Evidence-based Methods Research Articles

An Integrated Care Model for Pregnant and Postpartum Individuals Receiving Medication for Opioid Use Disorder.

Perinatal opioid use disorder is increasing. Integrated obstetric/addiction care models likely optimize parent-infant dyad outcomes, but the ideal combination of services is unknown. This study (1) describes pregnancy-to-postpartum service utilization by people receiving buprenorphine at an integrated Obstetric/Addiction Clinic and (2) explores the association between service utilization and postpartum buprenorphine continuation. This retrospective medical record review study uses research registry data from an outpatient Obstetric/Addiction Clinic. All patients are invited to participate in the research registry. For patients who consent, monthly medical record abstractions are conducted beginning with their first clinic visit to collect demographic, obstetric, and substance use disorder treatment variables. Present analyses included patients who delivered an infant between June 2019 and June 2021, started buprenorphine during pregnancy, and were receiving buprenorphine at delivery. Overall service utilization was the number of services (range 0-12) used between 28-weeks gestation and 12-weeks postpartum. Bivariate analyses and multivariable logistic regression assessed associations between service utilization and buprenorphine continuation. Participants (n = 42) were primarily non-Latinx White (67%) with comorbid psychiatric diagnoses (95%). On average, participants used 6 services; prenatal care, mental health care, and postpartum contraception were most utilized. Overall, 69% of participants continued buprenorphine at 6 months postpartum. This did not differ by level of service utilization (bivariate [ P = 0.07], multivariable [ P = 0.16]). Integrated care with a harm reduction focus supports pregnancy-to-postpartum service utilization and buprenorphine continuation in a patient sample at high risk for medication for opioid use disorder discontinuation. Further work is needed to identify evidence-based methods to individualize integrated obstetric/addiction care.

Benchmarking community/primary care musculoskeletal services: A narrative review and recommendation.

High quality data on service performance is essential in healthcare to evidence efficacy, efficiency, and value. There remains a paucity of publicly reported data in community and primary care musculoskeletal (MSK) services. There is also a lack of guidance on which metrics MSK services should be collecting and reporting, and how this data could be used to directly improve patient outcomes, experiences, and value. A narrative review of the evidence around benchmarking MSK services was undertaken with a focus on how to develop routine data collection within community/primary care settings, and how to develop benchmarking capabilities for the future, looking towards a national MSK audit. This evidence was triangulated with the findings from recent MSK data studies undertaken by the authors and emerging UK policy and guidance in this area. To enable MSK benchmarking services need to collect consistent, standardised outcomes and, therefore, we have developed a recommendation on a minimum MSK 'core outcome set' of Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) (PROMs: MSK-HQ, NPRS, WPAI; PREMs: National MSK PREM). In addition, we make recommendations on the use of a standardised evidence-based method for case-mix adjustment and outlier identification (using the following baseline demographics and clinical factors; age, sex, ethnicity, pain site, comorbidities, duration of symptoms, previous surgery, previous pain episodes), alongside considerations on how this data should be integrated and reported within NHS systems. Capturing high quality MSK data in a standardised, consistent, and sustainable way is a significant challenge. Policy holders, commissioners, managers, and clinicians need to be realistic with expectations, and take time to explore barriers to implementation including, funding, digital infrastructure/intra-operability, data sharing/governance, digital literacy, and local/national leadership. Next steps include developing a national MSK audit programme to provide a benchmarking model to support continuous improvements in care quality for patients living with MSK conditions.

Speech-Language Pathology Assessment of School-Age Children With Traumatic Brain Injury: A Scoping Review.

The purpose of this study was to describe evidenced-based assessment practices for school-age children with any severity of traumatic brain injury (TBI) that could inform the practice of speech-language pathologists (SLPs). A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Included studies were assigned thematic labels related to the International Classification of Functioning, Disability and Health framework. A total of 30 articles met inclusion criteria for this study. Most studies included adolescent or teenage participants with mild TBIs in the acute stages of recovery. Twenty-two different assessments were reported on for children with TBI addressing body structure/function (n = 19 assessments), activities and participation (n = 1 assessment), and contextual factors (n = 3 assessments). Current assessments have a clear focus on body structure/function for adolescents after childhood TBI, with little research evidence to address activities and participation or contextual factors. The limited amount of functional assessments directly related to the SLP scope of practice stresses the need for additional research on ecologically valid and comprehensive assessment approaches for school-age children with TBI. The results of this review could be utilized as a resource in providing theoretical, evidence-based, and person-centered evaluation methods for children with TBI. https://doi.org/10.23641/asha.20422170.

