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Research Evidence (research + evidence)
Selected AbstractsSources and Models for Moving Research Evidence Into Clinical PracticeJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2002Barbara L. Davies RN High quality research evidence for nursing practice is available from the Cochrane Library and in clinical practice guidelines produced by professional associations. The transfer of research evidence into practice is a complex process, and changing provider behavior is a challenge, even when the relative advantages are strong. An active approach with multifaceted interventions based on the assessment of barriers has been found most effective. An array of interventions for implementing research findings in practice is included, and promising organizational and theoretical perspectives on increasing the use of research evidence for nursing practice are described. [source] The UK air inclusive-tour industry: a reassessment of the competitive positioning of the ,independent' sectorINTERNATIONAL JOURNAL OF TOURISM RESEARCH, Issue 6 2001Nigel G. Evans Abstract This paper investigates the increasing concentration in the UK air inclusive-tour (AIT) market and the behaviour of the dominant companies (Thomson, Airtours, First Choice and Thomas Cook) operating in the sector. Arguments relating to the theoretical organisational structure of the industry are explored and regulatory investigations that have taken place are discussed. Research evidence as to the competitive position of independent tour operators in the overall UK AIT market is provided. The research indicates that a key area of difficulty for the independent sector relates to the provision of charter airline capacity although access to distribution channels and the ability to contract accommodation are viewed as further concerns. The paper concludes that regulatory authorities are faced with trying to ensure that diversity is maintained while at the same time ensuring any economies of scale derived from consolidation of the sector are passed on to consumers. In order to properly understand the true effects of industrial concentration the assembled package must be dissembled into its component parts and an increasingly a pan-European perspective is necessary. Copyright © 2001 John Wiley & Sons, Ltd. [source] The role of women's self-injury support-groups: a grounded theoryJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 1 2007Jennifer Corcoran Abstract Research evidence suggests that services are struggling to adequately address the increasing incidence of self-injury and the needs of women who self-injure, while national self-injury support-groups across the UK appear to be growing in number. Despite their reported value, evidence regarding the role of self-injury support-groups in women's management of their self-injury is lacking although government policy and official guidelines are advocating the incorporation of support-groups into self-injury services. Seven semi-structured interviews were conducted and analysed using Grounded Theory to investigate the role of three UK self-injury support-groups in women's management of self-injury and associated difficulties. Empowerment-as-process emerged as the core theme of self-injury support-groups, mediated through experiences of belonging, sharing, autonomy, positive feeling and change. Findings are discussed in relation to relevant theory and research, followed by critical evaluation and implications of the study. Copyright © 2006 John Wiley & Sons, Ltd. [source] Weight monitoring of breastfed babies in the United Kingdom , interpreting, explaining and interveningMATERNAL & CHILD NUTRITION, Issue 1 2006MA (Cantab), Magda Sachs BA Abstract Weighing infants in their first 6 months is an important aspect of growth monitoring and a common activity of child health care services worldwide. During the same 6 months, support for establishing breastfeeding and the promotion of continued exclusive breastfeeding are important activities of health professionals. Parents and health professionals may perceive conflicts between achieving both robust growth and continuing breastfeeding. In this narrative review, the literature on weighing breastfed babies in the United Kingdom is examined. A companion paper examined issues of growth charts, scales and weighing frequency and accuracy. This paper considers issues of interpretation of the plotted weight values for individual breastfed babies, noting the complexities of growth patterns, which may lead to difficulties of accurate identification of those individuals whose growth merits further investigation. Little attention has been given to issues of explaining the interpreted growth curves to parents and this issue is explored and noted as of importance for further study. Research evidence on choosing appropriate interventions to improve the growth of breastfed babies is reviewed. The paucity of such evidence leads to suggestions for future study. This review gathers together a wide range of literature from many different perspectives, with the hope of informing weight monitoring practice so that this can both identify infants whose weight may be of concern, and who may need appropriate intervention, and support continued breastfeeding. [source] Solutions out of context: Examining the transfer of business concepts to nonprofit organizationsNONPROFIT MANAGEMENT & LEADERSHIP, Issue 2 2008Tammy E. Beck Small nonprofit organizations face a dilemma when applying management theories and techniques developed for large, private businesses. Research evidence suggests both benefits and problems associated with application of these techniques. To avoid potential problems, nonprofit managers commonly limit the selection and transfer of business techniques to those that solve specific problems or appear consistent with nonprofit orientations. One consequence is that business solutions often create unintended negative outcomes that are due to contextual differences between the two types of organizations. One possible solution to this dilemma is adoption of bundles, or configurations, of practices that introduce important contextual checks and balances along with the specific tools and techniques. We explore this option through a critical, participatory