Knowledge translation in surgery: a scoping review of implementation strategies, effectiveness and contextual barriers and enablers

Evaluating Blinatumomab Treatment Adoption in Varied Resource Settings Using the RE-AIM Framework

More knowledge is needed regarding the complex factors and perceptions that enable the implementation of change in health care. The study aimed to examine the enabling factors and barriers encountered in the implementation of improvements in health care in order to achieve patient-centred care (PCC) and to study if there was a correlation in the extent the improvements were perceived to be implemented and the preconditions that were considered to affect them. Using a mixed method design, data were gathered via a questionnaire and individual interviews with health care personnel, clinic managers, and first-line managers. The data collection and analyses were based on the framework for Promoting Action on Research Implementation in Health Services (PARiHS). Correlations between PCC improvements and preconditions for improvements were performed. A high level of involvement, knowledge, and adequate resources were considered important to achieve an implementation of PCC with joint responsibility. Leadership and management need to be explicit and promote continuous follow-up and feedback. Preconditions for improvement had a linear correlation with the perceived level of implementation. Knowledge-related preconditions had greatest impact on implementation. The PARiHS framework was appropriate to use since the three components of evidence, context, and facilitation present different important preconditions in the implementation process. Evidence was the highest rated contributor since evidence-based practices in health care are necessary. It is vital that the important role of the context and facilitators is acknowledged in the implementation process to enable a successful implementation of change. There is a need to incorporate a clear strategy involving all levels in the organization. Furthermore, leaders play an important role in the implementation by facilitating communication and support and by having trust in facilitators and health care personnel. The results are applicable to other interventions implementing change in health care.

This article summarizes recent research on the effectiveness of efforts to implement evidence-based health care. The authors conclude that the evidence in support of single interventions being effective in bringing about practitioner change is weak at best. The authors give examples and evaluative comments on more complex organizational and systemic interventions that are aimed at changing clinical practice, and discuss some of the barriers to their application.

The Foucauldian concepts of governmentality and pastoral power have been used to explain the way health professionals internalise evidence-based practices in health care generally and clinical networks more specifically. However, we know little about the work, practices and process involved in developing and implementing an ‘evidence-based governmentality’ outside the West, particularly in Low and Middle Income Counties (LMICs), where governmentality often has a different transnational character. We explain the development and implementation of a Western transnational evidence-based governmentality in a clinical network in Kenya, using a decentred analytical approach. We highlight the essential work of medical professional ‘pastors’, with experience of both health care in Kenya and evidence-based medicine in Western High-Income Countries, in transposing this governmentality into health care in a LMIC in a way improving clinical care.

Journal Article Evidence-Based Practices in Health Care: Social Work Possibilities Get access Joan Levy Zlotnik, Joan Levy Zlotnik Search for other works by this author on: Oxford Academic PubMed Google Scholar Colleen Galambos Colleen Galambos Search for other works by this author on: Oxford Academic PubMed Google Scholar Health & Social Work, Volume 29, Issue 4, November 2004, Pages 259–261, https://doi.org/10.1093/hsw/29.4.259 Published: 01 November 2004

IntroductionUrgent, tailored and equitable action is needed to address the alarming rise in syphilis rates in Canada. In the last decade, the rates of infectious syphilis have increased by 345%...

With the focus on evidence-based practice in healthcare, a well-conducted systematic review that includes a meta-analysis where indicated represents a high level of evidence for treatment effectiveness. The purpose of this commentary is to assist clinicians in understanding meta-analysis as a statistical tool using both published articles and explanations of components of the technique. We describe what meta-analysis is, what heterogeneity is, and how it affects meta-analysis, effect size, the modeling techniques of meta-analysis, and strengths and weaknesses of meta-analysis. Common components like forest plot interpretation, software that may be used, special cases for meta-analysis, such as subgroup analysis, individual patient data, and meta-regression, and a discussion of criticisms, are included.

