Forensic reports use various types of conclusions, such as a categorical (CAT) conclusion or a likelihood ratio (LR). In order to correctly assess the evidence, users of forensic reports need to understand the conclusion and its evidential strength. The aim of this paper is to study the interpretation of the evidential strength of forensic conclusions by criminal justice professionals. In an online questionnaire 269 professionals assessed 768 reports on fingerprint examination and answered questions that measured self-proclaimed and actual understanding of the reports and conclusions. The reports entailed CAT, verbal LR and numerical LR conclusions with low or high evidential strength and were assessed by crime scene investigators, police detectives, public prosecutors, criminal lawyers, and judges. The results show that about a quarter of all questions measuring actual understanding of the reports were answered incorrectly. The CAT conclusion was best understood for the weak conclusions, the three strong conclusions were all assessed similarly. The weak CAT conclusion correctly emphasizes the uncertainty of any conclusion type used. However, most participants underestimated the strength of this weak CAT conclusion compared to the other weak conclusion types. Looking at the self-proclaimed understanding of all professionals, they in general overestimated their actual understanding of all conclusion types.
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Forensic DNA Trace Evidence Interpretation: Activity Level Propositions and Likelihood Ratios provides all foundational information required for a reader to understand the practice of evaluating forensic biology evidence given activity level propositions and to implement the practice into active casework within a forensic institution. The book begins by explaining basic concepts and foundational theory, pulling together research and studies that have accumulated in forensic journal literature over the last 20 years.The book explains the laws of probability - showing how they can be used to derive, from first principles, the likelihood ratio - used throughout the book to express the strength of evidence for any evaluation. Concepts such as the hierarchy of propositions, the difference between experts working in an investigative or evaluative mode and the practice of case assessment and interpretation are explained to provide the reader with a broad grounding in the topics that are important to understanding evaluation of evidence. Activity level evaluations are discussed in relation to biological material transferred from one object to another, the ability for biological material to persist on an item for a period of time or through an event, the ability to recover the biological material from the object when sampled for forensic testing and the expectations of the prevalence of biological material on objects in our environment. These concepts of transfer, persistence, prevalence and recovery are discussed in detail in addition to the factors that affect each of them.The authors go on to explain the evaluation process: how to structure case information and formulate propositions. This includes how a likelihood ratio formula can be derived to evaluate the forensic findings, introducing Bayesian networks and explaining what they represent and how they can be used in evaluations and showing how evaluation can be tested for robustness. Using these tools, the authors also demonstrate the ways that the methods used in activity level evaluations are applied to questions about body fluids. There are also chapters dedicated to reporting of results and implementation of activity level evaluation in a working forensic laboratory. Throughout the book, four cases are used as examples to demonstrate how to relate the theory to practice and detail how laboratories can integrate and implement activity level evaluation into their active casework.
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Are professionals better at assessing the evidential strength of different types of forensic conclusions compared to students? In an online questionnaire 96 crime investigation and law students, and 269 crime investigation and legal professionals assessed three fingerprint examination reports. All reports were similar, except for the conclusion part which was stated in a categorical (CAT), verbal likelihood ratio (VLR) or numerical likelihood ratio (NLR) conclusion with high or low evidential strength. The results showed no significant difference between the groups of students and professionals in their assessment of the conclusions. They all overestimated the strength of the strong CAT conclusion compared to the other conclusion types and underestimated the strength of the weak CAT conclusion. Their background (legal vs. crime investigation) did have a significant effect on their understanding. Whereas the legal professionals performed better compared to the crime investigators, the legal students performed worse compared to crime investigation students.
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This thesis describes an Action Research (AR) project aimed at the implementation of Evidence Based Practice in a mental health nursing setting in the Netherlands. The main research question addressed in this thesis is: In what way is Action Research with an empowering appropriate to implement Evidence Based Practice in a mental health nursing setting in the Netherlands and what is the effect of this implementation on the care experienced by the client, the nursing interventions and the context in this setting compared to a comparative setting? To answer this main research question, the following questions derived from it were addressed: What is Evidence Based Practice? What is known about implementing evidence-based practice in nursing through Action Research? Which factors have to be dealt with in a mental health nursing setting, so the implementation of EBP with AR with an empowering intent will be more successful? Which factors have to be dealt with in a mental health nursing setting, so the implementation of EBP with AR with an empowering intent will be successful? How is EBP implemented through AR with an empowering intent and what are the outcomes for the use of evidence, the context and the facilitation in the setting? What is the effect of the implementation of EBP in mental health nursing using AR with an empowering intent on the care experienced by the client, the nursing interventions and the context compared to a comparison setting? The first two questions were answered by a search of the literature while the remaining questions were answered during the AR study conducted in two mental health organisations in the Netherlands.