ethnographic analysis of a small nonprofit service organization. [source] Structures and processes in intermediary nongovernmental organizations: Research evidence from Northern IrelandNONPROFIT MANAGEMENT & LEADERSHIP, Issue 4 2005John M. Bruton This article reports the results of an exploratory study of the organizational characteristics, functions, and roles of intermediary nonprofit organizations selected by the European Union to deliver global grant funding in relation to its Special Support Programme for Peace and Reconciliation in Northern Ireland. The results show that the main factor for determining organizational processes is the need to respond to conflicting pressures from two directions: upward to funding agencies and downward to community groups. This produces contradictory demands that are imported into the organizations as a set of internal tensions. The different structures and capabilities developed by the organizations to maintain unity and integrity in response to these tensions are explored and related to differences in the perceived role of the organizations. [source] An evidence-based appraisal of splinting luxated, avulsed and root-fractured teethDENTAL TRAUMATOLOGY, Issue 1 2008Bill Kahler For this systematic review of splinting of teeth that have been luxated, avulsed or root-fractured, the clinical PICO question is (P) what are splinting intervention decisions for luxated, avulsed and root-fractured teeth (I) considering that the splinting intervention choice may include (i) no splinting, (ii) rigid or functional splinting for the different types of trauma and (iii) different durations of the splinting period (C) when comparing these splinting choices for the different types of trauma and their effect on (O) healing outcomes for the teeth. A keyword search of PubMed was used. Reference lists from identified articles and dental traumatology texts were also appraised. The inclusion criterion for this review was either a multivariate analysis or controlled stratified analyses as many variables have the potential to confound the assessment and evaluation of healing outcomes for teeth that have been luxated, avulsed or root-fractured. A positive statistical test is not proof of a causal conclusion, as a positive statistical relationship can arise by chance, and so this review also appraises animal studies that reportedly explain biological mechanisms that relate to healing outcomes of splinted teeth. The clinical studies were ranked using the ,Centre of Evidence-based Medicine' categorization (levels 1,5). All 12 clinical studies selected were ranked as level 4. The studies generally indicate that the prognosis is determined by the type of injury rather than factors associated with splinting. The results indicate that the types of splint and the fixation period are generally not significant variables when related to healing outcomes. This appraisal identified difficulties in the design of animal experimentation to correctly simulate some dental injuries. Some of the studies employed rigid splinting techniques, which are not representative of current recommendations. Recommended splinting treatment protocols for teeth that have been luxated, avulsed or root-fractured teeth are formulated on the strength of research evidence. Despite the ranking of these studies in this appraisal as low levels of evidence, these recommendations should be considered ,best practice', a core philosophy of evidence-based dentistry. [source] Balancing policy development and research evidence: are we falling short?ACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2000Professor Pamela Taylor No abstract is available for this article. [source] Brief interventions: good in theory but weak in practiceDRUG AND ALCOHOL REVIEW, Issue 1 2004Professor ANN M. ROCHE Director Abstract A substantial body of research evidence has accumulated in support of the efficacy of brief interventions for a number of alcohol and drug-related problem areas, most notably alcohol and tobacco. This evidence has been used to exhort a range of professional groups such as general practitioners (GPs), and more recently emergency department hospital staff to engage in brief interventions. Internationally, however, these secondary prevention efforts have largely failed. Why have these proven interventions not been embraced by frontline workers? This is a little-asked question as efforts to press-gang unwilling professionals to take up the cudgel continue. This paper examines the characteristics of brief interventions and their principal delivery agents and explores reasons for the failure to move from efficacy to effectiveness. Given the prevention potential that rests with brief intervention, these are crucial questions to address. A key feature of brief intervention delivery also examined is the role of GPs versus the less well-explored option of the practice nurse. It will be proposed that perhaps we have the right vehicle but the wrong driver and that until closer scrutiny is made of this issue efforts in this key prevention area will continue to fail to achieve optimum results. [source] Drug prevention programmes for young people: where have we been and where should we be going?ADDICTION, Issue 10 2010Richard Midford ABSTRACT Aim Substance use by young people has long been a concern of western society, but opinion is mixed as to which prevention approach offers the greatest benefit, and whether indeed there is any benefit at all. This paper reviews the nature of prevention programmes, the research evidence that underpins these programmes and the prevention objectives against which effectiveness is measured. The aim of this is to create better understanding of the elements that maximize programme effectiveness, what can be achieved by prevention programmes and how programmes can be improved. Findings There is a range of prevention approaches for which there is evidence of effectiveness. Some are classroom-based; some focus upon parenting; some have substantial whole-of-school and community elements; and some target risk and protective factors in early childhood. All, however, are based substantially on the social influence model. In an attempt to improve practice lists of effective programmes have been developed, but there are concerns about the science behind