Characteristics and Drivers of the Registered Dietitian Nutritionist’s Sustained Involvement in Clinical Research Activities: A Mixed Methods Study

BackgroundResearch contributions by registered dietitian nutritionists (RDNs) are important for enhancing the use of nutrition-related evidence-based guidelines in dietetics practice. Involvement of RDNs in research activities has been studied previously, but little is known about the drivers (motivators) of sustaining research involvement by RDNs who work in clinical practice.ObjectiveTo identify key characteristics of established RDN clinician researchers and drivers that contributed to their sustained research involvement.DesignWe used a convergent parallel mixed methods study design utilizing the clinician career research trajectory as a framework. Research involvement was examined using the Practice-Based Dietitian Research Involvement Survey (PBDRIS). Workplace support was assessed using the Research Capacity and Culture (RCC) survey. Semistructured interviews were used to investigate key themes in established RDN clinician researchers.Participants/settingWe identified 450 RDNs involved with research activities in the United States through hand-searching clinically relevant nutrition journals and contacted them to participate in an online survey. A total of 29 RDNs met criteria and completed (6.4%) the quantitative survey, then a subsample (n=10) participated in semistructured interviews to explore drivers for continued research involvement.ResultsResearch involvement scores (n=29) from the PBDRIS ranged from 60.0% to 97.5%, indicating involvement in higher-level research-related tasks by our sample participants. RCC results revealed the importance of workplace support and mentorship. Interviews with established RDN clinician researchers identified exposure, curiosity, and dedication as three overarching themes with eight subthemes driving continued research involvement.ConclusionBased on the experiences of select RDN clinician researchers who have demonstrated success in sustaining their research involvement, we found that having an available mentor, support from their workplace environment, and personal drive were integral to their success.     

The interface between research and policy: experience from South Africa

Increasing attention has been paid in recent years to efforts to strengthen the impact of research on policy in low- and middle-income countries. However, the processes by which such research might have policy impact remain a subject of debate. This paper presents an analysis of the research/policy interface, drawing on the experiences of two South African health policy and systems research (HPSR) units and one specific study which traced the development and implementation of three areas of health care financing policy change and debate between 1994 and 1999. The analysis is based primarily on the authors' own experiences and has been developed through a deliberate process of reflection. It suggests, first, that it is important to acknowledge the conceptual and symbolic uses and impacts of research--perhaps, particularly in relation to the system-oriented work of HPSR groups. These uses may not be verifiable by specific changes in policy and practice but are important contributions to the policy environment and do filter into policy-makers' understandings and actions. Second, achieving any form of impact on policy is linked to the attention researchers pay to the context in which the research is undertaken, the nature and credibility of the research; and the importance of nesting any single project in a broader programme of engagement with the policy environment that builds trust in the researchers.     

Exploring the use of feminist philosophy within nursing research to enhance post-positivist methodologies in the study of cardiovascular health

Abstract  Nursing has historically relied heavily on scientific knowledge. It is not surprising that the cardiovascular health literature has been highly influenced by the post-positivist philosophy. The nursing discipline, as well as the cardiovascular nursing speciality, continues to benefit from research grounded within this philosophical tradition. At the same time, there are limitations associated with post-positivism. Therefore, it is beneficial for researchers and clinicians to examine the potential contributions various philosophical traditions can have for their research and practice. This paper is an exploration of the compatibilities of feminist and post-positivist philosophies in the study of cardiovascular nursing research. The ensuing discussion entails an examination of my clinical and research interests, the grounding of my research within the post-positivist perspective and the significant contribution feminist philosophy can make to my research.     

医学高校附属医院临床基础研究现状与对策

医学基础理论与临床实践的结合是医学发展的源泉.我国医学高校附属医院存在着医学临床实践与基础理论研究脱节的问题,临床医学基础研究水平一直相对滞后.本文以汕头大学医学院几所附属医院为例,认为强化临床科研平台建设、规范科研管理、引导临床工作人员从医疗实践出发开展基础研究,是提升医学高校附属医院临床基础研究水平的关键.     

