Improve Knowledge Translation Research Articles

Childhood dyslipidemia: Clinician management practices in the primary care setting

Abstract Objectives To describe clinician management practices for childhood dyslipidemia in the community setting. Methods A descriptive study was conducted for children aged 2 to 10 years with dyslipidemia as defined by the National Cholesterol Education Program Expert Panel on Cholesterol in Children criteria. A convenience sample of participants from the TARGet Kids! cohort study (Toronto, Canada) was used. Trained research assistants reviewed participant medical records to document clinician management practices of abnormal lipid levels. The study outcome was the proportion of clinicians engaging in each management practice. Descriptive statistics were completed, reporting the proportion of clinician engagement in management practices. Results All 768 children were seen by primary paediatric care providers after lipid levels identified dyslipidemia. Medical history regarding lifestyle behaviours and cardiovascular risk factors were frequently obtained (n = 565, 73.6%). Physicians rarely informed families about abnormal lipid levels (n = 11, 1.43%). Management plans for abnormal lipid levels were rarely documented (n = 4, 0.5%). Clinicians did not refer to paediatric lipid specialists or initiate statin therapy. Conclusions Paediatric care providers rarely identified and initiated early management for abnormal lipid levels. Our results may inform the need for improved knowledge translation of the recently published Canadian clinical practice update for the detection and management of childhood dyslipidemia.

Research Priorities Regarding Physical Activity, Sedentary Behaviour, And Sleep In Pregnancy: A Delphi Study

PURPOSE: To produce a top 10 list of research priorities in pregnancy regarding physical activity, sedentary behaviour, and sleep according to pregnant/postpartum women, healthcare providers and exercise professionals. METHODS: A modified Delphi method was used that comprised of two rounds. In Round 1, pregnant/postpartum individuals (N = 118), exercise professionals and healthcare providers (N = 55) were asked to list up to 10 questions perceived as unanswered regarding exercise/physical activity, sedentary behaviour, and sleep in pregnancy. All responses were subjected to content analysis and were redirected to participants in Round 2 where respondents were asked to rate each question on a Likert importance scale of 1 (not important) to 5 (very important). The sum of ratings received were calculated to generate a total score for each question. RESULTS: Within the exercise/physical activity category, pregnant/postpartum individuals (N = 67) prioritised questions regarding exercise prescription, exercise on maternal and fetal outcomes and impact of exercise on pregnancy conditions. This was extended within the healthcare provider and exercise professional group (N = 22) to questions about special population groups, and clinical education and access to information. Within the sedentary behaviour category, pregnant/postpartum individuals prioritised questions regarding the impact of sedentary behaviour on maternal and fetal outcomes, sedentary recommendations, and exercise and sedentary positioning. Healthcare providers and exercise professionals prioritised similar topics, surplus to questions regarding to safe sedentary positions for mum and baby. Within the sleep category, pregnant/postpartum individuals prioritised questions regarding the impact of pregnancy on sleep, safety, sleeping aids, and the role of exercise and these were similar for healthcare providers and exercise professionals. CONCLUSION: Pregnant/postpartum women, healthcare providers and exercise professionals have prioritised questions that have in part been addressed by existing research, highlighting a need for improved knowledge translation from research to practice. They have also identified novel questions that warrant prioritisation that may help direct future research.

Approaches to managing work-related fatigue to meet the needs of American workers and employers.

