This paper starts from an examination of an epistemological framework that underpins practice in particular educational contexts. It examines work-based knowledge, relating this to practitioner research and evidence informed practice. This is followed by an exploration of arguments that call for increased rigour in educational research as well as the use of systematic reviews. The paper examines tensions within educational research located in particular institutional contexts which draw upon 'post-modern' conceptualisations of practice, setting these against (...) research concerned with generalisability that veers towards traditional positivist claims. The paper concludes by suggesting that such arguments readily fold back into a conservative empiricism and a more appropriate position should be based upon dialogue across a range of constituents. However, such a notion needs to recognise social antagonism as well as aspirations towards the deepening of notions of social justice. (shrink)

Elite athletes, coaches and high-performance staff are exposed to a range of stressors that have been shown to increase their susceptibility to experiencing mental ill-health. Despite this, athletes may be less inclined than the general population to seek support for their mental health due to stigma, perceptions of limited psychological safety within sport to disclose mental health difficulties and/or fears of help-seeking signifying weakness in the context of high performance sport. Guidance on the best ways to promote mental health within (...) sporting environments is increasing, though current frameworks and position statements require greater focus on a whole of system approach, in which the needs of athlete, coaches and high-performance staff are considered within the context of the broader ecological system in which they operate and perform. This paper synthesizes existing research, reviewed for translatability by mental health professionals working in elite sport, to provide an evidence-informed framework with real world utility to promote mentally healthy environments for all stakeholders in elite sporting organizations, from athletes through to administrators. Recommendations are provided to positively impact the mental wellbeing of athletes and support staff, which may in turn influence athletic performance. This framework is intended to provide sporting organizations with evidence-informed or best practice principles on which they can develop or progress their policies to support mental health promotion and prevent the onset of mental health difficulties. It is intended that the framework can be adapted or tailored by elite sporting organizations based upon their unique cultural, contextual and resourcing circumstances. (shrink)

Currently there are several psychotherapy modalities utilising theory and research from neuroscience in treatment frameworks for mental health and recovery from trauma. In Australia this includes: the Conversational Model of Psychodynamic Psychotherapy, a contemporary psychodynamic approach used for treating Borderline Personality Disorder and other trauma-related disorders; Electroencephalogram Neurofeedback, a brain training therapy which has been used as an adjunct to counselling/psychotherapy in traumatic stress and developmental trauma; and Somatic Experiencing, an integrative mind-body approach based on body responses to threat and (...) fear, especially thwarted attempts to enact fight or flight in the face of threat. These modalities have a promising but still-limited evidence base. This paper explores the role of different types of evidence to frame a descriptive review of the current evidence base available for clinicians practicing in these three modalities. While large clinical trials can provide evidence of comparative effectiveness, case studies, observational, qualitative and practice-based enquiry can assist in discovering other aspects of therapy important for individual clients and practitioners. Existing frameworks of evidence- and ethics-informed health and clinical decision-making suggest an ethical approach can incorporate new, developing and evidence-building therapies. Recommendations include careful consideration of informed consent for therapy including disclosure of efficacy and safety, and specific to psychotherapies incorporating neuroscience, a need for practitioners to reflectively assess their own knowledge, competence, heuristic approaches and biases. (shrink)

This paper puts forward the argument that there are various, competing, and antithetical evidence‐based practice (EBP) definitions and acknowledges that the different EBP definitions are based on different epistemological perspectives. However, this is not enough to understand the way in which nurse professionals choose between the various EBP formations and consequently facilitate them in choosing the most appropriate for their needs. Therefore, the current article goes beyond and behind the various EBP epistemologies to identify how individuals choose an (...) epistemology, which consequently will assist our understanding as to how an individual chooses a specific EBP formation. Individuals choose an epistemology on the mere belief that the specific epistemology offers the ideals or ideas of best explaining or interpreting daily reality. These ideals or ideas are termed by science, history, and politics as ideology. Similarly, individual practitioners choose or should choose between the different EBP formations based on their own personal ideology. Consequently, this article proceeds to analyse the various ideologies behind different EBP definitions as to conclude that there are two broad ideologies that inform the various EBP formations, namely the ideology of truth and the ideology of individual emancipation. These two ideologies are analysed and their connections to the various EBP formations are depicted. Eventually, the article concludes that the in‐depth, critical, and intentional analysis by individual nurses of their own ideology will allow them to choose the EBP formation that is most appropriate and fitting for them, and their specific situation. Hence, the conscious analysis of individual ideology becomes the criterion for choosing between competing EBP formations and allows for best evidence to be implemented in practice. Therefore, the best way to teach EBP courses is by facilitating students to analyse their own ideology. (shrink)

