Evidence-based Change Research Articles

The Need for Manual Skills in an Automated World to Obtain Timely Blood Pressures in Trauma Patients.

Obtaining the first blood pressure (BP) during adult trauma team activations was often delayed. A review of patient charts revealed that the average time to first documented BP was 6.6 minutes when using an automatic BP cuff. The purpose was to determine whether taking the initial BP using a manual cuff decreases the time it takes to obtain the first BP. The Iowa Model Revised was used as the framework for this project. An algorithm was developed, and staff were educated and validated on their ability to obtain manual BPs. A 2-month practice change pilot was launched on adult full and partial trauma team activations. It was determined that taking a BP manually during adult trauma resuscitations was more efficient, allowing for earlier determination of patient status. Obtaining the initial BP manually was 54% more timely and led to an evidence-based practice change.

Work-related factors in the etiology of symptoms of post-traumatic stress among first responders: the Brazilian Firefighters Longitudinal Health Study (FLoHS).

Two important aspects must be accounted for when discussing the mental health of first responders and, in particular, their report of post-traumatic stress symptoms (PTSS). The first concerns the provision of quantitative data from longitudinal study designs, the second concerns the sophistication of the work-related model used to frame such studies. This is a report on the development of a model for Brazilian firefighters who also work as first responders, from the establishment of a longitudinal panel design study, the Brazilian Firefighter Longitudinal Health Study (FLoHS). The first objective was to compare trainee and active firefighters based on their follow-up data with a nationwide sample of similarly aged Brazilians. The second was to test the effect that operational and organizational experiences had on firefighters' PTSS level during follow up. At baseline, trainee firefighters came from higher socioeconomic backgrounds, were healthier and less exposed to trauma compared to a similarly aged national sample. At follow up, they reported higher prevalence of smoking, sleep problems, anhedonia and were more likely to be overweight. PTSS was predicted by operational and organizational stressors, even when controlled for health status at baseline. The results present not only the differences in the predictive status of operational and organizational events in relation to PTSS, but also how the effects of such events might interact. The data suggest the need for evidence-based interventions, support provided and changes at work environments to improve report rates for mental health in general and for PTSS in particular.

An Initiative to Reduce Preterm Infants Pre-discharge Growth Failure Through Time-specific Feeding Volume Increase.

Introduction:Very low birth weight infants often demonstrate poor postnatal longitudinal growth, which negatively impacts survival rates and long-term health outcomes. Improving extrauterine growth restriction (EUGR) among extremely premature infants has become a significant focus of quality improvement initiatives. Prior efforts in the University of Massachusetts Memorial Medical Center neonatal intensive care unit were unsuccessful in improving the EUGR rate at discharge.Methods:The primary aim of this initiative was to improve EUGR at discharge [defined as weight less than 10th percentile for postmenstrual age (PMA)] for infants born ≤32 0/7 weeks from a baseline of 25% to 20% by June 2019. We excluded all small for gestational age infants due to the limitation in the EUGR definition. A multidisciplinary team implemented evidence-based nutritional guideline changes using the Institute of Healthcare Improvement methods. The most notable change was the time-specific feeding volume advancement that increased the goal feeding volume between 31 0/7 and 34 0/7 weeks PMA from 150–160 to 170–180 milliliters per kilogram per day. The team monitored nutritional intake, weight, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and length of stay (LOS).Results:The EUGR rate improved from 25% to 12% after initiation of increased time-specific, enteral feeding guidelines at 31–34 weeks PMA. NEC rate, BPD rate, and LOS remained unchanged throughout the initiative.Conclusions:By implementing a time-specific volume increase guideline from 31 0/7 to 34 0/7 weeks PMA, the EUGR rate improved from baseline of 25% to 12% without increasing NEC rate, BPD rate, and LOS.

Can the Multi-Theory Model (MTM) of Health Behavior Change Explain the Intent for People to Practice Meditation?

