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Fąferek J, Cariou PL, Hege I, Mayer A, Morin L, Rodriguez-Molina D, Sousa-Pinto B, Kononowicz AA. Integrating virtual patients into undergraduate health professions curricula: a framework synthesis of stakeholders' opinions based on a systematic literature review. BMC MEDICAL EDUCATION 2024; 24:727. [PMID: 38969998 DOI: 10.1186/s12909-024-05719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/27/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Virtual patients (VPs) are widely used in health professions education. When they are well integrated into curricula, they are considered to be more effective than loosely coupled add-ons. However, it is unclear what constitutes their successful integration. The aim of this study was to identify and synthesise the themes found in the literature that stakeholders perceive as important for successful implementation of VPs in curricula. METHODS We searched five databases from 2000 to September 25, 2023. We included qualitative, quantitative, mixed-methods and descriptive case studies that defined, identified, explored, or evaluated a set of factors that, in the perception of students, teachers, course directors and researchers, were crucial for VP implementation. We excluded effectiveness studies that did not consider implementation characteristics, and studies that focused on VP design factors. We included English-language full-text reports and excluded conference abstracts, short opinion papers and editorials. Synthesis of results was performed using the framework synthesis method with Kern's six-step model as the initial framework. We appraised the quality of the studies using the QuADS tool. RESULTS Our search yielded a total of 4808 items, from which 21 studies met the inclusion criteria. We identified 14 themes that formed an integration framework. The themes were: goal in the curriculum; phase of the curriculum when to implement VPs; effective use of resources; VP alignment with curricular learning objectives; prioritisation of use; relation to other learning modalities; learning activities around VPs; time allocation; group setting; presence mode; VPs orientation for students and faculty; technical infrastructure; quality assurance, maintenance, and sustainability; assessment of VP learning outcomes and learning analytics. We investigated the occurrence of themes across studies to demonstrate the relevance of the framework. The quality of the studies did not influence the coverage of the themes. CONCLUSIONS The resulting framework can be used to structure plans and discussions around implementation of VPs in curricula. It has already been used to organise the curriculum implementation guidelines of a European project. We expect it will direct further research to deepen our knowledge on individual integration themes.
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Affiliation(s)
- Joanna Fąferek
- Center for Innovative Medical Education, Jagiellonian University Medical College, Medyczna 7, Krakow, 30-688, Poland.
| | - Pierre-Louis Cariou
- Faculty of Medicine, Paris Saclay University, Le Kremlin-Bicetre, 94270, France
| | - Inga Hege
- Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Germany
| | - Anja Mayer
- Medical Education Sciences, University of Augsburg, 86159, Augsburg, Germany
| | - Luc Morin
- Faculty of Medicine, Paris Saclay University, Le Kremlin-Bicetre, 94270, France
| | - Daloha Rodriguez-Molina
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, 80336, Munich, Germany
| | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andrzej A Kononowicz
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Medyczna 7, Krakow, 30-688, Poland.
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Kent JT, Ritchie LMP, Klaiman M, Dell EM, Garnett M, Landes M, Ginocchio GF, Alsefaou A. Barriers and facilitators to the implementation of rapid HIV testing in Canadian Emergency Departments: a mixed methods study. CAN J EMERG MED 2024:10.1007/s43678-024-00716-1. [PMID: 38960973 DOI: 10.1007/s43678-024-00716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/27/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES 1 in 7 Canadians with Human Immunodeficiency Virus (HIV) do not know their status. Patients at increased risk of HIV routinely access the emergency department (ED), yet few are tested, representing a missed opportunity for diagnosis and linkage-to-care. Rapid HIV testing provides reliable results within the same ED encounter but is not routinely implemented. The objective of this study was to identify barriers and facilitators to rapid HIV testing in Ontario EDs. METHODS We employed a mixed-methods, convergent, parallel design study including online surveys and semi-structured interviews of physicians, nurses, and allied health across four hospitals in Toronto and Thunder Bay, Ontario. Data were analyzed in equal priority using descriptive statistics for quantitative data and thematic analysis for qualitative data guided by the Theoretical Domains framework and Capability, Opportunity, Motivation Behaviour change model. RESULTS Among 187 survey respondents, 150 (80%) felt implementing rapid HIV testing would be helpful in the ED. Facilitators included availability of resources to link patients to care after testing (71%), testing early in patient encounters (41%), and having dedicated staff with lived experience support testing (34%). Motivation to offer testing included opportunities to support an underserved population (66%). Challenges to implementation included limited time during ED patient encounters (51%) and a lack of knowledge around HIV testing (42%) including stigma. Interview themes confirmed education, and integration of people with lived experience being essential to provide rapid HIV testing and linkage-to-care in the ED. CONCLUSIONS Implementation of rapid HIV testing in the ED is perceived to be important irrespective of practice location or profession. Intrinsic motivations to support underserved populations and providing linkage-to-care are novel insights to facilitate testing in the ED. Streamlined implementation, including clear testing guidelines and improved access to follow-up care, is felt to be necessary for implementation.
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Affiliation(s)
- Jessica T Kent
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Michelle Klaiman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Evelyn Marion Dell
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Meghan Garnett
- Emergency and Critical Care Services, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
- Division of Clinical Sciences, NOSM University, Thunder Bay, ON, Canada
| | - Megan Landes
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Galo Fernando Ginocchio
- Emergency Department, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
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Vandervelde S, Van den Bosch N, Vlaeyen E, Dierckx de Casterlé B, Flamaing J, Belaen G, Tuand K, Vandendriessche T, Milisen K. Determinants influencing the implementation of multifactorial falls risk assessment and multidomain interventions in community- dwelling older people: a systematic review. Age Ageing 2024; 53:afae123. [PMID: 38952187 DOI: 10.1093/ageing/afae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/08/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Multifactorial falls risk assessment and multidomain interventions are recommended by the World guidelines for falls prevention and management. To successfully implement these interventions, it is important to understand determinants influencing the implementation. METHODS A literature search was conducted for this systematic review on the 3 December 2021 and updated on the 3 April 2023 in five databases: PubMed (including MEDLINE), EMBASE (via Embase.com), Cochrane Central Register of Controlled Trials (via Cochrane Library), Web of Science Core Collection and CINAHL (via EBSCO). Studies were included if they reported on determinants influencing the implementation of a multifactorial falls risk assessment and/or multidomain interventions in community-dwelling older people. Editorials, opinion papers, systematic reviews and studies focusing on one population (e.g. Parkinson) were excluded. Two researchers independently screened the articles on title, abstract and full text. The quality was evaluated based on a sensitivity analysis. 'The Comprehensive Integrated Checklist of Determinants of practice' was used to categorise the determinants. RESULTS Twenty-nine studies were included. Determinants were classified as barriers (n = 40) and facilitators (n = 35). The availability of necessary resources is the most reported determinant. Other commonly reported determinants are knowledge, intention/beliefs and motivation at the levels of older people and healthcare professionals, fitting of the intervention into current practice, communication, team and referral processes and financial (dis)incentives. CONCLUSIONS Mapping of the barriers and facilitators is essential to choose implementation strategies tailored to the context, and to enhance the uptake and effectiveness of a multifactorial falls risk assessment and/or multidomain interventions.
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Affiliation(s)
- Sara Vandervelde
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Natalie Van den Bosch
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Ellen Vlaeyen
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
- Hasselt University, Faculty of Medicine and Life Sciences, Agoralaan, 3590 Diepenbeek, Belgium
| | - Bernadette Dierckx de Casterlé
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Johan Flamaing
- KU Leuven, Department of Public Health and Primary Care, Gerontology and Geriatrics, Kapucijnenvoer 7 bus 7001 3000 Leuven, Belgium
- KU Leuven, University Hospital Leuven, Department of Geriatric Medicine, Herestraat 49 3000 Leuven, Belgium
| | - Goedele Belaen
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
| | - Krizia Tuand
- KU Leuven Libraries, 2Bergen - Learning Centre Désiré Collen, Herestraat 49, 3000 Leuven, Belgium
| | - Thomas Vandendriessche
- KU Leuven Libraries, 2Bergen - Learning Centre Désiré Collen, Herestraat 49, 3000 Leuven, Belgium
| | - Koen Milisen
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Centre of Expertise for Falls and Fracture Prevention Flanders, Kapucijnenvoer 7 bus 7001, Leuven 3000, Belgium
- KU Leuven, University Hospital Leuven, Department of Geriatric Medicine, Herestraat 49 3000 Leuven, Belgium
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Hatzikiriakidis K, Ayton D, O'Connor A, Cox R, MacRae A, Gulline H, Callaway L. Biopsychosocial determinants of physical activity and healthy eating for people with disability living in supported accommodation: A systematic review of qualitative research. Disabil Health J 2024; 17:101618. [PMID: 38548523 DOI: 10.1016/j.dhjo.2024.101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND People with disability living in supported accommodation experience ongoing health disparities. Physical activity and dietary quality are factors that may minimise the risk of chronic disease, however this population may experience a range of biopsychosocial barriers to physical activity and healthy eating. OBJECTIVE The aim of this review was to synthesise the biopsychosocial determinants of physical activity and healthy eating for people with disability living in supported accommodation, as reported by existing qualitative research. METHODS A systematic review of qualitative evidence was conducted according to the JBI's methodological guidance. In September 2023, five academic databases were searched for relevant literature published since database inception. A secondary analysis of the results of included studies was guided by the International Framework for Functioning, Disability, and Health (ICF), using the ICF Linking Rules. RESULTS A total of 31 articles were included. The analysis identified 154 determinants of physical activity and 112 determinants of healthy eating. Determinants were most prominently representative of environmental factors that captured the health promoting role and attitudes of staff, alongside the influence of the organisational context. CONCLUSION This review provided evidence for the complex interactions between body functions and structures, activities and participation, personal factors, and the environment that influence physical activity and healthy eating within supported accommodation. Although there is a limited body of evidence to guide practice, the findings highlight the multifactorial nature of interventions that can be utilised by direct care professionals and adapted to the individual needs and interests of people with disability.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Amanda O'Connor
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Rachael Cox
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Ann MacRae
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Hannah Gulline
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Libby Callaway
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, School of Allied Health and Primary Care, Monash University, Australia; Occupational Therapy Department, School of Primary and Allied Health Care, Monash University, Australia.
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Hook M, Woda A, Bohr K, Ford C, Singh M. Using Implementation Science to Improve Short Peripheral Intravenous Catheter Outcomes. JOURNAL OF INFUSION NURSING 2024; 47:266-276. [PMID: 38968589 DOI: 10.1097/nan.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
Short peripheral intravenous catheters (short PIVCs) are commonly used in acute care, guided by evidence-based policy with interventions to limit premature failure. Research on how nurses use evidence and change processes to optimize outcomes is needed. The study objective was to use a theory-based implementation science approach to evaluate and improve short PIVC insertion and care processes and reduce removals for adverse outcomes in acute care. This mixed-methods study was conducted with inpatient nursing units (n = 23) at a large urban quaternary medical center. Units identified and implemented one PIVC care intervention that could lower catheter removals for adverse outcomes over 3 months. Data from multiple sources were convergently analyzed to evaluate process and outcomes postintervention. Although overall frequency of PIVC removals for adverse outcomes was unchanged, several units improved their outcomes using implementation strategies. The determinant framework provides a plausible explanation for the study results. While adverse outcome rates remained below published rates, some units had limited success improving outcomes with traditional change strategies. Implementation strategies and readily accessible data can offer nursing units a new approach to effectively deploy, monitor, and maintain interventions to achieve improved outcomes.
