96小時重置周邊靜脈導管之效應：資料庫分析

<p>目的：透過異常通報資料庫分析，探討96小時對照72小時重置周邊靜脈導管，對於靜脈炎發生率之影響。</p> <p>方法：方便取樣臺灣南部某醫學中心之異常通報資料庫，分析2011年9月1日至2014年8月31日之72小時重置組，與2014年9月1日至2017年8月31日之96小時重置組，2個時期之住院個案的靜脈炎發生率。</p> <p>結果：96小時對照72小時重置周邊靜脈導管，並未增加靜脈炎發生率。靜脈炎總發生率（勝算比[odds ratio,OR] = 0.70, p=.0290）與細菌性靜脈炎發生率(OR= 0.11, p=.0097)顯著減少，化學性與機械性靜脈炎發生率則無顯著差異。</p> <p>結論：本土性資料庫分析結果為在臺灣熱帶海島型潮濕氣候，三班評估無靜脈炎症狀下，96小時重置周邊靜脈導管並不會顯著增加靜脈炎風險，建議醫療機構可據此調整臨床作業規範，落實實證知識轉譯。</p> <p>&nbsp;</p><p>&quot;Purpose: To compare the effect of replacement of peripheral venous catheters at 96-hour intervals on the incidence of phlebitis with that at 72-hour intervals through analysis of an incident-reporting database.</p> <p>Methods: Convenience sampling of records from the incident-reporting database of a medical center in southern Taiwan was used to analyze the incidence of phlebitis among hospitalized patients with replacement of peripheral venous catheters at 72-hour intervals (from September 1, 2011, to August 31, 2014) or 96-hour intervals (from September 1, 2014, to August 31, 2017).</p> <p>Result: The analysis revealed that replacing peripheral venous catheters every 96 hours rather than every 72 hours did not increase the incidence of phlebitis. The total incidence of phlebitis (odds ratio [OR]=0.70, p=.0290) and the incidence of bacterial phlebitis (OR=0.11, p=.0097) decreased significantly, and no significant differences in the incidence rates of chemical or mechanical phlebitis were identified.</p> <p>Conclusion: According to the analysis results of a local database, under the humid tropical insular climate of Taiwan, replacement of peripheral venous catheters at 96-hour intervals did not significantly increase the risk of phlebitis in patients who exhibited no symptoms of phlebitis as assessed in three shifts. Medical institutions can adjust their clinical operation standards and implement knowledge translation accordingly.</p> <p>&nbsp;</p>

World Health Organization and knowledge translation in maternal, newborn, child and adolescent health and nutrition

The World Health Organization (WHO) has a mandate to promote maternal and child health and welfare through support to governments in the form of technical assistance, standards, epidemiological and statistical services, promoting teaching and training of healthcare professionals and providing direct aid in emergencies. The Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child and adolescent health and nutrition (MNCAHN) was established in 2020 to advise the Director-General of WHO on issues relating to MNCAHN. STAGE comprises individuals from multiple low-income and middle-income and high-income countries, has representatives from many professional disciplines and with diverse experience and interests.Progress in MNCAHN requires improvements in quality of services, equity of access and the evolution of services as technical guidance, community needs and epidemiology changes. Knowledge translation of WHO guidance and other guidelines is an important part of this. Countries need effective and responsive structures for adaptation and implementation of evidence-based interventions, strategies to improve guideline uptake, education and training and mechanisms to monitor quality and safety. This paper summarises STAGE’s recommendations on how to improve knowledge translation in MNCAHN. They include support for national and regional technical advisory groups and subnational committees that coordinate maternal and child health; support for national plans for MNCAHN and their implementation and monitoring; the production of a small number of consolidated MNCAHN guidelines to promote integrated and holistic care; education and quality improvement strategies to support guidelines uptake; monitoring of gaps in knowledge translation and operational research in MNCAHN.

Context Matters in Evidence Implementation Globally; Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis"

Context influences the effectiveness of healthcare interventions and should be considered to inform their implementation. However, context remains poorly defined in the knowledge translation (KT) literature. The paper by Squires and colleagues constitutes a valuable contribution to the field of KT as it provides the basis for a comprehensive framework to assess the influence of context on implementation success. In their study, Squires et al. identified 66 context features, grouped into 16 attributes. Their findings highlight a great convergence in the context features mentioned by stakeholders across countries, experience levels and roles in KT. Thus, the proposed framework could eventually transfer to several implementation settings. However, all study participants were from high-income countries. It would therefore be important to replicate this research in low- and middle-income countries. A common understanding of what context means is essential to assessing its influence on the implementation of healthcare interventions globally.

