Practice Model Research Articles

Pulmonary embolism risk stratification: external validation of the 4-level Clinical Pretest Probability Score (4PEPS)

BackgroundThe 4-level clinical pretest probability score (4PEPS) was recently introduced as a clinical decision rule for the diagnosis of pulmonary embolism (PE). Based on the score, patients are classified into clinical pretest probability categories (c-PTP). The “very low” category aims at excluding PE without further testing; “low” and “moderate” categories require D-dimer testing with specific thresholds, while patients with a “high” pretest directly proceed to imaging. ObjectivesTo provide further external validation of the 4PEPS model. MethodsThe 4PEPS was applied to a previously collected prospective database of 756 patients with clinically suspected PE enrolled from European emergency departments in 2002 to 2003. The safety threshold for the failure rate in our study was calculated at 1.95% based on a 26% prevalence of PE in our study, as per the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee guidance. ResultsPatients were classified as follows: 90 (12%) in the very low c-PTP group, of whom 5 (5.6%; 95% CI, 2.4%-12.4%) had PE; 363 (49%) in the low c-PTP group, of whom 34 had PE (9.4%); 246 (34%) in the moderate c-PTP group, of whom 124 (50%) had PE; and 35 (5%) in the high c-PTP group of whom 30 (86%) had PE. Overall, the failure rate of the 4PEPS was 9/734 (1.2%; 95% CI, 0.59%-2.23%) Overall, 9 out of 734 patients (1.2%; 95% CI, 0.59%-2.23%) were diagnosed with PE despite a negative 4PEPS rule; 5 (5.6%) from the very low c-PTP group, 3 (1.4%) in the low c-PTP group, and 1 (3.2%) in the moderate c-PTP group. ConclusionWe provide external validation data of the 4PEPS. In this high-prevalence cohort (26% prevalence), PE prevalence in the very low-risk group was higher than expected. A prospective validation study is needed before implementing the 4PEPS model in routine clinical practice.

Nurses' evaluation of a professional practice model: Increasing relevancy and sustainability.

Nurses' evaluation of a professional practice model: Increasing relevancy and sustainability.

The Effectiveness of Implementing Nursing Professional Practice Model on Nurses' Work Engagement

The Effectiveness of Implementing Nursing Professional Practice Model on Nurses' Work Engagement

The Inquiry-Driven VCoP Model to Promote Digital Agriculturalists’ Learning Competencies in the Agriculture 4.0 Era

This research was conducted to develop the Inquiry-Driven Virtual Communities of Practice model (The ID VCoP model) in order to enhance the learning competencies of Thai digital agriculturists in preparation for the agriculture 4.0 era. The objectives of this study were to 1) develop the ID VCoP model to promote digital agriculturalists’ learning competencies, and 2) evaluate the suitability of the ID VCoP model. The research procedure consisted of two phases. The first phase involved the development of the model: 1) studying, analyzing, and synthesizing existing documents and previous research findings; 2) organzing the ID VCoP model; and 3) establishing the ID VCoP model. The second phase involved model validation and evaluation. This study’s expert panel was divided into two expert groups: 1) qualitative research by the focus group method, consisting of seven experts recruited through purposive sampling; and 2) quantitative research by the expert judgment method, consisting of five experts recruited through purposive sampling. Five components with 19 subcomponents comprise the model’s structure. The model contributes to VCoP members’ digital agriculturalists’ learning competencies. Experts agreed that the model as a whole was suitable at a very high level.

Simulation Modeling of Information Transfer Between Stock Exchanges Based on a Multi-Agent Model

The article substantiates the relevance of solving the problem of stock exchange modeling as an information system accumulating the orders of market participants and executing them. The object of the study is the process of information transfer between stock exchanges. The subject of the study is the use of simulation multi-agent model to study the process of information transfer between stock exchanges. The paper analyzes the possibilities of building a simulation model to analyze rare phenomena in the financial market using a multiagent approach. It is substantiated that this approach allows taking into account those features of complex dynamic systems, for which either no effective analytical approaches have been developed or it is impossible to conduct the necessary numerical experiments. The proposed logic of the market simulator is based on the allocation of certain trader classes, that may differ in the logic of making their decisions on the stock exchange, for this purpose the scheme of agent interaction in the model of the stock exchange is described. On the example of modeling the information transmission and market shocks between markets the possibilities of the proposed simulator are studied. The use of the proposed model in practice allows us to analyze rare phenomena occurring on the stock exchange, which cannot be described analytically, but their recreation by means of the simulation model will allow us to study them. The study of rare phenomena on the stock exchange with the help of simulation modeling allows to obtain different variants of the results of the phenomena at different sets of parameters of the model (agents), i.e. to carry out parameter.

