Amblyopia treatment : an evidence-based approach to maximising treatment outcome

The basis of treatment for amblyopia (poor vision due to abnormal visual experience early in life) for 250 years has been patching of the unaffected eye for extended times to ensure a period of use of the affected eye. Over the last decade randomised controlled treatment trials have provided some evidence on how to tailor amblyopia therapy more precisely to achieve the best visual outcome with the least negative impact on the patient and the family. This review highlights the expansion of knowledge regarding treatment for amblyopia and aims to provide optometrists with a summary of research evidence to enable them to better treat amblyopia. Treatment for amblyopia is effective, as it reduces overall prevalence and severity of visual loss in this population. Correction of refractive error alone significantly improves visual acuity, sometimes to the point where further amblyopia treatment is not required. Atropine penalisation and patch occlusion are effective in treating amblyopia. Lesser amounts of occlusion or penalisation have been found to be just as effective as greater amounts. Recent evidence has highlighted that occlusion or penalisation in amblyopia treatment can create negative changes in behaviour in children and impact on family life. These complications should be considere when prescribing treatment because they can negatively affect compliance. Studies investigating the maximum age at which treatment of amblyopia can still be effective and the importance of near activities during occlusion are ongoing.

Evidence-based practice and information literacy

Evidence-based Practice (EBP) has recently emerged as a topic of discussion amongst professionals within the library and information services (LIS) industry. Simply stated, EBP is the process of using formal research skills and methods to assist in decision making and establishing best practice. The emerging interest in EBP within the library context serves to remind the library profession that research skills and methods can help ensure that the library industry remains current and relevant in changing times. The LIS sector faces ongoing challenges in terms of the expectation that financial and human resources will be managed efficiently, particularly if library budgets are reduced and accountability to the principal stakeholders is increased. Library managers are charged with the responsibility to deliver relevant and cost effective services, in an environment characterised by rapidly changing models of information provision, information access and user behaviours. Consequently they are called upon not only to justify the services they provide, or plan to introduce, but also to measure the effectiveness of these services and to evaluate the impact on the communities they serve. The imperative for innovation in and enhancements to library practice is accompanied by the need for a strong understanding of the processes of review, measurement, assessment and evaluation. In 2001 the Centre for Information Research was commissioned by the Chartered Institute of Library and Information Professionals (CILIP) in the UK to conduct an examination into the research landscape for library and information science. The examination concluded that research is “important for the LIS [library and information science] domain in a number of ways” (McNicol & Nankivell, 2001, p.77). At the professional level, research can inform practice, assist in the future planning of the profession, raise the profile of the discipline, and indeed the reputation and standing of the library and information service itself. At the personal level, research can “broaden horizons and offer individuals development opportunities” (McNicol & Nankivell, 2001, p.77). The study recommended that “research should be promoted as a valuable professional activity for practitioners to engage in” (McNicol & Nankivell, 2001, p.82). This chapter will consider the role of EBP within the library profession. A brief review of key literature in the area is provided. The review considers issues of definition and terminology, highlights the importance of research in professional practice and outlines the research approaches that underpin EBP. The chapter concludes with a consideration of the specific application of EBP within the dynamic and evolving field of information literacy (IL).

Are library and information professionals ready for evidence based practice?

Evidence based practice (EBP) is recognised as a way of improving the quality of professional practice in many disciplines however its adoption within library and information sciences (LIS) has been gradual. The term was first introduced into the library and information profession‟s vocabulary a decade ago but an impediment to its uptake is the lack of clear understanding regarding how LIS practitioners understand the concept. Partridge, Thorpe, Edwards and Hallam (2007) identified the need to understand how LIS professionals experience or understand evidence based practice and proposed a model of four categories of experience to describe how LIS professionals experience EBP. This paper extends that framework by refining the different conceptions of evidence based practice and identifying relationships which exist between the categories of experience to provide a rich description of the EBP phenomenon. The paper also argues that the phrase “evidence based librarianship” and its variations be abandoned as practitioners do not see a distinction between EBP as applied to librarianship and information practice and industry specific jargon like “evidence based library and information practice”. This research will help current and future LIS practitioners, leaders and educators engage more actively in the establishment of an evidence based culture to improve library and information practice in Australia and internationally.

Sampling perceptions; testing reality : an evidence-based approach to measurably improve information literacy and student research skills

Do commencing students possess the level of information literacy (IL) knowledge and skills they need to succeed at university? What impact does embedding IL within the engineering and design curriculum have? This paper reports on the self-perception versus the reality of IL knowledge and skills, across a large cohort of first year built environment and engineering students. Acting on the findings of this evaluation, the authors (a team of academic librarians) developed an intensive IL skills program which was integrated into a faculty wide unit. Perceptions, knowledge and skills were re-evaluated at the end of the semester to determine if embedded IL education made a difference. Findings reveal that both the perception and reality of IL skills were significantly and measurably improved.

