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Zaveri S, Teshome M, Reyna C, Francescatti AB, Yi M, Katz MHG, Hunt KK, Vreeland T. Assessing Surgeon Familiarity with the Commission on Cancer Operative Standards for Cancer Surgery. Ann Surg Oncol 2024; 31:6378-6386. [PMID: 39090487 DOI: 10.1245/s10434-024-15624-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/04/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND In response to growing evidence that proper performance of operative techniques during cancer surgery is associated with improved patient outcomes, the American College of Surgeons (ACS) implemented six operative standards as part of Commission on Cancer (CoC) accreditation. This study aimed to assess surgeon familiarity with these standards when first introduced and 2 years after their adoption. METHODS The ACS Cancer Surgery Standards Program distributed an anonymous 36-question survey to CoC-accredited cancer programs in 2021 and 2023. Questions specific to operative techniques determined the Surgery Score, and those specific to the accreditation standards determined the Standards Score. Mean scores were compared using one-way analysis of variance (ANOVA) and t tests. RESULTS The survey was completed by 376 surgeons in 2021 and 380 surgeons in 2023. The Surgery Scores were higher than the Standards Scores in 2021 and 2023. The surgeons who practiced at institutions with CoC accreditation had significantly higher Standards Scores than the surgeons at non-accredited institutions in 2021 (p = 0.005) and 2023 (p = 0.004), but not significantly different Surgery Scores. CONCLUSIONS The baseline survey in 2021 demonstrated significant knowledge of technical aspects of cancer surgery among a broad surgeon base, but a need for greater understanding of the accreditation standards. The repeat survey distribution 2 years after rollout of the operative standards and associated educational programing showed increased awareness surrounding the operative standards in 2023 and a trend toward improvement in knowledge of the accreditation standards across all specialties. Further evaluation will be directed toward compliance with the accreditation standards.
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Affiliation(s)
- Shruti Zaveri
- Department of Surgery, Division of Surgical Oncology, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chantal Reyna
- Department of Surgery, Loyola University Medical Center, Chicago, IL, USA
| | | | - Min Yi
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy Vreeland
- Department of Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
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Nieto-Martinez R, Neira C, de Oliveira D, Velasquez-Rodriguez A, Neira A, Velasquez-Rodriguez P, Garcia G, González-Rivas JP, Mechanick JI, Velasquez-Mieyer P. Lifestyle Medicine in Diabetes Care: The Lifedoc Health Model. Am J Lifestyle Med 2023; 17:336-354. [PMID: 37304744 PMCID: PMC10248374 DOI: 10.1177/15598276221103470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
Introduction The relevance of lifestyle medicine in diabetes treatment is now incorporated in clinical practice guidelines but finding an exemplar for the creation of a Lifestyle Medicine Program (LMP) is a difficult task. Aim To use Lifedoc Health (LDH) as a LMP exemplar by describing their multidisciplinary team (MDT) approach to diabetes care along with tactics to address sustainability challenges. Results The LDH model facilitates early activation of patients with diabetes and other cardiometabolic risk factors, MDT approaches, and protocols/policies that are able to overcome barriers to equitable healthcare in the community. Specific programmatic targets are clinical outcomes, effective dissemination, economic viability, and sustainability. Infrastructure centers on patient-driven problem-based visits, shared medical appointments, telemedicine, and patient tracking. Further discussions on program conceptualization and operationalization are provided. Conclusion Even though strategic plans for LMPs that specialize in diabetes care are well represented in the literature, implementation protocols, and performance metrics are lacking. The LDH experience provides a starting point for those healthcare professionals interested in translating ideas into action.
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Affiliation(s)
- Ramfis Nieto-Martinez
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Claudia Neira
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Diana de Oliveira
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Andrés Velasquez-Rodriguez
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Andres Neira
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Pedro Velasquez-Rodriguez
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Gabriela Garcia
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Juan P. González-Rivas
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Jeffrey I. Mechanick
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Pedro Velasquez-Mieyer
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
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Frequency and patterns of editorial rejections (rejections without peer review) across medical journals. J Am Acad Dermatol 2022; 87:1127-1129. [PMID: 35131399 DOI: 10.1016/j.jaad.2022.01.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/22/2022]
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Sales A. Reporting on implementation trials with null findings: the need for concurrent process evaluation reporting. BMJ Qual Saf 2022; 31:779-781. [PMID: 35701169 DOI: 10.1136/bmjqs-2022-014693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Anne Sales
- Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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van der Vliet N, den Broeder L, Romeo-Velilla M, Staatsen B, Kruize H, Friedrich B, Schuit AJ. Facilitators and barriers of intersectoral co-operation to promote healthier and more environmentally friendly behaviour: a qualitative evaluation through focus groups for the INHERIT project. BMC Public Health 2022; 22:617. [PMID: 35351055 PMCID: PMC8966286 DOI: 10.1186/s12889-022-12974-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tackling challenges related to health, environmental sustainability and equity requires many sectors to work together. This "intersectoral co-operation" can pose a challenge on its own. Research commonly focuses on one field or is conducted within one region or country. The aim of this study was to investigate facilitators and barriers regarding intersectoral co-operative behaviour as experienced in twelve distinct case studies in ten European countries. The COM-B behavioural system was applied to investigate which capabilities, opportunities and motivational elements appear necessary for co-operative behaviour. METHOD Twelve focus groups were conducted between October 2018 and March 2019, with a total of 76 participants (policymakers, case study coordinators, governmental institutes and/or non-governmental organisations representing citizens or citizens). Focus groups were organised locally and held in the native language using a common protocol and handbook. One central organisation coordinated the focus groups and analysed the results. Translated data were analysed using deductive thematic analysis, applying previous intersectoral co-operation frameworks and the COM-B behavioural system. RESULTS Amongst the main facilitators experienced were having highly motivated partners who find common goals and see mutual benefits, with good personal relationships and trust (Motivation). In addition, having supportive environments that provide opportunities to co-operate in terms of support and resources facilitated co-operation (Opportunity), along with motivated co-operation partners who have long-term visions, create good external visibility and who have clear agreements and clarity on roles from early on (Capability). Barriers included not having necessary and/or structural resources or enough time, and negative attitudes from specific stakeholders. CONCLUSIONS This study on facilitators and barriers to intersectoral co-operation in ten European countries confirms findings of earlier studies. This study also demonstrates that the COM-B model can serve as a relatively simple tool to understand co-operative behaviour in terms of the capability, opportunity and motivation required amongst co-operation partners from different sectors. Results can support co-operators' and policymakers' understanding of necessary elements of intersectoral co-operation. It can help them in developing more successful intersectoral co-operation when dealing with challenges of health, environmental sustainability and equity.