In this essay, Gert Biesta provides a critical analysis of the idea of evidence‐based practice and the ways in which it has been promoted and implemented in the field of education, focusing on the tension between scientific and democratic control over educational practice and research. Biesta examines three key assumptions of evidence‐based education: first, the extent to which educational practice can be compared to the practice of medicine, the field in which evidence‐based (...) class='Hi'>practice was first developed; second, the role of knowledge in professional actions, with special attention to what kind of epistemology is appropriate for professional practices that wish to be informed by the outcomes of research; and third, the expectations about the practical role of research implicit in the idea of evidence‐based education. Biesta concludes that evidence‐based practice provides a framework for understanding the role of research in educational practice that not only restricts the scope of decision making to questions about effectivity and effectiveness, but that also restricts the opportunities for participation in educational decision making. He argues that we must expand our views about the interrelations among research, policy, and practice to keep in view education as a thoroughly moral and political practice that requires continuous democratic contestation and deliberation. (shrink)

Governing nursing conduct: the rise of evidence‐based practice Drawing on the Foucauldian concept of ‘governmentality’ to analyse the evidence‐based movement in nursing, we argue that it is possible to identify the governance of nursing practice and hence nurses across two distinct axes; that of the political (governance through political and economic means) and the personal (governance of the self through the cultivation of the practices required by nurses to put evidence into practice). The evaluation (...) of nursing work through evidence‐based reviews provides detailed information that may enable governments to target and instruct nurses regarding their work in the interest of preserving the health of the population as a whole. Political governance of the nursing population becomes possible through centralised discursive mechanisms, such as evidence‐based reviews that present nursing practice as an intelligible field whose elements are connected in a more or less systematic manner. The identity of the evidence‐based nurse requires the modern nurse to develop new skills and attitudes. Evidence‐based nursing is an emerging technology of government that judges nursing research and knowledge and has the capacity to direct nursing practice at both the political and personal level. (shrink)

Too many boys do not like to read, are choosing not to read, and are suffering academically as a result. All concerned adults need to redouble their efforts to ensure that boys who bring the greatest challenges to our classrooms and schools receive responsive literacy texts and practices to increase their chances for academic, personal, and occupational success. This book is more than a compendium of techniques, it also provides an analysis of the research literature on central issues and related (...) aspects of literacy and learning for boys. The author identifies issues that impinge on boys' literacy development and explores what the research literature has to say about these issues. The descriptions of how teachers have used engaging texts and practices to help boys overcome low literacy engagement and skill in order to stay on course as readers and writers are highly informative and practical as models of best practice. (shrink)

In seeking general accounts of evidence, confirmation, or inference, philosophers have looked to logical relationships between evidence and hypotheses. Such logics of evidential relationship, whether hypothetico-deductive, Bayesian, or instantiationist fail to capture or be relevant to scientific practice. They require information that scientists do not generally have (e.g., an exhaustive set of hypotheses), while lacking slots within which to include considerations to which scientists regularly appeal (e.g., error probabilities). Building on my co-symposiasts contributions, I suggest some directions (...) in which a new and more adequate philosophy of evidence can move. (shrink)

Most writing on informed consent in Africa highlights different cultural and social attributes that influence informed consent practices, especially in research settings. This review presents a composite picture of informed consent in Nigeria using empirical studies and legal and regulatory prescriptions, as well as clinical experience. It shows that Nigeria, like most other nations in Africa, is a mixture of sociocultural entities, and, notwithstanding the multitude of factors affecting it, informed consent is evolving along a purely (...) Western model. Empirical studies show that 70–95% of Nigerian patients report giving consent for their surgical treatments. Regulatory prescriptions and adjudicated cases in Nigeria follow the Western model of informed consent. However, adversarial legal proceedings, for a multiplicity of reasons, do not play significant roles in enforcing good medical practice in Nigeria. Gender prejudices are evident, but not a norm. Individual autonomy is recognized even when decisions are made within the family. Consent practices are influenced by the level of education, extended family system, urbanization, religious practices, and health care financing options available. All limitations notwithstanding, consent discussions improved with increasing level of education of the patients, suggesting that improved physician's knowledge and increasing awareness and education of patients can override other influences. Nigerian medical schools should restructure their teaching of medical ethics to improve the knowledge and practices of physicians. More research is needed on the preferences of the Nigerian people regarding informed consent so as to adequately train physicians and positively influence physicians' behaviors. (shrink)