Testing the effectiveness of a Practice Development intervention on changing the culture of evidence based practice in an acute care environment

In this age of evidence-based practice, nurses are increasingly expected to use research evidence in a systematic and judicious way when making decisions about patient care practices. Clinicians recognise the role of research when it provides valid, realistic answers in practical situations. Nonetheless, research is still perceived by some nurses as external to practice and implementing research findings into practice is often difficult. Since its conceptual platform in the 1960s, the emergence and growth of Nursing Development Units, and later, Practice Development Units has been described in the literature as strategic, organisational vehicles for changing the way nurses think about nursing by promoting and supporting a culture of inquiry and research-based practice. Thus, some scholars argue that practice development is situated in the gap between research and practice. Since the 1990s, the discourse has shifted from the structure and outcomes of developing practice to the process of developing practice, using a Practice Development methodology; underpinned by critical social science theory, as a vehicle for changing the culture and context of care. The nursing and practice development literature is dominated by descriptive reports of local practice development activity, typically focusing on reflection on processes or outcomes of processes, and describing perceived benefits. However, despite the volume of published literature, there is little published empirical research in the Australian or international context on the effectiveness of Practice Development as a methodology for changing the culture and context of care - leaving a gap in the literature. The aim of this study was to develop, implement and evaluate the effectiveness of a Practice Development model for clinical practice review and change on changing the culture and context of care for nurses working in an acute care setting. A longitudinal, pre-test/post-test, non-equivalent control group design was used to answer the following research questions: 1. Is there a relationship between nurses' perceptions of the culture and context of care and nurses' perceptions of research and evidence-based practice? 2. Is there a relationship between engagement in a facilitated process of Practice Development and change in nurses' perceptions of the culture and context of care? 3. Is there a relationship between engagement in a facilitated process of Practice Development and change in nurses' perceptions of research and evidence-based practice? Through a critical analysis of the literature and synthesis of the findings of past evaluations of Nursing and Practice Development structures and processes, this research has identified key attributes consistent throughout the chronological and theoretical development of Nursing and Practice Development that exemplify a culture and context of care that is conducive to creating a culture of inquiry and evidence-based practice. The study findings were then used in the development, validation and testing of an instrument to measure change in the culture and context of care. Furthermore, this research has also provided empirical evidence of the relationship of the key attributes to each other and to barriers to research and evidence-based practice. The research also provides empirical evidence regarding the effectiveness of a Practice Development methodology in changing the culture and context of care. This research is noteworthy in its contribution to advancing the discipline of nursing by providing evidence of the degree to which attributes of the culture and context of care, namely autonomy and control, workplace empowerment and constructive team dynamics, can be connected to engagement with research and evidence-based practice.

Developing a culture of enquiry to sustain evidence-based practice

Evidence-based practice (EBP) is having a significant effect on the health service environment. It constructs a language that bridges the healthcare disciplines and the clinical and managerial components of health services. Most experienced clinicians in nursing, medicine and allied health now recognise that the contemporary healthcare environment calls for our practice to be justified by sound, credible evidence. There is pressure on all clinicians to accommodate innovation, while at the same time ensuring their practice is effective, safe and efficient (Forbes & Griffiths 2002). Consequently, EBP in healthcare is having a profound effect on nursing and the way we think about nursing. There are many available models for research utilisation that are dependent on organisational strategies for change. This chapter describes the relationship between organisation and culture, and explores the notion of cultural change; that is, developing a culture of inquiry that can sustain evidence-based practice. We begin this chapter with a clear conception of what we mean by EBP and what we mean by ‘culture’.

Evidence-based practice : information professionals' experience of information literacy in the workplace

Evidence-based practice is increasingly being recognised as an important issue in a range of professional contexts including education, nursing, occupational therapy and librarianship. Many of these professions have observed a relationship or interface between evidence-based practice and information literacy. Using a phenomenographic approach this research explores variation in the how library and information professionals are experiencing evidence-based practice as part of their professional work. The findings of the research provide a basis for arguing that evidence-based practice represents the professional's enactment of information literacy in the workplace.

Making a match: Combining theory and evidence in policy-oriented macroeconomic modeling

A persistent question in the development of models for macroeconomic policy analysis has been the relative role of economic theory and evidence in their construction. This paper looks at some popular strategies that involve setting up a theoretical or conceptual model (CM) which is transformed to match the data and then made operational for policy analysis. A dynamic general equilibrium model is constructed that is similar to standard CMs. After calibration to UK data it is used to examine the utility of formal econometric methods in assessing the match of the CM to the data and also to evaluate some standard model-building strategies. Keywords: Policy oriented economic modeling; Model evaluation; VAR models

An evidence-based approach to professional development planning in large state educational systems

This paper presents a systems-level approach for adjudicating the prioritization, selection, and planning of inservcie professional development (PD) for teachers. We present a step-by-step model for documenting and assessing system-wide 'bids' for professional development programs

Changing academic practice to prepare nursing undergraduates for an evidence-based approach

Evidence based practice (EBP) has been accepted as a process to assist health professionals in clinical decision making to improve patient outcomes. It requires applying skills in a prescribed sequence to critique existing practices. Many countries, including Australia, require nurses to demonstrate competencies in EBP skills to be registered. In the last ten years, this has lead to universities incorporating EBP in undergraduate nursing degree courses. The literature reports many challenges including students’ difficulties in critically appraising research evidence, and their need for both simplification of the process and extensive support. The purpose of our study was to investigate the effectiveness of a standalone introductory EBP subject for a diverse group of third-year undergraduates, based on a novel but challenging approach to assessment. Despite many changes made in the second iteration of the subject, most students’ perceptions of the subject’s difficulty remained unchanged. This research aligns with the issues identified in the literature and has wider applicability to the teaching of rapidly changing disciplines, where evidence-driven consumers have easy access to information and expect up-to-date practices.