Operational research as implementation science: definitions, challenges and research priorities

Background: Operational research (OR) is the discipline of using models, either quantitative or qualitative, to aid decision-making in complex implementation problems. The methods of OR have been used in healthcare since the 1950s in diverse areas such as emergency medicine, the interface between acute and community care; hospital performance; scheduling, management of patient home visits; scheduling of patient appointments; and many other complex implementation problems of an operational or logistical nature.Discussion: To date there has been limited debate about the role that operational research should take within implementation science. I detail three such roles for OR all grounded in upfront systems thinking: structuring implementation problems; prospective evaluation of improvement interventions; and strategic reconfiguration. Case studies from mental health, emergency medicine and stroke care are used to illustrate each role. I then describe the challenges for applied OR within implementation science at the organisational, interventional and disciplinary levels. Two key challenges include the difficulty faced in achieving a position of mutual understanding between implementation scientists and research users; and a stark lack of evaluation of OR interventions. To address these challenges, I propose a research agenda to evaluate applied OR through the lens of implementation science, the liberation of OR from the specialist research and consultancy environment, and co-design of models with service users.Summary: Operational research is a mature discipline that has developed a significant volume of methodology to improve health services. OR offers implementation scientists the opportunity to do more upfront system thinking before committing resources or taking risks. OR has three roles within implementation science: structuring an implementation problem; prospective evaluation of implementation problems; and a tool for strategic reconfiguration of health services. Challenges facing OR as implementation science include limited evidence and evaluation of impact; limited service user involvement; a lack of managerial awareness; effective communication between research users and OR modellers; and availability of healthcare data. To progress the science a focus is needed in three key areas: evaluation of OR interventions; embedding the knowledge of OR in health services; and educating OR modellers about the aims and benefits of service user involvement

Comparing model reuse with model building : an empirical study of learning from simulation

What are the benefits of involving decision makers in simulation model development? Do decision makers learn more about their problem if they are involved in model development than if they had been excluded? This thesis presents an experiment which compares decision maker learning outcomes and process in two different types of discrete-event simulation (DES) study. The first is a traditional simulation project where decision makers take the role of domain experts and are involved in the building of a simulation model through to its use. The second is where a model is reused rather than built. Sixty four undergraduate participants were individually involved in one of three experimental conditions: development of an A&E simulation model and its subsequent use; development of the same model, but with less time for model use; or were presented with the model already developed and asked to reuse it. Participants of each condition were then allowed to run the model, change variables and review results in an attempt to improve the performance of the system. Learning was measured at two levels: attitude change, to infer learning about a business problem, and transfer of learning, to infer a deeper learning. Results indicated that, firstly, model building aided participant's discovery of aspects of the problem that were previously unconsidered. However, attitudes about these novel aspects of the problem were only converted to transferable knowledge when experimentation was not limited. Secondly, participants that reused the model learnt about the model through quick cycles of experimentation followed by validation, although these tended to be focused on factors with which participants were most familiar. In fact, model reuse participants learnt more following this approach than by scrutinizing the results of each scenario in detail. Little empirical evidence exists to support the discussions and the view that involvement in model building aids learning. This thesis contributes to this debate by providing insight into the mechanisms that in uence learning. Moreover, results suggest that learning from experimentation when reusing a model is also valid, although the process followed may be different. Of course, there are limitations to the approach used to perform the comparison. For instance, the experiment uses novice decision makers and measures attitude immediately after the experiment. Refl ection on such points is used to aid the generation of testable hypotheses that can be explored in future research

Young people's views regarding participation in mental health and wellbeing research through social media

Social media is a central component in the lives of many young people, and provides innovative potential to conduct research among this population. Ethical issues around online research have been subject to much debate, yet young people have seldom been consulted to provide a youth perspective and voice. Eight (8) focus groups involving 48 Grade 9 Western Australian secondary school students aged 13-14 years were held in 2012, to investigate how young people perceive the feasibility and acceptability of social media when used as a research tool to investigate various issues relevant to their mental health and wellbeing. Whilst young people recognise many benefits of researchers using social media in this way, such as its relevance, innovation and accessibility, there were salient issues of privacy, consent, and practicality that require careful negotiation. There is a need for continued exploration and scientific debate of the moral and ethical implications of using social media for research, to help ensure this is employed in an appropriate and effective way that is respectful of and sensitive to the needs and views of young peoplepeer-reviewe

Arguments for and against the use of multiple comparison control in stochastic simulation studies

Pick up any of the standard discrete-event simulation textbooks and you will find that the output analysissection includes a note on multiple comparison control (MCC). These procedures aim to mitigate theproblem of inflating the probability of making a single type I error when comparing many simulatedscenarios simultaneously. We consider the use of MCC in stochastic simulation studies and present anargument discouraging its use in the classical sense. In particular, we focus on the impracticality ofprocedures, the benefits of common random numbers and that simulation is very different from empiricalstudies where MCC has its roots. We then consider in what instances would abandoning MCC altogetherbe problematic and what alternatives are available. We present an argument for medium to largeexploratory studies to move their attention away from classical Type I errors and instead control asubtlety different quantity: the rate of false positives amongst all ‘discoveries’

