scholarly journals What does it take to provide clinical interventions with temporal consistency? A qualitative study of London hyperacute stroke units

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e025367 ◽  
Author(s):  
Georgia B Black ◽  
Angus I G Ramsay ◽  
Abigail Baim-Lance ◽  
Jeannie Eng ◽  
Mariya Melnychuk ◽  
...  
Keyword(s):  
Social Services ◽  
Time Of Day ◽  
Weekend Effect ◽  
Evidence Based ◽  
Observation Study ◽  
Stroke Units ◽  
Clinical Interventions ◽  
Front Door ◽  
Hyperacute Stroke ◽  
The Impact

ObjectivesSeven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of day and week. We aimed to identify factors influencing such variations in London hyperacute stroke units (HASUs).DesignInterview and observation study to explain patterns of variation in delivery and outcomes of care described in a quantitative partner paper (Melnychuk et al).SettingEight HASUs in London.ParticipantsWe interviewed HASU staff (n=76), including doctors, nurses, therapists and administrators. We also conducted non-participant observations of delivery of care at different times of the day and week (n=45; ~102 hours). We analysed the data for thematic content relating to the ability of staff to provide evidence-based interventions consistently at different times of the day and week.ResultsStaff were able to deliver ‘front door’ interventions consistently by taking on additional responsibilities out of hours (eg, deciding eligibility for thrombolysis); creating continuities between day and night (through, eg, governance processes and staggering rotas); building trusting relationships with, eg, Radiology and Emergency Departments and staff prioritisation of ‘front door’ interventions. Variations by time of day resulted from reduced staffing in HASUs and elsewhere in hospitals in the evenings and at the weekend. Variations by day of week (eg, weekend effect) resulted from lack of therapy input and difficulties repatriating patients at weekends, and associated increases in pressure on Fridays and Mondays.ConclusionsEvidence-based service standards can facilitate 7-day working in acute stroke services. Standards should ensure that the capacity and capabilities required for ‘front door’ interventions are available 24/7, while other services, for example, therapies are available every day of the week. The impact of standards is influenced by interdependencies between HASUs, other hospital services and social services.

scholarly journals Domestic violence: Evidence-based policies before and during the pandemic in Greece

Temida ◽  
2021 ◽  
Vol 24 (1) ◽  
pp. 3-23
Author(s):  
Vasiliki Artinopoulou
Keyword(s):  
Domestic Violence ◽  
Social Services ◽  
Evidence Based ◽  
Gender Based Violence ◽  
The Public ◽  
The Social ◽  
Gender Based ◽  
And Gender ◽  
The Impact ◽  
Critical Aspects

Domestic violence and gender-based violence has been studied and recognised for many years in Greece. Adequate legislation on the criminalization of domestic violence has been implemented since 2006 (Law 3500/2006 on the Confrontation of Domestic Violence). A network of support services has also operated across the country for many years, staffed with professionals trained in the gender-sensitive perspective. However, Greece still faces the impact of the economic crisis that started in 2010 and the critical aspects of the crisis from the reduction of the public budget imposed by the European institutions in the lives of the individuals, the victims and the providers of the social services have not been fully assessed yet. The COVID-19 pandemic created problems in the victims? access to social services and not only. The shadow pandemic describes the alarm on the increase of domestic violence during the pandemic and the isolation of the victims from the providers of social and psychological support. Addressing both the issue of domestic violence through a victim-centered approach before and during the pandemic in Greece and the need for the implementation of evidence-based policies are the general aims of the paper. To this, we present few findings from an original victimological online research on domestic violence during the first lockdown in the country (March to May 2020) and we justify the need for the implementation of evidence-based policies in the criminal justice system in Greece.

scholarly journals Impact and sustainability of centralising acute stroke services in English metropolitan areas: retrospective analysis of hospital episode statistics and stroke national audit data

BMJ ◽  
2019 ◽  
pp. l1 ◽  
Author(s):  
Stephen Morris ◽  
Angus I G Ramsay ◽  
Ruth J Boaden ◽  
Rachael M Hunter ◽  
Christopher McKevitt ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Acute Hospital ◽  
Evidence Based ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Clinical Interventions ◽  
Hyperacute Stroke ◽  
Stroke Services

