Search

Background: This position paper highlights the opportunistic integral role of the pharmacist across the patient pathway utilizing cardiovascular care as an example. The paper aims to highlight the potential roles that pharmacists worldwide can have (or already have) to provide efficient patient care in the context of interprofessional collaboration. Methods: It results from a literature review and experts seeking advice to identify existing interventions and potential innovative interventions. We developed a conceptual framework highlighting seven critical phases in the patient pathway and for each of those listed some of the initiatives identified by our experts worldwide. Results: Existing pharmacists' interventions in each of these phases have been identified globally. Various examples in the area of prevention and self‐management were found to exist for long; the contribution for early detection and subsequently to timely diagnosis were also quite clear; integration of care was perhaps one of the areas needing greater development, although interventions in secondary care were also quite common. Tertiary care and end of life interventions were found to often be left for other healthcare professionals. Conclusion: On the basis of the findings, we can argue that much has been done but globally consider that pharmacists are still an untapped resource potentially useful for improved patient care. [ABSTRACT FROM AUTHOR]

Introduction: Self‐management support for schizophrenia has become expected practice leaving organisations to find ways for feasible implementation. Self‐management support involves a foundational cultural shift for traditional disease‐based services, new ways of clients‐providers working together, coupled with delivering a portfolio of tools and techniques. A new model of self‐management support embedded into traditional case management services, called SET for Health (Self‐management Engaging Together for Health), was designed and tailored to make such services meaningfully accessible to clients of a tertiary care centre. This paper describes the proof of concept demonstration efforts, the successes/challenges, and initial organisational changes. Method: An integrated knowledge translation approach was selected as a means to foster organisational change grounded in users' daily realities. Piloting the model in two community case management programmes, we asked two questions: Can a model of self‐management support be embedded in existing case management and delivered within routine specialised mental health services? What organisational changes support implementation? Results: Fifty‐one clients were enroled. Indicators of feasible delivery included 72.5% completion of self‐management plans in a diverse sample, exceeding the 44% set minimum; and an attrition rate of 21.6%, less than 51% set maximum. Through an iterative evaluation process, the innovation evolved to a targeted hybrid approach revolving around client goals and a core set of co‐created reference tools, supplemental tools and resources. Operationalisation by use of tools was implemented to create spaces for client‐provider collaborations. Monitoring of organisational changes identified realignment of practices. Changes were made to procedures and operations to further spread and sustain the model. Conclusion: This study demonstrated how self‐management support can be implemented, within existing resources, for routine delivery of specialised services for individuals living with schizophrenia. The model holds promise as a hybrid option for supporting clients to manage their own health and wellness. [ABSTRACT FROM AUTHOR]

Abstract: Something important is happening in applied, interdisciplinary research, particularly in the field of applied health research. The vast array of papers in this edition are evidence of a broad change in thinking across an impressive range of practice and academic areas. The problems of complexity, the rise of chronic conditions, overdiagnosis, co‐morbidity, and multi‐morbidity are serious and challenging, but we are rising to that challenge. Key conceptions regarding science, evidence, disease, clinical judgement, and health and social care are being revised and their relationships reconsidered: Boundaries are indeed being redrawn; reasoning is being made “fit for practice.” Ideas like “person‐centred care” are no longer phrases with potential to be helpful in some yet‐to‐be‐clarified way: Theorists and practitioners are working in collaboration to give them substantive import and application. [ABSTRACT FROM AUTHOR]

Rationale: Following the onset of the COVID‐19 pandemic, a clinical practice guideline (CPG) around virtual hearing aid practices was developed to fill a knowledge gap within the field of audiology. Details outlining the development and mobilization of this draft guideline were outlined as Phase 1 (described in a paired paper). Aims and Objectives: This study describes Phase 2 of this project as part of the Knowledge‐to‐Action Framework, including an evaluation of the methodological quality of the guideline and the resulting tailored version of the document (v2.0). Method: The Appraisal of Guidelines for Research and Evaluation II instrument was used to assess methodological quality and to guide revisions. Twenty‐two clinicians, from a variety of clinical backgrounds, participated in the evaluation. Results and Conclusion: Findings reported across six domains suggest high mean scores, ranging from 78% to 81%, in order of scope and purpose (highest rated), stakeholder involvement, rigour of development, applicability, clarity of presentation, and editorial independence. Specific recommendations made by in international co‐creation team during the evaluation informed the final version of the CPG. Future development and evaluation efforts should aim to include greater representation from nontraditional practice contexts to strengthen global applicability. [ABSTRACT FROM AUTHOR]

Rationale: There is a growing demand for comprehensive, evidence‐based, and accessible clinical practice guidelines (CPGs) to address virtual service delivery. This demand was particularly evident within the field of hearing healthcare during the COVID‐19 pandemic, when providers were faced with an immediate need to offer services at a distance. Considering the recent advancement in information and communication technologies, the slow uptake of virtual care, and the lack of knowledge tools to support clinical integration in hearing healthcare, a Knowledge‐to‐Action Framework was used to address the virtual care delivery research‐to‐practice gap. Aims and Objectives: This paper outlines the development of a CPG specific to provider‐directed virtual hearing aid care. Clinical integration of the guideline took place during the COVID‐19 pandemic and in alignment with an umbrella project aimed at implementing and evaluating virtual hearing aid care incorporating many different stakeholders. Method: Evidence from two systematic literature reviews guided the CPG development. Collaborative actions around knowledge creation resulted in the development of a draft CPG (v1.9) and the mobilisation of the guideline into participating clinical sites. Results and Conclusion: Literature review findings are discussed along with the co‐creation process that included 13 team members, from various research and clinical backgrounds, who participated in the writing, revising, and finalising of the draft version of the guideline. [ABSTRACT FROM AUTHOR]

Introduction: This article describes the planning and development of a novel self‐management support protocol, self‐management engaging together (SET) for Health, purposefully designed and embedded within traditional case management services to be accessible to people living with schizophrenia and comorbidities. Drawing on established self‐management principles, SET for Health was codesigned by researchers, healthcare providers and clients, to create a practical and meaningful intervention to support the target group to manage their own health and wellness. Decision making is described behind tailoring the self‐management innovation to meet the needs of an at risk, disadvantaged group served by tertiary, public health care in Canada. Method: This integrated knowledge translation (IKT) study used a descriptive approach to document the process of planning and operationalizing the SET for Health intervention as a part of routine care in two community‐based teams providing predominantly schizophrenia services. Diffusion of innovations literature informed planning. The setting was strategically prepared for organizational change. A situational assessment and theoretical frameworks identified contextual elements to be addressed. Existing established self‐management approaches for mental illness were appraised. Results: When a review of established approaches revealed incongruence with the aims and context of service delivery, common essential elements were distilled. To facilitate collaborative client–provider self‐management conversations and self‐management learning opportunities, core components were operationalized by the use of tailored interactive tools. The materials coproduced by clients and providers offered joint reference tools, foundational for capacity‐building and recognition of progress. Conclusion: Planning and developing a model of self‐management support for integration into traditional schizophrenia case management services required attention to the complex social ecological nature of the treatment approach and the workplace context. Demonstration of proof of concept is described in a separate paper. [ABSTRACT FROM AUTHOR]

