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1.
Eur J Public Health ; 30(Supplement_1): i36-i40, 2020 Mar 01.
Article in English | MEDLINE | ID: mdl-32391902

ABSTRACT

We are far from reaching the sustainable development goals (SDGs) for health despite a wealth of novel insights in disease mechanisms and possible solutions. Why have we failed in knowledge translation and implementation? Starting from the case of cardiovascular diseases as one of the most prevalent non-communicable diseases, we examine barriers and hurdles, and perspectives for future health research. Health has multiple links with other SDGs. To accelerate the progress towards a healthy society, health research needs to take a broader view and become more cross-disciplinary and cross-sectoral. As one example, behavioural studies will underpin better prevention and treatment adherence. The next generation workforce in health and research needs an adapted education and training to implement more effective health approaches. As well, only effective dialogue and communication between researchers, practitioners, society and policymakers can lead to translation of evidence into policies, addressing the complexity of socioeconomic factors and commercial interests. Within Europe, health research needs a comprehensive vision and strategy that connects to achieving better health, as one of the interconnected SDGs.

2.
Disabil Rehabil ; : 1-10, 2020 May 02.
Article in English | MEDLINE | ID: mdl-32362162

ABSTRACT

Purpose: This project aimed to develop, implement and evaluate a train-the-trainer initiative for community rehabilitation workers (CRWs) and rehabilitation specialists within a community rehabilitation program for children with delayed development in Tamil Nadu, India.Methods: Guided by the Knowledge to Action framework, non-governmental and academic partners collaboratively developed two 2-day workshops for (1) rehabilitation specialists and (2) CRWs. Outcomes were evaluated using mixed methods, with pre and 2.5-months post surveys (59 participants) and three focus groups (17 participants) involving trainers and trainees (including rehabilitation specialists and CRWs).Results: There were significant increases in the CRWs' self-perception of their capacity to assess comprehension, provide explanations, respond to questions, adjust teaching, motivate learners, communicate effectively, and provide feedback. Significant changes were noted for rehabilitation specialists in five of seven domains, and for rehabilitation specialist leads in six of seven domains. Participants appreciated the interactive training style, and the use of immersive methods such as role play, though noted challenges when instructions were unclear or when they felt that material was more theoretical.Conclusions: This collaboratively developed train-the-trainer project demonstrates the value of such an intervention, provides an example of how a tailored program can be developed, and suggests the importance of stakeholder-driven design processes.Implications for RehabilitationThe ability to provide effective training is a core skill set for people engaged in community-based rehabilitation (CBR) programs, yet examples of initiatives to train trainers are lacking, as is their evaluation.This project demonstrates the value of a collaborative and tailored train-the-trainer program to support community rehabilitation workers and rehabilitation specialists in their training roles within a CBR program in India.A stakeholder-driven design process supported by a collaboration between non-governmental organization and academic partners enhanced the capacity to develop, implement and evaluate the train-the-trainer program.

