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Yi TW, O’Hara DV, Smyth B, Jardine MJ, Levin A, Morton RL. Identifying Barriers and Facilitators for Increasing Uptake of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors in British Columbia, Canada, using the Consolidated Framework for Implementation Research. Can J Kidney Health Dis 2023; 11:20543581231217857. [PMID: 38161391 PMCID: PMC10757432 DOI: 10.1177/20543581231217857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024] Open
Abstract
Background Care gaps remain in modern health care despite the availability of robust, evidence-based medications. Although sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated profound benefits in improving both cardiovascular and kidney outcomes in patients, the uptake of these medications remain suboptimal, and the causes have not been systematically explored. Objective The purpose of this study was to use the Consolidated Framework for Implementation Research (CFIR) to describe the barriers and facilitators faced by clinicians in British Columbia, Canada, when prescribing an SGLT2 inhibitor. To achieve this, we conducted semistructured interviews using the CFIR with practicing family physicians, nephrologists, endocrinologists, and cardiologists in British Columbia. Design Semistructured interviews. Setting British Columbia, Canada. Participants Actively practicing family physicians, nephrologists, endocrinologists, and cardiologists in British Columbia. Methods Twenty-one clinicians were interviewed using questions derived from the CFIR. The audio recordings were transcribed verbatim, and each transcription was individually analyzed in duplicate using thematic analysis. The analysis focused on identifying barriers and facilitators to using SGLT2 inhibitors in clinical practice and coded using the CFIR constructs. Once the transcriptions were coded, overarching themes were created. Results Five overarching themes were identified to the barriers and facilitators to using SGLT2 inhibitors: current perceptions and beliefs, clinician factors, patient factors, medication factors, and health care system factors. The current perceptions and beliefs were that SGLT2 inhibitors are efficacious and have distinct advantages over other agents but are underutilized in British Columbia. Clinician factors included varying levels of knowledge of and comfort in prescribing SGLT2 inhibitors, and patient factors included intolerable adverse events and additional pill burden, but many were enthusiastic about potential benefits. Multiple SGLT2 inhibitor related adverse events like mycotic infections and euglycemic diabetic ketoacidosis and the difficulty in obtaining reimbursement for these medications were also identified as a barrier to prescribing these medications. Facilitators for the use of SGLT2 inhibitors included consensus among colleagues, influential leaders, and peers in support of their use, and endorsement by national guidelines. Limitations The experience from the clinicians regarding costs and the reimbursement process is limited to British Columbia as each province has its own procedures. There may be responder bias as clinicians were approached through purposive sampling. Conclusion This study highlights different themes to the barriers and facilitators of using SGLT2 inhibitors in British Columbia. The identification of these barriers provides a specific target for improvement, and the facilitators can be leveraged for the increased use of SGLT2 inhibitors. Efforts to address and optimize these barriers and facilitators in a systematic approach may lead to an increase in the use of these efficacious medications.
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Affiliation(s)
- Tae Won Yi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Daniel V. O’Hara
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Brendan Smyth
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia
- Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia
| | - Meg J. Jardine
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia
- Department of Nephrology, Concord Repatriation General Hospital, Sydney, Australia
| | - Adeera Levin
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Rachael L. Morton
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia
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Moldovan F, Moldovan L. Fair Healthcare Practices in Orthopedics Assessed with a New Framework. Healthcare (Basel) 2023; 11:2753. [PMID: 37893827 PMCID: PMC10606008 DOI: 10.3390/healthcare11202753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Background and Objectives: Healthcare systems are supported by the European ideology to develop their egalitarian concerns and to encourage the correct and fair behavior of medical staff. By integrating fair healthcare practices into sustainability, this requirement is addressed. In this research, our objective is to develop and validate, in the current activity of healthcare facilities, a new instrument for evaluating fair healthcare practices as a component of social responsibility integrated into sustainability. Materials and Methods: The research methods consist of deciding the domains of a new framework that integrates fair healthcare practices; the collection of the most recent fair healthcare practices reported by healthcare facilities around the world; elaboration of the contents and evaluation grids of the indicators; the integration of indicators related to fair healthcare practices in the matrix of the new framework for sustainable development; validation of the theoretical model at an orthopedic hospital. Results: The theoretical model of the new framework is composed of five domains: organizational management, provision of sustainable medical care services, economic, environmental, and social. The last domain is developed on the structure of the seven subdomains of the social responsibility standard ISO 26000. The seven indicators that describe fair healthcare practices are attitudes of the profession towards accreditation, effective intervention application, promoting a culture of patient safety, characteristics that affect the effectiveness of transfers, effective healthcare practices, feedback to medical staff, safety checklists. The new reference framework was implemented and validated in practice at an emergency hospital with an orthopedic profile. Conclusions: The practical implementation highlighted the usefulness of the new reference framework, its compatibility, and the possibility of integration with the reference frameworks for the evaluation of European hospitals, with the national legislation for the accreditation of hospitals and outpatient units, as well as with the ISO 9001 standard regarding the implementation of quality management systems. Its added value consists in promoting sustainable development by orienting staff, patients, and interested parties towards sustainability.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Faculty of Engineering and Information Technology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania;
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van Leuven J, Evans S, Kichenadasse G, Steeghs N, Bonevski B, Mikus G, van Dyk M. Framework for Implementing Individualised Dosing of Anti-Cancer Drugs in Routine Care: Overcoming the Logistical Challenges. Cancers (Basel) 2023; 15:3293. [PMID: 37444404 DOI: 10.3390/cancers15133293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 07/15/2023] Open
Abstract
Precision medicine in oncology involves identifying the 'right drug', at the 'right dose', for the right person. Currently, many orally administered anti-cancer drugs, particularly kinase inhibitors (KIs), are prescribed at a standard fixed dose. Identifying the right dose remains one of the biggest challenges to optimal patient care. Recently the Precision Dosing Group established the Accurate Dosing of Anti-cancer Patient-centred Therapies (ADAPT) Program to address individualised dosing; thus, use existing anti-cancer drugs more safely and efficiently. In this paper, we outline our framework, based on the Medical Research Council (MRC) framework, with a simple 6-step process and strategies which have led to the successful implementation of the ADAPT program in South Australia. Implementation strategies in our 6-step process involve: (1) Evaluate the evidence and identify the cancer drugs: Literature review, shadowing other experts, establishing academic partnerships, adaptability/flexibility; (2) Establishment of analytical equipment for drug assays for clinical purposes: assessment for readiness, accreditation, feasibility, obtaining formal commitments, quality assurance to all stakeholders; (3) Clinical preparation and education: educational material, conducted educational meetings, involve opinion leaders, use of mass media, promote network weaving, conduct ongoing training; (4) Blood collection, sample preparation and analyses: goods received procedures, critical control points (transport time); (5) Interpret and release results with recommendations: facilitate the relay of clinical data to providers; (6) Clinical application: providing ongoing consultation, identify early adopters, identify, and prepare champions. These strategies were selected from the 73 implementation strategies outlined in the Expert Recommendations for Implementing Change (ERIC) study. The ADAPT program currently provides routine plasma concentrations for patients on several orally administered drugs in South Australia and is currently in its evaluation phase soon to be published. Our newly established framework could provide great potential and opportunities to advance individualised dosing of oral anti-cancer drugs in routine clinical care.
