Skip header and navigation

Refine By

16 records – page 1 of 2.

The antibiotic management of gonorrhoea in Ontario, Canada following multiple changes in guidelines: an interrupted time-series analysis.

https://arctichealth.org/en/permalink/ahliterature290374
Source
Sex Transm Infect. 2017 12; 93(8):561-565
Publication Type
Journal Article
Date
12-2017
Author
Catherine Dickson
Monica Taljaard
Dara Spatz Friedman
Gila Metz
Tom Wong
Jeremy M Grimshaw
Author Affiliation
Medical Resident,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Alta Vista Campus Room, Ottawa, Canada.
Source
Sex Transm Infect. 2017 12; 93(8):561-565
Date
12-2017
Language
English
Publication Type
Journal Article
Keywords
Female
Gonorrhea - drug therapy - epidemiology
Guideline Adherence
Humans
Interrupted Time Series Analysis
Male
Microbial Sensitivity Tests
Neisseria gonorrhoeae - drug effects
Ontario - epidemiology
Practice Guidelines as Topic
Public Health
Abstract
This study assessed adherence with first-line gonorrhoea treatment recommendations in Ontario, Canada, following recent guideline changes due to antibiotic resistance.
We used interrupted times-series analyses to analyse treatment data for cases of uncomplicated gonorrhoea reported in Ontario, Canada, between January 2006 and May 2014. We assessed adherence with first-line treatment according to the guidelines in place at the time and the use of specific antibiotics over time. We used the introduction of new recommendations in the Canadian Guidelines for Sexually Transmitted Infections in 2008 and 2011 and the release of the province of Ontario's Guidelines for the Treatment and Management of Gonococcal Infections in Ontario in 2013 as interruptions in the time-series analysis.
Overall, 34?287 gonorrhoea cases were reported between 1 January 2006 and 31 May 2014. Treatment data were available for 32?312 (94.2%). Our analysis included 32?272 (94.1%) cases without either a conjunctival or disseminated infection. Following the release of the 2011 recommendations, adherence with first-line recommendations immediately decreased to below 30%. Adherence slowly increased but did not reach baseline levels before the 2013 guidelines were released. Following release of the 2013 guidelines, adherence again decreased; adherence is slowly recovering but by May 2014, was only approximately 60%.
Due to concerns about antibiotic resistance, gonorrhoea treatment guidelines need to be updated regularly and rapidly adopted in practice. Our study showed poor adherence following dissemination of updated guidelines. Over a year after the latest Ontario guidelines were released, 40% of patients did not receive first-line treatment, putting them at risk of treatment failure and potentially promoting further drug resistance. Greater attention should be devoted to dissemination and implementation of new guidelines.
PubMed ID
28844044 View in PubMed
Less detail

Attitudes and beliefs related to the Canadian critical care nutrition practice guidelines: an international survey of critical care physicians and dietitians.

https://arctichealth.org/en/permalink/ahliterature139112
Source
JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34(6):685-96
Publication Type
Article
Author
Naomi E Cahill
Sweta Narasimhan
Rupinder Dhaliwal
Daren K Heyland
Author Affiliation
Kingston General Hospital, Kingston, Ontario, Canada.
Source
JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34(6):685-96
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Canada
Critical Care
Data Collection
Dietetics
Female
Guideline Adherence
Humans
Male
Middle Aged
Nutrition Therapy
Physicians
Practice Guidelines as Topic
United States
Young Adult
Abstract
The objective of this study was to evaluate the attitudes of critical care practitioners toward the Canadian Critical Care Nutrition Clinical Practice Guidelines (CPGs) and compare them with actual practice.
An international Web-based survey was conducted. Respondents were asked to rate their strength of recommendation for 26 nutrition practices included in the Canadian CPGs. Attitudinal results were compared with actual practice on each recommendation.
514 practitioners from 27 countries completed the survey. The majority (91.4%) considered nutrition therapy to be very important for critically ill patients. There was strong endorsement for the following established practices: enteral nutrition (EN) used in preference to parenteral nutrition (PN), use of polymeric solutions and feeding protocols, and avoiding hyperglycemia. There was also strong endorsement for the following practices that are not routinely done in actual practice: EN initiated within 24 to 48 hours of admission, use of motility agents, head-of-bed elevation, use of glutamine and antioxidants, and maximizing EN before starting PN. There was diversity of opinion on the recommendations pertaining to arginine-supplemented diets, small bowel feeding, use of pharmaconutrients, intensive insulin therapy, and withholding soybean oil lipids in PN solutions and hypocaloric PN.
Overall, attitudes toward the Canadian CPGs were positive. However, we identified some areas where there was diversity of opinion, highlighting a need for further research and education. System tools may be a useful strategy to integrate guideline recommendations into practice where there is strong endorsement but the recommendation is not happening in actual practice.
Notes
Comment In: JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34(6):606-721097759
PubMed ID
21097769 View in PubMed
Less detail

