Implementation science approaches to enhance uptake of complex interventions in surgical settings

Achieving practice change in the complex healthcare environment is difficult. Effective surgical care requires coordination of services across the continuum of care, involving interdisciplinary collaboration across multiple units, with systems and processes that may not connect effectively. Principles of enhanced recovery after surgery (ERAS) are increasingly being incorporated into facility policies and practice, but the literature reports challenges with both initial adherence and mid- to long-term sustainability. Greatest adherence is typically observed for the intraoperative elements, which are within the control of a single discipline, with poorest adherence reported for postoperative processes occurring in the complex ward environment. Using ERAS as an example, this perspective piece describes the challenges associated with implementation of complex interventions in the surgical setting, highlighting the value that implementation science approaches can bring to practice change initiatives and providing recommendations as to suggested course of action for effective implementation.

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Pragmatic approaches to analyzing qualitative data for implementation science: an introduction

Implementation Science Communications ◽

10.1186/s43058-021-00174-1 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Shoba Ramanadhan ◽

Anna C. Revette ◽

Rebekka M. Lee ◽

Emma L. Aveling

Keyword(s):

Qualitative Methods ◽

Implementation Science ◽

Qualitative Inquiry ◽

Practice Change ◽

Analytic Approach ◽

Pragmatic Approach ◽

Framework Analysis ◽

Research And Practice ◽

Qualitative Approaches ◽

Science Projects

AbstractQualitative methods are critical for implementation science as they generate opportunities to examine complexity and include a diversity of perspectives. However, it can be a challenge to identify the approach that will provide the best fit for achieving a given set of practice-driven research needs. After all, implementation scientists must find a balance between speed and rigor, reliance on existing frameworks and new discoveries, and inclusion of insider and outsider perspectives. This paper offers guidance on taking a pragmatic approach to analysis, which entails strategically combining and borrowing from established qualitative approaches to meet a study’s needs, typically with guidance from an existing framework and with explicit research and practice change goals.Section 1 offers a series of practical questions to guide the development of a pragmatic analytic approach. These include examining the balance of inductive and deductive procedures, the extent to which insider or outsider perspectives are privileged, study requirements related to data and products that support scientific advancement and practice change, and strategic resource allocation. This is followed by an introduction to three approaches commonly considered for implementation science projects: grounded theory, framework analysis, and interpretive phenomenological analysis, highlighting core analytic procedures that may be borrowed for a pragmatic approach. Section 2 addresses opportunities to ensure and communicate rigor of pragmatic analytic approaches. Section 3 provides an illustrative example from the team’s work, highlighting how a pragmatic analytic approach was designed and executed and the diversity of research and practice products generated.As qualitative inquiry gains prominence in implementation science, it is critical to take advantage of qualitative methods’ diversity and flexibility. This paper furthers the conversation regarding how to strategically mix and match components of established qualitative approaches to meet the analytic needs of implementation science projects, thereby supporting high-impact research and improved opportunities to create practice change.

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SP6.1.11 The Effect of the Enhanced Recovery Programme for Liver Surgery on Long Term Survival

British Journal of Surgery ◽

10.1093/bjs/znab361.138 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Kalaiyarasi Arujunan ◽

Abdulwarith Shugaba ◽

Harmony Uwadiae ◽

Joel Lambert ◽

Georgios Sgourakis ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Postoperative Complications ◽

Liver Surgery ◽

Patient Survival ◽

Enhanced Recovery ◽

Readmission Rates ◽

Term Survival ◽

Significant Difference

Abstract Aims The Enhanced Recovery Programme for Liver Surgery (ERPLS) has been shown to promote functional recovery and reduce hospital stay. However, its effect on long term survival has yet to be established. The aim of this study was to determine the effect of the ERPLS on 5-year patient survival. Methods This was a retrospective study of patients who underwent liver resection for colorectal liver metastasis (CRLM) between January 2011 and December 2016 at a regional hepatobiliary centre. The cohort comprised of 60 pre-ERPLS and 60 post-ERPLS patients. The primary outcome was 5-year patient survival. The secondary outcomes were length of stay (LOS), postoperative complications and 90-day readmission rates. Multivariate analysis was performed to identify independent predictors of overall survival. Results There was no significant difference in the age (p = 0.960), gender (p = 0.332) and type of resection (p = 0.198) between both groups. ERPLS was not an independent predictor for overall survival (Gehan Wilcoxon Test, p = 0.828). There was no significant difference in the LOS (p = 0.874) and 90-day readmission rates (p = 0.349). Major postoperative complications (>3a Clavien-Dindo classification) were significantly less in the ERPLS group (p = 0.02). On multivariate analysis, positive resection margins and major postoperative complications were independent predictors for overall survival. Conclusions ERPLS does not seem to have an effect on long term patient survival. However, it appears to reduce the rate of major postoperative complications. LOS and 90-day readmission rates were not influenced by ERPLS.

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Enablers and Barriers to Implement COVID-19 Measures in Long-Term Care Facilities: A Mixed Methods Implementation Science Assessment in Chile

Journal of Long-Term Care ◽

10.31389/jltc.72 ◽

2021 ◽

pp. 114-123

Author(s):

Jorge Browne ◽

Josefa Palacios ◽

Ignacio Madero-Cabib ◽

Pablo Villalobos Dintrans ◽

Rocío Quilodrán ◽

...

Keyword(s):

Mixed Methods ◽

Implementation Science ◽

Long Term Care ◽

Science Assessment ◽

Term Care ◽

Care Facilities

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Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458518754451 ◽

2018 ◽

Vol 9 ◽

pp. 215145851875445 ◽

Cited By ~ 4

Author(s):

Christopher P. Childers ◽

Anaar E. Siletz ◽

Emily S. Singer ◽

Claire Faltermeier ◽

Q. Lina Hu ◽

...

