Involving Patients and Clinicians in the Design of Wireframes for Cancer Medicines Electronic Patient Reported Outcome Measures in Clinical Care: Mixed Methods Study.

BACKGROUND: Cancer treatment is a key component of health care systems, and the increasing number of cancer medicines is expanding the treatment landscape. However, evidence of the impact on patients has been focused more on chemotherapy toxicity and symptom control and less on the effect of cancer medicines more broadly on patients' lives. Evolving electronic patient-reported outcome measures (ePROMs) presents the opportunity to secure early engagement of patients and clinicians in shaping the collection of quality-of-life metrics and presenting these data to better support the patient-clinician decision-making process. OBJECTIVE: The aim of this study was to obtain initial feedback from patients and clinicians on the wireframes of a digital solution (patient app and clinician dashboard) for the collection and use of cancer medicines ePROMs. METHODS: We adopted a 2-stage, mixed methods approach. Stage 1 (March to June 2019) consisted of interviews and focus groups with cancer clinicians and patients with cancer to explore the face validity of the wireframes, informed by the technology acceptance model constructs (perceived ease of use, perceived usefulness, and behavioral intention to use). In stage 2 (October 2019 to February 2020), the revised wireframes were assessed through web-based, adapted technology acceptance model questionnaires. Qualitative data (stage 1) underwent a framework analysis, and descriptive statistics were performed on quantitative data (stage 2). Clinicians and patients with cancer were recruited from NHS Greater Glasgow & Clyde, the largest health board in Scotland. RESULTS: A total of 14 clinicians and 19 patients participated in a combination of stage 1 interviews and focus groups. Clinicians and patients indicated that the wireframes of a patient app and clinician dashboard for the collection of cancer medicines ePROMs would be easy to use and could focus discussions, and they would be receptive to using such tools in the future. In stage 1, clinicians raised the potential impact on workload, and both groups identified the need for adequate IT skills to use each technology. Changes to the wireframes were made, and in stage 2, clinicians (n=8) and patients (n=16) indicated it was "quite likely" that the technologies would be easy to use and they would be "quite likely" to use them in the future. Notably, clinicians indicated that they would use the dashboard to enable treatment decisions "with around half" of their patients. CONCLUSIONS: This study emphasizes the importance of consulting both patients and clinicians in the design of digital solutions. The wireframes were perceived positively by patients and clinicians who were willing to use such technologies if available in the future as part of routine care. However, challenges were raised, and some differences were identified between participant groups, which warrant further research.

Decision Support Tools in Adult Long-term Care Facilities: Scoping Review.

BACKGROUND: Digital innovations are yet to make real impacts in the care home sector despite the considerable potential of digital health approaches to help with continued staff shortages and to improve quality of care. To understand the current landscape of digital innovation in long-term care facilities such as nursing and care homes, it is important to find out which clinical decision support tools are currently used in long-term care facilities, what their purpose is, how they were developed, and what types of data they use. OBJECTIVE: The aim of this review was to analyze studies that evaluated clinical decision support tools in long-term care facilities based on the purpose and intended users of the tools, the evidence base used to develop the tools, how the tools are used and their effectiveness, and the types of data the tools use to contribute to the existing scientific evidence to inform a roadmap for digital innovation, specifically for clinical decision support tools, in long-term care facilities. METHODS: A review of the literature published between January 1, 2010, and July 21, 2021, was conducted, using key search terms in 3 scientific journal databases: PubMed, Cochrane Library, and the British Nursing Index. Only studies evaluating clinical decision support tools in long-term care facilities were included in the review. RESULTS: In total, 17 papers were included in the final review. The clinical decision support tools described in these papers were evaluated for medication management, pressure ulcer prevention, dementia management, falls prevention, hospitalization, malnutrition prevention, urinary tract infection, and COVID-19 infection. In general, the included studies show that decision support tools can show improvements in delivery of care and in health outcomes. CONCLUSIONS: Although the studies demonstrate the potential of positive impact of clinical decision support tools, there is variability in results, in part because of the diversity of types of decision support tools, users, and contexts as well as limited validation of the tools in use and in part because of the lack of clarity in defining the whole intervention.

