Impact of North American Institutions on Orthopedic Research in Low- and Middle-Income Countries

There exists an unmet need for locally relevant and sustainable orthopedic research in low- and middle-income countries. Partnerships between high-income countries and low- and middle-income countries can bridge gaps in resources, knowledge, infrastructure, and skill. This article presents a select list of models for high-income countries/low- and middle-income countries research partnerships including academic partnerships, international research consortia, professional society-associated working groups, and nongovernmental organization partnerships. Models that produce research with lasting legacy are those that promote mutually beneficial partnerships over individual gains.

[Peer support. Essential for quality improvement following a patient safety incident]

Patient safety incidents have strong personal and professional impact on the health care professionals involved. Following such an incident, many of them experience long-term negative emotions and impaired professional functioning. For this reason, in 2016 Shapiro argued for the provision of peer support directly after an incident. Five Dutch University Medical Centres formed a partnership that same year to set up a Peer Support program. A descriptive evaluation of their experience shows that Peer Support is widely provided, fulfils an apparent need, is highly valued by colleagues who received it, and noticeably contributes to an open culture. The Peer Support program helps the upset professionals to continue to function in their role and to contribute to quality improvement after the incident. The benefits of Peer Support are clearly noticeable, but difficult to quantify. Therefore, we suggest that Peer Support should be assessed by the new, more qualitative evaluation of health care benefits, so hospital boards will support continuation of the program.

Built environment changes and active transport to school among adolescents: BEATS Natural Experiment Study protocol

INTRODUCTION

Natural experiments are considered a priority for examining causal associations between the built environment (BE) and physical activity (PA) because the randomised controlled trial design is rarely feasible. Few natural experiments have examined the effects of walking and cycling infrastructure on PA and active transport in adults, and none have examined the effects of such changes on PA and active transport to school among adolescents. We conducted the Built Environment and Active Transport to School (BEATS) Study in Dunedin city, New Zealand, in 2014-2017. Since 2014, on-road and off-road cycling infrastructure construction has occurred in some Dunedin neighbourhoods, including the neighbourhoods of 6 out of 12 secondary schools. Pedestrian-related infrastructure changes began in 2018. As an extension of the BEATS Study, the BEATS Natural Experiment (BEATS-NE) (2019-2022) will examine the effects of BE changes on adolescents' active transport to school in Dunedin, New Zealand.

METHODS AND ANALYSIS

The BEATS-NE Study will employ contemporary ecological models for active transport that account for individual, social, environmental and policy factors. The published BEATS Study methodology (surveys, accelerometers, mapping, Geographic Information Science analysis and focus groups) and novel methods (environmental scan of school neighbourhoods and participatory mapping) will be used. A core component continues to be the community-based participatory approach with the sustained involvement of key stakeholders to generate locally relevant data, and facilitate knowledge translation into evidence-based policy and planning.

ETHICS AND DISSEMINATION

The BEATS-NE Study has been approved by the University of Otago Ethics Committee (reference: 17/188). The results will be disseminated through scientific publications and symposia, and reports and presentations to stakeholders.

TRIAL REGISTRATION NUMBER

ACTRN12619001335189.

Exploring the evolution of engagement between academic public health researchers and decision-makers: from initiation to dissolution

CONTEXT

Relationships between researchers and decision-makers have demonstrated positive potential to influence research, policy and practice. Over time, interest in better understanding the relationships between the two parties has grown as demonstrated by a plethora of studies globally. However, what remains elusive is the evolution of these vital relationships and what can be learned from them with respect to advancing evidence-informed decision-making. We therefore explored the nuances around the initiation, maintenance and dissolution of academic-government relationships.

METHODS

We conducted in-depth interviews with 52 faculty at one school of public health and 24 government decision-makers at city, state, federal and global levels. Interviews were transcribed and coded deductively and inductively using Atlas.Ti. Responses across codes and respondents were extracted into an Excel matrix and compared in order to identify key themes.

FINDINGS

Eight key drivers to engagement were identified, namely (1) decision-maker research needs, (2) learning, (3) access to resources, (4) student opportunities, (5) capacity strengthening, (6) strategic positioning, (7) institutional conditionalities, and (8) funder conditionalities. There were several elements that enabled initiation of relationships, including the role of faculty members in the decision-making process, individual attributes and reputation, institutional reputation, social capital, and the role of funders. Maintenance of partnerships was dependent on factors such as synergistic collaboration (i.e. both benefit), mutual trust, contractual issues and funding. Dissolution of relationships resulted from champions changing/leaving positions, engagement in transactional relationships, or limited mutual trust and respect.

CONCLUSIONS

As universities and government agencies establish relationships and utilise opportunities to share ideas, envision change together, and leverage their collaborations to use evidence to inform decision-making, a new modus operandi becomes possible. Embracing the individual, institutional, networked and systems dynamics of relationships can lead to new practices, alternate approaches and transformative change. Government agencies, schools of public health and higher education institutions more broadly, should pay deliberate attention to identifying and managing the various drivers, enablers and disablers for relationship initiation and resilience in order to promote more evidence-informed decision-making.