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Affiliation(s)
- Jason van Leuven
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
- Medical Oncology, Flinders Medical Centre, Adelaide 5042, Australia
| | - Simon Evans
- Implementation Science Unit, Department for Health and Wellbeing, Adelaide 5042, Australia
| | - Ganessan Kichenadasse
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
- Medical Oncology, Flinders Medical Centre, Adelaide 5042, Australia
| | - Neeltje Steeghs
- Antoni van Leeuwenhoek Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Billie Bonevski
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
| | - Gerd Mikus
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Madelé van Dyk
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
- Medical Oncology, Flinders Medical Centre, Adelaide 5042, Australia
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Gittus M, Chong J, Sutton A, Ong ACM, Fotheringham J. Barriers and facilitators to the implementation of guidelines in rare diseases: a systematic review. Orphanet J Rare Dis 2023; 18:140. [PMID: 37286999 DOI: 10.1186/s13023-023-02667-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 03/11/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Rare diseases present a challenge to guideline implementation due to a low prevalence in the general population and the unfamiliarity of healthcare professionals. Existing literature in more common diseases references barriers and facilitators to guideline implementation. This systematic review aims to identify these barriers and facilitators in rare diseases from existing literature. METHODS A multi-stage strategy included searching MEDLINE PubMed, EMBASE Ovid, Web of Science and Cochrane library from the earliest date available to April 2021, Orphanet journal hand-search, a pearl-growing strategy from a primary source and reference/citation search was performed. The Integrated Checklist of Determinants of Practice which comprises of twelve checklists and taxonomies, informed by 57 potential determinants was selected as a screening tool to identify determinants that warrant further in-depth investigation to inform design of future implementation strategies. RESULTS Forty-four studies were included, most of which were conducted in the United States (54.5%). There were 168 barriers across 36 determinants (37 studies) and 52 facilitators across 22 determinants (22 studies). Fifteen diseases were included across eight WHO ICD-11 disease categories. Together individual health professional factors and guideline factors formed the majority of the reported determinants (59.5% of barriers and 53.8% of facilitators). Overall, the three most reported individual barriers were the awareness/familiarity with the recommendation, domain knowledge and feasibility. The three most reported individual facilitators were awareness/familiarity with the recommendation, agreement with the recommendation and ability to readily access the guidelines. Resource barriers to implementation included technology costs, ancillary staff costs and more cost-effective alternatives. There was a paucity of studies reporting influential people, patient advocacy groups or opinion leaders, or organisational factors influencing implementation. CONCLUSIONS Key barriers and facilitators to the implementation of clinical practice guidelines in the setting of rare diseases were at the individual health professional and guideline level. Influential people and organisational factors were relatively under-reported and warrant exploration, as does increasing the ability to access the guidelines as a potential intervention.
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Affiliation(s)
- Matthew Gittus
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK.
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK.
| | - Jiehan Chong
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Albert C M Ong
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - James Fotheringham
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Moldovan F, Moldovan L, Bataga T. Assessment of Labor Practices in Healthcare Using an Innovatory Framework for Sustainability. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040796. [PMID: 37109755 PMCID: PMC10143905 DOI: 10.3390/medicina59040796] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: The concept of sustainability in healthcare is poorly researched. There is a perceived need for new theoretical and empirical studies, as well as for new instruments to assess the implementation of new labor practices in the field. Such practices address unmet social needs and consolidate the sustainable development systems which promote health equity. The objective of the research is to design an innovative reference framework for sustainable development and health equity of healthcare facilities, and to provide a practical validation of this framework. Materials and Methods: The research methods consist of designing the elements of the new frame of reference, designing an indicator matrix, elaborating indicator content, and assessing the reference framework. For the assessment stage, we used sustainable medical practices reported in the scientific literature as well as a pilot reference framework that was implemented in healthcare practice. Results: The new reference framework suggested by the present study is composed of 57 indicators organized in five areas: environmental responsibility, economic performance, social responsibility, institutional capacity, and provision of sustainable healthcare services. These indicators were adapted and integrated into the seven basic topics of the social responsibility standard. The study presents the content of the indicators in the field of labor practices, as well as their evaluation grids. The innovative format of the evaluation grids aims to describe achievement degrees, both qualitatively and quantitatively. The theoretical model was validated in practice through its implementation at the Emergency Hospital in Targu Mures. Conclusions: The conclusions of the study reflect the usefulness of the new reference framework, which is compatible with the requirements in the healthcare field, but differs from other existing frameworks, considering its objective regarding the promotion of sustainable development. This objective facilitates the continuous quantification of the sustainability level, the promotion of sustainable development strategies, and sustainability-oriented approaches on the part of interested parties.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Quality Engineering Research Center, Faculty of Engineering and Information Technology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Tiberiu Bataga
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Mrozik A, Sellier Y, Lemaitre D, Gaucher L. Evaluation of Midwives' Practises on Herpetic Infections during Pregnancy: A French Vignette-Based Study. Healthcare (Basel) 2023; 11:healthcare11030364. [PMID: 36766939 PMCID: PMC9914294 DOI: 10.3390/healthcare11030364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
(1) Background: One out of two pregnant women has a history of herpes infection. Initial infections have a high risk of neonatal transmission. Our objective was to analyse the professional practises of midwives regarding the management of herpes infections during pregnancy in France; (2) Methods: A national survey conducted via an online self-questionnaire, including clinical vignettes for which the midwives proposed a diagnosis, a drug treatment, a mode of birth, and a prognosis. These responses were used to evaluate the conformity of the responses to the guidelines, as well as the influence of certain criteria, such as mode of practise and experience; (3) Results: Of 728 responses, only 26.1% of the midwives reported being aware of the 2017 clinical practise guidelines. The midwives proposed taking the appropriate actions in 56.1% of the responses in the case of a recurrence, and in 95.1% of the responses in the case of a primary infection. For the specific, high-risk case of a nonprimary initial infection at 38 weeks of gestation, reporting knowledge of the recommendations improved the compliance of the proposed care by 40% (p = 0.02). However, 33.8% of the midwives underestimated the neonatal risk at term after a primary initial infection, and 43% underestimated the risk after a primary initial infection at term; (4) Conclusions: The majority of reported practises were compliant despite a low level of knowledge of the guidelines. The dissemination of guidelines may be important to improve information and adherence to appropriate therapeutic practise.
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Affiliation(s)
- Adrian Mrozik
- Obstetric Department, Hospital Group Paris Saint Joseph, 75014 Paris, France
- French College of Midwives (Collège National des Sages-Femmes de France, CNSF), 75010 Paris, France
| | - Yann Sellier
- French College of Midwives (Collège National des Sages-Femmes de France, CNSF), 75010 Paris, France
- EA 7328, Fetal Medicine Department Necker Hospital France, AP-HP, 92150 Suresnes, France
- School of Maieutics of Foch, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Déborah Lemaitre
- French College of Midwives (Collège National des Sages-Femmes de France, CNSF), 75010 Paris, France
| | - Laurent Gaucher
- French College of Midwives (Collège National des Sages-Femmes de France, CNSF), 75010 Paris, France
- Public Health Unit, Hospices Civils de Lyon, 69500 Bron, France
- INSERM U1290, Research on Healthcare Performance (RESHAPE), Claude Bernard Lyon 1 University, 69008 Lyon, France
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
- Correspondence:
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Lee S, Bobb Swanson M, Fillman A, Carnahan RM, Seaman AT, Reisinger HS. Challenges and opportunities in creating a deprescribing program in the emergency department: A qualitative study. J Am Geriatr Soc 2023; 71:62-76. [PMID: 36258309 PMCID: PMC10092723 DOI: 10.1111/jgs.18047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND As the population of older adults increases, appropriate deprescribing becomes increasingly important for emergency geriatric care. Older adults represent the sickest patients with chronic medical conditions, and they are often exposed to high-risk medications. We need to provide an evidence-based, standardized deprescribing program in the acute care setting, yet the evidence base is lacking and standardized medication programs are needed. METHODS We conducted a qualitative study with the goal to understand the perspective of healthcare workers, patients, and caregivers on deprescribing high-risk medications in the context of emergency care practices, provider preferences, and practice variability, along with the facilitators and barriers to an effective deprescribing program in the emergency department (ED). To ensure rich, contextual data, the study utilized two qualitative methods: (1) a focus group with physicians, advanced practice providers, nurses, pharmacists, and geriatricians involved in care of older adults and their prescriptions in the acute care setting; (2) semi-structured interviews with patients and caregivers involved in treatment and emergency care. Transcriptions were coded using thematic content analysis, and the principal investigator (S.L.) and trained research staff categorized each code into themes. RESULTS Data collection from a focus group with healthcare workers (n = 8) and semi-structured interviews with patients and caregivers (n = 20) provided evidence of a potentially promising ED medication program, aligned with the vision of comprehensive care of older adults, that can be used to evaluate practices and develop interventions. We identified four themes: (1) Challenges in medication history taking, (2) missed opportunities in identifying high-risk medications, (3) facilitators and barriers to deprescribing recommendations, and (4) how to coordinate deprescribing recommendations. CONCLUSIONS Our focus group and semi-structured interviews resulted in a framework for an ED medication program to screen, identify, and deprescribe high-risk medications for older adults and coordinate their care with primary care providers.