Meditation is gaining popularity as adjuvant therapy for many chronic ailments, mental well-being, and spiritual growth. Behavioral theories have been underutilized in understanding meditation behavior. This study aimed to test if a fourth-generation multi-theory model (MTM) could explain the intent for starting and maintaining meditation behavior in a sample of US adults. A face and content valid 48-item instrument based on MTM was administered in a cross-sectional design through an online survey (n = 330). Internal consistency (Cronbach's alpha > 0.70) and construct validation using structural equation modeling of the subscales were all acceptable. Hierarchical multiple regression revealed that, after controlling for demographic covariates, the MTM constructs of participatory dialogue (β = 0.153; P = .002) and behavioral confidence (β = 0.479; P < .001) were statistically significant in predicting intent for starting meditation behavior and accounted for 32.9% of the variance. Furthermore, after controlling for demographic covariates, the MTM constructs of emotional transformation (β = 0.390; P < .001) and changes in the social environment (β = 0.395; P < .001) were statistically significant and accounted for 52.9% of the variance in the intent for maintaining meditation behavior. Based on this study, it can be concluded that MTM offers a pragmatic framework to design, implement, and evaluate evidence-based (theory-based) meditation behavior change interventions.

Learning to Live with the Virus

Learning to Live with the Virus

Teaching I-O psychology to undergraduate students: Do we practice what we preach?

AbstractAs industrial-organizational (I-O) psychologists, we have expertise in applying psychological and/or organizational science to the workplace. However, many of us haven’t taken the time to think about how our I-O psychology knowledge can apply to our teaching practice. We walk through some examples of how I-O psychology research can help us be better teachers, and the goal of our paper is to encourage readers to make evidence-based changes to their teaching based on I-O psychology research. We organize our discussion around four areas: training and development, diversity and inclusion, groups and teams, and leadership. Within each, we offer small, medium, and large changes that could be incorporated into classrooms. We hope that readers will be inspired to build on what they do in their classrooms to help students learn about (and be inspired by) our field.

Taking outcomes to the next level: The clinical nurse specialist as a partner in changing practice.

In Brief This article describes the implementation of a nursing practice model incorporating the clinical nurse specialist role to lead multidisciplinary, evidence-based practice change efforts across a large regional healthcare system.

Five Features to Look for in Early-Phase Clinical Intervention Studies

Neurorehabilitation relies on core principles of neuroplasticity to activate and engage latent neural connections, promote detour circuits, and reverse impairments. Clinical interventions incorporating these principles have been shown to promote recovery and demote compensation. However, many clinicians struggle to find interventions centered on these principles in our nascent, rapidly growing body of literature. Not to mention the immense pressure from regulatory bodies and organizational balance sheets that further discourage time-intensive recovery-promoting interventions, incentivizing clinicians to prioritize practical constraints over sound clinical decision making. Modern neurorehabilitation practices that result from these pressures favor strategies that encourage compensation over those that promote recovery. To narrow the gap between the busy clinician and the cutting-edge motor recovery literature, we distilled 5 features found in early-phase clinical intervention studies—ones that value the more enduring biological recovery processes over the more immediate compensatory remedies. Filtering emerging literature through this lens and routinely integrating promising research into daily practice can break down practical barriers for effective clinical translation and ultimately promote durable long-term outcomes. This perspective is meant to serve a new generation of mechanistically minded and caring clinicians, students, activists, and research trainees, who are poised to not only advance rehabilitation science, but also erect evidence-based policy changes to accelerate recovery-based stroke care.

Does the method of delivering e-health behaviour change interventions in patients with/or survivors of cancer impact engagement, health behaviours and health outcomes? a systematic review and meta-analysis

Rationale: Increased accessibility to the mobile internet has seen a rapid expansion in e-health behaviour change interventions delivered to cancer survivors using synchronous and asynchronous delivery Methods. There is a need to characterise effective delivery Methods of e-health health interventions to enable improved design and implementation of evidence-based health behaviour change interventions.

