Assessment of intimate partner violence by child welfare services

The purpose of this study was to describe policy and practice with respect to the assessment of intimate partner violence in a sample of child welfare agencies located throughout the United States and to examine the relationship of contextual characteristics and assessment practices. Telephone interviews were conducted with key informants from child welfare agencies. A snowball interviewing strategy was used to identify the best informant in each agency. Almost all of the participating agencies conducted some assessment of intimate partner violence, with most reporting that the majority of screening or assessment occurred during investigation of referrals. However, only 43.1% reported that all of the families referred to the child welfare system were assessed for intimate partner violence, and 52.8% indicated they had a written policy pertaining to screening and assessment of the problem. There was little relationship between county or agency characteristics and assessment practices. Additional research is needed to determine factors that influence assessment practices and to identify strategies to support and extend efforts to identify intimate partner violence and provide appropriate services for families in the child welfare system

How and why are communities of practice established in the healthcare sector? A systematic review of the literature

Background: Communities of Practice (CoPs) are promoted in the healthcare sector as a means of generating and sharing knowledge and improving organisational performance. However CoPs vary considerably in the way they are structured and operate in the sector. If CoPs are to be cultivated to benefit healthcare organisations, there is a need to examine and understand their application to date. To this end, a systematic review of the literature on CoPs was conducted, to examine how and why CoPs have been established and whether they have been shown to improve healthcare practice. Methods. Peer-reviewed empirical research papers on CoPs in the healthcare sector were identified by searching electronic health-databases. Information on the purpose of establishing CoPs, their composition, methods by which members communicate and share information or knowledge, and research methods used to examine effectiveness was extracted and reviewed. Also examined was evidence of whether or not CoPs led to a change in healthcare practice. Results: Thirty-one primary research papers and two systematic reviews were identified and reviewed in detail. There was a trend from descriptive to evaluative research. The focus of CoPs in earlier publications was on learning and exchanging information and knowledge, whereas in more recently published research, CoPs were used more as a tool to improve clinical practice and to facilitate the implementation of evidence-based practice. Means by which members communicated with each other varied, but in none of the primary research studies was the method of communication examined in terms of the CoP achieving its objectives. Researchers are increasing their efforts to assess the effectiveness of CoPs in healthcare, however the interventions have been complex and multifaceted, making it difficult to directly attribute the change to the CoP. Conclusions: In keeping with Wenger and colleagues' description, CoPs in the healthcare sector vary in form and purpose. While researchers are increasing their efforts to examine the impact of CoPs in healthcare, cultivating CoPs to improve healthcare performance requires a greater understanding of how to establish and support CoPs to maximise their potential to improve healthcare

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Design and Analysis in Dissemination and Implementation Research

There remains a lack of consensus on methodological approaches to the study of dissemination and implementation (D&I) processes, and especially tests of implementation strategies. To begin to address these deficiencies, this chapter reviews design issues for dissemination and implementation research. It presents an overview of some of the analytic approaches to D&I research, recognizing that this analytic work is still at an early stage of development. Finally, the chapter presents a case study of research that crosses three of four recognized D&I phases and illustrates a number of design and analysis issues