Pediatric emergency research networks: a global initiative in pediatric emergency medicine.

OBJECTIVES: Objectives of the Pediatric Emergency Research Network's (PERN's) meeting included (1) learn about each of the participating network's missions, goals, and infrastructure; (2) share important contributions each network has made to the creation of new knowledge; (3) discuss "best practices" to improve each network's effectiveness; and (4) explore the potential for a collaborative research project as proof of concept that would help us promote quality of care of the acutely ill and injured child/youth globally. METHODS: In October 2009, a multiday meeting was attended by 18 delegates representing the following pediatric emergency medicine research networks: Pediatric Emergency Medicine Collaborative Research Committee (United States), Pediatric Emergency Care Applied Research Network (United States), Pediatric Emergency Research of Canada (Canada), Paediatric Research in Emergency Departments International Collaborative (Australia and New Zealand), and Research in European Pediatric Emergency Medicine (15 countries in Europe and the Middle East). RESULTS: The inaugural meeting of PERN demonstrated that there is a common desire for high-quality research and the dissemination of this research to improve health and outcomes of acutely ill and injured children and youths throughout the world. Presently, the PERN group is in the final stages of developing a protocol to assess H1N1 risk factors with the collection of retrospective data. CONCLUSIONS: Several members of PERN will be gathering at the International Conference on Emergency Medicine in Singapore, where the group will be presenting information about the H1N1 initiative. The PERN group is planning to bring together all 5 networks later in 2010 to discuss future global collaborations.

MyHEARTSMAP: development and evaluation of a psychosocial self-assessment tool, for and by youth.

BACKGROUND: Paediatric mental health-related visits to the emergency department are rising. However, few tools exist to identify concerns early and connect youth with appropriate mental healthcare. Our objective was to develop a digital youth psychosocial assessment and management tool (MyHEARTSMAP) and evaluate its inter-rater reliability when self-administered by a community-based sample of youth and parents. METHODS: We conducted a multiphasic, multimethod study. In phase 1, focus group sessions were used to inform tool development, through an iterative modification process. In phase 2, a cross-sectional study was conducted in two rounds of evaluation, where participants used MyHEARTSMAP to assess 25 fictional cases. RESULTS: MyHEARTSMAP displays good face and content validity, as supported by feedback from phase 1 focus groups with youth and parents (n=38). Among phase 2 participants (n=30), the tool showed moderate to excellent agreement across all psychosocial sections (κ=0.76-0.98). CONCLUSIONS: Our findings show that MyHEARTSMAP is an approachable and interpretable psychosocial assessment and management tool that can be reliably applied by a diverse community sample of youth and parents.

Valuing the scholarship of integration and the scholarship of application in the academy for health sciences scholars: recommended methods.

In the landmark 1990 publication Scholarship Reconsidered, Boyer challenged the 'teaching verses research debates' by advocating for the scholarship of discovery, teaching, integration, and application. The scholarship of discovery considers publications and research as the yardstick in the merit, promotion and tenure system the world over. But this narrow view of scholarship does not fully support the obligations of universities to serve global societies and to improve health and health equity. Mechanisms to report the scholarship of teaching have been developed and adopted by some universities. In this article, we contribute to the less developed areas of scholarship, i.e. integration and application. We firstly situate the scholarship of discovery, teaching, integration and application within the interprofessional and knowledge exchange debates. Second, we propose a means for health science scholars to report the process and outcomes of the scholarship of integration and application with other disciplines, decision-makers and communities. We conclude with recommendations for structural and process change in faculty merit, tenure, and promotion systems so that health science scholars with varied academic portfolios are valued and many forms of academic scholarship are sustained. It is vital academic institutions remain relevant in an era when the production of knowledge is increasingly recognized as a social collaborative activity.

Treating vulnerable populations: the case of eating disorders during pregnancy.

While eating disorders are a prevalent psychiatric issue for women, only a moderate amount of literature discussing the implications for pregnancy exists and even less explores how to identify and manage eating disorders in this patient population. This is despite known risks for adverse fetal, birth, and maternal outcomes because of these disorders. To enhance standard assessment practice and facilitate early intervention for the eating disordered patient, a general obstetrics role need not dramatically change to improve outcomes for mother and child.

Eating disorders: identification and treatment in obstetrical patients.

