Jbi Evidence Implementation最新文献

Introduction: HIV is a retrovirus affecting the body's immune system. People living with HIV (PWH) aged ≥45 have a higher risk of atherosclerotic cardiovascular disease (ASCVD). Statins are generally recommended for PWH with a 10-year ASCVD risk of ≥5%.

Objective: This project aimed to promote evidence-based practices (EBPs) regarding statin-prescribing for eligible PWH in an outpatient specialty clinic.

Methods: Guided by the JBI Evidence Implementation Framework, two EBPs for increasing statin-prescribing were used as audit criteria: (1) use of a validated tool to estimate ASCVD risk and (2) presence of an alert for clinicians in the electronic health record (EHR) for positive screenings. To determine compliance with EBPs, a baseline audit was completed via EHR reviews. Then, barriers to compliance were identified and strategies to improve compliance were implemented. A follow-up audit was conducted to measure changes in compliance with best practices.

Results: The baseline audit revealed 56% and 0% compliance with the two EBPs, respectively. Barriers to compliance included the absence of a standardized process for estimating patients' CVD risk and clinicians often being unaware of patients' statin eligibility. Strategies to improve EBP compliance included using a "Smart Phrase" to automatically insert a calculation of the 10-year ASCVD risk score into the EHR and placing a statin eligibility notification into eligible patients' EHRs. The follow-up audit indicated a decrease in compliance for Criterion 1 (56% to 52%) but an increase of 100% for Criterion 2.

Conclusions: The project objective was partially met, but interventions were impractical for sustainability. Prescribing practices among nurse practitioners and medical doctors should be explored, as differences in prescribing habits were noticeable.

Spanish abstract: http://links.lww.com/IJEBH/A516.

Introduction: Neonates in the Neonatal Intensive Care Unit (NICU) frequently experience pain, negatively influencing short- and long-term outcomes. As effective pain management in the NICU is complicated, we developed "a comfort dashboard," an innovative pain management dashboard.

Aim: This study aimed to identify the barriers and facilitators of implementing "a comfort dashboard" in the complex NICU setting to enhance successful adoption and implementation.

Methods: A qualitative research design was employed, involving semi-structured interviews with NICU nurses and physicians in a level III-IV NICU. The Consolidated Framework for Implementation Research (CFIR) was applied to identify and analyze barriers and facilitators for implementing "a comfort dashboard."

Results: Interviews with 13 nurses and 5 physicians revealed 21 CFIR constructs, with 4 identified as barriers, 12 as facilitators, and 5 as both. Key facilitators included the dashboard's perceived advantage in enhancing current practices, improving communication between nurses and physicians, and aligning with the NICU's focus on patient comfort. Barriers included concerns about the dashboard's technical complexity and reliability, and the difficulty in reaching all users. Participants emphasized the need for adequate communication and training to achieve user acceptance.

Conclusions: The study identified crucial factors influencing the implementation of "a comfort dashboard" in the NICU. Facilitators such as the relative advantage and alignment with existing practices supported its adoption, while barriers such as technical usability and reaching all users needed to be addressed. These insights will guide the development of tailored implementation strategies, aiming to improve pain management and patient outcomes in the NICU.

Spanish abstract: http://links.lww.com/IJEBH/A513.

Introduction: Prolonged bed rest after coronary angiographic procedures remains routine, guided by tradition and concerns over vascular complications. However, emerging evidence suggests early ambulation may improve patient outcomes without compromising safety.

Aim: This study evaluated the impact and feasibility of ambulating patients 4 hours post-procedure on back pain, urinary difficulty, and vascular complications.

Methods: A best practice implementation project was conducted in two adult cardiology wards in a Singapore tertiary hospital, comprising 30 adult patients who were ambulated 4 hours post-procedures. The JBI Evidence Implementation Framework was used to curate a set of audit criteria to assess nurses' compliance with early ambulation and its effect on patients. Barriers and facilitators to change were identified and addressed using JBI's Getting Research into Practice (GRiP) tool. Data were analyzed using the JBI Practical Application of the Clinical Evidence System (PACES).