4.
Hum Antibodies ; 2020 May 06.
Article in English | MEDLINE | ID: mdl-32417769

ABSTRACT

A case report of a 38 years old ABO group A and Rhesus D negative multiparous, gravidae 8 and para 2, Nigerian woman who had a case of premarital miscarriage and who was not offered anti-D prophylaxis as part of her management. Lady went on to develop alloantibody D and Jka. Lady has had 7 further pregnancies post the miscarriage. The first child who is B Rhesus D positive is the only surviving child. The surviving child was delivered severely jaundiced and needed management post-delivery for haemolytic disease of the foetus and newborn (HDFN). Lady has had a history of a stillbirth. She was given a non-clinically indicated anti-D prophylaxis during the second pregnancy despite having been previously sensitized. The second baby died 3 months after delivery from complications of HDFN. She had had a further history of 5 miscarriages. She has had challenge with conception since 2010. Alloantibody testing confirms the presence alloantibody D and anti-Jka. Finding from this case study is a clear case of sub-optimal laboratory, obstetric and neonatal care offered particularly to pregnant women who are Rh D negative and those with alloantibodies in Nigeria. The Nigerian government will need to implement evidenced-based best practices; determination of alloantibody status of pregnant women during their first antenatal visit; provision of facilities for alloantibody identification, titration, quantification and feto maternal haemorrhage testing (FMH); implementation of a policy on universal access to anti-D prophylaxis for pregnant Rh D negative women who are not previously sensitized; provision of facilities required for the optimal intrauterine management of HDFN (foetal genotype testing, intrauterine transfusion, doppler ultrasound to diagnose anaemia inutero and provision of donor blood that meet the minimum requirements for intrauterine transfusion); determination of Rh D status of women who require a termination of pregnancy and provision of prophylactic anti-D for those found Rh D negative within 72 hours of procedure and the optimization of the knowledge of Medical Laboratory Scientist, Obstetricians, Neonatologist, Pharmacist and Traditional Birth Attendants in a bid to reduce the residual number of women who become sensitized and the number of preventable deaths of babies with HDFN.

5.
Clin Dermatol ; 2020 May 14.
Article in English | MEDLINE | ID: mdl-32419721

ABSTRACT

The emergence of the COVID-19 pandemic led to significant uncertainty among physicians and patients about the safety of immunosuppressive medications used for the management of dermatologic conditions. We review available data on commonly used immunosuppressants and their effect on viral infections beyond COVID-19. Notably, the effect of some immunosuppressants on viruses related to SARS-CoV2, including SARS and MERS, has been previously investigated. In the absence of data on the effect of immunosuppressants on COVID-19, these data could be used to make clinical decisions on initiation and continuation of immunosuppressive medications during this pandemic. In summary, we recommend considering the discontinuation of oral JAK inhibitors and prednisone, considering the delay of rituximab infusion, and the careful continuation of cyclosporine, mycophenolate, azathioprine, methotrexate, and biologics in patients currently benefitting from such treatments.

6.
Int J Health Policy Manag ; 9(4): 138-142, 2020 Apr 01.
Article in English | MEDLINE | ID: mdl-32331493

ABSTRACT

Multi-sectoral, interdisciplinary health research is increasingly recognizing integrated knowledge translation (iKT) as essential. It is characterized by diverse research partnerships, and iterative knowledge engagement, translation processes and democratized knowledge production. This paper reviews the methodological complexity and decision-making of a large iKT project called Seniors - Adding Life to Years (SALTY), designed to generate evidence to improve late life in long-term care (LTC) settings across Canada. We discuss our approach to iKT by reviewing iterative processes of team development and knowledge engagement within the LTC sector. We conclude with a brief discussion of the important opportunities, challenges, and implications these processes have for LTC research, and the sector more broadly.

7.
Int J Health Policy Manag ; 9(4): 170-174, 2020 Apr 01.
Article in English | MEDLINE | ID: mdl-32331497

ABSTRACT

Healthcare organisations are looking at strategies and activities to improve patient outcomes, beyond clinical interventions. Increasingly, health organisations are investing significant resources in leadership, management and team work training to optimise professional collaboration, shared decision-making and, by extension, high quality services. Embedded clinical academics are a norm in, and considered a strength of, healthcare organisations and universities. Their role contributes, formally and informally, to clinical teaching, knowledge sharing and research. An equivalent, but significantly less common role, addressing the management of healthcare organisations, is the embedded health management academic (EHMA). A stimulus encouraging this intertwined embedded academic role, in both clinical and managerial fields, is the demand for the translation of knowledge between academic and industry contexts. In this essay, we describe the EHMA role, its value, impact and potential for enabling healthcare organisation improvement. Focusing on the business of healthcare, the EHMA is a conduit between sectors, stakeholders and activities, enabling different organisations and experts to co-create, share and embed knowledge. The value and impact achieved is significant and ongoing, through the nurturing of an evidence-based management culture that promotes ongoing continuous improvement and research activities.