Predicting mortality after hospitalisation for COPD using electronic health records.

BACKGROUND: Few prognostic models exist for patients hospitalised with chronic obstructive pulmonary disease (COPD); most are based on small cohorts enroled by specialists in academic centres. Electronic health records (EHRs) provide an opportunity to develop more representative models, although they may not record some variables used in existing models. MATERIALS AND METHODS: for this retrospective cohort study, using EHRs, we identified 17,973 patients with an unplanned hospitalisation for COPD (in any diagnostic position) in the Glasgow area between 2011 and 2017. Patients with known lung cancer were excluded. EHR were linked to prior admissions, community prescribing and laboratory data. A pragmatic, parsimonious multivariable model was developed to predict 90-day mortality. RESULTS: we identified 12 variables strongly related to prognosis, including age, sex, length of index hospitalisation stay, prior diagnosis of cancer (excluding lung cancer) or dementia, prescription of oxygen or digoxin, neutrophil/lymphocyte ratio and serum chloride, urea, creatinine and albumin. The model achieved excellent calibration with reasonable discrimination (area under the curve: 0.806; 95% CI: 0.792-0.820). A risk-score was developed and an electronic risk-calculator is provided. CONCLUSIONS: a small number of variables, including prescriptions and laboratory data obtained from routine EHRs predict 90-day mortality after a hospitalisation for COPD. The risk-calculator provided might prove useful for service-evaluation and audit, to guide clinical management and to risk-stratify and select patients to be invited to participate in clinical research.

Decision support for Scotland's health and social care: learning from an outcomes-focused approach.

This short report shares learning from the research and development phase of the national decision support programme in NHS Scotland. It outlines how the programme has adopted an outcomes-focused approach which has guided critical decisions on solution design, engagement of policy sponsors, clinical and management leaders, implementation and evaluation approach, technical architecture and technology development. It discusses how this outcomes-led approach positions decision support as catalyst for a learning health and care system that continuously refreshes the healthcare knowledge base through new insights generated by evaluating impact and outcomes.

Research into practice: the path to development of an African network of knowledge brokers among health librarians

The knowledge broker role is an opportunity for librarians to support health care workers' by inserting knowledge into the nurse's frontline clinical practice. Conception of an African network of knowledge brokers arose out of a knowledge broker project for health care workers initiated at Chitambo District hospital of Chitambo district in Central Zambia by the Friends of Chitambo. The pilot knowledge broker learning course was designed through a collaborative network between organisations in Scotland, the United Kingdom, South Africa and Zambia. The course was set in modules corresponding to elements of the Promoting Action on Research Implementation Framework ­Evidence, Context and Facilitation. Formation of the African knowledge broker network was instigated through the course designed for health librarians from Zambia and Zimbabwe. The course has been refined and was to be delivered to six health librarians from Malawi, Rwanda and Zambia in March 2020; which was postponed due to COVID-19. An envisaged online version could not take place as most participants indicated lack of access to the internet due to the fact that their workplaces went on recess owing to COVID-19.The pilot knowledge broker learning course for Africa marks the beginning of the practice of knowledge brokering by African health librarians.

Health librarians making a difference in a health care setting: the Chitambo emergency care communications project

Health librarians in the role of a knowledge broker can encourage health care workers to use evidence based health information. The knowledge broker role is an intervention dedicated to translating knowledge into action originating from the evidence-based medicine campaign. The Chitambo Emergency Care Communications Project through its knowledge component work strand has visualisations of converting knowledge into action to improve emergency care response by health workers, through the implementation of the knowledge broker role for health care workers in Chitambo district, Central Zambia. Implementation of the knowledge broker activity for Chitambo adopted a framework purposefully designed to build capacity for health librarians by the National Health Service Education for Scotland. The knowledge to action model can be useful in providing the relevant information to improve patient outcomes for healthcare workers. These knowledge gaps can be alleviated by knowledge brokering as it straddles through any knowledge gaps between the health workers' knowledge and their service delivery practice.

