Enhancing Dissemination,Implementation, and Improvement Science in CTSAs through Regional Partnerships

Background and Importance

Challenges in healthcare policy and practice have stimulated interest in dissemination and implementation science. The Institute of Medicine Committee on the Clinical Translational Science Award (CTSA) program recommended expanding the CTSA program''s investment and activity in this domain. Guidance is needed to facilitate successful growth of DII science infrastructure, activity and impacts.

Objectives

Several CTSAs in Southern California collaborated to identify and respond to local challenges and opportunities to expand dissemination, implementation and improvement research by strengthening capacity and relationships between DII researchers and community, health system, and population health partners.

Main outcomes

Planning and outreach by the Southern California CTSAs increased awareness and interest in DII research and generated recommendations for growth. Recommendations include: increasing strong partnerships with healthcare and population health systems to guide policy research agendas and collaborative DII science; promoting multi‐sector partnerships that involve researchers and delivery systems throughout DII processes; bringing together multiple disciplines; and addressing national and international barriers as well as opportunities in DII science.

Implications

CTSAs through regional collaboration can increase their contributions to improved community health via skill‐building, partnership development and enhanced outreach to local healthcare and public health agencies and delivery systems.     

Community Outreach and Engagement Strategies from the Wisconsin Study Center of the National Children's Study

The purpose of this methods article was to describe and evaluate outreach and engagement strategies designed to initially build county‐wide awareness and support for the National Children's Study (NCS or the study) and subsequently to target the segment communities where recruitment for the study occurred. Selected principles from community outreach, social marketing, and health care system and personal referral formed the foundation for the strategies. The strategies included a celebration event, community advisory board, community needs assessment, building relationships with health care providers and systems, eliciting a network of study supporters, newsletters, appearances at local young family‐oriented events (health fairs, parades), presentations to local community leaders, community forums, “branding” with assistance from a women‐owned local marketing firm, and mailings including an oversized, second‐touch postcard. Six months after study launch, approximately 4,600 study‐eligible women were asked in a door‐to‐door survey if and how they became aware of the study. On average, 40% of eligible women reported being aware of the study. The most frequently cited strategy to cultivate their awareness was study‐specific mailings. Awareness of the NCS increased by 7.5% among those receiving a second‐touch postcard relative to controls (95% CIs [4.9, 10.7] z = 5.347, p < 0.0000, d = 0.16). Community outreach and engagement strategies, in particular the oversized postcard as a second‐touch effort, may be used effectively by researchers for participant recruitment and by public health nurses for delivery of important population‐focused messages.     

Retraction: Chan,M.‐f., Wong,F. K. Y., Chang,K., Chow,S., Chung,L., Lee,W.‐m. and Lee,R. (2009), Identifying patient readmission subtypes from unplanned readmissions to hospitals in Hong Kong: A cluster analysis. Nursing & Health Sciences. 11: 37–44

The above article from Nursing & Health Sciences, “Identifying patient readmission subtypes from unplanned readmissions to hospitals in Hong Kong: A cluster analysis” by Moon‐fai Chan, Frances K. Y. Wong, Katherine Chang, Susan Chow, Loretta Chung, Wai‐man Lee and Rance Lee, first published online on 10th February 2009 on Wiley Online Library (wileyonlinlibrary.com), has been retracted by agreement between the lead author, the journal's Editor in Chief, Teresa Stone, and Wiley Publishing Asia Pty Ltd. The retraction has been agreed due to unattributed overlap with previously published work (Chan, M.‐f., Wong, F. K. Y., Chang, K. K. P., Chow, S. K. Y., Chung, L. Y. F., Lee, R. P.‐L. and Lee, W.‐m. (2008), A study on investigating unplanned readmission patterns. Journal of Clinical Nursing, 17: 2164–2173.).     

Establishing a training programme for rehabilitation aides in Haiti: Successes,challenges, and dilemmas

Background.?In Haiti, there are scarce resources available for physical rehabilitation. Healing Hands for Haiti International Foundation has established a rehabilitation aide programme as a means of providing rehabilitation services. This article illustrates some of the successes, challenges, and dilemmas that arise in the provision of such an education.

Methods.?Graduates and students answered a 23-item questionnaire designed to investigate respondents' perceptions of the training programme. These responses were then coded and quantified for analysis.

Results.?The author interviewed 32 of 49 graduates and current students. Forty-five percent of graduates were working as rehabilitation aides, and the majority of those were working in urban areas. Graduate's earnings differed greatly. Respondents suggested that the programme needed to help the graduates find employment after graduation and to provide continuing training. The most common limitation in education mentioned by the graduates was a need for basic nursing skills and first-aid education.

