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Fauci AJ, D'Angelo D, Coclite D, Napoletano A, Gianola S, Ferrara C, Di Nitto M, Gensini G. Exploring the definition and methodology of "best practice" in the health care literature: a scoping review protocol. JBI Evid Synth 2023; 21:2134-2141. [PMID: 37435680 DOI: 10.11124/jbies-23-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVE This review will map and define the terminology used in health care literature for "best practice" as well as its underpinning framework/methodology. INTRODUCTION Numerous international organizations and institutions have sought to develop models or frameworks to guide health care providers to integrate the best evidence into clinical practice. However, different concepts related to best practice have been used, both in the biomedical literature and by public institutions, leading to a lack of consistency in definitions of the term. This poses a potential difficulty for clinical professionals in applying evidence effectively to achieve desired patient outcomes. INCLUSION CRITERIA This review will adopt the following inclusion criteria: i) the study must contain a definition of the term "best practice" or its related concepts; ii) the concept of best practice must refer to clinical activities and not have organizational features; and iii) any study design can be included. Studies will be excluded if they describe a definition of best practice that is not directly related to clinical practice (eg, business). METHODS The review will follow the JBI methodology for scoping reviews. An initial search of MEDLINE identified keywords and MeSH terms. MEDLINE (PubMed), Embase, CINAHL (EBSCOhost), and Google Scholar will be searched from 2001 until the present, the year in which the first definition of best practice appeared in the literature. Four pairs of reviewers will independently select studies and perform data extraction and data synthesis. Data will be presented in figures or tables, accompanied by a narrative summary. Searches will be limited to articles in English, Italian, German, French, and Spanish. REVIEW REGISTRATION Open Science Framework: https://osf.io/52vxe/.
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Affiliation(s)
- Alice Josephine Fauci
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Daniela D'Angelo
- CECRI, Evidence-based Practice Group for Nursing Scholarship, A JBI Affiliated Group, Rome, Italy
| | - Daniela Coclite
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Antonello Napoletano
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Carla Ferrara
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Marco Di Nitto
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
- Azienda USL di Bologna, Bologna, Italy
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Bazant E, McPhillips-Tangum C, Shrestha SD, G S P, Khera A, Nic Lochlainn L, Habtamu E, Patel VI, Muhire G, Saarlas KN. Promising practices for the collaborative planning of integrated health campaigns from a synthesis of case studies. BMJ Glob Health 2022; 7:bmjgh-2022-010321. [PMID: 36517112 PMCID: PMC9756207 DOI: 10.1136/bmjgh-2022-010321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
A combination of public health campaigns and routine primary healthcare services are used in many countries to maximise the number of people reached with interventions to prevent, control, eliminate or eradicate diseases. Health campaigns have historically been organised within vertical (disease-specific) programmes, which are often funded, planned and implemented independently from one another and from routinely offered primary healthcare services. Global health agencies have voiced support for enhancing campaign effectiveness, including campaign efficiency and equity, through collaboration among vertical programmes. However, limited guidance is available to country-level campaign planners and implementers about how to effectively integrate campaigns. Planning is critical to the implementation of effective health campaigns, including those related to neglected tropical diseases, malaria, vitamin A supplementation and vaccine-preventable diseases, including polio, measles and meningitis. However, promising approaches to planning integrated health campaigns have not been sufficiently documented. This manuscript highlights promising practices for the collaborative planning of integrated health campaigns that emerged from the experiences of eight project teams working in three WHO regions. Adoption of the promising practices described in this paper could lead to enhanced collaboration among campaign stakeholders, increased agreement about the need for and anticipated benefits of campaign integration, and enhanced understanding of effective planning of integrated health campaigns.
