85 research outputs found
A comparison of policy and direct practice stakeholder perceptions of factors affecting evidence-based practice implementation using concept mapping
<p>Abstract</p> <p>Background</p> <p>The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States.</p> <p>Methods</p> <p>Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and <it>t</it>-tests were used to analyze the data.</p> <p>Results</p> <p>A total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding) were rated among the most important and least likely to change by both groups.</p> <p>Conclusions</p> <p>EBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light.</p
Hypertension and type 2 diabetes: What family physicians can do to improve control of blood pressure - an observational study
Background: The prevalence of type 2 diabetes is rising, and most of these patients also have hypertension,
substantially increasing the risk of cardiovascular morbidity and mortality. The majority of these patients do not
reach target blood pressure levels for a wide variety of reasons. When a literature review provided no clear focus
for action when patients are not at target, we initiated a study to identify characteristics of patients and providers
associated with achieving target BP levels in community-based practice.
Methods: We conducted a practice- based, cross-sectional observational and mailed survey study. The setting was
the practices of 27 family physicians and nurse practitioners in 3 eastern provinces in Canada. The participants
were all patients with type 2 diabetes who could understand English, were able to give consent, and would be
available for follow-up for more than one year. Data were collected from each patient’s medical record and from
each patient and physician/nurse practitioner by mailed survey. Our main outcome measures were overall blood
pressure at target (< 130/80), systolic blood pressure at target, and diastolic blood pressure at target. Analysis
included initial descriptive statistics, logistic regression models, and multivariate regression using hierarchical
nonlinear modeling (HNLM).
Results: Fifty-four percent were at target for both systolic and diastolic pressures. Sixty-two percent were at systolic
target, and 79% were at diastolic target. Patients who reported eating food low in salt had higher odds of
reaching target blood pressure. Similarly, patients reporting low adherence to their medication regimen had lower
odds of reaching target blood pressure.
Conclusions: When primary care health professionals are dealing with blood pressures above target in a patient
with type 2 diabetes, they should pay particular attention to two factors. They should inquire about dietary salt
intake, strongly emphasize the importance of reduction, and refer for detailed counseling if necessary. Similarly,
they should inquire about adherence to the medication regimen, and employ a variety of patient-oriented
strategies to improve adherence
Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors
Implementation science is a quickly growing discipline. Lessons learned from business and medical settings are being applied but it is unclear how well they translate to settings with different historical origins and customs (e.g., public mental health, social service, alcohol/drug sectors). The purpose of this paper is to propose a multi-level, four phase model of the implementation process (i.e., Exploration, Adoption/Preparation, Implementation, Sustainment), derived from extant literature, and apply it to public sector services. We highlight features of the model likely to be particularly important in each phase, while considering the outer and inner contexts (i.e., levels) of public sector service systems
New materials and devices for preventing catheter-related infections
Catheters are the leading source of bloodstream infections for patients in the intensive care unit (ICU). Comprehensive unit-based programs have proven to be effective in decreasing catheter-related bloodstream infections (CR-BSIs). ICU rates of CR-BSI higher than 2 per 1,000 catheter-days are no longer acceptable. The locally adapted list of preventive measures should include skin antisepsis with an alcoholic preparation, maximal barrier precautions, a strict catheter maintenance policy, and removal of unnecessary catheters. The development of new technologies capable of further decreasing the now low CR-BSI rate is a major challenge. Recently, new materials that decrease the risk of skin-to-vein bacterial migration, such as new antiseptic dressings, were extensively tested. Antimicrobial-coated catheters can prevent CR-BSI but have a theoretical risk of selecting resistant bacteria. An antimicrobial or antiseptic lock may prevent bacterial migration from the hub to the bloodstream. This review discusses the available knowledge about these new technologies
Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina
Background. Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions. Methods. An epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I 2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I 14,432 per DALY saved); and one intervention was not found to be cost-effective: tobacco cessation with bupropion (I$ 59,433 per DALY saved). Conclusions. Most of the interventions selected were cost-saving or very cost-effective. This study aims to inform policy makers on resource-allocation decisions to reduce the burden of CVD in Argentina.Centro de Endocrinología Experimental y Aplicada (CENEXA
2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease
The recommendations listed in this document are, whenever possible, evidence based. An extensive evidence review was conducted as the document was compiled through December 2008. Repeated literature searches were performed by the guideline development staff and writing committee members as new issues were considered. New clinical trials published in peer-reviewed journals and articles through December 2011 were also reviewed and incorporated when relevant. Furthermore, because of the extended development time period for this guideline, peer review comments indicated that the sections focused on imaging technologies required additional updating, which occurred during 2011. Therefore, the evidence review for the imaging sections includes published literature through December 2011
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