Three-Tiered Communities of Practice and Professional Development Model

Many global studies indicate academicians in higher education institutions are alone in their development journey. When the Ministry of Higher Education Malaysia had set in motion Higher Education 4.0, focus was on academicians’ Professional Development (PD), to adapt Learning and Teaching 4.0. This is a qualitative case study on a Malaysian private higher educational institution that fostered PD by creating organizational Communities of Practice (CoP). Focus group discussions with fourteen experienced academicians who were actively involved in many CoPs, revealed in-depth knowledge on the workings of CoPs. The results were further reviewed by two subject matter experts in CoP, a Malaysian professor from an esteemed national university and an international consultant on group mentoring for organizational development. The study found CoPs benefitted the academicians to improve and sustain technologically advanced pedagogical methods and other academic duties towards Education 4.0. Additionally, organizational development was evident because of the CoPs, as these academicians’ won awards at exhibitions, produced more publications, improved the overall standards of teaching and classroom management. This study revealed organizational CoPs have three levels of workings to be nurtured for its efficiency and sustainability, the individual CoP members, the CoP and the organization where its embedded, thus the development of the Three-Tiered CoP and PD model.

A Study on the Potential of Site-Specific Theatre as Content for Liberal Arts Education

This study proposes a teaching model for liberal arts education utilizing site-specific theater and examines its implications. By exploring various theoretical backgrounds and practical examples related to place-specific theater, the course covers a variety of concepts and deepens students' knowledge of theater. Theoretical explorations are followed by practical activities that encourage creative and critical thinking and provide opportunities to exercise the theatrical imagination. Practical activities provide learners with important experiences that allow them to see everyday spaces in a new light and to extend theater to personal and social meanings. There are also opportunities for students to watch and critique the work of other learners and to reflect on their own work in order to consolidate their knowledge and experience and to acquire new questions. The whole process is an educational one that leads to embodied knowledge. This study argues that theater, especially place-specific theater, is suitable content for liberal arts education, promoting learners' creativity and critical thinking skills, and offering another model of practice.

Community health practice: the Nigerian model

The Nigerian model of community health practice is a unique approach to healthcare delivery that emphasizes the involvement of community members in the planning and implementation of healthcare services. This model is based on the principle that healthcare should be accessible, affordable, and equitable for all members of the community. This review focused on the Nigerian model of community health practice yesterday, today, and in the future. Findings indicated that the Nigerian model of community health practice was established in 1978 and is characterized by the use of community health practitioners who have acquired National Diplomas, Higher National Diploma, Bachelor, Master and Ph.D. degrees in Community Health. They are licensed by the Community Health Practitioners Registration Board of Nigeria to provide basic healthcare services such as health education, preventive care, treatment of common illnesses, maternal and child health services, and family planning at primary health centers and community levels. While the model of community health practice has faced significant challenges, including inadequate funding, lack of infrastructure, and a shortage of trained personnel, it has demonstrated promising results in improving healthcare access and outcomes in rural communities. The Nigerian Model of community health practice holds important lessons for other countries seeking to strengthen their primary healthcare systems.

Integrating Models of Observing and Observed Activities Based on an Example of Empirical Research in Information Systems Discipline

A situation where both observing and observed activities need to be taken into consideration is not uncommon in practice. In Viable System Model (VSM), System 3* is dedicated to making sudden inspections on how the work is done “on the floor”. A typical case in research is an empirical study, where research activities are aimed at understanding the activities of the object under investigation. Though separate models of the observation activity and the observed activity are often presented, having an integrated model that connects both often falls under the radar. This article investi-gates how the latter model can be built and used in empirical research pro-jects in the Information System (IS) discipline. Articles in the IS field pre-senting research projects that use data from practice, as a rule, describe the practice and research process, including which research methods have been used for obtaining and analyzing the data. Some articles present models of practice under investigation using appropriate modeling notations. Some ar-ticles present a research process in some graphical form. However, to the best of our knowledge, there is no established practice of presenting a model that interconnects practical and research activities. This article tries to fill the gap, and it presents some ideas on how to build a model that inte-grates observing and observed activities. Such a model can be used for planning a research project and to better understand the limitations of the approaches used or to be used in the project.

