Search

Background: There is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. To address this issue, the Cardiovascular Assessment Screening Program (CASP) was developed, implemented, and evaluated. This manuscript reports on the second phase of an exploratory sequential mixed methods study that tested the effectiveness of the CASP with nurse practitioners (NPs) and patients in Canada. Methods: A two-armed, non-blinded, cluster randomised controlled trial (cRCT) compared the NP-led implementation of CASP with usual care by NPs in community practice clinics across one Canadian province. The NPs were the cluster variable as their screening practices could be affected by their educational training, resources, or other factors. NPs were eligible for inclusion in the study if they were located in different urban and rural community settings and could conduct follow-up visits with patients. NPs recruited and enrolled the patients from their own practices as participants if they were healthy individuals, aged 40–74 years, with no established CVD or vascular disease. Researchers randomly allocated the NPs (n = 10) to the intervention group (IG) or the control group (CG). Results: Eight (8) NPs and 167 patients participated in the cRCT study. Patient participant-level data were analysed by the originally assigned groups IG (n = 68) and CG (n = 99). Utilising GLM (generalized linear modeling) more IG patients (90%; n = 61) received comprehensive CVD screening compared to the CG patients (2%; n = 2), RR = 30.2, 95% CI [8.76, 103.9], p <.0001, controlling for the effect of NP and BP category. Conclusion: NP implementation of CASP was effective for comprehensive screening compared to usual care and led to identifying previously unknown CVD risk factors, calculated FRS, heart health priorities and personalised goal-setting. Trial registration: ClinicalTrial.gov ID#: NCT03170752, date of registration 2017/05/31. [ABSTRACT FROM AUTHOR]

This article presents highlights from a recently updated systematic Cochrane review evaluating the effectiveness of interventions to improve hand hygiene compliance in patient care. It is an advance on the two earlier reviews we undertook on the same topic as it has, for the first time, provided very rigorous synthesis of evidence that such interventions can improve practice. In this article, we provide highlights from a recently updated Cochrane systematic review. We identify omissions in the information reported and point out important aspects of hand hygiene intervention studies that were beyond the scope of the review. A full report of the review is available free of charge on the Cochrane website. [ABSTRACT FROM AUTHOR]

Background: There is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. This manuscript reports on the first phase of an exploratory sequential mixed methods study describing the integration of the qualitative study findings with the Theoretical Domains Framework (TDF) that led to the development of the Cardiovascular Assessment Screening Program (CASP). The main objective of the qualitative study was to inform the development of CASP. Methods: Focus groups (5) and interviews (10) were conducted in rural and urban settings in one Canadian province with target health professionals, managers in health care organizations, and the public to obtain different perspectives to inform the CASP intervention. Three focus groups were held with nurse practitioners and two with members of the public; individual interviews were conducted with target groups as well. Application of the TDF provided a comprehensive approach to determine the main factors influencing clinician behaviour, to assess the implementation process, and to support intervention design. Behaviour change techniques, modes of delivery, and intervention components were selected for the development of the CASP. Results: Themes identified such lack of knowledge about comprehensive screening, ambiguity around responsibility for screening, lack of time and commitment to screening were addressed in the components of the CASP intervention that were developed, including a website, education module, decision tools, and a toolkit. Conclusion: CASP is a theory-informed intervention developed through the integration of the findings from the focus groups and interviews with selected TDF domains, behaviour change techniques, and modes of delivery available in the local context that may be a useful approach for knowledge translation of evidence into practice. [ABSTRACT FROM AUTHOR]

Background: Policies and procedures (P&Ps) have been suggested as one possible strategy for moving research evidence into practice among nursing staff in hospitals. Research in the area of P&Ps is limited, however. This paper explores: 1) nurses' use of eight specific research-based practices (RBPs) and RBP overall, 2) nurses' use and understanding of P&Ps, and 3) the role of P&Ps in promoting research utilization. Methods: Staff nurses from the eight health regions governing acute care services across the Canadian province of Newfoundland and Labrador completed an anonymous questionnaire regarding their use of eight RBPs and associated P&Ps. Data were also obtained from authorities in six of the eight regions about existing relevant P&Ps. We used descriptive statistics and multivariate regression analysis to assess the relationship between key independent variables and self-reported use of RBP. Results: Use of the eight RBPs ranged from 7.8% to 88.6%, depending on the practice. Nurses ranked P&P manuals as their number one source of practice knowledge. Most respondents (84.8%) reported that the main reason they consult the P&P manual is to confirm they are practicing according to agency rules. Multivariate regression analysis identified three significant predictors of being a user versus non-user of RBP overall: awareness, awareness by regular use, and persuasion. Six significant predictors of being a consistent versus less consistent user of RBP overall were also identified: perception of P&P existence, unit, nursing experience, personal experience as a source of practice knowledge, number of existing research-based P&Ps, and lack of time as a barrier to consulting P&P manuals. Conclusion: Findings suggest that nurses use P&Ps to guide their practice. However, the mere existence of P&Ps is not sufficient to translate research into nursing practice. Individual and organizational factors related to nurses' understanding and use of P&Ps also play key roles. Thus, moving research evidence into practice will require careful interplay between the organization and the individual. P&Ps may be the interface through which this occurs. [ABSTRACT FROM AUTHOR]