The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies.

https://arctichealth.org/en/permalink/ahliterature105874
Source
Nutr Clin Pract. 2014 Feb;29(1):29-43
Publication Type
Article
Date
Feb-2014
Author
Rupinder Dhaliwal
Naomi Cahill
Margot Lemieux
Daren K Heyland
Author Affiliation
Daren K. Heyland, MSc, Department of Public Health Sciences, Queen's University, 76 Stuart St, Kingston, ON K7L 2V7, Canada. Email: dkh2@queensu.ca.
Source
Nutr Clin Pract. 2014 Feb;29(1):29-43
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Canada
Critical Care - methods
Enteral Nutrition - methods
Evidence-Based Medicine
Guideline Adherence
Humans
Nutrition Policy
Practice Guidelines as Topic
Randomized Controlled Trials as Topic
Abstract
Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances, and are designed to minimize practice variation, improve costs, and improve clinical outcomes. The Canadian Critical Care Practice Guidelines (CCPGs) were first published in 2003 and most recently updated in 2013. A total of 68 new randomized controlled trials were identified since the last version in 2009, 50 of them published between 2009 and 2013. The remaining articles were trials published before 2009 but were not identified in previous iterations of the CCPGs. For clinical practice guidelines to be useful to practitioners, they need to be up-to-date and be reflective of the current body of evidence. Herein we describe the process by which the CCPGs were updated. This process resulted in 10 new sections or clinical topics. Of the old clinical topics, 3 recommendations were upgraded, 4 were downgraded, and 27 remained the same. To influence decision making at the bedside, these updated guidelines need to be accompanied by active guideline implementation strategies. Optimal implementation strategies should be guided by local contextual factors including barriers and facilitators to best practice recommendations. Moreover, evaluating and monitoring performance, such as participating in the International Nutrition Survey of practice, should be part of any intensive care unit's performance improvement strategy. The active implementation of the updated CCPGs may lead to better nutrition care and improved patient outcomes in the critical care setting.
PubMed ID
24297678 View in PubMed
Less detail

Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study.

