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1.
Curr Opin Immunol ; 71: iii-vi, 2021 08.
Article in English | MEDLINE | ID: covidwho-1788036
2.
J Int AIDS Soc ; 24(12): e25845, 2021 12.
Article in English | MEDLINE | ID: covidwho-1568146

ABSTRACT

INTRODUCTION: In public clinics in Kenya, separate, sequential delivery of the component services of pre-exposure prophylaxis (PrEP) (e.g. HIV testing, counselling, and dispensing) creates long wait times that hinder clients' ability and desire to access and continue PrEP. We conducted a mixed methods study in four public clinics in western Kenya to identify strategies for operationalizing a one-stop shop (OSS) model and evaluate whether this model could improve client wait time and care acceptability among clients and providers without negatively impacting uptake or continuation. METHODS: From January 2020 through November 2020, we collected and analysed 47 time-and-motion observations using Mann-Whitney U tests, 29 provider and client interviews, 68 technical assistance reports, and clinic flow maps from intervention clinics. We used controlled interrupted time series (cITS) to compare trends in PrEP initiation and on-time returns from a 12-month pre-intervention period (January-December 2019) to an 8-month post-period (January-November 2020, excluding a 3-month COVID-19 wash-out period) at intervention and control clinics. RESULTS: From the pre- to post-period, median client wait time at intervention clinics dropped significantly from 31 to 6 minutes (p = 0.02), while median provider contact time remained around 23 minutes (p = 0.4). Intervention clinics achieved efficiency gains by moving PrEP delivery to lower volume departments, moving steps closer together (e.g. relocating supplies; cross-training and task-shifting), and differentiating clients based on the subset of services needed. Clients and providers found the OSS model highly acceptable and additionally identified increased privacy, reduced stigma, and higher quality client-provider interactions as benefits of the model. From the pre- to post-period, average monthly initiations at intervention and control clinics increased by 6 and 2.3, respectively, and percent of expected follow-up visits occurring on time decreased by 18% and 26%, respectively; cITS analysis of PrEP initiations (n = 1227) and follow-up visits (n = 2696) revealed no significant difference between intervention and control clinics in terms of trends in PrEP initiation and on-time returns (all p>0.05). CONCLUSIONS: An OSS model significantly improved client wait time and care acceptability without negatively impacting initiations or continuations, thus highlighting opportunities to improve the efficiency of PrEP delivery efficiency and client-centredness.


Subject(s)
COVID-19 , HIV Infections , Pre-Exposure Prophylaxis , HIV Infections/prevention & control , Humans , Implementation Science , Kenya , SARS-CoV-2
3.
Pan Afr Med J ; 40: 51, 2021.
Article in English | MEDLINE | ID: covidwho-1547785

ABSTRACT

Implementing health-system strengthening policies remains a challenge in Africa. Past successes, predictable but unanticipated flaws, underutilization of health services, traditional medicine, global inequity and poor practice by local stakeholders are some of the reasons many African countries have made little progress towards attaining global health goals. As a result, Africa has the highest disease burden despite multiple efforts from the global health community. These raise the question: what has to change so that health systems strengthening efforts in Africa are successful?


Subject(s)
Delivery of Health Care/organization & administration , Global Health , Health Policy , Africa , Health Services Misuse , Humans , Implementation Science
4.
J Gen Intern Med ; 36(11): 3503-3510, 2021 11.
Article in English | MEDLINE | ID: covidwho-1525591

ABSTRACT

Health services made many changes quickly in response to the SARS-CoV-2 pandemic. Many more are being made. Some changes were already evaluated, and there are rigorous research methods and frameworks for evaluating their local implementation and effectiveness. But how useful are these methods for evaluating changes where evidence of effectiveness is uncertain, or which need adaptation in a rapidly changing situation? Has implementation science provided implementers with tools for effective implementation of changes that need to be made quickly in response to the demands of the pandemic? This perspectives article describes how parts of the research and practitioner communities can use and develop a combination of implementation and improvement to enable faster and more effective change in the future, especially where evidence of local effectiveness is limited. We draw on previous reviews about the advantages and disadvantages of combining these two domains of knowledge and practice. We describe a generic digitally assisted rapid cycle testing (DA-RCT) approach that combines elements of each in order to better describe a change, monitor outcomes, and make adjustments to the change when implemented in a dynamic environment.


