Prioritisation Of Issues Research Articles

Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care

BackgroundParamedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making.MethodsThe study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded ‘digital diaries’ (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified.ResultsThe use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research process. Feedback workshops allowed stakeholders to discuss and prioritise findings as well as identify new research areas.ConclusionCombining multiple qualitative methods with a collaborative research approach can facilitate exploration of system influences on patient safety in under-researched settings. The paper highlights empirical issues, strengths and limitations for this approach. Feedback workshops were effective for verifying findings and prioritising areas for future intervention and research.

El diálogo con los grupos de interés en las memorias de sostenibilidad del sector hotelero español

BackgroundRecent years have witnessed an increasing number of companies issuing sustainability reports. However, there are concerns of the extent to which this increase in the number and length of reports have been accompanied with an increase in the accountability and transparency. Scholars have studied the degree of disclosure of environmental, social and economic aspects, while less literature has focused on what companies disclose regarding how the stakeholder engagement has informed the process of reporting. AimThe purpose of this exploratory study is to analyse the transparency of Spanish hotels’ sustainability reports with a focus on stakeholder engagement process as inclusiveness is considered a starting point to materiality and responsiveness. MethodContent analysis of most visible hotels chains and hotels sustainability reports. ResultsSustainability reports are not a generalised practice among hospitality companies. Five sustainability reports show scarce information about how stakeholder engagement process has informed decisions and there is no information about the basis for identification and selection of stakeholders with whom to engage. Only 2 major hotel chains include a materiality analysis omitting the logic behind the prioritisation of issues. ConclusionResults show the level of transparency in the process of determining reports content is very low, companies struggling to apply materiality and a need to increase external assurance.

Substance abuse and the family: An examination of the South African policy context

National policy documents are important platforms for the prioritisation of social issues which is likely to spur research into the development of evidence-based practice guidelines that are effective and cost-efficient. In relation to the impact of substance abuse on the family, carefully designed policies that magnify support for the family can help lessen the burden of substance abuse on families. Using the Family Impact Lens (FIL) framework, this paper explored how family issues in relation to substance abuse are addressed within three South African policy and strategic documents: the Prevention of and Treatment for Substance Abuse (PTSA) Act (2008), the National drug master plan (NDMP; 2013–2017) and the White paper on families in South Africa (2012). In keeping with the framework of the FIL, we evaluated whether the policies (1) mention the effects of substance abuse on the family, (2) recognise the importance of the family in the relative’s rehabilitation and (3) address the needs of family members by providing policy directives to support families who are affected by substance abuse (affected family members (AFMs)). Although all three policies recognise that families are negatively impacted by a relative’s substance abuse, the policies are overly focussed on individual approaches to deal with substance abuse and fail to adequately address the support needs of AFMs. Research on the support needs of AFMs is warranted in addition to the evaluation or development of evidence-based strategies to support AFMs. Further implications and recommendations for policy-makers, researchers and practitioners are provided in the paper.

D2R2: an evidence-based decision support tool to aid prioritisation of animal health issues for government funding

An evidence-based decision support tool, ‘D2R2’, has been developed by Defra. It contains a wide range of standardised information about exotic and endemic diseases held in ‘disease profiles’. Each profile...

Agenda responsiveness in the European Council: public priorities, policy problems and political attention

The existence of political responsiveness in multi-level systems like the EU remains an open question despite significant recent research on the topic. This article studies whether the European Council responds to the shifting policy priorities of European citizens. More specifically, it explores the synchronic and diachronic associations between what people consider to be the most important problems and the political attention devoted to these issues from 2003 to 2014. The economic crisis after 2008 appears to have made the ranking of public concerns and the European Council agenda more alike. However, a detailed examination of the shifts in prioritisation of single issues over time reveals little evidence for dynamic issue responsiveness. Recently the European Council has paid more attention to the issues that the public considered the most pressing problems but the convergence could possibly be driven by the intensity of the underlying policy problems.