Results: Post-intervention, compliance exceeded 80% for all audit criteria. Patient outcomes showed significant reductions in back pain and urinary difficulty, with no changes in vascular complication rates, affirming the safety and effectiveness of early ambulation.

Conclusion: Early ambulation following coronary angiographic procedures enhances recovery and maintains patient safety, demonstrating its feasibility as a practice change. These findings support the potential for wider adoption of this evidence-based approach across additional units to improve care delivery.

Spanish abstract: http://links.lww.com/IJEBH/A510.

Introduction: To explicitly assess the impact of theory in implementation strategies, it is essential to isolate theoretical components while controlling other variables.

Aim: This exploratory two-arm cluster-randomized implementation trial compared theory-driven versus intuition-based approaches to the development of strategies to improve risk-appropriate tumor testing and referral to genetics services for Lynch syndrome (LS), a hereditary cancer predisposition condition.

Methods: Seven major Australian hospitals received an identical, seven-step implementation approach, with the only difference being either the use of theory-driven or intuition-based implementation strategy development, which was randomly assigned (theory n = 4; intuition n = 3). The theory-driven approach was guided by the Theoretical Domains Framework (step 4) and matched Behavior Change Techniques (step 5), with all other steps identical between both trial arms. The primary outcome was the rate of risk-appropriate LS tumor testing and referral within 2 months of colorectal cancer (CRC) resection, using data from January 1, 2017 to September 30, 2021 (n = 3,321 patients). Secondary outcomes included the proportion of risk-appropriate patients with a genetic referral.

Results: The theory-driven arm showed a modest but non-significant improvement in the primary outcome of risk-appropriate LS pathway completion (adjusted risk ratio [aRR]=1.22, 95% CI: 0.92-1.61, p  = 0.1713); however, this was driven by one large hospital, with null effect when excluding that hospital (aRR = 1.00, 95% CI: 0.86-1.18, p  = 0.9639) and heterogeneous results across different hospitals. For patients with high LS risk tumor test results, the theory-driven arm showed a significantly lower proportion without a genetics referral (secondary outcome: aRR = 0.50, 95% CI: 0.41-0.61, p  < 0.0001).

Conclusion: Theory-driven implementation led to stronger improvements in a secondary outcome. Primary outcome evidence was inconclusive. While theory-driven approaches led to some improvements in a secondary outcome, there was no conclusive difference in the primary outcome. A published process evaluation reports on the contextual factors influencing results at each site, as well as theoretical alignment of intuitive strategies and their proposed mechanisms of action. This trial design offers a template for isolating and evaluating the contribution of theory to implementation strategies.

Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12618001072202. Registered June 27, 2018 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375348&isReview=true.

Spanish abstract: http://links.lww.com/IJEBH/A491.

Introduction: Antibiotic stewardship is becoming increasingly important in neonatal care. This is particularly the case for managing early-onset sepsis (EOS), given the impact on hospitalization, short- and long-term health, and antibiotic resistance. Despite the available evidence supporting various antibiotic stewardship interventions to reduce antibiotic use, evidence regarding their implementation remains limited.

Aim: This study aimed to identify barriers and facilitators of implementing three evidence-based antibiotic stewardship interventions in EOS care: the EOS calculator, procalcitonin (PCT)-guided therapy, and IV-to-oral switch therapy.

Methods: Eleven semi-structured focus group interviews were conducted with 81 participants, including pediatricians, neonatal nurses, pediatric residents, midwives, primary care maternity nurses, microbiologists, pharmacists, and general practitioners. The Consolidated Framework for Implementation Research (CFIR), with its five domains (intervention characteristics, outer setting, inner setting, individual characteristics, and implementation process), was used for data collection and analysis. A rapid deductive content analysis approach was used.