Purpose: Differences in Indigenous worldviews, practices and values highlight the need for Indigenous‐specific health quality indicators, such as patient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMs). The purpose of this paper is to present our methodology, as part of a larger study that sought to develop a framework for creating Indigenous‐specific PROMs and PREMs. Methods: The research design was informed by Indigenous research methodology and a community‐based participatory approach. It had three core components: (1) a literature exploration of existing Indigenous‐specific PROMs and PREMs; (2) interviews with researchers with expertise in PROMs and PREMs developed for Indigenous populations and community leaders interested in using these Indigenous‐informed evaluation tools; and (3) conversations with Indigenous community members about their experiences with health surveys. Interviews were audio‐recorded and transcribed verbatim; transcripts were analyzed qualitatively using an inductive and deductive approach. Themes and sub‐themes were identified to build a framework that honours Indigenous knowledges and ways of knowing. Results were validated with select research participants and the Project Advisory Committee. Results: Findings demonstrate how relationship building is the necessary starting point for engagement when developing survey instruments with Indigenous peoples. Engagement requires respectful collaboration through all stages of the project from determining what questions are asked to how the information will be collected, interpreted, and managed. A relational stance requires responsibility to Indigenous communities and peoples that goes beyond research carried out using a western scientific lens. It means ensuring that the project is beneficial to the community and framing questions based on Indigenous knowledge, worldviews, and community involvement. Conclusions: This study employed a collaborative, participatory qualitative approach to develop a framework for creating PROMs and PREMs with Indigenous peoples. The methods described offer concrete examples of strategies that can be employed to support relationship‐building and collaboration when developing Indigenous‐specific survey instruments. [ABSTRACT FROM AUTHOR]

Rationale: COVID‐19 has fundamentally changed the practice of Emergency Medicine (EM). Care delivery on the front lines has historically depended upon ostensibly reliable input‐output models for staffing, supplies, policies, and therapies. Challenged by the complexity of healthcare during the pandemic, the fallibility of these reductionist models was quickly revealed. Providers and systems quickly had to reconceptualize their dependence on the wider, complex system in which healthcare operates and find adaptive solutions to rapid changes. Aims/Method: This papers seeks to review and describe how Systems Thinking and Complexity Theory (ST/CT)—concepts, principles, and tools that can be used to understand and impact our constantly evolving health system—can be applied to better understand and enact change in complex settings such as during COVID‐19. Some of these ST/CT are described through the real world example of the Alameda Health System Vaccine Taskforce. Results: ST/CT concepts such as Unintended Consequences, Interrelationships, Emergent Behavior, Feedback Loops, and Path Dependence can help EM providers and planners understand the context in which their system operates. Key principles such as Collaboration, Iterative Learning, and Transformational Leadership can help these actors respond to current and future challenges. The integration of these concepts and principles into the Learning Health System offers a model for tying these key concepts and principles together into an adaptive, cross‐sectoral organizational approach. Conclusion: By integrating ST/CT into the practice of EM, we can not only improve our ability to care for patients but also our capacity to understand and strengthen our wider systems of care. [ABSTRACT FROM AUTHOR]

Background: Implementation science (IS) should contribute to maintaining high standards of care across healthcare systems and enhancing care practices. However, despite the evident need for greater and more rapid uptake and integration of evidence in practice, IS design and methodology fall short of the needs of effective translation. Aim: In this paper we examine what it is about IS that makes it so appealing for effective uptake of interventions in routine practice, and yet so difficult to achieve. We propose a number of ways that implementation scientists could build mutual relationships with healthcare practitioners and other stakeholders including public members to ensure greater shared care practices, and highlight the value of IS training, collaborative educational events, and co‐designed research. Discussion: More consideration should be given to IS applications in healthcare contexts. Implementation scientists can make a valuable contribution by mobilizing theory and improving practice. However, goals for an evidence‐based system may be more appropriately achieved through greater outreach and collaboration, with methods that are flexible to support rapid implementation in complex adaptive systems. Collective learning and mutual trust can be cultivated by embedding researchers into healthcare services while offering greater opportunities for practitioners to learn about, and engage in, implementation research. Conclusion: To bridge the worlds of healthcare practice and IS, researchers could be more consistent in the relationships they build with professionals and the public, communicating through a shared language and co‐joining practical approaches to effective implementation. This will build capacity for improved collaboration and foster respectful, interdisciplinary relationships. [ABSTRACT FROM AUTHOR]

Background: In the United States chronic illnesses have become a way of life for multiple generations – they are the number one cause of death and disability (accounting for more than 70% of deaths), 60% of American adults have at least one chronic disease, and 40% have multiple chronic conditions. Although multiple factors contribute to the growth in chronic disease prevalence, a major factor has been overreliance on health care systems for promoting health and preventing disease. Large health care systems are ill equipped for this role since they are designed to detect, treat, and manage disease, not to promote health or address the underlying causes of disease. Methods: Improving health outcomes in the U.S. will require implementing broad‐based prevention strategies combining biological, behavioral, and societal variables that move beyond clinical care. According to community medicine, clinical care alone cannot create, support, or maintain health. Rather, health can only ensue from combining clinical care with epidemiology and community organization, because health is a social outcome resulting from a combination of clinical science, collective responsibility, and informed social action. Results: During the past 20 years, our team has developed an operational community medicine approach known as community health science. Our model provides a simple framework for integrating clinical care, population health, and community organization, using community‐based participatory research (CBPR) practices for developing place‐based initiatives. In the present paper, we present a brief overview of the model and describe its evolution, applications, and outcomes in two major urban environments. Conclusion: The paper demonstrates means for integrating the social determinants of health into collaborative place‐based approaches, for aligning community assets and reducing health disparities. It concludes by discussing how asset‐based community development can promote social connectivity and improve health, and how our approach reflects the emerging national consensus on the importance of place‐based population system change. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Alignment between patients' treatment choices and treatments received is acknowledged as an important outcome of shared decision‐making (SDM), yet recent research suggests that patients' choices do not always align with their actual treatment trajectories. This paper explores the alignment of patient‐expressed treatment choices (for surgery or medical management) after exposure to decision aids and treatments received among patients with hip or knee osteoarthritis within High Value Healthcare Collaborative (HVHC) systems as the collaborative integrated decision aids intended to support SDM into routine clinical practice. Method: This retrospective cohort study examines data from adult (≥18 years) patients with hip or knee osteoarthritis who received decision aids as part of orthopaedic consultations within HVHC systems between 2012 and 2015. Multivariable logistic regression explored the association between patient‐level characteristics with the odds of treatment choice‐receipt alignment. Results: The majority of patients with knee osteoarthritis (68.3%) and hip osteoarthritis (71.9%) received treatments aligned with their choices following exposure to decision aids, but analyses reveal important differences in the odds of such alignment across patient characteristics. In adjusted models, African American patients with knee osteoarthritis had 50% lower odds of receiving treatment aligned with their choices compared with Caucasian patients (OR = 0.52, P <.05). Medicare‐ or Medicaid‐insured knee patients had 49% and 59% lower odds (respectively) of receiving choice‐aligned treatments relative to privately insured patients. Patients with knee (OR = 0.40, P <.01) or hip (OR = 0.75, P <.05) osteoarthritis at earlier decision‐making stages had lower odds of receiving treatments congruent with their choices. Conclusion: This work elucidates the odds of treatment choice‐aligned care for patients within health care systems attempting to routinely integrate decision aids to support SDM into clinical practice and underscores the gaps in achieving this alignment among African American patients, those with public insurance and those at early decision‐making stages. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: Transitions of care between healthcare facilities are associated with increased risk of adverse events and hospital readmissions. Previous studies employing pharmacists in transitions of care showed reduced 30‐day readmissions, however, many were without an active comparator. There is no standardized approach to pharmacist involvement in transitions of care services, making it difficult to ascertain where pharmacist expertise is most meaningful. This paper aims to compare the 30‐day hospital readmissions between an interprofessional hospital discharge visit (iHDV) with physician and pharmacist involvement to a non‐interprofessional HDV (PHDV) without pharmacist involvement. Method: This was a retrospective quality improvement initiative examining patients of two outpatient clinical practices within a large, academic medical centre. The primary analysis compared 30‐day hospital readmission rates for patients with a scheduled PHDV or iHDV within 30‐days of index hospital discharge date, regardless of attendance at the HDV. The secondary outcome compared 30‐day hospital readmission rates for patients who completed a PHDV or iHDV. Primary and secondary outcomes were evaluated using bivariate analysis and multivariate analysis by stepwise logistic regression, for both intention‐to‐treat (ITT) and per protocol (PP). Results: This study found significantly lower 30‐day hospital readmissions for patients scheduled for a PHDV compared to an iHDV (16.7% vs 21.5%, P =.0230) in an unadjusted analysis, but no significant difference in adjusted analyses (P =.4856). Per‐protocol analysis found no significant difference in 30‐day hospital readmission rates between groups in unadjusted and adjusted analyses. Visit completion rates were significantly different between groups, with approximately twice as many PHDV group patients completing visits as compared to the iHDV group (74.1% vs 61.5%, P <.0001). Conclusion: This study demonstrates an interprofessional clinic visit employing a clinical pharmacist in the post‐hospital discharge visit did not significantly reduce 30‐day hospital readmission rates compared to a post‐hospital discharge visit without pharmacist involvement. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Involving members of the public in health research is said to produce higher quality research of greater clinical relevance. However, many of the anecdotal accounts of public involvement published in the academic literature to date have focused on the process of recruiting and involving members of the public and the effect of participation on these individuals rather than on how public involvement influenced the research process or outcomes. To strengthen the evidence base, there is clearly a need for more formal methods of capturing and documenting the impact of public involvement in health research. Methods In the first half of this paper, we discuss the importance of public involvement in health research and critically review the literature to identify current barriers to its successful implementation. In the second half, we present a conceptual model for evaluating and reporting the impact of public involvement in health research. Developed from our examination of the academic literature, we provide empirical support for the model by applying it to our recent experience of conducting a clinically based falls prevention study with members of the public. Results The conceptual model presented in this paper proposes key concepts and terminology that promote consistency when evaluating and reporting the impact of public involvement in health research. Reflecting on the experiential learning process, we demonstrate how the model promotes conceptual clarity whilst permitting the degree of flexibility required when working in a diverse culture such as the National Health Service. Conclusion If more evidence can be provided that public involvement enhances research processes and outcomes, researchers may be less inclined to treat this initiative as something they have to do in order to satisfy funding agencies and regulatory bodies and actively embrace this phenomenon, producing accounts of successful public involvement that transcend current barriers to its successful implementation. [ABSTRACT FROM AUTHOR]