Developing a framework to evaluate knowledge into action interventions.

BACKGROUND: There are many challenges in delivering and evaluating knowledge for healthcare, but the lack of clear routes from knowledge to practice is a root cause of failures in safety within healthcare. Various types and sources of knowledge are relevant at different levels within the healthcare system. These need to be delivered in a timely way that is useful and actionable for those providing services or developing policies. How knowledge is taken up and used through networks and relationships, and the difficulties in attributing change to knowledge-based interventions, present challenges to understanding how knowledge into action (K2A) work influences healthcare outcomes. This makes it difficult to demonstrate the importance of K2A work, and harness support for its development and resourcing. This paper presents the results from a project commissioned by NHS Education for Scotland (NES) and Healthcare Improvement Scotland (HIS) to create an evaluation framework to help understand the NHS Scotland Knowledge into Action model. METHODS: The team took a developmental approach to creating an evaluation framework that would be useful and practical. This included a literature review to ensure the evaluation was evidence-based; adaptation of contribution analysis for K2A project; action research with K2A project leads to refine the work and develop suitable measures. RESULTS: Principles for evaluation and an evaluation framework based on contribution analysis were developed and implemented on a trial project. An outcomes chain was developed for the K2A programme and specific projects. This was used to design, collect and collate evidence of the K2A intervention. Data collected routinely by the intervention was supplemented with specific feedback measures from K2A project users. CONCLUSIONS: The evaluation approach allowed for scrutiny of both processes and outcomes and was adaptable to projects on different scales. This framework has proved useful as a planning, reflecting and evaluation tool for K2A, and could be more widely used to evidence the ways in which knowledge to action work helps improve healthcare outcomes.

Decision Support for Diabetes in Scotland: Implementation and Evaluation of a Clinical Decision Support System.

BACKGROUND: Automated clinical decision support systems (CDSS) are associated with improvements in health care delivery to those with long-term conditions, including diabetes. A CDSS was introduced to two Scottish regions (combined diabetes population ~30 000) via a national diabetes electronic health record. This study aims to describe users' reactions to the CDSS and to quantify impact on clinical processes and outcomes over two improvement cycles: December 2013 to February 2014 and August 2014 to November 2014. METHODS: Feedback was sought via patient questionnaires, health care professional (HCP) focus groups, and questionnaires. Multivariable regression was used to analyze HCP SCI-Diabetes usage (with respect to CDSS message presence/absence) and case-control comparison of clinical processes/outcomes. Cases were patients whose HCP received a CDSS messages during the study period. Closely matched controls were selected from regions outside the study, following similar clinical practice (without CDSS). Clinical process measures were screening rates for diabetes-related complications. Clinical outcomes included HbA1c at 1 year. RESULTS: The CDSS had no adverse impact on consultations. HCPs were generally positive toward CDSS and used it within normal clinical workflow. CDSS messages were generated for 5692 cases, matched to 10 667 controls. Following clinic, the probability of patients being appropriately screened for complications more than doubled for most measures. Mean HbA1c improved in cases and controls but more so in cases (-2.3 mmol/mol [-0.2%] versus -1.1 [-0.1%], P = .003). DISCUSSION AND CONCLUSIONS: The CDSS was well received; associated with improved efficiencies in working practices; and large improvements in guideline adherence. These evidence-based, early interventions can significantly reduce costly and devastating complications.

Knowledge into action - supporting the implementation of evidence into practice in Scotland.

BACKGROUND: The knowledge into action model for NHS Scotland provides a framework for librarians and health care staff to support getting evidence into practice. Central to this model is the development of a network of knowledge brokers to facilitate identification, use, creation and sharing of knowledge. OBJECTIVE: To translate the concepts described in the model into tangible activities with the intention of supporting better use of evidence in health care and subsequently improving patient outcomes. METHODS: Four areas of activity were addressed by small working groups comprising knowledge services staff in local and national boards. The areas of activity were as follows: defining existing and required capabilities and developing learning opportunities for the knowledge broker network; establishing national search and summarising services; developing actionable knowledge tools; and supporting person-to-person knowledge sharing. CONCLUSION: This work presents the development of practical tools and support to translate a conceptual model for getting knowledge into action into a series of activities and outputs to support better use of evidence in health care and subsequently improved patient outcomes.