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Affiliation(s)
- Mary Hook
- Author Affiliations: Advocate Health, Milwaukee, Wisconsin (Hook); Marquette University College of Nursing & Aurora St. Luke's Medical Center, Milwaukee, Wisconsin (Woda); Vivent Health, Kenosha, Wisconsin (Bohr); Aurora St. Luke Medical Center, Milwaukee, Wisconsin (Ford); Marquette University College of Nursing, Milwaukee, Wisconsin (Singh)
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6
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Chaboyer W, Latimer S, Priyadarshani U, Harbeck E, Patton D, Sim J, Moore Z, Deakin J, Carlini J, Lovegrove J, Jahandideh S, Gillespie BM. The effect of pressure injury prevention care bundles on pressure injuries in hospital patients: A complex intervention systematic review and meta-analysis. Int J Nurs Stud 2024; 155:104768. [PMID: 38642429 DOI: 10.1016/j.ijnurstu.2024.104768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Numerous interventions for pressure injury prevention have been developed, including care bundles. OBJECTIVE To systematically review the effectiveness of pressure injury prevention care bundles on pressure injury prevalence, incidence, and hospital-acquired pressure injury rate in hospitalised patients. DATA SOURCES The Medical Literature Analysis and Retrieval System Online (via PubMed), the Cumulative Index to Nursing and Allied Health Literature, EMBASE, Scopus, the Cochrane Library and two registries were searched (from 2009 to September 2023). STUDY ELIGIBILITY CRITERIA Randomised controlled trials and non-randomised studies with a comparison group published in English after 2008 were included. Studies reporting on the frequency of pressure injuries where the number of patients was not the numerator or denominator, or where the denominator was not reported, and single subgroups of hospitalised patients were excluded. Educational programmes targeting healthcare professionals and bundles targeting specific types of pressure injuries were excluded. PARTICIPANTS AND INTERVENTIONS Bundles with ≥3 components directed towards patients and implemented in ≥2 hospital services were included. STUDY APPRAISAL AND SYNTHESIS METHODS Screening, data extraction and risk of bias assessments were undertaken independently by two researchers. Random effects meta-analyses were conducted. The certainty of the body of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS Nine studies (seven non-randomised with historical controls; two randomised) conducted in eight countries were included. There were four to eight bundle components; most were core, and only a few were discretionary. Various strategies were used prior to (six studies), during (five studies) and after (two studies) implementation to embed the bundles. The pooled risk ratio for pressure injury prevalence (five non-randomised studies) was 0.55 (95 % confidence intervals 0.29-1.03), and for hospital-acquired pressure injury rate (five non-randomised studies) it was 0.31 (95 % confidence intervals 0.12-0.83). All non-randomised studies were at high risk of bias, with very low certainty of evidence. In the two randomised studies, the care bundles had non-significant effects on hospital-acquired pressure injury incidence density, but data could not be pooled. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Whilst some studies showed decreases in pressure injuries, this evidence was very low certainty. The potential benefits of adding emerging evidence-based components to bundles should be considered. Future effectiveness studies should include contemporaneous controls and the development of a comprehensive, theory and evidence-informed implementation plan. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42023423058. TWEETABLE ABSTRACT Pressure injury prevention care bundles decrease hospital-acquired pressure injuries, but the certainty of this evidence is very low.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia.
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia. https://twitter.com/SharonLLatimer
| | - Udeshika Priyadarshani
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka
| | - Emma Harbeck
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons Ireland, University of Medicine and Health Sciences, 123 St Stephens's Green, Dublin, 2, Ireland
| | - Jenny Sim
- Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia; School of Nursing, Midwifery & Paramedicine, Australian Catholic University, North Sydney Australia
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons Ireland, University of Medicine and Health Sciences, 123 St Stephens's Green, Dublin, 2, Ireland
| | - Jodie Deakin
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia. https://twitter.com/jodie_deakin3
| | - Joan Carlini
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Health Consumer and Department of Marketing, Griffith Business School, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Josephine Lovegrove
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Sepideh Jahandideh
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia. https://twitter.com/bgillespie6
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Persaud D, Hutchison T, Anthony SJ, Davidge KM, Clarke HM, Ho ES. Mental health and psychosocial support for children with upper limb musculoskeletal conditions. J Hand Surg Eur Vol 2024; 49:885-891. [PMID: 37987683 DOI: 10.1177/17531934231214138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
This study describes mental health and psychosocial screening processes, access to care and interventions provided to children with upper limb musculoskeletal conditions. A cross-sectional e-survey study was conducted of 107 healthcare professionals who work with children with congenital hand and upper limb differences and brachial plexus birth injuries. Of them, 41 (38%) reported that they routinely screen for mental health and psychosocial concerns. Few (12%) reported the use of standardized outcome measures. In total, 51 (48%) healthcare professionals reported that there was a waiting list for mental health services at their institution. Collectively, healthcare professionals were unsatisfied with the staffing, access to care and types of interventions available. Reported barriers to care included the growing need for mental health support, lack of resources and poor continuity of care after referrals. Future research should focus on identifying and validating a mental health screening tool and investigating the processes affecting access to mental health care.Level of evidence: IV.
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Affiliation(s)
- Deanna Persaud
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Tamsen Hutchison
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Samantha J Anthony
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kristen M Davidge
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Howard M Clarke
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Emily S Ho
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada
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Dolansky MA, Horvat Davey C, Moore SM. Research and Practice in Quality Improvement and Implementation Science: The Synergy for Change Model. J Nurs Care Qual 2024; 39:199-205. [PMID: 38232232 DOI: 10.1097/ncq.0000000000000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Nurses play an essential role in the achievement of quality depicted by the Quintuple Aim to improve clinical outcomes, patient experience, equity, provider well-being, and reduction of costs. When quality gaps occur, practice change is required and is facilitated by quality improvement (QI) and implementation science (IS) methods. QI and IS research are required to advance our understanding of the mechanisms that explain how evidence is implemented and improvements are made. PROBLEM Despite past efforts of the evidence-based practice and QI movements, challenges persist in sustaining practice improvements and translating research findings to direct patient care. APPROACH The purpose of this article is to describe the Synergy for Change Model that proposes that both QI and IS research and practice be used to accelerate improvements in health care quality. CONCLUSIONS Recognizing the synergy of QI and IS practice and research will accelerate nursing's contributions to high-quality and safe care.
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Affiliation(s)
- Mary A Dolansky
- Author Affiliations: Hirsh Institute (Dr Dolansky); and Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Drs Dolansky, Horvat Davey, and Moore)
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Ramadurai D, Shea JA. Leveraging the health equity implementation framework to foster an equity focus in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1047-1058. [PMID: 37668934 PMCID: PMC10912357 DOI: 10.1007/s10459-023-10277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Abstract
Teaching equitable clinical practice is of critical importance, yet how best to do so remains unknown. Educators utilize implementation science frameworks to disseminate clinical evidence-based practices (EBP). The Health Equity Implementation Framework (HEIF) is one of these frameworks, and it delineates how health equity may be concomitantly assessed and addressed in planning the implementation of an EBP. The HEIF therefore lays a strong foundation to understand and explain barriers and facilitators to implementation through an equity lens, making it well-suited for use by medical educators. Three equity-focused frames of reference within the model include (1) the clinical encounter, (2) societal context, and (3) culturally relevant factors, herein referred to as domains. The HEIF provides a structure for prospective and retrospective assessment of how EBP are taught and ultimately incorporated into clinical practice by trainees, with specific attention to delivering equitable care. We present three examples of common topics in internal medicine, contextualized by the three equity domains of the HEIF. We additionally acknowledge the limitations of this framework as a research tool with complex features that may not be suitable for brief teaching in the clinical environment. We propose a 360-degree learner assessment to ensure implementation of this framework is successful. By encouraging trainees to explore the narrative experiences of their patients and examine their own implicit biases, the HEIF provides a structure to address gaps in knowledge about delivering equitable care.
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Affiliation(s)
- Deepa Ramadurai
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Judy A Shea
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Murali M, Ni M, Karbing DS, Rees SE, Komorowski M, Marshall D, Ramnarayan P, Patel BV. Clinical practice, decision-making, and use of clinical decision support systems in invasive mechanical ventilation: a narrative review. Br J Anaesth 2024; 133:164-177. [PMID: 38637268 PMCID: PMC11213991 DOI: 10.1016/j.bja.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 04/20/2024] Open
Abstract
Invasive mechanical ventilation is a key supportive therapy for patients on intensive care. There is increasing emphasis on personalised ventilation strategies. Clinical decision support systems (CDSS) have been developed to support this. We conducted a narrative review to assess evidence that could inform device implementation. A search was conducted in MEDLINE (Ovid) and EMBASE. Twenty-nine studies met the inclusion criteria. Role allocation is well described, with interprofessional collaboration dependent on culture, nurse:patient ratio, the use of protocols, and perception of responsibility. There were no descriptions of process measures, quality metrics, or clinical workflow. Nurse-led weaning is well-described, with factors grouped by patient, nurse, and system. Physician-led weaning is heterogenous, guided by subjective and objective information, and 'gestalt'. No studies explored decision-making with CDSS. Several explored facilitators and barriers to implementation, grouped by clinician (facilitators: confidence using CDSS, retaining decision-making ownership; barriers: undermining clinician's role, ambiguity moving off protocol), intervention (facilitators: user-friendly interface, ease of workflow integration, minimal training requirement; barriers: increased documentation time), and organisation (facilitators: system-level mandate; barriers: poor communication, inconsistent training, lack of technical support). One study described factors that support CDSS implementation. There are gaps in our understanding of ventilation practice. A coordinated approach grounded in implementation science is required to support CDSS implementation. Future research should describe factors that guide clinical decision-making throughout mechanical ventilation, with and without CDSS, map clinical workflow, and devise implementation toolkits. Novel research design analogous to a learning organisation, that considers the commercial aspects of device design, is required.
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Affiliation(s)
- Mayur Murali
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK.
| | - Melody Ni
- NIHR London In Vitro Diagnostics Cooperative, London, UK
| | - Dan S Karbing
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stephen E Rees
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Matthieu Komorowski
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Dominic Marshall
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Padmanabhan Ramnarayan
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Imperial Centre for Paediatrics and Child Health, London, UK
| | - Brijesh V Patel
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Anaesthesia & Critical Care, Royal Brompton Hospital, London, UK
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11
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Lawrence J, Emory J, Sousa S, Thompson D, Jenkins K, Bettencourt AP, McLaughlin MK, Russell-Babin K. Implementing the Brøset Violence Checklist in the ED. Am J Nurs 2024; 124:52-60. [PMID: 38900125 DOI: 10.1097/01.naj.0001025656.82073.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
ABSTRACT The emerging field of implementation science (IS) facilitates the sustainment of evidence-based practice in clinical care. This article, the second in a series on applying IS, describes how a nurse-led IS team at a multisite health system implemented the Brøset Violence Checklist-a validated, evidence-based tool to predict a patient's potential to become violent-in the system's adult EDs, with the aim of decreasing the rate of violence against staff. The authors discuss how they leveraged IS concepts, methods, and tools to achieve this goal.
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Affiliation(s)
- John Lawrence
- John Lawrence is a sepsis coordinator at Inova Mount Vernon Hospital in Alexandria, VA. Johanna Emory is a pediatric ED nurse at Inova Loudoun Hospital in Leesburg, VA. Sara Sousa is an ED nurse manager at Inova Fairfax Hospital in Falls Church, VA. Danielle Thompson is a clinical mentor at Inova Alexandria Hospital in Alexandria, VA. Kenya Jenkins is an education coordinator at Inova Health System in Falls Church, VA, where Maureen Kirkpatrick McLaughlin is an implementation science consultant and Kathleen Russell-Babin is vice president of professional practice. Amanda P. Bettencourt is an assistant professor in the University of Pennsylvania School of Nursing in Philadelphia and an implementation science consultant. Contact author: Kathleen Russell-Babin, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Hoffmeister LV, Gama A, Gonçalves B, Figueiredo C, Cordeiro JV, Polley M, Souto de Moura G, Dias S. Implementing a social prescribing program in primary care units in Portugal: A qualitative study exploring enablers, barriers and lessons learned from the perspectives of stakeholders involved in the program implementation. PLoS One 2024; 19:e0306404. [PMID: 38941342 PMCID: PMC11213352 DOI: 10.1371/journal.pone.0306404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/17/2024] [Indexed: 06/30/2024] Open
Abstract
Social prescribing (SP) is a promising intersectoral strategy of integrated and person-centered care that can improve individual health and well-being by going beyond medical treatment, potentially reducing overall disease burden on health system. SP addresses health and social determinants of health by linking patients to community responses, i.e. services and initiatives fostering social interaction, physical activity and creativity, among other health-promoting aspects, provided by local public, private, and non-profit entities. There is limited research on the implementation processes of SP beyond the UK, hindering improvement and scale-up. This study aims to identify enablers and barriers of implementation of an SP program conducted in Portugal. A participatory and qualitative approach was used to assess the implementation of an SP program in health units. Semi-structured interviews were conducted with family doctors, social workers and representatives of community partners who participated in SP implementation. The Consolidated Framework for Implementation Research was used to conduct thematic analysis. The main enablers of SP implementation included its recognition as an evolution towards a holistic model of health, the personal characteristics of professionals as being proactive, motivated, and concerned with social determinants of health, and the communication strategy used to engage the stakeholders. Perceived challenges included raising users' awareness of SP and ensuring intervention adherence. Lack of preparedness for intersectoral working processes, including insufficient communication channels, limited community responses and the need for a more systematic collection of data on activities adherence and progress were also highlighted as barriers to SP implementation. SP implementation seems simple, but the results show that in practice, we are facing a complex intervention with multiple stakeholders, diverse community responses and factors influencing project success. A deeper understanding of SP specificities, local context, enablers, and barriers is vital to develop strategies for improvement and successful implementation, ensuring scalability and sustainability.
