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Background, aim and objectives: Evaluating quality of care is essential when redesigning or improving practice. Medicines reconciliation (MR) on hospital admission is now policy in the UK. It is the process of obtaining an up-to-date and accurate medication list and documenting any discrepancies. The overall aim of this work was to develop quality indicators to evaluate MR on admission to hospital; the specific objectives include developing MR quality indicators, achieving consensus on their appropriateness and testing their feasibility by applying them in a hospital setting. Design: The study was designed in three parts, each consisting of three steps. In part I, ideas about potential indicators were obtained from two sources: a literature search and the nominal group technique. These ideas were converted to potential indicators using criteria for good indicators and then reviewed by nine reviewers. Part II was designed to achieve consensus on the appropriateness of the indicators to evaluate MR. It involved pre-piloting, piloting and conducting the main two-round online Delphi study. Several methods were used to approach predefined experts. Part III involved applying in hospital settings those MR indicators that had achieved consensus. It included developing operational definitions and directly observing the MR process as conducted by pharmacy staff in two hospitals. The indicators were further tested by collecting data about the MR process for all patients seen by pharmacy staff on one weekday in the two hospitals. Results: A systematic approach was followed to develop MR indicators. The idea generation step produced over 90 ideas about potential indicators, which were converted to 85 MR indicators. The assessment by the nine practicing hospital pharmacists discarded 29 of them and the remaining 56 MR indicators were carried forward to the Delphi study, during which 41 indicators achieved consensus as appropriate for evaluating MR on admission to hospital. In the feasibility study, 5 MR indicators were found not to be feasible and three not adequately assessed, while 33 indicators were considered feasible to be used in a hospital setting. Conclusions: This work provided a novel list of 33 indicators that achieved consensus and were found to be feasible to evaluate the MR process on admission to hospital. Further research should explore the use of these indicators, among others, to assess and improve the overall quality of care provided to patients on admission and throughout the hospitalization journey.

Background: Physical Therapists in the United States can perform Dry Needling (DN) in most states with the legal requirement for the therapist to obtain written and/or verbal informed consent (IC). When consenting patients to DN treatment, it is necessary to inform patients of potential risks of harms.In cases where risks are disclosed as part of IC, patients have potentially shown poor recall which calls into question how best this type of information should be presented.Purpose: To develop a risk of harm statement that can be used on an IC form for DN in both the clinic and research settings to improve patient autonomy and decision making.Research Design and Methods: The Delphi study involved three rounds of questionnaires to gain expert consensus for inclusion of AEs for IC. Inclusion criteria for DN experts included: (1) >= 5 years practice performing DN and one of the following secondary criteria: (a) Certification in DN, (b) Completion of a manual therapy fellowship that included DN training, or (c) >= 1 publication involving the use of DN. Participants rated their level of agreement using a 4-point Likert scale. Consensus was defined as >= 80% agreement or >=70% and < 80% agreement with Median >= 3, Interquartile Range = 80% agreement following 2 rounds of voting.Analysis: In both studies, median, Interquartile range (IQR), standard deviation, and percent agreement (combined “strongly agree” and “agree” responses) were calculated. A Wilcoxon rank-sum test was used to evaluate the consistency and stability of responses between questionnaire responses. Statistical significance was defined as P < 0.05. Kendall’s coefficient of concordance (w) was calculated in each round to determine agreement between participants. Readability analysis included: Flesch-Kincaid grade level, Flesch Reading Ease Score, and sentences.Results: Thirty-Nine DN experts were included in the Delphi Study and five participants were recruited in the NGT study (N=1 legal expert, N=1 policy expert, N=2 DN experts, and N=1 patient). Fourteen AEs identified for inclusion on a risk of harm statement: bleeding, diaphoresis, fatigue, pain during/after, pneumothorax, soreness, bruising, dizziness/lightheadedness, drowsiness, superficial hematoma under skin, skin redness, neurological symptoms, syncope, and temporary increase in symptoms. Each AE was categorized by the experts where 93.6% agreed with the definitions for both severity and likelihood. In the NGT, participants identified 27 elements for IC, 22 of which reached final consensus. The elements pertaining to a risk of harm statement included being able to order the risks that can occur and to stratify the severity and likelihood of each risk.Conclusion: A final risk of harm statement was generated for inclusion on IC for DN. The final risk of harm statement was 20 sentences long, was written at a 7th grade reading level, contained an ordered list of risks by severity and likelihood of occurrence, and had a Flesch Reading Ease Score of 65.0.

Approximately 1 in 5 youth aged 8–18 experiences a mental health problem (e.g., anxiety, depression, conduct, trauma) that requires mental health services; however, only about half receive evidence-based services, 70-80% of which are received in schools. There is an urgent need to address the implementation gap that limits youth access to quality mental health services and compromises longer term youth mental health outcomes. Improving mental health service implementation in schools requires the development and use of effective implementation strategies tailored to address context-specific barriers. Currently, implementation strategies are often selected based on a one-size-fits-all approach; however, to increase the likelihood that they will exert their desired effect, there is a need to use evidence-based knowledge and include participatory involvement of stakeholders to select and adapt strategies that are matched to site-specific barriers and deemed feasible for use in a given setting. The purpose of this development study was to engage school-based stakeholders in mixed method inquiry that facilitated the design of an implementation facilitation approach, the Facilitated Implementation Tailoring (FIT) technique. Our findings highlight the need to engage end-users at the outset of implementation strategy design. While all stakeholders welcomed the use of facilitation for school-based implementation efforts, several major and minor revisions to the FIT strategy were recommended following synthesis of stakeholder. Major revisions recommended included using a flexible yet structured “Pick-and-Choose" model that was comprehensive yet not over packaged to respond to stakeholders’ preferences and based needs. In addition, minor changes were suggested. Implications for theory and practice as well as limitations and future research are discussed.