Setting priorities and identifying barriers for general practice research in Europe. Results from an EGPRW meeting

BACKGROUND: In spring 2002, WONCA Europe, the European Society of General Practice/Family Medicine and its Network organizations reached consensus on a 'new' European definition of general practice. Subsequently, the European General Practice Research Workshop (EGPRW) started working on a European General Practice Research Agenda. This topic was addressed during the 2002 EGPRW autumn meeting. OBJECTIVE: Our aim was to explore the views of European general practice researchers on needs and priorities as well as barriers for general practice research in Europe. METHODS: In seven discussion groups, 43 general practice researchers from 18 European countries had to answer the following questions. (i) What major topics should be included in a research agenda for general practice in your country? (ii) What are the barriers to adequate implementation of general practice research in your country? Group answers were listed and subsequently categorized by two authors. RESULTS: Research on 'clinical issues' (common diseases, chronic diseases, etc.), including diagnostic strategies, was considered to be the core content of general practice research, with primary care-based morbidity registration essential for surveillance of disease, clinical research and teaching in general practice. There was also consensus on the need for research on education and teaching. 'Insufficient funding opportunities' was perceived to be the major barrier to the development of general practice research. CONCLUSIONS: These findings could be used as a basis for national checklists of 'content of' and 'conditions for' general practice research. European general practice research training programmes should be developed further.     

Patient stories, narratives of resistance and the ethics of humane care: a la recherche du temps perdu

Over the past 20 years, the study of patient-physician relationships and the discourse of clinical encounters has become a major area of inquiry. Interest in these topics is closely linked to an ethic of humane care, reflecting widespread criticism of a technocratic approach to clinical practice. A narrow framing of this approach led to the neglect of a category of patients' socially grounded accounts of their illness and treatment experiences referred to as 'narratives of resistance'. The problem addressed in this article is the lack of connection, in research and practice, between an approach grounded in a humane care ethic and an ethic of social justice that addresses the impact of social and economic inequalities on rates of illness and access to health care. The aim is to open up a critical discussion among researchers, health care educators, practitioners and patients about relationships between ethical standpoints, clinical practice and research.     

A double-edged sword? Health research and research governance in UK primary care

Contemporary health research is becoming increasingly formalised, regulated and institutionalised. In the UK, this has manifested itself in the development of a framework for ‘governing’ health research. The framework is often presented as a neutral decision-making tool guiding elements of research (such as ethical and peer review) through formal governance processes and approval procedures. We locate the framework as emerging in the wider context of the growth of ‘guidelines’ in healthcare that raises questions about the extent to which formal rationality has taken hold on knowledge production and what this means for health research. We therefore explore if and how the framework prioritises particular approaches to the production of knowledge and the tensions that emerge between managerial requirements and the work of researchers. We employed qualitative telephone interviews to access the accounts of both researchers and administrators across a range of primary healthcare settings in England and to capture a range of experiences and levels of involvement in research and governance. Our analysis revealed the double-edged nature of research governance: on the one hand, the framework provided a valuable aid to decision-making and the formalisation of tacit knowledge about ‘good research practice’; on the other, consequent managerial processes engaged researchers in a series of low-level activities and privileged particular ways of viewing the world. Our findings add to existing knowledge by moving beyond documenting concerns over research governance and show how the reduction of research governance according to a ‘common’ set of principles and procedures facilitates the production (and managerial oversight) of quantitative and clinical, over qualitative and experiential, knowledge.     

主观幸福感研究进展

搜集、分析国内外相关文献,总结分析近年国内外主观幸福感研究的进展。国外对主观幸福感的研究主要经历了比较描述、理论形成和测量发展3个阶段,且研究方法及工具比较全面;我国主观幸福感研究虽然取得了一定的进展,但基于国情对主观幸福感影响因素的研究和本土化的研究方法及测评工具不多,对主观幸福感培养方面的研究还比较缺乏。我国应借鉴国外经验,结合自己的国情,扩大主观幸福感研究人群,进一步探索制定适合我国国民的主观幸福感测量的工具及方法。     

Reasonable patient care under uncertainty

This paper discusses how limited ability to predict illness and treatment response may affect the welfare achieved in patient care. The discussion covers both decentralized clinical decision making and care that adheres to clinical practice guidelines. I explain why predictive ability has been limited, calling attention to questionable methodological practices in the research that supports evidence‐based medicine. I summarize research on identification whose objective is to yield credible prediction of patient outcomes. Recognizing that uncertainty will continue to afflict medical decision making, I apply basic decision theory to suggest reasonable decision criteria with well‐understood welfare properties. Previous research on medical decision making has largely embraced Bayesian decision theory. I summarize research studying the minimax‐regret criterion, which seeks uniformly near‐optimal decisions.     

