Addressing social needs in oncology care: another research-to-practice gap

Social determinants of health and unmet social needs are directly related to cancer outcomes, from diagnosis to survivorship. If identified, unmet social needs can be addressed in oncology care by changing care plans in collaboration with patients' preferences and accounting for clinical practice guidelines (eg, reducing the frequency of appointments, switching treatment modalities) and connecting patients to resources within healthcare organizations (eg, social work support, patient navigation) and with community organizations (eg, food banks, housing assistance programs). Screening for social needs is the first step to identifying those who need additional support and is increasingly recognized as a necessary component of high-quality cancer care delivery. Despite evidence about the relationship between social needs and cancer outcomes and the abundance of screening tools, the implementation of social needs screening remains a challenge, and little is known regarding the adoption, reach, and sustainability of social needs screening in routine clinical practice. We present data on the adoption and implementation of social needs screening at two large academic cancer centers and discuss three challenges associated with implementing evidence-based social needs screening in clinical practice: (1) identifying an optimal approach for administering social needs screening in oncology care, (2) adequately addressing identified unmet needs with resources and support, and (3) coordinating social needs screening between oncology and primary care.

The Evidence-practice Gap in Minimal Intervention Dentistry: An International Comparison Between Dentists in Japan and Brazil

OBJECTIVES

This study was designed to: 1) evaluate and compare the evidence-practice gap (EPG) in minimal intervention dentistry (MID) in Japan and Brazil by measuring concordance between dentists' clinical practice and published evidence; and 2) identify dentists' factors associated with the EPG in both countries.

METHODS

We performed a cross-sectional study using a web-delivered questionnaire among 136 Japanese and 110 Brazilian dentists. The questionnaire consisted of three questions concerning "restoration diagnosis and treatment," "deep caries diagnosis and treatment," and "caries risk assessment" regarding MID. A chi-square test was used to analyze differences in concordance among clinical practice and evidence from the literature between Japanese and Brazilian dentists. Logistic regression analyses were performed to analyze dentists' factors associated with overall concordance for all three questions.

RESULTS

Overall concordance was significantly higher in Brazil (55%) than in Japan (38%) (p<0.01). Concerning how evidence was obtained, textbooks, nonacademic journals, and seminars and workshops were used as information sources more frequently by Japanese than Brazilian dentists (p<0.001), whereas scientific journal articles in English were used more frequently by Brazilian dentists (p<0.001). On logistic regression analysis, overall concordance was higher for Japanese dentists who frequently obtained evidence from scientific journal articles in English (p<0.05), whereas Brazilian dentists who frequently obtained evidence from the Internet were associated with lower overall concordance (p<0.05).

CONCLUSIONS

Because overall concordance was significantly higher in Brazil than in Japan, Japan may have a greater EPG in MID practice. Specific characteristics of Japanese and Brazilian dentists showed significant associations with overall concordance.

Mind the Gap in Kidney Care: Translating What We Know Into What We Do

Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay. DOI: 10.52547/ijkd.8216.

Illuminating the nutrition-related policy-practice gaps in colorectal cancer survivorship

PURPOSE

Colorectal cancer (CRC) is among the three most commonly diagnosed cancers globally, after breast and lung cancer, with an estimated 2 million new cases each year, comprising ten per cent of all cancers worldwide. CRC has a complex aetiology associated with several nutrition-related risk factors. Cancer survivors frequently report alterations to their dietary habits and nutritional intake, with related adverse impacts on health-related quality of life (QOL). Whilst nutrition-related factors are recognised as survivor priorities and embedded in survivor care policies, dietary support is frequently not the standard of care in practice.

METHODS AND RESULTS

In this Commentary, we present details of a critical policy-practice gap for CRC survivors across the spectrum of nutrition care that we have seen growing in the literature, in hospitals, community and private practice.

CONCLUSION

As these nutrition concerns can adversely impact QOL and morbidity and mortality risks, we hope to raise awareness of these issues to provide a basis of future work in this area, so that policymakers and clinicians can improve support and outcomes for CRC survivors and their families.

Evidence-practice gap analysis in the role of tick in brucellosis transmission: a scoping review

BACKGROUND

Brucellosis is a zoonotic affliction instigated by bacteria belonging to the genus Brucella and is characterized by a diverse range of pervasiveness, multiple transmission routes, and serious hazards. It is imperative to amalgamate the current knowledge and identify gaps pertaining to the role of ticks in brucellosis transmission.

METHODS

We systematically searched China National Knowledge Infrastructure (CNKI), WanFang, Google Scholar, and PubMed on the topic published until April 23, 2022. The procedure was performed in accordance with the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The selected articles were categorized across three major topic areas, and the potential data was extracted to describe evidence-practice gaps by two reviewers.

RESULTS

The search identified 83 eligible studies for the final analyses. The results highlighted the potential capacity of ticks in brucellosis transmission as evidenced by the detection of Brucella in 16 different tick species. The pooled overall prevalence of Brucella in ticks was 33.87% (range: 0.00-87.80%). The review also revealed the capability of Brucella to circulate in parasitic ticks' different developmental stages, thus posing a potential threat to animal and human health. Empirical evidence from in vitro rodent infection experiments has revealed that ticks possess the capability to transmit Brucella to uninfected animals (range: 45.00-80.00%). Moreover, significant epidemiological associations have been found between the occurrence of brucellosis in animals and tick control in rangelands, which further suggests that ticks may serve as potential vectors for brucellosis transmission in ruminants. Notably, a mere three cases of human brucellosis resulting from potential tick bites were identified in search of global clinical case reports from 1963 to 2019.

CONCLUSIONS

It is imperative to improve the techniques used to identify Brucella in ticks, particularly by developing a novel, efficient, precise approach that can be applied in a field setting. Furthermore, due to the lack of adequate evidence of tick-borne brucellosis, it is essential to integrate various disciplines, including experimental animal science, epidemiology, molecular genetics, and others, to better understand the efficacy of tick-borne brucellosis. By amalgamating multiple disciplines, we can enhance our comprehension and proficiency in tackling tick-borne brucellosis.

