Appraisal In Practice Research Articles

Assessment of Youth Coping and Appraisals Through a Timelining Activity: Validation and Utility of a Tool for Pediatric Research and Practice

Many tools to assess coping in youth fail to engage youth meaningfully in the assessment process. This study aimed to evaluate a brief timeline activity as an interactive way to assess appraisal and coping in pediatric research and practice. We used a mixed method convergent design to collect and analyze survey and interview data from 231 youths aged 8-17 years in a community-based setting. The youth engaged readily in the timeline activity and found the activity easy to understand. Relationships among appraisal, coping, subjective well-being and depression were in the hypothesized directions, suggesting the tool supports a valid assessment of appraisals and coping in this age group. The timelining activity is well-accepted by youth and supports reflexivity, prompting youth to share insights on strengths and resilience. The tool may augment existing practices for assessing and intervening in youth mental health in research and practice.

Systematic Review and Meta-Analysis: Pearls for Interpretation, Appraisal, and Application in Clinical Practice

Systematic reviews (SR) are a category of literature review that presents a comprehensive synthesis and analysis of all available literature evidence addressing a specific clinical question. Meta-analysis (MA) is a quantitative technique that is applied to data collected through SR that provides an estimate of an effect across a larger population. By synthesizing data from a large number of sources SR and MA often provide insights that cannot be obtained from single studies and can aid in clinical decision-making. However, these techniques are subject to important limitations. Both the validity and the usefulness of the results of an SR/MA depend on the methodological rigor used in preparing the review and the quality of included studies. In applying SR/MA to clinical decision-making the reader should be able to assess these features. Here we present an overview of important concepts in understanding SR and MA. We provide a general approach to interpretation and evaluation of an SR/MA, model the use of a critical appraisal tool for SR, and discuss the applications of SR and MA to clinical practice.

Learning to Critically Appraise Rheumatic Disease Literature: Educational Opportunities During Training and into Practice.

To provide optimal patient care, rheumatologists must be equipped and motivated to critically appraise the literature. The conceptual frameworks Retrieval Enhanced Learning, Self-Determination Theory, and Communities of Practice can inform the design of educational approaches to promote critical appraisal in practice. HSS CLASS-Rheum® is a learning tool that can be used to help rheumatologists learn skills for critical appraisal through retrieval practice. Combining retrieval practice with opportunities for connection through Peer Instruction, journal clubs, and other forums can help support engagement and internalization of motivation, promoting persistence with critical appraisal in practice.

Embedding meaningful patient involvement in the process of proposal appraisal at the Dutch Cancer Society

Although academic interest for patient involvement in health research decision-making is growing, in practice it proves challenging to involve patients meaningfully and sustainably. This article aims to unravel systemic factors influencing the embedding of meaningful patients' involvement in proposal appraisal at a private cancer research funding organization. In the case study, the emergent and participatory research approach Reflexive Monitoring in Action was applied. At first, a positive stance of stakeholders towards patient involvement was accompanied by a lack of tools and structures. This lack of tools led to the execution of various interventions. Analysis reveals that structural interventions succeeded in the bureaucratic context. The required cultural shift was also addressed, but took longer to materialize. This may have reduced the meaningful involvement of patients in proposal appraisal in practice. To overcome the underlying systemic barriers, an approach is needed that encourages stakeholders' reflexivity in the structural, cultural, and practical domain.

Reconsidering critical appraisal in social work: choice, care and organization in real-time treatment decisions

This paper seeks to provide an empirically grounded discussion of the critical appraisal model of Evidence-based practice (EBP) in social work practice. Studying real-time treatment decisions, the paper looks ethnographically at an attempt to implement critical appraisal in everyday social work practice, and problematizes some of the assumptions underlying this idea. Whereas critical appraisal tends to view treatment decisions as clear-cut events emanating from autonomous social workers, participant observation shows that decisions emerge over time and are ‘organizational’ rather than individual. Drawing on the notion of ‘logic of care’ and findings from studies of organizational decision-making, a more practice oriented understanding of treatment decision-making is outlined.