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Affiliation(s)
- Nina van der Vliet
- National Institute for Public Health and the Environment, Bilthoven, Netherlands.
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.
| | - Lea den Broeder
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Achieve, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Maria Romeo-Velilla
- EuroHealthNet, Brussels, Belgium
- University College Leuven-Limburg, Leuven, Belgium
| | - Brigit Staatsen
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Hanneke Kruize
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | | | - A Jantine Schuit
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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Coates D, Catling C. The Use of Ethnography in Maternity Care. Glob Qual Nurs Res 2021; 8:23333936211028187. [PMID: 34263014 PMCID: PMC8243125 DOI: 10.1177/23333936211028187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
While the value of ethnography in health research is recognized, the extent to which it is used is unclear. The aim of this review was to map the use of ethnography in maternity care, and identify the extent to which the key principles of ethnographies were used or reported. We systematically searched the literature over a 10-year period. Following exclusions we analyzed 39 studies. Results showed the level of detail between studies varied greatly, highlighting the inconsistencies, and poor reporting of ethnographies in maternity care. Over half provided no justification as to why ethnography was used. Only one study described the ethnographic approach used in detail, and covered the key features of ethnography. Only three studies made reference to the underpinning theoretical framework of ethnography as seeking to understand and capture social meanings. There is a need to develop reporting guidelines to guide researchers undertaking and reporting on ethnographic research.
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Scaccia JP, Scott VC. 5335 days of Implementation Science: using natural language processing to examine publication trends and topics. Implement Sci 2021; 16:47. [PMID: 33902657 PMCID: PMC8077727 DOI: 10.1186/s13012-021-01120-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Moving evidence-based practices into the hands of practitioners requires the synthesis and translation of research literature. However, the growing pace of scientific publications across disciplines makes it increasingly difficult to stay abreast of research literature. Natural language processing (NLP) methods are emerging as a valuable strategy for conducting content analyses of academic literature. We sought to apply NLP to identify publication trends in the journal Implementation Science, including key topic clusters and the distribution of topics over time. A parallel study objective was to demonstrate how NLP can be used in research synthesis. METHODS We examined 1711 Implementation Science abstracts published from February 22, 2006, to October 1, 2020. We retrieved the study data using PubMed's Application Programming Interface (API) to assemble a database. Following standard preprocessing steps, we use topic modeling with Latent Dirichlet allocation (LDA) to cluster the abstracts following a minimization algorithm. RESULTS We examined 30 topics and computed topic model statistics of quality. Analyses revealed that published articles largely reflect (i) characteristics of research, or (ii) domains of practice. Emergent topic clusters encompassed key terms both salient and common to implementation science. HIV and stroke represent the most commonly published clinical areas. Systematic reviews have grown in topic prominence and coherence, whereas articles pertaining to knowledge translation (KT) have dropped in prominence since 2013. Articles on HIV and implementation effectiveness have increased in topic exclusivity over time. DISCUSSION We demonstrated how NLP can be used as a synthesis and translation method to identify trends and topics across a large number of (over 1700) articles. With applicability to a variety of research domains, NLP is a promising approach to accelerate the dissemination and uptake of research literature. For future research in implementation science, we encourage the inclusion of more equity-focused studies to expand the impact of implementation science on disadvantaged communities.
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Affiliation(s)
| | - Victoria C Scott
- Department of Psychological Science, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA
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Patey AM, Grimshaw JM, Francis JJ. Changing behaviour, 'more or less': do implementation and de-implementation interventions include different behaviour change techniques? Implement Sci 2021; 16:20. [PMID: 33632274 PMCID: PMC7905859 DOI: 10.1186/s13012-021-01089-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Decreasing ineffective or harmful healthcare practices (de-implementation) may require different approaches than those used to promote uptake of effective practices (implementation). Few psychological theories differentiate between processes involved in decreasing, versus increasing, behaviour. However, it is unknown whether implementation and de-implementation interventions already use different approaches. We used the behaviour change technique (BCT) taxonomy (version 1) (which includes 93 BCTs organised into 12 groupings) to investigate whether implementation and de-implementation interventions for clinician behaviour change use different BCTs. METHODS Intervention descriptions in 181 articles from three systematic reviews in the Cochrane Library were coded for (a) implementation versus de-implementation and (b) intervention content (BCTs) using the BCT taxonomy (v1). BCT frequencies were calculated and compared using Pearson's chi-squared (χ2), Yates' continuity correction and Fisher's exact test, where appropriate. Identified BCTs were ranked according to frequency and rankings for de-implementation versus implementation interventions were compared and described. RESULTS Twenty-nine and 25 BCTs were identified in implementation and de-implementation interventions respectively. Feedback on behaviour was identified more frequently in implementation than de-implementation (Χ2(2, n=178) = 15.693, p = .000057). Three BCTs were identified more frequently in de-implementation than implementation: Behaviour substitution (Χ2(2, n=178) = 14.561, p = .0001; Yates' continuity correction); Monitoring of behaviour by others without feedback (Χ2(2, n=178) = 16.187, p = .000057; Yates' continuity correction); and Restructuring social environment (p = .000273; Fisher's 2-sided exact test). CONCLUSIONS There were some significant differences between BCTs reported in implementation and de-implementation interventions suggesting that researchers may have implicit theories about different BCTs required for de-implementation and implementation. These findings do not imply that the BCTs identified as targeting implementation or de-implementation are effective, rather simply that they were more frequently used. These findings require replication for a wider range of clinical behaviours. The continued accumulation of additional knowledge and evidence into whether implementation and de-implementation is different will serve to better inform researchers and, subsequently, improve methods for intervention design.