Subject(s)
COVID-19 , Implementation Science , Humans , Pandemics , SARS-CoV-2
5.
Int J Environ Res Public Health ; 18(21)2021 10 21.
Article in English | MEDLINE | ID: covidwho-1512278

ABSTRACT

Total Worker Health® (TWH), an initiative of the U.S. National Institute for Occupational Safety and Health, is defined as policies, programs, and practices that integrate protection from work-related health and safety hazards by promoting efforts that advance worker well-being. Interventions that apply the TWH paradigm improve workplace health more rapidly than wellness programs alone. Evidence of the barriers and facilitators to the adoption, implementation, and long-term maintenance of TWH programs is limited. Dissemination and implementation (D&I) science, the study of methods and strategies for bridging the gap between public health research and practice, can help address these system-, setting-, and worker-level factors to increase the uptake, impact, and sustainment of TWH activities. The purpose of this paper is to draw upon a synthesis of existing D&I science literature to provide TWH researchers and practitioners with: (1) an overview of D&I science; (2) a plain language explanation of key concepts in D&I science; (3) a case study example of moving a TWH intervention down the research-to-practice pipeline; and (4) a discussion of future opportunities for conducting D&I science in complex and dynamic workplace settings to increase worker safety, health, and well-being.


Subject(s)
Occupational Health , Health Promotion , Implementation Science , Public Health , Workplace
7.
8.
PLoS Med ; 18(9): e1003762, 2021 09.
Article in English | MEDLINE | ID: covidwho-1470655

ABSTRACT

Beryne Odeny discusses strategies to improve equity in health care and health research.


Subject(s)
Health Equity , Humans , Implementation Science
9.
J Med Internet Res ; 23(9): e26623, 2021 09 22.
Article in English | MEDLINE | ID: covidwho-1443943

ABSTRACT

BACKGROUND: Prior studies have shown that virtual reality (VR) is an efficacious treatment modality for opioid-sparing pain management. However, the majority of these studies were conducted among primarily White, relatively advantaged populations and in well-resourced settings. OBJECTIVE: We conducted a qualitative, theory-informed implementation science study to assess the readiness for VR in safety-net settings. METHODS: Using the theoretical lens of the Consolidated Framework for Implementation Research (CFIR) framework, we conducted semistructured interviews with current VR users and nonusers based in safety-net health systems (n=15). We investigated barriers and facilitators to a commercially available, previously validated VR technology platform AppliedVR (Los Angeles, CA, USA). We used deductive qualitative analysis using the overarching domains of the CFIR framework and performed open, inductive coding to identify specific themes within each domain. RESULTS: Interviewees deemed the VR intervention to be useful, scalable, and an appealing alternative to existing pain management approaches. Both users and nonusers identified a lack of reimbursement for VR as a significant challenge for adoption. Current users cited positive patient feedback, but safety-net stakeholders voiced concern that existing VR content may not be relevant or appealing to diverse patients. All respondents acknowledged the challenge of integrating and maintaining VR in current pain management workflows across a range of clinical settings, and this adoption challenge was particularly acute, given resource and staffing constraints in safety-net settings. CONCLUSIONS: VR for pain management holds interest for frontline pain management clinicians and leadership in safety-net health settings but will require significant tailoring and adaption to address the needs of diverse populations. Integration into complex workflows for pain management is a significant barrier to adoption, and participants cited structural cost and reimbursement concerns as impediments to initial implementation and scaling of VR use.


