Using knowledge brokering activities to promote allied health clinicians' engagement in research: a qualitative exploration.

INTRODUCTION: Engaging clinicians in research can improve healthcare organisational performance, patient and staff satisfaction. Emerging evidence suggests that knowledge brokering activities potentially support clinicians' research engagement, but it is unclear how best they should be used. OBJECTIVES: This study explores how embedded researchers utilised knowledge brokering activities to engage research interested clinicians in research. DESIGN: A longitudinal qualitative interview based study was co-designed to investigate how experienced research fellows utilise knowledge brokering activities to facilitate allied health clinicians' engagement in research. SETTING: In one large tertiary level, regional Australian health service, research fellows were matched with research interested clinicians. METHODS: Qualitative analysis of three longitudinal semi-structured interviews for each research fellow was undertaken. Initial descriptions of their utilisation of knowledge brokering activities were deductively coded. Reflexive thematic analysis was utilised to generate a shared explanation of clinicians' engagement in research. RESULTS: Three research fellows facilitated 21 clinicians' participation in and leadership of clinical research projects over 12 months. They utilised all ten key knowledge brokering activities with each clinician, with differing patterns and examples. Research fellows described using linkage and exchange activities of communicating and collaborating with key stakeholders, and they tailored knowledge management products for individual's engagement. Further, they described a broader learning journey where they clarified and monitored individuals' capabilities, motivation and their contextual support for research engagement. CONCLUSION: When research fellows chose and tailored knowledge brokering activities to align and extend clinicians' research capabilities and motivation, they created individualised learning curriculums to support clinicians' participation in and leadership of local research projects. Health and academic leaders should consider structuring embedded researcher positions to include knowledge brokering roles and activities, specifically for research interested clinicians who are ready to participate in and lead research projects.

Play or hard work: unpacking well-being at preschool.

Well-being or quality of life is thought to give a more accurate picture of the impact a condition has on day-to-day functioning than traditional outcome measures. This study sought to examine the relationship between engagement in play and well-being for preschool children with and without developmental coordination disorder (DCD). A quasi-experimental design was used with two independent groups of preschool children aged 4-6 years with (n=32) and without (n=31) probable DCD. Play skills were assessed using the Play Observation Scale based on 30min of videotape of free-play at preschool. Well-being was assessed using a parent-proxy version of the Revised Children Quality of Life Questionnaire (KINDL(R)). Spearman rho correlations were performed to examine the relationship between play and well-being. Well-being at preschool was significantly lower for the children in the DCD group however overall well-being was not significantly different. Engagement in type of social play (solitary, parallel or group) was found to predict well-being for the typically developing children. For the children with DCD, engagement in group play was not associated with well-being. An explanation for this difference may be that children with DCD may not experience free-play at preschool as "play" but rather as hard work. Further research is needed to determine why children with DCD experience lower well-being at preschool than their peers and to investigate children's perceptions of free-play. This may enable teachers and therapists to better support children with DCD in the preschool environment.

Evidence for non-communicable diseases: analysis of Cochrane reviews and randomised trials by World Bank classification.

INTRODUCTION: Prevalence of non-communicable diseases (NCDs) is increasing globally, with the greatest projected increases in low-income and middle-income countries. We sought to quantify the proportion of Cochrane evidence relating to NCDs derived from such countries. METHODS: We searched the Cochrane database of systematic reviews for reviews relating to NCDs highlighted in the WHO NCD action plan (cardiovascular, cancers, diabetes and chronic respiratory diseases). We excluded reviews at the protocol stage and those that were repeated or had been withdrawn. For each review, two independent researchers extracted data relating to the country of the corresponding author and the number of trials and participants from countries, using the World Bank classification of gross national income per capita. RESULTS: 797 reviews were analysed, with a reported total number of 12 340 trials and 10 937 306 participants. Of the corresponding authors 90% were from high-income countries (41% from the UK). Of the 746 reviews in which at least one trial had met the inclusion criteria, only 55% provided a summary of the country of included trials. Analysis of the 633 reviews in which country of trials could be established revealed that almost 90% of trials and over 80% of participants were from high-income countries. 438 (5%) trials including 1 145 013 (11.7%) participants were undertaken in low-middle income countries. We found that only 13 (0.15%) trials with 982 (0.01%) participants were undertaken in low-income countries. Other than the five Cochrane NCD corresponding authors from South Africa, only one other corresponding author was from Africa (Gambia). DISCUSSION: The overwhelming body of evidence for NCDs pertains to high-income countries, with only a small number of review authors based in low-income settings. As a consequence, there is an urgent need for research infrastructure and funding for the undertaking of high-quality trials in this area.

Aggressive interactions during free-play at preschool of children with and without developmental coordination disorder.