21st century medical education: critical decision-making guidance through smartphone/tablet applications-the Lothian pilot.

Introduction: In starting a new clinical placement, doctors in training must become aware of and apply standard operating procedures, as well as learn guidelines, simultaneously adjusting to new patient presentations, environments and personnel. This transition is thought to correlate with increased risk to patient safety, notably during the annual UK changeover. Mobile technologies are increasingly commonplace throughout the National Health Service. Clinicians at all levels are employing medical technology and applications (apps) with minimal local guidance. We set out to test the feasibility and utility of offering medical apps to out-of-hours (OOH) practitioners as an aid to clinical decision-making at point of patient contact. The theorised benefits were threefold: clinical education-real time support for clinical decision-making as one component of deliberate practice to build expert performance; decreased administrative burden-updating and accessing current guidelines; and service development-readily accessible feedback from users. Method: We provided 32 devices in our emergency departments and OOH environments. The devices were preloaded with apps approved by our medical education department and clinical service leads to be used in support of care delivery. Results: We surveyed 123 clinical staff prior to the pilot discovering that 65% had used mobile apps to aid their decision-making. During our project, we saw the number of clinical users expand with our data series, suggesting the apps most useful to care delivery for this group of service providers. Future developments: There was huge enthusiasm for the project and we hope to maintain a clinician-led environment.

Scotland's knowledge network: a progress report on Knowledge into Action.

Launched in 2012, Knowledge into Action is the national knowledge management strategy for the health and social care workforce in Scotland. It is transforming the role of the national digital knowledge service--NHS Education for Scotlands' Knowledge Network--and the NHSS librarian role to offer more active, tailored support for translating knowledge into frontline clinical practice. This includes the development of a national evidence search and summary service, help with converting knowledge into practical and usable formats for easy use at point of care and with using digital tools to share clinicians' learning, experience and expertise. Through this practical support, Knowledge into Action is contributing to quality and safety outcomes across NHS Scotland, building clinicians' capacity and capability in applying knowledge in frontline practice and service improvement.

International trends in health science librarianship Part 9: the UK - Scotland and Wales.

This is the 9th in a series of articles exploring international trends in health science librarianship. The previous article in this series looked at Northern Ireland and the Republic of Ireland. In this issue the focus is Scotland and Wales. There will be three or four more articles this year tracking trends in the Far East, Africa, South Asia and the Middle East. JM.

Scottish toolkit for knowledge management.

BACKGROUND: Using specific examples, this paper describes the tools, methods and resources used to develop Managed Knowledge Networks (MKNs) within the NHS Scotland e-Library (http://www.elib.scot.nhs.uk). MKNs help to complete the knowledge management cycle by providing a place to share the learning and discuss the evidence for practice through combining the use of the published material (explicit knowledge) with the experience and knowledge held by individuals, communities and organizations (tacit knowledge). OBJECTIVES: First of all, this paper outlines the e-Library infrastructure, which provides an inter-operable framework to manage the published knowledge using a metadata management system; and a knowledge-sharing tool to support the development of MKNs. It then covers the various stages involved in developing an MKN: gathering and analysing information needs in a variety of ways; presenting and organizing the resources and services for the users as identified in the needs analysis; managing the tacit, personal and local knowledge. CONCLUSION: The toolkit described enables the Knowledge Services Group to take the needs of users, transcribe these into Specialist e-Libraries to provide access to the published information and to support this with accessing and sharing the knowledge of colleagues via MKNs.

Managing knowledge to support the patient journey in NHS Scotland: strategic vision and practical reality.

