From knowledge translation theory to practice: developing an evidence to care hub in a pediatric rehabilitation setting

Knowledge Translation Interventions to Increase the Uptake of Evidence-Based Practice Among Pediatric Rehabilitation Professionals: A Systematic Review

AIMS

To summarize evidence on effective knowledge translation (KT) interventions to increase evidence-based practice among pediatric rehabilitation professionals.

METHODS

The PRISMA 2020 Checklist was used for search, selection, and data extraction. The Mixed Methods Appraisal Tool assessed quality, while the Cochrane Effective Practice and Organization of Care described KT interventions.

RESULTS

Our search yielded 7233 records; 29 met the inclusion criteria. Two studies used educational materials alone. The remaining 27 studies used multifaceted KT interventions, combining education with local opinion leaders or knowledge brokers (n = 12), continuous quality improvement (n = 11), reminders (n = 6), communities of practice (n = 6), provider performance monitoring (n = 5), audit and feedback (n = 2), information and communication technology (n = 2), clinical practice guideline (n = 1), or routine patient-reported outcome measures (n = 1). Significant improvements in knowledge (n = 10), skills (n = 6), adherence and use (n = 4), perceptions (n = 3), intentions of use (n = 2), confidence level (n = 1), beliefs and attitudes (n = 3), and professional behavior change (n = 2) were reported. Included studies had a moderate to high-risk bias.

CONCLUSION

Educational and local opinion leaders were common in multifaceted KT interventions, the majority resulting in improved professional knowledge, skills, attitudes and beliefs, and behaviors. Rigorous study designs are needed to confirm these findings.

Connecting for Care: a protocol for a mixed-method social network analysis to advance knowledge translation in the field of child development and rehabilitation

BACKGROUND

Connections between individuals and organizations can impact knowledge translation (KT). This finding has led to growing interest in the study of social networks as drivers of KT. Social networks are formed by the patterns of relationships or connections generated through interactions. These connections can be studied using social network analysis (SNA) methodologies. The relatively small yet diverse community in the field of child development and rehabilitation (CD&R) in Canada offers an ideal case study for applying SNA. The purposes of this work are to (1) quantify and map the structure of Canadian CD&R KT networks among four groups: families, health care providers, KT support personnel, and researchers; (2) explore participant perspectives of the network structure and of KT barriers and facilitators within it; and (3) generate recommendations to improve KT capacity within and between groups. Aligning with the principles of integrated KT, we have assembled a national team whose members contribute throughout the research and KT process, with representation from the four participant groups.

METHODS

A sequential, explanatory mixed-method study, within the bounds of a national case study in the field of CD&R. Objective 1: A national SNA survey of family members with advocacy/partnership experience, health care providers, KT support personnel, and researchers, paired with an anonymous survey for family member without partnership experience, will gather data to describe the KT networks within and between groups and identify barriers and facilitators of network connections. Objective 2: Purposive sampling from Phase 1 will identify semi-structured interview participants with whom to examine conventional and network-driven KT barriers, facilitators, and mitigating strategies. Objective 3: Intervention mapping and a Delphi process will generate recommendations for network and conventional interventions to strengthen the network and facilitate KT.

DISCUSSION

This study will integrate network and KT theory in mapping the structure of the CD&R KT network, enhance our understanding of conventional and network-focused KT barriers and facilitators, and provide recommendations to strengthen KT networks. Recommendations can be applied and tested within the field of CD&R to improve KT, with the aim of ensuring children achieve the best health outcomes possible through timely access to effective healthcare.

Internet of Things Task Migration Algorithm under Edge Computing in the Design of English Translation Theory and Teaching Practice Courses

This study aims to improve the quality of English teaching in contemporary colleges and universities, so as to cultivate more English translation talents. Taking corpus, English translation, and teaching practice as the main research horizons, this study analyzes the application of master of translation and interpreting (MTI) course design, English translation, and task migration by combining the task migration algorithm under Internet of Things (IoT) with the self-built corpus, so as to realize the cultivation of translation talents and design of teaching practice. A translation corpus is constructed, a two-way interactive online course is designed, and the experimental results of the complete local migration algorithm (CLM algorithm), random migration algorithm (RM algorithm), and greedy heuristic migration algorithm (GHM algorithm) used in English teaching practice courses are analyzed and compared. The experimental simulation results reveal that the GHM algorithm proposed in this study shows good system stability, its duration is 60% better than that of the CLM algorithm, and its system throughput is increased by 50% compared with the CLM algorithm. In addition, the maximum delay time has little effect on the system throughput. When the system time slot length is fixed at 20 ms, the user migration rate of the genetic algorithm is the highest under the different total numbers of users. In addition, in view of the wide application of neural network in English translation teaching, this study establishes an English translation evaluation model based on the combination of particle swarm optimization (PSO) algorithm and neural network and compares it with the traditional neural network model in simulation experiments. The results show that the addition of PSO algorithm can effectively improve the convergence speed of artificial neural network (ANN), reduce the training time of the model, and improve the accuracy of the ANN network. Using the PSO algorithm to train the neural network, the optimal solutions of different particle swarms can be obtained, and the error is small. The PSO-ANNs model can promote the quality of English translation teaching and improve the English translation ability of the students. Therefore, applying the task transfer algorithm and PSO algorithm to the practice of English translation teaching has greatly improved the efficiency of the English classroom. To sum up, this study provides new ideas for the curriculum design of contemporary college English teaching and has reference value for the cultivation of college English translation talents.