On September 13-14, 2019, the National Institute for Occupational Safety and Health (NIOSH) hosted a national forum entitled "Working hours, sleep and fatigue: Meeting the needs of American workers and employers."The purpose of this inaugural meeting was to discuss current evidence about the broad-based risks and effective countermeasures related to working hours, sleep, and fatigue, with further considerations to tailor solutions for specific industries and worker populations. We aimed to identify the knowledge gaps and needs in this area and future directions for research. We also sought to identify similarities across industries with the goal of sharing lessons learned and successful mitigation strategies across sectors. Participants included an international representation of academics, scientists, government representatives, policymakers, industry leaders, occupational health and safety professionals, and labor representatives.A total of eight manuscripts were developed following stakeholder comments and forum discussions. Six focused on sector-specific approaches (i.e., Agriculture, Forestry & Fishing; Healthcare & Social Assistance; Mining; Oil and Gas Extraction; Public Safety; Transportation, Warehousing & Utilities) to identify unique factors for fatigue-risk and effective countermeasures. Two additional manuscripts addressed topic areas that cut across all industries (disproportionate risks, and economic evaluation).Findings from the Forum highlight that the identification of common risk factors across sectors allows for transfer of information, such as evidence for effective mitigation strategies, from sectors where fatigue risk has been more widely studied to those sectors where it has been less so. Further considerations should be made to improve knowledge translation activities by incorporating different languages and modes of dissemination such that information is accessible for all workers. Additionally, while economic evaluation can be an important decision-making tool for organizational- and policy-level activities, multi-disciplinary approaches combining epidemiology and economics are needed to provide a more balanced approach to economic evaluation with considerations for societal impacts. Although fatigue risk management must be tailored to fit industries, organizations, and individuals, knowledge gained in this forum can be leveraged, modified, and adapted to address these variabilities. Our hope is to continue sharing lessons learned to encourage future innovative, multi-disciplinary, cross-industry collaborations that will meet the needs of workers and employers to mitigate the risks and losses related to workplace fatigue.

The Meaning of Words Related to Orofacial Pain and Headache Conditions: The Need for a Single and Unified Classification Scheme in a People-Centered Language

The Meaning of Words Related to Orofacial Pain and Headache Conditions: The Need for a Single and Unified Classification Scheme in a People-Centered Language

A Delphi Study to Identify Research Priorities Regarding Physical Activity, Sedentary Behavior and Sleep in Pregnancy

This study aimed to produce a list of the top 10 research priorities regarding physical activity, sedentary behavior, and sleep in pregnancy. Using the Delphi methodology, pregnant/postpartum individuals (N = 118), exercise professionals and healthcare providers (N = 55) listed up to 10 questions perceived as unanswered regarding physical activity, sedentary behavior, and sleep in pregnancy (Round 1). Respondents rated the proposed questions on a Likert importance scale (Round 2), and the sum of ratings received were totaled. Questions of priority regarding physical activity among pregnant/postpartum individuals (N = 67), healthcare providers and exercise professionals (N = 22) pertained to exercise prescription, impact of exercise on maternal and fetal outcomes and impact of exercise on pregnancy conditions, special population groups and clinical education and access to information. Sedentary behavior priorities included the impact of sedentary behavior on maternal and fetal outcomes, sedentary recommendations and exercise and sedentary positioning. Sleep research priorities included the impact of pregnancy on sleep, safety, sleeping aids and the effect of exercise on sleep. Pregnant/postpartum women, healthcare providers and exercise professionals prioritized questions that have in part been addressed by existing research, highlighting a need for improved knowledge translation from research to practice. They have also identified novel questions that warrant prioritization within future research.

Which Recommendations Are You Using? A Survey of Emergency Physician Management of Paroxysmal Atrial Fibrillation

BackgroundBoth the Canadian Cardiovascular Society (CCS) and the Canadian Association of Emergency Physicians (CAEP) have published documents to guide atrial fibrillation (AF) management. In 2021, the CAEP updated its AF checklist. Prior to this update, the recommendations of the 2 organizations differed in several key areas, including the suggested cardioversion timeframe, the factors determining cardioversion eligibility, and anticoagulant initiation after cardioversion. Whether emergency physicians (EPs) are aware of, or adhering to, one, both, or neither of these documents is unknown. MethodsWe assessed document awareness, adherence, and EP practice using a piloted questionnaire administered to EPs at 5 emergency departments in 3 provinces. ResultsOf 166 survey recipients, 123 (74.1%) responded. The majority (64.7%) worked at an academic site, 38.8% identified as female, and median years in practice was 10.0. Most (93.1%) were aware of at least one of the documents; 45.7% were aware of both. Reported awareness was higher for the CCS (77.6%) vs the CAEP (61.2%) guidelines. Respondents varied in their adherence, with 40.5% using parts of both documents. Considerable practice variability occurred when recommendations conflicted. Despite its use not being recommended by either organization, half of respondents (50.0%) reported using the CHA2DS2-VASc score as their stroke-risk assessment tool. ConclusionsAlthough most surveyed EPs were aware of at least one organization’s AF documents, many reported using parts of both. When recommendations conflicted, EPs were divided in their decision-making. These findings emphasize the need to improve consensus between organizations and further improve knowledge translation.

