Analysis and deliberation as a mechanism to assess changes in preferences for indicators of sustainable forest management: a case study in Puebla, Mexico

The purpose of this study was to assess changes in forest owners' preferences regarding indicators of sustainable forest management. The analysis and deliberation framework served as a platform upon which to explore these changes in a rural community in Puebla, Mexico. Sixty-two indicators were selected from existing sets to design a five-point Likert survey instrument. The instrument was administered three times: early in the study to capture the forest owners' preferences before intervention (baseline); following an educational meeting in which the participants learned of three alternative forest management plans (analysis); and following a community meeting in which the forest owners deliberated to choose one of the alternatives (deliberation). As forest owners were exposed to knowledge (analysis) and deliberation, their preferences for the indicators changed significantly. An examination of the instrument demonstrated how the indicators increased or decreased in importance. Social and economic indicators tended to be ranked differently following analysis and again following deliberation because of the commitment to pursue a forest management plan that would benefit the community without jeopardizing stakeholder values. The ecological indicators directly associated with forest structure gained relevance following the analysis meeting. The deliberation process elucidated the importance of forest administration and professional help. Forest owners' preferences were reflected by the selection of the management plan that included good science and accommodated community values. The forest owners changed their preferences in response to new knowledge, management objectives, and their commitment to safeguarding the future condition of the forest. Analysis and deliberation is a participatory forum that facilities communication and learning and allows stakeholders to share values; thus, it serves as a mechanism for forest planning.

[Knowledge management and healthcare organizations]

The present scenario is characterized by a high "environmental turbulence". Healthcare professionals and organizations must increase their knowledge, skills and attitudes for choosing wisely. Healthcare organizations are complex adaptive systems which should use integrated governance systems: knowledge management should be a strategic goal. These organizations should become learning organizations: they should build and renovate their knowledge in a systematic, explicit and definite way.

[Clinical practice guidelines and knowledge management in healthcare]

Clinical practice guidelines are key tools for the translation of scientific evidence into everyday patient care. Therefore guidelines can act as cornerstones of evidence based knowledge management in healthcare, if they are trustworthy, and its recommendations are not biased by authors' conflict of interests. Good medical guidelines should be disseminated by means of virtual (digital/electronic) health libraries - together with implementation tools in context, such as guideline based algorithms, check lists, patient information, a.s.f. The article presents evidence based medical knowledge management using the German experiences as an example. It discusses future steps establishing evidence based health care by means of combining patient data, evidence from medical science and patient care routine, together with feedback systems for healthcare providers.

Metasynthesis and bricolage: an artistic exercise of creating a collage of meaning

During the past decades, new approaches to synthesizing qualitative data have been developed. However, this methodology continues to face significant philosophical and practical challenges. By reviewing the literature on this topic, our overall aim in this article is to explore the systematic and creative research processes involved in the act of metasynthesizing. By investigating synthesizing processes borrowed from two studies, we discuss matters of transparency and transferability in relation to how multiple qualitative studies are interpreted and transformed into one narrative. We propose concepts such as bricolage, metaphor, playfulness, and abduction as ideas that might enhance understanding of the importance of combinations of scientific and artistic approaches to the way the synthesizer "puzzles together" an interpretive account of qualitative studies. This study can benefit researchers by increasing their awareness of the artistic processes involved in qualitative analysis and metasynthesis to expand the domain and methods of their fields.

Knowledge exchange systems for youth health and chronic disease prevention: a tri-provincial case study

INTRODUCTION

The research teams undertook a case study design using a common analytical framework to investigate three provincial (Prince Edward Island, New Brunswick and Manitoba) knowledge exchange systems. These three knowledge exchange systems seek to generate and enhance the use of evidence in policy development, program planning and evaluation to improve youth health and chronic disease prevention.

METHODS

We applied a case study design to explore the lessons learned, that is, key conditions or processes contributing to the development of knowledge exchange capacity, using a multi-data collection method to gain an in-depth understanding. Data management, synthesis and analysis activities were concurrent, iterative and ongoing. The lessons learned were organized into seven "clusters."

RESULTS

Key findings demonstrated that knowledge exchange is a complex process requiring champions, collaborative partnerships, regional readiness and the adaptation of knowledge exchange to diverse stakeholders.

