Classifying clinical decision making:a unifying approach

This is the first of two linked papers exploring decision making in nursing which integrate research evidence from different clinical and academic disciplines. Currently there are many decision-making theories, each with their own distinctive concepts and terminology, and there is a tendency for separate disciplines to view their own decision-making processes as unique. Identifying good nursing decisions and where improvements can be made is therefore problematic, and this can undermine clinical and organizational effectiveness, as well as nurses' professional status. Within the unifying framework of psychological classification, the overall aim of the two papers is to clarify and compare terms, concepts and processes identified in a diversity of decision-making theories, and to demonstrate their underlying similarities. It is argued that the range of explanations used across disciplines can usefully be re-conceptualized as classification behaviour. This paper explores problems arising from multiple theories of decision making being applied to separate clinical disciplines. Attention is given to detrimental effects on nursing practice within the context of multidisciplinary health-care organizations and the changing role of nurses. The different theories are outlined and difficulties in applying them to nursing decisions highlighted. An alternative approach based on a general model of classification is then presented in detail to introduce its terminology and the unifying framework for interpreting all types of decisions. The classification model is used to provide the context for relating alternative philosophical approaches and to define decision-making activities common to all clinical domains. This may benefit nurses by improving multidisciplinary collaboration and weakening clinical elitism.

Classifying clinical decision making:interpreting nursing intuition, heuristics and medical diagnosis

This is the second of two linked papers exploring decision making in nursing. The first paper, 'Classifying clinical decision making: a unifying approach' investigated difficulties with applying a range of decision-making theories to nursing practice. This is due to the diversity of terminology and theoretical concepts used, which militate against nurses being able to compare the outcomes of decisions analysed within different frameworks. It is therefore problematic for nurses to assess how good their decisions are, and where improvements can be made. However, despite the range of nomenclature, it was argued that there are underlying similarities between all theories of decision processes and that these should be exposed through integration within a single explanatory framework. A proposed solution was to use a general model of psychological classification to clarify and compare terms, concepts and processes identified across the different theories. The unifying framework of classification was described and this paper operationalizes it to demonstrate how different approaches to clinical decision making can be re-interpreted as classification behaviour. Particular attention is focused on classification in nursing, and on re-evaluating heuristic reasoning, which has been particularly prone to theoretical and terminological confusion. Demonstrating similarities in how different disciplines make decisions should promote improved multidisciplinary collaboration and a weakening of clinical elitism, thereby enhancing organizational effectiveness in health care and nurses' professional status. This is particularly important as nurses' roles continue to expand to embrace elements of managerial, medical and therapeutic work. Analysing nurses' decisions as classification behaviour will also enhance clinical effectiveness, and assist in making nurses' expertise more visible. In addition, the classification framework explodes the myth that intuition, traditionally associated with nurses' decision making, is less rational and scientific than other approaches.

Innovation, networking and globalisation:the role of regional innovation systems in the global innovation process

In the global economy, innovation is one of the most important competitive assets for companies willing to compete in international markets. As competition moves from standardised products to customised ones, depending on each specific market needs, economies of scale are not anymore the only winning strategy. Innovation requires firms to establish processes to acquire and absorb new knowledge, leading to the recent theory of Open Innovation. Knowledge sharing and acquisition happens when firms are embedded in networks with other firms, university, institutions and many other economic actors. Several typologies of innovation and firm networks have been identified, with various geographical spans. One of the first being modelled was the Industrial Cluster (or in Italian Distretto Industriale) which was for long considered the benchmark for innovation and economic development. Other kind of networks have been modelled since the late 1970s; Regional Innovation Systems represent one of the latest and more diffuse model of innovation networks, specifically introduced to combine local networks and the global economy. This model was qualitatively exploited since its introduction, but, together with National Innovation Systems, is among the most inspiring for policy makers and is often cited by them, not always properly. The aim of this research is to setup an econometric model describing Regional Innovation Systems, becoming one the first attempts to test and enhance this theory with a quantitative approach. A dataset of 104 secondary and primary data from European regions was built in order to run a multiple linear regression, testing if Regional Innovation Systems are really correlated to regional innovation and regional innovation in cooperation with foreign partners. Furthermore, an exploratory multiple linear regression was performed to verify which variables, among those describing a Regional Innovation Systems, are the most significant for innovating, alone or with foreign partners. Furthermore, the effectiveness of present innovation policies has been tested based on the findings of the econometric model. The developed model confirmed the role of Regional Innovation Systems for creating innovation even in cooperation with international partners: this represents one of the firsts quantitative confirmation of a theory previously based on qualitative models only. Furthermore the results of this model confirmed a minor influence of National Innovation Systems: comparing the analysis of existing innovation policies, both at regional and national level, to our findings, emerged the need for potential a pivotal change in the direction currently followed by policy makers. Last, while confirming the role of the presence a learning environment in a region and the catalyst role of regional administration, this research offers a potential new perspective for the whole private sector in creating a Regional Innovation System.

