semi-structured interview, the Medical Adherence Measure, to assesses the patient's knowledge of the prescribed regimen, reported adherence (missed and late doses), the system used to organized medications, and who holds the primary responsibility over medication management. Better knowledge of the medication regimen was associated with fewer missed doses (r = ,0.48, p < 0.001). Patients who perceived more barriers had more missed (r = 0.38, p = 0.004) and late (r = 0.47, p < 0.001) doses. Patients who endorsed "just forget," the most common barrier (56.4%), reported significantly more missed (z = ,4.25, p < 0.001) and late (z = ,2.2, p = 0.02) doses. Only one-third of the transplant candidates used a pillbox to organize medications but these patients had significantly better adherence, z = ,2.2, p = 0.03. With regard to responsibility over managing the regimens, adolescents missed fewer doses when their parents were in charge than when they were solely responsible, z = ,2.1, p = 0.04. Interventions developed to prepare transplant candidates for a stringent post-transplant regimen need to focus on ensuring accurate knowledge of as simple a regimen as possible. Use of an organized system such as a pillbox to establish a routine and facilitate tracking of medications is recommended with integration of reminders that may be appealing for this age group. Although individuation is developmentally normative at this age, parent involvement seems critical until the adolescent is able to manage the responsibility more independently. [source] Perceptions of older people about falls injury prevention and physical activityAUSTRALASIAN JOURNAL ON AGEING, Issue 2 2005Suzanne J Snodgrass Objectives:,The purpose of this study was to explore the beliefs and perceptions of older people about falls injury prevention services, and to identify incentives and barriers to attending falls prevention services, including programs targeting physical activity. Methods:,Seventy-five people over age 60 years who were members of community groups completed a 23-item survey that was returned by mail. Survey items included self-reported falls and confidence when walking, awareness of falls prevention strategies, desirable programs for a falls prevention service, and incentives and barriers to participation in physical activity programs. Results:,Twenty-eight per cent of respondents had fallen within the previous 6 months, yet just over half (54%) were aware there were strategies to prevent falling, despite the majority of the sample being physically active (81%) and at least reasonably confident about walking (84%). The features that were considered most desirable for a falls prevention service were group exercise programs (61%), educational talks about health issues (57%), and vision/eye glasses assessment (52%). The most commonly reported incentives for attending a physical activity group included having a doctor advise them to attend (61%) or having a friend who attended the group (55%), and the most common barrier to attending a physical activity group was transportation (43%). Conclusions:,Despite consistent numbers of older people experiencing falls, there is little awareness among older people that strategies exist to prevent falling. It appears that motivating older people to participate in physical activity with the aim of falls prevention will largely depend on the encouragement of their doctor or their peers. [source] Issues with recruitment to randomised controlled trials in the drug and alcohol field: a literature review and Australian case studyDRUG AND ALCOHOL REVIEW, Issue 2 2008CLARE L. THOMSON Abstract Issues. The randomised control trial (RCT) is a widely used tool for measuring the effectiveness of health treatments and services. However, subject recruitment is an ongoing challenge for those conducting RCTs and may have a serious impact on the success of the study and the reliability of the outcomes. Approach. In this review we present an examination of the problems and strategies associated with recruitment to RCTs, with particular reference to studies conducted in the drug and alcohol field. A case study of recruitment to an RCT for the treatment of alcohol dependence is presented, supplemented by PubMed, Current Contents and Medline searches to identify relevant publications. Key Findings. The literature suggests that the most common barriers to patient participation involve fears of assignment to placebo treatment, insufficient compensation and poor attendance at initial appointments. Moreover, subject referrals from staff may be a greater problem than reluctance of patients. Referrals are inhibited by complicated entry criteria, time constraints due to busy work schedules or a limited research culture. Implications. Subject recruitment may be promoted by financial reimbursement, close partnerships between research and referral staff; increasing the treatment group ratio in multi-drug trials to minimise randomisation to placebo; addressing negative staff attitudes; and simplifying the referral process. Conclusion. The need for multi-centre sites in Australian drug and alcohol treatment studies is highlighted. [source] Population-based controlled study of social support, self-perceived stress, activity and work issues, and access to health care in inflammatory bowel diseaseINFLAMMATORY BOWEL DISEASES, Issue 4 2008Linda Rogala RN Abstract Background: The Manitoba IBD Cohort Study is a longitudinal, population-based study of multiple determinants of health outcomes in persons with inflammatory bowel disease (IBD) diagnosed within 7 years at enrollment. In this cross-sectional substudy we compared IBD participants' levels of social support, self-perceived stress, disability, and access to healthcare with those of a matched community sample. Methods: IBD participants (n = 388) were interviewed using the Canadian Community Health Surveys (CCHS) 1.1 and 1.2 to assess psychosocial variables. The national CCHS data were accessed to extract a community comparison group, matched on age, sex, and geographic residence. Results: Compared to the community sample, IBD participants received more tangible, affective, or emotional support in the past year and were more likely to have experienced a positive social interaction. Those with IBD were as