Objective--To explore the opinions of unpaid healthy volunteers on the payment of research subjects. Design--Prospective cohort. Setting--Southern Alberta, Canada. Participants--Medically eligible persons responding to recruiting advertisements for a randomised vaccine trial were invited to take part in a study of informed consent at the point at which they formally consented or refused trial participation. Of 72 invited, 67 (62 trial consenters, 5 trial refusers) returned questionnaires at baseline and 54 at follow-up. Outcome measures--Proportions of persons who agreed or disagreed with three close-ended statements on the payment of research subjects; themes and categories identified by content analysis of responses to an open-ended question. Results--A minority (43.3%) agreed with paying either patient or healthy volunteer participants. Opinions did not change over time. Participants' comments addressed: benefits and drawbacks to research participation; benefits and drawbacks to paying research participants; conditions under which payment of research subjects would be acceptable, and the nature of acceptable recognition. Acceptable conditions were to improve problematic recruitment, to reimburse costs, and to recognise participants, particularly for their time investment. Both non-monetary and monetary recognition of volunteers were thought to be appropriate. Conclusions--Most unpaid volunteers disagreed with paying research participants. The themes arising from their comments are similar to those that have been raised by ethicists and suggest that recognising the time and effort of participants should receive greater emphasis than presently occurs. [ABSTRACT FROM AUTHOR]

The article discusses a cohort study on whether smoking increases risk of cervical cancer which is caused by high-risk types of human papillomavirus (HPV) The case-control study was done in 5 serum banks, with most of the blood obtained during early pregnancy. The study involved 588 women in Nordic countries suffering from invasive cervical cancer.

QUESTION When collecting a midstream urine sample from toilet-trained children, does cleaning of the perineal/genital area before collection prevent sample contamination? METHODS Design: cluster randomised (by week) controlled trial. Allocation: not concealed. Blinding: blinded (microbiologists). Follow-up period: 48 hours. Setting: emergency department of a tertiary care paediatric centre in Montreal, Quebec, Canada. Patients: 350 toilet-trained children 2-18 years of age (45% 2-5 y, 37% 6-12 y, and 18% 13-18 y; 60% girls) who had a midstream urine sample requested for any medical reason. Children with developmental delay were excluded. Intervention: cleaning of the perineal/genital area twice, using liquid soap and gauze pads (n = 179) or no cleaning (n = 171) before collecting a midstream urine sample in a sterile container. Only samples with a positive urinalysis result were sent to the microbiology laboratory for culture. Outcomes: positive urinalysis (positive leukocyte esterase or nitrites on dipstick or ≥5 white blood cells per high-powered field after centrifuging) and contaminated urine culture (<108 colony-forming units of a single organism or a mix of ≥2 organisms per litre of urine). Urinary tract infection was diagnosed by a positive urine culture (≥108 colony-forming units of a single pathogenic organism per litre of urine). Patient follow-up: 100% (intention-to-treat analysis). MAIN RESULTS Cleaning of the perineal/genital area reduced the risks of a positive urinalysis result and contamination of the urine culture (table). The intervention was more beneficial in children 6-18 years of age (6.3% v 29% contamination) than in those 2-5 years of age (10% v 15% contamination). The prevalence of urinary tract infection was 7%. The predictive value of a positive urinalysis result was 41% in the cleaning group and 13% in the no cleaning group (p = 0.001). 93% of contaminated specimens and 96% of positive cultures were from girls. CONCLUSION When collecting a midstream urine sample from toilet-trained children, cleaning of the perineal/genital area before collection reduced the frequency of sample contamination and a positive urinalysis result. [ABSTRACT FROM AUTHOR]

The article describes the Promoting Action on Research Implementation in Health Services (PARiHS) framework and how nurse leaders can use the framework to support the implementation of research-based policies and procedures. The PARiHS framework is discussed with respect to various components including the evidence, context, culture, leadership and evaluation. The article also suggests that in the rapidly growing healthcare environment, designing interventions that have higher likelihood of increasing research use is essential to ensure patients receive quality care and to ensure patients and organizations achieve optimal outcome.