Experiences of a community of research practice: a service evaluation.

BACKGROUND: A community of research practice (CRP) was established to increase research capacity and provide learning opportunities and networking for healthcare practitioners, working within a Children's Care Group. The CRP aimed to engage research-interested practitioners in research to develop their skills and confidence, encourage networking, and build research capacity. AIM: To report the results of a service evaluation that was undertaken to review the CRP's value in practice. DISCUSSION: Thematic analysis revealed four themes - 'positive environment', 'confidence', 'professional development' and 'networking' - highlighting benefits from the CRP, alongside the challenges encountered. CONCLUSION: This article highlights the significant contribution of CRP for practitioners in the context of an innovative organisation with a supportive culture. IMPLICATIONS FOR PRACTICE: A CRP empowers healthcare practitioners to engage with research while in clinical practice, enabling increased research confidence, and the development of research skill and knowledge and enhanced networking. CRP can potentially influence recruitment and retention.

Clinical practice guideline and pathways for the evaluation and management of patients with dizziness in family and community practice

Background@#Dizziness is a commonly encountered symptom in the primary care which can be caused, most of the time by benign condition and rarely due to serious conditions needing higher level of care.@*Objective@#To develop a clinical guideline and pathway that will serve as guide in the diagnosis and management of adult patients with dizziness in primary care and outpatient setting@*Methods@#A guideline development team was formed which is composed of family and community medicine specialists from different institutions. Searching, selection and assessment of the latest evidence on dizziness diagnosis and management was done using the search terms: “dizziness”, “diagnosis”, “management”, and “primary care”. Formulation of the recommendation was done using Grade approach and graded with modified GRADEPro and expert panel consensus. External review was also done by an expert in otorhinolaryngology.@*Recommendations@#Clinical Assessment •Recommendation1.Askforthepatient’sdescriptionofdizzinessandclassifythepatientintooneofthefourtypes: vertigo, presyncope, disequilibrium, and lightheadedness and classify as acute/episodic or chronic/sustained. (Strong Recommendation, Low Quality Evidence) •Recommendation2.Obtainamedicalhistoryfocusingonthetiming,triggers,associatedsymptoms,riskfactorsfor atherosclerotic vascular disease, and functional status or quality of life. (Strong Recommendation, High Quality Evidence) •Recommendation3.Performaphysicalexaminationfocusingonvitalsigns,HEENT(includingotoscopy),cardiovascular and neurologic examination. (Strong Recommendation, High Quality Evidence) •Recommendation4.PerformspecialphysicalexaminationslikeDix-Hallpikemaneuverforacuteepisodictriggeredvertigo to check for BPPV (most common cause of peripheral vertigo), HINTS plus test for spontaneous episodic vertigo to check for stroke and hyperventilation provocation test for patients suspected of anxiety (Strong Recommendation, High Quality Evidence) •Recommendation5.Elicitredflagsthatshouldwarrantreferrallikeseveredizzinessandassociated,alteredmentalstatus, loss of consciousness and abnormal vital signs. Other symptoms like chest pain, palpitations, dyspnea, neurologic deficit may warrant referral for evaluation and management. (Strong Recommendation, High Quality Evidence) •Recommendation6.Forpatientsconsultingviatelemedicine,obtainamedicalhistoryfocusingonthetiming,triggers, associated symptoms, risk factors for atherosclerotic vascular disease, and functional status or quality of life, and observe and conduct self-physical examination (vital signs, mental status, ocular and facial nerve) (Strong Recommendation, Low Quality Evidence) Diagnostic •Recommendation7.Laboratorytestingisnotroutinelyrecommendedamongpatientswithdizziness.However,testingmay be requested if there is a need to identify a definite etiology to guide treatment and should be guided by the classification of dizziness, possible etiology, and the medical history and physical examination. (Strong Recommendation, High Quality Evidence).Recommendation8.Forpatientswithvertigoandwithauditorysymptoms(i.e.,hearingloss,tinnitusandauralfullness, etc.), pure tone audiometry speech test may be requested if available. (Strong Recommendation, High Quality Evidence) •Recommendation9.Forpatientswithpresyncope/syncopeandachronicmedicalconditionisbeingconsidered,complete blood count may be requested for those with probable blood dyscrasia, serum blood glucose may be requested for those with diabetes, electrocardiogram and lipid profile may be requested for those with