Eating disorders are well defined in females ages 14 to 24, and consist primarily of anorexia nervosa (AN) and bulimia nervosa (BN). Collectively, these two eating disorders are characterized by severe disturbances in eating behaviors and acute distress over body shape and weight. In AN, fear of weight gain coupled with a distorted body image leads to refusal to maintain a minimally accepted body weight (American Psychiatric Association [APA], 1994). Although women with BN also overvalue body size and shape, this disorder is characterized by episodes of binge eating followed by efforts to undo the binge episode (oral purging is the most widely known effort) (APA, 1994). Developmental, psychological, socioenvironmental and behavioral factors contribute to the complex development and persistence of AN and BN (Rosen & Neumark-Sztainer, 1998).

Exploring the psychopathology of anorexia nervosa: a Mahlerian standpoint.

TOPIC: Anorexia nervosa is an eating disorder that extends beyond the well-known phenomenon of self-starvation to include dynamic psychological themes of autonomy and ego disturbances as well as self-regulation through eating disordered behaviors. PURPOSE AND SOURCE: Exploration of these themes within Mahler's (1975) object relational framework provides the opportunity to examine the genesis of these themes during early psychological ego development and how they may characterize the development of the anorectic experience. CONCLUSION: The Mahlerian perspective can provide psychiatric nursing with a psychoanalytical perspective outside of standard practice, thus promoting critical analysis and integration among the varying professions of psychiatry.

Discharge instructions for caregivers in the context of pediatric emergency care: a narrative synthesis protocol.

BACKGROUND: The period following discharge from a pediatric emergency department (ED) can be a time of significant vulnerability for caregivers who provide ongoing care to their child when they return home. Discharge communication practice varies widely at the individual practitioner and departmental level. At present, there are no nationally accepted guidelines for discharge communication for children and/or their caregivers in the ED.The primary objective of this knowledge synthesis is to understand how and why discharge instructions work and under what conditions. We will also examine the contextual factors and barriers and facilitators associated with discharge communication across varied ED settings. METHODS/DESIGN: Using an integrated narrative approach, we will synthesize different types of evidence and explore relationships within and between included studies to develop a theory-based and knowledge user-informed discharge communication practice guideline. We will follow key principles for knowledge synthesis including: (1) involvement of a multidisciplinary team (for example, information specialists, statisticians, and content experts); (2) developing focused and answerable questions in collaboration with the knowledge users; (3) using a systematic method including specific tools and techniques appropriate for answering questions concerned with effectiveness and the implementation of interventions; and, (4) involving knowledge users throughout the process in an integrated knowledge translation approach. DISCUSSION: This collaborative and narrative approach will be a determining factor in increasing the reliability, validity and relevance of the study findings for healthcare practice and policy decision-makers. TRIAL REGISTRATION: PROSPERO registration number: CRD42014007106.

One-on-one lifestyle coaching for managing adolescent obesity: Findings from a pilot, randomized controlled trial in a real-world, clinical setting.

BACKGROUND: Interventions for obese adolescents in real-world, clinical settings need to be evaluated because most weight management care occurs in this context. OBJECTIVES: To determine whether a lifestyle intervention that includes motivational interviewing and cognitive behavioural therapy (Health Initiatives Program [HIP]) leads to weight management that is superior to a similar lifestyle intervention (Youth Lifestyle Program [YLP]) that does not include these techniques; and to determine whether the HIP and YLP interventions are superior to a wait list control (WLC) group. METHODS: Obese adolescents were randomly assigned to a YLP (n=15), HIP (n=17) or WLC (n=14) group. The YLP and HIP were 16-session, one-on-one interventions. The primary outcome was the percentage change of body mass index z-score. RESULTS: Completers-only analyses revealed 3.9% (YLP) and 6.5% (HIP) decreases in the percentage change of body mass index z-score compared with a 0.8% (WLC) increase (P<0.001). Levels of attrition did not differ among groups, but were relatively high (approximately 20% to 40%). CONCLUSION: Lifestyle interventions delivered in a real-world, clinical setting led to short-term improvements in the obesity status of adolescents.

Pediatric Emergency Research Networks: a global initiative in pediatric emergency medicine.

