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Effectiveness of implementation strategies to improve nutrition education interventions in adults living in rural and/or low-income communities. 改善农村和/或低收入社区成人营养教育干预措施实施战略的有效性。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000371
Victoria M Gholar, Robin Christian

Objective: The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities.

Introduction: Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided.

Methods: The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels.

Results: The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance.

Conclusion: Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.

目的:该项目的目的是促进循证实践,并确定如何最好地实施农村和/或低收入社区成年人的营养教育干预措施。导言:生活在农村和/或低收入社区的成年人患营养不良和慢性疾病的风险增加。患者被转介到EversCare诊所(ECC),这是美国密西西比州一家学术医疗中心的门诊诊所,以接受社会需求方面的援助。除了生活在农村和/或低收入社区之外,在ECC就诊的90%以上的患者都是粮食不安全的,但营养教育却没有得到持续的提供。方法:采用JBI临床证据系统(pace)的实际应用和get Research into Practice (GRiP)的审核和反馈工具。ECC小组对30名患者电子健康记录进行了基线审计,设计和实施了最佳做法营养教育战略,并完成了对30名患者电子健康记录的后续审计。对农村和/或低收入社区成人营养教育的四项循证标准进行了审核,并采用了多种干预措施来解决多个层面的问题。结果:基线审计显示患者没有接受推荐的营养教育干预。在实施之后,在遵守所有四个最佳实践标准方面有64.2%的改进。让护生参与是提高依从性的有效方法。结论:实施营养教育干预的最佳实践的依从性是令人满意的,80%的患者在个人、人际、社区和社会层面接受了干预。计划未来的审计以确保可持续性。
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引用次数: 0
Breastfeeding support and avoiding inappropriate breast milk substitute marketing in a neonatal ward in the Czech Republic: a best practice implementation project. 捷克共和国新生儿病房的母乳喂养支持和避免不适当的母乳代用品营销:最佳做法实施项目
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000388
Lucia Kantorová, Andrea Poloková, Michal Sýkora, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová

Objectives: The aim of this implementation project was to improve breastfeeding support, and more specifically, to increase compliance with the Baby-Friendly Hospital Initiative (BFHI) and the requirements of the International Code of Marketing of Breastmilk Substitutes (the Code).

Introduction: The Ten Steps to Successful Breastfeeding of the BFHI have been shown to improve breastfeeding outcomes at target hospitals. The Code is a minimum standard for the regulation of marketing practices related to breastfeeding support.

Methods: We used the JBI evidence implementation model to identify a group of stakeholders in a hospital in the Czech Republic and carried out a best practice implementation project from January 2021 to May 2022. After conducting a baseline audit, the clinical team and external breastfeeding experts discussed challenges and devised an implementation plan using the JBI Getting Research into Practice framework. Follow-up audits were undertaken from January to December 2021 and in May 2022.

Results: Compliance improved across all audited criteria, namely, to fully comply with the Code (0% to 100%); to have a written infant feeding policy (0% to 100%); to ensure staff have skills to support breastfeeding (0% to 100%); to discuss breastfeeding with pregnant women (0% to 100%); to facilitate skin-to-skin contact (67.86% to 83.58%); to support and provide help with breastfeeding (67.86% to 82.09%); to not provide fluids other than breast milk (50% to 58.21%); to practice rooming-in (57.14% to 61.19%); to respond to infant cues (50% to 64.18%); to provide information about community support services (32.14% to 62.69%); and to coordinate discharge and ongoing care (0% to 100%).

Conclusions: Breastfeeding support requires a sustained long-term effort before it can become fully established. The involvement of national-level policy makers is needed.