cardiovascular disease. (Strong Recommendation, High Quality Evidence) •Recommendation10.Forpatientswithdisequilibriumandwithanabnormalneurologicphysicalexaminationfinding,CT scan may be requested. (Strong Recommendation, High Quality Evidence) Pharmacologic •Recommendation11.Empirictrialofshortcourse(7days)pharmacologictreatmentforsymptomreliefshouldbeoffered. Referral should be considered if the dizziness become more severe or it did not improve in 7 days. (Strong Recommendation, High Quality Evidence) •Recommendation12.Forpatientswithmildtomoderatevertigo,offerhistamineanalogue(betahistine)orantihistamine (meclizine, diphenhydramine, dimenhydrinate or cinnarizine) for symptom relief. (Strong Recommendation, High Quality Evidence) •Recommendation13.Forpatientswithmildtomoderatevertigoassociatedwithmigraine(vestibularmigraine),aside from symptom relief, offer any of the triptans as preventive medication. (Strong Recommendation, High Quality Evidence) •Recommendation14.Forpatientswhosedizzinessisdescribedasdisequilibrium(gaitimbalance)orpresyncope(near faintness) or dizziness with anxiety attack, offer symptomatic treatment and intervention based on the underlying cause or consider referral to appropriate specialist. (Strong Recommendation, High Quality Evidence) Non-pharmacologic •Recommendation15.Allpatientsshouldbeprovidedwithhealtheducationoncauses,triggersandfollowup.(Strong Recommendation, Low Quality Evidence) •Recommendation16.Allpatientsshouldbeadvisedonappropriatedietandlifestylemodification.(StrongRecommendation, Low Quality Evidence) •Recommendation17.Dependingonthenatureofvertigo,educateandtrainthepatientoncanalrepositioningmaneuver and vestibular rehabilitation. Referral to rehabilitation medicine may be considered. (Strong Recommendation, High Quality Evidence) •Recommendation18.Thepatient’sfamilymustalsobeprovidedwithhealtheducationandidentifyacaregivertoassist and promote compliance to management. (Strong Recommendation, Low Quality Evidence) •Recommendation19.Encouragecommunity-basedvestibularrehabilitationactivitiessuchasgroupbalancetraining exercise. (Strong Recommendation, Low Quality Evidence) Patient Outcomes •Recommendation20.Thepatientshouldknowthenatureofdizziness,causesandpotentialcomplicationsanddevelop skills in postural exercises. (Strong Recommendation, Moderate Quality Evidence) •Recommendation21.Decreaseinfrequencyandseverityshouldexpectedwithin48hoursandresolutionisexpectedwithin a month. (Strong Recommendation, Moderate Quality Evidence) •Recommendation22.Improvedqualityoflifeshouldalsobeelicited.(StrongRecommendation,ModerateQualityEvidence) •Recommendation23.Referraltoappropriatespecialtyshouldbedoneifnoresolutionorprogressionofsymptomsor impaired quality of life for more than a month. (Strong Recommendation, Expert Opinion)@*Implementation@#The committee shall disseminate the guidelines through presentations and via journal publications. The QA committee shall be in charge of implementation of the guideline and pathway.

Public opinion and practice towards COVID-19 pandemic in Libya

Introduction: World Health Organization declared COVID-19 as a pandemic, and like any global health crisis at its beginning, need a commitment to take the necessary precautions due to its spread among people before and during the presence of vaccine or drug. This study aims to assess public opinion and practice of Libyan community in the context of the COVID-19 pandemic. Materials and methods: A cross-sectional online study was conducted among Libyans between Sep. 15th, and Oct. 29th, 2020 using a developed-design questionnaire consisting of 23 questions assessing the aim of the study. 2305, who agreed to participate, was involved in the present study. Results: The response rate of Libyan regions, the west, east, middle and south areas, was 80.0%, 8.7%, 10.0 % and 1.3%, respectively. The majority were female (63.1%), with mostly in the 20- 50 years’ age group (86.6%). The high level of education was university graduate (71.3%). The opinion average rate of participants was 33.2 % disagree and 26.4 % strongly disagree towards ban measures issued by authorities. Findings reveal good practice of applying preventive measures (always, an average rate of 35.1%). The relationship between opinion score and the participant’s demographic data show highly significant difference with the educational level (P = 0.002), but no differences found with residence (P = 0.183), with age (P = 0.212), and with gender (P = 0.313). With regard to the practice score, a significant difference was existed with gender (P = 0.029), age (P = 0.000), level of education (P = 0.013) and residence (P = 0.000). Conclusions: Libyan people has an acceptable level of awareness and opinion in applying the necessary precautionary measures towards COVID-19 pandemic, where prevention practices are influenced by level of education, residence, age and gender. (AU)

