Using Implementation Science in Nursing Research

ObjectivesClinical research continues to build knowledge that can potentially improve clinical and health service outcomes; however, integrating evidence into routine care is challenging, resulting in a knowledge practice gap. The field of implementation science is a resource available for nurses to translate evidence into their practice. This article aims to provide nurses with an overview of implementation science, illustrate its value integrating evidence into practice, and show how it can be applied with high rigor in nursing research practice.Data SourcesA narrative synthesis of the implementation science literature was conducted. A series of case studies were purposively selected to demonstrate the application of commonly used implementation theories, models, and frameworks across health care settings relevant to nursing. These case studies demonstrate how the theoretical framework was applied and how the outcomes of the work reduced the knowledge practice gap.ConclusionImplementation science theoretical approaches have been used by nurses and multidisciplinary teams to better understand the gap between knowledge and practice for better informed implementation. These can be used to understand the processes involved, identify the determinants at play, and undertake an effective evaluation.Implications for Nursing PracticeBy using implementation science research practice, nurses can also build a strong foundation of evidence about nursing clinical practice. As an approach, implementation science is practical and can optimize the valuable nursing resource

Adults with impaired gastrointestinal function show improvements in gastrointestinal symptoms and protein intake with a high-protein, peptide-based oral nutritional supplement

Summary: Background: Provision of feeds containing hydrolysed, peptide-based proteins and medium-chain triglycerides (MCT), can help mitigate gastrointestinal (GI) intolerance in adults with impaired GI function, maldigestion and/or malabsorption. Aim: This study evaluated a high-protein, peptide-based, MCT-containing oral nutritional supplement (PEHP; 1.5 kcal/mL and 7.5 g protein/100 mL). Methods: Adults with impaired GI function were recruited by their managing dietitian and took PEHP orally for 28-days, with GI tolerance, compliance, weight, energy and protein intake assessed via non-validated questionnaires and a 24-hour dietary recall at baseline and at intervention end. Results: Fifteen, adults (56 years (16), 67 kg (26.0), 24 kg/m2 (7.6)) took part in this study. Intensity of nausea (Z= -2.070, p=0.038, n=15) and abdominal pain (Z= -2.236, p=0.025, n=15) improved significantly compared to baseline. Reductions in the intensity of diarrhoea, constipation, vomiting, flatulence, and burping were observed but were not statistically significant (p>0.05 for all). Compliance was higher with PEHP (81% (24)) than baseline feeds (63% (42)) but not significantly. Weight remained stable between baseline (67 kg (26)) and at intervention end (67 kg (27), p=0.414, n=15). Compared to baseline, total energy intake increased with PEHP albeit not significantly (1661 kcal/day (572) vs 1981 kcal/day (592), p=0.137, n=15). Increases in total protein intake were also observed, this time significantly (61 g/day (23) vs 78 g/day (29), p=0.042, n=15). Conclusions: This study in adults with impaired GI function found that PEHP improved GI tolerance and protein intake compared to feeds taken at baseline (including both polymeric and peptide-based feeds)

Complex Enterally Tube-Fed Community Patients Display Stable Tolerance, Improved Compliance and Better Achieve Energy and Protein Targets with a High-Energy, High-Protein Peptide-Based Enteral Tube Feed: Results from a Multi-Centre Pilot Study.

This pilot study evaluated a high-energy, high-protein, peptide-based, (medium-chain triglycerides) MCT-containing enteral tube feed (Nutrison Peptisorb Plus HEHP, Nutricia Ltd., Trowbridge, BA14 0XQ, UK.) containing 1.5 kcal/mL and 7.5 g protein/100 mL. Fifteen community-based, enterally tube-fed adults (42 (SD 16.3) years) received the intervention feed daily for 28 days, with gastrointestinal tolerance, compliance and nutrient intake assessed at baseline and after the intervention period. Incidence and intensity of constipation ( = 0.496), nausea ( = 1.000), abdominal pain ( = 0.366) and bloating ( = 0.250) remained statistically unchanged, yet the incidence and intensity of diarrhoea improved significantly after receiving the intervention feed (Z = -2.271, = 0.023). Compliance with the intervention feed was significantly greater compared to the patient's baseline regimens (99% vs. 87%, = 0.038). Compared to baseline, use of the intervention feed enabled patients to significantly increase total energy (1676 kcal/day (SD 449) to 1884 kcal/day (SD 537), = 0.039) and protein intake (73 g/day (SD 17) to 89 g/day (SD 23), = 0.001), allowing patients to better achieve energy (from 88% to 99%, = 0.038) and protein (from 101% to 121%, < 0.001) requirements. This pilot study demonstrates that a high-energy, high-protein, peptide-based, MCT-containing enteral tube feed maintains gastrointestinal tolerance and improves compliance, energy and protein intake in complex, enterally tube-fed, community-based adult patients, though more work is recommended to confirm this

Characterization of glucose oxidase-modified poly(phenylenediamine)-coated electrodes in vitro and in vivo: Homogeneous interference by ascorbic acid in hydrogen peroxide detection

The response of glucose oxidase (GOx) modified poly(o-phenylenediamine) coated Pt disk electrodes to glucose was well-behaved with a rapid response time and displaying Michaelis-Menten kinetics. However, the glucose response was lowered in a concentration-dependent manner by ascorbic acid when the glucose calibrations were carried out in solutions containing this reducing agent. The possibility of a homogeneous redox reaction in which the H2O2 generated by tie enzymatic oxidation of glucose at the GOx/polymer surface is consumed by ascorbate was investigated. Similar ''negative'' interference at GOx-modified carbon powder electrodes not involving membranes and for H2O2 calibrations at bare Pt electrodes supported the hypothesis. The observation that this interference could be blocked by the chelating agent EDTA suggests that the homogeneous reaction is catalyzed by trace metal ion impurities in solution. A model for the homogeneous reaction based on these experimental findings is proposed and tested by comparing quiescent and stirred solutions. No homogeneous interference by uric acid was observed. The electrodes were found to be free from lipid fouling in vitro, and experiments monitoring brain glucose levels in vivo indicate the absence of the homogeneous reaction in this environment. The results highlight the need to test each individual assay procedure involving H2O2 under relevant conditions for both positive and negative interference by ascorbic acid

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes