To explore and share information on the methods, models, tools and theory of Knowledge Transfer, Translation, and Utilization.
Latest Activity: Dec 31, 2012
KTM Volume 4, Issue 4: 2013
In this edition of Knowledge Transfer Methodology I will provide an updated bibliography of "Knowledge Translation" articles. Knowledge Translation is mostly found in health and medical research, very much akin to current Translational Science initiatives.
McDonnell, C. Interventions guided by analysis of quality indicators decrease the frequency of laryngospasm during pediatric anesthesia
(2013) Paediatric Anaesthesia, 23 (7), pp. 579-587.
Department of Anesthesiology and Pain Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
Introduction Clinical outcomes in pediatric anesthesia have improved significantly over the last 20-30 years but unexpected laryngospasm that is difficult to treat can still result in patient morbidity, increased postoperative medical management and unnecessary hospital admission. The incidence of laryngospasm in pediatric anesthesia is difficult to determine with incidences from 0.9% to as high as 14% quoted in the literature. Clinical experience in our institution suggests that laryngospasm is one of the more frequent unanticipated complications that occur under general anesthesia. Therefore, we applied quality improvement (QI) methodology to: (i) identify the etiology and contributing factors that lead to unanticipated incidents during pediatric anesthesia care; and (ii) decrease the incidence of laryngospasm during pediatric anesthesia care by focusing on awareness, preparedness, education and knowledge translation. Materials & Methods We conducted a 30-month improvement project. Twelve months of baseline data describing unanticipated events during pediatric anesthesia care were collected prospectively in a single institution. Data were analyzed to identify leading causes of these unanticipated events and to identify key drivers to improve overall quality of care. Interventions focused on raising awareness of the impact of laryngospasm on quality of patient care, knowledge dissemination and the creation of a knowledge translation tool to encourage future early learning. The primary objective was to decrease the incidence of unanticipated calls for help due to laryngospasm by 50% over a 12-month period. Results During the 12-month baseline data period, laryngospasm was responsible for 33 instances (50%) of the 65 'calls for help' identified. The incidence of laryngospasm for which help was sought was 0.25% of all anesthetics performed during the baseline data period. After the introduction of our interventions, 16 (24%) of the 68 'calls for help' over the subsequent 16 months were attributed to laryngospasm. The incidence of laryngospasm for which help was sought during the second time period was 0.09% of all anesthetics performed. Conclusions We applied QI methodology to identify potential improvements in the quality of anesthesia care we deliver to our patients. By designing a number of key drivers and interventions specifically focused on laryngospasm, we decreased the incidence of unanticipated calls for help due to laryngospasm by 50% and maintained this improvement to clinical care across a 12-month period. © 2012 John Wiley & Sons Ltd.
education; general anesthesia; laryngospasm; quality improvement
Fredericks, S., Bechtold, A.
Challenges associated with delivering education to patients after heart surgery
(2013) Japan Journal of Nursing Science, . Article in Press.
Daphne Cockwell School of Nursing Ryerson University Toronto, Ontario Canada
Aim: The aim of this report is to provide a detailed description of the challenges that arose throughout the implementation of an individualized patient education intervention delivered to patients during their home recovery following heart surgery. Methods: The intervention was delivered at two points in time by telephone to patients following heart bypass and/or valvular replacement. Results: The individualized patient education intervention was found to be effective in reducing the rate and number of complications developed during the first three months following hospital discharge. However, throughout the implementation of this intervention, specific challenges arose that included: onset of symptoms that interfered with intervention delivery, patient's request for information beyond the scope of the teaching interaction, and the need to provide continued support to the therapist. Conclusion: These challenges were addressed throughout the course of the study and the strategies are currently being implemented into the planned knowledge translation activities associated with this intervention. © 2013 Japan Academy of Nursing Science.
Cardiac surgery; Complications; Patient education; Self-care
Tricco, A.C.a , Cogo, E.a , Ashoor, H.a , Perrier, L.a , McKibbon, K.A.b , Grimshaw, J.M.cd , Straus, S.E.ae
Sustainability of knowledge translation interventions in healthcare decision-making: Protocol for a scoping review
(2013) BMJ Open, 3 (5), art. no. 002970, .
a Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
b Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
c Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
d Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
e Department of Medicine, University of Toronto, Toronto, ON, Canada
Introduction: Knowledge translation (KT also known as research utilisation, translational medicine and implementation science) is a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health. After the implementation of KT interventions, their impact on relevant outcomes should be monitored. The objectives of this scoping review are to: (1) conduct a systematic search of the literature to identify the impact on healthcare outcomes beyond 1 year, or beyond the termination of funding of the initiative of KT interventions targeting chronic disease management for end-users including patients, clinicians, public health officials, health services managers and policy-makers; (2) identify factors that influence sustainability of effective KT interventions; (3) identify how sustained change from KT interventions should be measured; and (4) develop a framework for assessing sustainability of KT interventions. Methods and analysis: Comprehensive searches of relevant electronic databases (eg, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials), websites of funding agencies and websites of healthcare provider organisations will be conducted to identify relevant material. We will include experimental, quasiexperimental and observational studies providing information on the sustainability of KT interventions targeting chronic disease management in adults and focusing on end-users including patients, clinicians, public health officials, health services managers and policy-makers. Two reviewers will pilot-test the screening criteria and data abstraction form. They will then screen all citations, full articles and abstract data in duplicate independently. The results of the scoping review will be synthesised descriptively and used to develop a framework to assess the sustainability of KT interventions. Discussion and dissemination: Our results will help inform end-users (ie, patients, clinicians, public health officials, health services managers and policy-makers) regarding the sustainability of KT interventions. Our dissemination plan includes publications, presentations, website posting and a stakeholder meeting.
Pauly, B.B., MacDonald, M., Hancock, T., Martin, W., Perkin, K.
Reducing health inequities: The contribution of core public health services in BC
(2013) BMC Public Health, p. 550. Article in Press.
Background: Within Canada, many public health leaders have long identified the importance of improving the health of all Canadians especially those who face social and economic disadvantages. Future improvements in population health will be achieved by promoting health equity through action on the social determinants of health. Many Canadian documents, endorsed by government and public health leaders, describe commitments to improving overall health and promoting health equity. Public health has an important role to play in strengthening action on the social determinants and promoting health equity. Currently, public health services in British Columbia are being reorganized and there is a unique opportunity to study the application of an equity lens in public health and the contribution of public health to reducing health inequities. Where applicable, we have chosen mental health promotion, prevention of mental disorders and harms of substance use as exemplars within which to examine specific application of an equity lens. Methods: This research protocol is informed by three theoretical perspectives: complex adaptive systems, critical social justice, and intersectionality. In this program of research, there are four inter-related research projects with an emphasis on both integrated and end of grant knowledge translation. Within an overarching collaborative and participatory approach to research, we use a multiple comparative case study research design and are incorporating multiple methods such as discourse analysis, situational analysis, social network analysis, concept mapping and grounded theory. Discussion: An important aim of this work is to help ensure a strong public health system that supports public health providers to have the knowledge, skills, tools and resources to undertake the promotion of health equity. This research will contribute to increasing the effectiveness and contributions of public health in reducing unfair and inequitable differences in health among population groups. As a collaborative effort between public health practitioners/decision makers and university researchers, this research will provide important understanding and insights about the implementation of the changes in public health with a specific focus on health equity, the promotion of mental health and the prevention of harms of substance use.
Ganz, F.D.a , Ofra, R.b , Khalaila, R.c , Levy, H.d , Arad, D.e , Kolpak, O.f , Nun, M.B.g , Drori, Y.h , Benbenishty, J.i
Translation of Oral Care Practice Guidelines Into Clinical Practice by Intensive Care Unit Nurses
(2013) Journal of Nursing Scholarship, . Article in Press.
a Master's Program Hadassah-Hebrew University School of Nursing Faculty of Medicine Jerusalem Israel
b Sheba School of Nursing Tel Hashomer Israel
c Faculty of Nursing Zefat Academic College Zefat Israel
d Cardiology Rambam Health Care Campus Haifa Israel
e Ichilov Medical Center Tel Aviv Israel
f Western Galilee Hospital-Nahariya Nahariya Israel
g Kaplan Medical Center Rehovot Israel
h Cardiac ICU Bnei Zion Medical Center Haifa Israel
i Academic Consultant/Trauma Coordinator, Nursing Administration Hadassah Hebrew University Hospital Jerusalem Israel
Purpose: The purpose of this study was to determine whether there was a change in the oral care practices of intensive care unit (ICU) nurses for ventilated patients after a national effort to increase evidence-based oral care practices. Design: Descriptive comparison of ICU nurses in 2004-2005 and 2012. Method: Two convenience national surveys of ICU nurses were collected in 2004-2005 (n = 218) and 2012 (n = 233). After the results of the initial survey were reported, a national effort to increase awareness of evidence-based oral care practices was conducted that included in-service presentations; publication of an evidence-based protocol in a national nursing journal; publication of the survey findings in an international nursing journal; and reports to the local press. A repeat survey was conducted 7 to 8 years later. The same survey instrument was used for both periods of data collection. This questionnaire included questions about demographic and personal characteristics and a checklist of oral care practices. Nurses rated their perceived priority level concerning oral care on a scale from 0 to 100. An evidence-based practice (EBP)[O4] score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the evidence. The EBP score, priority score, and oral care practices were compared between the two samples. A regression model was built based on those variables that were associated with the EBP score in 2012. Findings: There was a statistically significant increase in the use of EBPs as shown by the EBP score and in the perceived priority level of oral care. Increased EBPs were found in the areas of teeth brushing and oral assessment. Decreases were found in the use of non-evidence-based practices, such as the use of gauze pads, tongue depressors, lemon water, and sodium bicarbonate. No differences were found in the use of chlorhexidine, toothpaste, or the nursing documentation of oral care practices. A multiple regression model was found to be significant with the time of participation (2004-2005 vs. 2012) and priority level of oral care significantly contributing to the regression model. Conclusions: The national effort was partially successful in improving evidence-based oral care practices; however, increased awareness to EBP also might have come from other sources. Other strategies related to knowledge translation need to be attempted and researched in this clinical setting such as the use of opinion leaders, audits and feedback, small group consensus, provider reminder systems, incentives, clinical information systems, and computer decision support systems. Clinical Relevance: This national effort to improve EBP did reap some rewards; however, other knowledge translation strategies should be used to further improve clinical practice. © 2013 Sigma Theta Tau International.
Intensive care; Oral care; Translation research
Tomm-Bonde, L.a , Schreiber, R.S.a , Allan, D.E.a , MacDonald, M.a , Pauly, B.a , Hancock, T.b
Fading vision: Knowledge translation in the implementation of a public health policy intervention
(2013) Implementation Science, 8 (1), art. no. 59, .
a University of Victoria, School of Nursing, P.O. Box 1700 Stn CSC, Victoria, BC, Canada
b University of Victoria, School of Public Health and Social Policy, P.O. Box 1700 Stn CSC, Victoria, BC, Canada
Background: In response to several high profile public health crises, public health renewal is underway in Canada. In the province of British Columbia, the Ministry of Health initiated a collaborative evidence-informed process involving a steering committee of representatives from the six health authorities. A Core Functions (CF) Framework was developed, identifying 21 core public health programs. For each core program, an evidence review was conducted and a model core program paper developed. These documents were distributed to health authorities to guide development of their own renewed public health services. The CF implementation was conceptualized as an embedded knowledge translation process. A CF coordinator in each health authority was to facilitate a gap analysis and development of a performance improvement plan for each core program, and post these publically on the health authority website.Methods: Interviews (n = 19) and focus groups (n = 8) were conducted with a total of 56 managers and front line staff from five health authorities working in the Healthy Living and Sexually Transmitted Infection Prevention core programs. All interviews and focus groups were digitally recorded, transcribed and verified by the project coordinator. Five members of the research team used NVivo 9 to manage data and conducted a thematic analysis.Results: Four main themes emerged concerning implementation of the CF Framework generally, and the two programs specifically. The themes were: 'you've told me what, now tell me how'; 'the double bind'; 'but we already do that'; and the 'selling game.' Findings demonstrate the original vision of the CF process was lost in the implementation process and many participants were unaware of the CF framework or process.Conclusions: Results are discussed with respect to a well-known framework on the adoption, assimilation, and implementation of innovations in health services organizations. Despite attempts of the Ministry of Health and the Steering Committee to develop and implement a collaborative, evidence-informed policy intervention, there were several barriers to the realization of the vision for core public health functions implementation, at least in the early stages. In neglecting the implementation process, it seems unlikely that the expected benefits of the public health renewal process will be realized. © 2013 Tomm-Bonde et al.; licensee BioMed Central Ltd.