The Next EPISOD: Trends in Utilization of Endoscopic Sphincterotomy for Sphincter of Oddi Dysfunction from 2010-2019

For years, the endoscopic management of the disorder formerly known as Type III Sphincter of Oddi Dysfunction (SOD) had been controversial. In 2013, the results of the Evaluating Predictors and Interventions in Sphincter of Oddi Dysfunction (EPISOD) trial demonstrated that there was no benefit associated with endoscopic sphincterotomy for patients with Type III SOD. We aimed to assess the utilization of endoscopic sphincterotomy for patients with SOD in a large population database from 2010-2019. We searched a large electronic health record (EHR)-based dataset incorporating over 300 individual hospitals in the United States (Explorys, IBM Watson health, Armonk, NY). Using Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) we identified patients with a first-ever diagnosis of "disorder of Sphincter of Oddi" annually from 2010-2019. Subclassification of SOD types was not feasible using SNOMED-CT codes. Stratified by year, we identified the proportion of patients with newly-diagnosed SOD undergoing endoscopic sphincterotomy and those receiving newly-prescribed medical therapy. A total of 39,950,800 individual patients were active in the database with 7,750 index diagnoses of SOD during the study period. The incidence rates of SOD increased from 2.4 to 12.8 per 100,000 persons from 2010-2019 (P < .001). In parallel, there were reductions in the rates of biliary (34.3% to 24.5%) and pancreatic sphincterotomy (25% to 16.4%), respectively (P < .001). Sphincter of Oddi manometry (SOM) was infrequently utilized, <20 times in any given year, throughout the study duration. There were no significant increases in new prescriptions for TCAs, nifedipine, or vasodilatory nitrates. Among a wide range of practice settings which do not utilize routine SOM, a sudden and sustained decrease in rates of endoscopic sphincterotomy for newly-diagnosed SOD was observed beginning in 2013. These findings highlight the critical importance of high-quality, multi-center, randomized controlled trials in endoscopy to drive evidence-based changes in real-world clinical practice.

Students' Perceptions of the Value of Learning the Skill Sets of a DNP-Prepared Nurse: An Exploratory Study.

Students enter doctor of nursing practice (DNP) programs with varying interests and professional experiences. Little is known about how this impacts learning. To explore if differences existed in students' perceptions of task values related to learning the skill sets of a DNP-prepared nurse. Students were sent a link to a 17-item electronic survey consisting of demographic questions and nine statements based on competencies as outlined in The Essentials of Doctoral Education for Advanced Nursing Practice (American Association of Colleges of Nursing [AACN], 2006). Students ranked the statements in order of perceived value of performing after program completion. Mean rankings of task values demonstrated the advanced practice registered nurse (APRN) group (n = 32) identified the most valuable skill as "suggest an evidence-based change in professional practice based on the findings of published research articles and professional practice experience." The non-APRN group (n = 10) reported "work collaboratively with other non-nursing healthcare professionals to improve patient and population health outcomes." Students' perceptions of the value of learning the skill sets vary amongst APRNs and non-APRNs, and are shaped by past professional experiences and future role demands. Findings provide faculty with knowledge that can be used to tailor teaching and engagement strategies.

Swaddled Immersion Bathing for Healthy Full-Term and Late-Preterm Newborns

An academic medical center’s implementation of an evidence-based practice change to provide swaddled immersion bathing to healthy full-term and late-preterm newborns in the well-baby nursery. The purpose of this project was to align with the Association of Women’s Health, Obstetric and Neonatal Nurses’ (AWHONN’s) evidence-based clinical practice guideline, Neonatal Skin Care, in the use of swaddled immersion tub bathing. The goal is for newborns and caregivers to experience the benefits when switching from sponge to swaddled immersion bathing while overcoming challenges and building into daily practice on the mother–baby unit. Swaddled immersion bathing is recommended by AWHONN as a safe and well-tolerated mode of bathing compared with sponge bathing. Term- and late-preterm neonates who are bathed in a tub experience significantly less variability in body temperature and show reduction in crying and inducement of a calm, quiet state compared with newborns who receive a sponge bath. Comment cards were used to collect baseline data on sponge bathing within the following areas: temperature, perceived newborn stress–crying, and parental involvement. After education of staff and implementation, chart audits and interviews of staff were used to collect data on swaddled immersion bathing. Collection of data via our comment cards and chart review of 61 total baths demonstrated a –0.8℉ average temperature change after a sponge bath versus only a –0.1℉ average temperature change after a swaddled immersion bath. The staff interviewed verbalized a decrease in total crying and perceived newborn stress during the swaddled immersion baths versus the sponge baths, as well as an increase in parental involvement during the bath. Swaddled immersion bathing is a safe and pleasurable alternative to sponge bathing in healthy full-term and late-preterm newborns, with many positive benefits for parents and their newborn: decreased stress and crying, more stable heart rate and temperature, and increased parent satisfaction and involvement.

