An international experience of electronic communication and implementation of eHealth solutions in a vascular surgery clinic.

INTRODUCTION: Communication is key to any successful relationship with the patient-physician partnership being no different. Recent advances in technology have provided us with an array of new communication tools such as the mobile phone, computer, internet, and email. This new technology has revolutionized communications; however, limitations to their widespread use include access, literacy, and willingness for both the physician and patient to change. METHODS: To gather international data, questionnaires were completed by patients attending vascular surgery outpatient clinics in hospitals in Ireland and Canada. RESULTS: Five hundred ninety-seven patients participated in the study. Of the participants, 83.2% were over 50 years old. The mean age was 63.1 years, with a range of 18-95 years. Overall, home phone call was the most preferred method of communication with 41.0% of patients selecting this option. Of the patients, 82.4% had a mobile phone but just 48.5% use text message. In those over the age of 70, 72.1% use a mobile phone and just 25.3% use text message. Of the participants, 64.1% had access to a computer, and 67.2% had access to the internet with a decline in the usage of both with increasing age. DISCUSSION: Within this patient population, the use of technologies decreases with increasing age of the patients. This demonstrates a large population of service users who are contented with conventional methods of communication. Change within healthcare ICT is inevitable, and therefore, these patients need to be guided and educated to allow a smooth transition from the old to the new.

Sustainability of knowledge translation interventions in healthcare decision-making: a scoping review.

BACKGROUND: Knowledge translation (KT, also known as research utilization, and sometimes referring to implementation science) is a dynamic and iterative process that includes the synthesis, dissemination, exchange, and ethically sound application of knowledge to improve health. A KT intervention is one which facilitates the uptake of research. The long-term sustainability of KT interventions is unclear. We aimed to characterize KT interventions to manage chronic diseases that have been used for healthcare outcomes beyond 1 year or beyond the termination of initial grant funding. METHODS: We conducted a scoping review by searching MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Campbell from inception until February 2013. We included experimental, quasi-experimental, and observational studies providing information on the sustainability of KT interventions for managing chronic diseases in adults and focusing on end-users including patients, clinicians, public health officials, health service managers, and policy-makers. Articles were screened and abstracted by two reviewers, independently. The data were charted and results described narratively. RESULTS: We included 62 studies reported in 103 publications (total 260,688 patients) plus 41 companion reports after screening 12,328 titles and abstracts and 464 full-text articles. More than half of the studies were randomized controlled trials (RCTs). The duration of the KT intervention ranged from 61 to 522 weeks. Nine chronic conditions were examined across the studies, such as diabetes (34 %), cardiovascular disease (28 %), and hypertension (16 %). Thirteen KT interventions were reported across the studies. Patient education was the most commonly examined (20 %), followed by self-management (17 %). Most studies (61 %) focused on patient-level outcomes (e.g. disease severity), while 31 % included system-level outcomes (e.g. number of eye examinations), and 8 % used both. The interventions were aimed at the patient (58 %), health system (28 %), and healthcare personnel (14 %) levels. CONCLUSIONS: We found few studies focusing on the sustainability of KT interventions. Most of the included studies focused on patient-level outcomes and patient-level KT interventions. A future systematic review can be conducted of the RCTs to examine the impact of sustainable KT interventions on health outcomes.

The effectiveness of knowledge translation interventions for promoting evidence-informed decision-making among nurses in tertiary care: a systematic review and meta-analysis.