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Affiliation(s)
- Louíse Viecili Hoffmeister
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
| | - Barbara Gonçalves
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
| | - Cristiano Figueiredo
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
- Baixa Family Health Unit, São José Local Health Unit, National Health Service, Lisbon, Portugal
| | - João V. Cordeiro
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
- CICS, NOVA Interdisciplinary Center of Social Sciences, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Marie Polley
- Meaningful Measures Ltd., Bristol, United Kingdom
| | | | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, CHRC, REAL, NOVA University Lisbon, Lisbon, Portugal
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13
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van der Zanden M, Helder O, Westland H, Ista E. Barriers and facilitators for the implementation of co-created nursing innovations in a Dutch university hospital. JBI Evid Implement 2024:02205615-990000000-00109. [PMID: 38932713 DOI: 10.1097/xeb.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Escalating global nursing shortages require solutions for efficient care, fewer injuries and lost workdays. When commercial solutions are lacking, innovations developed through co-creation can be a viable alternative. However, many co-created nursing innovations are ineffectively implemented. Understanding the barriers and facilitators for the successful implementation of co-created nursing innovations is crucial. OBJECTIVE This study explored nurses' perceived determinants influencing the implementation of co-created nursing innovations. METHODS We conducted a qualitative study using semi-structured interviews with nurses at a Dutch university hospital who were working with co-created nursing innovations. The Theoretical Domains Framework (TDF) was employed to identify the barriers and facilitators. Data analysis followed a deductive theoretical thematic analysis approach based on the 14 TDF domains. Determinants were labeled as a barrier, facilitator, or both. RESULTS Of the 14 TDF domains, 9 appeared relevant, including Intention, Professional Role and Identify, and Knowledge. The absence of a "superuser," lack of storage space, and negative experiences during use were perceived as barriers to the implementation of nursing innovations. The importance of time-saving features, user-friendliness, reminders to use the innovation, and team enthusiasm were perceived as facilitators. CONCLUSIONS Participants confirmed that the Social Influences domain, combined with Behavioral Regulation and Knowledge, were barriers to implementation, while Intentions and Reinforcements and Rewards were seen as facilitators. SPANISH ABSTRACT http://links.lww.com/IJEBH/A235.
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Affiliation(s)
- Myrthe van der Zanden
- Department of Internal Medicine, Section Nursing Science, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Onno Helder
- Create4Care, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section Nursing Science, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
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14
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McLoughlin GM, Salmon J. How Can We Equitably Scale-Up Physical Activity Interventions to Ensure Everyone Has Opportunities to Thrive? J Phys Act Health 2024:1-2. [PMID: 38936804 DOI: 10.1123/jpah.2024-0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/12/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Gabriella M McLoughlin
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA
- Washington University Implementation Science Center for Cancer Control, Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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15
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Strifler L, Fahim C, Hillmer MP, Barnsley JM, Straus SE. Development and usability testing of an online support tool to identify models and frameworks to inform implementation. BMC Med Inform Decis Mak 2024; 24:182. [PMID: 38937692 PMCID: PMC11209996 DOI: 10.1186/s12911-024-02580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Theories, models and frameworks (TMFs) are useful when implementing, evaluating and sustaining healthcare evidence-based interventions. Yet it can be challenging to identify an appropriate TMF for an implementation project. We developed and tested the usability of an online tool to help individuals who are doing or supporting implementation practice activities to identify appropriate models and/or frameworks to inform their work. METHODS We used methods guided by models and evidence on implementation science and user-centered design. Phases of tool development included applying findings from a scoping review of TMFs and interviews with 24 researchers/implementers on barriers and facilitators to identifying and selecting TMFs. Based on interview findings, we categorized the TMFs by aim, stage of implementation, and target level of change to inform the tool's algorithm. We then conducted interviews with 10 end-users to test the usability of the prototype tool and administered the System Usability Scale (SUS). Usability issues were addressed and incorporated into the tool. RESULTS We developed Find TMF, an online tool consisting of 3-4 questions about the user's implementation project. The tool's algorithm matches key characteristics of the user's project (aim, stage, target change level) with characteristics of different TMFs and presents a list of candidate models/frameworks. Ten individuals from Canada or Australia participated in usability testing (mean SUS score 84.5, standard deviation 11.4). Overall, participants found the tool to be simple, easy to use and visually appealing with a useful output of candidate models/frameworks to consider for an implementation project. Users wanted additional instruction and guidance on what to expect from the tool and how to use the information in the output table. Tool improvements included incorporating an overview figure outlining the tool steps and output, displaying the tool questions on a single page, and clarifying the available functions of the results page, including adding direct links to the glossary and to complementary tools. CONCLUSIONS Find TMF is an easy-to-use online tool that may benefit individuals who support implementation practice activities by making the vast number of models and frameworks more accessible, while also supporting a consistent approach to identifying and selecting relevant TMFs.
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Affiliation(s)
- Lisa Strifler
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Michael P Hillmer
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
- Ontario Ministry of Health, Toronto, ON, Canada
| | - Jan M Barnsley
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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16
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McKay HA, Kennedy SG, Macdonald HM, Naylor PJ, Lubans DR. The Secret Sauce? Taking the Mystery Out of Scaling-Up School-Based Physical Activity Interventions. J Phys Act Health 2024:1-10. [PMID: 38936808 DOI: 10.1123/jpah.2024-0274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 06/29/2024]
Abstract
Over the last 4 decades, physical activity researchers have invested heavily in determining "what works" to promote healthy behaviors in schools. Single and multicomponent school-based interventions that target physical education, active transportation, and/or classroom activity breaks effectively increased physical activity among children and youth. Yet, few of these interventions are ever scaled-up and implemented under real-world conditions and in diverse populations. To achieve population-level health benefits, there is a need to design school-based health-promoting interventions for scalability and to consider key aspects of the scale-up process. In this opinion piece, we aim to identify challenges and advance knowledge and action toward scaling-up school-based physical activity interventions. We highlight the key roles of planning for scale-up at the outset, scale-up pathways, trust among partners and program support, program adaptation, evaluation of scale-up, and barriers and facilitators to scaling-up. We draw upon our experience scaling-up effective school-based interventions and provide a solid foundation from which others can work toward bridging the implementation-to-scale-up gap.
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Affiliation(s)
- Heather A McKay
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Sarah G Kennedy
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Heather M Macdonald
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, Faculty of Education, University of Victoria, Victoria, BC, Canada
| | - David R Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Rendle KA, Tan ASL, Spring B, Bange EM, Lipitz-Snyderman A, Morris MJ, Makarov DV, Daly R, Garcia SF, Hitsman B, Ogedegbe O, Phillips S, Sherman SE, Stetson PD, Vachani A, Wainwright JV, Zullig LL, Bekelman JE. A Framework for Integrating Telehealth Equitably across the cancer care continuum. J Natl Cancer Inst Monogr 2024; 2024:92-99. [PMID: 38924790 PMCID: PMC11207920 DOI: 10.1093/jncimonographs/lgae021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/23/2024] [Accepted: 04/15/2024] [Indexed: 06/28/2024] Open
Abstract
The COVID-19 pandemic placed a spotlight on the potential to dramatically increase the use of telehealth across the cancer care continuum, but whether and how telehealth can be implemented in practice in ways that reduce, rather than exacerbate, inequities are largely unknown. To help fill this critical gap in research and practice, we developed the Framework for Integrating Telehealth Equitably (FITE), a process and evaluation model designed to help guide equitable integration of telehealth into practice. In this manuscript, we present FITE and showcase how investigators across the National Cancer Institute's Telehealth Research Centers of Excellence are applying the framework in different ways to advance digital and health equity. By highlighting multilevel determinants of digital equity that span further than access alone, FITE highlights the complex and differential ways structural determinants restrict or enable digital equity at the individual and community level. As such, achieving digital equity will require strategies designed to not only support individual behavior but also change the broader context to ensure all patients and communities have the choice, opportunity, and resources to use telehealth across the cancer care continuum.
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Affiliation(s)
- Katharine A Rendle
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA, USA
| | - Andy S L Tan
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA, USA
- Annenberg School for Communications, University of Pennsylvania, Philadelphia, PA, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erin M Bange
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Danil V Makarov
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Urology, New York University Grossman School of Medicine, New York, New York
- Department of Medicine, VA New York Harbor Healthcare System, New York, NY, USA
| | - Robert Daly
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sofia F Garcia
- Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Olugbenga Ogedegbe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Siobhan Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Scott E Sherman
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Medicine, VA New York Harbor Healthcare System, New York, NY, USA
| | | | - Anil Vachani
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Jocelyn V Wainwright
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Justin E Bekelman
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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18
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Lyzwinski L, Mcdonald S, Zwicker J, Tough S. Digital and Hybrid Pediatric and Youth Mental Health Program Implementation Challenges During the Pandemic: Literature Review With a Knowledge Translation and Theoretical Lens Analysis. JMIR Pediatr Parent 2024; 7:e55100. [PMID: 38916946 DOI: 10.2196/55100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation. OBJECTIVE The aims of this knowledge synthesis were to gain a deeper understanding of what types of mental health knowledge translation (KT) programs, mental health first aid training, and positive psychology interventions were developed and evaluated for youth mental health. METHODS We undertook a literature review of PubMed and MEDLINE for relevant studies on youth mental health including digital and hybrid programs undertaken during the pandemic (2020-2022). RESULTS A total of 60 studies were included in this review. A few KT programs were identified that engaged with a wide range of stakeholders during the pandemic, and a few were informed by KT theories. Key challenges during the implementation of mental health programs for youth included lack of access to technology and privacy concerns. Hybrid web-based and face-to-face KT and mental health care were recommended. Providers required adequate training in using telehealth and space. CONCLUSIONS There is an opportunity to reduce the barriers to implementing tele-mental health in youth by providing adequate technological access, Wi-Fi and stationary internet connectivity, and privacy protection. Staff gained new knowledge and training from the pandemic experience of using telehealth, which will serve as a useful foundation for the future. Future research should aim to maximize the benefits of hybrid models of tele-mental health and face-to-face sessions while working on minimizing the potential barriers that were identified. In addition, future programs could consider combining mental health first aid training with hybrid digital and face-to-face mental health program delivery along with mindfulness and resilience building in a unified model of care, knowledge dissemination, and implementation.
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Affiliation(s)
- Lynnette Lyzwinski
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- The School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Sheila Mcdonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jennifer Zwicker
- The School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Yager Z. Something, everything, and anything more than nothing: stories of school-based prevention of body image concerns and eating disorders in young people. Eat Disord 2024:1-19. [PMID: 38910350 DOI: 10.1080/10640266.2024.2364523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Much work has been done to promote the development of positive body image in schools. This paper aims to tell some stories from the past 35 years of work in this field that illuminate important issues in developing, evaluating, and disseminating programs, and in removing policies and practices that could trigger weight stigma and body shame or disordered eating attitudes and behaviours. The need for, goals of, and approaches to body image programs, problematic activities we have 'good enough' evidence to avoid, and next steps for advocacy, research, and action are explored as we celebrate how far we've come and have hope for the future.
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Affiliation(s)
- Zali Yager
- The Embrace Collective
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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20
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Harden SM, Brow K, Zoellner J, Armbruster SD. Identification of weight loss interventions for translation among endometrial cancer survivors: A RE-AIM analysis. Transl Behav Med 2024:ibae030. [PMID: 38907663 DOI: 10.1093/tbm/ibae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
Interventions for obesity-related cancers that combine nutrition and physical activity for weight loss exist; however, their application to survivors of endometrial cancer is unknown. Furthermore, little is known about pre-implementation perceptions of existing programs from a variety of interested persons (physicians, researchers) who may be part of the implementation team. Adapting an existing intervention rather than developing a new intervention may speed the translational lag time as long as intervention characteristics and fit within the delivery system are considered during the planning phase. To describe the process of determining the core elements of obesity-related interventions for cancer survivors and determine which one might be best delivered by an urban healthcare system that predominantly serves individuals who live in rural areas of Virginia and West Virginia. A pragmatic review of the literature was conducted via PubMed and Google Scholar with broad search terms of cancer survivor AND weight loss AND health intervention. Identified interventions were scored related to the Practical, Robust Implementation and Sustainability Model-which is an extension of RE-AIM framework to guide the understanding of who, what, where, when, and how the intervention was conducted. Intervention characteristics are reported. In addition, ratings from three independent reviewers on the validated 5-point Likert scale of an intervention's acceptability, appropriateness, and feasibility in the intended delivery system were collected and summarized. Twelve interventions were identified with an average sample size of 241(±195) and a range of 48-683 participants. Target populations included survivors of colorectal, breast, and endometrial cancers as well as general cancer survivors and included both men and women or only women. Most participants (74%) identified as white/Caucasian and average age ranged from 47.1 to 65.9 years. Program duration ranged from 4 weeks to 18 months, with an average duration of 32 weeks. Intervention dosage ranged from three times a week to once a month. Intervention acceptability, appropriateness, and feasibility had average and standard deviation ratings of 3.52(±0.46), 3.41(±0.45), and 3.21(±0.46), respectively, out of 5. The four interventions with the highest combined acceptable, appropriate, and feasible scores are being considered for potential use as an obesity-related intervention for survivors of endometrial cancer. Future work is needed to determine relevant adaptations and efficacy among survivors of endometrial cancer with obesity. Our approach may be beneficial for other interventionists aiming to speed intervention development and implementation.
