Disseminating the Foundations of Knowledge Translation and Patient Engagement Science Through the KnowledgeNudge Blog and Twitter Profile: Quantitative Descriptive Evaluation.

BACKGROUND: There is a documented need to build capacity for theory- and evidence-informed knowledge translation (KT) and patient engagement (PE) practice in health research. Dissemination of foundational content online coupled with social media promotion may build capacity by increasing awareness, knowledge, and positive attitudes. OBJECTIVE: This retrospective study sought to (1) describe exposure and engagement of the KnowledgeNudge KT and PE dissemination strategy (online blog and Twitter profile) over 2 years and (2) identify and compare characteristics of individual posts with the most and least exposure and reach. METHODS: Exposure was assessed by blog site views per month and Twitter profile impressions per month. Engagement was assessed by Twitter profile interactions per month. Descriptive statistics were calculated for 6-month blocks and compared using one-way analysis of variance or Student t test. Individual post exposure was assessed by average post views per week. Individual post reach was assessed by average post reads per week. High- and low-profile blog posts with the highest and lowest 10th percentile for exposure and reach were identified. RESULTS: A total of 99 posts and 755 tweets were published during the study period. There was a significant increase in exposure (P=.004) and reach (P<.001) during the final 6 months. Seven high-profile and 6 low-profile posts were identified. High-profile posts had a significantly greater average word count than low-profile posts (P=.003). There were no other significant differences between posts. CONCLUSIONS: The increases in KnowledgeNudge exposure and engagement offer preliminary evidence in support of this dissemination strategy for the practice of KT and PE. Variation in individual post exposure and reach warrants further exploration to tailor content to user needs. Future work will include a prospective evaluation strategy to explore the effect of KnowledgeNudge on awareness, knowledge, attitudes, and behavior.

Creation of an Integrated Knowledge Translation Process to Improve Pediatric Emergency Care in Canada.

TREKK (Translating Emergency Knowledge for Kids) was established to address knowledge needs to support care of children in general emergency departments. To achieve this goal, we developed an integrated knowledge translation (KT) process based on identified priorities to create the TREKK Evidence Repository, containing "knowledge pyramids" and Bottom Line Recommendations (summary documents) on the diagnosis and treatment of emergency pediatric conditions. The objective of this article is to describe our methods for developing and disseminating the TREKK Evidence Repository to improve pediatric emergency care in Canada. Our work was guided by the research question: Can an integrated KT process address an information gap in healthcare practice? We utilized a pyramid-shaped framework, built upon the "4S" hierarchy of evidence model, to provide detailed evidence appropriate to stakeholders' needs. For each priority condition (asthma, bronchiolitis, croup, etc.), clinical advisors and KT experts collaborated to create a Bottom Line Recommendation and to select guidelines, reviews, and key studies for that condition's topic area in the Evidence Repository on the TREKK website (trekk.ca). Targeted promotion, including a social media campaign, communicated the availability of new topics in the Evidence Repository and available knowledge tools. Feedback from 35 end-users on pilot versions of the Evidence Repository was positive with 91% indicating that they would use the resource in the emergency department. Using an integrated KT process, we responded to end-users' requests for varying level of information on priority pediatric conditions through the creation of knowledge tools and development of a process to identify and vet high quality evidence-based resources.

Diagnosis of VTE postdischarge for major abdominal and pelvic oncologic surgery: implications for a change in practice.

BACKGROUND: Extended thromboprophylaxis after hospital discharge following cancer surgery has been shown to reduce the incidence of venous thromboembolism (VTE); however, this practice has not been universally adopted. We conducted a population-based analysis to determine the proportion of patients with symptomatic VTE diagnosed within 90 days after initial discharge following major abdominopelvic cancer surgery who might have benefited from extended thromboprophylaxis. METHODS: We used the Manitoba Cancer Registry to identify patients who underwent major abdominopelvic cancer surgery between 2004 and 2009. The proportion in whom VTE was diagnosed during the initial hospital stay was determined by accessing the Hospital Separations Abstracts. The proportion in whom VTE was diagnosed after discharge was determined by examining repeat admissions within 90 days and by accessing Drug Programs Information Network records for newly prescribed anticoagulants. Detailed tumour and treatment-specific data allowed calculation of VTE predictors. RESULTS: Of 6612 patients identified, 106 (1.60%) had VTE diagnosed during the initial stay and 96 (1.45%) presented with VTE after discharge. Among patients in whom VTE developed after discharge, 33.3% had a pulmonary embolus, 24% had deep vein thrombosis, and 6.3% had both. Predictors of presenting with VTE after discharge within 90 days of surgery included advanced disease, presence of other complications, increased hospital resource utilization, primary tumours of noncolorectal gastrointestinal origin and age younger than 45 years. The development of VTE was an independent predictor of decreased 5-year overall survival. CONCLUSION: The cumulative incidence of VTE within 90 days of major abdominopelvic oncologic surgery was 3.01%, with about half (1.45%) having been diagnosed within 90 days after discharge.