Closing the Academic-Practice Gap With Enhanced Preceptor Training

A successful pilot program served as a model for how educators in healthcare organizations can reduce the academic-practice gap by supporting preceptors. Preceptors received enhanced training using self-paced online modules and an asynchronous online problem-based learning. Statistically significant increases in self-efficacy and satisfaction with training were reported. Preceptor training included strategies for teaching prioritization, communication, and clinical judgment. Preceptors experienced sustained resilience, increased awareness of well-being, and more engagement in the precepting role.

Effect of Virtual Simulation on Nurse Residents' Prioritization and Delegation Skills: A Pilot Study

Data indicate a widening academic-practice gap. Utilizing a single-group pre-post interventional design, the purpose of this project was to determine if repeated participation in Sentinel U Patient Management and Delegation virtual simulations influenced new graduate nurses' prioritization and delegation. Increased confidence in ability to complete patient care assignments on time and transferability of learning outcomes to practice were identified. There may be value in nurses receiving virtual simulations within their residency program to close the academic-practice gap.

Advance statements in mental healthcare: time to close the evidence to practice gap

This article discusses advance statements in mental health care, which allow individuals with mental disorders to express their preferences for treatment during mental health crises. Despite the evidence supporting their effectiveness, their implementation in clinical practice remains limited. This article explores variations among advance statements, such as psychiatric advance directives (PADs), joint crisis plans (JCPs) and self-binding directives (SBDs), highlighting their content, development process and legal status. We outline the benefits of advance statements, including empowerment, early intervention, improved therapeutic relationships and reduced compulsory admissions. We then draw attention to the challenges that may contribute to their lack of implementation, including legal complexities, communication issues, cultural factors, potential inequities, healthcare provider knowledge, changing preferences, resource constraints, crisis responses, data privacy, family involvement, and long-term evaluation. In conclusion, advance statements offer significant benefits but require addressing these critical aspects to ensure ethical and effective use. Bridging the evidence-to-practice gap is essential, with a focus on implementation science. Integrating these tools into routine clinical practice can significantly benefit individuals with severe mental disorders and mental health systems.

Treating persistent pain after breast cancer: practice gaps and future directions

This paper discusses the growing problem of persisting pain after successful treatment of breast cancer and presents recommendations for improving pain-related outcomes for this group. We discuss the dominant treatment approach for persisting pain post-breast cancer treatment and draw contrasts with contemporary treatment approaches to persistent pain in non-cancer-related populations. We discuss modern application of the biopsychosocial model of pain and the notion of variable sensitivity within the pain system, moment by moment and over time. We present the implications of increasing sensitivity over time for treatment selection and implementation. By drawing on transformative changes in treatment approaches to persistent non-cancer-related pain, we describe the potentially powerful role that an intervention called pain science education, which is now recommended in clinical guidelines for musculoskeletal pain, may play in improving pain and disability outcomes after successful breast cancer treatment. Finally, we present several research recommendations that centre around adaptation of the content and delivery models of contemporary pain science education, to the post-breast cancer context.

Execution of anticipatory guidance and the knowledge and practice gap among caregivers in Southern Taiwan: A retrospective study

BACKGROUND/PURPOSE

This study examined the practice rate of Anticipatory Guidance (AG) and the gap between knowledge and practice among caregivers.

METHODS

We retrospectively collected data from caregivers who brought their children for seven age-based well-child visits (birth to 7 years old) and seven corresponding AG checklists for practice (each ranged from 16 to 19 guidance items, 118 items in total) between 2015 and 2017. Practice rates of guidance items and their association with children's sex, age, residence, and body mass index were collected and analyzed.

RESULTS

We enrolled 2310 caregivers (330 per well-child visit). Average practice rates of guidance items in the seven AG checklists were 77.6%-95.1%, generally without significant differences between urban/rural or male/female children. However, lower (<80%) rates were observed for 32 items, including dental check-ups (38.9%), use of fluoride toothpaste (44.6%), screen time (69.4%), and drinking less sugar-sweetened beverages (SSBs) (75.5%), with corresponding knowledge-to-practice gap rates of 55.5%, 47.9%, 30.3%, and 23.8%, respectively. "Drinking less SSBs" was the only item with a higher obesity rate in the non-achieved group versus the achieved group (16.7% vs. 7.4%, p = 0.036; odds ratio: 3.509, 95% CI: 1.153-10.677, p = 0.027).

CONCLUSION

Caregivers in Taiwan practiced most AG recommendations. However, dental check-ups, fluoride toothpaste use, drinking less SSBs, and limiting screen time were less executed items. A higher obesity rate was found among 3-7-year-old children whose caregivers failed to practice the "Drink less SSBs" guidance. Strategies to overcome the gap between knowledge and practice are needed to improve these less-achieved guidance items.

Anorexia of aging: An international assessment of healthcare providers' knowledge and practice gaps

BACKGROUND

Anorexia of aging is a common geriatric syndrome that includes loss of appetite and/or reduced food intake, with associated undernutrition, unintended weight loss, sarcopenia, functional decline, loss of independence and other adverse health outcomes. Anorexia of aging can have multiple and severe consequences and is often overlooked by healthcare professionals (HCPs). Even more concerningly, clinicians commonly accept anorexia of aging as an inevitable part of 'normal' aging. The aim of this assessment was to identify current gaps in professional knowledge and practice in identifying and managing older persons with anorexia. Results may guide educational programmes to fill the gaps identified and therefore improve patient outcomes.

METHODS

This international assessment was conducted using a mixed-methods approach, including focus group interviews with subject matter experts and an electronic survey of practicing HCPs. The assessment was led by the Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD) and was supported by in-country collaborating organizations.