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BackgroundIn a global effort to design better hospital buildings for people and organizations, some design principles are still surrounded by great mystery. The aim of this online study was to compare anxiety in an existing single-bed inpatient hospital room with three redesigns of this room in accordance with the principles of Golden Ratio, Feng Shui, and Evidence-Based Design.MethodsIn this online multi-arm parallel-group randomized trial participants were randomly assigned (1:1:1:1) to one of four conditions, namely Golden Ratio condition, Feng Shui condition, Evidence-Based Design condition, or the control condition. The primary outcomes were anxiety, sense of control, social support, positive distraction, and pleasantness of the room.FindingsBetween June 24, 2022, and August 22, 2022, 558 individuals were randomly assigned to one of the four conditions, 137 participants to the control condition, 138 participants to the Golden Ratio condition, 140 participants to the Feng Shui condition, and 143 participants to the Evidence-Based Design condition. Compared with baseline, participants assigned to the Evidence-Based Design condition experienced less anxiety (mean difference -1.35, 95% CI -2.15 to -0.55, Cohen’s d = 0.40, p < 0.001). Results also showed a significant indirect effect of the Feng Shui condition on anxiety through the pleasantness of the room (B = -0.85, CI = -1.29 to -0.45) and social support (B = -0.33, CI = -0.56 to -0.13). Pleasantness of the room and social support were mediators of change in anxiety in the Evidence-Based Design and Feng Shui conditions. In contrast, application of the design principle Golden Ratio showed no effect on anxiety and remains a myth.InterpretationTo our knowledge, this is the first randomized controlled trial linking design principles directly to anxiety in hospital rooms. The findings of our study suggest that Feng Shui and Evidence-Based Design hospital rooms can mitigate anxiety by creating a pleasant looking hospital room that fosters access to social support.
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Aims and objectives: To describe the process of implementing evidence-based practice (EBP) in a clinical nursing setting. Background: EBP has become a major issue in nursing, it is insufficiently integrated in daily practice and its implementation is complex. Design: Participatory action research. Method: The main participants were nurses working in a lung unit of a rural hospital. A multi-method process of data collection was used during the observing, reflecting, planning and acting phases. Data were continuously gathered during a 24-month period from 2010 to 2012, and analysed using an interpretive constant comparative approach. Patients were consulted to incorporate their perspective. Results: A best-practice mode of working was prevalent on the ward. The main barriers to the implementation of EBP were that nurses had little knowledge of EBP and a rather negative attitude towards it, and that their English reading proficiency was poor. The main facilitators were that nurses wanted to deliver high-quality care and were enthusiastic and open to innovation. Implementation strategies included a tailored interactive outreach training and the development and implementation of an evidence-based discharge protocol. The academic model of EBP was adapted. Nurses worked according to the EBP discharge protocol but barely recorded their activities. Nurses favourably evaluated the participatory action research process. Conclusions: Action research provides an opportunity to empower nurses and to tailor EBP to the practice context. Applying and implementing EBP is difficult for front-line nurses with limited EBP competencies. Relevance to clinical practice: Adaptation of the academic model of EBP to a more pragmatic approach seems necessary to introduce EBP into clinical practice. The use of scientific evidence can be facilitated by using pre-appraised evidence. For clinical practice, it seems relevant to integrate scientific evidence with clinical expertise and patient values in nurses’ clinical decision making at the individual patient level.
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Accurate and reliable decision-making in the criminal justice system depends on accurate expert reporting and on the correct interpretation of evidence by the judges, prosecutors, and defense lawyers. The present study aims to gain insight into the judiciary's capability to assess the accuracy and reliability of forensic expert reports by first examining the extent to which criminal justice professionals are able to differentiate between an accurate (or sound) expert report and an inaccurate (or unsound) expert report. In an online questionnaire, 133 participants assessed both a sound and an unsound expert report. The findings show that, on average, participants were unable to significantly distinguish between sound and unsound forensic expert reports. Second, the study explored the influence of institutional authority on the evaluation of forensic expert reports. Reports that were not recognized as flawed—particularly those originating from well-known and reputable institutions—were subjected to less critical examination, increasing the risk of evaluation errors. These results suggest that the perceived institutional authority influences the assessment of forensic evidence. The study highlights the need for tools to support criminal justice professionals in evaluating forensic evidence, particularly when experts are unregistered. Recommendations include adhering to established quality standards, consulting counter-expert evaluations, improving courtroom communication, and enhancing forensic knowledge through training. Overall, the findings underscore the importance of critical evidence evaluation to reduce the risk of misinterpretation and wrongful convictions in the judicial process.
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The aim of the research reported in this thesis was to gain knowledge about the implementation of evidence‐based practice (EBP) in nursing to find a way to integrate shared decision making (SDM) with EBP in a chronic care environment in nursing, and to develop a strategy for an integrated approach of EBP and SDM in daily nursing practice in the individual aftercare for cancer survivors.
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Objectives: This study assesses social workers’ orientation toward the evidence-based practice (EBP) process and explores which specific variables (e.g. age) are associated. Methods: Data were collected from 341 Dutch social workers through an online survey which included a Dutch translation of the EBP Process Assessment Scale (EBPPAS), along with 13 background/demographic questions. Results: The overall level of orientation toward the EBP process is relatively low. Although respondents are slightly familiar with it and have slightly positive attitudes about it, their intentions to engage in it and their actual engagement are relatively low. Respondents who followed a course on the EBP process as a student are more oriented toward it than those who did not. Social workers under 29 are more familiar with the EBP process than those over 29. Conclusions: We recommend educators to take a more active role in teaching the EBP process to students and social workers.
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In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient’s values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient’s values. The shared decision-making model seems to be helpful in the integration of the individual patient’s values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient’s willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making – integrated with evidence-based practice – can facilitate the shared decision-making process. We conclude that nurses as well as other health care professionals in chronic care should integrate shared decision making with evidence- based practice to deliver patient-centred care.
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