A model to assess the cost effectiveness of statins in achieving the UK National Service Framework target cholesterol levels

Background: Coronary heart disease (CHD) is a public health priority in the UK. The National Service Framework (NSF) has set standards for the prevention, diagnosis and treatment of CHD, which include the use of cholesterol-lowering agents aimed at achieving targets of blood total cholesterol (TC) < 5.0 mmol/L and low density lipoprotein-cholesterol (LDL-C) < 3.0 mmol/L. In order to achieve these targets cost effectively, prescribers need to make an informed choice from the range of statins available. Aim: To estimate the average and relative cost effectiveness of atorvastatin, fluvastatin, pravastatin and simvastatin in achieving the NSF LDL-C and TC targets. Design: Model-based economic evaluation. Methods: An economic model was constructed to estimate the number of patients achieving the NSF targets for LDL-C and TC at each dose of statin, and to calculate the average drug cost and incremental drug cost per patient achieving the target levels. The population baseline LDL-C and TC, and drug efficacy and drug costs were taken from previously published data. Estimates of the distribution of patients receiving each dose of statin were derived from the UK national DIN-LINK database. Results: The estimated annual drug cost per 1000 patients treated with atorvastatin was £289 000, with simvastatin £315 000, with pravastatin £333 000 and with fluvastatin £167 000. The percentages of patients achieving target are 74.4%, 46.4%, 28.4% and 13.2% for atorvastatin, simvastatin, pravastatin and fluvastatin, respectively. Incremental drug cost per extra patient treated to LDL-C and TC targets compared with fluvastafin were £198 and £226 for atorvastatin, £443 and £567 for simvastatin and £1089 and £2298 for pravastatin, using 2002 drug costs. Conclusions: As a result of its superior efficacy, atorvastatin generates a favourable cost-effectiveness profile as measured by drug cost per patient treated to LDL-C and TC targets. For a given drug budget, more patients would achieve NSF LDL-C and TC targets with atorvastatin than with any of the other statins examined.

Incorporating social role theory into topic models for social media content analysis

In this paper, we explore the idea of social role theory (SRT) and propose a novel regularized topic model which incorporates SRT into the generative process of social media content. We assume that a user can play multiple social roles, and each social role serves to fulfil different duties and is associated with a role-driven distribution over latent topics. In particular, we focus on social roles corresponding to the most common social activities on social networks. Our model is instantiated on microblogs, i.e., Twitter and community question-answering (cQA), i.e., Yahoo! Answers, where social roles on Twitter include "originators" and "propagators", and roles on cQA are "askers" and "answerers". Both explicit and implicit interactions between users are taken into account and modeled as regularization factors. To evaluate the performance of our proposed method, we have conducted extensive experiments on two Twitter datasets and two cQA datasets. Furthermore, we also consider multi-role modeling for scientific papers where an author's research expertise area is considered as a social role. A novel application of detecting users' research interests through topical keyword labeling based on the results of our multi-role model has been presented. The evaluation results have shown the feasibility and effectiveness of our model.