BACKGROUND: Nurses are increasingly expected to engage in evidence-informed decision-making (EIDM) to improve client and system outcomes. Despite an improved awareness about EIDM, there is a lack of use of research evidence and understanding about the effectiveness of interventions to promote EIDM. This project aimed to discover if knowledge translation (KT) interventions directed to nurses in tertiary care are effective for improving EIDM knowledge, skills, behaviours, and, as a result, client outcomes. It also sought to understand contextual factors that affect the impact of such interventions. METHODS: A systematic review funded by the Canadian Institutes of Health Research (PROSPERO registration: CRD42013003319) was conducted. Included studies examined the implementation of any KT intervention involving nurses in tertiary care to promote EIDM knowledge, skills, behaviours, and client outcomes or studies that examined contextual factors. Study designs included systematic reviews, quantitative, qualitative, and mixed method studies. The search included electronic databases and manual searching of published and unpublished literature to November 2012; key databases included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica (EMBASE). Two reviewers independently performed study selection, risk of bias assessment, and data extraction. Studies with quantitative data determined to be clinically homogeneous were synthesized using meta-analytic methods. Studies with quantitative data not appropriate for meta-analysis were synthesized narratively by outcome. Studies with qualitative data were synthesized by theme. RESULTS: Of the 44,648 citations screened, 30 citations met the inclusion criteria (18 quantitative, 10 qualitative, and 2 mixed methods studies). The quality of studies with quantitative data ranged from very low to high, and quality criteria was generally met for studies with qualitative data. No studies evaluated the impact on knowledge and skills; they primarily investigated the effectiveness of multifaceted KT strategies for promoting EIDM behaviours and improving client outcomes. Almost all studies included an educational component. A meta-analysis of two studies determined that a multifaceted intervention (educational meetings and use of a mentor) did not increase engagement in a range of EIDM behaviours [mean difference 2.7, 95 % CI (-1.7 to 7.1), I (2) = 0 %]. Among the remaining studies, no definitive conclusions could be made about the relative effectiveness of the KT interventions due to variation of interventions and outcomes, as well as study limitations. Findings from studies with qualitative data identified the organizational, individual, and interpersonal factors, as well as characteristics of the innovation, that influence the success of implementation. CONCLUSIONS: KT interventions are being implemented and evaluated on nurses' behaviour and client outcomes. This systematic review may inform the selection of KT interventions and outcomes among nurses in tertiary care and decisions about further research.

Knowledge translation strategies for enhancing nurses' evidence-informed decision making: a scoping review.

BACKGROUND: Nurses are increasingly expected to engage in evidence-informed decision making (EIDM); the use of research evidence with information about patient preferences, clinical context and resources, and their clinical expertise in decision making. Strategies for enhancing EIDM have been synthesized in high-quality systematic reviews, yet most relate to physicians or mixed disciplines. Existing reviews, specific to nursing, have not captured a broad range of strategies for promoting the knowledge and skills for EIDM, patient outcomes as a result of EIDM, or contextual information for why these strategies "work." AIM: To conduct a scoping review to identify and map the literature related to strategies implemented among nurses in tertiary care for promoting EIDM knowledge, skills, and behaviours, as well as patient outcomes and contextual implementation details. METHODS: A search strategy was developed and executed to identify relevant research evidence. Participants included registered nurses, clinical nurse specialists, nurse practitioners, and advanced practice nurses. Strategies were those enhancing nurses' EIDM knowledge, skills, or behaviours, as well as patient outcomes. Relevant studies included systematic reviews, randomized controlled trials, cluster randomized controlled trials, non-randomized trials (including controlled before and after studies), cluster non-randomized trials, interrupted time series designs, prospective cohort studies, mixed-method studies, and qualitative studies. Two reviewers performed study selection and data extraction using standardized forms. Disagreements were resolved through discussion or third party adjudication. RESULTS: Using a narrative synthesis, the body of research was mapped by design, clinical areas, strategies, and provider and patient outcomes to determine areas appropriate for a systematic review. CONCLUSIONS: There are a sufficiently high number of studies to conduct a more focused systematic review by care settings, study design, implementation strategies, or outcomes. A focused review could assist in determining which strategies can be recommended for enhancing EIDM knowledge, skills, and behaviours among nurses in tertiary care.

Dialysis search filters for PubMed, Ovid MEDLINE, and Embase databases.

BACKGROUND AND OBJECTIVES: Physicians frequently search bibliographic databases, such as MEDLINE via PubMed, for best evidence for patient care. The objective of this study was to develop and test search filters to help physicians efficiently retrieve literature related to dialysis (hemodialysis or peritoneal dialysis) from all other articles indexed in PubMed, Ovid MEDLINE, and Embase. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A diagnostic test assessment framework was used to develop and test robust dialysis filters. The reference standard was a manual review of the full texts of 22,992 articles from 39 journals to determine whether each article contained dialysis information. Next, 1,623,728 unique search filters were developed, and their ability to retrieve relevant articles was evaluated. RESULTS: The high-performance dialysis filters consisted of up to 65 search terms in combination. These terms included the words "dialy" (truncated), "uremic," "catheters," and "renal transplant wait list." These filters reached peak sensitivities of 98.6% and specificities of 98.5%. The filters' performance remained robust in an independent validation subset of articles. CONCLUSIONS: These empirically derived and validated high-performance search filters should enable physicians to effectively retrieve dialysis information from PubMed, Ovid MEDLINE, and Embase.