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Affiliation(s)
- Eva Bazant
- Health Campaign Effectiveness Coalition, The Task Force for Global Health, Decatur, Georgia, USA
| | | | | | - Preetha G S
- International Institute of Health Management Research, Delhi, India
| | | | - Laura Nic Lochlainn
- Department of Immunization, Vaccines & Biologicals (IVB), World Health Organization, Geneve, Switzerland
| | - Esmael Habtamu
- International Centre for Eye Health (ICEH), London School of Hygiene & Tropical Medicine, London, UK
| | - Vivek I Patel
- Health Campaign Effectiveness Coalition, The Task Force for Global Health, Decatur, Georgia, USA
| | | | - Kristin N Saarlas
- Health Campaign Effectiveness Coalition, The Task Force for Global Health, Decatur, Georgia, USA
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Varada S, Lacson R, Raja AS, Ip IK, Schneider L, Osterbur D, Bain P, Vetrano N, Cellini J, Mita C, Coletti M, Whelan J, Khorasani R. Characteristics of knowledge content in a curated online evidence library. J Am Med Inform Assoc 2019; 25:507-514. [PMID: 29092054 DOI: 10.1093/jamia/ocx092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/09/2017] [Indexed: 11/12/2022] Open
Abstract
Objective To describe types of recommendations represented in a curated online evidence library, report on the quality of evidence-based recommendations pertaining to diagnostic imaging exams, and assess underlying knowledge representation. Materials and Methods The evidence library is populated with clinical decision rules, professional society guidelines, and locally developed best practice guidelines. Individual recommendations were graded based on a standard methodology and compared using chi-square test. Strength of evidence ranged from grade 1 (systematic review) through grade 5 (recommendations based on expert opinion). Finally, variations in the underlying representation of these recommendations were identified. Results The library contains 546 individual imaging-related recommendations. Only 15% (16/106) of recommendations from clinical decision rules were grade 5 vs 83% (526/636) from professional society practice guidelines and local best practice guidelines that cited grade 5 studies (P < .0001). Minor head trauma, pulmonary embolism, and appendicitis were topic areas supported by the highest quality of evidence. Three main variations in underlying representations of recommendations were "single-decision," "branching," and "score-based." Discussion Most recommendations were grade 5, largely because studies to test and validate many recommendations were absent. Recommendation types vary in amount and complexity and, accordingly, the structure and syntax of statements they generate. However, they can be represented in single-decision, branching, and score-based representations. Conclusion In a curated evidence library with graded imaging-based recommendations, evidence quality varied widely, with decision rules providing the highest-quality recommendations. The library may be helpful in highlighting evidence gaps, comparing recommendations from varied sources on similar clinical topics, and prioritizing imaging recommendations to inform clinical decision support implementation.
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Affiliation(s)
- Sowmya Varada
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ronilda Lacson
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ali S Raja
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ivan K Ip
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Louise Schneider
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - David Osterbur
- Harvard Medical School, Boston, MA, USA.,Countway Library of Medicine, Boston, MA, USA
| | - Paul Bain
- Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nicole Vetrano
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacqueline Cellini
- Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Carol Mita
- Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret Coletti
- Agoos Medical Library/Knowledge Services, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Julia Whelan
- Agoos Medical Library/Knowledge Services, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Bosch M, McKenzie JE, Ponsford JL, Turner S, Chau M, Tavender EJ, Knott JC, Gruen RL, Francis JJ, Brennan SE, Pearce A, O'Connor DA, Mortimer D, Grimshaw JM, Rosenfeld JV, Meares S, Smyth T, Michie S, Green SE. Evaluation of a targeted, theory-informed implementation intervention designed to increase uptake of emergency management recommendations regarding adult patients with mild traumatic brain injury: results of the NET cluster randomised trial. Implement Sci 2019; 14:4. [PMID: 30654826 PMCID: PMC6337860 DOI: 10.1186/s13012-018-0841-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/22/2018] [Indexed: 01/22/2023] Open
Abstract