Abstract: Medical scientists have expressed scepticism about whether philosophy is relevant to medicine. We challenged this in a conference on the topic of “too much medicine” (TMM) held in Oxford in April 2017. The topic of TMM provided an opportunity to bring the two disciplines together because of its history both in philosophy and in medicine. We found that the collaboration between the two disciplines was fruitful when two conditions were met. First, both disciplines had to avoid discipline‐specific jargon. Second, each discipline had to engage with the other. Specifically, medical scientists had to engage with some philosophical literature, and philosophers had to “get their hands dirty with data.” In this conference report, we provide an overview of our discussions and summarize the other papers in the series. [ABSTRACT FROM AUTHOR]

Rationale Intersectoral action (ISA) has been at the forefront of public health policy discussions since the 1970s. ISA incorporates a broader perspective of public health issues and coordinates efforts to address the social, political, economic and environmental contexts from which health determinants operate and are created. Despite being forwarded as a useful way to address and treat complex or 'wicked' problems, such policy issues are still often addressed within, rather than across, disciplinary silos and ISA has been documented to fail more often than it succeeds. Aims and objectives This paper contributes to an understanding of ISA by outlining and applying critical systems heuristics (CSH) theory and methods. Methods CSH theory and methods are described and discussed before applying them to the example of addressing climate change and health equity through public health practice. Results CSH thinking provides useful tools to engage stakeholders, question relations of power that may exist between collaborating partners, and move beyond power inequalities that guide ISA initiatives. Conclusions CSH is a compelling framing that can improve an understanding of the collaborative relationships that are a prerequisite for engaging in ISA to address complex or 'wicked' policy problems such as climate change. [ABSTRACT FROM AUTHOR]

Rationale: The purpose of this paper is to explore new perspectives about difficulties academicians may have communicating with clinicians, obtaining subjects, and gaining compliance for their research., Aims and Objectives: Evidence-based medicine (EBM) has been defined as an integration of best research evidence, clinical expertise, and patient values; however, clinical observation and experience are placed last in the evidence hierarchy with the randomized controlled trial held as the standard for clinical intervention. This paper describes how the hierarchical model of power in the research community obstructs new areas of knowledge, and how clinicians create resistance. Methods Foucault gave new perspectives describing how power circulates through individuals within organizational discourse. Drawing on literature and experience, and using a framework based on postmodern theoretical concepts, this paper examines patterns of discourse, subjectivity, resistance, and power/knowledge within the physical therapy profession., Results: The hierarchical discourse of medical knowledge produces opposition rather than collaboration between researcher, clinician, and patient. Alleviating perceptions of dominance and creating connections produces cohesion within medical communities., Conclusions: Evidence to practice and practice to evidence redefines EBM as a circular integration of best research evidence, clinical expertise, and patient values.

Rationale, Aims and Objectives: The aim of this paper is to examine the issue of telephone reporting by consultants in the medical community, which is rarely used in medicine today., Methods: The paper reviews principal publications addressing this field that have shown that communication between consultants and primary care physicians has many shortcomings, frequently leaving the primary care physician with unanswered questions., Discussion and Conclusions: We present the value of routine telephone reporting by consultants to their primary care counterparts and also discuss possible future implications of communication via electronic mail.

The article offers information on the work of Cochrane Charity. Topics discussed include public disagreements within organizations that provide evidence‐informed advice; global organizations producing evidence‐informed advice on health care policy; and success and sustainability of the Collaboration depends on addressing; and developed a wider process theory of organization that focuses on continuous change and movement.

In this paper we reflect upon and problematize the ways in which 'patient involvement' is interpreted in a substantial proportion of the research literature on involvement and shared decision making. Drawing upon an analysis of this literature we raise concerns about the 'medicalization of involvement' embedded in, and reproduced by, some dominant research lenses, suggesting that this medicalization has powerful discursive and material effects. For example, we suggest that it tends to normalize and arguably trivialize intrinsically problematic and contentious concepts such as 'patient preferences' and, at the same time, to obscure the full range of possibilities for reciprocity in the exchanges between the medical world of the professional and the experiential and narrative world of the patient. We argue that richer conceptualizations of collaboration in clinical work are both possible and very much needed, and we indicate some examples of scholarly resources and perspectives that point towards richer and more defensible accounts of involvement. Overall we call for more attention to the idea of 'epistemic involvement' and much greater cross-fertilization between different epistemological paradigms in this area of research. [ABSTRACT FROM AUTHOR]

The increasing complexity of contemporary health care policy and practice leads us to ask questions about what might constitute 'the good health care practitioner'. Yet, attempts through empirical work to address such questions are sparse. This paper reports on a small-scale qualitative study, which sought to explore questions with a number of health care professionals and academics about the nature of 'the good practitioner'. Four themes emerged from our exploration and analysis: the difficulty in trying to talk about 'the good practitioner', the importance of systems and contexts in understanding this area, the place of consultation and diagnosis in conceptions of 'good practice' and 'the good practitioner', and the dissembling of the elusive idea of the 'practitioner who is good' into a more realistic idea of constituent 'good practices'. We draw conclusions from our work and suggest a way forward. [ABSTRACT FROM AUTHOR]

Rationale Quality medical decision making requires that clinicians and patients incorporate the best available clinical evidence with the patients' values and preferences to develop a mutually agreed upon treatment plan. The interactive process involved in medical decision making is complex and requires patients and clinicians to use both cognitive and communicative skills to reach a shared understanding of the decision. Aims and objectives The purpose of this paper is to present a communication model to help better understand quality medical decision making, and how patient-centered, collaborative communication enhances the decision-making process. Methods We present research on shared mind and cognitive and communicative skills to highlight how they can facilitate the management of uncertainty during the interactive process involved in medical decision making. We provide simple examples about how to frame messages to achieve shared mind and foster uncertainty tolerance. Conclusions Strategies such as providing clear explanations, checking for understanding, eliciting the patient's values, concerns, needs, finding common ground, reaching consensus on a treatment plan, and establishing a mutually acceptable follow-up plan can facilitate collaborative decision making. Future research should explore ways to implement collaborative decision-making processes in existing health care systems. [ABSTRACT FROM AUTHOR]