Conclusion.?The most common difficulties and dilemmas in providing a rehabilitation aide programme were: lack of resources including job opportunities for graduates, and lack of proper support available from supervising healthcare providers. Curricula for similar programs must be culturally sensitive, help create employment opportunities, and provide continuing educational opportunities for their graduates.     

A scoping review of the experiences,benefits, and challenges involved in volunteer work among youth and young adults with a disability

Purpose: To develop a better understanding of the experiences of volunteer work among youth with disabilities. Method: A scoping review was undertaken to assess the benefits and challenges of volunteering among youth with disabilities. Comprehensive searches using six international databases were conducted. Eligible articles included: (a) youth aged 30 or younger, with a disability; (b) empirical research on the benefits or challenges of volunteering; (c) published in a peer-reviewed journal between 1980 and 2014. Results: Of the 1558 articles identified, 20 articles – involving 1409 participants, aged 12–30, across five countries – met the inclusion criteria. Studies linked volunteering to the development of human capital (i.e. practical experience, improved self-determination, self-confidence, coping), enhanced social capital (i.e. social and communication skills, social inclusion) and improved cultural capital (i.e. helping others, contributing to community). Many youth with disabilities also encountered challenges – including lack of accessible volunteer opportunities, difficulties arranging transportation, and negative attitudes from potential supervisors. Conclusions: Young people with disabilities are willing and able to volunteer, and they report benefits of volunteering; however, they face many challenges in finding suitable volunteer positions. More rigorous research is needed to understand the health and social benefits of volunteering and how it can help youth develop career pathways.

• Implications for Rehabilitation

• Clinicians, educators and parents should discuss the benefits of volunteering with youth with disabilities and assist them in finding placements that match their interests and abilities.

• Managers and clinicians should consider incorporating volunteering into vocational rehabilitation programming (i.e. addressing how to find placements and connecting youth to organisations).

• Clinicians should encourage youth to take part in social and extracurricular activities to help build their social skills and networks where they can learn about volunteer opportunities.

• Clinicians and educators should advocate on behalf of youth with disabilities among community organisations to help break down barriers and reduce misconceptions and negative attitudes by showcasing the abilities that youth with disabilities have to offer.

     

Cosleeping,sleep disturbances,children's behavioral problems,and parenting self‐efficacy among Korean American families

The purpose of this study was to compare sleep disturbances of children and their mothers, children's behavioral problems, and parenting self‐efficacy between Korean American families who coslept and those who did not cosleep. Forty‐eight mothers of children between 3 and 8 years of age completed the following surveys: Children's Sleep Habits Questionnaire, Pediatric Symptom Checklist, Pittsburgh Sleep Quality Index, Parenting Self‐Efficacy Questionnaire, and Acculturation Rating Scale for Mexican Americans II. Overall, 48% (n = 23) of families coslept, and families with younger children coslept more than families with older children (). When the families were divided into non‐cosleeping (i.e., rarely) and cosleeping (i.e., sometimes and usually) groups, 100% of the cosleeping children had sleep disturbances compared to 56% of the non‐cosleeping children (). For mothers, 28% (n = 7) of the non‐cosleeping mothers reported sleep disturbances, compared to 52% (n = 12) of the cosleeping mothers ). Children's behavioral problems were not different between the two groups (F = 1.78, p = NS). Cosleeping mothers reported lower parenting self‐efficacy than non‐cosleeping mothers (F = 6.26, p < .05). When providing care to Korean American families with young children, their cosleeping, sleep disturbances, and parenting self‐efficacy need to be addressed.     

A family perspective: Helping children acknowledge and express grief following the death of a parent

Abstract

Children grieve and experience a tremendous, devastating loss at the death of a parent; yet they often struggle with identifying and expressing their grief verbally. Thus, the surviving parent, as well as the adult helpers (teachers, therapists, nurses, and others) need to be aware of the unique developmental nature of children's understandings of and responses to death. An adult helper can encourage children to acknowledge, identify, and express their emotional reactions to grief by modeling, validating, and normalizing children's grief responses. Grieving children are helped not only through direct expression of grief but especially through symbolic expression of grief. Included in this article are specific examples of activities designed for grief expression in young children (preschool through grade six) and their families.     