This paper aims to contribute to the present debate about business ethics and Corporate Social Responsibility (CSR) that the Journal of Business Ethics is hosting. Numerous contributions argued theoretical frameworks and taxonomies of CSR practices. The authors want to ground in this knowledge and provide further evidence about how companies adopt CSR practices to address stakeholders’ claims and consolidate their trust. Evidence was provided by a longitudinal case study about an Italian food company that is one of the (...) largest producers of baby food. This company reshaped its corporate strategy along three decades through the adoption of CSR practices in order to win stakeholders’ trust about food safety and supply chain behaviour. The empirical exercise was informed by a literature review of the relevant contributions in terms of CSR business practices and levels of efforts to adopt them. In light of this review, the authors adopted for the research framework the taxonomy of business practices proposed by Spiller (2000, “Ethical Business and Investment: A Model for Business and Society”, Journal of Business Ethics 27, 149-160) and the levels of commitment towards CSR proposed by Stahl and Grigsby (1997, Strategic Management; Total Quality & Global Competition (Blackwell, Oxford)). The main findings are discussed in order to argue theoretical implications and identify further areas of research and debate. (shrink)

Most writing on informed consent in Africa highlights different cultural and social attributes that influence informed consent practices, especially in research settings. This review presents a composite picture of informed consent in Nigeria using empirical studies and legal and regulatory prescriptions, as well as clinical experience. It shows that Nigeria, like most other nations in Africa, is a mixture of sociocultural entities, and, notwithstanding the multitude of factors affecting it, informed consent is evolving along a purely (...) Western model.Empirical studies show that 70–95% of Nigerian patients report giving consent for their surgical treatments. Regulatory prescriptions and adjudicated cases in Nigeria follow the Western model of informed consent. However, adversarial legal proceedings, for a multiplicity of reasons, do not play significant roles in enforcing good medical practice in Nigeria. Gender prejudices are evident, but not a norm. Individual autonomy is recognized even when decisions are made within the family. Consent practices are influenced by the level of education, extended family system, urbanization, religious practices, and health care financing options available. All limitations notwithstanding, consent discussions improved with increasing level of education of the patients, suggesting that improved physician's knowledge and increasing awareness and education of patients can override other influences.Nigerian medical schools should restructure their teaching of medical ethics to improve the knowledge and practices of physicians. More research is needed on the preferences of the Nigerian people regarding informed consent so as to adequately train physicians and positively influence physicians’ behaviors. (shrink)

Clinicians and policy makers the world over are embracing evidence-based medicine. The promise of EBM is to use summaries of research evidence to determine which healthcare interventions are effective and which are not, so that patients may benefit from effective interventions and be protected from useless or harmful ones. EBM provides an ostensibly rational and objective means of deciding whether or not an intervention should be provided on the basis of its effectiveness, in theory leading to fair and (...) effective healthcare for all. In this paper I closely examine these claims from the perspective of healthcare for women, using relevant examples. I argue that the current processes of evidence-based medicine contain a number of biases against women. These biases occur in the production of the research that informs evidence-based medicine, in the methods used to analyse and synthesise the evidence, and in the application of EBM through the use of guidelines. Finally, the biomedical model of health that underpins most of the medical research used by EBM ignores the social and political context which contributes so much to the ill-health of women. (shrink)

Informal home education occurs without much that is generally considered essential for formal education—including curriculum, learning plans, assessments, age related targets or planned and deliberate teaching. Our research into families conducting this kind of education enables us to consider learning away from such imposed structures and to explore how children go about learning for themselves within the context of their own socio-cultural setting. In this paper we consider what and how children learn when no educational agenda is arranged for them (...) and we link this manner of learning to the Deweyan ideas of learning as transactional and learning-in-context. We also use our empirical evidence to explore the notion of ZPD with regard to informal learning and to consider how children, without specific guidance, go about charting a course of learning through the ZPD. We consider the quality of informal learning particularly with regard to the educational aim of developing reflective and critical thinking, showing how these are integral to informal learning. We suggest that a much wider conception of what learning is and how it happens is needed, away from the confines of formal educational structures. (shrink)

Deanna Kuhn's theory of informal argumentation (1991) evaluates arguments according to a theory/evidence model where subjects first articulate a theory and then must provide critical testing of alternatives on the basis of evidence. Using this model, Kuhn reports that many subjects fail to supply adequate evidence for their 'theories' and are often unable or unwilling to generate alternatives. In this paper an account of practical reasoning is provided that suggests an alternate interpretation for Kuhn's subjects' poor perfonnance. (...) It is argued that treating practical arguments as failed theoretical justifications causes Kuhn to misrepresent the contribution of many of her subjects' arguments. (shrink)