Knowledge translation strategies for policy and action focused on sexual, reproductive, maternal, newborn, child and adolescent health and well-being: a rapid scoping review

OBJECTIVE

The aim of this study was to identify knowledge translation (KT) strategies aimed at improving sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) and well-being.

DESIGN

Rapid scoping review.

SEARCH STRATEGY

A comprehensive and peer-reviewed search strategy was developed and applied to four electronic databases: MEDLINE ALL, Embase, CINAHL and Web of Science. Additional searches of grey literature were conducted to identify KT strategies aimed at supporting SRMNCAH. KT strategies and policies published in English from January 2000 to May 2020 onwards were eligible for inclusion.

RESULTS

Only 4% of included 90 studies were conducted in low-income countries with the majority (52%) conducted in high-income countries. Studies primarily focused on maternal newborn or child health and well-being. Education (81%), including staff workshops and education modules, was the most commonly identified intervention component from the KT interventions. Low-income and middle-income countries were more likely to include civil society organisations, government and policymakers as stakeholders compared with high-income countries. Reported barriers to KT strategies included limited resources and time constraints, while enablers included stakeholder involvement throughout the KT process.

CONCLUSION

We identified a number of gaps among KT strategies for SRMNCAH policy and action, including limited focus on adolescent, sexual and reproductive health and rights and SRMNCAH financing strategies. There is a need to support stakeholder engagement in KT interventions across the continuum of SRMNCAH services. Researchers and policymakers should consider enhancing efforts to work with multisectoral stakeholders to implement future KT strategies and policies to address SRMNCAH priorities.

REGISTRATION

The rapid scoping review protocol was registered on Open Science Framework on 16 June 2020 (https://osf.io/xpf2k).

Understanding Acceptability, Barriers, and Facilitators to Clinical Implementation of the on Track Developmental Monitoring System for Children with Cerebral Palsy: A Qualitative Study

AIMS

On Track Developmental Monitoring System (DMS) is a novel series of tools to assist in shared-decision making, guide rehabilitation intervention based on functional ability levels, and promote episodic care service models. Further understanding of the acceptability, feasibility, and appropriateness of On Track DMS in clinical settings is critical. The purpose of this study was to understand clinician perspectives of the acceptability of On Track DMS and to identify potential implementation barriers and facilitators within pediatric physical therapist practice.

METHODS

Three, day-long training workshops were conducted with 32 pediatric physical therapists across the US. Focus groups with 21 workshop participants were conducted following training. Results were audio recorded, transcribed verbatim, and coded into themes.

RESULTS

Three themes emerged from the data: (1) Valuing the On Track Approach to Intervention; (2) Setting-Specific Needs and Challenges to Implementation; and (3) Training Material/Tool Strengths and Limitations.

CONCLUSIONS

On Track DMS appears to have initial value and acceptability for pediatric physical therapists across practice settings. Perceived benefits include facilitation of data-driven practice and therapist/family collaboration to improve health outcomes for children with CP. Using this data to understand and assess barriers and facilitators to knowledge use are first steps in successfully implementing On Track DMS.

Rehabilitation in practice: improving delivery of upper limb rehabilitation for children and young people with acquired brain injuries through the development and implementation of a clinical pathway

PURPOSE

Decision making regarding upper limb assessment and management of children and young people (CYP) with acquired brain injury (ABI) is complex. This project aimed to standardise and improve upper limb provision in one residential rehabilitation unit for CYP with ABI.

METHODS

Plan-do-study-act (PDSA) methodology was used. Available evidence was synthesised and recommendations for assessment and intervention of CYP who present at different functional levels were made. A multi-modal knowledge translation process was used for pathway implementation, with regular review and updates in each PDSA cycle. Audit and staff survey at one year and two years post implementation were conducted.

