Knowledge Translation (knowledge + translation)

Distribution by Scientific Domains


Selected Abstracts


Continuing Medical Education, Continuing Professional Development, and Knowledge Translation: Improving Care of Older Patients by Practicing Physicians

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2006
David C. Thomas MD
Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners. [source]


A Preliminary Report of Knowledge Translation: Lessons From Taking Screening and Brief Intervention Techniques From the Research Setting Into Regional Systems of Care

ACADEMIC EMERGENCY MEDICINE, Issue 11 2009
Edward Bernstein MD
Abstract This article describes a limited statewide dissemination of an evidence-based technology, screening, brief intervention, and referral to treatment (SBIRT), and evaluation of the effects on emergency department (ED) systems of care, utilizing the knowledge translation framework of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM), using both quantitative and qualitative data sources. Screening and brief intervention (SBI) can detect high-risk and dependent alcohol and drug use in the medical setting, provide early intervention, facilitate access to specialty treatment when appropriate, and improve quality of care. Several meta-analyses demonstrate its effectiveness in primary care, and the federal government has developed a well-funded campaign to promote physician training and adoption of SBI. In the busy environment of the ED, with its competing priorities, researchers have tested a collaborative approach that relies on peer educators, with substance abuse treatment experience and broad community contact, as physician extenders. The ED-SBIRT model of care reflects clinician staff time constraints and resource limitations and is designed for the high rates of prevalence and increased acuity typical of ED patients. This report tracks services provided during dissemination of the ED-SBIRT extender model to seven EDs across a northeastern state, in urban, suburban, and rural community settings. Twelve health promotion advocates (HPAs) were hired, trained, and integrated into seven ED teams. Over an 18-month start-up period, HPAs screened 15,383 patients; of those, 4,899 were positive for high risk or dependent drinking and/or drug use. Among the positive screens, 4,035 (82%) received a brief intervention, and 57% of all positives were referred to the substance abuse treatment system and other community resources. Standardized, confidential interviews were conducted by two interviewers external to the program with 24 informants, including HPAs and their supervisors, clinicians, nurse managers, and ED directors across five sites. A detailed semistructured format was followed, and results were coded for thematic material. Barriers, challenges, and successes are described in the respondents' own words to convey their experience of this demonstration of SBIRT knowledge translation. Five of seven sites were sustained through the second year of the program, despite cutbacks in state funding. The dissemination process provided a number of important lessons for a large rollout. Successful implementation of the ED-SBIRT HPA model depends on 1) external funding for start-up; 2) local ED staff acting as champions to support the HPA role, resolve territorial issues, and promote a cultural shift in the ED treatment of drug and alcohol misuse from "treat and street" to prevention, based on a knowledge of the science of addiction; 3) sustainability planning from the beginning involving administrators, the billing and information technology departments, medical records coders, community service providers, and government agencies; and 4) creation and maintenance of a robust referral network to facilitate patient acceptance and access to substance abuse services. [source]


The Canadian Prehospital Evidence-based Protocols Project: Knowledge Translation in Emergency Medical Services Care

ACADEMIC EMERGENCY MEDICINE, Issue 7 2009
Jan L. Jensen ACP
Abstract Objectives:, The principles of evidence-based medicine are applicable to all areas and professionals in health care. The care provided by paramedics in the prehospital setting is no exception. The Prehospital Evidence-based Protocols Project Online (PEP) is a repository of appraised research evidence that is applicable to interventions performed in the prehospital setting and is openly available online. This article describes the history, current status, and potential future of the project. Methods:, The primary objective of the PEP is to catalog and grade emergency medical services (EMS) studies with a level of evidence (LOE). Subsequently, each prehospital intervention is assigned a class of recommendation (COR) based on all the appraised articles on that intervention, in an effort to organize the evidence so it may be put into practice efficiently. An LOE is assigned to each article by the section editor, based on the study rigor and applicability to EMS. The section editor committee consists of EMS physicians and paramedics from across Canada, and two from Ireland and a paramedic coordinator. The evidence evaluation cycle is continuous; as the section editors send back appraisals, the coordinator updates the database and sends out another article for review. Results:, The database currently has 182 individual interventions organized under 103 protocols, with 933 citations. Conclusions:, This project directly meets recent recommendations to improve EMS by using evidence to support interventions and incorporating it into protocols. Organizing and grading the evidence allows medical directors and paramedics to incorporate research findings into their daily practice. As such, this project demonstrates how knowledge translation can be conducted in EMS. [source]