Background Evidence-based guidelines for management of mild traumatic brain injury (mTBI) in the emergency department (ED) are now widely available; however, clinical practice remains inconsistent with these guidelines. A targeted, theory-informed implementation intervention (Neurotrauma Evidence Translation (NET) intervention) was designed to increase the uptake of three clinical practice recommendations regarding the management of patients who present to Australian EDs with mild head injuries. The intervention involved local stakeholder meetings, identification and training of nursing and medical local opinion leaders, train-the-trainer workshops and standardised education materials and interactive workshops delivered by the opinion leaders to others within their EDs during a 3 month period. This paper reports on the effects of this intervention. Methods EDs (clusters) were allocated to receive either access to a clinical practice guideline (control) or the implementation intervention, using minimisation, a method that allocates clusters to groups using an algorithm to minimise differences in predefined factors between the groups. We measured clinical practice outcomes at the patient level using chart audit. The primary outcome was appropriate screening for post-traumatic amnesia (PTA) using a validated tool until a perfect score was achieved (indicating absence of acute cognitive impairment) before the patient was discharged home. Secondary outcomes included appropriate CT scanning and the provision of written patient information upon discharge. Patient health outcomes (anxiety, primary outcome: Hospital Anxiety and Depression Scale) were also assessed using follow-up telephone interviews. Outcomes were assessed by independent auditors and interviewers, blinded to group allocation. Results Fourteen EDs were allocated to the intervention and 17 to the control condition; 1943 patients were included in the chart audit. At 2 months follow-up, patients attending intervention EDs (n = 893) compared with control EDs (n = 1050) were more likely to have been appropriately assessed for PTA (adjusted odds ratio (OR) 20.1, 95%CI 6.8 to 59.3; adjusted absolute risk difference (ARD) 14%, 95%CI 8 to 19). The odds of compliance with recommendations for CT scanning and provision of written patient discharge information were small (OR 1.2, 95%CI 0.8 to 1.6; ARD 3.2, 95%CI − 3.7 to 10 and OR 1.2, 95%CI 0.8 to 1.8; ARD 3.1, 95%CI − 3.0 to 9.3 respectively). A total of 343 patients at ten interventions and 14 control sites participated in follow-up interviews at 4.3 to 10.7 months post-ED presentation. The intervention had a small effect on anxiety levels (adjusted mean difference − 0.52, 95%CI − 1.34 to 0.30; scale 0–21, with higher scores indicating greater anxiety). Conclusions Our intervention was effective in improving the uptake of the PTA recommendation; however, it did not appreciably increase the uptake of the other two practice recommendations. Improved screening for PTA may be clinically important as it leads to appropriate periods of observation prior to safe discharge. The estimated intervention effect on anxiety was of limited clinical significance. We were not able to compare characteristics of EDs who declined trial participation with those of participating sites, which may limit the generalizability of the results. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12612001286831), date registered 12 December 2012. Electronic supplementary material The online version of this article (10.1186/s13012-018-0841-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marije Bosch
- Department of Surgery, Monash University, Melbourne, Australia. .,National Trauma Research Institute, Alfred Hospital and Monash University, Melbourne, Australia. .,Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia.,School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Simon Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marisa Chau
- Department of Surgery, Monash University, Melbourne, Australia.,National Trauma Research Institute, Alfred Hospital and Monash University, Melbourne, Australia
| | - Emma J Tavender
- Department of Surgery, Monash University, Melbourne, Australia.,National Trauma Research Institute, Alfred Hospital and Monash University, Melbourne, Australia
| | - Jonathan C Knott
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Russell L Gruen
- National Trauma Research Institute, Alfred Hospital and Monash University, Melbourne, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jill J Francis
- School of Health Sciences, City University of London, London, UK
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Pearce
- MedSTAR Emergency Medical Retrieval Service, Adelaide, Australia.,Royal Adelaide Hospital Emergency Department, Adelaide, Australia
| | - Denise A O'Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jeffrey V Rosenfeld
- Department of Surgery, Monash University, Melbourne, Australia.,National Trauma Research Institute, Alfred Hospital and Monash University, Melbourne, Australia.,Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia
| | - Susanne Meares
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Tracy Smyth
- Emergency Department, Westmead Hospital, Sydney, Australia
