Knowledge-to-action processes in SHRTN collaborative communities of practice: A study protocol

<p>Abstract</p> <p>Background</p> <p>The Seniors Health Research Transfer Network (SHRTN) Collaborative is a network of networks that work together to improve the health and health care of Ontario seniors. The collaborative facilitates knowledge exchange through a library service, knowledge brokers (KBs), local implementation teams, collaborative technology, and, most importantly, Communities of Practice (CoPs) whose members work together to identify innovations, translate evidence, and help implement changes.</p> <p>This project aims to increase our understanding of knowledge-to-action (KTA) processes mobilized through SHRTN CoPs that are working to improve the health of Ontario seniors. For this research, KTA refers to the movement of research and experience-based knowledge between social contexts, and the use of that knowledge to improve practice. We will examine the KTA processes themselves, as well as the role of human agents within those processes. The conceptual framework we have adopted to inform our research is the Promoting Action on Research Implementation in Health Services (PARIHS) framework.</p> <p>Methods/design</p> <p>This study will use a multiple case study design (minimum of nine cases over three years) to investigate how SHRTN CoPs work and pursue knowledge exchange in different situations. Each case will yield a unique narrative, framed around the three PARIHS dimensions: evidence, context, and facilitation. Together, the cases will shed light on how SHRTN CoPs approach their knowledge exchange initiatives, and how they respond to challenges and achieve their objectives. Data will be collected using interviews, document analysis, and ethnographic observation.</p> <p>Discussion</p> <p>This research will generate new knowledge about the defining characteristics of CoPs operating in the health system, on leadership roles in CoPs, and on the nature of interaction processes, relationships, and knowledge exchange mechanisms. Our work will yield a better understanding of the factors that contribute to the success or failure of KTA initiatives, and create a better understanding of how local caregiving contexts interact with specific initiatives. Our participatory design will allow stakeholders to influence the practical usefulness of our findings and contribute to improved health services delivery for seniors.</p

Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes?:Systematic review

background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. methods: Systematic review of the literature and narrative synthesis. results: We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. conclusions: This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers

Paroxismos occipitais após o fechamento dos olhos: correlações clínico-eletrencefalográficas em 24 casos

Paroxismos occipitais aparecendo com o fechamento dos olhos (POFO) constituem o padrão eletrencefalográfico fundamental da epilepsia idiopática da infância com paroxismos occipitais (EIIPO). A associação de POFO e epilepsia idiopática tem sido questionada. Estudamos 24 pacientes que apresentavam POFO. A idade esteve compreendida entre 3 e 25 anos. Em 12 casos havia atividade epileptiforme de outras localizações (generalizada em 8 e rolândica em 4). Em 4 casos havia desorganização da atividade de base. Crises epilépticas espontâneas foram relatadas em 16 pacientes sendo focais em 9, generalizadas em 6 e inclassificáveis em um caso. Foi possível identificar as seguintes síndromes epilépticas: EIIPO em 7 casos; epilepsia benigna com pontas centro-temporais em um; EIIPO ou epilepsia benigna com pontas centro-temporais em um; epilepsia parcial sintomática/criptogênica em 4; idiopática generalizada em 2 e convulsões febris em 2 pacientes. Assim, concluímos que POFO foram mais comumente associados às epilepsias benignas da infância mas ocorreram em várias síndromes epilépticas ou mesmo em pacientes sem manifestações convulsivas

Considerações clínicas e etiológicas das síndromes epilépticas sintomáticas com paroxismos occipitais bloqueados à abertura dos olhos Clinical and ethiological considerations about the symptomatic epileptic syndromes with occipital paroxism bloqued when the eyes open

A síndrome da epilepsia parcial com paroxismos occipitais no eletrencefalograma (EEG) mostra características clínicas heterogêneas. Visando descrever esta rara forma de epilepsia, investigamos a significância dos achados eletrofisiológicos e clínicos em oito pacientes com paroxismos occipitais bloqueados pela abertura dos olhos. Os pacientes foram submetidos a exames radiológicos de RNM do encéfalo e/ou TC de crânio. Houve concordância entre as alterações do EEG e do tipo de crise em 5 pacientes, e entre as anormalidades anatômicas na TC ou RNM com anormalidades focais no EEG em 7 casos. Nossos resultados confirmam que este padrão inusitado origina-se de uma expressão eletrográfica multifatorial.<br>The syndrome of idiophatic partial epilepsy with occipital paroxysms in the EEG shows a considerable clinical heterogeneity. The present paper investigated the signficance of electrophysiologic and clinical characteristics in eigth patients with occipital paroxysms blocked by the eye opening. All patients were submitted to radiological exams including brain MRI and/or CT. There was agreement between EEG findings and type of seizures in 5 patients and between anatomical abnormalities in the MRI or CT and EEG focal abnormalities in 7 patients. Our results confirm that the unusual pattern comes from eletrographic multifactors origins

Hydrogen sulfide inhibits IL-8 expression in human keratinocytes via MAP kinase signaling

Sulfur is able to penetrate the skin, and a sulfur-rich balneotherapy has been suggested to be effective in the treatment of psoriasis. Psoriasis is now considered a genetically programmed, immune-mediated, inflammatory disease, in which intralesional T lymphocytes trigger keratinocytes to proliferate and perpetuate the disease process. Interleukin (IL)-17 and IL-22 produced by Th1/Th17 lymphocytes induce IL-8 secretion by keratinocytes, a key event in the pathogenesis of the disease. It is now clear that mitogen-activated protein kinase (MAPK) (extracellular signal-regulated kinases (ERK) 1 and 2) activity is required for IL-17-induced IL-8 synthesis by keratinocytes, and, in fact, MAPK activity is increased in lesional psoriatic skin. Here, we demonstrate both in vitro and in vivo on primary psoriatic lesions that pharmacological inhibitors of ERKs as well as hydrogen sulfide not only reduce the basal expression and secretion of IL-8, but also interfere with IL-17- and IL-22-induced IL-8 production. These observations, together with the known anti-inflammatory activity of H2S, are relevant to understanding some previously unexplained biological effects exerted by sulfur therapy