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Affiliation(s)
- Samantha M Harden
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Katie Brow
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Jamie Zoellner
- Public Health Sciences, University of Virginia, Christiansburg, VA, USA
| | - Shannon D Armbruster
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Obstetrics and Gynecology, Carilion Clinic, Roanoke, VA, USA
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21
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Dubbeldeman EM, Crone MR, Jong JCKD, van der Kleij RMJJ. Optimizing implementation: elucidating the role of behavior change techniques and corresponding strategies on determinants and implementation performance: a cross-sectional study. Implement Sci Commun 2024; 5:68. [PMID: 38902838 PMCID: PMC11191141 DOI: 10.1186/s43058-024-00604-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/09/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Behavior change techniques (BCTs) are considered as active components of implementation strategies, influencing determinants and, ultimately, implementation performance. In our previous Delphi study, experts formulated 'implementation hypotheses', detailing how specific combinations of BCTs and strategies (referred to as BCT-strategy combinations) might influence determinants and guideline implementation within youth care. For example, educational meetings providing instructions on guideline use were hypothesized to enhance practitioners' knowledge and, consequently, guideline implementation. However, these hypotheses have not been verified in practice yet. METHOD We conducted a cross-sectional study involving practitioners and management professionals from youth (health)care organizations. Using questionnaires, we obtained data on the presence of BCT-strategy combinations and their perceived influence on determinants and implementation performance. Chi-squared tests and regression analyses were employed to determine the influence of specific BCT-strategy combinations on determinants and implementation performance. RESULTS Our analyses included data from 104 practitioners and 34 management professionals. Most of the management professionals indicated that the BCT-strategy combinations positively influenced or had the potential to influence their implementation performance. At the practitioner level, half of the combinations were perceived to have a positive influence on determinants and implementation performance. Furthermore, practitioners who reported the absence of BCT-strategy combinations were more skeptical about their potential influence on determinants and implementation performance. CONCLUSION Several BCT-strategy combinations were perceived to improve or potentially improve implementation performance of both practitioners and management professionals. In the development and evaluation of implementation efforts, we advocate for clearly describing the implementation effort's objective and using frameworks that detail the BCTs inducing behavior change, the strategy employed, and the processes driving the observed changes. Understanding these interconnected processes is important in designing targeted, evidence-based behavior change interventions. This understanding optimizes resource allocation and contributes to the overall success of implementation efforts in youth care.
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Affiliation(s)
- Eveline M Dubbeldeman
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands
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Petersen HS, Rothmann MJ, Jensen HI. Certified Registered Nurse Anesthetists' Experiences of Nursing in Anesthesia Care: An Interview Study. J Perianesth Nurs 2024:S1089-9472(24)00042-X. [PMID: 38904601 DOI: 10.1016/j.jopan.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE The purpose of this study was to understand certified registered nurse anesthetists' (CRNAs) experiences of nursing in anesthesia care. DESIGN An explorative qualitative study was conducted with inspiration from Ricoeur's hermeneutic phenomenological theory of interpretation. METHODS Three focus group interviews were carried out with participants representing 5 anesthesiology departments from 3 hospitals in Denmark (a total of 14 participants). The participants were all CRNAs. The transcribed interviews were examined as one coherent text using a Ricoeur-inspired approach, in which the analysis was conducted on three levels: naive reading, structural analysis, and critical interpretation. FINDINGS The structural analysis identified three themes relevant to the CRNAs' experiences of nursing: (1) the relationship with the patient, in which caring and professionalism are equally important; (2) differences between professions when sitting in the operating room; and (3) conflicts between production and caring. The study showed that CRNAs are aware of their professional identities as nurses and view anesthesia nursing as an integration of technical tasks and caring, in which the relationship with the patient and serving as the patient's representative are central. A major aspect of nursing is performed while the patient is anesthetized, and the CRNA attends to the patient's basic needs. The study also found that CRNAs find it difficult to define nursing in anesthesia care because of the overlapping tasks and skills between CRNAs and anesthesiologists. CONCLUSIONS CRNAs are very aware of their professional identities as nurses. The professionalism involved in their relationships with patients is evident in the CRNAs' representation of the patients themselves.
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Affiliation(s)
- Henriette Simone Petersen
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, A Part of Lillebaelt Hospital, Denmark.
| | - Mette Juel Rothmann
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark; Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, A Part of Lillebaelt Hospital, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Mustafa M, Hatah E, Makmor-Bakry M. Integrating design thinking and implementation science principles in delivering a medication review service in the community pharmacy setting-An implementation testing study. PLoS One 2024; 19:e0304291. [PMID: 38870126 PMCID: PMC11175411 DOI: 10.1371/journal.pone.0304291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/04/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Medication review (MR) services are evidenced-based practices in which a systematic assessment of a patient's medication is conducted, primarily aiming to optimize drug therapy and minimize adverse drug events through pharmacist interventions. Although studies show that MR services are effective, the implementation of MR services in Malaysia has been challenging due to several barriers. An MR services blueprint was developed to be adapted to the Malaysian community pharmacy setting as part of tailoring strategies. OBJECTIVE Through utilizing the design thinking triple diamond model and implementation science principles, a powerful guide for healthcare researchers and stakeholders to assist with effective service implementation, this study aimed to evaluate the implementation testing and observe the effectiveness of the developed MR service blueprint. METHOD The study utilizes an effectiveness-implementation Type 3 hybrid implementation science framework conducted from May 2021 to April 2022. Employing a qualitative ethnographic approach, researchers observed pharmacy study sites during the implementation of MR services. Both qualitative and quantitative data were collected across exploration, preparation, testing, and operational phases. Implementation outcomes evaluated include phases, reach, fidelity, acceptability, as well as implementation barriers and strategies. MR intervention outcomes included service characteristics and the number and type of drug-related problems and interventions offered. RESULTS 17 community pharmacists were invited to pilot the MR service blueprint for six months in their setting. Of this, 78.5% (n = 11) of the pharmacies reached the testing phase, and 36% (n = 4) reached the implementation phase. Fifty-four patients were in the study, giving an implementation reach of 70%. The majority of surveyed patients expressed satisfaction with the service. The total DRP identified was 133, and 64 interventions were provided by the pharmacists. Facilitation strategies such as "Engage stakeholders by creating ownership of the change" and "Equip stakeholders with training" are needed to overcome the barriers. CONCLUSION This study marked the beginning of successful MR service implementation at Malaysian community pharmacies. Future studies with multi-level partnered strategies are required to reach full implementation and sustainability.
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Affiliation(s)
- Maali Mustafa
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, Cyberjaya, Selangor, Malaysia
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
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Bartels SM, Phan HTT, Hutton HE, Nhan DT, Sripaipan T, Chen JS, Rossi SL, Ferguson O, Nong HTT, Nguyen NTK, Giang LM, Bui HTM, Chander G, Sohn H, Kim S, Tran HV, Nguyen MX, Powell BJ, Pence BW, Miller WC, Go VF. Scaling up a brief alcohol intervention to prevent HIV infection in Vietnam: a cluster randomized, implementation trial. Implement Sci 2024; 19:40. [PMID: 38867283 PMCID: PMC11170841 DOI: 10.1186/s13012-024-01368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Evidence-based interventions (EBIs) often address normative behaviors. If a behavior is also common among clinicians, they may be skeptical about the necessity or effectiveness of an EBI. Alternatively, clinicians' attitudes and behaviors may be misaligned, or they may lack the knowledge and self-efficacy to deliver the EBI. Several EBIs address unhealthy alcohol use, a common and often culturally acceptable behavior. But unhealthy alcohol use may be particularly harmful to people with HIV (PWH). Here, we present an implementation trial using an experiential implementation strategy to address clinicians' knowledge, attitudes, and behaviors. Clinicians receive the experiential intervention before they begin delivering an evidence-based brief alcohol intervention (BAI) to PWH with unhealthy alcohol use. METHODS Design: In this hybrid type 3 implementation-effectiveness cluster randomized controlled trial, ART clinics (n = 30) will be randomized 1:1 to facilitation, a flexible strategy to address implementation barriers, or facilitation plus the experiential brief alcohol intervention (EBAI). In the EBAI arm, clinicians, irrespective of their alcohol use, will be offered the BAI as experiential learning. EBAI will address clinicians' alcohol-related attitudes and behaviors and increase their knowledge and confidence to deliver the BAI. PARTICIPANTS ART clinic staff will be enrolled and assessed at pre-BAI training, post-BAI training, 3, 12, and 24 months. All PWH at the ART clinics who screen positive for unhealthy alcohol use will be offered the BAI. A subset of PWH (n = 810) will be enrolled and assessed at baseline, 3, and 12 months. OUTCOMES We will compare implementation outcomes (acceptability, fidelity, penetration, costs, and sustainability) and effectiveness outcomes (viral suppression and alcohol use) between the two arms. We will assess the impact of site-level characteristics on scaling-up the BAI. We will also evaluate how experiencing the BAI affected clinical staff's alcohol use and clinic-level alcohol expectations in the EBAI arm. DISCUSSION This trial contributes to implementation science by testing a novel strategy to implement a behavior change intervention in a setting in which clinicians themselves may engage in the behavior. Experiential learning may be useful to address normative and difficult to change lifestyle behaviors that contribute to chronic diseases. TRIAL REGISTRATION NCT06358885 (04/10/2024), https://clinicaltrials.gov/study/NCT06358885 .
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Affiliation(s)
- Sophia M Bartels
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Huong T T Phan
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - Heidi E Hutton
- Johns Hopkins Hospital University School of Medicine, Baltimore, MD, USA
| | - Do T Nhan
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - Teerada Sripaipan
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Jane S Chen
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Sarah L Rossi
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Olivia Ferguson
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | | | - Le Minh Giang
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Hao T M Bui
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Hojoon Sohn
- Seoul National University College, Seoul, Korea
| | - Sol Kim
- Seoul National University College, Seoul, Korea
| | | | - Minh X Nguyen
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MI, USA
| | - Brian W Pence
- Department of Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - William C Miller
- Department of Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Vivian F Go
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
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Nilsen P, Sundemo D, Heintz F, Neher M, Nygren J, Svedberg P, Petersson L. Towards evidence-based practice 2.0: leveraging artificial intelligence in healthcare. FRONTIERS IN HEALTH SERVICES 2024; 4:1368030. [PMID: 38919828 PMCID: PMC11196845 DOI: 10.3389/frhs.2024.1368030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024]
Abstract
Background Evidence-based practice (EBP) involves making clinical decisions based on three sources of information: evidence, clinical experience and patient preferences. Despite popularization of EBP, research has shown that there are many barriers to achieving the goals of the EBP model. The use of artificial intelligence (AI) in healthcare has been proposed as a means to improve clinical decision-making. The aim of this paper was to pinpoint key challenges pertaining to the three pillars of EBP and to investigate the potential of AI in surmounting these challenges and contributing to a more evidence-based healthcare practice. We conducted a selective review of the literature on EBP and the integration of AI in healthcare to achieve this. Challenges with the three components of EBP Clinical decision-making in line with the EBP model presents several challenges. The availability and existence of robust evidence sometimes pose limitations due to slow generation and dissemination processes, as well as the scarcity of high-quality evidence. Direct application of evidence is not always viable because studies often involve patient groups distinct from those encountered in routine healthcare. Clinicians need to rely on their clinical experience to interpret the relevance of evidence and contextualize it within the unique needs of their patients. Moreover, clinical decision-making might be influenced by cognitive and implicit biases. Achieving patient involvement and shared decision-making between clinicians and patients remains challenging in routine healthcare practice due to factors such as low levels of health literacy among patients and their reluctance to actively participate, barriers rooted in clinicians' attitudes, scepticism towards patient knowledge and ineffective communication strategies, busy healthcare environments and limited resources. AI assistance for the three components of EBP AI presents a promising solution to address several challenges inherent in the research process, from conducting studies, generating evidence, synthesizing findings, and disseminating crucial information to clinicians to implementing these findings into routine practice. AI systems have a distinct advantage over human clinicians in processing specific types of data and information. The use of AI has shown great promise in areas such as image analysis. AI presents promising avenues to enhance patient engagement by saving time for clinicians and has the potential to increase patient autonomy although there is a lack of research on this issue. Conclusion This review underscores AI's potential to augment evidence-based healthcare practices, potentially marking the emergence of EBP 2.0. However, there are also uncertainties regarding how AI will contribute to a more evidence-based healthcare. Hence, empirical research is essential to validate and substantiate various aspects of AI use in healthcare.