Subject(s)
Virtual Reality , Analgesics, Opioid , Humans , Implementation Science , Pain Management
10.
Stroke ; 52(11): 3739-3747, 2021 11.
Article in English | MEDLINE | ID: covidwho-1443690

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has presented unique challenges to stroke care and research internationally. In particular, clinical trials in stroke are vulnerable to the impacts of the pandemic at multiple stages, including design, recruitment, intervention, follow-up, and interpretation of outcomes. A carefully considered approach is required to ensure the appropriate conduct of stroke trials during the pandemic and to maintain patient and participant safety. This has been recently addressed by the International Council for Harmonisation which, in November 2019, released an addendum to the Statistical Principles for Clinical Trials guidelines entitled Estimands and Sensitivity Analysis in Clinical Trials. In this article, we present the International Council for Harmonisation estimand framework for the design and conduct of clinical trials, with a specific focus on its application to stroke clinical trials. This framework aims to align the clinical and scientific objectives of a trial with its design and end points. It also encourages the prospective consideration of potential postrandomization intercurrent events which may occur during a trial and either impact the ability to measure an end point or its interpretation. We describe the different categories of such events and the proposed strategies for dealing with them, specifically focusing on the COVID-19 pandemic as a source of intercurrent events. We also describe potential practical impacts posed by the COVID-19 pandemic on trials, health systems, study groups, and participants, all of which should be carefully reviewed by investigators to ensure an adequate practical and statistical strategy is in place to protect trial integrity. We provide examples of the implementation of the estimand framework within hypothetical stroke trials in intracerebral hemorrhage and stroke recovery. While the focus of this article is on COVID-19 impacts, the strategies and principles proposed are well suited for other potential events or issues, which may impact clinical trials in the field of stroke.


Subject(s)
COVID-19 , Clinical Trials as Topic/methods , Data Interpretation, Statistical , Research Design , Stroke/therapy , Clinical Trials as Topic/standards , Guidelines as Topic , Humans , Implementation Science , SARS-CoV-2
11.
Ann Biol Clin (Paris) ; 79(4): 325-330, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1412311

ABSTRACT

Health care workers (HCWs) are at major risk to be infected by SARS-CoV-2 and transmit the virus to the patients. Furthermore, travels are a major factor in the diffusion of the virus. We report our experience regarding the screening of asymptomatic HCWs returning from holidays, following the issue of a national guideline on 08/20/2020. The organization of the occupational health department and the clinical laboratory was adapted in order to start the screening on August, 24, 2020. All HCWs tested for SARS-CoV-2 the week before and 4 weeks after the implementation of the screening were included. The mean number of tests was analyzed per working day and working week. Overall, 502 (31.4%) HCWs were tested for SARS-CoV-2 during the study period. The mean number of HCWs tested per working day was 27.1. HCWs accounted for 36.9% (n = 167) and 11.2% (n = 84) of the tests performed in the 1st and the 4th week following the implementation of the guidelines. The number of tests performed each week in HCWs increased by at least 20-fold after the implementation of the guidelines. No asymptomatic HCW was tested positive. Screening of asymptomatic HCWs was poorly effective in the context of low circulation of the virus. We suggest giving priority to infection prevention and control measures and screening of symptomatic subjects and asymptomatic contacts.


Subject(s)
COVID-19 Testing , COVID-19/diagnosis , Health Personnel , Asymptomatic Infections , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing/methods , COVID-19 Testing/standards , Cross Infection/prevention & control , France/epidemiology , Guideline Adherence/organization & administration , Guideline Adherence/standards , Guideline Adherence/statistics & numerical data , Health Personnel/statistics & numerical data , Hospitals, General , Humans , Implementation Science , Infection Control/methods , Infection Control/organization & administration , Infection Control/standards , Mass Screening/methods , Mass Screening/organization & administration , Mass Screening/standards , Occupational Health Services/organization & administration , Occupational Health Services/standards , Occupational Health Services/statistics & numerical data , Return to Work/statistics & numerical data , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification
12.
J Gen Intern Med ; 36(11): 3503-3510, 2021 11.
Article in English | MEDLINE | ID: covidwho-1397044