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Affiliation(s)
- Sangil Lee
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Morgan Bobb Swanson
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Allison Fillman
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ryan M Carnahan
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Aaron T Seaman
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Heather Schacht Reisinger
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Le Compte CG, Lu SE, Ani J, McDougall J, Walters ST, Toppmeyer D, Boyce TW, Stroup A, Paddock L, Grumet S, Lin Y, Heidt E, Kinney AY. Understanding cancer genetic risk assessment motivations in a remote tailored risk communication and navigation intervention randomized controlled trial. Health Psychol Behav Med 2022; 10:1190-1215. [PMID: 36518606 PMCID: PMC9744218 DOI: 10.1080/21642850.2022.2150623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022] Open
Abstract
Background National guidelines recommend cancer genetic risk assessment (CGRA) (i.e. genetic counseling prior to genetic testing) for women at increased risk for hereditary breast and ovarian cancer (HBOC). Less than one-half of eligible women obtain CGRA, leaving thousands of women and their family members without access to potentially life-saving cancer prevention interventions. Purpose The Genetic Risk Assessment for Cancer Education and Empowerment Project (GRACE) addressed this translational gap, testing the efficacy of a tailored counseling and navigation (TCN) intervention vs. a targeted print brochure vs. usual care on CGRA intentions. Selected behavioral variables were theorized to mediate CGRA intentions. Methods Breast and ovarian cancer survivors meeting criteria for guideline-based CGRA were recruited from three state cancer registries (N = 654), completed a baseline survey, and were randomized. TCN and targeted print arms received the brochure; TCN also participated in a tailored, telephone-based decision coaching and navigation session grounded in the Extended Parallel Process Model and Ottawa Decision Support Framework. Participants completed a one-month assessment. Logistic regression was used to compare the rate of CGRA intentions. CGRA intentions and theorized mediator scores (continuous level variables) were calculated using mixed model analysis. Results CGRA intentions increased for TCN (53.2%) vs. targeted print (26.7%) (OR = 3.129; 95% CI: 2.028, 4.827, p < .0001) and TCN vs. usual care (23.1%) (OR = 3.778, CI: 2.422, 5.894, p < .0001). Perceived risk (p = 0.023) and self-efficacy (p = 0.035) mediated CGRA intentions in TCN. Conclusions Improvements in CGRA intentions and theorized mediators support the use of a tailored communication intervention among women at increased HBOC risk. (Clinicaltrials.gov: NCT03326713.)Trial registration: ClinicalTrials.gov identifier: NCT03326713.
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Affiliation(s)
- Circe Gray Le Compte
- Biobehavioral Cancer Health Equity Research Lab, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Shou-En Lu
- Rutgers Environmental Epidemiology and Statistics, Rutgers University School of Public Health, Rutgers, The State University of New Jersey University, New Brunswick, NJ, USA
| | - Julianne Ani
- Biobehavioral Cancer Health Equity Research Lab, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Jean McDougall
- Department of Internal Medicine, Division of Epidemiology, Biostatistics, and Preventive Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Scott T. Walters
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Deborah Toppmeyer
- Stacy Goldstein Breast Cancer Center, LIFE Center, Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Tawny W. Boyce
- Biostatistics Shared Resource, UNM Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Antoinette Stroup
- New Jersey State Cancer Registry, Stroup Research Center, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Lisa Paddock
- Cancer Surveillance Research Program, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Sherry Grumet
- LIFE Center, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Yong Lin
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey University, New Brunswick, NJ, USA
| | - Emily Heidt
- Biobehavioral Cancer Health Equity Research Lab, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Anita Y. Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey University, New Brunswick, NJ, USA
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Ockner SA, Fieg EL. Geriatric Emergency Medicine: Providing Older Missourians with the Care They Need and Deserve. MISSOURI MEDICINE 2022; 119:444-451. [PMID: 36337997 PMCID: PMC9616449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Emergency care of older adults evolved in an effort to meet the needs of our aging population. The pace of improving the quality and cost-effectiveness of emergency department (ED) care for older adults is accelerating with the development of Geriatric Emergency Department Accreditation (GEDA) and research initiatives forged by the Center for Leading Innovation and Collaboration (CLIC) and Geriatric Emergency care Applied Research (GEAR). The innovations of two Missouri EDs are highlighted, including how each approached fall risk and quality improvement efforts for aging populations with multimorbidity. Additional work is needed to accommodate this growing population and implement sustainable solutions.
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Affiliation(s)
- Samuel A Ockner
- Instructor of Emergency Medicine at Washington University School of Medicine, St. Louis, Missouri
| | - Edward L Fieg
- Director, Emergency Department at John Cochran Veterans Hospital, and is affiliated with St. Louis University Hospital, St. Louis, Missouri
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An Innovative Framework for Sustainable Development in Healthcare: The Human Rights Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042222. [PMID: 35206410 PMCID: PMC8872572 DOI: 10.3390/ijerph19042222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 12/21/2022]
Abstract
Healthcare providers are investing considerable resources for the development of quality management systems in hospitals. Contrary to these efforts, the number of tools that allow the evaluation of implementation efforts and the results of quality, security and sustainable development is quite limited. The purpose of the study is to develop a reference framework for quality and sustainable development in healthcare, Sanitary-Quality (San-Q) at the micro system level, which is compatible with applicable national and international standards in the field. The research method consisted of the study of literature, identification and analysis of good sustainability practices in healthcare, which allowed identification of the areas of the new San-Q framework: quality, economic, environmental, social, institutional and healthcare. These areas are incorporated into the core topics of social responsibility mentioned by ISO26000. A total of 57 indicators have been defined that make up the new reference framework. The evaluation format of the indicators is innovative through a couple of values: completion degree–significance. In the experimental part of the research, a pilot implementation of the San-Q framework at an emergency hospital was performed, the results recorded in terms of responsibility for human rights being presented. The conclusions of the study reveal the innovative aspects of the framework that facilitate the development of a sustainability strategy promoted through performance indicators, the results obtained after evaluation being useful in establishing a reference level of sustainability but also in developing sustainability policies.
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McDonald J, Clements J. Evaluation of a brief video intervention aimed at UK-based veterinary surgeons to encourage neutering cats at four months old: A randomised controlled trial. PLoS One 2022; 17:e0263353. [PMID: 35139101 PMCID: PMC8827477 DOI: 10.1371/journal.pone.0263353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/16/2022] [Indexed: 12/04/2022] Open
Abstract
In the UK, it is currently recommended that owned cats be neutered from four months of age. However, its uptake is inconsistent across the veterinary profession. Here we assess the effect of a brief video intervention that aimed to encourage four month neutering, whilst preserving clinical autonomy. We compare this theory-driven approach with traditional information giving and a control group. Veterinary surgeons who regularly undertook feline neutering work in the UK but did not routinely neuter cats at four months and/or recommend four month neutering for client owned cats were randomised into three groups (n = 234). Participants received either no information, a written summary of evidence or the video. The primary behaviour outcomes were the recommending and carrying out of neutering cats at four months. Evaluative, belief and stages of change measures were also collected. Self-reported outcomes were assessed pre-intervention, immediately post-intervention, two months post-intervention and six months post-intervention. At two months, participants that had received the video intervention were significantly more likely to have started recommending neutering cats at four months. At six months, participants that had received the video intervention were significantly more likely to have started carrying out neutering cats at four months. There were no significant behaviour changes for the other groups. At two months, the video intervention was associated with a significant increase in thinking about, and speaking to colleagues about, four-month neutering, relative to the control group. The written summary of evidence had no similar effect on stages of change, despite it being perceived as a significantly more helpful resource relative to the video. To conclude, a brief one-off video intervention resulted in an increase in positive behaviours towards neutering cats at 4 months, likely mediated by the social influences of the intervention prompting the opportunity to reflect and discuss four-month neutering with colleagues.