Educational and Research Advances Stemming from the Academic Emergency Medicine Consensus Conference in Knowledge Translation

ACADEMIC EMERGENCY MEDICINE, Issue 8 2010
Eddy S. Lang MD
ACADEMIC EMERGENCY MEDICINE 2010; 17:865,869 2010 by the Society for Academic Emergency Medicine Abstract The 2007 Academic Emergency Medicine (AEM) consensus conference "Knowledge Translation in Emergency Medicine" yielded a number of initiatives in both education and research that directly reflected the conference's published objectives and recommendations. One research initiative, CONCERT, is a national consortium of chronic obstructive pulmonary disease (COPD) investigators who set forth an effort designed to optimize COPD care through the identification of gaps between research and practice in diagnosis and management of the chronic and acute care aspects of this disease. In addition to CONCERT, educational programs designed to identify barriers to evidence implementation and to develop solutions to achieve uptake through multidisciplinary collaboration have emerged that reflect the impact of the consensus conference. This article describes these initiatives and highlights the potential for future innovative opportunities. [source]


13 Knowledge Translation Shift

ACADEMIC EMERGENCY MEDICINE, Issue 2008
Rawle Seupaul
Health care providers have demonstrated difficulty in adopting the latest information into their clinical practice patterns. This gap in "Knowledge Translation" (KT) is currently under broad discussion within the medical community and was the focus of SAEM's Consensus Conference in 2007. In an effort to bridge this gap, we implemented a novel "KT shift" for our PGY-2 residents. PGY-2 emergency medicine (EM) residents are required to work a nine hour KT shift during their scheduled EM rotation at one of two large urban training emergency departments (EDs). This shift has reduced patient responsibilities to allow for the development of clinical queries that are answered by searching for the best evidence to be applied to patient care. This process is summarized on a "KT Shift Log" that records the PICO question, databases searched, and level of evidence found to answer clinical questions. KT shift log sheets and search strategies are reviewed by EM faculty with expertise in evidence-based medicine and KT principles. We believe that the implementation of a KT shift will improve residents' ability to obtain high quality evidence to answer real-time clinical questions. This may serve as an important measure in closing the knowledge to practice gap. [source]


18 Graduate Medical Education and Knowledge Translation: One Problem-Specific Approach in Residency

ACADEMIC EMERGENCY MEDICINE, Issue 2008
Christopher Carpenter
Traditional graduate medical education approaches to improving clinical performance based upon the latest research have included Journal Club and didactic lectures. Unfortunately, these educational interventions have rarely been demonstrated to change practice behavior or improve patient-important outcomes. Using a structured approach to identifying a gap between best-evidence knowledge and clinical practice, an illustrative one-year residency-wide translational research project was developed in a four year emergency medicine training program. Step one (assigned to the second year residents): identify and quantitatively justify a Knowledge Translation (KT) deficit within our institution. They identified steroids in adult bacterial meningitis as an unequivocal therapeutic option. Based upon a structured one-year chart review, they next demonstrated that only 7% of meningitis patients received pre-antimicrobial steroids. The next step (assigned to the first year residents): identify and quantify the physician "leaks" within the pipeline of information from publication to bedside utilization via an online survey. The third year residents hypothesized plugs for these information leaks, including examples of other specialties or institutions which have successfully navigated this specific clinical scenario. Finally, at an end-of-year Journal Club, the fourth year residents formulated a protocol for the appropriate use of steroids in suspected adult meningitis and brought together individuals from within the institution contributing to the best-practice leak. Knowledge Translation involves multiple stages beyond simple evidence awareness and usually involves continuation beyond the emergency department. The Washington University KT project offers a structured, multidisciplinary example of moving beyond contemplation to implementation of an unequivocal therapy. [source]