目标:该实施项目的目的是改善对母乳喂养的支持,更具体地说,是加强对爱婴医院倡议(BFHI)和《国际母乳代用品销售守则》(《守则》)要求的遵守。导言:该计划的成功母乳喂养的十个步骤已被证明可以改善目标医院的母乳喂养结果。《守则》是管理与母乳喂养支持有关的营销做法的最低标准。方法:我们使用JBI证据实施模型确定了捷克共和国一家医院的一组利益相关者,并于2021年1月至2022年5月开展了最佳实践实施项目。在进行基线审计后,临床小组和外部母乳喂养专家讨论了挑战,并利用JBI将研究付诸实践框架制定了实施计划。后续审计分别于2021年1月至12月和2022年5月进行。结果:所有审计标准的合规性得到改善,即完全符合准则(0%至100%);有书面的婴儿喂养政策(0% - 100%);确保工作人员具备支持母乳喂养的技能(0%至100%);与孕妇讨论母乳喂养(0%至100%);便于皮肤接触(67.86% ~ 83.58%);支持和帮助母乳喂养(67.86% ~ 82.09%);不提供母乳以外的液体(50%至58.21%);实行同住制(57.14% ~ 61.19%);对婴儿提示有反应(50% ~ 64.18%);提供社区支持服务信息(32.14% ~ 62.69%);并协调出院和持续护理(0%至100%)。结论:母乳喂养支持需要持续的长期努力才能完全建立。国家一级决策者的参与是必要的。
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引用次数: 0
Pain assessment and management among adult patients in a gynecology ward: a best practice implementation project. 妇科病房成年患者疼痛评估与管理:最佳实践实施项目。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000387
Leticia Bernués-Caudillo, Laura Albornos-Muñoz, M Paz Fernández Rodrigo, Marta Álvarez García, Marta De Rioja Benito, María Jesús Ruano Serrano, Paloma García Navarro, Patricia Ledesma Pérez, Sonia González Sotelo, M Teresa Moreno-Casbas, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová, Esther Gonzalez-María

Objectives: This project aimed to improve compliance with evidence-based practice in pain assessment and management in a gynecology ward.

Introduction: Effective pain control is important to prevent the negative consequences of pain that is poorly managed. However, it remains undervalued and inadequately treated. Applying evidence-based practices to correctly evaluate and manage pain is essential to improve pain relief.

Methods: This project followed the JBI Evidence Implementation Framework. A baseline audit of 41 women admitted to the gynecology ward was conducted and measured against 5 best practice criteria, along with a patient satisfaction questionnaire. Targeted strategies were then implemented and a follow-up audit was conducted using the same criteria, methods, and sample size as the baseline audit.

Results: The baseline audit revealed gaps between current and best practice. Barriers to implementation were identified and strategies to resolve the barriers were designed and implemented (nurse education, informative materials, electronic patient records system improvements). Comprehensive pain assessment, including dynamic and static pain assessment, use of a validated tool, and education provided to patients and carers, improved in the follow-up audit. There was no change in patient satisfaction levels; however, the discrepancy between pain measured by nurses and pain measured by patients was reduced.

Conclusions: The JBI methodology was useful in improving compliance with evidence-based practice criteria. It also facilitated adaptation to new barriers, such as the COVID-19 pandemic. Improving nurses' knowledge of pain assessment can lead to more accurate assessment. Inadequate records systems also made it difficult to record the care that was provided. Subsequent audits will assess sustainability and the project will be escalated to other wards.