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Affiliation(s)
- Jenni McDonald
- Veterinary Department, Cats Protection, National Cat Centre, Haywards Heath, United Kingdom
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
- * E-mail: (JMD); (JC)
| | - Jane Clements
- Veterinary Department, Cats Protection, National Cat Centre, Haywards Heath, United Kingdom
- * E-mail: (JMD); (JC)
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Zhang W, Jiang P, Tong P, Xu T, Yuan R, Diao L. The Influence of Industry Leaders’ Behavior on the Decisions of Common Enterprise Leaders in Enterprise Clustering: An Event-Related Potential Study. Psychol Res Behav Manag 2022; 15:237-249. [PMID: 35173494 PMCID: PMC8841668 DOI: 10.2147/prbm.s329200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/22/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose This study aims to explore the influence of industry leaders’ behavior on common enterprise leaders’ decisions in enterprise clustering by recognizing top executives’ cognitive processes of brains. Methods Twenty-one real top executives from twelve textile enterprises were recruited in the lab experiment, and decisions about whether entering an industrial zone under two conditions of following an industry leader or a common enterprise were designed as the experiment task. Throughout the formal experimental task, participants’ electroencephalograms were recorded. Results The behavioral results preliminarily proved the effect of industry leaders’ behaviors on the real top executives’ decisions in common enterprises: participants had a higher acceptance rate with a shorter reaction time in the condition of following an industry leader rather than that in the condition of following a common enterprise. Event-related potential results indicated that choices of following an industry leader led to a more positive perception of emotional valence (reflected by a smaller P2 amplitude) and better evaluation categorization and greater decision confidence (reflected by a larger late positive potential amplitude) than choices of following a common enterprise. Conclusion Top executives from common enterprises tend to evaluate industry leaders’ behaviors better than other common enterprises’ behaviors, and they tend to make a similar business decision to keep their enterprises consistent with these industry leaders.
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Affiliation(s)
- Wuke Zhang
- Business School, Ningbo University, Ningbo, Zhejiang Province, People's Republic of China
| | - Pengtao Jiang
- International Affairs Office, NingboTech University, Ningbo, Zhejiang Province, People's Republic of China
- Business School, University of Nottingham Ningbo China, Ningbo, Zhejiang Province, People's Republic of China
| | - Pengcheng Tong
- Business School, Ningbo University, Ningbo, Zhejiang Province, People's Republic of China
| | - Ting Xu
- Business School, Ningbo University, Ningbo, Zhejiang Province, People's Republic of China
| | - Ruizhi Yuan
- Business School, University of Nottingham Ningbo China, Ningbo, Zhejiang Province, People's Republic of China
| | - Liuting Diao
- Business School, Ningbo University, Ningbo, Zhejiang Province, People's Republic of China
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Southerland LT, Hunold KM, Van Fossen J, Caterino JM, Gulker P, Stephens JA, Bischof JJ, Farrell E, Carpenter CR, Mion LC. An implementation science approach to geriatric screening in an emergency department. J Am Geriatr Soc 2022; 70:178-187. [PMID: 34580860 PMCID: PMC8742753 DOI: 10.1111/jgs.17481] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The Geriatric Emergency Department (ED) Guidelines recommend screening older adults during their ED visit for delirium, fall risk/safe mobility, and home safety needs. We used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementation Change (ERIC) tool for preimplementation planning. METHODS The cross-sectional survey was conducted among ED nurses at an academic medical center. The survey was adapted from the CFIR Interview Guide Tool and consisted of 21 Likert scale questions based on four CFIR domains. Potential barriers identified by the survey were mapped to identify recommended implementation strategies using ERIC. RESULTS Forty-six of 160 potential participants (29%) responded. Intervention Characteristics: Nurses felt geriatric screening should be standard practice for all EDs (76.1% agreed some/very much) and that there was good evidence (67.4% agreed some/very much). Outer setting: The national and regional practices such as the existence of guidelines or similar practices in other hospitals were unknown to many (20.0%). Nurses did agree some/very much (64.4%) that the intervention was good for the hospital/health system. Inner Setting: 67.4% felt more staff or infrastructure and 63.0% felt more equipment were needed for the intervention. When asked to pick from a list of potential barriers, the most commonly chosen were motivational (I often do not remember (n = 27, 58.7%) and It is not a priority (n = 14, 30.4%)). The identified barriers were mapped using the ERIC tool to rate potential implementation strategies. Strategies to target culture change were identifying champions, improve adaptability, facilitate the nurses performing the intervention, and increase demand for the intervention. CONCLUSION CFIR domains and ERIC tools are applicable to an ED intervention for older adults. This preimplementation process could be replicated in other EDs considering implementing geriatric screening.
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Affiliation(s)
| | | | - Jenifer Van Fossen
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | | | - Peg Gulker
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | - Julie A. Stephens
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, OH, USA
| | - Jason J. Bischof
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | - Erin Farrell
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | | | - Lorraine C. Mion
- College of Nursing, The Ohio State Wexner Medical Center, Columbus, OH, USA
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O'Malley G, Beima-Sofie KM, Roche SD, Rousseau E, Travill D, Omollo V, Delany-Moretlwe S, Bekker LG, Bukusi EA, Kinuthia J, Barnabee G, Dettinger JC, Wagner AD, Pintye J, Morton JF, Johnson RE, Baeten JM, John-Stewart G, Celum CL. Health Care Providers as Agents of Change: Integrating PrEP With Other Sexual and Reproductive Health Services for Adolescent Girls and Young Women. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:668672. [PMID: 36303982 PMCID: PMC9580786 DOI: 10.3389/frph.2021.668672] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 10/07/2023] Open
Abstract
Background: Successful integration of pre-exposure prophylaxis (PrEP) with existing reproductive health services will require iterative learning and adaptation. The interaction between the problem-solving required to implement new interventions and health worker motivation has been well-described in the public health literature. This study describes structural and motivational challenges faced by health care providers delivering PrEP to adolescent girls and young women (AGYW) alongside other SRH services, and the strategies used to overcome them. Methods: We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with HCWs from two demonstration projects delivering PrEP to AGYW alongside other SRH services. The Prevention Options for the Women Evaluation Research (POWER) is an open label PrEP study with a focus on learning about PrEP delivery in Kenyan and South African family planning, youth mobile services, and public clinics at six facilities. PrIYA focused on PrEP delivery to AGYW via maternal and child health (MCH) and family planning (FP) clinics in Kenya across 37 facilities. IDIs and FGDs were transcribed verbatim and analyzed using a combination of inductive and deductive methods. Results: We conducted IDIs with 36 participants and 8 FGDs with 50 participants. HCW described a dynamic process of operationalizing PrEP delivery to better respond to patient needs, including modifying patient flow, pill packaging, and counseling. HCWs believed the biggest challenge to sustained integration and scaling of PrEP for AGYW would be lack of health care worker motivation, primarily due to a misalignment of personal and professional values and expectations. HCWs frequently described concerns of PrEP provision being seen as condoning or promoting unprotected sex among young unmarried, sexually active women. Persuasive techniques used to overcome these reservations included emphasizing the social realities of HIV risk, health care worker professional identities, and vocational commitments to keeping young women healthy. Conclusion: Sustained scale-up of PrEP will require HCWs to value and prioritize its incorporation into daily practice. As with the provision of other SRH services, HCWs may have moral reservations about providing PrEP to AGYW. Strategies that strengthen alignment of HCW personal values with professional goals will be important for strengthening motivation to overcome delivery challenges.
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Affiliation(s)
- Gabrielle O'Malley
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Stephanie D. Roche
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Elzette Rousseau
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Danielle Travill
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Victor Omollo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Elizabeth A. Bukusi
- Department of Global Health, University of Washington, Seattle, WA, United States
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Gena Barnabee
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Julie C. Dettinger
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jennifer F. Morton
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Rachel E. Johnson
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Connie L. Celum
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
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Xiong L, Cho V, Law KMY, Lam L. A study of KOL effectiveness on brand image of skincare products. ENTERP INF SYST-UK 2021. [DOI: 10.1080/17517575.2021.1924864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Liping Xiong
- The Integrated Graduate Development Scheme (IGDS), The Hong Kong Polytechnic University, Hong Kong, China
| | - Vincent Cho
- Department of Management and Marketing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Kris MY Law
- School of Engineering, Faculty of Science Engineering & Built Environment, Deakin University, Geelong, Australia
| | - Lianne Lam
- Department of Management and Marketing, The Hong Kong Polytechnic University, Hong Kong, China
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Hsieh K, Housri N, Haffty B, Smith B, Burt LM. Radiation Oncologists' Views on Breast Radiation Therapy Guidelines: Utilizing an Online Q&A Platform to Assess Current Views on Whole-Breast Irradiation Therapy. Clin Breast Cancer 2021; 21:408-416. [PMID: 33814285 DOI: 10.1016/j.clbc.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/26/2021] [Accepted: 02/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Poor adherence to the 2011 American Society for Radiation Oncology (ASTRO) evidence-based guideline on whole-breast irradiation (WBI) has been reported. We utilized theMednet to assess the views of the updated 2018 guideline among radiation oncologists (ROs). METHODS We identified 11 questions asked by community ROs on theMednet, a web-based platform, between October 27, 2014 and May 2, 2017 that were updated in the 2018 guideline. New answers provided by senior authors of the 2018 guideline, cited guidelines, and polls to survey ROs were disseminated in 3 theMednet's newsletters between March 16, 2018 and May 1, 2018. Any question with less than 60% consensus was resubmitted on October 9, 2019 and assessed on February 13, 2020. RESULTS A total of 792 ROs responded to the initial surveys. In each survey, the answer choice(s) that received the majority of the votes aligned with the 2018 guideline. The strongest consensus was for the use of hypofractionated (HF)-WBI regardless of histology (97%), followed by HF-WBI boost dose (92%), molecular subtype (90%), grade (88%), and concurrent use of trastuzumab (87%). The least consensus was for age at which HF-WBI should be offered with 53% of respondents, specifically 73% of academic ROs versus 47% of community ROs (P = .001), agreeing with the guideline. The re-submitted survey 19 months later showed 77% of 287 new respondents now agreed with the guideline regarding age. CONCLUSION The majority of ROs concur with the 2018 WBI guideline in theMednet surveys, with better agreement among academic ROs than community ROs for certain components of the guideline. Further research into the different practice patterns may optimize patient care.