Executive Summary: Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Eddy S. Lang MD
First page of article [source]


The Development of the Academic Emergency Medicine Consensus Conference Project on Knowledge Translation

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Eddy S. Lang MD
First page of article [source]


Some Theoretical Underpinnings of Knowledge Translation

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Ian D. Graham PhD
A careful analysis of the definition of knowledge translation highlights the importance of the judicious translation of research into practice and policy. There is, however, a considerable gap between research and practice. Closing the research-to-practice gap involves changing clinical practice, a complex and challenging endeavor. There is increasing recognition that efforts to change practice should be guided by conceptual models or frameworks to better understand the process of change. The authors conducted a focused literature search, developed inclusion criteria to identify planned action theories, and then extracted data from each theory to determine the origins, examine the meaning, judge the logical consistency, and define the degree of generalizability, parsimony, and testability. An analysis was conducted of the concepts found in each theory, and a set of action categories was developed that form the phases of planned action. Thirty-one planned action theories were identified that formed the basis of the analyses. An Access database was created, as well as a KT Theories User's Guide that synthesizes all the planned change models and theories, identifies common elements of each, and provides information on their use. There are many planned change models and frameworks with many common elements and action categories. Whenever any planned change model is used, change agents should consider documenting their experiences with the model so as to advance understanding of how useful the model is and to provide information to others who are attempting a similar project. [source]


Decision Support Technology in Knowledge Translation

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Brian R. Holroyd MD
Information technologies, and specifically clinical decision support systems (CDSSs), are tools that can support the process of knowledge translation in the delivery of emergency department (ED) care. It is essential that during the implementation process, careful consideration be given to the workflow and culture of the ED environment where the system is to be utilized. Despite significant literature addressing factors contributing to successful deployment of these systems, the process is frequently problematic. Careful research and analysis are essential to evaluate the impact of the CDSS on the delivery of ED care, its influence on the health care providers, and the impact of the CDSS on clinical decision-making processes and information behaviors. The logistical and educational implications of CDSSs in the ED must also be considered. The specialty of emergency medicine must actively collaborate with other stakeholders in the design, implementation, and evaluation of CDSSs that will be utilized during the delivery of care to our patients. [source]


Funding Opportunities in Knowledge Translation: Review of the AHRQ's "Translating Research into Practice" Initiatives, Competing Funding Agencies, and Strategies for Success

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Michael Handrigan MD
The Agency for Healthcare Research and Quality actively funds and conducts research to improve health care for all Americans. This article is intended to provide a brief overview of Agency for Healthcare Research and Quality activities in knowledge translation and to accompany the presentation given on May 15, 2007, to the Academic Emergency Medicine Consensus Conference, "Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake." [source]


Bridging the Gap between Clinical Research and Knowledge Translation in Pediatric Emergency Medicine

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Lisa Hartling MSc
In 2006, a multidisciplinary group of researchers from across Canada submitted a successful application to the Canadian Institutes for Health Research for a Canadian Institutes for Health Research Team in Pediatric Emergency Medicine. The conceptual foundation for the proposal was to bring together two areas deemed critical for optimizing health outcomes: clinical research and knowledge translation (KT). The framework for the proposed work is an iterative figure-eight model that provides logical steps for research and a seamless flow between the development and evaluation of therapeutic interventions (clinical research) and the implementation and uptake of those interventions that prove to be effective (KT). Under the team grant, we will conduct seven distinct projects relating to the two most common medical problems affecting children in the emergency department: respiratory illness and injury. The projects span the research continuum, with some projects targeting problems for which there is little evidence, while other projects involve problems with a strong evidence base but require further work in the KT realm. In this article, we describe the history of the research team, the research framework, the individual research projects, and the structure of the team, including coordination and administration. We also highlight some of the many advantages of bringing this research program together under the umbrella of a team grant, including opportunities for cross-fertilization of ideas, collaboration among multiple disciplines and centers, training of students and junior researchers, and advancing a methodological research agenda. [source]