Planning and developing a web-based intervention for active surveillance in prostate cancer: an integrated self-care programme for managing psychological distress

ObjectivesTo outline the planning, development and optimisation of a psycho-educational behavioural intervention for patients on active surveillance for prostate cancer. The intervention aimed to support men manage active surveillance-related psychological distress.MethodsThe person-based approach (PBA) was used as the overarching guiding methodological framework for intervention development. Evidence-based methods were incorporated to improve robustness. The process commenced with data gathering activities comprising the following four components:• A systematic review and meta-analysis of depression and anxiety in prostate cancer• A cross-sectional survey on depression and anxiety in active surveillance• A review of existing interventions in the field• A qualitative study with the target audienceThe purpose of this paper is to bring these components together and describe how they facilitated the establishment of key guiding principles and a logic model, which underpinned the first draft of the intervention.ResultsThe prototype intervention, named PROACTIVE, consists of six Internet-based sessions run concurrently with three group support sessions. The sessions cover the following topics: lifestyle (diet and exercise), relaxation and resilience techniques, talking to friends and family, thoughts and feelings, daily life (money and work) and information about prostate cancer and active surveillance. The resulting intervention has been trialled in a feasibility study, the results of which are published elsewhere.ConclusionsThe planning and development process is key to successful delivery of an appropriate, accessible and acceptable intervention. The PBA strengthened the intervention by drawing on target-user experiences to maximise acceptability and user engagement. This meticulous description in a clinical setting using this rigorous but flexible method is a useful demonstration for others developing similar interventions.Trial registration and Ethical ApprovalISRCTN registered: ISRCTN38893965. NRES Committee South Central – Oxford A. REC reference: 11/SC/0355

Aligning objectives with assessment in online courses: Integrating learning analytics and measurement theory

Well-designed online courses enhance learning experiences and allow effective development of learners' skills and knowledge. A critical factor contributing to the design of online courses in the higher education settings are well-defined learning objectives that align with course assessments and learning activities. While there are several introspective instruments to evaluate course designs, with the broader adoption of educational technologies and digital tools, there is a wealth of data that offers insights on the alignment of learning objectives to assessments. Such data has paved the way for evidence-based methods of investigating course effectiveness within higher education. This study outlines a methodology for designing and evaluating the alignment between course learning objectives and assessment activities at scale, utilising a combination of learning analytics and measurement theory approaches, more specificially exploratory multi-dimensional item response theory (MIRT) models. We demonstrate the proposed methodology within a professional development MOOC on leadership skills development, where we evaluate the alignemnt between course objectives and reflective writing assessments activities. Our results suggested that the alignment of the existing course objectives to assessment activities can be improved, showing the practical value of the proposed approach. The theoretical and practical implications of this research are further illustrated.

Patient Engagement by the Tobacco Quitline After Electronic Referrals.

Referrals through the electronic health record (EHR) system provide an efficient evidence-based method to connect patients to the Tobacco Quitline. However, patients frequently do not respond to Quitline phone calls or accept services. The goal of this study was to characterize factors associated with successful engagement with Quitline following e-referrals by physicians in Maryland. This is a cross-sectional study with hierarchical data modeling. Data for 1790 patients e-referred in 2018-2019 by the University of Maryland Medical System (UMMS) were analyzed. Patients' engagement was assessed using a generalized estimating equation multivariable regression model for ordinal outcomes at two levels: Picking up a phone call from Quitline (1-800-QUIT-NOW) and enrollment in tobacco cessation programs. Older age, female gender, black race, low socioeconomic status, and provider's skills were significantly associated with successful outcomes of Quitline referral. The engagement with Quitline was higher in black non-Hispanic patients compared to other racial/ethnic groups (phone call response odds ratio [OR] = 1.99, 95% confidence interval [CI] = 1.35% to 2.93% and service acceptance OR = 1.89, 95% CI = 1.28% to 2.79%). Patients residing in socioeconomically deprived areas were more likely to respond to Quitline phone calls compared to those from affluent neighborhoods (OR = 1.52, 95% CI = 1.03% to 2.25%). Patients referred by faculty or attending physicians were more likely to respond compared to those referred by residents (OR = 1.23, 95% CI 1.04, 1.44, p = .0141). Multiple factors impact successful engagement with Quitline. Additional means to improve Quitline engagement success may include focused messaging on tobacco cessation benefits to patients, and skillful counseling by the provider. Implementation of the clinical decision support (CDS) tool for electronic referrals to the Tobacco Quitline at the UMMS was successful in providing evidence-based free service to elderly patients and socioeconomically disadvantaged racial and ethnic minorities. The CDS also served to engage physicians in conversation about tobacco use and cessation with every tobacco-using patient. Curricular content for physicians in training should be enriched to expand tobacco use and treatment.