マクロ評価選別の昨日、今日、明日

マクロ評価選別の昨日、今日、明日

Standing out and moving up: performance appraisal of cultural minority physicians.

Despite a growing diversity within society and health care, there seems to be a discrepancy between the number of cultural minority physicians graduating and those in training for specialization (residents) or working as a specialist in Dutch academic hospitals. The purpose of this article is to explore how performance appraisal in daily medical practice is experienced and might affect the influx of cultural minority physicians into specialty training. A critical diversity study was completed in one academic hospital using interviews (N=27) and focus groups (15 participants) with cultural minority physicians and residents, instructing specialists and executives of medical wards. Data were digitally recorded and transcribed verbatim. A thematic and integral content analysis was performed. In addition to explicit norms on high motivation and excellent performance, implicit norms on professionalism are considered crucial in qualifying for specialty training. Stereotyped imaging on the culture and identity of cultural minority physicians and categorical thinking on diversity seem to underlie daily processes of evaluation and performance appraisal. These are experienced as inhibiting the possibilities to successfully profile for selection into residency and specialist positions. Implicit criteria appear to affect selection processes on medical wards and possibly hinder the influx of cultural minority physicians into residency and making academic hospitals more diverse. Minority and majority physicians, together with the hospital management and medical education should target inclusive norms and practices within clinical practice.

Antecedents of Social Entrepreneurial Intentions: The Role of an Individual's General Social Appraisal

This study addresses antecedents of social entrepreneurial intentions. First, this study argues that an individual's appraisal to become a social entrepreneur is an important predictor of social entrepreneurial intention. Second, this study hypothesizes that this general social appraisal moderates the influences of two opportunity characteristics on social entrepreneurial intention. In line with our main argument, the results of our empirical experiment show a positive influence of general social appraisal. In addition, this appraisal weakens the influence of perceived probability of success and strengthens the influence of perceived social impact on social entrepreneurial intention. This study concludes with a discussion of the important role of an individual's general social appraisal in research and practice.

MAPPING OF HEALTH TECHNOLOGY ASSESSMENT IN SELECTED COUNTRIES

The aim of this study was to develop and apply an instrument to map the level of health technology assessment (HTA) development at country level in selected countries. We examined middle-income countries (Argentina, Brazil, India, Indonesia, Malaysia, Mexico, and Russia) and countries well-known for their comprehensive HTA programs (Australia, Canada, and United Kingdom). A review of relevant key documents regarding the HTA process was performed to develop the instrument which was then reviewed by selected HTAi members and revised. We identified and collected relevant information to map the level of HTA in the selected countries. This was supplemented by information from a structured survey among HTA experts in the selected countries (response rate: 65/385). Mapping of HTA in a country can be done by focusing on the level of institutionalization and the HTA process (identification, priority setting, assessment, appraisal, reporting, dissemination, and implementation in policy and practice). Although HTA is most advanced in industrialized countries, there is a growing community in middle-income countries that uses HTA. For example, Brazil is rapidly developing effective HTA programs. India and Russia are at the very beginning of introducing HTA. The other middle-income countries show intermediate levels of HTA development compared with the reference countries. This study presents a set of indicators for documenting the current level and trends in HTA at country level. The findings can be used as a baseline measurement for future monitoring and evaluation. This will allow a variety of stakeholders to assess the development of HTA in their country, help inform strategies, and justify expenditure for HTA.

Einschätzung, Diagnose und Therapie der chronischen metabolischen Azidose in Deutschland

Data concerning chronic metabolic acidosis (CMA) has been sparse for a long time. This might be one reason why the diagnosis and therapy of this common complication in CKD patients has not received much attention. Emerging clinical data indicate that the treatment of metabolic acidosis, which is simple and cost-efficient, offers great therapeutic potential. Survey among German nephrologists to collect information about current appraisal, diagnostic and therapeutic routine in clinical practice, and to determine the need for recommendations by the medical society. In August 2012, all nephrologists in Germany (n = 2095) were asked to complete a standardized questionnaire regarding diagnosis, evaluation and therapy of CMA. 207 questionnaires (9.9 %) were returned and analysed. The CMA was rated as the second most important contributor for the progression of renal insufficiency, with the most important being hypertension. In addition, there was a high consensus concerning diagnosis and therapy of CMA. But estimates on prevalence were highly diverse. In this survey the CMA was rated as an important co-morbidity. Participating nephrologists mostly followed treatment guidelines. However, major differences in the perception of prevalence of CMA were observed, leaving the possibility that CMA is still underdiagnosed. Further recommendations of the German Society of Nephrology could improve the diagnosis and therapy.