BACKGROUND: The strategy for NHS Scotland Knowledge Services is set in the context of a global transition to a networked model of management within health services. OBJECTIVES: Development planning for NHS Scotland aims to establish strategic vision and operational delivery systems which meet the needs of this changing health environment. METHODS: Analysis of knowledge needs at strategic organizational level and through consultation with healthcare staff form the basis of a vision of seamless knowledge support throughout all stages of the patient journey, based on a hybrid model of complementary human- and technology-based knowledge networks. RESULTS: The central role of the NHS Scotland e-library as a system-wide technology infrastructure facilitating management of both explicit and tacit knowledge is described. The implementation pathway and approaches to evaluation are outlined, based on practical steps to translate the concept of knowledge networks into a working reality. CONCLUSIONS: The model emerging is that of a knowledge matrix, with the primary delivery system comprising inter-dependent human, organizational and technology-based networks focused on the overriding common purpose of improving patient care.

Information needs of specialist healthcare professionals: a preliminary study based on the West of Scotland Colorectal Cancer Managed Clinical Network.

OBJECTIVES: Funded by Research in the Workplace Award (RIWA) 2001, the study investigated the information needs and use of NHS library services by members of the West of Scotland Colorectal Cancer Managed Clinical Network (MCN), a single subject, cross boundary, multi-professional organization. METHOD: A postal questionnaire sent out in October 2002 was returned by 100 members and follow-up interviews were held in March 2003 with 11 of the respondents. The questions related to access to resources, library services such as literature searches, current awareness and training. They also explored the use of electronic resources and the Internet. RESULTS: Respondents were mainly hospital doctors and a few nurses from across five health boards. Most had access to a library, although not all made use of it, possibly an indication of the need for improved communications between librarians and health-care staff. Generally, research and professional development were reported as reasons for needing cancer information, but on further investigation the motivation to conduct literature searches was more related to patient care. Examples included treatment of unusual cases, locating information for patients and identifying guidelines. There are indications of unmet needs for local contact information and evaluated patient information. CONCLUSION: Development of a cancer portal within the NHS Scotland e-Library available from May 2004 based on the Managed Knowledge Network (MKN) concept is attempting to address many of the issues raised in the survey, including inequities of access to services and signposting to a variety of types of information.

Influence of strategic direction for NHS Scotland knowledge services on indexing policy for the NHS Scotland e-library.

OBJECTIVES: Indexing policy for the NHS Scotland e-Library needs to maximize future inter-operability with other significant health- and social-care-related resources. The strategic drive towards integration and partnership working means that the indexing system has to be widely acceptable to the full range of disciplines within the integrated health-care family. METHODS: Indexes identified by various means and then shortlisted using predefined criteria. RESULTS: Three subject indexes have been chosen--Medical Subject Headings (MeSH), CareData and the Government Category List (GCL), plus mapping between natural language and MeSH terms. This decision was a reasonable compromise between the strategy-driven aim of seamless access for all 'partners in care', and practical constraints of time/manpower. Other authority files (e.g. geographical area, language) are also standards based, and customised to reflect the information needs of an increasingly integrated health-care system. CONCLUSIONS: No single index could provide the scope required to meet the widening range of NHS information need. The influence of high-level strategic aims and objectives have extended their reach to influence indexing policy for the e-Library. Our indexing policy will continue to evolve and contribute to a knowledge management infrastructure capable of supporting current and future NHS Scotland information needs and strategy. Layperson terminology was identified as a gap; additional measures to address this gap are highlighted.

A Delphi study to determine nursing research priorities in the North Glasgow University Hospitals NHS Trust and the corresponding evidence base.

The aims of the study are to identify and prioritize research questions of importance to nurses in North Glasgow University Hospitals NHS Trust and to investigate and describe the existing evidence base for the highest priority questions identified. The consensus method known as the Delphi technique was used. Systematic searching of the literature for each question identified from the research priorities enabled the existing evidence base to be characterized. The following priorities were identified as the most important (in descending order of importance): Recruitment and Retention of Nursing Staff; Staff Stress & Morale; Training & Education of Nursing Staff; Infection Control; and Pain Management. The Delphi technique proved a useful method to determine and prioritize research areas in nursing.