Introducción: La Organización Mundial de la Salud declaró la COVID-19 como una pandemia y, como cualquier crisis de salud global en sus inicios, es necesario el compromiso de tomar las precauciones necesarias debido a su propagación entre las personas antes y durante la presencia de una vacuna o fármaco. Este estudio tiene como objetivo evaluar la opinión pública y la práctica de la comunidad libia en el contexto de la pandemia de COVID-19. Materiales y métodos: Se realizó un estudio transversal en línea entre libios entre el 15 de septiembre y el 29 de octubre de 2020 utilizando un cuestionario de diseño desarrollado que consta de 23 preguntas que evalúan el objetivo del estudio. 2305 sujetos accedieron a participar en el presente estudio. Resultados: La tasa de respuesta de las regiones libias, las áreas oeste, este, medio y sur, fue del 80,0%, 8,7%, 10,0% y 1,3%, respectivamente. La mayoría eran mujeres (63,1%), en su mayoría en el grupo de edad de 20 a 50 años (86,6%). El nivel de educación alto fue de titulado universitario (71,3%). La tasa promedio de opinión de los participantes fue del 33,2% en desacuerdo y del 26,4% en total desacuerdo con las medidas de prohibición emitidas por las autoridades. Los hallazgos revelan buenas prácticas de aplicación de medidas preventivas (siempre, una tasa promedio del 35,1%). La relación entre la puntuación de opinión y los datos demográficos del participante muestra una diferencia altamente significativa con el nivel educativo (P = 0,002), pero no se encontraron diferencias con la residencia (P = 0,183), con la edad (P = 0,212) y con el género (P = 0,313). Con respecto al puntaje de práctica, existió una diferencia significativa con el género (P = 0.029), la edad (P = 0.000), el nivel de educación (P = 0.013) y la residencia (P = 0.000)...(AU)

Trust-Based Partnerships Are Essential - and Achievable - in Health Care Service.

When people think about trust in the context of health care, they typically focus on whether patients trust the competence of doctors and other health professionals. But for health care to reach its full potential as a service, trust must also include the notion of partnership, whereby patients see their clinicians as reliable, caring, shared decision-makers who provide ongoing "healing" in its broadest sense. Four interrelated service-quality concepts are central to fostering trust-based partnerships in health care: empathetic creativity, discretionary effort, seamless service, and fear mitigation. Health systems and institutions that prioritize trust-based partnerships with patients have put these concepts into practice using several concrete approaches: investing in organizational culture; hiring health professionals for their values, not just their skills; promoting continuous learning; attending to the power of language in all care interactions; offering patients "go-to" sources for timely assistance; and creating systems and structures that have trust built into their very design. It is in the real-world implementation of trust-based partnership that health care can reclaim its core mission.

Innovations in Evaluating Nursing Academic Practice Partnerships.

Academic-practice partnerships are formalized relationships encouraged by the American Association of Colleges of Nursing to meet healthcare and societal needs. While Academic-practice partnerships have existed for decades, the process for evaluating their outcomes often lacks a robust, standardized structure. The purpose of this article is to describe one organization's process for developing and implementing an evaluation blueprint for appraising an Academic-practice partnership.

Knowledge and behavior changes in clinician after training of partnership for Diabetes Control in Indonesia.