selection. On balance, there is consistent evidence that social influence prevention programmes do have a small, positive effect on drug use, but this then raises the question as to whether harm, rather than use, would be the more worthwhile target for prevention. Prevention that seeks to reduce harm has been demonstrably effective, but has found little support in some jurisdictions. Conclusion Research has created a progressively better understanding of how to optimize programme effectiveness and what can be achieved realistically by even the most effective programmes. However, further research is required to identify which, if any, particular approach offers greater promise. The effectiveness of harm reduction should be compared with more traditional abstinence and the additional effects of whole of school, parent and community elements need to be measured more accurately. Contemporary social influence prevention programmes are flawed, but the approach is still the best way of influencing drug use behaviour in young people as a whole. Evidence-based refinement is the best option for greater benefit. [source] A tale of CIN,the Cannabis Infringement Notice scheme in Western AustraliaADDICTION, Issue 5 2010Simon Lenton ABSTRACT Aims To describe the development and enactment of the Western Australian (WA) Cannabis Infringement Notice scheme and reflect on the lessons for researchers and policy-makers interested in the translation of policy research to policy practice. Methods An insiders' description of the background research, knowledge transfer strategies and political and legislative processes leading to the enactment and implementation of the WA Cannabis Control Act 2003. Lenton and Allsop were involved centrally in the process as policy-researcher and policy-bureaucrat. Results In March 2004, Western Australia became the fourth Australian jurisdiction to adopt a ,prohibition with civil penalties' scheme for possession and cultivation of small amounts of cannabis. We reflect upon: the role of research evidence in the policy process; windows for policy change; disseminating findings when apparently no one is listening; the risks and benefits of the researcher as advocate; the differences between working on the inside and outside of government; and the importance of relationships, trust and track record. Conclusions There was a window of opportunity and change was influenced by research that was communicated by a reliable and trusted source. Those who want to conduct research that informs policy need to understand the policy process more clearly, look for and help create emerging windows that occur in the problem and political spheres, and make partnerships with key stakeholders in the policy arena. The flipside of the process is that, when governments change, policy born in windows of opportunity can be a casualty. [source] The age-21 minimum legal drinking age: a case study linking past and current debatesADDICTION, Issue 12 2009Traci L. Toomey ABSTRACT Background The minimum legal drinking age (MLDA) in the United States (U.S.) has raised debate over the past several decades. During the 1970s many states lowered their MLDAs from age 21 to 18, 19, or 20. However, as a result of studies showing that these lower MLDAs were associated with increases in traffic crashes, state-level movements began in the later1970s to return MLDAs to age 21. A new movement has arisen to again lower the MLDA in the U.S. Aim The aim is to discuss this current MLDA debate within the context of the long history of the U.S. MLDA. Methods A search of research articles, websites, and newspaper articles was conducted to identify key messages and influences related to the MLDA movements. Results The complexity of state movements to change their MLDAs is illustrated by the Michigan experience, where strong political forces on both sides of the issue were involved, resulting in the MLDA returning to 21. Because the 21st Constitutional amendment prevents the federal government from mandating a MLDA for all states, a federal policy was proposed to provide incentives for all states to implement age-21 MLDAs. Due largely to strong research evidence, the National Minimum Legal Drinking Age Act was enacted in 1984, stipulating that states set their MLDA to 21 or face loss of federal highway funds. By 1988, all states had an age-21 MLDA. Conclusion Any current debate about the MLDA should be informed by the historical context of this policy and the available research. [source] A randomized controlled trial of an internet-based intervention for alcohol abusersADDICTION, Issue 12 2009John A. Cunningham ABSTRACT Objective Misuse of alcohol imposes a major public health cost, yet few problem drinkers are willing to access in-person services for alcohol abuse. The development of brief, easily accessible ways to help problem drinkers who are unwilling or unable to seek traditional treatment services could therefore have significant public health benefit. The objective of this project is to conduct a randomized controlled evaluation of the internet-based Check Your Drinking (CYD) screener ( http://www.CheckYourDrinking.net). Method Participants (n = 185) recruited through a general telephone population survey were assigned randomly to receive access to the CYD, or to a no-intervention control group. Results Follow-up rates were excellent (92%). Problem drinkers provided access to the CYD displayed a six to seven drinks reduction in their weekly alcohol consumption (a 30% reduction in typical weekly drinking) at both the 3- and 6-month follow-ups compared to a one drink per week reduction among control group respondents. Conclusions The CYD is one of a growing number of internet-based interventions with research evidence supporting its efficacy to reduce alcohol consumption. The internet could increase the range of help-seeking options available because it takes treatment to the problem drinker rather than making the problem drinker come to treatment. [source] Advanced Phonics: Teaching Strategies for Poor Readers at Key Stage 2ENGLISH IN EDUCATION, Issue 3 2000Susan Jennings Abstract Poor readers at Key Stage 2 need ongoing support for their reading development. They are frequently weak in the metacognitive skills that enable good readers to make their own progress and they require