目的:本项目旨在提高妇科病房疼痛评估和管理的循证实践依从性。引言:有效的疼痛控制对于预防管理不善的疼痛的负面后果很重要。然而,它仍然被低估,得不到充分的治疗。应用循证实践来正确评估和管理疼痛是改善疼痛缓解的必要条件。方法:本项目遵循JBI证据实施框架。对41名入住妇科病房的妇女进行了基线审计,并根据5项最佳实践标准进行了测量,同时进行了患者满意度问卷调查。然后实施有针对性的策略,并使用与基线审计相同的标准、方法和样本量进行后续审计。结果:基线审计揭示了当前和最佳实践之间的差距。确定实施的障碍,并设计和实施解决障碍的策略(护士教育、信息材料、电子病历系统改进)。全面的疼痛评估,包括动态和静态疼痛评估,有效工具的使用,以及向患者和护理人员提供的教育,在后续审计中得到改善。患者满意度没有变化;然而,护士测量的疼痛与患者测量的疼痛之间的差异减小了。结论:JBI方法有助于提高循证实践标准的依从性。它还促进了对新障碍的适应,例如COVID-19大流行。提高护士对疼痛评估的认识可以使评估更加准确。不完善的记录系统也使记录所提供的护理变得困难。随后的审计将评估可持续性,并将项目升级到其他地区。
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引用次数: 0
Postdischarge telephone follow-up among chronic disease patients discharged from a vascular surgery service: a best practice implementation project. 心血管外科慢性病患者出院后电话随访:最佳实践实施项目
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000380
Pedro Sousa, Daniela Cardoso, Tereza Vrbová, João Apóstolo, Margarida Santos, Gracinda Manso, Daniel Mourão, Goreti Ferreira, Manuela Monteiro, Jacinta Manata, Alexandre Vaz, Jitka Klugarová, Miloslav Klugar

Objectives: To improve postdischarge telephone follow-up in the context of chronic disease management (peripheral artery disease), in a vascular surgery service.

Introduction: Patients with chronic diseases, such as peripheral artery disease, present a higher risk of complications and greater constraints regarding their adherence to treatment, leading to an increasing mortality rate and decreased functional capacity. Comprehensive discharge planning plus postdischarge telephone follow-up may reduce 30-day re-hospitalization rates.

Methods: The project used the JBI audit and feedback methodological approach to implement the best available evidence into practice. Two audit criteria were used: existence of comprehensive discharge planning and timely telephone follow-up. A baseline audit was conducted, followed by analysis of barriers, which led to the implementation of several strategies, namely, a targeted training program, the development of educational resources and standardized procedures for the discharge process, and postdischarge telephone follow-up.

Results: Results from the baseline and first follow-up audits showed improvement for both criteria. Compliance for criterion 1 (comprehensive discharge planning, including postdischarge telephone follow-up) increased from 0% to 40.7%, and for criterion 2 (patient is followed up by telephone within 2 weeks of discharge) increased from 0% to 44.4%. These two criteria sustained improvements in the second follow-up audit: compliance increased to 45% (criterion 1) and 60% (criterion 2).

Conclusions: This implementation project contributed to the optimization of the chronic disease management, including improved compliance with discharge planning and early postdischarge telephone follow-up.

目的:改善血管外科慢性病(外周动脉疾病)的出院后电话随访。慢性疾病(如外周动脉疾病)患者出现并发症的风险更高,并且在坚持治疗方面受到更大的限制,导致死亡率上升和功能下降。综合出院计划加上出院后电话随访可降低30天再住院率。方法:该项目采用JBI审计和反馈方法,将可获得的最佳证据付诸实践。采用两项审计标准:是否有全面的出院计划和及时的电话随访。进行了基线审计,然后分析了障碍,从而实施了几项战略,即有针对性的培训计划,开发出院过程的教育资源和标准化程序,以及出院后的电话随访。结果:基线和第一次随访审计的结果显示两项标准均有改善。标准1(综合出院计划,包括出院后电话随访)的依从性从0%增加到40.7%,标准2(出院后2周内电话随访)的依从性从0%增加到44.4%。这两个标准在第二次随访审计中持续改善:依从性增加到45%(标准1)和60%(标准2)。结论:该实施项目有助于优化慢性病管理,包括提高出院计划的依从性和出院后早期电话随访。
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引用次数: 0
Facilitation in evidence implementation - experiences, challenges, and determinants of perceived effectiveness: a qualitative systematic review. 促进证据实施-经验,挑战和感知有效性的决定因素:定性系统回顾。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000399
Lucylynn Lizarondo, Alexa McArthur, Demetrius Porche, Marleen Corremans, Beatrice Perrenoud, Rogério Rodrigues, Craig Lockwood

Introduction: Facilitation is a key element of evidence implementation. Although quantitative systematic reviews have been undertaken to examine its components and effectiveness, no attempt has been made to synthesize qualitative evidence examining the experiences of facilitators on how facilitation is operationalized, the challenges associated with it, and the factors that can influence its perceived effectiveness.