Development appraisal in practice: some evidence from the planning system

Due to the requirement to demonstrate financial feasibility of policy proposals and scheme-specific planning obligations, development viability and development appraisal have become core themes in the English planning system. The objective of this paper is to evaluate the application of development appraisal in practice. The paper reviews the literature and the models available to assess the viability of development and analyses a sample 19 development viability appraisals to identify practice. The paper concludes that the practice of development appraisal deviates significantly from the tenets of capital budgeting theory. In particular, in addition to a propensity to oversimplify the timing of income and expenditure, the way in which debt, developer’s return and value and cost change are handled in practice illustrates a major gap between mainstream capital budgeting theory and development appraisal in practice.

The good, the bad and the ‘not so bad’: reflecting on moral appraisal in practice

The aim of this study is to facilitate reflection on the moral merit of practitioners in various contexts. Insight is gained from Aristotelian and Kantian accounts of moral character and an original framework for reflection is presented as an adjunct to ethical theory and principles considered when appraising others. In relation to states of character, there is an irreconcilable difference between Kantian (deontic) and Aristotelian (aretaic) conceptions of the nature of full virtue (excellence of character), but at the same time it can be argued that in relation to practice their approaches complement each other. It is also argued that in relation to caring for the vulnerable, Aristotle's conception of full virtue is more compelling than Kant's. On the other hand, Kant's notion of self-serving action is important in nursing and it therefore needs to be considered when reflecting on professional conduct. The conclusion reached is that Aristotelian and Kantian accounts of character appraisal should be used in a combined approach to moral appraisal. This approach draws on the accounts of both philosophers and offers valuable insight into moral character, professional conduct and, in a more formal setting, fitness to practise.

A review of significant events analysed in general practice: implications for the quality and safety of patient care

BackgroundSignificant event analysis (SEA) is promoted as a team-based approach to enhancing patient safety through reflective learning. Evidence of SEA participation is required for appraisal and contractual purposes in UK general practice. A voluntary educational model in the west of Scotland enables general practitioners (GPs) and doctors-in-training to submit SEA reports for feedback from trained peers. We reviewed reports to identify the range of safety issues analysed, learning needs raised and actions taken by GP teams.MethodContent analysis of SEA reports submitted in an 18 month period between 2005 and 2007.Results191 SEA reports were reviewed. 48 described patient harm (25.1%). A further 109 reports (57.1%) outlined circumstances that had the potential to cause patient harm. Individual 'error' was cited as the most common reason for event occurrence (32.5%). Learning opportunities were identified in 182 reports (95.3%) but were often non-specific professional issues not shared with the wider practice team. 154 SEA reports (80.1%) described actions taken to improve practice systems or professional behaviour. However, non-medical staff were less likely to be involved in the changes resulting from event analyses describing patient harm (p < 0.05)ConclusionThe study provides some evidence of the potential of SEA to improve healthcare quality and safety. If applied rigorously, GP teams and doctors in training can use the technique to investigate and learn from a wide variety of quality issues including those resulting in patient harm. This leads to reported change but it is unclear if such improvement is sustained.