Cognitive and Social Issues in Emergency Medicine Knowledge Translation: A Research Agenda

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Jamie C. Brehaut PhD
The individual practitioner is a linchpin in the process of translating new knowledge into practice, particularly in the emergency department, where physician autonomy is high, resources are limited, and decision-making situations are complex. An understanding of the cognitive and social processes that affect knowledge translation (KT) in emergency medicine (EM) is crucial and at present understudied. As part of the 2007 Academic Emergency Medicine Consensus Conference on KT in EM, our group sought to identify key research areas that would inform our understanding of these cognitive and social processes. We combined an online discussion group of interdisciplinary stakeholders, an extensive review of the existing literature, and a "public hearing" of the recommendations at the Consensus Conference to establish relative preference for the recommendations, as well as their relevance and clarity to attendees. We identified five key research areas as follows. 1) What provider-specific barriers/facilitators to the use of new knowledge are relevant in the EM setting? 2) Can social psychological theories of behavior change be used to develop better KT interventions for EM? 3) Can the study of "distributed cognition" suggest new vehicles for KT in the emergency department? 4) Can the concept of dual-process reasoning inform our understanding of the KT process? 5) Can patient-specific, immediate feedback serve as a vehicle for KT in EM? We believe that exploring these key research questions will directly lead to improved KT interventions and to further discussion of the cognitive and social factors impacting KT in EM. [source]


Informatics and Knowledge Translation

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Michael J. Bullard MD
To ensure that the benefits of knowledge translation synthesis are accessible to care providers at the point of decision-making, fast, efficient, usable clinical information systems are required. Medical informatics appears to hold the greatest promise to be able to create systems with the necessary capacity and functionality. Emergency medicine needs to be actively engaged at all levels of the process. This includes driving the development and filtering of emergency-specific synopses and summaries. It requires advocating for hardware and software that suit the needs of the emergency department environment. It is increasingly important to educate and participate on committees with funders and policy-makers to ensure they support this growing evolution. To determine the outcome of these initiatives, careful evaluation is required to inform the discussion. End-users need to be actively involved in the development and usability testing of clinical information retrieval technology and clinical decision-support systems and make certain relevant best evidence is readily accessible and formatted to meet the needs of the working emergency physician. The integration of knowledge translation into clinical practice, and the impact of delivering electronic clinical decision-support, requires methodologically sound studies to confirm or refute its benefits and guide future development of medical informatics. [source]


The Emergency Physician and Knowledge Transfer: Continuing Medical Education, Continuing Professional Development, and Self-improvement

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Barbara J. Kilian MD
A workshop session from the 2007 Academic Emergency Medicine Consensus Conference, Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake, focused on developing a research agenda for continuing medical education (CME) in knowledge transfer. Based on quasi-Delphi methodology at the conference session, and subsequent electronic discussion and refinement, the following recommendations are made: 1) Adaptable tools should be developed, validated, and psychometrically tested for needs assessment. 2) "Point of care" learning within a clinical context should be evaluated as a tool for practice changes and improved knowledge transfer. 3) The addition of a CME component to technological platforms, such as search engines and databases, simulation technology, and clinical decision-support systems, may help knowledge transfer for clinicians or increase utilization of these tools and should, therefore, be evaluated. 4) Further research should focus on identifying the appropriate outcomes for physician CME. Emergency medicine researchers should transition from previous media-comparison research agendas to a more rigorous qualitative focus that takes into account needs assessment, instructional design, implementation, provider change, and care change. 5) In the setting of continued physician learning, barriers to the subsequent implementation of knowledge transfer and behavioral changes of physicians should be elicited through research. [source]


Graduate Medical Education and Knowledge Translation: Role Models, Information Pipelines, and Practice Change Thresholds

