Disaster Evaluation: Why Use A Comprehensive “Eight-Step Approach”

This thesis focuses on the potential for comprehensive, scientific, public health evaluations to affect policy development by conducting a retrospective literature investigation of studies and evaluations published in the aftermath of Hurricane Katrina. Using Ricci et al.’s Disaster Evaluation Research: A field guide as a model of comprehensive evaluation, 161 articles were winnowed down to 73 that were then reviewed in three ways. The articles were categorized based on time-frame of focus (more or less than two weeks after Hurricane Katrina’s landfall); and their topic within Ricci et al.’s “List of Emergency Public Health Activities.” To identify the comprehensiveness of the articles, four core components of the “Eight-Step Approach” were highlighted and used as a comparison measure. Ultimately, eight articles met the criteria for comprehensiveness. This exercise demonstrates the lack of comprehensive evaluations following one of the most significant disasters in US history and discusses its effects on policy development and the disaster cycle

A universal display? Investigating the role of Panathenaic amphorae in the British Museum

Museum displays can serve to educate and inform the public about various concepts and classes of objects. However, the ways in which these displays present information is typically filtered through selective interpretive lenses that reflect a variety of biases, including theoretical and institutional ones. As a result, the museum’s mission and goals directly affect gallery displays by orienting information so that it is in alignment with the museum’s aims. For example, the British Museum of London, a public natural history and archeological museum, is considered to be a universal, or encyclopedic, museum. The creation of universal museums developed alongside imperial powers, whose wealth and influence allowed them to collect a wide variety of specimens, including microbes, plant species, glass, and elements of monumental architecture. Because of the scope of their collections, an encyclopedic museum is expected to comment on many topics using a variety of demonstrative objects. The British Museum, for instance, holds the largest collection of Panathenaic prize amphorae (athletic awards ca. 6th to 2nd centuries BC) outside of Greece. Using Panathenaic amphorae as a case study, this thesis investigates whether the display of the amphorae reflects the British Museum’s position as an encyclopedic museum. In order to better comprehend the relationship between the mission of the universal museum and the artifacts it collects, display choices surrounding the British Museum’s collection of Panathenaic amphorae are analyzed using summative evaluation techniques, such as curator interviews, head counts, and label evaluation. For comparison, the same summative evaluation techniques were employed at the Ashmolean Museum in Oxford, which pursues a different mission as it is a university, rather than a universal museum. The comparison of these two museums highlights the distinction between the British Museum’s universal mission and the Ashmolean’s teaching mission, and it is determined that the British Museum’s display of Panathenaic amphorae does indeed reflect its encyclopedic mission. The large quantity of vases provides the museum with the opportunity to present the vessels in multiple contexts and effectively convey their overall significance—an opportunity that a museum with fewer vases does not have

Refining Expert Recommendations for Implementing Change (ERIC) strategy surveys using cognitive interviews with frontline providers

BACKGROUND: The Expert Recommendations for Implementing Change (ERIC) compilation includes 73 defined implementation strategies clustered into nine content areas. This taxonomy has been used to track implementation strategies over time using surveys. This study aimed to improve the ERIC survey using cognitive interviews with non-implementation scientist clinicians. METHODS: Starting in 2015, we developed and fielded annual ERIC surveys to evaluate liver care in the Veterans Health Administration (VA). We invited providers who had completed at least three surveys to participate in cognitive interviews (October 2020 to October 2021). Before the interviews, participants reviewed the complete 73-item ERIC survey and marked which strategies were unclear due to wording, conceptual confusion, or overlap with other strategies. They then engaged in semi-structured cognitive interviews to describe the experience of completing the survey and elaborate on which strategies required further clarification. RESULTS: Twelve VA providers completed surveys followed by cognitive interviews. The Engage Consumer and Support Clinicians clusters were rated most highly in terms of conceptual and wording clarity. In contrast, the Financial cluster had the most wording and conceptual confusion. The Adapt and Tailor to Context cluster strategies were considered to have the most redundancy. Providers outlined ways in which the strategies could be clearer in terms of wording (32%), conceptual clarity (51%), and clarifying the distinction between strategies (51%). CONCLUSIONS: Cognitive interviews with ERIC survey participants allowed us to identify and address issues with strategy wording, combine conceptually indistinct strategies, and disaggregate multi-barreled strategies. Improvements made to the ERIC survey based on these findings will ultimately assist VA and other institutions in designing, evaluating, and replicating quality improvement efforts