Abstract Objectives To investigate whether further centralisation of acute stroke services in Greater Manchester in 2015 was associated with changes in outcomes and whether the effects of centralisation of acute stroke services in London in 2010 were sustained. Design Retrospective analyses of patient level data from the Hospital Episode Statistics (HES) database linked to mortality data from the Office for National Statistics, and the Sentinel Stroke National Audit Programme (SSNAP). Setting Acute stroke services in Greater Manchester and London, England. Participants 509 182 stroke patients in HES living in urban areas admitted between January 2008 and March 2016; 218 120 stroke patients in SSNAP between April 2013 and March 2016. Interventions Hub and spoke models for acute stroke care. Main outcome measures Mortality at 90 days after hospital admission; length of acute hospital stay; treatment in a hyperacute stroke unit; 19 evidence based clinical interventions. Results In Greater Manchester, borderline evidence suggested that risk adjusted mortality at 90 days declined overall; a significant decline in mortality was seen among patients treated at a hyperacute stroke unit (difference-in-differences −1.8% (95% confidence interval −3.4 to −0.2)), indicating 69 fewer deaths per year. A significant decline was seen in risk adjusted length of acute hospital stay overall (−1.5 (−2.5 to −0.4) days; P<0.01), indicating 6750 fewer bed days a year. The number of patients treated in a hyperacute stroke unit increased from 39% in 2010-12 to 86% in 2015/16. In London, the 90 day mortality rate was sustained (P>0.05), length of hospital stay declined (P<0.01), and more than 90% of patients were treated in a hyperacute stroke unit. Achievement of evidence based clinical interventions generally remained constant or improved in both areas. Conclusions Centralised models of acute stroke care, in which all stroke patients receive hyperacute care, can reduce mortality and length of acute hospital stay and improve provision of evidence based clinical interventions. Effects can be sustained over time.

scholarly journals How can evidence-based interventions give the best value for users in social services? Balance between adherence and adaptations: a study protocol

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Henna Hasson ◽  
Hedvig Gröndal ◽  
Åsa Hedberg Rundgren ◽  
Gunilla Avby ◽  
Håkan Uvhagen ◽  
...  
Keyword(s):  
Decision Support ◽  
Social Services ◽  
Social Service ◽  
Evidence Based ◽  
Basic Premise ◽  
Social Service Organizations ◽  
Context Sensitive ◽  
Group Interviews ◽  
Prospective Longitudinal ◽  
The Impact

Abstract Background Using evidence-based interventions (EBIs) is a basic premise of contemporary social services (e.g., child and family social services). However, EBIs seldom fit seamlessly into a specific setting but often need to be adapted. Although some adaptions might be necessary, they can cause interventions to be less effective or even unsafe. The challenge of balancing adherence and adaptations when using EBIs is often referred to as the adherence and adaptation dilemma. Although the current literature identifies professionals’ management of this dilemma as problematic, it offers little practical guidance for professionals. This research aims to investigate how the adherence and adaptation dilemma is handled in social services and to explore how structured decision support can impact the management of the dilemma. Methods The design is a prospective, longitudinal intervention with a focus on the feasibility and usefulness of the structured decision support. The project is a collaboration between academic researchers, embedded researchers at three research and development units, and social service organizations. A multi-method data collection will be employed. Initially, a scoping review will be performed, and the results will be used in the development of a structured decision support. The decision support will be further developed and tested during a series of workshops with social service professionals. Different forms of data—focus group interviews, questionnaires, and documentation—will be used on several occasions to evaluate the impact of the structured decision support. Qualitative and quantitative analysis will be performed and usefulness for practice prioritized throughout the study. Discussion The study will contribute with knowledge on how the adherence and adaption dilemma is handled and experienced by social service professionals. Most importantly, the study will generate rich empirical data on how a structured decision support impacts professionals’ management of adherence and adaptions. The goal is to produce more strategic and context-sensitive implementation of EBIs in social service, which will increase value for service users.