Surgical practice patterns and outcomes in T2 and T3 gallbladder cancer: a population-based study.

Background:The extent of resection required in advanced gallbladder cancer is controversial. We aimed to describe the management and outcomes in patients with resected stage T2 and T3 gallbladder cancer.Methods:In this population-based study, all T2 and T3 gallbladder cancer cases from Jan. 1, 2002, to Mar. 31, 2012, were identified from the Ontario Cancer Registry; pathology reports were linked and abstracted. The type of resection was classified as extended (cholecystectomy + liver resection, with or without bile duct resection) or simple (cholecystectomy only). We used Kaplan–Meier survival analysis to model time to death and evaluated factors associated with overall survival using the Cox proportional hazards regression model.Results:A total of 370 patients were included, 232 with T2 disease and 138 with T3 disease. The proportions who underwent extended resection were 24.1% (56/232) and 37.0% (51/138), respectively. The unadjusted 5-year overall survival rates for simple and extended resection were 39.7% and 49.5%, respectively, for T2 disease (p = 0.03), and 13.5% and 22.8%, respectively, for T3 disease (p = 0.05). In adjusted analysis, extended resection significantly improved overall survival among patients with T2 disease (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.30–0.97), whereas higher grade of differentiation, presence of lymphovascular invasion and positive lymph nodes led to worse survival. Extended resection was not associated with improved survival in the T3 group; however, in subgroup analysis stratified by lymph node status, a trend toward improved overall survival with extended resection was seen in node-negative patients (HR 0.20, 95% CI 0.03–1.06).Conclusion:Extended resection improved overall survival in T2 disease regardless of nodal status but appeared most beneficial in node-negative T3 disease. The finding that extended resection was offered only to a small proportion of eligible patients highlights the need for improved knowledge translation at national surgical meetings.

Exploration of a Short-term Learning Community Focused on Evidence-based Occupational Therapy Interventions for Children and Youth with Autism

Continuing education (CE) for occupational therapists typically takes place in workshops, seminars, or webinars with little support for practice change after the event concludes. Continuing education that occurs over an extended time with opportunities for social learning and competence assessment may improve knowledge translation. This study explored how pediatric occupational therapists who participated in a short-term, online learning community acquired new knowledge about evidence-based interventions from learning activities and how they applied this new knowledge to practice. Weekly modules with facilitated discussions, competency self-assessment, and peer-reviewed journal article readings occurred over a six-week period. An exploratory design included content analysis of participants’ online discussion postings, goal-setting activities, reflections, and a researcher-developed evaluation survey. Of the 19 participants who completed the evaluation survey, 17 participants indicated that the case simulation helped to assess their competence and that readings on evidence-based interventions obtained from ProQuestTM were helpful. All participants (n = 19) agreed that the learning community enriched their understanding of how to work with children and youth with autism spectrum disorder and they planned to apply new knowledge to their practice. Qualitative data analysis yielded two themes: becoming evidence-based and integrating evidence into practice. A community of occupational therapists with shared interests who participated in socially mediated learning opportunities with multiple educational components increased understanding and application of evidence-based interventions. Future research should investigate the relationship between engagement in a short-term learning community and application of evidence-based interventions with follow-up.

A review of menstrual sex education and management in women with congenital adrenal hyperplasia

ABSTRACT Congenital adrenal hyperplasia (CAH) encompasses a range of autosomal recessive inherited enzyme deficiencies that impact cortisol biosynthesis pathways. Although reported as a rare and lifelong disorder, it holds chronic health risks for individuals that can influence menstruation. The purpose of this environmental scan and integrative literature review was to identify health information pertinent to CAH and menstruation in order to inform health providers, increase patient education, and promote menstrual wellbeing. Analysis identified that while information about menses is reported, information about menstrual irregularities and their management in adolescents and women with CAH is uncertain. Furthermore, there is insufficient good quality research and knowledge on CAH and menstruation to inform health providers in their practice with this population. The need for individuals with CAH to access evidence-informed information is constrained by the state of current understanding and limitations in knowledge translation. The importance of having trustworthy and safe spaces in which to ask questions and draw on ethically sound, language appropriate, and evidence-informed material is paramount in supporting women’s confidence and wellbeing across their lifetime. We encourage the building of stronger relationships between researchers, health providers, support groups and individuals to improve knowledge translation and dissemination regarding CAH and menstruation.

