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Sullivan MO, Curtin M, Flynn R, Cronin C, Mahony JO, Trujillo J. Telehealth interventions for transition to self-management in adolescents with allergic conditions: A systematic review. Allergy 2024; 79:861-883. [PMID: 38041398 DOI: 10.1111/all.15963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
Telehealth is an emerging approach that uses technology to provide healthcare remotely. Recent publications have outlined the importance of supporting the transition to self-management of adolescents with allergic conditions. However, no synthesis of the evidence base on the use and impact of telehealth interventions for this purpose has been conducted to date. This review achieves these aims, in addition to exploring the language use surrounding these interventions, and their implementation. Four databases were searched systematically. References were independently screened by two reviewers. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was undertaken. Eighteen articles were included, reporting on 15 telehealth interventions. A total of 86% targeted adolescents with asthma. Mobile applications were the most common telehealth modality used, followed by video-conferencing, web-based, virtual reality and artificial intelligence. Five intervention content categories were identified; educational, monitoring, behavioural, psychosocial and healthcare navigational. Peer and/or healthcare professional interaction, gamification and tailoring may increase engagement. The studies showed positive effects of the interventions or no difference from active controls, in self-management outcomes such as knowledge, health outcomes such as quality-of-life, and economic outcomes such as healthcare utilization. The most common implementation outcomes reported were acceptability, appropriateness, feasibility and fidelity.
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Affiliation(s)
- Meg O' Sullivan
- University College Cork, Cork, Ireland
- Cork University Hospital, Cork, Ireland
| | | | | | | | | | - Juan Trujillo
- University College Cork, Cork, Ireland
- Cork University Hospital, Cork, Ireland
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Byrnes A, Flynn R, Watt A, Barrimore S, Young A. Sustainability of enhanced recovery after surgery programmes in gastrointestinal surgery: A scoping review. J Eval Clin Pract 2024; 30:217-233. [PMID: 37957803 DOI: 10.1111/jep.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) is an evidence-based intervention that is well-recognised across multiple surgical specialties as having potential to lead to improved patient and hospital outcomes. Little is known about sustainability of ERAS programmes. AIMS This review aimed to describe available evidence evaluating sustainability of ERAS programmes in gastrointestinal surgery to understand: (a) how sustainability has been defined; (b) examine determinants of sustainability; (c) identify strategies used to facilitate sustainability; (d) identify adaptations to support sustainability; and (e) examine outcomes measured as indicators of sustainability of ERAS programmes. METHODS This scoping review was conducted following the Joanna Briggs Institute's methodology. Research databases (PubMed, Embase, CINHAL) and the grey literature were searched (inception to September 2022) for studies reporting sustainability of ERAS programmes in gastrointestinal surgery. Included articles reported an aspect of sustainability (i.e., definition, determinants, strategies, adaptations, outcomes and ongoing use) at ≥2 years following initial implementation. Aspects of sustainability were categorised according to relevant frameworks to facilitate synthesis. RESULTS The search strategy yielded 1852 records; first round screening excluded 1749, leaving 103 articles for full text review. Overall, 22 studies were included in this review. Sustainability was poorly conceptualised and inconsistently reported across included studies. Provision of adequate resources was the most frequently identified enabler to sustainability (n/N = 9/12, 75%); however, relatively few studies (n = 4) provided a robust report of determinants, with no study reporting determinants of sustainability and strategies and adaptations to support sustainability alongside patient and service delivery outcomes. CONCLUSION Improved reporting, particularly of strategies and adaptations to support sustainability is needed. Refinement of ERAS reporting guidelines should be made to facilitate this, and future implementation studies should plan to document and report changes in context and corresponding programme changes to help researchers and clinicians sustain ERAS programmes locally.
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Affiliation(s)
- Angela Byrnes
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Rachel Flynn
- Health Information and Standards Directorate, Health Information and Quality Authority, Cork, Ireland
| | - Amanda Watt
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Sally Barrimore
- Nutrition and Dietetics Department, Prince Charles Hospital, Chermside, Queensland, Australia
| | - Adrienne Young
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, Australia
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Cassidy CE, Flynn R, Campbell A, Dobson L, Langley J, McNeil D, Milne E, Zanoni P, Churchill M, Benzies KM. Knowledge translation strategies used for sustainability of an evidence-based intervention in child health: a multimethod qualitative study. BMC Nurs 2024; 23:125. [PMID: 38368328 PMCID: PMC10874067 DOI: 10.1186/s12912-024-01777-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/30/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Sustainability of evidence-based interventions (EBIs) is suboptimal in healthcare. Evidence on how knowledge translation (KT) strategies are used for the sustainability of EBIs in practice is lacking. This study examined what and how KT strategies were used to facilitate the sustainability of Alberta Family Integrated Care (FICare)™, a psychoeducational model of care scaled and spread across 14 neonatal intensive care units, in Alberta, Canada. METHODS First, we conducted an environmental scan of relevant documents to determine the use of KT strategies to support the sustainability of Alberta FICare™. Second, we conducted semi-structured interviews with decision makers and operational leaders to explore what and how KT strategies were used for the sustainability of Alberta FICare™, as well as barriers and facilitators to using the KT strategies for sustainability. We used the Expert Recommendations for Implementation Change (ERIC) taxonomy to code the strategies. Lastly, we facilitated consultation meetings with the Alberta FICare™ leads to share and gain insights and clarification on our findings. RESULTS We identified nine KT strategies to facilitate the sustainability of Alberta FICare™: Conduct ongoing training; Identify and prepare local champions; Research co-production; Remind clinicians; Audit and provide feedback; Change record systems; Promote adaptability; Access new funding; and Involve patients/consumers and family members. A significant barrier to the sustainability of Alberta FICare™ was a lack of clarity on who was responsible for the ongoing maintenance of the intervention. A key facilitator to sustainability of Alberta FICare was its alignment with the Maternal, Newborn, Child & Youth Strategic Clinical Network (MNCY SCN) priorities. Co-production between researchers and health system partners in the design, implementation, and scale and spread of Alberta FICare™ was critical to sustainability. CONCLUSION This research highlights the importance of clearly articulating who is responsible for continued championing for the sustainability of EBIs. Additionally, our research demonstrates that the adaptation of interventions must be considered from the onset of implementation so interventions can be tailored to align with contextual barriers for sustainability. Clear guidance is needed to continually support researchers and health system leaders in co-producing strategies that facilitate the long-term sustainability of effective EBIs in practice.
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Affiliation(s)
- Christine E Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, 5869 University Avenue, B3H 4R2, Halifax, NS, PO Box 15000, Canada.
| | - Rachel Flynn
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College of Cork, College Road, T12 AK54, Cork, Ireland
| | - Alyson Campbell
- Faculty of Nursing, University of Prince Edward Island, 550 University Avenue, HSB Room 116, C1A 4P3, Charlottetown, PE, Canada
| | - Lauren Dobson
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Level 3, 11405 87 Avenue, T6G 1C9, Edmonton, AB, Canada
| | - Jodi Langley
- Faculty of Health, Dalhousie University, 5790 University Avenue, B3H 1V7, Halifax, NS, Canada
| | - Deborah McNeil
- Strategic Clinical Networks, Alberta Health Services, 10101 Southport Road SW, T2W 3N2, Calgary, AB, Canada
- Faculty of Nursing, Departments of Pediatrics and Community Health Science, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, T2N 1N4, Calgary, AB, Canada
| | - Ella Milne
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Level 3, 11405 87 Avenue, T6G 1C9, Edmonton, AB, Canada
| | - Pilar Zanoni
- Faculty of Nursing , University of Calgary, 2500 University Drive NW, T2N 1N4, Calgary, AB, Canada
| | - Megan Churchill
- Department of Pediatrics, IWK Health, 5980 University Ave #5850, B3K 6R8, Halifax, NS, Canada
| | - Karen M Benzies
- Faculty of Nursing, Departments of Pediatrics and Community Health Science, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, T2N 1N4, Calgary, AB, Canada
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Flynn R, Cassidy C, Dobson L, Al-Rassi J, Langley J, Swindle J, Graham ID, Scott SD. Knowledge translation strategies to support the sustainability of evidence-based interventions in healthcare: a scoping review. Implement Sci 2023; 18:69. [PMID: 38049900 PMCID: PMC10694920 DOI: 10.1186/s13012-023-01320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Knowledge translation (KT) strategies are widely used to facilitate the implementation of EBIs into healthcare practices. However, it is unknown what and how KT strategies are used to facilitate the sustainability of EBIs in institutional healthcare settings. OBJECTIVES This scoping review aimed to consolidate the current evidence on (i) what and how KT strategies are being used for the sustainability of EBIs in institutional healthcare settings; (ii) the reported KT strategy outcomes (e.g., acceptability) for EBI sustainability, and (iii) the reported EBI sustainability outcomes (e.g., EBI activities or component of the intervention continue). METHODS We conducted a scoping review of five electronic databases. We included studies describing the use of specific KT strategies to facilitate the sustainability of EBIs (more than 1-year post-implementation). We coded KT strategies using the clustered ERIC taxonomy and AIMD framework, we coded KT strategy outcomes using Tierney et al.'s measures, and EBI sustainability outcomes using Scheirer and Dearing's and Lennox's taxonomy. We conducted descriptive numerical summaries and a narrative synthesis to analyze the results. RESULTS The search identified 3776 studies for review. Following the screening, 25 studies (reported in 27 papers due to two companion reports) met the final inclusion criteria. Most studies used multi-component KT strategies for EBI sustainability (n = 24). The most common ERIC KT strategy clusters were to train and educate stakeholders (n = 38) and develop stakeholder interrelationships (n = 34). Education was the most widely used KT strategy (n = 17). Many studies (n = 11) did not clearly report whether they used different or the same KT strategies between EBI implementation and sustainability. Seven studies adapted KT strategies from implementation to sustainability efforts. Only two studies reported using a new KT strategy for EBI sustainability. The most reported KT strategy outcomes were acceptability (n = 10), sustainability (n = 5); and adoption (n = 4). The most commonly measured EBI sustainability outcome was the continuation of EBI activities or components (n = 23), followed by continued benefits for patients, staff, and stakeholders (n = 22). CONCLUSIONS Our review provides insight into a conceptual problem where initial EBI implementation and sustainability are considered as two discrete time periods. Our findings show we need to consider EBI implementation and sustainability as a continuum and design and select KT strategies with this in mind. Our review has emphasized areas that require further research (e.g., KT strategy adaptation for EBI sustainability). To advance understanding of how to employ KT strategies for EBI sustainability, we recommend clearly reporting the dose, frequency, adaptations, fidelity, and cost of KT strategies. Advancing our understanding in this area would facilitate better design, selection, tailored, and adapted use of KT strategies for EBI sustainability, thereby contributing to improved patient, provider, and health system outcomes.
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Affiliation(s)
- Rachel Flynn
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College of Cork, College Road Cork, Cork, T12 AK54, Ireland.