Critical review of methodology and application of risk ranking for prioritisation of food and feed related issues, on the basis of the size of anticipated health impact

This study aimed to critically review methodologies for ranking of risks related to feed/food safety and nutritional hazards, on the basis of their anticipated human health impact. An extensive systematic literature review was performed to identify and characterize the available methodologies for risk ranking in the fields of feed and food safety and nutritional hazards, as well as the socio-economic field. Risk ranking methods from the environmental field were studied as well to determine whether approaches used in this field could also be applied for ranking human health risks related to feed and food safety and nutritional hazards. The review used a predefined search protocol. It covered the bibliographic databases Scopus, CAB Abstracts, Web of Sciences, and PubMed over the period 1993-2013. All references obtained were stored into an Endnote database and evaluated for their relevance. All references deemed to be relevant were studied in–depth so as to characterize the risk ranking method described. Characteristics of each method were stored in an Excel database. The methods for risk ranking were then grouped into method categories, which were described in general. These groups included: risk assessment, comparative risk assessment, risk ratio method, scoring method, cost of illness, DALY/QALY, willingness to pay, multi criteria decision analysis, risk matrix, flow charts/decision trees and expert judgment methods. Based on the characteristics of the individual methods and the method categories, an overarching framework was developed for selection of the appropriate method(s) that could be used for risk ranking of feed and food related hazards, on the basis of human health impact. This framework has the format of a decision tool, with which – given the characteristics of the risk ranking question at hand - the most appropriate method(s) can be selected. Application of this overall framework to several case studies showed it can be a useful tool for risk managers/assessors to select the most suitable method for risk ranking of feed/food and diet related hazards, on the basis of expected human health impact.

Application of West Java water sustainability index to Citarum catchment in West Java, Indonesia

Water authorities in West Java, Indonesia have difficulties in implementing water improvement programs due to lack of tools for prioritisation of water-related issues and their respective programs. To facilitate more efficient management of the water resources, the West Java Water Sustainability Index (WJWSI) was recently developed. This paper outlines the tasks for developing WJWSI and highlights the results of its application in one of West Java catchments, Citarum catchment. The results showed that five out of the thirteen indicators and sub-indicators, namely ‘Water Availability, Water Quality, Education, Water Loss and Poverty’, had low sub-indices and thus had poor performances. Then, the sub-indices were aggregated using the geometric aggregation method to produce the final index. The results of the aggregation indicated that the overall condition of water resources in Citarum catchment was considered poor, with a final index value of 20.04. Based on the WJWSI application, recommendations are suggested to the relevant authorities in the Citarum catchment. It is expected that the implementation of these recommendations will improve the performance of these five indicators and sub-indicators from Poor to at least the next higher level of Poor–Medium, thus improving the value of the final index from 20.04 to 37.19.

Prioritisation of companion dog welfare issues using expert consensus

AbstractResources for tackling animal welfare issues are often limited. Obtaining a consensus of expert opinion on the most pressing issues to address is a valuable approach to try to ensure that resources are wisely spent. In this study, seven independent experts in a range of disciplines (including veterinary medicine, animal behaviour and welfare science and ethics) were consulted on the relative prioritisation of welfare issues impacting companion dogs in Great Britain. Experts first anonymously ranked the priority of 37 welfare issues, pre-defined from a literature review and an earlier published survey. In a subsequent two-day panel workshop, experts refined these issues into 25 composite groups and used specific criteria to agree their relative priorities as a Welfare Problem (WP; incorporating numbers of dogs affected, severity, duration and counter-balancing benefits) and a Strategic Priority (SP; a combination of WP and tractability). Other criteria — anthropogenicity, ethical significance and confidence in the issue-relevant evidence — were also discussed by the panel. Issues that scored highly for both WP and SP were: inappropriate husbandry, lack of owner knowledge, undesirable behaviours, inherited disease, inappropriate socialisation and habituation and conformation-related disorders. Other welfare issues, such as obese and overweight dogs, were judged as being important for welfare (WP) but not strategic priorities (SP), due to the expert-perceived difficulties in their management and resolution. This information can inform decisions on where future resources can most cost-effectively be targeted, to bring about the greatest improvement in companion dog welfare in Great Britain.