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Affiliation(s)
- Andrea M. Patey
- School of Health Sciences, City, University of London, 10 Northampton Square, London, EC1V 0HB UK
- Centre of Implementation Research, Ottawa Hospital Research Institute – General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Jeremy M. Grimshaw
- Centre of Implementation Research, Ottawa Hospital Research Institute – General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Jill J. Francis
- School of Health Sciences, City, University of London, 10 Northampton Square, London, EC1V 0HB UK
- Centre of Implementation Research, Ottawa Hospital Research Institute – General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
- School of Health Sciences, University of Melbourne, Melbourne, Victoria 3010 Australia
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Abstract
OBJECTIVE For the past 30 years there has been a growing emphasis on evidence as the primary or exclusive basis for nursing practice. METHODS Critical examination of literature related to evidence-based practice from the 1990s to the present. RESULTS This review of the nursing literature from the 1990s to the present reveals that in the midst of the movement to promote evidence-based practice as the gold standard, there have been persistent expressions of concern. These concerns are (a) lack of alignment of evidence-based practice with nursing's disciplinary perspective; (b) wrongful privileging of empirical knowledge over other sources of knowledge; (c) underappreciation of the complexity of practice and practice wisdom;(d) possibilities of evidence-based practice thwarting innovation and creativity;(e) vulnerabilities of empirical evidence to be flawed, inconsistent, and influenced by competing interests; (f) situational realities that limit access to and critical appraisal of evidence that access to and critical appraisal of evidence is not feasible or practical; and (g) lack of relationship of evidence-based practice to theory. CONCLUSIONS We call for a recalibrated practice epistemology that promotes a greater appreciation for the myriad sources of knowledge for nursing practice, and offer recommendations for international change in education, literature, scholarship, and public media.
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Rudd BN, Davis M, Beidas RS. Integrating implementation science in clinical research to maximize public health impact: a call for the reporting and alignment of implementation strategy use with implementation outcomes in clinical research. Implement Sci 2020; 15:103. [PMID: 33239097 PMCID: PMC7690013 DOI: 10.1186/s13012-020-01060-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/25/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although comprehensive reporting guidelines for implementation strategy use within implementation research exist, they are rarely used by clinical (i.e., efficacy and effectiveness) researchers. In this debate, we argue that the lack of comprehensive reporting of implementation strategy use and alignment of those strategies with implementation outcomes within clinical research is a missed opportunity to efficiently narrow research-to-practice gaps. MAIN BODY We review ways that comprehensively specifying implementation strategy use can advance science, including enhancing replicability of clinical trials and reducing the time from clinical research to public health impact. We then propose that revisions to frequently used reporting guidelines in clinical research (e.g., CONSORT, TIDieR) are needed, review current methods for reporting implementation strategy use (e.g., utilizing StaRI), provide pragmatic suggestions on how to both prospectively and retrospectively specify implementation strategy use and align these strategies with implementation outcomes within clinical research, and offer a case study of using these methods. CONCLUSIONS The approaches recommended in this article will not only contribute to shared knowledge and language among clinical and implementation researchers but also facilitate the replication of efficacy and effectiveness research. Ultimately, we hope to accelerate translation from clinical to implementation research in order to expedite improvements in public health.
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Affiliation(s)
- Brittany N Rudd
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, USA.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Penn Implementation Science Center, Leonard Davis Institute (PISCE@LDI), Philadelphia, PA, USA.
| | - Molly Davis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center, Leonard Davis Institute (PISCE@LDI), Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center, Leonard Davis Institute (PISCE@LDI), Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Davis R, D’Lima D. Building capacity in dissemination and implementation science: a systematic review of the academic literature on teaching and training initiatives. Implement Sci 2020; 15:97. [PMID: 33126909 PMCID: PMC7597006 DOI: 10.1186/s13012-020-01051-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/08/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The field of dissemination and implementation (D&I) science has grown significantly over recent years. Alongside this, an increased demand for training in D&I from researchers and implementers has been seen. Research describing and evaluating D&I training opportunities, referred to here as 'capacity building initiatives' (CBIs), can help provide an understanding of different methods of training as well as training successes and challenges. However, to gain a more detailed understanding of the evidence-base and how D&I CBIs are being reported in publications, a field-wide examination of the academic literature is required. METHODS Systematic review to identify the type and range of D&I CBIs discussed and/or appraised in the academic literature. EMBASE, Medline and PsycINFO were searched between January 2006 and November 2019. Articles were included if they reported on a D&I CBI that was developed by the authors (of each of the included articles) or the author's host institution. Two reviewers independently screened the articles and extracted data using a standardised form. RESULTS Thirty-one articles (from a total of 4181) were included. From these, 41 distinct D&I CBIs were identified which focussed on different contexts and professions, from 8 countries across the world. CBIs ranged from short courses to training institutes to being part of academic programmes. Nearly half were delivered face-face with the remainder delivered remotely or using a blended format. CBIs often stipulated specific eligibility criteria, strict application processes and/or were oversubscribed. Variabilities in the way in which the D&I CBIs were reported and/or evaluated were evident. CONCLUSIONS Increasing the number of training opportunities, as well as broadening their reach (to a wider range of learners), would help address the recognised deficit in D&I training. Standardisation in the reporting of D&I CBIs would enable the D&I community to better understand the findings across different contexts and scientific professions so that training gaps can be identified and overcome. More detailed examination of publications on D&I CBIs as well as the wider literature on capacity building would be of significant merit to the field.