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Affiliation(s)
- Kristin Hsieh
- Columbia University Vagelos College of Physicians and Surgeons, New York City, NY
| | - Nadine Housri
- Department of Therapeutic Radiology, Yale University School of Medicine and Yale Comprehensive Cancer Center, New Haven, CT.
| | - Bruce Haffty
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School and the Cancer Institute of New Jersey, New Brunswick, NJ.
| | - Benjamin Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Lindsay M Burt
- Department of Radiation Oncology, University of Utah Huntsman Cancer Institute, Salt Lake City, UT.
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Virtanen L, Kaihlanen AM, Laukka E, Gluschkoff K, Heponiemi T. Behavior change techniques to promote healthcare professionals' eHealth competency: A systematic review of interventions. Int J Med Inform 2021; 149:104432. [PMID: 33684712 DOI: 10.1016/j.ijmedinf.2021.104432] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The use of eHealth is rapidly -->increasing; however, many healthcare professionals have insufficient eHealth competency. Consequently, interventions addressing eHealth competency might be useful in fostering the effective use of eHealth. OBJECTIVE Our systematic review aimed to identify and evaluate the behavior change techniques applied in interventions to promote healthcare professionals' eHealth competency. METHODS We conducted a systematic literature review following the Joanna Briggs Institute's Manual for Evidence Synthesis. Published quantitative studies were identified through screening PubMed, Embase, and CINAHL. Two reviewers independently performed full-text and quality assessment. Eligible interventions were targeted to any healthcare professional and aimed at promoting eHealth capability or motivation. We synthesized the interventions narratively using the Behavior Change Technique Taxonomy v1 and the COM-B model. RESULTS This review included 32 studies reporting 34 heterogeneous interventions that incorporated 29 different behavior change techniques. The interventions were most likely to improve the capability to use eHealth and less likely to enhance motivation toward using eHealth. The promising techniques to promote both capability and motivation were action planning and participatory approach. Information about colleagues' approval, emotional social support, monitoring emotions, restructuring or adding objects to the environment, and credible source are techniques worth further investigation. CONCLUSIONS We found that interventions tended to focus on promoting capability, although motivation would be as crucial for competent eHealth performance. Our findings indicated that empathy, encouragement, and user-centered changes in the work environment could improve eHealth competency as a whole. Evidence-based techniques should be favored in the development of interventions, and further intervention research should focus on nurses and multifaceted competency required for using different eHealth systems and devices.
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Affiliation(s)
- Lotta Virtanen
- Finnish Institute for Health and Welfare, Helsinki, Finland.
| | | | - Elina Laukka
- Finnish Institute for Health and Welfare, Helsinki, Finland; Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Kia Gluschkoff
- Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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18
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Kyei S, Obeng PA, Kwarteng MA, Assiamah F. Epidemiology and clinical presentation of glaucoma in a referral facility in Ghana: Any lessons for public health intervention? PLoS One 2021; 16:e0245486. [PMID: 33449975 PMCID: PMC7810334 DOI: 10.1371/journal.pone.0245486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/03/2021] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to evaluate the epidemiological and clinical profile of patients living with glaucoma and receiving care in a tertiary eye center in Ghana. This was a hospital-based retrospective study of clinical records of glaucoma patients from January 2010 to December 2019. The study involved collating demographic information of patients, clinical presentation, and the management of glaucoma. A total of nineteen thousand (19,000) charts were retrieved from the eye center's archives. Out of these, 660 (3.5%) records of patients qualified for the study and were analyzed. There were 398 (60.3%) males and 262 (39.7%) females. Their ages ranged from 9 to 86 years (mean age = 47.30; SD ± 16.86 years). The averages of ocular parameters of 1,320 eyes (660 patients) were visual acuity = 0.26 ± 0.55 logMAR; intraocular pressure: 17.31 ± 6.11 mmHg; cup-to-disc ratios: 0.67 ± 0.17 D; and the average retinal nerve fibers thickness was 95.03 ± 21.74 μm. The mainstay of treatment was the sole use of medication. Males were the major group receiving glaucoma care at the tertiary level. Glaucoma cases included juveniles but the mean age suggests most were of adult-onset. Socio-demographic characteristics affected the diagnosis and management of glaucoma among patients receiving care at a referral center. Public health, stakeholders, and policymakers' interventions can help identify individuals with glaucoma.
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Affiliation(s)
- Samuel Kyei
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Patience Asantewaa Obeng
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Michael Agyemang Kwarteng
- Department of Optometry, Faculty of Science and Engineering, Bindura University of Science Education, Bindura, Zimbabwe
| | - Frank Assiamah
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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Bejjani A, Burt L, Washington C, Terao M, Housri S, Housri N. Using a Collaborative, Virtual Discussion Platform to Mobilize Oncologic Expertise for the COVID-19 Pandemic. JCO Clin Cancer Inform 2020; 4:794-798. [PMID: 32897736 DOI: 10.1200/cci.20.00073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE COVID-19 is a rapidly emerging worldwide pandemic that has drastically changed health care across the United States. Oncology patients are especially vulnerable. Novel point-of-care resources may be useful to rapidly disseminate peer-reviewed information from oncology experts nationwide. We describe our initial experience with distributing this information through a private, curated, virtual collaboration question-and-answer (Q&A) platform for oncologists. METHODS The Q&A database was queried for a 2-month period from March 12 to May 12, 2020. We collected the total number of views and unique viewers for the questions. We classified the questions according to their emphasis (practice management, clinical management, both) and disease type across radiation oncology, medical oncology, gynecologic oncology, and pediatric oncology. RESULTS Seventy-nine questions were approved, 67 of which were answered and generated 49,494 views with 5,148 unique viewers. Most discussions covered clinical management, with breast cancer being the most active disease site. Ten questions covered pediatric oncology and gynecologic oncology. Forty-seven percent of the 11,010 users of the platform visited the website during the 2-month period. CONCLUSION Discussions on the Q&A platform reached a substantial number of oncologists throughout the nation and may help oncologists to modify their treatment in real time with the rapidly evolving COVID-19 pandemic.
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Affiliation(s)
- Anthony Bejjani
- Jonsson Comprehensive Cancer Center, Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Lindsay Burt
- Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, UT
| | - Christina Washington
- Division of Gynecologic Oncology, Stephenson Cancer Center, University of Oklahoma Health Science Center, Oklahoma City, OK
| | - Michael Terao
- Division of Pediatric Oncology, St Jude Children's Research Hospital, Memphis, TN.,Division of Pediatric Hematology/Oncology, MedStar Georgetown University Hospital, Washington, DC
| | | | - Nadine Housri
- theMednet.org, New York, NY.,Department of Radiation Oncology, Yale School of Medicine, Trumbull, CT
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Abstract
Free Open Access Medical education (FOAM) has taken the emergency medicine and critical care worlds by storm in the past decade. This article represents one perspective on the stages of transition for FOAM from its humble beginnings as a grassroots movement to the more recent multiauthor blogs that are described in the peer-reviewed literature. In this article, the authors describe the following four distinct waves of people within the movement, with each wave creating a new stage in the evolution of the FOAM community: Creation by the Founders, Adoption by the Enthusiasts, Structure and Formalization by the Structuralists, and Engagement and Activity by the End Users. The authors contextualize some of the phenomena that have been observed within this field and highlight challenges for the field moving forward.
