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To better understand barriers and facilitators that contribute to antibiotic overuse in long-term care and to use this information to inform an evidence and theory-informed program.
Information on barriers and facilitators associated with the assessment and management of urinary tract infections were identified from a mixed-methods survey and from focus groups with stakeholders working in long-term care. Each barrier or facilitator was mapped to corresponding determinants of behavior change, as described by the theoretical domains framework (TDF). The Rx for Change database was used to identify strategies to address the key determinants of behavior change.
In total, 19 distinct barriers and facilitators were mapped to 8 domains from the TDF: knowledge, skills, environmental context and resources, professional role or identity, beliefs about consequences, social influences, emotions, and reinforcements. The assessment of barriers and facilitators informed the need for a multifaceted approach with the inclusion of strategies (1) to establish buy-in for the changes; (2) to align organizational policies and procedures; (3) to provide education and ongoing coaching support to staff; (4) to provide information and education to residents and families; (5) to establish process surveillance with feedback to staff; and (6) to deliver reminders.
The use of a stepped approach was valuable to ensure that locally relevant barriers and facilitators to practice change were addressed in the development of a regional program to help long-term care facilities minimize antibiotic prescribing for asymptomatic bacteriuria. This stepped approach provides considerable opportunity to advance the design and impact of antimicrobial stewardship programs.
This chapter explores the potential of implementation science to support the development of school psychology. Implementation science perspectives and evidence base provide essential information for effective school psychology service delivery. In Scotland in particular, systems and frameworks exist in school psychology that provide a substrate for the effective incorporation of evidence-based implementations. Over the last forty years, school psychology practitioners have anticipated much of the evidence now emerging from implementation science. They have highlighted contextual barriers to change experienced in schools but arguably have lacked sufficient scientific influence and the large-scale evidential basis required to create scientific impact. Diversity in origins and scope is clearly influential in the context of the development of the role of educational psychology day to day. For school psychology, the development of realist epistemology has proved central to understanding, defining, focusing and measuring the processes which govern change in real-world contexts.
The articles collected here bear witness to the continued and wide interest in England and its neighbours in the "long" thirteenth century. The volume includes papers on the high politics of the thirteenth century, international relations, the administrative and governmental structures of medieval England and aspects of the wider societal and political context of the period. A particular theme of the papers is Anglo-French political history, and especially the ways in which that relationship was reflected in the diplomatic and dynastic arrangements associated with the Treaty of Paris, the 750th anniversary of which fell during 2009, a fact celebrated in this collection of essays and the Paris conference at which the original papers were first delivered.
Contributors: Caroline Burt, Julie E. Kanter, Julia Barrow, Benjamin L. Wild, William Marx, Caroline Dunn, Adrian Jobson, Adrian R. Bell, Chris Brooks, Tony K. Moore, David A. Trotter, William Chester Jordan, Daniel Power, Florent Lenègre