Deprescribing psychotropic medications in children: results of a national qualitative study

2019 ◽  
Vol 29 (8) ◽  
pp. 655-663
Author(s):  
Erin R Barnett ◽  
Alissa Z Trepman ◽  
Hannah A Fuson ◽  
Stephanie C Acquilano ◽  
Jennifer L McLaren ◽  
...  
Keyword(s):  
Contextual Factors ◽  
Psychotropic Medications ◽  
Social Needs ◽  
Theory Approach ◽  
Vulnerable Families ◽  
The Usa ◽  
Paediatric Outpatient ◽  
Facilitators And Barriers ◽  
Axial Coding ◽  
Audio Files

Background and ObjectivePrescriptions for psychotropic medications to children have risen dramatically in recent years despite few regulatory approvals and growing concerns about side effects. Government policy and numerous programmes are attempting to curb this problem. However, the perspectives of practising clinicians have not been explored. To characterise the perspectives and experiences of paediatric primary care clinicians and mental health specialists regarding overprescribing and deprescribing psychotropic medications in children.MethodsWe conducted 24 semistructured interviews with clinicians representing diverse geographic regions and practice settings in the USA. Interview questions focused on clinician perspectives surrounding overprescribing and experiences with deprescribing. We transcribed audio files verbatim and verified them for accuracy. We analysed transcripts using a grounded theory approach, identifying emergent themes and developing a conceptual model using axial coding.ResultsAnalysis yielded themes within four domains: social and clinical contextual factors contributing to overprescribing, opportunities for deprescribing, and facilitators and barriers to deprescribing in paediatric outpatient settings. Most participants recognised the problem of overprescribing, and they described complex clinical and social contextual factors, as well as internal and external pressures, that contribute to overprescribing. Opportunities for deprescribing included identification of high-risk medications, routine reassessment of medication needs and recognition of the broader social needs of vulnerable children. Facilitators and barriers to deprescribing were both internal (eg, providing psychoeducation to families) and external (eg, parent and child preferences) to clinicians.ConclusionOur findings highlight a discrepancy between clinicians’ concerns about overprescribing and a lack of resources to support deprescribing in outpatient paediatric settings. To successfully initiate deprescribing, clinicians will need practical tools and organisational supports, as well as social resources for vulnerable families.

scholarly journals The Motivation Journey: A Grounded Theory Study on Female Cancer Survivors’ Experience of a Psychological Intervention for Quality of Life

2021 ◽  
Vol 18 (3) ◽  
pp. 950
Author(s):  
Ilaria Durosini ◽  
Lucrezia Savioni ◽  
Stefano Triberti ◽  
Paolo Guiddi ◽  
Gabriella Pravettoni
Keyword(s):  
Quality Of Life ◽  
Grounded Theory ◽  
Cancer Survivors ◽  
Psychological Intervention ◽  
Psychological Interventions ◽  
Theory Approach ◽  
Axial Coding ◽  
Motivation To Participate ◽  
Female Cancer Survivors

Psychological interventions are proposed to cancer survivors to support their quality of life against the emotional trauma of cancer and the side effects of treatment. Psychological interventions often require patient engagement and commitment to activities that could be more or less demanding in terms of lifestyle change (e.g., psychotherapy, sports). Analyzing participant motivations (personal aims, expectations, needs) prior to participation is useful to predict their adherence to the intervention as well as final outcomes. Yet, participant motivations may evolve during the intervention because the intervention experience turns out to be meaningful and positively challenging. The present study aimed to obtain a preliminary understanding of the process of motivation change in female cancer survivors who participated in a sport-based intervention to promote quality of life by employing a grounded theory approach. Data analysis took place alongside data collection and according to the procedure of grounded theory (“open coding”, “axial coding”, and “selective coding”) in order to describe the process of motivation change during women’s participation in psychological intervention for quality of life. On 14 women interviewed, 13 reported changing their motivation to participate during the first months of involvement, mostly changing from individualistic to group-related motivations (i.e., from self-care to friendship with other participants and enriching group membership), and from physical to psychological growth (i.e., pursuing not only physical health but also self-fulfillment). The discussion explains the preliminary aspects of the motivation change process and highlights the importance to monitor motivation dynamics within psychological interventions.

scholarly journals LECTURER’S STRATEGIES IN ENGLISH SPEAKING CLASS

2014 ◽  
Vol 3 (1) ◽  
pp. 54
Author(s):  
Herlina Daddi ◽  
Muhammad Zia Ul Haq
Keyword(s):  
Grounded Theory ◽  
Private University ◽  
Learning Activity ◽  
Theory Approach ◽  
Seating Arrangement ◽  
Performance Based Assessment ◽  
Simulation Strategy ◽  
English Speaking ◽  
Axial Coding ◽  
Teaching Learning