Cognitive Behavior-Based Programming to Increase Physical Activity and Control Overweight/Obesity in Youth: An 18-Year Research Program Informing Novel Curricula.

IntroductionBecause only 42% of elementary school-aged children and 8% of adolescents complete the recommended amount of physical activity, programs beyond physical education are required to address this inadequacy and the associated rise in overweight/obesity. ObjectiveOur 18-year research program, conducted through the lens of accepted behavioral theory, field-based investigations, and predictive models intended to shape programs to address physical inactivity and high body mass index in youths, was reviewed. ResultsIn research-to-practice task 1, studies evaluated a cognitive-behavioral elementary afterschool treatment developed from principles of social cognitive theory. It provided exercise/physical activity through an individualized goal-setting perspective and training in self-regulatory skills such as restructuring unproductive self-talk. In task 2, the research program focused on favorable associations between treatment-induced improvements in physical self-concept, the overall self, physical appearance, exercise-related self-efficacy, and mood; it also focused on increased physical activity and reductions in excess weight. Program adaptations for preschool and middle school were also found productive. As the treatment model was extended in research-to-practice task 3, a refined focus on self-regulation, self-efficacy, and mood yielded findings of enhanced effects. In task 4, protocol adaptations intended for youths with severe obesity, additional diabetes risks, and candidacies for bariatric surgery were reported. Finally, the reviewed research evaluated treatment adjuncts that incorporate technology. ConclusionOur program of field research yielded progress on physical inactivity and high body mass index in youths via psychosocial pathways. Findings suggested medical professionals more strongly attend to physical inactivity and weight issues in their young patients while seeking evidence-based methods to induce ongoing behavioral progress.

Diagnostic value of double low-dose targeted perfusion CT imaging for the diagnosis of invasive and preinvasive pulmonary ground-glass nodules: systematic review and meta-analysis.

BackgroundThis study aimed to systematically evaluate and compare the diagnostic value of bubble lucency, interface, lobulated margin and spiculation in distinguishing early invasive and preinvasive intrapulmonary ground-glass nodules (GGNs) using evidence-based meta-analysis methods. Dual low-dose targeted perfusion computed tomography (CT) imaging is controversial in the diagnosis of invasive and preinvasive ground-glass nodules. Different studies have different views and opinions. Therefore, it is necessary to conduct a systematic review of this subject in the form of meta-analysis to guide clinical diagnosis and treatment.MethodsPubMed, Web of Science, Cochrane library and Embase were searched for recent documentation on the diagnostic value of different signs in invasive and preinvasive pulmonary GGNs. CT imaging signs of bubble lucency, speculation, interface, lobulated margin, and spiculation were used as diagnostic references to discriminate pre‐invasive and invasive disease. The sensitivity, specificity, summary receiver operating characteristic (SROC) curves, and the area under the SROC curve (AUC) were calculated to evaluate diagnostic efficiency.ResultsThe diagnostic sensitivity and specificity using bubble lucency as a reference of invasive ground-glass opacity (GGO) discrimination was 0.33 (0.24–0.44) and 0.74 (0.62–0.83) respectively. For interface, lobulated margin, and speculation, the diagnostic sensitivity were 0.30 (0.21–0.41), 0.49 (0.39–0.60) and 0.22 (0.14–0.33); and the specificity were 0.83 (0.74–0.89), 0.66 (0.49–0.80) and 0.86 (0.67–0.95). The pooled ROC curve was drawn by sensitivity against 1-specificity using Stata version 15.0. The area under the ROC curve (AUC) values were 0.53, 0.60, 0.58, and 0.43 for bubble lucency, speculation, lobulated margin, and pleural indentation of GGO for discriminating pre‐invasive and invasive disease.ConclusionsThe diagnostic value of a single CT imaging sign of GGO, such as bubble lucency, speculation, interface, lobulated margin, and spiculation is limited for discriminating pre‐invasive and invasive disease because of low sensitivity, specificity, and AUC.

Use of the international classification of diseases (ICD)-11 method applied to veterinary forensic pathology for coding the cause and manner of death in wildlife.