Objectives: To gather information about the practices and attitudes of providers of maternity care with respect to informed consent for newborn screening .Methods: A questionnaire concerning information provision and parental consent for NBS was sent to all 1036 registered lead maternity carers in New Zealand.Results: 93% of LMC in New Zealand report giving parents information concerning NBS, most frequently after delivery and in the third trimester . The majority of LMC currently obtain some form of consent for NBS from (...) parents and consider this to be the ideal approach . Despite this a significant minority of LMC reported considering that NBS should be mandatory. Of those in our survey who believed that NBS should be mandatory, paradoxically most still believed that some form of parental consent should be obtained; of those who believed testing should not be mandatory, only a small proportion would accept parental refusal without question.Conclusions: When the results of this survey are considered in conjunction with existing evidence there appears to be a consensus that good quality information in the prenatal period should be an integral part of any NBS programme. The issue of consent is more complex and there is less agreement on the preferred degree of parental involvement in decisions to allow babies to undergo NBS. A policy that both strongly recommends NBS but also allows parental choice appears to be most consistent with the views of LMC in this survey. (shrink)

The call for evidence-based practice in education emphasizes the need for research to provide evidence for particular fields of educational practice. With this systematic literature review we summarize and analyze aggregated effectiveness information from 41 meta-analyses published between 2004 and 2019 to inform evidence-based practice in a particular field. In line with target specifications in education that are provided for a certain school subject and educational level, we developed and adopted a selection heuristic for (...) filtering aggregated effect sizes specific to both science and mathematics education and the secondary student population. The results include 78 context-specific aggregated effect sizes based on data from over one million students. The findings encompass a multitude of different teaching strategies, most of which offer a measurable advantage to alternatives. Findings demonstrate that context-specific effect size information may often differ from more general effect size information on teaching effectiveness and adherence to quality standards varies in sampled meta-analyses. Thus, although meta-analytic research has strongly developed over the last few years, providing context-specific and high-quality evidence still needs to be a focus in the field of secondary mathematics and science teaching and beyond. (shrink)

Over the span of nearly 10 years, the social work labor force grew from 0.2 million to approximately 1.2 million in China. Despite these increases, studies have shown social workers in China are also experiencing equally high burnout rates. For this analysis, we collected data from 537 social workers based in Guangzhou, China. We used the job demands and resources theory, to examine the relations between JD-R and burnout and whether mindfulness practice could reduce any such burnout. Our results (...) suggest JD-R affects social workers’ burnout through both health and motivation impairment. High job demands were linked to high burnout while high job resources were linked to a reduction in burnout. Formal and informal MP were associated with low burnout amongst social workers. The significant interaction between JD and MP also suggests that MP can reduce burnout for social workers with high JD. The findings call for using MP to be used to shield social workers from the effects of increasing JD and to prevent an increase of burnout amongst Chinese social workers. (shrink)

Until about thirty years ago, the extent of disclosure about and consent-seeking for medical interventions was influenced by a beneficence model of professional behaviour. Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American scene in two separate contexts: for daily practice in 1957, and for clinical study in 1966. A confusing double standard has been established. 'Daily consent' is reviewed, if at all, only in retrospect. Doctors are (...) merely exhorted to obtain informed consent; they often minimise uncertainties about 'best' treatment and they feel duty-bound to provide patients with an unequivocal recommendation for action. 'Study consent' in a clinical trial is reviewed prospectively, and doctors are compelled by regulation to point out that there is insufficient evidence to make a rational choice between two compared treatments. It has been impossible to devise informed consent practices that satisfy, in full, the competing moral imperatives of respect for autonomy, concern for beneficence with emphasis on the value of health, and a vigil for justice. A way must be found to experiment with various discretionary approaches that would strike a realistic balance among competing interests. (shrink)

Informed consent, a cornerstone of research ethics, ensures participant protection and informed participation, particularly in online settings. Despite its significance, engagement with online consent forms remains low, underscoring the need for improved presentation strategies. This study investigates the impact of interactive elements and diverse presentation formats on the comprehension and engagement of online informed consent documents among a broad demographic beyond the commonly studied student populations. Employing a between-subjects experimental design, we explored six versions of online consent (...) forms varying in interactivity, readability, and visual formatting to identify optimal strategies for enhancing participant comprehension and engagement. Our findings reveal that interactive formats significantly improve comprehension and perceived readability, highlighting the pivotal role of design in facilitating informed consent. The study also examines the influence of individual differences, such as self-efficacy and trust in science, on the effectiveness of consent forms, providing insights into the nuanced dynamics between participant characteristics and consent form engagement. These results advocate for integrating interactive elements and thoughtful design in consent forms to foster a more informed and engaged participant base. Implications for research ethics, best practices in consent form development, and future research directions are also discussed, emphasizing the need for ongoing innovation in the consent process to adapt to the evolving landscape of online research. This study contributes to the body of knowledge on research ethics by offering evidence-based recommendations for enhancing the informed consent process, ultimately promoting participant-centered research practices. (shrink)