Core public health functions; Implementation; Knowledge translation; Public health reform
Isaranuwatchai, W.a , Brydges, R.bc , Carnahan, H.cde , Backstein, D.fg , Dubrowski, A.chi
Comparing the cost-effectiveness of simulation modalities: a case study of peripheral intravenous catheterization training
(2013) Advances in Health Sciences Education, pp. 1-14. Article in Press.
a Centre for Excellence in Economic Analysis Research, Keenan Research Centre, Li Ka Shing Knowledge I, St. Michael's Hospital, Toronto, Canada
b Department of Medicine, University of Toronto, Toronto, Canada
c Wilson Centre for Research in Education, University Health Network, Toronto, Canada
d Centre for Ambulatory Care Education, Women's College Hospital, Toronto, Canada
e Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
f Department of Surgery, University of Toronto, Toronto, Canada
g Division of Orthopaedic Surgery, The Musculoskeletal Centre of Excellence, Mount Sinai Hospital, Toronto, Canada
h Department of Paediatrics, University of Toronto, Toronto, Canada
i SickKids Learning Institute, Hospital for Sick Children, 525 University Ave, Room 6021, Unit 600, Toronto, M5G 2L3, Canada
While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p < 0.001) whereas the high-fidelity program had the highest implementation cost (p < 0.001). While the most cost-effective program depended on the decision makers' willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators). © 2013 Springer Science+Business Media Dordrecht.
Cost-effective; Cost-effectiveness acceptability curve; Cost-effectiveness analysis; Knowledge translation; Medical education; Net benefit regression; Simulation; Technical skills
Orr, B.a , Brown, C.a , Hemsing, J.a , Mccormick, T.a , Pound, S.a , Otto, D.b , Emery, C.A.c , Beaupre, L.A.d
Female soccer knee injury: Observed knowledge gaps in injury prevention among players/parents/coaches and current evidence (the KNOW study)
(2013) Scandinavian Journal of Medicine and Science in Sports, 23 (3), pp. 271-280.
a Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
b Department of Surgery, University of Alberta, Edmonton, AB, Canada
c Sport Injury Prevention Research Centre, Faculty of Kinesiology, Departments of Community Health Sciences and Paediatrics, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
d Departments of Physical Therapy and Surgery (Division of Orthopaedic Surgery), University of Alberta, Edmonton, AB, Canada
This study sought to determine if knowledge regarding the risk for knee injuries and the potential for their prevention is being translated to female adolescent soccer players (13-18 years), their parents, and coaches. Eligible participants in the 2007 indoor soccer season were surveyed to determine their knowledge of the risk for and the potential to prevent knee injuries, and their knowledge of effective prevention strategies, if they felt that injury prevention was possible. Team selection was stratified to be representative of both competitive and recreational level play and age group distributions within the selected soccer association. Of the study subjects, 773/1396 (55.4%) responded to the survey: 408 (53%) players, 292 (38%) parents, and 73 (9%) coaches. Most respondents (538 [71%]) were aware of the risk for knee injury. Coaches and parents were more likely than players to view knee injuries as preventable; however, appropriate prevention strategies were often not identified. Four hundred eighty-four (63.8%) respondents reported that they had never received information on knee injuries. Substantial knowledge gaps regarding knee injury prevention and effective preventative strategies were identified. Given the predominance of knee injuries in female adolescent soccer players, there is an urgent need for knowledge translation of prevention strategies to decrease both incidence and long-term consequences of knee injuries. © 2011 John Wiley & Sons A/S.
Adolescent females; Athletic injuries; Knowledge translation
Galvao, M.C.B.a , Ricarte, I.L.M.b , Grad, R.M.c , Pluye, P.c
The Clinical Relevance of Information Index (CRII): Assessing the relevance of health information to the clinical practice
(2013) Health Information and Libraries Journal, 30 (2), pp. 110-120. Cited 1 time.
a Faculty of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil
b School of Electrical and Computer Engineering, University of Campinas, Campinas, Brazil
c Faculty of Medicine, McGill University, Montreal, QC, Canada
Background: The high volume of health information creates a need for processes and tools to select, evaluate and disseminate relevant information to health professionals in clinical practice. Objectives: To introduce an index of the clinical relevance of information and to show that it is different from existing measures. Methods: A conceptual model of knowledge translation was developed to explain the need for a new index, whose application was verified by an exploratory study with two (quantitative and qualitative) phases. The Clinical Relevance of Information Index (CRII) was defined employing descriptive statistical analyses of assessments performed by health professionals. The model and the CRII were applied in a primary healthcare context. Results: The CRII was applied to 4574 relevance assessments of 194 evidence synopses. The assessments were performed by 41 family physicians in 2008. The CRII value of each synopsis was compared with the number of citations received by its corresponding research paper and with the level of evidence of the study, presenting weak correlation with both. Conclusion: The CRII captures aspects of information not considered by other indices. It can be a parameter for information providers, institutions, editors, as well as health and information professionals targeting knowledge translation. © 2013 Health Libraries Group.
Evaluation, qualitative; Evaluation, quantitative; Evidence-based practice (EBP); Information sources; Knowledge translation; Primary healthcare; Selective dissemination of information (SDI)
Augestad, K.M.abcd , Bellika, J.G.a , Budrionis, A.a , Chomutare, T.a , Lindsetmo, R.-O.bd , Patel, H.b , Delaney, C.c
Surgical telementoring in knowledge translation - Clinical outcomes and educational benefits: A comprehensive review
(2013) Surgical Innovation, 20 (3), pp. 273-281.
a Norwegian Centre for Telemedicine and Integrated Care, Tromsø, Norway
b Department of Telemedicine and Integrated Care, University Hospital of North Norway, 9037 Breivika, Tromsø, Norway
c University Hospitals Case Medical Center, Cleveland, OH, United States
d Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
Background. Surgical telementoring has been reported for decades. However, there exists limited evidence of clinical outcome and educational benefits. Objective. To perform a comprehensive review of surgical telementoring surveys published in the past 2 decades. Results. Of 624 primary identified articles, 34 articles were reviewed. A total of 433 surgical procedures were performed by 180 surgeons. Most common telementored procedures were laparoscopic cholecystectomy (57 cases, 13%), endovascular treatment of aortic aneurysm (48 cases, 11%), laparoscopic colectomy (32 cases, 7%), and nefrectomies (41 cases, 9%). In all, 167 (38%) cases had a laparoscopic approach, and 8 cases (5%) were converted to open surgery. Overall, 20 complications (5%) were reported (liver bleeding, trocar port bleeding, bile collection, postoperative ileus, wound infection, serosa tears, iliac artery rupture, conversion open surgery). Eight surveys (23%) have structured assessment of educational outcomes. Telementoring was combined with simulators (n = 2) and robotics (n = 3). Twelve surveys (35%) were intercontinental. Technology satisfaction was high among 83% of surgeons. Conclusion. Few surveys have a structured assessment of educational outcome. Telementoring has improved impact on surgical education. Reported complication rate was 5%. © The Author(s) 2012.
general surgery; laparoscopy; surgical education; surgical telementoring; telemedicine; videoconferencing
Nixon, S.A.ab , Casale, M.b , Flicker, S.c , Rogan, M.d
Applying the principles of knowledge translation and exchange to inform dissemination of HIV survey results to adolescent participants in South Africa
(2013) Health Promotion International, 28 (2), pp. 233-243. Cited 1 time.
a Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
b Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, University Road, Durban, South Africa
c Faculty of Environmental Studies, York University, 4700 Keele Street, Toronto ON, M3J 1P3, Canada
d School of Development Studies, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
It is widely accepted that researchers have an obligation to inform survey participants of research results. However, there is little evidence on the effectiveness of various dissemination strategies. The emerging field of knowledge transfer and exchange (KTE) may offer insight given its focus on techniques to enhance the effectiveness of communicating evidence-based information. To date, KTE has focused primarily on information exchange between researchers and policy-makers as opposed to study participants; however, there are principles that may be relevant in this new context. This gap in the literature becomes even more salient in the context of public health research where research results can reveal particular misunderstandings or shortcomings in knowledge that threaten to severely compromise participants' health. The objective of this article is to describe how KTE principles were used to inform dissemination of results of a self-administered sexual health survey to adolescent study participants in a resource-deprived, peri-urban area of South Africa. Strategies for enhancing two-way information exchange included constructing interactive dissemination sessions led by young, isiZulufieldworkers. We also employed techniques to create a safe space for dialogue, encouraged the shared ownership of results and crafted targeted messages. Particularly noteworthy was the benefit accrued by the research team through this process of exchange, including novel explanations for study findings and new ideas for future research. © The Author (2012). Published by Oxford University Press. All rights reserved.
HIV; knowledge translation and exchange (KTE); youth
Mikkelsen, M.E.ab , Christie, J.D.ab , Abella, B.S.ac , Kerlin, M.P.a , Fuchs, B.D.a , Schweickert, W.D.a , Berg, R.A.d , Mosesso, V.N.e , Shofer, F.S.c , Gaieski, D.F.c
Use of therapeutic hypothermia after in-hospital cardiac arrest
(2013) Critical Care Medicine, 41 (6), pp. 1385-1395. Cited 1 time.
a Pulmonary Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States
b Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States
c Department of Emergency Medicine, Center for Resuscitation Science, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States
d Children's Hospital of Philadelphia, Philadelphia, PA, United States
e University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
OBJECTIVES: Formal guidelines recommend that therapeutic hypothermia be considered after in-hospital cardiac arrest. The rate of therapeutic hypothermia use after in-hospital cardiac arrest and details about its implementation are unknown. We aimed to determine the use of therapeutic hypothermia for adult in-hospital cardiac arrest, whether use has increased over time, and to identify factors associated with its use. DESIGN: Multicenter, prospective cohort study. SETTING: A total of 538 hospitals participating in the Get With the Guidelines-Resuscitation database (2003-2009). PATIENTS: A total of 67,498 patients who had return of spontaneous circulation after in-hospital cardiac arrest. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the initiation of therapeutic hypothermia. We measured the proportion of therapeutic hypothermia patients who achieved target temperature (32-34 C) and were overcooled. Of 67,498 patients, therapeutic hypothermia was initiated in 1,367 patients (2.0%). The target temperature (32-34 C) was not achieved in 44.3% of therapeutic hypothermia patients within 24 hours and 17.6% were overcooled. The use of therapeutic hypothermia increased from 0.7% in 2003 to 3.3% in 2009 (p < 0.001). We found that younger age (p < 0.001) and occurrence in a non-ICU location (p < 0.001), on a weekday (p = 0.005), and in a teaching hospital (p = 0.001) were associated with an increased likelihood of therapeutic hypothermia being initiated. CONCLUSIONS: After in-hospital cardiac arrest, therapeutic hypothermia was used rarely. Once initiated, the target temperature was commonly not achieved. The frequency of use increased over time but remained low. Factors associated with therapeutic hypothermia use included patient age, time and location of occurrence, and type of hospital. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
cardiac arrest; hypothermia; in-hospital cardiac arrest; knowledge translation; utilization
Synthesizing research evidence for therapists providing home-based rehabilitative care
(2013) Physical and Occupational Therapy in Geriatrics, 31 (2), pp. 115-127.