Rationale, aim, and objective This study aimed to explore programme theories of a national quality register. A programme theory is a bundle of assumptions underpinning how and why an improvement initiative functions. The purpose was to examine and establish programme theories of a national quality register widely used in Sweden: Senior alert. The paper reports on how programme theories among change recipients emerge in relation to the established programme theory of the initiator. Methods A qualitative approach and a longitudinal research design were used. To develop programme theories among change recipients, individual semistructured interviews were conducted. Three sets of interviews were conducted in the period of 2011 to 2013, totalling 22 interviews. In addition, 4 participant observations were made. To develop the initiator's programme theory, an iterative multistage collaboration process between the researchers and the initiator was used. A directed content analysis was used to analyse data. Findings The initiator and change recipients described similar programme logics, but differing programme theories. With time, change recipients' programme theories emerged. Their programme theories converged and became more like the programme theory of the initiator. Conclusions This study has demonstrated the importance of making both the initiator's and change recipients' programme theories explicit. To learn about conditions for improvement initiatives, comparisons between their programme theories are valuable. Differences in programme theories provide information on how initiators can customize support for their improvement initiatives. Similar programme logics can be underpinned by different programme theories, which can be deceptive. Programme theories emerge over time and need to be understood as dynamic phenomena. [ABSTRACT FROM AUTHOR]

Rationale: Radiologic imaging is an essential component in the workup of many patients with neuro‐otologic conditions. However, patients often present for consultation with a neurotologist without the imaging that they have already undergone as part of their workup by a referring clinician. This disconnect causes frustration for clinicians and possible delays in care for patients. Anecdotally, clinicians felt that patients who had contact with clinic coordinators before their appointment were more likely to have their prior imaging available for review at the time of their initial consultation. Aims and Objectives: We aimed to increase the rate at which new patients brought their prior imaging to their initial consultation to at least 80% by improving previsit communication with patients and referring providers. Methods: Key stakeholders identified pain points in the flow of information from patients' outside facility workups. We then used the Plan‐Do‐Study‐Act quality improvement framework to develop, implement and iterate on two interventions intended to improve communication with patients, referring clinics and outside imaging centres. Chart review was used to assess the proportion of patients with imaging available for review at the time of initial consultation and a short satisfaction survey was sent to attending neurotologists in the pre and postintervention periods. Results: Before any interventions, 56.5% of typical new patients who reported having prior imaging had that imaging available for review at the time of their initial consultation. Following our interventions, this percentage increased to 73.5% and then 80.9% of new patients, respectively. Additionally, physicians reported improved satisfaction in several areas and spent less time reviewing imaging outside of clinic visits after our interventions. Conclusions: Improved communication and tracking of image receipt in clinics receiving many referrals saves physicians' time, reduces frustration and cuts down on the overall administrative burden following patients' appointments. [ABSTRACT FROM AUTHOR]

Medically trained health professionals have been central to the development of policy responses to the coronavirus 2019 (COVID‐19) crisis. In their multiple roles—as clinicians, public health leaders, members of scientific advisory boards, and also as media pundits and health professionals—they have helped shape discourses of science‐based policy options during the first 2 years of the pandemic. In particular, health professionals as a collective voice insisted on the necessity of society‐wide measures of social control to curb the morbidity and mortality of the virus. These measures, in turn, informed the political and moral imagination of the political class, the media and the larger public. Yet, as emerging evidence suggests, measures of social control posed a serious and long‐term risk for health equity. In this discussion piece on the first 2 years of COVID‐related public health directives, we interrogate the tensions that advocating for extensive and protracted measures of social control can pose to the social contract between medicine and society, health equity and democracy. To illustrate these tensions, we discuss the public fallout between vocal members of the OSAT, an ad hoc biomedical‐led organization, and the Government of Ontario in light of the disagreement on the scope of 'stay home' orders to manage the third wave of the pandemic in the Spring of 2021 and, more recently, the mass protest against mass‐scale public health measures in Ottawa, Canada. We argue that while decision making under emergency conditions is a difficult task, the legitimacy of the social contract between medicine and society depends on medical experts' judicious exercise of public health ethics principles. We offer a set of recommendations for building a more collaborative response to future health crises. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Ward rounds (WRs) are complex social processes. Done well, WR discussions and decisions contribute to timely, safe, effective progression of care. However, literature highlights medical dominance; marginalisation or absence of other perspectives, safety risks and suboptimal resource use. This study examined leadership behaviours and what supported good interprofessional WRs, defined as enabling interprofessional collaboration and decision making which progresses patient care in a safe and timely manner. Deepening appreciation of this art should support learning and improvements. Method: Mixed‐method appreciative inquiry (AI) into how WRs go well and could go well more often. Context: daily interprofessional consultant‐led WRs in a large adult critical care unit. Data: ethnographic and structured observations (73 h, 348 patient reviews); AI conversations and interviews (71 participants). Inductive iterative analysis shaped by Activity Theory. Participants: 256 qualified healthcare professionals working in the unit. Results: Leadership of good WRs supported (and minimized contradictions to): making good use of expertise and time, and effective communication. These three key activities required careful and skilled orchestration of contributions to each patient review, which was achieved through four distinct phases (a broadly predictable script), ensuring opportunity to contribute while maintaining focus and a productive pace. This expertise is largely tacit knowledge, learnt informally, which is difficult to analyse and articulate oneself, or explain to others. To make this easier, and thus support learning, we developed the metaphor of a conductor leading musicians. Conclusions: Whilst everyone contributes to the joint effort of delivering a good WR, WR leadership is key. It ensures effective use of time and diverse expertise, and coordinates contributions rather like a conductor working with musicians. Although WR needs and approaches vary across contexts, the key leadership activities we identified are likely to transfer to other settings. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Healthcare practitioners often note system‐level barriers to empathy between patients and practitioners. These include burnout‐inducing administrative workloads, unfriendly meeting times, burdensome protocols, lack of wellbeing spaces, and undervaluing empathy as a core part of an institution's mission. The need for empathy in healthcare has been magnified with the current SARS‐COV‐2 outbreak which has limited the expression of interpersonal empathy due to rigid isolation protocols and the use of personal protective equipment. Method: This study—the first of its kind that we are aware of—outlines the details of a facilitated workshop run with the leadership of a tertiary level pediatric center in Canada. The workshop used a modified nominal group technique to discuss and prioritize actions to enhance empathy into the hospital system. Results: Inter‐professional and inter‐disciplinary group of healthcare leader participants agreed on several immediately actionable steps, including embedding patient satisfaction with care measures as standard, and streamlining booking appointments. A roadmap was created to implement the other priorities. Conclusion: A systematic approach to infusing empathy into the structure of our healthcare system is much needed. Furthermore, inter‐professional and inter‐disciplinary educational workshops was well‐received as a way to facilitate discussion and drive change. [ABSTRACT FROM AUTHOR]

Rationale Electronic health systems are commonly included in health care reform discussions. However, their embrace by the health care community has been slow. Methods At Addiction Research and Treatment Corporation, a methadone maintenance programme that also provides primary medical care, HIV medical care and case management, substance abuse counselling and vocational services, we describe our experience in implementing an electronic health information system that encompasses all of these areas. Results We describe the challenges and opportunities of this process in terms of change management, hierarchy of corporate objectives, process mastering, training issues, information technology governance, electronic security, and communication and collaboration. Conclusion This description may provide practical insights to other institutions seeking to pursue this technology. [ABSTRACT FROM AUTHOR]