a repetition of much phonics material from Key Stage 1. Beyond that, they have a need for the further complexities of English to be taught to them as phonics, not as spelling strategies/investigations. Additionally, they have difficulty in tackling polysyllabic words and must be taught appropriate decoding strategies. There is a dearth of teaching materials in this area and little research evidence as to how such material might best be taught. This paper charts the development of a phonics booster programme for poor readers in Year 5. [source] From research evidence to context: the challenge of individualising careEQUINE VETERINARY JOURNAL, Issue 3 2006S. J. Weiner No abstract is available for this article. [source] Empirically evaluated treatments for body image disturbance: a reviewEUROPEAN EATING DISORDERS REVIEW, Issue 5 2006Clare Farrell Abstract Body image disturbance is both a risk factor for the development of disturbed eating and a central feature of clinical eating disorders. This review examines empirically tested interventions for people with high levels of body image disturbance. The most commonly used therapies with the most empirical support are cognitive-behavioural. The specificity of the body image interventions and the importance of individual components have not yet been established. Prevention programmes to address body image disturbance appear promising, although further research evidence is required. It is concluded that treatments for addressing body image disturbance are hindered by the lack of a clearly specified theoretical model of the maintenance of body image disturbance and that such an analysis is needed to increase the effectiveness of current interventions. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Special considerations for haematology patients in relation to end-of-life care: Australian findingsEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2007P. MCGRATH bsocwk, senior research fellow Recent haematology clinical guidelines recommend that palliative care specialists should have central roles in haemato-oncology teams. However, the available research evidence indicates there are presently significant obstacles to the integration of palliative care in haematology. The following discussion presents findings from an Australian study designed to address the problems associated with lack of referral of haematology patients to the palliative system through the development of a best-practice model for end-of-life care for these diagnostic groups. The preliminary step in the development of such a model is to document the factors that denote the special characteristics of the end-of-life stage of haematological conditions and their treatments. This article presents the list of special considerations from a nursing perspective, including issues associated with the high-tech nature of treatments, the speed of change to a terminal event, the need for blood products and possibility of catastrophic bleeds, the therapeutic optimism based on a myriad of treatment options and the clinical indices of the terminal trajectory. The nursing insights provide an important foundation for building a practical, patient-centred model for terminal care in haematology. [source] Work Design for Flexible Work Scheduling: Barriers and Gender ImplicationsGENDER, WORK & ORGANISATION, Issue 1 2000Ann M. Brewer The purpose of this article is to examine the nature of work design in relation to flexible work scheduling (FWS), particularly in respect to participation by women and men. There is a paucity of research evidence on this topic. Work design, essentially an artefact of enterprise culture, is constructed by the social rules of place, distance and time. Work practices that assume that work tasks are only conducted in the workplace during standard work time in the proximity of co-workers and managers do not, in the main, support FWS. While there is no significant evidence in this study that women and men perceive the barriers differently when considering taking up the option to engage in FWS options, the study addresses the reasons for this using a large survey of the Australian workforce. This article concludes that it is time to redefine these critical work design dimensions, in relation to existing power structures, in order to inject real flexibility into the workplace. [source] Late-life insomnia: A reviewGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2009Arne Fetveit Aging is associated with substantial changes in sleep patterns, which are almost always negative in nature. Typical findings in the elderly include a reduction in the deeper stages of sleep and a profound increase in the fragmentation of nighttime sleep by periods of wakefulness. The prevalence of specific sleep disorders increases with age, such as a phase advance in the normal circadian sleep cycle, restless legs syndrome, and obstructive sleep apnea, which is increasingly seen among older individuals and is significantly associated with cardio- and cerebrovascular disease as well as cognitive impairment. Elderly patients with sleep disturbances are often considered difficult to treat; yet, they are among the groups with the greatest need of treatment. Management of sleep disturbances begins with recognition and adequate assessment. Hypnotic drugs have clearly been shown to improve subjective and objective sleep measures in short-term situations, but their role in chronic insomnia still remains to be further defined by research evidence. Non-pharmacological treatments, particularly stimulus control and sleep restriction, are effective for conditioned aspects of insomnia and are associated with a stable, long-term improvement in sleep. This review delineates the common causes of disordered sleep in older individuals, and effective diagnostic approaches and treatments for these conditions. [source] Changing Research Perspectives on the Management of Higher Education: Can Research Permeate the Activities of Manager-Academics?HIGHER EDUCATION QUARTERLY, Issue 3 2006Rosemary Deem The paper considers whether, and if so how, research evidence can permeate the world of higher education (HE) management in publicly funded institutions. The paper explores the author's experience of two recent research projects (1998,2000 and 2004) on aspects of