Medical-Legal Partnerships to Support Continuity of Care for Immigrants Impacted by HIV: Lessons Learned from California

The United States (US) has experienced a surge of anti-immigrant policies and rhetoric, raising concerns about the influence on health outcomes for immigrants living in the US. We conducted qualitative interviews (n = 20) with health care and social service providers, attorneys, and legal/policy experts in California to understand how agencies were maintaining access to HIV care and prevention for immigrant clients. We conducted a thematic analysis to describe the role of medical-legal partnerships (MLPs) and document best practices. Informants reported high demand for legal services. Referrals were facilitated by case managers, medical providers, and pre-existing relationships between clinics and legal agencies. Informants identified a need for additional funding and further guidance on screening for and supporting patients with legal needs. MLPs have the capacity to create sustainable, efficient, comprehensive structural changes that minimize barriers to HIV prevention and treatment and improve health outcomes among immigrant populations.

Building a culture of health through research: The role of the physical activity research center

This paper provides brief context for why the physical activity research center was created and how it supports the national movement to build a culture of health.

Essential Partners for Student Health and Safety: Round Table Discussion With School Nurses and School Resource Officers

This article explores the partnership between school nurses and school resource officers. Through an interviewing process, the authors summarize current examples of how the partnership is essential and effective in 21st-century schools across the United States.

Twelve tips for distributed health professions training

Increasing numbers of health professions students are being trained in healthcare facilities that are geographically removed from central academic hospitals. Consequently, studies have evaluated this distributed training, assessed the impact that it has on student learning as well as on the facilities where the training occurs, and explored factors that enable and constrain successful clinical training at such sites. The 12 tips presented in this article have been developed from a longitudinal project that has focused on developing a framework for effective distributed health professions training through an extensive review of the literature and a national consultative process. These 12 tips should, therefore, have applicability across multiple contexts. The purpose of this article is to assist people in implementing, adapting, upscaling, maintaining, and evaluating the distributed training of students in the health professions.

Getting the Sergeants on your side: the importance of interpersonal relationships and cultural interoperability for generating interagency collaboration between nurses and the police in custody suites

In this article, I contribute to the literature around interagency collaboration, especially between law enforcement and health care, by reconciling the previous work of Sarah Charman (2014) with the interprofessional teamwork literature. Drawing upon a semi-structured interview-based study with 20 custody nurses working in English police custody suites (analysed using Framework Analysis), I explore the ways they are able to achieve interagency collaboration with a particular police officer, the Desk Sergeant. I argue that nurses accomplish interagency interoperability by interacting regularly with the Desk Sergeant, anticipating their needs and limiting their own goals to those that are commensurate with the Desk Sergeant's, notably providing information and avoiding deaths in custody. Such practices are similar to the strategies of 'Cultural Interoperability' noted by Charman (2014); however, this study also identifies that such strategies are only available once a successful working relationship has formed between Desk Sergeant and nurse, and as a result, similarly to the findings of interprofessional teamwork studies, the success or failure of attempts to collaborate across agencies is underpinned by interpersonal relations. The paper concludes by commenting on the importance of analysing both the interpersonal and organisation levels when studying collaboration.

Culinary medicine and community partnership: hands-on culinary skills training to empower medical students to provide patient-centered nutrition education

Given the economic burden and numerous morbidities associated with obesity and poor dietary choices, it is increasingly important for medical students to receive education on nutrition and preventive medicine so that they are equipped to advise patients about healthy lifestyle choices. Currently, 71% of US medical schools do not reach the minimum benchmark of 25 hours of nutrition education set by the National Academy of Sciences. In order to improve the quality and quantity of nutrition education at the Keck School of Medicine of USC (KSOM), medical students and faculty have partnered with LA Kitchen (LAK), a local teaching kitchen, and the Wellness Center at LA County Medical Center (LAC+USC). They developed a hands-on preclinical culinary and nutrition course that aims to teach students practical skills and knowledge that they will be able to apply to their own lives and pass onto patients. Following the completion of the first three years of the course (2016-2018), analysis suggests that the class was well-received and has improved students' nutrition knowledge, confidence in lifestyle counseling, and personal culinary skills. Given these highly encouraging observations, the project is currently aimed at incorporating nutrition education more broadly into the required preclinical curriculum at KSOM.

Partnering in postacute darkness? CMS has data that will help

Health systems will improve postacute outcomes when CMS begins sharing its performance data on nursing facility chains.

Task sharing for family planning services, Burkina Faso

PROBLEM

In Burkina Faso, the coverage of services for family planning is low due to shortage of qualified health staff and limited access to services.

