Roles and effectiveness of knowledge brokers for translating clinical practice guidelines in health-related settings: a systematic review.

BACKGROUND: Poor translation of clinical practice guidelines (CPGs) into clinical practice is a barrier to the provision of consistent and high-quality evidence-based care. The objective was to systematically review the roles and effectiveness of knowledge brokers (KBs) for translating CPGs in health-related settings. METHODS: MEDLINE, Embase, PsycINFO and CINAHL Plus were searched from 2014 to June 2022. Randomised controlled trials (RCTs), controlled and uncontrolled preintervention and postintervention studies involving KBs, either alone or as part of a multicomponent intervention, that reported quantitative postintervention changes in guideline implementation in a healthcare setting were included. A KB was defined as an intermediary who facilitated knowledge translation by acting in at least two of the following core roles: knowledge manager, linkage agent or capacity builder. Specific activities undertaken by KBs were deductively coded to the three core roles, then common activities were inductively grouped. Screening, data extraction, quality assessment and coding were performed independently by two authors. RESULTS: 16 studies comprising 6 RCTs, 8 uncontrolled precomparisons-postcomparisons, 1 controlled precomparison-postcomparison and 1 interrupted time series were included. 14 studies (88%) were conducted in hospital settings. Knowledge manager roles included creating and distributing guideline material. Linkage agent roles involved engaging with internal and external stakeholders. Capacity builder roles involved audit and feedback and educating staff. KBs improved guideline adherence in 10 studies (63%), had mixed impact in 2 studies (13%) and no impact in 4 studies (25%). Half of the RCTs showed KBs had no impact on guideline adherence. KBs acted as knowledge managers in 15 (94%) studies, linkage agents in 11 (69%) studies and capacity builders in all studies. CONCLUSION: Knowledge manager and capacity builder roles were more frequently studied than linkage agent roles. KBs had mixed impact on translating CPGs into practice. Further RCTs, including those in non-hospital settings, are required. PROSPERO REGISTRATION NUMBER: CRD42022340365.

Collagen incorporation within electrospun conduits reduces lipid oxidation and impacts conduit mechanics.

Modulating the host response, including the accumulation of oxidized lipid species, is important for improving tissue engineered vascular graft (TEVG) viability. Accumulation of oxidized lipids promotes smooth muscle cell (SMC) hyper-proliferation and inhibits endothelial cell migration, which can lead to several of the current challenges for small-diameter TEVGs. Generating biomaterials that reduce lipid oxidation is important for graft survival and this assessment can provide a reliable correlation to clinical situations. In this study, we determined the collagen to poly(ε-caprolactone) (PCL) ratio required to limit the production of pro-inflammatory species, while maintaining the required mechanical strength for the graft. Electrospun conduits were prepared from 0%, 10%, and 25% blends of collagen/PCL (w/w) and implanted in the rat peritoneal cavity for four weeks. The results showed that adding collagen to the PCL conduits reduced the accumulation of oxidized lipid species within the implanted conduits. In addition, the ratio of collagen had a significant impact on the recruited cell phenotype and construct mechanics. All conduits exhibited greater than 44% yield strain and sufficient tensile strength post-implantation. In conclusion, these results demonstrate that incorporating collagen into synthetic electrospun scaffolds, both 10% and 25% blend conditions, appears to limit the pro-inflammatory characteristics after in vivo implantation.

Evaluación de la adherencia a la Guía de Práctica Clínica para la Neumonía asociada a la Ventilación Mecánica / Avaliação da adesão às diretrizes da prática clínica para pneumonia associada à ventilação mecânica / Evaluation of adherence to the clinical practice guideline for pneumonia associated with mechanical ventilation

Introducción: En el Hospital General Docente Dr Agostinho Neto no se ha explorado el nivel de adherencia profesional a la Guía de práctica clínica ante la neumonía asociada a la ventilación mecánica. Objetivo: Determinar el nivel de adherencia profesional a esta Guía durante el 2018. Método: Durante el año 2018 se realizó un estudio descriptivo, prospectivo, aprobado por el Comité de Ética. Participaron ocho profesionales. Se emplearon métodos teóricos, empíricos y matemático-estadístico. Se estudiaron las siguientes variables: opinión de los profesionales sobre la guía y su evaluación, diagnóstico de la adherencia profesional a la guía. Resultados: El 100,0 por ciento de los profesionales expresó un dominio de su contenido, utilidad y aseguraron estar adheridos a la guía. Cuatro (57,1 por ciento) de los siete indicadores que se consideraron en la evaluación adherencia a la guía fueron evaluados en la categoría adecuado, uno (14,2 por ciento) se evaluó en la categoría parcialmente adecuado y 2 (28,7 por ciento) en la categoría poco adecuado. En general, la adherencia a la guía se evaluó en la categoría adecuada (85,7 por ciento). Conclusiones: Fue adecuada la adherencia profesional a la guía, la que estuvo limitada por la insuficiente estructura para el desarrollo del proceso de atención médica al paciente tratado con ventilación mecánica y de modo particular al afectado por este tipo de neumonía(AU)

Introduction: In the General Teaching Hospital Dr Agostinho Neto the level of professional adherence to the clinical practice guideline before pneumonia associated with mechanical ventilation has not been explored. Objective: To determine the level of professional adherence to this guide during 2018. Method: During the year 2018 a descriptive, prospective study was approved, approved by the Ethics Committee. Eight professionals participated. Theoretical, empirical and mathematical-statistical methods were used. The following variables were studied: professional opinion on the guide and its evaluation, diagnosis of professional adherence to the guide. Results: The total of the professionals (100.0per cent) expressed a mastery of their content, usefulness and said they were adhering to the guide. Four (57.1per cent) of the seven indicators that were considered in the evaluation adherence to the guide were evaluated in the Adequate category, one (14.2per cent) was valuated in the Partially Adequate category and 2 (28.7per cent) in the category Unsuitable. In general, adherence to the guide was assessed in the Adequate category (85.7per cent). Conclusions: Professional adherence to the guide was adequate, which was limited by the insufficient structure for the development of the medical care process for patients treated with mechanical ventilation and particularly for those affected by this type of pneumonia(AU)

Introdução: No Hospital Geral de Ensino Dr Agostinho Neto não explorou o nível de adesão profissional às diretrizes da prática clínica para pneumonia associada à ventilação mecânica. Objetivo: Determinar o nível de adesão profissional a este guia em 2018. Método: durante o ano de 2018, foi aprovado um estudo descritivo e prospectivo, aprovado pelo Comitê de Ética. Oito profissionais participaram. Foram utilizados métodos teóricos, empíricos e matemático-estatísticos. Foram estudadas as seguintes variáveis: opinião profissional sobre o guia e sua avaliação, diagnóstico de adesão profissional ao guia. Resultados: O total dos profissionais (100,0por cento) manifestaram domínio do seu conteúdo, utilidade e afirmaram estar aderindo ao guia. Quatro (57,1por cento) dos sete indicadores considerados na adesão à avaliação foram avaliados na categoria Adequado, um (14,2por cento) foi avaliado na categoria Parcialmente Adequado e 2 (28,7por cento) na categoria Inadequado. De maneira geral, a adesão ao guia foi avaliada na categoria Adequado (85,7por cento). Conclusões: A adesão profissional ao guia foi adequada, limitada pela estrutura insuficiente para o desenvolvimento do processo de assistência médica aos pacientes tratados com ventilação mecânica e principalmente aos acometidos por esse tipo de pneumonia(AU)