Background
Few validated assessment tools are available to increase understanding and measure factors associated with sustainment of clinical practices, an increasingly recognized need among clinicians. We describe the development of the Clinical Sustainability Assessment Tool (CSAT), designed to assess factors that contribute to sustainable practices in clinical settings.
Methods
Sixty-four participants from clinical and research fields participated in concept mapping and were recruited to brainstorm factors that lead to sustained clinical practices. Once repeated factors were removed, participants sorted items based on similarity and rated them by importance and feasibility. Using concept mapping analyses, items were grouped into meaningful domains to develop an initial tool. We then recruited pilot sites and early adopters, for a total of 286 practicing clinicians, to pilot and evaluate the tool. Individuals were recruited from clinical settings across pediatric and adult medical and surgical subspecialties. The data were analyzed using confirmatory factor analysis (CFA) to test hypothesized subscale structure in the instrument. We used root mean square error of approximation (RMSEA) and the standardized root mean square residual (SRMR) to assess fit and thus the ability of CSAT to measure the identified domains.
Results
The concept mapping produced sorted statements that were edited into items that could be responded to, resulting in the creation of a tool with seven determinant domains and 47 items. The pilot and CFA testing resulted in a final CSAT instrument made up 35 items, five per domain. CFA results demonstrated very good fit of the seven domain structure of the CSAT (RMSEA = 0.049; SRMR = 0.049). Usability testing indicated the CSAT is brief, easy to use, easy to learn, and does not require extensive training. Additionally, the measure scored highly (18/20) on the Psychometric and Pragmatic Evidence Rating Scale (PAPERS). The seven final CSAT domains were engaged staff and leadership, engaged stakeholders, organizational readiness, workflow integration, implementation and training, monitoring and evaluation, and outcomes and effectiveness.
Conclusions
The CSAT is a new reliable assessment tool which allows for greater practical and scientific understanding of contextual factors that enable sustainable clinical practices over time.
In this prospective study, VMAT plans were chosen over IMRT 90% of the time. Compared to IMRT, VMAT plans used only one third of the MUs, had shorter treatment times, and similar sparing of OAR. Overall, VMAT provided similar dose homogeneity but less conformity in PTV irradiation compared to IMRT. This difference in conformity was not clinically significant.
Prairie fens are globally vulnerable wetlands that are considered a conservation priority due to threats to their high biodiversity and hydrological functions. Establishing a thorough and repeatable plant sampling protocol is critical to evaluating conservation and management initiatives. Our goal was to evaluate a sample methodology designed to assess prairie fen plant diversity and determine if it produced results (1) representative of site diversity, (2) comparable among fens, and (3) efficient to collect. Nineteen fens between 8.5 and 28.4 ha were surveyed twice within one growing season during 2012 and 2013 field seasons using an area-proportional, random design. The turnover in species between spring and summer sampling periods within a site ranged from 8 to 50 %. Sample coverage of total estimated plant species richness ranged from 84.8 to 95.0 % with a mean of 90.1 %. We compared results from our areaproportional, random design to simulated random samples of 10, 15, 20, 25, 30, 35 and 40 quadrats per site. No significant difference was found in sample coverage per fen when using sampling rates of 25, 30, or 35 quadrats per site versus the area-proportional design. Shannon's diversity index and floristic quality index differed by sample period and number of quadrats sampled per fen. Our sample design produced acceptable levels of coverage and facilitated comparisons across fens. Our methodology could be applied to future research, restoration monitoring, and conservation planning efforts in Midwestern prairie fens.
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