RESULTS

A quantitative survey of 26 multiple-choice questions was completed by physicians, dietitians and other HCPs (n = 1545). Most HCPs (56.8%) recognize a consistent definition of anorexia of aging as a loss of appetite and/or low food intake. Cognitive changes/dementia (91%) and dysphagia (87%) are seen as the biggest risk factors. Most respondents were confident to give nutritional (62%) and physical activity (59.4%) recommendations and engaged caregivers such as family members in supporting older adults with anorexia (80.6%). Most clinicians assessed appetite at each visit (66.7%), although weight is not measured at every visit (41.5%). Apart from the Mini-Nutritional Assessment Short Form (39%), other tools to screen for appetite loss are not frequently used or no tools are used at all (29.4%). A high number of respondents (38.7%) believe that anorexia is a normal part of aging. Results show that treatment is focused on swallowing disorders (78%), dentition issues (76%) and increasing oral intake (fortified foods [75%] and oral nutritional supplements [74%]). Nevertheless, the lack of high-quality evidence is perceived as a barrier to optimal treatment (49.2%).

CONCLUSIONS

Findings from this international assessment highlight the challenges in the care of older adults with or at risk for anorexia of aging. Identifying professional practice gaps between individual HCPs and team-based gaps can provide a basis for healthcare education that is addressed at root causes, targeted to specific audiences and developed to improve individual and team practices that contribute to improving patient outcomes.

Theory-practice gap: Nursing students' self-reported depth of understanding of bioscience and its relevance to clinical practice

BACKGROUND

Bioscience subjects are essential as they allow nurses to have a clear understanding of the patient's condition and ultimately allow them to provide appropriate and timeous care. However, these subjects remain a significant problem in the endeavour to produce highly competent nurses.

AIM

The study aimed to investigate the nursing students' self-reported depth of understanding of bioscience and its relevance to clinical practice.

METHODS

A quantitative research approach using a descriptive survey design was employed. The sample (n = 211) included second-, third- and fourth-year undergraduate nursing students. A three-part self-administered questionnaire was adapted and used to collect the data. Data were analysed using IBM Statistical Package for Social Sciences software version 25.0 (IBM SPSS-25). Descriptive statistics and Chi-squared test were performed to describe the relationship among the study variables.

RESULTS

Participants rated their understanding of the application of Human Biology (n = 86, 40.76%) and Pharmacology (n = 88, 41.71%) as good, while Physics (n = 80, 37.91%) and Chemistry (n = 85, 40.28%) were rated as adequate. Most participants rated Human Biology (n = 175, 83.73%) and Pharmacology (n = 181, 86.19%) as essential, while Physics (n = 129, 61.72%) and Chemistry (n = 133, 63.64%) were rated as relevant to clinical practice. Physics (n = 112, 60.54%; n = 95, 50.53%) and Chemistry (n = 126, 68.85%; n = 113 61.41%) were rated as not relevant to monitoring a patient's heart rate and blood pressure. Participants' perception of the relevance of Chemistry in monitoring a patient's blood pressure was statistically significant (χ2 = 6.871 (df 2), p<0.05). Most participants (n = 57, 41.91%) performed at Task specific on Akinsanya's Bionursing model, suggesting an overall understanding of the foundational concepts and principles of bioscience.

CONCLUSION

The findings of the study provided evidence of the students' self-reported depth of understanding and perception of the relevance of bioscience and indicate a need for more emphasis on the importance of bioscience integration in clinical practice.

Confidence in nicotine for tobacco harm reduction-Bridging the policy-practice gap

Decades of research show that constituents other than nicotine are the harmful agents in tobacco products. This knowledge is incorporated into the nicotine regulatory policies of countries leading in tobacco control, such as the UK and New Zealand. Alternative nicotine products, such as nicotine replacement therapy and e-cigarettes, are now endorsed in the UK by a number of healthcare bodies in a tobacco harm reduction approach that encourages tobacco users to completely switch to a less risky nicotine-containing product. The potential role of 'clean' nicotine alternatives to reduce the harms from tobacco is, however, not being translated into practice. Many healthcare practitioners still bundle tobacco, cigarettes, smoking, cancer and nicotine into one, thus preventing them from supporting their patients to make informed choices on safer nicotine alternatives. This misperception among healthcare professionals, in turn, is a hurdle to effective tobacco control policymaking in many low- and middle-income countries and effective cessation support everywhere in the world. Nicotine confidence based on nicotine literacy among the key decision-makers should start with reforming medical curricula and myth-busting in the lay media to include factual statements about nicotine and public health policy discussions on the principles of harm reduction.

Meeting Theory-to-Practice Gaps? Evaluation of New Graduates

For decades, nursing graduates have exhibited a gap between theory and practice. Healthcare organizations have implemented transition programs to support successful entry into practice. Nurse educators can restructure residency programs to help graduates develop the confidence and competence needed for practice by identifying the gaps between theory and practice for nursing graduates. This study's findings support continual process improvement through evaluation and contribute to the literature about the challenges new nurses encounter.

Speech-Language Pathologists' Endorsement of Speech, Language, and Literacy Myths Reveals Persistent Research-Practice Gap

PURPOSE

We explore the extent to which speech-language pathologists (SLPs) are operating under assumptions about speech, language, and literacy that are not supported by evidence or are contradicted by evidence.

METHOD

SLPs (N = 106) marked the degree to which they endorsed or rejected four true and 11 myth (i.e., false) statements on a visual analog scale via an online survey. We analyzed the degree to which participants agreed or disagreed with these statements related to speech, language, and literacy development and impairment.

RESULTS

Based on results of one-sample t tests, participants as a group correctly rejected seven myth statements and correctly endorsed three true statements. Participants as a group provided equivocal responses to the remaining four myth statements and one true statement. Scores for each statement spanned all or nearly all of the possible range. Even when participants overall showed relatively strong disagreement with a particular myth statement, at least a few participants endorsed the myth statement.