The Dynamics of University-School Partnerships in Teacher Education Practicum: A Comprehensive Analysis and Framework for Successful Implementation

This research delves into the dynamics of university-school partnerships in the context of the teaching practicum at the Open University of Sri Lanka, aiming to develop a framework for successful implementation. The study recognizes the critical role of the teaching practicum in shaping effective educators and acknowledges the diverse teacher education programs offered by the Faculty of Education. The literature review establishes the importance of the teacher education practicum, emphasizing its role as a bridge between theoretical knowledge and practical classroom experiences. University-school partnerships are explored as integral to the success of the practicum, with various models identified, including the clinical practice model and co-teaching model. Challenges in these partnerships, such as communication gaps and differing expectations, are discussed. Existing frameworks and strategies for successful implementation are also examined, highlighting the need for a collective approach and reciprocal learning models. The methodology involves a qualitative research approach, including documentary analysis and focus group discussions with master teachers and university academics. The research objectives include identifying the existing framework of the teaching practicum, exploring strategies for enhancing its quality, and establishing a new school-university partnership framework. Results and discussions present the existing framework of the teaching practicum at the Open University of Sri Lanka, emphasizing specific assessment mechanisms and school-based projects. Stakeholders' perspectives contribute to the formulation of innovative strategies, such as improving program interactions, building partnerships with model schools, and creating a stable master-teacher pool. A conceptual framework/model is proposed, illustrating the collaborative synergy between the university and schools to optimize the teaching practicum. In conclusion, the study underscores the critical role of a robust university-school partnership in the success of the teaching practicum. Recommendations include enhancing communication, capacity building for examiners, implementing innovative partnership strategies, maintaining a stable master teacher pool, establishing empirical arrangements, and creating a dedicated helpdesk. The research findings provide valuable insights for improving the quality and impact of the teaching practicum at the Open University of Sri Lanka.

The BCG Economic Model in Practice: A Case Study of Thai Eastern Eco-Industrial Land

The BCG Economic Model in Practice: A Case Study of Thai Eastern Eco-Industrial Land

THE INFLUENCE OF MENTORING AND INSTITUTIONAL PARTNERSHIPS ON GOOD PRACTICE MODELS AND PROFESSIONAL TRAINING IN SOCIAL WORK

The relationship with social institutions and the business environment is an essential component both in terms of the employability of graduates of the Social Work specialization and the adaptation of educational plans, of the contents taught to the existing changes in the economic and social environment by consulting employers and professional associations. Beyond the institutional, administrative, and legislative aspects regarding the training of professionals in the field of social assistance, the usefulness of mentors and models of good practice is considered. The practical research from the social assistance specialization of the "Alexandru Ioan Cuza" University of Iași regarding the importance and usefulness of students' practice in their professional training, had as its objectives the identification of difficulties in training professional skills for obtaining skills, the collaboration between professionals and practicing students, the importance practices for social assistance specialization, identifying the perception of professionals towards practicing students as well as identifying the professional's image as a mentor and model for them. The questionnaire was used for the practice coordinators, and for the undergraduate students from the social assistance specialization, reports of the practical activity, structured thematically, were used. The conclusions of the research highlighted their perceptions on the role and training of social workers through practice activity as well as the practical implications and benefits of inter-institutional collaboration in professional training.