Development of a Novel Regulatory Pharmacovigilance Prioritisation System: An Evaluation of Its Performance at the UK Medicines and Healthcare products Regulatory Agency

The prioritisation of drug safety issues for further evaluation or regulatory action is critical to ensure that acceptable timelines and appropriate resource allocation are defined to meet public health and regulatory obligations. Our objective was to develop, pilot and implement a novel tool for prioritising pharmacovigilance issues within the Medicines and Healthcare products Regulatory Agency (MHRA). An initial system was developed empirically and then piloted over a 10-month period in the pharmacovigilance signal management meeting at the MHRA that discusses potential pharmacovigilance issues, and determines, through consensus, their priority and a timescale for action. The priority assigned by the tool was compared with the priority decided by collective judgement at the meeting. Once an acceptable level of concordance between the tool and the meeting had been achieved, the finalised tool was implemented into routine use at the MHRA, with an evaluation of its performance conducted after the first year. The Regulatory Pharmacovigilance Prioritisation System (RPPS) tool prioritises pharmacovigilance issues according to the following four broad categories, each with four inputs: strength of evidence, public health implications, agency regulatory obligations and public perceptions. A weighted scoring system links the inputs to a pre-defined number of points where if a threshold is reached then the points are awarded. The overall priority is determined by the sum of all points obtained from each of the inputs. The pilot study included a total of 73 pharmacovigilance issues during the 10-month study period, with an overall exact agreement between the RPPS priority and the collective judgement of the meeting of 60.3%. Where exact agreement was not obtained, the RPPS generally prioritised the issues slightly higher than the meeting. Over the first year following implementation, the RPPS achieved an overall exact agreement of 82.2%. Following the pilot study and implementation at the UK MHRA, the RPPS has provided a systematic approach to drug safety issue prioritisation that should help to reduce the subjectivity of reliance on individual judgement.

Understanding the Threats Posed by Non-Native Species: Public vs. Conservation Managers

Public perception is a key factor influencing current conservation policy. Therefore, it is important to determine the influence of the public, end-users and scientists on the prioritisation of conservation issues and the direct implications for policy makers. Here, we assessed public attitudes and the perception of conservation managers to five non-native species in the UK, with these supplemented by those of an ecosystem user, freshwater anglers. We found that threat perception was not influenced by the volume of scientific research or by the actual threats posed by the specific non-native species. Media interest also reflected public perception and vice versa. Anglers were most concerned with perceived threats to their recreational activities but their concerns did not correspond to the greatest demonstrated ecological threat. The perception of conservation managers was an amalgamation of public and angler opinions but was mismatched to quantified ecological risks of the species. As this suggests that invasive species management in the UK is vulnerable to a knowledge gap, researchers must consider the intrinsic characteristics of their study species to determine whether raising public perception will be effective. The case study of the topmouth gudgeon Pseudorasbora parva reveals that media pressure and political debate has greater capacity to ignite policy changes and impact studies on non-native species than scientific evidence alone.

Local disposition to environmental protection, poverty alleviation and other issues in the sustainable development agenda in Ondo State, Nigeria

Abstract Sustainable development is the global agenda designed to ensure that the world’s climate is not irretrievably damaged and future generations have equal access to the world’s resources for their own development. The institutionalisation of measures to promote sustainable development has however not had unanimous cooperation. This study therefore investigated the attitude of officials at the local government level to topical issues in the sustainable development agenda in Ondo State, Nigeria, as a pointer to entrenched attitudes in the Third World. Prioritisation of issues varied between localities but premium was placed on poverty alleviation more than on climate change or power generation. People were more concerned with the improvement of their general well-being including health. Respondents indicated that most of the topical issues on the sustainable development agenda could be addressed at the local level thereby lending support for the notion that local action can contribute to global action. However, inclusive measures to promote positive action need to be institutionalised.

Assessing the Responsiveness of Spanish Policymakers to the Priorities of their Citizens

This article analyses how well Spanish political elites have responded to the issues signalled as priorities preferred by Spanish citizens from the early 1990s to the present, and to what extent the degree of correspondence between citizens' and policymakers' priorities is related to elections, type of government, issue jurisdiction and institutional friction. To measure this the authors rely on Most Important Problem surveys and several databases on laws, bills, oral questions and annual speeches, coded according to the comparative agendas project. They argue that the prioritisation of issues by political elites better matches public preferences at the agenda-setting stage than at the decision-making stage, and that correspondence of public and policymakers' priorities is inversely related to institutional friction. The evidence also illustrates that policymakers are more responsive to public priorities on those issues without shared jurisdiction, when the executive governs without a majority and immediately after elections.