Empirical research paints a dismal portrayal of the role of reason in morality. It suggests that reason plays no substantive role in how we make moral judgments or are motivated to act on them. This paper explores how it is that an empirically oriented philosopher, committed to methodological naturalism, ought to respond to the skeptical challenge presented by this research. While many think taking this challenge seriously requires revising, sometimes dramatically, how we think about moral agency, this paper will defend (...) the opposite reaction. Contrary to what recent discussions lead us to expect, practical reason is not simply a philosophical fiction lacking empirical roots. Empirical research does not exclude the possibility that practical reason can play a substantive role; rather, there is evidence that it can help us both to determine our first personal moral judgments and to motivate us to act on them. (shrink)

The idea that professional practices such as education should be based upon or at least be informed by evidence continues to capture the imagination of many politicians, policy makers, practitioners and researchers. There is growing evidence of the influence of this line of thought. At the same time there is a growing body of work that has raised fundamental questions about the feasibility of the idea of evidence-based or evidence-informed practice. In this paper (...) I make a further contribution to this discussion through an analysis of a number of assumptions that inform the discussion. I focus on the epistemological, ontological and praxeological dimensions of the discussion and in each domain identify a deficit. In the epistemological domain there is a knowledge deficit, in the ontological domain an effectiveness or efficacy deficit and in the practice domain an application deficit. Taken together these deficits not only raise some important questions about the very idea of evidence-based practice but also highlight the role of normativity, power and values. Against this background I outline the case for the idea of value-based education as an alternative for evidence-based education. As I am generally concerned about the expectations policy makers hold about what evidence can and should achieve in professional practices such as education, my contribution is primarily meant to provide educators and other professionals with arguments that can help them to resist unwarranted expectations about the role of evidence in their practices and even more so of unwarranted interventions in their practices. (shrink)

Much of the debate surrounding the concept of information in biology centers on the question of whether or not biological systems ‘really’ carry information. The criterion for determining if a system “really” carries information is whether or not there is a principled, theoretical account of information that captures the relevant biological usages. If biological systems do not carry information in this sense, information talk is termed merely heuristic and dismissed as philosophically uninteresting. To date, all three proposed theoretical accounts of (...) information—mathematical, causal and teleosemantic—fail to capture the meaning of biologists. Details of other biological practices that utilize informational concepts are often lost because the debate is too focused on one instance of information talk—genetic information and because biological representations are thought to need a certain kind of theoretical foundation. The problem with this methodology is that it takes the failure of philosophical accounts of information to capture current biological practices as conclusive evidence that informational representations in biology are incoherent. This approach is backwards. A better strategy is to get a clear understanding of biological practice and then to use it to shape our understanding of the philosophical significance of biological information. In this paper, I shift attention from abstract reasoning about information in the philosophical literature to concrete reasoning about informational models in biology. The current debate pays too little attention to the biologically prominent concept of signal. I develop a contextualized understanding of signaling models in biological practice. I argue that biologists use the concept of signal to model distinct functional roles in biological systems and not in any of the theoretical senses of information found in the current philosophical literature. For cell biologists, a signal causally indicates the state of a system at a given point and is used in the context of a style of functional explanation generally known as ‘causal role function,’ in which a mechanism or entity has a function if its behavior explains a contribution to a capacity of interest. I support this analysis with an example drawn from cell biology and reframe the debate over the significance of informational terms in biology. The focus on signal recasts the debate by highlighting examples of information talk which are central to active research programs in biology. The advantage of looking at these models is that their centrality to biological practice forces us to reconsider the adequacy of a methodology that dismisses biological models because we lack a particular kind of philosophical understanding of them. Standard philosophical accounts of information rely on assumptions appropriate for the needs of philosophers but are ill-suited for capturing biological practice. A contextualized understanding of the role of signal in biological practice allows us to work out from the details of practice to tackle broader philosophical issues. On this view, the significance of information talk in biology hinges more on our understanding of how biologists represent function than on our understanding of philosophical accounts of information. (shrink)

