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Gogovor A, Zomahoun HTV, Ben Charif A, Ekanmian G, Moher D, McLean RKD, Milat A, Wolfenden L, Prévost K, Aubin E, Rochon P, Rheault N, Légaré F. Informing the development of the SUCCEED reporting guideline for studies on the scaling of health interventions: A systematic review. Medicine (Baltimore) 2024; 103:e37079. [PMID: 38363902 PMCID: PMC10869056 DOI: 10.1097/md.0000000000037079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Quality reporting contributes to effective translation of health research in practice and policy. As an initial step in the development of a reporting guideline for scaling, the Standards for reporting stUdies of sCaling evidenCEd-informED interventions (SUCCEED), we performed a systematic review to identify relevant guidelines and compile a list of potential items. METHODS We conducted a systematic review according to Cochrane method guidelines. We searched the following databases: MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, from their respective inceptions. We also searched websites of relevant organizations and Google. We included any document that provided instructions or recommendations, e.g., reporting guideline, checklist, guidance, framework, standard; could inform the design or reporting of scaling interventions; and related to the health sector. We extracted characteristics of the included guidelines and assessed their methodological quality using a 3-item internal validity assessment tool. We extracted all items from the guidelines and classified them according to the main sections of reporting guidelines (title, abstract, introduction, methods, results, discussion and other information). We performed a narrative synthesis based on descriptive statistics. RESULTS Of 7704 records screened (published between 1999 and 2019), we included 39 guidelines, from which data were extracted from 57 reports. Of the 39 guidelines, 17 were for designing scaling interventions and 22 for reporting implementation interventions. At least one female author was listed in 31 guidelines, and 21 first authors were female. None of the authors belonged to the patient stakeholder group. Only one guideline clearly identified a patient as having participated in the consensus process. More than half the guidelines (56%) had been developed using an evidence-based process. In total, 750 items were extracted from the 39 guidelines and distributed into the 7 main sections. CONCLUSION Relevant items identified could inform the development of a reporting guideline for scaling studies of evidence-based health interventions. This and our assessment of guidelines could contribute to better reporting in the science and practice of scaling.
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Affiliation(s)
- Amédé Gogovor
- VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC
| | | | | | - Giraud Ekanmian
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC
| | - David Moher
- Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - Robert K. D. McLean
- International Development Research Centre, Ottawa, ON
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, ON
| | - Andrew Milat
- School of Public Health, University of Sydney, Camperdown, NSW
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW
- The National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW
| | | | | | - Paula Rochon
- Women’s Age Lab, Women’s College Hospital, Toronto, ON
- Department of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - France Légaré
- VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC
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Abstract
This Viewpoint discusses the expansion of firearm injury research that involves diverse disciplinary perspectives that could potentially lead to lifesaving policy innovation.
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McClung HL, Raynor HA, Volpe SL, Dwyer JT, Papoutsakis C. A Primer for the Evaluation and Integration of Dietary Intake and Physical Activity Digital Measurement Tools into Nutrition and Dietetics Practice. J Acad Nutr Diet 2022; 122:207-218. [PMID: 33863675 PMCID: PMC8593109 DOI: 10.1016/j.jand.2021.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Holly L McClung
- US Army Research Institute of Environmental Medicine, Natick, MA
| | - Hollie A Raynor
- Department of Nutrition with the University of Tennessee Knoxville, Knoxville, TN
| | - Stella L Volpe
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | - Johanna T Dwyer
- Frances Stern Nutrition Center, Tufts Medical Center, Boston, MA
| | - Constantina Papoutsakis
- Nutrition and Dietetics Data Science Center, Research International and Scientific Affairs with the Academy of Nutrition and Dietetics, Chicago, IL.
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Chao GF, Emlaw J, Chiu AS, Yang J, Thumma J, Brackett A, Pei KY. Asian American Pacific Islander Representation in Outcomes Research: NSQIP Scoping Review. J Am Coll Surg 2021; 232:682-689.e5. [PMID: 33705984 DOI: 10.1016/j.jamcollsurg.2021.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND If Asian American and Pacific Islanders (AAPIs) are not recognized within patients in health services research, we miss an opportunity to ensure health equity in patient outcomes. However, it is unknown what the rates are of AAPIs inclusion in surgical outcomes research. STUDY DESIGN Through a scoping review, we used Covidence to search MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, and CINAHL for studies published in 2008-2018 using NSQIP data. NSQIP was chosen because of its national scope, widespread use in research, and coding inclusive of AAPI patients. We examined the proportion of studies representing AAPI patients in the demographic characteristics and Methods, Results, or Discussion section. We then performed multivariable logistic regression to examine associations between study characteristics and AAPI inclusion. RESULTS In 1,264 studies included for review, 62% included race. Overall, only 22% (n = 278) of studies included AAPI patients. Of studies that included race, 35% represented AAPI patients in some component of the study. We found no association between sample size or publication year and inclusion. Studies were significantly more likely to represent AAPI patients when there was a higher AAPI population in the region of the first author's institution (lowest vs highest tercile; p < 0.001). Studies with a focus on disparities were more likely to include AAPI patients (p = 0.001). CONCLUSIONS Our study is the first to examine AAPI representation in surgical outcomes research. We found < 75% of studies examine race, despite availability within NSQIP. Little more than one-third of studies including race reported on AAPI patients as a separate group. To provide the best care, we must include AAPI patients in our research.
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Affiliation(s)
- Grace F Chao
- National Clinician Scholars Program, Veterans Affairs Ann Arbor, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Surgery, New Haven, CT.
| | - Jonel Emlaw
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | | | - Jie Yang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Jyothi Thumma
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, CT
| | - Kevin Y Pei
- Department of Surgery, Houston Methodist Hospital, Houston, TX
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Burki T. Action framework on healthy food: a way forward for the public sector. Lancet Diabetes Endocrinol 2021; 9:143. [PMID: 33539726 DOI: 10.1016/s2213-8587(21)00024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Affiliation(s)
- Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational Clinical Research Institute, Newcastle University and Newcastle-upon-Tyne NHS Trust, Newcastle upon Tyne, UK
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK
- NIHR Applied Research Collaboration-East Midlands, Nottingham, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Royal United Hospital Bath NHS Foundation Trust, Bath, UK
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA
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Abstract
To address the global mental health crisis exacerbated by the COVID-19 pandemic, an urgent need has emerged to transform the accessibility, efficiency, and quality of mental health care. The next suite of efforts to transform mental health care must foster the implementation of "learning organizations," that is, organizations that continuously improve patient-centered care through ongoing data collection. The concept of learning organizations is highly regarded, but the key features of such organizations, particularly those providing mental health care, are less well defined. Using telepsychiatry care as an example, the authors of this Open Forum concretely describe the key building blocks for operationalizing a learning organization in mental health care to set a research agenda for services transformation.
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Affiliation(s)
- Rinad Beidas
- Departments of Psychiatry, Medical Ethics & Health Policy, Medicine, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3015, Philadelphia, PA 19104
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Shannon Wiltsey Stirman
- National Center for PTSD, Menlo Park, CA
- Department of Psychiatry and Biobehavioral Sciences, Stanford University, Stanford, CA
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Abstract
The Patient-Centered Outcomes Research Institute’s (PCORI) methodology standards for qualitative methods and mixed methods research help ensure that research studies are designed and conducted to generate the evidence needed to answer patients’ and clinicians’ questions about which methods work best, for whom, and under what circumstances. This set of standards focuses on factors pertinent to patient centered outcomes research, but it is also useful for providing guidance for other types of clinical research. The standards can be used to develop and evaluate proposals, conduct the research, and interpret findings. The standards were developed following a systematic process: survey the range of key methodological issues and potential standards, narrow inclusion to standards deemed most important, draft preliminary standards, solicit feedback from a content expert panel and the broader public, and use this feedback to develop final standards for review and adoption by PCORI’s board of governors. This article provides an example on how to apply the standards in the preparation of a research proposal.
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Affiliation(s)
- Bridget Gaglio
- Patient-Centered Outcomes Research Institute, 1828 L Street, Suite 900, Washington, DC, 20036, USA
| | - Michelle Henton
- Patient-Centered Outcomes Research Institute, 1828 L Street, Suite 900, Washington, DC, 20036, USA
| | - Amanda Barbeau
- Patient-Centered Outcomes Research Institute, 1828 L Street, Suite 900, Washington, DC, 20036, USA
| | - Emily Evans
- Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC, USA
| | - David Hickam
- Patient-Centered Outcomes Research Institute, 1828 L Street, Suite 900, Washington, DC, 20036, USA
| | - Robin Newhouse
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Susan Zickmund
- United States Department of Veterans Affairs, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
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Sabin JE, Cocoros NM, Garcia CJ, Goldsack JC, Haynes K, Lin ND, McCall D, Nair V, Pokorney SD, McMahill-Walraven CN, Granger CB, Platt R. Bystander Ethics and Good Samaritanism: A Paradox for Learning Health Organizations. Hastings Cent Rep 2020; 49:18-26. [PMID: 31429964 DOI: 10.1002/hast.1031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In 2012, a U.S. Institute of Medicine report called for a different approach to health care: "Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets." The answer, they suggested, would be a "continuously learning" health system. Ethicists and researchers urged the creation of "learning health organizations" that would integrate knowledge from patient-care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation-a trial known as IMPACT-AFib-gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be "bystanders" in relation to a control group receiving suboptimal care. In response, the researchers designed a "workaround" that allowed the project to go forward. We believe the experience suggests that what we call "bystander ethics" will create challenges for the kinds of quality improvement research that LHOs are designed to do.