Getting to implementation: Adaptation of an implementation playbook

IntroductionImplementation strategies supporting the translation of evidence into practice need to be tailored and adapted for maximum effectiveness, yet the field of adapting implementation strategies remains nascent. We aimed to adapt “Getting To Outcomes”® (GTO), a 10-step implementation playbook designed to help community-based organizations plan and evaluate behavioral health programs, into “Getting To Implementation” (GTI) to support the selection, tailoring, and use of implementation strategies in health care settings.MethodsOur embedded evaluation team partnered with operations, external facilitators, and site implementers to employ participatory methods to co-design and adapt GTO for Veterans Health Administration (VA) outpatient cirrhosis care improvement. The Framework for Reporting Adaptations and Modifications to Evidenced-based Implementation Strategies (FRAME-IS) guided documentation and analysis of changes made pre- and post-implementation of GTI at 12 VA medical centers. Data from multiple sources (interviews, observation, content analysis, and fidelity tracking) were triangulated and analyzed using rapid techniques over a 3-year period.ResultsAdaptations during pre-implementation were planned, proactive, and focused on context and content to improve acceptability, appropriateness, and feasibility of the GTI playbook. Modifications during and after implementation were unplanned and reactive, concentrating on adoption, fidelity, and sustainability. All changes were collaboratively developed, fidelity consistent at the level of the facilitator and/or implementer.ConclusionGTO was initially adapted to GTI to support health care teams' selection and use of implementation strategies for improving guideline-concordant medical care. GTI required ongoing modification, particularly in steps regarding team building, context assessment, strategy selection, and sustainability due to difficulties with step clarity and progression. This work also highlights the challenges in pragmatic approaches to collecting and synthesizing implementation, fidelity, and adaptation data.Trial registrationThis study was registered on ClinicalTrials.gov (Identifier: NCT04178096)

Refining Expert Recommendations for Implementing Change (ERIC) strategy surveys using cognitive interviews with frontline providers

BackgroundThe Expert Recommendations for Implementing Change (ERIC) compilation includes 73 defined implementation strategies clustered into nine content areas. This taxonomy has been used to track implementation strategies over time using surveys. This study aimed to improve the ERIC survey using cognitive interviews with non-implementation scientist clinicians.MethodsStarting in 2015, we developed and fielded annual ERIC surveys to evaluate liver care in the Veterans Health Administration (VA). We invited providers who had completed at least three surveys to participate in cognitive interviews (October 2020 to October 2021). Before the interviews, participants reviewed the complete 73-item ERIC survey and marked which strategies were unclear due to wording, conceptual confusion, or overlap with other strategies. They then engaged in semi-structured cognitive interviews to describe the experience of completing the survey and elaborate on which strategies required further clarification.ResultsTwelve VA providers completed surveys followed by cognitive interviews. The "Engage Consumer" and "Support Clinicians" clusters were rated most highly in terms of conceptual and wording clarity. In contrast, the "Financial" cluster had the most wording and conceptual confusion. The "Adapt and Tailor to Context" cluster strategies were considered to have the most redundancy. Providers outlined ways in which the strategies could be clearer in terms of wording (32%), conceptual clarity (51%), and clarifying the distinction between strategies (51%).ConclusionsCognitive interviews with ERIC survey participants allowed us to identify and address issues with strategy wording, combine conceptually indistinct strategies, and disaggregate multi-barreled strategies. Improvements made to the ERIC survey based on these findings will ultimately assist VA and other institutions in designing, evaluating, and replicating quality improvement efforts