8.
RECIIS (Online) ; 14(1): 225-246, jan.-mar. 2020. ilus
Article in Portuguese | LILACS | ID: biblio-1087311

ABSTRACT

O uso dos resultados da pesquisa e do conhecimento bem como a aplicação das descobertas científicas no mundo real não ocorrem de forma natural. Instituições acadêmicas e governos têm definido que a translação da pesquisa é uma prioridade para a saúde: as evidências científicas devem embasar as decisões para melhorar a saúde. Porém, a lacuna entre ciência e prática, os entraves naturais e criados entre elas mostram que a translação do conhecimento é um processo que precisa ser implementado. As formas de fazê-lo requerem atitudes do meio acadêmico e do ambiente político e de gestão, algo complexo e de difícil solução. Este artigo busca compreender o tema por meio da leitura de autores da área de saúde. Detémse com especial atenção na conceituação e nos modelos disponíveis, além de analisar como se dá essa passagem de evidências entre o campo da ciência e os responsáveis pelas tomadas de decisão e como estas são utilizadas.


The use of research results and knowledge as well as the application of scientific discoveries in the real world do not occur naturally. Academic institutions and governments have defined that the research translation is a priority for health: decisions should be based on scientific evidence to improve health. However, the gap between science and practice, the natural and created barriers between them show that the knowledge translation is a process that has to be implemented. The ways to do it involve attitudes in both academic, managerial and political environment, which are a issue quite complex and difficult to solve. This paper proposes to understand the topic by reading some authors of the health field. We give a special attention to the concepts, the available models and we analyze how the exchange of evidence between science and decision makers takes place and how the evidence is used.


El uso de los resultados de la investigación y el conocimiento, así como la aplicación de descubrimientos científicos en el mundo real, no ocurren naturalmente. Instituciones académicas y gobiernos han definido que la traslación de la investigación es una prioridad para la salud: las evidencias científicas deben respaldar las decisiones para mejorar la salud. Sin embargo, el intervalo entre ciencia y práctica, los obstáculos naturales y creados entre ellas muestran que la traslación del conocimiento es un proceso que necesita ser implementado. Las formas de hacerlo implican actitudes del medio académico y del ambiente político y de gestión, algo complejo y de difícil solución. Este artículo propone entender el tema por medio de la lectura de autores del área de salud. Nos detenemos en la conceptualización, los modelos, y analizamos la manera de intercambiar evidencias entre el campo de la ciencia y los responsables de la toma de decisiones y el modo como estas son usadas.


Subject(s)
Humans , Knowledge , Access to Information , Decision Making , Scientific Research and Technological Development , Translational Medical Research , Information Dissemination , Evidence-Informed Policy , Health Policy
9.
Health Res Policy Syst ; 18(1): 35, 2020 Mar 30.
Article in English | MEDLINE | ID: mdl-32228692

ABSTRACT

BACKGROUND: Research funders in Canada and abroad have made substantial investments in supporting collaborative research approaches to generating and translating knowledge as it is believed to increase knowledge use. Canadian health research funders have advocated for the use of integrated knowledge translation (IKT) in health research, however, there is limited research around how IKT compares to other collaborative research approaches. Our objective was to better understand how IKT compares with engaged scholarship, Mode 2 research, co-production and participatory research by identifying the differences and similarities among them in order to provide conceptual clarity and reduce researcher and knowledge user confusion about these common approaches. METHODS: We employed a qualitative descriptive method using interview data to better understand experts' perspectives and experiences on collaborative research approaches. Participants' responses were analysed through thematic analysis to elicit core themes. The analysis was centred around the concept of IKT, as it is the most recent approach; IKT was then compared and contrasted with engaged scholarship, Mode 2 research, co-production and participatory research. As this was an iterative process, data triangulation and member-checking were conducted with participants to ensure accuracy of the emergent themes and analysis process. RESULTS: Differences were noted in the orientation (i.e. original purpose), historical roots (i.e. disciplinary origin) and partnership/engagement (i.e. role of partners etc.). Similarities among the approaches included (1) true partnerships rather than simple engagement, (2) focus on essential components and processes rather than labels, (3) collaborative research orientations rather than research methods, (4) core values and principles, and (5) extensive time and financial investment. Core values and principles among the approaches included co-creation, reciprocity, trust, fostering relationships, respect, co-learning, active participation, and shared decision-making in the generation and application of knowledge. All approaches require extensive time and financial investment to develop and maintain true partnerships. CONCLUSIONS: This qualitative study is the first to systematically synthesise experts' perspectives and experiences in a comparison of collaborative research approaches. This work contributes to developing a shared understanding of collaborative research approaches to facilitate conceptual clarity in use, reporting, indexing and communication among researchers, trainees, knowledge users and stakeholders to advance IKT and implementation science.

