Multifaceted Knowledge Research Articles

The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on student symptoms.

Many students are afraid of receiving vaccinations at school. We implemented a novel, multifaceted knowledge translation intervention incorporating evidence-based vaccination coping strategies-The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract)-and evaluated impact on student attitudes, knowledge, coping strategies used, and symptoms during school-based vaccinations. Mixed methods. Ten schools participated in a controlled clinical trial: five experimental and five control. Experimental School (ES) students completed a knowledge and attitudes survey during an in-class CARD™ educational session prior to school vaccinations and selected coping strategies for upcoming vaccinations. Control School (CS) students received the usual vaccine education lesson, which did not include information about or selection of coping strategies. At all schools and during both vaccination clinic visits (fall and spring), injecting nurses recorded specific coping strategies used, and students independently rated their fear, pain, and dizziness during vaccinations. Focus groups were conducted at five schools after all clinics were completed (three ES, two CS). ES students had higher knowledge (P<0.001), less fear (P=0.03), and greater willingness to be vaccinated (P=0.001) after the in-class education session. Students rated the education as understandable, sufficient, useful, and that it prepared them for vaccinations. During school vaccination clinics, ES students selected more coping interventions than CS students. There were fewer students with high levels of fear (P=0.008) and dizziness (P=0.04) in the ES group. In round 2, fewer students (P=0.02) in the ES group returned to the clinic postvaccination because they were feeling unwell. ES students participating in focus groups scored higher on their knowledge test (P<0.001) compared with CS students and reported learning and benefitting from CARD™. This small-scale implementation study provides preliminary evidence of the effectiveness of CARD™ in improving vaccination experiences for students at school. Future research is recommended that examines CARD™ in different settings to confirm these results.

Stakeholder feedback on The CARD™ System to improve the vaccination experience at school.

School-based vaccination programs can be a source of distress for many students due to the pain from the needle injection and related fears. We created a multifaceted Knowledge Translation (KT) intervention to address vaccination and pain, fear, and fainting called The CARD™ System. The objectives were to document acceptability of key tools included in the multifaceted KT intervention and their effectiveness in improving knowledge and attitudes about vaccination pain and fear. Quantitative and qualitative methods were used. Students, school staff, public health nurses, and parents participated in separate focus groups whereby they independently completed a knowledge and attitudes survey and provided structured and qualitative feedback on key KT tools of the multifaceted KT intervention. They then repeated the knowledge and attitudes survey. Altogether, 22 students (grade 6 and 7), 16 school staff (principals, grade 7 and 8 teachers, resource teachers, secretaries), 10 nurses (injecting, charge, and school nurses), and 3 parents participated. Knowledge test scores increased post-KT tool review: 8.5 (2.1) versus 7.3 (1.9); P<0.001. Attitudes were more positive about the individual nature of pain and fear experience during vaccination. Student fear scores were lower post-tool review: 5.1 (2.9) versus 4.6 (3.0); P<0.001. The majority of the participants reported they understood all the information, the amount was just right and that the information was useful. The KT tools were demonstrated to be acceptable and to improve knowledge. Future research is warranted to determine their impact on student experience during school vaccinations.

The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on program delivery.

We conducted a small-scale implementation study that integrated The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract)-a multifaceted knowledge translation intervention designed to improve the vaccination experience at school-within the school vaccination program. Mixed methods design, including a controlled clinical trial and focus group interviews. The experimental group included five schools whereby CARD™ was implemented. The control group included five schools whereby no changes were made. Focus groups were held at the end of the school year. For nurses trained in CARD™, additional focus groups were held at CARD™ training and after the first round of vaccine clinic visits. Outcomes included vaccination rate at school and adult stakeholder perceptions. Altogether, 323 students attended study schools. Fifty-five nurses, school staff, and parents participated in 15 focus groups. The school vaccination rate did not differ (P>0.05) between groups for round 1 clinics (76% versus 77%) or round 2 clinics (68% versus 70%). Participants reported acceptability, appropriateness, feasibility, and satisfaction with CARD™. Experimental group nurses were able to integrate CARD™ within usual activities, including clinic planning, student education, and clinic-day set-up and student vaccinations. Students in experimental schools were described by nurses and school staff as more prepared and less fearful during vaccinations. Nurses reported that CARD™ built on their practice; they had higher confidence in their ability to assess pain and fear and higher satisfaction with their ability to manage it. Nurses also reported improved collaboration with students and with each other. All stakeholder groups recommended continuing CARD™. Some additional time was required, primarily related to clinic planning activities and data collection for study purposes. CARD™ is a promising new approach for improving the delivery of vaccinations at school. Exploration of approaches to increase parental reach and monitoring of vaccination uptake rate over time are recommended.