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Affiliation(s)
- Per Nilsen
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - David Sundemo
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Lerum Närhälsan Primary Healthcare Center, Lerum, Sweden
| | - Fredrik Heintz
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Margit Neher
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jens Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Lena Petersson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Bruce BR, Shepherd HL, Khan SA, Haunton CR, Leask J, De Vries BS. Association between intravenous fluids during labor and primary postpartum hemorrhage: A retrospective cohort study. Acta Obstet Gynecol Scand 2024. [PMID: 38856239 DOI: 10.1111/aogs.14896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/19/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION There is a major research gap relating to the impact of intravenous (IV) fluids administration during labor on maternal and neonatal outcomes. It is biologically plausible that a relationship between volume of IV fluids and primary postpartum hemorrhage (PPH) exists. The primary objective of this study was to evaluate whether the administration of high-volume IV fluids during labor (≥ 2500 mL) increases the risk of primary PPH and other adverse outcomes for women with a term, singleton pregnancy, in comparison to low-volume IV fluids during labor (<2500 mL). MATERIAL AND METHODS A retrospective cohort study was conducted at a tertiary referral hospital in Sydney, Australia between 1st September 2021 and 31st October 2022. Inclusion criteria were: women with a live singleton fetus in a cephalic presentation; planning a vaginal birth; and admitted for labor and birth care between 37 and 42 week gestation. The study factor was IV fluids during labor and the primary outcome was primary PPH ≥500 mL. Secondary outcomes included cesarean section and major perineal injury. Pregnancy, birth, and postnatal data were obtained from the hospital's electronic clinical database, electronic medical records, and paper fluid order documentation. Multivariable logistic regression and multiple imputation were used to explore the relationship between volume of IV fluids in labor and PPH. RESULTS A total of 1023 participants were included of which 339 had a primary PPH (33.1%). There was no association between high-volume IV fluids and PPH after adjusting for demographic and clinical factors (adjusted odds ratio [ORadj]1.02 95% confidence interval [95%CI] 0.72, 1.44). However, there was a positive association between high-volume IV fluids and cesarean section (ORadj 1.99; 95%CI 1.4, 2.8). CONCLUSIONS The findings of this research are important to further knowledge relating to the administration of IV fluids during labor. The findings emphasize the importance of accurately documenting IV fluids administration and identifies research priorities to enable us to better understand the broader implications of IV fluids administration on pregnancy and perinatal outcomes.
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Affiliation(s)
- Belinda R Bruce
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Heather L Shepherd
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Saleem Ahmed Khan
- RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Charlotte R Haunton
- RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Bradley S De Vries
- Sydney Institute for Women, Children and their Families, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Brown CEB, Richardson K, Halil-Pizzirani B, Hughes S, Atkins L, Pitt J, Yücel M, Segrave RA. PEAK Mood, Mind, and Marks: a pilot study of an intervention to support university students' mental and cognitive health through physical exercise. Front Psychiatry 2024; 15:1379396. [PMID: 38915845 PMCID: PMC11194434 DOI: 10.3389/fpsyt.2024.1379396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/13/2024] [Indexed: 06/26/2024] Open
Abstract
Introduction Regular exercise has the potential to enhance university students' mental and cognitive health. The PEAK Mood, Mind and Marks program (i.e., PEAK) is a neuroscience-informed intervention developed using the Behaviour Change Wheel to support students to exercise three or more times per week to benefit their mental and cognitive health. This pilot study assessed the impact of PEAK on exercise, mental and cognitive health, and implementation outcomes. Methods PEAK was delivered to 115 undergraduate university students throughout a 12-week university semester. The primary outcome was weekly exercise frequency. Secondary outcomes were: time spent engaged in moderate-vigorous exercise, sedentary behaviour and perceived mental health and cognitive health. All were measured via online self-report questionnaires. Qualitative interviews with 15 students investigated influences on engagement, the acceptability and appropriateness of PEAK, and its mechanisms of behaviour change. Paired t-tests, Wilcoxon Signed-Rank tests and template analysis were used to analyse quantitative and qualitative data, respectively. Results On average, 48.4% of students engaged in the recommended frequency of three or more exercise sessions per week. This proportion decreased towards the end of PEAK. Sedentary behaviour significantly decreased from baseline to end-point, and moderate-vigorous exercise significantly increased among students' who were non-exercisers. Mental wellbeing, stress, loneliness, and sense of belonging to the university significantly improved. There were no significant changes in psychological distress. Concentration, memory, and productivity significantly improved. Sixty-eight percent of students remained engaged in one or more components of PEAK at end-point. Qualitative data indicated students found PEAK to be acceptable and appropriate, and that it improved aspects of their capability, opportunity, and motivation to exercise. Conclusions Students are receptive to an exercise-based program to support their mental and cognitive health. Students exercise frequency decreased; however, these figures are likely a conservative estimate of students exercise engagement. Students valued the neuroscience-informed approach to motivational and educational content and that the program's goals aligned with their academic goals. Students identified numerous areas PEAK's content and implementation can be optimised, including use of a single digital delivery platform, more opportunities to connect with peers and to expand the content's cultural inclusivity.
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Affiliation(s)
- Catherine E. B. Brown
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Karyn Richardson
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Bengianni Halil-Pizzirani
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Sam Hughes
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Lou Atkins
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Joseph Pitt
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Murat Yücel
- Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Rebecca A. Segrave
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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Johnson G, Singh H, Helewa RM, Sibley KM, Reynolds KA, El-Kefraoui C, Doupe MB. Gastroenterologist and surgeon perceptions of recommendations for optimal endoscopic localization of colorectal neoplasms. Sci Rep 2024; 14:13157. [PMID: 38849393 PMCID: PMC11161634 DOI: 10.1038/s41598-024-63753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
National consensus recommendations have recently been developed to standardize colorectal tumour localization and documentation during colonoscopy. In this qualitative semi-structured interview study, we identified and contrast the perceived barriers and facilitators to using these new recommendations according to gastroenterologists and surgeons in a large central Canadian city. Interviews were analyzed according to the Consolidated Framework for Implementation Research (CFIR) through directed content analysis. Solutions were categorized using the Expert Recommendations for Implementing Change (ERIC) framework. Eleven gastroenterologists and ten surgeons participated. Both specialty groups felt that the new recommendations were clearly written, adequately addressed current care practice tensions, and offered a relative advantage versus existing practices. The new recommendations appeared appropriately complex, applicable to most participants, and could be trialed and adapted prior to full implementation. Major barriers included a lack of relevant external or internal organizational incentives, non-existing formal feedback processes, and a lack of individual familiarity with the evidence behind some recommendations. With application of the ERIC framework, common barriers could be addressed through accessing new funding, altering incentive structures, changing record systems, educational interventions, identifying champions, promoting adaptability, and employing audit/feedback processes. Future research is needed to test strategies for feasibility and effectiveness.
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Affiliation(s)
- Garrett Johnson
- Department of Surgery, Section of General Surgery, University of Manitoba, AE101-820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada.
- Clinician Investigator Program, University of Manitoba, Winnipeg, Canada.
| | - Harminder Singh
- Department of Internal Medicine, University of Manitoba, and CancerCare Manitoba Research Institute, Winnipeg, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Ramzi M Helewa
- Department of Surgery, Section of General Surgery, University of Manitoba, AE101-820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Kristin A Reynolds
- Departments of Psychology and Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Charbel El-Kefraoui
- Department of Surgery, Section of General Surgery, University of Manitoba, AE101-820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Kabukye JK, Namagembe R, Nakku J, Kiberu V, Sjölinder M, Nilsson S, Wamala-Larsson C. Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach. JMIR Hum Factors 2024; 11:e53976. [PMID: 38843515 PMCID: PMC11190627 DOI: 10.2196/53976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/01/2024] [Accepted: 05/01/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. OBJECTIVE This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. METHODS This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. RESULTS Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. CONCLUSIONS This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption.
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Affiliation(s)
- Johnblack K Kabukye
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
- Uganda Cancer Institute, Kampala, Uganda
| | - Rosemary Namagembe
- Hutchinson Centre Research Institute of Uganda, Uganda Cancer Institute, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Vincent Kiberu
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Susanne Nilsson
- Unit for Integrated Product Development and Design, Department of Machine Design, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Caroline Wamala-Larsson
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
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Martinez Leal I, Siddiqi AD, Rogova A, Britton M, Chen TA, Williams T, Casey K, Sanchez H, Reitzel LR. Enablers and Inhibitors to Implementing Tobacco Cessation Interventions within Homeless-Serving Agencies: A Qualitative Analysis of Program Partners' Experiences. Cancers (Basel) 2024; 16:2162. [PMID: 38893280 PMCID: PMC11171900 DOI: 10.3390/cancers16112162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Despite the high tobacco use rates (~80%) and tobacco-related cancers being the second leading cause of death among people experiencing homelessness within the United States, these individuals rarely receive tobacco use treatment from homeless-serving agencies (HSAs). This qualitative study explored the enablers and inhibitors of implementing an evidence-based tobacco-free workplace (TFW) program offering TFW policy adoption, specialized provider training to treat tobacco use, and nicotine replacement therapy (NRT) within HSAs. Pre- and post-implementation interviews with providers and managers (n = 13) pursued adapting interventions to specific HSAs and assessed the program success, respectively. The organizational readiness for change theory framed the data content analysis, yielding three categories: change commitment, change efficacy and contextual factors. Pre- to post-implementation, increasing challenges impacted the organizational capacity and providers' attitudes, wherein previously enabling factors were reframed as inhibiting, resulting in limited implementation despite resource provision. These findings indicate that low-resourced HSAs require additional support and guidance to overcome infrastructure challenges and build the capacity needed to implement a TFW program. This study's findings can guide future TFW program interventions, enable identification of agencies that are well-positioned to adopt such programs, and facilitate capacity-building efforts to ensure their successful participation.
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Affiliation(s)
- Isabel Martinez Leal
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA; (A.D.S.); (M.B.); (H.S.); (L.R.R.)
| | - Ammar D. Siddiqi
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA; (A.D.S.); (M.B.); (H.S.); (L.R.R.)
- Department of Biosciences, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Anastasia Rogova
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA;
| | - Maggie Britton
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA; (A.D.S.); (M.B.); (H.S.); (L.R.R.)
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd., Houston, TX 77204, USA;
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Teresa Williams
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (T.W.); (K.C.)
| | - Hector Sanchez
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA; (A.D.S.); (M.B.); (H.S.); (L.R.R.)
| | - Lorraine R. Reitzel
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA; (A.D.S.); (M.B.); (H.S.); (L.R.R.)
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Tseng E, Smith K, Clark JM, Segal JB, Marsteller JA, Maruthur NM. Using the Translating Research into Practice framework to develop a diabetes prevention intervention in primary care: a mixed-methods study. BMJ Open Qual 2024; 13:e002752. [PMID: 38839396 PMCID: PMC11163602 DOI: 10.1136/bmjoq-2024-002752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Pre-diabetes affects one-third of US adults and increases the risk of type 2 diabetes. Effective evidence-based interventions, such as the Diabetes Prevention Program, are available, but a gap remains in effectively translating and increasing uptake of these interventions into routine care. METHODS We applied the Translating Research into Practice (TRiP) framework to guide three phases of intervention design and development for diabetes prevention: (1) summarise the evidence, (2) identify local barriers to implementation and (3) measure performance. In phase 1, we conducted a retrospective cohort analysis of linked electronic health record claims data to evaluate current practices in the management of pre-diabetes. In phase 2, we conducted in-depth interviews of 16 primary care physicians, 7 payor leaders and 31 patients to elicit common barriers and facilitators for diabetes prevention. In phase 3, using findings from phases 1 and 2, we developed the core elements of the intervention and performance measures to evaluate intervention uptake. RESULTS In phase 1 (retrospective cohort analysis), we found few patients with pre-diabetes received diabetes prevention interventions. In phase 2 (stakeholder engagement), we identified common barriers to include a lack of knowledge about pre-diabetes among patients and about the Diabetes Prevention Program among clinicians. In phase 3 (intervention development), we developed the START Diabetes Prevention Clinical Pathway as a systematic change package to address barriers and facilitators identified in phases 1 and 2, performance measures and a toolkit of resources to support the intervention components. CONCLUSIONS The TRiP framework supported the identification of evidence-based care practices for pre-diabetes and the development of a well-fitted, actionable intervention and implementation plan designed to increase treatment uptake for pre-diabetes in primary care settings. Our change package can be adapted and used by other health systems or clinics to target prevention of diabetes or other related chronic conditions.