CONCLUSIONS

The findings indicate areas of relative strength for SLPs' knowledge of current evidence for augmentative and alternative communication, bilingualism, and language input that supports language development. Identified areas of relative weakness include knowledge of the expected grammatical and speech production skills of children with typical development and the influence of ear infections in childhood on language impairment. Additional research is needed to evaluate efforts to enhance SLPs' knowledge and use of evidence-based practices.

How a Power Differential Between Clinicians and Researchers Contributes to the Research-to-Practice Gap

PURPOSE

The purpose of this article is to contend that there is a power differential between researchers and clinicians where researchers are the primary creators of knowledge and clinicians are the primary consumers of knowledge. Rooted in a sociological model illustrating interacting levels of power at macro-, meso-, and microlevels, we argue that authentic research-practice partnerships and clinician-researcher collaborations can mitigate this power differential.

CONCLUSIONS

Clinicians and researchers in our field have vastly different responsibilities and priorities that impact our ability to work collaboratively to solve the most pressing problems for the clients we serve. Although some current research practices may reinforce a power differential causing clinicians to feel less than and to only consume knowledge, there are examples of successful collaborations where this power differential is mitigated. These examples can contribute meaningfully to the dialogue on research-practice partnerships, with the goal of improving outcomes for the clients we serve.

Causes of the Evidence-practice Gap and Its Association with the Effects of Minimal Intervention Dentistry Education to Clinicians

OBJECTIVES

To identify causes of the evidence-practice gap (EPG) in dentistry in Japan and analyze whether these causes are associated with: (a) improvement of EPG in minimal intervention dentistry (MID) following an educational intervention and (b) specific dentist characteristics.

METHODS

We conducted a mixed-methods questionnaire survey among 197 Japanese dentists that integrated both quantitative and qualitative data. Causative factors for the EPG identified in the quantitative survey were clarified by qualitative analysis. We measured the EPG in a baseline survey using an EPG measurement tool based on MID. To examine how feedback using the latest scientific evidence affected change in the EPG, we measured the EPG again immediately after feedback was provided to participating dentists.

RESULTS

Qualitative analysis classified all dentists into one of four "EPG cause" groups, namely "evidence-", "dentist-", "patient-", and "health insurance system-related" causes. Quantitative analysis confirmed that improvement in the EPG following the feedback intervention was indeed associated with group classification. The highest concordance was found for the "evidence-related" group while the lowest concordance was in the "dentist-related" group (p=0.004). Concordance improved after evidence feedback in all groups but was lowest in the "dentist-related" group. More dentists reported practice busyness in the "dentist-related" group.

CONCLUSIONS

In this study, we identified four groups of causes of EPG among Japanese dentists. The degree of concordance between evidence and clinical practice was the lowest in the "dentist-related" group, and the results of this study are expected to provide useful information for the development of intervention methods for closing the EPG in the future.

Revising ruling discourses: The griefwork evidence-to-practice gap and the mental health workforce

Elisabeth Kübler-Ross' pioneering work focused on dying, yet some clinicians persist in prescribing it as a path through grief. We surveyed 964 mental health clinicians who completed a five-section mixed methods survey: two sections assessed knowledge with multiple choice questions and a case study to assess clinicians' knowledge-base and approach to grief/loss in practice. Analysis of four items related to Kübler-Ross' model and 66/962 case studies indicates ongoing use of "stages" and Kübler-Ross' model. Only 330 (34.2%) of the clinicians were deemed knowledgeable; 462 (47.9%) were questionable; and 172 (17.9%) were misinformed, continuing to use Kübler-Ross' stage theory for grief.

Studying the Research-Practice Gap in Physical Therapies for Cerebral Palsy: Preliminary Outcomes Based on a Survey of Spanish Clinicians

The purpose of this work is to study the gap between the research evidence and the clinical practice in the physical rehabilitation of people with cerebral palsy. A review process was performed to (1) identify physical therapies to improve postural control in children with cerebral palsy and (2) determine the scientific evidence supporting the effectiveness of those therapies. A Likert-based survey addressing a total of 43 healthcare professionals involved in pediatric physical therapy departments in Spain was carried out. The discussion was mainly supported by studies of level I or II evidence (according to the Oxford scale). The search process yielded 50 studies reporting 16 therapies. A strong positive correlation between the most used treatments and elevated levels of satisfaction was found. Some well-known but not often used techniques, such as hippotherapy, were identified. The treatment with the highest degree of use and satisfaction-neurodevelopment therapy (Bobath)-and some emerging techniques, such as virtual reality, were also identified. The fact that there is a meaningful gap between clinical practice and the scientific evidence was confirmed. The identified gap brings a certain degree of controversy. While some classic and well-known therapies had poor levels of supporting evidence, other relatively new approaches showed promising results.

Learning Health Systems to Bridge the Evidence-Policy-Practice Gap in Primary Health Care: Lessons From the African Health Initiative

The compilation of lessons in this supplement on the Doris Duke Charitable Foundation’s African Health Initiative’s work in the application of implementation research in primary health care in sub-Saharan Africa reflects the evolution of the discipline that is now increasingly recognized as integral to health systems strengthening.

Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem

BACKGROUND

Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers.

MAIN BODY

Ten mid-career extramurally funded US-based researchers completed a "pre-mortem" or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it - to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a "legitimate science," (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches.

CONCLUSION

We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.