This research aimed to reveal (1) what strategies were applied by lecturers in English speaking class, (2) how those strategies were applied and (3) to know the students’ perceptions toward the use of those strategies.This research employed qualitative grounded theory design. The subjects of the research were two non-native English lecturers who taught at the same private university in Makassar. The instruments of research were; observation, interview, and documents examination. The technique of data analysis adopted three series of codification of grounded theory approach; open coding, axial coding, and selective coding.The result of this research revealed five categories of strategies that applied by the two subjects. They were; (1) strategy of checking attendance, (2) strategy of seating arrangement, (3) strategy of teaching-learning activity, (4) strategy of correction and (5) strategy of assessment. Strategy of checking attendance, they were: numbering and one-off calling name; strategy of seating arrangement, they were: one-big circle, two circle, U-model, and island model; strategy of teaching-learning activity, they were: audio-based presentation, topic-based presentation, peer share idea, role play, discussion, and simulation; strategy of correction, they were: teacher correction and peer correction; and strategy of assessment, that was: performance-based assessment. In accordance with those strategies, the students raised perception that those strategies encouraged them to be good at speaking in terms of improving their confidence to share idea, vocabulary, pronunciation, and grammar.Keywords: Lecturer’s Strategy, Teaching Speaking, Perception

HR Shared Service Centers

2009 ◽  
pp. 419-434
Author(s):  
Mitchell van Balen ◽  
Tanya Bondarouk
Keyword(s):  
Grounded Theory ◽  
Risk Analysis ◽  
Human Resource ◽  
Theory Approach ◽  
Professional Literature ◽  
Shared Service ◽  
Axial Coding ◽  
Grounded Theory Approach

In this chapter the authors consider articles in professional literature regarding Human Resource Centers, with the goal to explore issues raised by practice: motivation, risk analysis, structure and implementation. Using Grounded Theory approach, they analysed 34 articles, and through open and axial coding, we have modeled the HR SSC’s.

Development and validation of the Leadership Effectiveness in Africa and the Diaspora (LEAD) scale

2020 ◽  
Vol 20 (3) ◽  
pp. 361-384
Author(s):  
James Michaud ◽  
Elena Lvina ◽  
Bella L Galperin ◽  
Terri R Lituchy ◽  
Betty Jane Punnett ◽  
...  
Keyword(s):  
Factor Analysis ◽  
African Diaspora ◽  
Leadership Effectiveness ◽  
Culturally Sensitive ◽  
Theory Approach ◽  
Cultural Leadership ◽  
Sensitive Measure ◽  
The Usa ◽  
Combination Of Methods ◽  
Development And Validation

This article contributes to the literature on cross-cultural leadership by describing the development and validation of the Leadership Effectiveness in Africa and the Diaspora (LEAD) Scale. The LEAD Scale is a culturally sensitive measure of leadership effectiveness in the understudied settings of Africa and the African diaspora. A combination of methods and four studies using samples from Africa and the African diaspora based in Canada, the USA, and the Caribbean were used to develop the measure. Using the grounded theory approach and the Delphi technique ( n = 192), followed by a set of increasingly rigorous tests including exploratory factor analysis ( n = 441), confirmatory factor analysis ( n = 116), and a test of measure invariance ( n =1384), we developed and validated a culturally sensitive measure of effective leadership. Our results demonstrate that spirituality, tradition and community-centredness are important and culturally specific components of leadership in Africa and the African diaspora. This paper provides a validated measure of leadership and offers recommendations regarding the use of the measure by managers and researchers working in Africa or with African diaspora.

scholarly journals Evaluating M-Learning System Adoption by Faculty Members in Saudi Arabia Using Concern Based Adoption Model (CBAM) Stages of Concern

2019 ◽  
Vol 14 (05) ◽  
pp. 153
Author(s):  
Mohammed Al Masarweh
Keyword(s):  
Educational Technology ◽  
Saudi Arabia ◽  
User Interaction ◽  
Research Literature ◽  
Faculty Members ◽  
Learning System ◽  
Concern Based Adoption Model ◽  
The Usa ◽  
Adoption Model ◽  
Facilitators And Barriers

This study assesses the use of an m-learning system by faculty members in Saudi Arabia using a new approach and methodology. Optimum use of educational technology requires consideration of requirements, obstacles and opportunities expected from user interaction with such systems and tools. While the use of m-learning in Saudi Arabia is relatively new, different research studies have investigated the use of m-learning in Saudi Arabia using different models. Most of the presented models investigated the acceptance and use from student perspectives, with little consideration of adoption by faculty members, their use of m-learning systems and their concerns (i.e. facilitators and barriers) as users. Some of the used models managed to provide significant results in relation to m-learning use, while others were found to lack a systematic and appropriate methodology. Concern Based Adoption Model (CBAM), which is widely used in the USA, Canada and (more recently) the Middle East (particularly Jordan), was used in this study to investigate m-learning adoption as an educational technology in Saudi Arabia. This framework provides tools to evaluate the use of educational technology within educational settings. This framework has not previously been used in Saudi Arabian educational research literature, and it is believed that the output will be valuable for enhancing the level of concern, adoption and use of m-learning in the future.