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sally E Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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“Sleep? Maybe Later…” A Cross-Campus Survey of University Students and Sleep Practices. EDUCATION SCIENCES 2017. [DOI: 10.3390/educsci7030066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sharwood LN, Stanford R, Middleton JW, Burns B, Joseph A, Flower O, Rigby O, Ball J, Dhaliwal S. Improving care standards for patients with spinal trauma combining a modified e-Delphi process and stakeholder interviews: a study protocol. BMJ Open 2017; 7:e012377. [PMID: 28104707 PMCID: PMC5253580 DOI: 10.1136/bmjopen-2016-012377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Around 300 people sustain a new traumatic spinal cord injury (TSCI) in Australia each year; a relatively low incidence injury with extremely high long-term associated costs. Care standards are inconsistent nationally, lacking in consensus across important components of care such as prehospital spinal immobilisation, timing of surgery and timeliness of transfer to specialist services. This study aims to develop 'expertly defined' and agreed standards of care across the majority of disciplines involved for these patients. METHODS AND ANALYSIS A modified e-Delphi process will be used to gain consensus for best practice across specific clinical early care areas for the patient with TSCI; invited participants will include clinicians across Australia with relevant and significant expertise. A rapid literature review will identify available evidence, including any current guidelines from 2005 to 2015. Level and strength of evidence identified, including areas of contention, will be used to formulate the first round survey questions and statements. Participants will undertake 2-3 online survey rounds, responding anonymously to questionnaires regarding care practices and indicating their agreement or otherwise with practice standard statements. Relevant key stakeholders, including patients, will also be interviewed face to face. ETHICS AND DISSEMINATION Ethics approval for this study was obtained by the NSW Population & Health Services Research Ethics Committee on 14 January 2016 (HREC/12/CIPHS/74). Seeking comprehensive understanding of how the variation in early care pathways and treatment can be addressed to achieve optimal patient outcomes and economic costs; the overall aim is the agreement to a consistent approach to the triage, treatment, transport and definitive care of acute TSCI victims. The agreed practice standards of care will inform the development of a Clinical Pathway with practice change strategies for implementation. These standards will offer a benchmark for state-wide and potentially national policy.
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Affiliation(s)
- Lisa N Sharwood
- Sydney Medical School Northern, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ralph Stanford
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - James W Middleton
- Sydney Medical School Northern, The University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- State Spinal Cord Injury Service, NSW Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - Brian Burns
- Sydney Medical School Northern, The University of Sydney, Sydney, New South Wales, Australia
- Greater Sydney Area Helicopter Emergency Medical Service, Sydney, New South Wales, Australia
| | - Anthony Joseph
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Oliver Flower
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Oran Rigby
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Greater Sydney Area Helicopter Emergency Medical Service, Sydney, New South Wales, Australia
- Institute for Trauma and Injury Management, NSW Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - Jonathon Ball
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Shelly Dhaliwal
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia
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Surviving or thriving: quality assurance mechanisms to promote innovation in the development of evidence-based parenting interventions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:421-31. [PMID: 24610566 DOI: 10.1007/s11121-014-0475-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Parenting interventions have the potential to make a significant impact to the prevention and treatment of major social and mental health problems of children. However, parenting interventions fail to do so because program developers pay insufficient attention to the broader ecological context that influences the adoption and implementation of evidence-based interventions. This context includes the professional and scientific community, end users, consumers, and broader sociopolitical environment within which parenting services are delivered. This paper presents an iterative stage model of quality assurance steps to guide ongoing research and development particularly those related to program innovations including theory building, intervention development, pilot testing, efficacy and effectiveness trials, program refinement, dissemination, and planning for implementation and political advocacy. The key challenges associated with each phase of the research and development process are identified. Stronger consumer participation throughout the entire process from initial program design to wider community dissemination is an important, but an often ignored part of the process. Specific quality assurance mechanisms are discussed that increase accountability, professional, and consumer confidence in an intervention and the evidence supporting its efficacy.