The growth of human population has led, in recent years, to increasingly frequent contacts with the wild animals with which we share the territory, sometimes leading to negative interactions with them. The purpose of the study is to apply the codes contained in the 11th Revision of the International Classification of Diseases (ICD-11) method to investigate the cause and the manner of death, also to entrust the veterinarian with the task of recognizing and describing a suspected animal abuse as a sentinel indicator of violence toward humans and non-humans, thus expanding the concept of “One Health” from a forensic investigation perspective. The subjects recruited are wild mammals submitted for autopsy to the Pathology Unit of the Department of Veterinary Science, University of Parma, Italy, from 2015 to 2018. The manner and the cause of death of 167 wild animals of 16 different species have been investigated. When possible, an on-site inspection where the corpse was found was performed. Injuries were classified according to the on-line 11th Revision of the International Classification of Diseases method. Section 22 (Injury, poisoning or certain other consequences of external causes) was used to record the “immediate cause of death” (cause of death) and Section 23 (External causes of morbidity or mortality) was used to record the “underlying cause of death” (manner of death) for each animal. In most cases, death occurred as a result of road trauma but in some cases, abuse and voluntary killing were investigated. The recognition of non-accidental injuries is particularly important for both the defense in court of animals and for the connection between crimes committed against animals and against humans, known as “The Link”. The use of the ICD-11 method, as a sort of summary of the autopsy report, was confirmed to be of great value for the clarity and simplicity of processing the data collected also by veterinary pathologists. The veterinary pathologists can use this evidence-based method with the aim of creating a national register and therefore, to understand the real extent of the human impact on wildlife and document it in a scientific and statistically usable way.

Effectiveness of the national German quitline for smoking cessation: study protocol of a randomized controlled trial

BackgroundDespite the decline in cigarette smoking prevalence during nearly the past two decades, tobacco use is still widespread in the German adult population, accounting for 125,000 deaths each year and causing tremendous social costs. To accelerate the reduction in tobacco smoking prevalence, evidence-based smoking cessation methods are pivotal to a national tobacco control strategy. The present study aims to evaluate the effectiveness of the national German Smokers Quitline offering cessation support to smokers.MethodsA total sample of 910 daily smokers, who are motivated to quit, will be recruited via an online access panel and randomly assigned to either the intervention (telephone counselling) or control condition. In the intervention group, participants will receive up to six proactive phone calls during an intervention period of approximately six weeks. The provided treatment will combine the principles of motivational interviewing and those of the cognitive behavioural approach to treating substance use. Participants in the control condition will receive a self-help brochure to support smoking cessation. Data collection will take place at baseline as well as three (post assessment) and twelve months (follow-up assessment) after baseline assessment. Primary outcome measures will include the seven-day point prevalence abstinence at 3-month and 12-month assessments as well as prolonged abstinence (abstinence over the 12 month period). Secondary outcome measures will include a change in smoking-related cognitions and coping strategies among all participants. Among non-abstainers, treatment success indicators such as a reduction in number of cigarettes smoked per day and changes in the number and duration of quit attempts after intervention start will be assessed. It is expected that after both three and twelve months, smoking cessation rates will be higher in the telephone counselling condition compared to the control condition.DiscussionThe results will provide insights into the effectiveness of proactive telephone counselling by the national German Smokers Quitline.Trial registrationThe protocol for this study is registered with the German Clinical Trials Register: DRKS00025343, Date of registration: 2021/06/07, https://www.drks.de/drks_web/setLocale_EN.do

Motivational Interviewing and Self-Determination Theory in Suicide Assessment: A Practical Application to Aid Residents' Management of Suicide.

Suicide is a problem on the rise in the United States. One significant avenue to help reverse the trend is through family medicine and interventions within primary care clinics. This can be a significant stressor for many family medicine physicians to manage patients experiencing suicidal ideation within their busy schedule. Motivational Interviewing is an evidence-based method of interacting with patients in a healthy and collaborative manner. The literature is growing on how to use Motivational Interviewing in assessments of suicidal ideation. Additionally, Self-Determination Theory proposes that individuals have three basic needs: a sense of connection, a level of autonomy, and a degree of competence. These needs and the associated principles of intrinsic and extrinsic motivation help to explain why Motivational Interviewing can be so helpful in the change process. By examining the principles of Motivational Interviewing and Self-Determination Theory residents will be able to better create an environment conducive to collaborative sharing, honest discussion, and meaningful assessment to ensure safety for patients in primary care.

Is Home Blood Pressure Monitoring Effective at Controlling Hypertension in African American Patients? A Clin-IQ.