Physicians commonly recommend ?placebo treatments?, which are not believed to have specific efficacy for the patient's condition. Motivations for placebo treatments include complying with patient expectations and promoting a placebo effect. In this article, we focus on two key empirical questions that must be addressed in order to assess the ethical legitimacy of placebo treatments in clinical practice: 1) do placebo treatments have the potential to produce clinically significant benefit? and 2) can placebo treatments be effective in promoting a (...) therapeutic placebo response without the use of deception? We examine evidence from clinical trials and laboratory experiments bearing on these two questions. The conclusion is reached that based on currently available evidence, it is premature to judge whether placebo treatments are ethically justifiable, with the possible exception of acupuncture for pain relief. (shrink)

An evidence-based approach to crime and justice policy can go a long way toward ensuring that the best available research is considered in decisions that bear on the public good. However, the term "evidence-based" is characterized by a great deal of rhetoric. Indeed, there remains a marked disjuncture between calls for "evidence-based" policy and an understanding of what it means for policy to be "evidence-based." The calls for evidence-based policy nonetheless provide a powerful foundation for (...) propelling a movement toward bringing about rational, cost-effective, and humane policies for the betterment of society. This handbook showcases the state of research on evidence-based crime and justice policy and the challenges that impede its creation and use. The volume has three core objectives: to promote new and productive ways to think about evidence-based policy; to demonstrate how research can contribute to and guide evidence-based policy in juvenile justice, criminal justice, and alternatives to system responses; and to identify strategies that can increase reliance on evidence-based policy. To meet these objectives, each chapter is guided by several central questions: What do we know about evidence-based policy and practice in crime and justice? How can we improve knowledge of evidence-based policy and practice? How can we promote more use of evidence-based policy and practice? Taken as a whole, the volume emphasizes the critical need for policies that are grounded in high-quality research, that address critical research gaps, and that fully acknowledge the limitations of what extant research can do to inform policy decisions. (shrink)

Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and (...) doctors in the informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

"Your confidentiality will be respected. Information that discloses your identity will not be released without your consent unless required by law or regulation." I sat there with Missy, reading the consent form line by line. When I got to the section on confidentiality, I told her she could pick a nickname, or fake name, that I would use in my research notes and later when the research was written up. She wanted to use "Missy." It wasn't exactly a pseudonym—this was (...) the same name that a number of her friends in the neighborhood knew her by. I'd also heard a couple of nurses calling her Missy when I had gone to visit with her in the hospital earlier that winter. I asked her if she was sure she wanted to use that .. (shrink)

Methodological strategies for the identification and synthesis of ‘evidence’ to support decision‐making in relation to complex healthcare systems and practices This paper addresses the limitations of current methods supporting ‘evidence‐based health‐care’ in relation to complex aspects of care, including those questions that are best supported by descriptive or non‐empirical evidence. The paper identifies some new methods, which may be useful in aiding the synthesis of data in these areas. The methods detailed are broadly divided into those that (...) facilitate the identification of evidence and those that enable the interpretation of the data retrieved. To illustrate some of the issues involved, reference is made to a multimethod review recently completed by the authors, which aimed to identify factors that promote continuity in the transition from child to adult health and social care. It is argued that as healthcare organisations are becoming increasingly preoccupied with the evidence base of practice, such methods may help ensure that aspects of care and approaches that are outside the dominant pharmaco‐medical domain maintain a prominent position on the healthcare agenda while remaining open to external scrutiny. Healthcare professionals who use such approaches need to know their relative utility and benefits to inform clinical decisions, so as to ensure that best practice is observed. (shrink)

This study intended to examine the effect of information technology (IT) investment and corporate governance mechanism on the performance of the Saudi telecommunication sector with mediating role of corporate social responsibility (CSR). A survey method was used to collect data from the targeted Saudi telecom firm. Results show that corporate governance practices, i.e., internal audit, internal audit committee, and internal board size, have a significant and positive relationship with firm performance. Furthermore, IT investment positively affects the performance of Saudi telecommunication (...) firms. Moreover, CSR mediates the relationship among internal audit, internal audit committee, internal board size, IT investment, and firm performance. This study contributes to the body of knowledge regarding IT investment, corporate governance mechanism, corporate social responsibilities, and firm performance of telecommunication firms in emerging markets. Furthermore, this study will help the top management of the telecom firms to improve corporate governance and IT investment, which will be beneficial to enhance firm performance. (shrink)