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Barry M. Diner MD
This article reflects the proceedings of a workshop session, Postgraduate Education and Knowledge Translation, at the 2007 Academic Emergency Medicine Consensus Conference on knowledge translation (KT) in emergency medicine (EM). The objective was to develop a research strategy that incorporates KT into EM graduate medical education (GME). To bridge the gap between the best evidence and optimal patient care, Pathman et al. suggested a multistage model for moving from evidence to action. Using this theoretical knowledge-to-action framework, the KT consensus conference group focused on four key components: acceptance, application, ability, and remembering to act on the existing evidence. The possibility that basic familiarity, along with the pipeline by Pathman et al., may improve KT uptake may be an initial starting point for research on GME and KT. Current residents are limited by faculty GME role models to demonstrate bedside KT principles. The rapid uptake of KT theory will depend on developing KT champions locally and internationally for resident physicians to emulate. The consensus participants combined published evidence with expert opinion to outline recommendations for identifying the barriers to KT by asking four specific questions: 1) What are the barriers that influence a resident's ability to act on valid health care evidence? 2) How do we break down these barriers? 3) How do we incorporate this into residency training? 4) How do we monitor the longevity of this intervention? Research in the fields of GME and KT is currently limited. GME educators assume that if we teach residents, they will learn and apply what they have been taught. This is a bold assumption with very little supporting evidence. This article is not an attempt to provide a complete overview of KT and GME, but, instead, aims to create a starting point for future work and discussions in the realm of KT and GM. [source]


Toward Improved Implementation of Evidence-based Clinical Algorithms: Clinical Practice Guidelines, Clinical Decision Rules, and Clinical Pathways

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Gary M. Gaddis MD
This is a summary of the consensus-building workshop entitled "Guideline Implementation and Clinical Pathways," convened May 15, 2007, at the Academic Emergency Medicine Consensus Conference, "Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake." A new term, "evidence-based clinical algorithms" is suggested to encompass evidence-based information codified into clinical pathways, clinical practice guidelines, and clinical decision rules. Examples of poor knowledge translation (KT) relevant to the specialty of emergency medicine are identified, followed by brief descriptions of important research and concepts that inform the research recommendations. Four broad themes for research to improve the KT of evidence-based clinical algorithms are suggested: organizational factors, cognitive factors, social factors, and motivational factors. In all cases, research regarding optimizing KT for the subthemes identified by Glasziou and Haynes, "getting the evidence straight," and "getting the evidence used," are interwoven into the thematic research recommendations. Consensus was reached that the majority of research efforts to evaluate means to improve KT need to be centered on the factors that show promise to enhance "getting the evidence used," focused especially on organizational factors. [source]


The Use of Health Care Policy to Facilitate Evidence-based Knowledge Translation in Emergency Medicine

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Charlene B. Irvin MD
Health care policy can facilitate emergency medicine knowledge translation (KT). Because of this, the 2007 Academic Emergency Medicine Consensus Conference on KT identified a specific theme regarding issues of health care policy and KT. Six months before the Consensus Conference, international experts in the area were invited to communicate on health care policies regarding all areas of KT via e-mail and "Google groups." From this communication, and using available evidence, specific recommendations and research questions were developed. At the Consensus Conference, additional comments were incorporated. This report summarizes the results of this collaborative effort and provides a set of recommendations and accompanying research questions to guide development, implementation, and evaluation of health care policies intended to promote KT in emergency medicine. The recommendations are to 1a) involve appropriate stakeholders in the health care policy process; 1b) collaborate with policy makers when health care policy focus areas are being developed; 2) use previously validated clinical practice guideline development tools; 3) address implementation issues during the development of health care policies; 4) monitor outcomes with performance measures appropriate to different practice environments; and 5) plan periodic reviews to uncover new clinical evidence, new methods to improve KT, and new technologies. To advance the further development of these recommendations, a research agenda is proposed. [source]