DISCUSSION

Overall, knowledge exchange systems can increase the capacity to exchange and use evidence by moving beyond collecting and reporting data. Areas of influence included development of new partnerships, expanded knowledge-sharing activities, and refinement of policy and practice approaches related to youth health and chronic disease prevention.

Knowledge production and learning for sustainable landscapes: seven steps using social-ecological systems as laboratories

There are multiple challenges regarding use and governance of landscapes' goods, functions and intangible values for ecosystem health and human well-being. One group of challenges is to measure and assess principal sustainability dimensions through performance targets, so stakeholders have transparent information about states and trends. Another group is to develop adaptive governance at multiple levels, and management of larger geographical areas across scales. Addressing these challenges, we present a framework for transdisciplinary research using multiple landscapes as place-based case studies that integrates multiple research disciplines and non-academic actors: (1) identify a suite of landscapes, and for each (2) review landscape history, (3) map stakeholders, use and non-use values, products and land use, (4) analyze institutions, policies and the system of governance, (5) measure ecological, economic, social and cultural sustainability, (6) assess sustainability dimensions and governance, and finally (7) make comparisons and synthesize. Collaboration, communication and dissemination are additional core features. We discuss barriers bridges and bridges for applying this approach.

Knowledge production and learning for sustainable landscapes: forewords by the researchers and stakeholders

This special issue of AMBIO presents a new approach to sustainability science that goes beyond interdisciplinary research. Using coupled natural and human systems, or landscapes, as multiple case studies in Europe's East and West knowledge production and learning toward transdisciplinary research was applied in Sweden, countries in Central and Eastern Europe, and Russia. First, the research group Forest-Landscape-Society summarizes the research program (2005-2012) behind this special issue of AMBIO and its development to participate in transdisciplinary research. Second, stakeholders at multiple levels provide their views on the new approach presented and reported.

West Nile virus: the production of a public health pandemic

The West Nile virus (WNV), as it was presented in the texts and discourses on the Public Health Agency of Canada's (PHAC) website during its initial emergence, was an effect of the kinds of knowledge, techniques of power and disciplinary apparatuses that operate on that website and in society. With reference to Michel Foucault's relations of power, this article offers an approach for translating theories of power into techniques and technologies of power that can be used to conduct a social construction discourse analysis, and gives examples from the use of surveillance, normalisation, exclusion and regulation in PHAC's responses to the WNV epidemic in Canada. This study concludes with the assertion that shifting the ways in which social and political relations of power contour public health theories and practice is crucial. The present moment requires the development of global health responses to pandemics that are rooted less in the proliferation of apparatuses of control and more in epidemiological innovations and integrated, multi-perspectival research approaches to infectious diseases research, and in the governance of pandemic control and prevention initiatives.

The role of healthcare IT: becoming a learning organization

IT advances that will support healthcare providers' transition toward becoming "learning organizations" include the following: The increase in big data" (patient data captured in EHRs, coupled with data from imaging, molecular medicine, patient-provided data, and insurance claims). Real-time analytics and novel decision aids. Ease-of-use advancements and effective data capture methods. Efforts to increase facile interoperability. Extended reach of EHRs in gathering data from other processes and sources

How is clinical reasoning developed, maintained, and objectively assessed? Views from expert internists and internal medicine interns

INTRODUCTION

There is limited understanding of how clinical reasoning is developed, maintained, and objectively assessed. Using the theoretical lens of deliberate practice, we explored physicians' views on clinical reasoning. We compared responses from internists (faculty) and internal medicine interns, to identify potential qualitative and/or quantitative differences in how clinical reasoning is developed and maintained.

METHODS

Participants' free-text comments regarding how clinical reasoning is developed, maintained, and objectively assessed were analyzed. Three investigators coded responses using a constant-comparative, grounded theory approach. We also compared the frequencies of each theme between the 2 groups.

RESULTS

Twenty-two faculty and 17 interns participated in this study. Faculty and intern themes for how clinical reasoning is developed, maintained, and objectively assessed were similar, but quantitative and qualitative differences emerged. Interrater reliability of themes was high (overall kappa: 0.92; range: 0.88-0.98). Only experts (faculty) mentioned the value of teaching for development and maintenance of clinical reasoning. Interns focused on knowledge acquisition activities and use of online resources. Experts and intern participants both struggled with how to best measure clinical reasoning; direct observation was rarely mentioned as a strategy.

DISCUSSION

Consistent with our theoretical expectations, we found quantitative and qualitative differences in participants' responses, which have implications for teaching and assessment of clinical reasoning. By capturing the types of activities and their relative frequencies within and between these groups, this work adds to the deliberate practice literature.

The effects of legacy organization culture on post-merger integration

We explore the relationship between the characteristics of pre-existing organization cultures and post-merger integration dynamics; this study involves examining data produced by computer simulation. Two characteristics of organization culture, its characteristic complexity and its propensity for members' to share information, are controlled in computational experiments. To characterize post-merger integration dynamics, we measure the transfer of information with respect to two types: (a) that which is necessary in performing work tasks, and (b) that which underlies the features of a group's culture. The extent to which this information is common in a group is indicative of task performance and the cultural cohesiveness of its members; leading to the level of performance for the group. We consider cultural knowledge as it pertains to both that of the entire organization and at the work-team level; often times, these can be dissimilar. We find that cultural complexity and exchange motivation vary in their influence on the diffusion of task and cultural knowledge: the more complex the culture, the longer for post-merger integration to complete, while simultaneously task performance suffers. However, the inclination for an organization to energetically share their culture with another group does not immensely impact the diffusion of cultural or task knowledge; moreover, high levels of task focus in a culture can hinder cultural diffusion, though performance is positively correlated with this characteristic. This study has relevance to post-merger integration research and practice by providing a theoretically grounded, quantitative model useful for estimating the post-merger dynamics of cultural awareness and knowledge diffusion for a specific merger situation.

Knowledge representation and management: towards an integration of a semantic web in daily health practice

OBJECTIVE

To summarize the best papers in the field of Knowledge Representation and Management (KRM).

METHODS

A synopsis of the four selected articles for the IMIA Yearbook 2013 KRM section is provided, as well as highlights of current KRM trends, in particular, of the semantic web in daily health practice. The manual selection was performed in three stages: first a set of 3,106 articles, then a second set of 86 articles followed by a third set of 15 articles, and finally the last set of four chosen articles.

RESULTS

Among the four selected articles (see Table 1), one focuses on knowledge engineering to prevent adverse drug events; the objective of the second is to propose mappings between clinical archetypes and SNOMED CT in the context of clinical practice; the third presents an ontology to create a question-answering system; the fourth describes a biomonitoring network based on semantic web technologies.

CONCLUSION

These four articles clearly indicate that the health semantic web has become a part of daily practice of health professionals since 2012. In the review of the second set of 86 articles, the same topics included in the previous IMIA yearbook remain active research fields: Knowledge extraction, automatic indexing, information retrieval, natural language processing, management of health terminologies and ontologies.

Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers

BACKGROUND

In rationing decisions in health, many criteria like costs, effectiveness, equity and feasibility concerns play a role. These criteria stem from different disciplines that all aim to inform health care rationing decisions, but a single underlying concept that incorporates all criteria does not yet exist. Therefore, we aim to develop a conceptual mapping of criteria, based on the World Health Organization's Health Systems Performance and Health Systems Building Blocks frameworks. This map can be an aid to decision makers to identify the relevant criteria for priority setting in their specific context.

METHODS

We made an inventory of all possible criteria for priority setting on the basis of literature review. We categorized the criteria according to both health system frameworks that spell out a country's health system goals and input. We reason that the criteria that decision makers use in priority setting exercises are a direct manifestation of this.

RESULTS

Our map includes thirty-one criteria that are distributed among five categories that reflect the goals of a health system (i.e. to improve level of health, fair distribution of health, responsiveness, social & financial risk protection and efficiency) and leadership/governance one category that reflects feasibiliy based on the health system building blocks (i.e. service delivery, health care workforce , information, medical products, vaccines & technologies, financing and).

CONCLUSIONS

This conceptual mapping of criteria, based on well-established health system frameworks, will further develop the field of priority setting by assisting decision makers in the identification of multiple criteria for selection of health interventions.