A usability study of patients setting up a cardiac event loop recorder and BlackBerry gateway for remote monitoring at home.

This article reports on a usability study of remote noninvasive cardiac testing in homes. We studied the Vitaphone 3100BT (Bluetooth®) event loop recorder (Vitaphone GmbH, Mannheim, Germany) and paired BlackBerry® Curve™ 8520 smartphone (Research In Motion, Ltd., Waterloo, ON, Canada). This application requires independent device set-up by patients in their own homes following receipt by mail out of the kit (instructions plus the event loop recorder and smartphone). The case studies of five participants, each with varying experience with technology, were documented as they interacted with the devices. Participants were videotaped following written instructions as they performed a "think aloud" procedure while completing 20 device set-up tasks. Interviews provided insight into how the independent device set-up and processes could be improved. This study concluded that gender, age, and familiarity with technology seemed to influence the participants' abilities to successfully set up these devices and that sending the kit by mail appeared to be an acceptable strategy to provide remote noninvasive cardiac diagnostic services. This study provides a foundation for future research assessing usability of mobile healthcare technology.

International trends in health science librarianship: part 1 - the English speaking world.

This is the second in a series of articles exploring international trends in health science librarianship in the first decade of the 21st century. The invited authors were asked to reflect on developments in their country - viz. Australia, Canada, New Zealand and the United States. Future issues will track trends in Northern Europe, the Nordic countries, Southern Europe and Latin America. JM.

Kidney transplantation search filters for PubMed, Ovid Medline, and Embase.

BACKGROUND: Clinicians commonly search bibliographic databases such as Medline to find sound evidence to guide patient care. Unfortunately, this can be a frustrating experience because database searches often miss relevant articles. We addressed this problem for transplant professionals by developing kidney transplantation search filters for use in Medline through PubMed and Ovid Technologies, and Embase. METHODS: We began by reading the full-text versions of 22,992 articles from 39 journals published across 5 years. These articles were labeled relevant to kidney transplantation or not forming our "gold standard." We then developed close to five million kidney transplantation filters using different terms and their combinations. Afterward, these filters were applied to development and validation subsets of the articles to determine their accuracy and reliability in identifying articles with kidney transplantation content. The final kidney transplantation filters used multiple terms in combination. RESULTS: The best performing filters achieved 97.5% sensitivity (95% confidence interval, 96.4%-98.5%), and 98.0% specificity (95% confidence interval, 97.8%-98.3%). Similar high performance was achieved for filters developed for Ovid Medline and Embase. Proof-of-concept searches confirmed more relevant articles are retrieved using these filters. CONCLUSIONS: These kidney transplantation filters can now be used in Medline and Embase databases to improve clinician searching.

Optimal search filters for renal information in EMBASE.

BACKGROUND: EMBASE is a popular database used to retrieve biomedical information. Our objective was to develop and test search filters to help clinicians and researchers efficiently retrieve articles with renal information in EMBASE. STUDY DESIGN: We used a diagnostic test assessment framework because filters operate similarly to screening tests. SETTINGS & PARTICIPANTS: We divided a sample of 5,302 articles from 39 journals into development and validation sets of articles. INDEX TEST: Information retrieval properties were assessed by treating each search filter as a "diagnostic test" or screening procedure for the detection of relevant articles. We tested the performance of 1,936,799 search filters made of unique renal terms and their combinations. REFERENCE STANDARD & OUTCOME: The reference standard was manual review of each article. We calculated the sensitivity and specificity of each filter to identify articles with renal information. RESULTS: The best renal filters consisted of multiple search terms, such as "renal replacement therapy," "renal," "kidney disease," and "proteinuria," and the truncated terms "kidney," "dialy," "neph," "glomerul," and "hemodial." These filters achieved peak sensitivities of 98.7% (95% CI, 97.9-99.6) and specificities of 98.5% (95% CI, 98.0-99.0). The retrieval performance of these filters remained excellent in the validation set of independent articles. LIMITATIONS: The retrieval performance of any search will vary depending on the quality of all search concepts used, not just renal terms. CONCLUSIONS: We empirically developed and validated high-performance renal search filters for EMBASE. These filters can be programmed into the search engine or used on their own to improve the efficiency of searching.