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Blecha S, Weber-Carstens S, Bein T. [Health services research in intensive care medicine in Germany : Status quo and future challenges exemplified by acute pulmonary failure]. Anaesthesist 2020; 68:343-352. [PMID: 31101923 DOI: 10.1007/s00101-019-0602-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Health services research (HSR) is a multidisciplinary field of research that describes disease treatment and health care and their framework conditions. In the last 20 years, the HSR aspect became more and more the clinical focus of intensive care medicine. Under this aspect HSR investigates the use of clinical measures and their impact on patient outcome under routine intensive care medical conditions. This article provides an overview of the current state of HSR in intensive care medicine in Germany using the example of acute respiratory distress syndrome (ARDS). The ARDS still represents a clinical disease with high intra-hospital mortality (30-60%) despite progress in intensive care medicine. Survivors of ARDS have substantial long-term limitations on physical and mental health. The treatment of ARDS patients is tedious, laborious for intensive care unit staff and complex. Despite evident treatment recommendations, these are only insufficiently implemented in the clinical routine. With the help of quality indicators, benchmarking, certification and peer review procedures, the quality of intensive care treatment in the clinical routine can be documented and improved. An important role in HSR is patient safety and focusing on the outcome with evaluation of the patient's will. As part of the establishment of the innovation fund for HSR, promising intensive medical care projects have been promoted to improve the quality of care and the quality of long-term outcome for intensive care patients. An important focus lies on the identification of factors that improve long-term quality of life after intensive care. The expansion of registries and telemedicine in intensive care offers the opportunity to bundle and share experiences more effectively and thereby establish (guideline-based) treatment recommendations faster in the clinical practice.
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Affiliation(s)
- S Blecha
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - S Weber-Carstens
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Mitte, Berlin, Deutschland
| | - T Bein
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Abstract
The literature is replete with clinical practice guidelines (CPGs) and evidence supporting them. Translating guidelines into practice, however, is often challenging. We conducted a concept analysis to define the concept of "implementation of CPGs in health care settings." We utilized Walker and Avant's methodology to define the concept of "implementation of CPGs in health care settings." This included a focused review of the literature, defining the relevant attributes, defining implementation, case examples, and antecedents and potential consequences from implementation of CPGs in health care settings. The concept "implementation" is complex, with numerous frameworks, facilitators, and barriers to implementation described in the literature. The existing literature supports our definition of implementation of CPGs in a health care setting as a process of changing practice in health care while utilizing the best level of evidence that is available in the published literature. These include 7 attributes necessary for effective implementation. Implementation of CPGs in health care settings requires an ongoing iterative process that considers these attributes and is inclusive to administrators, clinicians, and patients to ensure guidelines are understood, accepted, implemented, and evaluated for continued adoption of best practices. Ongoing efforts inclusive at all steps of implementation across multiple levels are needed to effectively change practice.
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Affiliation(s)
| | - Elizabeth Cohn
- Hunter College, The Graduate Center, City University of New York, New York, 10016
| | - Rachel C. Shelton
- Mailman School of Public Health, Columbia University, New York, NY 10032
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Abstract
Advancements in evidence-based psychosocial interventions, digital technologies, and implementation strategies (i.e., health services research products) for youth mental health services have yet to yield significant improvement in public health outcomes. Achieving such impact will require that these research products are easy to use, useful, and contextually appropriate. This paper describes how human-centered design (HCD), an approach that aligns product development with the needs of the people and settings that use those products, can be leveraged to improve youth mental health services. We articulate how HCD can advance accessibility, effectiveness, and equity, with specific consideration of unique aspects of youth mental health services.
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Affiliation(s)
- Aaron R. Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Alex R. Dopp
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401 USA
| | - Stephanie K. Brewer
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Julie A. Kientz
- Department of Human Centered Design and Engineering, University of Washington, 428 Sieg Hall, Seattle, WA 98195 USA
| | - Sean A. Munson
- Department of Human Centered Design and Engineering, University of Washington, 428 Sieg Hall, Seattle, WA 98195 USA
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Mühlbacher AC. Science or Art? Reproducibility of Health Preference Research. Value Health 2020; 23:829-830. [PMID: 32762983 DOI: 10.1016/j.jval.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Axel C Mühlbacher
- Health Economics and Health Care Management, Hochschule Neubrandenburg, Neubrandenburg, Germany.
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Spence ND, Skelton JA, Ball GDC. A proposed standardized approach to studying attrition in pediatric weight management. Obes Res Clin Pract 2019; 14:60-65. [PMID: 31818674 DOI: 10.1016/j.orcp.2019.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/29/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022]
Abstract
Pediatric obesity is a major public health issue. Lifestyle and behavioral interventions are the foundation of pediatric weight management; however, intervention effectiveness is compromised when families (children, youth, and/or parent[s]) discontinue care prematurely. Intervention attrition minimizes the potential health benefits derived from interventions, results in inefficient use of health services resources, and can magnify health disparities. Most attrition research in pediatric weight management has been descriptive, highlighting the need to advance the field, both academically and clinically. Herein, we propose a standard approach to studying attrition in pediatric weight management interventions to enhance our understanding, elevate the quality of research, enable study-to-study comparisons, and inform strategies designed to mitigate its impact. We focus on three issues. First, "Conceptualization and operationalization," whereby the processes underlying attrition from interventions should be decomposed into clinically important phases that are defined based on intervention characteristics. Relatedly, theoretically relevant variables should be identified with different mechanisms driving attrition in each phase. We propose a matrix of attrition, a tool designed to delineate the relevant stages of attrition and associated variables of analytical value. Second, "Pre-study" underscores the value of developing a plan to study attrition a priori rather than post hoc, including variable and sample size considerations, which broadens the range and quality of analysis. Finally, "Post-study" emphasizes comprehensive reporting of attrition, outlines typical comparisons of analytical interest, and statistical techniques used to handle missing data. Implications for clinical practice in pediatric weight management are discussed. Clinical Trial Registration: Not applicable.
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Affiliation(s)
- Nicholas D Spence
- Department of Sociology, University of Toronto, Toronto, ON, Canada; Interdisciplinary Center for Health and Society, University of Toronto, Toronto, ON, Canada
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, United States; Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Medical Center Boulevard, Winston-Salem, NC, United States; Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; Pediatric Centre for Weight & Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada.
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Parolini A, Tan WW, Shlonsky A. Decision-based models of the implementation of interventions in systems of healthcare: Implementation outcomes and intervention effectiveness in complex service environments. PLoS One 2019; 14:e0223129. [PMID: 31622372 PMCID: PMC6797080 DOI: 10.1371/journal.pone.0223129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/14/2019] [Indexed: 11/18/2022] Open
Abstract
Implementation is a crucial component for the success of interventions in health service systems, as failure to implement well can have detrimental impacts on the effectiveness of evidence-based practices. Therefore, evaluations conducted in real-world contexts should consider how interventions are implemented and sustained. However, the complexity of healthcare environments poses considerable challenges to the evaluation of interventions and the impact of implementation efforts on the effectiveness of evidence-based practices. In consequence, implementation and intervention effectiveness are often assessed separately in health services research, which prevents the direct investigation of the relationships of implementation components and effectiveness of the intervention. This article describes multilevel decision juncture models based on advances in implementation research and causal inference to study implementation in health service systems. The multilevel decision juncture model is a theory-driven systems approach that integrates structural causal models with frameworks for implementation. This integration enables investigation of interventions and their implementation within a single model that considers the causal links between levels of the system. Using a hypothetical youth mental health intervention inspired by published studies from the health service research and implementation literature, we demonstrate that such theory-based systems models enable investigations of the causal pathways between the implementation outcomes as well as their links to patient outcomes. Results from Monte Carlo simulations also highlight the benefits of structural causal models for covariate selection as consistent estimation requires only the inclusion of a minimal set of covariates. Such models are applicable to real-world context using different study designs, including longitudinal analyses which facilitates the investigation of sustainment of interventions.
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Affiliation(s)
- Arno Parolini
- Department of Social Work, University of Melbourne, Carlton, Victoria, Australia
- * E-mail:
| | - Wei Wu Tan
- Department of Social Work, University of Melbourne, Carlton, Victoria, Australia
| | - Aron Shlonsky
- Department of Social Work, Monash University, Caulfield East, Victoria, Australia
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16
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Defourny N, Monten C, Grau C, Lievens Y, Perrier L. Critical review and quality-assessment of cost analyses in radiotherapy: How reliable are the data? Radiother Oncol 2019; 141:14-26. [PMID: 31630866 DOI: 10.1016/j.radonc.2019.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE/OBJECTIVE Health economic evaluations (HEE) are increasingly having an impact on policymakers, although the results greatly depend on the quality of the methodology used and on transparent reporting. The two main objectives of this study were to evaluate the quality of cost analyses of external beam radiotherapy (EBRT) and to assess the comprehensiveness and relevance of cost criteria defined in three validated quality-assessment instruments. MATERIALS AND METHODS The selection of articles was based on a previous systematic literature review of EBRT-costing studies retrieved from January 2004 to January 2015 (Period 1) in MEDLINE, Embase, and NHS-EED databases and completed in a second time period from January 2015 to November 2018 (Period 2). Three validated instruments to assess the methodology quality with the CHEC and the QHES, and the methodology with the CHEERS checklists were used. The quality was evaluated by both quantitative and qualitative analyses. The scoring robustness was examined with the Kendall coefficient of concordance and inter-class correlation coefficients. RESULTS In total, twenty-three articles were selected. The main geographic areas of cost analyses were Canada (n = 5), France (n = 4), and the USA (n = 4). The most commonly studied pathologies and technologies were prostate (n = 7) and head and neck cancer (n = 5) and IMRT (n = 8) and IGRT (n = 2), respectively. The mean instrument scores demonstrated a fair degree of methodological quality, with 69.7% for the CHEC, 73.6% for the QHES, as well as for the reporting quality, with 59.4% for CHEERS for Period 1 (74.4%, 71.5%, and 66.1%, respectively, for Period 2). An additional qualitative analysis per criterion revealed that certain items, essential for understanding the costing methodology and the results (e.g., the time horizon, discount rate, sensitivity analysis) were often only partially completed. Statistical analysis confirmed that the reviewers' scoring was consistent. The instruments identified the same top three articles, albeit with a degree of variation in the ranking. CONCLUSION Qualitative and quantitative assessment of cost analyses in EBRT exhibits a fair level of study quality in terms of the methodology and reporting transparency. The impact of cost calculations on the final HEE result appears to be underestimated, and increased transparency of the data sources and the methodologies is needed.