Improving Immunizations in Children: A Clinical Break-even Analysis

IntroductionImmunizing the population is a vital public health priority. This article describes a resident-led continuous quality improvement project to improve the immunization rates of children under 3 years of age at two urban family medicine residency clinics in Salt Lake City, Utah, as well as a break-even cost analysis to the clinics for the intervention.MethodsImmunization records were distributed to provider-medical assistant teamlets daily for each pediatric patient scheduled in clinic to decrease missed opportunities. An outreach intervention by letter, followed by telephone call reminders, was conducted to reach children under 3 years of age who were behind on recommended immunizations for age (total n=457; those behind on immunizations n=101). Immunization rates were monitored at 3 months following start of intervention. A break-even analysis to the clinics for the outreach intervention was performed.ResultsImmunizations were improved from a baseline of 75.1% (n=133) and 79.6% (n=223) at the two clinics to 92.1% (n=163) and 89.6% (n=251), respectively, at 3 months following the start of intervention (P<0.01). The average revenue per immunization given was $81.57. The financial break-even point required 36 immunizations to be administered.ConclusionSignificant improvement in the immunization rate of patients under 3 years of age at two family medicine residency training clinics was achieved through decreasing missed opportunities for immunization in clinic, and with outreach through letters and follow-up phone calls. The intervention showed positive revenue to both clinics.     

Innovative methods for parents and clinics to create tools for kids' care (IMPACCT Kids' Care) study protocol

BackgroundDespite expansions in public health insurance, many children remain uninsured or experience gaps in coverage. Community health centers (CHCs) provide primary care to many children at risk for uninsurance and are well-positioned to help families obtain and retain children's coverage. Recent advances in health information technology (HIT) capabilities provide the means to create tools that could enhance CHCs' insurance outreach efforts.ObjectiveTo present the study design, baseline patient characteristics, variables, and statistical methods for the Innovative Methods for Parents And Clinics to Create Tools for Kids' Care (IMPACCT Kids' Care) study.Methods/designIn this mixed methods study, we will design, test and refine health insurance outreach HIT tools through a user-centered process. We will then implement the tools in four CHCs and evaluate their effectiveness and barriers and facilitators to their implementation. To measure effectiveness, we will quantitatively assess health insurance coverage continuity and utilization of healthcare services for pediatric patients in intervention CHCs compared to matched control sites using electronic health record (EHR) and Oregon Medicaid administrative data over 18 months pre- and 18 months post-implementation (n = 34,867 children). We will also qualitatively assess the implementation process to understand how the tools fit into the clinics' workflows and the CHC staff experiences with the tools.ConclusionsThis study creates, implements, and evaluates health insurance outreach HIT tools. The use of such tools will likely improve care delivery and health outcomes, reduce healthcare disparities for vulnerable populations, and enhance overall healthcare system performance.ClinicalTrials.gov Identifier: NCT02298361.     

Needs and Program Strengths: Perceptions of Hospice Volunteers

A state-wide survey was conducted of highly effective hospice volunteers who were questioned about their motivations for becoming a volunteer, training experience and needs, and reasons for continuing in the volunteer role. Needs identified included having a volunteer support group, on-going training opportunities, and opportunities for getting to know other volunteers better. Excellent training, belief in the hospice mission, the relationship with staff, feeling valued, and personal fulfillment were strengths and motivations to continue as a hospice volunteer. Findings from the study will be helpful to hospice staff who recruit, train, and support volunteers. [Article copies available from The Haworth Document Delivery Service: 1-800-342-9678.]     

Familial outbreak of Yersinia enterocolitica serotype O9 biotype 2

In Japan, infection with Yersinia enterocolitica of the pathogenic serobiogroup serotype O9 biotype 2 (O9/2) has rarely occurred, and familial outbreaks of Y. enterocolitica are also infrequently reported. We found a familial outbreak of Y. enterocolitica O9/2. Y. enterocolitica O9/2 was detected from stools collected from three persons in the same family. Two patients (an 11-month-old girl and her 68-year-old grandmother) contemporaneously suffered from enterocolitis, and the third person, a carrier (a 5-year-old girl), manifested no symptoms. This bacteria was not detected from other family members or from their pet hamster. All the bacteria obtained from the three people were genetically identified by pulsed-field gel electrophoresis (PFGE). The infection route was likely to have been via food, because Y. enterocolitica was not found from the pet hamster. This is the first report of a familial outbreak of Y. enterocolitica O9/2 genetically identified by PFGE in Japan.     