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Lauren Dobson
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Joyce Al-Rassi
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jodi Langley
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jennifer Swindle
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- The Centre for Implementation Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 241, Ottawa, Ontario, K1H 8L6, Canada
| | - Shannon D Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Kelly Y, O'Rourke N, Flynn R, O'Connor L, Hegarty J. Factors that influence the implementation of (inter)nationally endorsed health and social care standards: a systematic review and meta-summary. BMJ Qual Saf 2023; 32:750-762. [PMID: 37290917 PMCID: PMC10803983 DOI: 10.1136/bmjqs-2022-015287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 04/15/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Health and social care standards have been widely adopted as a quality improvement intervention. Standards are typically made up of evidence-based statements that describe safe, high-quality, person-centred care as an outcome or process of care delivery. They involve stakeholders at multiple levels and multiple activities across diverse services. As such, challenges exist with their implementation. Existing literature relating to standards has focused on accreditation and regulation programmes and there is limited evidence to inform implementation strategies specifically tailored to support the implementation of standards. This systematic review aimed to identify and describe the most frequently reported enablers and barriers to implementing (inter)nationally endorsed standards, in order to inform the selection of strategies that can optimise their implementation. METHODS Database searches were conducted in Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SocINDEX, Google Scholar, OpenGrey and GreyNet International, complemented by manual searches of standard-setting bodies' websites and hand searching references of included studies. Primary qualitative, quantitative descriptive and mixed methods studies that reported enablers and barriers to implementing nationally or internationally endorsed standards were included. Two researchers independently screened search outcomes and conducted data extraction, methodological appraisal and CERQual (Confidence in Evidence from Reviews of Qualitative research) assessments. An inductive analysis was conducted using Sandelowski's meta-summary and measured frequency effect sizes (FES) for enablers and barriers. RESULTS 4072 papers were retrieved initially with 35 studies ultimately included. Twenty-two thematic statements describing enablers were created from 322 descriptive findings and grouped under six themes. Twenty-four thematic statements describing barriers were created from 376 descriptive findings and grouped under six themes. The most prevalent enablers with CERQual assessments graded as high included: available support tools at local level (FES 55%); training courses to increase awareness and knowledge of the standards (FES 52%) and knowledge sharing and interprofessional collaborations (FES 45%). The most prevalent barriers with CERQual assessments graded as high included: a lack of knowledge of what standards are (FES 63%), staffing constraints (FES 46%), insufficient funds (FES 43%). CONCLUSIONS The most frequently reported enablers related to available support tools, education and shared learning. The most frequently reported barriers related to a lack of knowledge of standards, staffing issues and insufficient funds. Incorporating these findings into the selection of implementation strategies will enhance the likelihood of effective implementation of standards and subsequently, improve safe, quality care for people using health and social care services.
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Affiliation(s)
- Yvonne Kelly
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Cork, Ireland
- Catherine McAuley School of Nursing and Midwifery and School of Public Health (SPHeRE programme), University College Cork, Cork, Ireland
| | - Niamh O'Rourke
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Rachel Flynn
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Laura O'Connor
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Drummond L, Guiney S, Connolly D, Foley C, O'Connor L, O'Carroll T, Flynn R, Rohde D. Experiences of shared decision making in acute hospitals: A mixed methods secondary analysis of the Irish National Inpatient Experience Survey. Patient Educ Couns 2023; 113:107755. [PMID: 37099839 DOI: 10.1016/j.pec.2023.107755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/04/2023] [Accepted: 04/12/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION This study explored patient experiences of shared decision making (SDM) in public acute hospitals in Ireland. METHODS Quantitative and qualitative data from three years of the Irish National Inpatient Experience Survey were analysed. Survey questions were mapped to definitions of SDM and subjected to principal components analysis. Three SDM subscales (care on the ward; treatments; discharge) and one overall SDM scale were created. Differences in experiences of SDM by aspects of care and patient group were assessed. Thematic analysis of qualitative responses was undertaken. RESULTS 39,453 patients participated in the survey. The mean SDM experience score was 7.60 ± 2.43. Experience scores were highest on the treatments sub-scale, and lowest during discharge. Patients who had a non-emergency admission, those aged 51-80 years and men had more positive experiences than other groups. Patient comments highlighted that opportunities to clarify information and facilitation of families/caregivers in SDM were found to be lacking. CONCLUSION There were differences in experiences of SDM by aspects of care and patient group. PRACTICE IMPLICATIONS Efforts to improve SDM in acute hospitals are required, particularly at the time of discharge. SDM may be improved by facilitation of more time for discussion between clinicians and patients and/or their families/caregivers.
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Affiliation(s)
- Linda Drummond
- Health Information and Quality Authority, Dublin, Ireland.
| | | | | | - Conor Foley
- Health Information and Quality Authority, Dublin, Ireland
| | - Laura O'Connor
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Rachel Flynn
- Health Information and Quality Authority, Dublin, Ireland
| | - Daniela Rohde
- Health Information and Quality Authority, Dublin, Ireland
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Kelly Y, O'Rourke N, Flynn R, Hegarty J, O'Connor L. Definitions of health and social care standards used internationally: A narrative review. Int J Health Plann Manage 2023; 38:40-52. [PMID: 36128602 PMCID: PMC10087784 DOI: 10.1002/hpm.3573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 01/05/2023] Open
Abstract
Setting standards is a quality improvement mechanism and an important means for shaping the provision of health and social care services. Standards comprise statements describing a process or outcome of care. Setting standards is a global practice. It would be useful to have an understanding of the underpinning definitions of standards used internationally. Therefore, the aim of this review was to examine definitions of health and social care standards used internationally and identify similarities and differences. A targeted grey literature search of standard-setting bodies' websites and related health legislation was conducted to retrieve explicit definitions of standards. Of 15 standard-setting bodies that were searched, 12 definitions of standards were narratively synthesised. Terms that appeared in two or more of the definitions were extracted. Counts and percentages were calculated for these terms to determine magnitude of use. The commonalities among definitions included 'quality' (n = 6, 50%), 'statements' (n = 5, 42%), 'performance' (n = 5, 42%), and 'measureable' (n = 4, 33%). The less commonly used terms were 'processes' (n = 3, 25%), 'set' (n = 3, 25%), 'evidence based' (n = 2, 17%), 'outcome' (n = 2, 17%), 'safe' (n = 2, 17%), and 'guidance' (n = 2, 17%). Explicit definitions of standards were not retrieved from health legislation documents. Standard-setting bodies develop standards in the context of the health systems in which they are implemented; some are aspirational levels of quality, while others are minimum levels of quality. Researchers, standards developers and policy makers should be cognisant of this when comparing standards between countries.
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Affiliation(s)
- Yvonne Kelly
- Health Information and Standards Directorate, Health Information and Quality Authority, Cork, Ireland
| | - Niamh O'Rourke
- Health Information and Standards Directorate, Health Information and Quality Authority, Cork, Ireland
| | - Rachel Flynn
- Health Information and Standards Directorate, Health Information and Quality Authority, Cork, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Laura O'Connor
- Health Information and Standards Directorate, Health Information and Quality Authority, Cork, Ireland
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Flaherty SJ, Duggan C, O'Connor L, Foley B, Flynn R. What influences a person's willingness to share health information for both direct care and uses beyond direct care? Findings from a focus group study in Ireland. HRB Open Res 2022; 5:36. [PMID: 36072819 PMCID: PMC9411973 DOI: 10.12688/hrbopenres.13548.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The sharing of health information is invaluable for direct care provision and reasons beyond direct care, such as for health services management. Previous studies have shown that willingness to share health information is influenced by an individual's trust in a healthcare professional or organisation, privacy and security concerns, and fear of discrimination based on sensitive information. The importance of engaging the public in policy and practice development relating to the use and sharing of health information has been identified as an essential step for countries to take. This study's aim was to examine the factors that influence the Irish public's willingness to share their health information as part of a national public engagement on health information. Methods: A qualitative study using online focus groups was conducted as part of a wider national public engagement on health information. Participants were purposively recruited from a combination of public, patient, and service user groups in Ireland. Focus group interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Results: In total, 85 participants took part in 14 focus groups between January and March 2021. Two major themes were identified, trust and personal and public benefits of sharing health information. The ability to exercise control over personal information, perceived transparency of the process, and the extent to which the healthcare service was viewed as confidential, all influenced the level of trust a person held. Perceived benefits were influenced by the extent to which participants believed information sharing would support improved care or provide broader public benefit, and balanced against the potential for personal harm. Conclusions: The findings allow for new insights into the views of the public on the use and sharing of personal health information and can be used to inform the development of a consent model for health information.
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Affiliation(s)
| | - Catherine Duggan
- 1. Health Information and Quality Authority, Cork, T12 Y2XT, Ireland
| | - Laura O'Connor
- 1. Health Information and Quality Authority, Cork, T12 Y2XT, Ireland
| | - Barbara Foley
- 1. Health Information and Quality Authority, Cork, T12 Y2XT, Ireland
| | - Rachel Flynn
- 1. Health Information and Quality Authority, Cork, T12 Y2XT, Ireland
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Flynn R, Stevens B, Bains A, Kennedy M, Scott SD. Identifying existing approaches used to evaluate the sustainability of evidence-based interventions in healthcare: an integrative review. Syst Rev 2022; 11:221. [PMID: 36243760 PMCID: PMC9569065 DOI: 10.1186/s13643-022-02093-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence to evaluate the sustainability of evidence-based interventions (EBIs) for healthcare improvement. Through an integrative review, we aimed to identify approaches to evaluate the sustainability of evidence-based interventions (EBIs) and sustainability outcomes. METHODS Following Whittemore and Knafl's methodological process: (1) problem identification; (2) literature search; (3) data evaluation; (4) data analysis; and (5) presentation, a comprehensive search strategy was applied across five databases. Included studies were not restricted by research design; and had to evaluate the sustainability of an EBI in a healthcare context. We assessed the methodological quality of studies using the Mixed Methods Appraisal Tool. RESULTS Of 18,783 articles retrieved, 64 fit the inclusion criteria. Qualitative designs were most commonly used for evaluation (48%), with individual interviews as the predominant data collection method. Timing of data collection varied widely with post-intervention data collection most frequent (89%). Of the 64 studies, 44% used a framework, 26% used a model, 11% used a tool, 5% used an instrument, and 14% used theory as their primary approach to evaluate sustainability. Most studies (77%) did not measure sustainability outcomes, rather these studies focused on sustainability determinants. DISCUSSION It is unclear which approach/approaches are most effective for evaluating sustainability and what measures and outcomes are most commonly used. There is a disconnect between evaluating the factors that may shape sustainability and the outcomes approaches employed to measure sustainability. Our review offers methodological recommendations for sustainability evaluation research and highlights the importance in understanding mechanisms of sustainability to advance the field.
