Suchergebnisse

Inappropriate or incorrect use of child restraints can influence crash injury outcome. This study examined the role of restraint factors in child passenger deaths and the effect of legislation requiring appropriate restraint systems up to 7 years old. Data for child (0&ndash ; 12 years) passenger deaths occurring in New South Wales (NSW) from 2007 to 2016 were collected by the child death review team including photographs, reports of in-depth crash investigation, witness reports and medical reports. Restraint use, type of restraint, appropriateness of the restraint for the age of the child and correctness of restraint use were examined. The primary contributor to death was determined in each case. Sixty-four child passengers died in NSW during the data period. Twenty-nine (29/64, 45%) were properly restrained. Thirteen children (13/64, 20%) were unrestrained. In 20 cases (20/64, 31%), children were using a restraint that was either inappropriate for their age (6) or not used correctly (14). Restraint factors were a primary contributor in 22 (22/64, 34%) child deaths. Compared to pre-legislation, appropriate restraint use was more common post-legislation (13/22. 59% vs. 30/42, 71%). However, incorrect use was also greater (3/22, 14% vs. 11/42, 26%). Interventions targeting increasing restraint use and reduction of common &lsquo ; use&rsquo ; errors are needed to prevent further restraint factor-related deaths.

Future scenarios provide challenging, plausible and relevant stories about how the future could unfold. Urban Futures (UF) research has identified a substantial set (>450) of seemingly disparate scenarios published over the period 1997–2011 and within this research, a sub-set of >160 scenarios has been identified (and categorized) based on their narratives according to the structure first proposed by the Global Scenario Group (GSG) in 1997; three world types (Business as Usual, Barbarization, and Great Transitions) and six scenarios, two for each world type (Policy Reform—PR, Market Forces—MF, Breakdown—B, Fortress World—FW, Eco-Communalism—EC and New Sustainability Paradigm—NSP). It is suggested that four of these scenario archetypes (MF, PR, NSP and FW) are sufficiently distinct to facilitate active stakeholder engagement in futures thinking. Moreover they are accompanied by a well-established, internally consistent set of narratives that provide a deeper understanding of the key fundamental drivers (e.g., STEEP—Social, Technological, Economic, Environmental and Political) that could bring about realistic world changes through a push or a pull effect. This is testament to the original concept of the GSG scenarios and their development and refinement over a 16 year period.

Inappropriate or incorrect use of child restraints can influence crash injury outcome. This study examined the role of restraint factors in child passenger deaths and the effect of legislation requiring appropriate restraint systems up to 7 years old. Data for child (0–12 years) passenger deaths occurring in New South Wales (NSW) from 2007 to 2016 were collected by the child death review team including photographs, reports of in-depth crash investigation, witness reports and medical reports. Restraint use, type of restraint, appropriateness of the restraint for the age of the child and correctness of restraint use were examined. The primary contributor to death was determined in each case. Sixty-four child passengers died in NSW during the data period. Twenty-nine (29/64, 45%) were properly restrained. Thirteen children (13/64, 20%) were unrestrained. In 20 cases (20/64, 31%), children were using a restraint that was either inappropriate for their age (6) or not used correctly (14). Restraint factors were a primary contributor in 22 (22/64, 34%) child deaths. Compared to pre-legislation, appropriate restraint use was more common post-legislation (13/22. 59% vs. 30/42, 71%). However, incorrect use was also greater (3/22, 14% vs. 11/42, 26%). Interventions targeting increasing restraint use and reduction of common 'use' errors are needed to prevent further restraint factor-related deaths.

We explored the factors influencing the use of age-appropriate car seats in a community with a high proportion of Aboriginal families in regional New South Wales. We conducted a survey and three focus groups with parents of children aged 3–5 years enrolled at three early learning centres on the Australian south-east coast. Survey data were triangulated with qualitative data from focus groups and analysed using the PRECEDE-PROCEED conceptual framework. Of the 133 eligible families, 97 (73%) parents completed the survey including 31% of parents who reported their children were Aboriginal. Use of age-appropriate car seats was reported by 80 (83%) of the participants, and awareness of the child car seat legislation was high (91/97, 94%). Children aged 2–3 years were less likely reported to be restrained in an age-appropriate car seat than were older children aged 4–5 years (60% versus 95%: χ2 = 19.14, p < 0.001). Focus group participants highlighted how important their child's safety was to them, spoke of the influence grandparents had on their use of child car seats and voiced mixed views on the value of authorised child car seat fitters. Future programs should include access to affordable car seats and target community members as well as parents with clear, consistent messages highlighting the safety benefits of using age-appropriate car seats.