Forthcoming Economic Changes on the World Market under the Influence of 4.0 and the Following Revolutions

2020 ◽  
Vol 9 (1) ◽  
pp. 85-91
Author(s):  
K. Gylka ◽  
Ho Jin Han ◽  
A. Gribincha
Keyword(s):  
Natural Resources ◽  
World Market ◽  
Social Needs ◽  
Economic Changes ◽  
Global Competitiveness ◽  
Goods And Services ◽  
Aging Populations ◽  
The Usa ◽  
Cis Countries ◽  
New Generation

The leading countries have taken the direction of the vector towards digitalization. In the CIS countries, this direction means “digital economy”, but in other countries, it is Industry 4.0 (Germany), in the USA — Industrial Internet Consortium. In fact, this is one and the same process — the translation of the economy into a digital mode, technology, an algorithm for expressing phenomena and actions, goods and services, thoughts, artificial intelligence, etc. Other countries went further by announcing the development of strategy 5.0 (Japan) or 6.0 (China). Many countries do not have rich natural resources, so they completely depend on the quality of education of the new generation, and it needs to be prepared for revolutionary changes. Therefore, the emphasis is on children — this is our future — the theme is as relevant as ever. Humanity is subject to a number of shocks. They are reducing the number of employees, aging populations, declining global competitiveness of production, the need to upgrade infrastructure, environmental problems, lack of natural resources, issues of tackling natural disasters and countering terrorism. There was a necessity to create a universal concept that would go beyond sectoral problems and respond primarily to social needs and needs.

Critical elements in defining work-based identity in a post-apartheid South Africa

2011 ◽  
Vol 37 (1) ◽  
Author(s):  
Sandra Lloyd ◽  
Gert Roodt ◽  
Aletta Odendaal
Keyword(s):  
South African ◽  
Management Strategies ◽  
Integrative Model ◽  
Theory Approach ◽  
Training Interventions ◽  
Managerial Implications ◽  
Value Add ◽  
Axial Coding ◽  
Definition Of ◽  
Individual Self

Orientation: The main focus of the study was to answer the question: ‘Who am I at work?’ in a post-apartheid South African organisation.Research purpose: The aim of the specific research questions was to determine which life sphere and life role elements, and which work-based identity facets were significant in forming work-based identity.Motivation for the study: The findings of the study will enable the formulation of an integrative definition of work-based identity applicable to the South African context.Research design, approach and method: Qualitative data was collected by means of unstructured interviews with 29 employees representing a range of job titles, levels and demographics in a large South African manufacturing company. A grounded theory approach (open and axial coding) was used to analyse the data.Main findings: Distinctive individual self-definitions and a number of common themes integrating social and personal identity perspectives emerged from the data. These themes provided a sound basis for the proposed integrative model to define work-based identity.Practical/managerial implications: The findings of this research will assist human resource practitioners to develop training interventions and management strategies for the potential enhancement of work-based identities. This will result in a more engaged and harmonised workforce.Contribution/value-add: This was the first study of its kind to identify and delineate significant work-based identity elements for the formation of a work-based identity within a South African work context.

The regulation of statutory auditing: an institutional theory approach

2014 ◽  
Vol 29 (5) ◽  
pp. 371-394 ◽  
Author(s):  
C. Richard Baker ◽  
Jean Bédard ◽  
Christian Prat dit Hauret
Keyword(s):  
Institutional Theory ◽  
Capital Markets ◽  
Theory Approach ◽  
Content Type ◽  
Sarbanes Oxley ◽  
External Pressures ◽  
The Usa ◽  
Institutional Field ◽  
Apparent Similarity ◽  
External Forces