African Americans are disproportionately affected by hypertension, a modifiable contributor to multiple chronic diseases and premature death. Primary care physicians play an important role in hypertension control. Home blood pressure monitoring (HBPM) is an evidence-based method for confirming diagnosis and monitoring hypertension over time. Some studies have found that HBPM may lead to clinically relevant reductions in blood pressure when combined with additional interventions, but few studies have focused specifically on African American populations. Evidence of effectiveness could increase clinical recommendation of HBPM. This clinical inquiry examined whether HBPM improves blood pressure control in African Americans with uncontrolled hypertension. Reviewed studies included 4 randomized controlled trials and 2 comparative research studies. Because these studies often were coupled with various co-interventions, ascertaining the independent effects of HBPM was difficult. When examining reviews of HBPM without a co-intervention and conducted independent of race, HBPM alone was insufficient to achieve long-term changes in hypertension control. More research focused on African Americans, with use of control groups, is needed to determine the true role for HBPM in controlling hypertension in this at-risk patient population.

Analysis of The State of The Tourism Industry in Russia аnd The Direction of Its Development

The purpose of the study. The purpose of the work is to assess the state of the tourism industry using statistical methods, analysis of scientific literature and identification of the main trends and promising directions of its development. The article is devoted to the possibilities of statistical analysis in the conditions of limited statistical information on Russia in relation to the tourism industry.Materials and methods. The following scientific methods are used in the article: analysis of scientific literature, analysis of dynamics and structure, coefficient analysis, correlation and regression analysis, graphical analysis, forecasting of indexes of the tourism industry. The analysis of Russian and foreign literature allowed us to formulate conclusions about modern methods of analysis used to assess the problems of the tourism industry. The analysis of the indexes in dynamics made it possible to identify and describe the main trends in the development of tourist flows, the volume and cost of selling tourist packages. The calculated structure of collective accommodation facilities showed their percentage ratio during the study period and the change in their shares. The use of correlation analysis made it possible to establish the closeness and direction of statistical relationships between individual factors affecting the state of the industry and the volume of tourist trips. A multiple regression model based on indexes characterizing the dynamics of prices for tours sold, the state of the transport sector and the food sector methodology is created. Based on the Box–Jenkins methodology, predictive models were created and medium-term forecasts were calculated for variables characterizing the number of tourist firms and the number of sanatorium-resort organizations and recreation organizations. The initial data for the study were Rosstat data in annual and spatial dimensions for the period 2011–2020.Results. The article highlights the main directions of research in the field of tourism industry, presented in the works of domestic and foreign authors. The foreign approach to its assessment is carried out through evidence-based methods. The research of domestic authors is more focused on the implementation of program-targeted methods and the identification of problems of assessment and prospects for the development of the industry in the Russian Federation. The analysis of the dynamics of inbound and outbound tourist trips showed a tendency to decrease their total number, which is due to the low level of tourist attractiveness, shocks and restrictive measures caused by the SARSCoV-2 pandemic, the tense foreign policy situation. It is established that the most active external tourist flows of the Russian Federation are observed with neighboring countries. Correlation analysis showed the presence of a statistical relationship between the number of trips made with the state of the transport infrastructure and the cost of the tour packages sold. The trend of growth in the implementation of tour packages in Russian destinations and a reduction in their number in foreign destinations, which is due to an increase in the disparity between the average cost of tour packages depending on the destination of the holiday, is established. The carried out regression analysis procedure showed the relationship between the number of tourist packages sold to citizens of the Russian Federation with the variables “average cost of sold tourist packages” and “fleet of aircraft”, which indicates the need to develop transport infrastructure and optimize the cost of recreation. Forecast calculations on the number of travel agencies and sanatorium-resort organizations have shown their decline in the medium term, which indicates the need to take appropriate measures to activate tourism entrepreneurship.Conclusion. Based on the results of the statistical analysis, the analysis of scientific literature and the content of tourism development programs in the Russian Federation, the authors identified common problems and directions of development of the industry. The main problems of the industry are the following: weak tourist attractiveness, insufficient development of tourist and transport infrastructure, lack of accommodation facilities aimed at mass tourists, low quality of domestic accommodation services, and high cost of foreign tours. The priority directions of the development of the domestic tourism business are related to: the introduction of modern digital technologies, active advertising of domestic tourism, optimization of the costs of tourism industry enterprises, activation of state support in difficult economic conditions.