APPROACH

Following the launch of the Ouagadougou Partnership, an alliance to catalyse the expansion of family planning services, the health ministry created a consortium of family planning stakeholders in 2011. The consortium adopted a collaborative framework to implement a pilot project for task sharing in family planning at community and primary health-care centre levels in two rural districts. Stakeholders were responsible for their areas of expertise. These areas included advocacy; monitoring and evaluation; and capacity development of community health workers (CHWs) to offer oral and injectable contraceptives to new users and of auxiliary nurses and auxiliary midwives to provide implants and intrauterine devices. The health ministry implemented supportive supervision cascades involving relevant planning and service levels.

LOCAL SETTING

In Burkina Faso, only 15% (2563/17 087) of married women used modern contraceptives in 2010.

RELEVANT CHANGES

Adoption of new policies and clinical care standards expanded task sharing roles in family planning. The consortium trained a total of 79 CHWs and 124 auxiliary nurses and midwives. Between January 2017 and December 2018, CHWs provided injectables to 3698 new users, and auxiliary nurses or midwives provided 726 intrauterine devices and 2574 implants to new users. No safety issues were reported.

LESSONS LEARNT

The pilot project was feasible and safe, however, financial constraints are hindering scale-up efforts. Supportive supervision cascades were critical in ensuring success.

A multisectoral institutional arrangements approach to integrating civil registration, vital statistics, and identity management systems

This paper reviews the essential components of a recommended institutional arrangements framework of integrated civil registration and vital statistics (CRVS) and civil identification systems. CRVS typically involves several ministries and institutions, including health institutions that notify the occurrence of births and deaths; the judicial system that records the occurrence of marriages, divorces, and adoptions; the national statistics office that produces vital statistics reports; and the civil registry, to name a few. Considering the many stakeholders and close collaborations involved, it is important to establish clear institutional arrangements-"the policies, practices and systems that allow for effective functioning of an organization or group" (United Nations Development Programme, Capacity development: a UNDP primer. New York: United Nations Development Programme, 2009). An example of a component of institutional arrangements is the establishment of a multisectoral national CRVS coordination committee consisting of representatives from key stakeholder groups that can facilitate participatory decision-making and continuous communication. Another important component of institutional arrangements is to create a linkage between CRVS and the national identity management system using unique identification numbers, enabling continuously updated vital events data to be accessible to the civil identification agency. By using birth registration in the civil registry to trigger the generation of a new identification and death registration to close it, this link accounts for the flow of people into and out of the identification management system. Expanding this data link to enable interoperability between different databases belonging to various ministries and agencies can enhance the efficiency of public and private services, save resources, and improve the quality of national statistics which are useful for monitoring the national development goals and the Sustainable Development Goals. Examples from countries that have successfully implemented the recommended components of an integrated CRVS and national identity management system are presented in the paper.

eLearning course for improving civil registration and vital statistics systems

The World Bank Group (WBG), in partnership with the Global Civil Registration and Vital Statistics (CRVS) Group, the Korea Ministry of Economy and Finance, and the WBG Open Learning Campus, launched the first comprehensive CRVS eLearning course in May 2017. The development of this course demonstrates the commitment and collaboration of development partners and governments working closely together in building the capacity of national institutions to improve CRVS systems in low- and middle-income countries. As of December 2018, over 2300 learners from 137 countries have enrolled in the course. This paper discusses how the course has been developed, disseminated, and evaluated thus far. It also presents the challenges faced and how the course has improved based on feedback from course participants.

Framework for ethical international academic partnerships in family medicine: The Besrour Papers: a series on the state of family medicine in Canada and Brazil

OBJECTIVE

To develop an ethical framework for collaboration in international academic partnerships in family medicine.

COMPOSITION OF THE COMMITTEE

A subgroup of the Besrour Centre of the College of Family Physicians of Canada including family medicine and bioethics experts began to collaborate in 2014 to undertake the development of an ethical framework and tools for the establishment of ethically sound international academic partnerships.

METHODS

Following 2 consultative workshops and a wider consultation process with the Besrour Centre global community, the authors developed an ethical framework and tools for approval by the Besrour Centre leadership in November 2017.

REPORT

Partnerships are essential to family practice and to the field of international development. The flawed nature of many North-South research partnerships underlines the importance of and need for delineating core principles for ethically sound partnerships, of which 10 have been identified in this process: accountability, cost and efficiencies, excellence, equity, humility, justice, leadership, reciprocity, respect for self-determination, and transparency. Based on these principles, a decision-making framework was created to translate these values into actions and to promote a cohesive and transparent structure for discussions. Fostering fairness, transparency, and consistency in decision making reduces the potential for inequity in a partnership, leading to lasting relationships that endure beyond the scope of a partnership agreement.

Bridging the academic and practice/policy gap in public health: perspectives from Scotland and Canada

This article presents a critical commentary of specific organizational models and practices for bridging 'the gap' between public health research and policy and practice. The authors draw on personal experiences of such models in addition to the wider knowledge translation and exchange literature to reflect on their strengths and weaknesses as implemented in Scotland and Canada since the early 1990s.