https://arctichealth.org/en/permalink/ahliterature130373
Source
BMC Fam Pract. 2011;12:114
Publication Type
Article
Date
2011
Author
Clare Liddy
Jatinderpreet Singh
William Hogg
Simone Dahrouge
Monica Taljaard
Author Affiliation
CT Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, K1N 5C8, Canada. cliddy@bruyere.org
Source
BMC Fam Pract. 2011;12:114
Date
2011
Language
English
Publication Type
Article
Keywords
Capitation Fee
Cardiovascular Diseases - economics - epidemiology - prevention & control
Community Health Centers - economics - organization & administration - standards
Comorbidity
Cross-Sectional Studies
Evidence-Based Practice - economics - statistics & numerical data
Fee-for-Service Plans
Guideline Adherence - economics - statistics & numerical data
Humans
Medical Audit
Models, Economic
Models, organizational
Ontario - epidemiology
Primary Health Care - classification - economics - standards
Reimbursement Mechanisms - classification - economics - statistics & numerical data
Abstract
Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models.
This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models.
The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69%) than in fee-for-service (45%) practices (Adjusted Odds Ratio (AOR) = 2.4 [95% CI 1.4-4.2], p = 0.001). Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006), and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007). Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices had the greatest gaps in care, most noticeably in diabetes care and weight management.
This study adds to the evidence suggesting that primary care delivery model impacts quality of care. These findings support current Ontario reforms to move away from the traditional fee-for-service practice.
ClinicalTrials.gov: NCT00574808.
Notes
Cites: Health Care Manage Rev. 2004 Apr-Jun;29(2):129-3815192985
Cites: Health Serv Res. 2003 Jun;38(3):831-6512822915
Cites: Diabetes Care. 2004 Oct;27(10):2312-615451893
Cites: Fam Pract. 1989 Sep;6(3):168-722792614
Cites: JAMA. 1991 Oct 23-30;266(16):2268-711920727
Cites: Obes Res. 1998 Sep;6 Suppl 2:51S-209S9813653
Cites: CMAJ. 2005 Apr 12;172(8):995-815824401
Cites: Ann Fam Med. 2005 May-Jun;3 Suppl 1:S12-2015928213
Cites: Fam Med. 2005 Sep;37(8):581-816145629
Cites: Med Care. 2006 Jan;44(1):47-5416365612
Cites: Health Serv Res. 2006 Aug;41(4 Pt 1):1221-4116899004
Cites: J R Soc Med. 2006 Nov;99(11):576-8117082303
Cites: BMC Med Res Methodol. 2006;6:5417092344
Cites: Med Care. 2007 Jun;45(6):480-817515774
Cites: N Engl J Med. 2007 Jun 14;356(24):2496-50417568030
Cites: Tob Control. 2007 Dec;16 Suppl 1:i53-918048633
Cites: Circulation. 2008 Apr 1;117(13):1658-6718362231
Cites: Ann Fam Med. 2009 Jul-Aug;7(4):309-1819597168
Cites: CMAJ. 2009 Nov 10;181(10):668-919805502
Cites: BMC Public Health. 2010;10:15120331861
Cites: Ann Fam Med. 2011 Jan-Feb;9(1):57-6221242562
Cites: Can Fam Physician. 2011 Jun;57(6):e202-721673196
Cites: Implement Sci. 2011;6:11021952084
Cites: Am J Med. 2000 Jun 1;108(8):642-910856412
Cites: BMJ. 2000 Aug 12;321(7258):405-1210938048
Cites: J Health Serv Res Policy. 2001 Jan;6(1):44-5511219360
Cites: Health Policy. 2002 Jun;60(3):201-1811965331
Cites: JAMA. 2003 Jan 22-29;289(4):434-4112533122
Cites: Med Care. 2004 Sep;42(9):829-3915319608
PubMed ID
22008366 View in PubMed
Less detail

Development and psychometric properties of a questionnaire to assess barriers to feeding critically ill patients.