International research priorities on the role of cognition in power mobility device use: In pursuit of informed clinical practices and knowledge translation

ABSTRACT Cognition is an important factor affecting power mobility device (PMD) use. However, a gap in knowledge on the role of cognition in PMD use limits evidence of best practices for screening, assessment and training. The overall goal of this research activity was to identify strategic research priorities to delineate the next steps in research. Following the Collaborative Prioritized Planning Process (CP3), a 1.5-day meeting was held with an interdisciplinary and international team of assistive technology users, clinicians, service providers, and researchers with expertise in PMD use and cognition. Our four-stage process included: knowledge synthesis; identification and prioritization of challenges; identification, consolidation, and prioritization of solutions; and action planning. Five of 14 challenges for research on cognition and PMD use were prioritized, and five solutions (of the 100 generated) perceived to be the most impactful were selected as the focus for the remainder of the meeting. The resulting prioritized solutions included, improving knowledge translation of existing and new evidence, profiling and addressing individualized needs, creating and evaluating training tools, development of practice guidelines, and validating and developing evaluation tools or toolkit. Preliminary action planning facilitated discussion of potential future projects, initiated new research collaborations and partnerships, and provided a foundation to build a program of research for investigating the role of cognition in PMD use.

Living with deafblindness during COVID-19: An international webinar to facilitate global knowledge translation

Arguably, individuals living with deafblindness are among the hardest hit by the effects of the corona virus disease of 2019 (COVID- 19), given the importance of the sense of touch for their ability to interact with the world. To address this challenge, it is imperative to facilitate the implementation of evidence- and experience-based recommendations, and to improve knowledge translation on a global scale. Deafblind International organized a webinar to provide a platform where participants could exchange experiences and solutions to overcome the challenges created by the arrival of COVID-19, in order to facilitate information exchange among stakeholders in deafblindness during this pandemic. We present an overview of its content here and place the summarized themes in context with existing research literature. Abstract submission was open for 4 weeks in May 2020, resulting in 30 submissions from 13 countries across 5 continents. Of the 26 presenter teams, 9 (35%) had a co-presenter that was living with deafblindness themselves. The number of individual participants across all sessions ranged from 55 to 140 ( M = 98), with a total of 3709 session registrations overall, and the organizers estimate a total attendance of around 400 participants. Based on extensive field notes taken during the webinar, and repeated viewing of the recordings, qualitative description allowed the team to synthesize eight principal themes across the event: access to information, communication, service accessibility, adaptations to service delivery, online safety and security, physical distancing, mental health and research. The first Deafblind International webinar was able to fill an important gap by bringing together a variety of stakeholders in deafblindness across the globe. The event created a sense of group membership and peer support, brought the participants, researchers, the professionals as well as their service agencies closer together and generated a sense of hope and collaboration.

Exercise-nutrient interactions for improved postprandial glycemic control and insulin sensitivity.

Type 2 diabetes (T2D) is a rapidly growing yet largely preventable chronic disease. Exaggerated increases in blood glucose concentration following meals is a primary contributor to many long-term complications of the disease that decrease quality of life and reduce lifespan. Adverse health consequences also manifest years prior to the development of T2D due to underlying insulin resistance and exaggerated postprandial concentrations of the glucose-lowering hormone insulin. Postprandial hyperglycemic and hyperinsulinemic excursions can be improved by exercise, which contributes to the well-established benefits of physical activity for the prevention and treatment of T2D. The aim of this review is to describe the postprandial dysmetabolism that occurs in individuals at risk for and with T2D, and highlight how acute and chronic exercise can lower postprandial glucose and insulin excursions. In addition to describing the effects of traditional moderate-intensity continuous exercise on glycemic control, we highlight other forms of activity including low-intensity walking, high-intensity interval exercise, and resistance training. In an effort to improve knowledge translation and implementation of exercise for maximal glycemic benefits, we also describe how timing of exercise around meals and post-exercise nutrition can modify acute and chronic effects of exercise on glycemic control and insulin sensitivity. Novelty: Exaggerated postprandial blood glucose and insulin excursions are associated with disease risk. Both a single session and repeated sessions of exercise improve postprandial glycemic control in individuals with and without T2D. The glycemic benefits of exercise can be enhanced by considering the timing and macronutrient composition of meals around exercise.

