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1.
Clin J Pain ; 36(1): 47-60, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31567219

RESUMO

OBJECTIVES: Parents can play an integral role in managing their child's pain, yet many parents remain unaware of evidence-based strategies to support their child during painful experiences. Recent advances in knowledge translation research, which include dissemination and implementation studies, have resulted in programs geared towards parents to offset this knowledge gap. The nature of these programs and the degree to which parents find them useful remains unclear. Our goal was to systematically review programs aimed as disseminating and implementing evidence-based pain-related knowledge to parents. MATERIALS AND METHODS: Systematic searches of PubMed, Web of Science, CINAHL, and PsycInfo were completed. Articles in which information was disseminated to parents with the goal of assessing dissemination and implementation outcomes were retained. Information was extracted to identify study characteristics, primary outcomes, and quality of evidence. RESULTS: A total of 24,291 abstracts were screened and 12 articles describing programs were retained. Programs were positively rated by parents in terms of the appropriateness of formats selected, presentation of information, and helpfulness of content. The majority of research has been focused in the area of procedural pain among infants. Although several implementation domains are reported by researchers, certain areas have been overlooked to date, including the cost and sustainability of programs. The majority of reports presented with methodological limitations and bias. DISCUSSION: Knowledge translation research in pediatric pain is in its infancy. Development of theories and guidelines to increase the utility and quality of evidence are needed.

2.
R I Med J (2013) ; 102(10): 30-33, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31795531

RESUMO

This article summarizes current data and recommendations regarding the care of patients in an intensive care unit (ICU) at the end of life. Through analysis of recent literature and society guidelines, we identified three areas of focus for practitioners in order to deliver compassionate care to patients and their families at this critical time - family communication, caregiver support, and palliative care involvement. Attention to these topics during critical illness may reduce stress-related disorders in both patients and family members, as well as increase satisfaction with the care delivered.

3.
JAMA Psychiatry ; 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31774490

RESUMO

Importance: Great interest exists in identifying methods to predict neuropsychiatric disease states and treatment outcomes from high-dimensional data, including neuroimaging and genomics data. The goal of this review is to highlight several potential problems that can arise in studies that aim to establish prediction. Observations: A number of neuroimaging studies have claimed to establish prediction while establishing only correlation, which is an inappropriate use of the statistical meaning of prediction. Statistical associations do not necessarily imply the ability to make predictions in a generalized manner; establishing evidence for prediction thus requires testing of the model on data separate from those used to estimate the model's parameters. This article discusses various measures of predictive performance and the limitations of some commonly used measures, with a focus on the importance of using multiple measures when assessing performance. For classification, the area under the receiver operating characteristic curve is an appropriate measure; for regression analysis, correlation should be avoided, and median absolute error is preferred. Conclusions and Relevance: To ensure accurate estimates of predictive validity, the recommended best practices for predictive modeling include the following: (1) in-sample model fit indices should not be reported as evidence for predictive accuracy, (2) the cross-validation procedure should encompass all operations applied to the data, (3) prediction analyses should not be performed with samples smaller than several hundred observations, (4) multiple measures of prediction accuracy should be examined and reported, (5) the coefficient of determination should be computed using the sums of squares formulation and not the correlation coefficient, and (6) k-fold cross-validation rather than leave-one-out cross-validation should be used.