Public Health Considerations in Knowledge Translation in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Steven L. Bernstein MD
Effective preventive and screening interventions have not been widely adopted in emergency departments (EDs). Barriers to knowledge translation of these initiatives include lack of knowledge of current evidence, perceived lack of efficacy, and resource availability. To address this challenge, the Academic Emergency Medicine 2007 Consensus Conference, "Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake," convened a public health focus group. The question this group addressed was "What are the unique contextual elements that need to be addressed to bring proven preventive and other public health initiatives into the ED setting?" Public health experts communicated via the Internet beforehand and at a breakout session during the conference to reach consensus on this topic, using published evidence and expert opinion. Recommendations include 1) to integrate proven public health interventions into the emergency medicine core curriculum, 2) to configure clinical information systems to facilitate public health interventions, and 3) to use ancillary ED personnel to enhance delivery of public health interventions and to obtain successful funding for these initiatives. Because additional research in this area is needed, a research agenda for this important topic was also developed. The ED provides medical care to a unique population, many with increased needs for preventive care. Because these individuals may have limited access to screening and preventive interventions, wider adoption of these initiatives may improve the health of this vulnerable population. [source]


Knowledge Translation at the Macro Level: Legal and Ethical Considerations

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Gregory Luke Larkin MD, MSPH
Macro-level legal and ethical issues play a significant role in the successful translation of knowledge into practice. The medicolegal milieu, in particular, can promote clinical inertia and stifle innovation. Embracing new clinical practice guidelines and best practice models has not protected physicians from superfluous torts; in some cases, emerging evidence has been used as the dagger of trial lawyers rather than the scalpel of physicians. Beyond the legal challenges are overarching justice issues that frame the broad goals of knowledge translation (KT) and technology diffusion. Optimal implementation of the latest evidence requires attention to be paid to the context of the candidate community and the key opinion leaders therein, characterized by the "8Ps" (public, patients, press, physicians, policy makers, private sector, payers, and public health). Ethical and equitable KT also accounts for the global burdens and benefits of implementing innovation such that disparities and gaps in health experienced by the least advantaged are prioritized. Researchers and thought leaders must attend to questions of fairness, economics, and legal risk when investigating ways to promote equity-oriented KT. [source]


Knowledge Translation in International Emergency Medical Care

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
L. Kristian Arnold MD
More than 90% of the world population receives emergency medical care from different types of practitioners with little or no specific training in the field and with variable guidance and oversight. Emergency medical care is being recognized by actively practicing physicians around the world as an increasingly important domain in the overall health services package for a community. The know-do gap is well recognized as a major impediment to high-quality health care in much of the world. Knowledge translation principles for application in this highly varied young domain will require investigation of numerous aspects of the knowledge synthesis, exchange, and application domains in order to bring the greatest benefit of both explicit and tacit knowledge to increasing numbers of the world's population. This article reviews some of the issues particular to knowledge development and transfer in the international domain. The authors present a set of research proposals developed from a several-month online discussion among practitioners and teachers of emergency medical care in 16 countries from around the globe and from all economic strata, aimed at improving the flow of knowledge from developers and repositories of knowledge to the front lines of clinical care. [source]


Knowledge Translation in the Emergency Medical Services: A Research Agenda for Advancing Prehospital Care

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
David C. Cone MD
Little is known about knowledge translation in the practice of out-of-hospital medicine. It is generally accepted that much work is needed regarding "getting the evidence straight" in emergency medical services, given the substantial number of interventions that are performed regularly in the field but lack meaningful scientific support. Additional attention also needs to be given to "getting the evidence used," because there is some evidence that evidence-based practices are being incompletely or incorrectly applied in the field. In an effort to help advance a research agenda for knowledge translation in emergency medical services, nine recommendations are put forth to help address the problems identified. [source]


Knowledge Translation of the American College of Emergency Physicians Clinical Policy on Hypertension

