Stakeholder engagement infrastructure to support multicenter research networks: Advances from the clinical research networks participating in PCORnet.

Background: The evidence based on the inclusion of patients and other stakeholders as partners in the clinical research process has grown substantially. However, little has been reported on how stakeholders are engaged in the governance of large-scale clinical research networks and the infrastructure used by research networks to support engagement in network-affiliated activities. Objectives: The objective was to document engagement activities and practices emerging from Clinical Research Networks (CRNs) participating in PCORnet, the National Patient-Centered Clinical Research Network, specifically regarding governance and engagement infrastructure. Methods: We conducted an environmental scan of PCORnet CRN engagement structures, assets, and services, focusing on network oversight structures for policy development and strategic decision-making. The scan included assets and services for supporting patient/stakeholder engagement. Data were collected by searching web-based literature and tool repositories, review of CRN Engagement Plans, analysis of previously collected key informant interviews, and CRN-based iterative review of structured worksheets. Results: We identified 87 discrete engagement structures, assets, and services across nine CRNs. All CRNs engage patients/stakeholders in their governance, maintain workgroups and/or staff dedicated to overseeing engagement strategies, and offer one or more services to non-CRN researchers to enhance conducting engaged clinical research. Conclusions: This work provides an important resource for the research community to explore engagement across peers, reflect on progress, consider opportunities to leverage existing infrastructure, and identify new collaborators. It also serves to highlight PCORnet as a resource for non-CRN researchers seeking to efficiently conduct engaged clinical research and a venue for advancing the science of engagement.

Aligning systems science and community-based participatory research: A case example of the Community Health Advocacy and Research Alliance (CHARA).

Partnered research may help bridge the gap between research and practice. Community-based participatory research (CBPR) supports collaboration between scientific researchers and community members that is designed to improve capacity, enhance trust, and address health disparities. Systems science aims to understand the complex ways human-ecological coupled systems interact and apply knowledge to management practices. Although CBPR and systems science display complementary principles, only a few articles describe synergies between these 2 approaches. In this article, we explore opportunities to utilize concepts from systems science to understand the development, evolution, and sustainability of 1 CBPR partnership: The Community Health Advocacy and Research Alliance (CHARA). Systems science tools may help CHARA and other CBPR partnerships sustain their core identities while co-evolving in conjunction with individual members, community priorities, and a changing healthcare landscape. Our goal is to highlight CHARA as a case for applying the complementary approaches of CBPR and systems science to (1) improve academic/community partnership functioning and sustainability, (2) ensure that research addresses the priorities and needs of end users, and (3) support more timely application of scientific discoveries into routine practice.

Population segmentation: an approach to reducing childhood obesity inequalities.

AIMS: The aims of this study are threefold: (1) to investigate the relationship between socio-economic status (inequality) and childhood obesity prevalence within Birmingham local authority, (2) to identify any change in childhood obesity prevalence between deprivation quintiles and (3) to analyse individualised Birmingham National Child Measurement Programme (NCMP) data using a population segmentation tool to better inform obesity prevention strategies. METHODS: Data from the NCMP for Birmingham (2010/2011 and 2014/2015) were analysed using the deprivation scores from the Income Domain Affecting Children Index (IDACI 2010). The percentage of children with excess weight was calculated for each local deprivation quintile. Population segmentation was carried out using the Experian's Mosaic Public Sector 6 (MPS6) segmentation tool. RESULTS: Childhood obesity levels have remained static at the national and Birmingham level. For Year 6 pupils, obesity levels have increased in the most deprived deprivation quintiles for boys and girls. The most affluent quintile shows a decreasing trend of obesity prevalence for boys and girls in both year groups. For the middle quintiles, the results show fluctuating trends. CONCLUSION: This research highlighted the link in Birmingham between obesity and socio-economic factors with the gap increasing between deprivation quintiles. Obesity is a complex problem that cannot simply be addressed through targeting most deprived populations, rather through a range of effective interventions tailored for the various population segments that reside within communities. Using population segmentation enables a more nuanced understanding of the potential barriers and levers within populations on their readiness for change. The segmentation of childhood obesity data will allow utilisation of social marketing methodology that will facilitate identification of suitable methods for interventions and motivate individuals to sustain behavioural change. Sequentially, it will also inform policy makers to commission the most appropriate interventions.

