Knowledge Translation Strategies Research Articles

Implementing accurate identification and measurement of dyskinesia in cerebral palsy into clinical practice: A knowledge translation study.

The application of current, best evidence into clinical practice is problematic. This article describes a knowledge translation (KT) project aimed at improving clinician identification, classification and measurement of dyskinesia in children with cerebral palsy (CP). A 2-year KT fellowship investigated clinicians' understanding of dyskinetic CP, identified knowledge gaps, determined educational needs and implemented a multifaceted KT strategy and dissemination framework to address those needs. Australian and New Zealand medical and allied health clinicians identified significant gaps in their clinical knowledge regarding dyskinetic CP, particularly confidence in identifying and measuring dyskinesia and poor knowledge of available identification and measurement tools. Following a targeted implementation strategy, there was a definite shift towards increased awareness of dyskinetic CP, a significant improvement in identification and measurement confidence (mean change from 47 to 66% confidence, P < 0.0001), and the embedding of the knowledge and skills into everyday clinical practice. This targeted and well-resourced KT project in dyskinetic CP improved clinician knowledge and led to meaningful change in clinical practice. The strategy utilised would be appropriate across a range of health-care settings.

Arts-based knowledge translation in aerial silk to promote epilepsy awareness

IntroductionArts-based knowledge translation (ABKT) strategies represent an innovative approach to disseminate results of qualitative studies, especially to tackle social issues, such as stigma and prejudice, due to knowledge gaps. Epilepsy affects 1% of the world population and brings a strong psychosocial impact to the patient, family members, and caregivers. People with epilepsy have difficulties to establish social relationships due to stigma. MethodsIn this study, we narrate the construction of an aerial and contemporary dance based on the results of a qualitative study with patients with epilepsy, their families, and health professionals, called “‘Dialogue with Emotions’ to overcome barriers and to improve quality of life in epilepsy”. Under the ABKT classification, this study is defined as a strategy of subjective key messages, which are presented as active performances (contemporary dance and aerial acrobacies). ResultsIn this sense, the choreography called “Perspective” presented elements that relate to suffering, pain, fear, social isolation, followed by mutual support, resilience, adaptation, and happiness. Through its scenic poetry and acrobatics combined with special lighting effect and soundtrack, this choreography represents the potential to overcome suffering and experience happiness if people embrace a different perspective over epilepsy. ConclusionThis presentation conveyed perceptions on epilepsy in a way to create an experience for its audience. It represented an opportunity to stimulate reflection, discussion, and knowledge construction between members of the academy, as well as patients and caregivers. Thus, this artistic presentation was able to promote discussions about epilepsy, disseminating research results, promoting empathy and compassion.

Acute otitis media in children presenting to the emergency department: Is it diagnosed and managed appropriately?

To describe the diagnostic and management practice in children with acute otitis media (AOM) presenting to the emergency department (ED) and compare diagnosis and management against existing guidelines. We performed a retrospective descriptive cohort study of patients ≤15 years of age who presented to two EDs in Southeast Queensland between January 2016 and June 2017 with an ED diagnosis of AOM. Likelihood of diagnosis was based on medical records and classified as likely, possible or unlikely using paediatric practice guidelines. Appropriateness of antibiotics prescription was classified using the National Antibiotic Prescribing Survey, which takes into account adherence to the Australian Therapeutic Guidelines. Each medical record was extracted by two blinded reviewers, and discrepancies were resolved by consensus or arbitration. Of the 305 patients included for analysis, 87% had a likely or possible diagnosis of AOM. Otalgia was the presenting complaint in 75%. Standard otoscopy was the routine method for tympanic membrane visualisation, and 70% had abnormal tympanic membrane findings. Almost two-thirds (62%) of all children were prescribed antibiotics. Antibiotic appropriateness could be ascertained for 286 patients (94%). A total of 39% received inappropriate antibiotic management for AOM. The majority of patients received analgesia in the form of paracetamol and/or ibuprofen. ED clinicians make the diagnosis of AOM fairly accurately, although better assessment of the tympanic membrane by tympanometry and/or pneumatic otoscopy may improve accuracy. More than one-third of patients are prescribed antibiotics inappropriately. Our data can inform knowledge translation and education strategies to ensure the correct evidence-based management of this condition.