A 3D Model as a Tool for Increasing the Effectiveness of E-Learning

The paper proposes a 3D model which could be used as a tool for increasing the effectiveness of e-learning. It also offers an approach for applying this 3D model for increasing the effectiveness of e-learning. This approach has methodical value in line with the idea for dynamic adjustment of the individual learning profile of each student in order to increase the personalization level in the e-learning process.

Effectiveness of Olympic sponsorship by foreign and domestic companies: the influential role of consumer ethnocentrism

This study investigates Chinese consumers' responses to foreign and domestic sponsors engaged in the Beijing Olympic Games. It identifies direct causal relationships between consumer ethnocentrism, attitudes towards the sponsor and product judgement. Findings reveal that event involvement mediates the positive relationship between consumer ethnocentrism and attitudes towards the domestic sponsor. Attitudes towards foreign sponsors are found to be a significant mediator in the relationship between consumer ethnocentrism and judgements of the sponsors' products. Theoretical and managerial implications are discussed.

The effectiveness of workplace coaching:A meta-analysis of learning and performance outcomes; scale development; theoretical model of individual differences and longitudinal study

The extant literature on workplace coaching is characterised by a lack of theoretical and empirical understanding regarding the effectiveness of coaching as a learning and development tool; the types of outcomes one can expect from coaching; the tools that can be used to measure coaching outcomes; the underlying processes that explain why and how coaching works and the factors that may impact on coaching effectiveness. This thesis sought to address these substantial gaps in the literature with three linked studies. Firstly, a meta-analysis of workplace coaching effectiveness (k = 17), synthesizing the existing research was presented. A framework of coaching outcomes was developed and utilised to code the studies. Analysis indicated that coaching had positive effects on all outcomes. Next, the framework of outcomes was utilised as the deductive start-point to the development of the scale measuring perceived coaching effectiveness. Utilising a multi-stage approach (n = 201), the analysis indicated that perceived coaching effectiveness may be organised into a six factor structure: career clarity; team performance; work well-being; performance; planning and organizing and personal effectiveness and adaptability. The final study was a longitudinal field experiment to test a theoretical model of individual differences and coaching effectiveness developed in this thesis. An organizational sample of 84 employees each participated in a coaching intervention, completed self-report surveys, and had their job performance rated by peers, direct reports and supervisors (a total of 352 employees provided data on participant performance). The results demonstrate that compared to a control group, the coaching intervention generated a number of positive outcomes. The analysis indicated that coachees’ enthusiasm, intellect and orderliness influenced the impact of coaching on outcomes. Mediation analysis suggested that mastery goal orientation, performance goal orientation and approach motivation in the form of behavioural activation system (BAS) drive, were significant mediators between personality and outcomes. Overall, the findings of this thesis make an original contribution to the understanding of the types of outcomes that can be expected from coaching, and the magnitude of impact coaching has on outcomes. The thesis also provides a tool for reliably measuring coaching effectiveness and a theoretical model to understand the influence of coachee individual differences on coaching outcomes.

Examination of the role of Mycoplasma bovis in bovine pneumonia and a mathematical model for its evaluation

The authors screened 34 large cattle herds for the presence of Mycoplasma bovis infection by examining slaughtered cattle for macroscopic lung lesions, by culturing M. bovis from lung lesions and at the same time by testing sera for the presence of antibodies against M. bovis. Among the 595 cattle examined, 33.9% had pneumonic lesions, mycoplasmas were isolated from 59.9% of pneumonic lung samples, and 10.9% of sera from those animals contained antibodies to M.bovis. In 25.2% of the cases M. bovis was isolated from lungs with no macroscopic lesions. The proportion of seropositive herds was 64.7%. The average seropositivity rate of individuals was 11.3% but in certain herds it exceeded 50%. A probability model was developed for examining the relationship among the occurrence of pneumonia, the isolation of M. bovis from the lungs and the presence of M. bovis specific antibodies in sera.

Miami-Dade Health Department to Move to Florida International University , Model Clinic to Work with Medical, Public Health and Nursing Faculty

Press Release from Florida International University 's Office of Media Relations on the Miami-Dade Health Department's agreement with Florida International University to relocate its department to Florida International University 's University Park campus.