Should my patient use a mechanical lift? Part 2: algorithm and case application.

The use of algorithms for safe patient handling in the acute care setting has been established and integrated into the standards of practice. This is not the case in the home care setting where the patient and caregivers are at risk for injury during patient transfers. Many factors need to be assessed before recommending a mechanical lift for home use. Some of the factors include the patient's weight-bearing status, cognitive level, and upper extremity strength, and the caregiver's ability to lift more than 35 pounds. All of these factors have been included in the clinical decision-making algorithm described in this article. Two case scenarios are presented to assist the reader with the analysis and application of the algorithm.

Improving fall risk assessment in home care: interdisciplinary use of the Timed Up and Go (TUG).

The Timed Up and Go (TUG) is a popular, effective, and valid test of functional mobility and fall risk that is often completed by registered nurses (RNs) and physical therapists (PTs) throughout the course of a home care episode. As reimbursement becomes tied to outcomes, it is essential that all disciplines are consistent in their methods when administering the TUG. Results of this study confirm the hypothesis that test-specific training will significantly improve reliability of the TUG when completed by 2 different disciplines. The purpose of this article is to describe an initiative that provided tool-specific training to all clinical staff at our home care agency. The inter-rater reliability between PTs and RNs improved significantly from 0.77 to 0.86 (p = 0.001) after standardized training on administration of the TUG.

Work at school: teacher and parent perceptions about children's participation.

OBJECTIVE: Little research has been carried out on the behaviours that lead to children's successful participation in work roles at school. The objective of this study was to identify some of the elements critical to participation of students by listening to the perspectives of teachers and parents of children who have difficulties with school work. The study is part of a larger research project aimed at developing an assessment tool to describe the participation of children at school with particular reference to students who experience a difficulty with learning. PARTICIPANTS: 50 teachers and 44 parents of children referred to occupational therapy for problems with school work. METHODS: A survey approach using an open ended written response questionnaire. RESULTS: The findings indicated that there are core elements of participation in work that are commonly perceived as crucial by teachers and parents. These included common definitions of work participation with the emergence of several themes relative to work roles and meaning, opportunity for inclusion in school work, risk taking and enjoyment as part of work, and thinking processes. Differences between teacher and parent responses related to perceived reasons for a difficulty with participation, activities which require high levels of participation and aspects of participation that are most difficult to change. CONCLUSION: This study provided descriptive data on which to build further research into children's experiences of work, and highlights the need for occupational therapists to consider perceptions of key stakeholders when assessing children's work ability at school.

Establishing an interdisciplinary geriatric education center.

To remain viable, academic institutions preparing the future workforce need to be attentive and responsive to changes in the social environment. This is particularly true when considering the preparation of a health care workforce for the field of geriatrics. An Interdisciplinary Geriatric Education Center is an innovative, deliberate, institutional strategy to prepare and deliver an effective healthcare workforce for the future geriatric population. The model and processes for the implementation of such a center are presented.

Managing gait disorders in older persons residing in nursing homes: a review of literature.

Managing gait disorders in the nursing home setting is a challenge. Nursing home residents can present with a variety of factors that may contribute to the presentation of gait abnormalities. The development of an individualized intervention program can be effective in improving a resident's ability to ambulate. This article reviews the research pertaining to the management of gait disorders including deconditioning, therapeutic exercise intervention, dementia, and cardiovascular and cardiopulmonary systems. The review provides the reader with strategies to help improve and understand gait performance in older persons residing in nursing homes.