4.
Aust Occup Ther J ; 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31758581

RESUMO

INTRODUCTION: The clinical practice patterns and use of research evidence by Australian occupational therapists working with clients experiencing neurocognitive impairments has not been surveyed for nearly 10 years. This survey aimed to evaluate the current status of occupational therapy practice and evidence use and provide recommendations for ongoing evidence translation. METHODS: An online survey of occupational therapists working in Australia was conducted over four months targeting registered clinicians working with adults experiencing neurocognitive impairments. RESULTS: 191 occupational therapists from a wide range of clinical practice areas, with a significant level of experience completed the survey. Functional retraining (n = 180, 94%), compensatory training (n = 173, 91%) and task/environmental modifications (n = 161, 84%) were the most commonly reported intervention techniques, while more targeted interventions such as context-sensitive training (n = 54, 28%), positive behaviour supports (n = 42, 22%) and metacognitive strategy training (n = 37, 19%) were used less frequently. Half the respondents were aware of current research evidence and suggested a wide range of strategies supporting evidence translation. Traditional barriers of limited time, access and skills to interpret research were also reported. CONCLUSION: Consistent with earlier surveys most occupational therapists continue to use a functional/compensatory approach to cognitive rehabilitation, with an increasing number of therapists using specialist cognitive interventions. The current challenge for occupational therapists is embedding specialist techniques into occupation-based intervention. Knowledge translation and implementation strategies will be a critical component to achieving this.

5.
Health Res Policy Syst ; 17(1): 88, 2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31760953

RESUMO

Research co-production is about doing research with those who use it. This approach to research has been receiving increasing attention from research funders, academic institutions, researchers and even the public as a means of optimising the relevance, usefulness, usability and use of research findings, which together, the argument goes, produces greater and more timely impact. The papers in this cross BMC journal collection raise issues about research co-production that, to date, have not been fully considered and suggest areas for future research for advancing the science and practice of research co-production. These papers address some gaps in the literature, make connections between subfields and provide varied perspectives from researchers and knowledge users.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31738892

RESUMO

OBJECTIVE: To examine the odds of persons with stroke achieving minimal clinically important difference (MCID) in functional independence during inpatient rehabilitation relative to cognitive impairment (CI) severity, site, and rehabilitation teams' exposure to a Cognitive Orientation to daily Occupational Performance (CO-OP) knowledge translation (KT) intervention DESIGN: A pre-post observational study was conducted using data from a centralized referral system. Our research team implemented a CO-OP KT intervention as part of a larger study aimed at training teams to use the CO-OP approach. SETTING: Five inpatient rehabilitation units. PARTICIPANTS: Cases extracted from a centralized referral system from the five participating units. INTERVENTIONS: Not Applicable MAIN OUTCOME MEASURES: The FIM™ instrument data from twelve months pre-intervention and 6 months post-intervention were analyzed. A logistic regression was performed to determine the odds ratios for achieving MCID based on sample cohort (historical control not exposed to CO-OP KT versus post CO-OP KT intervention), controlling for site and severity of CI. RESULTS: A model that considered the intervention, admission score, CI severity, and site was the best fit for the cases analyzed. Those with Severe CI were less likely to achieve FIM Total MCID compared to those with no CI (p=<.001; OR=.18; Confidence Interval .09-.39). Taking site and CI into account, cases post CO-OP KT intervention were significantly more likely to achieve MCID on FIM™ Motor (p=.048; OR=1.4; Confidence Interval 1.00-1.98) than historical controls. CONCLUSION: The CO-OP KT intervention is associated with increased odds of achieving MCID in the FIM™ Motor subscale in inpatient stroke rehabilitation.