A planning model for needs analysis for subacute care

The purpose of this study is to produce a model to be used by state regulating agencies to assess demand for subacute care. In accomplishing this goal, the study refines the definition of subacute care, demonstrates a method for bed need assessment, and measures the effectiveness of this new level of care. This was the largest study of subacute care to date. Research focused on 19 subacute units in 16 states, each of which provides high-intensity rehabilitative and/or restorative care carried out in a high-tech unit. Each of the facilities was based in a nursing home, but utilized separate staff, equipment, and services. Because these facilities are under local control, it was possible to study regional differences in subacute care demand.^ Using this data, a model for predicting demand for subacute care services was created, building on earlier models submitted by John Whitman for the American Hospital Association and Robin E. MacStravic. The Broderick model uses the "bootstrapping" method and takes advantage of high technology: computers and software, databases in business and government, publicly available databases from providers or commercial vendors, professional organizations, and other information sources. Using newly available sources of information, this new model addresses the problems and needs of health care planners as they approach the challenges of the 21st century. ^

Assessing the effectiveness of five-year mechanical engineering technology programs of junior colleges in Taiwan, R.O.C.: An application of the CIPP evaluation model

The purpose of this study was to evaluate the mechanical engineering technology curriculum effectiveness at the junior college in Taiwan by using the CIPP evaluation model. The study concerned the areas of the curriculum, curriculum materials, individualized instruction, support services, teaching effectiveness, student achievement, and job performance. A descriptive survey method was used with questionnaires for data collection from faculty, students, graduates, and employers.^ All categories of respondents tended to agree that the curriculum provides appropriate occupational knowledge and skills. Students, graduates, and faculty tended to be satisfied with the curriculum; faculty tended to be satisfied with student achievement; graduates tended to be satisfied with their job preparation; and employers were most satisfied with graduates' job performance.^ Conclusions were drawn in the context, input, process, and product of the CIPP model. In Context area: Students were dissatisfied with curriculum flexibility in students characteristics. Graduates were dissatisfied with curriculum design for student's adaptability in new economic and industrial conditions; practicum flexibility in student characteristics; and course overlap. Both students and graduates were dissatisfied with practicum credit hours. Both faculty and students were dissatisfied with the number of required courses.^ In Input area: Students, faculty, and graduates perceived audiovisuals and manipulative aids positively. Faculty and students perceive CAI implementation positively. Students perceived textbooks negatively.^ In Process area: Faculty, students, and graduates perceived all support service negatively. Faculty tended to perceive the ratios of graduates who enter advanced study and related occupation, and who passed the professional skills certification, negatively. Students tended to perceive teaching effectiveness in terms of instructional strategies, the quality of instruction, overall suitability, and receivable, negatively. Graduates also tended to identify the instructional strategies as a negative perception. Faculty and students perceived curriculum objectives and practicum negatively. Both faculty and students felt that instructors should be more interested in making the courses a useful learning experience.^ In Product area: Employers were satisfied with graduates' academic preparation and job performance, adaptability, punctuality, and their ability to communicate, cooperate, and meet organization needs. Graduates were weak in terms of equipment familiarity and supervisory ability.^ In sum, the curriculum of the five-year mechanical engineering technology programs of junior college in Taiwan has served adequately up to this time in preparing a work force to enter industry. It is now time to look toward the future and adapt the curriculum and instruction for the future needs of this high-tech society. ^

A qualitative analysis of the lived experience of nursing staff developers in the process of changing to a new educational model