Improving knowledge translation of clinical practice guidelines for epilepsy

BackgroundClinical practice guidelines (CPGs) have the potential to improve quality of care. However, implementation of CPGs into the clinical care of people with epilepsy is less than optimal. This study aimed to examine barriers and facilitators to the use of CPGs for the care of people with epilepsy. MethodsA cross-sectional survey of Canadian neurologists was conducted to evaluate CPG use, barriers and facilitators of CPG use, and factors associated with CPG use among neurologists. The barriers and facilitators of CPG use among neurologists that manage people with epilepsy were compared with those who do not. ResultsOf 311 responders (response rate = 38.7%), 78.7% indicated that they manage people with epilepsy. Neurologists that manage people with epilepsy did not differ from those who do not with regard to demographic characteristics nor in the proportion that report using CPGs in their clinical practice. The barriers and facilitators of CPG use were largely similar between neurologist that do and do not manage people with epilepsy; except applicability of CPGs tended to be less commonly endorsed as a barrier to CPG use by those who manage people with epilepsy compared with those who do not. ConclusionsThis study suggests that knowledge, applicability, motivation, resources, and targeting of CPGs to appropriate audience are barriers and facilitators of CPG use among neurologists who manage people with epilepsy. The similarity between barriers and facilitators of CPG use among neurologists who manage people with epilepsy compared with those who do not provides support for the use of a knowledge translation (KT) strategy tailored to these barriers and facilitators of CPG use, and targeted towards neurologists. Implementation of epilepsy CPGs has the potential to improve the quality of care for people with epilepsy.

Completeness of Reporting of Systematic Reviews of Diagnostic Test Accuracy Based on the PRISMA-DTA Reporting Guideline.

We evaluated the completeness of reporting of diagnostic test accuracy (DTA) systematic reviews using the recently developed Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA)-DTA guidelines. MEDLINE® was searched for DTA systematic reviews published October 2017 to January 2018. The search time span was modulated to reach the desired sample size of 100 systematic reviews. Reporting on a per-item basis using PRISMA-DTA was evaluated. One hundred reviews were included. Mean reported items were 18.6 of 26 (71%; SD = 1.9) for PRISMA-DTA and 5.5 of 11 (50%; SD = 1.2) for PRISMA-DTA for abstracts. Items in the results were frequently reported. Items related to protocol registration, characteristics of included studies, results synthesis, and definitions used in data extraction were infrequently reported. Infrequently reported items from PRISMA-DTA for abstracts included funding information, strengths and limitations, characteristics of included studies, and assessment of applicability. Reporting completeness was higher in higher impact factor journals (18.9 vs 18.1 items; P = 0.04), studies that cited PRISMA (18.9 vs 17.7 items; P = 0.003), or used supplementary material (19.1 vs 18.0 items; P = 0.004). Variability in reporting was associated with author country (P = 0.04) but not journal (P = 0.6), abstract word count limitations (P = 0.9), PRISMA adoption (P = 0.2), structured abstracts (P = 0.2), study design (P = 0.8), subspecialty area (P = 0.09), or index test (P = 0.5). Abstracts with a higher word count were more informative (R = 0.4; P < 0.001). No association with word counts was observed for full-text reports (R = -0.03; P = 0.06). Recently published reports of DTA systematic reviews are not fully informative when evaluated against the PRISMA-DTA guidelines. These results should guide knowledge translation strategies, including journal level (e.g., PRISMA-DTA adoption, increased abstract word count, and use of supplementary material) and author level (PRISMA-DTA citation awareness) strategies.

Development and implementation of dementia-related integrated knowledge translation strategies in rural home care

Purpose: As the Canadian population ages the provision of high quality dementia care may be increasingly challenging, particularly in under-resourced rural areas. Researchers have also suggested that rural care providers have unmet dementia-related educational needs and would benefit from formal knowledge exchange supports, such as a knowledge broker (KB). The current research aimed to address this issue by employing a KB to facilitate the development and implementation of integrated knowledge translation (iKT) strategies within two rural home care centres.Methods: In this longitudinal multiple case study, iKT processes at each site were assessed at baseline, 6 months, and following the termination of KB assistance. Data from 38 semi-structured interviews at the latter time points with registered and licensed practical nurses, health care aides, managers, and other care providers (n=19) were analyzed thematically to examine their perceptions of strategy processes and impacts, including the KB role.Findings: Perceived facilitators of iKT strategy development and implementation included collaborative development by knowledge users, alignment with organizational values and culture, and regular communication. Home care providers (HCPs) identified the importance of leadership and perceived the KB to be integral for facilitating communication, keeping strategies on track, and brokering information. Barriers to strategy implementation also emerged however, including significant time constraints, limited resources, and the variable nature of dementia. HCP reported that the iKT strategies enabled rural/community-specific solutions, enhanced their knowledge and ability to use best practice dementia information, increased their capacity to exchange dementia knowledge, and ultimately enhanced family and client well-being.Conclusions: HCPs reported professional benefits from their participation in the iKT strategies, and perceived benefits for people living with dementia and their caregivers. Findings suggest the utility of such strategies for addressing ongoing education needs of rural care providers. Keywords: dementia, integrated knowledge translation, home care, rural DOI: http://dx.doi.org/10.14574/ojrnhc.v18i2.509