Visual Storytelling for Knowledge Translation: A Study on BRAC’s Novel Health Loans in Protecting the Poor Against Health and Asset Vulnerability In Bangladesh

Knowledge Translation (KT) is a dynamic and iterative process that includes synthesizing, disseminating, exchanging, and ethically sound application of knowledge to improve health and strengthen the health care system. It facilitates sharing the information generated through research outcomes with the public, the policymakers, or others for further scaling up or continuation of the interventions. Literature suggests a substantial gap exists in communicating with the decision-makers. BRAC JPGSPH produced a documentary/video that iterates how BRAC’s revised medical treatment loan program (MTL+) works with its microcredit clients and modalities. After reviewing all possible options for communication, the video was chosen as the best knowledge translation tool. The video creation and dissemination process are comprised of four phases: pre-production, production, post-production, and exhibition. The video production team reviewed documents and articles and conducted multiple interviews before developing the script. Later, a series of interviews were taken with the beneficiaries who receive medical treatment loans, mid-level, senior managers at BRAC, and researchers. After the production, the director, with a professional editor, edited the video. Over three hours of footage was viewed and ultimately compiled into a six-minute-long video documentary. The audience for the video was more expansive than narrow; from potential beneficiaries to policymakers and every group of stakeholders in between, the video was well-understood. The new MTL+ was integrated into the main program and would be scaled up soon.

The Feasibility of a Stroke Rehabilitation Educational Program for Occupational Therapy Students and Practitioners (Preprint)

BACKGROUND Gaps in knowledge translation of current evidence-based practice regarding stroke assessment and rehabilitation delivered through teletherapy can prevent occupational therapy students and practitioners from implementing current research findings to obtain the best possible results in practice. The purpose of this pilot feasibility study was to create an educational program to translate knowledge into practice about the remote delivery of stroke assessment and rehabilitation to occupational therapy students and practitioners. This study examined knowledge gained from specific educational modules and feedback of delivery with regards to design, feasibility, acceptability, and usability. Four areas of focus were addressed in the educational program including: knowledge translation (KT), task-oriented training (TOT), stroke assessments, and telerehabilitation. OBJECTIVE The purpose of this pilot feasibility study was to create an educational program to translate knowledge into practice about the remote delivery of stroke assessment and rehabilitation to occupational therapy students and practitioners. This study examined knowledge gained from specific educational modules and feedback of delivery with regards to design, feasibility, acceptability, and usability. Four areas of focus were addressed in the educational program including: knowledge translation (KT), task-oriented training (TOT), stroke assessments, and telerehabilitation. METHODS Two feasibility studies were conducted to assess knowledge gained via pretests and posttests of knowledge, followed by a System Usability Scale (SUS) and general feedback questionnaire. Participants in Study 1 were five current occupational therapy practitioners and one occupational therapy assistant. Initial recruitment of participants in Study 2 included ten current occupational therapy students, however only nine students participated in the modules. Four, one-hour modules were emailed weekly to participants over the course of four weeks, with each module covering a different topic (KT, TOT, stroke assessments, and telerehabilitation). Preliminary results were reviewed with median comparisons and nonparametric analyses of pretests and posttests of knowledge for each module. Descriptive statistics from the SUS and a general feedback questionnaire were used to gain overall comments regarding the educational program. RESULTS This study revealed statistically significant results related to increased scores of knowledge through a Wilcoxon Signed-Ranks Test for students, practitioners, and combined. The stroke assessments module for the practitioner study and the stroke assessments and telerehabilitation modules for the student study were found to be statistically significant for increases in knowledge. Task-oriented training, stroke assessments, and telerehabilitation were statistically significant for the combination of the two studies. The task-oriented training module for students and practitioners, and the knowledge translation and telerehabilitation modules for practitioners also demonstrated a notable trend towards significance. The majority of the educational modules had an above average score regarding feasibility as well as positive feedback for the educational program as a whole from the participants. CONCLUSIONS Overall, the results of this pilot study indicate that an online educational program is a feasible, informational method of increasing the translation of knowledge in the remote delivery of stroke assessment and rehabilitation. Occupational therapy students and practitioners found the information presented to be valuable and relevant to their future profession and current practice.