Healthcare Professional and Service User Perspectives on Formal Educational Programmes for Children and Young People with Cancer in the UK

Caring for children and young people with cancer requires specific knowledge, skills and experience to deliver the complex care regimes both within the hospital or community environment. This study explored the educational gaps in caring for children and young people with cancer. To address this, a mixed methodology approach was adopted in two phases. Phase one was a questionnaire circulated to healthcare professional members (n = 850) of the Children's Cancer and Leukaemia Group and Managed Service Network, Scotland. Response rate (n = 121) (14%) was achieved. In phase two of the study, a focus groups (n = 4) was conducted with young people in Scotland through the Managed Service Network. This was to gain a critical understanding from service user perspective and what they deemed as important to their overall care delivery. Phase one: healthcare professional results reported that 76% (n = 93) were aware of education; 69% (n = 84) found that knowledge supported practice development, but only 45% (n = 55) finding current education provision useful. The top education topics identified to be lacking in educational availability were communication, psychological support, dealing with young people, supportive care, diagnosis and treatment and challenges to learning. Several participants 64% (n = 78) suggested that funding and time was a barrier, and that there was a lack of provision. Phase two: Findings from the focus group (n = 4) thematic analysis identified five key themes. Service users expected professionals to be knowledgeable and trained, but when talking about experiencing care, gave insights into the gaps in their care. Findings suggest that formal cancer education is required.

Critical decisions in the trauma intensive care unit: Are we practicing primary palliative care?

BACKGROUND

Devastating injuries require both urgent assessment by a trauma service and early attention to patients' goals of care (GOC). American College of Surgeons Trauma Quality Improvement Program (TQIP) guidelines recommend an initial palliative assessment within 24 hours of admission and family meeting, if needed, within 72 hours. We hypothesize that a primary palliative care-based practice improves adherence to TQIP guidelines in trauma patients.

METHODS

All adult trauma patients who died while inpatient from January 2014 to December 2018 were reviewed. Timing of GOC discussions, transition to comfort measures only (CMO), and the utilization of specialty palliative services were analyzed with univariate analysis.

RESULTS

During the study period, 415 inpatients died. Median Injury Severity Score was 26 (interquartile range [IQR], 17-34), median age was 67 years (IQR, 51-81 years), and 72% (n = 299) transitioned to CMO before death. Documented GOC discussions increased from 77% of patients in 2014 to 95% of patients in 2018 (p < 0.001), and in 2018, the median time to the first GOC discussion was 15 hours (IQR, 7- 24 hours). Specialty palliative care was consulted in 7% of all patients. Of patients who had at least one GOC discussion, 98% were led by the trauma intensive care unit (TICU) team. Median time from admission to first GOC discussion was 27 hours (IQR, 6-91 hours). Median number of GOC discussions was 1 (IQR, 1-2). Median time to CMO after the final GOC discussion was 0 hours (IQR, 0-3). Median time to death after transition to CMO was 4 hours (IQR, 1-18 hours).

CONCLUSION

Of those who died during index admission, we demonstrated significant improvement in adherence to American College of Surgeons TQIP palliative guidelines across the 5-year study period, with the TICU team guiding the majority of GOC discussions. Our TICU team has developed an effective primary palliative care approach, selectively consulting specialty palliative care only when needed.

LEVEL OF EVIDENCE

Therapeutic/care management, level III.

Sources of the knowledge-practice gap in nursing: Lessons from an integrative review

BACKGROUND

The ultimate value of learning lies in the transfer of knowledge to real-life settings. The gap between knowledge and practice can be described as the disconnection between acquired knowledge, the skills learned in nursing school, and those skills needed to practice safely and independently. This is a concerning issue that needs to be investigated deeply to address all the circumstances and factors contributing to the gap.

OBJECTIVES

To reveal the full range of factors leading to the knowledge-practice gap in nursing by means of a thorough survey of the most recent evidence and updates.

METHODS

An integrative review design was selected. Three data bases (MEDLINE, CINAHL Plus and ERIC) were searched electronically for research articles from 2009 up to June 2020 on the gap between knowledge and practice. The 406 articles that appeared were appraised for inclusion or exclusion using the JBI Critical Appraisal Checklist for qualitative research.

RESULT

Eight qualitative studies were included in the review, which identified three major themes and subthemes. The first theme is personal factors, with the following subthemes: internal motivation, learning style and attitude. The second theme is educational structure, with the following subthemes: clinical instructor role, preceptor effect and curriculum. The third theme is organisational characteristics, with the following subthemes: resources, clinical setting features and staffing.

CONCLUSION

The review revealed that the knowledge-practice gap has deep roots in multiple factors. Considering all dimensions of these factors is the key to bridging the knowledge-practice gap.

Solutions to bridge the theory-practice gap in nursing education in the UAE: a qualitative study

BACKGROUND

The theoretical knowledge of nursing underpins the practice, while the practice environment determines the circumstances within which the theoretical knowledge is applied. The biggest challenge facing nursing as an academic field is the theory-practice gap, which is a universal issue in nursing. This study aimed to raise solutions to close the gap between theory and practice in nursing education through the eyes of nursing students in UAE.

METHODS

A qualitative descriptive approach was followed; whereby 25 Emirati nursing students were interviewed.

RESULTS

Two main themes are discussed in this study: 'Clinical Culture Creation' and 'Curriculum Content Reformation'. The students suggested to decreased the loud and stress on their clinical educators. They also suggested creating synchronization between what is taught in classrooms and labs and what is offered in the clinical training. Moreover, some of the students expected to have more benefit if they get their clinical training in health institutions owned by their college. On the other side, many of the participants suggested to move from the integration system to the block system. Another interesting suggestion includes having the same college staff to teach the theory and the clinical. The final suggestion includes decreasing the paper work during clinical training.

CONCLUSIONS

This study explored the solutions to bridge the theory-practice gap in nursing education in the UAE. The study has implications for nursing education and practice within the UAE and is imperative for graduating workplace ready professional nurses within the country.