Midwifery leaders’ views on the factors considered crucial to implementing evidence-based practice in clinical areas

ProblemThe evidence-to-practice gap continues to persist in healthcare and midwives report limited knowledge and use of effective intervention strategies to support the implementation of new evidence-based practices in clinical settings. BackgroundDespite ongoing development and dissemination of high quality research findings, the translation of latest research evidence by midwives into new evidence-based practices remains sub-optimal. This inefficiency places consumers at risk of obsolete or potentially dangerous healthcare interventions. AimTo explore midwifery leaders’ views on what information and support midwives require to lead practice change initiatives in clinical areas. MethodsThe study formed part of a broader Participatory Action Research (PAR) project designed to improve the processes by which midwives implement evidence-based practice change in clinical settings. The study employed a qualitative design and was guided by the methodological underpinnings of Action Research (AR). FindingsOne core finding emerged to fulfil the aim and objectives of the study. To lead implementation of evidence-based practices, midwives need practical solutions and a map of the process, packaged into a centralised web-based resource. DiscussionThe findings reported in this study provide valuable insight into the specific needs of midwives wanting to improve the uptake and longevity of new evidence based practices in clinical areas. This includes information specific to evidence implementation, support networks and knowledge of Implementation Science. ConclusionTo lead practice change initiatives, midwives require a web-based resource that standardises the process of evidence implementation, while providing midwives with clear direction and the support needed to confidently champion for evidence base change in clinical areas.

Toward a Digital Platform for the Self-Management of Noncommunicable Disease: Systematic Review of Platform-Like Interventions.

BackgroundDigital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the individual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change.ObjectiveThis review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change.MethodsA literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool.ResultsA total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD; n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69% (SD 20%). Of the 7 studies, 4 with the highest adherence rates (80%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score.ConclusionsIterative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care.

Patients' Experiences of Using Smartphone Apps to Support Self-Management and Improve Medication Adherence in Hypertension: Qualitative Study.

BackgroundWorldwide, hypertension control rates remain suboptimal despite clinically effective antihypertensive drug therapy. Patient failure to take medication as prescribed (ie, nonadherence) is the most important factor contributing to poor control. Smartphone apps can facilitate the delivery of evidence-based behavior change techniques to improve adherence and may provide a scalable, usable, and feasible method to deliver self-management support.ObjectiveThe aim of this study is to explore patients’ experiences of the usability and feasibility of smartphone apps to support self-management and improve medication adherence in hypertension.MethodsA qualitative descriptive study was conducted. A total of 11 people living with hypertension from the West of Ireland were sampled purposively and interviewed about their experience of using a self-management app for a 4-week period, which included two key functionalities: self-monitoring of blood pressure (BP) and medication reminders. Thematic analysis was carried out on the semistructured interview data.ResultsParticipants’ age ranged from 43 to 74 years (mean 62 years, SD 9.13). Three themes were identified: digital empowerment of self-management, human versus digital systems, and digital sustainability. Although patients’ experience of using the technology to self-monitor BP was one of empowerment, characterized by an enhanced insight and understanding into their condition, control, and personal responsibility, the reminder function was only feasible for patients who reported unintentional nonadherence to treatment. Patients experienced the app as a sustainable tool to support self-management and found it easy to use, including those with limited technological competence.ConclusionsThe study’s findings provide new insights into the experience of using apps to support medication adherence in hypertension. Overall, the data support apps as a usable and feasible method to aid self-management of hypertension and highlight the need for personalized functionality, particularly with regard to medication adherence reminder strategies. The study’s findings challenge the perspective that the use of these technologies to support self-management can inevitably add to the burden of treatment experienced by patients.