Self-assessment: With all its limitations, why are we still measuring and teaching it? Lessons from a scoping review

Introduction Self-Assessment (SA) is often assumed to be essential for learning, however, this assumption has been extensively rebutted. Research shows SA has significant limitations, including its lack of correlation with competence. Method We undertook a scoping review of SA in medical education (2011–2021) and surprisingly discovered substantial research where SA was erroneously assumed to be a valid measure of successful learning, or a skill needing to be taught. Although the initial intent of our scoping review was to explore where SA is being effectively used to advance lifelong learning, we paused to explore the extent of the problem of its misuse and resulting in wasted research, by examining excluded studies. Results From 1151 articles, we identified 207 which ignored the documented limitations of SA. Thirty-nine studies explored SA of learning. This research has limited utility: increasing the accuracy of SA does not improve performance or lifelong learning. One hundred and sixty-eight used SA as an outcome measure to assess a program or intervention, including 63 where self-assessed improvement in knowledge/skills was the sole measure. SA of self-confidence was measured in 62 studies. When confidence was compared with an objective measure of performance, both invariably increased, but confidence did not always align with competence when measured. Discussion Many researchers mistakenly assume the ability to accurately self-assess is essential for learning, so focus on teaching self-calibration rather than evidence-based methods of advancing learning. Other researchers incorrectly suppose that self-reported improvements in knowledge/skills provide evidence of the efficacy of a program/intervention. This is particularly troubling with regards to novices, who may believe that because they self-assess to have improved/gained confidence, they are now competent. Conclusion Our findings highlight the significant volume of research being done where SA is misunderstood and/or misused as a measurement. We posit reasons that such research continues to take place and suggest solutions moving forward.

Theoretical foundations of processbased management of technological processes in agricultural enterprises

One of the main aspects of the development of the domestic agricultural sector, stabilization and increase in the efficiency of its production is the creation and use of the latest technologies, optimization of the use of resources, the implementation of which requires significant investments in the agricultural sector. However, many experts emphasize the insufficient technological preparation of production, which entails a deterioration in the quality of work and unforeseen disruptions in production. Therefore, there is a need to use relevant, evidence-based management methods in agricultural production. Process-based management assumes the continuity of material flows, since the output of each production process is linearly dependent on the resources consumed. In this regard, the most important feature of process –based management is its focus on the results. The purpose of the research is to define and describe the processes of production and economic activity using reference or reference models in the management of agribusiness enterprises. They are the basis for direct adaptation to the activities of a particular enterprise. These process standards contain the main (key) processes that are included in the technological process set of any enterprise without identifying it by industry. The methodological basis of the research is represented by system and process approaches. The theoretical and methodological basis of the research are the works of domestic and foreign authors in the field of agricultural enterprise management, solving the problems of introducing and using reference models in the management of technological processes. We have proposed a reference model of an agro-industrial enterprise using the example of the plant growing industry, which reflects a methodological option for systematizing and identifying processes for their further detailing when introducing process management at an enterprise. Isolation of the end-to-end chain of the main processes makes it possible to apply new approaches to production planning, organization of accounting and control, AHD, to make optimal management decisions. The results of the research can be used by managers and specialists of agricultural enterprises in the implementation of process models in management at agribusiness enterprises.

Updates in the Management of Mild Cognitive Impairment and Alzheimer Disease.

At the end of the activity, participants will be able to:Implement evidence-based methods for cognitive impairment screening in primary care. Identify correct diagnostic criteria for mild cognitive impairment (MCI) and Alzheimer disease (AD) based on current guideline recommendations. Design appropriate and effective treatment plans for patients with MCI and AD and refer to a specialist when necessary. Describe advances in testing and treatment for AD that may impact dementia care.

Poster 111: Poor Inter-observer Reliability of TT-TG Measurement Among Orthopaedic Sports Medicine Surgeons Regardless of Measurement Technique