7.
Disabil Rehabil ; : 1-13, 2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31741400

RESUMO

Purpose: To evaluate the implementation of an integrated multidisciplinary Movement Disorder Clinic using a model of knowledge translation.Methods: A mixed methods design was used to evaluate implementation outcomes. After recognising poor referral rates to allied health, Movement Disorder Clinic team-members identified implementation barriers. Team- and process-level implementation strategies were designed and tailored to address these barriers. The primary outcome measure was the change in the proportion of patients referred to allied health, determined by comparing pre- and post-implementation documentation audits. Secondary outcome measures included clinician and consumer surveys to identify ongoing implementation barriers and stakeholder satisfaction.Results: Documentation from 90 medical records was included in the audits (post-intervention n = 45). There was a significant improvement in the referral rates to allied health from 53% to 84% (mean improvement 31%, p = 0.003, Fisher's exact test). However, documentation of disease education decreased by 38% (p = 0.000, Fisher's exact test). Movement Disorder Clinic team-members identified three main barriers to ongoing implementation: "memory and automaticity", "environmental context and resources" and "beliefs about capabilities". Thirty-seven consumer surveys were completed, showing high levels of satisfaction (86%) but ongoing educational needs (51%).Conclusions: Implementation of an integrated multidisciplinary Movement Disorder Clinic was facilitated by a knowledge translation framework, leading to improved allied health referral rates and high levels of staff and consumer satisfaction, but unmet educational needs of consumers. Future research in the field of multidisciplinary healthcare for people with movement disorders is needed to determine the impact of these changes on patients' healthcare outcomes.Implications for rehabilitationMultidisciplinary integrated healthcare models may lead to better outcomes in progressive diseases such as Parkinson's disease, however, can be challenging to implement.A knowledge translation framework facilitated successful implementation of an integrated multidisciplinary Movement Disorders Clinic, leading to significantly improved rates of appropriate referrals to allied health, and staff and consumer satisfaction.Team-members identified three main barriers to ongoing implementation - "memory and automaticity", "environmental context and resources," and "beliefs about capabilities" - which may impact sustainability and should be considered in future implementation efforts.

8.
Australas J Ageing ; 2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31742880

RESUMO

OBJECTIVES: To identify attributes of rapid response services designed to support people with very severe and extreme responsive behaviours, otherwise known as behavioural and psychological symptoms of dementia, in aged care homes. METHODS: A rapid evidence assessment was conducted to inform the evaluation of the Severe Behaviour Response Team (SBRT) service, including a targeted search of peer-reviewed academic literature and an Internet-based search of government, service provider, peak body and university websites. RESULTS: A number of localised rapid response services targeting people with similar clinical profiles were identified, but none operated on the scale of the SBRT. Five operational attributes in common were as follows: clearly defined parameters and processes; provision of clinical expertise and knowledge translation activities; person-centred philosophy; relationship-oriented approach to stakeholders; and generalisable and sustainable outcomes. CONCLUSION: The five attributes provided a useful framework to guide the evaluation of the SBRT and clarify opportunities for continued service development.

9.
Phys Ther ; 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31750521

RESUMO

BACKGROUND: Providing physical therapists with evidence-based and consensus-derived guidelines to manage post-operative shoulder patients is essential; these guidelines should be readily available and provide clinically applicable information. Knowledge translation (KT) initiatives that encourage interaction between clinicians and researchers, have multifaceted components, and use a variety of strategies, can significantly change practice. OBJECTIVE: The objective of this study was to determine the uptake and acceptability of standardized post-operative shoulder guidelines with an accompanying online KT resource through evaluation of website analytics and a quantitative survey. DESIGN: A multi-pronged approach was used to assess uptake and acceptability of the guidelines and online KT resource. METHODS: Website analytics of usage and geographical location of users was measured as well as physical therapist survey responses. RESULTS: Website analytics revealed that 5406 individuals used the online resource between October 2012 and September 2013 with the average visit extending eight minutes; only 47% of users were within the guideline developers' surgical referral region. Physical therapists who used the new shoulder guidelines were very satisfied or satisfied (96%) with the guidelines, reporting they promoted patient-specific clinical decision-making extremely or very well (68%). They viewed the online KT resource positively, with 79% rating it as "very useful" or "quite useful". Physical therapists from regions beyond those expected to use the new shoulder guidelines were also aware of the website and also rated it as very useful. LIMITATIONS: Survey sample was relatively small and did not directly assess patient outcomes. CONCLUSIONS: An online KT web resource developed in conjunction with standardized post-operative shoulder guidelines was perceived as useful based upon web-site analytics and survey responses. Active KT strategies such as this can improve uptake and dissemination of best practice in physical therapy.