BackgroundClinical interventions often need to be adapted from their original design when they are applied to new settings. There is a growing literature describing frameworks and approaches to deploying and documenting adaptations of evidence-based practices in healthcare. Still, intervention modifications are often limited in detail and justification, which may prevent rigorous evaluation of interventions and intervention adaptation effectiveness in new contexts. We describe our approach in a case study, combining two complementary intervention adaptation frameworks to modify CONNECT for Quality, a provider-facing team building and communication intervention designed to facilitate implementation of a new clinical program.MethodsThis process of intervention adaptation involved the use of the Planned Adaptation Framework and the Framework for Reporting Adaptations and Modifications, for systematically identifying key drivers, core and non-core components of interventions for documenting planned and unplanned changes to intervention design.ResultsThe CONNECT intervention’s original context and setting is first described and then compared with its new application. This lays the groundwork for the intentional modifications to intervention design, which are developed before intervention delivery to participating providers. The unpredictable nature of implementation in real-world practice required unplanned adaptations, which were also considered and documented. Attendance and participation rates were examined and qualitative assessment of reported participant experience supported the feasibility and acceptability of adaptations of the original CONNECT intervention in a new clinical context.ConclusionThis approach may serve as a useful guide for intervention implementation efforts applied in diverse clinical contexts and subsequent evaluations of intervention effectiveness.Trial registrationThe study was registered at ClinicalTrials.gov (NCT03300336) on September 28, 2017.

BackgroundResearch is crucial for improved healthcare and better patient outcomes, but there is a current shortage of clinician-researchers who can connect research and practice in the health professions field. This study aimed to investigate the effect of career stage, previous training and involvement in research on health professionals' (HPs) motivations to engage in research while in public hospital clinical roles. HPs' perceived motivation concerning the importance, value, and barriers attributed to research during different career stages were examined.MethodsA mixed methods study design was adopted for this research. An online survey developed based on the Expectancy-Value-Cost (EVC) theory was distributed to HPs (doctors, nurses, midwives, and allied health professionals) in three North Queensland Public Hospitals. Data analysis included descriptive and inferential statistics for the quantitative data and content analysis for the qualitative text responses.ResultsThree hundred and fifty-five responses were received. Prior research training and involvement in research influenced respondents' perceptions about the importance, attitude, motivators, and barriers to research. Attainment value was the overarching motivation for involvement in research and research training for all career stages and all professional HP groups. Positive attitude to research was significantly higher (P = 0.003) for the allied health group (27.45 ± 4.05), followed by the medical (26.30 ± 4.12) and then the nursing and midwifery group (25.62 ± 4.21). Perceived importance and attitude attributed to research were significantly higher (P < 0.05) for those who had research training (26.66 ± 3.26 and 28.21 ± 3.73) compared to those who did not have research training (25.77 ± 3.77 and 23.97 ± 3.53). Significantly higher (P < 0.05) perceptions of organisational and individual barriers were reported among early career (50.52 ± 7.30) respondents compared to their mid-career (48.49 ± 8.14) and late career (47.71 ± 8.36) counterparts.ConclusionThe findings from this study provide valuable insights into the factors that influence HPs' motivation for research. The results underscore the importance of professional group, involvement in research, exposure to research training, career stage, gender, and organisational support in shaping HPs' attitudes, values, and perceived barriers to research. Understanding these factors can inform the development of targeted strategies to enhance research engagement among HPs and promote evidence-based practice in healthcare.

Implementing Evidence-Based Practice In Healthcare

BackgroundAlthough evidence-based practice in healthcare has been facilitated by Internet access through wireless mobile devices, research on the effectiveness of clinical decision support for clinicians at the point of care is lacking. This study examined how evidence as abstracts and the bottom-line summaries, accessed with PubMed4Hh mobile devices, affected clinicians’ decision making at the point of care.MethodsThree iterative steps were taken to evaluate the usefulness of PubMed4Hh tools at the NIH Clinical Center. First, feasibility testing was conducted using data collected from a librarian. Next, usability testing was carried out by a postdoctoral research fellow shadowing clinicians during rounds for one month in the inpatient setting. Then, a pilot study was conducted from February, 2016 to January, 2017, with clinicians using a mobile version of PubMed4Hh. Invitations were sent via e-mail lists to clinicians (physicians, physician assistants and nurse practitioners) along with periodic reminders. Participants rated the usefulness of retrieved bottom-line summaries and abstracts and indicated their usefulness on a 7-point Likert scale. They also indicated location of use (office, rounds, etc.).ResultsOf the 166 responses collected in the feasibility phase, more than half of questions (57%, n = 94) were answerable by both the librarian using various resources and by the postdoctoral research fellow using PubMed4Hh. Sixty-six questions were collected during usability testing. More than half of questions (60.6%) were related to information about medication or treatment, while 21% were questions regarding diagnosis, and 12% were specific to disease entities. During the pilot study, participants reviewed 34 abstracts and 40 bottom-line summaries. The abstracts’ usefulness mean scores were higher (95% CI [6.12, 6.64) than the scores of the bottom-line summaries (95% CI [5.25, 6.10]). The most frequent reason given was that it confirmed current or tentative diagnostic or treatment plan. The bottom-line summaries were used more in the office (79.3%), and abstracts were used more at point of care (51.9%).ConclusionsClinicians reported that retrieving relevant health information from biomedical literature using the PubMed4Hh was useful at the point of care and in the office.