Methods: A systematic review of qualitative studies was conducted using the JBI methodology.

Results: A total of 36 qualitative studies was included in the systematic review, with the majority being assessed as high quality following critical appraisal. The findings were extracted and further synthesized, highlighting that facilitation involves providing technical and non-technical support to health professionals, as well as high-intensity collaborations and relationship building. Determinants of perceived effectiveness of facilitation include facilitators' access to resources and learning support; their skills, traits/attitudes, and approach to facilitation; and the context of the organization where the implementation occurs. Work demands, emotional stress, and lack of clarity in roles and career development can pose challenges for facilitators.

Conclusion: To maximize the outcomes of facilitation in evidence implementation, the team of facilitators should be carefully selected to ensure they have the right skills, traits/attitudes, and approach to facilitation. They should also be provided with dedicated time to conduct the facilitation and have access to resources, training, and mentoring support. Future research should aim to examine the perspectives of the "implementers" who received support from facilitators to gain a better understanding of which facilitation strategies have an impact on clinical practice behavior.

Review registration number: PROSPERO CRD42023402496.

导言:促进是证据实施的关键要素。虽然已经进行了定量系统审查,以检查其组成部分和有效性,但没有尝试综合定性证据,审查促进者在如何实施促进、与之相关的挑战以及可能影响其感知有效性的因素方面的经验。方法:采用JBI方法对定性研究进行系统回顾。结果:共有36项定性研究被纳入系统评价,其中大多数被评价为高质量。对调查结果进行了摘录和进一步综合,强调促进工作涉及向卫生专业人员提供技术和非技术支助,以及高强度合作和建立关系。促进效果感知的决定因素包括促进者获得资源和学习支持的机会;他们的技能、特点/态度和促进的方法;以及实现发生的组织环境。工作需求、情绪压力、角色和职业发展不清晰,都可能给引导者带来挑战。结论:为了最大限度地提高证据实施中的促进效果,应仔细选择促进者团队,以确保他们具有正确的技能、特征/态度和促进方法。他们还应该有专门的时间来进行促进,并有机会获得资源、培训和指导支持。未来的研究应着眼于考察获得促进者支持的“实施者”的观点,以更好地理解哪些促进策略对临床实践行为有影响。审核注册号:PROSPERO CRD42023402496。
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引用次数: 0
Empowering nurses to increase engagement in advance care planning in a medicine transitional care unit: a best practice implementation project. 授权护士增加参与医疗过渡护理单位的预先护理计划:最佳实践实施项目。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000373
Philip Garcia, Hannah Jang Kim, Susan Barbour, Adam S Cooper

Introduction and objective: Advance care planning (ACP) communication and documentation are often inadequate, leading to care that is inconsistent with patients' preferences and moral dilemmas for family members. Nurses are patient advocates optimally positioned to initiate ACP but many feel that they lack the training and skills to navigate these conversations. The objective of this project was to increase nurses' capacity to engage in ACP.

Methods: This project used the JBI audit and feedback method to implement evidence into practice. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used to incorporate ACP into nursing workflow. Eight audit criteria were created based on a JBI evidence summary. Compliance was measured by reviewing ACP notes from electronic health records and online survey responses. A baseline audit was followed by educational presentations and development of posted materials. Three follow-up audits examined sustainability.

Results: Compliance with the best practice recommendation for nurses to engage in ACP discussions increased from 55% to 80%. There was improvement from zero ACP notes at baseline (0% compliance) to 12 ACP notes in the final audit. Of these notes, 42% included all best practice elements and 92% included patients' treatment preferences.