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Affiliation(s)
- Eva Tseng
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Katherine Smith
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeanne M Clark
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jodi B Segal
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA
| | - Jill A Marsteller
- Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nisa M Maruthur
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Song MY, Blake-Hepburn D, Karbasi A, Fadel SA, Allin S, Ataullahjan A, Ruggiero ED. Public health partnerships with faith-based organizations to support vaccination uptake among minoritized communities: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002765. [PMID: 38837963 DOI: 10.1371/journal.pgph.0002765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/22/2024] [Indexed: 06/07/2024]
Abstract
Faith-based vaccine initiatives are of growing interest to public health agencies who are looking to increase vaccine confidence among ethnoracially minoritized populations. Despite evidence that support faith-based organizations' (FBOs) partnerships with public health agencies (PHAs) to increase vaccine confidence, reviews on the scope and efforts to ensure equitable vaccination delivery for ethnoracially minoritized populations are scarce. We aimed to understand how public health agencies collaborate with FBOs or faith communities to improve vaccine confidence among minoritized communities in high-, low- and middle- income countries. We conducted a scoping review by searching OVID MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, and PROQUEST from 2011 to 2023. We included case studies, news reports, observational studies, experimental, and quasi-experimental studies and multimedia content that describes PHA-FBO partnerships that created vaccine initiatives for marginalized and minoritized communities. The data was extracted, summarized, and results were described narratively. We included 167 initiatives reported in 160 publications; 83.8% of the included articles were published between 2019 to 2023. The interventions carried out by PHA-FBO partnerships attempted to increase vaccine uptake using any or all the following methods. First, the initiatives provided digital and in-person platforms for interfaith learning and established training programs to empower faith leaders to become vaccine ambassadors. Second, the initiatives designed and disseminated education and awareness materials that aimed to be sensitive to religious and gender norms. Third, PHA-FBO partnered to apply equity and faith-based frameworks and provided wrap-around support to enable equitable vaccine access. Majority of the initiatives reported that PHA-FBO partnerships improved vaccine confidence and uptake (71.3%). About 22.2% of the initiatives reported quantitative outcomes post-intervention. PHA-FBO initiatives over the past decade increased vaccine uptake and acceptance among diverse ethnoracially minoritized populations. Reporting of faith-based initiatives are subject to publication bias and can be strengthened by examining more evaluation studies and establishment of key outcome indicators to critically appraise intervention outcomes.
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Affiliation(s)
- Melodie Yunju Song
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Anna Karbasi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Shaza A Fadel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sara Allin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Mutsaers B, Langmuir T, MacDonald-Liska C, Presseau J, Larocque G, Harris C, Chomienne MH, Giguère L, Garcia Mairena PM, Babiker D, Thavorn K, Lebel S. Applying Implementation Science to Identify Primary Care Providers' Enablers and Barriers to Using Survivorship Care Plans. Curr Oncol 2024; 31:3278-3290. [PMID: 38920732 PMCID: PMC11202923 DOI: 10.3390/curroncol31060249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
Primary care providers (PCPs) have been given the responsibility of managing the follow-up care of low-risk cancer survivors after they are discharged from the oncology center. Survivorship Care Plans (SCPs) were developed to facilitate this transition, but research indicates inconsistencies in how they are implemented. A detailed examination of enablers and barriers that influence their use by PCPs is needed to understand how to improve SCPs and ultimately facilitate cancer survivors' transition to primary care. An interview guide was developed based on the second version of the Theoretical Domains Framework (TDF-2). PCPs participated in semi-structured interviews. Qualitative content analysis was used to develop a codebook to code text into each of the 14 TDF-2 domains. Thematic analysis was also used to generate themes and subthemes. Thirteen PCPs completed the interview and identified the following barriers to SCP use: unfamiliarity with the side effects of cancer treatment (Knowledge), lack of clarity on the roles of different healthcare professionals (Social Professional Role and Identity), follow-up tasks being outside of scope of practice (Social Professional Role and Identity), increased workload, lack of options for psychosocial support for survivors, managing different electronic medical records systems, logistical issues with liaising with oncology (Environmental Context and Resources), and patient factors (Social Influences). PCPs value the information provided in SCPs and found the follow-up guidance provided to be most helpful. However, SCP use could be improved through streamlining methods of communication and collaboration between oncology centres and community-based primary care settings.
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Affiliation(s)
- Brittany Mutsaers
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (J.P.); (L.G.); (P.M.G.M.); (D.B.); (S.L.)
| | - Tori Langmuir
- The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; (T.L.); (C.H.)
| | | | - Justin Presseau
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (J.P.); (L.G.); (P.M.G.M.); (D.B.); (S.L.)
- The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; (T.L.); (C.H.)
- Clinical Epidemiology Program, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Gail Larocque
- Wellness Beyond Cancer Program, The Ottawa Hospital, Ottawa, ON K1H 7W9, Canada;
| | - Cheryl Harris
- The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; (T.L.); (C.H.)
| | - Marie-Hélène Chomienne
- C.T. Lamont Primary Health Care Research Centre, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Lauriane Giguère
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (J.P.); (L.G.); (P.M.G.M.); (D.B.); (S.L.)
| | | | - Dina Babiker
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (J.P.); (L.G.); (P.M.G.M.); (D.B.); (S.L.)
| | - Kednapa Thavorn
- Clinical Epidemiology Program, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (J.P.); (L.G.); (P.M.G.M.); (D.B.); (S.L.)
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Dowrick A, Ziebland S, Rai T, Friedemann Smith C, Nicholson BD. A manifesto for improving cancer detection: four key considerations when implementing innovations across the interface of primary and secondary care. Lancet Oncol 2024:S1470-2045(24)00102-5. [PMID: 38848741 DOI: 10.1016/s1470-2045(24)00102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 06/09/2024]
Abstract
Improving cancer outcomes through innovative cancer detection initiatives in primary care is an international policy priority. There are unique implementation challenges to the roll-out and scale-up of different innovations, requiring synchronisation between national policy levers and local implementation strategies. We draw on implementation science to highlight key considerations when seeking to sustainably embed cancer detection initiatives within health systems and clinical practice. Points of action include considering the implications of change on the current configuration of responsibility for detecting cancer; investing in understanding how to adapt systems to support innovations; developing strategies to address inequity when planning innovation implementation; and anticipating and making efforts to mitigate the unintended consequences of innovation. We draw on examples of contemporary cancer detection issues to illustrate how to apply these recommendations to practice.
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Affiliation(s)
- Anna Dowrick
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK.
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Tanvi Rai
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | | | - Brian D Nicholson
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
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Li DH, Macapagal K, Mongrella M, Saber R, Mustanski B. "Your Package Could Not Be Delivered": The State of Digital HIV Intervention Implementation in the US. Curr HIV/AIDS Rep 2024; 21:152-167. [PMID: 38502421 DOI: 10.1007/s11904-024-00693-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE OF REVIEW Despite continuous innovations and federal investment to create digital interventions addressing the HIV prevention and care continua, these interventions have not reached people in the U.S. at scale. This article reviews what is known about U.S. implementation of digital HIV interventions and presents a strategy to cross the research-to-practice chasm for these types of interventions. RECENT FINDINGS We conducted a narrative review of U.S.-based original research on implementation of digital HIV interventions and identified few studies reporting on implementation determinants, strategies, processes, or outcomes, particularly outside the context of effectiveness trials. To supplement the literature, in 2023, we surveyed 47 investigators representing 64 unique interventions about their experiences with implementation after their research trials. Respondents placed high importance on intervention implementation, but major barriers included lack of funding and clear implementation models, technology costs, and difficulty identifying partners equipped to deliver digital interventions. They felt that responsibility for implementation should be shared between intervention developers, deliverers (e.g., clinics), and a government entity. If an implementation center were to exist, most respondents wanted to be available for guidance or technical assistance but largely wanted less involvement. Numerous evidence-based, effective digital interventions exist to address HIV prevention and care. However, they remain "on the shelf" absent a concrete and sustainable model for real-world dissemination and implementation. Based on our findings, we call for the creation of national implementation centers, analogous to those in other health systems, to facilitate digital HIV intervention delivery and accelerate progress toward ending the U.S. epidemic.
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Affiliation(s)
- Dennis H Li
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Center for Dissemination and Implementation Science, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Macapagal
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Melissa Mongrella
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Huneycutt BJ, Acha V. The ASAP Framework: A New Tool for Regulatory Agencies to Facilitate Adoption of Pandemic Approaches. Health Secur 2024; 22:249-262. [PMID: 38624265 DOI: 10.1089/hs.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Affiliation(s)
- Brenda J Huneycutt
- Brenda J. Huneycutt, PhD, JD, MPH, is Director, Global Regulatory Policy and Intelligence, Merck & Co., Inc., Rahway, NJ
| | - Virginia Acha
- Virginia Acha, DPhil, MPhil, is Associate Vice President, Global Regulatory Policy and Intelligence, MSD (UK) Limited, London, UK
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Wandersman A, Scheier LM. Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers. Eval Health Prof 2024; 47:143-153. [PMID: 38790113 DOI: 10.1177/01632787241248768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Hundreds of millions of dollars are spent each year by U.S. federal agencies for training and technical assistance (TTA) to be delivered by training and technical assistance centers (TTACs) to "delivery system organizations" (e.g., federally qualified health centers, state departments of health, substance abuse treatment centers, schools, and healthcare organizations). TTACs are often requested to help delivery system organizations implement evidence-based interventions. Yet, counterintuitively, TTACs are rarely required to use evidence-based approaches when supporting delivery systems (in the use of evidence-based programs). In fact, evaluations of TTAC activities tend to be minimal; evaluation of technical assistance (if conducted at all) often emphasizes outputs (number of encounters), satisfaction, and self-reports of knowledge gained-more substantive outcomes are not evaluated. The gap between (a) the volume of TTA services being funded and provided and (b) the evaluation of those services is immense and has the potential to be costly. The basic question to be answered is: how effective are TTA services? This article introduces the special issue on Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers. The special issue promotes 1) knowledge of the state of the art of evaluation of TTACs and 2) advances in what to evaluate in TTA. A major goal of the issue is to improve the science and practice of implementation support, particularly in the areas of TTA.
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Coulter E, McQueen C, Abu-Jurji Z, Chan-Emery I, Rukavina M, Solecki R, Wojkowski S, Dhir J. Development and delivery of justice, equity, diversity, inclusion, and anti-oppression concepts in entry-level health professional education: a scoping review protocol. JBI Evid Synth 2024; 22:1103-1114. [PMID: 38165208 DOI: 10.11124/jbies-23-00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The objective of this scoping review is to identify the frameworks, guidelines, and models used to develop and deliver justice, equity, diversity, inclusion (JEDI), and anti-oppression (AO) principles in mandatory, entry-level health care professional program curricula (EHCPPC). A secondary objective will be to examine how these frameworks, guidelines, and models are used. INTRODUCTION Health inequities are perpetuated globally, as observed by the suboptimal quality of care and health outcomes among equity-deserving groups. An understanding of JEDI and AO concepts is necessary in health care settings to promote culturally safe and high-quality care; however, entry-level health care programs may lack adequate integration of content and/or delivery of these principles. This scoping review will summarize the international literature on frameworks, guidelines, and models used to develop and deliver JEDI and AO concepts in EHCPPC. INCLUSION CRITERIA This review will consider articles that discuss frameworks, models, or guidelines included in EHCPPC that guide the development and/or delivery of JEDI and AO principles in any country. Studies will be considered if they were published from 2015 to the present and are in English. All study designs will be considered for inclusion. METHODS This review will be conducted in accordance with the JBI methodology for scoping reviews. A search of MEDLINE (Ovid), Embase (Ovid), and CINAHL (EBSCOhost) will be conducted. Two or more independent reviewers will assess titles and abstracts, screen full-text studies, and extract data from included studies. Data from the included studies will be collated into tables or figures and described in a narrative summary. REVIEW REGISTRATION Open Science Framework osf.io/ewqf8.