Expectations and experiences of accessing and participating in services for childhood speech impairment

Speech impairment (speech sound disorder) is a high prevalence condition that responds well to early intervention provided by speech-language pathologists (SLPs). However, not all children in Australia are able to access necessary speech-language pathology services. The aim of this research was to investigate Australian parents' experiences of accessing and engaging in speech-language pathology services for their children with speech impairment. Two studies were conducted to achieve this aim. In Study 1, questionnaires were completed by 109 parents of pre-school children who had been identified with concerns about their speech. Only a third (n?=?34, 31.2%) of the parents had previously accessed speech-language pathology services for assessment of their children's speech and just 29 of these (26.6% of the entire sample) reported their children had received intervention. Two thirds (n?=?68, 62.4%) of the parents had not sought speech-language pathology services and half of these (n?=?35, 32.1% of the entire sample) reported that “services were not needed”. There was a small number of parents (n?=?7, 6.4%) who had attempted to access services but had been unsuccessful. Parents identified teachers, family, friends, and doctors as important sources of information about their children's speech. In Study 2, interviews were conducted with 13 of the parents to discuss their experiences of speech impairment and service delivery in greater depth. Parents expected that others would make them aware of their child's speech impairment and that they should be able to access speech-language pathology services when required. Consequently, there is a need to raise awareness about speech impairment and speech-language pathology services to ensure appropriate identification, referral, and service provision for children at risk.     

Retraction: ‘Osteoporosis prevention education programme for women’ by Chan,M. F. and Ko,C.Y.

The above article, published online on 20 March 2006 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor in Chief and John Wiley & Sons Ltd. The retraction has been agreed following an investigation carried out by the National University of Singapore due to major overlap with another article: Chan M.F., Ko C.Y. and Day M.C. (2005) The effectiveness of an osteoporosis prevention education programme for women in Hong Kong: a randomized controlled trial. Journal of Clinical Nursing 14 : 1112–1123. doi: 10.1111/j.1365‐2702.2005.01224.x Reference Chan M.F. & Ko C.Y. (2006) Osteoporosis prevention education programme for women. Journal of Advanced Nursing 54, 159–170. doi: 10.1111/j.1365‐2648.2006.03804.x     

Consanguineous hemolytic uremic syndrome secondary to Escherichia coli O157:H7 infection treated with aggressive therapeutic plasma exchange

We describe the successful management of an elderly husband and wife with Escherichia coli O157:H7 associated hemolytic uremic syndrome (HUS) treated with aggressive therapeutic plasma exchange (TPE) with replacement with fresh frozen plasma. Following twelve TPEs (three 1.5 volume; nine 1 volume), the husband's platelet count increased from 45 × 10⁹/L to 183 × 10⁹/L. Following ten 1.5 volume TPEs, the wife's platelet count increased from 30 × 10⁹/L to 193 × 10⁹/L. This is the first known occurrence of E. coli O157:H7 associated HUS in an elderly husband and wife successfully treated with aggressive TPE. We conclude that early, aggressive TPE should be considered and may be life‐saving for E coli O157:H7 associated HUS in the elderly. J. Clin. Aperesis 16:155–156, 2001 © 2001 Wiley‐Liss, Inc.     

A systematic review of disability awareness interventions for children and youth

Purpose: Children’s lack of knowledge about disability can adversely impact their attitudes toward people with disabilities. The purpose of this study is to review the common elements of effective disability awareness interventions. Methods: A systematic review of disability awareness interventions for children and youth was conducted to assess the effective components of these interventions. Electronic searches were conducted using OVID, CENTRAL, PsychInfo, ERIC, Social Science Citation Index, GreyNET Scopus and Google Scholar. The inclusion criteria included (i) an intervention raising awareness about disability, (ii) school-age children with the average age between 5–19 years old, (iii) at least one measurable outcome focusing on knowledge about disability or attitudes towards and/or acceptance of people with a disability and (iv) published article or grey literature. Results: Of the 1031 articles that were identified in the search, 42 met the criteria to be included in the review. We classified the disability awareness interventions into 5 broad types including (i) social contact, (ii) simulation, (iii) curriculum, (iv) multi-media curriculum and (v) multiple components. Thirty-four studies showed an improvement in attitudes towards and/or acceptance of peers with disabilities. Eight of these studies also demonstrated an improvement in knowledge of people with disabilities. Five of the interventions found no support for improving knowledge about, or acceptance of people with disabilities. Conclusion: Disability awareness interventions can successfully improve children’s knowledge about and attitudes towards peers with a disability; they should include several different components over multiple sessions. Relevance: These findings are being used to further develop disability awareness interventions to help improve the social inclusion and participation of children with disabilities within mainstream classrooms.