Testing a Multifaceted Knowledge Translation Intervention for Acute Care Occupational Therapists

Abstract Date Presented 4/19/2018 This study examined short- and long-term effects of an evidence-based practice knowledge translation (KT) intervention with acute care occupational therapists. Significant positive results in attitudes and behavior were found in the short term. KT interventions are a practical means to bridge the gap between research and practice. Primary Author and Speaker: Katelin Iott Additional Authors and Speakers: Kelly Lawrence Contributing Authors: Susan Murphy

Mummification in Korea and China: Mawangdui, Song, Ming and Joseon Dynasty Mummies

Over the decades, mummy studies have expanded to reconstruct a multifaceted knowledge about the ancient populations' living conditions, pathologies, and possible cause of death in different spatiotemporal contexts. Mainly due to linguistic barriers, however, the international knowledge of East Asian mummies has remained sketchy until recently. We thus analyse and summarize the outcomes of the studies so far performed in Korea and China in order to provide mummy experts with little-known data on East Asian mummies. In this report, similarities and differences in the mummification processes and funerary rituals in Korea and China are highlighted. Although the historical periods, the region of excavation, and the structures of the graves differ, the cultural aspects, the mechanisms of mummification, and biological evidence appear to be essentially similar to each other. Independently from the way they are called locally, the Korean and Chinese mummies belong to the same group with a shared cultural background.

САМООСВІТНЯ КОМПЕТЕНТНІСТЬ МАЙБУТНЬОГО ВЧИТЕЛЯ ТРУДОВОГО НАВЧАННЯ ТА ТЕХНОЛОГІЙ

The article reflects the essence, structure and problem of forming the self-educational competence. The “self-education competence of the future teacher of labor education and technologies” is defined as the quality of the teacher’s personality, characterized by the ability and readiness for the continuous self-education during studying and in the process of professional activity. It is marked that the peculiarity of self-educational competence is forming on the basis of gaining an experience of independent attempts and achievements in self-education, developing its own individual learning system, moving from copying the self-education samples to creating its own model, adding self-education to the student’s lifestyle. The attetion is accented on the development of self-educational competence of the future teachers of labor education and technology, because this specialty requires the constant professionalism, as it directly depends on the multifaceted knowledge, skills and abilities, which in turn are connected with the constantly changing technologies. The research considers the functions of self-educational competence of the teacher (motivational, developmental, educational, cognitive, methodological, informative, diagnostic-prognostic, communicative, reflexive, adaptive and interactive). The author reveals the theoretical and practical skills that the future teachers of technology have to possess in organizing their own activities. It is also educed that the effectiveness of forming the self-education competence of future teachers of labor education and technology largely depends on informational support of the educational process. The using of advanced information and communication technologies makes it possible to intensify the students’ independent activity and thus increase the level of development of self-education competence.

Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial.

BackgroundPhysicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports.ObjectiveThe aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators.MethodsThe study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm.ResultsA total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=−0.19, P=.85). Two variables predicted algorithm-based reporting—caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001).ConclusionsOn the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians.Trial RegistrationClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8)

Getting inTOUCH: outcomes of a knowledge translation intervention for tactile assessment knowledge, barriers, and practice in paediatric therapists working with children with cerebral palsy

Background: Tactile impairments are common in children with cerebral palsy (CP), however assessment is not routinely carried out by therapists. We investigated a multi-faceted Knowledge Translation intervention to improve Knowledge, remove Barriers and enhance Practice of tactile assessments by paediatric therapists.Method: Twelve therapists from a state-wide service for children with CP (seven physiotherapists, five occupational therapists; 12 female) received: written information, demonstration videos, a face-to-face workshop, equipment provision, and on-call mentoring. Therapists completed pre–post-intervention questionnaires reporting their perceived tactile assessment Knowledge, current Practices and implementation Barriers.Results: Following intervention, therapists improved Knowledge of correct (1) tactile impairment prevalence in children with CP (pre 3/12; post 9/12), (2) tactile assessment items (e.g. Registration – pre 1/12; post 9/12; Localisation – pre 2/12; post 10/12), and (3) equipment choice (e.g. Monofilaments – pre 1/12; post 10/12). Tactile assessment Practice improved slightly. All major clinician-level implementation Barriers were resolved and less obvious organisational-level Barriers were identified for follow-up.Conclusion: A 12-month multi-faceted Knowledge Translation intervention can improve tactile assessment Knowledge, resolve major clinician-level implementation Barriers, and identify less obvious organisational-level Barriers to be addressed to achieve maximum Practice improvement. Ongoing multi-faceted knowledge translation processes are essential for high-performing organisations.Implications for rehabilitationA multi-faceted knowledge translation intervention significantly improved paediatric therapists’ knowledge of the items and equipment necessary for tactile assessment.A 12-month intervention can address clinician-level barriers of knowledge, confidence, and access to equipment and assist in the identification of less obvious organisational-level barriers.Consideration of motivational readiness for change, intervention timelines, monitoring of emergent barriers, and fitting tactile assessment into a broader assessment framework are critical for improving uptake of tactile assessment in practice.

Learning From the Past: Uncovering Design Process Models Using an Enriched Process Mining

Design documents and design project footprints accumulated by corporate information technology systems have increasingly become valuable sources of evidence for design information and knowledge management. Identification and extraction of such embedded information and knowledge into a clear and usable format will greatly accelerate continuous learning from past design efforts for competitive product innovation and efficient design process management in future design projects. Most of the existing design information extraction systems focus on either organizing design documents for efficient retrieval or extracting relevant product information for product optimization. Different from traditional systems, this paper proposes a methodology of learning and extracting useful knowledge using past design project documents from design process perspective based on process mining techniques. Particularly different from conventional techniques that deal with timestamps or event logs only, a new process mining approach that is able to directly process textual data is proposed at the first stage of the proposed methodology. The outcome is a hierarchical process model that reveals the actual design process hidden behind a large amount of design documents and enables the connection of various design information from different perspectives. At the second stage, the discovered process model is analyzed to extract multifaceted knowledge patterns by applying a number of statistical analysis methods. The outcomes range from task dependency study from workflow analysis, identification of irregular task execution from performance analysis, cooperation pattern discovery from social net analysis to evaluation of personal contribution based on role analysis. Relying on the knowledge patterns extracted, lessons and best practices can be uncovered which offer great support to decision makers in managing any future design initiatives. The proposed methodology was tested using an email dataset from a university-hosted multiyear multidisciplinary design project.

L1000FWD: fireworks visualization of drug-induced transcriptomic signatures.

As part of the NIH Library of Integrated Network-based Cellular Signatures program, hundreds of thousands of transcriptomic signatures were generated with the L1000 technology, profiling the response of human cell lines to over 20000 small molecule compounds. This effort is a promising approach toward revealing the mechanisms-of-action (MOA) for marketed drugs and other less studied potential therapeutic compounds. L1000 fireworks display (L1000FWD) is a web application that provides interactive visualization of over 16000 drug and small-molecule induced gene expression signatures. L1000FWD enables coloring of signatures by different attributes such as cell type, time point, concentration, as well as drug attributes such as MOA and clinical phase. Signature similarity search is implemented to enable the search for mimicking or opposing signatures given as input of up and down gene sets. Each point on the L1000FWD interactive map is linked to a signature landing page, which provides multifaceted knowledge from various sources about the signature and the drug. Notably such information includes most frequent diagnoses, co-prescribed drugs and age distribution of prescriptions as extracted from the Mount Sinai Health System electronic medical records. Overall, L1000FWD serves as a platform for identifying functions for novel small molecules using unsupervised clustering, as well as for exploring drug MOA. L1000FWD is freely accessible at: http://amp.pharm.mssm.edu/L1000FWD. Supplementary data are available at Bioinformatics online.

MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP)\u2014implementation of a national guideline in Canada

BackgroundEvidence supports magnesium sulphate (MgSO4) for women at risk of imminent birth at < 32–34 weeks to reduce the likelihood of cerebral palsy in the child. MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP) was a multifaceted knowledge translation (KT) strategy for this practice.MethodsThe KT strategy included national clinical practice guidelines, a national online e-learning module and, at MAG-CP sites, educational rounds, focus group discussions and surveys of barriers and facilitators. Participating sites contributed data on pregnancies with threatened very preterm birth. In an interrupted time-series study design, MgSO4 use for fetal neuroprotection (NP) was tracked prior to (Aug 2005–May 2011) and during (Jun 2011–Sept 2015) the KT intervention. Effectiveness of the strategy was measured by optimal MgSO4 use (i.e. administration when and only when indicated) over time, evaluated by a segmented generalised estimating equations logistic regression (p < 0.05 significant). Secondary outcomes included maternal effects and, using the Canadian Neonatal Network (CNN) database, national trends in MgSO4 use for fetal NP and associated neonatal resuscitation. With an anticipated recruitment of 3752 mothers over 4 years at Canadian Perinatal Network sites, we anticipated > 95% power to detect an increase in optimal MgSO4 use for fetal NP from < 5 to 80% (2-sided, alpha 0.05) and at least 80% power to detect any increases observed in maternal side effects from RCTs.ResultsSeven thousand eight hundred eighty-eight women with imminent preterm birth were eligible for MgSO4 for fetal NP: 4745 pre-KT (18 centres) and 3143 during KT (11 centres). The KT intervention was associated with an 84% increase in the odds of optimal use (OR 1.00 to 1.84, p < 0.001), a reduction in the odds of underuse (OR 1.00 to 0.47, p < 0.001) and an increase in suboptimal use (too early or at ≥ 32 weeks; OR 1.18 to 2.18, p < 0.001) of MgSO4 for fetal NP. Maternal hypotension was uncommon (7/1512, 0.5%). Nationally, intensive neonatal resuscitation decreased (p = 0.024) despite rising MgSO4 use for fetal NP (p < 0.001).ConclusionMultifaceted KT was associated with significant increases in use of MgSO4 for fetal NP, with neither important maternal nor neonatal risks.

Coccygodynia - pathogenesis, diagnostics and therapy. Review of the writing.

Coccygodynia is a problem with a small percentage (1%) of the population suffering from musculoskeletal disorders. This pain is often associated with trauma, falling on the tailbone, long cycling, or by women after childbirth. The reason for the described problem can be the actual morphological changes. Idiopathic coccygodynia causes therapeutic difficulties to specialists of many fields. Unsatisfactory treatment, including coccygectomy tends to seek new solutions. They belong to them techniques exploited in the manual therapy which in their spectrum hold: direct techniques - per rectum as well as indirect techniques taking into account distant structures of the motor organ, remaining in dense interactions with the coccygeal part. Idiopathic coccygodynia is a result perhaps from exaggerated tension the muscle of the levator ani, coccygeus and gluteus maximus as well as from irritating soft tissue structures surrounding the coccyx: of sacrococcygeum, sacrospinale, and sacrotuberale ligament. Unfortunately we can't see them in objective examinations so as: the RTG, MR or TK, therefore constitute the both diagnostic and therapeutic problem. For describing the problem a writing of the object was used both from the field of the surgery and of manual therapy. Detailed and multifaceted knowledge about causes of the described problem allows more accurately to categorize the patient to the appropriate group and helps to select the best procedure of treatment.