Impact of an organization-wide knowledge translation strategy to support evidence-informed public health decision making

BackgroundThe public health sector is moving toward adopting evidence-informed decision making into practice, but effort is still required to effectively develop capacity and promote contextual factors that advance and sustain it. This paper describes the impact of an organization-wide knowledge translation intervention delivered by knowledge brokers on evidence-informed decision making knowledge, skills and behaviour.MethodsA case study design was implemented with the intervention and data collection tailored to the unique needs of each case (health department). A knowledge broker provided training workshops and mentored small groups through a seven step process of evidence-informed decision making. The intervention was delivered over 22 months; data related to evidence-informed decision making knowledge, skills and behaviour were collected at baseline and follow-up. Mixed effects regression models were developed to assess the impact of involvement in the intervention on the evidence-informed decision making outcomes.ResultsData from a total of 606 health department staff were collected during baseline: 207 (33%) staff from Case A, 304 (28%) from Case B, and 95 (47%) from Case C. There were a total of 804 participants at follow-up: 258 (42%) from Case A, 391 from Case B (37%), and 155 (50%) from Case C. Statistically significant increases in knowledge and skills were observed overall, and in all three health departments. An increase in evidence-informed decision making behaviour was observed among those intensively involved in the intervention from all cases (statistically significant in Case A). The organizational characteristics of strategic priority, leadership, readiness, and choice of staff emerged as important factors in the change process.ConclusionsKnowledge brokering is a promising organizational knowledge translation intervention to support evidence-informed decision making. The intervention appeared to have the greatest impact on those who became actively engaged with the knowledge broker in the intervention. Active participation in face-to-face training activities with a knowledge broker, focused specifically on evidence-informed decision making skill development, led to the greatest impact on associated behaviours, knowledge, and skills. Several organizational factors emerged as integral to success of the knowledge translation intervention.

Frozen Plasma Transfusion Practices in Ontario-an Electronic Audit at Five Tertiary Care Hospitals to Inform a Knowledge Translation Strategy to Reduce Inappropriate Plasma Transfusions

Frozen plasma transfusions are blood components that are frequently transfused to patients who are bleeding or require an invasive procedure and have a deficiency of coagulation factors detected on abnormal coagulation testing as inferred by a prolonged prothrombin time (PT), partial thromboplastin time (PTT), or increased international normalized ratio (INR). Despite published guidelines, supporting optimal plasma use, two recent provincial audits have suggested that 50% of the plasma transfused in the Province of Ontario is inappropriate. Inappropriate utilization of plasma has numerous adverse consequences for the recipient, including transfusion associated lung overload, allergic reactions, and delays necessary procedures while awaiting completion of the transfusion. In addition to the direct risks that inappropriate utilization of plasma has on the patient, it also has adverse consequences for the health care system; Given 98,521 units transfused in Canada in 2017, of which 50% are unnecessary, the annual revenue loss is estimated to be CAN$1.7 million.We will include all adult Inpatients receiving plasma during the time period January 1, 2017 and December 31, 2017. The study population will be subdivided into 5 groups of inappropriate plasma use that include: (1) patients with a normal INR≤1.5 and who were not actively bleeding, as indicated by no RBC transfusion; (2) patients with normal INR≤1.5 with moderate bleeding only; (3) elevated INR>1.5, without active bleeding or procedures; (4) no INR drawn before or after plasma infusion; or, (5) transfused a non-therapeutic dose of plasma, defined by less than or equal to 2 units. RBC transfusion requirement and the quantitative drop in hemoglobin will be used as a surrogate marker for bleeding. We plan to analyze the number and proportion of unnecessary plasma transfusions at five tertiary care centres by patient demographics, by triggering INR, and by the presence or absence of bleeding.As part of preliminary work to facilitate future audits and monitor appropriate plasma utilization in Ontario, there has been an Ontario Blood Utilization Data Strategy (ONBUDS) data extraction project where preliminary data has been extracted from blood transfusion databases, laboratory databases, and the discharge abstract database (DAD) for four institutions. We expect to confirm previous findings that 50% of the plasma transfused in Ontario is transfused inappropriately. Based on the preliminary ONBUDS data, it was found that the majority of inappropriate plasma transfusions were in the areas of cardiac surgery, orthopedic surgery, intensive care and gastroenterology.This study will inform a large quality improvement study aimed at reducing unnecessary plasma transfusion. The long-term goal is to develop an alternative electronic auditing strategy that is more comprehensive, faster, and more cost efficient than the historical annual Provincial audit which requires manual chart reviews by physicians, nurses and technologists. DisclosuresNo relevant conflicts of interest to declare.