https://arctichealth.org/en/permalink/ahliterature105823
Source
Implement Sci. 2013;8:140
Publication Type
Article
Date
2013
Author
Naomi E Cahill
Andrew G Day
Deborah Cook
Daren K Heyland
Author Affiliation
Department of Public Health Sciences, Queen's University, Carruthers Hall, Kingston, Ontario, Canada. cahilln@kgh.kari.net.
Source
Implement Sci. 2013;8:140
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Canada
Critical Illness
Enteral Nutrition - utilization
Factor Analysis, Statistical
Female
Guideline Adherence
Humans
Intensive Care Units
Male
Medical Staff, Hospital - psychology
Middle Aged
Psychometrics
Questionnaires - standards
United States
Young Adult
Abstract
To successfully implement the recommendations of critical care nutrition guidelines, one potential approach is to identify barriers to providing optimal enteral nutrition (EN) in the intensive care unit (ICU), and then address these barriers systematically. Therefore, the purpose of this study was to develop a questionnaire to assess barriers to enterally feeding critically ill patients and to conduct preliminary validity testing of the new instrument.
The content of the questionnaire was guided by a published conceptual framework, literature review, and consultation with experts. The questionnaire was pre-tested on a convenience sample of 32 critical care practitioners, and then field tested with 186 critical care providers working at 5 hospitals in North America. The revised questionnaire was pilot tested at another ICU (n = 43). Finally, the questionnaire was distributed to a random sample of ICU nurses twice, two weeks apart, to determine test retest reliability (n = 17). Descriptive statistics, exploratory factor analysis, Cronbach alpha, intraclass correlations (ICC), and kappa coefficients were conducted to assess validity and reliability.
We developed a questionnaire with 26 potential barriers to delivery of EN asking respondents to rate their importance as barriers in their ICU. Face and content validity of the questionnaire was established through literature review and expert input. The factor analysis indicated a five-factor solution and accounted for 72% of the variance in barriers: guideline recommendations and implementation strategies, delivery of EN to the patient, critical care provider attitudes and behavior, dietitian support, and ICU resources. Overall, the indices of internal reliability for the derived factor subscales and the overall instrument were acceptable (subscale Cronbach alphas range 0.84 - 0.89). However, the test retest reliability was variable and below acceptable thresholds for the majority of items (ICC's range -0.13 to 0.70). The within group agreement, an indices reflecting the reliability of aggregating individual responses to the ICU level was also variable (ICC's range 0.0 to 0.82).
We developed a questionnaire to identify barriers to enteral feeding in critically ill patients. Additional studies are planned to further revise and evaluate the reliability and validity of the instrument.
PubMed ID
24305039 View in PubMed
Less detail

Factors predicting adherence to the Canadian Clinical Practice Guidelines for nutrition support in mechanically ventilated, critically ill adult patients.

https://arctichealth.org/en/permalink/ahliterature155514
Source
J Crit Care. 2008 Sep;23(3):301-7
Publication Type
Article
Date
Sep-2008
Author
Naomi E Jones
Rupinder Dhaliwal
Andrew G Day
Hélène Ouellette-Kuntz
Daren K Heyland
Author Affiliation
Department of Community Health and Epidemiology, Queen's University, Kingston, ON, Canada.
Source
J Crit Care. 2008 Sep;23(3):301-7
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Critical Illness - therapy
Female
Guideline Adherence - statistics & numerical data
Hospital Bed Capacity - standards - statistics & numerical data
Hospitals, Community - standards - statistics & numerical data
Hospitals, University - standards - statistics & numerical data
Humans
Intensive Care Units - standards - statistics & numerical data
Male
Middle Aged
Nutritional Support - standards
Practice Guidelines as Topic
Prospective Studies
Respiration, Artificial
Sex Factors
Young Adult
Abstract
The aim of this study was to determine factors that are associated with adherence to the Canadian nutrition support clinical practice guidelines (CPGs).
We conducted a secondary analysis of data from a prospective observational cohort study of nutrition support practices in 58 intensive care units (ICUs) across Canada, grouped into 50 clusters. Adequacy of enteral nutrition (EN) (energy received from EN / energy prescribed by the dietitian x 100), was used as a marker of adherence to the guidelines. We applied hierarchical modeling techniques to examine the impact of various hospital, ICU, and patient factors on EN adequacy.
The overall average EN adequacy was 51.3% (SE, 1.8%). In a multiple regression analysis, after adjusting for varying days of observation, hospital type (academic 54.3% vs community 45.2%, P
PubMed ID
18725033 View in PubMed
Less detail

Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study.