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Weissman A, Nguyen TT, Nguyen HT, Mathisen R. The Role of the Opinion Leader Research Process in Informing Policy Making for Improved Nutrition: Experience and Lessons Learned in Southeast Asia. Curr Dev Nutr 2020; 4:nzaa093. [PMID: 32551413 PMCID: PMC7293205 DOI: 10.1093/cdn/nzaa093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
Opinion leader research (OLR) has been widely used in public health to identify influential persons or organizations to affect health care practice, inform policy-making processes, and help shape communication strategies. We used OLR to gather information related to barriers and possible solutions to guide strategic engagement for strengthening policy making for improved maternal, infant, and young child nutrition (MIYCN) practices in 5 Southeast Asian countries-Cambodia, Laos, Indonesia, Timor-Leste, and Thailand. In most countries, MIYCN policies and policymaker interest exist, but effective implementation and/or enforcement of current policies is weak. This article aims to share our experience in and lessons learned from using OLR as an advocacy tool: It helped identify opinion leaders with interest and influence to affect nutrition-related policies, it raised opinion leaders' interest in MIYCN, and it identified themes that would help generate political priority setting. Based on our experience, we recommend OLR as a strategic activity for informing and generating support for MIYCN policy-making processes.
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Affiliation(s)
- Amy Weissman
- FHI 360, Asia Pacific Regional Office, Bangkok, Thailand
- Alive & Thrive Southeast Asia, FHI 360, Hanoi, Vietnam
| | - Tuan T Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi, Vietnam
| | - Hoa T Nguyen
- Institute for Families in Society, University of South Carolina, Columbia, SC, USA
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Atzema CL. Stroke Prevention for High-Risk Atrial Fibrillation in the Emergency Setting: The Emergency Physician Perspective. Can J Cardiol 2018; 34:125-131. [DOI: 10.1016/j.cjca.2017.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 12/23/2022] Open
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23
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Vachon B, Foucault ML, Giguère CÉ, Rochette A, Thomas A, Morel M. Factors Influencing Acceptability and Perceived Impacts of a Mandatory ePortfolio Implemented by an Occupational Therapy Regulatory Organization. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:25-31. [PMID: 29261571 DOI: 10.1097/ceh.0000000000000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The use of ePortfolios has been implemented in several regulatory organizations to encourage clinicians' engagement in continuing professional development (CPD). However, their use has achieved mixed success, and multiple personal and contextual factors can influence their impacts on practice change. The aim of this study was to identify which factors influence the acceptability and perceived impacts of an ePortfolio implemented by an occupational therapy regulatory organization in one Canadian province. METHOD A cross-sectional online survey design was used. The survey was sent to registered occupational therapists in Quebec. Multiple regression analyses were conducted to identify factors influencing acceptability and outcomes: ease of use, satisfaction, impact on implementation of the CPD plan, and competence improvement. RESULTS The survey was fully completed by 546 participants. Factors significantly influencing the ePortfolio acceptability and perceived impacts were attitude toward and familiarity with the portfolio, confidence in reflective skills, engagement in the CPD plan, and desire for feedback. Time spent completing the ePortfolio and the fact of completing it in teams were negatively associated with the outcomes. DISCUSSION Shaping more favorable user attitudes, helping users recognize and experience the tool's benefits for their practice, and fostering confidence in their reflective skills are important factors that can be addressed to improve ePortfolio acceptability and outcomes. Contextual factors, such as time spent completing the ePortfolio and completing it in teams, seem to reflect greater difficulty with using the tool. Study findings can contribute to improving ePortfolio implementation in the CPD context.
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Affiliation(s)
- Brigitte Vachon
- Dr. Vachon: Associate Professor, School of Rehabilitation, Faculty of Medicine, Université de Montréal; Centre de Recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Canada. Mrs. Foucault: School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada. Mr. Giguère: Centre de Recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Canada. Dr. Rochette: Full Professor, School of Rehabilitation, Faculty of Medicine, Université de Montréal; Centre for Interdisciplinary Research in Rehabilitation of the Greater Montreal, Montreal, Canada. Dr. Thomas: Assistant Professor, School of Physical and Occupational Therapy, Centre for Medical Education, McGill University; Centre for Interdisciplinary Research in Rehabilitation of the Greater Montreal, Montreal, Canada. Ms. Morel: School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
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The impact of social media promotion with infographics and podcasts on research dissemination and readership. CAN J EMERG MED 2017; 20:300-306. [PMID: 28899440 DOI: 10.1017/cem.2017.394] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In 2015 and 2016, the Canadian Journal of Emergency Medicine (CJEM) Social Media (SoMe) Team collaborated with established medical websites to promote CJEM articles using podcasts and infographics while tracking dissemination and readership. METHODS CJEM publications in the "Original Research" and "State of the Art" sections were selected by the SoMe Team for podcast and infographic promotion based on their perceived interest to emergency physicians. A control group was composed retrospectively of articles from the 2015 and 2016 issues with the highest Altmetric score that received standard Facebook and Twitter promotions. Studies on SoMe topics were excluded. Dissemination was quantified by January 1, 2017 Altmetric scores. Readership was measured by abstract and full-text views over a 3-month period. The number needed to view (NNV) was calculated by dividing abstract views by full-text views. RESULTS Twenty-nine of 88 articles that met inclusion were included in the podcast (6), infographic (11), and control (12) groups. Descriptive statistics (mean, 95% confidence interval) were calculated for podcast (Altmetric: 61, 42-80; Abstract: 1795, 1135-2455; Full-text: 431, 0-1031), infographic (Altmetric: 31.5, 19-43; Abstract: 590, 361-819; Full-text: 65, 33-98), and control (Altmetric: 12, 8-15; Abstract: 257, 159-354; Full-Text: 73, 38-109) articles. The NNV was 4.2 for podcast, 9.0 for infographic, and 3.5 for control articles. Discussion Limitations included selection bias, the influence of SoMe promotion on the Altmetric scores, and a lack of generalizability to other journals. CONCLUSION Collaboration with established SoMe websites using podcasts and infographics was associated with increased Altmetric scores and abstract views but not full-text article views.
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Carpenter CR, Pinnock H. Starry Aims to Overcome Knowledge Translation Inertia: The Standards for Reporting Implementation Studies (StaRI) Guidelines. Acad Emerg Med 2017; 24:1027-1029. [PMID: 28574631 DOI: 10.1111/acem.13235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Christopher R. Carpenter
- Division of Emergency Medicine and Emergency Care Research Core; Washington University in St. Louis School of Medicine; St. Louis MO
| | - Hilary Pinnock
- University of Edinburgh Medical School; Edinburgh Scotland UK
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Bussières AE, Maiers M, Grondin D, Brockhusen S. Selecting and training opinion leaders and best practice collaborators: experience from the Canadian Chiropractic Guideline Initiative. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2017; 61:53-64. [PMID: 28413224 PMCID: PMC5381488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To describe the process for selecting and training chiropractic opinion leaders (OLs) and best practice collaborators (BPCs) to increase the uptake of best practice. METHODS In Phase 1, OLs were identified using a cross-sectional survey among Canadian chiropractic stakeholders. A 10-member committee ranked nominees. Top-ranked nominees were invited to a training workshop. In Phase 2, a national e-survey was administered to 7200 Canadian chiropractors to identify additional OLs and BPCs. Recommended names were screened by OLs and final selection made by consensus. Webinars were utilized to train BPCs to engage peers in best practices, and facilitate guideline dissemination. RESULTS In Phase 1, 21 OLs were selected from 80 nominees. Sixteen attended a training workshop. In Phase 2, 486 chiropractors recommended 1126 potential BPCs, of which 133 were invited to participate and 112 accepted. CONCLUSIONS OLs and BPCs were identified across Canada to enhance the uptake of research among chiropractors.