managing UK HE institutions and issues arising from the preparation of the HE element of a third study of leadership and public service change agendas in education and health during 2004. Despite the topicality in education and other public services of debates about evidence-based practice, there is little indication that this debate has permeated HE management qua management. The paper utilises Bourdieu's work on academics and social and cultural capital to explore why manager-academics may resist taking the findings of research seriously in relation to their own work. It is suggested that, where there is reluctance to learn from research, this may reflect the changing nature of HE, the status of HE research as an academic field and form of academic capital and the relative paucity until recently of training in management for most UK manager-academics. [source] The Impact of Increased Fees on Participation in Higher Education in EnglandHIGHER EDUCATION QUARTERLY, Issue 2 2005Hazel Pennell This article explores some recent research evidence on the possible impact of the higher education reforms in England on participation by students from lower socio-economic backgrounds. The evidence is examined in terms of costs, debt and term-time working. Financial issues have been shown to constrain choice of institution and place of study for lower-income students, and financial problems are commonly cited as reasons for dropping out of higher education. The greatest difference in debt levels has been found to be linked to family background, with students who were poor before they entered university leaving university with the largest debts. Overdrafts and credit card debt levels have been shown to be lower for students in receipt of grants than for those who are not. Research has shown that school leavers who are least debt-averse are more likely to go to university than those who are anti-debt; the latter include those from the lowest socio-economic groups and certain black and minority ethnic groups. Students who work in term-time may achieve less academically: those who work in term-time are more often those from lower socio-economic groups or minority ethnic groups. Overall, the evidence indicates that financial payments and grants are likely to be the most promising way forward to increase participation in higher education among those from lower socio-economic backgrounds. [source] Using extracurricular activity as an indicator of interpersonal skill: Prudent evaluation or recruiting malpractice?HUMAN RESOURCE MANAGEMENT, Issue 4 2002Robert S. Rubin There is widespread agreement that success in organizations requires more than high intellect. Thus, college recruiters commonly examine job candidates' extracurricular activities in search of "well-rounded," emotionally intelligent, and interpersonally skilled students. Intuitively, extracurricular activities seem like valuable student experiences; however, research evidence is sparse, suggesting far more questions than answers. Is participation in extracurricular activity truly linked to interpersonal skill performance? Does leadership experience make a difference? Do extracurricular experiences yield higher skill development? Six hundred eighteen business students and the relationship of their extracurricular involvement to four interpersonal skills were examined. Significant relationships were found and recruitment implications are discussed. © 2002 Wiley Periodicals, Inc. [source] Striker Replacements in the United States, Canada, and Mexico: A Review of the Law and Empirical Research A Review of the Law andEmpirical ResearchINDUSTRIAL RELATIONS, Issue 1 2001Parbudyal Singh The debate on striker replacements is marked by considerable passion and controversy, with many unions and workers' rights advocates proposing legal prohibitions and employers and "free market" advocates generally opposing such prohibitions. In this article we go beyond the rhetoric and examine the nature and extent of striker replacement laws across North America. We also examine the research evidence on this issue and make suggestions for future research. [source] Evidence-based practice and the professionalization of dental hygieneINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 4 2004Sandra J Cobban Abstract: The application of knowledge is fundamental to human problem solving. In health disciplines, knowledge utilization commonly manifests through evidence-based decision making in practice. The purpose of this paper is to explore the development of the evidence-based practice (EBP) movement in health professions in general, and dental hygiene in particular, and to examine its relationship to the professionalization agenda of dental hygiene in Canada. EBP means integrating practitioner expertise with the best available external evidence from research. Proponents of EBP believe that it holds promise for reducing a research,practice gap by encouraging clinicians to seek current research results. Both the Canadian and American Dental Hygienists Associations support practice based on current research evidence, yet recent studies show variation in practice. Professionalization refers to the developmental stages through which an organized occupation passes as it develops traits that characterize it as a profession. The status conferred by professionalization privileges a group to make and monitor its own decisions relative to practice. Dental hygiene's success in acquiring attributes of a profession suggests that transformation to a profession is occurring. This paper compares the assumptions and challenges of both movements, and argues the need for a principal focus on the development of a culture of evidence-based dental hygiene practice. [source] Principles of evidence-based management using stage I,II melanoma as a modelINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 11 2002Tsu-Yi Chuang MD Evidence-Based Medicine (EBM) is the practice of integrating best research evidence with clinical expertise and patent values. 