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Tavender EJ, Bosch M, Gruen RL, Green SE, Michie S, Brennan SE, Francis JJ, Ponsford JL, Knott JC, Meares S, Smyth T, O'Connor DA. Developing a targeted, theory-informed implementation intervention using two theoretical frameworks to address health professional and organisational factors: a case study to improve the management of mild traumatic brain injury in the emergency department. Implement Sci 2015; 10:74. [PMID: 26003785 PMCID: PMC4446082 DOI: 10.1186/s13012-015-0264-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background Despite the availability of evidence-based guidelines for the management of mild traumatic brain injury in the emergency department (ED), variations in practice exist. Interventions designed to implement recommended behaviours can reduce this variation. Using theory to inform intervention development is advocated; however, there is no consensus on how to select or apply theory. Integrative theoretical frameworks, based on syntheses of theories and theoretical constructs relevant to implementation, have the potential to assist in the intervention development process. This paper describes the process of applying two theoretical frameworks to investigate the factors influencing recommended behaviours and the choice of behaviour change techniques and modes of delivery for an implementation intervention. Methods A stepped approach was followed: (i) identification of locally applicable and actionable evidence-based recommendations as targets for change, (ii) selection and use of two theoretical frameworks for identifying barriers to and enablers of change (Theoretical Domains Framework and Model of Diffusion of Innovations in Service Organisations) and (iii) identification and operationalisation of intervention components (behaviour change techniques and modes of delivery) to address the barriers and enhance the enablers, informed by theory, evidence and feasibility/acceptability considerations. We illustrate this process in relation to one recommendation, prospective assessment of post-traumatic amnesia (PTA) by ED staff using a validated tool. Results Four recommendations for managing mild traumatic brain injury were targeted with the intervention. The intervention targeting the PTA recommendation consisted of 14 behaviour change techniques and addressed 6 theoretical domains and 5 organisational domains. The mode of delivery was informed by six Cochrane reviews. It was delivered via five intervention components : (i) local stakeholder meetings, (ii) identification of local opinion leader teams, (iii) a train-the-trainer workshop for appointed local opinion leaders, (iv) local training workshops for delivery by trained local opinion leaders and (v) provision of tools and materials to prompt recommended behaviours. Conclusions Two theoretical frameworks were used in a complementary manner to inform intervention development in managing mild traumatic brain injury in the ED. The effectiveness and cost-effectiveness of the developed intervention is being evaluated in a cluster randomised trial, part of the Neurotrauma Evidence Translation (NET) program.
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Affiliation(s)
- Emma J Tavender
- National Trauma Research Institute, The Alfred, Monash University, Melbourne, Australia. .,Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
| | - Marije Bosch
- National Trauma Research Institute, The Alfred, Monash University, Melbourne, Australia. .,Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
| | - Russell L Gruen
- National Trauma Research Institute, The Alfred, Monash University, Melbourne, Australia. .,Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia. .,Department of Trauma, The Alfred Hospital, Melbourne, Australia.
| | - Sally E Green
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Sue E Brennan
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
| | - Jill J Francis
- School of Health Sciences, City University London, London, UK.
| | - Jennie L Ponsford
- National Trauma Research Institute, The Alfred, Monash University, Melbourne, Australia. .,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia. .,School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Jonathan C Knott
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia. .,Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia.
| | - Sue Meares
- Department of Psychology, Macquarie University, Sydney, Australia.
| | - Tracy Smyth
- Emergency Department, Westmead Hospital, Westmead, Australia.
| | - Denise A O'Connor
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
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9
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Bosch M, McKenzie JE, Mortimer D, Tavender EJ, Francis JJ, Brennan SE, Knott JC, Ponsford JL, Pearce A, O'Connor DA, Grimshaw JM, Rosenfeld JV, Gruen RL, Green SE. Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: study protocol for a cluster randomised controlled trial. Trials 2014; 15:281. [PMID: 25012235 PMCID: PMC4107995 DOI: 10.1186/1745-6215-15-281] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/30/2014] [Indexed: 12/02/2022] Open
Abstract
Background Mild head injuries commonly present to emergency departments. The challenges facing clinicians in emergency departments include identifying which patients have traumatic brain injury, and which patients can safely be sent home. Traumatic brain injuries may exist with subtle symptoms or signs, but can still lead to adverse outcomes. Despite the existence of several high quality clinical practice guidelines, internationally and in Australia, research shows inconsistent implementation of these recommendations. The aim of this trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients (18 years of age or older) who present following mild head injuries (concussion), compared with passive dissemination of these recommendations. The primary objective is to establish whether the intervention is effective in increasing the percentage of patients for which appropriate post-traumatic amnesia screening is performed. Methods/design The design of this study is a cluster randomised trial. We aim to include 34 Australian 24-hour emergency departments, which will be randomised to an intervention or control group. Control group departments will receive a copy of the most recent Australian evidence-based clinical practice guideline on the acute management of patients with mild head injuries. The intervention group will receive an implementation intervention based on an analysis of influencing factors, which include local stakeholder meetings, identification of nursing and medical opinion leaders in each site, a train-the-trainer day and standardised education and interactive workshops delivered by the opinion leaders during a 3 month period of time. Clinical practice outcomes will be collected retrospectively from medical records by independent chart auditors over the 2 month period following intervention delivery (patient level outcomes). In consenting hospitals, eligible patients will be recruited for a follow-up telephone interview conducted by trained researchers. A cost-effectiveness analysis and process evaluation using mixed-methods will be conducted. Sample size calculations are based on including 30 patients on average per department. Outcome assessors will be blinded to group allocation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612001286831 (date registered 12 December 2012).