Objectives:Tibial tubercle-trochlear groove distance (TT-TG) is an important radiologic parameter in the diagnosis and treatment of patellar instability. However, there is substantial heterogeneity in the literature regarding the most appropriate measurement protocol for assessing TT-TG distance. The objective of this study was to evaluate the inter- and intra-observer reliability of TT-TG distance measurement in healthy knees performed by fellowship-trained orthopaedic sports medicine surgeons.Methods:A convenience sample of 29 magnetic resonance imaging scans (MRIs) of the knee was assembled after screening to ensure there was no ligamentous rupture, meniscal pathology, cartilage injury, subchondral edema, or abnormal masses in the bone or muscle. An a priori power analysis determined that this number of MRIs would provide greater than 90% power to detect a statistically significant difference in intraclass correlation of 0.95 (a < 0.05). Three fellowship-trained orthopaedic sports medicine surgeons read the MRIs and recorded the TT-TG distance using their method of choice. After a minimum of 5 months, the MRIs were read again, this time using a standardized evidence-based method to measure the TT-TG distance. Kappa statistics were calculated to evaluate inter- and intra-observer reliability.Results:Among the initial TT-TG distance measurements, kappa was equal to -0.006 (P = 0.690) when assessing inter-observer reliability. Introduction of the standardized measurement protocol was associated with no significant change in inter-observer reliability (kappa = 0.124, P = 0.070). The individual TT slice that was selected for TT-TG distance measurement demonstrated a kappa statistic of 0.192 (P < 0.001) for the surgeons’ method of choice and a kappa statistic of 0.037 (P = 0.455) for the standardized method. Similarly, TG slice selection using the surgeons’ method of choice yielded a kappa statistic of -0.005 (P = 0.949) and a kappa statistic of -0.102 (P = 0.140) for the standardized method.Conclusions:Our findings demonstrate poor inter-observer reliability of TT-TG distance measurement in healthy knees that was not improved with the application of a standardized evidence-based measurement protocol. TT and TG slices selected by surgeons varied widely. Future research should focus on comparing TT-TG distance measurements across a wider variety of knees (ranging from healthy to those with patellar instability), as this may improve the inter-observer reliability of TT-TG measurement.Table I.Variation in TT-TG Distance Measurement and MRI Slice Selection Between Surgeons

A Deweyan Approach to Religious and Moral Education

Pragmatizmin öncü filozoflarından olan John Dewey, genel olarak felsefesinde insanın karşılaştığı problemlere çözümler sunmaya çalışmıştır. Bu çözümlerinde onun düalizme karşı olduğu, insanın çevresiyle uyumuna ehemmiyet verdiği ve insan deneyimini merkeze aldığı görülmektedir. Felsefesinin bu temel özellikleri başta eğitim felsefesi olmak üzere onun din ve ahlaka ilişkin fikirlerinde de öne çıkmaktadır. Dewey’in eğitim felsefesi, deneyime dayalı ilerlemeci bir karakter taşımaktadır. Literatürde Dewey’in eğitim felsefesiyle ilgili çok sayıda araştırma olmasına rağmen onun din ve ahlak eğitimine yönelik yaklaşımını ortaya koyan ikincil bir çalışmaya rastlanmamıştır. Bu makalenin amacı, Dewey’in eserlerinden yola çıkarak onun din ve ahlak eğitimine ilişkin yaklaşımını ortaya koymaktır. Bu amaca bağlı olarak bu araştırmanın sorusu şöyle belirlenmiştir: Dewey’e göre din ve ahlak eğitimi nasıl olmalıdır? Dewey’in din anlayışına bakıldığında, onun düşüncesinde din özel doğruluk iddiaları nedeniyle dogmatik bir alan olarak görülebileceği gibi insana sunduğu açıklıklar nedeniyle bir imkânlar alanı olarak da görülebilir. Bu bağlamda Dewey’in, kurumsallaşmış dinleri eleştirmekle birlikte dini insanın doğal bir eğilimi ve mahrem bir alanı olarak gördüğü anlaşılmaktadır. Buna bağlı olarak da onun, dinin, okullarda bilimsel bir anlayışla ve resmi bir şekilde öğretilmesine sıcak bakmadığı söylenebilir. Bunun nedenleri olarak şunlar sıralanabilir: 1. Herhangi bir dini, okullarda kanıta dayalı bilimsel bir yöntemle ele almanın onun doğasına aykırı olması. 2. Çok kültürlü toplumlarda öğretmek için hangi dinin nasıl seçileceği problemi. 3. Okullarda öğretmek için birden fazla din seçilse bile dinlerin kendilerine mahsus doğruluk iddialarının sosyal bütünlüğe zarar verebilme ihtimali. Görüldüğü gibi Dewey, örgün din eğitimine karşı mesafeli bir yaklaşım sergilese de genel olarak çocukların ve gençlerin din eğitimi almalarına karşı değildir. Bu, onun çocukların ve gençlerin gelişimlerine uygun bir din eğitimi almaları için disiplinler arası bir iş birliğine ihtiyaç olduğunu belirtmesinden anlaşılmaktadır. Dewey’in ahlak anlayışı incelendiğinde, onun düşüncesinde ahlaki eyleme yön veren soyut evrensel bir ilkeye yer verilmediği görülmektedir. Ona göre ahlaki eylemin doğasında belirsizlik ve çatışma vardır. Bunun nedeni ise ahlaki bir eylemde bulunurken çok sayıda farklı kaynaktan gelen etkilerin iç içe girmesidir. Kişi ahlaki bir eylem sırasında, bireysel ve sosyal amaçları dikkate alma, hak ve sorumlulukları gözetme, eylemin sonuçlarını hesap etme ve ahlaki ilkeleri deneyimde doğrulamaya tabi tutma gibi birçok hususu göz önünde bulundurmak durumundadır. Bu süreçlerde akıl ve deneyim iş birliği hâlindedir. Aklın aktif olduğu bir deneyim, ahlaki yaşamın bir rehberidir. Dewey’in bu ahlak anlayışı, ahlak eğitimine ilişkin bakışına da yansımaktadır. Ona göre okullarda, insanın doğasını ve deneyimlerini görmezden gelerek ahlaki ilkeleri teorik bir şekilde öğretmeye çalışmak doğru değildir. Zira ahlak bilgisi, insanı iyi ve karakterli yapmaz, insan ancak deneyimleri aracılığıyla iyiliğe ulaşabilir. O hâlde okullarda ahlak eğitimi verilirken, bu eğitimin insanın doğasına, deneyimlerine ve sosyal yaşamına uygun olmasına dikkat edilmelidir. Dewey’in din ve ahlak eğitimine ilişkin yaklaşımı birlikte değerlendirildiğinde kimi noktalarda benzerlik, kimi noktalarda da farklılık arz ettiği görülmektedir. Benzer noktalardan başlamak gerekirse, Dewey’in her iki konuya yaklaşımında da mümkün mertebe düalizmden kaçındığı, insanın bireysel ve sosyal uyumuna ehemmiyet verdiği ve deneyim temelli bir eğitimi savunduğu söylenebilir. Buna ek olarak o, hem din hem de ahlak konusunda teorik bilgileri insanlara öğretmenin onları daha dindar veya daha iyi yapmayacağı kanaatindedir. Bunun yerine Dewey, insanın doğasına ve deneyimlerine uygun bir din ve ahlak eğitimini önermektedir. Farklılıklara gelecek olursak, Dewey’in, insanın doğasını ve deneyimlerini dikkate alan bir ahlak eğitiminin okullarda bütün bir eğitimle birlikte verilmesinden yana olduğu ancak dinin okullarda öğretilmesine sıcak bakmadığı anlaşılmaktadır. Son olarak bu araştırmada, Dewey’in konuyla ilgili yazılı çalışmaları nitel araştırma yöntemlerinden doküman incelemesi yoluyla incelenmiş ve toplanan veriler içerik analizi ile yorumlanmıştır.