https://arctichealth.org/en/permalink/ahliterature118301
Source
Crit Care Med. 2013 Jan;41(1):15-23
Publication Type
Article
Date
Jan-2013
Author
Tasnim Sinuff
John Muscedere
Deborah J Cook
Peter M Dodek
William Anderson
Sean P Keenan
Gordon Wood
Richard Tan
Marilyn T Haupt
Michael Miletin
Redouane Bouali
Xuran Jiang
Andrew G Day
Janet Overvelde
Daren K Heyland
Author Affiliation
Sunnybrook Research Institute, Sunnybrook Health Sciences Center and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. taz.sinuff@sunnybrook.ca
Source
Crit Care Med. 2013 Jan;41(1):15-23
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Canada
Female
Guideline Adherence
Humans
Inservice training
Male
Middle Aged
Outcome Assessment (Health Care)
Pneumonia, Ventilator-Associated - diagnosis - prevention & control - therapy
Practice Guidelines as Topic
Prospective Studies
Translational Medical Research
United States
Abstract
Ventilator-associated pneumonia is an important cause of morbidity and mortality in critically ill patients. Evidence-based clinical practice guidelines for the prevention, diagnosis, and treatment of ventilator-associated pneumonia may improve outcomes, but optimal methods to ensure implementation of guidelines in the intensive care unit are unclear. Hence, we determined the effect of educational sessions augmented with reminders, and led by local opinion leaders, as strategies to implement evidence-based ventilator-associated pneumonia guidelines on guideline concordance and ventilator-associated pneumonia rates.
Two-year prospective, multicenter, time-series study conducted between June 2007 and December 2009.
Eleven ICUs (ten in Canada, one in the United States); five academic and six community ICUs.
At each site, 30 adult patients mechanically ventilated >48 hrs were enrolled during four data collection periods (baseline, 6, 15, and 24 months).
Guideline recommendations for the prevention, diagnosis, and treatment of ventilator-associated pneumonia were implemented using a multifaceted intervention (education, reminders, local opinion leaders, and implementation teams) directed toward the entire multidisciplinary ICU team. Clinician exposure to the intervention was assessed at 6, 15, and 24 months after the introduction of this intervention.
The main outcome measure was aggregate concordance with the 14 ventilator-associated pneumonia guideline recommendations. One thousand three hundred twenty patients were enrolled (330 in each study period). Clinician exposure to the multifaceted intervention was high and increased during the study: 86.7%, 93.3%, 95.8%, (p
Notes
Comment In: Crit Care Med. 2013 Jan;41(1):329-3123269134
PubMed ID
23222254 View in PubMed
Less detail

Implementation of the Canadian Clinical Practice Guidelines for Nutrition Support: a multiple case study of barriers and enablers.

https://arctichealth.org/en/permalink/ahliterature162343
Source
Nutr Clin Pract. 2007 Aug;22(4):449-57
Publication Type
Article
Date
Aug-2007
Author
Naomi E Jones
Jeanette Suurdt
Hélène Ouelette-Kuntz
Daren K Heyland
Author Affiliation
Department of Community Health and Epidemiology, Queen's University, 76 Stuart Street, Kingston, ON, Canada, K7L 2V7.
Source
Nutr Clin Pract. 2007 Aug;22(4):449-57
Date
Aug-2007
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Canada
Case-Control Studies
Clinical Competence
Female
Guideline Adherence
Humans
Intensive Care - methods - psychology - standards
Interviews as Topic
Male
Middle Aged
Nutritional Support - methods - standards
Practice Guidelines as Topic
Abstract
The Canadian Nutrition Support Clinical Practice Guidelines (CPGs), published in 2003, were designed to improve nutrition support practices in intensive care units (ICUs). However, their impact to date has been modest. This study aimed to identify important barriers and enablers to implementation of these guidelines.
Case studies were completed at 4 Canadian ICUs. Semistructured interviews were conducted with 7 key informants at each site. During the interviews, the key informants were asked about their perceptions of the barriers and enablers to implementation of the Canadian Nutrition Support CPGs. Interview transcripts were analyzed qualitatively, using a framework approach.
Resistance to change, lack of awareness, lack of critical care experience, clinical condition of the patient, resource constraints, a slow administrative process, workload, numerous guidelines, complex recommendations, paucity of evidence, and outdated guidelines were cited as the main barriers to guideline implementation. Agreement of the ICU team, easy access to the guidelines, ease of application, incorporation into daily routine, education and training, the dietitian as an opinion leader, and open discussion were identified as the primary enabling factors. Although consistent across all sites, the influence of these factors seemed to differ by site and profession.
Our findings suggest that implementation of the Canadian Nutrition Support CPGs is profoundly complex and is determined by practitioner, patient, institutional, and guideline factors. Further research is required to quantify the impact of each barrier and enabler and the mechanism by which they influence guideline adherence.
PubMed ID
17644700 View in PubMed
Less detail