The Impact of TimeSlips on Undergraduate Students in Service Learning With Older Adults

2020 ◽  
pp. 1-8
Author(s):  
Sabine Heuer
Keyword(s):  
Older Adults ◽  
Service Learning ◽  
Undergraduate Students ◽  
Attitude Scale ◽  
Evidence Based ◽  
Attitudes Toward Older Adults ◽  
Students Attitudes ◽  
Attitude Shift ◽  
The Impact ◽  
Journal Entries

Purpose Future speech-language pathologists are often unprepared in their academic training to serve the communicative and cognitive needs of older adults with dementia. While negative attitudes toward older adults are prevalent among undergraduate students, service learning has been shown to positively affect students' attitudes toward older adults. TimeSlips is an evidence-based approach that has been shown to improve health care students' attitudes toward older adults. The purpose of this study is to explore the change in attitudes in speech-language pathology students toward older adults using TimeSlips in service learning. Method Fifty-one students participated in TimeSlips service learning with older adults and completed the Dementia Attitude Scale (DAS) before and after service learning. In addition, students completed a reflection journal. The DAS data were analyzed using nonparametric statistics, and journal entries were analyzed using a qualitative analysis approach. Results The service learners exhibited a significant increase in positive attitude as indexed on the DAS. The reflective journal entries supported the positive change in attitudes. Conclusions A noticeable attitude shift was indexed in reflective journals and on the DAS. TimeSlips is an evidence-based, patient-centered approach well suited to address challenges in the preparation of Communication Sciences and Disorders students to work with the growing population of older adults.

Systematic review methodology for development: An example from microfinance

2018 ◽  
Vol 43 (1) ◽  
pp. 65-77 ◽  
Author(s):  
Carina Van Rooyen ◽  
Ruth Stewart ◽  
Thea De Wet
Keyword(s):  
Systematic Review ◽  
International Development ◽  
Health Sector ◽  
Evidence Based ◽  
Systematic Review Methodology ◽  
Development Interventions ◽  
The Us ◽  
Sub Saharan ◽  
The Impact ◽  
Evidence Based Decision Making

Big international development donors such as the UK’s Department for International Development and USAID have recently started using systematic review as a methodology to assess the effectiveness of various development interventions to help them decide what is the ‘best’ intervention to spend money on. Such an approach to evidence-based decision-making has long been practiced in the health sector in the US, UK, and elsewhere but it is relatively new in the development field. In this article we use the case of a systematic review of the impact of microfinance on the poor in sub-Saharan African to indicate how systematic review as a methodology can be used to assess the impact of specific development interventions.

33 An Evidence Based Laser Therapy Algorithm for the Treatment of Burn Scars

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S26-S27
Author(s):  
Rajiv Sood
Keyword(s):  
Laser Treatment ◽  
Laser Therapy ◽  
Co2 Laser ◽  
Statistical Significance ◽  
Evidence Based ◽  
Baseline Measurement ◽  
Burn Scar ◽  
Therapy Algorithm ◽  
Laser Treatments ◽  
The Impact

Abstract Introduction Hypertrophic scarring after burn injury can be extremely painful, cause profound itching, and affect the way patients view themselves and how the outside world perceives them. We have utilized laser therapy as a modality for scar modulation for our patients since 2013. In 2014, we initiated and completed a prospective IRB approved study to evaluate the outcome of scars treated with fractional CO2 laser therapy (FLT) utilizing objective and subjective tools. Recently, we have completed a prospective study evaluating the use of pulse dye laser (PDL) therapy and the impact on post-burn pruritis. In reviewing the outcomes from these two studies, we have developed an evidence-based laser therapy algorithm for burn scar management. Methods The FLT study entailed a series of three CO2 laser treatments minimally 4–6 weeks apart with scar measurements and POSAS form completion performed prior to each laser treatment and four weeks after the last FLT. Scar measurements that included color, pliability, and scar thickness; and completion of the POSAS form were obtained prior to each laser therapy session and four weeks after the third laser treatment. The measurements of color, pliability, and scar thickness were measured with the Colorimeter, Cutometer, and ultrasound. The PDL study utilized the 5-D Itch scale to evaluate post-burn pruritis. A baseline measurement was obtained prior to any laser treatments. Each patient underwent two PDL sessions and a 5-D itch scale was completed four to six weeks after the second PDL session. The baseline measurement was then compared to the final 5-D itch scale measurement. Results Data from the FLT study is in Table 1 and shows that there were statistically significant improvements in the Patient and Observer POSAS scores, patient rated Itch score, scar thickness, and measured skin density. Changes to patient rated scar pain, scar color, and pliability were noted but were not of statistical significance. Data from the PDL study is in Table 2 and shows a statistically significant decrease in the treated patients’ post-burn pruritis. Conclusions In reviewing the outcomes of these two studies, we have developed an algorithm based on our studies. All of our patients undergoing laser therapy receive two PDL sessions that are four to six weeks apart followed by 3 FLT sessions. The use of both PDL and FLT decreases post-burn pruritis, decreases scar thickness, decreases pain, and increases patient satisfaction as shown in our research.