Community action and reflective practice in health promotion research

While health promotion practitioners are engaging increasingly in research, there has been little examination of the practical dilemmas they may face in negotiating and collaborating with academics and community members in action research projects. This paper analyses how the practice of health promotion can interact with action research, and considers issues that arise for organizationally based health promotion practitioners and professional researchers. The first section charts types of action research along three dimensions (power, goals/values, resources). The second section examines some of the issues and practical dilemmas which arise in negotiating and researching collaborative projects in community health promotion. The discussion includes the differing perspectives of: practitioners (managerial and frontline), community members and academic researchers. The final section outlines a hybrid model of action research, developed in our work with community members, organizationally based health promoters and academy-based researchers. It combines the reflective practice of practice-based action research with the community participation and control of participatory research. The model is called community reflective action research.     

Roy适应模式理论的研究进展

Roy适应理论是护理学科中应用最广泛的广域理论之一,其中的Roy适应模式是该理论的核心,在国内外得到广泛研究和应用。Roy适应模式强调系统评估和整体人思想,更加契合现代生物-心理-社会生物医学模式的要求,很好地诠释了护理学的4大核心概念。国外学者在教育、临床实践和理论外延方面对其进行了多维的探索,其内涵被不断挖掘,相关的中域理论层出不穷;而该理论在我国护理实践中的应用较晚,深度和广度尚待发掘。文章通过综述Roy适应理论的起源与内涵,其在国内外的研究与应用现状,通过对比探讨了该理论在我国护理领域应用的局限性和不足,强调了Roy适应理论在群体适应系统和老年护理服务中的潜在价值,以期为Roy适应理论更好地应用于我国护理领域提供参考。     

The evolving concept of health literacy

The relationship between poor literacy skills and health status is now well recognized and better understood. Interest in this relationship has led to the emergence of the concept of health literacy. The concept has emerged from two different roots - in clinical care and in public health. This paper describes the two distinctive concepts that reflect health literacy, respectively, as a clinical "risk", or a personal "asset". In the former case a strong science is developing to support screening for poor literacy skills in clinical care and this is leading to a range of changes to clinical practice and organization. The conceptualization of health literacy as an asset has its roots in educational research into literacy, concepts of adult learning, and health promotion. The science to support this conceptualization is less well developed and is focused on the development of skills and capacities intended to enable people to exert greater control over their health and the factors that shape health. The paper concludes that both conceptualizations are important and are helping to stimulate a more sophisticated understanding of the process of health communication in both clinical and community settings, as well as highlighting factors impacting on its effectiveness. These include more personal forms of communication and community based educational outreach. It recommends improved interaction between researchers working within the two health literacy perspectives, and further research on the measurement of health literacy. The paper also emphasizes the importance of more general strategies to promote literacy, numeracy and language skills in populations.     

The evolving concept of health literacy

The relationship between poor literacy skills and health status is now well recognized and better understood. Interest in this relationship has led to the emergence of the concept of health literacy. The concept has emerged from two different roots – in clinical care and in public health. This paper describes the two distinctive concepts that reflect health literacy, respectively, as a clinical “risk”, or a personal “asset”. In the former case a strong science is developing to support screening for poor literacy skills in clinical care and this is leading to a range of changes to clinical practice and organization. The conceptualization of health literacy as an asset has its roots in educational research into literacy, concepts of adult learning, and health promotion. The science to support this conceptualization is less well developed and is focused on the development of skills and capacities intended to enable people to exert greater control over their health and the factors that shape health.The paper concludes that both conceptualizations are important and are helping to stimulate a more sophisticated understanding of the process of health communication in both clinical and community settings, as well as highlighting factors impacting on its effectiveness. These include more personal forms of communication and community based educational outreach. It recommends improved interaction between researchers working within the two health literacy perspectives, and further research on the measurement of health literacy. The paper also emphasizes the importance of more general strategies to promote literacy, numeracy and language skills in populations.     