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Affiliation(s)
- Emma Coulter
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Kitto S, Fantaye AW, Zevin B, Fowler A, Sachdeva AK, Raiche I. A Scoping Review of the Literature on Entrustable Professional Activities in Surgery Residency Programs. JOURNAL OF SURGICAL EDUCATION 2024; 81:823-840. [PMID: 38679495 DOI: 10.1016/j.jsurg.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/20/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Entrustable professional activities (EPAs) are a crucial component of contemporary postgraduate medical education with many surgery residency programs having implemented EPAs as a competency assessment framework to assess and provide feedback on the performance of their residents. Despite broad implementation of EPAs, there is a paucity of evidence regarding the impact of EPAs on the learners and learning environments. A first step in improving understanding of the use and impact of EPAs is by mapping the rising number of EPA-related publications from the field of surgery. The primary objective of this scoping review is to examine the nature, extent, and range of articles on the development, implementation, and assessment of EPAs. The second objective is to identify the experiences and factors that influence EPA implementation and use in practice in surgical specialties. DESIGN Scoping review. Four electronic databases (Medline, Embase, Education Source, and ERIC) were searched on January 20, 2022, and then again on July 19, 2023. A quasi-statistical content analysis was employed to quantify and draw meaning from the information related to the development, implementation, assessment, validity, reliability, and experiences with EPAs in the workplace. PARTICIPANTS A total of 42 empirical and nonempirical articles were included. RESULTS Four thematic categories describe the topic areas in included articles related to: 1) the development and refinement of EPAs, including the multiple steps taken to develop and refine unique EPAs for surgery residency programs; 2) the methods for implementing EPAs; 3) outcomes of EPA use in practice; 4) barriers, facilitators, and areas for improvement for the implementation and use of EPAs in surgical education. CONCLUSIONS This scoping review highlights the key trends and gaps from the rapidly increasing number of publications on EPAs in surgery residency, from development to their use in the workplace. Existing EPA studies lack a theoretical and/or conceptual basis; future development and implementation studies should adopt implementation science frameworks to better structure and operationalize EPAs within surgery residency programs.
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Affiliation(s)
- Simon Kitto
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Arone W Fantaye
- Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Canada
| | - Amanda Fowler
- Department of Surgery, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, Illinios
| | - Isabelle Raiche
- Department of Surgery, University of Ottawa, Ottawa, Canada.
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Liang W, Meng J, He S. Comment on Fan et al. (2023) 'Text messaging interventions for breastfeeding outcomes: A systematic review and meta-analysis'. Int J Nurs Stud 2024; 154:104745. [PMID: 38522187 DOI: 10.1016/j.ijnurstu.2024.104745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Weiwei Liang
- Department of Nursing, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Jun Meng
- Department of Nursing, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Shaoying He
- Department of Nursing, Yantai Yuhuangding Hospital, Yantai, Shandong, China.
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Weybright E, Phibbs S, Watters C, Myers A, Peavy M, Martin A. The Role of Cooperative Extension in Delivering Training and Technical Assistance to Support Evidence-Based Behavioral Health Practices in Rural Communities. Eval Health Prof 2024; 47:192-203. [PMID: 38790114 DOI: 10.1177/01632787241237515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The opioid epidemic in the United States continues to disproportionately affect those in rural, compared to urban, areas due to a variety of treatment and recovery barriers. One mechanism to increase capacity of rural-serving providers is through delivery of training and technical assistance (TTA) for evidence-based programs by leveraging the Cooperative Extension System. Guided by the Interactive Systems Framework, the current study evaluates TTA delivered by the Northwest Rural Opioid Technical Assistance Collabroative to opioid prevention, treatment, and recovery providers on short- (satisfaction, anticipated benefit), medium-, (behavioral intention to change current practice), and long-term goals (changes toward adoption of evidence-based practices). We also evaluated differences in short- and medium-term goals by intensity of TTA event and rurality of provider. Surveys of 351 providers who received TTA indicated high levels of satisfaction with TTA events attended, expressed strong agreement that they would benefit from the event, intended to make a professional practice change, and preparation toward implementing changes. Compared to urban-based providers, rural providers reported higher intention to use TTA information to change current practice. We conclude with a review of remaining gaps in the research to practice pipeline and recommendations for moving forward.
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Affiliation(s)
- Elizabeth Weybright
- Department of Human Development, Washington State University, Pullman, WA, USA
- Extension Youth and Families Unit, Washington State University, Pullman, WA, USA
| | - Sandi Phibbs
- Oregon State University Center for Health Innovation, Oregon State University, Corvallis, OR, USA
| | - Cassandra Watters
- Department of Human Development, Washington State University, Pullman, WA, USA
| | - Allison Myers
- Extension Family and Community Health, Oregon State University, Corvallis, OR, USA
| | - Michelle Peavy
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University Spokane, Spokane, WA, USA
| | - Abbey Martin
- Oregon State University Center for Health Innovation, Oregon State University, Corvallis, OR, USA
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Pestka DL, Boes S, Ramezani S, Peters M, Usher MG, Koopmeiners JS, Beebe TJ, Melton GB, Streib CD. Implementing Telestroke in the Inpatient Setting: Identifying Factors for Success. Stroke 2024; 55:1517-1524. [PMID: 38639090 DOI: 10.1161/strokeaha.123.046024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/13/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Inpatient telestroke programs have emerged as a solution to provide timely stroke care in underserved areas, but their successful implementation and factors influencing their effectiveness remain underexplored. This study aimed to qualitatively evaluate the perspectives of inpatient clinicians located at spoke hospitals participating in a newly established inpatient telestroke program to identify implementation barriers and facilitators. METHODS This was a formative evaluation relying on semistructured qualitative interviews with 16 inpatient providers (physicians and nurse practitioners) at 5 spoke sites of a hub-and-spoke inpatient telestroke program. The Integrated-Promoting Action on Research Implementation in Health Services framework guided data analysis, focusing on the innovation, recipients, context, and facilitation aspects of implementation. Interviews were transcribed and coded using thematic analysis. RESULTS Fifteen themes were identified in the data and mapped to the Integrated-Promoting Action on Research Implementation in Health Services framework. Themes related to the innovation (the telestroke program) included easy access to stroke specialists, the benefits of limiting patient transfers, concerns about duplicating tests, and challenges of timing inpatient telestroke visits and notes to align with discharge workflow. Themes pertaining to recipients (care team members and patients) were communication gaps between teams, concern about the supervision of inpatient telestroke advanced practice providers and challenges with nurse empowerment. With regard to the context (hospital and system factors), providers highlighted familiarity with telehealth technologies as a facilitator to implementing inpatient telestroke, yet highlighted resource limitations in smaller facilities. Facilitation (program implementation) was recognized as crucial for education, standardization, and buy-in. CONCLUSIONS Understanding barriers and facilitators to implementation is crucial to determining where programmatic changes may need to be made to ensure the success and sustainment of inpatient telestroke services.
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Affiliation(s)
- Deborah L Pestka
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
| | - Samuel Boes
- Department of Neurology (S.B., S.R., C.D.S.), University of Minnesota, Minneapolis
| | - Solmaz Ramezani
- Department of Neurology (S.B., S.R., C.D.S.), University of Minnesota, Minneapolis
| | - Maya Peters
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
| | - Michael G Usher
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
| | - Joseph S Koopmeiners
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
- Division of Biostatistics and Health Data Science, School of Public Health (J.S.K.), University of Minnesota, Minneapolis
| | - Timothy J Beebe
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
- Division of Health Policy Management, School of Public Health (T.J.B.), University of Minnesota, Minneapolis
| | - Genevieve B Melton
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
- Department of Surgery (G.B.M.), University of Minnesota, Minneapolis
- Institute for Health Informatics (G.B.M.), University of Minnesota, Minneapolis
| | - Christopher D Streib
- Department of Neurology (S.B., S.R., C.D.S.), University of Minnesota, Minneapolis
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Ejaredar M, Ruzycki SM, Glazer TS, Trudeau P, Jim B, Nelson G, Cameron A. Implementation of a surgical site infection prevention bundle in gynecologic oncology patients: An enhanced recovery after surgery initiative. Gynecol Oncol 2024; 185:173-179. [PMID: 38430815 DOI: 10.1016/j.ygyno.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/10/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To evaluate the clinical outcomes pre- and post-implementation of an evidence-informed surgical site infection prevention bundle (SSIPB) in gynecologic oncology patients within an Enhanced Recovery After Surgery (ERAS) care pathway. METHODS Patients undergoing laparotomy for a gynecologic oncology surgery between January-June 2017 (pre-SSIPB) and between January 2018-December 2020 (post-SSIPB) were compared using t-tests and chi-square. Patient characteristics, surgical factors, and ERAS process measures and outcomes were abstracted from the ERAS® Interactive Audit System (EIAS). The primary outcomes were incidence of surgical site infections (SSI) during post-operative hospital admission and at 30-days post-surgery. Secondary outcomes included total postoperative infections, length of stay, and any surgical complications. Multivariate models were used to adjust for potential confounding factors. RESULTS Patient and surgical characteristics were similar in the pre- and post-implementation periods. Evaluation of implementation suggested that preoperative and intraoperative components of the intervention were most consistently used. Infectious complications within 30 days of surgery decreased from 42.1% to 24.4% after implementation of the SSIPB (p < 0.001), including reductions in wound infections (17.0% to 10.8%, p = 0.02), urinary tract infections (UTI) (12.7% to 4.5%, p < 0.001), and intra-abdominal abscesses (5.4% to 2.5%, p = 0.05). These reductions were associated with a decrease in median length of stay from 3 to 2 days (p = 0.001). In multivariate analysis, these SSI reductions remained statistically significant after adjustment for potential confounders. CONCLUSION Implementation of SSIPB was associated with a reduction in SSIs and infectious complications, as well as a shorter length of stay in gynecologic oncology patients.
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Affiliation(s)
- Maede Ejaredar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tali Sara Glazer
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pat Trudeau
- Surgery Strategic Clinical Network TM, Alberta Health Services, Edmonton, Alberta, Canada
| | - Brent Jim
- Department of Oncology & Department of Obstetrics and Gynecology, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Gregg Nelson
- Department of Oncology and Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anna Cameron
- Department of Oncology and Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Abdellatife OE, Makowsky MJ. Factors influencing Implementation of point-of-care testing for acute respiratory infectious diseases in community pharmacies: A scoping review using the Consolidated Framework for Implementation research. Res Social Adm Pharm 2024; 20:1-24. [PMID: 38431516 DOI: 10.1016/j.sapharm.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Emerging evidence suggests pharmacy-based point-of-care (POC) testing for acute respiratory infectious diseases is beneficial, but not widely implemented. A theory-informed review to understand the factors influencing service Implementation is lacking. OBJECTIVE To examine the extent, range, and nature of research available on enablers and barriers to POC testing Implementation for infectious respiratory diseases in community pharmacies and identify their underpinning theoretical constructs using the Consolidated Framework for Implementation Research (CFIR). METHODS Scoping review guided by the JBI Manual for Evidence Synthesis. A comprehensive search from inception to June 28th, 2022 was conducted using Medline, Embase, CINAHL, Cochrane Library, and ProQuest dissertations without date or language restriction. Eligible articles investigated barriers and/or facilitators to strep throat, influenza, C-reactive protein, and COVID-19 POC testing in community pharmacies. Two reviewers independently performed title & abstract screening, full-text screening, and data extraction. Content analysis was conducted according to a pre-established Framework and concepts were mapped to the CFIR. RESULTS Forty-three studies were included. Most originated from the USA (n = 24; 56%) and investigated strep throat. The majority were testing/initial Implementation projects (n = 23; 54%) conducted in urban centers (n = 17; 40%). Thirty-six (84%) studies used quantitative methodology, while 6 (14%) were qualitative. Only four studies (9%) used theory to guide their inquiry. The 124 identified Implementation factors mapped onto 21 CFIR constructs, covering all 5 domains. The domain "Outer setting" (n = 35/43; 81%) was most prevalent as were the constructs "Patient needs and resources," (n = 21/43; 49%) "External policy & incentives," (n = 17/43; 40%) and "Relative advantage" (n = 17/43; 40%). CONCLUSION A large volume of research explores factors influencing the Implementation of pharmacy-based respiratory infectious disease POC testing services, but few studies use qualitative or theory-informed methods. Knowledge of the wide range of facilitators and barriers identified can help pharmacy managers and researchers design strategies to support successful service Implementation.
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Affiliation(s)
- Omar E Abdellatife
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada, T6G 1C9
| | - Mark J Makowsky
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada, T6G 1C9.