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Affiliation(s)
- Rachel Davis
- Centre for Implementation Science, Health Service and Population Research Department, King’s College London, London, UK
| | - Danielle D’Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Warren AM, Frongillo EA, Rawat R. Building Implementation Science in Nutrition. Adv Nutr 2020; 11:1392-1398. [PMID: 32583850 PMCID: PMC7490173 DOI: 10.1093/advances/nmaa066] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/17/2020] [Accepted: 05/12/2020] [Indexed: 11/14/2022] Open
Abstract
The field of nutrition has been investing in the development of many nutrition-specific and -sensitive policies and programs aimed at improving population-level malnutrition in all its forms. When there is a need to learn about a new system, programmatic context, or target population to understand how to effectively deploy an intervention to help improve nutrition, it is important to be able to ask a broad range of questions, both in topic and in scope. Our aim is to provide a simple and conceptually clear definition and principles to elaborate the science of implementation for nutrition to distinguish it from other ways of knowing and learning and to serve as a guide to the articulation of implementation science questions and methods. Implementation science is a body of systematized knowledge about how to improve implementation that 1) is distinguished by its aims to learn about the process of implementation, 2) uses methods that derive from and fit with the aims, and 3) is built with tacit (as well as expert) knowledge and experiential learning. Implementation science aims to generate the learning needed to improve implementation through facilitating collaboration among stakeholders to articulate and pursue the aims; capturing and using tacit knowledge and experiential learning from stakeholders, systems, providers, and recipients; and applying a mix of methods suited to the aims. This elaboration of the science provides a simple way to help those who already do, or want to do, implementation science understand and communicate how this science is unique and the value that it adds to the current landscape of nutrition priorities, innovations, and the attendant complex learning needs that follow. Implementation science encompasses both discovery- and mission-oriented research, and centers implementation as the object of study for the purposes of broad-based learning.
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Affiliation(s)
- Andrea M Warren
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Rahul Rawat
- Bill & Melinda Gates Foundation, Seattle, WA, USA
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Buckel WR, Kaye KS, Patel PK. Collaborative Antimicrobial Stewardship: Working with Hospital and Health System Administration. Infect Dis Clin North Am 2019; 34:1-15. [PMID: 31836330 DOI: 10.1016/j.idc.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Successful antimicrobial stewardship programs rely on engagement with hospital administrators. Antimicrobial stewards should understand the unique pressures and demands of hospital and health system administration and be familiar with key terminology and regulatory requirements. This article provides guidance on strategies for engaging hospital and health system administration to support antimicrobial stewardship, including recommendations for designing a successful antimicrobial stewardship program structure, pitching resource requests, setting meaningful and measurable goals, achieving and communicating results, and fostering ongoing relationships with hospital and health system administration.
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Affiliation(s)
- Whitney R Buckel
- Intermountain Healthcare Pharmacy Services, 4393 South Riverboat Road, Suite 100, Taylorsville, UT 84123, USA.
| | - Keith S Kaye
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Payal K Patel
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, VA Ann Arbor Healthcare System (111-I), 2215 Fuller Road, Ann Arbor, MI 48109-2399, USA
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Implementing a Clinical Practice Guideline on Opioid-Induced Advancing Sedation and Respiratory Depression. J Nurs Care Qual 2019; 35:13-19. [PMID: 31094877 DOI: 10.1097/ncq.0000000000000406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Opioid-induced respiratory depression (OIRD) is a serious adverse reaction associated with opioid administration. LOCAL PROBLEM The purpose of this quality improvement study was to evaluate the impact of implementing a clinical practice guideline for OIRD in a medical-surgical setting lacking standardized monitoring techniques and reporting criteria for patients receiving opioid analgesia. METHODS An American Society for Pain Management Nursing protocol was implemented in 4 medical/surgical units. The impact on OIRD-related nurse knowledge, documentation, and opioid-related rapid response calls was measured pre- and postimplementation. RESULTS Nurse OIRD-related knowledge significantly increased. The number of naloxone administrations associated with prior intravenous opioid analgesic administration did not significantly change. However, there was a significant decrease in the postimplementation number of respiratory distress-related rapid response calls. CONCLUSIONS Implementation of the American Society for Pain Management Nursing guidelines had a positive impact on knowledge, documentation, early intervention of OIRD, and the number of opioid-related rapid response calls.
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Norton WE, Lungeanu A, Chambers DA, Contractor N. Mapping the Growing Discipline of Dissemination and Implementation Science in Health. Scientometrics 2017; 112:1367-1390. [PMID: 29249842 DOI: 10.1007/s11192-017-2455-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The field of dissemination and implementation (D&I) research in health has grown considerably in the past decade. Despite the potential for advancing the science, limited research has focused on mapping the field. Methods We administered an online survey to individuals in the D&I field to assess participants' demographics and expertise, as well as engagement with journals and conferences, publications, and grants. A combined roster-nomination method was used to collect data on participants' advice networks and collaboration networks; participants' motivations for choosing collaborators was also assessed. Frequency and descriptive statistics were used to characterize the overall sample; network metrics were used to characterize both networks. Among a sub-sample of respondents who were researchers, regression analyses identified predictors of two metrics of academic performance (i.e., publications and funded grants). Results A total of 421 individuals completed the survey, representing a 30.75% response rate of eligible individuals. Most participants were White (n = 343), female (n = 284, 67.4%), and identified as a researcher (n = 340, 81%). Both the advice and the collaboration networks displayed characteristics of a small world network. The most important motivations for selecting collaborators were aligned with advancing the science (i.e., prior collaborators, strong reputation, and good collaborators) rather than relying on human proclivities for homophily, proximity, and friendship. Among a sub-sample of 295 researchers, expertise (individual predictor), status (advice network), and connectedness (collaboration network) were significant predictors of both metrics of academic performance. Conclusions Network-based interventions can enhance collaboration and productivity; future research is needed to leverage these data to advance the field.
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Affiliation(s)
- Wynne E Norton
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Alina Lungeanu
- Population Research Institute, Pennsylvania State University, University Park, PA, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Noshir Contractor
- Departments of Industrial Engineering and Management Sciences, Communication Studies, and Management and Organizations, Northwestern University, Evanston, IL, USA
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Nieto-Martínez R, González-Rivas JP, Florez H, Mechanick JI. Transcultural Endocrinology: Adapting Type-2 Diabetes Guidelines on a Global Scale. Endocrinol Metab Clin North Am 2016; 45:967-1009. [PMID: 27823615 DOI: 10.1016/j.ecl.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Type-2 diabetes (T2D) needs to be prevented and treated effectively to reduce its burden and consequences. White papers, such as evidence-based clinical practice guidelines (CPG) and their more portable versions, clinical practice algorithms and clinical checklists, may improve clinical decision-making and diabetes outcomes. However, CPG are underused and poorly validated. Protocols that translate and implement these CPG are needed. This review presents the global dimension of T2D, details the importance of white papers in the transculturalization process, compares relevant international CPG, analyzes cultural variables, and summarizes translation strategies that can improve care. Specific protocols and algorithmic tools are provided.