School of Occupational Therapy, Dalhousie University, 5869 University Av., Halifax, NS, B3H 3J5, Canada
Background: Accessible and relevant summaries of research findings can facilitate therapists' ability to practice evidence-informed care. Purpose: Our study used a knowledge translation framework to explore what topics of research evidence rehabilitation therapists who provided home-based care for older adults would like summarized, and whether a short narrative summary was an acceptable format. Methods: An online survey was administered to community-based occupational therapists and physiotherapists who worked for district health authorities across one province. Findings: Respondents identified topics such as effective ways to educate clients and families and how interventions in rural settings differed from urban settings. The short narrative format was not sufficient for therapists to evaluate the strength of the research evidence. Implications: Researchers trying to disseminate research evidence to home-based therapists need to create short summaries that have sufficient details to assess the strength of the evidence which are pertinent to therapists delivering services in the home. © 2013 Informa Healthcare USA, Inc.
Community rehabilitation practice; Evidence-informed practice; Home rehabilitation; Knowledge translation; Older adult care; PARIHS
Hack, T.F.abh , Ruether, J.D.cd , Weir, L.M.ef , Grenier, D.bg , Degner, L.F.a
Promoting consultation recording practice in oncology: Identification of critical implementation factors and determination of patient benefit
(2013) Psycho-Oncology, 22 (6), pp. 1273-1282.
a Faculty of Nursing, University of Manitoba, Winnipeg, MB, Canada
b CancerCare Manitoba, Winnipeg, MB, Canada
c Tom Baker Cancer Centre, Calgary, AB, Canada
d Faculty of Medicine, University of Calgary, AB, Canada
e British Columbia Cancer Agency, Vancouver, BC, Canada
f Faculty of Medicine, University of British Columbia, BC, Canada
g Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
h Asper Clinical Research Institute, St. Boniface Research Centre, 369 Taché Avenue, Winnipeg, MB R2H 2A6, Canada
Objective The objectives of this implementation study were to (i) address the evidentiary, contextual, and facilitative mechanisms that serve to retard or promote the transfer and uptake of consultation recording use in oncology practice and (ii) follow patients during the first few days following receipt of the consultation recording to document, from the patient's perspective, the benefits realized from listening to the recording. Methods Nine medical and nine radiation oncologists from cancer centers in three Canadian cities (Calgary, Vancouver, and Winnipeg) recorded their primary consultations for 228 patients newly diagnosed with breast (n = 174) or prostate cancer (n = 54). The Digital Recording Use Semi-Structured Interview was conducted at 2 days and 1 week postconsultation. Each oncologist was provided a feedback letter summarizing the consultation recording benefits reported by their patients. Results Sixty-nine percent of patients listened to at least a portion of the recording within the first week following the consultation. Consultation recording favorableness ratings were high: 93.6% rated the intervention between 75 and 100 on a 100-point scale. Four main areas of benefit were reported: (i) anxiety reduction; (ii) enhanced retention of information; (iii) better informed decision making; and (iv) improved communication with family members. Eight fundamental components of successful implementation of consultation recording practice were identified. Conclusions Further randomized trials are recommended, using standardized measures of the patient-reported benefit outcomes reported herein, to strengthen the evidence base for consultation recording use in oncology practice. Copyright © 2012 John Wiley & Sons, Ltd.
cancer; communication; consultation recording; knowledge translation; oncology
Matthew-Maich, N.a , Ploeg, J.b , Jack, S.b , Dobbins, M.c
Leading on the frontlines with passion and persistence: A necessary condition for breastfeeding best practice guideline uptake
(2013) Journal of Clinical Nursing, 22 (11-12), pp. 1759-1770.
a School of Nursing and Health Sciences Research and Innovation, Mohawk College, Hamilton, ON, Canada
b School of Nursing, McMaster University, Hamilton, ON, Canada
c School of Nursing, Department of Epidemiology and Biostatistics, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
Aims and objectives: The research question explored was what are the processes and strategies used by frontline leaders to support the uptake of the Breastfeeding Best Practice Guideline by nurses in maternity care practice settings? Background: Best Practice Guidelines have been shown to enhance client care and outcomes. Leadership is known to have a key role in moving Best Practice Guidelines into nursing practice yet how this happens is poorly understood. This insight is needed to consistently and efficiently facilitate Best Practice Guideline uptake into clinical practice. Design: Constructivist grounded theory was used to explore the social processes and strategies involved in facilitating Best Practice Guideline uptake. Methods: Purposive, criterion-based, theoretical and negative case sampling were used recruiting 58 health professionals and 54 clients. Triangulation and constant comparison of data sources and types (interviews, documents and field notes) were used for analysis and rigour. Results: Passionate, persistent, respected frontline leaders using tailored, multifaceted strategies aimed at three groups of nurse adopters effectively support the uptake of the Breastfeeding Best Practice Guideline in nursing practice. Successful uptake strategies used by frontline leaders that are new or underdeveloped in the previous literature are presented. Conclusions: The study findings illuminated multidimensional, tailored strategies that frontline leaders use to facilitate the uptake of Best Practice Guidelines. Attention to individual attitudes and beliefs, as well as organisational, interorganisational and interprofessional partnerships are vital to uptake. Organisations that aspire to foster Best Practice Guideline uptake must invest in frontline leaders to 'make it happen' and sustain Best Practice Guideline uptake in practice. Relevance to clinical practice: Understanding how frontline leaders facilitate Best Practice Guideline uptake is essential to selecting, educating and supporting them to foster desired practice changes. Strategies are explicated that frontline leaders can adopt and tailor to their own practice contexts. © 2012 Blackwell Publishing Ltd.
Breastfeeding; Evidence-based practice; Frontline leader; Knowledge translation; Knowledge utilisation; Leadership; Nursing; Practice guidelines; Research uptake; Research utilisation
Arbour-Nicitopoulos, K.P.a , Martin Ginis, K.A.a , Latimer-Cheung, A.E.b , Bourne, C.c , Campbell, D.d , Cappe, S.e , Ginis, S.f , Hicks, A.L.a , Pomerleau, P.g , Smith, K.h
Development of an evidence-informed leisure time physical activity resource for adults with spinal cord injury: The SCI Get Fit Toolkit
(2013) Spinal Cord, 51 (6), pp. 491-500.
a Department of Kinesiology, McMaster University, Hamilton, ON, Canada
b School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
c Active Living Alliance for Canadians with A Disability, Ottawa, ON, Canada
d G.F. Strong Rehabilitation Centre, Vancouver, BC, Canada
e Department of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
f SCI Action Canada, Hamilton, ON, Canada
g Institut de Réadaptation en Déficience Physique de Québec, Quebec City, QC, Canada
h Department of Physical Medicine and Rehabilitation, Queen's University and Providence Care, Kingston, ON, Canada
Objectives:To systematically develop an evidence-informed leisure time physical activity (LTPA) resource for adults with spinal cord injury (SCI).Setting:Canada.Methods:The Appraisal of Guidelines, Research and Evaluation (AGREE) II protocol was used to develop a toolkit to teach and encourage adults with SCI how to make smart and informed choices about being physically active. A multidisciplinary expert panel appraised the evidence and generated specific recommendations for the content of the toolkit. Pilot testing was conducted to refine the toolkit's presentation.Results:Recommendations emanating from the consultation process were that the toolkit be a brief, evidence-based resource that contains images of adults with tetraplegia and paraplegia, and links to more detailed online information. The content of the toolkit should include the physical activity guidelines (PAGs) for adults with SCI, activities tailored to manual and power chair users, the benefits of LTPA, and strategies to overcome common LTPA barriers for adults with SCI. The inclusion of action plans and safety tips was also recommended.Conclusion:These recommendations have resulted in the development of an evidence-informed LTPA resource to assist adults with SCI in meeting the PAGs. This toolkit will have important implications for consumers, health care professionals and policy makers for encouraging LTPA in the SCI community. © 2013 International Spinal Cord Society All rights reserved.
evidence-based; exercise; heath promotion guidelines; knowledge translation; leisure time physical activity; spinal cord injury
Lal, S.a , Korner-Bitensky, N.bc
Motivational interviewing: A novel intervention for translating rehabilitation research into practice
(2013) Disability and Rehabilitation, 35 (11), pp. 919-923.
a Rehabilitation Sciences Graduate Programs, University of British Columbia, Vancouver, BC, Canada
b School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
c Centre de Recherche Interdisciplinaire en Readaptation du Montreal Metropolitain, Montreal, QC, Canada
Purpose: Despite recent advances in rehabilitation research, moving evidence into clinical practice remains a challenge. This article explores a novel approach to knowledge translation (KT)-motivational interviewing (MI). MI is a style of communication that is typically used to facilitate health related behavior change in patients. Here we explore its potential use as a KT intervention aimed at clinicians. Methods: Commentary. Relevant literature on MI and KT is summarized and discussed by considering how MI could be used in a KT strategy aimed at rehabilitation clinicians. Results: Clinician motivation and readiness to change are key issues influencing implementation of evidence-based practice. We provide an argument suggesting that clinicians' readiness to change clinical practices can potentially be enhanced through MI. The MI conceptual framework, principles, and strategies, typically used in patients, are discussed here in a novel context-enhancing clinician change in practice. Conclusions: MI is an effective intervention when the goal is to motivate individuals to change a current behavior. We suggest that MI is an evidence-based intervention that has been proven to be effective with patients and warrants study as a promising KT intervention. Implications for Rehabilitation Despite recent advances in rehabilitation research, moving evidence into practice remains a challenge. Clinician motivation is one key issue influencing the implementation of evidence-based practice. Clinician motivation to implement evidence-based practice can potentially be enhanced through an approach called motivational interviewing (MI). Motivational interviewing is an evidence-based intervention that has proven to be effective in promoting behavioral change in patients, and warrants study in terms of its potential as a KT intervention. © 2013 Informa UK, Ltd.
Evidence-based practice; Implementation science; Knowledge transfer; Stroke rehabilitation; Translational gap
Ramanadhan, S.a , Viswanath, K.ab
Priority setting for evidence-based health outreach in community-based organizations: A mixed-methods study in three Massachusetts communities
(2013) Translational Behavioral Medicine, 3 (2), pp. 180-188.
a Center for Community-Based Research, Dana-Farber Cancer Institute, 450 Brookline Ave., LW 703, Boston, MA, 02215, United States
b Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, United States
Priority setting, or determining how to best allocate limited resources, is an important first step for evidence-based public health approaches in community-based organizations (CBOs), but guidance for such work is limited. This study aims to study drivers of priority setting and the way CBOs use data for this work. Data come from PLANET MassCONECT, a Community-Based Participatory Research project focused on knowledge translation among CBOs targeting the underserved in Boston, Lawrence, and Worcester, MA. We conducted four focus group discussions with CBO staff members (31 participants) in 2008 and a survey of 214 CBO staff members in 2009. Multiple, often competing factors appear to drive priority setting, including data, funding, partnerships, and community preferences. The process may be hindered by challenges related to finding, evaluating, and utilizing data for priority setting. Supporting CBOs in efforts to use data effectively and incorporate context into systematic priority-setting processes is vital. © 2013 Society of Behavioral Medicine.
Community-based organizations; Community-based, participatory research; Evidence-based program; Evidence-based public health; Priority setting; Research evidence
Richardson, C.G., Hamadani, L.G., Gotay, C.
Quantifying Canadians' use of the Internet as a source of information on behavioural risk factor modifications related to cancer prevention
(2013) Chronic Diseases and Injuries in Canada, 33 (3), pp. 123-128.
School of Population and Public Health, University of British Columbia, BC, Canada
Introduction: The purpose of this study was to quantify the frequency and timing of Canadians' Internet searches for information on modifying cancer prevention-related behavioural risk factors. Methods: We used the Google AdWords Keyword tool to estimate the number of Internet searches in Canada from July 2010 to May 2011 for content associated with the keywords "physical activity / exercise," "healthy eating / weight loss" and "quit smoking." Results: For "physical activity / exercise," 663 related keywords resulted in 117 951 699 searches. For "healthy eating / weight loss," 687 related search terms yielded 98 277 954 searches. "Quit smoking" was associated with 759 related keywords with 31 688 973 searches. All search patterns noticeably peaked in January 2011. Conclusion: Many Canadians are actively searching for information on the Internet to support health behaviour change associated with cancer prevention, especially during the month of January. To take advantage of this opportunity, key stakeholders in cancer prevention need to identify knowledge translation priorities and work with health agencies to develop evidence-based strategies to support Internet-facilitated behaviour change.