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Affiliation(s)
- Rachel Flynn
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Bonnie Stevens
- Lawrence S Bloomberg Faculty of Nursing and Faculties of Medicine and Dentistry, University of Toronto, Toronto, Canada.,Associate Chief Nursing Research & Senior Scientist, Research Institute, The Hospital for Sick Children, 686 Bay St., Toronto, ON, M5G 0A4, Canada
| | - Arjun Bains
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Megan Kennedy
- John W. Scott Health Sciences Library, 2K312 WMC University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Shannon D Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Muheilan M, Scanlon L, Barea B, Smyth L, Thomas A, Flynn R, Manecksha R, Casey R. A Comparison of Urology Service Provision Between the First and the Third Waves of the COVID-19 Pandemic. Ir Med J 2022; 115:659. [PMID: 36327989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- M Muheilan
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - L Scanlon
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - B Barea
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - L Smyth
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - A Thomas
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - R Flynn
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - R Manecksha
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - R Casey
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
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Rohde D, Isazad Mashinchi M, Rizun N, Gruda D, Foley C, Flynn R, Ojo A. Generating actionable insights from free-text care experience survey data using qualitative and computational text analysis: A study protocol. HRB Open Res 2022; 5:60. [PMID: 37994330 PMCID: PMC10663659 DOI: 10.12688/hrbopenres.13606.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/24/2023] Open
Abstract
Introduction:The National Care Experience Programme (NCEP) conducts national surveys that ask people about their experiences of care in order to improve the quality of health and social care services in Ireland. Each survey contains open-ended questions, which allow respondents to comment on their experiences. While these comments provide important and valuable information about what matters most to service users, there is to date no unified approach to the analysis and integration of this detailed feedback. The objectives of this study are to analyse qualitative responses to NCEP surveys to determine the key care activities, resources and contextual factors related to positive and negative experiences; to identify key areas for improvement, policy development, healthcare regulation and monitoring; and to provide a tool to access the results of qualitative analyses on an ongoing basis to provide actionable insights and drive targeted improvements. Methods:Computational text analytics methods will be used to analyse 93,135 comments received in response to the National Inpatient Experience Survey and National Maternity Experience Survey. A comprehensive analytical framework grounded in both service management literature and the NCEP data will be employed as a coding framework to underpin automated analyses of the data using text analytics and deep learning techniques. Scenario-based designs will be adopted to determine effective ways of presenting insights to knowledge users to address their key information and decision-making needs. Conclusion:This study aims to use the qualitative data collected as part of routine care experience surveys to their full potential, making this information easier to access and use by those involved in developing quality improvement initiatives. The study will include the development of a tool to facilitate more efficient and standardised analysis of care experience data on an ongoing basis, enhancing and accelerating the translation of patient experience data into quality improvement initiatives.
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Affiliation(s)
- Daniela Rohde
- National Care Experience Programme, Health Information and Quality Authority, Dublin, Ireland
| | - Mona Isazad Mashinchi
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Nina Rizun
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
- Department of Informatics in Management, Gdansk University of Technology, Gdansk, Poland
| | - Dritjon Gruda
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Conor Foley
- National Care Experience Programme, Health Information and Quality Authority, Dublin, Ireland
| | - Rachel Flynn
- National Care Experience Programme, Health Information and Quality Authority, Dublin, Ireland
| | - Adegboyega Ojo
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
- School of Public Policy and Administration (SPPA), Carleton University, Ottawa, K1S 5B6, Canada
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12
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Hooshafza S, Orlandi F, Flynn R, McQuaid L, Stephens G, O'Connor L. Modelling temporal data in knowledge graphs: a systematic review protocol. HRB Open Res 2022; 4:101. [PMID: 38433955 PMCID: PMC10907873 DOI: 10.12688/hrbopenres.13403.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 03/05/2024] Open
Abstract
Background: The benefits of having high-quality healthcare data are well established. However, high-dimensionality and irregularity of healthcare data pose challenges in their management. Knowledge graphs have gained increasing popularity in many domains, as a method for representing data to overcome such challenges. However, little is known about their suitability for use with healthcare data. One important factor in representing data is "time". Data with time related attributes are considered, temporal data. Temporal data are frequently observed in healthcare and the management of rapidly changing patient data is an ongoing challenge. Traditionally, data models have focused on presenting static data and do not account for temporal data. Temporal data models ensure time consistency in data models and assist analysing the history of data and predicting the future trends in data. Knowledge graphs can include temporal data models and are therefore of interest to the field of healthcare data management. As such, the herein aim is to outline a protocol for an inter-disciplinary systematic review of approaches, applications and challenges in modelling temporal data in knowledge graphs so that we can inform the application of knowledge graphs to healthcare data. Method: The research questions is, what are the existing approaches in modelling temporal data in RDF based knowledge graphs. Two sub-questions on applications, and challenges will also be evaluated. ACM digital library, IEEE Xplore and Scopus will be searched for this review. The search will be limited to peer-reviewed literature referring to knowledge graphs based on Resource Description Framework (RDF). A narrative synthesis of the papers will be conducted. Conclusion: The findings of this systematic review will be useful for data engineers to better represent data and perform analytics through temporal data modelling. They can be applied in the context of healthcare data and the current challenges faced in managing rapidly changing patient data.
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Affiliation(s)
- Sepideh Hooshafza
- Health Information and Quality Authority (HIQA), Cork, Ireland
- The SFI ADAPT Research Centre for AI-Driven Digital Content Technology, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Fabrizio Orlandi
- The SFI ADAPT Research Centre for AI-Driven Digital Content Technology, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Rachel Flynn
- Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Louise McQuaid
- Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Gaye Stephens
- The SFI ADAPT Research Centre for AI-Driven Digital Content Technology, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Laura O'Connor
- Health Information and Quality Authority (HIQA), Cork, Ireland
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13
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Flaherty SJ, Duggan C, O'Connor L, Foley B, Flynn R. What influences a person’s willingness to share health information for both direct care and uses beyond direct care? Findings from a focus group study in Ireland. HRB Open Res 2022; 5:36. [PMID: 36072819 PMCID: PMC9411973 DOI: 10.12688/hrbopenres.13548.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The sharing of health information is invaluable for direct care provision and reasons beyond direct care, such as for health services management. Previous studies have shown that willingness to share health information is influenced by an individual’s trust in a healthcare professional or organisation, privacy and security concerns, and fear of discrimination based on sensitive information. The importance of engaging the public in policy and practice development relating to the use and sharing of health information has been identified as an essential step for countries to take. This study’s aim was to examine the factors that influence the Irish public’s willingness to share their health information as part of a national public engagement on health information. Methods: A qualitative study using online focus groups was conducted as part of a wider national public engagement on health information. Participants were purposively recruited from a combination of public, patient, and service user groups in Ireland. Focus group interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Results: In total, 85 participants took part in 14 focus groups between January and March 2021. Two major themes were identified, trust and personal and public benefits of sharing health information. The ability to exercise control over personal information, perceived transparency of the process, and the extent to which the healthcare service was viewed as confidential, all influenced the level of trust a person held. Perceived benefits were influenced by the extent to which participants believed information sharing would support improved care or provide broader public benefit, and balanced against the potential for personal harm. Conclusions: The findings allow for new insights into the views of the public on the use and sharing of personal health information and can be used to inform the development of a consent model for health information.
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Affiliation(s)
| | - Catherine Duggan
- 1. Health Information and Quality Authority, Cork, T12 Y2XT, Ireland
| | - Laura O'Connor
- 1. Health Information and Quality Authority, Cork, T12 Y2XT, Ireland
| | - Barbara Foley
- 1. Health Information and Quality Authority, Cork, T12 Y2XT, Ireland
| | - Rachel Flynn
- 1. Health Information and Quality Authority, Cork, T12 Y2XT, Ireland
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14
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Hooshafza S, Mc Quaid L, Stephens G, Flynn R, O’Connor L. Development of a framework to assess the quality of data sources in healthcare settings. J Am Med Inform Assoc 2022; 29:944-952. [PMID: 35190833 PMCID: PMC9006677 DOI: 10.1093/jamia/ocac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/21/2021] [Accepted: 02/07/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The purpose of this study was to develop a framework to assess the quality of healthcare data sources. MATERIALS AND METHODS First, a systematic review was performed and a thematic analysis of included literature conducted to identify items relating to the quality of healthcare data sources. Second, expert advisory group meetings were held to explore experts' perception of the results of the review and identify gaps in the findings. Third, a framework was developed based on the findings. RESULTS Synthesis of the review results and expert advisory group meetings resulted in 8 parent themes and 22 subthemes. The parent themes were: Governance, leadership, and management; Data; Trust; Context; Monitoring; Use of information; Standardization; Learning and training. The 22 subthemes were: governance, finance, organization, characteristics, time, data management, data quality, ethics, access, security, quality improvement, monitoring and feedback, dissemination, analysis, research, standards, linkage, infrastructure, documentation, definitions and classification, learning, and training. DISCUSSION The herein presented framework was developed using a robust methodology which included reviewing literature and extracting data source quality items, filtering, and matching items, developing a list of themes, and revising them based on expert opinion. To the best of our knowledge, this study is the first to apply a systematic approach to identify aspects related to the quality of healthcare data sources. CONCLUSIONS The framework, can assist those using healthcare data sources to identify and assess the quality of a data source and inform whether the data sources used are fit for their intended use.
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Affiliation(s)
- Sepideh Hooshafza
- Health Information and Quality Authority (HIQA), Cork, Ireland,The SFI ADAPT Research Centre for AI-Driven Digital Content Technology, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Louise Mc Quaid
- Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Gaye Stephens
- The SFI ADAPT Research Centre for AI-Driven Digital Content Technology, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Rachel Flynn
- Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Laura O’Connor
- Corresponding Author: Laura O’Connor, BSc, PhD, Health Information and Quality Authority (HIQA), Unit 1301, City Gate, Mahon, Cork T12 Y2XT, Ireland;
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15
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Mwakilasa MT, Foley C, O'Carroll T, Flynn R, Rohde D. Care Experiences of Older People in the Emergency Department: A Concurrent Mixed-Methods Study. J Patient Exp 2021; 8:23743735211065267. [PMID: 34917753 PMCID: PMC8669876 DOI: 10.1177/23743735211065267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The growing population of older people has increased demand to meet their complex healthcare needs, including in emergency departments (EDs). This study explored the experiences of people aged 65+ in Irish EDs, involving secondary analysis of quantitative and qualitative data from the 2019 National Inpatient Experience Survey (NIES). Experiences in the ED and overall hospital experiences were dichotomized as poor to fair or good to very good. Logistic regression was used to model quantitative data. Free text comments relating to EDs were thematically analyzed. Of 12,343 survey participants, 4,442 (39.9%) were aged 65+ years and used the ED. Longer waiting times, completion of the questionnaire by another person either with or on behalf of the patient, and having both a medical card and private health insurance were predictors of poor to fair ED experiences. Patients aged 85+ years were more likely to report good to very good ED experiences. Poor experiences in the ED were associated with poorer overall hospital experiences (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.76 to 2.73, p < .001). Thematic analysis revealed that long waiting times and unpleasant waiting conditions, including lack of communication, privacy, and personal care were important challenges encountered in the ED, with some older patients noting their preference for separate ED services. There is a need to reduce waiting times and integrate user perspectives in the planning, organization, and delivery of ED care to improve experiences and quality of care for a growing older population.