Conclusions: Development of an integrative nursing education plan for ACP empowers nurses to engage in vital conversations. Informing nurses of their scope of practice, defining terms and expectations, and encouraging them to attempt and document conversations will benefit patients. Future initiatives would benefit from incorporating practical opportunities without real-life implications and providing continued support to cohorts.

前言和目的:预先护理计划(ACP)的沟通和文件往往不足,导致护理不符合患者的偏好和家庭成员的道德困境。护士是病人的倡导者,最适合发起ACP,但许多人觉得他们缺乏引导这些对话的培训和技能。该项目的目标是提高护士参与ACP的能力。方法:本项目采用JBI审计和反馈方法,将证据落实到实践中。采用JBI临床证据系统的实际应用和将研究转化为实践的审计工具,将ACP纳入护理工作流程。根据JBI证据摘要制定了八项审计标准。通过审查电子健康记录和在线调查回复中的ACP记录来衡量依从性。在基线审计之后,进行了教育介绍和编制张贴材料。三次后续审计审查了可持续性。结果:护士参与ACP讨论的最佳实践建议依从性从55%增加到80%。从基线时的0个ACP记录(0%依从性)改善到最终审计时的12个ACP记录。在这些记录中,42%包括所有最佳实践要素,92%包括患者的治疗偏好。结论:为ACP制定一个综合护理教育计划,使护士能够参与重要的对话。告知护士他们的执业范围,定义术语和期望,并鼓励他们尝试和记录对话将有利于患者。今后的倡议将受益于纳入不涉及现实生活的实际机会,并继续向群组提供支助。
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引用次数: 0
COVID-19 infection prevention and control management during hyperbaric oxygen therapy: a best practice implementation project. 高压氧治疗期间COVID-19感染防控管理:最佳实践实施项目。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000400
Michal Hájek, Dittmar Chmelař, Miroslav Rozložník, Alexandra Lochmanová, Jakub Tlapák, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová

Objective: This implementation project compared standard operating procedures, accepted preventive measures, and disinfection procedures between the initial stage of the COVID-19 pandemic (first wave: March 15 to May 31, 2020) and the later stages of the pandemic (second and third waves: September 1, 2020 to January 31, 2021).

Introduction: This project sought to improve compliance with international evidence-based guidelines and clinical standards for the prevention and control of COVID-19 infection during hyperbaric oxygen therapy taking into account the conditions of the local hospital.

Methods: Guided by the JBI evidence implementation framework, seven evidence-based audit criteria were developed for the prevention and control of COVID-19 infection during hyperbaric oxygen therapy. A questionnaire was used to measure compliance in baseline and follow-up audits.

Results: Differences between the baseline and follow-up audits were noted for criteria 6 and 7. Criterion 6 increased from 0% to 100% as the hyperbaric facility was equipped with certified ultraviolet-C radiation for air disinfection during the later period, but this equipment was not available in the initial period of the pandemic. Criterion 7 dropped from 100% in the baseline audit to 0% in the follow-up audit because of a significant increase in the operational burden of the treatment capacity of the facility, which made it impossible to comply with the recommended distancing between patients.

Conclusions: Differences were found in preventive measures, disinfection procedures, work organization, and approach to care strategy. The project objectives were met and the implementation strategies proved effective. Larger sample sizes would need be needed to confirm the reproducibility of the results.