Bridging the science-practice gaps in nature-based solutions: A riverfront planning in China

Prominent gaps exist between science and practice in the field of nature-based solutions (NBS) worldwide, with relatively well formulated concepts but less clear application procedures. China urgently needs to address this gap because many so called NBS practices advance rapidly nowadays, including river landscapes. Advocating planning as a bridging procedure in China's top down governance system, this study introduces NBS planning for the Jialing River in Wusheng County to address three challenges: how to transform the riverfront planning from specialized to holistic, how to effectively communicate NBS in planning, and how to incorporate both scientific results and local wisdom into NBS decision-making. A planning scope was negotiated to incorporate holistic solutions. Five NBS paradigms were identified for better communication, and then spatially allocated with specific design guidelines and governance strategies. Our pilot study calls for reflection on the communication of NBS to the public, and alternative models of NBS implementations customized to different government regimes.

A Clinical Perspective on the Dietary Therapies for Pediatric Eosinophilic Esophagitis: The Gap Between Research and Daily Practice

Pediatric eosinophilic esophagitis (ped-EoE) is an immune-mediated pathology affecting 34 per 100.000 children. It is characterized by an esophageal inflammation caused by an immune response towards food antigens that come into contact with the esophageal lining. Depending on the age of the child, symptoms can vary from abdominal pain, vomiting and failure to thrive to dysphagia and food impaction. The diagnosis of this chronic disease is based on the symptoms of esophageal dysfunction combined with an infiltration of more than 15 eosinophils per high-power field and the exclusion of secondary causes. The treatment modalities include the 3Ds: Drugs, allergen avoidance by Diet and/or esophageal Dilation. In this review we focused on the efficacy of dietary approaches in ped-EoE, which currently include the elemental diet (amino acid-based diet), the empiric elimination diet and the allergy test-directed elimination diet. Although several reviews have summarized these dietary approaches, a lack of consistency between and within the elimination diets hampers its clinical use and differences in subsequent reintroduction phases present a barrier for dietary advice in daily clinical practice. We therefore conducted an analysis driven from a clinician's perspective on these dietary therapies in the management of ped-EoE, whereby we examined whether these variations within dietary approaches, yet considered to be similar, could result in significant differences in dietary counseling.

Identifying and bridging the knowledge-to-practice gaps in rehabilitation professionals working with at-risk infants in the public health sector of South Africa: a multimethod study protocol

INTRODUCTION

Early childhood is a critical time when the benefits of early interventions are intensified, and the adverse effects of risk can be reduced. For the optimal provision of early intervention, professionals in the field are required to have specialised knowledge and skills in implementing these programmes. In the context of South Africa, there is evidence to suggest that therapists are ill-prepared to handle the unique challenges posed in neonatal intensive care units and wards with at-risk infants in the first few weeks of life. This is attributed to several reasons; however, irrespective of the causative factors, the need to bridge this knowledge-to-practice gap remains essential.

METHODS AND ANALYSIS

This study is a multimethod stakeholder-driven study using a scoping review followed by an appreciative inquiry and Delphi process that will aid in the development, implementation and evaluation of a knowledge translation intervention to bridge knowledge-gaps in occupational and physiotherapists working in the field. Therapists currently working in the public health sector will be recruited for participation in the various stages of the study. The analysis will occur via thematic analysis for qualitative data and percentages and frequencies for descriptive quantitative data. Issues around trustworthiness and rigour, and reliability and validity, will be ensured within each of the phases, by use of a content validity index and inter-rater reliability for the Delphi survey; thick descriptions, peer debriefing, member checking and an audit trail for the qualitative data.

ETHICS AND DISSEMINATION

The study has received full ethical approval from the Health Research and Knowledge Management Directorate of the Department of Health and a Biomedical Research Ethics Committee. The results will be published in peer-reviewed academic journals and disseminated to the relevant stakeholders within this study.

Quantifying and Remediating the New Graduate Nurse Resident Academic-Practice Gap Using Online Patient Simulation

BACKGROUND

There is an ever-widening academic-practice gap. Less than one third of new graduates demonstrate entry-level competencies required for practice. Hospitals expend many resources to create nurse residency programs to remediate this gap. Online interactive case simulation is effective to increase competencies and decrease the length of orientation and rate of turnover. The aims of this pilot research study were to quantify the academic-practice gap and to strengthen areas of development for competent and safe clinical practice through use of an online patient simulation program.

METHOD

A pretest-posttest quasi-experimental study using an online patient simulation program was implemented in a convenience sample of nurse residents over 16 months.

RESULTS

Twenty-nine residents completed more than 3,400 patient simulations. Improvement in pretest and posttest metrics included 100% of nurse residents committing a sentinel error event decreased to 20.7%, 766 medication errors decreased to 160, and failed-to-rescue an average of 81% of the time decreased to 23%.

CONCLUSION

Interactive online patient simulation programs provide a powerful learning methodology in which learners improve patient safety and reduce failures to rescue. [J Contin Educ Nurs. 2021;52(5):240-247.].

Barriers to diabetic foot management in Italy: A multicentre survey in diabetic foot centres of the Diabetic Foot Study Group of the Italian Society of Diabetes (SID) and Association of Medical Diabetologists (AMD)

BACKGROUND AND AIMS

Diabetic foot (DF) disease is a current health and social burden. The authors aimed to identify the barriers to the DF management across Italy.

METHODS AND RESULTS

A questionnaire was submitted to Italian centres dedicated to DF care. The questionnaire was composed of 12 questions focused on the barriers to the DF management including timing of referral, hospital management, and community follow-up. Each centre could answer by choosing a score from 1 to 5 for every item with the following numerical variables: 1 = never; 2 = rarely; 3 = sometimes; 4 = often; 5 = always. Accordingly, for each item a national and regional score was reported and a comparison between regions was carried out. National and regional scores were estimated using the total score for each item as a numerator and the number of national centres included as a denominator. Among 102 centres, 99 were included and 3 were excluded due to missing data. The 99 centres belonged to 16 regions with the following distribution: Calabria 4, Campania 5, Emilia-Romagna 14, Friuli-Venezia-Giulia 4, Lazio 12, Liguria 4, Lombardy 10, Marche 1, Molise 1, Piedmont 5, Apulia 5, Sardinia 5, Sicily 4, Tuscany 11, Veneto 9, Umbria 5. The items with the highest score were late referral (3.3) and urgent surgery (3.2). The regions with the highest score were Molise (3.9) and Calabria (3.5).