RESULTS

A clinical pathway consisting of an assessment decision tree, intervention matrix and evidence based summaries was developed. Audit at one year demonstrated 70% of CYP had an appropriate assessment form, which increased to 82% at two years. Staff survey showed increased knowledge and use of the pathway, and decreased perceived training needs between years one and two.

CONCLUSIONS

Use of an upper limb pathway can standardise care in line with best available evidence, and increase staff confidence in this complex rehabilitation area. Several years of development and implementation were required to embed its use in practice.Implications for rehabilitationUpper limb rehabilitation for CYP with ABI is complex, with no "one size fits all" assessment or intervention techniques available.Developing a pathway in which the evidence for assessment and management interventions for CYP of different functional levels, and recommendations for clinical practice can improve the consistency of assessment and intervention, and staff confidence with upper limb management.A multimodal strategy for implementation planned from the outset of pathway development can facilitate the translation of the pathway into routine clinical practice.

Implementing compassion in pediatric healthcare: A qualitative study of Canadian patients', parents', and healthcare providers' perspectives

BACKGROUND

Compassion has received significant scholarly attention over the past decade. Research has been largely theoretical, with interventions focused on self-care practices of healthcare providers (HCPs), rather than implementation at a systems level. This study aimed to identify how compassion can be operationalized within pediatric healthcare.

DESIGN AND METHODS

Data was analyzed from a secondary dataset of a larger Straussian grounded theory study of perspectives and experiences of compassion in pediatric healthcare. Patients (n = 33); parents (n = 16); and HCPs (n = 17) were asked specifically how compassion could be implemented within the clinical culture and healthcare system.

RESULTS

66 participants generated an operational model of compassion indicating how compassion could be implemented across the organization and larger healthcare system. The data revealed four themes and associated subthemes: teach and train; recognize and reward; measure and report; and embed compassion across the healthcare system.

CONCLUSIONS

Improving compassion in pediatric healthcare needs to extend beyond the efforts of individual HCPs. Compassion is the responsibility of the entire healthcare system and needs to traverse the patient and family experience. In addition to embedding compassion in policy, procedures, practice, and education, compassion should be considered a performance indicator that is measured and reported.

PRACTICE IMPLICATIONS

This study provides a preliminary framework for organizational leaders to operationalize compassion across the services, structures, polices, procedures and practices of pediatric healthcare. This includes ongoing compassion training across the organization; assessing compassion, recognizing compassion as a performance indicator, and ensuring that the infrastructure and ancillary services of the organization reflect compassion.

Building knowledge translation competency in a community-based hospital: a practice-informed curriculum for healthcare providers, researchers, and leadership

BACKGROUND

Enacting knowledge translation (KT) in healthcare settings is a complex process that requires organizational facilitation. In addition to addressing organizational-level barriers, targeting individual-level factors such as KT competencies are a necessary component of this aim. While literature on KT competency training is rapidly growing, there has been little exploration of the potential benefits of training initiatives delivered from an intra-organizational perspective. Addressing this gap, we developed the Knowledge Translation Facilitator Network (KTFN) to meet the KT needs of individuals expected to use and produce knowledge (e.g., healthcare providers, research staff, managers, family advisors) within an academic health sciences center. The aim of this study is to describe the development, implementation, and evaluation of the KTFN curriculum.

METHODS

An educational framework was used to guide creation of the KTFN curriculum. Stakeholder interviews, a literature review of KT competency, and environmental scan of capacity building initiatives plus adult learning principles were combined with in-house experience of KT practitioners to inform content and delivery. An evaluation strategy consisting of pre/post-test curriculum and post-session satisfaction surveys, as well as post-curriculum interviews assessed impact on participant knowledge and skills and captured perceived value of KFTN.

RESULTS

The curriculum has been delivered three times over 3 years, with 30 individuals trained, representing healthcare providers, graduate level research trainees, managers, and family advisors. Using the New World Kirkpatrick Model as an analysis framework, we found that the KTFN curriculum was highly valued and shifted learners' perceptions of KT. Participants identified enhanced knowledge and skills that could be applied to different facets of their work; increased confidence in their ability to execute KT tasks; and intention to use the content in future projects. Barriers to future use included time to plan and conduct KT activities.

CONCLUSION

KTFN was developed to enhance KT competency among organizational members. This initiative shows promise as a highly valued training program that meets both individual and organizational KT needs and speaks to the importance of investing in tailored KT competency initiatives as an essential building block to support moving evidence into practice.