Knowledge ‘Translation’ as Social Learning: Negotiating the Uptake of Research-Based Knowledge in Practice

BACKGROUND: Knowledge translation and evidence-based practice have relied on research derived from clinical trials, which are considered to be methodologically rigorous. The result is practice recommendations based on a narrow view of evidence. We discuss how, within a practice environment, in fact individuals adopt and apply new evidence derived from multiple sources through ongoing, iterative learning cycles. DISCUSSION: The discussion is presented in four sections. After elaborating on the multiple forms of evidence used in practice, in section 2 we argue that the practitioner derives contextualized knowledge through reflective practice. Then, in section 3, the focus shifts from the individual to the team with consideration of social learning and theories of practice. In section 4 we discuss the implications of integrative and negotiated knowledge exchange and generation within the practice environment. Namely, how can we promote the use of research within a team-based, contextualized knowledge environment? We suggest support for: 1) collaborative learning environments for active learning and reflection, 2) engaged scholarship approaches so that practice can inform research in a collaborative manner and 3) leveraging authoritative opinion leaders for their clinical expertise during the shared negotiation of knowledge and research. Our approach also points to implications for studying evidence-informed practice: the identification of practice change (as an outcome) ought to be supplemented with understandings of how and when social negotiation processes occur to achieve integrated knowledge. SUMMARY: This article discusses practice knowledge as dependent on the practice context and on social learning processes, and suggests how research knowledge uptake might be supported from this vantage point

COVID-19, systemic crisis, and possible implications for the wild meat trade in sub-Saharan Africa

Wild animals play an integral and complex role in the economies and ecologies of many countries across the globe, including those of West and Central Africa, the focus of this policy perspective. The trade in wild meat, and its role in diets, have been brought into focus as a consequence of discussions over the origins of COVID-19. As a result, there have been calls for the closure of China’s “wet markets”; greater scrutiny of the wildlife trade in general; and a spotlight has been placed on the potential risks posed by growing human populations and shrinking natural habitats for animal to human transmission of zoonotic diseases. However, to date there has been little attention given to what the consequences of the COVID-19 economic shock may be for the wildlife trade; the people who rely on it for their livelihoods; and the wildlife that is exploited. In this policy perspective, we argue that the links between the COVID-19 pandemic, rural livelihoods and wildlife are likely to be more complex, more nuanced, and more far-reaching, than is represented in the literature to date. We develop a causal model that tracks the likely implications for the wild meat trade of the systemic crisis triggered by COVID-19. We focus on the resulting economic shockwave, as manifested in the collapse in global demand for commodities such as oil, and international tourism services, and what this may mean for local African economies and livelihoods. We trace the shockwave through to the consequences for the use of, and demand for, wild meats as households respond to these changes. We suggest that understanding and predicting the complex dynamics of wild meat use requires increased collaboration between environmental and resource economics and the ecological and conservation sciences

"This does my head in". Ethnographic study of self-management by people with diabetes

<p>Abstract</p> <p>Background</p> <p>Self-management is rarely studied 'in the wild'. We sought to produce a richer understanding of how people live with diabetes and why self-management is challenging for some.</p> <p>Method</p> <p>Ethnographic study supplemented with background documents on social context. We studied a socio-economically and ethnically diverse UK population. We sampled 30 people with diabetes (15 type 1, 15 type 2) by snowballing from patient groups, community contacts and NHS clinics. Participants (aged 5-88, from a range of ethnic and socio-economic groups) were shadowed at home and in the community for 2-4 periods of several hours (total 88 visits, 230 hours); interviewed (sometimes with a family member or carer) about their self-management efforts and support needs; and taken out for a meal. Detailed field notes were made and annotated. Data analysis was informed by structuration theory, which assumes that individuals' actions and choices depend on their dispositions and capabilities, which in turn are shaped and constrained (though not entirely determined) by wider social structures.</p> <p>Results</p> <p>Self-management comprised both practical and cognitive tasks (e.g. self-monitoring, menu planning, medication adjustment) and socio-emotional ones (e.g. coping with illness, managing relatives' input, negotiating access to services or resources). Self-management was hard work, and was enabled or constrained by economic, material and socio-cultural conditions within the family, workplace and community. Some people managed their diabetes skilfully and flexibly, drawing on personal capabilities, family and social networks and the healthcare system. For others, capacity to self-manage (including overcoming economic and socio-cultural constraints) was limited by co-morbidity, cognitive ability, psychological factors (e.g. under-confidence, denial) and social capital. The consequences of self-management efforts strongly influenced people's capacity and motivation to continue them.</p> <p>Conclusion</p> <p>Self-management of diabetes is physically, intellectually, emotionally and socially demanding. Non-engagement with self-management may make sense in the context of low personal resources (e.g. health literacy, resilience) and overwhelming personal, family and social circumstances. Success of self-management as a policy solution will be affected by interacting influences at three levels: [a] at micro level by individuals' dispositions and capabilities; [b] at meso level by roles, relationships and material conditions within the family and in the workplace, school and healthcare organisation; and [c] at macro level by prevailing economic conditions, cultural norms and expectations, and the underpinning logic of the healthcare system. We propose that the research agenda on living with diabetes be extended and the political economy of self-management systematically studied.</p

New insights into measurement variability in glaucomatous visual fields from computer modelling.