PurposeThe purpose of this paper is to explore a particular philosophical underpinning for Information Systems (IS) research – critical systemic thinking (CST). Drawing upon previous work, the authors highlight the principal features of CST within the tradition of critical research and attempt to relate it to trends in the Italian school of IS research in recent years, as exemplified by the work of Claudio Ciborra but also evident in work by, e.g. Resca, Jacucci and D'Atri.Design/methodology/approachThis is a conceptual paper which (...) explores CST, characterised by a focus on individual uniqueness, and socially‐constructed, individual worldviews as generators of human knowing.FindingsThe paper draws on work by Heinz Klein in which he elaborated three constitutive stages in critical research: interpretive, genealogical and constructive. The authors introduce a fourth, reflective stage and discuss five categories of critical research, reflecting different perspectives on emancipation, culminating in emergent expressionism, associated with Ciborra and the Italian school more generally.Research limitations/implicationsThis paper discusses approaches to CST and how they might have practical implications in IS development. The distinction between approaches founded in logical empiricism and those founded in hermeneutic dialectics are considered and the development of critical and systems strands are discussed.Practical implicationsThe paper addresses CST as an approach to development of information systems. Such approaches enable users to explore their individually unique understandings and create a constructive dialogue with one another, which emancipates and empowers users to own and control their own development processes and hence build more productive and usable systems.Social implicationsA focus on research which is oriented towards emancipation in the tradition of critical social theory.Originality/valueThe paper draws on extensive theoretical research carried out by the authors over a period of more than ten years in CST and synthesises the practical implications. (shrink)

Despite increasing recognition of the ways in which ethical and social values play a role in science (Kitcher 2001; Longino 1990, 2002), scientists are often still reluctant to acknowledge or discuss ethical and social values at stake in their research. Even when research is closely connected to developing public policy, it is generally held that it should be empirical data, and not the values of scientists, that inform policy. According to this view, scientists need not, and should not, endorse non-epistemic (...) values related to their research, as doing so may bias their assessment of what the evidence is. As a result, debates over science-based policy tend to be construed solely as empirical discussions to be .. (shrink)

Although typically implicit, clinicians face an inherent conflict between their roles as medical healers and as providers of technical biomedicine (Scott et al. in Philos Ethics Humanit Med 4:11, 2009). This conflict arises from the tension between the physicalist model which still predominates in medical training and practice and the extra-physicalist dimensions of medical practice as epitomised in the concept of patient-centred care. More specifically, the problem is that, as grounded in a "borrowed" physicalist philosophy, the dominant "applied (...) scientist" model exhibits a number of limitations which severely restrict its ability to underwrite the effective practice of care. Moreover, being structural in character, these problems cannot be resolved by piecemeal modifications of the existing model, nor by an appeal to evidence-based medicine (Miles in J Eval Clin Pract 15(6):887-890, 2009; Miles in Folia Med 55(1):5-24, 2013; Miles et al. in J Eval Clin Pract 14(5):621-649, 2008). Hence, the need for medical theorists to "partner with experts in the humanities to build a sui generis philosophy of medicine" (Whatley in J Eval Clin Pract 20(6):961-964, 2014, p. 961). In response, the present paper seeks to vindicate the merits of hermeneutically-informed template in providing the requisite grounding. While capable of correcting for the limitations of the applied scientist model, a hermeneutically-informed template is a "both/and" approach, which seeks to complement rather than exclude the physicalist dimension, and thereby aspires to reconcile technical mastery with patient-centred care, rather than eschew one in favour of the other. As such, it can provide a cogent philosophical template for current best practice, which does justice to the art as well as the science of medical care. (shrink)

BackgroundThe concept of evidence-based medicine has strongly influenced the appraisal and application of empirical information in health care decision-making. One principal characteristic of this concept is the distinction between "evidence" in the sense of high-quality empirical information on the one hand and rather low-quality empirical information on the other hand. In the last 5 to 10 years an increasing number of articles published in international journals have made use of the term "evidence-based ethics", making a systematic analysis (...) and explication of the term and its applicability in ethics important.DiscussionIn this article four descriptive and two normative characteristics of the general concept "evidence-based" are presented and explained systematically. These characteristics are to then serve as a framework for assessing the methodological and practical challenges of evidence-based ethics as a developing methodology. The superiority of evidence in contrast to other empirical information has several normative implications such as the legitimization of decisions in medicine and ethics. This implicit normativity poses ethical concerns if there is no formal consent on which sort of empirical information deserves the label "evidence" and which does not. In empirical ethics, which relies primarily on interview research and other methods from the social sciences, we still lack gold standards for assessing the quality of study designs and appraising their findings.ConclusionThe use of the term "evidence-based ethics" should be discouraged, unless there is enough consensus on how to differentiate between high- and low-quality information produced by empirical ethics. In the meantime, whenever empirical information plays a role, the process of ethical decision-making should make use of systematic reviews of empirical studies that involve a critical appraisal and comparative discussion of data. (shrink)