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Affiliation(s)
- Marije Bosch
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
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Understanding practice: the factors that influence management of mild traumatic brain injury in the emergency department--a qualitative study using the Theoretical Domains Framework. Implement Sci 2014; 9:8. [PMID: 24418161 PMCID: PMC3895840 DOI: 10.1186/1748-5908-9-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 08/12/2013] [Indexed: 11/25/2022] Open
Abstract
Background Mild traumatic brain injury is a frequent cause of presentation to emergency departments. Despite the availability of clinical practice guidelines in this area, there is variation in practice. One of the aims of the Neurotrauma Evidence Translation program is to develop and evaluate a targeted, theory- and evidence-informed intervention to improve the management of mild traumatic brain injury in Australian emergency departments. This study is the first step in the intervention development process and uses the Theoretical Domains Framework to explore the factors perceived to influence the uptake of four key evidence-based recommended practices for managing mild traumatic brain injury. Methods Semi-structured interviews were conducted with emergency staff in the Australian state of Victoria. The interview guide was developed using the Theoretical Domains Framework to explore current practice and to identify the factors perceived to influence practice. Two researchers coded the interview transcripts using thematic content analysis. Results A total of 42 participants (9 Directors, 20 doctors and 13 nurses) were interviewed over a seven-month period. The results suggested that (i) the prospective assessment of post-traumatic amnesia was influenced by: knowledge; beliefs about consequences; environmental context and resources; skills; social/professional role and identity; and beliefs about capabilities; (ii) the use of guideline-developed criteria or decision rules to inform the appropriate use of a CT scan was influenced by: knowledge; beliefs about consequences; environmental context and resources; memory, attention and decision processes; beliefs about capabilities; social influences; skills and behavioral regulation; (iii) providing verbal and written patient information on discharge was influenced by: beliefs about consequences; environmental context and resources; memory, attention and decision processes; social/professional role and identity; and knowledge; (iv) the practice of providing brief, routine follow-up on discharge was influenced by: environmental context and resources; social/professional role and identity; knowledge; beliefs about consequences; and motivation and goals. Conclusions Using the Theoretical Domains Framework, factors thought to influence the management of mild traumatic brain injury in the emergency department were identified. These factors present theoretically based targets for a future intervention.
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Healthcare reform: implications for knowledge translation in primary care. BMC Health Serv Res 2013; 13:490. [PMID: 24274773 PMCID: PMC3893505 DOI: 10.1186/1472-6963-13-490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 10/31/2013] [Indexed: 01/11/2023] Open
Abstract
Background The primary care sector represents the linchpin of many health systems. However, the translation of evidence-based practices into patient care can be difficult, particularly during healthcare reform. This can have significant implications for patients, their communities, and the public purse. This is aptly demonstrated in the area of sexual health. The aim of this paper is to determine what works to facilitate evidence-based sexual healthcare within the primary care sector. Methods 431 clinicians (214 general practitioners and 217 practice nurses) in New South Wales, Australia, were surveyed about their awareness, their use, the perceived impact, and the factors that hindered the use of six resources to promote sexual healthcare. Descriptive statistics were calculated from the responses to the closed survey items, while responses to open-ended item were thematically analyzed. Results All six resources were reported to improve the delivery of evidence-based sexual healthcare. Two resources – both double-sided A4-placards – had the greatest reach and use. Barriers that hindered resource-use included limited time, limited perceived need, and limited access to, or familiarity with the resources. Furthermore, the reorganization of the primary care sector and the removal of particular medical benefits scheme items may have hampered clinician capacity to translate evidence-based practices into patient care. Conclusions Findings reveal: (1) the translation of evidence-based practices into patient care is viable despite reform; (2) the potential value of a multi-modal approach; (3) the dissemination of relatively inexpensive resources might influence clinical practices; and (4) reforms to governance and/or funding arrangements may widen the void between evidence-based practices and patient care.