Implications for Rehabilitation

• Well-designed disability awareness interventions for children and youth can help improve knowledge about disability, attitudes towards people with a disability and acceptance of peers with a disability.

• Rehabilitation health care providers and educators should be trained to recognize when children with disabilities are being socially excluded and be prepared to provide or recommend appropriate resources and interventions on how to address this issue.

• Clinicians, educators and children with disabilities should all be involved in the development of disability awareness programs.

• Educators should carefully choose an appropriate intervention to meet the needs of the children in their class while considering age appropriateness and diversity of the students. It is also important for educators to be cognizant of the broader societal influences that impact attitudes towards disability.

     

Understanding the barriers to clubfoot treatment adherence in Uganda: A rapid ethnographic study

Purpose. The Ponseti method has been demonstrated to be an effective, low-technology method of correcting congenital clubfoot. The purpose of this paper is to identify barriers to adherence to the Ponseti method of clubfoot treatment in Uganda. Understanding of barriers underlies successful and culturally appropriate approaches to program implementation.

Method. A qualitative study (rapid ethnographic study), using semi-structured interviews, focus groups and observation, was conducted. Interviews were conducted with parents of children with clubfoot (42), adults with clubfoot (2), community leaders (40), traditional healers (39) and practitioners treating clubfoot (38). Some 48 focus groups (24 male, 24 female) were conducted with general community members to ascertain their opinions on the potential barriers. The data was collected by a team of researchers in 8 districts of Uganda over the period of one month. It was then coded manually by the researchers and sorted into themes.

Results. The barriers to adherence were classified into 6 themes: (i) problems with programmatic resource availability and regional differences, (ii) distance to treatment site, (iii) poverty, (iv) lack of paternal support, (v) caregiver's other responsibilities, and (vi) challenges of the treatment process. A number of factors that were helpful for encouraging adherence were also identified: (i) outreach and follow-up services, (ii) counselling/caregiver-practitioner partnership, (iii) family harmony and solidarity, and (iv) receiving quality care.

Conclusions. Our study highlights the barriers to adherence in the treatment of clubfoot, as well as factors that could be helpful for overcoming these barriers. This information provides health planners with knowledge to assist them in meeting the needs of the population and implementing effective and appropriate awareness and treatment programs for clubfoot in Uganda.     

Continuous flow 50:50 nitrous oxide:oxygen is effective for relief of procedural pain in the pediatric emergency department

Objectives: To determine applicability of continuous flow 50:50 N₂O:oxygen during painful procedures in our university-hospital pediatric emergency department (ED). Methods: Children scheduled to undergo a painful procedure were enrolled consecutively. 50:50 N₂O:oxygen was provided throughout the procedure. Pain was evaluated using a numerical pain scale (0: no pain to 10: unbearable pain) by children ≥6 years old, medical providers and parent. Duration of N₂O inhalation, recovery time, side effects, provision and type of supplementary analgesics were recorded. Results: Fifty-nine children, 0.5–15 years enrolled and 55 comprised the final study cohort. Pain scores, as reported by the different observers, were low. N₂O administration was more beneficial in children >3 versus <3. Under N₂O, pain during infiltration of the skin with lidocaine was higher than during suturing. Children returned to pre-inhalation behavior by a mean of 2.7±1.6 min. Vomiting, the most common side effect, occurred in five (9.0%) children. All parents reported that they would be willing for their child to use N₂O again, if necessary. Conclusions: Continuous flow 50:50 N₂O:oxygen is effective for procedural pain in the pediatric ED. It is agreeable to children, particularly >3 years old, medical providers and parents, provides short recovery times and bears minor adverse effects.     

Social acceleration,alienation, and resonance: Hartmut Rosa's writings applied to nursing

This article aims to present the life and work of German thinker Hartmut Rosa as a philosopher of interest for nursing. Although his theoretical framework remains fairly unknown in the nursing domain, its main key concepts open up a philosophical and sociological approach that can contribute to the understanding of a wide range of study phenomena related to nurses, nursing, and healthcare. The concepts of social acceleration, alienation, and resonance are useful to explore healthcare organizations' performance by bringing the time dimension of modernity to the center; to grasp nurses' experiences of caring for patients; and to understand nurses as agents endowed with the capacity to deploy their political agency to create alternative forms of relationship to themselves, to others, and the world, challenging the institutional order of healthcare organizations when it fails to resonate with their professional ethos. In this article, we propose Hartmut Rosa's theoretical framework as a new and inspiring phenomenological and critical lens that should be further explored to advance knowledge concerning phenomena that are found at the crossroads of the nursing domain and other fields of knowledge.