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Affiliation(s)
- Noémie Defourny
- Ghent University, European SocieTy for Radiotherapy & Oncology, Brussels, Belgium.
| | - Chris Monten
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Belgium
| | - Cai Grau
- Aarhus University Hospital, Aarhus C, Denmark
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Belgium
| | - Lionel Perrier
- Université de Lyon, Léon Bérard Cancer Centre, GATE UMR 5824, Lyon, France
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Luciani M, Campbell KA, Whitmore C, Di Mauro S, Jack SM. How to critically appraise a qualitative health research study. Prof Inferm 2019; 72:283-293. [PMID: 32243743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Evidence-based nursing is a process that requires nurses to have the knowledge, skills, and confidence to critically reflect on their practice, articulate structured questions, and then reliably search for research evidence to address the questions posed. Many types of research evidence are used to inform decisions in health care and findings from qualita- tive health research studies are useful to provide new insights about individuals' experi- ences, values, beliefs, needs, or perceptions. Before qualitative evidence can be utilized in a decision, it must be critically appraised to determine if the findings are trustworthy and if they have relevance to the identified issue or decision. In this article, we provide practical guidance on how to select a checklist or tool to guide the critical appraisal of qualitative studies and then provide an example demonstrating how to apply the critical appraisal process to a clinical scenario.
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Affiliation(s)
- Michela Luciani
- RN, MScN, PhD, School of Nursing, Dept. of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy.
| | - Karen A Campbell
- RN MScN PhD student, School of Nursing, McMaster University,Hamilton, Ontario, Canada
| | - Carly Whitmore
- RN, PhD student, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Stefania Di Mauro
- RN, MScN PhD, School of Nursing, Dept. of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - Susan M Jack
- RN, PhD, School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Lega F. A "new normality" for health services management research. Health Serv Manage Res 2019; 32:167. [PMID: 31488019 DOI: 10.1177/0951484819875834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nyanchoka L, Tudur-Smith C, Porcher R, Hren D. Key stakeholders' perspectives and experiences with defining, identifying and displaying gaps in health research: a qualitative study protocol. BMJ Open 2019; 9:e027926. [PMID: 31481368 PMCID: PMC6731867 DOI: 10.1136/bmjopen-2018-027926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Identifying research gaps can inform the design and conduct of health research, practice and policies by informing the current body of evidence. Audiences including researchers, clinical guideline developers, clinicians, policymakers, research regulatory bodies, funders and patients/the public can also benefit from understanding the status of research and research gaps to make informed choices. This study aims to explore how key informants define research gaps and characterise methods/practices used to identify and display gaps in health research to inform future research practice and policies. METHODS AND ANALYSIS This is an exploratory qualitative study using semi-structured in-depth interviews. The participants will be recruited by purposive sampling from initiatives and organisations previously identified in a scoping review on methods to identify, prioritise and display gaps in health research. We anticipate performing up to 28 interviews with the different key informant groups who are involved in using evidence to inform health policy, practice and research. Interviews will be thematically analysed as outlined by Braun and Clarke. The qualitative data-analysis software NVivo V.12 Pro will be used to aid data management and analysis. DISCUSSION This is the protocol for a follow-up study that aims to complement and enrich the findings of the scoping review on methods to identify, prioritise and display gaps in health research. The overall project aims to develop methodological guidance for describing, identifying and displaying gaps in health research. ETHICS AND DISSEMINATION The research obtained ethical approval from the University of Liverpool, UK. The findings will be disseminated via conferences, meetings (organised by the Methods in Research on Research project), peer-reviewed publications and lay magazines because the study participants will include the public/patients.
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Affiliation(s)
- Linda Nyanchoka
- Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Catrin Tudur-Smith
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Raphaël Porcher
- Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France
| | - Darko Hren
- School of Humanities and Social Sciences, University of Split, Split, Croatia
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Affiliation(s)
- Marcia Anderson
- Indigenous Academic Affairs, Ongomiizwin Indigenous Institute of Health and Healing, and Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
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Glenton C, Lewin S, Lawrie TA, Barreix M, Downe S, Finlayson KW, Tamrat T, Rosenbaum S, Tunçalp Ö. Qualitative Evidence Synthesis (QES) for Guidelines: Paper 3 - Using qualitative evidence syntheses to develop implementation considerations and inform implementation processes. Health Res Policy Syst 2019; 17:74. [PMID: 31391071 PMCID: PMC6686245 DOI: 10.1186/s12961-019-0450-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/04/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND This is the third in a series of three papers describing the use of qualitative evidence syntheses (QES) to inform the development of clinical and health systems guidelines. WHO has recognised the need to improve its guideline methodology to ensure that decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable to end users. In addition to the standard data on effectiveness, WHO guidelines increasingly use evidence derived from QES to provide information on acceptability and feasibility and to develop important implementation considerations. METHODS WHO convened a group drawn from the technical teams involved in formulating recent (2010-2018) guidelines employing QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. As members of WHO guideline technical teams, our aim in this paper is to explore how we have used findings from QES to develop implementation considerations for these guidelines. RESULTS For each guideline, in addition to using systematic reviews of effectiveness, the technical teams used QES to gather evidence of the acceptability and feasibility of interventions and, in some cases, equity issues and the value people place on different outcomes. This evidence was synthesised using standardised processes. The teams then used the QES to identify implementation considerations combined with other sources of information and input from experts. CONCLUSIONS QES were useful sources of information for implementation considerations. However, several issues for further development remain, including whether researchers should use existing health systems frameworks when developing implementation considerations; whether researchers should take confidence in the evidence into account when developing implementation considerations; whether qualitative evidence that reveals implementation challenges should lead guideline panels to make conditional recommendations or only point to implementation considerations; and whether guideline users find it helpful to have challenges pointed out to them or whether they also need solutions. Finally, we need to explore how QES findings can be incorporated into derivative products to aid implementation.
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Affiliation(s)
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - María Barreix
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Soo Downe
- University of Central Lancashire, Preston, United Kingdom
| | | | - Tigest Tamrat
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | | | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Lewin S, Glenton C, Lawrie TA, Downe S, Finlayson KW, Rosenbaum S, Barreix M, Tunçalp Ö. Qualitative Evidence Synthesis (QES) for Guidelines: Paper 2 - Using qualitative evidence synthesis findings to inform evidence-to-decision frameworks and recommendations. Health Res Policy Syst 2019; 17:75. [PMID: 31391119 PMCID: PMC6686513 DOI: 10.1186/s12961-019-0468-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/06/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND WHO has recognised the need to improve its guideline methodology to ensure that guideline decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. To help achieve this, WHO guidelines now typically enhance intervention effectiveness data with evidence on a wider range of decision-making criteria, including how stakeholders value different outcomes, equity, gender and human rights impacts, and the acceptability and feasibility of interventions. Qualitative evidence syntheses (QES) are increasingly used to provide evidence on this wider range of issues. In this paper, we describe and discuss how to use the findings from QES to populate decision-making criteria in evidence-to-decision (EtD) frameworks. This is the second in a series of three papers that examines the use of QES in developing clinical and health system guidelines. METHODS WHO convened a writing group drawn from the technical teams involved in its recent (2010-2018) guidelines employing QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. RESULTS We describe a step-wise approach to populating EtD frameworks with QES findings. This involves allocating findings to the different EtD criteria (how stakeholders value different outcomes, equity, acceptability and feasibility, etc.), weaving the findings into a short narrative relevant to each criterion, and inserting this summary narrative into the corresponding 'research evidence' sections of the EtD. We also identify areas for further methodological research, including how best to summarise and present qualitative data to groups developing guidelines, how these groups draw on different types of evidence in their decisions, and the extent to which our experiences are relevant to decision-making processes in fields other than health. CONCLUSIONS This paper shows the value of incorporating QES within a guideline development process, and the roles that qualitative evidence can play in integrating the views and experiences of relevant stakeholders, including groups who may not be otherwise represented in the decision-making process.
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Affiliation(s)
- Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | | | - Soo Downe
- University of Central Lancashire, Preston, United Kingdom
| | | | | | - María Barreix
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Downe S, Finlayson KW, Lawrie TA, Lewin SA, Glenton C, Rosenbaum S, Barreix M, Tunçalp Ö. Qualitative Evidence Synthesis (QES) for Guidelines: Paper 1 - Using qualitative evidence synthesis to inform guideline scope and develop qualitative findings statements. Health Res Policy Syst 2019; 17:76. [PMID: 31391057 PMCID: PMC6686511 DOI: 10.1186/s12961-019-0467-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/06/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND WHO has recognised the need to ensure that guideline processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. Along with decision-making criteria that require findings from effectiveness reviews, WHO is increasingly using evidence derived from qualitative evidence syntheses (QES) to inform the values, acceptability, equity and feasibility implications of its recommendations. This is the first in a series of three papers examining the use of QES in developing clinical and health systems guidelines. METHODS WHO convened a group of methodologists involved in developing recent (2010-2018) guidelines that were informed by QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. Our aim in this paper is to (1) describe and discuss how the findings of QES can inform the scope of a guideline and (2) develop findings for key guideline decision-making criteria. RESULTS QES resulted in the addition of new outcomes that are directly relevant to service users, a stronger evidence base for decisions about how much effective interventions and related outcomes are valued by stakeholders in a range of contexts, and a more complete database of summary evidence for guideline panels to consider, linked to decisions about values, acceptability, feasibility and equity. CONCLUSIONS Rigorously conducted QES can be a powerful means of improving the relevance of guidelines, and of ensuring that the concerns of stakeholders, at all levels of the healthcare system and from a wide range of settings, are taken into account at all stages of the process.