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Affiliation(s)
- Magreth Thadei Mwakilasa
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
- Muhimbili University of Health and Allied Sciences, Ilala, Tanzania
| | - Conor Foley
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Rachel Flynn
- Health Information and Quality Authority, Dublin, Ireland
| | - Daniela Rohde
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
- Health Information and Quality Authority, Dublin, Ireland
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16
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Flynn R, Mrklas K, Campbell A, Wasylak T, Scott SD. Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions. BMC Health Serv Res 2021; 21:1194. [PMID: 34736470 PMCID: PMC8570000 DOI: 10.1186/s12913-021-07214-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 10/21/2021] [Indexed: 12/04/2022] Open
Abstract
Background In 2012, Alberta Health Services created Strategic Clinical NetworksTM (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little research has been done on the sustainability of these evidence-based implementation efforts. Methods We conducted a qualitative realist evaluation using a case study approach to identify and explain the contextual factors and mechanisms perceived to influence the sustainability of two provincial SCN evidence-based interventions, a delirium intervention for Critical Care and an Appropriate Use of Antipsychotics (AUA) intervention for Senior’s Health. The context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic guided our research. Results We conducted thirty realist interviews in two cases and found four important strategies that facilitated sustainability: Learning collaboratives, audit & feedback, the informal leadership role, and patient stories. These strategies triggered certain mechanisms such as sense-making, understanding value and impact of the intervention, empowerment, and motivation that increased the likelihood of sustainability. For example, informal leaders were often hands-on and influential to front-line staff. Learning collaboratives broke down professional and organizational silos and encouraged collective sharing and learning, motivating participants to continue with the intervention. Continual audit-feedback interventions motivated participants to want to perform and improve on a long-term basis, increasing the likelihood of sustainability of the two multi-component interventions. Patient stories demonstrated the interventions’ impact on patient outcomes, motivating staff to want to continue doing the intervention, and increasing the likelihood of its sustainability. Conclusions This research contributes to the field of implementation science, providing evidence on key strategies for sustainability and the underlying causal mechanisms of these strategies that increases the likelihood of sustainability. Identifying causal mechanisms provides evidence on the processes by which implementation strategies operate and lead to sustainability. Future work is needed to evaluate the impact of informal leadership, learning collaboratives, audit-feedback, and patient stories as strategies for sustainability, to generate better guidance on planning sustainable improvements with long term impact. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07214-5.
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Affiliation(s)
- Rachel Flynn
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Alberta, T6G 1C9, Edmonton, Canada.
| | - Kelly Mrklas
- Strategic Clinical Networks™, Provincial Clinical Excellence, Alberta Health Services, Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, T2N 4N1, Calgary, Canada
| | - Alyson Campbell
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Alberta, T6G 1C9, Edmonton, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks™, Provincial Clinical Excellence, Alberta Health Services, Calgary, Canada.,Faculty of Nursing, University of Calgary, T2N 4V8, Alberta, Canada
| | - Shannon D Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Alberta, T6G 1C9, Edmonton, Canada
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17
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Abstract
Abstract
Background
While breastfeeding may be among the most effective ways to ensure child health and survival, breastfeeding rates in Ireland are consistently low. This study aimed to explore women's experiences of infant feeding in Ireland.
Methods
Thematic analysis of feeding-related free-text comments from the National Maternity Experience Survey 2020 was undertaken. The survey collected data on the experiences of women who were 16 years or older and gave birth in one of Ireland's 19 maternity hospitals or units or had a home birth.
Results
3,204 women participated in the survey (50% response rate). In the first few days after birth, 41.9% of women breastfed exclusively, 29.0% used formula and breast milk, and 29.1% bottle fed only. 824 comments related to feeding were received. A number of themes were identified, including support and encouragement from healthcare professionals, information and education regarding feeding, and pressure and respect for personal preferences. Women highlighted that while breastfeeding was encouraged in antenatal care, this was not always the case in the postnatal ward, where formula was readily available, with an apparent lack of resources for breastfeeding women. Some women described feeling pressured to use a feeding method that was not their first preference, with some feeling pushed to breastfeed when this may not have been their wish, while women who wished to breastfeed felt pressured to supplement with formula. Staffing shortages on postnatal wards, a lack of lactation consultants and contradictory advice from healthcare professionals exacerbated difficulties with both feeding methods.
Conclusions
Some women experience a lack of practical support with infant feeding, regardless of feeding method, and clear and concise information on feeding practices is needed. The addition of lactation consultants, home supports and further education and training could benefit mothers on their breastfeeding journey.
Key messages
Barriers to breastfeeding included a lack of support from healthcare professionals and conflicting information. It is important to support women regardless of their chosen feeding method.
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Affiliation(s)
- R Murphy
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - D Rohde
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - C Foley
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - T O'Carroll
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - R Flynn
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
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18
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Hooshafza S, Orlandi F, Flynn R, McQuaid L, Stephens G, O'Connor L. Modelling temporal data in knowledge graphs: a systematic review protocol. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13403.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The benefits of having high-quality healthcare data are well established. However, high-dimensionality and irregularity of healthcare data pose challenges in their management. Knowledge graphs have gained increasing popularity in many domains, as a method for representing data to overcome such challenges. However, little is known about their suitability for use with healthcare data. One important factor in representing data is “time”.Data with time related attributes are considered, temporal data. Temporal data are frequently observed in healthcare and the management of rapidly changing patient data is an ongoing challenge. Traditionally, data models have focused on presenting static data and do not account for temporal data. Temporal data models ensure time consistency in data models and assist analysing the history of data and predicting the future trends in data. Knowledge graphs can include temporal data models and are therefore of interest to the field of healthcare data management. As such, the herein aim is to outline a protocol for an inter-disciplinary systematic review of approaches, applications and challenges in modelling temporal data in knowledge graphs so that we can inform the application of knowledge graphs to healthcare data. Method: The research questions is, what are the existing approaches in modelling temporal data in knowledge graphs. Two sub-questions on applications, and challenges will also be evaluated. ACM digital library, IEEEXplore and ScienceDirect will be searched for this review. The search will be limited to peer-reviewed literature referring to knowledge graphs based on Resource Description Framework (RDF). A narrative synthesis of the papers will be conducted. Conclusion: The findings of this systematic review will be useful for data engineers to better represent data and perform analytics through temporal data modelling. They can be applied in the context of healthcare data and the current challenges faced in managing rapidly changing patient data.
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19
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Madden A, Naughton A, Flynn R, Thomas A. A video case series of migrated Hem-o-lok clip retrieval post robotic assisted laparoscopic prostatectomy and a review of the literature. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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20
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Schick-Makaroff K, Levay A, Thompson S, Flynn R, Sawatzky R, Thummapol O, Klarenbach S, Karimi-Dehkordi M, Greenhalgh J. An Evidence-Based Theory About PRO Use in Kidney Care: A Realist Synthesis. Patient 2021; 15:21-38. [PMID: 34109571 DOI: 10.1007/s40271-021-00530-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is international interest on the use of patient-reported outcomes (PROs) in nephrology. OBJECTIVES Our objectives were to develop a kidney-specific program theory about use of PROs in nephrology that may enhance person-centered care, both at individual and aggregated levels of care, and to test and refine this theory through a systematic review of the empirical literature. Together, these objectives articulate what works or does not work, for whom, and why. METHODS Realist synthesis methodology guided the electronic database and gray literature searches (in January 2017 and October 2018), screening, and extraction conducted independently by three reviewers. Sources included all nephrology patients and/or practitioners. Through a process of extraction and synthesis, each included source was examined to assess how contexts may trigger mechanisms to influence specific outcomes. RESULTS After screening 19,961 references, 84 theoretical and 34 empirical sources were used. PROs are proposed to be useful for providing nephrology care through three types of use. The first type is use of individual-level PRO data at point of care, receiving the majority of theoretical and empirical explorations. Clinician use to support person-centered care, and patient use to support patient engagement, are purported to improve satisfaction, health, and quality of life. Contextual factors specific to the kidney care setting that may influence the use of PRO data include the complexity of kidney disease symptom burden, symptoms that may be stigmatized, comorbidities, and time or administrative constraints in dialysis settings. Electronic collection of PROs may facilitate PRO use given these contexts. The second type is use of aggregated PRO data at point of care, including public reporting of PROs to inform decisions at point of care and improve quality of care, and use of PROs for treatment decisions. The third type is use of aggregated PRO data by organizations, including publicly available PRO data to compare centers. In single-payer systems, regular collection of PROs by dialysis centers can be achieved through economic incentives. Both the second and third types of PRO use include pressures that may trigger quality improvement processes. CONCLUSION The current state of the evidence is primarily theoretical. There is pressing need for empirical research to improve the evidence-base of PRO use at individual and aggregated levels of nephrology care.
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Affiliation(s)
- Kara Schick-Makaroff
- Faculty of Nursing, University of Alberta, Third Floor, Edmonton Clinica Health Academy, Edmonton, AB, Canada.
| | - Adrienne Levay
- Faculty of Nursing, University of Alberta, Third Floor, Edmonton Clinica Health Academy, Edmonton, AB, Canada
| | - Stephanie Thompson
- Division of Nephrology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rachel Flynn
- Faculty of Nursing, University of Alberta, Third Floor, Edmonton Clinica Health Academy, Edmonton, AB, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, BC, Canada.,Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Onouma Thummapol
- Faculty of Nursing Science, Assumption University of Thailand, Bangkok, Thailand
| | - Scott Klarenbach
- Division of Nephrology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mehri Karimi-Dehkordi
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
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21
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Kelly Y, O'Rourke N, Flynn R, Hegarty J, O'Connor L. Factors that influence the implementation of health and social care Standards: a systematic review and meta-summary protocol. HRB Open Res 2021; 4:24. [PMID: 34337321 PMCID: PMC8278248 DOI: 10.12688/hrbopenres.13212.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
Abstract
Health and social care Standards are evidence-based statements that demonstrate a desired level of care. Setting Standards for health and social care is a mechanism by which quality improvements can be achieved. Limited evidence exists on appropriate implementation strategies to overcome challenges with implementing Standards. The aim of this protocol is to set out a comprehensive plan to undertake a systematic search, appraisal and mixed research synthesis of the international literature that examines factors that hinder and facilitate implementation of health and social care Standards in order to inform the design of implementation strategies. A research question, “What are the enablers and barriers to implementing health and social care Standards in health and social care services?” was designed using the ‘SPICE’ (Setting, Perspectives, Interest phenomenon of, Comparison, Evaluation) framework. Electronic databases, grey literature and reference lists from included studies will be searched. Primary qualitative, quantitative descriptive and mixed methods studies reporting on enablers and barriers to implementing nationally endorsed Standards, will be included. The review will focus on experiences and perspectives from multi-level stakeholders including patient and public involvement. The quality of studies will be appraised using appropriate tools and findings used to weight interpretation of findings. Search outputs, data extraction and quality appraisal will be undertaken by two reviewers independently. Sandelowski meta-summary will be used to synthesise the data. Frequency and intensity effect sizes of enablers and barriers will be calculated to evaluate their prevalence across the studies. The Confidence in Evidence from Reviews of Qualitative research (CERQual) approach will be applied to assess confidence in the findings of the review. Findings from this examination will inform influencing factors to implementation. Subsequently, this will contribute to pairing Standards with appropriate implementation strategies that will optimise the enabling factors and overcome challenges to implementation.