The biological and socioeconomic feasibility of restoring elk (Cervus elaphus) to Virginia was assessed. Biological feasibility was determined by evaluating habitat suitability for elk while considering potential impacts of elk on existing fauna and flora in Virginia. Suitability was assessed by creating a habitat suitability index (HSI) model that measured the availability and accessibility of open foraging areas and forested cover areas, the availability of permanent water sources, and the degree of fragmentation by roads. Eight areas were identified as potential elk habitat: 1 in Southwest Virginia, 4 in the Shenandoah Mountains (Shenandoah, Highland, Big Meadows, Peaks of Otter), and 3 in the Southern Piedmont (Danville, Brookneal, Rehobeth). The highest potentials for supporting an elk herd were found in the Highland and Big Meadows study areas, medium biological feasibilities were found in the Southwest, Shenandoah, and Brookneal study areas, and low biological feasibilities were found in the Peaks of Otter, Danville, and Rehobeth study areas. A restored elk herd could negatively affect indigenous fauna and flora by changing the structure and diversity of existing forested ecosystems, but impacts can be minimized by maintaining elk populations at or below cultural carrying capacity. The introduction of diseases during restoration and possible transmission of those diseases from elk to humans, livestock, and other wildlife also are concerns, but these issues can be addressed by following a risk minimization protocol. Socioeconomic feasibility was assessed with a statewide mail survey of Virginia residents, 4 regional stakeholder workshops, an analysis of economic costs and benefits associated with elk restoration, and an assessment of the risks of elk-human conflicts in each of the 8 study areas. Overall, most (61%) respondents agreed that elk restoration would be good for Virginia. However, the low response rate (30%) and low confidence among respondents (49%) in their knowledge about elk indicated that most residents do not have the interest and/or necessary information to form a definitive opinion. Residents believe that the greatest benefits of restoration would be the value-based and indirect ecological benefits, such as returning an extirpated species to its native range, whereas the greatest perceived costs were the economic impacts to property, crop depredation, and public safety hazards. In contrast, local stakeholder representatives identified economic returns from increased tourism due to the presence of elk and the creation of new recreational opportunities as the most anticipated benefits; important concerns were the potential for property damage by elk, the potential impacts on local ecosystems, and the costs of implementing and administering an elk restoration program and subsequent elk management. Proposed resolutions for these issues varied by region. Representatives from the Southwest and northern Shenandoah Mountain (Shenandoah and Big Meadows study site) Regions preferred not to restore elk, whereas those from the southern Shenandoah Mountain (Highland and Peaks of Otter study site) and the Southern Piedmont Regions preferred to start out small with a carefully controlled and monitored "experimental" population. Economic benefits of elk restoration, as determined through analysis of data from other eastern states currently managing elk populations, are associated with tourism and the revenues brought to the community during elk hunting seasons, whereas economic costs are associated with crop damage, elk-vehicle collisions, and the administrative costs of managing an elk herd. Although the initial costs of transporting, releasing, and monitoring a founder population likely will exceed immediate benefits, once an elk population is established, benefits likely will exceed costs. However, an equitable distribution of costs and benefits must be devised so that the individuals who bear the costs are afforded a comparable or greater set of benefits. Risk of landowner elk-conflicts was examined by comparing human population densities and growth rates, percent private versus public land, and agricultural trends across the 8 study areas. Highest risk for elk-human conflicts was identified in the Southern Piedmont Region and in the Shenandoah study site, risk was moderate in the Southwest, Big Meadows, and Peaks of Otter study sites, and risk in the Highland study site was low. Overall, the Highland study site had the highest feasibility for elk restoration of all study areas examined; the Big Meadows and Southwest study sites both demonstrated moderate feasibility. Restoration in these areas is possible so long as management objectives remain flexible, plans are made in advance to address potential concerns, and the public is involved in the decision-making processes both before and after elk are released.

As education systems, in particular Technology Education, adapt to new expectations for secondary students entering an uncertain workforce, the time is appropriate to investigate the need for school facilities to meet these present demands and those that continue to change curricula. This study has been conducted in order to determine the facility requirements for the delivery of the evolving technology/manual arts curriculum in Queensland. A set of validated design criteria for evaluating technology education and vocational education settings was developed and trialed to assist the designer of such facilities to meet the needs of this area on schools designed in different eras from the 1 960s to the present. A review of the published literature would indicate that little has been written on this aspect of facilities design. While related studies have been conducted in North America, they were not confined to the designing of the facilities and only had specific relevance in that country. An expert group consisting of prominent Queensland educators provided the impetus for developing the criteria which had been generated through a systematic search of the literature. The methodology utilised to involve the expert group was the Nominal Group Technique. After the criteria had been developed, they were validated by questionnaire through a 30% random sample of practicing heads of department across Queensland in both state and independent systems. A trial evaluation using current facilities was subsequently conducted to determine the effectiveness of the criteria in terms of teacher acceptability as well as establishing a pattern of needs for modification. Practitioners who use the facility for teaching technology education and/or vocational education could use the set of criteria to evaluate their facility in a similar manner to that of evaluating their students. Such evaluations could then become the basis for ffiture school planning and budgetary allocations as well as asset management of existing facilities. The study proved to be valuable as the validated criteria have the potential of being used as a tool by teachers to evaluate their facilities. At the systems level of operation, the criteria will provide assistance for designers, architects and teachers to prepare informal educational briefs. Such briefs would provide a consistent approach to the some times difficult task of clearly defining the function of a facility. The modem facility must meet the needs of current curriculum and be sufficiently flexible and adaptable to provide the educational requirements well into the twenty-first century. These developed criteria will greatly assist in this process.