Investigating links between diet and health – amalgamation, synthesis and decision making
Geoffrey P. Webb in Nutrition, 2019
RCTs are examples of a deductive or top-down approach to hypothesis testing (as argued by Nancy Cartwright in 2007). To make a hypothesis testable in a single trial, the hypothesis must be narrow, which means that the outcome of the trial can strictly only be applied to confirm or even prove that narrow hypothesis. The inductive or bottom-up approach is where one makes a series of observations and then tries to make generalisations on the basis of these. This approach uses all of the observational methods and may also include experimental evidence. A large body of evidence may be accumulated that is consistent with the initial hypothesis and although this cannot prove it definitively one may achieve a high level of confidence in that hypothesis, perhaps enough to introduce a carefully monitored change in policy (e.g. the UK “Back to Sleep” campaign to reduce cot deaths or early anti-smoking campaigns).
The Concept of Health Care Quality
A.F. Al-Assaf in Managed Care Quality, 2020
According to Deming (1984), the organization is made up of thousands of processes. Therefore, health care quality calls for identification and flowcharting of key processes and the early identification of opportunities for improvements in these processes in order to initiate early intervention. Deming also was sensitive to the issue of leadership commitment. He suggests that without this commitment quality will not succeed. In health care this is partly true. Leadership commitment still is important, but not a must for health care quality to succeed. Leaders can facilitate the process, making it work faster and produce faster results. However, in health care leaders change more frequently and total dependence on their commitment may not be prudent. Starting health care quality even at the staff level may produce positive results that will attract the attention of top leaders, thus earning their active support. This approach is a “bottom-up” approach, as opposed to the “top-down” approach described by Deming. In other experiences, both approaches might be implemented in the same system and this may be the most applicable
Theory-driven evaluation
Frances Rapport, Robyn Clay-Williams, Jeffrey Braithwaite in Implementation Science, 2022
Despite its popularity, TDE argues that the top-down approach for disseminating behavioural EBIs has a range of limitations: the conditions for designing and testing EBIs do not resemble real-world operation, EBIs do not address the nuts and bolts of implementation issues of interest to stakeholders, EBIs are ignorant of real-world social environments, and the EBI efficacy does not necessarily imply real-world effectiveness (Chen 2010, Chen and Garbe 2011). Because of these limitations, TDE argues that the top-down approach should be used as a discretionary option rather than as the gold standard for disseminating and implementing behavioural or social EBIs. TDE recognizes the merit of the bottom-up approach (Chen 2010, Chen and Garbe 2011) as illustrated in the right-hand side of Figure 43.2. This approach stresses that when developing and disseminating behavioural or social interventions, the initial evaluation should start with a viability evaluation to assure that a proposed intervention is practical, affordable, suitable, evaluable, and helpful for a community. If the intervention is viable, its subsequent effectiveness evaluation is likely to provide sufficient objective evidence for its merit. If necessary, an efficacy evaluation can rigorously assess causal relationships between the intervention and the outcomes. TDE argues that the bottom-up approach has several merits, including assuring that the intervention is useful to stakeholders and not the least, avoiding wasting money (Chen and Garbe 2011).
Improving the Knowledge, Attitudes, and Practices of Mental Health Professionals Regarding Dual Diagnosis Treatment – a Mixed Methods Study of an Intervention
Published in Issues in Mental Health Nursing, 2018
One of the training days focused on implementation and tools to implementation. The program champions were instructed to make a ‘SWOT analysis' (Strengths, Weaknesses, Opportunities, and Threats) of their workplace and action plans for implementing, in their organization, knowledge gained from the training. The action plans included goals for their workplace and those actions which would be required to reach these goals. These goals were developed by the program champions themselves to fit the needs of their respective workplaces, resulting in eight different action plans. Most of the groups planned to provide training to their colleagues in motivational interviewing and/or pharmacological treatment for patients with dual diagnosis, but only one of the groups wanted to implement motivational interviewing. There were five groups of program champions who wanted to implement dual diagnosis group treatment. Two groups wanted to implement a dual diagnosis treatment manual. Four groups wanted to strengthen the collaboration with the substance abuse treatment based in the municipality. Six groups of program champions chose to implement a screening instrument. The bottom-up approach was chosen because studies have shown that professionals are more likely to change their behaviour in line with instructions or guidelines if they have been involved in their development (Closs & Cheater, 1997; Torrey et al., 2001). Moreover, felt ownership increases the likelihood of successful implementation (Backer, David, & Soucy, 1995).
Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis
Published in Journal of Psychosocial Oncology, 2021
Jennifer J. McElfresh, Meghan B. Skiba, Chris G. Segrin, Terry A. Badger, Tracy E. Crane, Janice D. Crist, Cynthia A. Thomson
This systematic review offers researchers conducting studies addressing loneliness in adult cancer survivors a comprehensive and current assessment of the state of the evidence related to effective interventions. The appraisal of the literature has identified gaps including the limited number of interventions tested, the small sample size of most trials and the need to recruit more heterogeneous (age, sex, socioeconomic, etc.) samples. Advancing knowledge of the strengths and weaknesses of existing loneliness interventions supports the development of future studies particularly those fostering reduced loneliness in adult community-dwelling cancer survivors. With the majority (five of eight) of studies identified in the literature showing feasibility and modest but not robust effectiveness, there is a need to create future interventions with a bottom-up approach. Tailored methodologies informed by cancer survivors, rather than retrofitting existing interventions to cancer survivors, are advisable. Our evaluation of the interventions to date, offers insights into the future approaches, including attention to health behavior theory, and application of technology or telephone-based platforms to reduce the burden of loneliness after a cancer diagnosis.
Progress in the development of stabilization strategies for nanocrystal preparations
Published in Drug Delivery, 2021
Jingru Li, Zengming Wang, Hui Zhang, Jing Gao, Aiping Zheng
Due to the unique advantages of nanocrystals, various pharmaceutical nanocrystals have been successfully commercialized (Möschwitzer, 2013). The production techniques are classified as either bottom-up (antisolvent precipitation) or top-down techniques (high-pressure homogenization, media milling, etc.) (Ahire et al., 2018). The bottom-up approach has not yet led to a product on the market; the marketed products are typically produced via a wet media milling or high-pressure homogenization technology. In 2000, Rapamune® tablets of Sirolimus nanocrystals were marketed as immunosuppressants with 21% higher bioavailability compared to the oral solution (Zhou et al., 2016). An aprepitant nanocrystal, namely, Emend®, was introduced to the market in 2003 (Zhang et al., 2014; Roos et al., 2018), which showed increased absorption and reduced drug–food interactions compared with the micronized aprepitant, as well as improved bioavailability. Tricor® (2004) and Triglide® (2005) have significantly increased bioavailabilities compared to fenofibrate coarse and micronized suspensions with minimal impact on food intake (Sauron et al., 2006; Li et al., 2009). The emergence of nanotechnology has created a new prosperity in all fields, including chemistry, physics, and life sciences (Cai et al., 2020; Zhang et al., 2020), which provides a new direction for drug delivery system. In particular, nanotechnology drugs have great application prospects in tumor-targeted therapy (Chen et al., 2020; Pan et al., 2020; Zhai et al., 2020).
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