Moving from evidence to action: prioritisation of pediatric injury issues for focused injury prevention programming

ObjectiveTo develop a prioritised, evidence-informed list of pediatric injury issues to be addressed through injury prevention initiatives.MethodA quantitative review of trauma data with qualitative stakeholder discussions. Data representing all levels...

The relationship between external and local governance systems: the case of Health Care Associated Infections and medication errors in one NHS trust

Background‘Organisational governance’—the systems, processes, behaviours and cultures by which an organisation leads and controls its functions to achieve its objectives—is seen as an important influence on patient safety. The features...

Setting priorities for non-regulatory animal health in Ireland: Results from an expert Policy Delphi study and a farmer priority identification survey

Agriculture is a very important contributor to the Irish economy. In Ireland, national animal health services have been a government, rather than an industry, responsibility. In 2009, Animal Health Ireland (AHI) was established to provide a partnership approach to national leadership of non-regulatory animal health issues (those not subject to national and/or EU regulation). The objectives of this study were to elicit opinion from experts and farmers about non-regulatory animal health issues facing Irish livestock industries, including prioritisation of animal health issues and identification of opportunities to maximise the effective use of AHI resources. The study was conducted with experts using Policy Delphi methodology over three rounds, and with farmers using a priority identification survey. Non-regulatory bovine diseases/conditions were prioritised by both experts and farmers based on impact and international competitiveness. For each high-priority disease/condition, experts were asked to provide an assessment based on cost, impact, international perception, impediment to international market access and current resource usage effectiveness. Further information was also sought from experts about resource allocation preferences, methods to improve education and coordination, and innovative measures to improve prevention and management. There was close agreement between responses from experts and dairy farmers: each gave highest priority to 3 diseases with a biosecurity risk (subsequently termed ‘biosecure diseases’) (bovine viral diarrhoea [BVD], infectious bovine rhinotracheitis [IBR], paratuberculosis) and 4 diseases/conditions generally without a biosecurity risk (‘non-biosecure diseases/conditions’) (fertility, udder health/milk quality, lameness, calf health). Beef farmers also prioritised parasitic conditions and weanling pneumonia. The adverse impact of biosecure diseases is currently considered relatively minor by experts, but would increase substantially in time. There are already substantial costs to farms and agribusiness from non-biosecure diseases/conditions. Experts preferred an equal allocation of resources between these biosecure and non-biosecure diseases/conditions, with emphasis on adopting/adapting international models, education and awareness-raising. The results from this study provide robust insights about non-regulatory animal health priorities in Ireland, as perceived by experts and farmers, using methodologies that are both transparent and inclusive. They have already been extremely influential in shaping national policy, as a foundation for interdisciplinary (and multi-agency) cooperation, as a contribution to efforts to encourage stakeholder responsibility-taking, and to ongoing development of postgraduate and undergraduate veterinary education in Ireland.

Development of a clinician‑led research agenda for general practice nurses

Objective: This study sought to identify and prioritise research issues as perceived by Australian general practice nurses. In this context, a research priority refers to the most pressing research problems that necessitate exploration to improve clinical practice. Design: This paper reports the findings of a two‑round Delphi study. Initially, focus groups identified research issues. Subsequently, an online survey facilitated ranking of these issues on a 5‑point Likert scale. Setting: Australian general practices. Subjects: Twenty‑five practice nurses participated in the focus groups and 145 practice nurses responded to an online survey. Main outcome measure(s): The main outcome measure was the prioritisation of research issues by practice nurses. Results: The focus groups identified 53 research issues. These could be broadly classified as issues related to: (1) the practice nurse role and professional development; (2) general practice service delivery; and (3) disease prevention and health promotion. Survey data identified 34 priority areas from the 53 issues, that were considered important as indicated by a mean score greater than 4.0. These included 17 items related to disease prevention and health promotion, 12 items related to the practice nurse role and professional development and five items related to general practice service delivery. Conclusions: Issues identified in this study reflect current patterns of practice nurse workload. Emphasis needs to be placed on the translation and use of evidence by practice nurses, as well as the ways in which evidence can support and promote development of their role. The study findings highlight the need for research that is responsive to clinical demands.