Evaluating the impact of a simulation study in emergency stroke care

Very few discrete-event simulation studies follow up on recommendations with evaluation of whether modelled benefits have been realised and the extent to which modelling contributed to any change. This paper evaluates changes made to the emergency stroke care pathway at a UK hospital informed by a simulation modelling study. The aims of the study were to increase the proportion of people with strokes that undergo a time-sensitive treatment to breakdown a blood clot within the brain and decrease the time to treatment. Evaluation involved analysis of stroke treatment pre- and post- implementation, as well as a comparison of how the research team believed the intervention would aid implementation compared to what actually happened. Two years after the care pathway was changed, treatment rates had increased in line with expectations and the hospital was treating four times as many patients than before the intervention in half the time. There is evidence that the modelling process aided implementation, but not always in line with expectations of the research team. Despite user involvement throughout the study it proved difficult to involve a representative group of clinical stakeholders in conceptual modelling and this affected model credibility. The research team also found batch experimentation more useful than visual interactive simulation to structure debate and decision making. In particular, simple charts of results focused debates on the clinical effectiveness of drugs - an emergent barrier to change. Visual interactive simulation proved more useful for engaging different hospitals and initiating new projects

A randomized feasibility pilot-study of intravenous and subcutaneous administration of ketamine to prevent postpartum depression after planned cesarean delivery under neuraxial anesthesia

BACKGROUND: Evidence suggests ketamine may prevent postpartum depression (PPD) after cesarean delivery (CD) although intolerability and inconvenience of administration are problematic. We assessed the feasibility of studying ketamine (0.5 mg/kg, via subcutaneous injection or 40-min intravenous infusion) to prevent PPD after CD. METHODS: Twenty-three women scheduled for cesarean delivery under neuraxial anesthesia were randomized to one of three groups: subcutaneous ketamine (SC Group, n = 8), intravenous ketamine (IV Group, n = 8) or placebo (n = 7). We measured depression (Edinburgh Postpartum Depression Scale [EPDS]) scores pre-operatively and at 1, 2, 21 and 42 days postoperatively. Anxiety, adverse effects, surgical site pain and analgesic consumption were also assessed. Feasibility was assessed based on acceptability, burden of disease, ability to collect study data and, tolerability of interventions. RESULTS: Baseline characteristics of groups were similar, however, more women in the placebo group had pre-existing anxiety disorder (p = 0.03). 20.7% (25/121) of those approached consented to participate and 34.8% (8/23), of those assessed, screened positive for depression in the postpartum (EPDS \u3e 12). PPD screening data was complete in 78.3% (18/23). No differences were observed for any adverse effect outcomes except for fewer incidences of intraoperative shivering with ketamine (SC: 25%, IV: 0% and Placebo: 85.7%, p = 0.01). No statistically significant difference in positive screening for PPD was observed (SC: 14.3%, IV: 50% and Placebo: 42.9%, p = 0.58). CONCLUSION: An RCT was judged to be feasible and there was no evidence of intolerability of either route of ketamine administration. Dispensing with the need for intravenous access makes the subcutaneous route a particularly attractive option for use in the postpartum population. Further examination of these interventions to prevent, and possibly treat, postpartum depression is warranted. TRIAL REGISTRATION: NCT04227704, January 1

Young people\u27s views regarding participation in mental health and wellbeing research through social media

Social media is a central component in the lives of many young people, and provides innovative potential to conduct research among this population. Ethical issues around online research have been subject to much debate, yet young people have seldom been consulted to provide a youth perspective and voice. Eight (8) focus groups involving 48 Grade 9 Western Australian secondary school students aged 13-14 years were held in 2012, to investigate how young people perceive the feasibility and acceptability of social media when used as a research tool to investigate various issues relevant to their mental health and wellbeing. Whilst young people recognise many benefits of researchers using social media in this way, such as its relevance, innovation and accessibility, there were salient issues of privacy, consent, and practicality that require careful negotiation. There is a need for continued exploration and scientific debate of the moral and ethical implications of using social media for research, to help ensure this is employed in an appropriate and effective way that is respectful of and sensitive to the needs and views of young people

Australian covert bullying prevalence study

The safety of members of the school community is essential to enhance the academic, social development and well being of young people. In line with the United Nations\u27 Convention on the Rights of the Child, the National Safe Schools Framework (NSSF) is regarded as.a highly innovative, collaborative effort on behalf of the Commonwealth, State and Territory Governments to foster the development and implementation of a series of whole-of-school initiatives to produce an integrated national policy for the prevention and early intervention of bullying and other aggressive and violent behaviours. Yet despite the impact of the NSSF in terms of reducing direct, face-to-face \u27overt\u27 bullying, such as hitting, punching, kicking and teasing, evidence suggests that a less direct form of \u27covert\u27 bullying is becoming more prevalent and insidious, fuelled in part by the growth of new forms of Information and Communications Technology (ICT). From this perspective, the Australian Covert Bullying Prevalence Study (ACBPS), commissioned by the Department of Education, Employment and Workplace Relations (DEEWR), represents a significant first step to understand and tackle this phenomenon