scholarly journals When and why do people act on flawed science? Effects of anecdotes and prior beliefs on evidence-based decision-making

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Audrey L. Michal ◽  
Yiwen Zhong ◽  
Priti Shah
Keyword(s):  
Educational Interventions ◽  
Evidence Based ◽  
Prior Beliefs ◽  
Learning Experiment ◽  
Apply Research ◽  
Evidence Quality ◽  
The Media ◽  
The Impact ◽  
Learning Interventions

AbstractToday’s citizens are expected to use evidence, frequently presented in the media, to inform decisions about health, behavior, and public policy. However, science misinformation is ubiquitous in the media, making it difficult to apply research appropriately. Across two experiments, we addressed how anecdotes and prior beliefs impact readers’ ability to both identify flawed science and make appropriate decisions based on flawed science in media articles. Each article described the results of flawed research on one of four educational interventions to improve learning (Experiment 1 included articles about having a tidy classroom and exercising while learning; Experiment 2 included articles about using virtual/augmented reality and napping at school). Experiment 1 tested the impact of a single anecdote and found no significant effect on either participants’ evidence evaluations or decisions to implement the learning interventions. However, participants were more likely to adopt the more plausible intervention (tidy classroom) despite identifying that it was unsupported by the evidence, suggesting effects of prior beliefs. In Experiment 2, we tested whether this intervention effect was driven by differences in beliefs about intervention plausibility and included two additional interventions (virtual reality = high plausible, napping = low plausible). We again found that participants were more likely to implement high plausible than low plausible interventions, and that evidence quality was underweighed as a factor in these decisions. Together, these studies suggest that evidence-based decisions are more strongly determined by prior beliefs than beliefs about the quality of evidence itself.

scholarly journals Evaluating interventions with victims of intimate partner violence: a community psychology approach

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cinzia Albanesi ◽  
Carlo Tomasetto ◽  
Veronica Guardabassi
Keyword(s):  
Intimate Partner Violence ◽  
Social Services ◽  
Psychological Health ◽  
Partner Violence ◽  
Process Model ◽  
Professional Training ◽  
Phenomenological Approach ◽  
Intimate Partner ◽  
Structured Interviews ◽  
The Impact

Abstract Purpose Intimate Partner Violence (IPV) is one of the most common forms of domestic violence, with profound implication for women's physical and psychological health. In this text we adopted the Empowerment Process Model (EPM) by Cattaneo and Goodman (Psychol Violence 5(1):84–94) to analyse interventions provided to victims of IPV by a Support Centre for Women (SCW) in Italy, and understand its contribution to women’s empowerment. Method We conducted semi-structured interviews with ten women who had been enrolled in a program for IPV survivors at a SCW in the past three years. The interviews focused on the programs’ aims, actions undertaken to reach them, and the impact on the women’s lives, and were analysed using an interpretative phenomenological approach. Results Results showed that the interventions provided by the SWC were adapted according to women's needs. In the early phases, women’s primary aim was ending violence, and the intervention by the SCW was deemed as helpful to the extent it provided psychological support, protection and safe housing. Women’s aims subsequently moved to self-actualisation and economic and personal independence which required professional training, internships, and social support. Although satisfying the majority of the women’s expectations, other important needs (e.g., economic support or legal services) were poorly addressed, and cooperation with other services (e.g., police or social services) was sometimes deemed as critical. Conclusions By evaluating a program offered by a SCW to IPV survivors through the lens of the EPM model, we found that women deemed the program as effective when both individual resources and empowerment processes were promoted. Strengths, limitations and implications are discussed.

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