BACKGROUND AND AIMS: One of the main determinants of successful diabetes management is the quality of healthcare provider including general practitioner and internist which can be increased through medical training. This study aimed to describe the changes of clinician's knowledge and behavior of comprehensive diabetes management training program around Indonesia. METHOD: We conducted a three-day training program for general practitioners and internists for 3.5 years, 2013 to 2016. All clinicians invited as voluntary participant to send their patient data from medical record. Each participant was expected to submit a minimum of 25 type 2 diabetes (T2DM) set patient data before and 6 months after training program to analyze the impact of program in physician knowledge and behavior related to diabetes management. RESULT: 120 of 489 voluntary participants submitted completed baseline data with 4676 patient data. Meanwhile, only 32 participants that submitted completed data of 6 months before after training with 886 patient data. Most of parameters were improve before and after program. The greatest and lowest improvement were on A1c measurement (21%) and smoking assessment (2%). CONCLUSION: Intensive seminar and training was not enough to empower diabetes management. This research might push the creation of clinical practice program that were tailored to each care facilities and integrated within routine care aimed at continual improvement of its healthcare worker.

Transforming electronic health record polysomnographic data into the Observational Medical Outcome Partnership's Common Data Model: a pilot feasibility study.

Well-defined large-volume polysomnographic (PSG) data can identify subgroups and predict outcomes of obstructive sleep apnea (OSA). However, current PSG data are scattered across numerous sleep laboratories and have different formats in the electronic health record (EHR). Hence, this study aimed to convert EHR PSG into a standardized data format-the Observational Medical Outcome Partnership (OMOP) common data model (CDM). We extracted the PSG data of a university hospital for the period from 2004 to 2019. We designed and implemented an extract-transform-load (ETL) process to transform PSG data into the OMOP CDM format and verified the data quality through expert evaluation. We converted the data of 11,797 sleep studies into CDM and added 632,841 measurements and 9,535 observations to the existing CDM database. Among 86 PSG parameters, 20 were mapped to CDM standard vocabulary and 66 could not be mapped; thus, new custom standard concepts were created. We validated the conversion and usefulness of PSG data through patient-level prediction analyses for the CDM data. We believe that this study represents the first CDM conversion of PSG. In the future, CDM transformation will enable network research in sleep medicine and will contribute to presenting more relevant clinical evidence.

Trauma and Violence Informed Care Through Decolonising Interagency Partnerships: A Complexity Case Study of Waminda's Model of Systemic Decolonisation.

Through the lens of complexity, we present a nested case study describing a decolonisation approach developed and implemented by Waminda South Coast Women's Health and Welfare Aboriginal Corporation. Using Indigenous research methods, this case study has unfolded across three phases: (1) Yarning interviews with the workforce from four partner health services (n = 24); (2) Yarning circle bringing together key informants from yarning interviews to verify and refine emerging themes (n = 14); (3) Semi-structured interviews with a facilitator of Waminda's Decolonisation Workshop (n = 1) and participants (n = 10). Synthesis of data has been undertaken in stages through collaborative framework and thematic analysis. Three overarching themes and eight sub-themes emerged that centred on enhancing the capabilities of the workforce and strengthening interagency partnerships through a more meaningful connection and shared decolonisation agenda that centres Aboriginal and Torres Strait Islander families and communities. Health and social services are complex systems that function within the context of colonisation. Waminda's innovative, model of interagency collaboration enhanced workforce capability through shared language and collective learning around colonisation, racism and Whiteness. This process generated individual, organisational and systemic decolonisation to disable power structures through trauma and violence informed approach to practice.

What sets the conditions for success in community-partnered evaluation work? Multiple perspectives on a small-scale research-practice partnership evaluation.

The goals of this study are: (a) to share reflections from multiple stakeholders involved in a foundation-funded community-partnered evaluation project, (b) to share information that might be useful to researchers, practitioners, and funders considering the merits of researcher/practitioner evaluation projects, and (c) to make specific suggestions for funders and researcher/practitioner teams starting an evaluation project. Three stakeholders in a small-scale research-practice partnership (RPP) reflected on the evaluation project by responding to three prompts. A researcher, community organization leader, and funder at a small foundation share specific tips for those considering a small-scale RPP. Engaging in a small-scale RPPs can be a very meaningful experience for individual researchers and smaller organizations and funders. The benefits and challenges align and differ in many ways with those encountered in larger projects.

Community Partnership in Response to Hoarding Disorder in Montreal.