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Affiliation(s)
- André E. Bussières
- Assistant Professor, School of Physical and Occupational Therapy, McGill University
- Professor, Département Chiropratique, Université du Québec à Trois-Rivières
| | - Michele Maiers
- Executive Director of Research and Innovation, Northwestern Health Sciences University
| | - Diane Grondin
- Assistant Professor, Canadian Memorial Chiropractic College
- PhD student, Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Simon Brockhusen
- Research assistant, Nordic Institute of Chiropractic and Clinical Biomechanics
- MD (Student), University of Southern Denmark
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Rosenberg SA, Baschnagel AM, Bagley SJ, Housri N. Strategies for Translating Evidence-Based Medicine in Lung Cancer into Community Practice. Curr Oncol Rep 2017; 19:5. [PMID: 28168606 DOI: 10.1007/s11912-017-0563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The landscape of non-small cell lung cancer (NSCLC) treatment has rapidly evolved over the past decade. This is exemplified by the use of molecular targeted agents, immunotherapies, and newer technologies such as stereotactic body radiotherapy (SBRT). As the translation of preclinical discoveries into clinical practice continues, the effective dissemination and implementation of evidence-based treatment of NSCLC will remain a foremost challenge for oncologists. To further extend evidence-based medicine into the community setting, community oncologists are being engaged on multiple fronts including leadership and participation in national clinical trials and utilization of internet-based resources.
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Affiliation(s)
- Stephen A Rosenberg
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Andrew M Baschnagel
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Stephen J Bagley
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Perelman Center South Pavilion Extension, 10th Floor, Room 134, Philadelphia, PA, 19104, USA
| | - Nadine Housri
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, 195 Little Albany St, New Brunswick, NJ, 08903, USA.
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Evidence-based medicine in the era of social media: Scholarly engagement through participation and online interaction. CAN J EMERG MED 2017; 20:3-8. [PMID: 28077195 DOI: 10.1017/cem.2016.407] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The integration of new knowledge into clinical practice continues to lag behind discovery. The use of Free Open Access Medical education (FOAM) has disrupted communication between emergency physicians, making it easy for practicing clinicians to interact with colleagues from around the world to discuss the latest and highest impact research. FOAM has the potential to decrease the knowledge translation gap, but the concerns raised about its growing influence are 1) research that is translated too quickly may cause harm if its findings are incorrect; 2) there is little editorial oversight of online material; and 3) eminent online individuals may develop an outsized influence on clinical practice. We propose that new types of scholars are emerging to moderate the changing landscape of knowledge translation: 1) critical clinicians who critically appraise research in the same way that lay reviewers critique restaurants; 2) translational teachers adept with these new technologies who will work with researchers to disseminate their findings effectively; and 3) interactive investigators who engage with clinicians to ensure that their findings resonate and are applied at the bedside. The development of these scholars could build on the promise of evidence-based medicine by enhancing the appraisal and translation of research in practice.
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Hao H, Padman R. An empirical study of opinion leader effects on mobile technology implementation by physicians in an American community health system. Health Informatics J 2016; 24:323-333. [DOI: 10.1177/1460458216675499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study empirically examines the opinion leader effects on a mobile clinical information technology implementation by physicians in an American community health system using a fixed effect regression model. The model result suggests that the opinion leader effects are statistically significant during this information technology implementation process. Quantitatively, if opinion leaders increase their technology usage by 10 percent, the physicians who work closely with those opinion leaders would increase their technology usage by 3.5 percent, after controlling for physician individual-level fixed effects, time effects, working environment, and workload. This empirical result of opinion leader effects provides policy implications such as, if a healthcare system wants to promote a new information technology or a new mobile information technology implementation within their organization, they should leverage this opinion leader effects.
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Steinhart BD, Levy P, Vandenberghe H, Moe G, Yan AT, Cohen A, Thorpe KE, McGowan M, Mazer CD. A Randomized Control Trial Using a Validated Prediction Model for Diagnosing Acute Heart Failure in Undifferentiated Dyspneic Emergency Department Patients-Results of the GASP4Ar Study. J Card Fail 2016; 23:145-152. [PMID: 27565045 DOI: 10.1016/j.cardfail.2016.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diagnosing acute heart failure (AHF) in undifferentiated dyspneic emergency department (ED) patients can be challenging. We prospectively studied a validated diagnostic prediction model for AHF that uses patient age, clinician pretest probability for AHF, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) as a continuous value to determine its utility and performance. METHODS AND RESULTS This was a multicenter randomized controlled trial of undifferentiated dyspneic patients with an indeterminate pretest probability of AHF as assessed by the treating emergency physician (EP). After recording its components, the calculated model results with validated treatment threshold guidelines were provided to EPs for patients randomized to the intervention arm. Final diagnoses with the use of 60-day follow-up information were adjudicated by 2 independent cardiologists. The primary outcomes were accuracy of the model and of physician diagnosis comparing intervention and standard care arms. A total of 197 patients were randomized and had outcome data recorded; 41% were determined to have had heart failure. Final EP diagnostic accuracy was 76% (sensitivity 68.2%, specificity 83.9%) with no significant difference between exposed versus blinded arms (accuracy 77% vs 74%; P = .77). Area under the model receiver operating characteristic curve was 0.93. Using the model treatment thresholds would have redirected 48% of patients with 95% accuracy. CONCLUSIONS This study prospectively validated the diagnostic accuracy of our AHF model in a significant proportion of indeterminate dyspneic ED patients, but provision of this information did not improveEP diagnostic accuracy. Future studies should determine how such a clinical prediction tool could be effectively integrated into routine practice and improve early management of suspected AHF patients in the ED.
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Affiliation(s)
- Brian D Steinhart
- Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Phillip Levy
- Department of Emergency Medicine and Cardiovascular Research Institute, Wayne State University, Detroit, Michigan
| | - Hilde Vandenberghe
- Department of Laboratory Medicine, St Michael's Hospital, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Gordon Moe
- Division of Cardiology, St Michael's Hospital, Division of Cardiology, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew T Yan
- Division of Cardiology, St Michael's Hospital, Division of Cardiology, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Cohen
- Applied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Melissa McGowan
- Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - C David Mazer
- Departments of Anaesthesia and Critical Care, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
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Feldman K, Berall A, Karuza J, Senderovich H, Perri GA, Grossman D. Knowledge translation: An interprofessional approach to integrating a pain consult team within an acute care unit. J Interprof Care 2016; 30:816-818. [PMID: 27341407 DOI: 10.1080/13561820.2016.1195342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Management of pain in the frail elderly presents many challenges in both assessment and treatment, due to the presence of multiple co-morbidities, polypharmacy, and cognitive impairment. At Baycrest Health Sciences, a geriatric care centre, pain in its acute care unit had been managed through consultations with the pain team on a case-by-case basis. In an intervention informed by knowledge translation (KT), the pain specialists integrated within the social network of the acute care team for 6 months to disseminate their expertise. A survey was administered to staff on the unit before and after the intervention of the pain team to understand staff perceptions of pain management. Pre- and post-comparisons of the survey responses were analysed by using t-tests. This study provided some evidence for the success of this interprofessional education initiative through changes in staff confidence with respect to pain management. It also showed that embedding the pain team into the acute care team supported the KT process as an effective method of interprofessional team building. Incorporating the pain team into the acute care unit to provide training and ongoing decision support was a feasible strategy for KT and could be replicated in other clinical settings.
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Affiliation(s)
- Kira Feldman
- a Arts and Science Program , McMaster University , Hamilton , Ontario , Canada
| | - Anna Berall
- b Program Evaluation Unit , Baycrest Health Sciences , Toronto , Ontario , Canada
| | - Jurgis Karuza
- b Program Evaluation Unit , Baycrest Health Sciences , Toronto , Ontario , Canada
| | - Helen Senderovich
- c Department of Family and Community Medicine , Baycrest Health Sciences , Toronto , Ontario , Canada
| | - Giulia-Anna Perri
- c Department of Family and Community Medicine , Baycrest Health Sciences , Toronto , Ontario , Canada
| | - Daphna Grossman
- c Department of Family and Community Medicine , Baycrest Health Sciences , Toronto , Ontario , Canada
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Akenroye AT, Stack AM. The development and evaluation of an evidence-based guideline programme to improve care in a paediatric emergency department. Emerg Med J 2015; 33:109-17. [PMID: 26150121 DOI: 10.1136/emermed-2014-204363] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 06/12/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Care guidelines can improve the quality of care by making current evidence available in a concise format. Emergency departments (EDs) are an ideal site for guidelines given the wide variety of presenting conditions and treating providers, and the need for timely decision making. We designed a programme for guideline development and implementation and evaluated its impact in an ED. METHODS The setting was an urban paediatric ED with an annual volume of 60 000. Common and/or high-risk conditions were identified for guideline development. Following implementation of the guidelines, their impact on effectiveness of care, patient outcomes, efficiency and equitability of care was assessed using a web-based provider survey and performance on identified metrics. Variation in clinical care between providers was assessed using funnel plots. RESULTS Eleven (11) guidelines were developed and implemented. 3 years after the initiation of the programme, self-reported adherence to recommendations was high (95% for physicians and 89% for nurses). 97% of physicians and 92% of nurses stated that the programme improved the quality of care in the ED. For some guidelines, provider-to-provider care practice variation was reduced significantly. We found reduced disparity in imaging when assessing one guideline. There were also reductions in utilisation of diagnostic tests or therapies. As a balancing measure, the percentage of patients with any of the guideline conditions who returned to the ED within 72 h of discharge did not change from before to after guideline initiation. Overall, 80% of physician and 56% of nurse respondents rated the guideline programme at the highest value. CONCLUSIONS A programme for guideline development and implementation helped to improve efficiency, and standardise and eliminate disparities in emergency care without jeopardising patient outcomes.