10.
BMJ Open ; 9(10): e032738, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666277

RESUMO

INTRODUCTION: Substantial delays in translating evidence to practice mean that many beneficial and vital advances in medical care are not being used in a timely manner. Traditional knowledge translation (KT) strategies have tended to target academics by disseminating findings in academic journals and at scientific conferences. Alternative strategies, such as theatre-based KT, appear to be effective at targeting broader audiences. The purpose of this scoping review is to collate and understand the current state of science on the use of theatre as a KT strategy. This will allow us to identify gaps in literature, determine the need for a systematic review and develop additional research questions to advance the field. METHODS AND ANALYSIS: This review will follow established scoping review methods outlined by Arksey and O'Malley in conjunction with enhanced recommendations made by Levac et al. The search strategy, guided by an experienced librarian, will be conducted in PubMed, CINHAL and OVID. Study selection will consist of three stages: (1) initial title and abstract scan by one author to remove irrelevant articles and create a shortlist for double screening, (2) title and abstract scan by two authors, and (3) full-text review by two authors. Included studies will report specifically on the use of theatre as means of KT of health-related information to any target population. Two reviewers will independently extract and chart the data using a standardised data extraction form. Descriptive statistics will be used to produce numerical summaries related to study characteristics, KT strategy characteristics and evaluation characteristics. For those studies that included an evaluation of the theatre production as a KT strategy, we will synthesise the data according to outcome. ETHICS AND DISSEMINATION: Ethical approval was not required for this study. Results will be published in relevant journals, presented at conferences and distributed via social media.

11.
Syst Rev ; 8(1): 266, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699136

RESUMO

BACKGROUND: Experimental designs for evaluating knowledge translation (KT) interventions can provide strong estimates of effectiveness but offer limited insight into how the intervention worked. Consequently, process evaluations have been used to explore the causal mechanisms at work; however, there are limited standards to guide this work. This study synthesizes current evidence of KT process evaluations to provide future methodological recommendations. METHODS: Peer-reviewed search strategies were developed by a health research librarian. Studies had to be in English, published since 1996, and were not excluded based on design. Studies had to (1) be a process evaluation of a KT intervention study in primary health, (2) be a primary research study, and (3) include a licensed healthcare professional delivering or receiving the intervention. A two-step, two-person hybrid screening approach was used for study inclusion with inter-rater reliability ranging from 94 to 95%. Data on study design, data collection, theoretical influences, and approaches used to evaluate the KT intervention, analysis, and outcomes were extracted by two reviewers. Methodological quality was assessed with the Mixed Methods Appraisal Tool (MMAT). RESULTS: Of the 20,968 articles screened, 226 studies fit our inclusion criteria. The majority of process evaluations used qualitative forms of data collection (43.4%) and individual interviews as the predominant data collection method. 72.1% of studies evaluated barriers and/or facilitators to implementation. 59.7% of process evaluations were stand-alone evaluations. The timing of data collection varied widely with post-intervention data collection being the most frequent (46.0%). Only 38.1% of the studies were informed by theory. Furthermore, 38.9% of studies had MMAT scores of 50 or less indicating poor methodological quality. CONCLUSIONS: There is widespread acceptance that the generalizability of quantitative trials of KT interventions would be significantly enhanced through complementary process evaluations. However, this systematic review found that process evaluations are of mixed quality and lack theoretical guidance. Most process evaluation data collection occurred post-intervention undermining the ability to evaluate the process of implementation. Strong science and methodological guidance is needed to underpin and guide the design and execution of process evaluations in KT science. REGISTRATION: This study is not registered with PROSPERO.

12.
Artigo em Inglês | MEDLINE | ID: mdl-31697326

RESUMO

This case report applied principles from the data visualization (DV) literature and feedback from nurses to develop an effective report to display adherence with an evidence-based fall prevention program. We tested the usability of the original and revised reports using a Health Information Technology Usability Evaluation Scale (Health-ITUES) customized for this project. Items were rated on a 5-point Likert scale, strongly disagree (1) to strongly agree (5). The literature emphasized that the ideal display maximizes the information communicated, minimizes the cognitive efforts involved with interpretation, and selects the correct type of display (eg, bar versus line graph). Semi-structured nurse interviews emphasized the value of simplified reports and meaningful data. The mean (standard deviation [SD]) Health-ITUES score for the original report was 3.86 (0.19) and increased to 4.29 (0.11) in the revised report (Mann Whitney U Test, z = -12.25, P < 0.001). Lessons learned from this study can inform report development for clinicians in implementation science.