A deliberative dialogue as a knowledge translation strategy on road traffic injuries in Burkina Faso: a mixed-method evaluation

IntroductionDeliberative dialogues are increasingly being used, particularly on the African continent. They are a promising interactive knowledge translation strategy that brings together and leverages the knowledge of diverse stakeholders important to the resolution of a societal issue. Following a research project carried out in Burkina Faso on road traffic injuries, a 1-day workshop in the form of a deliberative dialogue was organised in November 2015. The workshop brought together actors involved in road safety, such as researchers, police and fire brigades, health professionals, non-governmental and civil society organisations, and representatives of government structures. The objective was to present the research results, propose recommendations to improve the situation and develop a collective action plan.MethodTo better understand the workshop’s utility and effects, a mixed-method evaluation was conducted. Data were obtained from two questionnaires distributed at the end of the workshop (n = 37) and 14 qualitative interviews with participants 6–10 weeks after the workshop. Descriptive statistics were used to analyse the quantitative data, and a thematic analysis was conducted for the qualitative data.ResultsThe data revealed several positive impacts of the workshop, such as the acquisition of new knowledge about road safety, the opportunity for participants to learn from each other, the creation of post-workshop collaborations, and individual behaviour changes. However, several challenges were encountered that constrained the potential effects of the workshop, including the limited presence of political actors, the lack of engagement among participants to develop an action plan, and the difficulty in setting up a monitoring committee following the workshop.ConclusionWhile the deliberative workshop is not the standard format for reporting research results in Burkina Faso, this model should be reproduced in different contexts. This interactive knowledge translation strategy is useful to benefit from the experiential knowledge of the various actors and to encourage their involvement in formulating recommendations.

Factors Influencing the Uptake of Canadian Research Findings into the Care of Children with Arthritis: A Healthcare Provider Perspective.

To determine barriers and facilitators to the uptake of findings from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) study into clinical care by pediatric rheumatologists (PR) and allied health professionals (AHP) caring for children with juvenile idiopathic arthritis (JIA) in Canada. PR and AHP participated in this qualitative study through telephone interviews. Interview guides were developed using the Theoretical Domains Framework and focused on the use of information from the ReACCh-Out study in the practice of counseling patients and families. A directed content analysis approach was used for coding. Nineteen interviews (8 PR and 11 AHP) were completed. All PR had knowledge of the ReACCh-Out study. Three major themes were identified: (1) both groups are motivated to use information from research in clinical care; (2) volume and emotional effect of information on families are barriers; and (3) specific timepoints in care trigger providing this information. AHP had less knowledge of the ReACCh-Out study, did not feel it was their primary role to provide this information, and have a desire for more opportunity to participate in academic forums related to research. We have described a comprehensive overview of the barriers and facilitators perceived by healthcare providers in the translation of knowledge from JIA research into use in clinical practice. These findings provide a foundation for the development of knowledge translation strategies in the care of children with JIA and other rheumatic diseases.