目的:本实施项目比较2019冠状病毒病大流行初期(第一波:2020年3月15日至5月31日)和后期(第二波和第三波:2020年9月1日至2021年1月31日)的标准操作流程、可接受的预防措施和消毒程序。项目简介:本项目旨在结合当地医院的实际情况,提高高压氧治疗期间COVID-19感染防控的国际循证指南和临床标准的合规性。方法:以JBI证据实施框架为指导,制定高压氧治疗期间防控COVID-19感染的7项循证审计标准。使用问卷来衡量基线和后续审计的依从性。结果:基线审计和随访审计在标准6和标准7上存在差异。标准6从0%增加到100%,因为高压设施在后期配备了经过认证的紫外线- c辐射,用于空气消毒,但在大流行初期没有这种设备。标准7从基线审计的100%下降到后续审计的0%,因为该设施的治疗能力的运营负担显著增加,这使得不可能遵守建议的患者之间的距离。结论:在预防措施、消毒程序、工作组织、护理方法等方面存在差异。项目目标已经实现,实施战略证明是有效的。需要更大的样本量来确认结果的可重复性。
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引用次数: 0
Implementation of virtual music therapy in the practice of Czech music therapists: a best practice implementation project. 虚拟音乐治疗在捷克音乐治疗师实践中的实施:最佳实践实施项目。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000386
Jiří Kantor, Anna Neuwirthová, Barbora Hořejší, Jan Koucun, Lucia Kantorová, Tereza Vrbová, Zachary Munn, Jitka Klugarová, Miloslav Klugar

Introduction and aims: Czech music therapists lacked the skills and knowledge to adapt their practice to virtual music therapy (VMT) at the beginning of the COVID-19 pandemic, when physical contact was restricted. The aims of this project were to implement the best evidence-based recommendations concerning VMT in the practice of Czech music therapists and increase the number of therapists using VMT.

Methods: The project used the JBI Evidence Implementation Framework to promote change in the practice of participants. A baseline audit of 26 practitioners was conducted using questionnaires and interviews. The audit criteria consisted of 8 best practice recommendations, followed by the implementation of targeted strategies and a follow-up audit.

Results: Of the 26 music therapists, 18 began practicing VMT following the rollout of the implementation strategies. Strategies included educational workshops, instructional materials, technological support, individual counseling, and interactive training sessions. There was an increase in compliance with all audit criteria. The most critical barriers were lack of knowledge about VMT and lack of technical skills; lack of resources; technological challenges; low confidence of music therapists to provide VMT; and reduced need for VMT after the lockdown restrictions were relaxed.

Conclusions: The implementation project helped to overcome temporary pandemic restrictions, increase the quality of VMT practice, develop strategies for VMT training, and identify reasons for using VMT during the pandemic and beyond.

简介和目的:在新冠肺炎大流行初期,身体接触受到限制,捷克音乐治疗师缺乏将他们的实践适应虚拟音乐疗法(VMT)的技能和知识。该项目的目的是在捷克音乐治疗师的实践中实施关于VMT的最佳循证建议,并增加使用VMT的治疗师的数量。方法:本项目采用JBI证据实施框架来促进参与者实践的改变。通过问卷调查和访谈对26名从业人员进行了基线审计。审计标准包括8项最佳实践建议,其次是实施有针对性的战略和后续审计。结果:在26名音乐治疗师中,18名在实施策略推出后开始练习VMT。策略包括教育工作坊、教学材料、技术支持、个人咨询和互动训练课程。遵守所有审计标准的情况有所增加。最关键的障碍是缺乏对自动驾驶汽车的了解和缺乏技术技能;缺乏资源;技术挑战;音乐治疗师提供VMT的信心较低;在封锁限制放松后,对VMT的需求也有所减少。结论:实施项目有助于克服大流行期间的临时限制,提高VMT实践的质量,制定VMT培训战略,并确定在大流行期间和之后使用VMT的原因。
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引用次数: 0
Providing a scaffold for considering theoretical frameworks in evidence implementation projects: the JBI approach to evidence implementation. 为在证据实施项目中考虑理论框架提供一个脚手架:JBI的证据实施方法。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000397
Zachary Munn, Alexa McArthur, Miloslav Klugar, Daphne Stannard, Adam S Cooper, Yeetey Enuameh, Kylie Porritt

Abstract: There are many theories, models, and frameworks that have been proposed in the field of implementation science. Despite this, many evidence implementation or practice improvement projects do not consider these theories, models, or frameworks in their improvement efforts. The JBI approach is one example of an implementation theory, model, or framework. This approach has been developed particularly with health care professionals in mind and is designed to clearly guide pragmatic evidence implementation efforts based on the best available evidence. In this paper, we discuss how the JBI approach to evidence implementation can interact with and support theory-informed, pragmatic evidence implementation projects.