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Affiliation(s)
- Soo Downe
- University of Central Lancashire, Preston, United Kingdom
| | | | | | - Simon A. Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | | | - María Barreix
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Affiliation(s)
- Ligia Gómez
- Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali, Colombia
| | - Andrés Jaramillo
- Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Beatrice Halpaap
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Pascal Launois
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Luis Gabriel Cuervo
- Health Services and Access Unit, Department of Health Systems and Services of the Pan-American Health Organization/World Health Organization, Washington, DC, United States of America
| | - Nancy Gore Saravia
- Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali, Colombia
- Universidad Icesi, Cali, Colombia
- * E-mail:
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Abstract
BACKGROUND Academic faculty who devote most of their time to clinical work often struggle to engage in meaningful scholarly work. They may be disadvantaged by limited research training and limited time. Simply providing senior mentors and biostatistical support has limited effectiveness. OBJECTIVE We aimed to increase productivity in scholarly work of hospitalists and internal medicine physicians by integrating an Academic Research Coach into a robust faculty development program. DESIGN This was a pre-post quality improvement evaluation. SETTING This was conducted at the University of Washington in faculty across three academic-affiliated hospitals and 10 academic-affiliated clinics. PARTICIPANTS Participants were hospitalists and internists on faculty in the Division of General Internal Medicine at the University of Washington. INTERVENTION The coach was a 0.50 full time equivalent health services researcher with strong research methods, project implementation, and interpersonal skills. The coach consulted on research, quality improvement, and other scholarship. MEASUREMENTS We assessed the number of faculty supported, types of services provided, and numbers of grants, papers, and abstracts submitted and accepted. RESULTS The coach consulted with 49 general internal medicine faculty including 30 hospitalists who conducted 63 projects. The coach supported 13 publications, 11 abstracts, four grant submissions, and seven manuscript reviews. Forty-eight faculty in other departments benefited as co-authors. CONCLUSION Employing a dedicated health services researcher as part of a faculty development program is an effective way to engage clinically oriented faculty in meaningful scholarship. Key aspects of the program included an accessible and knowledgeable coach and an ongoing marketing strategy.
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Affiliation(s)
- Christy M McKinney
- Department of Pediatrics, Division of Craniofacial Medicine and Seattle Children's Research Institute, University of Washington, Seattle, Washington
| | - Somnath Mookherjee
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, Washington
| | - Stephan D Fihn
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, Washington
| | - Thomas H Gallagher
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, Washington
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Affiliation(s)
- Katerini T Storeng
- Centre for Development and the Environment, University of Oslo, Oslo, Norway; Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Jennifer Palmer
- Department of Global Health, London School of Hygiene and Tropical Medicine, London, UK
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Mollayeva T, Amodio V, Mollayeva S, D’Souza A, Colquhoun H, Quilico E, Haag H(L, Colantonio A. A gender-transformative approach to improve outcomes and equity among persons with traumatic brain injury. BMJ Open 2019; 9:e024674. [PMID: 31110084 PMCID: PMC6530315 DOI: 10.1136/bmjopen-2018-024674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The initiation and translation of sex-sensitive and gender-sensitive research programmes into clinically useful considerations for patients with traumatic brain injury (TBI) have been difficult. Clinical frameworks are currently not specific according to sex and gender, despite evidence that these constructs influence the incidence, course and outcome of patients with TBI. The present protocol outlines a strategy for a research programme, supported by the Canadian Institutes of Health Research (CIHR) Institute of Gender and Health, which explores sex and gender topics in the context of TBI, with the goal of building an infrastructure to facilitate the implementation of sex/gender-sensitive research findings into clinical considerations. METHODS AND ANALYSIS A comprehensive multistep research programme is proposed to support three research objectives: (1) documentation of important concepts and ideas for education on topics of sex and gender in the TBI context using a knowledge-user feedback framework, current scientific evidence and the research team's expertise; (2) development of educational materials for patients with TBI, significant others and clinicians providing care that account for sex/gender and (3) testing the application of these educational materials for feasibility and effectiveness. This programme supports the CIHR Institute's mission by facilitating partnership with knowledge users across clinical, research, academic and community sectors, through a range of platforms and activities. ETHICS AND DISSEMINATION The Research Ethics Board of the University Health Network has approved the programme. It is anticipated that this work will add significant value to the advancement of the field of sex, gender and health by serving as a model to foster the integration of these constructs across the spectrum of disorders. This will transform clinical practices and ensure that generated knowledge is translated into improved training programmes, policies and health services that are responsive to the diverse needs of men and women with TBI. PROSPERO REGISTRATION NUMBER CRD42018098697.
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Affiliation(s)
- Tatyana Mollayeva
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Research Department, Toronto Rehabilitation Institute–University Health Network, Toronto, Ontario, Canada
| | - Vanessa Amodio
- Research Department, Toronto Rehabilitation Institute–University Health Network, Toronto, Ontario, Canada
| | - Shirin Mollayeva
- Research Department, Toronto Rehabilitation Institute–University Health Network, Toronto, Ontario, Canada
| | - Andrea D’Souza
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Enrico Quilico
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Halina (Lin) Haag
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Ontario, Canada
| | - Angela Colantonio
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Research Department, Toronto Rehabilitation Institute–University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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Gerrits RG, Jansen T, Mulyanto J, van den Berg MJ, Klazinga NS, Kringos DS. Occurrence and nature of questionable research practices in the reporting of messages and conclusions in international scientific Health Services Research publications: a structured assessment of publications authored by researchers in the Netherlands. BMJ Open 2019; 9:e027903. [PMID: 31097488 PMCID: PMC6530378 DOI: 10.1136/bmjopen-2018-027903] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Explore the occurrence and nature of questionable research practices (QRPs) in the reporting of messages and conclusions in international scientific Health Services Research (HSR) publications authored by researchers from HSR institutions in the Netherlands. DESIGN In a joint effort to assure the overall quality of HSR publications in the Netherlands, 13 HSR institutions in the Netherlands participated in this study. Together with these institutions, we constructed and validated an assessment instrument covering 35 possible QRPs in the reporting of messages and conclusions. Two reviewers independently assessed a random sample of 116 HSR articles authored by researchers from these institutions published in international peer-reviewed scientific journals in 2016. SETTING Netherlands, 2016. SAMPLE 116 international peer-reviewed HSR publications. MAIN OUTCOME MEASURES Median number of QRPs per publication, the percentage of publications with observed QRP frequencies, occurrence of specific QRPs and difference in total number of QRPs by methodological approach, type of research and study design. RESULTS We identified a median of six QRPs per publication out of 35 possible QRPs. QRPs occurred most frequently in the reporting of implications for practice, recommendations for practice, contradictory evidence, study limitations and conclusions based on the results and in the context of the literature. We identified no differences in total number of QRPs in papers based on different methodological approach, type of research or study design. CONCLUSIONS Given the applied nature of HSR, both the severity of the identified QRPs, and the recommendations for policy and practice in HSR publications warrant discussion. We recommend that the HSR field further define and establish its own scientific norms in publication practices to improve scientific reporting and strengthen the impact of HSR. The results of our study can serve as an empirical basis for continuous critical reflection on the reporting of messages and conclusions.
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Affiliation(s)
- Reinie G Gerrits
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Tessa Jansen
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joko Mulyanto
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Michael J van den Berg
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Niek S Klazinga
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dionne S Kringos
- Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Hess LM, Zhu YE, Sugihara T, Fang Y, Collins N, Nicol S. Challenges of Using ICD-9-CM and ICD-10-CM Codes for Soft-Tissue Sarcoma in Databases for Health Services Research. Perspect Health Inf Manag 2019; 16:1a. [PMID: 31019431 PMCID: PMC6462881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Soft-tissue sarcoma (STS) is a heterogeneous group of rare solid tumors that arise from various soft tissues in the body, such as muscle, fat, nerves, and blood vessels. Current International Classification of Diseases (ICD) coding systems include a set of nonspecific codes for malignancies of connective and soft tissue (ICD-9-CM code 171 and ICD-10-CM code C49). The goal of this study was to evaluate the use of these codes for health services research involving patients with a diagnosis of this rare malignancy. METHODS Two databases were utilized to explore ICD coding for STS: claims data from Truven MarketScan and electronic medical records (EMRs) from Flatiron Health. Eligible patients from claims data were those with at least two ICD-9-CM codes of 171.x on two different days between July 1, 2004, and March 30, 2014. The treatment patterns of these cases were evaluated for consistency with known therapeutic approaches for STS. Eligible patients from the Flatiron EMR system were those who received olaratumab (a drug indicated only for use in patients diagnosed with STS) after its US Food and Drug Administration approval in October 2016 through the end of the data set (November 2017). ICD-10-CM codes were evaluated for this known STS cohort. RESULTS In claims data, 4,159 patients were eligible for inclusion. Although national treatment guidelines include only a limited number of drugs used to treat STS, 98 unique anticancer drugs were identified as being used to treat patients in a claims data cohort. Only 7.7 percent of patients had claims for doxorubicin-based therapy and 3.8 percent had claims for ifosfamide-based therapy as initial treatment for STS, despite these being a standard of care. In the EMR data, 350 patients were eligible; only 170 patients (48.6 percent) had any evidence in the database of a connective or soft-tissue ICD-10-CM malignancy code within 60 days before or after initiation of olaratumab. CONCLUSIONS ICD coding for STS using the "Malignant neoplasm of connective and soft tissue" code is not reliable as a method to identify patients diagnosed with STS. Although codes reflecting the primary site of disease may have clinical relevance, lack of consistency in ICD coding for the diagnosis and treatment of this disease is a limiting factor in the ability to conduct real-world observational research of this rare disease. In the absence of consistent use of this code, an algorithm needs to be developed and validated to accurately identify patients with STS in these databases.