Introduction: Shared decision‐making (SDM) processes, combining patients' and professionals' perspectives, are especially necessary for patients with complex needs (CNs) during their care transitions. In 2016, we started implementing interprofessional and interinstitutional SDM processes (IIPs) for patients admitted to a short‐stay unit (SSU) for inpatient care and then followed‐up by primary care providers. Two types of IIPs were identified: (a) iterative IIPs, and (b) meeting IIPs. These differed in terms of the timing of SDM processes: whereas the former were multilateral and iterative, meeting IIPs were simultaneous. However, the two processes had similar outcomes and participants had similar characteristics. The intervention included other components, such as CNs assessment and a care coordinator position. The present study aimed to assess the feasibility of the intervention's implementation. Methods: The intervention's feasibility was assessed using fidelity and coverage indicators. We collected data from the patients' records on (a) patients' and professionals' characteristics, (b) the fidelity (CNs evaluations and occurrences of IIPs), and (c) the intervention's coverage (types of IIPs, participants). Results: The study included 453 patients between September 2017 and February 2019: mean age of 82.3 years, 65.6% women and 61.1% considered to have CNs. For patients with CNs, iterative IIPs and meeting IIPs occurred in 78.3% and 23.8% of cases, respectively. 35.1% of iterative IIPs and 8.8% of meeting IIPs for patients with CNs involved patients or their informal caregivers, inpatient professionals, primary care physicians and homecare professionals. Discussion: These results showed that an intervention targeting the implementation of formalized IIPs for SDM in transitional care was feasible. However, to improve the evaluation of such interventions, other methods should be used to measure their appropriateness and acceptability. Additionally, assessing the effects of IIPs would legitimize their funding, supporting their sustainability and generalisability. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: Pressure ulcers may have severe impacts on the quality of life of patients, including pain, low mood and restrictions in performing daily life and social life activities. In Switzerland, 4% of patients develop hospital‐acquired pressure ulcers. Six hospitals teamed up with the Vaud Hospital Federation (Switzerland) in a Breakthrough Collaborative, with the goal of reducing hospital‐acquired pressure ulcers by 50%. The aim of this study was to assess the actual reduction. Methods: A multimodal set of interventions was deployed in all wards except obstetrics and gynaecology, over 18 months starting in October 2016, including systematic risk assessment, use of a prevention bundle, education through e‐learning, measurement and feedback, patient engagement and promotion of a safety culture. All six hospitals monitored compliance with the use of the risk assessment, bundle application and patient involvement aspects. A safety calendar was implemented in all wards, for recording and visually displaying the numbers of new patients with pressure ulcers, as well as the presence of such ulcers upon admission and their category. Results: Compliance with performing Braden risk assessments rose from 39% at baseline to 61% by the end of the collaborative (P <.001), prevention bundle compliance from 2% to 30% (P <.001%) and documented patient engagement from 2% to 21% (P <.001%). The percentage of days where one or more patient was reported as having developed one or more pressure ulcers in the ward decreased from 8.21% to 4.18%, a 49% reduction (P <.001) which amounts to preventing 1124 new patients from developing one or more pressure ulcers during the collaborative. Conclusions: The Breakthrough Collaborative using a multimodal improvement approach combined with measurement and feedback was associated with a statistically and clinically significant improvement in compliance to best practice and with a reduction of hospital‐acquired pressure ulcers by half. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Cell‐based therapeutics are among the latest advances in health care technologies. The rapid evolution of stem cell science in Iran has necessitated the application of scientific achievements in clinical settings. However, various issues hindered their translation, in particular, impediments in the interactions of basic stem cell scientists and clinicians. We highlighted the impediments in the interactions of stem cell scientists and physicians involved in the opinion of professionals from both groups. Method: This qualitative research was conducted with thematic analysis, performed by purposive sampling. Thirty‐two distinguished stem cell scientists and clinicians were interviewed to identify their perspectives on this matter. MAXQDA 2018 was used to classify the axial codes based on factors related to communications inefficiencies. The analysis of coded data recognized 18 subthemes and six major themes. Results: Central themes include different registers of the two parties, counterproductive clusters hampered networking, external communication barriers, the competition to access resources, leadership conflicts, and the dissatisfaction of stakeholders with their share. Conclusions: Most of the impediments were seemingly global, for example, the incoherent medical and basic science educational systems, the vulnerable career path of physician‐scientists, and an increasing tendency towards overspecialization. However, some local specific issues were also described, for example, limited funding opportunities and the negative impacts of the division of medical education from the ministry of science, research, and technology in Iran. Proposed interventions include the reinforcement of physician‐scientist programs, designing a distributed leadership model, and bringing back the scientific integrity to higher education in Iran. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The practice of hospital pharmacists in many developing countries has been changing to include the delivery of direct patient care services, but practice change can be a challenging process. This article explores the perceptions of hospital pharmacists in Kuwait about the enablers and challenges to expanding their scope of practice to include direct patient care. Methods: A phenomenological qualitative approach was employed to conduct focus group interviews to explore pharmacists' perceptions about their professional practice at different hospitals across Kuwait. Data were collected from 110 pharmacists using 11 focus group interviews. The interviews were audio‐recorded, transcribed verbatim, and analysed using framework analysis. Results: The practice of most hospital pharmacists includes limited direct patient care role. However, a growing number of pharmacists have been introducing clinical pharmacy services at hospitals. Three themes about enablers to practice change emerged from data: (a) increasing physicians' acceptance to pharmacists' role in patient care, (b) patients' trust in pharmacists' knowledge about medications, and (c) pharmacists' perceived benefits of providing direct patient care. These benefits includes enhancing patients' safety and adherence to therapy and improving the professional identity of pharmacists. Participants' perceived challenges to practice change include professional, individual, and organizational challenges. Most participants welcomed assuming direct patient care role. They agreed that pharmacists need to receive adequate education and training and to be equipped with a clinical degree to responsibly provide direct patient care services at hospitals. Conclusions: Pharmacists have been increasingly attempting to provide clinical pharmacy services in Kuwait hospitals. This qualitative data revealed breadth of challenges hindering pharmacists' attempts to expand their professional practice to include direct patient care role. It also outlines facets of improvement and enablers to practice change. The collaboration between different stakeholders in the profession is essential to support pharmacists' efforts in achieving the change in the scope of pharmacy practice to improve patient care services. [ABSTRACT FROM AUTHOR]

Aims and objectives: The present study aimed to investigate the effects of interprofessional education on healthcare providers' intentions to engage in an interprofessional shared decision‐making (IP‐SDM) process at emergency department and exploring the affecting factors on their intentions. Methods: We conducted the study through a sequential explanatory mixed method (quantitative‐qualitative) design. All ED residents and nurses from two university hospitals were invited and assigned to the intervention and control groups. The intervention group was exposed to case‐based learning sessions conducted by applying interprofessional strategies. The intentions of the participants engaged in IP‐SDM were assessed before and 2 weeks after the intervention by a questionnaire designed based on the theory of planned behaviour. The questionnaire scores were compared between the intervention and control groups using analysis of covariance (ANCOVA). Partial eta‐squared (η2) was used for effect size calculations in ANCOVA. Subsequently, to explore the affecting factors in engagement in IP‐SDM, qualitative data were collected through semi‐structured individual interviews. The inductive content analysis approach by Elo and Kyngas was employed to analyze the qualitative data. Results: Out of 117 potentially eligible healthcare professionals, 113 completed the study in the intervention (n = 55) and control (n = 58) groups. The results showed that the difference between the mean scores of the learners in the intervention (1.41 ± 0.27) and control (0.80 ± 0.52) groups was statistically significant (P‐value =.00001). The main effect of the intervention and a large educational effect size for the intervention were found to be statistically significant F (1, 11) = 180.54, P‐value =.00001, η2 = 0.62. The qualitative data analysis showed two main categories of "team‐based facilitators" and "contextual challenges" as the main affecting factors in the engagement of participant in IP‐SDM. Conclusion: Our findings suggested that applying interprofessional education strategies could improve the learners' intention to engage in IP‐SDM. Moreover, the results showed that the interprofessional collaboration among team members, adherence to the team‐based care principles, and administrative support at different levels could be the influential factors the intentions of the participants to engage in IP‐SDM. [ABSTRACT FROM AUTHOR]