발달장애인 평생교육 전문인력의 전문교사형 자격 융합(convergence) 요구

The purpose of this study was to analyze the needs of the professional teacher-type qualification level in fostering professional human resources for lifelong education for individuals with developmental disabilities. As for the research method, FGI was applied by forming five teams for each job type targeting professors, center directors, special teachers, rehabilitation counselors, and speech language pathologists in related fields. First, it was found that the function and context of the school should be reflected in the training of professional manpower for lifelong education for individuals with developmental disabilities from the perspective of professional teacher type. The sub-basins were analyzed for the disconnection of special teachers, diversified educational institutions, long-term approaches to the specificity of developmental disabilities, university-based leadership, road map structure among career-based institutions, one-time experience activities and simple educational opportunities, and interconnected culture of higher education and lifelong education. In the second upper category, standardization of curriculum guidelines was analyzed. Sub-bases include curriculum guidelines-based education program development and operation diversification, individual lifelong education plan (ILEP) document-based performance management, step-by-cycle learning system based on adult life cycle of individuals with developmental disabilities, and in-depth education according to adult life-based ecological assessment for individuals with developmental disabilities. As the third upper category, the evidence-based teaching -learning method was analyzed, and the application of special education evidencebased teaching and learning method linkage was analyzed as lower grounds. In the fourth upper category, differentiation from existing professional manpower qualifications and work competencies was analyzed, and the boundary of the repetitive tendency of special teachers’ work competencies and the expansion of educational competencies tailored to adults with developmental disabilities in the field of rehabilitation sciences were analyzed. According to the research results, it was analyzed that the level of professional teaching type is important in fostering professional human resources for individuals with developmental disabilities, unlike other types of disability, and to this end, measures such as university-based leadership were reviewed and discussed.

A review on prescription and non-prescription appetite suppressants and evidence-based method to treat overweight and obesity

A review on prescription and non-prescription appetite suppressants and evidence-based method to treat overweight and obesity