Engaging service users in the development of stroke services: an action research study

To develop local stroke services by involving, in a meaningful way, those affected by stroke in identifying and prioritising service development issues. Consideration should be given to including the views of service users in the evaluation and re-design of services. In stroke, the involvement of patients and carers in the development of services has generally been at a consultative level. There is a need to explore strategies to engage patients and carers more fully with the service development agenda. Action research. Within the Reflection Phase of this action research study patients' and carers' experiences of stroke services were explored by semi-structured interviews and focus groups. In the Planning and Action Phases, externally facilitated workgroups comprising patients, carers and professionals used a synthesis of the data to identify a range of service development priorities, which informed the development of action plans. Information provision, preparation for transfer of care and the integration of social and leisure activities appear to be priorities for the development of stroke services from the perspective of patients and carers. These findings informed the work of four collaborative workgroups to lead developments in the stroke pathway as follows: stroke prevention and immediate care, early and continuing rehabilitation, transfer of care and long-term support and information provision. Stroke patients and carers played a key and meaningful part in the identification and prioritisation of service development issues. External facilitation ensured progress with service development and maintaining patient and carer participation. Several pragmatic recommendations for enhancing the local delivery of stroke services were made. With external facilitation it is possible for stroke service users to take a meaningful role in service developments that moves beyond consultation.

The politics of symbolism: Richard Nixon's appeal to white ethnics and the frustration of realignment 196972

Sensing a tangible political opportunity to bolster his and his party's minority status, Richard Nixon made an unprecedented attempt to align disaffected ethnic Americans with the Republican Party in the late 1960s and early 1970s. Nixon possessed a keen awareness of the ethnic revival of the early 1970s and engaged with specifically ethnic issues such as parochial school aid and ethnic heritage studies, and also shaped much of his early substantive policy to appeal to ethnics, culminating in the publication of the Rosow Report on blue-collar workers in May 1970. However, Nixon's presidential style and eventual prioritisation of symbolic or ephemeral issues, notably the appointment of ethnic Americans to government positions, over more substantive policy doomed any attempt to build a new Republican majority to failure. If white ethnic voters were to realign, Nixon would need to offer enduring presidential policy that appealed to their ethnic and class interests, but his politics of symbolism subjugated his plans for a new Republican majority to quick-fix tactics for ensuring his re-election.

Integrated Computational Methods for Prediction of the Lowest Observable Adverse Effect Level of Food‐Borne Molecules

AbstractIn this work we present an integrated system partly based on the commercially available software TOPKAT, which predicts chronic toxicity through provision of a computational estimation of Lowest Observed Adverse Effect Level (LOAEL) values. We found evidence that the LOAEL correlated with a specific class of molecular descriptors, known as 2D autocorrelation descriptors. The system developed is found to be helpful in supporting – with reasonable confidence – the prioritisation of issues in chemical food research, by establishing levels of safety concern in the absence of sufficient experimental toxicological data.

Unpacking developmental local government using Soft Systems Methodology and MCDA tools

This paper presents two different analytical approaches that may be useful in developing an understanding of developmental local government (DLG). DLG implies a significant commitment with respect to poverty relief at the local administrative level as well as strong emphasis on participation and accountability to communities1. This paper attempts to apply Soft Systems Methodology (SSM) to clarify the activities that DLG implies for local authorities and focuses specifically on their ability to be developmental and to effectively impact upon poverty. An expected product of this approach will be the identification of specific indicators of (inter alia) poverty that may be used to monitor the effectiveness of local government from a constitutional and developmental perspective. Indicators may also be generated from the perspective of community needs and this paper reports on a case study which identifies the needs of a small community, Pniel, in the South African Western Cape, using a Multi-Criteria Decision Analysis approach. This approach allows for both the identification and prioritisation of issues from the perspective of the community. Further, it is suggested that the SSM approach can be used to provide a context within which community needs may be considered. This framework clarifies what it is that local government have the aims, powers and functions to perform. Viewing the community needs within this framework provides a mechanism for realistically linking the community needs to the local authority’s budget. A process of ongoing monitoring and evaluation of DLG, using the two sets of indicators, can assist to focus the functioning of local government on effective poverty relief.