Understanding consumer perceptions of frailty screening to inform knowledge translation and health service improvements

Published electronically October 2020BACKGROUND AND OBJECTIVES: despite growing support for the clinical application of frailty, including regular frailty screening for older adults, little is known about how older adults perceive frailty screening. The purpose of this study was to examine older adults' perspectives on frailty screening to inform knowledge translation and service improvements for older adults with frailty. RESEARCH DESIGN: interpretive descriptive qualitative design. PARTICIPANTS: a total of 39 non-frail (18%), pre-frail (33%) and frail or very frail (49%) South Australian older adults aged 62-99 years, sampled from community, assisted living and residential aged care settings. METHODS: seven focus groups were conducted and analysed by two independent investigators using inductive thematic analysis. RESULTS: three themes were identified. First, older adults question the necessity and logic of an objective frailty measure. Second, older adults believe any efforts at frailty screening need to culminate in an action. Third, older adults emphasise that frailty screening needs to be conducted sensitively given negative perceptions of the term frailty and the potential adverse effects of frailty labelling. DISCUSSION AND IMPLICATIONS: previous screening experiences and underlying beliefs about the nature of frailty as inevitable shaped openness to, and acceptance of, frailty screening. Findings correspond with previous research illuminating the lack of public awareness of frailty and the nascent stage of frailty screening implementation. Incorporating consumer perspectives, along with perspectives of other stakeholder groups when considering implementing frailty screening, is likely to impact uptake and optimise suitability-important considerations in person-centred care provision.Mandy M. Archibald, Michael T. Lawless, Rachel C. Ambagtsheer, Alison L. Kitso

Transdisciplinary research for impact: protocol for a realist evaluation of the relationship between transdisciplinary research collaboration and knowledge translation

Transdisciplinary teams are increasingly regarded as integral to conducting effective research. Similarly, knowledge translation is often seen as a solution to improving the relevance and benefits of health research. Yet, whether, how, for whom and under which circumstances transdisciplinary research influences knowledge translation is undertheorised, which limits its potential impact. The proposed research aims to identify the contexts and mechanisms by which transdisciplinary research contributes to developing shared understandings and behaviours of knowledge translation between team members.Using a longitudinal case-study design approach to realist evaluation, we outline a study protocol examining whether, how, if and for whom transdisciplinary collaboration can impact knowledge translation understandings and behaviours within a 5-year transdisciplinary Centre of Research Excellence. Data are being collected between February 2017 and December 2020 over four rounds of theory development, refinement and testing using interviews, observation, document review and visual elicitation as data sources.The Health Research Ethics Committee of the University of Adelaide approved this study. Findings will be communicated with team members at scheduled intervals throughout the study verbally and by means of creative reflective approaches (eg, arts elicitation, journalling). This research will be used to help support optimal team functioning by identifying strategies to support knowledge sharing and communication within and beyond the team to facilitate attainment of research objectives. Academic dissemination will occur through publication and presentations.Mandy M Archibald, Michael Lawless, Gillian Harvey, Alison L Kitso

"There is nothing so practical as a good theory": a pragmatic guide for selecting theoretical approaches for implementation projects

Background: A multitude of theories, models and frameworks relating to implementing evidence-based practice in health care exist, which can be overwhelming for clinicians and clinical researchers new to the field of implementation science. Clinicians often bear responsibility for implementation, but may be unfamiliar with theoretical approaches designed to inform or understand implementation. Main Text: In this article, a multidisciplinary group of clinicians and health service researchers present a pragmatic guide to help clinicians and clinical researchers understand what implementation theories, models and frameworks are; how a theoretical approach to implementation might be used; and some prompts to consider when selecting a theoretical approach for an implementation project. Ten commonly used and highly cited theoretical approaches are presented, none of which have been utilised to their full potential in the literature to date. Specifically, theoretical approaches tend to be applied retrospectively to evaluate or interpret findings from a completed implementation project, rather than being used to plan and design theory-informed implementation strategies which would intuitively have a greater likelihood of success. We emphasise that there is no right or wrong way of selecting a theoretical approach, but encourage clinicians to carefully consider the project's purpose, scope and available data and resources to allow them to select an approach that is most likely to "value-add" to the implementation project. Conclusion: By assisting clinicians and clinical researchers to become confident in selecting and applying theoretical approaches to implementation, we anticipate an increase in theory-informed implementation projects. This then will contribute to more nuanced advice on how to address evidence-practice gaps and ultimately to contribute to better health outcomes.Elizabeth A. Lynch, Alison Mudge, Sarah Knowles, Alison L. Kitson, Sarah C. Hunter and Gill Harve

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Clinical guidelines: an introduction to their development and implementation

There is a great deal of interest in the United Kingdom in clinical guidelines as a means of assisting practitioner and patient decision making about care options and in improving the quality of the care provided Confusion remains, however, over what is meant by a clinical guideline and how it differs from and relates to protocols and standards This paper was written under the auspices of the Royal College of Nursing Steering Group for the college's work on clinical guidelines, with the aim of clarifying some of the terminology used in the field and introducing ways in which clinical guidelines might be used by practitioners and patients to readers At the moment just how effective the use of clinical guidelines can be on care is poorly established What is known, however, is that crucial to their success are the strategies and methods used for their implementation Such strategies and methods raise questions about how a sense of ownership can be engendered in those using the clinical guidelines and how they may be best operationalized These questions are considered in this paper