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Understanding how to translate research discoveries into solutions for healthcare improvement is a priority of NIH-funded Clinical and Translational Science Awards (CTSA). This study, supported by one CTSA, aims to capture one process of shaping and implementing innovations to advance the timeliness and patient-centeredness of cardiovascular care. Specifically, we sought to understand a partnership between a private digital health startup company, a university innovation lab, and an academic health system’s cardiology program pursuing this goal.
The collaboration proceeded through clear phases to address the questions and challenges: problem definition, exploration and formalization of the partnership, innovation co-creation and pilot test, and scale-up planning. Phases were punctuated by key decisions, such as forming the partnership, negotiating terms of the partnership, iterating form and features of the innovation, and exploring sufficiency of its value-add for scale-up and sustainment. Key implementation concepts were apparent, including implementation strategies (e.g., champions and iterative trialing) and the implementation outcomes of acceptability, sustainment, and scale-up. Participants identified potential risks of collaboration, reflected on their co-creation process, and the value of engaging stakeholders in innovation design. Findings may inform subsequent collaborations between innovators and translational researchers.
We conducted a case study to understand the partnership; characterize the questions they pursued, their decision points, information and data sources; and identify the challenges and risks. Data were collected through a series of four focus groups with members of each partnering organization. A transdisciplinary research team iteratively worked to condense and synthesize data from audio recorded transcripts into a case narrative.
The NIH Clinical and Translational Science Awards (CTSA) Program supports the creation of program infrastructure promoting scientific collaboration and improvement in translational research. While most evaluations of these and similar programs focus on scientific outcomes such as grants and publications, few studies investigate the underlying mechanisms through which large infrastructure grants produce scientific or translational benefits. This study investigated how engagement – researchers’ interactions with CTSA-funded resources – can help to increase scientific productivity.
Authors 1) developed process indicators to define engagement in the CTSA infrastructure at Washington University in St. Louis in four general categories (core service use, internal funding, mentor-mentee opportunities, and leadership roles); 2) explored the relationship between CTSA engagement and scholarly productivity; and 3) compared the relationships between engagement and productivity across gender and race/ethnicity. Mixed effects Poisson regressions modeled productivity outcomes on engagement, controlling for demographic and academic characteristics.
CTSA members who were engaged were more likely to publish papers and submit grants when compared to others. They were more likely to receive external grant awards – 10% to 20% percent more – than those who were not engaged. Productivity disparities between men and women and to a lesser extent across categories of race and ethnicity persisted even in samples matched on previous productivity levels.
CTSAs could see larger growth in scientific productivity by increasing researcher engagement and addressing demographic disparities – possibly through focused communications to raise awareness of opportunities – and dissemination of case studies and success stories of engagement to membership.
Observation of surgical personnel in four specialties (cardio-thoracic, general, gynecologic, and orthopedic) in the operating room was performed prior to implementation of an educational intervention designed to improve compliance with Universal Precautions and at 1- and 2-years post-intervention. Use of protective eyewear and double gloving increased following the intervention, whereas the incidence of documented blood and body fluid exposures decreased.
To identify independent risk factors for enteric carriage of vancomycin-resistant Enterococcus faecium (VREF) in hospitalized patients tested for Clostridium difficile toxin.
Retrospective case-cohort study.
Tertiary-care teaching hospital.
Convenience sample of 215 adult inpatients who had stool tested for C difficile between January 29 and February 25,1996.
41 (19%) of 215 patients had enteric carriage of VREF. Five independent risk factors for enteric VREF were identified: history of prior C difficile (odds ratio [OR], 15.21; 95% confidence interval [CI95], 3.30-70.10; P<.001), parenteral treatment with vancomycin for ≥5 days (OR, 4.06; CI95, 1.54-10.73; P=.005), treatment with antimicrobials effective against gram-negative organisms (OR, 3.44; CI95, 1.20-9.87; P=.021), admission from another institution (OR, 2.95; CI95, 1.21-7.18; P=.017), and age >60 years (OR 2.57; CI95, 1.13-5.82; P=.024). These risk factors for enteric VREF were independent of the patient's current C difficile status.
Antimicrobial exposures are the most important modifiable independent risk factors for enteric carriage of VREF in hospitalized patients tested for C difficile.
To investigate differences in second-, third-, and fourth-year medical students' knowledge of bloodborne pathogen exposure risks, as well as their attitudes toward, and intentions to comply with, Universal Precautions (UP).
Participants And Setting:
Surveys about students' knowledge, attitudes, and intentions to comply with UP were completed by 111 second-year (preclinical), 80 third-year, and 60 fourth-year medical students at Washington University School of Medicine in the spring of 1996.
Preclinical students knew more than clinical students about the efficacy of hepatitis B vaccine, use of antiretroviral therapy after occupational exposure to human immunodeficiency virus, and nonvaccinated healthcare workers' risk of infection from needlestick injuries (P<.001). Students' perceived risk of occupational exposure to bloodborne pathogens and attitudes toward hepatitis B vaccine did not differ, but preclinical students agreed more strongly that they should double glove for all invasive procedures with sharps (P<.001). Clinical students agreed more strongly with reporting only high-risk needlestick injuries (P = .057) and with rationalizations against using UP (P = .008). Preclinical students more frequently reported contemplating or preparing to comply with double gloving, wearing protective eyewear, reporting all exposures, and safely disposing of sharps, whereas students with clinical experience were more likely to report compliance. Clinical students also were more likely to report having “no plans” to practice the first three of these precautions (P<.001).
Differences in knowledge, attitudes, and intentions to comply with UP between students with and without clinical experience may have important implications for the timing and content of interventions designed to improve compliance with UP.
We describe variations in healthcare workers' attitudes toward double gloving and reporting needlesticks, and in their readiness to comply with double gloving and hepatitis B vaccine. Differences related to occupation, specialty, and gender have implications for the need to tailor interventions for specific groups of healthcare workers to improve compliance with Universal Precautions.
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