Evaluating the pedagogical quality of international summer courses in a university program

The study evaluated the pedagogical quality of 16 university courses in a three-week international summer program. Short-term study-abroad programs have gained increasing popularity, but their pedagogical approaches have not been investigated widely before. Lesson observations, teacher interviews, and course materials were used to investigate the pedagogical approach of the courses. Answers to an online feedback form were used to examine students’ study experiences. The courses were categorized into the following three pedagogical types: Self-directed academic studying, Practices of active learning, and Practices of shared expertise. Based on the survey data, the students valued the second and third types of courses more than the first type. Factors that students mentioned as positive in their open-ended responses were related to high-quality teaching arrangements, expert knowledge and practices, intercultural social interaction, and interesting and useful course content. Innovative pedagogy in international courses would include taking the multicultural assembly of participants into account to support multifaceted knowledge sharing and the development of cultural expertise in the target domain. The results can be used to create criteria and guidelines for subsequent courses, to develop feedback instruments, and in teacher training.

The role of organizational context in moderating the effect of research use on pain outcomes in hospitalized children: a cross sectional study

BackgroundDespite substantial research on pediatric pain assessment and management, health care professionals do not adequately incorporate this knowledge into clinical practice. Organizational context (work environment) is a significant factor in influencing outcomes; however, the nature of the mechanisms are relatively unknown. The objective of this study was to assess how organizational context moderates the effect of research use and pain outcomes in hospitalized children.MethodsA cross-sectional survey was undertaken with 779 nurses in 32 patient care units in 8 Canadian pediatric hospitals, following implementation of a multifaceted knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ). The influence of organizational context was assessed in relation to pain process (assessment and management) and clinical (pain intensity) outcomes. Organizational context was measured using the Alberta Context Tool that includes: leadership, culture, evaluation, social capital, informal interactions, formal interactions, structural and electronic resources, and organizational slack (staff, space, and time). Marginal modeling estimated the effects of instrumental research use (direct use of research knowledge) and conceptual research use (indirect use of research knowledge) on pain outcomes while examining the effects of context.ResultsSix of the 10 organizational context factors (culture, social capital, informal interactions, resources, and organizational slack [space and time]) significantly moderated the effect of instrumental research use on pain assessment; four factors (culture, social capital, resources and organizational slack time) moderated the effect of conceptual research use and pain assessment. Only two factors (evaluation and formal interactions) moderated the effect of instrumental research use on pain management. All organizational factors except slack space significantly moderated the effect of instrumental research use on pain intensity; informal interactions and organizational slack space moderated the effect of conceptual research use and pain intensity.ConclusionsMany aspects of organizational context consistently moderated the effects of instrumental research use on pain assessment and pain intensity, while only a few influenced conceptual use of research on pain outcomes. Organizational context factors did not generally influence the effect of research use on pain management. Further research is required to further explore the relationships between organizational context and pain management outcomes.

A touchy topic: tactile assessment among pediatric therapists

Purpose: Tactile impairments affect over 77% of children with unilateral cerebral palsy (CP). This study aimed to examine the current practices of pediatric therapists in relation to tactile assessment and the barriers to carrying out tactile assessment in children with CP.Method: The study was in two parts. In part one, pediatric therapists (n = 35) completed a questionnaire detailing their current knowledge and the use of tactile assessments in children. In part two, therapists (n = 12) completed a questionnaire based on the Theoretical Domains Framework examining the barriers and facilitators to completing tactile assessments in clinical practice.Results: Most therapists (over 90%) carry out tactile assessments in the minority (less than 25%) of children with CP that they treat. Therapists reported the need for improved knowledge/skills (n = 24) and confidence (n = 19) in carrying out tactile assessments, alongside the provision of necessary equipment (n = 17). Qualitative reports also suggested that organizational assessment guidelines and templates may facilitate the implementation of tactile assessment.Conclusions: A multi-faceted knowledge translation strategy to address the barriers to tactile assessment among pediatric therapists needs to be developed.Implications for rehabilitationPediatric occupational therapists and physiotherapists may not be completing tactile assessments according to current evidence-based recommendations.Therapists identified five main barriers, including a lack of knowledge, skills, belief in their capabilities (confidence), behavioral regulation (organizational procedures), and environmental context (e.g., equipment).Therapists recommended several potential facilitators, including access to necessary equipment, procedures, record sheets, training in tactile assessments, and research supporting related interventions.Service providers are encouraged to develop multi-faceted knowledge translation strategies that address these barriers and maximize facilitators.