1 The term, Evidence-Based Medicine, was named in 1992 by a group led by Gordon Guyatt at McMaster University in Canada. The practice of EBM arose from the awareness of: 1the daily need for valid information pertinent to clinical practice; 2the inadequacy of traditional sources, like textbooks, for such information; 3the disparity between clinical enhancing skills and declining up-to-date knowledge and eventually, clinical performance; and 4the inability to spend more time in finding and assimilating evidence pertinent to clinical practice. EBM simply emphasizes three As: Access, Appraisal and Application. Access requires refining a clinical question into a searchable term and an answerable question and using search engines to track down the information. Appraisal is using epidemiological principles and methods to critically review evidence for its validity and applicability. Application is integrating the critically appraised evidence with clinical expertise and each patient's unique situation. The outcomes following such practices are then assayed. The last step involves evaluating the effectiveness and efficiency in executing the first two As and seeking ways for improvement. In this article, we describe the concept and steps of practising EBM and utilize melanoma as an example to illustrate how we integrate the best evidence to outline the management plan for stage I-II melanoma. [source] Heart failure self-management education: a systematic review of the evidenceINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2009Suzanne Austin Boren PhD MHA Abstract Objective, The objective of this systematic review is to identify educational content and techniques that lead to successful patient self-management and improved outcomes in congestive heart failure education programs. Methods, MEDLINE, CINAHL and the Cochrane Central Register of Controlled Trials, as well as reference lists of included studies and relevant reviews, were searched. Eligible studies were randomised controlled trials evaluating congestive heart failure self-management education programs with outcome measures. Two of the investigators independently abstracted descriptive information, education content topics and outcomes data. Results, A total of 7413 patients participated in the 35 eligible congestive heart failure self-management education studies. The congestive heart failure self-management programs incorporated 20 education topics in four categories: (i) knowledge and self-management (diagnosis and prognosis, pathophysiology of how congestive heart failure affects the body, aims of treatment, management and symptoms, medication review and discussion of side-effects, knowing when to access/call the general practitioner, communication with the physician, follow up for assessment or reinforcement); (ii) social interaction and support (social interaction and support, stress, depression); (iii) fluids management (sodium restriction, fluid balance, daily measurement of weight, ankle circumference, self-monitoring and compliance relative to fluids); and (iv) diet and activity (dietary assessment and instructions, physical activity and exercise, alcohol intake, smoking cessation). A total of 113 unique outcomes in nine categories (satisfaction, learning, behaviour, medications, clinical status, social functioning, mortality, medical resource utilisation and cost) were measured in the studies. Sixty (53%) of the outcomes showed significant improvement in at least one study. Conclusion, Educational interventions should be based on scientifically sound research evidence. The education topic list developed in this review can be used by patients and clinicians to prioritise and personalise education. [source] Association between pacifier use and breast-feeding, sudden infant death syndrome, infection and dental malocclusionINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 6 2005Ann Callaghan RN RM BNurs(Hons) Executive summary Objective, To critically review all literature related to pacifier use for full-term healthy infants and young children. The specific review questions addressed are: What is the evidence of adverse and/or positive outcomes of pacifier use in infancy and childhood in relation to each of the following subtopics: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Inclusion criteria, Specific criteria were used to determine which studies would be included in the review: (i) the types of participants; (ii) the types of research design; and (iii) the types of outcome measures. To be included a study has to meet all criteria. Types of participants,The participants included in the review were healthy term infants and healthy children up to the age of 16 years. Studies that focused on preterm infants, and infants and young children with serious illness or congenital malformations were excluded. However, some total population studies did include these children. Types of research design, It became evident early in the review process that very few randomised controlled trials had been conducted. A decision was made to include observational epidemiological designs, specifically prospective cohort studies and, in the case of sudden infant death syndrome research, case,control studies. Purely descriptive and cross-sectional studies were excluded, as were qualitative studies and all other forms of evidence. A number of criteria have been proposed to establish causation in the scientific and medical literature. These key criteria were applied in the review process and are described as follows: (i) consistency and unbiasedness of findings; (ii) strength of association; (iii) temporal sequence; (iv) dose,response relationship; (v) specificity; (vi) coherence with biological background and previous knowledge; (vii) biological plausibility; and (viii) experimental evidence. Studies that did not meet the requirement of appropriate temporal sequencing of events and studies that did not present an estimate of the strength of association were not included in the final review. Types of outcome measures,Our specific interest was pacifier use related to: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Studies that examined pacifier use related to procedural pain relief were excluded. Studies that examined the relationship between pacifier use and gastro-oesophageal reflux were also excluded as this information has been recently presented as a systematic review. Search strategy, The review comprised published and unpublished research literature. The search was restricted to reports published in English, Spanish and German. The time period covered research