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Lawson GM, Azad G. School-Based Mental Health Interventions: Recommendations for Selecting and Reporting Implementation Strategies . THE JOURNAL OF SCHOOL HEALTH 2024; 94:581-585. [PMID: 38627895 DOI: 10.1111/josh.13458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Gwendolyn M Lawson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gazi Azad
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
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Burgess L, Theobald KA, Kynoch K, Keogh S. Assessment of Barriers, Supports, and Context to Implement Best Practice Pain Management in the Emergency Department: The IMPAINED Study. Pain Manag Nurs 2024:S1524-9042(24)00108-5. [PMID: 38825427 DOI: 10.1016/j.pmn.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/18/2024] [Accepted: 03/12/2024] [Indexed: 06/04/2024]
Abstract
AIM To assess the emergency department practice context and identify strategies to improve outcomes of patients with acute pain. BACKGROUND Effective treatment of acute pain in the emergency department depends upon clinicians adopting pain interventions into practice. However, it is well-recognized that acute pain is often undertreated. The local practice context strongly influences clinicians' adoption of interventions into their clinical practice. An assessment of this practice context can inform implementation interventions and strategies to improve outcomes for patients with acute pain. METHODS Chart audit, staff survey, and staff working groups were conducted from June 2020 to May 2021 Data were analyzed and synthesized across sources informed by assessment elements of the Ottawa model of research use (OMRU) implementation model and expert recommendations for implementing change strategies. RESULTS The OMRU facilitated contextual assessment of pain treatment practice in the emergency department and the development of implementation strategies. Adoption of evidence-based pain interventions was low in the sample studied. Workflow and workload were the primary barriers to evidence-based pain practices by potential adopters, while positive beliefs and high awareness of evidence-based pain interventions were supportive factors. Implementation strategies were informed by assessment findings and mapped to the Ottawa model and expert recommendations for implementing change elements. CONCLUSION The adoption of evidence into practice in the emergency department relies upon a comprehensive assessment of the local context. The use of the OMRU assessment process resulted in meaningful engagement with staff and a deeper understanding of local pain management practices. Clinicians view evidence-based pain management as important, however, there are competing priorities within the emergency department, such as patient flow and triage. This study provides an exemplar of utilizing an implementation framework to identify pain practices within the emergency department. CLINICAL IMPLICATIONS Achieving impactful change in clinical practice to improve patient outcomes should start with the application of implementation methods that enable comprehensive analysis of the local practice context. The assessment should begin with collaboration with local clinicians that persist throughout the life of the study to ensure change is sustainable.
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Affiliation(s)
- Luke Burgess
- School of Nursing, Queensland University of Technology, Brisbane, Australia; Mater Health and Queensland Centre for Evidence Based Nursing and Midwifery, A JBI Centre of Excellence, Brisbane, Australia.
| | - Karen A Theobald
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Kate Kynoch
- School of Nursing, Queensland University of Technology, Brisbane, Australia; Mater Health and Queensland Centre for Evidence Based Nursing and Midwifery, A JBI Centre of Excellence, Brisbane, Australia
| | - Samantha Keogh
- School of Nursing, Queensland University of Technology, Brisbane, Australia; Centre for Healthcare Transformation, Queensland University of Tecchnology, Brisbane, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Koldestam M, Rolander B, Broström A, Lindqvist G, Knutsson S. Undergraduate nursing student's attitudes to learning during clinical practice in different semesters when using a conceptual learning model grounded in a caritative caring perspective - A cross-sectional study. Scand J Caring Sci 2024; 38:294-305. [PMID: 38041229 DOI: 10.1111/scs.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/03/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
AIM To describe undergraduate nursing students' attitudes to learning during clinical practice in different semesters when using the conceptual learning model, Model for Improvements in Learning Outcomes (MILO) grounded in a caritative caring perspective. BACKGROUND With the intention to support interlinking between theory and praxis and offer understanding and structure to facilitate learning, MILO, theoretically grounded in hermeneutics and a caritative caring perspective based on ethical values, was implemented. MILO consists of four contextual concepts (peer learning, co-clinical teachers, student-centred and student-active supervision) and four intrapersonal concepts (nursing, a reflective approach, a critical approach, quality and safety). METHODS A descriptive comparative quantitative study design was applied at a Swedish university, 3 hospitals and 13 municipalities in one county. Cross-sectional data collected via a questionnaire developed to assess attitudes to learning related to MILO's contextual and intrapersonal concepts and their applications were used. RESULTS 209 students in semester 3, 4 and 6 participated in 6 different clinical practice courses. In comparison, intrapersonal concepts, that is, the student's own characteristics and abilities were viewed to be of greater value for learning than contextual, that is, organisational-related concepts in all semesters. Understanding the needs of others and reflective learning were rated to be of major importance. Students in semester 3 valued the use of the applications the highest. To be supervised in pairs was rated the lowest in semester 6. Some of the concepts and their applications were to great extent not applied. CONCLUSIONS In all semesters, fundamentals in caritative caring and characteristics and abilities related to the individual student were rated to be of greater importance for learning than environmental support. Providing students opportunities to develop independency seems essential. Use of a learning model such as MILO is dependent on a bearing of a caritative caring culture and a shared understanding between all involved in student learning during clinical practice.
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Affiliation(s)
- Maria Koldestam
- Department of Accident and Emergency, Region Jönköping County, Jonkoping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Vaxjo, Sweden
| | - Bo Rolander
- Futurum, Academy for Health and Care, Jönköping County Council, Jonkoping, Sweden
- Department of Social Work, School of Health and Welfare, Jönköping University, Jonkoping, Sweden
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jonkoping, Sweden
- Department of Clinical Neurophysiology, University Hospital, Linkoping, Sweden
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Gunilla Lindqvist
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Vaxjo, Sweden
| | - Susanne Knutsson
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Vaxjo, Sweden
- CHILD Research Group, Jönköping University, Jonkoping, Sweden
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Miano TA, Barreto EF, McNett M, Martin N, Sakhuja A, Andrews A, Basu RK, Ablordeppey EA. Toward Equitable Kidney Function Estimation in Critical Care Practice: Guidance From the Society of Critical Care Medicine's Diversity, Equity, and Inclusion in Renal Clinical Practice Task Force. Crit Care Med 2024; 52:951-962. [PMID: 38407240 PMCID: PMC11098700 DOI: 10.1097/ccm.0000000000006237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Accurate glomerular filtration rate (GFR) assessment is essential in critically ill patients. GFR is often estimated using creatinine-based equations, which require surrogates for muscle mass such as age and sex. Race has also been included in GFR equations, based on the assumption that Black individuals have genetically determined higher muscle mass. However, race-based GFR estimation has been questioned with the recognition that race is a poor surrogate for genetic ancestry, and racial health disparities are driven largely by socioeconomic factors. The American Society of Nephrology and the National Kidney Foundation (ASN/NKF) recommend widespread adoption of new "race-free" creatinine equations, and increased use of cystatin C as a race-agnostic GFR biomarker. DATA SOURCES Literature review and expert consensus. STUDY SELECTION English language publications evaluating GFR assessment and racial disparities. DATA EXTRACTION We provide an overview of the ASN/NKF recommendations. We then apply an Implementation science methodology to identify facilitators and barriers to implementation of the ASN/NKF recommendations into critical care settings and identify evidence-based implementation strategies. Last, we highlight research priorities for advancing GFR estimation in critically ill patients. DATA SYNTHESIS Implementation of the new creatinine-based GFR equation is facilitated by low cost and relative ease of incorporation into electronic health records. The key barrier to implementation is a lack of direct evidence in critically ill patients. Additional barriers to implementing cystatin C-based GFR estimation include higher cost and lack of test availability in most laboratories. Further, cystatin C concentrations are influenced by inflammation, which complicates interpretation. CONCLUSIONS The lack of direct evidence in critically ill patients is a key barrier to broad implementation of newly developed "race-free" GFR equations. Additional research evaluating GFR equations in critically ill patients and novel approaches to dynamic kidney function estimation is required to advance equitable GFR assessment in this vulnerable population.
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Affiliation(s)
- Todd A. Miano
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Erin F. Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, MN, United States of America
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, Ohio
| | - Niels Martin
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ankit Sakhuja
- Division of Data Driven and Digital Medicine, The Charles Bronfman Institute for Personalized Medicine and Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adair Andrews
- Society of Critical Care Medicine, Mount Prospect, IL
| | - Rajit K. Basu
- Ann & Robert Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Enyo Ama Ablordeppey
- Washington University School of Medicine, Department of Anesthesiology and Emergency Medicine, St. Louis, Missouri
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Walsh EI, Sargent GM, Gooyers L, Masters J, Laachir K, Vardoulakis S. How researchers can translate health evidence into books for children. Health Promot Int 2024; 39:daae035. [PMID: 38722020 PMCID: PMC11079950 DOI: 10.1093/heapro/daae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
The health promotion literature that considers how scientific evidence can be effectively communicated tends to focus on evaluating the effectiveness of communication materials. This has resulted in a knowledge gap regarding effective knowledge translation processes. This study explores the process, reasoning and practices for developing books for children that incorporate evidence-based information to aid understanding of scientific evidence about health and environmental or natural disasters. This study is informed by a systematic review of the literature combined with responses to an email interview with authors of books for children. Nine published studies were included in the systematic review. Twenty-two authors responded to the email survey (25% response rate, following 86 invitations). We report seven key findings to guide the development of health-promoting books for children: (i) understand the needs and expectations of the audience, (ii) articulate the topic and research evidence, (iii) assemble a team with a mix of content knowledge and creative expertise, (iv) format should be chosen to suit the user group and guided by the creative team, (v) early testing with children and their support system is crucial, (vi) develop a dissemination strategy to reach the user group and (vii) engage in reflexivity through evaluation of effectiveness of messaging. The current investigation can guide the process, reasoning and practice of developing books for children that incorporate evidence about health and environmental disasters.
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Affiliation(s)
- Erin I Walsh
- PHXchange (Population Health Exchange), National Centre for Epidemiology and Population Health, Australian National University, 62 Mills Rd, Acton 2601, Canberra, ACT, Australia
| | - Ginny M Sargent
- PHXchange (Population Health Exchange), National Centre for Epidemiology and Population Health, Australian National University, 62 Mills Rd, Acton 2601, Canberra, ACT, Australia
| | - Laura Gooyers
- Australian Child and Adolescent Trauma, Loss & Grief Network, Australian National University, Building 4 Level 2 The Canberra Hospital Yamba Drive, Garran 2605, Canberra, ACT, Australia
| | - Jessica Masters
- Australian Child and Adolescent Trauma, Loss & Grief Network, Australian National University, Building 4 Level 2 The Canberra Hospital Yamba Drive, Garran 2605, Canberra, ACT, Australia
- School of Literature, Arts and Media, University of Sydney, John Woolley Building, A20 Science Rd, Camperdown 2050, Sydney, NSW, Australia
| | - Karima Laachir
- Centre for Arab and Islamic Studies, Australian National University, 127 Ellery Cres, Acton 2601, Canberra, ACT, Australia
| | - Sotiris Vardoulakis
- Healthy Environments And Lives (HEAL) National Research Network, Australia
- National Centre for Epidemiology and Population Health, Australian National University, 62 Mills Rd, Acton 2601, Canberra, ACT, Australia
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Mehmood K, Qiu X, Ghaffar A, Khan MA. Deciphering the future of electric vehicles amid emissions and adoption drivers. AMBIO 2024:10.1007/s13280-024-02026-3. [PMID: 38822966 DOI: 10.1007/s13280-024-02026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 02/27/2024] [Accepted: 04/09/2024] [Indexed: 06/03/2024]
Abstract
Climate change and CO2 emissions are critical challenges for the environment and humanity. There is extensive literature on greenhouse gas (GHG) emissions, in particular CO2 emissions. However, comprehensive analyses focusing on electric vehicles (EVs) and their impact are lacking. This study fills this gap by conducting a bibliometric analysis of 1143 peer-reviewed studies from 1989 to 2023. We aimed to identify influential contributions, understand the field's structure, and reveal research gaps. Analysis included citation networks, research impact, authorship patterns, content, and publication trends. We utilized bibliometric techniques to identify the most dominant countries, institutions, authors, journals, articles, and thematic areas related to EVs and emissions. Additionally, we overviewed publications associated with key search terms. Guided by five research dimensions (EVs, emissions, adoption, policies, and infrastructures), we framed specific research questions. This research provides valuable insights for environmentalists, policymakers, regulators, and academic researchers, facilitating access to crucial data on EVs and emissions.
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Affiliation(s)
- Khalid Mehmood
- Institute of Environmental Health and Ecological Security, School of the Environment and Safety Engineering, Jiangsu University, No. 301 Xuefu Road, Jingkou District, Zhenjiang, 212013, Jiangsu, China
| | - Xuchun Qiu
- Institute of Environmental Health and Ecological Security, School of the Environment and Safety Engineering, Jiangsu University, No. 301 Xuefu Road, Jingkou District, Zhenjiang, 212013, Jiangsu, China.
- Jiangsu Collaborative Innovation Center of Technology and Material of Water Treatment, Suzhou University of Science and Technology, Suzhou, 215009, China.
| | - Abdul Ghaffar
- Zhejiang University-University of Illinois at Urbana-Champaign Institute (ZJU-UIUC), No. 718, Haizhou East Road, Haining City, 314400, Zhejiang Province, China
| | - Muhammad Ajmal Khan
- Directorate of Library Affairs, Build A-3, Eastern Campus, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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