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Jill F. Lehrmann MD
Objectives To determine if dissemination of the American College of Emergency Physicians clinical policy on hypertension to emergency physicians would lead to improvements in blood pressure reassessment and referral of emergency department (ED) patients with elevated blood pressure. Methods Two academic centers implemented a pre-post intervention design, with independent samples at pre and post phases. ED staff were blinded to the investigation. A total of 377 medical records were reviewed before policy dissemination and 402 were reviewed after policy dissemination. Medical records were eligible for review if the patient was at least 18 years of age, was not pregnant, was discharged from the ED, and had a triage systolic blood pressure ,140 mm Hg or diastolic blood pressure ,90 mm Hg. Patient records with a chief complaint of chest pain, shortness of breath, or neurologic complaints were excluded. Demographics, blood pressures, and evidence of discharge referral were abstracted from the medical record. The policy was disseminated after the initial medical record review. Post,policy dissemination medical record review was conducted within two weeks. Results A total of 779 medical records were reviewed. The mean age of patients was 45 years, 55% were male, and 46% were white, 13% Hispanic, 35% African American, and 6% other. No differences in reassessment or referral rates were found between study phases. Blood pressure reassessments were low during both phases: 33% (pre) and 37% (post). Referral rates of patients with elevated blood pressure were very low: 13% (pre) and 7% (post). Conclusions Knowledge of guidelines did not translate into changes in physician practice. Additional systems-based approaches are necessary to effectively translate guidelines into clinical practice. [source]


Implementation of an Emergency Department,based Transient Ischemic Attack Clinical Pathway: A Pilot Study in Knowledge Translation

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Michael D. Brown MD
Objectives To assess the feasibility of implementing an emergency department (ED),based transient ischemic attack (TIA) clinical pathway that uses computer-based clinical support, and to evaluate measures of quality, safety, and efficiency. Methods This was a prospective cohort study of adult patients presenting to a community ED with symptoms consistent with acute TIA. Adherence to the clinical pathway served as a test of feasibility. Compliance with guideline recommendations for antithrombotic therapy and vascular imaging were used as process measures of quality. The 90-day risk of recurrent TIA, stroke, or death provided estimates of safety. Efficiency was assessed by measuring the rate of uneventful hospitalization, defined as a hospital admission that did not result in any major medical event or vascular intervention such as endarterectomy or stent placement. Results Of the 75 subjects enrolled, physician adherence to the clinical pathway was 85.3%, and 35 patients (46.7%) were discharged home from the ED. Antithrombotic agents were prescribed to 68 (90.7%), and vascular imaging was performed in 70 (93.3%). The 90-day risk of recurrent TIA was seven out of 75 (9.3%; 95% confidence interval [CI] = 4.6% to 18.0%), one patient experienced stroke (1.3%; 95% CI = 0.2% to 7.2%), and three patients died (4.0%; 95% CI = 1.4% to 11.1%). Uneventful hospitalization occurred in 38 of 40 patients (95.0%). Conclusions Implementation of a clinical pathway for the evaluation and management of TIA using computer-based clinical support is feasible in a community ED setting. This pilot study in knowledge translation provides a design framework for further studies to assess the safety and efficiency of a structured ED-based TIA clinical pathway. [source]


Knowledge translation: An opportunity to reduce global health inequalities

JOURNAL OF INTERNATIONAL DEVELOPMENT, Issue 8 2009
Vivian Welch
Abstract Knowledge translation represents an opportunity to redress global health inequalities. This paper first assesses models for how health inequalities are produced and sustained, including effects of catastrophic illness and globalisation. Secondly, this paper illustrates how methods for knowledge translation can be applied to reducing inequalities in health by ensuring the best evidence is applied when appropriate. Thirdly, the paper describes available databases and tools for monitoring effects of knowledge translation on global health inequalities. In particular, mapping methods for creating visual representations of changes in global health inequalities are useful for setting priorities for action and research. Copyright 2009 John Wiley & Sons, Ltd. [source]


Critical inquiry and knowledge translation: exploring compatibilities and tensions

