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推动证据向临床转化 (二)如何选择知识转化理论模式 总被引:2,自引:0,他引:2
本文作为证据临床转化方法学系列文章的第二篇,旨在详细阐述如何选择合适的知识转化理论模式,以指导和促进证据向临床的转化。本文分析了理论、模式和概念框架的内涵,并介绍了5个知识转化领域最常用的理论模式,包括KTA知识转化框架、渥太华研究应用模式、PARIHS框架、复旦循证护理路径图和基于证据的持续质量改进模式图。在此基础上,分析了在推动证据临床转化的过程中,选择合适的知识转化理论模式的重要性、依据及应注意的问题。 相似文献
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目的:探讨我国护理领域内证据临床转化研究的现状、所依据的证据质量、研究方法及研究内容。方法:使用证据转化证据应用等检索词在中国生物医学文献数据库、中国知网、万方数据库、维普中文科技期刊数据库中进行检索,应用Arksey和O’Malley的范围综述方法对文献进行分析。结果:共纳入152篇文献,95.4%的文献发表于2015年之后,92.1%的文献发表在护理类期刊上,27.0%的文献提供了系统的检索策略,43.3%的文献进行了方法学质量评价,74.3%的文献均没有对证据的可用性进行评价。证据转化以症状护理为主题的文献最多,占39.5%,87.5%的文献采用了前后对照方法来评价证据转化的效果,所有的研究均构建了综合性、多元化的证据转化策略,包括基于证据(42.1%)和基于障碍因素的干预策略(57.9%)。73.7%的文献采用了多元化指标对效果进行评价,仅有7.2%的文献提出了应维持证据在临床的持续应用。结论:我国护理领域内证据临床转化研究数量上呈现明显的增加趋势,但转化所依据的证据质量及研究方法尚需要加强,应采取策略推动证据在实践的持续应用。 相似文献
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Background
To reduce the burden of chronic illness, prevention and management interventions must be efficacious, adopted and implemented with fidelity, and reach those at greatest risk. Yet, many research-tested interventions are slow to translate into practice.Purpose
This paper describes how The University of North Carolina at Chapel Hill School of Nursing’s NINR-funded institutional pre- and postdoctoral research-training program is addressing the imperative to speed knowledge translation across the research cycle.Methods
The training emphasizes six research methods (“catalysts”) to speed translation: stakeholder engagement, patient-centered outcomes, intervention optimization and sequential multiple randomized trials (SMART), pragmatic trials, mixed methods approaches, and dissemination and implementation science strategies. Catalysts are integrated into required coursework, biweekly scientific and integrative seminars, and experiential research training. Trainee and program success is evaluated based on benchmarks applicable to all PhD program students, supplemented by indicators specific to the catalysts. Trainees must also demonstrate proficiency in at least two of the six catalysts in their scholarly products. Proficiency is assessed through their works in progress presentations and peer reviews at T32 integrative seminars.Discussion
While maintaining the emphasis on theory-based interventions, we have integrated six catalysts into our ongoing research training to expedite the dynamic process of intervention development, testing, dissemination and implementation.Conclusions
Through a variety of training activities, our research training focused on theory-based interventions and the six catalysts will generate future nurse scientists who speed translation of theory-based interventions into practice to maximize health outcomes for patients, families, communities and populations affected by chronic illness. 相似文献14.
《Disability and rehabilitation》2013,35(18):1571-1577
AbstractPurpose: Knowledge translation (KT) has emerged as a concept that can lead to a greater utilization of evidence-based research in systems of care. Despite a rise in KT research, the literature on KT in relation to physical therapy practice is scarce. This article provides physical therapists (PTs) with recommendations that can support the effective implementation of new knowledge and scientific evidence in clinical practice. Method: Recommendations are grounded in the Ottawa Model of Research Use and in the literature in KT in the health professions. Results: A well-established KT process, which is supported by a planning model, is essential to guide the implementation of scientific evidence. Consensus among all stakeholders about what evidence will be implemented must be reached. Context-related barriers and facilitators should be assessed and tailored active and multi-component interventions should be considered. Participation from individuals in intermediary positions (e.g. opinion leaders) supports implementation of KT interventions. Monitoring of the process and assessment of intended outcomes should be performed in order to assess the success of the implementation. Conclusion: Five major recommendations grounded in the Ottawa model are provided that can assist PTs with the complex task of implementing new knowledge in their clinical practice.
- Implications for Rehabilitation
In order to support EBP, knowledge translation interventions can be used to support best practice.
Implementation of new knowledge should be guided by a framework or a conceptual model.
Consensus on the evidence must be reached and assessment of context-related factors should be done prior to the implementation of any KT intervention.
Intervention strategies should be active, multi-component and include individuals with intermediary positions that can facilitate the KT process.