Cancer; Healthy eating; Internet; Physical activity; Prevention; Smoking; Weight loss
Barker, A.L.ab , Kamar, J.cd , Tyndall, T.J.de , White, L.df , Hutchinson, A.gh , Klopfer, N.b , Weller, C.b
Implementation of pressure ulcer prevention best practice recommendations in acute care: An observational study
(2013) International Wound Journal, 10 (3), pp. 313-320.
a The University of Queensland, Brisbane, Australia
b Centre of Research Excellence in Patient Safety, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
c Monash University, Melbourne, Australia
d Injury Prevention Unit, The Northern Hospital, Epping, Melbourne, Australia
e University of Ballarat, Mt Helen, VIC, Australia
f Div2 Fairfield Hospital, Melbourne, Australia
g The University of Melbourne, Melbourne, Australia
h Northern Clinical Research Centre, The Northern Hospital, Epping, VIC, Australia
Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P < 0·001). Audits between 2003 and 2011 of 4368 patient medical records identified compliance with pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital. © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.
Best practice guidelines; Pressure ulcer; Prevention strategies; Risk assessment tool
Hamm, M.P.a , Klassen, T.P.b , Scott, S.D.cd , Moher, D.e , Hartling, L.a
Education in Health Research Methodology: Use of a Wiki for Knowledge Translation
(2013) PLoS ONE, 8 (5), art. no. e64922, .
a Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
b Manitoba Institute of Child Health and Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
c Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
d Faculty of Nursing, University of Alberta, Edmonton, Canada
e Ottawa Hospital Research Institute, Ottawa, Canada
Introduction:A research-practice gap exists between what is known about conducting methodologically rigorous randomized controlled trials (RCTs) and what is done. Evidence consistently shows that pediatric RCTs are susceptible to high risk of bias; therefore novel methods of influencing the design and conduct of trials are required. The objective of this study was to develop and pilot test a wiki designed to educate pediatric trialists and trainees in the principles involved in minimizing risk of bias in RCTs. The focus was on preliminary usability testing of the wiki.Methods:The wiki was developed through adaptation of existing knowledge translation strategies and through tailoring the site to the identified needs of the end-users. The wiki was evaluated for usability and user preferences regarding the content and formatting. Semi-structured interviews were conducted with 15 trialists and systematic reviewers, representing varying levels of experience with risk of bias or the conduct of trials. Data were analyzed using content analysis.Results:Participants found the wiki to be well organized, easy to use, and straightforward to navigate. Suggestions for improvement tended to focus on clarification of the text or on esthetics, rather than on the content or format. Participants liked the additional features of the site that were supplementary to the text, such as the interactive examples, and the components that focused on practical applications, adding relevance to the theory presented. While the site could be used by both trialists and systematic reviewers, the lack of a clearly defined target audience caused some confusion among participants.Conclusions:Participants were supportive of using a wiki as a novel educational tool. The results of this pilot test will be used to refine the risk of bias wiki, which holds promise as a knowledge translation intervention for education in medical research methodology. © 2013 Hamm et al.
Kitson, A.a , Powell, K.b , Hoon, E.b , Newbury, J.b , Wilson, A.c , Beilby, J.d
Knowledge translation within a population health study: How do you do it?
(2013) Implementation Science, 8 (1), art. no. 54, .
a School of Nursing, University of Adelaide, Adelaide 5005, Australia
b School of Population Health, University of Adelaide, Adelaide 5005, Australia
c School of Medicine, Flinders University, Sturt Road Bedford Park, Adelaide, Australia
d University of Adelaide, Adelaide 5005, Australia
Background: Despite the considerable and growing body of knowledge translation (KT) literature, there are few methodologies sufficiently detailed to guide an integrated KT research approach for a population health study. This paper argues for a clearly articulated collaborative KT approach to be embedded within the research design from the outset.Discussion: Population health studies are complex in their own right, and strategies to engage the local community in adopting new interventions are often fraught with considerable challenges. In order to maximise the impact of population health research, more explicit KT strategies need to be developed from the outset. We present four propositions, arising from our work in developing a KT framework for a population health study. These cover the need for an explicit theory-informed conceptual framework; formalizing collaborative approaches within the design; making explicit the roles of both the stakeholders and the researchers; and clarifying what counts as evidence. From our deliberations on these propositions, our own co-creating (co-KT) Framework emerged in which KT is defined as both a theoretical and practical framework for actioning the intent of researchers and communities to co-create, refine, implement and evaluate the impact of new knowledge that is sensitive to the context (values, norms and tacit knowledge) where it is generated and used. The co-KT Framework has five steps. These include initial contact and framing the issue; refining and testing knowledge; interpreting, contextualising and adapting knowledge to the local context; implementing and evaluating; and finally, the embedding and translating of new knowledge into practice.Summary: Although descriptions of how to incorporate KT into research designs are increasing, current theoretical and operational frameworks do not generally span a holistic process from knowledge co-creation to knowledge application and implementation within one project. Population health studies may have greater health impact when KT is incorporated early and explicitly into the research design. This, we argue, will require that particular attention be paid to collaborative approaches, stakeholder identification and engagement, the nature and sources of evidence used, and the role of the research team working with the local study community. © 2013 Kitson et al.; licensee BioMed Central Ltd.
Co-KT Framework; Engaged scholarship; Health system redesign; Knowledge translation; Population health
Albrecht, L., Archibald, M., Arseneau, D., Scott, S.D.
Development of a checklist to assess the quality of reporting of knowledge translation interventions using the Workgroup for Intervention Development and Evaluation Research (WIDER) recommendations
(2013) Implementation Science, 8 (1), art. no. 52, .
University of Alberta, Edmonton Clinic Health Academy, Level 3, Edmonton, AB, Canada
Background: Influenced by an important paper by Michie et al., outlining the rationale and requirements for detailed reporting of behavior change interventions now required by Implementation Science, we created and refined a checklist to operationalize the Workgroup for Intervention Development and Evaluation Research (WIDER) recommendations in systematic reviews. The WIDER recommendations provide a framework to identify and provide detailed reporting of the essential components of behavior change interventions in order to facilitate replication, further development, and scale-up of the interventions. Findings: The checklist was developed, applied, and improved over the course of four systematic reviews of knowledge translation (KT) strategies in a variety of healthcare settings conducted by Scott and associates. The checklist was created as one method of operationalizing the work of the WIDER in order to facilitate comparison across heterogeneous studies included in these systematic reviews. Numerous challenges were encountered in the process of creating and applying the checklist across four stages of development. The resulting improvements have produced a 'user-friendly' and replicable checklist to assess the quality of reporting of KT interventions in systematic reviews using the WIDER recommendations. Conclusions: With journals, such as Implementation Science, using the WIDER recommendations as publication requirements for evaluation reports of behavior change intervention studies, it is crucial to find methods of examining, measuring, and reporting the quality of reporting. This checklist is one approach to operationalize the WIDER recommendations in systematic review methodology. © 2013 Albrecht et al.; licensee BioMed Central Ltd.
Behavior change intervention reporting; Knowledge translation interventions; Quality assessment; Reporting checklist; Systematic review
Cole, E.T.a , Harvey, G.a , Foster, G.bc , Thabane, L.abcd , Parker, M.J.ae
Study protocol for a randomised controlled trial comparing the efficiency of two provider-endorsed manual paediatric fluid resuscitation techniques
(2013) BMJ Open, 3 (3), art. no. e002754, .
a Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, ON, Canada
b Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
c Biostatistics Unit/FSORC, St Joseph's Healthcare Hamilton, Hamilton, Canada
d Department of Anesthesia, McMaster University, Hamilton, ON, Canada
e Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Introduction: Paediatric shock is a life-threatening condition with many possible causes and a global impact. Current resuscitation guidelines require rapid fluid administration as a cornerstone of paediatric shock management. However, little evidence is available to inform clinicians how to most effectively perform rapid fluid administration where this is clinically required, resulting in suboptimal knowledge translation of current resuscitation guidelines into clinical practice. Objectives: This study aims to determine which of the two commonly used techniques for paediatric fluid resuscitation (disconnect-reconnect technique and push-pull technique) yields a higher fluid administration rate in a simulated clinical scenario. Secondary objectives include determination of catheter dislodgement rates, subjective and objective measures of provider fatiguability and descriptive information regarding any technical issues encountered with performance of each method under the study. Methods and analysis: This study will utilise a randomised crossover trial design. Participants will include consenting healthcare providers from McMaster Children's Hospital. Each participant will administer 900 ml (60 ml/kg) of normal saline to a simulated 15 kg infant as quickly as possible on two separate occasions using the manual fluid administration techniques under the study. The primary outcome, rate of fluid administration, will be evaluated using a paired two-tailed Student t test. Ethics and dissemination: This protocol has been approved by the Hamilton Health Sciences Research Ethics Board. Results: These will be published in a peer-reviewed scientific journal and presented at one or more scientific conferences. Protocol Registration: Protocol Registered on ClinicalTrials.gov NCT01774214.
Twycross, A.a , Finley, G.A.bc
Children's and parents' perceptions of postoperative pain management: A mixed methods study
(2013) Journal of Clinical Nursing, . Article in Press.
a Faculty of Health, Social Care and Education Kingston University and St George's University of London London UK
b Anesthesia and Psychology Dalhousie University Halifax, NSCanada
c Dr Stewart Wenning Chair in Pediatric Pain Management IWK Health Centre Halifax, NS Canada
Aims and objectives: To explore children's and parents' perceptions about the quality of postoperative pain management. Background: Children continue to experience moderate to severe pain postoperatively. Unrelieved pain has short- and long-term undesirable consequences. Thus, it is important to ensure pain is managed effectively. Little research has explored children's and parents' perceptions of pain management. Design: Exploratory study. Methods: Children (n = 8) were interviewed about their perceptions of pain care using the draw-and-write technique or a semi-structured format and asked to rate the worst pain experienced postoperatively on a numerical scale. Parents (n = 10) were asked to complete the Information About Pain questionnaire. Data were collected in 2011. Results: Most children experienced moderate to severe pain postoperatively. Children reported being asked about their pain, receiving pain medication and using non-pharmacological methods of pain relief. A lack of preoperative preparation was evident for some children. Most parents indicated they had received information on their child's pain management. Generally, participants were satisfied with care. Conclusion: Participants appeared satisfied with the care provided despite experiencing moderate to severe pain. This may be attributable to beliefs that nurses would do everything they could to relieve pain and that some pain is to be expected postsurgery. Relevance to clinical practice: Children are still experiencing moderate to severe pain postoperatively. Given the possible short- and long-term consequences of unrelieved pain, this is of concern. Knowledge translation models may support the use of evidence in practice, and setting a pain goal with parents and children may help improve care. © 2013 John Wiley & Sons Ltd.
Children; Paediatric pain; Parents; Postoperative pain
Girlanda, F., Fiedler, I., Ay, E., Barbui, C., Koesters, M.
Guideline implementation strategies for specialist mental healthcare
(2013) Current Opinion in Psychiatry, . Article in Press.
PURPOSE OF REVIEW: Clinical practice guidelines in mental healthcare are viewed as an essential asset if appropriately developed and implemented. The purpose of this article was to review the existing literature on how guidelines should be implemented to optimize their impact on provider performance and patient outcomes in specialist mental healthcare settings. RECENT FINDINGS: Findings from recent studies suggest a trend toward an improvement in process and patient outcomes following guideline implementation. However, studies are heterogeneous in terms of design, implementation strategies and outcome measures, making it very difficult to draw firm conclusions about which implementation strategy is effective in different healthcare contexts. SUMMARY: Current knowledge about how guidelines should be implemented is still sparse and inconclusive in mental healthcare. Future studies should attempt to employ more rigorous designs, including random allocation of patients or clusters of patients, to shed further light on this compelling issue. Research on guideline implementation strategies should additionally take into account potential barriers to knowledge translation, which can heavily influence the implementability of treatment recommendations.
Harrison, M.B.a , Graham, I.D.b , van den Hoek, J.a , Dogherty, E.J.a , Carley, M.E.a , Angus, V.a
Guideline adaptation and implementation planning: A prospective observational study
(2013) Implementation Science, 8 (1), art. no. 49, .
a School of Nursing, Queen's University, 78 Barrie Street, Kingston, ON K7L 3N6, Canada
b School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1N 6N5, Canada
Background: Adaptation of high-quality practice guidelines for local use has been advanced as an efficient means to improve acceptability and applicability of evidence-informed care. In a pan-Canadian study, we examined how cancer care groups adapted pre-existing guidelines to their unique context and began implementation planning.Methods: Using a mixed-methods, case-study design, five cases were purposefully sampled from self-identified groups and followed as they used a structured method and resources for guideline adaptation. Cases received the ADAPTE Collaboration toolkit, facilitation, methodological and logistical support, resources and assistance as required. Documentary and primary data collection methods captured individual case experience, including monthly summaries of meeting and field notes, email/telephone correspondence, and project records. Site visits, process audits, interviews, and a final evaluation forum with all cases contributed to a comprehensive account of participant experience.Results: Study cases took 12 to >24 months to complete guideline adaptation. Although participants appreciated the structure, most found the ADAPTE method complex and lacking practical aspects. They needed assistance establishing individual guideline mandate and infrastructure, articulating health questions, executing search strategies, appraising evidence, and achieving consensus. Facilitation was described as a multi-faceted process, a team effort, and an essential ingredient for guideline adaptation. While front-line care providers implicitly identified implementation issues during adaptation, they identified a need to add an explicit implementation planning component.Conclusions: Guideline adaptation is a positive initial step toward evidence-informed care, but adaptation (vs. 'de novo' development) did not meet expectations for reducing time or resource commitments. Undertaking adaptation is as much about the process (engagement and capacity building) as it is about the product (adapted guideline). To adequately address local concerns, cases found it necessary to also search and appraise primary studies, resulting in hybrid (adaptation plus de novo) guideline development strategies that required advanced methodological skills.Adaptation was found to be an action element in the knowledge translation continuum that required integration of an implementation perspective. Accordingly, the adaptation methodology and resources were reformulated and substantially augmented to provide practical assistance to groups not supported by a dedicated guideline panel and to provide more implementation planning support. The resulting framework is called CAN-IMPLEMENT. © 2013 Harrison et al.; licensee BioMed Central Ltd.
Evidence-informed practice; Guideline adaptation; Implementation planning; Knowledge activation; Knowledge to action; Practice guidelines
Latimer-Cheung, A.E.a , Rhodes, R.E.b , Kho, M.E.cd , Tomasone, J.R.e , Gainforth, H.L.a , Kowalski, K.b , Nasuti, G.b , Perrier, M.-J.a , Duggan, M.f
Evidence-informed recommendations for constructing and disseminating messages supplementing the new Canadian Physical Activity Guidelines
(2013) BMC Public Health, 13 (1), art. no. 419, .
a School of Kinesiology and Health Studies, Queen's University, 28 Division St., Kingston, ON K7L 3N6, Canada
b Behavioural Medicine Laboratory, School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 3010, Victoria, BC V8W 3N4, Canada
c School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 4K1, Canada
d Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Phipps 197, Baltimore, MD 21287, United States
e Department of Kinesiology, McMaster University, 1280 Main St. W, Hamilton, ON L8S 4K1, Canada
f Canadian Society for Exercise Physiology, 18 Louisa St., Ottawa, ON K1R 6Y6, Canada
Background: Few validated guidelines exist for developing messages in health promotion practice. In clinical practice, the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) Instrument is the international gold standard for guideline assessment, development, and reporting. In a case study format, this paper describes the application of the AGREE II principles to guide the development of health promotion guidelines for constructing messages to supplement the new Canadian Physical Activity Guidelines (CPAG) released in 2011. Methods. The AGREE II items were modified to suit the objectives of developing messages that (1) clarify key components of the new CPAG and (2) motivate Canadians to meet the CPAG. The adapted AGREE II Instrument was used as a systematic guide for the recommendation development process. Over a two-day meeting, five workgroups (one for each CPAG - child, youth, adult, older adult - and one overarching group) of five to six experts (including behavior change, messaging, and exercise physiology researchers, key stakeholders, and end users) reviewed and discussed evidence for creating and targeting messages to supplement the new CPAG. Recommendations were summarized and reviewed by workgroup experts. The recommendations were pilot tested among end users and then finalized by the workgroup. Results: The AGREE II was a useful tool in guiding the development of evidence-based specific recommendations for constructing and disseminating messages that supplement and increase awareness of the new CPAG (child, youth, adults, and older adults). The process also led to the development of sample messages and provision of a rationale alongside the recommendations. Conclusions: To our knowledge, these are the first set of evidence-informed recommendations for constructing and disseminating messages supplementing physical activity guidelines. This project also represents the first application of international standards for guideline development (i.e., AGREE II) to the creation of practical recommendations specifically aimed to inform health promotion and public health practice. The messaging recommendations have the potential to increase the public health impact of evidence-based guidelines. © 2013 Latimer-Cheung et al.; licensee BioMed Central Ltd.
AGREE II; Knowledge translation; Messaging; Physical activity guidelines
Bajracharya, S.M.a , Wigglesworth, J.K.b
Colorectal cancer screening:Knowledge, perceived benefits and barriers, and intentions among college and university employees
(2013) American Journal of Health Education, 44 (2), pp. 88-95.
a Ithaca College, United States
b Western Illinois University, United States
Early detection through routine screening is critical in reducing the incidence rate of colorectal cancer (CRC). Purpose: The purpose of this study was to examine college and university employees' knowledge of CRC issues, their perceptions of the benefits of and barriers to CRC screening, and their intentions toward it. Methods: This study surveyed a targeted sample of 350 employees aged 45 and older and examined their knowledge of CRC issues and screening, their screening status, and group differences in perceptions about screening and in their intentions toward it. Results: Less than half of the participants answered correctly about CRC being one of the leading causes of cancer. The top perceived barriers were "fears," followed by "doctor never recommended" and "preparation for the test is difficult." A discriminant analysis revealed that individuals who had not been screened and those who did not intend to get screened perceived significantly more barriers. Discussion: Perceptions about screening appear to be a major determinant in CRC screening, regardless of knowledge. Translation to Health Education Practice: Further study using a representative sample of university employees may provide a clearer picture of the determinants of CRC screening so that specific health education interventions can be planned. © AAHPERD.
Wan, S., Lei, T.C., Chou, T.Y.
Optimized object-based image classification: development of landslide knowledge decision support system
(2013) Arabian Journal of Geosciences, pp. 1-12. Article in Press.
Feng Chia University, Taichung, China
Landslide spatial decision support systems (LS-DSS) are computer-based systems that combine the geographic storage, search, and retrieval capabilities of geographic information systems with the decision models and optimizing algorithms used to support decision-making for landslide problems. This study proposes an optimization process of region object-oriented classification (ROC) to analyze the landslide image information. The surface information from the Wan Da reservoir area is collected and studied. We collected different spectrum with several texture information to analyze the surrounding area of the Wan Da reservoir. ROC is used to classify the landslide area. Entropy-based classification is used as a classifier in ROC to determine the landslide/nonlandslide area. The parameters of S (similarity) and A (area) are used and then the best combinations are found. An optimize algorithm is developed to access the above variables to perform the best classification outcomes. The relations of occurrence vs. non-occurrence of landslide which are linked to the attributes of land surface are studied. An improved translation model (Expert Knowledge Translation Platform) is also presented to increase the accuracy. This could be of help to manage/monitor the landslide area near the reservoir. © 2013 Saudi Society for Geosciences.
Image classification; Landslide; Region object-oriented classification (ROC)
Nieuwlaat, R.ab , Schwalm, J.-D.bc , Khatib, R.b , Yusuf, S.bc
Why are we failing to implement effective therapies in cardiovascular disease?
(2013) European Heart Journal, 34 (17), pp. 1262-1269.
a Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
b Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
c Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
Worldwide, there are ∼18 million deaths each year from cardiovascular disease and at least 2-3 times as many experience non-fatal cardiovascular events. Numerous evidence-based prevention and management guideline recommendations for cardiovascular disease are available. However, significant gaps between the evidence and its implementation persist ('evidence-practice gap'). There exist 'under-use' gaps with lack of implementation of proven effective strategies and 'over-use' gaps with inappropriate use of strategies with strong evidence against, or insufficient evidence for their effectiveness and safety. To better tackle the global burden of cardiovascular disease (CVD), more effective strategies are needed. We discuss three selected areas where advances in implementation research for CVD could provide improvements. First, a better assessment and understanding of the most important modifiable context-specific barriers to evidence-based care will allow optimal tailoring of interventions to overcome them. Second, novel community intervention strategies from outside current CVD research should be considered, especially for CVD areas where major barriers exist and little progress has been made. Examples of such interventions include cell phone text messaging, non-physician health workers for the delivery community CVD care in areas of need, and low-cost single-pill combination CVD therapy. Third, increasing our understanding of successful implementation and sustainability of improvements is essential for CVD as a widespread chronic disease. Learning how to better implement effective therapies for CVD will have a larger effect on patient outcomes than most single new drugs and is a priority for tackling the global burden of CVD. © 2013 The Author.
Adherence; Cardiovascular disease; Guidelines; Implementation; Knowledge translation; Management; Prevention
Matthew-Maich, N.a , Ploeg, J.b , Dobbins, M.c , Jack, S.d
Supporting the uptake of nursing guidelines: What you really need to know to move nursing guidelines into practice
(2013) Worldviews on Evidence-Based Nursing, 10 (2), pp. 104-115. Cited 1 time.
a School of Nursing, Faculty of Health Sciences, Mohawk College, McMaster-Mohawk Institute for Applied Health Sciences, Hamilton, ON, Canada
b School of Nursing, Hamilton, ON, Canada
c Cross Appointed with the Department of Epidemiology and Biostatistics, The School of Rehabilitation Sciences McMaster University, Hamilton, ON, Canada
d McMaster University, Hamilton, ON, Canada
Background: There is a current push to use best practice guidelines (BPGs) in health care to enhance client care and outcomes. Even though intensive resources have been invested internationally to develop BPGs, a gap in knowledge exists about how to consistently and efficiently move them into practice. Methods: Constructivist grounded theory was used to explore the complex processes of a breastfeeding BPG implementation and uptake in three acute care hospitals. Interviews (n = 120) with 112 participants representing clients, nurses, lactation consultants, midwives, physicians, managers, administrators, and nurse educators as well as document and field note analysis informed this study. Data were analyzed using constant comparison and coding steps outlined by Charmaz: initial coding, selective (focused) coding, then theoretical coding. Triangulation of data types and sources were used as well as theoretical sampling. Data were collected from 2009 to 2010. Results: Two sites showed BPG uptake while one did not. Factors present in the uptake sites included, ongoing passionate frontline leaders, the use of multifaceted strategies, and processes that occurred at organizational, leadership, individual and social levels. Particularly noteworthy was the transformation of individual nurses to believing in and using the BPG. Impacts occurred at client, nurse, unit, inter-professional, organizational and system levels. Conclusions: A conceptual framework: Supporting the Uptake of Nursing Guidelines, was developed that reveals essential processes used to facilitate BPG uptake into nursing practice and a process of nurse transformation to believing in and using the BPG. © Sigma Theta Tau International.
Best practice guidelines; Breastfeeding; Clinical practice guidelines; Evidence based practice; Framework; Knowledge translation; Nursing; Practice guidelines; Research uptake; Research utilization
Tasca, G.A.a , Machado, P.P.P.b
Eating disorder psychotherapy research - beyond the brand: Introduction to a Special Section
(2013) Psychotherapy Research, 23 (3), pp. 247-251.
a Psychology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
b Escola de Psicologia, Universidade do Minho, Braga, Portugal
Psychological interventions and research for eating disorders tend to be complex, and outcomes on average are modest. Given the frequency and severity of eating disorders, these levels of outcomes are disconcerting. Adding to the current state of research is evidence that practicing clinicians do not tend to use evidence-based psychotherapies consistently for eating disorders. This is a problem not only of dissemination and uptake of research, but also one of knowledge translation. More practice-based research, in which clinicians are equal partners in developing interventions and designing research, may be necessary in order to solve the problems of modest outcomes and low research uptake. The psychotherapy research of eating disorders in this special section presents examples of research that takes place in real-world clinical contexts with complex patients and that can be more easily translated into clinical practice. © 2013 Copyright Society for Psychotherapy Research.