Pay Attention to This: A Knowledge Translation Study of ADHD and its Brain Basis to Preservice and In-Service Teachers

The purpose of the present study was to develop a knowledge translation (KT) activity for educators about the brain in children and adolescents with attention deficit hyperactivity disorder (ADHD). The goal was to increase our participants’ knowledge about ADHD and its brain basis. In addition to neuroscience content, the KT activity included the personal story of the lead researcher’s lived experience with ADHD to provide context, and to inform the participants’ perceptions of ADHD. Framed in an action research paradigm, our study undertook three cycles of reflection, planning, action, and observation to develop and improve a knowledge translation activity. The knowledge translation activity was presented to 48 preservice and in-service teachers and members of the public across Canada, with a mixed methods approach to evaluate the outcomes. The findings demonstrated that this knowledge translation activity was effective in enhancing participant knowledge about ADHD. Quantitively, a non-significant trend was observed that participants shifted their perceptions from social and behavioural causes to brain-based causes of ADHD. Qualitatively, the participants indicated making connections between the personal story and neuroscience. Effective KT requires a review of context vocabulary and opportunity for teacher interaction. Teachers are aware of several behavioural management strategies but do not have a clear idea of how or why they work. Teaching neuroscience to teachers allows for a discussion of neurodiversity and a strength-based approach to programming and accommodation. This research could help guide future knowledge translation research into the benefits of combining personal lived experience with neuroscience content. Keywords: knowledge translation, neuroscience, attention deficit hyperactivity disorder, lived experience, storytelling, action research, neurodiversity

Algo's Integrated Knowledge Translation Process in Homecare Services: A Cross-Sectional Correlational Study for Identifying its Level of Utilization and its Associated Characteristics

Background. Algo is an integrated knowledge translation (IKT)-based algorithm for supporting occupational therapists (OTs) with skill mix for selecting bathing equipment. While IKT approaches are increasingly valued in implementation science, their benefits with respect to the utilization of knowledge in clinical settings are scarcely documented. Purpose. To identify Algo's level of utilization and the characteristics associated with its level of utilization. Method. A cross-sectional correlational study was conducted with OTs working in homecare services (HCS) through an online survey based on Knott and Wildavsky's classification and the Promoting Action on Research Implementation in Health Services ( PARIHS) framework. Findings. Almost half (48%) of the OTs surveyed (n = 125; participation rate: 16%) reached one of the seven levels of utilization. While Evidence characteristics are perceived as facilitators to its utilization, Context statements indicate an unfavorable organizational climate to the implementation of change. Implications. Strategies should target additional stakeholders (e.g., HCS managers) and organizational adjustments in HCS to sustain Algo's utilization.

Integrated Knowledge Translation in Non-Communicable Disease Research in Sub-Saharan Africa: A Comparison of Systematic and Ad Hoc Stakeholder Engagement

BackgroundLow- and middle-income countries (LMICs) are currently experiencing an increasing prevalence of non-communicable diseases (NCDs). To address this as well as other health challenges, Integrated Knowledge Translation (IKT) approaches to build mutually beneficial relationships between researchers and decision-makers can concurrently inform research as well as enhance evidence use in policy and practice. The Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) is a research consortium which conducts research on NCDs and uses an IKT approach to facilitate the uptake of this research in five African countries: Ethiopia, Uganda, Rwanda, Malawi, and South Africa. Tailored IKT strategies were designed and implemented to plan and guide stakeholder engagement. This systematic approach contrasts with more commonly used ad hoc approaches to stakeholder engagement.MethodsIn this article, we explore the experiences of researchers engaged in the CEBHA+ IKT approach across the five African countries. Data sources included: 1) an informal document review of CEBHA+ country-specific IKT strategies, IKT team meeting minutes and activity reports, and 2) a semi-structured survey of IKT implementers to elicit country-specific experiences on actual implementation and adaptation of the IKT strategies. Results were collated and contrasted across all CEBHA+ countries with a focus on systematic versus ad hoc approaches to engagement.ResultsSouth Africa, Malawi and Ethiopia country teams indicated that their engagements benefited from a systematic IKT strategy. This was especially the case in the early stages of the project as it allowed focused and intentional engagement. However, ad hoc engagement was still required as new professional relationships developed, and contextual circumstances - including the SARS-CoV-2 pandemic - required responsive engagement with decision-makers and other stakeholders. In Rwanda and Uganda, continuous systematic engagement was found to bolster ownership of the research at both community and national levels.ConclusionPolitical and health climates are constantly shifting with a need to maintain flexibility in how IKT strategies are implemented. While strategic IKT can benefit from deliberate planning and stakeholder engagement, there is value in remaining flexible to respond to the needs of stakeholders and contextual circumstances. This paper highlights how IKT implementers in the five African CEBHA+ countries responded to this challenge.