13.
BMC Health Serv Res ; 19(1): 772, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666047

RESUMO

BACKGROUND: Health care researcher-research user partnerships, referred to as integrated knowledge translation (IKT), have been adopted on an international basis, and are an effective means of co-generating and implementing evidence into policy and practice. Prior research suggests that an initiation period is essential for establishing functional partnerships. To characterize IKT initiation and describe determinants of IKT initiation success, this study explored IKT initiation processes, enablers, and barriers among researchers and research users involved in IKT partnerships. METHODS: A descriptive qualitative approach was used compliant with COREQ standards. Canadian researchers and research users in research collaborations were identified on publicly-available directories and web sites, and referred by those interviewed. They were asked to describe how partnerships were initiated, influencing factors, the length of initiation, and interventions needed to support initiation. Sampling was concurrent with data collection and analysis to achieve thematic saturation. Data were analyzed using constant comparative technique by all members of the research team. RESULTS: In total, 22 individuals from 6 provinces were interviewed (9 researchers, 11 research users, 2 connectors). They confirmed that IKT initiation is a distinct early phase of partnerships. The period ranged from 6 months to 2 years for 75.0% of participants in pre-existing partnerships, to 6 years for newly-formed partnerships. High-level themes were: Newly identifying and securing partners is an intensive process; Processes and activities take place over a protracted period through multiple interactions; Identifying and engaging committed partners is reliant on funding; and Partnership building is challenged by maintaining continuity and enthusiasm. Participants underscored the need for an IKT partner matching forum, IKT initiation toolkit, and funding for non-research activities required during IKT initiation to establish functional researcher-research user partnerships. Themes were largely similar regardless of participant years of experience with IKT or being involved in a new versus pre-existing partnership. CONCLUSIONS: IKT initiation is a recognized and important early phase of IKT that establishes functional partnerships, and once established, ongoing partnership for subsequent projects is likely. Further research is needed to develop and evaluate approaches recommended by participants for stimulating IKT initiation.

14.
Nurs Forum ; 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31724185

RESUMO

AIM: The aim of this article is to clarify the concept of knowledge translation (KT) to close the gap that exists between research knowledge and actionable nursing practice. BACKGROUND: KT addresses the research to practice gap that exists in healthcare. KT is often confused with other terms and needs to be defined further as a concept for clarification and application in nursing practice. DESIGN: Concept analysis using the Walker and Avant method. DATA SOURCES: Databases searched were OVID, CINAHL, ProQuest, Mendeley, Western Libraries, and Google Scholar. Keywords used were "knowledge translation", "knowledge", "translation", "evidence-based practice", "research dissemination". Abstracts were reviewed for relevance, and 27 articles available in full-text and in English from 2000 to 2018 were retained. Online dictionaries included Merriam-Webster. The ancestry method was also used to retrieve relevant articles. RESULTS: KT is one of many terms used to describe the concept of moving research to actionable practice in healthcare. Six attributes of KT were identified: collaboration, action, receptivity, process, translation, and improved healthcare outcomes. CONCLUSIONS: Nurses are responsible to provide the best care to their patients, and effectively using KT in nursing practice can ensure better outcomes for patients.