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Affiliation(s)
- Lisa M Hess
- Eli Lilly and Company and adjunct professor of medicine and public health at Indiana University in Indianapolis, IN
| | | | | | - Yun Fang
- Syneos Health in Indianapolis, IN
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Yogarajan V, Ragupathy R. Adoption of international privacy standards in New Zealand health information research. N Z Med J 2019; 132:70-72. [PMID: 30921314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Vithya Yogarajan
- Doctoral Assistant and PhD Student, Department of Computer Science, The University of Waikato, Hamilton, Waikato
| | - Rajan Ragupathy
- Clinical Trials and Research Pharmacist, Pharmacy Services, Waikato District Health Board, Hamilton, Waikato
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Crowhurst N, Bergin M, Wells J. Implications for nursing and healthcare research of the general data protection regulation and retrospective reviews of patients' data. Nurse Res 2019; 27:45-49. [PMID: 31468836 DOI: 10.7748/nr.2019.e1639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND The European Union's general data protection regulation (GDPR) came into effect in May 2018. It is intended to prevent the unwanted sharing of private data and it has significant implications for healthcare research. A well-established research methodology that GDPR is likely to affect is the retrospective reviewing of patients' data. This has been used widely in healthcare research and commonly involves examining patients' medical records. AIM To examine GDPR and its potential effects on the use of patients' data in healthcare research. DISCUSSION Previous misuse of patients' data has affected public confidence in healthcare research. GDPR is intended to improve the public's confidence in the handling of their data, but it may negatively impact healthcare research. Researchers who want to review patients' data will need to consider consent issues carefully. GDPR does include exceptions to the rules of consent, but there is uncertainty about this process. CONCLUSION If GDPR results in stricter requirements to achieve patients' consent in research, the validity of some studies may be affected. Nurse researchers and organisations may need to consider innovative ways of engaging patients in research. IMPLICATIONS FOR PRACTICE Research using patients' data has played an important role in shaping nursing and healthcare policy and practice. Imminent Europe-wide changes prompted by GDPR could affect how patients' data are used in research.
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Affiliation(s)
- Neil Crowhurst
- School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
| | | | - John Wells
- Health sciences, Waterford Institute of Technology, Waterford, Ireland
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France EF, Uny I, Ring N, Turley RL, Maxwell M, Duncan EAS, Jepson RG, Roberts RJ, Noyes J. A methodological systematic review of meta-ethnography conduct to articulate the complex analytical phases. BMC Med Res Methodol 2019; 19:35. [PMID: 30777031 PMCID: PMC6380066 DOI: 10.1186/s12874-019-0670-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/28/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Decision making in health and social care requires robust syntheses of both quantitative and qualitative evidence. Meta-ethnography is a seven-phase methodology for synthesising qualitative studies. Developed in 1988 by sociologists in education Noblit and Hare, meta-ethnography has evolved since its inception; it is now widely used in healthcare research and is gaining popularity in education research. The aim of this article is to provide up-to-date, in-depth guidance on conducting the complex analytic synthesis phases 4 to 6 of meta-ethnography through analysis of the latest methodological evidence. METHODS We report findings from a methodological systematic review conducted from 2015 to 2016. Fourteen databases and five other online resources were searched. Expansive searches were also conducted resulting in inclusion of 57 publications on meta-ethnography conduct and reporting from a range of academic disciplines published from 1988 to 2016. RESULTS Current guidance on applying meta-ethnography originates from a small group of researchers using the methodology in a health context. We identified that researchers have operationalised the analysis and synthesis methods of meta-ethnography - determining how studies are related (phase 4), translating studies into one another (phase 5), synthesising translations (phase 6) and line of argument synthesis - to suit their own syntheses resulting in variation in methods and their application. Empirical research is required to compare the impact of different methods of translation and synthesis. Some methods are potentially better at preserving links with the context and meaning of primary studies, a key principle of meta-ethnography. A meta-ethnography can and should include reciprocal and refutational translation and line of argument synthesis, rather than only one of these, to maximise the impact of its outputs. CONCLUSION The current work is the first to articulate and differentiate the methodological variations and their application for different purposes and represents a significant advance in the understanding of the methodological application of meta-ethnography.
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Affiliation(s)
- Emma F. France
- NMAHP Research Unit, University of Stirling, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
| | - Isabelle Uny
- NMAHP Research Unit, University of Stirling, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
| | - Nicola Ring
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN UK
| | - Ruth L. Turley
- DECIPHEr, School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII, Cardiff, CF10 3WT UK
| | - Margaret Maxwell
- NMAHP Research Unit, University of Stirling, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
| | - Edward A. S. Duncan
- NMAHP Research Unit, University of Stirling, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
| | - Ruth G. Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, 20 West Richmond Street, Edinburgh, EH8 9DX UK
| | - Rachel J. Roberts
- NMAHP Research Unit, University of Stirling, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
| | - Jane Noyes
- School of Health Sciences, Bangor University, Bangor, Gwynedd LL57 2EF UK
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Hoffman JM, Keeling NJ, Forrest CB, Tubbs-Cooley HL, Moore E, Oehler E, Wilson S, Schainker E, Walsh KE. Priorities for Pediatric Patient Safety Research. Pediatrics 2019; 143:e20180496. [PMID: 30674609 PMCID: PMC6361358 DOI: 10.1542/peds.2018-0496] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 12/14/2022] Open
Abstract
: media-1vid110.1542/5972296743001PEDS-VA_2018-0496Video Abstract BACKGROUND: Developing a research agenda that is focused on the priorities of key stakeholders may expedite implementation and dissemination. Our objective was to identify the highest-priority patient-safety research topics among pediatric clinicians, health care leaders, and families. METHODS The Children's Hospitals Solutions for Patient Safety Network is a network of >100 children's hospitals working together to eliminate harm due to health care. Parents and site leaders responded to an open-ended, anonymous e-mail survey used to elicit research topics. A key stakeholder panel winnowed related topics and prioritized topics using Likert scale ratings. Site leaders and parents responded to a second anonymous e-mail survey and rated the importance of each topic. Health system executive interviews were used to elicit their opinions regarding top priorities for patient-safety research. RESULTS The elicitation survey had 107 respondents who produced 49 unique research topics. The key stakeholder panel developed a final list of 24 topics. The prioritization survey had 74 respondents. Top-priority research topics concerned high reliability, safety culture, open communication, and early detection of patient deterioration and sepsis. During 7 qualitative interviews, health system executives highlighted diagnostic error, medication safety, deterioration, and ambulatory patient safety as priority areas. CONCLUSIONS With this study, we take a first step toward a stakeholder-driven research agenda on the basis of the assumption that stakeholders are best positioned to determine what research will be used to address the problems of most concern to them.
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Affiliation(s)
- James M Hoffman
- Department of Pharmaceutical Sciences and
- Office of Quality and Patient Care, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Nicholas J Keeling
- Department of Pharmaceutical Sciences and
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Oxford, Mississippi
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heather L Tubbs-Cooley
- Division of Nursing, Research in Patient Services
- James M. Anderson Center of Health Systems Excellence, and
| | - Erin Moore
- Department of Pulmonology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Emily Oehler
- James M. Anderson Center of Health Systems Excellence, and
| | | | | | - Kathleen E Walsh
- James M. Anderson Center of Health Systems Excellence, and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Phad A, Johnston S, Tabak RG, Mazzucca S, Haire-Joshu D. Developing priorities to achieve health equity through diabetes translation research: a concept mapping study. BMJ Open Diabetes Res Care 2019; 7:e000851. [PMID: 31908801 PMCID: PMC6936412 DOI: 10.1136/bmjdrc-2019-000851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/17/2019] [Accepted: 11/03/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The goal of diabetes translation research is to advance research into practice and ensure equitable benefit from scientific evidence. This study uses concept mapping to inform and refine future directions of diabetes translation research with the goal of achieving health equity in diabetes prevention and control. RESEARCH DESIGN AND METHODS This study used concept mapping and input from a national network of diabetes researchers and public health practitioners. Concept mapping is a mixed-method, participant-based process. First, participants generated statements by responding to a focus prompt ("To eliminate disparities and achieve health equity in the prevention and treatment of diabetes, research should…"). Participants then sorted statements by conceptual similarity and rated each statement on importance and feasibility (Likert scale of 1-5). A cluster map was created using multidimensional scaling and hierarchical cluster analysis; statements were plotted by average importance and feasibility. RESULTS Ten clusters were identified containing between 6 and 12 statements from 95 total generated statements. The ranges of average importance and feasibility ratings for clusters were fairly high and narrow (3.62-4.09; 3.10-3.93, respectively). Clusters with the most statements in the "go-zone" quadrant (above average importance/feasibility) were community and partner engagement (n=7), dissemination and implementation principles (n=4), and enrichment and capacity building (n=4). Clusters with the most statements in the "innovative-targets" quadrant (above average importance, below average feasibility) included next generation interventions (n=6), policy approaches (n=4), and interventions for specific populations (n=4). CONCLUSIONS This study created a framework of 10 priority areas to guide current and future efforts in diabetes translation research to achieve health equity. Themes rated as highly important and feasible provide the basis to evaluate current research support. Future efforts should explore how to best support innovative-targets, those rated highly important but less feasible.