Towards a framework for developing students' fraction proficiency

ABSTRACTThe importance of the knowledge of fractions in mathematical learning, coupled with the difficulties students have with them, has prompted researchers to focus on this particular area of mathematics. The term ‘fraction proficiency' used in this article refers to a person's conceptual comprehension, procedural skills and the ability to approach daily situations involving fractions. In the area of fractions, there has been a call for more research to study how, and where, efforts should be focused in order to integrate the various aspects of fraction knowledge for students, and even for teachers, to help them develop proficiency in fractions. Thus, the article presents a theoretical synthesis of the specialized literature in the learning and teaching of fractions, with the aim of proposing a framework for developing students' fraction proficiency. The frameworks presented in the article may shed light upon the implications for the design of fraction instruction, which should focus on developing a multi-faceted knowledge of fractions, rather than simply isolating one facet from the others.

Consumers’ multifaceted deal knowledge in a grocery retail setting

Despite its relevance to retailers, studies of consumers’ deal knowledge have been few. This study explores consumers’ deal knowledge before, during, and after the store visit applying a between-subjects field-study design with 1204 respondents. In particular, the authors investigate perception of deal price status, typical deal price knowledge, and deal-spotting ability. Results show reasonably stable knowledge of typical deal prices, while knowledge of deal price status and deal-spotting ability improves significantly during grocery shopping. Surprisingly, consumers’ deal knowledge is not conditional on purchasing a special thus indicating that most consumers, consciously or unconsciously, scan for promotion signals when shopping groceries. In addition, the results suggest consumers are not easily fooled, as the vast majority is able to spot ‘good’ and ‘bad’ deals, while also possessing typical deal price knowledge. Furthermore, the findings suggest that consumers store internal reference deal prices. Retailers are therefore well advised to consider mixed depth and creative discount patterns to prevent ‘perfect’ perceptions of typical deal prices.

Enhancing the quality of oral nutrition support for hospitalized patients: a mixed methods knowledge translation study (The EQONS study)

The aim of this study was to report a multifaceted knowledge translation intervention to facilitate use of the Malnutrition Universal Screening Tool and innovation in nutritional care for patients at risk of malnutrition. Malnutrition among hospitalized patients is a widespread problem leading to adverse health outcomes. Despite evidence of the benefits of malnutrition screening and recommendations for achieving good nutrition, shortfalls in practice continue. A mixed method integrated knowledge translation study. The knowledge translation intervention comprised nutrition champions supported by knowledge translation facilitators and an action planning process. Data collection was undertaken over 18months between 2011-2012 in a hospital in England. Data comprised observation of mealtimes, audit of patient records, survey of nurses and semi-structured interviews with nutrition champions, knowledge translation facilitators, senior ward nurses and nurse managers. Statistically significant relationships (Chi Square) were observed between self-reported confidence of nurses (a) to assess patients using the Malnutrition Universal Screening Tool, (b) to teach colleagues how to use the Malnutrition Universal Screening Tool and (c) to ensure that patients were assessed within 24hours of admission. Ward-based nutrition champions facilitated successful innovation in nutrition support. Contextual factors operating at micro (ward), meso (organization) and macro (healthcare system) levels acted as barriers and enablers for change. Nutrition champions were successful in increasing the timely assessment of patients at risk of malnutrition and promoting innovation in nutritional care. Support from knowledge translation facilitators helped nutrition champions develop their role and work collaboratively with senior ward nurses to implement action plans for improving nutrition.