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Affiliation(s)
- Yvonne Kelly
- Health Information and Quality Authority, Unit 1301, Citygate, Mahon, Cork, T12 Y2XT, Ireland
| | - Niamh O'Rourke
- Health Information and Quality Authority, Unit 1301, Citygate, Mahon, Cork, T12 Y2XT, Ireland
| | - Rachel Flynn
- Health Information and Quality Authority, Unit 1301, Citygate, Mahon, Cork, T12 Y2XT, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, College Road Cork, T12 AK54, Ireland
| | - Laura O'Connor
- Health Information and Quality Authority, Unit 1301, Citygate, Mahon, Cork, T12 Y2XT, Ireland
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22
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Collins P, O'Connell C, Omer SA, Inder MS, Madden A, Smyth L, Casey R, Manecksha R, Thomas A, Browne R, O'Neill A, Tierney S, Flynn R. 401 Three Birds with One Stone: Ureteric Calculus Precipitates Diagnosis and Resection of Three Primary Neoplasms. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A 67 year-old female presented to our centre with a 2 day history of right flank pain, clinically suggestive of ureteric colic. Computed tomography (CT) confirmed a 6mm right ureteric calculus. However, CT also revealed a large 13cm ipsilateral renal mass, concerning for renal cell carcinoma (RCC). At ureteroscopy for management of the obstructing calculus, a small papillary lesion was noted in the bladder, and excised. Histology confirmed pTa low-grade transitional cell carcinoma.
Following discussion at the Urology multidisciplinary tumour board, MRI venogram (MRV) was recommended to delineate the extension of tumour into the renal vein, and to characterise a pelvic mass seen on original CT. MRV showed enhancing material extending into the IVC, consistent with tumour thrombus. However, it also identified a concerning 6cm solid ovarian mass.
The patient proceeded to open right radical nephrectomy and IVC thrombectomy, hysterectomy, bilateral salpingo-oopherectomy, and omental biopsy, with combined input from Urological, Gynaecological and Vascular surgical teams. Post-operative course was uneventful. Histology showed an 11cm pT3a G2 clear cell RCC, and 7.5cm ovarian fibroma, both fully excised. This case demonstrated the serendipity of a simple ureteric calculus precipitating a cascade of investigations, that ultimately led to complete resection of three primary neoplasms.
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Affiliation(s)
- P Collins
- Tallaght University Hospital, Dublin, Ireland
| | - C O'Connell
- Tallaght University Hospital, Dublin, Ireland
| | - S A Omer
- Tallaght University Hospital, Dublin, Ireland
| | - M S Inder
- Tallaght University Hospital, Dublin, Ireland
| | - A Madden
- Tallaght University Hospital, Dublin, Ireland
| | - L Smyth
- Tallaght University Hospital, Dublin, Ireland
| | - R Casey
- Tallaght University Hospital, Dublin, Ireland
| | - R Manecksha
- Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - A Thomas
- Tallaght University Hospital, Dublin, Ireland
| | - R Browne
- Tallaght University Hospital, Dublin, Ireland
| | - A O'Neill
- Tallaght University Hospital, Dublin, Ireland
| | - S Tierney
- Tallaght University Hospital, Dublin, Ireland
| | - R Flynn
- Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Kelly Y, O’Rourke N, Flynn R, Hegarty J, O’Connor L. Factors that influence the implementation of health and social care Standards: a systematic review and meta-summary protocol. HRB Open Res 2021; 4:24. [DOI: 10.12688/hrbopenres.13212.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/20/2022] Open
Abstract
Health and social care Standards are evidence-based statements that demonstrate a desired level of care. Setting Standards for health and social care is a mechanism by which quality improvements can be achieved. Limited evidence exists on appropriate implementation strategies to overcome challenges with implementing Standards. In order to inform the design of implementation strategies, there is a need to examine factors that influence their implementation. The aim of this protocol is to set out a comprehensive plan to undertake a systematic search, appraisal and mixed research synthesis of the international literature that examines implementation of health and social care Standards. A research question, “What are the enablers and barriers to implementing health and social care Standards in health and social care services?” was designed using the ‘SPICE’ (Setting, Perspectives, Interest phenomenon of, Comparison, Evaluation) framework. Electronic databases, grey literature and reference lists from included studies will be searched. Primary qualitative, quantitative descriptive and mixed methods studies reporting on enablers and barriers to implementing nationally endorsed Standards, will be included. The review will focus on experiences and perspectives from multi-level stakeholders including patient and public involvement. The quality of studies will be appraised using appropriate tools and findings used to weight interpretation of findings. Search outputs, data extraction and quality appraisal will be undertaken by two reviewers independently. Sandelowski meta-summary will be used to synthesise the data. Frequency and intensity effect sizes of enablers and barriers will be calculated to evaluate their prevalence across the studies. The Confidence in Evidence from Reviews of Qualitative research (CERQual) approach will be applied to assess confidence in the findings of the review. Findings from this examination will inform influencing factors to implementation. Subsequently, this will contribute to pairing Standards with appropriate implementation strategies that will optimise the enabling factors and overcome challenges to implementation.
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Cassidy CE, Flynn R, Shuman CJ. Preparing Nursing Contexts for Evidence-Based Practice Implementation: Where Should We Go From Here? Worldviews Evid Based Nurs 2021; 18:102-110. [PMID: 33493388 DOI: 10.1111/wvn.12487] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Context is important to the adoption and sustainability of evidence-based practices (EBPs). Currently, most published implementation efforts address context in relation to one specific EBP or a bundle of related EBPs. Since EBP and implementation are ongoing and dynamic, more discussion is needed on preparing nursing contexts to be more conducive to implementation generally. AIM To discuss the need to create contexts that are more adaptable to ongoing change due to the dynamic nature of EBPs and the ever-changing healthcare environment. METHODS This paper builds on a collection of our previous work, as nursing implementation scientists representing the Canadian and American healthcare contexts, and a literature review of the implementation science, knowledge translation, and sustainability literatures from 2006 to 2019. RESULTS We argue for a different way of thinking about the influence of context and implementation of EBPs. We contend that nursing contexts must be prepared to be more flexible and conducive to ongoing EBP implementation more generally. Contexts that embrace, facilitate, and have the capacity for change may be more likely to effectively de-implement ineffective interventions or implement and sustain new EBPs. We outline future directions to build a program of research on preparing the soil for implementation of EBPs, including building capacity among nurses, supporting organizations to embrace change, co-producing research evidence, and contributing to implementation science. LINKING EVIDENCE TO ACTION Supporting contexts to adopt and sustain evidence in nursing practice is essential for bridging the evidence to practice gap and improving outcomes for patients, clinicians, and the health system. Moving forward, we need to develop a better understanding of how to create contexts that embrace change prior to the implementation of EBPs in order sustain improvements to patient and health system outcomes.
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Affiliation(s)
| | - Rachel Flynn
- WCHRI, University of Alberta, Edmonton, AB, Canada.,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.,Child Health Evaluative Sciences and Centre for Nursing Research, The Hospital for Sick Children, Toronto, ON, Canada
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Polinsky N, Flynn R, Wartella EA, Uttal DH. The role of spatial abilities in young children’s spatially-focused touchscreen game play. Cognitive Development 2021. [DOI: 10.1016/j.cogdev.2020.100970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stenzel L, Flynn R, Moore M. PO-1625: Deformable image registration (DIR) and radiobiological recalculation for retreat plan evaluation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McGrath N, Foley B, Hurley C, Ryan M, Flynn R. A multi-method quality improvement approach to systematically improve and promote the quality of national health and social care information. HEALTH INF MANAG J 2020; 51:50-56. [PMID: 32586137 DOI: 10.1177/1833358320926422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Safe and reliable healthcare depends on access to health information that is accurate, valid, reliable, timely, relevant, legible and complete. National data collections are repositories of health and social care data and play a crucial role in healthcare planning and clinical decision-making. We describe the development of an evidence-informed multi-method quality improvement program aimed to improve the quality of health and social care data in Ireland. Specific components involved: development of guidance to support implementation of health information standards; review program to assess compliance with standards; and educating health information stakeholders about health data and information quality. Observations from implementation of the program indicate enhanced health information stakeholder awareness of, and increased adoption of information management standards. The methodology used in the review program has proved to be a robust approach to identify areas of good practice and opportunities for improvement in information management practices. There has been positive adoption of the program among organisations reviewed and acceptance of the proposed recommendations. Early indications are that this multi-method approach will drive improvements in information management practices, leading to an improvement in health and social care data quality in Ireland. Aspects of this approach may be adapted to meet the needs of other countries.