Hall, W.A.a , Bandsmer, J.C.b , Gregg, K.a , Ebbehoj, C.a
Translating Knowledge Directly to Childbearing Women: A Study of Canadian Women's Preferences
(2013) Health Care for Women International, 34 (5), pp. 363-379.
a School of Nursing, University of British Columbia, T. 201, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
b Victoria General Hospital, Victoria, BC, Canada
Knowledge translation has relied on research products that take years to disseminate, losing relevance for intended users. We used a mixed-methods approach to determine women's preferences for research results and format, intention to share results, and potential benefits. We sampled healthy, pregnant women who completed survey data during their third trimesters and wanted access to results. Mothers preferred results about sleep, fears, and anxieties during later pregnancy to benefit from reassurance that their experiences were shared. Women mostly intended to share results with their social networks. Organizational contacts increased dissemination of the women's preferred information to nonstudy participants. © 2013 Copyright Taylor and Francis Group, LLC.
Glegg, S.M.N.ab , Holsti, L.c , Velikonja, D.d , Ansley, B.e , Brum, C.e , Sartor, D.e
Factors influencing therapists' adoption of virtual reality for brain injury rehabilitation
(2013) Cyberpsychology, Behavior, and Social Networking, 16 (5), pp. 385-401.
a Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, BC, V5M 3E, Canada
b School of Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
c Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
d Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
e Hamilton Health Sciences, Hamilton, ON, Canada
Virtual reality (VR) is an important emerging technology that is increasingly being introduced in health centers as a rehabilitation intervention. Quantitative research is needed to identify the factors influencing therapists' adoption of VR for brain injury rehabilitation, including barriers and facilitators to VR use, in order to inform successful implementation strategies. A measure based on the Decomposed Theory of Planned Behavior (DTPB) was developed and administered to 42 therapists; early psychometric properties are reported. Mean or median composite scores and correlations were calculated for each DTPB construct. Overall, therapists had positive attitudes toward VR, perceived it as being useful, and had positive intentions to use it more in the future. The self-efficacy composite yielded the lowest scores. The most significant barrier to adoption was time, while social influences and knowledge were the primary facilitators. Future research will explore the impact of knowledge translation interventions on these mediators of VR adoption. © Mary Ann Liebert, Inc. 2013.
Newberry, A.G.a , Jean Choi, C.-W.a , Donovan, H.S.a , Schulz, R.bc , Bender, C.ac , Given, B.d , Sherwood, P.e
Exploring spirituality in family caregivers of patients with primary malignant brain tumors across the disease trajectory
(2013) Oncology Nursing Forum, 40 (3), pp. E119-E125.
a School of Nursing, United States
b Department of Psychology, United States
c University of Pittsburgh, PA, United States
d School of Nursing, Michigan State University, East Lansing, United States
e School of Nursing, University of Pittsburgh, United States
Purpose/ Objectives: To determine whether the perceived level of spirituality in family caregivers of patients with primary malignant brain tumors (PMBTs) changes across the disease trajectory. Design: Ongoing descriptive, longitudinal study. Setting: Southwestern Pennsylvania. Sample: 50 family caregivers of patients with PMBT. Methods: Caregivers and care recipients were recruited at time of diagnosis. Participants were interviewed at two subsequent time points, four and eight months following diagnosis. Main Research Variables: Care recipients' symptoms, neuropsychologic status, and physical function, as well as caregiver social support. Findings: Results showed no significant difference in spirituality scores reported at baseline and eight months (p = 0.8), suggesting that spirituality may be a stable trait across the disease trajectory. Conclusions: Spirituality remains relatively stable along the course of the disease trajectory. Reports of caregiver depressive symptoms and anxiety were lower when paired with higher reports of spirituality. Implications for Nursing: Clinicians can better identify caregivers at risk for negative outcomes by identifying those who report lower levels of spirituality. Future interventions should focus on the development and implementation of interventions that provide protective buffers such as increased social support. Knowledge Translation: Spirituality is a relatively stable trait. High levels of spirituality can serve as a protective buffer from negative mental health outcomes. Caregivers with low levels of spirituality may be at risk for greater levels of burden, anxiety, and stress. © 2013 by the Oncology Nursing Society. Unauthorized reproduction is prohibited.
Pre- and postoperative self-reported cognitive effectiveness and worry in patients with suspected lung malignancy
(2013) Oncology Nursing Forum, 40 (3), pp. E135-E141.
College of Nursing, Michigan State University, East Lansing, United States
Purpose/Objectives: To examine perceived cognitive effectiveness and worry in individuals with suspected lung cancer before and after surgical resection and to determine any differences between individuals with and without a postoperative diagnosis of lung cancer. Design: A repeated measures longitudinal design. Setting: A comprehensive cancer center and a Veterans Administration medical center in the midwestern United States. Sample: 15 men and 8 women aged 37-82 years (X = 61.4, SD = 10.7) with suspected lung cancer. Methods: Descriptive statistics were used to characterize data. Paired t tests and nonparametric correlation analysis were used to determine relationships among the main study variables. Main Research Variables: Perceived effectiveness in cog-nitive function as well as general and cancer-specific worry. Findings: Patients diagnosed with lung cancer were significantly older. Patients self-reported lowered perceived effectiveness in daily activities that require directed attention both pre- and postoperatively. Patients with nonmalignant postoperative reports had higher general worry at each time point, which was significant following surgery. Conclusions: A diagnosis of suspected lung cancer may contribute to compromised perceived effectiveness in cognitive function. Nonmalignant pathology following a diagnosis of suspected lung cancer may be associated with continued worry. Implications for Nursing: Nursing assessment and inter-ventions aimed at supporting effective cognitive function and modifying worry for patients with suspected lung cancer are essential to optimize adjustment. Knowledge Translation: Suspected lung cancer imposes high demands on cognitive and emotional function. Oncology nurses are in key positions to support patients during and following the diagnostic workup for lung cancer. Younger patients with nonmalignant postoperative reports may need continued follow-up. © 2013 by the Oncology Nursing Society. Unauthorized reproduction is prohibited.
Ginex, P.abf , Thom, B.cff , Jingeleski, M.cff , Vincent, A.dff , Plourde, G.f , Rizk, N.f , Rusch, V.W.eff , Bains, M.f
Patterns of symptoms following surgery for esophageal cancer
(2013) Oncology Nursing Forum, 40 (3), pp. E101-E107.
a Department of Nursing, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
b Department of Nursing, Lehman College, City University of New York, New York, NY, United States
c Department of Nursing, United States
d Office of Clinical Research, United States
e Thoracic Surgery Service, United States
f Department of Surgery, Memorial Sloan-Kettering Cancer Center, United States
Purpose/Objective: To explore patterns of symptoms before and after surgery for cancer of the esophagus. Design: Longitudinal, descriptive study. Setting: An urban comprehensive cancer center in the northeastern United States. Sample: 218 patients with cancer of the esophagus undergoing esophagectomy. Methods: Symptoms were assessed by self-report before surgery, at the first postoperative visit, and at 6 and 12 months postsurgery. Main Research Variables: Symptoms and demographic and clinical variables, including stage, treatment, gender, and comorbidities. Findings: Patients with esophageal cancer reported numerous symptoms before and after esophagectomy. Several patterns of symptoms were identified. General cancer symptoms (e.g., pain, cough, shortness of breath, weight loss) were reported as worse after surgery but recovered to baseline by one year. A second pattern of esophageal-specific symptoms (feeling full too quickly, feeling bloated, nausea, and diarrhea) worsened after surgery and did not recover to baseline by one year. Reflux was the only symptom that did not worsen after surgery but did worsen significantly during the first year of recovery. Conclusions: Patients with esophageal cancer experienced multiple prolonged symptoms following surgical treatment for their disease. General cancer symptoms resolved by one year post-treatment, whereas esophageal-specific symptoms worsened after surgery and did not recover to baseline. Implications for Nursing: Identification of symptom patterns preoperatively and during recovery can assist nurses in developing intervention protocols to minimize long-term complications for patients with esophageal cancer. Knowledge Translation: Patients with esophageal cancer are at risk for multiple prolonged symptoms following surgery. Symptom assessment should occur often after surgery and include a broad range of symptoms. © 2013 by the Oncology Nursing Society. Unauthorized reproduction is prohibited.
Nguyen-Truong, C.K.Y., Lee-Lin, F., Gedaly-Duff, V.
Contributing factors to colorectal cancer and hepatitis B screening among Vietnamese Americans
(2013) Oncology Nursing Forum, 40 (3), pp. 238-251.
School of Nursing, Oregon Health and Science University, Portland, United States
Purpose/Objectives: To identify factors associated with screening for colorectal cancer (CRC) and hepatitis B, because hepatitis B can increase the risk of liver cancer. Data Sources: MEDLINE®, CINAHL ®, and PsycINFO databases from January 1998 to April 2012. Data Synthesis: The 23 reviewed studies included 15 descriptive, 2 intervention, 3 qualitative, 2 chart or medical record review, and 1 mixed method. Most studies used an investigator-developed instrument with no reported reliability. Inconsistent operational definitions for contributing factors to screening made it challenging to make comparisons. Conclusions: CRC and hepatitis B screening are consistently low among Vietnamese Americans. Contributing factors included sociodemographics, knowledge, cultural beliefs, and external factors. External factors such as having a regular place of care and a healthcare provider were crucial because they influenced adherence to screening recommendations. Use of a public media education plus healthcare provider model and a culturally tailored intervention using Vietnamese lay advisors appeared to be promising for improving CRC screening. Additional intervention studies are needed to increase screening. Implications for Nursing: Vietnamese is a fast-growing subgroup within the Asian American Pacific Islander (AAPI) group that may require targeted approaches to screening for disease. Future studies should focus on immigrants or those who were born in the United States (men and women) as disaggregated subgroups. Such research can inform culturally sensitive and appropriate interventions that may improve cancer screening rates. Knowledge Translation: Although Vietnamese is the fourth largest racial-ethnic subgroup within the AAPI group, the literature about contributing factors to CRC and hepatitis B screening is limited among this subgroup. CRC and hepatitis B screening are consistently low among Vietnamese Americans. Use of public media education plus a healthcare provider model and a culturally tailored intervention using Vietnamese lay advisors appears promising for improving CRC screening. © 2013 by the Oncology Nursing Society. Unauthorized reproduction is prohibited.