Purpose – This paper aims to examine the recent evolution of the regulation of statutory auditing since the passage of the Sarbanes-Oxley Act of 2002 in the USA by comparing the regulatory structures for auditing in the USA, France and Canada. Design/methodology/approach – Using publicly available documents, the paper seeks to understand how the regulatory structures for statutory auditing have changed in the period since the passage of the Sarbanes-Oxley Act. The USA, France and Canada were chosen for analysis because prior to Sarbanes-Oxley the regulatory structures of these three countries were relatively distinct, whereas subsequent to the Act they appear to be becoming similar. Findings – The authors interpret the increasing apparent similarity in the regulatory structures for statutory auditing in these three countries to be the result of external pressures from global capital markets for standardized regulatory practices. However, this apparent similarity may also be a form of “decoupling”, whereby actors in the institutional field of professional regulation, under pressures from powerful external forces, seek to enhance their legitimacy while maintaining internal flexibility and a certain capacity for resistance against external pressures in the institutional field. Research limitations/implications – The paper relies on a qualitative analysis of regulatory structures based on a review and analysis of publicly available documents and legislation. As such, it has limitations similar to other qualitative studies. Practical implications – The regulation of statutory auditing is important to society both to assure the proper functioning of capital markets and to provide reliable information to the general public. Gaining a better understanding of the regulatory structures for statutory auditing advances the public interest. Originality/value – There have been few prior research efforts that have examined the regulation of statutory auditing through the lens of new institutional theory.

Realignment strategies in the US retail industry during a recessionary time

2015 ◽  
Vol 43 (8) ◽  
pp. 775-792 ◽  
Author(s):  
Manveer Mann ◽  
Sang-Eun Byun ◽  
Yishuang Li
Keyword(s):  
Economic Recession ◽  
Business Environment ◽  
Retail Industry ◽  
Theory Approach ◽  
Strategic Decisions ◽  
Theoretical Understanding ◽  
Content Type ◽  
Critical Gap ◽  
The Us ◽  
The Usa

Purpose – The purpose of this paper is to examine the range of realignment strategies employed by retailers in the USA in response to the 2008 economic recession. Design/methodology/approach – Following the grounded theory approach, National Retail Federation News Briefs published between 2008 and 2011 were analyzed by sorting them into thematic categories and comparing trends in strategic decisions during the recession (2008-2009) and after the recession (2010-2011). Based on the emergent categories, propositions were developed to provide theoretical explanations of the findings. Findings – The authors found five thematic categories of realignment strategies: promotional, organizational, price, operational, and product realignments. In line with contingency theories, retailers used these strategies to achieve a greater fit with the altered business environment and consumer consumption patterns. While promotional realignment was most prevalent, followed by organizational realignment, different realignment strategies were pursued based on the strategic focus and long-term vs short-term orientation of the retailers. Originality/value – The contribution of the findings is twofold: filling a critical gap in the literature examining the range of realignment decisions of the US retail industry in response to the recent economic recession; and enhancing the theoretical understanding of underlying factors or mechanisms of specific realignment decisions in the context of a turbulent economic environment.

scholarly journals A Critical Realist Evaluation of an Integrated Care Project for Vulnerable Families in Sydney, Australia

2020 ◽  
Author(s):  
Elaine Tennant ◽  
Erin Miller ◽  
Kathryn Costantino ◽  
Denise De Souza ◽  
Heidi Coupland ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Coordination ◽  
Social Needs ◽  
Local Health ◽  
Programme Theory ◽  
Critical Realist ◽  
Vulnerable Families ◽  
Integration Of Services

Abstract Background Healthy Homes and Neighbourhoods (HHAN) Integrated Care Initiative was established to improve the care of families with complex health and social needs who reside in Sydney Local Health District. HHAN seeks to provide long-term multi-disciplinary care coordination as well as enhance capacity building and promotion of integrated care. We describe the qualitative component of a critical realist pilot case study aimed at exploring, explaining and refining emerging HHAN programme theories in relation to care coordination. Methods Semi-structured qualitative interviews with HHAN clients (n=12), HHAN staff and other stakeholders (n=21). Emerging themes informed the development of Context-Mechanism-Outcome configurations aimed at evaluating HHAN’s effectiveness and refining the programme theory. Results HHAN’s effectiveness was based on two process mechanisms: Engagement of vulnerable clients and integration of services. The relational mechanisms underpinning effective engagement of clients by care coordinators included: building trust, leveraging other family, social and organisational relationships, meeting clients on their own terms, demonstrating staff effectiveness as quickly as possible, and client empowerment. Operational mechanisms for enhancing care integration included knowledge transfer activities and shared learning among collaborators, structural and cultural changes, enhancing mutual respect, co-location of multidisciplinary and/or interagency staff and cultivating faith in positive change among staff. Conclusions Use of a critical realism case study approach served to elucidate the varied influences of contexts and mechanisms on programme outcomes, to highlight what works for whom and in what context. Findings supported the initial programme theory that engagement and trust building with clients, alongside enhanced collaboration and integration of services, improved outcomes for vulnerable families with complex needs. Further research is needed to explore the cost-effectiveness of integrated care initiatives, in view of the long term nature of service provision and the risk of staff burnout.

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