The science of families: Nurturing hope, happiness, and health

AbstractObjectiveAuthors explored ways to understand how families and communities remain hopeful, happy, and healthy.BackgroundThe 2021 National Council on Family Relations annual conference set the groundwork for the special issue, The Science of Families: Nurturing Hope, Happiness, and Health, asking authors to take a strength‐based, transformative, and trans‐ and interdisciplinary perspective.MethodsTwo translational methodologies are offered: the inclusive cultural‐variant community‐based participatory research model (ICV‐CBPR) and Communities of Practice. The six emerging themes and a summary of the connotations of hope, happiness, and health are described in the articles.ResultsThe six emerging themes that connoted the meaning of hope, happiness, or health across 30 manuscripts included (a) the COVID‐19 pandemic and health, (b) diversity, equity, inclusion and accessibility, (c) family policies and academic program needs, (d) military families, (e) contemporary family topics, and (f) research innovations. In one third of the articles, authors transformed implications, with all authors offering practical and research implications.ConclusionsHealth and happiness were often implied in notions of resilience, relationship quality, parenting, and coping. Just over half of the articles (n = 16) directly or indirectly referenced COVID‐19, health, and diversity, equity, inclusion and accessibility. Other topics comprised mental and physical health, resilience, the social construction of gender, and military families. Some authors provided concrete suggestions; all submitted research and practical implications.ImplicationsThe movement toward Family Science disseminating and transforming research is moving forth. The diversity of topics, disciplines, and countries (n = 9) aligns with the inclusion and diversity goals of Family Relations.

Hiring Permanently Remote Clinical Staff at University Counseling Centers: A Descriptive and Qualitative Exploration of Barriers and Implications for Student Mental Health

ABSTRACT The COVID-19 pandemic has had a marked influence on the nature of psychotherapy in the transition from predominantly in-person services to predominantly remote, telemental health services, to an intermediary hybrid model. Increased availability of telehealth services has been denoted a point of equity in meeting service needs of diverse groups of people across the United States. However, some University and College Counseling Centers (UCCCs) have rapidly rolled back telemental health provisions in favor of in-person or hybrid models of practice, even amidst increased use of counseling services, pressure to expand service availability, and difficulties with clinical staff retention. To explore this phenomenon, 75 UCCC administrators in the U.S. were surveyed to elucidate the nature of remote staffing in UCCCs, including administrative perspectives regarding barriers to hiring permanently remote staff (PRS). Five thematic barriers to hiring PRS were identified: Institutional Roadblocks, Team Ethos, Equity in Clinical Duties, Student Demand, and Service Quality Concerns. A majority of these barriers coded into categories that were chronic and autonomy-limiting in nature. Implications and recommendations for UCCCs and college student wellness are discussed.

Development of a simulation model of the activities of a transport and forwarding enterprise in the organization of international road cargo transportation

The object of this study is the process of planning the work of a transport and forwarding company when serving different categories of customers who need organizational support for the delivery of goods by road transport in international traffic. The solved problem is due to the need to devise recommendations for organizing the work of forwarders when interacting with customers of transport and forwarding services that export or import different categories of cargo. A simulation model of the transport and forwarding company’s work in customer service was developed and implemented in the GPSS World simulation automation package. The model provides for the optimization of organizational and management processes in cooperation with customers of transport and forwarding services. When developing the model, the duration of the types of work in which freight forwarders are involved in the export and import of goods by road transport was taken into account. The model also predicts the probability of errors in the forwarder’s work and the duration of their elimination. The application of the developed model in practice will enable the owners of transport and forwarding companies to plan the full-time number of forwarders and the duration of service provision under different conditions of interaction with customers. The simulation results reflect the performance indicators of the enterprise in serving different categories of customers. This will make it possible to optimize the work of the enterprise by planning personnel support. At the same time, the duration of transport and forwarding services will be reduced by 10–15 %, the capacity of the enterprise will increase by 6–11 %, and the reliability of service provision will increase by 8–14 %

Transfer Learning for Anomaly Detection Using Bearings' Vibration Signals

Predictive maintenance is becoming increasingly important in the industry. Despite considerable advances in data collection and data-driven models, there are still limitations when deploying models in practice. One of the main limitations is the large datasets required to train these models. As a potential solution, transfer learning can be used to reuse knowledge acquired from large datasets for similar tasks under different conditions. This paper investigates the transferability of the specific anomaly detection scenario, an unsupervised learning task with heavily imbalanced label distribution. This paper uses a dataset generated from a bearing test platform in which bearings are run until failure under different operating conditions. A lightweight deep learning model, MobileNetV2, is employed to create a baseline model capable of detecting anomalies for a specific working condition. The model is then adapted using transfer learning to identify anomalies under new operating conditions with limited data accurately. The results show that the data for new conditions is insufficient to train an adequate model and that transfer learning can overcome this limitation. The adapted models can detect anomalies before the expert's knowledge reference value. Although this shows that transfer learning can detect anomalies earlier, the results must be evaluated carefully to avoid false positives. While anomaly detection aims to identify changes in feature distributions, transfer learning aims to align different feature distributions. Transfer learning for unsupervised learning has rarely been explored. To the best of our knowledge, this is one of the few works addressing it in the context of predictive maintenance for anomaly detection.