Putting family into family-based obesity prevention: enhancing participant engagement through a novel integrated knowledge translation strategy

BackgroundWith 1 in 4 Canadian preschoolers considered overweight or obese, identifying risk factors for excess weight gain and developing effective interventions aimed at promoting healthy weights and related behaviours among young children have become key public health priorities. Despite the need for this research, engaging and maintaining participation is a critical challenge for long-term, family-based studies. The aim of this study is to describe the implementation and evaluation of a parent-only advisory council designed to engage participants in the implementation and evaluation of a longitudinal, family-based obesity prevention intervention.MethodsA Family Advisory Council (n = 14 parents, 70% mothers, 64% white), was established to engage participant stakeholders in decisions related to research protocols and strategies to engage and sustain family participation. Using a mixed methods approach, including a participant survey and focus group, we examined the council members’ perceptions of their role and the impact this novel integrated Knowledge Translation (iKT) strategy had on the Guelph Family Health Study (GFHS), a longitudinal family-based study.ResultsAll members of the Family Advisory Council felt the topics discussed were appropriate, felt that their opinions were valued and that their suggestions have had an impact and direct benefit on the GFHS. The addition of the Family Advisory Council led to changes in study protocol (i.e. creation of more detailed intervention emails, creation of kid-friendly accelerometer bands) that may have contributed to the high retention rate of the GFHS (95% at 6-month follow-up).ConclusionsEngaging parents as research partners in family-based research studies may be an effective way to increase participant engagement and study retention.

Impact of the Diabetes Canada Guideline Dissemination Strategy on the Prescription of Vascular Protective Medications: A Retrospective Cohort Study, 2010-2015.

The 2013 Diabetes Canada guidelines launched targeted dissemination tools and a simple assessment for vascular protection. We aimed to 1) examine changes associated with the launch of the 2013 guidelines and additional dissemination efforts in the rates of vascular protective medications prescribed in primary care for older patients with diabetes and 2) examine differences in the rates of prescriptions of vascular protective medications by patient and provider characteristics. The study population included patients (≥40 years of age) from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) with type 2 diabetes and at least one clinic visit from April 2010 to December 2015. An interrupted time series analysis was used to assess the proportion of eligible patients prescribed a statin, ACE inhibitor (ACEI)/angiotensin receptor blocker (ARB), or antiplatelet prescription in each quarter. Proton pump inhibitor (PPI) prescriptions were the reference control. A dynamic cohort was used where participants were enrolled each quarter using a prespecified set of conditions (range 25,985-70,693 per quarter). There were no significant changes in statin (P = 0.43), ACEI/ARB (P = 0.42), antiplatelet (P = 0.39), or PPI (P = 0.16) prescriptions at baseline (guideline intervention). After guideline publication, there was a significant change in slope for statin (-0.52% per quarter, SE 0.15, P < 0.05), ACEI/ARB (-0.38% per quarter, SE 0.13, P < 0.05), and reference PPI (-0.18% per quarter, SE 0.05, P < 0.05) prescriptions. There was a decrease in prescribing trends over time that was not specific to vascular protective medications. More effective knowledge translation strategies are needed to improve vascular protection in diabetes in order for patients to receive the most effective interventions.

International experiments with different models of allocating funds to facilitate integrated care: a scoping review protocol

IntroductionIntegrated care is viewed widely as a potential solution to some of the major challenges faced by health and social care systems, such as those posed by service duplication, fragmentation...

Knowledge translation for realist reviews: a participatory approach for a review on scaling up complex interventions

BackgroundKnowledge syntheses that use a realist methodology are gaining popularity. Yet, there are few reports in the literature that describe how results are summarised, shared and used. This paper aims to inform knowledge translation (KT) for realist reviews by describing the process of developing a KT strategy for a review on pathways for scaling up complex public health interventions.MethodsThe participatory approach used for the realist review was also used to develop the KT strategy. The approach included three main steps, namely (1) an international meeting focused on interpreting preliminary findings from the realist review and seeking input on KT activities; (2) a targeted literature review on KT for realist reviews; and (3) consultations with primary knowledge users of the review.ResultsThe international meeting identified a general preference among knowledge users for findings from the review that are action oriented. A need was also identified for understanding how to tailor findings for specific knowledge user groups in relation to their needs. The literature review identified four papers that included brief descriptions of planned or actual KT activities for specific research studies; however, information was minimal on what KT activities or products work for whom, under what conditions and why. The consultations revealed that KT for realist reviews should consider the following: (1) activities closely aligned with the preferences of specific knowledge user groups; (2) key findings that are sensitive to factors within the knowledge user’s context; and (3) actionable statements that can advance KT goals, activities or products. The KT strategy derived from the three activities includes a planning framework and tailored KT activities that address preferences of knowledge users for findings that are action oriented and context relevant.ConclusionsThis paper provides an example of a KT strategy for realist reviews that blends theoretical and practical insights. Evaluation of the strategy’s implementation will provide useful insights on its effectiveness and potential for broader application.