Is a nudge all we need to promote deliberate clinical inertia and thoughtful clinical decision making?

Deliberate clinical inertia is the art of doing nothing as a positive response. Individual clinicians can promote deliberate clinical inertia through teaching, re-framing the act of 'doing nothing' as 'doing something' and engaging in shared decision making. Behaviour change on a larger scale requires a systematic approach. Nudging is a subtle change to the decision-making context to prompt specific choices. A nudge unit is a team of relevant professionals who engage with various multidisciplinary teams within a health service who help test and implement nudge interventions in a clinical environment. A nudge unit could be used to design environments to prompt clinicians to re-think before ordering unnecessary tests or treatments. Nudge units could improve knowledge translation, support continuous quality improvement and help build a learning health system. They could also boost collaboration and empower staff to evaluate their workplace decision-making frameworks.

Abstract IA017: Molecular classification and stratification: Diving deeper

Abstract As we move forward with integration of molecular classification into clinical care the assessment of additional clinicopathological and molecular features in the context of molecular subtype will enable us to further refine prognosis. In addition, molecular classification can enable stratification of clinical cohorts that have been often thought of as homogeneous but are clearly more diverse than recognized. These last few years have produced an abundance of literature supporting not only the value of consistent categorization and prognostic value but also predictive implications enabling action/change in practice. Molecular classification-driven care in endometrial cancer will reduce variation in practice with improved knowledge translation critical to implementation and uptake. Citation Format: Jessica N. McAlpine. Molecular classification and stratification: Diving deeper [abstract]. In: Proceedings of the AACR Virtual Special Conference: Endometrial Cancer: New Biology Driving Research and Treatment; 2020 Nov 9-10. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(3_Suppl):Abstract nr IA017.

Patient, Caregiver, and Provider Perspectives on Improving Information Delivery in Hemodialysis: A Qualitative Study.

Background:Patients with kidney failure are exposed to a surfeit of new information about their disease and treatment, often resulting in ineffective communication between patients and providers. Improving the amount, timing, and individualization of information received has been identified as a priority in in-center hemodialysis care.Objective:To describe and explicate patient, caregiver, and health care provider perspectives regarding challenges and solutions to information transfer in clinical hemodialysis care.Design:In this multicenter qualitative study, we gathered perspectives of patients, their caregivers, and health care providers conducted through focus groups and interviews.Setting:Five Canadian hemodialysis centers: Calgary, Edmonton, Winnipeg, Ottawa, and Halifax.Participants:English-speaking adults receiving in-center hemodialysis for longer than 6 months, their caregivers, and hemodialysis health care providers.Methods:Between May 24, 2017, and August 16, 2018, data collected through focus groups and interviews with hemodialysis patients and their caregivers subsequently informed semi-structured interviews with health care providers. For this secondary analysis, data were analyzed through an inductive thematic analysis using grounded theory, to examine the data more deeply for overarching themes.Results:Among 82 patients/caregivers and 31 healthcare providers, 6 main themes emerged. Themes identified from patients/caregivers were (1) overwhelmed at initiation of hemodialysis care, (2) need for peer support, and (3) improving comprehension of hemodialysis processes. Themes identified from providers were (1) time constraints with patients, (2) relevance of information provided, and (3) technological innovations to improve patient engagement.Limitations:Findings were limited to Canadian context, English speakers, and individuals receiving hemodialysis in urban centers.Conclusions:Participants identified challenges and potential solutions to improve the amount, timing, and individualization of information provided regarding in-center hemodialysis care, which included peer support, technological innovations, and improved knowledge translation activities. Findings may inform the development of interventions and strategies aimed at improving information delivery to facilitate patient-centered hemodialysis care.