The purpose of this study was to document and critically analyze the lived experience of selected nursing staff developers in the process of moving toward a new model for hospital nursing education. Eleven respondents were drawn from a nation-wide population of about two hundred individuals involved in nursing staff development. These subjects were responsible for the implementation of the Performance Based Development System (PBDS) in their institutions.^ A purposive, criterion-based sampling technique was used with respondents being selected according to size of hospital, primary responsibility for orchestration of the change, influence over budgetary factors and managerial responsibility for PBDS. Data were gathered by the researcher through both in-person and telephone interviews. A semi-structured interview guide, designed by the researcher was used, and respondents were encouraged to amplify on their recollections as desired. Audiotapes were transcribed and resulting computer files were analyzed using the program "Martin". Answers to interview questions were compiled and reported across cases. The data was then reviewed a second time and interpreted for emerging themes and patterns.^ Two types of verification were used in the study. Internal verification was done through interview transcript review and feedback by respondents. External verification was done through review and feedback on data analysis by readers who were experienced in management of staff development departments.^ All respondents were female, so Gilligan's concept of the "ethic of care" was examined as a decision making strategy. Three levels of caring which influenced decision making were found. They were caring: (a) for the organization, (b) for the employee, and (c) for the patient. The four existentials of the lived experience, relationality, corporeality, temporality and spatiality were also examined to reveal the everydayness of making change. ^

Assessing the effectiveness of two-year banking and insurance technology programs of junior colleges in Taiwan, R.O.C.: An application of the Context Input Process Product (CIPP) evaluation model

The purpose of this descriptive study was to evaluate the banking and insurance technology curriculum at ten junior colleges in Taiwan. The study focused on curriculum, curriculum materials, instruction, support services, student achievement and job performance. Data was collected from a diverse sample of faculty, students, alumni, and employers. ^ Questionnaires on the evaluation of curriculum at technical junior colleges were developed for use in this specific case. Data were collected from the sample described above and analyzed utilizing ANOVA, T-Tests and crosstabulations. Findings are presented which indicate that there is room for improvement in terms of meeting individual students' needs. ^ Using Stufflebeam's CIPP model for curriculum evaluation it was determined that the curriculum was adequate in terms of the knowledge and skills imparted to students. However, students were dissatisfied with the rigidity of the curriculum and the lack of opportunity to satisfy the individual needs of students. Employers were satisfied with both the academic preparation of students and their on the job performance. ^ In sum, the curriculum of the two-year banking and insurance technology programs of junior college in Taiwan was shown to have served adequately preparing a work force to enter businesses. It is now time to look toward the future and adapt the curriculum and instruction for the future needs of the ever evolving high-tech society. ^

Teams leading teams: Examining the role of leadership in multi-team systems

A major challenge of modern teams lies in the coordination of the efforts not just of individuals within a team, but also of teams whose efforts are ultimately entwined with those of other teams. Despite this fact, much of the research on work teams fails to consider the external dependencies that exist in organizational teams and instead focuses on internal or within team processes. Multi-Team Systems Theory is used as a theoretical framework for understanding teams-of-teams organizational forms (Multi-Team Systems; MTS's); and leadership teams are proposed as one remedy that enable MTS members to dedicate needed resources to intra-team activities while ensuring effective synchronization of between-team activities. Two functions of leader teams were identified: strategy development and coordination facilitation; and a model was developed delineating the effects of the two leader roles on multi-team cognitions, processes, and performance.^ Three hundred eighty-four undergraduate psychology and business students participated in a laboratory simulation that modeled an MTS; each MTS was comprised of three, two-member teams each performing distinct but interdependent components of an F-22 battle simulation task. Two roles of leader teams supported in the literature were manipulated through training in a 2 (strategy training vs. control) x 2 (coordination training vs. control) design. Multivariate analysis of variance (MANOVA) and mediated regression analysis were used to test the study's hypotheses. ^ Results indicate that both training manipulations produced differences in the effectiveness of the intended form of leader behavior. The enhanced leader strategy training resulted in more accurate (but not more similar) MTS mental models, better inter-team coordination, and higher levels of multi-team (but not component team) performance. Moreover, mental model accuracy fully mediated the relationship between leader strategy and inter-team coordination; and inter-team coordination fully mediated the effect of leader strategy on multi-team performance. Leader coordination training led to better inter-team coordination, but not to higher levels of either team or multi-team performance. Mediated Input-Process-Output (I-P-O) relationships were not supported with leader coordination; rather, leader coordination facilitation and inter-team coordination uniquely contributed to component team and multi-team level performance. The implications of these findings and future research directions are also discussed. ^