Midwives\u27 use of best available evidence in practice: An integrative review

Aims and objectives: To synthesise international research that relates to midwives\u27 use of best available evidence in practice settings and identify key issues relating to the translation of latest evidence into everyday maternity care. Background: Midwifery is a research‐informed profession. However, a gap persists in the translation of best available evidence into practice settings, compromising gold standard maternity care and delaying the translation of new knowledge into everyday practice. Design: A five‐step integrative review approach, based on a series of articles published by the Joanna Briggs Institute (JBI) for conducting systematic reviews, was used to facilitate development of a search strategy, selection criteria and quality appraisal process, and the extraction and synthesis of data to inform an integrative review. Methods: The databases CINAHL, MEDLINE, Web of Science, Implementation Science Journal and Scopus were searched for relevant articles. The screening and quality appraisal process complied with the PRISMA 2009 checklist. Narrative analysis was used to develop sub‐categories and dimensions from the data, which were then synthesised to form two major categories that together answer the review question. Results: The six articles reviewed report on midwives\u27 use of best available evidence in Australia, the UK and Asia. Two major categories emerged that confirm that although midwifery values evidence‐based practice (EBP), evidence‐informed maternity care is not always employed in clinical settings. Additionally, closure of the evidence‐to‐practice gap in maternity care requires a multidimensional approach. Conclusion: Collaborative partnerships between midwives and researchers are necessary to initiate strategies that support midwives\u27 efforts to facilitate the timely movement of best available evidence into practice. Relevance to clinical practice: Understanding midwives\u27 use of best available evidence in practice will direct future efforts towards the development of mechanisms that facilitate the timely uptake of latest evidence by all maternity care providers working in clinical settings

Readiness in HIV Treatment Adherence: A Matter of Confidence. An Exploratory Study§

Adherence to treatment is recognized as the essence of a successful HIV combination therapy. Optimal adherence implies a readiness to begin the treatment on the part of the patient. A better understanding of the "readiness phenomenon" will become an asset for optimizing HIV treatment. However, few studies have focused on understanding the process underlying the choice to adhere. The aim of this study is to understand the readiness process that leads to adhering to the HIV treatment, from both patient and professional perspectives. Twenty-seven in-depth interviews, with a qualitative exploratory design, were the source of our data. Participants were recruited in two hospitals in Paris. Throughout the data-collection process, analysed data were supplied to all participants and the research team, thus allowing for shared constructions. Four themes, interrelated with a constitutive pattern, emerged from the data we collected. Being ready to begin and adhere to treatment is a matter of confidence in oneself, as well as in relatives, in the treatment and in the health professional team. These themes are not constant and unvarying; instead, they constitute a picture moving across time and life events. Results of this study show that adherence that goes beyond “complying with” the medical instructions, but depends on how much of an active role the patient plays in the choice to adhere

Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed analyses of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hyper-activity disorder, autism spectrum disorder, bipolar disorder, major depression, obsessive-compulsive disorder, schizophrenia, and Tourette syndrome. Genetic correlation analyses revealed a meaningful structure within the eight disorders, identifying three groups of inter-related disorders. Meta-analysis across these eight disorders detected 109 loci associated with at least two psychiatric disorders, including 23 loci with pleiotropic effects on four or more disorders and 11 loci with antagonistic effects on multiple disorders. The pleiotropic loci are located within genes that show heightened expression in the brain throughout the lifespan, beginning prenatally in the second trimester, and play prominent roles in neurodevelopmental processes. These findings have important implications for psychiatric nosology, drug development, and risk prediction.Peer reviewe

Twenty years of evidence and excellence

EditorialSuzi Robertson-Mal

Public engagement in translating knowledge to action

Suzanne Robertson-Malt, Dagmara Riitan

Identifying the fundamentals of care within Cochrane systematic reviews: The role of the Cochrane nursing care field fundamentals of care node

The role of the Fundamentals of Care (FoC) Node within the Cochrane Nursing Care Field (CNCF) is to identify universal aspects of patient care as they relate to and potentially affect the application of the results of systematic reviews. The CNCF was established to provide a nursing perspective of Cochrane reviews and to promote their dissemination and uptake. The core functions of the CNCF include identifying topics for nursing care not currently addressed by Cochrane Reviews, raising awareness of the Cochrane Collaboration and the resources it has that supports the delivery of nursing care and the dissemination of relevant reviews to the nursing care community. We outline how volunteers with an interest in the FoC can work to identify care-related aspects for specific clinical reviews. This article describes the development of a tool designed to guide the review of a Cochrane Systematic Review from the vantage of the FoC. The FoC Node is seeking volunteers to undertake this review work, and we have outlined the steps used to do this. We also show how using the FoC Template can inform the tagging and classifying of existing reviews within the Cochrane library.Alison Kitson, Suzi Robertson-Malt, Tiffany Conro

Compliance to hand hygiene practice among nurses in Jimma University Specialized Hospital in Ethiopia: a best practice implementation project

Background: Hand hygiene practice reduces cross-contamination and infection, and it makes sense from a resource saving perspective. The hospital costs associated with a reduction of four or five Health Care Associated Infections may equal the entire annual budget for hand hygiene products. Objective: The objective of this best practice implementation project was to promote evidence informed best practice of hand hygiene among nurses in Jimma University Specialized Hospital Out Patient Department. Methods: An inter-professional project team conducted baseline and post implementation audits using Joanna Briggs Institute Practical Application of Evidences System (JBI PACES). Using six audit criteria, 163 hand hygiene opportunities were observed for both a baseline and follow-up audit. Seven nurses were interviewed for the seventh criteria. Results: The baseline audit revealed a compliance of 2% for using an effective hand washing technique involving three stages, and 4% for washing hands that are visibly soiled with liquid soap and water. Post implementation audit showed an average of 80% improvement in compliance to the evidence based audit criteria for effective hand hygiene. Conclusions: This project showed that role modeling, posting reminders about hand hygiene procedures and presenting evidence summaries to the clinical teams are strategies that result in improved adherence to best available evidence for hand hygiene. Involving key stakeholders in identifying the strategies to change practice is essential for the realization of the implementation of effective hand hygiene. A regular program of random audits conducted by an inter-professional team can help to achieve sustainable compliance to effective hand hygiene.Garumma Tolu Feyissa, Judith Christine Streak Gomersall, Suzanne Robertson-Mal