OBJECTIVES: The objectives of the Pediatric Emergency Research Network's (PERN) meeting were to (i) learn about each of the participating network's missions, goals, and infrastructure; (ii) share important contributions that each network has made to the creation of new knowledge; (iii) discuss 'best practices' to improve each network's effectiveness and (iv) explore the potential for a collaborative research project as proof-of-concept that would help promote quality of care of the acutely ill and injured child/youth globally. METHODS: In October 2009 a multiday meeting was attended by 18 delegates representing the following pediatric emergency medicine research networks: Pediatric Emergency Medicine Collaborative Research Committee (USA); Pediatric Emergency Care Applied Research Network (USA); Pediatric Emergency Research of Canada (Canada); Pediatric Research in Emergency Departments International Collaborative (Australia and New Zealand); and Research in European Pediatric Emergency Medicine (15 countries in Europe and the Middle East). RESULTS: The inaugural meeting of PERN showed that there is a common desire for high-quality research and the dissemination of this research to improve health and outcomes of acutely ill and injured children and youths throughout the world. At present, the PERN group is in the final stages of developing a protocol to assess H1N1 risk factors with the collection of retrospective data. CONCLUSION: Several members of PERN will be gathering at the International Conference on Emergency Medicine in Singapore, where the group will be presenting information about the H1N1 initiative. The PERN group is planning to bring together all five networks later in 2010 to discuss future global collaborations.

Taking stock of current societal, political and academic stakeholders in the Canadian healthcare knowledge translation agenda.

BACKGROUND: In the past 15 years, knowledge translation in healthcare has emerged as a multifaceted and complex agenda. Theoretical and polemical discussions, the development of a science to study and measure the effects of translating research evidence into healthcare, and the role of key stakeholders including academe, healthcare decision-makers, the public, and government funding bodies have brought scholarly, organizational, social, and political dimensions to the agenda. OBJECTIVE: This paper discusses the current knowledge translation agenda in Canadian healthcare and how elements in this agenda shape the discovery and translation of health knowledge. DISCUSSION: The current knowledge translation agenda in Canadian healthcare involves the influence of values, priorities, and people; stakes which greatly shape the discovery of research knowledge and how it is or is not instituted in healthcare delivery. As this agenda continues to take shape and direction, ensuring that it is accountable for its influences is essential and should be at the forefront of concern to the Canadian public and healthcare community. This transparency will allow for scrutiny, debate, and improvements in health knowledge discovery and health services delivery.

Health researchers in Alberta: an exploratory comparison of defining characteristics and knowledge translation activities.

BACKGROUND: Canadian funding agencies are no longer content to support research that solely advances scientific knowledge, and key directives are now in place to promote research transfer to policy- and decision-makers. Therefore, it is necessary to improve our understanding of how researchers are trained and supported to facilitate knowledge translation activities. In this study, we investigated differences in health researcher characteristics and knowledge translation activities. METHODS: Our sample consisted of 240 health researchers from three Alberta universities. Respondents were classified by research domain [basic (n = 72) or applied (n = 168)] and faculty [medical school (n = 128) or other health science (n = 112)]. We examined our findings using Mode I and Mode II archetypes of knowledge production, which allowed us to consider the scholarly and social contexts of knowledge production and translation. RESULTS: Differences among health researcher professional characteristics were not statistically significant. There was a significant gender difference in the applied researcher faculty group, which was predominantly female (p < .05). Research domain was linked to translation activities. Applied researchers reported engaging in significantly more Mode II activities than basic researchers (p < .001), and scored higher than basic researchers regarding the perceived importance of translation activities (Mode I, p = .01; Mode II, p < .001). Main effects of faculty were limited to engaged dissemination (medical school < other faculties; p = .025) and number of publications (medical school > other faculties; p = .004). There was an interaction effect for research domain and faculty group for number of publications (p = .01), in that applied researchers in medical faculties published more than their peers in other faculty groups. CONCLUSION: Our findings illustrate important differences between health researchers and provide beginning insights into their professional characteristics and engagement in Mode I and Mode II activities. A future study designed to examine these dimensions in greater detail, including potential covariates across more varied institutions, would yield richer insights and enable an examination of relative influences, needs and costs of each mode of activity.

Internet-based innovations for the prevention of eating disorders: a systematic review.

The objective of this systematic review was to compare the results of studies of Internet-based eating disorder prevention programs. Eight electronic bibliographic databases, three key journals, and study reference lists were searched. This method yielded five published studies: four experimental and one quasi-experimental. A meta-analysis of the study results indicated no statistical significance for pooled study outcome data. No robust evidence exists on the impact of Internet-based prevention strategies on eating disordered symptomatology and on putative factors that contribute to eating disorder development. Further intervention development and consideration to study design are needed to move this field forward.