16.
BMC Cancer ; 19(1): 1138, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752751

RESUMO

BACKGROUND: Many cancers are preventable through lifestyle modification; however, few adults engage in behaviors that are in line with cancer prevention guidelines. This may be partly due to the mixed messages on effective cancer prevention strategies in popular media. The goal of the McMaster Optimal Aging Portal (the Portal) is to increase access to trustworthy health information. The purpose of this study was to explore if and how knowledge translation strategies to disseminate cancer prevention evidence using the Portal influence participants' knowledge, intentions and health behaviors related to cancer risk. METHODS: Adults ≥40 years old, with no cancer history were randomized to a 12-week intervention (weekly emails and social media posts) or control group. Quantitative data on knowledge, intentions and behaviors (physical activity, diet, alcohol consumption and use of tobacco products) were collected at baseline, end of study and 3 months later. Participant engagement was assessed using Google Analytics, and participant satisfaction through open-ended survey questions and semi-structured interviews. RESULTS: Participants (n = 557, mean age 64.9) were predominantly retired (72%) females (81%). Knowledge of cancer prevention guidelines was higher in the intervention group at end of study only (+ 0.3, p = 0.01). Intentions to follow cancer prevention guidelines increased in both groups, with no between-group differences. Intervention participants reported greater light-intensity physical activity at end of study (+ 0.7 vs. 0.1, p = 0.03), and reduced alcohol intake at follow u (- 0.2 vs. + 0.3, p < 0.05), but no other between-group differences were found. Overall satisfaction with the Portal and intervention materials was high. CONCLUSIONS: Dissemination of evidence-based cancer prevention information through the Portal results in small increases in knowledge of risk-reduction strategies and with little to no impact on self-reported health behaviours, except in particular groups. Further tailoring of knowledge translation strategies may be needed to see more meaningful change in knowledge and health behaviours. TRIAL REGISTRATION: ClinicalTrials.gov NCT03186703, June 14, 2017.

17.
Clin J Sport Med ; 29(6): 486-493, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31688180

RESUMO

OBJECTIVE: To better understand the level of concussion knowledge of youth female hockey coaches and to identify preferred methods of knowledge translation for this population. DESIGN: Cross-sectional survey. SETTING: Participants independently completed written surveys before in-person concussion information sessions or online surveys through link provided in emails. PARTICIPANTS: Convenience sampling yielded 130 coaches of youth female hockey from Canada. MAIN OUTCOME MEASURES: Knowledge level on concussion, resources from which coaches obtained information on concussion, opinions on the current level of concussion knowledge, and knowledge translation. RESULTS: Coaches demonstrated adequate knowledge on concussion, achieving 84% correct on true-false questions and 92% correct on symptom identification accuracy. However, coaches showed limited awareness of concussion specific to mechanisms for injury (identification) and postconcussion symptoms. Internet resources were rated as the most used resources for concussion yet were not rated very helpful. Nonetheless, coaches indicated online courses and web sites as the most preferred method for concussion knowledge translation. CONCLUSIONS: Youth female hockey coaches have overall adequate knowledge of concussion; however, gaps in knowledge do exist. Future efforts to raise the concussion knowledge among coaches of female youth hockey should include information specific to the mechanism of injury, along with sign and symptom identification, with particular attention paid to emotional symptoms. Given the reported preferences and the widespread availability of the Internet, further exploration and research validation of online courses and web sites tailored to the youth female hockey community is encouraged.