摘要:在实施科学领域,已经提出了许多理论、模型和框架。尽管如此,许多证据实现或实践改进项目并没有在他们的改进工作中考虑这些理论、模型或框架。JBI方法是实现理论、模型或框架的一个例子。这一方法是专门为卫生保健专业人员制定的,旨在明确指导基于现有最佳证据的务实证据实施工作。在本文中,我们讨论了JBI的证据实施方法如何相互作用并支持基于理论的、务实的证据实施项目。
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引用次数: 0
Effectiveness of exercise interventions on urinary incontinence and pelvic organ prolapse in pregnant and postpartum women: umbrella review and clinical guideline development. 运动干预对妊娠和产后妇女尿失禁和盆腔器官脱垂的有效性:总括综述和临床指南制定。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000391
Iina Ryhtä, Anna Axelin, Heidi Parisod, Arja Holopainen, Lotta Hamari

Introduction and aims: Dysfunction related to pelvic floor muscles (PFM) is common among pregnant and postpartum women and can cause symptoms such as urinary incontinence or pelvic organ prolapse (POP). As part of developing a nationwide clinical practice guideline for nursing in Finland, the aim of this umbrella review is to summarize the existing evidence about the effectiveness of exercise interventions on urinary incontinence and POP in pregnant and postpartum women. To promote knowledge translation, recommendations for health care professionals are presented.

Methods: We conducted an umbrella review to summarize the existing evidence. The JBI methodology for umbrella reviews was used to guide the review. The level of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and recommendations based on the evidence were formulated by a clinical guideline working group.

Results: Altogether, 9 systematic reviews, reporting findings from 89 original studies, were included. The methodological quality of the reviews was evaluated using JBI's checklist. The highest level of evidence was found for preventing the symptoms of postpartum urinary incontinence through exercise and pelvic floor muscle training (PFMT) during pregnancy. Moderate-level evidence showed that exercise and PFMT are likely to reduce the symptoms and severity of urinary incontinence, but the level of evidence was low on PFMT reducing the symptoms of POP.

Conclusion: We recommend encouraging and guiding pregnant and postpartum women to exercise and train PFM. We also recommend identifying pregnant and postpartum women with symptoms of PFM dysfunction and directing them to a physiotherapist or other health care professional specializing in pelvic floor function.

引言和目的:与盆底肌(PFM)相关的功能障碍在孕妇和产后妇女中很常见,并可能导致尿失禁或盆腔器官脱垂(POP)等症状。作为制定芬兰全国护理临床实践指南的一部分,本综述的目的是总结关于运动干预对孕妇和产后妇女尿失禁和POP有效性的现有证据。为了促进知识翻译,提出了对卫生保健专业人员的建议。方法:我们进行了一项总括性审查,以总结现有的证据。综合审查采用了JBI方法来指导审查。证据水平采用建议、评估、发展和评估分级(GRADE)方法进行评估,临床指南工作组根据证据制定建议。结果:共纳入9项系统综述,报告了89项原始研究的结果。使用JBI的检查表对审查的方法质量进行了评估。在怀孕期间,通过运动和盆底肌肉训练(PFMT)预防产后尿失禁症状的证据最高。中等程度的证据表明,运动和PFMT有可能减轻尿失禁的症状和严重程度,但PFMT减轻POP症状的证据水平较低。结论:我们建议鼓励和指导孕妇和产后妇女锻炼和训练PFM。我们还建议识别有PFM功能障碍症状的孕妇和产后妇女,并指导她们去找物理治疗师或其他专门研究盆底功能的医疗保健专业人员。
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Jbi Evidence Implementation
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