CONCLUSION

The main issues across Italy were late referral and the requirement for urgent surgery for acute DF. In the regional scenario, the southern central areas showed more barriers than northern regions.

Blueprint for cancer research: Critical gaps and opportunities

We are experiencing a revolution in cancer. Advances in screening, targeted and immune therapies, big data, computational methodologies, and significant new knowledge of cancer biology are transforming the ways in which we prevent, detect, diagnose, treat, and survive cancer. These advances are enabling durable progress in the goal to achieve personalized cancer care. Despite these gains, more work is needed to develop better tools and strategies to limit cancer as a major health concern. One persistent gap is the inconsistent coordination among researchers and caregivers to implement evidence-based programs that rely on a fuller understanding of the molecular, cellular, and systems biology mechanisms underpinning different types of cancer. Here, the authors integrate conversations with over 90 leading cancer experts to highlight current challenges, encourage a robust and diverse national research portfolio, and capture timely opportunities to advance evidence-based approaches for all patients with cancer and for all communities.

Can an interactive case-based activity help bridge the theory-practice gap in operative dentistry?

INTRODUCTION

A theory-practice gap in pre-doctoral dental education is a common source of stress for dental students. An interactive, small-group, case-based activity was designed to bridge the gap between pre-clinical and clinical experiences. The aim of our study was to assess the effectiveness of the case-based activity by evaluating students' comfort level in operative procedures.

MATERIALS AND METHODS

Over 5 years, a total of 172 second-year students from the classes of 2017 through 2021 participated in the case-based activity delivered after the completion of the core operative dentistry course. The exercise included a pre-activity online quiz, an in-class case-based session and a laboratory exercise. Students' self-reported comfort levels in performing operative procedures were collected by surveys at three different times. They included the post-course survey distributed after the completion of the core operative dentistry course, the post-activity survey distributed after the completion of the case-based activity, and the follow-up survey distributed after students completed their first operative procedures in clinic.

RESULTS

There was a 93% response rate. The average rating of all eight statements revealed statistically significant increase in students' comfort level after completing the case-based activity and after performing their first operative procedures in the teaching practice.

CONCLUSION

This observation suggests that the case-based activity was effective in raising students' comfort levels. The activity may serve as an important tool in bridging the theory-practice gap between pre-clinical and clinical operative experiences.

An assessment of the use of patient reported outcome measurements (PROMs) in cancers of the pelvic abdominal cavity: identifying oncologic benefit and an evidence-practice gap in routine clinical practice

BACKGROUND

Patient reported outcome measurements (PROMs) are emerging as an important component of patient management in the cancer setting, providing broad perspectives on patients' quality of life and experience. The use of PROMs is, however, generally limited to the context of randomised control trials, as healthcare services are challenged to sustain high quality of care whilst facing increasing demand and financial shortfalls. We performed a systematic review of the literature to identify any oncological benefit of using PROMs and investigate the wider impact on patient experience, in cancers of the pelvic abdominal cavity specifically.

METHODS

A systematic review of the literature was conducted using MEDLINE (Pubmed) and Ovid Gateway (Embase and Ovid) until April 2020. Studies investigating the oncological outcomes of PROMs were deemed suitable for inclusion.

RESULTS

A total of 21 studies were included from 2167 screened articles. Various domains of quality of life (QoL) were identified as potential prognosticators for oncologic outcomes in cancers of the pelvic abdominal cavity, independent of other clinicopathological features of disease: 3 studies identified global QoL as a prognostic factor, 6 studies identified physical and role functioning, and 2 studies highlighted fatigue. In addition to improved outcomes, a number of included studies also reported that the use of PROMs enhanced both patient-clinician communication and patient satisfaction with care in the clinical setting.

CONCLUSIONS

This review highlights the necessity of routine collection of PROMs within the pelvic abdominal cancer setting to improve patient quality of life and outcomes.

Perceptions and experiences of promotoras and pharmacists in an academic-community partnership providing telephonic MTM services to a Spanish-speaking, rural population: a focus group study

BACKGROUND: The literature is limited concerning the collaboration between pharmacists and promotoras in the delivery of medication therapy management (MTM) services. Yet, this information could help address a practice gap while improving MTM collaborative care approaches. OBJECTIVE: To identify the knowledge, attitudes, and barriers of clinical call center health professionals (pharmacists, nurses, pharmacy interns) and promotoras towards MTM collaborative care in implementing the Rural Arizona Medication Therapy Management (RAzMTM) program. METHODS: A descriptive, qualitative study using semistructured focus groups was conducted with call center health professionals and promotoras who participated in the RAzMTM program to improve pharmaceutical care for patients with diabetes and/or hypertension in rural Arizona. Recruitment and consent letters, a demographic questionnaire, and a focus group guide were designed specifically for this project. Three facilitators participated in each focus group-one guided the discussion while the others took notes. Focus groups were audio recorded to verify all responses and transcribed verbatim with omission of participant identifiers. Thematic analysis was conducted by 2 independent researchers who reviewed the transcripts to identify codes, seek consensus, and agree on themes, with negotiation from a third independent researcher. RESULTS: Nine participants took part in 2 focus groups. Participants were predominantly female (89%), college graduates and/or had postgraduate/professional degrees (78%), and were Hispanic or Latino (89%). Five themes were identified: (1) roles and responsibilities of RAzMTM participants; (2) benefits unique to the RAzMTM program; (3) interprofessional experience of RAzMTM participants; (4) professional growth for RAzMTM participants; and (5) opportunities for future improvement. Perceptions of the participants in the RAzMTM program were consistent-experiences of health professionals and promotoras were positive; they recognized the benefit of each other's involvement in the program; and they learned how to work together to improve patient care. Future recommended program improvements include improving ease of scheduling (e.g., extending pharmacist availability to provide MTM services). CONCLUSIONS: These focus group results suggest that provision of telephonic MTM services, using an academic-community partnership, was positively received by participating pharmacists and promotoras. However, future work is needed for continued improvement of strategies to enhance interprofessional relationships in patient chronic disease management. DISCLOSURES: This project was supported by the Grant or Cooperative Agreement Number DP004793, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. This work also was supported, in part, by SinfoniaRx. Axon, Taylor, and Warholak received funding from SinfoniaRx. Axon reports grants from Tabula Rasa Op-Co, Merck & Co, Pharmacy Quality Alliance, Arizona Department of Health, and American Association of Colleges of Pharmacy, outside the submitted work. Warholak and Taylor received funding from Arizona Department of Health Services as part of a contract, outside the submitted work. Vaffis reports funding from Merck and Pharmacy Quality Alliance. This study was presented as a poster at the American Society of Health-System Pharmacists Summer Meetings & Exhibition (June 10-12, 2019, Boston, MA) and as a podium presentation at the Arizona Pharmacy Association Southwestern States Residency Conference (June 14, 2019, Phoenix, AZ).