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Affiliation(s)
- Ramfis Nieto-Martínez
- Department of Physiology, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Av. Andrés Bello con Av. Libertador, Apartado 516, Barquisimeto, Venezuela; Department of Physiology, School of Medicine, University of Panamá, Vía Transísmica, Apartado 0824, Estafeta Universitaria, Panamá, República de Panamá.
| | - Juan P González-Rivas
- The Andes Clinic of Cardio-Metabolic Studies, Av. Miranda entre calles Bermúdez y Arismendi, Apartado 3112, Timotes, Venezuela
| | - Hermes Florez
- Miami Veterans Affairs Medical Center, University of Miami Miller School of Medicine, 1201 Northwest 16th Street, CLC 207, Miami, FL 33125, USA
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, 1192 Park Avenue, New York, NY 10128, USA
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Manolio TA. Implementing genomics and pharmacogenomics in the clinic: The National Human Genome Research Institute's genomic medicine portfolio. Atherosclerosis 2016; 253:225-236. [PMID: 27612677 PMCID: PMC5064852 DOI: 10.1016/j.atherosclerosis.2016.08.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 01/08/2023]
Abstract
Increasing knowledge about the influence of genetic variation on human health and growing availability of reliable, cost-effective genetic testing have spurred the implementation of genomic medicine in the clinic. As defined by the National Human Genome Research Institute (NHGRI), genomic medicine uses an individual's genetic information in his or her clinical care, and has begun to be applied effectively in areas such as cancer genomics, pharmacogenomics, and rare and undiagnosed diseases. In 2011 NHGRI published its strategic vision for the future of genomic research, including an ambitious research agenda to facilitate and promote the implementation of genomic medicine. To realize this agenda, NHGRI is consulting and facilitating collaborations with the external research community through a series of "Genomic Medicine Meetings," under the guidance and leadership of the National Advisory Council on Human Genome Research. These meetings have identified and begun to address significant obstacles to implementation, such as lack of evidence of efficacy, limited availability of genomics expertise and testing, lack of standards, and difficulties in integrating genomic results into electronic medical records. The six research and dissemination initiatives comprising NHGRI's genomic research portfolio are designed to speed the evaluation and incorporation, where appropriate, of genomic technologies and findings into routine clinical care. Actual adoption of successful approaches in clinical care will depend upon the willingness, interest, and energy of professional societies, practitioners, patients, and payers to promote their responsible use and share their experiences in doing so.
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Affiliation(s)
- Teri A Manolio
- Division of Genomic Medicine, National Human Genome Research Institute, 5635 Fishers Lane, Room 4113, MSC 9305, Bethesda MD, USA.
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A review of diabetes prevention program translations: use of cultural adaptation and implementation research. Transl Behav Med 2015; 5:401-14. [PMID: 26622913 DOI: 10.1007/s13142-015-0341-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Diabetes Prevention Program (DPP) has been shown to prevent type 2 diabetes through lifestyle modification. The purpose of this study was to describe the literature on DPP translation, synthesizing studies using cultural adaptation and implementation research. A systematic search was conducted. Original studies evaluating DPP implementation and/or cultural adaptation were included. Data about cultural adaptation, implementation outcomes, and translation strategies was abstracted. A total of 44 were included, of which 15 reported cultural adaptations and 38 explored implementation. Many studies shortened the program length and reported a group format. The most commonly reported cultural adaptation (13 of 15) was with content. At the individual level, the most frequently assessed implementation outcome (n = 30) was adoption. Feasibility was most common (n = 32) at the organization level. The DPP is being tested in a variety of settings and populations, using numerous translational strategies and cultural adaptations. Implementation research that identifies, evaluates, and reports efforts to translate the DPP into practice is crucial.
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Lee JY, Lee CY, Kim HR, Lee CH, Kim HW, Kim JH. A Role of Serum-Based Neuronal and Glial Markers as Potential Predictors for Distinguishing Severity and Related Outcomes in Traumatic Brain Injury. J Korean Neurosurg Soc 2015; 58:93-100. [PMID: 26361523 PMCID: PMC4564754 DOI: 10.3340/jkns.2015.58.2.93] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 11/30/2022] Open
Abstract
Objective Optimal treatment decision and estimation of the prognosis in traumatic brain injury (TBI) is currently based on demographic and clinical predictors. But sometimes, there are limitations in these factors. In this study, we analyzed three central nervous system biomarkers in TBI patients, will discuss the roles and clinical applications of biomarkers in TBI. Methods From July on 2013 to August on 2014, a total of 45 patients were included. The serum was obtained at the time of hospital admission, and biomarkers were extracted with centrifugal process. It was analyzed for the level of S-100 beta (S100B), glial fibrillary acidic protein (GFAP), and ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1). Results This study included 33 males and 12 females with a mean age of 58.5 (19-84) years. TBI patients were classified into two groups. Group A was severe TBI with Glasgow Coma Scale (GCS) score 3-5 and Group B was mild TBI with GCS score 13-15. The median serum concentration of S100B, GFAP, and UCH-L1 in severe TBI were raised 5.1 fold, 5.5 fold, and 439.1 fold compared to mild injury, respectively. The serum levels of these markers correlated significantly with the injury severity and clinical outcome (p<0.001). Increased level of markers was strongly predicted poor outcomes. Conclusion S100B, GFAP, and UCH-L1 serum level of were significantly increased in TBI according to severity and associated clinical outcomes. Biomarkers have potential utility as diagnostic, prognostic, and therapeutic adjuncts in the setting of TBI.