International survey of emergency physicians' awareness and use of the Canadian Cervical-Spine Rule and the Canadian Computed Tomography Head Rule.

https://arctichealth.org/en/permalink/ahliterature154594
Source
Acad Emerg Med. 2008 Dec;15(12):1256-61
Publication Type
Article
Date
Dec-2008
Author
Debra Eagles
Ian G Stiell
Catherine M Clement
Jamie Brehaut
Monica Taljaard
Anne-Maree Kelly
Suzanne Mason
Arthur Kellermann
Jeffrey J Perry
Author Affiliation
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Source
Acad Emerg Med. 2008 Dec;15(12):1256-61
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Adult
Australasia
Canada
Cervical Vertebrae - injuries
Craniocerebral Trauma - radiography
Decision Support Techniques
Emergency Medicine - statistics & numerical data
Female
Great Britain
Guideline Adherence - statistics & numerical data
Health Care Surveys
Health Knowledge, Attitudes, Practice
Humans
Internationality
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Population Surveillance
Spinal Injuries - radiography
Tomography, X-Ray Computed - standards - utilization
United States
Abstract
The derivation and validation studies for the Canadian Cervical-Spine (C-Spine) Rule (CCR) and the Canadian Computed Tomography (CT) Head Rule (CCHR) have been published in major medical journals. The objectives were to determine: 1) physician awareness and use of these rules in Australasia, Canada, the United Kingdom, and the United States and 2) physician characteristics associated with awareness and use.
A self-administered e-mail and postal survey was sent to members of four national emergency physician (EP) associations using a modified Dillman technique. Results were analyzed using repeated-measures logistic regression models.
The response rate was 54.8% (1,150/2,100). Reported awareness of the CCR ranged from 97% (Canada) to 65% (United States); for the CCHR it ranged from 86% (Canada) to 31% (United States). Reported use of the CCR ranged from 73% (Canada) to 30% (United States); for the CCHR, it was 57% (Canada) to 12% (United States). Predictors of awareness were country, type of rule, full-time employment, younger age, and teaching hospital (p
PubMed ID
18945241 View in PubMed
Less detail
Source
JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34(6):610-5
Publication Type
Article
Author
Daren K Heyland
Naomi E Cahill
Rupinder Dhaliwal
Author Affiliation
Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada. dkh2@queensu.ca
Source
JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34(6):610-5
Language
English
Publication Type
Article
Keywords
Canada
Critical Care - methods - standards
Guideline Adherence
Humans
Intensive Care Units
Nutritional Sciences
Practice Guidelines as Topic
Randomized Controlled Trials as Topic
Abstract
Critical care nutrition guidelines have been developed to help busy practitioners decide how to feed their critically ill patients. However, despite the publication of guidelines and efforts to disseminate and implement them, there are large gaps between what the recommendations say and what is happening at the bedside. Consequently, the nutrition therapy received by many patients remains suboptimal. Knowledge translation is a term increasingly used in healthcare to describe the process of moving evidence learned from clinical research and summarized in clinical practice guidelines to incorporation into clinical and policy decision making. In this article, knowledge about the implementation of critical care nutrition guidelines is applied to Graham et al's knowledge-to-action model to illuminate the issues pertinent to knowledge translation in critical care nutrition. This model has 2 components: knowledge creation and action. The action component consists of 8 phases of the action cycle that represent activities needed to move knowledge into practice and are derived from planned-action theory. Components of this model are illustrated via empirically derived research, commentaries, and published studies from the field of critical care nutrition. It is hoped that this article and related articles in this issue of JPEN will help critical care nutrition practitioners to better understand the often complex and convoluted road of translating knowledge into practice so that as a community we are no longer "lost" but have direction that can bring about positive changes in nutrition practice.
PubMed ID
21097761 View in PubMed
Less detail

16 records – page 1 of 2.