Evolution in clinical knowledge management strategy at Intermountain Healthcare

In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs.

Evidence acquisition and evaluation for a U.S. Government Evidence Summit on Protecting Children Outside Family Care

Recognizing the need for evidence to inform policies, strategies, and programs to care for vulnerable children, the U.S. Government convened an Evidence Summit on Protecting Children Outside of Family Care on December 12-13, 2011, in Washington, DC, USA. This paper summarizes the background and methods for the acquisition and evaluation of the evidence used to achieve the goals of the Summit. A multistep process was undertaken to identify the appropriate evidence for review. It began by identifying crucial focal questions intended to inform low and middle income governments and the U.S. Government about effective systems for protecting children outside family care. This was followed by a systematic attempt to gather relevant peer reviewed and gray literature that would inform these focal questions. The search processes, methods used for screening and quality reviews are described. In addition, members of the Evidence Review Teams were invited to add relevant papers not identified in the initial literature review to complete the bibliographies. These teams were asked to comply with a specific evaluation framework for recommendations on practice and policy based on both expert opinion and the quality of the data. This was the first U.S. Government Evidence Summit originating in the U.S. Agency for International Development Global Health Bureau and valuable lessons were learned on the identification and assessment of evidence informing complex development challenges.

Integration of health and social care: a case of learning and knowledge management

This paper considers integration of health and social care as an exercise in learning and knowledge management (KM). Integration assembles diverse actors and organisations in a collective effort to design and deliver new service models underpinned by multidisciplinary working and generic practice. Learning and KM are integral to this process. A critical review of the literature is undertaken to identify theoretical insights and models in this field, albeit grounded mainly in a private sector context. The findings from a research study involving two integrated services are then used to explore the role of, and approach to, learning and KM. This case study research was qualitative in nature and involved an interrogation of relevant documentary material, together with 25 in-depth interviews with a cross-section of strategic managers and professionals undertaken between March and May 2011. The evidence emerging indicated no planned strategies for learning and KM, but rather, interventions and mechanisms at different levels to support integration processes. These included formal activities, particularly around training and appraisal, but also informal ones within communities of practice and networking. Although structural enablers such as a co-location of facilities and joint appointments were important, the value of trust and inter-personal relationships was highlighted especially for tacit knowledge exchange. The infrastructure for learning and KM was constructed around a collaborative culture characterised by a coherent strategic framework; clarity of purpose based on new models of service; a collaborative leadership approach that was facilitative and distributed; and, a focus on team working to exploit the potential of multidisciplinary practice, generic working and integrated management. The discussion and conclusion use Nonaka's knowledge conversation model to reflect on the research findings, to comment on the absence of an explicit approach to learning and KM, and to develop a template to assist policy-makers with the design of planned strategies.

Lessons learned from Toulouse and Buncefield disasters: from risk analysis failures to the identification of atypical scenarios through a better knowledge management

The recent occurrence of severe major accidents has brought to light flaws and limitations of hazard identification (HAZID) processes performed for safety reports, as in the accidents at Toulouse (France) and Buncefield (UK), where the accident scenarios that occurred were not captured by HAZID techniques. This study focuses on this type of atypical accident scenario deviating from normal expectations. The main purpose is to analyze the examples of atypical accidents mentioned and to attempt to identify them through the application of a well-known methodology such as the bow-tie analysis. To these aims, the concept of atypical event is accurately defined. Early warnings, causes, consequences, and occurrence mechanisms of the specific events are widely studied and general failures of risk assessment, management, and governance isolated. These activities contribute to outline a set of targeted recommendations, addressing transversal common deficiencies and also demonstrating how a better management of knowledge from the study of past events can support future risk assessment processes in the identification of atypical accident scenarios. Thus, a new methodology is not suggested; rather, a specific approach coordinating a more effective use of experience and available information is described, to suggest that lessons to be learned from past accidents can be effectively translated into actions of prevention.