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Affiliation(s)
- Niamh McGrath
- Health Information and Quality Authority, Ireland.,University College Cork, Ireland
| | | | | | - Maria Ryan
- Health Information and Quality Authority, Ireland
| | - Rachel Flynn
- Health Information and Quality Authority, Ireland
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Rotter T, Plishka C, Lawal A, Fiander M, Harrison EL, Flynn R, Chan JG, Kinsman L. Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems. Hippokratia 2020. [DOI: 10.1002/14651858.cd012831.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas Rotter
- School of Nursing, Queen's University; Healthcare Quality Programs; 82-84 Barrie Stret Kingston, Ontario Ontario Canada K7L 3N6
- Queen’s University School of Nursing; Healthcare Quality Programs; Kingston Canada
| | - Christopher Plishka
- University of Saskatchewan; College of Pharmacy and Nutrition; E3315 Health Sciences Building, 104 Clinic Place Saskatoon SK Canada S7N 5E5
| | - Adegboyega Lawal
- University of Saskatchewan; College of Pharmacy and Nutrition; E3315 Health Sciences Building, 104 Clinic Place Saskatoon SK Canada S7N 5E5
| | | | - Elizabeth L Harrison
- University of Saskatchewan; School of Physical Therapy, College of Medicine; School of Physical Therapy, College of Medicine Suite 3400, 3rd Floor, 104 Clinic Place, University of Saskatchewan Saskatoon SK Canada
| | - Rachel Flynn
- University of Alberta; Faculty of Nursing; 11405 87 Avenue, level 3, Edmonton Clinic Health Academy Edmonton Alberta Canada T6G1C9
| | - James G Chan
- University of Northern British Columbia; School of Health Sciences; Prince George BC Canada
| | - Leigh Kinsman
- The University of Newcastle and Mid North Coast Local Health District; School of Nursing and Midwifery; Port Macquarie New South Wales Australia 2444
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Flynn R, Rotter T, Hartfield D, Newton AS, Scott SD. A realist evaluation to identify contexts and mechanisms that enabled and hindered implementation and had an effect on sustainability of a lean intervention in pediatric healthcare. BMC Health Serv Res 2019; 19:912. [PMID: 31783853 PMCID: PMC6884784 DOI: 10.1186/s12913-019-4744-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 11/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2012, the Saskatchewan Ministry for Health mandated a system-wide Lean transformation. Research has been conducted on the implementation processes of this system-wide Lean implementation. However, no research has been done on the sustainability of these Lean efforts. We conducted a realist evaluation on the sustainability of Lean in pediatric healthcare. We used the context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic to explain under what contexts, for whom, how and why Lean efforts are sustained or not sustained in pediatric healthcare. METHODS We employed a case study research design. Guided by a realist evaluation framework, we conducted qualitative realist interviews with various stakeholder groups across four pediatric hospital units 'cases' at one acute hospital. Interview data was analyzed using an integrated approach of CMOc categorization coding, CMOc connecting and pattern matching. RESULTS We conducted thirty-two interviews across the four cases. Five CMOcs emerged from our realist interview data. These configurations illustrated a 'ripple-effect' from implementation outcomes to contexts for sustainability. Sense-making and staff engagement were prominent mechanisms to the sustainment of Lean efforts. Failure to trigger these mechanisms resulted in resistance. The implementation approach used influenced mechanisms and outcomes for sustainability, more so than Lean itself. Specifically, the language, messaging and training approaches used triggered mechanisms of innovation fatigue, poor 'sense-making' and a lack of engagement for frontline staff. The mandated, top-down, externally led nature of implementation and lack of customization to context served as potential pitfalls. Overall, there was variation between leadership and frontline staff's perceptions on how embedded Lean was in their contexts, and the degree to which participants supported Lean sustainability. CONCLUSIONS This research illuminates important contextual factors and mechanisms to the process of Lean sustainment that can be applicable to those implementing systems changes. Future work is needed to continue to develop the science on the sustainability of interventions for healthcare improvement.
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Affiliation(s)
- Rachel Flynn
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Thomas Rotter
- Healthcare Quality Programs, Queen's University School of Nursing, Kingston, Ontario, K7L 3N6, Canada
| | - Dawn Hartfield
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Shannon D Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Flynn R, Scott SD. Understanding Determinants of Sustainability Through a Realist Investigation of a Large-Scale Quality Improvement Initiative (Lean): A Refined Program Theory. J Nurs Scholarsh 2019; 52:65-74. [PMID: 31702091 DOI: 10.1111/jnu.12527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implementation science research seeks to understand ways to best ensure uptake of research-based initiatives to health care; however, there is little research done on how to sustain such efforts. Sustainability is the degree to which an initiative continues to be used in practice after efforts of implementation have ended. Sustainability research is a growing field of implementation science that needs further research to understand how to predict and measure the long-term use of effective initiatives to improve health care. The question of what influences the sustainability of research-based initiatives to improve health care remains unknown. PURPOSE The purpose of this article was to present a refined program theory on the contextual factors and mechanisms that influence the sustainability of one large-scale quality management initiative (Lean) in pediatric health care. DESIGN We conducted a multiphase realist investigation to explain under what contexts, for whom, how, and why Lean efforts are sustained or not sustained in pediatric health care through the generation of an explanatory program theory. METHODS This article presents the theoretical triangulation of our multiphase realist investigation, resulting in a refined program theory. We integrated the initial program theories (IPTs) from each research phase to form a refined program theory. It involved going back and forth from the initial IPT to the findings from each phase and our middle-range theories and examining the most substantiated IPTs on the contextual factors and mechanisms that influenced the sustainability of Lean efforts. FINDINGS The refined program theory depicts the complex nature to sustaining Lean efforts and that sustainability as a small, often unrepresentative portion of something much larger or more complex that cannot yet be seen or understood. The approach and nature of implementation is critical to shaping contexts for sustainability. Outcomes from implementation become facilitating or hindering contexts for sustainability. Customization to context is an important contextual factor for sustainability. Sense making, value congruency, and staff engagement are critical aspects from early implementation that enable or hinder processes of sustainment. Such mechanisms can trigger staff empowerment that can lead to a greater likelihood of sustainability. CONCLUSIONS These findings have important implications for sustainability research, in understanding the determinants of sustainability of research-based initiatives in health care. CLINICAL RELEVANCE It is important to understand and explain determinants of sustainability through theory-driven evaluative research in order to assist key stakeholders in sustaining the effective research-based initiatives made to improve healthcare services, patient care, and outcomes.
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Affiliation(s)
- Rachel Flynn
- Postdoctoral research fellow, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon D Scott
- Professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Scott SD, Rotter T, Flynn R, Brooks HM, Plesuk T, Bannar-Martin KH, Chambers T, Hartling L. Systematic review of the use of process evaluations in knowledge translation research. Syst Rev 2019; 8:266. [PMID: 31699136 PMCID: PMC6836407 DOI: 10.1186/s13643-019-1161-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/13/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Experimental designs for evaluating knowledge translation (KT) interventions can provide strong estimates of effectiveness but offer limited insight into how the intervention worked. Consequently, process evaluations have been used to explore the causal mechanisms at work; however, there are limited standards to guide this work. This study synthesizes current evidence of KT process evaluations to provide future methodological recommendations. METHODS Peer-reviewed search strategies were developed by a health research librarian. Studies had to be in English, published since 1996, and were not excluded based on design. Studies had to (1) be a process evaluation of a KT intervention study in primary health, (2) be a primary research study, and (3) include a licensed healthcare professional delivering or receiving the intervention. A two-step, two-person hybrid screening approach was used for study inclusion with inter-rater reliability ranging from 94 to 95%. Data on study design, data collection, theoretical influences, and approaches used to evaluate the KT intervention, analysis, and outcomes were extracted by two reviewers. Methodological quality was assessed with the Mixed Methods Appraisal Tool (MMAT). RESULTS Of the 20,968 articles screened, 226 studies fit our inclusion criteria. The majority of process evaluations used qualitative forms of data collection (43.4%) and individual interviews as the predominant data collection method. 72.1% of studies evaluated barriers and/or facilitators to implementation. 59.7% of process evaluations were stand-alone evaluations. The timing of data collection varied widely with post-intervention data collection being the most frequent (46.0%). Only 38.1% of the studies were informed by theory. Furthermore, 38.9% of studies had MMAT scores of 50 or less indicating poor methodological quality. CONCLUSIONS There is widespread acceptance that the generalizability of quantitative trials of KT interventions would be significantly enhanced through complementary process evaluations. However, this systematic review found that process evaluations are of mixed quality and lack theoretical guidance. Most process evaluation data collection occurred post-intervention undermining the ability to evaluate the process of implementation. Strong science and methodological guidance is needed to underpin and guide the design and execution of process evaluations in KT science. REGISTRATION This study is not registered with PROSPERO.
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Affiliation(s)
- Shannon D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | - Thomas Rotter
- School of Nursing, Queen’s University, Kingston, Ontario Canada
| | - Rachel Flynn
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | - Hannah M. Brooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | - Tabatha Plesuk
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | | | - Thane Chambers
- University of Alberta Libraries, Edmonton, Alberta Canada
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
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Rotter T, Plishka C, Lawal A, Harrison L, Sari N, Goodridge D, Flynn R, Chan J, Fiander M, Poksinska B, Willoughby K, Kinsman L. What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review. Eval Health Prof 2019; 42:366-390. [PMID: 29635950 PMCID: PMC6659584 DOI: 10.1177/0163278718756992] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization's mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.
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Affiliation(s)
- Thomas Rotter
- Healthcare Quality Programs, School of Nursing, Queen's University,
Kingston, Canada
| | - Christopher Plishka
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon,
Canada
| | - Adegboyega Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon,
Canada
| | - Liz Harrison
- School of Rehabilitation Science, College of Medicine, University of
Saskatchewan, Saskatoon, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Rachel Flynn
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - James Chan
- School of Health Sciences, University of Northern British Columbia,
Canada
| | - Michelle Fiander
- Assistant Research Professor, College of Pharmacy, Department of
Pharmacotherapy, University of Utah
| | - Bonnie Poksinska
- Department of Management and Engineering, Linköping University, Sweden
| | - Keith Willoughby
- Edwards School of Business, University of Saskatchewan, Saskatoon,
Canada
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Service (North), Launceston,
Tasmania, Australia
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Schick-Makaroff K, Thummapol O, Thompson S, Flynn R, Karimi-Dehkordi M, Klarenbach S, Sawatzky R, Greenhalgh J. Strategies for incorporating patient-reported outcomes in the care of people with chronic kidney disease (PRO kidney): a protocol for a realist synthesis. Syst Rev 2019; 8:20. [PMID: 30636637 PMCID: PMC6330465 DOI: 10.1186/s13643-018-0911-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/06/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patient-reported outcomes and experience measures (jointly referred to here as PROs) are internationally recognized as a means for patients to provide information about their quality of life, symptoms, and experiences with care. Although increasingly recognized as key to improving the quality of healthcare at individual (e.g., patients, caregivers, and providers) and aggregate (e.g., government, policy/system-wide decision-making) levels, there are important knowledge gaps in our understanding of how PROs are, and can be, used across different settings, particularly in nephrology to enhance person-centered care. This knowledge is needed for developing strategies to guide optimal use of PROs in nephrology care. Currently, no strategies exist. The purpose of this review is to address this knowledge gap by answering the following realist question: How can PROs be used to enhance person-centered nephrology care, both at individual and aggregate levels? METHODOLOGY Realist synthesis is an explanatory approach to data synthesis that aims to explain how context and mechanisms influence the outcome of an intervention. An initial program theory will be developed through the systematic search of the published literature in bibliographic databases (Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL, Web of Science, and Scopus) on existing theories explaining how PROs are used in healthcare settings. This initial program theory will then be tested and refined through the process of realist synthesis, using context-mechanism-outcome configurations. A kidney-specific program theory will then be created to address the utilization of PROs in nephrology across individual and aggregate levels to augment person-centered care. Searching will be iterative and refined as data is extracted and analyzed using a pilot-tested context + mechanism = outcome heuristic. Throughout, we will consult methodological experts, research team practitioners, and the Patient Advisory Committee to help refine the theories. Last, we will develop and disseminate knowledge translation products widely to knowledge user groups. DISCUSSION The utilization of PROs remains a challenge in nephrology. The findings from this synthesis will provide a framework to guide both policy makers and practitioners on how to enhance person-centered care through successful utilization of PROs across individual and aggregate levels in nephrology. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017056063.
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Affiliation(s)
- Kara Schick-Makaroff
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy 11405-87 Ave, Edmonton, Alberta T6G 1C9 Canada
| | - Onouma Thummapol
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy 11405-87 Ave, Edmonton, Alberta T6G 1C9 Canada
| | - Stephanie Thompson
- Faculty of Medicine and Dentistry, Division of Nephrology, University of Alberta, 11-112 Clinical Science Building, 11350-83 Ave, Edmonton, AB T6G 2G3 Canada
| | - Rachel Flynn
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy 11405-87 Ave, Edmonton, Alberta T6G 1C9 Canada
| | - Mehri Karimi-Dehkordi
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, Ontario K1N 6N5 Canada
| | - Scott Klarenbach
- Faculty of Medicine and Dentistry, Division of Nephrology, University of Alberta, 11-112 Clinical Science Building, 11350-83 Ave, Edmonton, AB T6G 2G3 Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, 588- 1081 Burrard Street, Vancouver, V6Z 1Y6 Canada
- Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, Box 400, 405 30 Gothenburg, Sweden
| | - Joanne Greenhalgh
- Sociology and Social Policy, University of Leeds, 11.21, Social Sciences Building, Leeds, LS2 9JT UK
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Flynn R, Walton S, Scott SD. Engaging children and families in pediatric Health Research: a scoping review. Res Involv Engagem 2019; 5:32. [PMID: 31700676 PMCID: PMC6827239 DOI: 10.1186/s40900-019-0168-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/11/2019] [Indexed: 05/16/2023]
Abstract
AIM Patient engagement (PE) in pediatric health services research is challenging due to contextual factors such as busyness of parenting, work schedules, and diverse family structures. This scoping review seeks to comprehensively map current PE strategies with parents and families across existing published pediatric health research literature. METHODS We followed Arksey and O'Malley (2005) and Levac et al., (2010) six-stage scoping review process. We conducted the search strategy in Medline, Embase, CINAHL, and Psychinfo databases. Data were extracted from included articles; evidence tables were developed and narrative synthesis was completed. RESULTS Of 3925 retrieved records, seventeen articles were included in the review. Patient engagement primarily occurred through strategies such as advisory groups, meetings, focus groups and interviews. Strategies were used to engage patients at various levels, for different purposes (e.g., to inform, participate, consult, involve collaborate and/or lead). These strategies were also used at various stages of the research process. Navigating power differences, time and money were commonly reported challenges. Inconsistent terminology plagued (e.g., stakeholder engagement, consumer participation, patient and public involvement, participatory research) this body of literature and clarity is urgently needed. CONCLUSIONS This review offers insights into current PE strategies used in pediatric health services research and offers insight for researchers considering employing PE in the future.
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Affiliation(s)
- Rachel Flynn
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, University of Alberta, Edmonton, Alberta T6G 1C9 Canada
| | - Sarah Walton
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, University of Alberta, Edmonton, Alberta T6G 1C9 Canada
| | - Shannon D. Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, University of Alberta, Edmonton, Alberta T6G 1C9 Canada
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Foley C, Huss T, O’Carroll T, Flynn R. ISQUA18-1307The Development, Implementation and Outcomes of a National Patient Experience Survey and Associated Quality Improvement Infrastructure: Lessons from Ireland. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Foley
- Health Information and Quality Authority, Cork, Ireland
| | - T Huss
- Health Information and Quality Authority, Cork, Ireland
| | - T O’Carroll
- Health Information and Quality Authority, Cork, Ireland
| | - R Flynn
- Health Information and Quality Authority, Cork, Ireland
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Flynn R, Newton AS, Rotter T, Hartfield D, Walton S, Fiander M, Scott SD. The sustainability of Lean in pediatric healthcare: a realist review. Syst Rev 2018; 7:137. [PMID: 30205842 PMCID: PMC6134523 DOI: 10.1186/s13643-018-0800-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lean is a quality improvement management system from the Toyota manufacturing industry. Since the early 2000's, Lean has been used as an intervention for healthcare improvement. Lean is intended to reduce costs and improve customer value through continuous improvement. Despite its extensive use, the contextual factors and mechanisms that influence the sustainability of Lean in healthcare have not been well studied. Realist synthesis is one approach to "unpack" the causal explanations of how and why Lean is sustained or not in healthcare. We conducted a realist synthesis using the context (C) + mechanim (M) = outcome (O) heuristic, to further develop and refine an initial program theory with seven CMO hypotheses, on the sustainability of Lean efforts across pediatric healthcare. METHODS Our search strategy was multi-pronged, iterative, and purposeful in nature, consisting of database, gray literature, and contact with three healthcare organizations known for Lean implementation. We included primary research studies, published and unpublished case studies or reports, if they included Lean implementation with a pediatric focus and sustainability outcome. We used the Normalization Process Theory and the National Health Services Sustainability Model, an operational definition for Lean and a comprehensive definition for sustainability as guidance for data extraction and analysis. Our initial program theory with was refined using a blend of abductive and retroductive analytical processes. RESULTS We identified six published primary research studies, two published quality improvement case studies, and three unpublished quality improvement case reports. Five CMO hypotheses from our initial program theory were substantially supported after synthesis, "sense-making and value congruency," "staff engagement and empowerment," and the "ripple effect" or causal pathway between Lean implementation outcomes that served as facilitating or hindering contexts for sustainability. Overall, there was variation with the conceptualization and measurement of sustainability. CONCLUSIONS This study is the first to examine Lean sustainability in pediatric healthcare using realist methods. Future research should examine whether the predictors of implementation are the same or different to sustainability and evaluate the underlying mechanisms that influence the sustainability of Lean. There is also a need for research to develop and test conceptual models and frameworks on sustainability. SYSTEMATIC REVIEW REGISTRATION PROSPERO-CRD42015032252 .
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Affiliation(s)
- Rachel Flynn
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Amanda S. Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Thomas Rotter
- Healthcare Quality Programs, Queen’s University School of Nursing, Kingston, ON K7L 3N6 Canada
| | - Dawn Hartfield
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Sarah Walton
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Michelle Fiander
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, L.S. Skaggs Building 4838, Salt Lake City, UT 84112 USA
| | - Shannon D. Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
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Zaidat OO, Bozorgchami H, Ribó M, Saver JL, Mattle HP, Chapot R, Narata AP, Francois O, Jadhav AP, Grossberg JA, Riedel CH, Tomasello A, Clark WM, Nordmeyer H, Lin E, Nogueira RG, Yoo AJ, Jovin TG, Siddiqui AH, Bernard T, Claffey M, Andersson T, Ribo M, Hetts S, Hacke W, Mehta B, Hacein-Bey L, Kim A, Abou-Chebl A, Shabe P, Hetts S, Hacein-Bey L, Kim A, Abou-Chebl A, Dix J, Gurian J, Zink W, Dabus G, O’Leary, N, Reilly A, Lee K, Foley J, Dolan M, Hartley E, Clark T, Nadeau K, Shama J, Hull L, Brown B, Priest R, Nesbit G, Horikawa M, Hoak D, Petersen B, Beadell N, Herrick K, White C, Stacey M, Ford S, Liu J, Ribó M, Sanjuan, E, Sanchis M, Molina C, Rodríguez-Luna, D, Boned Riera S, Pagola J, Rubiera M, Juega J, Rodríguez N, Muller N, Stauder M, Stracke P, Heddier M, Charron V, Decock A, Herbreteau D, Bibi R, De Sloovere A, Doutreloigne I, Pieters D, Dewaele T, Bourgeois P, Vanhee F, Vanderdouckt P, Vancaster E, Baxendell L, Gilchrist V, Cannon Y, Graves C, Armbruster K, Jovin T, Jankowitz B, Ducruet A, Aghaebrahim A, Kenmuir C, Shoirah H, Molyneaux B, Tadi P, Walker G, Starr M, Doppelheuer S, Schindler K, Craft L, Schultz M, Perez H, Park J, Hall A, Mitchell A, Webb L, Haussen D, Frankel M, Bianchi N, Belagaje S, Mahdi N, Lahoti S, Katema A, Winningham M, Anderson A, Tilley D, Steinhauser T, Scott D, Thacker A, Calderon V, Lin E, Becke S, Krieter S, Jansen O, Wodarg F, Larsen N, Binder A, Wiesen C, Hartney M, Bookhagan L, Ross H, Gay J, Snyder K, Levy E, Davies J, Sonig A, Rangel-Castilla L, Mowla A, Shakir H, Fennell V, Atwal G, Natarajan S, Beecher J, Thornton J, Cullen A, Brennan P, O’Hare A, Asadi H, Budzik R, Taylor M, Jennings M, Laube F, Jackson J, Gatrell R, Reebel L, Albon A, Gerniak J, Groezinger K, Lauf M, Voraco N, Pema P, Davis T, Hicks W, Mejilla J, Teleb M, Sunenshine P, Russo E, Flynn R, Twyford J, Ver Hage A, Smith E, Apolinar L, Blythe S, Maxan J, Carter J, Taschner T, Bergmann U, Meckel S, Elsheik S, Urbach H, Maurer C, Egger K, Niesen W, Baxter B, Knox, A, Hazelwood B, Quarfordt S, Calvert J, Hawk H, Malek, R, Padidar A, Tolley U, Gutierrez A, Mordasini P, Seip T, Balasubramaniam R, Gralla J, Fischer U, Zibold F, Piechowiak E, DeLeacy R, Apruzzeses R, Alfonso C, Haslett J, Fifi J, Mocco J, Starkman S, Guzy, J, Grunberg N, Szeder V, Tateshima S, Duckwiler G, Nour M, Liebeskind D, Tang X, Hinman J, Tipirneni A, Yavagal D, Guada L, Bates K, Balladeras S, Bokka S, Suir S, Caplan J, Kandewall P, Peterson E, Starke R, Puri A, Hawk M, Brooks C, L’Heurex J, Ty K, Rex D, Massari F, Wakhloo A, Lozano D, Rodrigua K, Pierot L, Fabienne M, Sebastien S, Emmoinoli M. Primary Results of the Multicenter ARISE II Study (Analysis of Revascularization in Ischemic Stroke With EmboTrap). Stroke 2018; 49:1107-1115. [DOI: 10.1161/strokeaha.117.020125] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/05/2018] [Accepted: 02/26/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Osama O. Zaidat
- From the Department of Neuroscience, Mercy St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | | | - Marc Ribó
- Department of Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain (M.R., A.T.)
| | - Jeffrey L. Saver
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Heinrich P. Mattle
- Department of Neurology, Inselspital, University of Bern, Switzerland (H.P.M.)
| | - René Chapot
- Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (R.C., H.N.)
| | - Ana Paula Narata
- Centre Hospitalier Régional Universitaire, Hôpitaux de Tours, France (A.P.N.)
| | | | - Ashutosh P. Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
| | - Jonathan A. Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA (J.A.G., R.G.N.)
| | | | - Alejandro Tomasello
- Department of Neuroradiology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden (T.A.)
| | - Wayne M. Clark
- Oregon Health and Science University Hospital, Portland (H.B., W.M.C.)
| | - Hannes Nordmeyer
- Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (R.C., H.N.)
| | - Eugene Lin
- From the Department of Neuroscience, Mercy St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | - Raul G. Nogueira
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA (J.A.G., R.G.N.)
| | - Albert J. Yoo
- Department of Interventional Radiology, Texas Stroke Institute, Dallas–Fort Worth (A.J.Y.)
| | - Tudor G. Jovin
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
| | | | | | | | - Tommy Andersson
- Department of Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain (M.R., A.T.)