NURSING PHILOSOPHY, Issue 3 2009
Sheryl Reimer-Kirkham PhD RN
Abstract Knowledge translation has been widely taken up as an innovative process to facilitate the uptake of research-derived knowledge into health care services. Drawing on a recent research project, we engage in a philosophic examination of how knowledge translation might serve as vehicle for the transfer of critically oriented knowledge regarding social justice, health inequities, and cultural safety into clinical practice. Through an explication of what might be considered disparate traditions (those of critical inquiry and knowledge translation), we identify compatibilities and discrepancies both within the critical tradition, and between critical inquiry and knowledge translation. The ontological and epistemological origins of the knowledge to be translated carry implications for the synthesis and translation phases of knowledge translation. In our case, the studies we synthesized were informed by various critical perspectives and hence we needed to reconcile differences that exist within the critical tradition. A review of the history of critical inquiry served to articulate the nature of these differences while identifying common purposes around which to strategically coalesce. Other challenges arise when knowledge translation and critical inquiry are brought together. Critique is one of the hallmark methods of critical inquiry and, yet, the engagement required for knowledge translation between researchers and health care administrators, practitioners, and other stakeholders makes an antagonistic stance of critique problematic. While knowledge translation offers expanded views of evidence and the complex processes of knowledge exchange, we have been alerted to the continual pull toward epistemologies and methods reminiscent of the positivist paradigm by their instrumental views of knowledge and assumptions of objectivity and political neutrality. These types of tensions have been productive for us as a research team in prompting a critical reconceptualization of knowledge translation. [source]


Using the knowledge to action process model to incite clinical change,

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 3 2010
Anita Petzold BSc
Abstract Introduction Knowledge translation (KT) has only recently emerged in the field of rehabilitation with attention on creating effective KT interventions to increase clinicians' knowledge and use of evidence-based practice (EBP). The uptake of EBP is a complex process that can be facilitated by the use of the Knowledge to Action Process model. This model provides a sequence of phases for researchers and clinicians to follow in order to optimize KT across various fields of practice. Methods In this article we use an example from a series of national studies in stroke rehabilitation to demonstrate how the Knowledge to Action Process model is being used to increase the use of best practices in the management of a very prevalent poststroke impairment, unilateral spatial neglect. Results The series of research projects and actions described herein each address a specific phase of the model. The reader is introduced to a specific example with the goal of generalizing the process to his or her own domain of interest. Gaps in our research agenda are also highlighted and future initiatives to complete the process are described. Discussion It is important that KT is maximized in health care to improve patient outcomes. As demonstrated here, the Knowledge to Action Process model provides an excellent guide for clinicians, managers, and researchers who wish to incite change in patient care. [source]


Development of the Capacity Necessary to Perform and Promote Knowledge Translation Research in Emergency Medicine

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Peter S. Dayan MD
Knowledge translation (KT) research in emergency medicine (EM) is in its infancy, and few EM investigators have the skills needed to perform KT research. Furthermore, the capacity to perform such KT research is underdeveloped in the field of EM. This consensus group used an iterative process to set forth initial recommendations and suggest methods for the development of EM KT research capacity. We have emphasized the need to form sustainable linkages, particularly between EM researchers and KT scientists, and to educate EM researchers in KT research methods to help create and sustain a culture of KT in our field. EM KT researchers must also engage local and national organizations and stakeholders to fund and promote KT research. Finally, we see the need to further develop and support EM research networks, as these networks will be both the clinical laboratories in which to perform the KT research and the incubators for the development of EM KT research experts. [source]


Connecting what we do with what we know: building a community of research and practice

INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2009
Julianne Cheek PhD
How to think about, develop, maintain and optimize connections between research and practice remains a vexed and contested area in the increasingly complex multidisciplinary and inter-professional practice that constitutes contemporary healthcare and service delivery. A body of literature challenging linear and passive notions of research uptake has emerged which views research uptake as a dynamic, contextualized and active process. This paper explores the development of a successful and exciting community of research and practice involving a university and an aged care organization in Australia. The community of research and practice is premised on dynamic, contextual and active interaction between research and practice; where the categories of research and practice are not mutually exclusive or static; and where community is more than just a structure to facilitate collaborative research projects. It is proposed that the idea of a community of research and practice is a useful one in terms of seeking to better understand and provide strategies for knowledge translation between researchers and practitioners and those who are both. [source]


Continuing Medical Education, Continuing Professional Development, and Knowledge Translation: Improving Care of Older Patients by Practicing Physicians

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2006
David C. Thomas MD
Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners. [source]