Effective treatment of depression involves collaboration with informed patients and families and appropriate knowledge sharing. We describe here our experience, as a case example, of a collaboration to "translate" a clinical guideline designed for practitioners into an accessible, plainlanguage version that patients and families can use during the care process, both to provide basic educational information and to foster informed discussions with their treatment providers. Content experts in knowledge translation, patient advocacy, patient‐oriented research, and psychiatry guided overall project design. Our first step was to identify lived experience writers to join in the codesign and co‐writing of the "CHOICE‐D Patient and Family Guide to Depression Treatment." A national call for writers attracted 62 applicants, from whom eight individuals with lived experience of depression and writing experience were selected. Individuals subsequently attended a welcoming teleconference, followed by a 1‐day workshop designed to provide (a) a detailed overview of the clinician guideline, (b) an opportunity to select what should be included in the Guide, and (c) key principles of knowledge translation/lay writing. Both from the workshop and subsequently through the codesign process, lived experience writers recommended that the Guide address symptoms, effects of illness course on treatment, first‐line treatments, safety/side effects, and treatment misconceptions. To promote patient autonomy, question scripts (how and what to ask your treatment provider), self‐triaging resources, and treatment selection aids were suggested. Stylistic considerations included use of simple yet hopeful language, brevity, white space, key terms glossary, and graphics. Several strategies were particularly useful to optimize writer engagement in the codesign process: a pre‐workshop conference call and circulation of project resources, an in‐person workshop to increase content knowledge, structured discussion with co‐writers and project leads to develop ideas, and practical training exercises with the provision of feedback. Both during and at the end of the project, writers provided additional recommendations for improving the process, including more in‐person meetings, distribution of step‐by‐step instructions on the writing task, and a key terms glossary of technical terms to support their role. In conclusion, we describe a process with practical tips and reflective feedback on important considerations for engaging persons with lived experience as leaders in the codesign and writing process of lay treatment guidelines. These methods may serve as a model for similar projects in other areas of healthcare. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Providing high‐quality primary care in patient‐centred medical homes (PCMHa) requires competencies that can only be provided by interprofessional (IP) education. The benefits of collaborative training have been documented for learners, but less is known about the perceptions of the clinical professionals who train the learners or the patients receiving IP primary care. This investigation compared stakeholder attitudes about IP education, training, and providing collaborative care prior to developing a new IP training programme. Methods: We conducted five focus groups at a large general internal medicine training practice. Learner and faculty groups included participants from medicine, psychology, pharmacy, and physician assistant professions; three patient groups were held to obtain perspectives on receiving health care from IP trainees. We used inductive analysis to identify themes across the three stakeholder groups. Results: We identified seven convergent themes across all three stakeholder groups: (a) team engagement, (b) technology in care delivery, (c) cost of care, (d) involving patients in learning, (e) time constraints, (f) scope of practice, and (g) autonomy/interdependence. Each group emphasized the need to define and communicate team members' roles. Learners anticipated high‐quality IP interactions, and patients noted the benefits of receiving care from well‐supervised trainees. Faculty struggled to navigate the training needs of diverse learner groups and to integrate PCMH mandates focused on documentation with authentic patient‐centred care. Conclusions: This is the first reported data comparing perceptions about IP training and care across these three stakeholder groups. Results suggest the need to clarify scope of practice, define professional roles, and bridge gaps between teaching PCMH principles and subsequently providing high‐quality health care. Results inform faculty development needs in learning ways to train learners across professions and outline ways to structure interactions with patients. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: While it has long been supported that faculty development programmes serve as a means to improving practical knowledge, professional skills, and identity formation for faculty, significantly less research is focused on how learning that occurs in faculty development programmes is actually employed in the workplace and ingrained in day‐to‐day activities. The present study qualitatively explored the long‐term impact of the Mentoring and Professionalism in Training (MAP‐IT) programme, a longitudinal, interprofessional faculty development curriculum designed to enhance clinicians' humanistic mentoring skills, specifically nurses and physicians. Method: Participants included 21 former high‐potential mentors and facilitator leaders who had graduated from the MAP‐IT programme from 2014 to 2016. Semi‐structured focus groups and interviews were conducted between August and September of 2017 to collect participant experiences of the impact of MAP‐IT skills on their professional roles (with colleagues and patients) in their clinical environments. Qualitative data were analysed using content analysis methodology. Results: Qualitative analyses using an editing analysis style resulted in nine major themes, including incorporation into clinical practice, self‐care, team building and conflict resolution, mindfulness, mentorship, professionalism, interprofessional collaboration, humanism, and appreciative inquiry. Conclusion: The personal and professional development instilled through the MAP‐IT programme was found to remain important over time, years after participation in the programme had concluded, supporting its "durability." Implications are also discussed. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The competence of nurses in anaesthesia care is important for the quality of anaesthesia nursing care and patient safety. However, there is a lack of psychometrically tested instruments to measure the competence. Therefore, this study aimed to develop and test the psychometric properties of an anaesthesia nursing competence scale (AnestComp) assessing nurses' competence in anaesthesia care. Method: The scale development and psychometric testing had three phases: (1) based on literature reviews and the description of experts, competence areas were identified and items were created; (2) the content validity of the scale was tested by a content expert group, and the scale was pilot tested; and (3) psychometric testing of scale was tested by anaesthesia nurses' (n = 222) and nursing students' (n = 205) self‐assessments. The psychometric testing assessed the reliability when using Cronbach's α and the construct validity using factor analyses (confirmatory and exploratory) and known‐group technique. Nursing students were included for the purpose of construct validity testing. Results: The AnestComp has 39 items and consists of seven competence areas: (a) ethics of anaesthesia care, (b) patient's risk care, (c) patient engagement with technology, (d) collaboration within patient care, (e) anaesthesia patient care with medication, (f) peri‐anaesthesia nursing intervention, and (g) knowledge of anaesthesia patient care. Cronbach's α values were high in all categories (0.83‐0.95), and factor analyses and known‐group technique supported a seven‐factor model. Conclusion: The initial results supported the reliability and construct validity of the AnestComp. The scale is considered a promising instrument for measuring anaesthesia nursing competence among anaesthesia nurses. Further research with larger and more diverse samples is suggested to refine the current psychometric evaluation. [ABSTRACT FROM AUTHOR]

The aim of this study was to employ knowledge user perspectives to develop recommendations that facilitate implementation of a complex, shared decision‐making (SDM)‐based intervention in an interprofessional setting. This study was part of a larger knowledge translation (KT) study in which interprofessional teams from five freestanding, academically affiliated, rehabilitation hospitals were tasked with implementing a cognitive strategy‐based intervention approach that incorporates SDM known as Cognitive Orientation to daily Occupational Performance (CO‐OP) to treat survivors of stroke. At the end of the 4‐month CO‐OP KT implementation support period, 10 clinicians, two from each site, volunteered as CO‐OP site champions. A semi‐structured focus group was conducted with 10 site champions 3 months following the implementation support period. To meet the study objective, an exploratory qualitative research design was used. The focus group session was audio‐recorded, transcribed verbatim and analyzed through the lens of the integrated promoting action on research implementation in health services (iPARIHS) framework. The focus group participants (n = 8) consisted of occupational therapists, physical therapists, and speech language pathologists. Ten recommendations for CO‐OP implementation were extracted and co‐constructed from the focus group transcript. The recommendations reflected all four iPARHIS constructs: Facilitation, Context, Innovation, and Recipients. Implementation recommendations, from the knowledge user perspective, highlight that context‐specific facilitation is key to integrating a novel, complex intervention into interprofessional practice. Facilitators should lay out a framework for training, communication and implementation that is structured but still provides flexibility for iterative learning and active problem‐solving within the relevant practice context. [ABSTRACT FROM AUTHOR]