Clinical practice and nursing management of pre-operative skin or skeletal traction for hip fractures in elderly patients: a cross-sectional three-institution study

BackgroundFemoral fractures are a major healthcare problem worldwide. One of the most difficult issues is their preoperative care, which is still managed by either skeletal or skin traction in some countries, including Italy. These issues are discussed and compared with the contemporary literature. ObjectiveThis study aims to analyse the distribution of these treatment options within the orthopaedic community and the reasons for their use, as well as to identify how this may impact nursing care in terms of pain management, hygiene care, venous thromboembolism (VTE)prophylaxis and prevention of pressure ulcers. DesignFor this cross-sectional study, a 12-item survey was administered to the nursing staff, consultants and residents of the Orthopaedic Units in three different hospitals in NorthEastern Italy. The questionnaire investigated the routine use of skeletal or skin traction for the preoperative management of hip fractures in those settings. Findings136 surveys were completed, providing a response rate of 87.74%. Preoperative traction for hip fractures was still in use in the three hospitals, mainly applied by experienced surgeons for subtrochanteric fractures. Pain management, VTE and pressure ulcer prevention were perceived as worse only with skeletal traction, while hygiene was described as more difficult with both skeletal and skin traction. Conclusions and recommendationsBased on the data and the literature revision, skin or skeletal traction for patients with proximal femoral fractures should be discouraged as standard practice. This is supported widely in the international literature, and consideration of knowledge translation strategies should be made to refine current practice in these settings.

Knowledge translation of clinical practice guidelines among neurologists: A mixed-methods study.

ObjectivesClinical practice guidelines have the potential to improve care, but are often not optimally implemented. Improving guideline use in clinical practice may improve care. The objective of this study was to identify the barriers and facilitators (determinants) of guidelines use among neurologists and to propose a strategy to improve guideline implementation.MethodsThis was a mixed-methods study design. A quantitative, population-based, cross-sectional survey of Canadian neurologists was conducted. Associations between guidelines use and determinants of guidelines use were examined. Focus groups and interviews were conducted using purposeful sampling of the population. Determinants of guideline use were mapped to interventions to establish a strategy for guideline implementation among neurologists.Results38.7% (n = 311) of neurologists responded to the survey. Typically, respondents had been practicing for 16.6 years and worked in an academic institution in an urban setting. Being male and having an academic affiliation was associated with guideline use. Determinants of guideline use differed between guideline users and non-users; non-users consistently rating determinants lower than users, especially applicability. Two focus groups and one interview (n = 11) identified six main themes of determinants of guideline use: Credibility, knowledge, applicability, resources, motivation, and target audience; which was congruent with the quantitative data. The proposed knowledge translation strategy contains three pillars: guidelines development, dissemination, and interventions.ConclusionsSeveral determinants of guideline use not commonly discussed in the literature were identified (applicability, target audience, credibility). The proposed implementation strategy is a valuable resource for guideline developers and policy/decision-makers to improve knowledge translation of guidelines among neurologists.

What are the perceptions about running and knee joint health among the public and healthcare practitioners in Canada?

ObjectivesTo evaluate the perceptions of the general public and healthcare practitioners (HCP) in Canada about the relationship between running and knee joint health, and to explore HCP`s usual recommendations to runners with knee osteoarthritis (KOA).MethodsNon-runners and runners (with and without KOA) and HCP completed an online survey regarding the safety of running for knee joint health. HCP also provided information related to usual clinical recommendations. Proportions of agreement were compared between non-runners and runners.ResultsA total of 114 non-runners, 388 runners and 329 HCP completed the survey. Overall, running was perceived as detrimental for the knee joint by 13.1% of the general public, while 25.9% were uncertain. More uncertainty was reported regarding frequent (33.9%) and long-distance (43.6%) running. Statistical analyses revealed greater proportions of non-runners perceiving running negatively compared with runners. Overall, 48.4% believed that running in the presence of KOA would lead to disease progression, while 53.1% believed running would lead to premature arthroplasty. In HCP, 8.2%, 9.1% and 22.2% perceived that running in general, running frequently, or running long-distances are risk factors for KOA, respectively. 37.1% and 2.7% of HCP typically recommended patients with KOA to modify their running training or to quit running, respectively.ConclusionHigh rates of uncertainty among the general public and HCP in Canada outline the need for further studies about running and knee joint health. Filling knowledge gaps will help inform knowledge translation strategies to better orientate the general public and HCP about the safety of running for knee joint health.