11.
Medwave ; 20(2): e7859, 2020 Mar 26.
Article in Spanish, English | MEDLINE | ID: mdl-32243430

ABSTRACT

Cochrane is an international collaboration whose mission is to promote evidence-based decision-making on health. This is done by conducting high-quality, relevant and accessible systematic reviews, as well as through other forms of summarized scientific evidence. Knowledge translation promotes the real use of scientific knowledge and Cochrane has been developing various projects within this theme. One of those projects includes a collaboration with Wikipedia to improve the quality of information provided in the medical articles published in this digital encyclopaedia. This article summarizes the main characteristics of these initiatives.

12.
Implement Sci ; 15(1): 14, 2020 03 04.
Article in English | MEDLINE | ID: mdl-32131861

ABSTRACT

BACKGROUND: While there is an ample literature on the evaluation of knowledge translation interventions aimed at healthcare providers, managers, and policy-makers, there has been less focus on patients and their informal caregivers. Further, no overview of the literature on dissemination strategies aimed at healthcare users and their caregivers has been conducted. The overview has two specific research questions: (1) to determine the most effective strategies that have been used to disseminate knowledge to healthcare recipients, and (2) to determine the barriers (and facilitators) to dissemination of knowledge to this group. METHODS: This overview used systematic review methods and was conducted according to a pre-defined protocol. A comprehensive search of ten databases and five websites was conducted. Both published and unpublished reviews in English, Spanish, or Portuguese were included. A methodological quality assessment was conducted; low-quality reviews were excluded. A narrative synthesis was undertaken, informed by a matrix of strategy by outcome measure. The Health System Evidence taxonomy for "consumer targeted strategies" was used to separate strategies into one of six categories. RESULTS: We identified 44 systematic reviews that describe the effective strategies to disseminate health knowledge to the public, patients, and caregivers. Some of these reviews also describe the most important barriers to the uptake of these effective strategies. When analyzing those strategies with the greatest potential to achieve behavioral changes, the majority of strategies with sufficient evidence of effectiveness were combined, frequent, and/or intense over time. Further, strategies focused on the patient, with tailored interventions, and those that seek to acquire skills and competencies were more effective in achieving these changes. In relation to barriers and facilitators, while the lack of health literacy or e-literacy could increase inequities, the benefits of social media were also emphasized, for example by widening access to health information for ethnic minorities and lower socioeconomic groups. CONCLUSIONS: Those interventions that have been shown to be effective in improving knowledge uptake or health behaviors should be implemented in practice, programs, and policies-if not already implemented. When implementing strategies, decision-makers should consider the barriers and facilitators identified by this overview to ensure maximum effectiveness. PROTOCOL REGISTRATION: PROSPERO: CRD42018093245.