Results: The interviews identified 34 barriers, mostly found in the inner setting (n = 11), intervention characteristics (n = 10), and the individual health professional level (n = 8). Twenty facilitators were identified, mostly related to intervention characteristics (n = 8). The overarching barriers were identified as external pressure to adhere to the national guidelines and the expected shift in care responsibility. Facilitators identified unanimously by all participants included universal dissatisfaction with the current national guidelines, a hospital culture of evidence-based and patient-centered care, and the presence of a strong opinion leader.

Conclusion: Implementation strategies should address these barriers and facilitators, seeking to balance quality of evidence with professional core values, managing shifts in care, enhancing interdisciplinary communication, and reducing practice variation by addressing dissatisfaction with un-updated guidelines at an earlier stage.

Introduction: Recognizing the right moment for discussions and defining a patient's care goals is essential. However, aligning these goals across the entire health care team involved in the patient's care can be challenging.

Aim: This project aimed to implement best practices to support a shared understanding and care goal concordance among health care professionals caring for hospitalized oncology patients.

Method: This project was guided by the JBI Evidence Implementation Framework, which is based on an audit and feedback process. The project was conducted in a Brazilian tertiary hospital and covered three phases: (1) establishing a working group and conducting a baseline audit; (2) reviewing audit results and implementing improvement strategies; and (3) conducting a follow-up audit to assess improvements in compliance.

Results: In the baseline audit, 13.04% of professionals discussed care goals and 6.25% demonstrated adequate knowledge of the topic. The first follow-up audit revealed a significant increase in compliance (90%). In the second follow-up audit, compliance increased to 96%, while the third follow-up audit maintained compliance at 96.15%, improving professionals' knowledge to 81.25%. Although the perception of therapeutic obstinacy increased to 78.13%, 53.13% of professionals reported moral distress.

Conclusion: The marked improvement in compliance with best practices in aligning care goals not only enhanced quality of care but also strengthened the team's confidence in discussing care. To ensure the sustainability of these initiatives, ongoing leadership support, team engagement, regular training, and periodic audits are essential. The project demonstrated that educational and structural interventions can positively affect clinical practice, particularly in challenging contexts such as oncology.

Introduction: After percutaneous coronary intervention (PCI), managing risk factors for coronary heart disease (CHD) is essential. Cardiac rehabilitation provides comprehensive management of these risk factors. However, in China, patient health education on cardiac rehabilitation remains inadequate, and evidence has not been effectively integrated into clinical practice.

Objective: This project aimed to promote evidence-based practices for post-PCI cardiac rehabilitation for patients with coronary heart disease to enhance patient prognoses.

Methods: This project followed the JBI Evidence Implementation Framework and used JBI's Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tool. The project was conducted in the cardiovascular ward of a tertiary general hospital in Changsha, China. Based on summarized best evidence, 13 audit criteria were established for baseline and follow-up audits involving 24 patients and 20 nursing staff. Gaps, barriers, and facilitators of compliance with best practices were identified, leading to targeted strategies to address these issues.

Results: The baseline audit indicated 0% compliance for 8 out of 13 criteria. After implementing strategies to address poor adherence, follow-up audits revealed positive outcomes, achieving 100% compliance across all criteria. Improvements were noted in nurses' cardiac rehabilitation education attitudes and behaviors, patient medication adherence, and patient self-management.

Conclusions: This project developed a standardized protocol for post-PCI cardiac rehabilitation education for CHD patients and created related educational materials. The project demonstrated that evidence-based practices can enhance clinical practice in this area.

Spanish abstract: http://links.lww.com/IJEBH/A499.

Introduction: Hospital infection prevention and control (IPC) is an important part of medical quality management, and the appropriate training of staff is therefore essential. Although many hospitals adopt training methods such as scenario simulation, this type of training has challenges, including unscientific evaluation of effects, unreasonable link setting, and failure to adapt to the characteristics of new employees.

Objective: This project aimed to establish an evidence-based evaluation framework for assessing hospital IPC training outcomes for newly recruited health care personnel, serving as a decision support tool to improve the quality of training programs.