Asynchronous telehealth: a scoping review of analytic studies.

BACKGROUND: Asynchronous telehealth captures clinically important digital samples (e.g., still images, video, audio, text files) and relevant data in one location and subsequently transmits these files for interpretation at a remote site by health professionals without requiring the simultaneous presence of the patient involved and his or her health care provider. Its utility in the health care system, however, still remains poorly defined. We conducted this scoping review to determine the impact of asynchronous telehealth on health outcomes, process of care, access to health services, and health resources. METHODS: A search was performed up to December 2006 of MEDLINE, CINAHL, HealthSTAR, the Database of Abstracts of Reviews of Effectiveness, and The Cochrane Library. Studies were included if they contained original data on the use of asynchronous telehealth and were published in English in a peer-reviewed journal. Two independent reviewers screened all articles and extracted data, reaching consensus on the articles and data identified. Data were extracted on general study characteristics, clinical domain, technology, setting, category of outcome, and results. Study quality (internal validity) was assessed using the Jadad scale for randomized controlled trials and the Downs and Black index for non-randomized studies. Summary data were categorized by medical specialty and presented qualitatively. RESULTS: The scoping review included 52 original studies from 238 citations identified; of these 52, almost half focused on the use of telehealth in dermatology. Included studies were characterized by diverse designs, interventions, and outcomes. Only 16 studies were judged to be of high quality. Most studies showed beneficial effects in terms of diagnostic accuracy, wait times, referral management, and satisfaction with services. Evidence on the impact of asynchronous telehealth on resource use in dermatology suggests a reduction in the number of, or avoidance of, in-person visits. Reports from other clinical domains also described the avoidance of unnecessary transfer of patients. CONCLUSIONS: A significant portion of the asynchronous telehealth literature involves its use in dermatology. Although the quality of many original studies remains poor, at least within dermatology, there is consistent evidence suggesting that asynchronous telehealth could lead to shorter wait times, fewer unnecessary referrals, high levels of patient and provider satisfaction, and equivalent (or better) diagnostic accuracy when compared with face-to-face consultations. With the exception of a few studies in pediatric asthma, the impact of this intervention on individual health outcomes remains unknown.

Diagnostic test systematic reviews: bibliographic search filters ("Clinical Queries") for diagnostic accuracy studies perform well.

BACKGROUND: Systematic reviews of health care topics are valuable summaries of all pertinent studies on focused questions. However, finding all relevant primary studies for systematic reviews remains challenging. OBJECTIVES: To determine the performance of the Clinical Queries sensitive search filter for diagnostic accuracy studies for retrieving studies for systematic reviews. METHODS: We compared the yield of the sensitive Clinical Queries diagnosis search filter for MEDLINE and EMBASE to retrieve studies in diagnostic accuracy systematic reviews reported in ACP Journal Club in 2006. RESULTS: Twelve of 22 diagnostic accuracy reviews (452 included studies) met the inclusion criteria. After excluding 11 studies not in MEDLINE or EMBASE, 95% of articles (417 of 441) were captured by the sensitive Clinical Queries diagnosis search filter (MEDLINE and EMBASE combined). Of 24 studies not retrieved by the filter, 22 were not diagnostic accuracy studies. Reanalysis of the Clinical Queries filter without these 22 nondiagnosis articles increased its performance to 99% (417 of 419). We found no substantive impact of the two articles missed by the Clinical Queries filter on the conclusions of the systematic reviews in which they were cited. CONCLUSION: The sensitive Clinical Queries diagnostic search filter captured 99% of articles and 100% of substantive articles indexed in MEDLINE and EMBASE in diagnostic accuracy systematic reviews.