Getting to implementation: Adaptation of an implementation playbook

IntroductionImplementation strategies supporting the translation of evidence into practice need to be tailored and adapted for maximum effectiveness, yet the field of adapting implementation strategies remains nascent. We aimed to adapt "Getting To Outcomes"® (GTO), a 10-step implementation playbook designed to help community-based organizations plan and evaluate behavioral health programs, into "Getting To Implementation" (GTI) to support the selection, tailoring, and use of implementation strategies in health care settings.MethodsOur embedded evaluation team partnered with operations, external facilitators, and site implementers to employ participatory methods to co-design and adapt GTO for Veterans Health Administration (VA) outpatient cirrhosis care improvement. The Framework for Reporting Adaptations and Modifications to Evidenced-based Implementation Strategies (FRAME-IS) guided documentation and analysis of changes made pre- and post-implementation of GTI at 12 VA medical centers. Data from multiple sources (interviews, observation, content analysis, and fidelity tracking) were triangulated and analyzed using rapid techniques over a 3-year period.ResultsAdaptations during pre-implementation were planned, proactive, and focused on context and content to improve acceptability, appropriateness, and feasibility of the GTI playbook. Modifications during and after implementation were unplanned and reactive, concentrating on adoption, fidelity, and sustainability. All changes were collaboratively developed, fidelity consistent at the level of the facilitator and/or implementer.ConclusionGTO was initially adapted to GTI to support health care teams' selection and use of implementation strategies for improving guideline-concordant medical care. GTI required ongoing modification, particularly in steps regarding team building, context assessment, strategy selection, and sustainability due to difficulties with step clarity and progression. This work also highlights the challenges in pragmatic approaches to collecting and synthesizing implementation, fidelity, and adaptation data.Trial registrationThis study was registered on ClinicalTrials.gov (Identifier: NCT04178096)

The long-term durability of cytogenetic responses in patients with accelerated phase chronic myeloid leukemia treated with imatinib 600 mg: the GIMEMA CML Working Party experience after a 7-year follow-up

The findings of this phase 2 multicenter trial indicate that imatinib may induce durable responses in patients with accelerated phase chronic myeloid leukemia

Achieving a major molecular response at the time of a complete cytogenetic response (CCgR) predicts a better duration of CCgR in imatinib-treated chronic myeloid leukemia patients

Purpose: Most patients with chronic-phase chronic myeloid leukemia (CML) who receive imatinib achieve a complete cytogenetic remission (CCgR) and low levels of BCR-ABL transcripts. CCgR is durable in the majority of patients but relapse occurs in a subset. Experimental Design: To determine the potential of quantitative reverse transcription-PCR of BCR-ABL to predict cytogenetic relapse, we serially monitored residual disease in 97 CML patients with an imatinib-induced CCgR. Patients with late chronic phase CML after IFN-αfailure were treated with imatinib (400 mg daily). Results: During the imatinib median follow-up time of 36 months (range, 12-54 months), disease monitoring occurred by cytogenetics and quantitative PCR. Twenty percent of patients experienced cytogenetic relapse at a median of 18 months after CCgR and a median of 24 months after starting imatinib. None of the possible prognostic factors studied in univariate and multivariate analyses seemed to predict for loss of cytogenetic response but the reduction of BCR-ABL transcript levels at the time of CCgR is an important prognostic factor. Conclusions: In our study, we showed not only that achieving a major molecular remission at 12 months is predictive of a durable cytogenetic remission but also that patients who achieved a major molecular remission (expressed both as the BCR-ABL/β2 microglobulin ratio % <0.0005 and as a 3-log reduction from median baseline value) already at the time of first achieving a CCgR have significantly longer cytogenetic remission durations than those without this magnitude of molecular response (P < 0.05). © 2006 American Association for Cancer Research

The Italian Mastocytosis Registry: 6-year experience from a hospital-based registry

Aim: We collected 'real-life' data on the management of patients with mastocytosis in the Italian Mastocytosis Registry. Methods: Six hundred patients diagnosed with mastocytosis between 1974 and 2014 were included from 19 centers. Results: Among adults (n = 401); 156 (38.9%) patients were diagnosed with systemic mastocytosis. In 212 adults, no bone marrow studies were performed resulting in a provisional diagnosis of mastocytosis of the skin. This diagnosis was most frequently established in nonhematologic centers. In total, 182/184 pediatric patients had cutaneous mastocytosis. We confirmed that in the most patients with systemic mastocytosis, serum tryptase levels were >20 ng/ml and KIT D816V was detectable. Conclusion: The Italian Mastocytosis Registry revealed some center-specific approaches for diagnosis and therapy. Epidemiological evidence on this condition is provided