published from January 1960 to October 2003. A protocol developed by New Zealand Health Technology Assessment was used to guide the search process. The search comprised bibliographic databases, citation searching, other evidence-based and guidelines sites, government documents, books and reports, professional websites, national associations, hand search, contacting national/international experts and general internet searching. Assessment of quality, All studies identified during the database search were assessed for relevance to the review based on the information provided in the title, abstract and descriptor/MeSH terms, and a full report was retrieved for all studies that met the inclusion criteria. Studies identified from reference list searches were assessed for relevance based on the study title. Keywords included: dummy, dummies, pacifier(s), soother(s), comforter(s), non-nutritive sucking, infant, child, infant care. Initially, studies were reviewed for inclusion by pairs of principal investigators. Authorship of articles was not concealed from the reviewers. Next, the methodological quality of included articles was assessed independently by groups of three or more principal investigators and clinicians using a checklist. All 20 studies that were accepted met minimum set criteria, but few passed without some methodological concern. Data extraction, To meet the requirements of the Joanna Briggs Institute, reasons for acceptance and non-acceptance at each phase were clearly documented. An assessment protocol and report form was developed for each of the three phases of review. The first form was created to record investigators' evaluations of studies included in the initial review. Those studies that failed to meet strict inclusion criteria were excluded at this point. A second form was designed to facilitate an in-depth critique of epidemiological study methodology. The checklist was pilot tested and adjustments were made before reviewers were trained in its use. When reviewers could not agree on an assessment, it was passed to additional reviewers and discussed until a consensus was reached. At this stage, studies other than cohort, case,control and randomised controlled trials were excluded. Issues of clarification were also addressed at this point. The final phase was that of integration. This phase, undertaken by the principal investigators, was assisted by the production of data extraction tables. Through a process of trial and error, a framework was formulated that adequately summarised the key elements of the studies. This information was tabulated under the following headings: authors/setting, design, exposure/outcome, confounders controlled, analysis and main findings. Results, With regard to the breast-feeding outcome, 10 studies met the inclusion criteria, comprising two randomised controlled trials and eight cohort studies. The research was conducted between 1995 and 2003 in a wide variety of settings involving research participants from diverse socioeconomic and cultural backgrounds. Information regarding exposure and outcome status, and potential confounding factors was obtained from: antenatal and postnatal records; interviews before discharge from obstetric/midwifery care; post-discharge interviews; and post-discharge postal and telephone surveys. Both the level of contact and the frequency of contact with the informant, the child's mother, differed widely. Pacifier use was defined and measured inconsistently, possibly because few studies were initiated expressly to investigate its relationship with breast-feeding. Completeness of follow-up was addressed, but missing data were not uniformly identified and explained. When comparisons were made between participants and non-participants there was some evidence of differential loss and a bias towards families in higher socioeconomic groups. Multivariate analysis was undertaken in the majority of studies, with some including a large number of sociodemographic, obstetric and infant covariates and others including just maternal age and education. As might be expected given the inconsistency of definition and measurement, the relationship between pacifier use and breast-feeding was expressed in many different ways and a meta-analysis was not appropriate. In summary, only one study did not report a negative association between pacifier use and breast-feeding duration or exclusivity. Results indicate an increase in risk for a reduced overall duration of breast-feeding from 20% to almost threefold. The data suggest that very infrequent use may not have any overall negative impact on breast-feeding outcomes. Six sudden infant death syndrome case,control studies met the criteria for inclusion. The research was conducted with information gathered between 1984 and 1999 in Norway, UK, New Zealand, the Netherlands and USA. Exposure information was obtained from a variety of sources including: hospital and antenatal records, death scene investigation, and interview and questionnaire. Information for cases was sought within 2 days after death, within 2,4 weeks after death and in one study between 3 and 11 years after death. Information for controls was sought from as early as 4 days of a nominated sudden infant death syndrome case, to between 1 and 7 weeks from the case date, and again in one study some 3,11 years later. In the majority of the studies case ascertainment was determined by post-mortem. Pacifier use was again defined and measured somewhat inconsistently. All studies controlled for confounding factors by matching and/or using multivariate analysis. Generally, antenatal and postnatal factors, as well as infant care practices, and maternal, family and socioeconomic issues were considered. All five studies reporting multivariate results found significantly fewer sudden infant death syndrome cases used a pacifier compared with controls. That is, pacifier use was associated with a reduced incidence of sudden infant death syndrome. These results indicate that the risk of sudden infant death syndrome for infants who did not use a pacifier in the last or reference sleep was at least twice, and possibly five times, that of infants who did use a pacifier. Three studies reported a moderately sized positive association between pacifier use and a variety of infections. Conversely, one