Evidence of practice gaps in emergency psychiatric care for borderline personality disorder: how can this be explained?

BACKGROUND

Recent research has highlighted that patients with borderline personality disorder (BPD) could experience symptomatic remissions. This led to the production of guidelines concerning the most appropriate care. In addition, as BPD patients frequently present at an emergency department (ED), specific recommendations concerning how they should be cared for there have also been developed. The recommendations include the referral of patients to inpatient, outpatient or specific crisis care. However, an issue that has not been addressed is the capacity of ED services to apply the care recommendations. The objective of our study, therefore, was to identify the factors limiting their use in the ED of Toulouse University Hospital.

METHODS

A panel of psychiatrists specializing in BPD care examined the medical files of 298 patients with a BPD diagnosis to determine which referrals were consistent or not, according to the care recommendations. A logistic regression was then performed to identify which sociodemographic, clinical, organizational or professional-training factors were associated with inconsistent referrals.

RESULTS

32% of patients experienced an inconsistent referral. Consultations performed during an on-call or day-off schedule were linked with inconsistent referrals, while an active follow-up was associated with the provision of consistent care.

CONCLUSION

Changing how evaluations of BPD patients in the ED are organized during on-call and day-off schedules could improve the application of the care recommendations regarding the most appropriate referrals.

Examining the Gaps and Issues of End-of-Life Care among Older Population through the Lens of Socioecological Model-A Multi-Method Qualitative Study of Hong Kong

End-of-life (EOL) care for terminal illness and life-limiting conditions is a sector in the health service spectrum that is drawing increased attention. Despite having the world's longest life expectancy and an ever-escalating demand for long-term care, Hong Kong's EOL care was underdeveloped. The current study aims to provide a holistic picture of gaps and issues to EOL care in Hong Kong. Data collection was conducted using a multi-method qualitative approach that included focus groups and in-depth interviews with key informants and stakeholders, and longitudinal case studies with patients and families. Deductive thematic analysis was used to examine service gaps in current EOL care through the lens of a socioecological model where gaps and issues in various nested, hierarchical levels of care as well as the relationships between these levels were studied in detail. Using the model, we identified gaps and issues of EOL care among older populations in Hong Kong at the policy, legal, community, institutional, as well as intrapersonal and interpersonal levels. These include but are not limited to a lack of overarching EOL care policy framework, ambiguity in the legal basis for mental incapacity, legislative barriers for advance directives, inadequate capacity, resources, and support in the community to administer EOL care, inadequate knowledge, training, and resources for EOL care in health and social care sectors, inadequate medical-social interface, general reluctance and fear of death and dying, as well as the cultural interpretation of filial piety that may lengthen the suffering of the dying patients. Findings highlight the multi-level gaps and issues of EOL care in a place where western and eastern culture meet, and shed light on how best to design more effective and comprehensive policy interventions that will likely have a more sustainable and instrumental impact on facilitating person-centered EOL care during the end of life.

Cohort profile: the LHIV-Manitoba clinical cohort of people living with HIV in Manitoba, Canada

PURPOSE

The LHIV-Manitoba cohort was developed as a way to provide a comprehensive source of HIV-related health information in the central Canadian Prairie province of Manitoba. The cohort will provide important information as we aim to better understand local HIV epidemiology and address key knowledge and practice gaps in HIV prevention, treatment and care programming in the province.

PARTICIPANTS

In total, 890 individuals, aged 18 or older and living or receiving HIV care in Manitoba are enrolled in the cohort. A complete clinical dataset exists for 725 participants, which includes variables on sociodemographic characteristics, comorbidities and co-infections, self-reported HIV exposure categories and HIV clinical indicators. A limited clinical dataset exists for an additional 165 individuals who were enrolled posthumously. 97.5% of cohort participants' clinical records are linked to provincial administrative health datasets.

FINDINGS TO DATE

The average age of cohort participants is 49.7 years. Approximately three-quarters of participants are male, 42% self-identified as white and 42% as Indigenous. The majority of participants (64%) reported condomless vaginal sex as a risk exposure for HIV. Nearly one-fifth (18%) of participants have an active hepatitis C virus infection and the cohort's median CD4 count increased from 316 cells/mm³ to 518 cells/mm³ between time of entry into care and end of the first quarter in 2019.

FUTURE PLANS

The LHIV-Manitoba cohort is an open cohort, and as such, participant enrolment, data collection and analyses will be continually ongoing. Future analyses will focus on the impact of provincial drug plans on clinical outcomes, determinants of mortality among cohort participants and deriving estimates for a local HIV care cascade.