Improving knowledge translation for increased engagement and impact in healthcare

Ineffective knowledge dissemination contributes to clinical practice and service improvements not being realised. Meaningful knowledge translation can occur through the understanding and matching of appropriate communication mediums that are relevant...

Pre-Licensure Inter-Professional Perspectives: Pelvic Health Physiotherapy.

Purpose: In this study, we examined knowledge and perspectives pertaining to pelvic health physiotherapy among medical, midwifery, nursing, and physician assistant students at McMaster University. Moreover, we identified opportunities to improve knowledge translation to facilitate inter-professional education in urogynecological care. Method: A cross-sectional design was created to distribute an online survey to participants using a modified Dillman approach. The survey assessed areas of clinical interest in, knowledge of the scope of practice of, and regulations governing pelvic health physiotherapy in specific, in addition to clinical applications. Fisher's exact and Kruskal-Wallis tests were used to assess statistical significance. Results: A total of 90% of the participants incorrectly indicated that internal digital exams could be delegated to physiotherapy assistants, and 50% believed that Kegel exercises were appropriate for all presentations of pelvic floor dysfunction. Moreover, when prompted to select conditions that could be treated by pelvic health physiotherapists, only 2% of the participants selected the correct conditions. Conclusions: Knowledge in all four programmes about the scope of practice, authorized activities, and application of pelvic health physiotherapy is inadequate. To foster the optimal integration of urogynecology into the relevant health science curriculums, enhanced inter-professional education, inclusive of pelvic health physiotherapy knowledge, appears to be needed.

The Extended Congress: Reimagining scientific meetings after the COVID-19 pandemic.

This article was migrated. The article was marked as recommended. The COVID-19 pandemic has profoundly impacted the medical meetings planned for 2020. This health crisis has caused the cancellation, postponement or a pivot in educational design to virtual formats. In the latter case, the format for virtual meetings has remained very similar to the cancelled face-to-face meeting, by using primarily web conferencing systems. This article intends to start a dialogue with the medical education and events community about possible delivery formats. Among them, the concept of an "Extended Congress" is introduced. The extended congress uses the extension of time, space and languages to a scientific meeting. It aims to: 1) unleash the reach of traditional meetings through the use of technology to access larger audiences in different languages, across a country and internationally, with local leaders to help interpret the knowledge and localize it, and 2) to improve knowledge translation into practice through a sequential and active learning process. An ongoing example is described as a proof of concept: the Latin American Peritoneal Dialysis Extended Congress attracted 774 remote participants from over 20 countries, 93% of whom were paid registrants. Initially designed as a hybrid (live plus remote) event scheduled for March 2020, it had to be reframed as a remote only meeting due to the COVID-19 pandemic, thus protecting the health of members while providing continued value to the organization and attendees of the event. With this experience in mind, the authors are currently designing programs in the United States, through collaboration with the University of Virginia Office of Continuing Medical Education. In summary, the design of meetings can better utilize and integrate technology and reach larger audiences with a blend of formats. Those organizations that adapt more quickly to offer these events will concentrate more of the share, as seen with the adoption of technology by other industries.

Impact of a Blood Conservation Bundle Checklist on Perioperative Transfusion Rates during Myomectomy

The primary objective was to introduce an intraoperative blood conservation bundle (BCB) checklist into clinical practice and assess its impact on perioperative blood transfusion rates during myomectomy. Prospective cohort study with retrospective control group. A Canadian tertiary-care teaching hospital. One hundred and eighty-six women who underwent myomectomy. The BCB is a physical checklist attached to the patient chart and consists of evidence-based medical and surgical interventions to reduce intraoperative blood loss. It was introduced in October 2018, and data were collected prospectively during a 12-month period for all open, robotic, and laparoscopic myomectomies at our institution. The primary outcome was the perioperative transfusion rate, and the secondary outcomes included estimated intraoperative blood loss, perioperative complications, readmissions, and BCB usage rates. Data were compared with those of a historic control group for a 24-month period before the BCB introduction. In the pre-BCB period, 134 myomectomies (90 open, 31 robotic, and 13 laparoscopic) were performed, and during our study period, 52 myomectomies (33 open, 10 robotic, and 9 laparoscopic) were performed. There was a decrease in transfusion rate from 15.7% (21/134) to 7.7% (4/52) after introduction of the BCB; however, this was not significant (p = .152). The mean estimated blood loss was lower postintervention (491 mL ± 440 mL vs 350 mL ± 255 mL; p <.05) as was the mean delta hemoglobin (-28 g/L ± 13.0 g/L vs -23 g/L ± 11.4g/L; p <.05]. The checklist was used in 92.3% of cases (48/52). There were no differences in intraoperative or postoperative complications or readmission rates. Best practice care bundles can improve knowledge translation of guidelines into care delivery. The introduction of the BCB was successful in reducing intraoperative blood loss during myomectomy at our institution. The BCB is a simple, effective tool that can be easily adopted by gynecologic surgeons to guide intraoperative decision-making during myomectomy.