ABSTRACT

Health services made many changes quickly in response to the SARS-CoV-2 pandemic. Many more are being made. Some changes were already evaluated, and there are rigorous research methods and frameworks for evaluating their local implementation and effectiveness. But how useful are these methods for evaluating changes where evidence of effectiveness is uncertain, or which need adaptation in a rapidly changing situation? Has implementation science provided implementers with tools for effective implementation of changes that need to be made quickly in response to the demands of the pandemic? This perspectives article describes how parts of the research and practitioner communities can use and develop a combination of implementation and improvement to enable faster and more effective change in the future, especially where evidence of local effectiveness is limited. We draw on previous reviews about the advantages and disadvantages of combining these two domains of knowledge and practice. We describe a generic digitally assisted rapid cycle testing (DA-RCT) approach that combines elements of each in order to better describe a change, monitor outcomes, and make adjustments to the change when implemented in a dynamic environment.


Subject(s)
COVID-19 , Implementation Science , Humans , Pandemics , SARS-CoV-2
13.
Am Heart J ; 241: 83-86, 2021 11.
Article in English | MEDLINE | ID: covidwho-1384824

ABSTRACT

SARS-CoV-2 infection has been associated with cardiovascular disease in children, but which children need cardiac evaluation is unclear. We describe our experience evaluating 206 children for cardiac disease following SARS-CoV-2 infection (one of whom had ventricular ectopy) and propose a new guideline for management of these children. Routine cardiac screening after SARS-CoV-2 infection in children without any cardiac signs or symptoms does not appear to be high yield.


Subject(s)
Aftercare , COVID-19/physiopathology , Heart Diseases/diagnosis , Referral and Consultation , Adolescent , Ambulatory Care , Atrioventricular Block/diagnosis , Atrioventricular Block/etiology , Atrioventricular Block/physiopathology , Bradycardia/diagnosis , Bradycardia/etiology , Bradycardia/physiopathology , COVID-19/complications , Cardiology , Chest Pain/physiopathology , Child , Child, Preschool , Dyspnea/physiopathology , Echocardiography , Electrocardiography , Fatigue/physiopathology , Female , Heart Diseases/etiology , Heart Diseases/physiopathology , Humans , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/physiopathology , Hypertrophy, Right Ventricular/diagnosis , Hypertrophy, Right Ventricular/etiology , Hypertrophy, Right Ventricular/physiopathology , Implementation Science , Male , Pediatrics , Practice Guidelines as Topic , SARS-CoV-2 , Severity of Illness Index , Syncope/physiopathology , Ventricular Premature Complexes/diagnosis , Ventricular Premature Complexes/etiology , Ventricular Premature Complexes/physiopathology , Young Adult
14.
BMJ Open Qual ; 10(Suppl 1)2021 07.
Article in English | MEDLINE | ID: covidwho-1341330

ABSTRACT

BACKGROUND: Inadequate quality of care has been identified as one of the most significant challenges to achieving universal health coverage in low-income and middle-income countries. To address this WHO-SEARO, the point of care quality improvement (POCQI) method has been developed. This paper describes developing a dynamic framework for the implementation of POCQI across India from 2015 to 2020. METHODS: A total of 10 intervention strategies were designed as per the needs of the local health settings. These strategies were implemented across 10 states of India, using a modification of the 'translating research in practice' framework. Healthcare professionals and administrators were trained in POCQI using a combination of onsite and online training methods followed by coaching and mentoring support. The implementation strategy changed to a fully digital community of practice platform during the active phase of the COVID-19 pandemic. Dashboard process, outcome indicators and crude cost of implementation were collected and analysed across the implementation sites. RESULTS: Three implementation frameworks were evolved over the study period. The combined population benefitting from these interventions was 103 million. A pool of QI teams from 131 facilities successfully undertook 165 QI projects supported by a pool of 240 mentors over the study period. A total of 21 QI resources and 6 publications in peer-reviewed journals were also developed. The average cost of implementing POCQI initiatives for a target population of one million was US$ 3219. A total of 100 online activities were conducted over 6 months by the digital community of practice. The framework has recently extended digitally across the South-East Asian region. CONCLUSION: The development of an implementation framework for POCQI is an essential requirement for the initiative's successful country-wide scale. The implementation plan should be flexible to the healthcare system's needs, target population and the implementing agency's capacity and amenable to multiple iterative changes.


