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Nurses' work in general practices is underestimated to an unknown degree due to the way practice records are kept, according to researchers in a major New Zealand study. Our study [...]

May 18, 2023 Where are high-needs patients cared for in general practice? This is the second in a series of articles about a major research project comparing models of general [...]

Researchers say the largest-ever study of general practice in Aotearoa New Zealand sheds new light and creates a powerhouse of data for decision-making. A study into general practice models in [...]

Purpose: This article aims to explore the meanings of positionality and demonstrate how reflective memos can illustrate positionality in a constructivist grounded theory (CGT) study. Design/methodology/approach: Acknowledging the positionality of the researcher through a reflective approach is an essential element of CGT studies. The first author (IS) used reflective memoing in her CGT study on Indian immigrant children's asthma to practice reflexivity and make her positionality explicit. Through memos, IS acknowledges her knowledge, beliefs, practices, experience and pre-existing assumptions about the research topic. This article is a compilation of the reflective memos that IS wrote during the initial phase of her research and draws on her motivations as they relate to the topic under study in the context of current literature. Findings: The reflective accounts of a researcher's background and experience can act as a lens for understanding the research question and the choice of methodology. Practical implications: This article may be useful to novice qualitative researchers who are struggling to define and establish their own positionality. John Dewey's and David Schon's works on reflective thinking serve as valuable tools to practice reflexivity. Philosophically underpinned reflections in the form of memos, employed from the outset and throughout the study, can enhance the study rigour by making research decisions transparent. Originality/value: This article provides practical guidance on how to outline positionality at the outset of a CGT study.

IMPORTANCE: In developed countries, bronchiolitis is the most common reason for infants to be admitted to the hospital, and all international bronchiolitis guidelines recommend supportive care; however, significant variation in practice continues with infants receiving non–evidence-based therapies. Deimplementation research aims to reduce the use of low-value care, and advancing science in this area is critical to delivering evidence-based care. OBJECTIVE: To determine the effectiveness of targeted interventions vs passive dissemination of an evidence-based bronchiolitis guideline in improving treatment of infants with bronchiolitis. DESIGN, SETTING, AND PARTICIPANTS: This international, multicenter cluster randomized clinical trial included 26 hospitals (clusters) in Australia and New Zealand providing tertiary or secondary pediatric care (13 randomized to intervention, 13 to control) during the 2017 bronchiolitis season. Data were collected on 8003 infants for the 3 bronchiolitis seasons (2014-2016) before the implementation period and 3727 infants for the implementation period (2017 bronchiolitis season, May 1-November 30). Data were analyzed from November 16, 2018, to December 9, 2020. INTERVENTIONS: Interventions were developed using theories of behavior change to target key factors that influence bronchiolitis management. These interventions included site-based clinical leads, stakeholder meetings, a train-the-trainer workshop, targeted educational delivery, other educational and promotional materials, and audit and feedback. MAIN OUTCOMES AND MEASURES: The primary outcome was compliance during the first 24 hours of care with no use of chest radiography, albuterol, glucocorticoids, antibiotics, and epinephrine, measured retrospectively from medical records of randomly selected infants with bronchiolitis who presented to the hospital. There were no patient-level exclusions. RESULTS: A total of 26 hospitals were randomized without dropouts. Analysis was by intention to treat. Baseline data collected on 8003 infants for 3 bronchiolitis seasons (2014-2016) before the implementation period were similar between intervention and control hospitals. Implementation period data were collected on 3727 infants, including 2328 boys (62%) and 1399 girls (38%), with a mean (SD) age of 6.0 (3.2) months. A total of 459 (12%) were Māori (New Zealand), and 295 (8%) were Aboriginal/Torres Strait Islander (Australia). Compliance with recommendations was 85.1% (95% CI, 82.6%-89.7%) in intervention hospitals vs 73.0% (95% CI, 65.3%-78.8%) in control hospitals (adjusted risk difference, 14.1%; 95% CI, 6.5%-21.7%; P < .001). CONCLUSIONS AND RELEVANCE: Targeted interventions led to improved treatment of infants with bronchiolitis. This study has important implications for bronchiolitis management and the development of effective interventions to deimplement low-value care. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry: ACTRN12616001567415.

Objective:To assess the usefulness of a national and a local system dynamics model of cardiovascular disease to planning and funding decision makers.