Evidence-based approaches to policy-making are growing in popularity. A generally embraced view is that with the appropriate evidence at hand, decision and policy making will be optimal, legitimate and publicly accountable. In practice, however, evidence-based policy making is constrained by a variety of problems of evidence. Some of these problems will be explored in this article, in the context of the debates on evidence from which they originate. It is argued that the source of (...) much disagreement might be a failure to addressing crucial philosophical assumptions that inform, often silently, these debates. Three controversial questions will be raised which appear central to some of the challenges faced by evidence-based policy making: firstly, how do certain types of facts candidate themselves as evidence; secondly, how do we decide what evidence we have, and how much of it; and thirdly, can we combine evidence. In addressing these questions it will be shown how a philosophically informed debate might prove instrumental in clarifying and settling practical difficulties. (shrink)

RATIONALE: The concept of evidence-based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence-based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence (...) around the management of low back pain into practice has been proposed. AIMS: The aim of this study was to investigate if physiotherapists' clinical management of patients with low back pain would change following an evidence-based education package, which utilized local opinion leaders and delivered the best evidence. METHOD: Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work, to two groups. The intervention group received an evidence-based programme on the management of low back pain, including advice regarding increasing activity levels and return to normal activity and challenging patients' fears and beliefs about their pain. The control group received a standard in-service training package on the management of common knee pathologies. The physiotherapists' clinical management of patients with low back pain was measured prior to training and 6 months post training. Outcome measures were based on physiotherapists completing 'discharge summary' questionnaires, which included information relating to the use and importance of therapies for treating their low back pain patients. RESULTS: There were few significant differences in treatment options between the intervention and control groups post training. Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain, there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention. CONCLUSIONS: Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care. (shrink)

BackgroundFor many decades, the debate on children’s competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children’s competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally children of (...) 11.2 years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children’s competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives.DiscussionAlthough assessment of children’s competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad.SummaryPrevious research outcomes showed that children’s medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children’s competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated. (shrink)

Evidence is often taken to be “normative” for doxastic agents. For instance, we are told to apportion our beliefs to the evidence, to not believe a claim without seeking out countervailing evidence, and so on. But what accounts for the normativity of evidence? This dissertation is devoted to answering this question. In order to answer it, I develop a novel approach to the theory of epistemic normativity. According to my approach, epistemic norms structure a social (...) class='Hi'>practice of epistemic accountability. This approach shares affinities with Strawsonian attempts to elucidate moral responsibility by considering the conditions under which it’s appropriate to subject a person to the “reactive attitudes” (e.g. resentment and indignation). However, when it comes to epistemic (as opposed to moral) accountability, I argue that the relevant attitudinal responses need not involve reactive emotions. Moreover, what I seek to elucidate by appealing to these attitudinal responses is not responsible agency, but rather the content and normative significance of epistemic norms. Crucial to my approach is a distinctly epistemic way of holding a person accountable for their doxastic attitudes. To hold a person epistemically accountable, on my approach, is to modify trust in the person in a particular way. For instance, someone might cease to take a person’s words at face value when it comes to a certain topic, or someone might be unwilling to rely on another as a testimonial source of information. I argue that our practice of epistemic accountability is a legitimate social practice. I then go on to consider what norms of belief structure its activities. I argue that a number of norms of belief are implicit in our practice of epistemic accountability, including evidential norms and knowledge norms. I ultimately argue that our acceptance of epistemic norms is itself grounded in the fact that we participate in a social practice wherein we hold each other epistemically accountable. (shrink)

Culturally Responsive Teaching (CRT) weaves together rigor and relevance while it improves student achievement and engagement. The Philippine Department of Education implemented Indigenous People’s education to respond to the demands for culturally responsive teaching. Teacher education graduates are expected to articulate the rootedness of education in sociocultural contexts in creating a learning environment that recognizes respect, connectedness, choice, personal relevance, challenges, engagement, authenticity, and effectiveness. Practice teachers need relevant exposure and immersion to fully develop their competence in CRT. This (...) scenario necessitates attention to assessing the competence of 191 practice teachers in CRT, correlating their competence across dimensions, and verifying the role of gender and degree programs in competence development. This investigation provides evidence on the role of gender in competence development toward culturally responsive teaching. Such competence is vital in practice teachers, especially because they are exposed to learners with diverse backgrounds during their teaching internship. This evidence informs supervising instructors in molding practice teachers. (shrink)