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Affiliation(s)
- Ayobami T Akenroye
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne M Stack
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Andrews V, Tonkin E, Lancastle D, Kirk M. Identifying the characteristics of nurse opinion leaders to aid the integration of genetics in nursing practice. J Adv Nurs 2014; 70:2598-611. [PMID: 24773467 DOI: 10.1111/jan.12431] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2014] [Indexed: 12/13/2022]
Abstract
AIM To identify the characteristics of nurses opinion leaders in the context of genetics in health care and consider the findings for the integration of genetics in nursing practice. BACKGROUND Nurses need a basic understanding of the role genetics plays in their practice and about how best to support patients using genetic knowledge. Opinion leaders have been used previously to incorporate change initiatives and increase educational application. Identifying the characteristics of nurse opinion leaders may aid the engagement and continued integration of genetics into nursing practice. DESIGN A primarily quantitative approach over two phases, using online surveys conducted during 2011. METHOD This article focuses on Phase 2 of a wider study. Oncology and primary care nurses were surveyed to identify the characteristics and demographic indicators of nurse opinion leaders. Tests for data normality followed by the suitable test for group comparison was applied with significance level set at <0·05. RESULTS Nineteen respondents (n = 19/88; 21·6%) were categorized as opinion leaders and two subgroups were identified: Genetic Opinion Leaders and Opinion Leaders with an Interest in Genetics. Seven characteristics were deemed statistically significant (Mann-Whitney, Chi-Square, t-test) in identifying nurse opinion leaders, including being open to experience and having a perceived level of influence over others. CONCLUSION The identified characteristics could be used to enhance the integration of genetics into nursing practice through the use of opinion leaders. Further thought needs to be given to the refinement of the identified characteristics and to the use of such a unique group of nurses.
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Affiliation(s)
- Verity Andrews
- School of Social and Community Medicine, University of Bristol, UK
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Boggi U, Caniglia F, Amorese G. Laparoscopic robot-assisted major hepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:3-10. [PMID: 24115394 DOI: 10.1002/jhbp.34] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND We herein present a systematic review of English literature on robot-assisted major hepatectomy (MH). METHODS Major hepatectomy was defined as resection of three or more liver segments. A literature search was performed using the Pubmed database. Articles containing more than five robotic MH were selected. In case of multiple publications from the same institution, only the most recent article was considered in order to avoid double counting of patients between series. RESULTS Five articles were included in this review. A total of 68 robotic MH were analyzed, including 38 right hepatectomies and 30 left hepatectomies. There were no deaths. Two right hepatectomies (5.2%) and one left hepatectomy (3.3%) were converted to open surgery. Weighted average of operative time and intraoperative blood loss were 418.6 min and 411.4 ml, respectively. Four patients received blood transfusions (6.3%) and 17 developed postoperative complications (26.9%). Information on tumor type were available for 57 patients of whom 42 were diagnosed with malignant tumors (73.6%) and 15 with benign diseases (26.3%). No port site metastasis, peritoneal carcinomatosis, or intrahepatic recurrence were reported. Three patients had microscopic margin positivity. CONCLUSIONS Major hepatectomy can be performed under robotic assistance. Further experience is needed before final conclusions can be drawn.
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Affiliation(s)
- Ugo Boggi
- Division of General and Transplant Surgery, Pisa University Hospital, Via Paradisa 2, Pisa, 56124, Italy.
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Lefebvre CW, Hiestand B, Bond MC, Fox SM, Char D, Weber DS, Glenn D, Patterson LA, Manthey DE. Increasing Faculty Attendance at Emergency Medicine Resident Conferences: Does CME Credit Make a Difference? J Grad Med Educ 2013; 5:41-5. [PMID: 24404225 PMCID: PMC3613316 DOI: 10.4300/jgme-d-12-00030.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/02/2012] [Accepted: 06/03/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Faculty involvement in resident teaching events is beneficial to resident education, yet evidence about the factors that promote faculty attendance at resident didactic conferences is limited. OBJECTIVE To determine whether offering continuing medical education (CME) credits would result in an increase in faculty attendance at weekly emergency medicine conferences and whether faculty would report the availability of CME credit as a motivating factor. METHODS Our prospective, multi-site, observational study of 5 emergency medicine residency programs collected information on the number of faculty members present at CME and non-CME lectures for 9 months and collected information from faculty on factors influencing decisions to attend resident educational events and from residents on factors influencing their learning experience. RESULTS Lectures offering CME credit on average were attended by 5 additional faculty members per hour, compared with conferences that did not offer CME credit (95% confidence interval [CI], 3.9-6.1; P < .001). Faculty reported their desire to "participate in resident education" was the most influential factor prompting them to attend lectures, followed by "explore current trends in emergency medicine" and the lecture's "specific topic." Faculty also reported that "clinical/administrative duties" and "family responsibilities" negatively affected their ability to attend. Residents reported that the most important positive factor influencing their conference experience was "lectures given by faculty." CONCLUSIONS Although faculty reported that CME credit was not an important factor in their decision to attend resident conferences, offering CME credit resulted in significant increases in faculty attendance. Residents reported that "lectures given by faculty" and "faculty attendance" positively affected their learning experience.
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Carpenter CR, Kane BG, Carter M, Lucas R, Wilbur LG, Graffeo CS. Incorporating evidence-based medicine into resident education: a CORD survey of faculty and resident expectations. Acad Emerg Med 2010; 17 Suppl 2:S54-61. [PMID: 21199085 PMCID: PMC3219923 DOI: 10.1111/j.1553-2712.2010.00889.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) invokes evidence-based medicine (EBM) principles through the practice-based learning core competency. The authors hypothesized that among a representative sample of emergency medicine (EM) residency programs, a wide variability in EBM resident training priorities, faculty expertise expectations, and curricula exists. OBJECTIVES The primary objective was to obtain descriptive data regarding EBM practices and expectations from EM physician educators. Our secondary objective was to assess differences in EBM educational priorities among journal club directors compared with non-journal club directors. METHODS A 19-question survey was developed by a group of recognized EBM curriculum innovators and then disseminated to Council of Emergency Medicine Residency Directors (CORD) conference participants, assessing their opinions regarding essential EBM skill sets and EBM curricular expectations for residents and faculty at their home institutions. The survey instrument also identified the degree of interest respondents had in receiving a free monthly EBM journal club curriculum. RESULTS A total of 157 individuals registered for the conference, and 98 completed the survey. Seventy-seven (77% of respondents) were either residency program directors or assistant/associate program directors. The majority of participants were from university-based programs and in practice at least 5 years. Respondents reported the ability to identify flawed research (45%), apply research findings to patient care (43%), and comprehend research methodology (33%) as the most important resident skill sets. The majority of respondents reported no formal journal club or EBM curricula (75%) and do not utilize structured critical appraisal instruments (71%) when reviewing the literature. While journal club directors believed that resident learners' most important EBM skill is to identify secondary peer-reviewed resources, non-journal club directors identified residents' ability to distinguish significantly flawed research as the key skill to develop. Interest in receiving a free monthly EBM journal club curriculum was widely accepted (89%). CONCLUSIONS Attaining EBM proficiency is an expected outcome of graduate medical education (GME) training, although the specific domains of anticipated expertise differ between faculty and residents. Few respondents currently use a formalized curriculum to guide the development of EBM skill sets. There appears to be a high level of interest in obtaining EBM journal club educational content in a structured format. Measuring the effects of providing journal club curriculum content in conjunction with other EBM interventions may warrant further investigation.
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Affiliation(s)
- Christopher R Carpenter
- Department of Emergency Medicine, Washington University in St. Louis, School of Medicine, St. Louis, MO, USA.
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