- AZ Groeninge, Kortrijk, Belgium (O.F., T.A.)
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O'Sullivan M, Gargan ML, Flynn R, Crowther S, Torreggiani W. Primary Renal Carcinoid - A Case Report. Ir Med J 2018; 111:677. [PMID: 29869858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Carcinoid tumours in the abdomen are uncommon, but typically occur in the gastrointestinal tract. Primary renal carcinoid is an extremely rare tumour, poorly described in the literature. We describe an unusual case where an atypical renal mass on imaging led to a preoperative diagnosis of renal carcinoid on imaging guiding biopsy.
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Affiliation(s)
- M O'Sullivan
- Trinity College Dublin
- Adelaide and Meath National Children's Hospital
| | - M L Gargan
- Trinity College Dublin
- Adelaide and Meath National Children's Hospital
| | - R Flynn
- Adelaide and Meath National Children's Hospital
| | - S Crowther
- Adelaide and Meath National Children's Hospital
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Rotter T, Plishka CT, Adegboyega L, Fiander M, Harrison EL, Flynn R, Chan JG, Kinsman L. Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems. Cochrane Database Syst Rev 2017; 2017:CD012831. [PMCID: PMC6486096 DOI: 10.1002/14651858.cd012831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess effects of Lean management in health care on patient, professional, and systems outcomes by addressing the following question. What are the effects of Lean management interventions in health care on patient outcomes, professional practice, and healthcare systems? What are the effects of Lean management interventions in health care on patient outcomes, professional practice, and healthcare systems? To answer the following questions in addressing secondary objectives: What are the effects of Lean management interventions in combination with other management systems (e.g. Six Sigma) on patient outcomes, professional practice, and healthcare systems (utilisation and access, adverse effects, cost)? Is the effectiveness of Lean interventions influenced by the setting (e.g. Emergency Department, Laboratory, Pharmacy) in which they are implemented? What are the effects of Lean management interventions in combination with other management systems (e.g. Six Sigma) on patient outcomes, professional practice, and healthcare systems (utilisation and access, adverse effects, cost)? Is the effectiveness of Lean interventions influenced by the setting (e.g. Emergency Department, Laboratory, Pharmacy) in which they are implemented?
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Affiliation(s)
| | - Christopher T Plishka
- University of SaskatchewanCollege of Pharmacy and NutritionE3315 Health Sciences Building, 104 Clinic PlaceSaskatoonCanadaS7N 5E5
| | - Lawal Adegboyega
- University of SaskatchewanCollege of Pharmacy and NutritionE3315 Health Sciences Building, 104 Clinic PlaceSaskatoonCanadaS7N 5E5
| | | | - Elizabeth L Harrison
- University of SaskatchewanSchool of Physical Therapy, College of MedicineSchool of Physical Therapy, College of MedicineSuite 3400, 3rd Floor, 104 Clinic Place, University of SaskatchewanSaskatoonCanada
| | - Rachel Flynn
- University of AlbertaFaculty of Nursing11405 87 Avenue, level 3, Edmonton Clinic Health AcademyEdmontonCanadaT6G1C9
| | - James G Chan
- University of Northern British ColumbiaSchool of Health SciencesPrince GeorgeCanada
| | - Leigh Kinsman
- University of TasmaniaHealthLaunceston Clinical School, Locked Bag 1377HobartAustralia7250
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Tornio A, Flynn R, Morant S, Velten E, Palmer C, MacDonald T, Doney A. Investigating Real-World Clopidogrel Pharmacogenetics in Stroke Using a Bioresource Linked to Electronic Medical Records. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Samuel SM, Flynn R, Zappitelli M, Dart A, Parekh R, Pinsk M, Mammen C, Wade A, Scott SD. Factors influencing practice variation in the management of nephrotic syndrome: a qualitative study of pediatric nephrology care providers. CMAJ Open 2017; 5:E424-E430. [PMID: 28592406 PMCID: PMC5498309 DOI: 10.9778/cmajo.20160078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome. METHODS Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis. RESULTS Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome. INTERPRETATION Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes.
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Affiliation(s)
- Susan M Samuel
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Rachel Flynn
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Michael Zappitelli
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Allison Dart
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Rulan Parekh
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Maury Pinsk
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Cherry Mammen
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Andrew Wade
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Shannon D Scott
- Affiliations: Section of Nephrology (Samuel, Wade), Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Nursing (Flynn), University of Alberta, Edmonton, Alta.; Division of Nephrology (Zappitelli), Department of Pediatrics, McGill University Health Centre, Montréal, Que.; Division of Nephrology (Dart, Pinsk), Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Man.; Division of Nephrology (Parekh), Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Nephrology (Mammen), Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Faculty of Nursing (Scott), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
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Affiliation(s)
- Rachel Flynn
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Shannon D. Scott
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Thomas Rotter
- College of Pharmacy and Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Dawn Hartfield
- Integrated Quality Management, Edmonton Zone; Alberta Health Services; Edmonton Alberta Canada
- Division of Pediatric Hospital Medicine; Department of Pediatrics; Faculty of Medicine and Dentistry; University of Alberta; Edmonton Alberta Canada
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Chukwuanukwu RC, Onyenekwe CC, Martinez-Pomares L, Flynn R, Singh S, Amilo GI, Agbakoba NR, Okoye JO. Modulation of the immune response to Mycobacterium tuberculosis during malaria/M. tuberculosis co-infection. Clin Exp Immunol 2016; 187:259-268. [PMID: 27577087 DOI: 10.1111/cei.12861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/10/2016] [Accepted: 08/18/2016] [Indexed: 01/20/2023] Open
Abstract
Tuberculosis (TB) causes significant morbidity and mortality on a global scale. The African region has 24% of the world's TB cases. TB overlaps with other infectious diseases such as malaria and HIV, which are also highly prevalent in the African region. TB is a leading cause of death among HIV-positive patients and co-infection with HIV and TB has been described as a syndemic. In view of the overlapping epidemiology of these diseases, it is important to understand the dynamics of the immune response to TB in the context of co-infection. We investigated the cytokine response to purified protein derivative (PPD) in peripheral blood mononuclear cells from TB patients co-infected with HIV or malaria and compared it to that of malaria- and HIV-free TB patients. A total of 231 subjects were recruited for this study and classified into six groups; untreated TB-positive, TB positive subjects on TB drugs, TB- and HIV-positive, TB- and malaria-positive, latent TB and apparently healthy control subjects. Our results demonstrate maintenance of interferon (IFN)-γ production in HIV and malaria co-infected TB patients in spite of lower CD4 counts in the HIV-infected cohort. Malaria co-infection caused an increase in the production of the T helper type 2 (Th2)-associated cytokine interleukin (IL)-4 and the anti-inflammatory cytokine IL-10 in PPD-stimulated cultures. These results suggest that malaria co-infection diverts immune response against M. tuberculosis towards a Th-2/anti-inflammatory response which might have important consequences for disease progression.
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Affiliation(s)
- R C Chukwuanukwu
- Medical Laboratory Science Department, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | - C C Onyenekwe
- Medical Laboratory Science Department, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | | | - R Flynn
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - S Singh
- School of Life, University of Nottingham, Nottingham, UK
| | - G I Amilo
- Haematology Department, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | - N R Agbakoba
- Medical Laboratory Science Department, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | - J O Okoye
- Medical Laboratory Science Department, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
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Flynn R, Scott SD, Rotter T, Hartfield D. The potential for nurses to contribute to and lead improvement science in health care. J Adv Nurs 2016; 73:97-107. [DOI: 10.1111/jan.13164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Rachel Flynn
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Shannon D. Scott
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Thomas Rotter
- College of Pharmacy and Nutrition; University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Dawn Hartfield
- Integrated Quality Management, Edmonton Zone; Alberta Health Services; Edmonton Alberta Canada
- Division of Pediatric Hospital Medicine; Department of Pediatrics; Faculty of Medicine and Dentistry; University of Alberta; Edmonton Alberta Canada
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Abstract
Purpose
The Edmonton Zone, one of five Zones in Alberta Health Services (the health system in the province of Alberta, Canada), established a quality management framework (QMF) as a means to improve the delivery of high quality health care in the spring of 2014. The purpose of this research study was to understand the factors that facilitated or hindered the implementation of a quality improvement (QI) initiative for hand hygiene led by a newly formed frontline unit quality council (UQC), a part of the QMF, based out of the pediatric intensive care unit (PICU) at the Stollery Children’s Hospital in the Edmonton Zone. This research will provide an understanding of the newly established QMF in the Edmonton Zone and the factors needed to foster the ongoing development of frontline UQC that do improvement work as part of their daily routine.
Design/methodology/approach
Using a qualitative case study research design data were collected using semi-structured open-ended interviews with six key stakeholders (one registered nurse, one physician, one patient case manager, medical director for QI, clinical QI consultant and director of clinical QI) involved in UQC at the PICU.
Findings
Individual, unit and organizational level factors were identified as influencing the function of the UQC. Leadership and work culture were the key facilitating factors to success and lack of QI training and personnel/dedicated time were perceived barriers to completing the QI initiative.
Originality/value
The findings from this research illustrate that frontline UQC are able to impact positive sustained change early in their establishment as part of a larger QMF. It is important, however, for the system to foster ongoing development of capacity and capability of these frontline UQC to ensure sustained success of the larger systems change.
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Flynn R. TU-B-201-03: Accounting for MV Imaging Dose and the Future of MV Imaging. Med Phys 2016. [DOI: 10.1118/1.4957454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Wears B, Mohiuddin I, Flynn R, Waldron T, Kim Y, Allen B, Xia J. WE-DE-BRA-10: Development of a Novel Scanning Beam Low-Energy Intraoperative Radiation Therapy (SBIORT) System for Pancreatic Cancer. Med Phys 2016. [DOI: 10.1118/1.4957839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Prajapati S, Mo X, Bednarz B, Lawless M, Hammer C, Flynn R, Westerly D, Jeraj R, Mackie T. SU-F-T-667: Development and Validation of Dose Calculation for An Open-Source KV Treatment Planning System for Small Animal Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4956853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Dadkhah H, Wu X, Kim Y, Flynn R. WE-DE-201-08: Multi-Source Rotating Shield Brachytherapy Apparatus for Prostate Cancer. Med Phys 2016. [DOI: 10.1118/1.4957813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Dalhart A, Hyer D, Allen B, Flynn R, Johnston H. SU-F-T-646: SBRT Lung: Moving Beyond the 3D Conformal Paradigm with An Elekta VersaHD Accelerator. Med Phys 2016. [DOI: 10.1118/1.4956831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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