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Affiliation(s)
- Allison Phad
- Washington University Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Shelly Johnston
- Washington University Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel G Tabak
- Prevention Research Center in St. Louis, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stephanie Mazzucca
- Prevention Research Center in St. Louis, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Debra Haire-Joshu
- The Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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O’Brien MA, Carson A, Barbera L, Brouwers MC, Earle CC, Graham ID, Mittmann N, Grunfeld E. Variable participation of knowledge users in cancer health services research: results of a multiple case study. BMC Med Res Methodol 2018; 18:150. [PMID: 30466391 PMCID: PMC6249816 DOI: 10.1186/s12874-018-0593-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/29/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Integrated knowledge translation (IKT) is a research approach in which knowledge users (KUs) co-produce research. The rationale for IKT is that it leads to research that is more relevant and useful to KUs, thereby accelerating uptake of findings. The aim of the current study was to evaluate IKT activities within a cancer health services research network in Ontario, Canada. METHODS An embedded multiple case study design was used. The cases were 5 individual studies within an overarching cancer health services research network. These studies focused on one of the following topics: case costing of cancer treatment, lung cancer surgery policy analysis, patient and provider-reported outcomes, colorectal cancer screening, and a team approach to women's survivorship. We conducted document reviews and held semi-structured interviews with researchers, KUs, and other stakeholders within a cancer system organization. The analysis examined patterns across and within cases. RESULTS Researchers and their respective knowledge users from 4 of the 5 cases agreed to participate. Eighteen individuals from 4 cases were interviewed. In 3 of 4 cases, there were mismatched expectations between researchers and KUs regarding KU role; participants recommended that expectations be made explicit from the beginning of the collaboration. KUs perceived that frequent KU turnover may have affected both KU engagement and the uptake of study results within the organization. Researchers and KUs found that sharing research results was challenging because the organization lacked a framework for knowledge translation. Uptake of research findings appeared to be related to the researcher having an embedded role in the cancer system organization and/or close alignment of the study with organizational priorities. Document reviews found evidence of planned IKT strategies in 3 of 4 cases; however, actual KU role/engagement on research teams was variable. CONCLUSIONS Barriers to KU co-production of cancer health services research include mismatched expectations of KU role and frequent KU turnover. When a research study directly aligns with organizational priorities, it appears more likely that results will be considered in programming. Research teams that take an IKT approach should consider specific strategies to address barriers to KU engagement.
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Affiliation(s)
- Mary Ann O’Brien
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON M5G 1V7 Canada
| | - Andrea Carson
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Lisa Barbera
- Tom Baker Cancer Centre, Calgary, AB Canada
- University of Calgary, Calgary, AB Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Melissa C. Brouwers
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
- Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Craig C. Earle
- Ontario Institute for Cancer Research, Toronto, ON Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Nicole Mittmann
- Cancer Care Ontario, Toronto, ON Canada
- Sunnybrook Research Institute, Toronto, ON Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON M5G 1V7 Canada
- Ontario Institute for Cancer Research, Toronto, ON Canada
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Finch TL, Girling M, May CR, Mair FS, Murray E, Treweek S, McColl E, Steen IN, Cook C, Vernazza CR, Mackintosh N, Sharma S, Barbery G, Steele J, Rapley T. Improving the normalization of complex interventions: part 2 - validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT). BMC Med Res Methodol 2018; 18:135. [PMID: 30442094 PMCID: PMC6238372 DOI: 10.1186/s12874-018-0591-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Successful implementation and embedding of new health care practices relies on co-ordinated, collective behaviour of individuals working within the constraints of health care settings. Normalization Process Theory (NPT) provides a theory of implementation that emphasises collective action in explaining, and shaping, the embedding of new practices. To extend the practical utility of NPT for improving implementation success, an instrument (NoMAD) was developed and validated. METHODS Descriptive analysis and psychometric testing of an instrument developed by the authors, through an iterative process that included item generation, consensus methods, item appraisal, and cognitive testing. A 46 item questionnaire was tested in 6 sites implementing health related interventions, using paper and online completion. Participants were staff directly involved in working with the interventions. Descriptive analysis and consensus methods were used to remove redundancy, reducing the final tool to 23 items. Data were subject to confirmatory factor analysis which sought to confirm the theoretical structure within the sample. RESULTS We obtained 831 completed questionnaires, an average response rate of 39% (range: 22-77%). Full completion of items was 50% (n = 413). The confirmatory factor analysis showed the model achieved acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.08, SRMR = 0.03). Construct validity of the four theoretical constructs of NPT was supported, and internal consistency (Cronbach's alpha) were as follows: Coherence (4 items, α = 0.71); Collective Action (7 items, α = 0.78); Cognitive Participation (4 items, α = 0.81); Reflexive Monitoring (5 items, α = 0.65). The normalisation scale overall, was highly reliable (20 items, α = 0.89). CONCLUSIONS The NoMAD instrument has good face validity, construct validity and internal consistency, for assessing staff perceptions of factors relevant to embedding interventions that change their work practices. Uses in evaluating and guiding implementation are proposed.
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Affiliation(s)
- Tracy L. Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Coach Lane, Newcastle-upon-Tyne, NE7 7XA UK
| | - Melissa Girling
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX UK
| | - Carl R. May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, Upper Floor 3, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX UK
| | - Ian Nicholas Steen
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX UK
| | - Clare Cook
- School of Law and Business, University of Northumbria, City Campus East 1, Newcastle upon Tyne, NE1 8ST UK
| | - Christopher R. Vernazza
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW UK
| | - Nicola Mackintosh
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH UK
| | - Samridh Sharma
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW UK
| | - Gaery Barbery
- International Business and Asian Studies, Griffith University, QLD, Gold Coast, 4222 Australia
| | - Jimmy Steele
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Coach Lane, Newcastle-upon-Tyne, NE7 7XA UK
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Rapley T, Girling M, Mair FS, Murray E, Treweek S, McColl E, Steen IN, May CR, Finch TL. Improving the normalization of complex interventions: part 1 - development of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT). BMC Med Res Methodol 2018; 18:133. [PMID: 30442093 PMCID: PMC6238361 DOI: 10.1186/s12874-018-0590-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 10/29/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Understanding and measuring implementation processes is a key challenge for implementation researchers. This study draws on Normalization Process Theory (NPT) to develop an instrument that can be applied to assess, monitor or measure factors likely to affect normalization from the perspective of implementation participants. METHODS An iterative process of instrument development was undertaken using the following methods: theoretical elaboration, item generation and item reduction (team workshops); item appraisal (QAS-99); cognitive testing with complex intervention teams; theory re-validation with NPT experts; and pilot testing of instrument. RESULTS We initially generated 112 potential questionnaire items; these were then reduced to 47 through team workshops and item appraisal. No concerns about item wording and construction were raised through the item appraisal process. We undertook three rounds of cognitive interviews with professionals (n = 30) involved in the development, evaluation, delivery or reception of complex interventions. We identified minor issues around wording of some items; universal issues around how to engage with people at different time points in an intervention; and conceptual issues around the types of people for whom the instrument should be designed. We managed these by adding extra items (n = 6) and including a new set of option responses: 'not relevant at this stage', 'not relevant to my role' and 'not relevant to this intervention' and decided to design an instrument explicitly for those people either delivering or receiving an intervention. This version of the instrument had 53 items. Twenty-three people with a good working knowledge of NPT reviewed the items for theoretical drift. Items that displayed a poor alignment with NPT sub-constructs were removed (n = 8) and others revised or combined (n = 6). The final instrument, with 43 items, was successfully piloted with five people, with a 100% completion rate of items. CONCLUSION The process of moving through cycles of theoretical translation, item generation, cognitive testing, and theoretical (re)validation was essential for maintaining a balance between the theoretical integrity of the NPT concepts and the ease with which intended respondents could answer the questions. The final instrument could be easily understood and completed, while retaining theoretical validity. NoMAD represents a measure that can be used to understand implementation participants' experiences. It is intended as a measure that can be used alongside instruments that measure other dimensions of implementation activity, such as implementation fidelity, adoption, and readiness.
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Affiliation(s)
- Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Coach Lane Campus West, Newcastle upon Tyne, NE7 7XA UK
| | - Melissa Girling
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX UK
| | - Frances S. Mair
- Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, Upper Floor 3, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX UK
| | - Ian Nicholas Steen
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX UK
| | - Carl R. May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Tracy L. Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Coach Lane Campus West, Newcastle upon Tyne, NE7 7XA UK
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Abstract
OBJECTIVE To develop an enriched set of core competencies for health services and policy research (HSPR) doctoral training that will help graduates maximize their impact across a range of academic and nonacademic work environments and roles. DATA SOURCES/STUDY SETTING Data were obtained from multiple sources, including literature reviews, key informant interviews, stakeholder consultations, and Expert Working Group (EWG) meetings between January 2015 and March 2016. The study setting is Canada. STUDY DESIGN The study used qualitative methods and an iterative development process with significant stakeholder engagement throughout. DATA COLLECTION/EXTRACTION METHODS The literature reviews, key informant interviews, existing data on graduate career trajectories, and EWG deliberations informed the identification of career profiles for HSPR graduates and the competencies required to succeed in these roles. Stakeholder consultations were held to vet, refine, and validate the competencies. PRINCIPAL FINDINGS The EWG reached consensus on six sectors and eight primary roles in which HSPR doctoral graduates can bring value to employers and the health system. Additionally, 10 core competencies were identified that should be included or further emphasized in the training of HSPR doctoral students to increase their preparedness and potential for impact in a variety of roles within and outside of traditional academic workplaces. CONCLUSION The results offer an expanded view of potential career paths for HSPR doctoral graduates and provide recommendations for an expanded set of core competencies that will better equip graduates to maximize their impact on the health system.