BackgroundMiddle managers are in a unique position to promote the implementation of evidence-based practices (EBPs) in healthcare organizations, yet knowledge of middle managers’ role in implementation and determinants (e.g., individual-, organizational-, and system-level factors) which influence their role remains fractured, spanning decades and disciplines. To synthesize understanding, we undertook a systematic review of studies of middle managers’ role in healthcare EBP implementation and determinants of that role.MethodsWe searched MEDLINE/PubMed and Business Source Complete (Ebsco) for literature on middle managers’ role in healthcare EBP implementation and its determinants. We abstracted data from records that met inclusion criteria (i.e., written in English, peer-reviewed, and reporting either a protocol or results of an empirical study) into a matrix for analysis. We summarized categorical variables using descriptive statistics. To analyze qualitative data, we used a priori codes and then allowed additional themes to emerge.ResultsOne hundred five records, spanning across several countries and healthcare settings and relating to a range of EBPs, met our inclusion criteria. Studies of middle managers’ role in healthcare EBP implementation and its determinants substantially increased from 1996 to 2015. Results from included studies suggest that middle managers shape implementation climate in addition to fulfilling the four roles hypothesized in extant theory of middle managers’ role in implementation. However, extant studies offered little understanding of determinants of middle managers’ role.ConclusionsOur findings suggest that middle managers may play an important role in facilitating EBP implementation. Included studies offered little understanding regarding the relative importance of various roles, potential moderators of the relationship between middle managers’ roles and EBP implementation, or determinants of middle managers’ role in EBP implementation. Future studies should seek to understand determinants and moderators of middle managers’ role. Clearer understanding may facilitate the translation of evidence into practice.

Background: Research competencies across nurses’ career stages have not been adequately explored. Yet, research skills to appraise, synthesize, and implement research findings are required for evidence-based practice. Purpose: To explore the literature on registered nurse research competencies; to identify core competencies (i.e., knowledge, skills, and attitudes), research capacity-building activities, strategies and recommendations to strengthen nurses’ research capacity; and to propose a conceptual developmental framework of nurse research competencies. Methods: As part of a larger project titled “Health Services Researcher Pathway”, with the consultation of a health sciences librarian, we conducted an integrative literature review drawing on relevant publications. The PubMed (Medline), CINAHL, Web of Science and ProQuest Dissertations and Theses databases were searched from 2000 to 2012. From the revealed publications (n=1012), only 22 articles were relevant to nurse research competencies. Findings: The key themes cited in the literature reviewed include models and partnerships for building and developing competencies for research production (rather than utilization), and educational strategies and recommendations for interventions to provide confidence in evidence-based practice including research utilization and in clinical decision-making. According to the five-step evidence-based practice model (i.e., formation of answerable research questions, literature search and retrieval of the best available evidence, critical appraisal of the evidence, application of research findings into practice, and evaluation of performance based on the outcomes), we propose a framework for a nurse researcher pathway that may contribute to two research competency streams: for research users and research producers. The important area of research users is open for further research, since scarce literature exists. Conclusions: The proposed conceptual developmental framework for a nurse researcher pathway includes essential steps toward evidence-based practice in healthcare that have implications at the micro-level (nurse), meso-level (organization), and macro-level (society). Our work continues to pilot and refine a nurse researcher pathway and its associated competencies.

According to the 2006 needs assessment conducted by the Hospital Libraries Section (HLS) of the Medical Library Association (MLA), 30.4% of the members responding to the assessment considered evidence-based medicine (EBM) the most important issue they would face in their workplace over the next three years [1]. The responsibilities and support systems of hospital librarians desiring to foster clinicians' practice of evidence-based health care (EBHC) might vary significantly from those of academic librarians. Scherrer et al. reported, “The academic librarian who supports active evidence-based practice curricula in health professions colleges will need teaching approaches that are appropriate for instruction of students in a classroom, while the hospital librarian may be looking for point-of-need instructional techniques that would be effective with residents and clinicians” [2]. While the EBHC support–related needs of individual librarians in either the academic or hospital settings will likely include other approaches as well, the specific needs and attitudes of hospital librarians toward EBHC have not been well explored. This paper reports data collected via a larger survey of hospital librarians regarding hospital librarians' perceptions of the skills required to support EBHC. Results of the survey may be used to inform exploration of the extent to which EBHC has penetrated beyond the academic medical library sphere into the domain of the hospital library and indicate areas for further training for librarians.

Evidence-based Practice Journal Club: How We Do It