Evaluation Capacity Building for Integrated Care Models in Practice

Quality and timely evaluation is key in creating a sustainable integrated care; however, it requires resources, expertise, and capacity building. Evaluation capacity building (ECB) is the process of improving an organization’s capacity to conduct rapid cycle evaluations by building knowledge and skills within the organisation. The process involves behavioral changes and could enhance collective capability to generate evidence for informed decision-making. ECB can be a complex process and it could become even more complicated in the context of integrated care where several organizations are involved. However, ECB could lay the groundwork for a stronger collaboration and eventually lead to achieving goals such as improving population health, patient/caregiver and provider experience, value for money, and equity (quintuple aim).
 The workshop is built on the following three questions:
 1.What is the state of the art on evaluation of integrated care?
 
 The workshop will focus on presenting evaluation approaches and techniques such as developmental, ethnographic, and realist evaluations, as well as quantitative methods such as comparative effectiveness)
 
 2.What can be done internally to build local capacity? What are some main considerations?
 
 We present a case study from Toronto, Canada. In partnership with Health System Performance Network, East Toronto Health Partners (ETHP) have invested in building internal evaluation capacity since 2020 to support learning, knowledge transfer, and decision making for scale and spread of their new models of care. We will talk about how ETHP made decisions about what they would evaluate, what/ who was needed to do this, and how they decided that it was possible to achieve their goals.
 From a local capacity perspective, we will also focus on intervention-level evaluation (i.e. understanding the goals of the intervention, the activities and their links to goals, and the ‘countable’ ‘measurable’ aspects of implementation (processes), and data collection, analysis, and interpretation).
 
 3.What are some practical tools that can be used for internal capacity building?
 
 We will share some practical tools with the audience including logic model and evaluation plan templates that were developed by HSPN/ETHP.
 
 We propose a 120-minute workshop with the following structure: 
 1)Welcome (5 minutes)
 2)Theory burst: State of the art (30 minutes)
 3)Group discussion: Getting to know each other and report back (20 minutes)
 4)Break (10 minutes)
 5)Case study: East Toronto Health Partners Journey (20 minutes)
 6)Fireside chat: A facilitated discussion on building evaluation capacity (20 minutes)
 7)Evaluation toolkit presentation (10 minutes)
 8)Wrap up (5 minutes)
 We will engage the audience by sharing practical example and inviting them to relate what they have learnt to their evaluation needs. We will share an evaluation toolkit with the audience as a way to summarize the take home messages of the workshop.

Co-creating a novel practice model for connecting oral health- and home health care services – The importance of the users’ experiences

Introduction and aim: Our society is faced with an increased number of elderly patients living at home with poor oral health status. Internationally and in Norway, the home health care service (HHCS) and the dental health care service (DHCS) are disbanding, resulting in a lack of adequate and coordinated oral health services. In the development of the intervention “Connecting ORAL health- and home health care service for patients receiving home health care” (CORAL), we recognised that user involvement was essential in the design of a coherent practice model. However, it has been debated whether users are listened to or whether they act as tokens when participating in development of interventions. The aim was therefore to investigate how different users expressed their perspectives in the co-creation process of the CORAL intervention.
 Methods: Three different user groups from which five patient representatives, three HHCS and five DHCS participated in two workshops. The workshops were based on innovation theories and led by researchers. To promote a creative and feasible dialogue among the users, a case was used as a boundary object in the discussions. All the user groups were encouraged to contribute with their knowledge and experiences in conversations about what they considered important in the development of a context-specific intervention to connect HHCS and DHCS. All conversations at the workshops were audio recorded and analysed using a thematic analysis approach.
 Results: The analysis of the development process showed that the different user groups’ perspectives varied. HHCS and DHCS were more active and had a stronger “voice” during the workshops than patient representatives. We did not find any distinct disagreement at the workshops. However, the various user groups had slightly different perspectives on what was highlighted as important in the development of a context-specific intervention. There are common elements among the users; for example, they all emphasised oral health knowledge as important. Patient representatives expressed that they need knowledge about oral health rights, HHCS expressed that they needed knowledge about oral health care and DHCS expressed that they could teach the requested knowledge to the other two groups. Furthermore, the users highlighted the current service organisation and contact between the services as challenging. The patient representatives expressed a need to ensure the continuity of care as they were the ones who provided contact between the services. HHCS and DHCS expressed that they needed patient information from each other, and both service representatives gave examples of how challenging it was to collaborate with each other.
 Conclusion: Overall, the results showed that the three user groups have different perspectives, which highlight the importance of including all end users in the development process of an intervention. However, we acknowledge that the patient representatives’ “voice” was somewhat unclear due to their relatively inactive participation in the conversations.
 Implications: Designing an intervention together with the end users may lead to successful uptake among the user groups. However, inequality in user participation, may lead to diminished adaptation of the intervention to the user group whose opinions are least expressed.