User participation is nowadays a desirable feature of social services work. The International Federation of Social Workers states that staff shall promote the participation of clients so as to "enable them to be empowered in all aspects of decisions and actions affecting their lives." The statement is codified in various national ethical codes; the Swedish Code of Conduct and Ethical Behaviour for Social Workers specifies that interventions shall build on client participation and common agreement. However, a 2012 Swedish governmental report noted that among 16 methods for user participation in the social services, psychiatry, and abuse and addiction care, only one, shared decision making (SDM), had been evaluated in randomized controlled trials (RCTs). Given this lack of evaluations, how ought professionals to choose between the various methods? The aim of this article is to introduce distinctions in order to answer the question of how social workers ought to choose between different user participation methods, to suggest how this choice could be made, and to argue that the case for SDM seems to be stronger than for other methods. We can distinguish between justificatory, motivational, and explanatory reasons in order to clarify what types of reasons are relevant when choosing between methods. Another distinction concerns general and specific reasons for user participation. No particular method for user participation can inherit its support only from general reasons, since these ordinarily do not point out any method as better than another one. Rather, specific reasons are needed. Social workers do have good reasons for choosing certain methods for user participation rather than others. These methods can be found by looking at specific justificatory reasons. The case for SDM is strengthened by its having been evaluated in RCTs and also because the SDM components harmonize with relevant components in the presented (Swedish) legislation. [ABSTRACT FROM AUTHOR]

Elements of shared decision‐making (ie, collaboration, patient preferences, and working alliance) have long been discussed and studied in the field of clinical psychology; however, research indicates that shared decision‐making is not typically used in clinical practice. Instead, clinicians often rely on a paternalistic approach. In this article, we provide a narrative review of the existing research supporting shared decision‐making for mental and behavioural health concerns, we discuss several barriers that impede its use in actual clinical practice, and we provide recommendations for increasing shared decision‐making when working with patients. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The field of implementation science has developed in response to slow and inconsistent translation of evidence into practice. Despite utilizing increasingly sophisticated approaches to implementation, including applying a complexity science lens and conducting realist evaluations, challenges remain to getting the kinds of outcomes hoped for by implementation efforts. These include gaining access and buy‐in from those implementing the change and accounting for the influence of local context. One emerging approach to address these challenges is embedded implementation research—a collaborative, adaptive approach to improvement. It involves researchers and implementers working together in situ from the outset of, and throughout, an implementation project. Both groups can benefit from the collaboration: it increases the rigor of evaluation, provides opportunities to improve the intervention through direct feedback, and promotes better on‐the‐ground understanding of the change process. We aimed to examine the potential benefits, and some of the challenges, of increased embeddedness. Method: We performed a multi‐case analysis of implementation research projects that varied by degree of embeddedness. Results: Embedded implementation research may offer a range of advantages over dichotomized research‐practice designs, including better understanding of local context and direct feedback to improve the implementation along the way. We present a model that spans four approaches: dichotomized research‐practice, collaborative linking‐up, partially‐embedded, and deep immersion. Conclusion: Embedded implementation research approaches hold promise in comparison to traditional dichotomized‐research practice designs, where the research is external to the implementation and conducts a summative evaluation. We are only beginning to understand how such partnerships operate in practice and what makes them successful. Our analysis suggests the time has come to consider such approaches. [ABSTRACT FROM AUTHOR]

Abstract: Background: To improve the efficiency of the health care system, new interprofessional models of care are emerging. In 2015, two provincial professional colleges, regulating the practice of physiotherapists and that of pharmacists in the province of Québec, Canada, developed a new interprofessional model of care. This model is designed to guide non‐prescription medication recommendations by physiotherapists treating patients in primary care with neuromusculoskeletal disorders (NMSKD) with the collaboration of pharmacists. Purpose: To assess Québec physiotherapists' interests to use this model and explore their opinions concerning their ability to recommend non‐prescription medications to patients in primary care with NMSKD. Methods: An email invitation to complete an electronic survey was sent in February 2016 to all the Ordre professionnel de la physiothérapie du Québec's registered physiotherapists. The survey included a questionnaire with 31 questions divided into 5 sections. Descriptive analyses and Chi‐square tests (χ2) were performed to compare proportions (%) across demographic and clinical characteristics. Results: Two hundred twenty‐five physiotherapists completed the full survey. Of these, 70% of respondents knew of the model of care, but only 15% had previously used it. Perceived workload increase was one major reason reported for this lack of use (51%). Most of the respondents had a positive perception of this model and interactions with pharmacists and were confident regarding their ability to safely recommend medication (63%). However, 63% believed that further training was necessary to enable physiotherapists to provide efficient and safe non‐prescription medication recommendations to patients with NMSKD. Conclusions: Overall, physiotherapists have a positive perception of this model, but there remain opportunities for increased integration into practice. Most respondents believe that additional training is required regarding non‐prescription medication recommendations. [ABSTRACT FROM AUTHOR]

Abstract: Rational: Tools used in clinical encounters to illustrate to patients the risks and benefits of treatment options have been shown to increase shared decision making. However, we do not have good information about how these tools are viewed by clinicians and how clinicians think patients would react to their use. Objective: Our aim was to examine clinicians' views about the possible and actual use of tools designed to support patients and clinicians to collaborate and deliberate about treatment options, namely, Option Grid decision aids. Method: We conducted a thematic analysis of qualitative interviews embedded in the intervention phase of a trial of an Option Grid decision aid for osteoarthritis of the knee. Interviews were conducted with 6 participating clinicians before they used the tool and again after clinicians had used the tool with 6 patients. Results: In the first interview, clinicians voiced concerns that the tool would lead to an increase in encounter duration, patient resistance regarding involvement in decision making, and potential information overload. At the second interview, after minimal training, the clinicians reported that the tool had changed their usual way of communicating, and it was generally acceptable and helpful to integrate it into practice. Discussion and Conclusions: After experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow, and clinical pathways. [ABSTRACT FROM AUTHOR]

Abstract: For older adults with osteoporosis, a fall resulting in hip fracture is a life‐changing event from which only one‐third fully recover. Current best evidence argues strongly for elderly patients to bear weight on their repaired hip fracture immediately after their surgery to maximize their chances of full or nearly full recovery. Patient stakeholders in Canada have argued that some surgeons fail to issue “weight‐bearing‐as‐tolerated” (WBAT) orders in all eligible cases, protecting their bony repair but contributing to increased mortality and long‐term disability rates. In collaboration with a national stakeholder organization, Bone and Joint Canada, we interviewed 20 orthopedic surgeons across Canada who perform hip fracture repair surgery, with the aim of understanding their attitudes and behavior toward patient management regarding weight bearing. Qualitative content analysis, in which themes are identified and agreed by multiple coders, suggested that both patient characteristics and surgeon factors influence surgeons' postoperative weight‐bearing orders. While almost all respondents agreed that weight bearing as tolerated is indeed therapeutic for most hip fracture repair or replacement patients, surgeons also described certain patient characteristics that would diminish the value of immediate weight bearing, including poor bone quality and certain types of fracture pattern. Surgeon factors that affect postoperative mobilization orders include choice of construct, previous experience of construct failure, and lack of local audit data regarding past weight‐bearing decisions and patient outcomes. Thus, although familiar with best practice guidelines, surgeons also have “rules to break the rules.” In an era when “good” medicine leans toward science rather than art, the role of individual experience in decision making with regard to hip fracture care continues to be important and would benefit from being discussed openly. [ABSTRACT FROM AUTHOR]