This aim of this study was to investigate an unexpected finding from a larger study examining the play of preschool children with and without developmental coordination disorder (DCD). We found that children with DCD were more frequently involved in aggressive incidents during free-play than their peers. Children with (n=32) and without DCD (n=31) were videotaped during free-play at preschool and their play was assessed using the Play Observation Scale. A post hoc analysis was conducted using a specifically developed rating instrument to examine the aggressive incidents captured on video. Videos from 18 children with DCD and 8 typically developing children without DCD were found to contain aggressive incidents. Children with DCD were significantly more often involved as both aggressor (p=.016) and victim (p=.008) than children without DCD (p=.031). This is the first study to identify victimization and aggression as being problematic for children with DCD as young as 4 years of age and needs replication. Given the negative consequences of involvement in aggression and victimization, play-based early intervention focusing on prevention needs to be developed and implemented.

The impact of hydration changes in fresh bio-tissue on THz spectroscopic measurements.

We present a study of how residual hydration in fresh rat tissue samples can vastly alter their extracted terahertz (THz) optical properties and influence their health assessment. Fresh (as opposed to preserved) tissue most closely mimics in vivo conditions, but high water content creates many challenges for tissue handling and THz measurement. Our THz measurements of fresh tissue over time highlight the effect of tissue hydration on tissue texture and dimension, the latter directly influencing the accuracy of calculated optical properties. We then introduce lyophilization (freeze drying) as a viable solution for overcoming hydration and freshness problems. Lyophilization removes large amounts of water while retaining sample freshness. In addition, lyophilized tissue samples are easy to handle and their textures and dimensions do not vary over time, allowing for consistent and stable THz measurements. A comparison of lyophilized and fresh tissue shows for the first time that freeze drying may be one way of overcoming tissue hydration issues while preserving tissue cellular structure. Finally, we compare THz measurements from fresh tissue against necrotic tissue to verify freshness over time. Indeed, THz measurements from fresh and necrotic tissues show marked differences.

Enhanced T-ray signal classification using wavelet preprocessing.

This study demonstrates the application of one-dimensional discrete wavelet transforms in the classification of T-ray pulsed signals. Fast Fourier transforms (FFTs) are used as a feature extraction tool and a Mahalanobis distance classifier is employed for classification. Soft threshold wavelet shrinkage de-noising is used and plays an important role in de-noising and reconstruction of T-ray pulsed signals. An iterative algorithm is applied to obtain three optimal frequency components and to achieve preferred classification performance.

Advising patients to increase fluid intake for treating acute respiratory infections.

BACKGROUND: Acute respiratory infection is a common reason for people to present for medical care. Advice to increase fluid intake is a frequent treatment recommendation. Attributed benefits of fluids include replacing increased insensible fluid losses, correcting dehydration from reduced intake and reducing the viscosity of mucus. However, there are theoretical reasons for increased fluid intake to cause harm. Anti-diuretic hormone secretion is increased in lower respiratory tract infections of various aetiologies. This systematic examination of the evidence sought to determine the benefit versus harm from increasing fluid intake. OBJECTIVES: To answer the following questions. (1) Does recommending increased fluid intake as a treatment for acute respiratory infections improve duration and severity of symptoms? (2) Are there adverse effects from recommending increased fluids in people with acute respiratory infections? (3) Are any benefits or harms related to site of infection (upper or lower respiratory tract) or a different severity of illness? SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to July Week 1, 2005), EMBASE (1974 to Week 29, 2005), Current Contents (current 5 years) and CINAHL (1982 to July week 3 2005). Reference lists of articles identified were searched, and experts in the relevant disciplines were contacted. SELECTION CRITERIA: Randomised controlled trials (RCTs) that examined the effect of increasing fluid intake in people with acute respiratory infections. DATA COLLECTION AND ANALYSIS: Each author assessed the identified studies to determine eligibility for inclusion. MAIN RESULTS: No RCTs assessing the effect of increasing fluid intake in acute respiratory infections were found. AUTHORS' CONCLUSIONS: There is currently no evidence for or against the recommendation to increase fluids in acute respiratory infections. The implications for fluid management in acute respiratory infections have not been studied in any RCTs to date. Some non-experimental (observational) studies report that increasing fluid intake in acute respiratory infections may cause harm. RCTs need to be done to determine the true effect of this very common medical advice.

The organisational context for teamwork: comparing health care and business literature.

Teams are a significant tool for promoting and managing change. There are shared definitions of teamwork in the literature, and agreement on general benefits and limitations of working in teams. However, the historical development of teamwork differs between health care and the business environments of manufacturing and service industries. The impact of the organisational context on teamwork appears to differ most, when literature from the two environments is compared. As a result, there are specific issues that are unique to the development and implementation of health care teams. This article summarises the unique team structures and the issue of professionalization in health care teams, while recommending that team members acknowledge their professional differences and focus foremost on meeting patient needs.

Characteristics of effective teams: a literature review.

Effective healthcare teams often elude consistent definition because of the complexity of teamwork. Systems theory offers a dynamic view of teamwork, in which input conditions are transformed via optimum throughput processes into maximal output. This article describes eighteen characteristics of effective teams across input conditions and teamwork processes, which have been identified from the literature.