14.
Article in English | MEDLINE | ID: mdl-32127266

ABSTRACT

OBJECTIVE: To develop a standardized approach to the implementation and performance of acute normovolemic hemodilution (ANH) in order to reduce the incidence of bleeding and allogeneic blood transfusion in high-risk surgical bleeding-related cardiac surgery with cardiopulmonary bypass (CPB). DESIGN: A 2-round modified RAND-Delphi consensus process. PARTICIPANTS: Seven physicians from multiple geographic locations and clinical disciplines including anesthesiology and cardiac surgery and 1 cardiac surgery perfusionist participated in the survey. One registered nurse, specializing in Patient Blood Management, participated in the discussion but did not participate in the survey. METHODS: A modified RAND-Delphi method was utilized that integrated evidence review with a face-to-face expert multidisciplinary panel meeting, followed by repeated scoring using a 9-point Likert scale. Consensus was determined as a result from the second round survey, as follows: median rating of 1-3: ANH acceptable; median rating of 7-9: ANH not acceptable; median rating of 4-6: use clinical judgment. RESULTS: Evidentiary review identified 18 key peer-reviewed manuscripts for discussion. Through the consensus-building process, 39 statements including 26 contraindications to ANH and 10 CPB patient variables were assessed. In total, 22 statements were accepted or modified for the second scoring round. CONCLUSIONS: Consensus was reached on 6 conditions in which ANH would or would not be acceptable, showing that development of a standardized approach for the use of ANH in high-risk surgical bleeding and allogeneic blood transfusion is clearly possible. The recommendations developed by this expert panel may help guide the management and inclusion of ANH as an evidence and consensus-based blood conservation modality.

15.
Br J Community Nurs ; 25(3): S26-S29, 2020 Mar 01.
Article in English | MEDLINE | ID: mdl-32160062

ABSTRACT

Throughout history, various wound healing and management concepts have been recorded, with some approaches such as honey, silver and larvae still in use and others such as blood-letting completely dismissed. In more recent times, dressing products have begun evolving, moving on from basic first-aid supplies to products that support positive healing by addressing the needs of the wound bed and considering underlying factors that impact healing. With an ageing population, the incidence of chronic wounds is predicted to rise, and chronic wounds can negatively impact the lives of patients physically, emotionally and financially. Clinicians continue to explore and review new approaches surrounding the management of wounds, as it is imperative that clinicians use technological advances in wound management alongside established gold standard evidence-based practice to achieve positive outcomes for patients experiencing delayed or challenging wound healing.

16.
Disabil Rehabil ; : 1-14, 2020 Mar 05.
Article in English | MEDLINE | ID: mdl-32135069

ABSTRACT

Purpose: To investigate the effect of a knowledge translation intervention on knowledge and frequency of routine evidence-based assessment behaviours of healthcare professionals working with children with cerebral palsy.Methods: A before-and-after longitudinal study was conducted in five disability organisations. Four organisations (Commencing Knowledge Translation group) implemented a multifaceted intervention: knowledge brokers, targeted education, electronic-evidence library, and clinical outcomes database. These strategies were already in place at the fifth organisation (Comparison group). Outcomes evaluated at 0, 6, 12, and 24 months were health-professional knowledge and routine assessment behaviours (self-report and "completeness" of clinical assessment). Generalised estimating equations determined longitudinal changes.Results: Four hundred and forty-seven professionals involved 861 children in the study. The Comparison group had higher knowledge and routine assessment behaviours at baseline. Professional knowledge in both groups remained stable (differences in change from baseline to 24 months: 0.3 units, 95%CI: -0.76 to 1.36). Assessment completeness of the Comparison group was stable (baseline mean 68 units, 95%CI: 65-71); the Commencing Knowledge Translation group improved from baseline mean 35 units (95%CI: 33-36), peaking at 12 months (mean 68 (95%CI: 65-71).Conclusions: Multifaceted organisational support improved health-professional routine evidence-based assessment behaviours with children with cerebral palsy, despite no change in knowledge. Trial registration: This trial was not a controlled health care intervention and was registered retrospectively: ACTRN12616001616460. The protocol of the trial was published in 2015 as follows: Imms et al. [6].Implications for rehabilitationA multifaceted knowledge translation intervention increased allied health professionals' assessment behaviours.Knowledge translation strategies can be chosen to target change in knowledge and/or change in behaviour.Knowledge translation interventions should be designed to address organisational barriers and enhance organisational supports.Interventions that target healthcare professionals' behaviour directly can be effective even if their knowledge does not change.