Abstract: Rational, aims and objectives: The aim of this review was to identify general theoretical frameworks used in online social network interventions for behavioral change. To address this research question, a PRISMA‐compliant systematic review was conducted. Methods: A systematic review (PROSPERO registration number CRD42014007555) was conducted using 3 electronic databases (PsycINFO, Pubmed, and Embase). Four reviewers screened 1788 abstracts. Results: 15 studies were selected according to the eligibility criteria. Randomized controlled trials and controlled studies were assessed using Cochrane Collaboration's “risk‐of‐bias” tool, and narrative synthesis. Five eligible articles used the social cognitive theory as a framework to develop interventions targeting behavioral change. Other theoretical frameworks were related to the dynamics of social networks, intention models, and community engagement theories. Only one of the studies selected in the review mentioned a well‐known theory from the field of health psychology. Conclusion: Conclusions were that guidelines are lacking in the design of online social network interventions for behavioral change. Existing theories and models from health psychology that are traditionally used for in situ behavioral change should be considered when designing online social network interventions in a health care setting. [ABSTRACT FROM AUTHOR]

Rationale Clinical practice is the primary focus of advanced practice nursing (APN) roles. However, with unprecedented needs for health care reform and quality improvement (QI), health care administrators are seeking new ways to utilize all dimensions of APN expertise, especially related to research and evidence-based practice. International studies reveal research as the most underdeveloped and underutilized aspect of these roles. Aims To improve patient care by strengthening the capacity of advanced practice nurses to integrate research and evidence-based practice activities into their day-to-day practice. Methods An academic-practice partnership was created among hospital-based advanced practice nurses, nurse administrators, and APN researchers to create an innovative approach to educate and mentor advanced practice nurses in conducting point-of-care research, QI, or evidence-based practice projects to improve patient, provider, and/or system outcomes. A practice-based research course was delivered to 2 cohorts of advanced practice nurses using a range of teaching strategies including 1-to-1 academic mentorship. All participants completed self-report surveys before and after course delivery. Results Through participation in this initiative, advanced practice nurses enhanced their knowledge, skills, and confidence in the design, implementation, and/or evaluation of research, QI, and evidence-based practice activities. Conclusion Evaluation of this initiative provides evidence of the acceptability and feasibility of academic-practice partnerships to educate and mentor point-of-care providers on how to lead, implement, and integrate research, QI and evidence-based activities into their practices. [ABSTRACT FROM AUTHOR]

The cultural divide between scientists and clinicians has been described as undermining the advance of medical science, by hindering the production of practice-relevant research and of research-informed clinical decisions. Here, I consider the field of post-marketing risk assessment of drugs as an example of strict interdependence between basic biomedical research, clinical research, and clinical evaluation and show how it would benefit from a closer collaboration between scientists and clinicians. The risk assessment of drugs after their marketing relies on spontaneous adverse effect reports to drug agencies and on peer-reviewed case reports. I emphasize the importance of qualitative analysis of such reports for the improvement of mechanistic understanding of harmful effects of drugs. I argue that mechanistic explanations of drug effects are at least as important as determination of their frequency, in order to establish causation. An ideal risk assessment, then, verifies not only the frequency of undesired effects but also why and how the harm happens. For this purpose, the frequency or novelty of the unintended outcome, although contextually indicative, should not determine the epistemic value of a report. Details about the context that generated an unexpected outcome, instead, can offer the chance of improving causal understanding about how the intervention works. This is illustrated through examples from medical research. Mechanistic understanding is a domain of joint collaboration among (1) clinicians, in charge of detailed, qualitative reporting of patient stories about side effects, (2) qualitative clinical researchers, in charge of analyzing clinical contexts or harmful effects and formulating explanatory hypotheses, and (3) basic biomedical researchers, in charge of verifying such hypotheses. In addition, direct information flow can on one side focus clinicians' attention on knowledge gaps about drugs/effects where more research is needed, while on the other side create a more contextualized concept of mechanism among scientists. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives As patients move across transition points, effective medication management is critical for patient safety. The aims of this study were to examine how health professionals, patients and family members communicate about managing medications as patients moved across transition points of care and to identify possible sources of communication failure. Method A descriptive approach was used involving observations and interviews. The emergency departments and medical wards of two hospitals were involved. Observations focused on how health professionals managed medications during interactions with other health professionals, patients and family members, as patients moved across clinical settings. Follow-up interviews with participants were also undertaken. Thematic analysis was completed of transcribed data, and descriptive statistics were used to analyse characteristics of communication failure. Results Three key themes were identified: environmental challenges, interprofessional relationships, and patient and family beliefs and responsibilities. As patients moved between environments, insufficient tracking occurred about medication changes. Before hospital admission, patients participated in self-care medication activities, which did not always involve exemplary behaviours or match the medications that doctors prescribed. During observations, 432 instances of communication failure (42.8%) were detected, which related to purpose, content, audience and occasion of the communication. Conclusions Extensive challenges exist involving the management of medications at transition points of care. Bedside handovers and ward rounds can be utilized as patient counselling opportunities about changes in the medication regimen. Greater attention is needed on how patients in the community make medication-related decisions. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The Hospital Federation of Vaud ( Switzerland) used a Breakthrough Collaborative with the aim of reducing adverse drug events ( ADEs) by 20% in 10 participating hospitals. Methods A set of interventions (covering patient identification, high-alert medication and medication preparation in the ward) was deployed over 18 months starting in October 2010. All hospitals monitored discrepancies between drugs prescribed and those prepared for administration, as well as the occurrence of ADEs using the ADE Trigger Tool for 18 months (cohort 1). A subset of five hospitals continued this monitoring for 12 additional months (cohort 2). Results In cohort 1, pill box discrepancies were present in 5.9% of doses ( n = 9772) in 2011 and in 5.8% ( n = 2251) in the first 3 months of 2012 (no statistical significance). There were no significant differences in the rate of ADEs/1000 doses across time (1.2 in 2010, 1.0 in 2011 and 1.0 in 2012). In cohort 2, pill box discrepancies were reduced from 6.5% ( n = 4846 doses) in 2011 to 4.4% ( n = 7355) in 2012 ( P < 0.001) to 3.0% for the first 3 months of 2013 ( n = 2251; P = 0.004). The rate of ADEs/1000 doses decreased (1.8 in 2010, 1.1 in 2011 and 0.6 in 2012/13 ( P = 0.008 for 2010-2011, and P < 0.001 for 2011-2012/2013). Conclusions Reductions in drug discrepancies and ADEs occurred in the cohort with the longer monitoring duration. Factors contributing to success may include the strategic status of the project, executive support, perseverance in post-intervention measurement, and institution-wide rather than partial deployment. [ABSTRACT FROM AUTHOR]

Contemporary health care is increasing in complexity and lacks a unifying understanding of epistemology, methodology and goals. Lack of conceptual consistency in concepts such as 'patient-centred care' ( PCC) typifies system-wide discordance. We contrast the fragmented descriptions of PCC and related tools to its own origins in the writings of Balint and to a subsequent construct, relationship-centred care ( RCC). We identify the explicit and elaborated connection between RCC and a defined epistemological foundation as a distinguishing feature of the construct and we demonstrate that this makes possible the recognition of alignments between RCC and independently developed constructs. Among these, we emphasize Schon's reflective practice, Nonaka's theory of organizational knowledge creation and the research methodology of realist synthesis. We highlight the relational principles common to these domains and to their common epistemologies and illustrate unsatisfying consequences of adherence to less adequate epistemological frameworks such as positivism. We offer RCC not as an 'antidote' to the dilemmas identified at the outset but as an example that illuminates the value and importance of explicit identification of the premises and assumptions underlying approaches to improvement of the health care system. We stress the potential value of identifying epistemological affinities across otherwise disparate fields and disciplines. [ABSTRACT FROM AUTHOR]