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Affiliation(s)
- Stephen Bornstein
- Department of Political Science and Division of Community Health and HumanitiesMemorial UniversitySt. John'sNLCanada
- Newfoundland and Labrador Centre for Applied Health ResearchSt. John'sNLCanada
| | | | | | - Robyn Tamblyn
- Institute of Health Services and Policy ResearchCanadian Institutes of Health ResearchMontrealQCCanada
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontréalQCCanada
| | - Meghan McMahon
- Institute of Health Services and Policy ResearchCanadian Institutes of Health ResearchMontrealQCCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
| | - Adalsteinn D. Brown
- Institute of Health Policy, Management and EvaluationDalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoONCanada
- Department of Obstetrics and GynecologyUniversity of TorontoTorontoONCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
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Baron D, Essien T, Pato S, Magongo M, Mbandazayo N, Scorgie F, Rees H, Delany‐Moretlwe S. Collateral benefits: how the practical application of Good Participatory Practice can strengthen HIV research in sub-Saharan Africa. J Int AIDS Soc 2018; 21 Suppl 7:e25175. [PMID: 30334610 PMCID: PMC6193316 DOI: 10.1002/jia2.25175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/20/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION The Good Participatory Practice (GPP): Guidelines for Biomedical HIV Prevention Trials, second edition (2011) were developed to provide clinical trial sponsors and implementers with a formal stakeholder engagement framework. As one of the largest African research institutes, Wits Reproductive Health and HIV Institute (Wits RHI) became an early adopter of GPP by implementing its principles within large-scale national and regional clinical trials. This article examines Wits RHI's lessons learned from implementing GPP, its ongoing efforts to institutionalize GPP, and the yet to be realized potential in creating fully sustainable structures for meaningful stakeholder engagement in HIV prevention research, implementation science and beyond. DISCUSSION For the past seven years, Wits RHI has undertaken both centralized leadership roles in implementing GPP across multi-party regional research consortia as well as overseeing GPP for smaller investigator-driven trials. Through this iterative roll-out of GPP, key lessons have emerged. Obtaining upfront funding to support GPP activities throughout and between the research life cycle, and a trained multi-disciplinary team of GPP practitioners have helped facilitate an enabling environment for GPP implementation. We further recommend formally integrating stakeholder engagement into study documents, including monitoring and evaluation plans with indicators and performance metrics, to assist teams to track and refine their GPP strategies. Finally, institutionalizing resources and supporting organization-wide GPP along with ongoing support can help build efficiencies and maximize economies of scale toward a pragmatic and innovative application of the GPP Guidelines. CONCLUSIONS Thanks to a growing global network of GPP practitioners and a burgeoning GPP Community of Practice, there has been substantive progress in making GPP an integral component of clinical HIV prevention research. The Wits RHI experience highlights the possibilities and the challenges to translating the GPP principles into concrete practices within specific clinical trials and across a research institute. Realizing the full potential of GPP, including direct and indirect - 'collateral benefits' will require the collective buy-in and support from sponsors, implementers and community stakeholders across the research field. As the HIV prevention research field expands, however, a more conscious and systematic implementation of GPP is timely.
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Affiliation(s)
- Deborah Baron
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Health Behavior at the UNC Gillings School of Global Public HealthJohannesburgSouth Africa
| | | | - Sinazo Pato
- International Partnership for MicrobicidesJohannesburgSouth Africa
| | - Miliswa Magongo
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Fiona Scorgie
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Helen Rees
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
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Langley J, Wolstenholme D, Cooke J. 'Collective making' as knowledge mobilisation: the contribution of participatory design in the co-creation of knowledge in healthcare. BMC Health Serv Res 2018; 18:585. [PMID: 30045726 PMCID: PMC6060522 DOI: 10.1186/s12913-018-3397-y] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 07/15/2018] [Indexed: 11/10/2022] Open
Abstract
The discourse in healthcare Knowledge Mobilisation (KMb) literature has shifted from simple, linear models of research knowledge production and action to more iterative and complex models. These aim to blend multiple stakeholders' knowledge with research knowledge to address the research-practice gap. It has been suggested there is no 'magic bullet', but that a promising approach to take is knowledge co-creation in healthcare, particularly if a number of principles are applied. These include systems thinking, positioning research as a creative enterprise with human experience at its core, and paying attention to process within the partnership. This discussion paper builds on this proposition and extends it beyond knowledge co-creation to co-designing evidenced based interventions and implementing them. Within a co-design model, we offer a specific approach to share, mobilise and activate knowledge, that we have termed 'collective making'. We draw on KMb, design, wider literature, and our experiences to describe how this framework supports and extends the principles of co-creation offered by Geenhalgh et al. [1] in the context of the state of the art of knowledge mobilisation. We describe how collective making creates the right 'conditions' for knowledge to be mobilised particularly addressing issues relating to stakeholder relationships, helps to discover, share and blend different forms of knowledge from different stakeholders, and puts this blended knowledge to practical use allowing stakeholders to learn about the practical implications of knowledge use and to collectively create actionable products. We suggest this collective making has three domains of influence: on the participants; on the knowledge discovered and shared; and on the mobilisation or activation of this knowledge.
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Affiliation(s)
- Joe Langley
- Lab4Living, Art & Design Research Centre, Sheffield Hallam University, Sheffield, UK
- NIHR Devices for Dignity HTC, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
- NIHR CLAHRC YH, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
| | - Daniel Wolstenholme
- Lab4Living, Art & Design Research Centre, Sheffield Hallam University, Sheffield, UK
- NIHR CLAHRC YH, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
| | - Jo Cooke
- NIHR CLAHRC YH, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
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Abstract
The region still needs to build its research capacity to inform effective public health policy and practices, say Fabio Zicker and colleagues
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Affiliation(s)
- Fabio Zicker
- Centre for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Pan American Health Organization/World Health Organization, Washington, DC, USA
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MA, USA
| | - Luis Gabriel Cuervo
- Centre for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Pan American Health Organization/World Health Organization, Washington, DC, USA
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MA, USA
| | - Luis Alejandro Salicrup
- Centre for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Pan American Health Organization/World Health Organization, Washington, DC, USA
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MA, USA
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Goldstein CE, Weijer C, Brehaut JC, Campbell M, Fergusson DA, Grimshaw JM, Hemming K, Horn AR, Taljaard M. Accommodating quality and service improvement research within existing ethical principles. Trials 2018; 19:334. [PMID: 29941000 PMCID: PMC6019798 DOI: 10.1186/s13063-018-2724-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 06/06/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? The lack of consensus on answers to these questions highlights the need for ethical guidance. MAIN BODY Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. CONCLUSION While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research.
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Affiliation(s)
| | - Charles Weijer
- Rotman Institute of Philosophy, Western University, London, Canada
| | - Jamie C. Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dean A. Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Austin R. Horn
- Rotman Institute of Philosophy, Western University, London, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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44
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Soril LJJ, Noseworthy TW, Dowsett LE, Memedovich K, Holitzki HM, Lorenzetti DL, Stelfox HT, Zygun DA, Clement FM. Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis. BMJ Open 2018; 8:e019912. [PMID: 29776919 PMCID: PMC5961610 DOI: 10.1136/bmjopen-2017-019912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To assess the impact of behaviour modification interventions to promote restrictive red blood cell (RBC) transfusion practices. DESIGN Systematic review and meta-analysis. SETTING, PARTICIPANTS, INTERVENTIONS Seven electronic databases were searched to January 2018. Published randomised controlled trials (RCTs) or non-randomised studies examining an intervention to modify healthcare providers' RBC transfusion practice in any healthcare setting were included. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the proportion of patients transfused. Secondary outcomes included the proportion of inappropriate transfusions, RBC units transfused per patient, in-hospital mortality, length of stay (LOS), pretransfusion haemoglobin and healthcare costs. Meta-analysis was conducted using a random-effects model and meta-regression was performed in cases of heterogeneity. Publication bias was assessed by Begg's funnel plot. RESULTS Eighty-four low to moderate quality studies were included: 3 were RCTs and 81 were non-randomised studies. Thirty-one studies evaluated a single intervention, 44 examined a multimodal intervention. The comparator in all studies was standard of care or historical control. In 33 non-randomised studies, use of an intervention was associated with reduced odds of transfusion (OR 0.63 (95% CI 0.56 to 0.71)), odds of inappropriate transfusion (OR 0.46 (95% CI 0.36 to 0.59)), RBC units/patient weighted mean difference (WMD: -0.50 units (95% CI -0.85 to -0.16)), LOS (WMD: -1.14 days (95% CI -2.12 to -0.16)) and pretransfusion haemoglobin (-0.28 g/dL (95% CI -0.48 to -0.08)). There was no difference in odds of mortality (OR 0.90 (95% CI 0.80 to 1.02)). Protocol/algorithm and multimodal interventions were associated with the greatest decreases in the primary outcome. There was high heterogeneity among estimates and evidence for publication bias. CONCLUSIONS The literature examining the impact of interventions on RBC transfusions is extensive, although most studies are non-randomised. Despite this, pooled analysis of 33 studies revealed improvement in the primary outcome. Future work needs to shift from asking, 'does it work?' to 'what works best and at what cost?' PROSPERO REGISTRATION NUMBER CRD42015024757.