Comparative evaluation of methods for obtaining the stress-free geometry of keratoconus corneas with different levels of severity

A biomechanical model that simulates the physiological pressure load on the cornea without considering the stresses in vivo will result in an overstress or underestimation of the stress field and incorrect deformation of the corneal structure. Therefore, it is essential to propose numerical models that consider the stress-free geometry of the cornea. In this study, the Displacement and Pre-stress methods were compared to obtain the stress-free geometry (S-FG) and the physiological estimated geometry (P-EG), based on the patient-specific geometric behavior and the computational time required to reach each geometry. The same shape and contour conditions were considered in the models obtained from both methods for each of the pathological scenarios analyzed. Both methods behaved differently to obtain the free geometry, and this difference increased with the severity grade of the disease. However, they behaved in a similar way to reach the physiological estimated geometry. The Displacement method required a lower computational cost to reach the free geometry, with both methods presenting a similar computational cost to obtain the physiological geometry. The stress-free geometries obtained by both methods allowed to characterize the existing biomechanical decompensation during the progression of the diseases. In conclusion, the calculation of the stress-free corneal geometry associated to the clinically measured intraocular pressure with the Displacement and Prestress Methods in keratoconus eyes allows the development of accurate and useable models in clinical practice in real time. This displacement method shows some benefits in terms of computational cost.

Putting patients’ goals first: strategies and challenges through the eyes of primary care stakeholders

Introduction: Primary care is in constant transformation to optimize integrated care delivery according the increase of people with multiple and long-term care needs. One of the suggested strategies is person centered integrated care (PC-IC). PC-IC has an explicit focus on patients’ personal goals. This should reorient care delivery from the focus on disease oriented quality indicators to outcomes that matter to people. To get this focus on patients goals implemented throughout the system, actions in practice, research, education and policy are required.
 Aim: This study aims to explore the experiences of primary care providers, scholars and policy makers towards putting patients’ goals first in primary care, the strategies they use, and challenges they encounter.
 Methods: Primary care stakeholders (n=41) - recruited via maximal variation purposive sampling- participated in six focus groups. Data were collected through a semi-structured interview guide, audio recorded, and analyzed following a phenomenological-hermeneutical philosophy of Lindseth and Norberg.
 Results: All participants emphasized their fundamental commitment in putting patients' goals first. Participants who were active in patient care discussed how they enabled patients to talk about their values and personal stories in order to elicit their personal goals. They also attempted to establish a balanced relationship by integrating their medical expertise with the goals of their patients. Participants stated that they listened to the goals of patients' significant others in order to gain common understanding on goals and recognize everyone's contribution to the care process. Finally, they used patients’ personal goals as a focus for guiding interprofessional collaboration. Both the clinicians and scholars stressed that (future) care providers need more training to develop the competencies necessary to discuss patients' personal goals and integrate them into care delivery. According to policy, all types of participants agreed that there’s challenges related to organizational constraints, such as time restrictions and a lack of registration systems.
 Discussion: The results of this study provide an integrated perspective on the strengths, weaknesses, opportunities and threats for adopting an explicit focus on patient goals throughout the system. In order to support primary care stakeholders to fully engage in the adoption of patients' personal goals in care delivery, the development of models of practice, training and policy plans from a person-centered integrated system approach are required.