18.
Ann Surg Oncol ; 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31659644

RESUMO

BACKGROUND: The breast surgeon, generally the first oncology specialist consulted, is ideally suited to offer fertility preservation (FP) referral to young women with breast cancer (YWBC). In the authors' 2015 survey of 84 surgeons participating in the pan-Canadian RUBY study of YWBC, oncofertility knowledge and rates of FP referral were suboptimal. The authors designed an oncofertility knowledge-translation intervention for surgeons. METHODS: A customized oncofertility toolbox was created including a seminar/webinar, an option grid, a three-question FP survey sent upon registration of each RUBY patient, and a management checklist. In 2018, the 28 site lead surgeons were re-invited to participate in a follow-up telephone interview, and 85 non-site lead surgeons were invited to complete a follow-up online questionnaire. RESULTS: A total of 27 site lead surgeons consented to be re-interviewed. After the intervention, 85% indicated that they "routinely" initiated a fertility discussion compared with 54% at baseline (p < 0.005), with 56% stating that the toolbox had been helpful for making positive changes in their practice regarding oncofertility, and 44% stating that they found it easier to initiate a fertility discussion. Among the 55 non-site lead surgeons who completed the questionnaire, a significant improvement in oncofertility knowledge was found. The percentage reporting "rarely" or "never" discussing FP options decreased from 41 to 14% (p < 0.005), and 84% stated that they referred patients who had not completed their families and were at risk for infertility to FP consultation compared with 32% before the intervention (p < 0.001). CONCLUSIONS: A multi-pronged but simple knowledge-translation intervention improved the attitudes, knowledge, and FP practice of Canadian breast surgeons.

19.
Pediatrics ; 144(6)2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31656225

RESUMO

Severe obesity among youth is an "epidemic within an epidemic" and portends a shortened life expectancy for today's children compared with those of their parents' generation. Severe obesity has outpaced less severe forms of childhood obesity in prevalence, and it disproportionately affects adolescents. Emerging evidence has linked severe obesity to the development and progression of multiple comorbid states, including increased cardiometabolic risk resulting in end-organ damage in adulthood. Lifestyle modification treatment has achieved moderate short-term success among young children and those with less severe forms of obesity, but no studies to date demonstrate significant and durable weight loss among youth with severe obesity. Metabolic and bariatric surgery has emerged as an important treatment for adults with severe obesity and, more recently, has been shown to be a safe and effective strategy for groups of youth with severe obesity. However, current data suggest that youth with severe obesity may not have adequate access to metabolic and bariatric surgery, especially among underserved populations. This report outlines the current evidence regarding adolescent bariatric surgery, provides recommendations for practitioners and policy makers, and serves as a companion to an accompanying technical report, "Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity," which provides details and supporting evidence.

20.
Chiropr Man Therap ; 27: 44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31636895

RESUMO

Background: The literature supports the effectiveness of self-management support (SMS) to improve health outcomes of patients with chronic spine pain. However, patient engagement in SMS programs is suboptimal. The objectives of this study were to: 1) assess participation in self-care (i.e. activation) among patients with spine pain, 2) identify patients' barriers and enablers to using SMS, and 3) map behaviour change techniques (BCTs) to key barriers to inform the design of a knowledge translation (KT) intervention aimed to increase the use of SMS. Methods: In summer 2016, we invited 250 patients with spine pain seeking care at the Canadian Memorial Chiropractic College in Ontario, Canada to complete the Patient Activation Measure (PAM) survey to assess the level of participation in self-care. We subsequently conducted individual interviews, in summer 2017, based on the Theoretical Domains Framework (TDF) in a subset of patients to identify potential challenges to using SMS. The interview guide included 20 open-ended questions and accompanying probes. Findings were deductively analysed guided by the TDF. A panel of 7 experts mapped key barriers to BCTs, designed a KT intervention, and selected the modes of delivery. Results: Two hundred and twenty-three patients completed the PAM. Approximately 24% of respondents were not actively involved in their care. Interview findings from 13 spine pain patients suggested that the potential barriers to using SMS corresponded to four TDF domains: Environmental Context and Resources; Emotion; Memory, Attention & Decision-Making; and Behavioural Regulation. The proposed theory-based KT intervention includes paper-based educational materials, webinars and videos, summarising and demonstrating the therapeutic recommendations including exercises and other lifestyle changes. In addition, the KT intervention includes Brief Action Planning, a SMS strategy based on motivational interviewing, along with a SMART plan and reminders. Conclusions: Almost one quarter of study participants were not actively engaged in their spine care. Key barriers likely to influence uptake of SMS among patients were identified and used to inform the design of a theory-based KT intervention to increase their participation level. The proposed multi-component KT intervention may be an effective strategy to optimize the quality of spine pain care and improve patients' health-outcomes.

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