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C Batchelor

Publications and source records attributed to C Batchelor.

6 recordsLinked to original sources
PubMed2006

From comparative risk assessment to multi-criteria decision analysis and adaptive management: recent developments and applications.

Environmental risk assessment and decision-making strategies over the last several decades have become increasingly more sophisticated, information-intensive, and complex, including such approaches as expert judgment, cost-benefit analysis, and toxicological risk assessment. One tool that has been used to support environmental decision-making is comparative risk assessment (CRA), but CRA lacks a structured method for arriving at an optimal project alternative. Multi-criteria decision analysis (MCDA) provides better-supported techniques for the comparison of project alternatives based on decision matrices, and it also provides structured methods for the incorporation of project stakeholders' opinions in the ranking of alternatives. We argue that the inherent uncertainty in our ability to predict ecosystem evolution and response to different management policies requires shifting from optimization-based management to an adaptive management paradigm. This paper brings together a multidisciplinary review of existing decision-making approaches at regulatory agencies in the United States and Europe and synthesizes state-of-the-art research in CRA, MCDA, and adaptive management methods applicable to environmental remediation and restoration projects. We propose a basic decision analytic framework that couples MCDA with adaptive management and its public participation and stakeholder value elicitation methods, and we demonstrate application of the framework to a realistic case study based on contaminated sediment management issues in the New York/New Jersey Harbor.

Community Participation↗
PubMed1996

Patient satisfaction and the elderly.

There is considerable current interest in patient satisfaction surveys; among other things they are often used to measure quality in health care. However, there are many unresolved issues concerning them, including how they might best be conducted. Some have challenged their raison d'-etre, arguing that they rely on unproven assumptions -1; Williams, Soc. Sci. Med. 38, 509, 1994]. In this paper we examine some of these assumptions in the light of a recent study of elderly patients' experience of the District Nursing Service. In doing so we argue that users' capacity, or willingness, to evaluate health care services cannot be taken for granted; that patients may have few if any expectations on which to base an evaluation of the care they receive; that the sense of dependency that patients have on service providers can impact on expressions of satisfaction and that, outside the acute sector in particular, we need to take into account the varied nature of the relationships that emerge between patient and service providers. We also argue that elderly patients cannot be treated as consumers unproblematically. While they may be seen as an extreme example, we argue, nevertheless, that many of the issues raised are relevant to much wider populations. This has general implications for research and we suggest that appropriately chosen qualitative methods can provide a useful starting point in studies which aim to establish how, to what extent and whether patients evaluate health services.

Aged↗
PubMed1994

Patient satisfaction studies: methodology, management and consumer evaluation.

Discusses how consumer evaluation studies of health-care services might be undertaken to provide valid assessments of consumer opinions and priorities, amenable to subsequent, effective management action. To do so, provides an account of the history of patient satisfaction surveys, presents a detailed examination of key examples, and discusses the well-documented strengths and weaknesses of this approach. Draws attention to recent critiques of survey methods and growing interest in qualitative research focusing on the rationale that the latter provides more useful data for managers. Argues that the search for a "best" consumer evaluation method is misplaced since appropriate methods should be determined by research objectives which themselves may vary. Points to existing analyses of relevant research which offer sound methodological guidelines and concludes by offering explicit suggestions for the future conduct of consumer evaluation research.

Health Services Research↗
PubMed1993

Assessment of the effectiveness of body substance precautions as the infection control system of a large teaching hospital.

BACKGROUND: Body substance precautions was the name given to the body substance isolation-based infection control system that was introduced in January 1990 at a Canadian university hospital with 650 acute care beds and 570 long-term care beds. When the body substance precautions system was begun, traditional category-specific isolation was discontinued. METHODS: After 2 years, we reviewed the incidence of several types of nosocomial infections and the frequency of isolation of hospital strains of bacteria before and after the introduction of body substance precautions to find out whether this system was as effective as the previous system of infection control. RESULTS: Most nosocomial infections did not increase. There was another likely cause for the only one that did. For many years, we had isolated patients infected or colonized by hospital bacteria, limiting their spread throughout the institution. Body substance precautions proved equally effective in doing this. CONCLUSION: Our results to date therefore indicate that the body substance precautions system was as successful as category-specific isolation used with other standard infection control techniques in maintaining low rates of nosocomial infections and in controlling the dissemination of hospital strains of bacteria in our institution. Body substance precautions provided a satisfactory alternative to universal precautions and traditional isolation categories for the protection of health care workers against the risk of infection by blood-borne viruses.

Body Fluids↗
PubMed1993

Relationship between family environment and children's hemodynamic responses to stress: a longitudinal evaluation.

Because interpersonal relationships may have an impact on the risk of developing cardiovascular disease, the authors examined the prospective relationship of family functioning upon hemodynamic stress responses in 87 6- to 8-year-old children. The parents completed the cohesion, conflict, expressiveness, and control subscales of the Family Environment Scale; 2 years later, the authors assessed the children's hemodynamic responses to postural change, forehead cold stimulation, and treadmill exercise. Maternal reports of greater cohesion and expressiveness were related to less increases in systolic pressure and systemic vascular resistance in response to the forehead cold. Mothers' reports of expressiveness were related to lower systolic pressure and cardiac index reactivity to postural change. Fathers' reports of greater control were associated with greater diastolic pressure and vascular resistance increases to forehead cold and to greater vascular resistance responses to exercise. Paternal reports of greater conflict were associated with greater systemic vascular resistance increases and with lower cardiac index increases to exercise. Results suggest family functioning may predict later hemodynamic reactivity to stress. The findings are discussed in terms of previous research on parent-child interaction patterns and children's cardiovascular health.

Arousal↗