CONTEXTE: La thromboprophylaxie prolongée après le congé hospitalier suite à une chirurgie pour cancer a permis de réduire l'incidence de la thrombo-embolie veineuse (TEV); or, cette pratique n'a pas été universellement adoptée. Nous avons procédé à une analyse de population afin de déterminer la proportion de patients qui ont reçu un diagnostic de TEV symptomatique dans les 90 jours suivant leur congé à la suite d'une chirurgie majeure pour cancer abdomino-pelvien et qui auraient pu bénéficier d'une thromboprophylaxie prolongée. MÉTHODES: Nous avons utilisé le registre du cancer du Manitoba pour recenser les patients ayant subi une chirurgie majeure pour cancer abdomino-pelvien entre 2004 et 2009. La proportion de patients chez qui une TEV a été diagnostiquée au cours du séjour hospitalier initial a été calculée à partir des sommaires d'hospitalisation préparés au congé du patient. La proportion de patients chez qui la TEV a été diagnostiquée après le congé provient de l'examen des dossiers de réadmission dans les 90 jours et du réseau provincial d'information sur les programmes de médicaments pour les anticoagulants nouvellement prescrits. L'analyse des données détaillées sur les tumeurs et les traitements a permis d'établir les prédicteurs de la TEV. RÉSULTANTS: Sur 6612 patients recensés, 106 (1,60 %) ont reçu un diagnostic de TEV durant leur séjour initial et 96 (1,45 %), après leur congé. Parmi les patients chez qui la TEV est survenue après le congé, 33,3 % ont souffert d'une embolie pulmonaire, 24 %, d'une thrombose veineuse profonde et 6,3 %, des deux. Les prédicteurs de la TEV consécutive au congé hospitalier dans les 90 jours suivant une chirurgie incluaient : maladie avancée, présence d'autres complications, utilisation accrue des ressources hospitalières, tumeur primitive d'origine gastro-intestinale non colorectale et âge < 45 ans. La TEV s'est révélée être un prédicteur indépendant d'une plus brève survie globale à 5 ans. CONCLUSION: L'incidence cumulative des TEV dans les 90 jours suivant une chirurgie majeure pour cancer abdomino-pelvien a été de 3,01 %, environ la moitié des cas (1,45 %) ayant été diagnostiqués dans les 90 jours suivant le congé.

Knowledge sharing between general and pediatric emergency departments: connections, barriers, and opportunities.

OBJECTIVE: Translating Emergency Knowledge for Kids (TREKK) is a national network aimed at improving emergency care for children by increasing collaborations and knowledge sharing between general and pediatric emergency departments (EDs). This study aimed to determine patterns of knowledge sharing within the network and to identify connections, barriers, and opportunities to obtaining pediatric information and training. METHODS: We conducted 22 semi-structured interviews with health care professionals working in general EDs, purposefully sampled to represent connected and disconnected sites, based on two previous internal quantitative social network analyses (SNA). Data were analyzed by two independent reviewers. RESULTS: Participants included physicians (59%) and nurses (41%) from 18 general EDs in urban (68%) and rural/remote (32%) Canada. Health care professionals sought information both formally and informally, by using guidelines, talking to colleagues, and attending pediatric related training sessions. Network structure and processes were found to increase connections, support practice change, and promote standards of care. Participants identified personal, organizational and system level barriers to information and skill acquisition, including resources and personal costs, geography, dissemination, and time. Providing easy access to information at the point of care was promoted through enhancing content visibility and by embedding resources into local systems. There remains a need to share successful methods of local dissemination and implementation across the network, and to leverage local professional champions such as clinical nurse liaisons. CONCLUSIONS: These findings reinforce the critical role of ongoing network evaluation to improve the design and delivery of knowledge mobilization initiatives.

Is the Provision of Physical Education to Senior-Years Students Associated With Greater Physical Activity Levels? Insight Into a Province-Wide Policy.

OBJECTIVES: The purpose of this study was to determine if participation in physical education (PE) was associated with increased moderate-to-vigorous physical activity (MVPA) levels in adolescents. METHODS: This was a cross sectional study comparing MVPA levels in senior-years students-grade 11 and 12-enrolled in high school PE during the semester data were collected compared with those not enrolled in PE in that same semester. The primary outcome measure was daily MVPA measured by accelerometry. The primary exposure was participation in PE. RESULTS: Among the 508 adolescents (16.9 ± 0.8 yrs, 49% female, n = 338 exposed to PE) studied, no differences in MVPA (47.0 ± 25.8 vs. 43.9 ± 25.0 mins/day, P = .25) or sedentary time (540.2 ± 94.7 vs. 550.2 ± 79.4 mins/day, P = .79) were noted between students enrolled in PE compared with students not enrolled in PE. Participation in PE was associated with a greater odds of achieving >60 minutes of MVPA daily (OR: 1.69; 95% CI: 1.04-2.75). This association was stronger among boys (OR: 2.4; 95% CI: 1.2-4.8) than girls (OR: 1.17; 95% CI: 0.5-2.7). CONCLUSION: Enrollment in PE in grade 11 or 12 is associated with modestly higher levels of MVPA and an increased likelihood of meeting PA guidelines among students in grades 11 and 12, particularly among boys.

Factors associated with physical activity among Canadian high school students.

OBJECTIVES: Identifying multi-level factors affecting physical activity (PA) levels among adolescents is essential to increasing activity to promote health within this population. This study examines the associations between PA and 11 independent factors among Manitoba high school students. METHODS: The sample included 31,202 grade 9-12 students who completed the Manitoba Youth Health Survey. Associations between PA and independent factors were examined separately and through multivariate regression. Analyses were stratified by gender. RESULTS: Perception of athletic ability, school location, parental encouragement and number of active friends were strong predictors of activity for moderately active and active males and females. Grade was a significant predictor of PA for females at both levels of activity but only significant for males when comparing active to inactive students. Perception of schoolwork and means of transport were minimally associated with PA. CONCLUSIONS: Results highlight the importance of targeting multiple levels of influence to increase PA among youth. Programs should focus on older students, females and those who are inactive or moderately active. In addition, social modeling of PA and increasing self-efficacy around activity should be encouraged.