Subject(s)
Delivery of Health Care/standards , Patient Care/standards , Point-of-Care Systems , Quality Improvement , Quality of Health Care , COVID-19 , Health Facilities , Health Personnel , Humans , Implementation Science , India , Pandemics
15.
Genome Med ; 13(1): 121, 2021 07 28.
Article in English | MEDLINE | ID: covidwho-1331954

ABSTRACT

BACKGROUND: Pathogen whole genome sequencing (WGS) is being incorporated into public health surveillance and disease control systems worldwide and has the potential to make significant contributions to infectious disease surveillance, outbreak investigation and infection prevention and control. However, to date, there are limited data regarding (i) the optimal models for integration of genomic data into epidemiological investigations and (ii) how to quantify and evaluate public health impacts resulting from genomic epidemiological investigations. METHODS: We developed the Pathogen Genomics in Public HeAlth Surveillance Evaluation (PG-PHASE) Framework to guide examination of the use of WGS in public health surveillance and disease control. We illustrate the use of this framework with three pathogens as case studies: Listeria monocytogenes, Mycobacterium tuberculosis and SARS-CoV-2. RESULTS: The framework utilises an adaptable whole-of-system approach towards understanding how interconnected elements in the public health application of pathogen genomics contribute to public health processes and outcomes. The three phases of the PG-PHASE Framework are designed to support understanding of WGS laboratory processes, analysis, reporting and data sharing, and how genomic data are utilised in public health practice across all stages, from the decision to send an isolate or sample for sequencing to the use of sequence data in public health surveillance, investigation and decision-making. Importantly, the phases can be used separately or in conjunction, depending on the need of the evaluator. Subsequent to conducting evaluation underpinned by the framework, avenues may be developed for strategic investment or interventions to improve utilisation of whole genome sequencing. CONCLUSIONS: Comprehensive evaluation is critical to support health departments, public health laboratories and other stakeholders to successfully incorporate microbial genomics into public health practice. The PG-PHASE Framework aims to assist public health laboratories, health departments and authorities who are either considering transitioning to whole genome sequencing or intending to assess the integration of WGS in public health practice, including the capacity to detect and respond to outbreaks and associated costs, challenges and facilitators in the utilisation of microbial genomics and public health impacts.


Subject(s)
Implementation Science , Infections/diagnosis , Listeria monocytogenes/isolation & purification , Mycobacterium tuberculosis/isolation & purification , SARS-CoV-2/isolation & purification , Whole Genome Sequencing/methods , Genome, Bacterial , Genome, Viral , Humans , Infections/epidemiology , Listeria monocytogenes/genetics , Mycobacterium tuberculosis/genetics , Population Surveillance , Public Health , SARS-CoV-2/genetics
18.
OTJR (Thorofare N J) ; 41(3): 206-215, 2021 07.
Article in English | MEDLINE | ID: covidwho-1277881

ABSTRACT

Occupational therapy practitioners often adapt evidence-based interventions for implementation into practice, yet these adaptations are seldom captured systematically. The purpose of this study was to apply the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to describe adaptations to one intervention modified for teletherapy in the wake of COVID-19. An embedded multiple case study design was used to track adaptations made to a vestibular and bilateral integration (VBI) protocol-traditionally delivered in-person-that was implemented via teletherapy in a pediatric outpatient clinic. The "Modification and Adaptation Checklist" was used to track protocol adaptations. Data were examined through descriptive analyses; 63 adaptations were made to the VBI protocol. The most frequently noted adaptation was "Repeating protocol activities," whereas the "Integrating another treatment approach with the VBI protocol" was the least common adaptation. The FRAME may be useful for tracking adaptations and evaluating how adaptations influence intervention effectiveness.