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Affiliation(s)
- Jae Yoon Lee
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Cheol Young Lee
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea. ; Graduate School of Medicine, Kyung Hee University, Seoul, Korea. ; Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - Hong Rye Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Hyun Woo Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Jong Hyun Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
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Ellis SD, Nielsen ME, Carpenter WR, Jackson GL, Wheeler SB, Liu H, Weinberger M. Gonadotropin-releasing hormone agonist overuse: urologists' response to reimbursement and characteristics associated with persistent overuse. Prostate Cancer Prostatic Dis 2015; 18:173-81. [PMID: 25849354 PMCID: PMC4430363 DOI: 10.1038/pcan.2015.10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/21/2015] [Accepted: 02/18/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Medicare reimbursement cuts have been associated with declining gonadotropin-releasing hormone (GnRH) agonist overuse in localized prostate cancer. Medical school affiliation and foreign training have been associated with persistent overuse. However, physician-level prescribing changes and the practice type of persistent overusers have not been examined. We sought to describe physician-level changes in GnRH agonist overuse and test the association of time in practice and solo practice type with GnRH agonist overuse. METHODS We matched American Medical Association physician data for 2138 urologists to Surveillance, Epidemiology and End Result-Medicare data for 12,943 men diagnosed with early-stage and lower-grade adenocarcinoma of the prostate between 2000 and 2007. We conducted a population-based, retrospective study using multilevel modeling to control for patient and provider characteristics. RESULTS Three distinct patterns of GnRH agonist overuse were observed. Urologists' time in practice was not associated with GnRH agonist overuse (odds ratio (OR) 0.89; 95% confidence interval (CI): 0.75-1.05). However, solo practice type (OR 1.65; 95% CI: 1.34-2.02), medical school affiliation (OR 0.65; 95% CI: 0.55-0.77) and patient race were. Compared with non-Hispanic whites, non-Hispanic blacks (OR 1.76; 95% CI: 1.37-2.27), Hispanics (OR 1.41; 95% CI: 1.12-1.79) and men of 'other' race (OR 1.44; 95% CI: 1.04-1.99) had greater odds of receiving unnecessary GnRH agonists. CONCLUSIONS GnRH agonist overuse remains high among some urologists who may be professionally isolated and difficult to reach. These urologists treat more vulnerable populations, which may contribute to health disparities in prostate cancer treatment quality. Nonetheless, these findings provide guidance to develop interventions to address overuse in prostate cancer.
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Affiliation(s)
- Shellie D. Ellis
- Department of Health Policy and Management, University of Kansas School of Medicine
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Matthew E. Nielsen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Department of Urology, School of Medicine, University of North Carolina at Chapel Hill
| | - William R. Carpenter
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - George L. Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center
- Division of General Internal Medicine, Duke University Medical Center
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Huan Liu
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center
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Foy R, Sales A, Wensing M, Aarons GA, Flottorp S, Kent B, Michie S, O'Connor D, Rogers A, Sevdalis N, Straus S, Wilson P. Implementation science: a reappraisal of our journal mission and scope. Implement Sci 2015; 10:51. [PMID: 25928695 PMCID: PMC4409721 DOI: 10.1186/s13012-015-0240-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 03/30/2015] [Indexed: 01/28/2023] Open
Abstract
The implementation of research findings into healthcare practice has become increasingly recognised as a major priority for researchers, service providers, research funders and policymakers over the past decade. Nine years after its establishment, Implementation Science, an international online open access journal, currently publishes over 150 articles each year. This is fewer than 30% of those submitted for publication. The majority of manuscript rejections occur at the point of initial editorial screening, frequently because we judge them to fall outside of journal scope. There are a number of common reasons as to why manuscripts are rejected on grounds of scope. Furthermore, as the field of implementation research has evolved and our journal submissions have risen, we have, out of necessity, had to become more selective in what we publish. We have also expanded our scope, particularly around patient-mediated and population health interventions, and will monitor the impact of such changes. We hope this editorial on our evolving priorities and common reasons for rejection without peer review will help authors to better judge the relevance of their papers to Implementation Science.
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Affiliation(s)
- Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Anne Sales
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Michel Wensing
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.
| | | | - Signe Flottorp
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
| | - Bridie Kent
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.
| | - Susan Michie
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Denise O'Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Anne Rogers
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College, London, UK.
| | - Sharon Straus
- Li Ka Shing Knowledge Institute of St Michael's, University of Toronto, Toronto, Canada.
| | - Paul Wilson
- Manchester Business School, University of Manchester, Manchester, UK.
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Cook CR, Frye M, Slemrod T, Lyon AR, Renshaw TL, Zhang Y. An integrated approach to universal prevention: Independent and combined effects of PBIS and SEL on youths' mental health. ACTA ACUST UNITED AC 2015; 30:166-183. [PMID: 25602629 DOI: 10.1037/spq0000102] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mental health among children and adolescents is a growing national concern and schools have taken center stage in efforts to prevent problems and promote wellness. Although research and policymakers support the integration of mental health services into the schools, there is limited agreement on the ways to package or combine existing supports to achieve prevention-oriented goals. Positive Behavioral Interventions and Supports (PBIS) and Social Emotional Learning (SEL) are 2 of the most widely adopted, evidence-based approaches that have been advocated to address student mental health. These universal prevention approaches, however, stem from different theoretical camps and are often advocated and implemented apart from one another. The purpose of this study was to examine the independent and combined effects of PBIS and SEL on student mental health outcomes. A quasi-randomized control design at the classroom level was used to make comparisons across 4 conditions: business-as-usual (BAU), PBIS alone, SEL alone, and COMBO condition with regard to their acceptability to teachers, integrity of program delivery, and student outcomes. As predicted, the COMBO condition produced significantly greater improvements in overall mental health and reductions in externalizing behaviors when compared to all other conditions. The results also indicated that the PBIS- and SEL-only conditions were both able to produce significant improvements in overall mental health functioning as compared with the BAU control. The implications of an integrated approach for school-based universal prevention and directions for future research are discussed.