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《Journal of Manual and Manipulative Therapy》2013,21(2):68-74
AbstractObjectives:Physical therapists have used continuing education as a method of improving their skills in conducting clinical examination of patients with low back pain (LBP). The purpose of this study was to evaluate how well the pathoanatomical classification of patients in acute or subacute LBP can be learned and applied through a continuing education format. The patients were seen in a direct access setting.Methods:The study was carried out in a large health-care center in Finland. The analysis included a total of 57 patient evaluations generated by six physical therapists on patients with LBP. We analyzed the consistency and level of agreement of the six physiotherapists’ (PTs) diagnostic decisions, who participated in a 5-day, intensive continuing education session and also compared those with the diagnostic opinions of two expert physical therapists, who were blind to the original diagnostic decisions. Evaluation of the physical therapists’ clinical examination of the patients was conducted by the two experts, in order to determine the accuracy and percentage agreement of the pathoanatomical diagnoses.Results:The percentage of agreement between the experts and PTs was 72–77%. The overall inter-examiner reliability (kappa coefficient) for the subgroup classification between the six PTs and two experts was 0·63 [95% confidence interval (CI): 0·47–0·77], indicating good agreement between the PTs and the two experts. The overall inter-examiner reliability between the two experts was 0·63 (0·49–0·77) indicating good level of agreement.Discussion:Our results indicate that PTs’ were able to apply their continuing education training to clinical reasoning and make consistently accurate pathoanatomic based diagnostic decisions for patients with LBP. This would suggest that continuing education short-courses provide a reasonable format for knowledge translation (KT) by which physical therapists can learn and apply new information related to the examination and differential diagnosis of patients in acute or subacute LBP. 相似文献
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Eira Karvonen Markku Paatelma Jukka-Pekka Kesonen Ari O Heinonen 《Journal of Manual and Manipulative Therapy》2015,23(2):68-74
Objectives:Physical therapists have used continuing education as a method of improving their skills in conducting clinical examination of patients with low back pain (LBP). The purpose of this study was to evaluate how well the pathoanatomical classification of patients in acute or subacute LBP can be learned and applied through a continuing education format. The patients were seen in a direct access setting.Methods:The study was carried out in a large health-care center in Finland. The analysis included a total of 57 patient evaluations generated by six physical therapists on patients with LBP. We analyzed the consistency and level of agreement of the six physiotherapists’ (PTs) diagnostic decisions, who participated in a 5-day, intensive continuing education session and also compared those with the diagnostic opinions of two expert physical therapists, who were blind to the original diagnostic decisions. Evaluation of the physical therapists’ clinical examination of the patients was conducted by the two experts, in order to determine the accuracy and percentage agreement of the pathoanatomical diagnoses.Results:The percentage of agreement between the experts and PTs was 72–77%. The overall inter-examiner reliability (kappa coefficient) for the subgroup classification between the six PTs and two experts was 0.63 [95% confidence interval (CI): 0.47–0.77], indicating good agreement between the PTs and the two experts. The overall inter-examiner reliability between the two experts was 0.63 (0.49–0.77) indicating good level of agreement.Discussion:Our results indicate that PTs’ were able to apply their continuing education training to clinical reasoning and make consistently accurate pathoanatomic based diagnostic decisions for patients with LBP. This would suggest that continuing education short-courses provide a reasonable format for knowledge translation (KT) by which physical therapists can learn and apply new information related to the examination and differential diagnosis of patients in acute or subacute LBP. 相似文献
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OBJECTIVE: To examine South Australian acupuncturists' attitudes towards the use of research evidence and concurrently identify predicative factors associated with the uptake and implementation of research evidence. METHODS: Questionnaires were mailed out to the entire South Australian acupuncturist population (n=94). The population was divided into two groups, medical acupuncturists (general practitioners or other medical specialists) and non-medical acupuncturists, as previous studies have suggested that clinicians' attitudes to EBP are particular to the clinical setting. RESULTS: The total response rate to the survey was 76.6% (n=72). The difference in response rates between non-medical acupuncturists (90.9%, n=60) and medical acupuncturists (42%, n=12) was significant (p<0.0001). Over half of all respondents had both prior research training and previous research experience. Both groups held positive attitudes to research utilization, the use of research information was considered to be an important component of their professional practice, although they prioritized patient care over both reading research evidence and undertaking primary research. There was no significant difference in research interest between groups. The only predicative factor that influenced research utilization was related to the non-medical acupuncturists period of time in practice; non-medical acupuncturists interest in research (rho=-0.29, p=0.036) declined as they accrued clinical experience. No predictive factors were identified for the medical acupuncturist group. CONCLUSION: South Australian acupuncturists hold favorable views towards research utilization and consider the integration of research evidence into clinical practice as an important component of professional development. Professional associations should implement strategies which capitalize on the respondents' positive attitudes in order to ensure high quality evidence-based care for patients seeking acupuncture. 相似文献
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Jennifer Leeman Linda Beeber Eric Hodges Shawn Kneipp Mark Toles Seon Ae Yeo Jessica Zègre-Hemsey 《Nursing outlook》2018,66(1):18-24
Only a small proportion of research-tested interventions translate into broad-scale implementation in real world practice, and when they do, it often takes many years. Partnering with national and regional organizations is one strategies that researchers may apply to speed the translation of interventions into real-world practice. Through these partnerships, researchers can promote and distribute interventions to the audiences they want their interventions to reach. In this paper, we describe five nurse scientists’ programs of research and their partnerships with networks of national, regional, and local organizations, including their initial formative work, activities to engage multi-level network partners, and lessons learned about partnership approaches to speeding broad-scale implementation. 相似文献