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Affiliation(s)
- Lesley J J Soril
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Thomas W Noseworthy
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Laura E Dowsett
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Katherine Memedovich
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Hannah M Holitzki
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - David A Zygun
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Critical Care Medicine, Alberta Health Services and Faculty of Medicine and Dentistry, University of Alberta, Calgary, Alberta, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
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Valdez J, Kim M, Rueschman M, Socrates V, Redline S, Sahoo SS. ProvCaRe Semantic Provenance Knowledgebase: Evaluating Scientific Reproducibility of Research Studies. AMIA Annu Symp Proc 2018; 2017:1705-1714. [PMID: 29854241 PMCID: PMC5977728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Scientific reproducibility is critical for biomedical research as it enables us to advance science by building on previous results, helps ensure the success of increasingly expensive drug trials, and allows funding agencies to make informed decisions. However, there is a growing "crisis" of reproducibility as evidenced by a recent Nature journal survey of more than 1500 researchers that found that 70% of researchers were not able to replicate results from other research groups and more than 50% of researchers were not able reproduce their own research results. In 2016, the National Institutes of Health (NIH) announced the "Rigor and Reproducibility" guidelines to support reproducibility in biomedical research. A key component of the NIH Rigor and Reproducibility guidelines is the recording and analysis of "provenance" information, which describes the origin or history of data and plays a central role in ensuring scientific reproducibility. As part of the NIH Big Data to Knowledge (BD2K)-funded data provenance project, we have developed a new informatics framework called Provenance for Clinical and Healthcare Research (ProvCaRe) to extract, model, and analyze provenance information from published literature describing research studies. Using sleep medicine research studies that have made their data available through the National Sleep Research Resource (NSRR), we have developed an automated pipeline to identify and extract provenance metadata from published literature that is made available for analysis in the ProvCaRe knowledgebase. NSRR is the largest repository of sleep data from over 40,000 studies involving 36,000 participants and we used 75 published articles describing 6 research studies to populate the ProvCaRe knowledgebase. We evaluated the ProvCaRe knowledgebase with 28,474 "provenance triples" using hypothesis-driven queries to identify and rank research studies based on the provenance information extracted from published articles.
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Affiliation(s)
- Joshua Valdez
- Division of Medical Informatics, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Matthew Kim
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University Boston, MA
| | - Michael Rueschman
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University Boston, MA
| | - Vimig Socrates
- Division of Medical Informatics, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University Boston, MA
| | - Satya S Sahoo
- Division of Medical Informatics, School of Medicine, Case Western Reserve University, Cleveland, OH
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Chapple A, Ziebland S. Methodological and Practical Issues in Cross-National Qualitative Research: Lessons From the Literature and a Comparative Study of the Experiences of People Receiving a Diagnosis of Cancer. Qual Health Res 2018; 28:789-799. [PMID: 29094645 DOI: 10.1177/1049732317736284] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Social science and health services research have much to gain from cross-national qualitative research, yet the logistics involved in setting up such studies, especially where different languages and health systems are involved, can seem daunting. In this article, we highlight issues to consider and suggest some solutions, drawing both on the literature and examples from our own cross-national research. We highlight the issues involved with synchronizing staffing and funding, ensuring comparable methods, project management, and communication between research groups, the consequences of the different criteria for ethical approval for recruitment, the challenge of working with multiple languages, teams involving different disciplines and skill sets, and coordinating and timing data collection and analysis. The aim of this article is to draw on the literature, which includes several useful insights, as well as reflections from our own cross-national research, to highlight considerations for cross-national qualitative research teams. Our approach is to highlight and discuss potential challenges and suggest potential solutions, using the format of an illustrated literature review.
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Abstract
There are calls for policymakers to make greater use of research when formulating policies. Therefore, it is important that policy organisations have a range of tools and systems to support their staff in using research in their work. The aim of the present study was to measure the extent to which a range of tools and systems to support research use were available within six Australian agencies with a role in health policy, and examine whether this was related to the extent of engagement with, and use of research in policymaking by their staff. The presence of relevant systems and tools was assessed via a structured interview called ORACLe which is conducted with a senior executive from the agency. To measure research use, four policymakers from each agency undertook a structured interview called SAGE, which assesses and scores the extent to which policymakers engaged with (i.e., searched for, appraised, and generated) research, and used research in the development of a specific policy document. The results showed that all agencies had at least a moderate range of tools and systems in place, in particular policy development processes; resources to access and use research (such as journals, databases, libraries, and access to research experts); processes to generate new research; and mechanisms to establish relationships with researchers. Agencies were less likely, however, to provide research training for staff and leaders, or to have evidence-based processes for evaluating existing policies. For the majority of agencies, the availability of tools and systems was related to the extent to which policymakers engaged with, and used research when developing policy documents. However, some agencies did not display this relationship, suggesting that other factors, namely the organisation's culture towards research use, must also be considered.
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Affiliation(s)
- Steve R. Makkar
- The Sax Institute, Ultimo, New South Wales, Australia
- * E-mail:
| | - Abby Haynes
- The Sax Institute, Ultimo, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | | | - Sally Redman
- The Sax Institute, Ultimo, New South Wales, Australia
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Banegas MP, Dickerson JF, Kent EE, de Moor JS, Virgo KS, Guy GP, Ekwueme DU, Zheng Z, Nutt S, Pace L, Varga A, Waiwaiole L, Schneider J, Robin Yabroff K. Exploring barriers to the receipt of necessary medical care among cancer survivors under age 65 years. J Cancer Surviv 2018; 12:28-37. [PMID: 28852970 PMCID: PMC6993114 DOI: 10.1007/s11764-017-0640-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/19/2017] [Indexed: 01/27/2023]
Abstract
PURPOSE With increasing cancer care costs and greater patient cost-sharing in the USA, understanding access to medical care among cancer survivors is imperative. This study aims to identify financial, psychosocial, and cancer-related barriers to the receipt of medical care, tests, or treatments deemed necessary by the doctor or patient for cancer among cancer survivors age < 65 years. METHODS We used data on 4321 cancer survivors aged 18-64 years who completed the 2012 LIVESTRONG Survey. Multivariable logistic regression was used to identify risk factors associated with the receipt of necessary medical care, including sociodemographic, financial hardship, debt amount, caregiver status, and cancer-related variables. RESULTS Approximately 28% of cancer survivors were within 1 year, and 43% between 1 and 5 years, since their last treatment at the time of survey. Nearly 9% of cancer survivors reported not receiving necessary medical care. Compared to survivors without financial hardship, the likelihood of not receiving necessary medical care significantly increased as the amount of debt increased among those with financial hardship (RRFinancial hardship w/< $10,000 debt = 1.94, 95% CI 1.55-2.42, and RR RRFinancial hardship w/≥ $10,000 debt = 3.41, 95% CI 2.69-4.33, p < 0.001). Survivors who reported lack of a caregiver, being uninsured, and not receiving help understanding medical bills were significantly more likely to not receive necessary medical care. CONCLUSION We identified key financial and insurance risk factors that may serve as significant barriers to the receipt of necessary medical care among cancer survivors age < 65 in the USA IMPLICATIONS FOR CANCER SURVIVORS: The majority of cancer survivors reported receiving medical care either they or their doctors deemed necessary. However, identifying potentially modifiable barriers to receipt of necessary medical cancer care among cancer survivors age < 65 is imperative for developing interventions to ensure equitable access to care and reducing cancer disparities.
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Affiliation(s)
- Matthew P Banegas
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
| | - John F Dickerson
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Gery P Guy
- Division of Cancer Prevention and Control, U.S Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, U.S Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zhiyuan Zheng
- Economics & Healthcare Delivery Research, American Cancer Society, Atlanta, GA, USA
- School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | | | | | - Alexandra Varga
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Lisa Waiwaiole
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Jennifer Schneider
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - K Robin Yabroff
- Office of the Assistant Secretary for Planning and Evaluation, Washington, DC, USA
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Reid P, Paine SJ, Curtis E, Jones R, Anderson A, Willing E, Harwood M. Achieving health equity in Aotearoa: strengthening responsiveness to Māori in health research. N Z Med J 2017; 130:96-103. [PMID: 29121628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Excellent health research is essential for good health outcomes, services and systems. Health research should also build towards equity and in doing so ensure that no one is left behind. As recipients of government funding, researchers are increasingly required to demonstrate an understanding of their delegated responsibilities to undertake research that has the potential to address Māori health needs and priorities. These requirements form the basis of responsiveness to Māori in health research, and several research institutions have implemented systems to support their organisational approach to this endeavour. However, many health researchers have a narrow view of responsiveness to Māori and how it might be relevant to their work. In this viewpoint paper we provide an overview of existing frameworks that can be used to develop thinking and positioning in relation to the Treaty of Waitangi and responsiveness to Māori. We also describe an equity-based approach to responsiveness to Māori and highlight four key areas that require careful consideration, namely: (1) relevance to Māori; (2) Māori as participants; (3) promoting the Māori voice, and; (4) human tissue. Finally, we argue for greater engagement with responsiveness to Māori activities as part of our commitment to achieving equitable health outcomes.
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Affiliation(s)
- Papaarangi Reid
- Tumuaki and Head of Department, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland
| | - Sarah-Jane Paine
- Senior Research Fellow, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland
| | - Elana Curtis
- Senior Lecturer, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland
| | - Rhys Jones
- Senior Lecturer, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland
| | - Anneka Anderson
- Lecturer, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland
| | - Esther Willing
- Lecturer, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland
| | - Matire Harwood
- Senior Lecturer, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland
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