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Ganz FD, Ofra R, Khalaila R, Levy H, Arad D, Kolpak O, Nun MB, Drori Y, Benbenishty J. Translation of Oral Care Practice Guidelines Into Clinical Practice by Intensive Care Unit Nurses. J Nurs Scholarsh 2013; 45:355-62. [DOI: 10.1111/jnu.12039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Freda DeKeyser Ganz
- Pi , Head, Master's Program; Hadassah-Hebrew University School of Nursing; Faculty of Medicine; Jerusalem Israel
| | - Raanan Ofra
- Lecturer, Sheba School of Nursing; Tel Hashomer Israel
| | - Rabia Khalaila
- Director, Faculty of Nursing; Zefat Academic College Zefat; Israel
| | - Hadassa Levy
- Head Nurse, Cardiology; Rambam Health Care Campus; Haifa Israel
| | - Dana Arad
- Staff Nurse, Ichilov Medical Center; Tel Aviv Israel
| | - Orly Kolpak
- ICU Head Nurse, Western Galilee Hospital-Nahariya; Nahariya Israel
| | | | - Yardena Drori
- Head Nurse, Cardiac ICU; Haemek Hospital; Afula Israel
| | - Julie Benbenishty
- Academic Consultant/Trauma Coordinator, Nursing Administration; Hadassah Hebrew University Hospital; Jerusalem Israel
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Green SE, Bosch M, McKenzie JE, O’Connor DA, Tavender EJ, Bragge P, Chau M, Pitt V, Rosenfeld JV, Gruen RL. Improving the care of people with traumatic brain injury through the Neurotrauma Evidence Translation (NET) program: protocol for a program of research. Implement Sci 2012; 7:74. [PMID: 22866892 PMCID: PMC3543324 DOI: 10.1186/1748-5908-7-74] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/27/2012] [Indexed: 11/10/2022] Open
Abstract
The Neurotrauma Evidence Translation (NET) program was funded in 2009 to increase the uptake of research evidence in the clinical care of patients who have sustained traumatic brain injury. This paper reports the rationale and plan for this five-year knowledge translation research program. The overarching aims of the program are threefold: to improve outcomes for people with traumatic brain injury; to create a network of neurotrauma clinicians and researchers with expertise in knowledge translation and evidence-based practice; and to contribute knowledge to the field of knowledge translation research. The program comprises a series of interlinked projects spanning varying clinical environments and disciplines relevant to neurotrauma, anchored within four themes representing core knowledge translation activities: reviewing research evidence; understanding practice; developing and testing interventions for practice change; and building capacity for knowledge translation in neurotrauma. The program uses a range of different methods and study designs, including: an evidence fellowship program; conduct of and training in systematic reviews; mixed method study designs to describe and understand factors that influence current practices (e.g., semi-structured interviews and surveys); theory-based methods to develop targeted interventions aiming to change practice; a cluster randomised trial to test the effectiveness of a targeted theory-informed intervention; stakeholder involvement activities; and knowledge translation events such as consensus conferences.
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Affiliation(s)
- Sally E Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marije Bosch
- Department of Surgery, Monash University / National Trauma Research Institute, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Denise A O’Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emma J Tavender
- Department of Surgery, Monash University / National Trauma Research Institute, Melbourne, Australia
| | - Peter Bragge
- Department of Surgery, Monash University / National Trauma Research Institute, Melbourne, Australia
| | - Marisa Chau
- Department of Surgery, Monash University / National Trauma Research Institute, Melbourne, Australia
| | - Veronica Pitt
- Department of Surgery, Monash University / National Trauma Research Institute, Melbourne, Australia
| | - Jeffrey V Rosenfeld
- Department of Surgery, Monash University / Department of Neurosurgery, The Alfred Hospital / National Trauma Research Institute, Melbourne, Australia
| | - Russell L Gruen
- Department of Trauma, The Alfred Hospital / Department of Surgery, Monash University / National Trauma Research Institute, Melbourne, Australia
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