17.
J Contin Educ Health Prof ; 40(1): 11-18, 2020.
Article in English | MEDLINE | ID: mdl-32149944

ABSTRACT

INTRODUCTION: The Accreditation Council for Graduate Medical Education provided guidelines, in 2013, regarding 13 clinical procedures pediatric residents should learn. Previous studies show that, when asked, general pediatricians (GPeds) self-report performing these procedures infrequently. When examined using the knowledge translation model, this low procedural performance frequency, especially by GPeds, may indicate a problem within the primary care landscape. METHODS: This was a descriptive study using the Partners For Kids, an accountable care organization, database to obtain how frequently each of the procedures was performed for a geographically representative sample of GPeds in central Ohio. RESULTS: A total of 296 physicians participated in Partners For Kids. Nearly one-third practiced for more than 15 years (n = 83, 28%) and one-third also lived in a rural region (n = 78, 26.4%). The most commonly billed procedure was administering immunizations (n = 79,292, 92.3%); the least was peripheral intravenous catheter placement (n = 2, 0.002%). Most procedures were completed in the office-based setting. DISCUSSION: General pediatricians in central Ohio do not frequently perform the 13 recommended procedures of Accreditation Council for Graduate Medical Education. Evaluation of this problem using the knowledge translation model shows that potential barriers could be inadequate training during or after residency or more likely that these procedures are not necessary in GPeds' current scope of practice. The next step should be to see, from the practitioner's perspective, what procedures are important to their daily practice. Adapting this knowledge to the local context will help target continuing medical education/continuing professional development interventions.

18.
Bull World Health Organ ; 98(3): 159-160, 2020 Mar 01.
Article in English | MEDLINE | ID: mdl-32132749

ABSTRACT

Karla Soares-Weiser talks to Gary Humphreys about her experiences in clinical practice, medical research, and systematic reviewing and her vision for a better Cochrane Library.


Subject(s)
Public Health , Systematic Reviews as Topic , Evidence-Based Medicine , Humans
20.
J Med Internet Res ; 22(3): e14562, 2020 Mar 13.
Article in English | MEDLINE | ID: mdl-32167478

ABSTRACT

BACKGROUND: Connecting parents to research evidence is known to improve health decision making. However, guidance on how to develop effective knowledge translation (KT) tools that synthesize child-health evidence into a form understandable by parents is lacking. OBJECTIVE: The aim of this study was to conduct a comparative usability analysis of three Web-based KT tools to identify differences in tool effectiveness, identify which format parents prefer, and better understand what factors affect usability for parents. METHODS: We evaluated a Cochrane plain language summary (PLS), Blogshot, and a Wikipedia page on a specific child-health topic (acute otitis media). A mixed method approach was used involving a knowledge test, written usability questionnaire, and a semistructured interview. Differences in knowledge and usability questionnaire scores for each of the KT tools were analyzed using Kruskal-Wallis tests, considering a critical significance value of P=.05. Thematic analysis was used to synthesize and identify common parent preferences among the semistructured interviews. Key elements parents wanted in a KT tool were derived through author consensus using questionnaire data and parent interviews. RESULTS: In total, 16 parents (9 female) with a mean age of 39.6 (SD 11.9) years completed the study. Parents preferred the Blogshot over the PLS and Wikipedia page (P=.002) and found the Blogshot to be the most aesthetic (P=.001) and easiest to use (P=.001). Knowledge questions and usability survey data also indicated that the Blogshot was the most preferred and effective KT tool at relaying information about the topic. Four key themes were derived from thematic analysis, describing elements parents valued in KT tools. Parents wanted tools that were (1) simple, (2) quick to access and use, and (3) trustworthy, and which (4) informed how to manage the condition. Out of the three KT tools assessed, Blogshots were the most preferred tool by parents and encompassed these four key elements. CONCLUSIONS: It is important that child health evidence be available in formats accessible and understandable by parents to improve decision making, use of health care resources, and health outcomes. Further usability testing of different KT tools should be conducted involving broader populations and other conditions (eg, acute vs chronic) to generate guidelines to improve KT tools for parents.

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