A Framework for Development of Useful Metabolomic Biomarkers and Their Effective Knowledge Translation.

Despite the significant advantages of metabolomic biomarkers, no diagnostic tests based on metabolomics have been introduced to clinical use. There are many reasons for this, centered around substantial obstacles in developing clinically useful metabolomic biomarkers. Most significant is the need for interdisciplinary teams with expertise in metabolomics, analysis of complex clinical and metabolomic data, and clinical care. Importantly, the clinical need must precede biomarker discovery, and the experimental design for discovery and validation must reflect the purpose of the biomarker. Standard operating procedures for procuring and handling samples must be developed from the beginning, to ensure experimental integrity. Assay design is another challenge, as there is not much precedent informing this. Another obstacle is that it is not yet clear how to protect any intellectual property related to metabolomic biomarkers. Viewing a metabolomic biomarker as a natural phenomenon would inhibit patent protection and potentially stifle commercial interest. However, demonstrating that a metabolomic biomarker is actually a derivative of a natural phenomenon that requires innovation would enhance investment in this field. Finally, effective knowledge translation strategies must be implemented, which will require engagement with end users (clinicians and lab physicians), patient advocate groups, policy makers, and payer organizations. Addressing each of these issues comprises the framework for introducing a metabolomic biomarker to practice.

Developing recommendations for the safe handling of oral anti-cancer drugs in community pharmacies: A pan-Canadian consensus approach.

To create a set of consensus-based and evidence-informed recommendations to provide guidance around the safe dispensing and handling of oral anti-cancer drugs in low-volume settings unique to the community pharmacy setting. A review of published and grey literature (published in non-commercial domains such as national organizations and associations) documents and nine key informant interviews were conducted and a modified Delphi approach was taken to achieve consensus. The final list of 47 candidate recommendations was reviewed by a task force and validated by multi-disciplinary stakeholders. A draft of the statements was circulated broadly within the community pharmacy community in an effort to assess relevance and implementation feasibility. The final report included 44 recommendations that addressed 11 key areas germane to the safe handling of oral anti-cancer drugs in community pharmacies. Mean agreement increased from 70% to 95%. Early feedback from community pharmacy leaders during the external review suggests that many of the proposed recommendations can be feasibly implemented within a reasonable timeframe when released with appropriate education and resource materials. A modified-Delphi approach supplemented by key informant interviews and a comprehensive external review resulted in a set of evidence-informed, community-driven recommendations for community pharmacies. The recommendations address a gap in existing literature to improve understanding of the risks associated with handling and dispensing oral anti-cancer drugs for both community pharmacy staff and management and offer mitigating strategies to reduce those risks. Incorporating feasibility assessment actions early (through the key informant interviews) and late (through the external review) ensures recommendations are grounded in practicality and support broad and early knowledge translation strategies.

Cognitive behavioural therapy for eating disorders: how do clinician characteristics impact on treatment fidelity?

BackgroundClinicians routinely report not practising evidence-based treatments with eating disorders. There has been limited research investigating the impact of adaptable clinician characteristics such as self-efficacy and therapeutic optimism in this area. This study evaluated if there is a relationship between clinician therapeutic optimism, self-efficacy and the provision of evidence-based practice in the treatment of bulimia nervosa and binge eating disorder.MethodA survey developed for this study was administered to 100 psychologists who were recruited online via a range of organisations affiliated with psychology and/or eating disorders. The survey measured demographic factors, eating disorder treatment knowledge, treatment fidelity, the use of individual treatment components and a range of clinician characteristics including self-efficacy and therapeutic optimism.ResultsResults demonstrated that clinician self-efficacy was positively associated with and predicted treatment fidelity. Therapeutic optimism had significant low correlations with treatment fidelity but did not predict treatment fidelity.ConclusionThese findings would suggest that strengthening clinician self-efficacy is useful in improving evidence-based practice in the treatment of binge eating disorder and bulimia nervosa and may also have implications in the training of clinicians. The study also demonstrated that the use of a range of knowledge translation strategies are valuable in enhancing clinician adherence to evidence-based practice. Further research with direct measures of treatment fidelity is needed to clarify these findings.