Clinical management of hoarding disorder is challenging because of the weak insight of people with hoarding disorder, the lack of available tools for disease management in the health care system, and the absence of communication between health care and primary responders. To tackle this communication gap and, hence, improve clinical management of hoarding disorder, a community partnership initiated by people with hoarding disorder took place in Montreal. This initiative could profitably offer guidelines for other communities facing hoarding disorder challenges.

How partnership should work to bring innovative medicines to patients.

Scientists increasingly find themselves working in bilateral drug development alliances. Alliances are conceptually simple, but operationally challenging, resulting in the value-eroding misalignment and delays that alliances often experience. This case study of an exemplary collaboration between a small biotech and a global biopharmaceutical company is based on 15 interviews and a lessons-learned workshop conducted with the principal alliance team members. We outline five repeatable practices identified as contributing to their success that other alliance teams can follow.

Transforming French Electronic Health Records into the Observational Medical Outcome Partnership's Common Data Model: A Feasibility Study.

BACKGROUND: Common data models (CDMs) enable data to be standardized, and facilitate data exchange, sharing, and storage, particularly when the data have been collected via distinct, heterogeneous systems. Moreover, CDMs provide tools for data quality assessment, integration into models, visualization, and analysis. The observational medical outcome partnership (OMOP) provides a CDM for organizing and standardizing databases. Common data models not only facilitate data integration but also (and especially for the OMOP model) extends the range of available statistical analyses. OBJECTIVE: This study aimed to evaluate the feasibility of implementing French national electronic health records in the OMOP CDM. METHODS: The OMOP's specifications were used to audit the source data, specify the transformation into the OMOP CDM, implement an extract-transform-load process to feed data from the French health care system into the OMOP CDM, and evaluate the final database. RESULTS: Seventeen vocabularies corresponding to the French context were added to the OMOP CDM's concepts. Three French terminologies were automatically mapped to standardized vocabularies. We loaded nine tables from the OMOP CDM's "standardized clinical data" section, and three tables from the "standardized health system data" section. Outpatient and inpatient data from 38,730 individuals were integrated. The median (interquartile range) number of outpatient and inpatient stays per patient was 160 (19-364). CONCLUSION: Our results demonstrated that data from the French national health care system can be integrated into the OMOP CDM. One of the main challenges was the use of international OMOP concepts to annotate data recorded in a French context. The use of local terminologies was an obstacle to conceptual mapping; with the exception of an adaptation of the International Classification of Diseases 10th Revision, the French health care system does not use international terminologies. It would be interesting to extend our present findings to the 65 million people registered in the French health care system.

Deep Learning Approach to Parse Eligibility Criteria in Dietary Supplements Clinical Trials Following OMOP Common Data Model.

Dietary supplements (DSs) have been widely used in the U.S. and evaluated in clinical trials as potential interventions for various diseases. However, many clinical trials face challenges in recruiting enough eligible patients in a timely fashion, causing delays or even early termination. Using electronic health records to find eligible patients who meet clinical trial eligibility criteria has been shown as a promising way to assess recruitment feasibility and accelerate the recruitment process. In this study, we analyzed the eligibility criteria of 100 randomly selected DS clinical trials and identified both computable and non-computable criteria. We mapped annotated entities to OMOP Common Data Model (CDM) with novel entities (e.g., DS). We also evaluated a deep learning model (Bi-LSTM-CRF) for extracting these entities on CLAMP platform, with an average F1 measure of 0.601. This study shows the feasibility of automatic parsing of the eligibility criteria following OMOP CDM for future cohort identification.

Long-term tracking demonstrates effectiveness of a partnership-led training program to advance the careers of biomedical researchers from underrepresented groups.

The demographic profile of the biomedical workforce in the U.S. does not reflect the population at large, raising concerns that there will be insufficient trained researchers in the future, and the scope of research interests will not be sufficiently broad. To diversify and expand the pool of researchers trained to conduct research on cancer and cancer health disparities, a series of training activities to recruit and train primarily Hispanic students at both the undergraduate and graduate level were developed. The strengths of both a Hispanic Serving Institution and an NIH-designated Comprehensive Cancer Center were leveraged to develop appropriate research training and professional development activities. The career progression of the participants and degree completion rates was tracked, along with persistent interest in biomedical research in general and cancer and cancer health disparities research in particular for these underrepresented individuals. Finally, this report demonstrates that these training activities increased general knowledge about cancer among participants.