likely to be employed as those in the community sample, although they reported greater rates of reduced activity and days missed. Work was not identified as a significant source of stress, but physical health was more likely to be identified as a main stressor by those with active IBD compared to the non-IBD sample. Individuals with IBD were twice as likely to report unmet healthcare needs than the community sample; however, there was agreement across both groups regarding common barriers, including long waits and availability. Conclusions: While the disease may contribute to greater interference with work quality and daily activities, IBD patients have similar levels of stress and appear to have enhanced social supports relative to those in the community without IBD. (Inflamm Bowel Dis 2008) [source] The relative effectiveness of practice change interventions in overcoming common barriers to change: a survey of 14 hospitals with experience implementing evidence-based guidelinesJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2007Fiona Simpson MND Abstract Aims and objectives, Changing practice to reflect current best evidence can be costly and time-consuming. The purpose of this survey was to determine the optimal combination of practice change interventions needed to overcome barriers to practice change commonly encountered in the intensive care unit (ICU). Design, A survey instrument delivered by mail with email follow-up reminders. Setting, Fourteen hospitals throughout Australia and New Zealand. Subjects, Individuals responsible for implementing an evidence-based guideline for nutritional support in the ICU. Survey, Practice change interventions were ranked in order of effectiveness and barriers to change were ranked in order of how frequently they were encountered. Results, A response rate of 100% was achieved. Interventions traditionally regarded as strong (academic detailing, active reminders) were ranked higher than those traditionally regarded as moderate (audit and feedback), or weak (posters, mouse mats). The high ranks of the site initiation visit (educational outreach, modest) and in-servicing (didactic lectures, weak) were unexpected, as was the relatively low rank of educationally influential, peer-nominated opinion leaders. Four hospitals reported the same doctor-related barrier as ,most common' and the remaining 10 hospitals reported three different doctor-related barriers, two nursing-related barriers and three organizational barriers as most common. Conclusions, When designing a multifaceted, multi-centre change strategy, the selection of individual practice change interventions should be based on: (1) an assessment of available resources; (2) recognition of the importance of different types of barriers to different sites; (3) the potential for combinations of interventions to have a synergistic effect on practice change, and (4) the potential for combinations of interventions to actually reduce workload. [source] Strategies for Managing Barriers to the Writing ProcessNURSING FORUM, Issue 4 2000Celia E. Wills RN Publication is essential to advancing nursing knowledge for clinical practice, but relatively few nurses publish the results of their research or other writings about clinical practice issues. This article identifies some common barriers to writing for publication-personal factors, such as inadequate knowledge and writing skills, lack of confidence, and low motivation for writing for publication; and situational factors, such as limited time, energy, and other resources constraints-and discusses strategies for managing such barriers. Key words: [source] Pediatric Emergency Physician Opinions on Ankle Radiograph Clinical Decision RulesACADEMIC EMERGENCY MEDICINE, Issue 7 2010Kathy Boutis MD ACADEMIC EMERGENCY MEDICINE 2010; 17:709,717 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The Low Risk Ankle Rule (LRAR) is a validated clinical decision rule (CDR) about the indications for ankle radiographs in children with acute blunt ankle trauma. Although application of the LRAR has the potential to safely reduce the rate of ankle radiography by 60%, current x-ray rates in most emergency departments (EDs) in the United States and Canada remain unnecessarily high (85%,100%). To evaluate this gap between knowledge and practice, physicians who treat pediatric ankle injuries in EDs were surveyed to determine physician awareness and use of the LRAR, acceptability of the LRAR as measured by the Ottawa Acceptability for Decision Rules Scale (OADRS), and perceived barriers to the use of a validated pediatric ankle x-ray rule. Methods:, An on-line survey of members of two national pediatric emergency medicine (PEM) physician associations in the United States and Canada was conducted using a modified Dillman technique. Results:, Response rates were 75.6% (149/197) in Canada and 45.7% (352/770) in the United States, yielding an aggregate rate of 51.8%. Only 119 of 478 respondents (24.9%) had heard of the LRAR, and 53 of 432 (12.3%) were sufficiently familiar with the LRAR to apply it. The LRAR scored a mean (± standard deviation [SD]) OADRS score of 4.28 out of 6 (±0.67), comparable to published OADRS scores for two well-known CDRs used in adults. Of the respondents, 434 of 471 (92.1%) at least "slightly agreed" that ankle x-ray CDRs would be useful in their practice, with no significant differences between the two sides of the border (p = 0.28). Ankle x-ray rules were felt to save time by 342 (72.6%) of the participants, and the pediatric ankle exam was considered easy enough to apply a CDR by 306 (65.0%). The most common barriers reported for use of any ankle x-ray rule included perceived reduction in family satisfaction without imaging in 380 (80.7%), nurse-initiated x-ray protocols not based on ankle x-ray rules in 285 (60.5%), concerns about missing a significant fracture in 248 (52.7%), and a preference for own clinical judgment in 246 (52.2%). Conclusions:, Although the LRAR had a high acceptability score among respondents in this survey, this validated CDR is not widely known and is even less frequently applied by PEM physicians in the United States and Canada. Barriers were identified that will guide efforts to improve the knowledge translation of the LRAR into pediatric EDs. [source] | ||||||||||