GeneTalk: an expert exchange platform for assessing rare sequence variants in personal genomes

Summary: Next-generation sequencing has become a powerful tool in personalized medicine. Exomes or even whole genomes of patients suffering from rare diseases are screened for sequence variants. After filtering out common polymorphisms, the assessment and interpretation of detected personal variants in the clinical context is an often time-consuming effort. We have developed GeneTalk, a web-based platform that serves as an expert exchange network for the assessment of personal and potentially disease-relevant sequence variants. GeneTalk assists a clinical geneticist who is searching for information about specific sequence variants and connects this user to other users with expertise for the same sequence variant.

Availability: GeneTalk is available at www.gene-talk.de. Users can login without registering in a demo account.

Contact: peter.krawitz@gene-talk.de

Knowledge integration at the center of genomic medicine

Three articles in this issue of Genetics in Medicine describe examples of "knowledge integration," involving methods for generating and synthesizing rapidly emerging information on health-related genomic technologies and engaging stakeholders around the evidence. Knowledge integration, the central process in translating genomic research, involves three closely related, iterative components: knowledge management, knowledge synthesis, and knowledge translation. Knowledge management is the ongoing process of obtaining, organizing, and displaying evolving evidence. For example, horizon scanning and "infoveillance" use emerging technologies to scan databases, registries, publications, and cyberspace for information on genomic applications. Knowledge synthesis is the process of conducting systematic reviews using a priori rules of evidence. For example, methods including meta-analysis, decision analysis, and modeling can be used to combine information from basic, clinical, and population research. Knowledge translation refers to stakeholder engagement and brokering to influence policy, guidelines and recommendations, as well as the research agenda to close knowledge gaps. The ultrarapid production of information requires adequate public and private resources for knowledge integration to support the evidence-based development of genomic medicine.

A theory-based model of translation practices in public health participatory research

This article explores the innovative practices of actors specifically mandated to support interactions between academic researchers and their partners from the community during public health participatory research. Drawing on the concept of translation as developed in actor-network theory and found in the literature on knowledge transfer and the sociology of intermediate actors, we build a theory-based model of the translation practices developed by these actors at the interface between community and university. We refine this model by using it to analyse material from two focus groups comprising participants purposively selected because they work at the nexus between research and practice. Our model of translation practices includes cognitive (dealing with the contents of the research), strategic (geared to facilitating the research process and balancing power relationships among the partners) and logistic practices (the hands-on tasks of coordination). Combined, these three types of translation practices demonstrate that actors working at the interface in participatory research contribute to multidirectional exchanges and the co-construction of knowledge among research partners. Beyond the case of participatory research, theorising translation practices helps understand how knowledge is produced at the interface between academic and experiential (or lay) knowledge.

Knowledge translation of research findings

BACKGROUND

One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health). We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred?

DISCUSSION

We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups. There are a large number of planned knowledge translation models, derived from different disciplinary, contextual (i.e., setting), and target audience viewpoints. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge translation strategy is informed by an assessment of the likely barriers and facilitators. Although our evidence on the likely effectiveness of different strategies to overcome specific barriers remains incomplete, there is a range of informative systematic reviews of interventions aimed at healthcare professionals and consumers (i.e., patients, family members, and informal carers) and of factors important to research use by policy makers.

SUMMARY

There is a substantial (if incomplete) evidence base to guide choice of knowledge translation activities targeting healthcare professionals and consumers. The evidence base on the effects of different knowledge translation approaches targeting healthcare policy makers and senior managers is much weaker but there are a profusion of innovative approaches that warrant further evaluation.

Knowledge translation of research findings

BACKGROUND

One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health). We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred?

DISCUSSION

We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups. There are a large number of planned knowledge translation models, derived from different disciplinary, contextual (i.e., setting), and target audience viewpoints. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge translation strategy is informed by an assessment of the likely barriers and facilitators. Although our evidence on the likely effectiveness of different strategies to overcome specific barriers remains incomplete, there is a range of informative systematic reviews of interventions aimed at healthcare professionals and consumers (i.e., patients, family members, and informal carers) and of factors important to research use by policy makers.

SUMMARY

There is a substantial (if incomplete) evidence base to guide choice of knowledge translation activities targeting healthcare professionals and consumers. The evidence base on the effects of different knowledge translation approaches targeting healthcare policy makers and senior managers is much weaker but there are a profusion of innovative approaches that warrant further evaluation.