study found no positive association between pacifier use at 15 months of age and a range of infections experienced between the ages of 6 and 18 months. Given the limited number of studies available and the variability of results, no meaningful conclusions could be drawn. Five cohort studies and one case,control study focused on the relationship between pacifier use and dental malocclusion. Not one of these studies reported a measure of association, such as an estimate of relative risk. It was therefore not possible to include these studies in the final review. Implications for practice, It is intended that this review be used as the basis of a ,best practice guideline', to make health professionals aware of the research evidence concerning these health and developmental consequences of pacifier use, because parents need clear information on which they can base child care decisions. With regard to the association between pacifier use and infection and dental malocclusion it was found that, due to the paucity of epidemiological studies, no meaningful conclusion can be drawn. There is clearly a need for more epidemiological research with regard to these two outcomes. The evidence for a relationship between pacifier use and sudden infant death syndrome is consistent, while the exact mechanism of the effect is not well understood. As to breast-feeding, research evidence shows that pacifier use in infancy is associated with a shorter duration and non-exclusivity. It is plausible that pacifier use causes babies to breast-feed less, but a causal relationship has not been irrefutably proven. Because breast-feeding confers an important advantage on all children and the incidence of sudden infant death syndrome is very low, it is recommended that health professionals generally advise parents against pacifier use, while taking into account individual circumstances. [source] The management of professional roles during boundary work in child welfareINTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 3 2010Christopher Hall Hall C, Slembrouck S, Haigh E, Lee A. The management of professional roles during boundary work in child welfare Int J Soc Welfare 2010: 19: 348,357 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. This article examines the ways in which child welfare professionals negotiate their roles and those of other professionals in home visits with clients, in this case the parents of young children. The concept of boundary work is developed within the context of the professional,client encounter. Drawing on Goffman's concept of ,footing', the analysis examines how professionals attend to ways of constructing family problems in terms of appropriate professional interventions , both from themselves and others. It is argued that the careful consideration of how problems merit interventions displays an adherence to the development of the supportive relations which move beyond strict professional remits. The article adds to the research evidence, which sees inter-professional coordination as a complex matter, located in everyday practice rather than as advocating more tightly monitored procedure. [source] Employability enhancement through formal and informal learning: an empirical study among Dutch non-academic university staff membersINTERNATIONAL JOURNAL OF TRAINING AND DEVELOPMENT, Issue 1 2009Beatrice Van Der Heijden Although learning is generally perceived as a way to improve employees' current job performance, so far, no research has been conducted to explore the possible relationships between formal and informal learning, on the one hand, and employability, on the other. Though contemporary views stress the importance of the job as a powerful learning site, considerable research evidence underpinning these views is lacking. This paper goes into the impact of formal and informal learning upon employability. The influence of employee characteristics and organizational factors is also taken into account. An e-questionnaire was used to collect data among 215 Dutch non-academic university staff members. Our findings emphasize the necessity of Human Resource Development strategies that encompass a mix of formal and informal learning opportunities. In particular, participation in networks appears to be an important predictor for employability. With the outcomes of this study, we aim to contribute to the further development of theoretical insights regarding employability enhancement through learning possibilities embedded in the workplace. It seems that strategies that focus exclusively on enhancing informal on-the-job learning should not be encouraged. Our study is limited to one context and further research is required to investigate the generalizability of the findings to other occupations and/or countries. [source] The impact of workplace support and identity on training transfer: a case study of drug and alcohol safety training in AustraliaINTERNATIONAL JOURNAL OF TRAINING AND DEVELOPMENT, Issue 4 2004Ken Pidd Previous research has indicated that the transfer climate of work organisations is an important factor in determining the degree to which knowledge, skills and abilities gained in training transfer to the workplace. In particular, workplace social support from supervisors and coworkers is consistently cited as an important factor that can facilitate or inhibit training transfer. However, research evidence regarding the impact of workplace social support on training transfer is mixed. In order to address this issue a study was conducted to identify under what conditions workplace social support impacts on training transfer. This study evaluated a workplace drug and alcohol training programme, to examine the impact of workplace social support and identification with workplace groups on training transfer. Results indicated that the influence of workplace social support on training transfer was moderated by the degree to which trainees identified with workplace groups that provided this support. This study supports the proposition that in order to fully understand training transfer, and to design effective training programmes, training research and practice needs to focus on both the personal and situational factors that may interact to influence learning and transfer. [source] | ||||||||||||||||||||||||||||||||||||||||