Prevalence of Iron Deficiency and Iron Deficiency Anemia during Pregnancy: A Single Centre Canadian Study

Background Iron deficiency (ID) is the most common and widespread nutritional deficiency in both developing and developed countries (Mei et al., 2011; World Health Organization, 2001). Women of childbearing potential are at highest risk of ID due to regular menstrual losses as well as the increased iron demands of pregnancy and lactation (Lynch, 2011; McMahon, 2010). During pregnancy, the risk for ID and iron deficiency anemia (IDA) increases due to the additional iron requirements to support expansion of blood volume/red cell mass and growth of the fetus and placenta (McMahon, 2010; Mei et al., 2011). Common symptoms of ID with or without anemia during pregnancy include fatigue, shortness of breath, difficulty concentrating, higher rates of preterm delivery, and red blood cell transfusions (World Health Organization, 2001). Poor prenatal iron status is also associated with diminished cognitive performance, language ability, and motor functions in the child (Tamura et al., 2002). Despite international recommendations and guidelines on the screening and management of ID in pregnancy, it remains a problem of epidemic proportions and is often left unrecognized and untreated. To increase recognition and appropriate management of ID and IDA in pregnancy, we developed and implemented a quality improvement project, the IRON Deficiency project in Pregnancy: Maternal Iron Optimization (IRON MOM). This project was implemented January 1st, 2017 at St. Michael's Hospital (SMH), an inner-city tertiary centre in Toronto, Canada. The IRON MOM included educational resources for clinicians and patients, standardized oral iron prescriptions, modified lab requisitions, and clinical pathways to guide the screening, diagnosis and management of ID for obstetricians. Objective The primary objective of this study was to assess the prevalence of ID and IDA in unselectively screened pregnant women after the implementation of the IRON MOM quality improvement project. Methods We performed a retrospective audit of administrative laboratory data collected from all obstetrical clinics between January 1 and December 31, 2017. ID was defined as a serum ferritin &lt;50μg/L (Guyatt et al., 1992) . IDA was defined as a dual diagnosis of ID and anemia based on hemoglobin levels &lt;110 g/L and ferritin levels &lt;50μg/L. Descriptive statistics were used to calculate frequencies and proportions. SAS version 9.4 was used to perform the analyses. Results A total of 1830 pregnant women were screened for ID during their obstetrical visit. Of the 1830 pregnant women, 1307 had one ferritin test and 523 pregnant women had two or more tests. A total of 91.3% (1193/1307) of pregnant women were iron deficient (ferritin &lt;50μg/L) where 31.5% (411/1307) had ferritin levels between 15-29μg/L, and 49.4% (645/1307) had severe ID (ferritin &lt;15μg/L). For the women who had two or more ferritin tests, 78.6% (411/ 523) were iron deficient at the first visit which then increased to 96.2% (503/523) by their second visit. When ferritin and hemoglobin values were linked and measured on the same day, 25.9% (346/1336) of pregnant women had IDA over the course of their outpatient care. Conclusion After the implementation of the IRON MOM, we found an extremely high prevalence of ID in our pregnant patient population in the outpatient setting. This confirms that ID remains an underappreciated problem, even at a tertiary care centre. Our findings highlight a tremendous gap in awareness, which demands strategies to improve knowledge translation. Future directions include the simplification and digitization of IRON MOM to empower pregnant women to advocate for their care. Disclosures Sholzberg: Novartis: Honoraria; Amgen: Honoraria, Research Funding.