Testing the feasibility of a knowledge translation intervention designed to improve chiropractic care for adults with neck pain disorders: study protocol for a pilot cluster-randomized controlled trial

BackgroundNeck pain in adults is common and a leading cause of physical disability. Recently, a guideline was developed for the management of non-specific neck pain (NSNP) with an aim to improve the quality of the delivery of chiropractic care. One key guideline recommendation is to undertake multimodal care for patients with NSNP. The aim of this pilot study is to determine the feasibility of implementing a multifaceted knowledge translation intervention by promoting the use of multimodal care by chiropractors managing patients with NSNP.Methods/designThe design is a cluster-randomized controlled pilot and feasibility trial. Chiropractors in private practice in Canada will be approached to participate in the study. Thirty consenting chiropractors will be randomized to receive either a theory-based educational intervention in the experimental group or simply a printed copy of the guideline in the control group. Each chiropractor will recruit five neck pain patients (a total of 150 patients) into the study. Development of the multifaceted intervention was informed by the results of a related qualitative study based on the Theoretical Domains Framework and consists of a series of three webinars, two online case scenarios, a self-management video on Brief Action Planning, and a printed copy of the practice guideline. Primary feasibility outcomes for both chiropractors and patients include rates of (1) recruitment, (2) retention, and (3) adherence to the intervention. A checklist of proxy measures embedded within patient encounter forms will be used to assess chiropractors’ compliance with guideline recommendations (e.g. exercise and self-care prescriptions) at study onset and at 3 months. Secondary outcomes include scores of behavioural constructs (level of knowledge and self-efficacy) for recommended multimodal care. Clinical outcomes include pain intensity and neck pain-specific disability. Analyses from this study will focus on generating point estimates and corresponding 95 % confidence intervals for parameters of a priori interest (recruitment, retention, adherence, pain intensity, Neck Disability Index).DiscussionResults of this study will inform the design of a larger cluster-randomized controlled trial aimed at evaluating the effectiveness of the theory-based tailored intervention and increasing the use of multimodal care by chiropractors managing patients with NSNP.Trial registration https://clinicaltrials.gov/, NCT02483091Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-016-0076-9) contains supplementary material, which is available to authorized users.

A multi-faceted knowledge translation approach to support persons with stroke and cognitive impairment: evaluation protocol.

BackgroundPatients with cognitive impairments following a stroke are often denied access to inpatient rehabilitation. The few patients with cognitive impairment admitted to rehabilitation generally receive services based on outdated impairment-reduction models, rather than recommended function-based approaches. Both reduced access to rehabilitation and the knowledge-to-practice gap stem from a reported lack of skills and knowledge regarding cognitive rehabilitation on the part of inpatient rehabilitation team members. To address these issues, a multi-faceted knowledge translation (KT) initiative will be implemented and evaluated. It will be targeted specifically at the inter-professional application of the cognitive orientation to daily occupational performance (CO-OP). CO-OP training combined with KT support is called CO-OP KT. The long-term objective of CO-OP KT is to optimize functional outcomes for individuals with stroke and cognitive impairments. Three research questions are posed:Is the implementation of CO-OP KT associated with a change in the proportion of patients with cognitive impairment following a stroke accepted to inpatient rehabilitation?Is the implementation of CO-OP KT associated with a change in rehabilitation clinicians’ practice, knowledge, and self-efficacy related to implementing the CO-OP approach, immediately following and 1 year later?Is CO-OP KT associated with changes in activity, participation, and self-efficacy to perform daily activities in patients with cognitive impairment following stroke at discharge from inpatient rehabilitation and at 1-, 3-, and 6-month follow-ups?Methods/DesignThree interrelated studies will be conducted. Study 1 will be a quasi-experimental, interrupted time series design measuring monthly summaries of stroke unit level data. Study 2, which relates to changes in health care professional practice and self-efficacy, will be a single group pre-post evaluation design incorporating chart audits and a self-report survey. Study 3 will assess patient functional outcomes using a non-randomized design with historical controls. Assessments will occur during admission and discharge from rehabilitation and at 1, 3, and 6 months following discharge from rehabilitation.DiscussionThis project will advance knowledge about the degree to which the implementation of a supported KT initiative can sustainably change health system, knowledge, and patient outcomes.