Methods: This methodological study integrated the Kirkpatrick and Context-Input-Process-Product (CIPP) models to develop a multidimensional evaluation structure. An initial indicator pool was generated through a systematic literature review and thematic analysis of semi-structured interviews with the clarity and specificity of training clinical educators. A three-phase structured expert consensus-building method (Delphi technique) involving 20 infection control experts was employed to refine and validate evaluation metrics.

Results: The Delphi process demonstrated high engagement, with survey response rates of 90% (18/20) and 100% (18/18) across the two rounds. Strong expert consensus was achieved, as evidenced by the authority coefficients of 0.87 and 0.89. The finalized framework comprises 7 domains, 22 secondary indicators, and 70 measurable indicators. These span training context assessment, implementation processes, competency development, and organizational impact.

Conclusion: This evaluation framework demonstrates strong validity and reliability for holistic assessment of IPC training programs. Its multidimensional structure enables the systematic monitoring of both immediate learning outcomes and long-term behavioral/organizational impacts, providing actionable insights for continuous quality improvement in health care workforce development.

Spanish abstract: http://links.lww.com/IJEBH/A479.

Introduction: Falls are among the most frequently reported serious and preventable adverse events in hospitalized adults, often leading to significant injuries, including fractures, subdural hematomas, or even death.

Objective: This project aimed to promote evidence-based fall prevention practices and reduce fall-related injuries among hospitalized adult patients at a tertiary hospital in China.

Methods: Guided by the JBI Evidence Implementation Framework, this project was conducted across nine pilot wards at a tertiary hospital in China from July 2024 to April 2025. Eight audit criteria were developed to measure compliance with best practices related to fall risk screening and multifactorial assessment, individualized and patient-centered interventions, staff training, and patient education. Barriers were analyzed and addressed through targeted strategies. A follow-up audit evaluated changes in compliance, as well as improvements in nurses' knowledge, attitudes, and practices. Falls and fall-related rates before and after the intervention were also assessed.

Results: Compliance improved across all eight audit criteria. Nurses demonstrated improved knowledge and practice, while patients showed improved knowledge, attitudes, and practices regarding fall prevention. The falls rate declined from 0.48 to 0.25 per 1,000 patient days, while the incidence of fall-related injuries decreased from 35.3% to 0%.

Conclusions: This best practice implementation project strengthened multifactorial falls risk assessment and personalized interventions, enhanced nurses' and patients' engagement in falls prevention, and ultimately reduced falls and fall-related injury rates among hospitalized patients.

Spanish abstract: http://links.lww.com/IJEBH/A498.

Objective: This study aimed to identify the barriers and facilitators of the implementation of community health management for cardiovascular-kidney-metabolic (CKM) syndrome in China, and develop a priority strategy combination.

Methods: This mixed methods study was conducted in Tianjin, China and involved 14 stakeholders and 228 medical personnel. Semi-structured interviews explored domains of the Consolidated Framework for Implementation Research (CFIR). Interview transcripts were double-coded via directed content analysis. The CFIR-ERIC Matching Tool was used to create matching strategies to address prioritized barriers. The Best-Worst Scaling method was used to further refine implementation strategies.

Results: The CFIR Outer Setting, Inner Setting, Intervention Characteristics, and Implementation Process domains were facilitating factors. The Inner Setting, Intervention Characteristics, and Implementation Process domains also emerged as key barriers impeding CKM syndrome health management. Developing a formal implementation blueprint, accessing new funding, promoting adaptability, and identifying and preparing champions may contribute to a more effective and sustainable approach to the community health management of CKM syndrome.

Conclusions: This study identified critical barriers and facilitators influencing community health management of CKM syndrome in China. The proposed strategies-systematic implementation protocols, multi-source funding, contextually tailored approaches, and institutional advocacy-address core obstacles, offering an innovative paradigm for chronic disease management in developing countries.

Spanish abstract: http://links.lww.com/IJEBH/A477.