Keyword(s):

Total Joint Replacement ◽

Enhanced Recovery ◽

Surgical Care ◽

Healthcare Research ◽

Continuous Passive Motion ◽

Safety Program ◽

Vte Prophylaxis ◽

Surgical Technical ◽

National Implementation ◽

Evidence Review

Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery—a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA). Study Design: This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format. Results: Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/ Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning. Conclusion: This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients.

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TWO YEARS IN THE DEVELOPMENT OF A NEW INTERDISCIPLINARY PEDIATRIC CHRONIC PAIN PROGRAM: OPPORTUNITIES, INITIATIVES, AND CHALLENGES

Paediatrics & Child Health ◽

10.1093/pch/pxy054.003 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e1-e2

Author(s):

Kim Edwards ◽

Nez Elik ◽

C Meghan McMurtry ◽

Sheri Findlay ◽

Allison Rodrigues ◽

...

Keyword(s):

Chronic Pain ◽

Interdisciplinary Collaboration ◽

Clinical Work ◽

Child Life ◽

Research Database ◽

Term Care ◽

Pediatric Chronic Pain ◽

Group Treatments ◽

Group A

Abstract BACKGROUND “…The field of paediatric pain medicine has demonstrated the benefits of interdisciplinary collaboration more than any other endeavour” (Law, Palermo, & Walco, 2013). Recently, the Ontario Ministry of Health and Long-term Care announced the funding of specialty paediatric chronic pain programs in several children’s hospitals across the province of Ontario, including McMaster Children’s Hospital. The Pediatric Chronic Pain Program includes Physicians (Pediatricians, Psychiatrist, Anesthesiologist), Psychologists, Child Life Specialist, Registered Nurse, Nurse Practitioner, Occupational Therapist, Physiotherapist, Social Workers, Pharmacist, and a Clinical Manager. OBJECTIVES The purpose of this poster is to highlight new initiatives within our clinic, including the development of a pain education session for families, group treatments (e.g., a 5 week Rise Above Pain Group; a 5-week Parenting Group), and a research database (to allow for program evaluation integrated within our clinical work). DESIGN/METHODS Challenges in developing a new clinic/new programs and providing care to complex families (e.g., professional roles and competencies, diagnostic discrepancies) will be discussed. CONCLUSION Implications for program development in new and established clinics will be highlighted.

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HISTORY OF THE RELATIONSHIP 4 CLIENTS’ REASONS FOR CONSULTING YOU 5 ADVICE GIVEN 6 COURSE OF ACTION AGREED: IMMEDIATE, LONG TERM

Family & Matrimonial Law ◽

10.4324/9781843143871-43 ◽

2000 ◽

pp. 209-209

Keyword(s):

Course Of Action ◽

History Of ◽

The Relationship

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Inducing Long-Term, Positive Behavior Change

Redesigning Teaching, Leadership, and Indigenous Education in the 21st Century - Advances in Educational Technologies and Instructional Design ◽

10.4018/978-1-7998-5557-6.ch011 ◽

2021 ◽

pp. 219-226

Author(s):

Derek Tranchina ◽

Charles Terenfenko ◽

Tracy Mulvaney

Keyword(s):

High School Students ◽

Public Schools ◽

Behavior Change ◽

Positive Impact ◽

Student Leadership ◽

Transformational Change ◽

Positive Behavior ◽

School Students ◽

Change Initiatives

The focus of this chapter is to highlight two different transformational change initiatives in public schools that rely on student leadership to be effective. Both programs will explore effective ways to empower students as leaders, to make better social decisions, and to improve their attachment to school and community. One program involves a student-led technology club in a middle school. The goal of the club is to assist with the school's technology usage while also making a positive impact on participating students' achievement and attachment to school. The other program involves educating high school students on the risks of heroin and opioid addiction. Both programs seek to leverage student empowerment to induce long-term, positive behavior change in the students directly involved as well as those around them.

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Akrasia

Routledge Encyclopedia of Philosophy ◽

10.4324/9780415249126-v003-1 ◽

2018 ◽

Author(s):

Helen Steward

Keyword(s):

Intentional Action ◽

General Term ◽

Self Control ◽

Best Interests ◽

Weakness Of Will ◽

Philosophy Of Action ◽

Moral Philosopher ◽

Moral Principles ◽

Course Of Action

The Greek word ‘akrasia’ is usually said to translate literally as ‘lack of self-control’, but it has come to be used as a general term for the phenomenon known as weakness of will, or incontinence, the disposition to act contrary to one’s own considered judgment about what it is best to do. Since one variety of akrasia is the inability to act as one thinks right, akrasia is obviously important to the moral philosopher, but it is also frequently discussed in the context of philosophy of action. Akrasia is of interest to philosophers of action because although it seems clear that it does occur – that people often do act in ways which they believe to be contrary to their own best interests, moral principles or long-term goals – it also seems to follow from certain apparently plausible views about intentional action that akrasia is simply not possible. A famous version of the suggestion that genuine akrasia cannot exist is found in Socrates, as portrayed by Plato in the Protagoras. Socrates argues that it is impossible for a person’s knowledge of what is best to be overcome by such things as the desire for pleasure – that one cannot choose a course of action which one knows full well to be less good than some alternative known to be available. Anyone who chooses to do something which is in fact worse than something they know they could have done instead, must, according to Socrates, have wrongly judged the relative values of the actions.

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