AbstractIntroductionIt is good practice to involve stakeholders in systematic reviews, but it is not clear how best to involve them.AimTo describe and reflect on the stakeholder involvement within an update of a Cochrane review of physical rehabilitation after stroke.MethodsA stakeholder group, comprising 15 stroke survivors, carers, and physiotherapists from across the United Kingdom, were recruited and contributed throughout the process of the review. A framework was used to describe when and how stakeholders were involved. Stakeholders provided feedback on their involvement after meetings. An amended version of a validated patient engagement tool was used to collect reflections on the stakeholder involvement process.ResultsFive stakeholder meetings were held throughout the review process, supplemented by additional communication. Several changes were made to the review structure, analyses, and wording as a direct result of the stakeholder involvement. Stakeholders and researchers agreed that stakeholders' contributions were taken seriously and influenced the review. Stakeholders felt that they were given the chance to share their views and that information was shared well before, during, and after each meeting to help them to contribute knowledgeably in the process. Stakeholder reflections highlighted a number of key lessons relating to stakeholder involvement, including process of reflection and feedback, use of remote/virtual meetings, need for adequate time and funding, tensions experienced by clinicians, and recruitment considerations.ConclusionsWe describe and reflect on stakeholder involvement in a systematic review and explores practical ways to support meaningful engagement during systematic review production. Our experience supports the view that coproducing reviews with stakeholders can make systematic reviews more relevant and meaningful. Our approach and experiences can be used to inform future review coproduction, supporting development of useful reviews that will improve clinical practice.

Guideline implementation tools (GI tools) can improve clinician behavior and patient outcomes. Analyses of guidelines published before 2010 found that many did not offer GI tools. Since 2010 standards, frameworks and instructions for GI tools have emerged. This study analyzed the number and types of GI tools offered by guidelines published in 2010 or later. Content analysis and a published GI tool framework were used to categorize GI tools by condition, country, and type of organization. English-language guidelines on arthritis, asthma, colorectal cancer, depression, diabetes, heart failure, and stroke management were identified in the National Guideline Clearinghouse. Screening and data extraction were in triplicate. Findings were reported with summary statistics. Eighty-five (67.5%) of 126 eligible guidelines published between 2010 and 2017 offered one or more of a total of 464 GI tools. The mean number of GI tools per guideline was 5.5 (median 4.0, range 1 to 28) and increased over time. The majority of GI tools were for clinicians (239, 51.5%), few were for patients (113, 24.4%), and fewer still were to support implementation (66, 14.3%) or evaluation (46, 9.9%). Most clinician GI tools were guideline summaries (116, 48.5%), and most patient GI tools were condition-specific information (92, 81.4%). Government agencies (patient 23.5%, clinician 28.9%, implementation 24.1%, evaluation 23.5%) and developers in the UK (patient 18.5%, clinician 25.2%, implementation 27.2%, evaluation 29.1%) were more likely to generate guidelines that offered all four types of GI tools. Professional societies were more likely to generate guidelines that included clinician GI tools. Many guidelines do not include any GI tools, or a variety of GI tools for different stakeholders that may be more likely to prompt guideline uptake (point-of-care forms or checklists for clinicians, decision-making or self-management tools for patients, implementation and evaluation tools for managers and policy-makers). While this may vary by country and type of organization, and suggests that developers could improve the range of GI tools they develop, further research is needed to identify determinants and potential solutions. Research is also needed to examine the cost-effectiveness of various types of GI tools so that developers know where to direct their efforts and scarce resources.

Future scenarios provide challenging, plausible and relevant stories about how the future could unfold. Urban Futures (UF) research has identified a substantial set (>450) of seemingly disparate scenarios published over the period 1997–2011 and within this research, a sub-set of >160 scenarios has been identified (and categorized) based on their narratives according to the structure first proposed by the Global Scenario Group (GSG) in 1997; three world types (Business as Usual, Barbarization, and Great Transitions) and six scenarios, two for each world type (Policy Reform—PR, Market Forces—MF, Breakdown—B, Fortress World—FW, Eco-Communalism—EC and New Sustainability Paradigm—NSP). It is suggested that four of these scenario archetypes (MF, PR, NSP and FW) are sufficiently distinct to facilitate active stakeholder engagement in futures thinking. Moreover they are accompanied by a well-established, internally consistent set of narratives that provide a deeper understanding of the key fundamental drivers (e.g., STEEP—Social, Technological, Economic, Environmental and Political) that could bring about realistic world changes through a push or a pull effect. This is testament to the original concept of the GSG scenarios and their development and refinement over a 16 year period.

Future scenarios provide challenging, plausible and relevant stories about how the future could unfold. Urban Futures (UF) research has identified a substantial set (>450) of seemingly disparate scenarios published over the period 1997–2011 and within this research, a sub-set of >160 scenarios has been identified (and categorized) based on their narratives according to the structure first proposed by the Global Scenario Group (GSG) in 1997; three world types (Business as Usual, Barbarization, and Great Transitions) and six scenarios, two for each world type (Policy Reform—PR, Market Forces—MF, Breakdown—B, Fortress World—FW, Eco-Communalism—EC and New Sustainability Paradigm—NSP). It is suggested that four of these scenario archetypes (MF, PR, NSP and FW) are sufficiently distinct to facilitate active stakeholder engagement in futures thinking. Moreover they are accompanied by a well-established, internally consistent set of narratives that provide a deeper understanding of the key fundamental drivers (e.g., STEEP—Social, Technological, Economic, Environmental and Political) that could bring about realistic world changes through a push or a pull effect. This is testament to the original concept of the GSG scenarios and their development and refinement over a 16 year period.