McClellan, W.a , Klemp, J.R.bd , Krebill, H.cd , Ryan, R.e , Nelson, E.-L.f , Panicker, J.g , Sharma, M.e , Stegenga, K.e
Understanding the functional late effects and informational needs of adult survivors of childhood cancer
(2013) Oncology Nursing Forum, 40 (3), pp. 254-262.
a Survive and Thrive Survivorship Program, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States
b Depratment of Medicine, Division of Clinical Oncology, United States
c Midwest Cancer Alliance, Westwood, United States
d University of Kansas Cancer Center, Westwood, United States
e Division of Hematology/Oncology, Children's Mercy Hospitals and Clinics, United States
f Institute for Community Engagement, University of Kansas Medical Center, Kansas City, KS, United States
g Department of Pediatrics, University of Kansas Cancer Center, United States
Purpose/Objectives: To report functional (physical and cognitive) late effects, experiences, and information needs of adult survivors of childhood cancer. Design: Descriptive, mixed methods survey. Setting: Two pediatric oncology programs in the Midwest. Sample: Convenience sample of 272 young adult survivors. Methods: Voluntary survey completion by young adult survivors regarding late effects, experiences, and educational needs to develop appropriate comprehensive care programs for care provision before, during, and after transition to adult care. Survey domains were identified from existing survivorship literature and focused on all aspects of survivorship; however, this article focuses on results specific to the functional domain. Main Research Variables: Functional late effects, experiences, information needs, age, gender, and treatment intensity of young adult survivors of childhood cancer. Findings: Response rate was 48%. Functional late effects, perceptions, and information needs all correlated with intensity of treatment (those survivors most heavily treated experienced the most symptoms). Survivors wanted more information about late effects and how to deal with them. Women wanted more information about fertility-related topics, and participants who received more intense treatment generally wanted more information. Brain tumor survivors perceived greater cognitive difficulties, cognitive late effects, fatigue, and financial difficulties. Conclusions: Survivors experience myriad physical late effects and require ongoing access to information as needs change over time. Implications for Nursing: Identifying new and innovative ways to reach survivors and better meet needs is important for care, research, and program development. Knowledge Translation: The findings of the research underscore the importance of continuous learning opportunities for adult survivors of childhood cancer. The findings also highlight the need for healthcare teams to better understand the current and long-term needs of this population. In addition to traditional communication approaches, technologies such as social media and telemedicine can provide innovative ways to deliver patient-centered care. © 2013 by the Oncology Nursing Society. Unauthorized reproduction is prohibited.
Yeom, H.-E.a , Heidrich, S.M.b
Relationships between three beliefs as barriers to symptom management and quality of life in older breast cancer survivors
(2013) Oncology Nursing Forum, 40 (3), pp. E108-E118.
a Department of Nursing, College of Medicine, Dongguk University, Gyeongbuk, South Korea
b School of Nursing, University of Wisconsin-Madison, United States
Purpose/Objectives: To describe relationships among perceived barriers to symptom management and quality of life and to test the mediating role of perceived communication difficulties on the relationships between other perceived barriers to symptom management and quality of life in older adult breast cancer survivors. Design: Cross-sectional descriptive-correlational design using baseline data from a randomized, controlled trial that tested the efficacy and durability of the individualized representational intervention in reducing symptom distress and improving quality of life in older adult breast cancer survivors. Setting: The community, an oncology clinic, and a state tumor registry. Sample: 190 older adult breast cancer survivors (-X age = 70.4 years) who were an average of 3.3 years after breast cancer diagnosis. Methods: Path analysis using Mplus, version 5.1. Main Research Variables: Negative beliefs about symptom management (Symptom Management Beliefs Questionnaire [SMBQ]), perceived negative attitudes from healthcare providers (Communication Attitudes [CommA]), perceived communication difficulties (CommD), and quality of life. Findings: Significant direct effects of SMBQ and CommA on CommD were found after controlling for age, number of health problems, and number of symptoms. CommD was a significant mediator of the effects of CommA on quality of life after controlling for the covariates. SMBQ had significant total effects on quality of life after adjusting for the covariates but was not mediated by CommD. Conclusions: Patient-provider communication is an important factor in the quality of life of older adult breast cancer survivors. Implications for Nursing: Developing and testing nursing interventions focusing on enhancing both positive beliefs about symptom management and effective communication in old age is suggested. Knowledge Translation: Older adults and healthcare providers must overcome stereotyped beliefs about aging that may affect self-care and health outcomes for this population. Older adults must be allowed to express their views and emotions about aging. © 2013 by the Oncology Nursing Society. Unauthorized reproduction is prohibited.
Hickey, S.a , Merz, E.L.bc , Malcarne, V.L.d , Gunsauls, D.C.e , Huang, J.f , Sadler, G.R.g
Breast cancer education for the deaf community in American sign language
(2013) Oncology Nursing Forum, 40 (3), pp. E86-E91.
a Department of Surgery, School of Medicine, University of California, San Diego, United States
b Joint Doctoral Program of Clinical Psychology, Department of Psychology, San Diego State University, United States
c Department of Psychiatry, School of Medicine, UCSD, United States
d Department of Psychology, SDSU, United States
e Department of Deaf Culture and American Sign Language, American River College, Sacramento, CA, United States
f Ally Pharmacy Solutions, San Francisco, CA, United States
g School of Medicine, Moores Cancer Center, UCSD, United States
Purpose/Objectives: To create and evaluate an educational video designed to increase breast cancer-related knowledge and screening behaviors among women who are deaf and use American Sign Language (ASL) as their preferred communication method. Design: A test-retest survey was used to determine retained knowledge following an intervention with an ASL breast cancer education video. Setting: Deaf-friendly community settings in southern California. Sample: 122 women who were deaf with a preference for communicating via ASL. Methods: Participants completed a knowledge survey to determine their breast cancer screening practices and baseline breast cancer awareness. Participants then viewed a 30- minute video in ASL. Immediately after viewing the video, participants completed an identical knowledge survey. The survey was administered again two months after the initial intervention to determine long-term breast cancer knowledge retention. Main Research Variables: Age, breast cancer knowledge and screening practices, education, and health insurance. Findings: At baseline, breast cancer knowledge varied widely and respondents' answered an average of 3 out of 10 questions correctly. Postintervention, respondents answered an average of 8 out of 10 questions correctly, a significant increase from the baseline scores. At the two-month follow-up, respondents answered an average of 6 out of 10 questions correctly, still a significant increase from the baseline scores. Conclusions: Breast cancer knowledge of women who are deaf increased significantly by viewing an educational video in ASL and most of the new knowledge remained at the two-month follow-up. Implications for Nursing: Nurses can help improve the Deaf community's (DC's) access to breast cancer-related information by disseminating awareness of this online program. Knowledge Translation: With this online resource, nurses can more easily initiate discussions to help improve knowledge and screening behaviors in a linguistically and culturally appropriate manner. Improving the DC's access to breast cancer information is of paramount importance to reducing breast cancer morbidity and mortality in the DC. © 2013 by the Oncology Nursing Society. Unauthorized reproduction is prohibited.
Gleeson, M.ab , Meiser, B.bc , Barlow-Stewart, K.d , Trainer, A.H.e , Tucker, K.f , Watts, K.J.bg , Friedlander, M.b , Kasparian, N.h
Communication and information needs of women diagnosed with ovarian cancer regarding treatment-focused genetic testing
(2013) Oncology Nursing Forum, 40 (3), pp. 275-283.
a Hunter Family Cancer Service, Newcastle, Australia
b Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
c Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
d Master of Genetic Counselling Program, University of Sydney, Australia
e Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
f Hereditary Cancer Clinic, Prince of Wales Hospital, Australia
g Psychosocial Research Group, Australia
h School of Women's and Children's Health, University of New South Wales, Australia
Purpose/Objectives: To identify women's information and communication preferences about treatment-focused genetic testing (TFGT) in the ovarian cancer context. Research Approach: A qualitative interview study. Setting: Two familial cancer services and a gynecologic oncology clinic at a major teaching hospital in Australia. Participants: 22 women diagnosed with ovarian cancer who had either advanced disease and had previously undergone TFGT (n = 12) or had been diagnosed in the previous 6-20 weeks with ovarian cancer and had not undergone TFGT (n = 10). Methodologic Approach: Participants were interviewed individually about actual and hypothetical views of TFGT. The interviews were transcribed and organized into themes using qualitative analysis software. Findings: Most women wanted to be informed about TFGT prior to their surgery for ovarian cancer. The majority preferred to receive the information verbally; slightly more women preferred their medical oncologist to deliver the information compared to a genetic specialist or oncology nurse. Women preferred the focus of pretest information to be on them and their treatment. Conclusions: Women diagnosed with ovarian cancer want information about genetic testing early with focus placed on the potential benefits of genetic testing on treatment. Interpretation: The findings of this study provide much- needed guidance to oncology nurses and other oncology healthcare professionals about when, what, and how information about TFGT should be delivered to patients diagnosed with ovarian cancer. Supportive patient education materials now need to be developed to assist these women in making informed decisions about genetic testing. Knowledge Translation: Knowing that women do want TFGT, how they want it presented and by whom, and the content and level of detail that women want means that TFGT can now be presented as an option to women newly diagnosed with ovarian cancer, which may influence firstline treatment. The findings also provide the knowledge required to prepare education tools to assist oncology nurses involved in frontline care. © 2013 by the Oncology Nursing Society. Unauthorized reproduction is prohibited.
Eisenberg, S.a , Wickline, M.b , Linenberger, M.cd , Gooley, T.c , Holmberg, L.ce
Prevention of dimethylsulfoxide-related nausea and vomiting by prophylactic administration of ondansetron for patients receiving autologous cryopreserved peripheral blood stem cells
(2013) Oncology Nursing Forum, 40 (3), pp. 285-292.
a Department of Infusion Services, Seattle Cancer Care Alliance, Seattle, WA, United States
b Clinical Faculty, School of Nursing, University of Washington Medical Center, Seattle, WA, United States
c Fred Hutchinson Cancer Research Center, Seattle, WA, United States
d Department of Hematology and Medicine, School of Medicine, University of Washington, Seattle, WA, United States
e School of Medicine, University of Washington, Seattle, WA, United States
Purpose/Objectives: To evaluate the effectiveness of ondansetron for the prevention of nausea and vomiting from dimethylsulfoxide (DMSO) during autologous stem cell transplantation (ASCT) infusion. Design: Nonrandomized cohort using historical control. Setting: Comprehensive cancer center outpatient infusion department. Sample: 50 patients receiving ASCT in the outpatient setting. Methods: Patients were assessed for nausea and vomiting on their infusion day using the Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) at arrival, pre-ASCT infusion, pre-ondansetron administration, prior to the first bag, and after each bag of stem cells. A standard script was used to ensure consistency. Ondansetron, 16 mg IV, was administered 30-90 minutes prior to each ASCT infusion. Number and volume of stem cells bags, as well as infusion rate and emesis episodes, were recorded. Nausea scores and vomiting episodes were compared to historical data. Main Research Variables: Subjectivity of nausea, potential Hawthorne Effect. Findings: Forty-five percent of patients had an MAT score greater than 2 on arrival, decreasing to 18% after receiving ondansetron before the first bag. Twenty-four percent had MAT increases of more than two points by infusion end compared to 58% in the historic control group. Eighteen percent of patients vomited compared to 28% of historic controls. Conclusions: The administration of 16 mg of IV ondansetron significantly reduced DMSO-related nausea and episodes of vomiting in patients receiving ASCT. Implications for Nursing: Prophylactic administration of ondansetron had a positive effect on reducing nausea symptoms and episodes of vomiting during ASCT infusions. These results prompted a change in clinical practice. More research is required to determine whether the inclusion of other antiemetic agents would provide even greater benefit. Knowledge Translation: To date, no other published studies have explored the benefits of premedicating patients with ondansetron prior to ASCT infusions. This study is the first to establish efficacy of ondansetron for an unlabeled indication. These results may pave the way for future research in decreasing nausea and vomiting in this setting. © 2013 by the Oncology Nursing Society. Unauthorized reproduction is prohibited.
Chemical sensitivity: Pathophysiology or pathopsychology?
(2013) Clinical Therapeutics, 35 (5), pp. 572-577.
Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
Background: Escalating numbers of people throughout the world are presenting to primary care physicians, allergists, and immunologists with myriad clinical symptoms after low-level exposure to assorted everyday chemicals such as smoke, perfumes, air fresheners, paints, glues, and other products. This clinical state is referred to by various diagnostic labels, including multiple chemical sensitivity disorder, environmental intolerance, chemical sensitivity (CS), and sensitivity-related illness, and has been the subject of much controversy within the health care community. Objective: The goal of this study was to provide a brief overview of the etiology, pathogenesis, clinical presentation, and management of CS. An evaluation of the medical community's response to this emerging diagnosis was also explored. Methods: This review was prepared by assessing available medical and scientific literature from MEDLINE, as well as by reviewing numerous books, toxicology journals, conference proceedings, government publications, and environmental health periodicals. A primary observation, however, is that there is limited scientific literature available on the issue of CS. The format of a traditional integrated review was chosen because such reviews play a pivotal role in scientific research and professional practice in medical issues with limited primary study and uncharted clinical territory. Results: The sensitization state of CS seems to be initiated by a significant toxic exposure, occurring as a 1-time event, or on surpassing a threshold of toxicity after toxicant accrual from repeated lower-level exposures. Once sensitized through a toxicant-induced loss of tolerance, individuals exposed to inciting triggers such as minute amounts of diverse everyday chemicals may experience various clinical and immune sequelae, sometimes involving lymphocyte, antibody, or cytokine responses. Precautionary avoidance of inciting triggers will prevent symptoms, and desensitization immunotherapy or immune suppression may improve symptoms in some cases. Sustained resolution of the CS state occurs after successful elimination of the accrued body burden of toxicants through natural mechanisms of toxicant bioelimination and/or interventions of clinical detoxification. Despite extensive clinical evidence to support the veracity of this clinical state, many members of the medical community are reluctant to accept this condition as a pathophysiologic disorder. Conclusions: The emerging problem of ubiquitous adverse toxicant exposures in modern society has resulted in escalating numbers of individuals developing a CS disorder. As usual in medical history, iconoclastic ideas and emerging evidence regarding novel disease mechanisms, such as the pathogenesis of CS, have been met with controversy, resistance, and sluggish knowledge translation. © 2013 Elsevier HS Journals, Inc.
Chemical sensitivity; Clinical detoxification; Environmental intolerance; Multiple chemical sensitivity disorder; Sensitivity-related illness; Toxicant-induced loss of tolerance
McMillan, S.C.ad , Tofthagen, C.bd , Small, B.cd , Karver, S.e , Craig, D.f
Trajectory of medication-induced constipation in patients with cancer
(2013) Oncology Nursing Forum, 40 (3), pp. E92-E100.
a Department of Oncology Nursing, College of Nursing, United States
b College of Nursing, United States
c School of Aging Studies, University of South Florida, Tampa, United States
d University of South Florida, Tampa, United States
f Moffitt Cancer Center and Research Institute, Tampa, FL, United States
Purpose/Objectives: To determine the severity and trajectory of constipation among patients with cancer from opioids and/or vinca alkaloids. Design: Exploratory, descriptive. Setting: Moffitt Cancer Center, a National Cancer Institute-designated comprehensive cancer center in Tampa, FL. Sample: 400 patients at risk for developing medication-induced constipation from opioids, vinca alkaloids, or both. Methods: Patients' baseline data included the Constipation Assessment Scale (CAS), the constipation item from the Memorial Symptom Assessment Scale (MSAS) for intensity and distress, and the laxative interview. Following the interview, the medical chart was reviewed for clinical and demographic data. Patients were asked about constipation (CAS) and laxatives consumed (laxative interview) during eight weekly telephone calls. Main Research Variables: Constipation presence, intensity, and distress. Findings: At baseline, 63% of patients reported some level of constipation. During the eight weeks, constipation fluctuated with scores ranging from 0-16, with the opioid-only group showing a small but statistically significant decrease in intensity. Constipation intensity and distress on the MSAS were significantly correlated (r = 0.76; p = 0.000). Conclusions: The majority of the sample reported constipation that ranged from mild to severe, persisted over time, and caused symptom distress. Therefore, healthcare providers in the cancer center likely were neither adequately managing the medication-induced constipation nor apparently teaching patients to manage it themselves. Implications for Nursing: National Comprehensive Cancer Network guidelines support the importance of managing medication-induced constipation. However, guidelines are not being followed in many cases; therefore, more focus is needed on constipation in clinical and educational settings as well as more research. Knowledge Translation: Patients receiving opioids and vinca alkaloids are at risk of constipation. Currently, medication- induced constipation is poorly managed. Managing constipation may lessen symptom distress, thereby improving quality of life in these patients. © 2013 by the Oncology Nursing Society. Unauthorized reproduction is prohibited.
Lovely, M.P.a , Stewart-Amidei, C.b , Page, M.c , Mogensen, K.d , Arzbaecher, J.b , Lupica, K.e , Maher, M.E.f
A new reality: Long-term survivorship with a malignant brain tumor
(2013) Oncology Nursing Forum, 40 (3), pp. 267-274.
a College of Nursing, University of California, San Francisco, United States
b Department of Neuro-Oncology, University of Chicago, IL, United States
c University of California, San Francisco, United States
d Ros-well Park Cancer Institute, Buffalo, NY, United States
e Cleveland Clinic, OH, United States
f Northwestern University, Chicago, United States
Purpose/Objectives: To explore the survivor experience of adults who have been diagnosed three years or longer with a primary malignant brain tumor (PMBT). Research Approach: Qualitative using a biographical narrative approach. Setting: Six sites across the United States. Participants: Survivors of PMBTs (N = 35) and their family caregivers (N = 35). Methodologic Approach: Using a semistructured interview guide, survivors and caregivers were interviewed individually about their lives before and since the PMBT diagnosis. Thematic analysis was performed to identify themes. Findings: Stability in survivor lives disintegrated as a result of the changes experienced related to the tumor and its treatment. Those changes were profound and ultimately contributed to multiple losses in key areas of their lives. Over time, living with the diagnosis and its consequences required survivors and their caregivers to adapt to the new reality of their lives. Through the process of becoming a survivor, individuals were able to take back control of their lives. Adaptation required survivors to use internal and external resources as ways of coping with their new reality. Conclusions: People with PMBTs require support as they adapt to losses and changes that impact their lives. Assessment of specific changes that impact survivors' lives may be useful in guiding type of support given. Symptom management and mobilization of internal and external resources may lessen the life-changing impact. Interpretation: Nurses should capture symptom meaning during assessments and expand assessments to include social support systems. Instituting measures that facilitate survivor independence may lessen the impact of disability. The significance of symptom worsening over time requires additional research. Knowledge Translation: Restoring self-worth and taking control of their lives are critical concerns for survivors of PMBTs. © 2013 by the Oncology Nursing Society. Unauthorized reproduction is prohibited.
Bédard, M.abc , Marshall, S.de , Man-Son-Hing, M.de , Weaver, B.ac , Gélinas, I.fg , Korner-Bitensky, N.fg , Mazer, B.fg , Naglie, G.hij , Porter, M.M.k , Rapoport, M.J.l, Tuokko, H.m , Vrkljan, B.n
It is premature to test older drivers with the SIMARD-MD
(2013) Accident Analysis and Prevention, . Article in Press.
a Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
b St. Joseph's Care Group, Thunder Bay, Ontario, Canada
c Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
d University of Ottawa, Ottawa, Ontario, Canada
e Ottawa Hospital Research Institute, Canada
f McGill University, Montréal, Québec, Canada
g Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Québec, Canada
h Department of Medicine and Rotman Research Institute, Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada
i Research Department, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
j Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
k University of Manitoba, Canada
l University of Toronto, Canada
m University of Victoria, Canada
n McMaster University, Canada
Background: A new tool, the SIMARD-MD, has been proposed to help physicians identify cognitively impaired drivers who may be unfit to drive, but little empirical evidence is available to justify its use. We analyzed data from a cohort of older Canadian drivers who had undergone cognitive testing to: (1) correlate the SIMARD-MD with other tools that measure cognition (e.g., trail-making test), (2) identify how many drivers, using published cut-offs on the SIMARD-MD, would be recommended to lose their license, or be considered fit to drive, or be required to undergo further driving assessment, and (3) determine if the SIMARD-MD is biased by level of education as many cognitive tools are. Methods: Cross-sectional data from 841 drivers aged 70 and over from seven Canadian sites who are enrolled in a 5-year cohort study were used for the analyses. Scores on the SIMARD-MD were correlated with scores on the other cognitive measures. The recommendations that would be made based on the SIMARD-MD scores were based on published cut-off values suggested by the authors of the tool. The impact of education status was examined using linear regression controlling for age. Results: Correlations between the SIMARD-MD and other cognitive measures ranged from .15 to .86. Using published cut-off scores, 21 participants (2.5%) would have been recommended to relinquish their licenses, 428 (50.9%) would have been deemed fit to drive, and 392 (46.6%) would have been required to undergo further testing. We found a difference of 8.19 points (95% CI = 4.99, 11.40, p < .001) in favor of drivers with post-secondary education versus those without, representing over 11% of the mean score. Discussion: The SIMARD-MD is unlikely to be valuable to clinicians because it lacks sufficient precision to provide clear recommendations about fitness-to-drive. Recommendations based solely on the SIMARD-MD may place many seniors at risk of losing their transportation mobility or incurring unnecessary stress and costs to prove they are safe to drive. Furthermore, the education bias may create an unwanted structural inequity. Hence, adoption of the SIMARD-MD as a tool to determine fitness-to-drive appears premature. © 2013 Elsevier Ltd. All rights reserved.
Candrive; Knowledge translation; Older drivers; Screening
Coates, K., Fraser, K.
A case for collaborative networks for clinical nurse educators
(2013) Nurse Education Today, . Article in Press.
University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave., Edmonton, Alberta T6G 1C9, Canada
Clinical Nurse Educators (CNEs) are a unique subspecialty of nurse educators whose primary purpose is to support the ongoing educational needs of clinical nurses. The role has been described as both isolating and overwhelming. In this paper, we first review the current context for CNEs, specifically, the lack of role clarity and explore some reasons for job dissatisfaction. We then propose collaborative networks as a strategy to address these concerns. The potential benefits of these networks include opportunities for: role clarity, decreased isolation, shared finite resources, reduced duplication of work, ongoing professional development, and mentorship. Additionally, we propose enhanced, intersectoral collaborations with Academic Nurse Educators, those nurses employed at academic institutions to educate nursing students. These networks could improve research capacity and knowledge translation to the frontlines of care delivery, professional growth, and responsible use of resources in both sectors. © 2013 Elsevier Ltd. All rights reserved.
Academic Nurse Educator; Academic Partnerships; Clinical Nurse Educator; Intersectoral Partnerships; Network/Networking; Staff Development Educator
Tran, N.T.a , Bennett, S.C.b , Bishnu, R.c , Singh, S.d
Analyzing the sources and nature of influence: How the Avahan program used evidence to influence HIV/AIDS prevention policy in India
(2013) Implementation Science, 8 (1), art. no. 44, .
a Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
b Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
c Tolly Niket, N.S.C. Bose Rd., Kolkata, India
d Amaltas, Hauz Khas, New Delhi, India
Background: Major investments by development partners in low- and middle-income countries (LMICs) often seek to develop a supportive policy environment. There is limited knowledge about the mechanisms that development partners use to influence government policy, or which mechanisms are effective. This study assessed the influence of Avahan, a large HIV/AIDS prevention program in India supported by the Bill and Melinda Gates Foundation, on the development of HIV/AIDS policies in India, particularly the National AIDS Control Program III (NACP III).Methods: A retrospective assessment of the contributions of Avahan to the development of NACP III was conducted based upon document review and in-depth interviews with key informants, including Avahan staff and staff of implementing partners. This assessment was carried out within a framework centered on three domains: evidence considered by policy and decision-makers; the channel through which influence is exerted; and the target audience for influence. Results: Respondents identified a number of respects in which Avahan influenced NACP III policy, notably, Avahan influenced perception of the feasibility of scaling up services (through a demonstration effect) and Avahan, along with others, helped ensure a strong focus on targeted interventions. Overall Avahan's influence was greatest during policy implementation. While the extent to which research evidence generated by Avahan influenced NACP III was limited, best practice evidence generated by Avahan, including the lessons learned from routine implementation and management, contributed significantly to NACP III. This was largely due to the credibility Avahan had established and strategic 'inside track' communications.Conclusion: While studies of knowledge translation typically focus primarily on scientific evidence, this study suggests that other forms of evidence, notably best practice evidence derived from program experience, and disseminated through personal communication, were particularly influential. The framework developed for the paper provides a useful tool to analyze how evidence-based influence is exerted. © 2013 Tran et al.; licensee BioMed Central Ltd.
Started by Paul J Graham Oct 5, 2012.
Started by Paul J Graham. Last reply by Neli Maria Mengalli Feb 7, 2010.
Started by Lyndal Thompson. Last reply by Paul J Graham Nov 28, 2009.
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