Use of a Smart Pump and Dedicated Medication Line to Reduce Peripherally Inserted Central Catheter Damage.

Neonatal intensive care unit (NICU) infants frequently require peripherally inserted central catheter (PICC) placement for medication and nutrition. The occurrence of leaking catheters led to practice evaluation of manual intravenous (IV) flush and medication push technique in an upper Midwest NICU. A variation in unit practice was revealed. To describe an evidence-based practice change that standardized medication administration, eliminating routine manual IV push medication and flush administration and reducing catheter malfunction. Emergency "code" medication administration was not addressed. A systematic review of the literature was performed. A unit practice investigation ensued to study medication administration techniques and syringe size utilization, understand syringe pressure generated by various sizes of syringes, select optimal IV tubing supplies, review the smart pump library, electronic order sets/documentation, and address staff knowledge and skills. Practice change eliminating IV push and recommendations incorporating best evidence occurred. Moving from a traditional method of manual pushing/flushing medication to use of medication delivery via smart pump can decrease or eliminate PICC damage and potential harm to neonatal patients. Examination of IV push technique may identify opportunities for safer medication administration. Use of an infusion pump and a dedicated medication line can be a feasible option to deliver most IV medication doses in the NICU. Safe medication administration practices for the neonatal population and barriers to that practice.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=41.

Translating research into practice: outcomes from the Healthy Living after Cancer partnership project

BackgroundHealthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program.MethodsIn this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata.ResultsFour of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed (p < 0.001). The program delivery costs were on average AU$427 (US$296) per referred cancer survivor.ConclusionsThis telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors’ health and quality-of-life at a relatively low cost.Trial registrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

Child transport injuries and deaths in Lebanon: a multicentre retrospective study

IntroductionRoad traffic injury (RTI) constitutes the leading cause of deaths and disabilities for individuals aged 5–29 years globally. Lebanon suffers from a high toll of transport mortality and morbidity, though...

PARTNER: a service delivery model to implement optimal primary care management of people with knee osteoarthritis: description of development

ObjectiveImplementation strategies, such as new models of service delivery, are needed to address evidence practice gaps. This paper describes the process of developing and operationalising a new model of service...

Feasibility and Process Evaluation of a Need-Supportive Physical Activity Program in Aged Care Workers: The Activity for Well-Being Project.

The need to undertake pilot testing and evaluation of novel health promotion programs has become increasingly apparent for the purpose of understanding the true effects of complex interventions and for testing and refining behavioral theories that these interventions are informed by. A mixed-methods process evaluation and feasibility study was undertaken for a need-supportive physical activity program that was piloted in a single-group pre–post study. The piloted program was designed to support participant needs of autonomy, competence, and relatedness through evidence-based and theory-informed behavior change strategies including a motivational interviewing style appointment, education on self-management tools (i.e., pedometers, goal setting, action and coping planning, a customized website for goal setting and self-monitoring), and self-determined methods of regulating physical activity intensity [affect, rating of perceived exertion (RPE), and self-pacing]. The program aimed to positively impact physical activity behavior, psychological well-being, and associated motivational processes. Reach, adoption, fidelity, context, change and performance objectives, and feasibility of the program were evaluated using information from survey respondents from the target population (n = 118) and implementing staff (n = 6); questionnaires from pilot study participants (n = 21); and individual semi-structured interviews with a combination of pilot study participants, non-participants, and implementing staff (n = 19). Process evaluation of the Activity for Well-Being program found that the reach of the program was moderate but adoption was low. The use of self-management tools and self-determined methods of regulating physical activity intensity appeared to be feasible. The website had mixed responses and low engagement. The element of having a support person elicited a strong positive response in the program participant interviews. Involving local implementing staff more directly into the delivery of the intervention could have potentially improved reach, adoption, and feasibility of the program.