Subject(s)
COVID-19 , Implementation Science , Occupational Therapy/methods , Telemedicine/methods , /methods , Humans , SARS-CoV-2
19.
Geriatr Nurs ; 42(4): 863-868, 2021.
Article in English | MEDLINE | ID: covidwho-1252920

ABSTRACT

Proctor's Framework for Implementation Research describes the role of implementation strategies and outcomes in the pathway from evidence-based interventions to service and client outcomes. This report describes the evaluation of a learning collaborative to implement a transitional care intervention in skilled nursing facilities (SNF). The collaborative protocol included implementation strategies to promote uptake of a transitional care intervention in SNFs. Using RE-AIM to evaluate outcomes, the main findings were intervention reach to 550 SNF patients, adoption in three of four SNFs that expressed interest in participation, and high fidelity to the implementation strategies. Fidelity to the transitional care intervention was moderate to high; SNF staff provided the five key components of the transitional care intervention for 64-93% of eligible patients. The evaluation was completed during the COVID-19 pandemic, which suggests the protocol was valued by staff and feasible to use amid serious internal and external challenges.


Subject(s)
COVID-19 , Quality Improvement , Skilled Nursing Facilities/organization & administration , Transitional Care/organization & administration , Aged, 80 and over , Delivery of Health Care/organization & administration , Humans , Implementation Science , Interprofessional Relations , Pandemics , Prospective Studies , SARS-CoV-2
20.
Acad Med ; 96(12): 1690-1695, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1226570

ABSTRACT

PROBLEM: Value-added medical education (VAME) has been difficult to implement due to student and educator constraints. The COVID-19 pandemic caused mass transitions to online learning, removed students from clinical settings, and underscored students' desires for meaningful VAME opportunities. The authors introduced the Stanford Frontline COVID-19 Consult Service (SFCS), through which off-service medical and physician assistant (PA) students provided assistance to clinicians in the form of rapid research regarding COVID-19 clinical questions. APPROACH: The SFCS, a student-derived VAME initiative, was implemented from March to May 2020 by Stanford University medical students, PA students, and faculty. SFCS aligned with not only the interests of clinicians and students but also national accreditation standards. Students attended weekly editorial meetings, didactic sessions on literature reviews and information management, and they underwent rigorous training on the peer review process. After 2 months, the authors expanded the service to local community clinicians. OUTCOMES: The SFCS enrolled 16 students, was supported by 13 faculty members, and produced 87 peer-reviewed evidence syntheses. Of the 16 SFCS students, 13 (81%) completed evaluations; of 128 Stanford Primary Care and Population Health clinicians, 48 (38%) completed evaluations. Overall student satisfaction with the SFCS was 4.9/5 (standard deviation [SD] 0.3). Self-assessed achievement of SFCS learning objectives exceeded 90% for all objectives. Overall faculty satisfaction with the SFCS was 4.4/5 (SD 0.8). Most faculty (40/46 [87%]) planned to use the database to answer future COVID-19 questions. NEXT STEPS: The SFCS is a novel, student-initiated VAME curriculum focused on increasing students' meaningful contributions to patient care. The authors will track SFCS students throughout their clerkships to gauge clerkship performance/preparedness, and they will develop training for integrating VAME into preclerkship curricula at other institutions. Given its adaptive, student-driven design, the VAME framework used to develop the SFCS empowers students to create their own personalized, experiential learning.


Subject(s)
COVID-19 , Education, Medical/methods , Problem-Based Learning/methods , Referral and Consultation , Students, Medical/psychology , Curriculum , Humans , Implementation Science , Program Evaluation , SARS-CoV-2
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