To develop a model to simulate visual fields (VFs) in glaucoma patients, and to characterize variability of the Mean Deviation (MD) VF summary measurement using real VFs and simulations

Process to practice: The evolving role of the academic middle manager in English further education colleges

The English further education sector has undergone significant change since the Further and Higher Education Act (1992) encouraged a culture of entrepreneurship, competition and the use of what was seen as best practice from the commercial sector. This led to a cultural shift and the introduction of many new initiatives – a situation that still exists now. The implementation of these initiatives was often delegated to middle managers – a group of people who occupied the gap between the senior leaders and the lecturers in the classroom. Current austerity measures, restructuring and the shift towards the creation of larger organizations have resulted in reorganizations that could present opportunities for middle managers to participate in the strategic processes and leadership of the organization, further developing their role (Greatbatch and Tate, 2018). The purpose of this article is to investigate the leadership and management aspects of the middle-manager’s role within the context of further education in England. Although many managers in the sector are reluctant to identify as leaders (Briggs, 2006), our research shows that their role has evolved so that they are undertaking a range of activities that could be classified as leadership. We suggest that using ‘practice’ rather than ‘process’ as a descriptor of the role would reframe, identify and bring forward the leadership aspects of what they do. Encouraging a focus on a holistic, practice-based approach, rather than a succession of process-driven tasks, could help managers to perform their role more effectively. Findings taken from interviews with 32 participants and a questionnaire with 302 responses are used to illustrate our argument. © 2019 British Educational Leadership, Management & Administration Society (BELMAS)

Describing knowledge encounters in healthcare: a mixed studies systematic review and development of a classification

This review was self-funded

Visual field test simulation and error in threshold estimation.

AIM: To establish, via computer simulation, the effects of patient response variability and staircase starting level upon the accuracy and repeatability of static full threshold visual field tests. METHOD: Patient response variability, defined by the standard deviation of the frequency of seeing versus stimulus intensity curve, is varied from 0.5 to 20 dB (in steps of 0.5 dB) with staircase starting levels ranging from 30 dB below to 30 dB above the patient's threshold (in steps of 10 dB). Fifty two threshold estimates are derived for each condition and the error of each estimate calculated (difference between the true threshold and the threshold estimate derived from the staircase procedure). The mean and standard deviation of the errors are then determined for each condition. The results from a simulated quadrantic defect (response variability set to typical values for a patient with glaucoma) are presented using two different algorithms. The first corresponds with that normally used when performing a full threshold examination while the second uses results from an earlier simulated full threshold examination for the staircase starting values. RESULTS: The mean error in threshold estimates was found to be biased towards the staircase starting level. The extent of the bias was dependent upon patient response variability. The standard deviation of the error increased both with response variability and staircase starting level. With the routinely used full threshold strategy the quadrantic defect was found to have a large mean error in estimated threshold values and an increase in the standard deviation of the error along the edge of the defect. When results from an earlier full threshold test are used as staircase starting values this error and increased standard deviation largely disappeared. CONCLUSION: The staircase procedure widely used in threshold perimetry increased the error and the variability of threshold estimates along the edges of defects. Using earlier data, when available, overcomes this problem and reduces examination time

Spatial classification of glaucomatous visual field loss.

AIMS--To develop and describe an objective classification system for the spatial patterns of visual field loss found in glaucoma. METHODS--The 560 Humphrey visual field analyser (program 24-2) records were used to train an artificial neural network (ANN). The type of network used, a Kohonen self organising feature map (SOM), was configured to organise the visual field defects into 25 classes of superior visual field loss and 25 classes of inferior visual field loss. Each group of 25 classes was arranged in a 5 by 5 map. RESULTS--The SOM successfully classified the defects on the basis of the patterns of loss. The maps show a continuum of change as one moves across them with early loss at one corner and advanced loss at the opposite corner. CONCLUSIONS--ANNs can classify visual field data on the basis of the pattern of loss. Once trained the ANN can be used to classify longitudinal visual field data which may prove valuable in monitoring visual field loss