Promotion of health in older people: a randomised controlled trial of health risk appraisal in British general practice

there is inadequate evidence to support currently formulated NHS strategies to achieve health promotion and preventative care in older people through broad-based screening and assessment in primary care. The most extensively evaluated delivery instrument for this purpose is Health Risk Appraisal (HRA). This article describes a trial using HRA to evaluate the effect on health behaviour and preventative-care uptake in older people in NHS primary care. a randomised controlled trial was undertaken in three London primary care group practices. Functionally independent community-dwelling patients older than 65 years (n = 2,503) received a self-administered Health Risk Appraisal for Older Persons (HRA-O) questionnaire leading to computer-generated individualised written feedback to participants and general practitioners (GPs), integrated into practice information-technology (IT) systems. All primary care staff received training in preventative health in older people. The main outcome measures were self-reported health behaviour and preventative care uptake at 1-year follow-up. of 2,503 individuals randomised, 2,006 respondents (80.1%) (intervention, n = 940, control n = 1,066) were available for analysis. Intervention group respondents reported slightly higher pneumococcal vaccination uptake and equivocal improvement in physical activity levels compared with controls. No significant differences were observed for any other categories of health behaviour or preventative care measures at 1-year follow-up. HRA-O implemented in this way resulted in minimal improvement of health behaviour or uptake of preventative care measures in older people. Supplementary reinforcement involving contact by health professionals with patients over and above routine clinical encounters may be a prerequisite to the effectiveness of IT-based delivery systems for health promotion in older people.

Preventing the Unpredicted: Managing Violence Risk in Mental Health Care

Preventing the Unpredicted: Managing Violence Risk in Mental Health Care

Using Stress, Appraisal, and Coping Theories in Clinical Practice: Assessments of Coping Strategies After Disasters

This conceptual article describes transactional theory (R. S. Lazarus, 1999; R. S. Lazarus and S. Folkman, 1984), a framework that integrates stress, appraisal, and coping theories as they relate to how individuals react to psychologically stressful situations and/or environments. In clinical practice, this theoretical framework can be effectively utilized in the assessment, intervention, and evaluation of an individual's psychological stress and coping responses. This paper also discusses the role that theory can play in facilitating clinicians' assessment of the coping strategies their clients use to decrease distress in the aftermath of a disaster. Illustrative examples are drawn from studies on social workers who experienced the World Trade Center disaster in New York City. Theoretical knowledge about stress, more specifically coping with the impact of psychological stress, will provide information that can help clinical professionals more effectively assist clients in resuming positive functioning and well-being after a disaster.

An Evidence‐Based Journal Club for Dental Residents in a GPR Program

The journal club offers a significant opportunity to serve as both an educational experience but also as a real-world example of the application of the principles and practices of evidence-based dentistry (EBD). Designed around the American Dental Association's recommended four steps in the implementation of the EBD process, the journal clubs are held once per month for GPR residents. The structured process allows residents to formulate answerable clinical questions, track down with maximum efficiency the best evidence with which to answer the questions, critically appraise the evidence for its validity and usefulness, and apply the results of this appraisal in clinical practice as appropriate.

New Agendas for Appraisal: Reflections on Theory, Practice, and Research

Appraisal—defined here to include a variety of ex ante techniques and procedures that seek to predict and evaluate the consequences of certain human actions—has been afforded an increasingly important role in environmental policy. We argue in this paper, however, that both the nature of appraisal and its role in the political process have been inadequately conceptualised. Exploring a literature that has tended to polarise ‘technical’ and ‘deliberative’ models, we identify a need for sensitive selection and combination of approaches, taking account of both the object and the objective of appraisal in particular contexts. We suggest that an important role for appraisal (by design or by default) may be that of providing spaces for dialogue and learning in the making of policies and decisions. A better understanding of such processes requires further research, particularly well-designed longitudinal work involving retrospective and ‘real time’ studies of appraisal in practice.

The Environmental Appraisal of National Park Management Plans in England and Wales

The Countryside Agency has recommended that national park authorities (NPAs) undertake an environmental appraisal of their national park management plans. A study of the appraisal practices of the NPAs of England and Wales has shown that, despite this guidance, the practice of environmental appraisal is uncommon but that a culture of applying sustainability appraisal is evolving. It is argued that the most likely explanation for this situation is the increasing influence of the concept of sustainable development on the workings of the national park management system. This broad policy development has manifested itself in a variety of ways, including the production of government guidance relating to sustainability appraisal and changes in best practice, each of which have influenced appraisal procedures in national parks. The wider implications of, and drivers behind, the evolution of appraisal procedure towards sustainability appraisal are thus identified and then discussed.

Appraisal and assessment in surgical practice

Appraisal and assessment in surgical practice