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Affiliation(s)
| | - Megan Frye
- College of Education, University of Washington
| | - Tal Slemrod
- College of Education, University of Washington
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Bunce AE, Gold R, Davis JV, McMullen CK, Jaworski V, Mercer M, Nelson C. Ethnographic process evaluation in primary care: explaining the complexity of implementation. BMC Health Serv Res 2014; 14:607. [PMID: 25475025 PMCID: PMC4265455 DOI: 10.1186/s12913-014-0607-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background The recent growth of implementation research in care delivery systems has led to a renewed interest in methodological approaches that deliver not only intervention outcome data but also deep understanding of the complex dynamics underlying the implementation process. We suggest that an ethnographic approach to process evaluation, when informed by and integrated with quantitative data, can provide this nuanced insight into intervention outcomes. The specific methods used in such ethnographic process evaluations are rarely presented in detail; our objective is to stimulate a conversation around the successes and challenges of specific data collection methods in health care settings. We use the example of a translational clinical trial among 11 community clinics in Portland, OR that are implementing an evidence-based, health-information technology (HIT)-based intervention focused on patients with diabetes. Discussion Our ethnographic process evaluation employed weekly diaries by clinic-based study employees, observation, informal and formal interviews, document review, surveys, and group discussions to identify barriers and facilitators to implementation success, provide insight into the quantitative study outcomes, and uncover lessons potentially transferable to other implementation projects. These methods captured the depth and breadth of factors contributing to intervention uptake, while minimizing disruption to clinic work and supporting mid-stream shifts in implementation strategies. A major challenge is the amount of dedicated researcher time required. Summary The deep understanding of the ‘how’ and ‘why’ behind intervention outcomes that can be gained through an ethnographic approach improves the credibility and transferability of study findings. We encourage others to share their own experiences with ethnography in implementation evaluation and health services research, and to consider adapting the methods and tools described here for their own research. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0607-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arwen E Bunce
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
| | - Rachel Gold
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA. .,OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - James V Davis
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
| | - Carmit K McMullen
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
| | - Victoria Jaworski
- Multnomah County Health Department, 426 SW Stark St., Portland, OR, 97204, USA.
| | - MaryBeth Mercer
- Virginia Garcia Memorial Health Center, PO Box 568, Cornelius, OR, 97113, USA.
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Lamb CR, Adams CA. Acceptance rates for manuscripts submitted to veterinary peer-reviewed journals in 2012. Equine Vet J 2014; 47:736-40. [PMID: 25302854 DOI: 10.1111/evj.12376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
Abstract
REASONS FOR PERFORMING STUDY Relatively few journals publish their annual acceptance rate, although this figure is of scientific and academic interest. OBJECTIVES To determine the acceptance rate for manuscripts submitted to veterinary peer-reviewed journals during 2012 and to determine the proportions of submitted manuscripts that were accepted without revision, accepted after revision or rejected. STUDY DESIGN Self-reporting email questionnaire METHODS Editors of 118 peer-reviewed journals listed in the Web of Science in the subject category veterinary sciences were invited by email to submit data pertinent to manuscripts submitted to their journal in 2012. RESULTS Data were received from 30 (26%) journals. Mean ± s.d. acceptance rate was 47 ± 15%. On average 3 ± 5% submitted manuscripts were accepted without revision, 44% ± 15% manuscripts were accepted after revision, 4 ± 4% manuscripts were withdrawn by authors, 46 ± 17% manuscripts were rejected and 3 ± 5% manuscripts were still pending at the end of the study period. CONCLUSIONS With so few manuscripts accepted without revision, prospective authors must expect to expend time and effort revising and resubmitting their manuscripts for publication. Although authors are frequently able to correct manuscript flaws identified by reviewers, the knowledge that less than half submitted manuscripts are accepted might help stimulate prospective authors to try to submit better quality manuscripts.
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Affiliation(s)
- C R Lamb
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, UK
| | - C A Adams
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, UK
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Hayes KJ, Reed N, Fitzgerald A, Watt V. Applying lean flows in pathology laboratory remodelling. J Health Organ Manag 2014; 28:229-46. [PMID: 25065112 DOI: 10.1108/jhom-03-2013-0064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This purpose of this paper is to examine the application and outcomes of applying all of the seven lean flows to pathology laboratory remodelling as part of a lean rapid improvement event (RIE). DESIGN/METHODOLOGY/APPROACH Longitudinal case study of a lean RIE linking emergency and pathology departments focusing on the systematic application of lean's seven flows to the physical environment. FINDINGS Following the lean RIE, changes improving patient specimen, technician, supplies and information flows avoided 187 km and eight days of unnecessary walking each year. RESEARCH LIMITATIONS/IMPLICATIONS The difficulty of making accurate comparisons between time periods in a health care setting is acknowledged. PRACTICAL IMPLICATIONS This research provides evidence that applying lean design concepts in a laboratory can make substantial improvements, particularly if the expertise of the people working in the laboratory is trusted to determine the most appropriate changes. Significant amounts of time and motion were saved by just one, easily quantifiable change. SOCIAL IMPLICATIONS The laboratory staff is processing increased numbers of time-critical tests, yet report a calmer working environment, without any increase in the pace of work. Laboratory personnel also experienced satisfaction in exercising control over their work environment. ORIGINALITY/VALUE To the best of the authors' knowledge this is the first comprehensive report applying lean flows to pathology laboratory remodelling and one of the few applications of Lean Systems Thinking between departments and between separate health services organisations.
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Manolio TA, Green ED. Leading the way to genomic medicine. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2014; 166C:1-7. [PMID: 24619573 DOI: 10.1002/ajmg.c.31384] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The National Human Genome Research Institute, in close collaboration with its research community, is pursuing an ambitious research agenda to facilitate and promote the implementation of genomics in clinical care. Since 2011, research programs utilizing next-generation sequencing in the management of cancer and other multigenic conditions, workup of undiagnosed conditions, and evaluation of disorders of the newborn period have been initiated, along with projects identifying clinically actionable variants and exploring the ethical and social implications of reporting these findings. Several genomic medicine symposia and other consultations have helped to shape these research initiatives and develop educational materials for physicians and others working to implement the use of genomic findings in clinical care. These efforts provide a valuable complement to the highly successful basic genomics research enterprise that has at last enabled the transition of genomics from the bench to the bedside.
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Wallace LM, Brown KE, Hilton S. Planning for, implementing and assessing the impact of health promotion and behaviour change interventions: a way forward for health psychologists. Health Psychol Rev 2013; 8:8-33. [PMID: 25053005 DOI: 10.1080/17437199.2013.775629] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Researchers in the field of health psychology have increasingly been involved in translating a body of knowledge about psychological factors associated with health-relevant behaviours, into the development and evaluation of interventions that seek to apply that knowledge. In this paper we argue that a changing economic and political climate, and the strong behavioural contribution to disease morbidity and mortality in developed nations, requires health psychologists to plan more rigorously for, and communicate more effectively, about how health promotion, social cognition and behaviour change interventions will have impact and be increasingly embedded into health services or health promotion activity. We explain academic and wider socio-economic uses of 'impact' in health services research. We describe the relationship between impact and dissemination, and impact as distinct from, but often used interchangeably with the terms 'implementation', 'knowledge transfer' and 'knowledge translation' (KT). The evidence for establishing impact is emergent. We therefore draw on a number of impact planning and KT frameworks, with reference to two self- management interventions, to describe a framework that we hope will support health psychologists in embedding impact planning and execution in research. We illustrate this further in an on-line annexe with reference to one of our own interventions, Mums-and-MS (see Supplemental Material).