Challenges of Patient-Reported Outcome Assessment in Hemophilia Care—a State of the Art Review

Introduction:  One of the recent advances in assessing outcomes of medical care is the inclusion of the patient perspective. The term patient-reported outcome (PRO) is used to reflect the patient perceptions of disease and its consequences as well as of treatment and health-care provision. The development of PRO measures has advanced rapidly, and implementation in clinical research and practice is now underway. From an evaluation perspective, recommendations for the choice of PRO measures and an appraisal of the potential benefits of PRO data collection within specific health conditions are needed.
Methods:  Hemophilia is a rare and clinically well-defined health condition with established and cost-intensive treatment strategies, in which PRO assessment is increasingly recognized as important. For this reason, measurement of PROs in hemophilia focusing on health-related quality of life (HRQoL) and patient preferences were reviewed to identify appropriate measures, to make recommendations for their choice, and to critically examine their impact in international hemophilia research and practice.
Results:  Using literature searches and expert discussion strategies, generic and targeted measures for HRQoL and patient preferences in adults and children with hemophilia were screened, and 20 were reviewed on the basis of their psychometric properties and international availability. Only a few of the 20 measures have been used in clinical settings or research related to persons with hemophilia.
Conclusion:  Consequently, an increased use of these measures is recommended to understand patient views on disease and treatment and to judge the impact of PROs for improvements in health care.     

医学科研机构应慎重使用SCI及影响因子评价科研成果

我国科研论文、科研成果的评估已经普遍将SCI收录及其影响因子的高低作为主要指标.SCI和影响因子是定量评价期刊水平的量化指标,将其原封不动地用来评价科研成果,其科学性有待探讨.科研机构的管理人员应正确认识、慎重使用SCI及影响因子,引导研究者根据论文的实际情况选择适合的投稿期刊.     

Clinical application research: a hermeneutical approach to the appropriation of caring science

Clinical caring science researchers contribute, by means of various participatory research efforts, to bring clinical practice closer to the ideals of caring. These research efforts have in the main been developed from classical action research rooted in critical theory. In this article, the authors launch an alternative research approach called clinical application research, the basis of which can be traced to the interpretative paradigm, or hermeneutics. The basic cornerstones of this research approach are ontology, context, and appropriation as well as understanding, interpretation, and application. Using an example from ongoing clinical research, the authors demonstrate the utility of this approach. Their aim in this article is to contribute to the development of methods within clinical research.     

An integrative framework for community partnering to translate theory into effective health promotion strategy

INTRODUCTION: Although there is general agreement about the complex interplay among individual-, family-, organizational-, and community-level factors as they influence health outcomes, there is still a gap between health promotion research and practice. The authors suggest that a disjuncture exists between the multiple theories and models of health promotion and the practitioner's need for a more unified set of guidelines for comprehensive planning of programs. Therefore, we put forward in this paper an idea toward closing the gap between research and practice, a case for developing an overarching framework--with several health promotion models that could integrate existing theories--and applying it to comprehensive health promotion strategy. AN INTEGRATIVE FRAMEWORK: We outline a theoretical foundation for future health promotion research and practice that integrates four models: the social ecology; the Life Course Health Development; the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation-Policy, Regulatory and Organizational Constructs in Educational and Environmental Development; and the community partnering models. The first three models are well developed and complementary. There is little consensus on the latter model, community partnering. However, we suggest that such a model is a vital part of an overall framework, and we present an approach to reconciling theoretical tensions among researchers and practitioners involved in community health promotion. INTEGRATING THE MODELS: THE NEED FOR SYSTEMS THEORY AND THINKING: Systems theory has been relatively ignored both by the health promotion field and, more generally, by the health services. We make a case for greater use of systems theory in the development of an overall framework, both to improve integration and to incorporate key concepts from the diverse systems literatures of other disciplines. VISION FOR HEALTHY COMMUNITIES: (1) Researchers and practitioners understand the complex interplay among individual-, family-, organizational-, and community-level factors as they influence population health; (2) health promotion researchers and practitioners collaborate effectively with others in the community to create integrated strategies that work as a system to address a wide array of health-related factors; (3) The Healthy People Objectives for the Nation includes balanced indicators to reflect health promotion realities and research-measures effects on all levels; (4) the gap between community health promotion "best practices" guidelines and the way things work in the everyday world of health promotion practice has been substantially closed. CONCLUSIONS AND RECOMMENDATIONS: We suggest critical next steps toward closing the gap between health promotion research and practice: investing in networks that promote, support, and sustain ongoing dialogue and sharing of experience; finding common ground in an approach to community partnering; and gaining consensus on the proposed integrating framework.