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Affiliation(s)
- L M Wallace
- a Applied Research Centre for Health & Lifestyle Interventions , Coventry University , Coventry CV1 5FB , UK
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Kleinman LC, Dougherty D. Assessing quality improvement in health care: theory for practice. Pediatrics 2013; 131 Suppl 1:S110-9. [PMID: 23457146 DOI: 10.1542/peds.2012-1427n] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To review the role of theory as a means to enhance the practice of quality improvement (QI) research and to propose a novel conceptual model focused on the operations of health care. METHODS Conceptual model, informed by literature review. RESULTS To optimize learning across QI studies requires the integration of small-scale theories (middle-range theories, theories of change) within the context of larger unifying theories. We propose that health care QI research would benefit from a theory that describes the operations of health care delivery, including the multiplicity of roles that interpersonal interactions play. The broadest constructs of the model are entry into the system, and assessment and management of the patient, with the subordinate operations of access; recognition, assessment, and diagnosis; and medical decision-making (developing a plan), coordination of care, execution of care, referral and reassessment, respectively. Interpersonal aspects of care recognize the patient/caregiver as a source of information, an individual in a cultural context, a complex human being, and a partner in their care. Impacts to any and all of these roles may impact the quality of care. CONCLUSIONS Such a theory can promote opportunities for moving the field forward and organizing the planning and interpretation of comparable studies. The articulation of such a theory may simultaneously provide guidance for the QI researcher and an opportunity for refinement and improvement.
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Affiliation(s)
- Lawrence C Kleinman
- Mount Sinai School of Medicine, Department of Health Evidence and Policy, One Gustave Levy Place, Box 1077, New York, NY 10029, USA.
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Manolio TA, Chisholm RL, Ozenberger B, Roden DM, Williams MS, Wilson R, Bick D, Bottinger EP, Brilliant MH, Eng C, Frazer KA, Korf B, Ledbetter DH, Lupski JR, Marsh C, Mrazek D, Murray MF, O'Donnell PH, Rader DJ, Relling MV, Shuldiner AR, Valle D, Weinshilboum R, Green ED, Ginsburg GS. Implementing genomic medicine in the clinic: the future is here. Genet Med 2013; 15:258-67. [PMID: 23306799 PMCID: PMC3835144 DOI: 10.1038/gim.2012.157] [Citation(s) in RCA: 371] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Although the potential for genomics to contribute to clinical care has long been anticipated, the pace of defining the risks and benefits of incorporating genomic findings into medical practice has been relatively slow. Several institutions have recently begun genomic medicine programs, encountering many of the same obstacles and developing the same solutions, often independently. Recognizing that successful early experiences can inform subsequent efforts, the National Human Genome Research Institute brought together a number of these groups to describe their ongoing projects and challenges, identify common infrastructure and research needs, and outline an implementation framework for investigating and introducing similar programs elsewhere. Chief among the challenges were limited evidence and consensus on which genomic variants were medically relevant; lack of reimbursement for genomically driven interventions; and burden to patients and clinicians of assaying, reporting, intervening, and following up genomic findings. Key infrastructure needs included an openly accessible knowledge base capturing sequence variants and their phenotypic associations and a framework for defining and cataloging clinically actionable variants. Multiple institutions are actively engaged in using genomic information in clinical care. Much of this work is being done in isolation and would benefit from more structured collaboration and sharing of best practices. Genet Med 2013:15(4):258–267
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Affiliation(s)
- Teri A Manolio
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Fuller T, Pearson M, Peters JL, Anderson R. Evaluating the impact and use of Transparent Reporting of Evaluations with Non-randomised Designs (TREND) reporting guidelines. BMJ Open 2012; 2:bmjopen-2012-002073. [PMID: 23257774 PMCID: PMC3533093 DOI: 10.1136/bmjopen-2012-002073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Accurate and full reporting of evaluation of interventions in health research is needed for evidence synthesis and informed decision-making. Evidence suggests that biases and incomplete reporting affect the assessment of study validity and the ability to include this data in secondary research. The Transparent Reporting of Evaluations with Non-randomised Designs (TREND) reporting guideline was developed to improve the transparency and accuracy of the reporting of behavioural and public health evaluations with non-randomised designs. Evaluations of reporting guidelines have shown that they can be effective in improving reporting completeness. Although TREND occupies a niche within reporting guidelines, and despite it being 8 years since publication, no study yet has assessed its impact on reporting completeness or investigated what factors affect its use by authors and journal editors. This protocol describes two studies that aim to redress this. METHODS AND ANALYSIS Study 1 will use an observational design to examine the uptake and use of TREND by authors, and by journals in their instructions to authors. A comparison of reporting completeness and study quality of papers that do and do not use TREND to inform reporting will be made. Study 2 will use a cross-sectional survey to investigate what factors inhibit or facilitate authors' and journal editors' use of TREND. Semistructured interviews will also be conducted with a subset of authors and editors to explore findings from study 1 and the surveys in greater depth. ETHICS AND DISSEMINATION These studies will generate evidence of how implementation and dissemination of the TREND guideline has affected reporting completeness in studies with experimental, non-randomised designs within behavioural and public health research. The project has received ethics approval from the Research Ethics Committee of the Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth.
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Affiliation(s)
- Thomas Fuller
- Peninsula Collaborations for Leadership in Applied Health Research and Care (PenCLAHRC), University of Exeter, Exeter, UK
| | - Mark Pearson
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Jaime L Peters
- Peninsula Collaborations for Leadership in Applied Health Research and Care (PenCLAHRC), University of Exeter, Exeter, UK
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Rob Anderson
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
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