Rapid Acceleration of Diagnostics - Underserved Populations (RADx-UP): Bridging the Evidence-to-Practice Gap: Evaluating Practice Facilitation as a Strategy to Accelerate Translation of a Systems-level Adherence Intervention into Safety Net Practices/Pro
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PROVIDER: PRJNA765068 | ENA |
REPOSITORIES: ENA
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Project description:Rapid Acceleration of Diagnostics - Underserved Populations (RADx-UP): Bridging the Evidence-to-Practice Gap: Evaluating Practice Facilitation as a Strategy to Accelerate Translation of a Systems-level Adherence Intervention into Safety Net Practices/Pro
| PRJNA765069 | ENA
Project description:BackgroundPoor adherence to antihypertensive medications is a significant contributor to the racial gap in rates of blood pressure (BP) control among Latino adults, as compared to Black and White adults. While multi-level interventions (e.g., those aiming to influence practice, providers, and patients) have been efficacious in improving medication adherence in underserved patients with uncontrolled hypertension, the translation of these interventions into routine practice within "real world" safety-net primary care settings has been inadequate and slow. This study will fill this evidence-to-practice gap by evaluating the effectiveness of practice facilitation (PF) as a practical and tailored strategy for implementing Advancing Medication Adherence for Latinos with Hypertension through a Team-based Care Approach (ALTA), a multi-level approach to improving medication adherence and BP control in 10 safety-net practices in New York that serve Latino patients.Methods and designWe will conduct this study in two phases: (1) a pre-implementation phase where we will refine the PF strategy, informed by the Consolidated Framework for Implementation Research, to facilitate the implementation of ALTA into routine care at the practices; and (2) an implementation phase during which we will evaluate, in a stepped-wedge cluster randomized controlled trial, the effect of the PF strategy on ALTA implementation fidelity (primary outcome), as well as on clinical outcomes (secondary outcomes) at 12 months. Implementation fidelity will be assessed using a mixed methods approach based on the five core dimensions outlined by Proctor's Implementation Outcomes Framework. Clinical outcome measures include BP control (defined as BP< 130/80 mmHg) and medication adherence (assessed using the proportion of days covered via pharmacy records).DiscussionThe study protocol applies rigorous research methods to identify how implementation strategies such as PF may work to expedite the translation process for implementing evidence-based approaches into routine care at safety-net practices to improve health outcomes in Latino patients with hypertension, who suffer disproportionately from poor BP control. By examining the barriers and facilitators that affect implementation, this study will contribute knowledge that will increase the generalizability of its findings to other safety-net practices and guide effective scale-up across primary care practices nationally.Trial registrationClinicalTrials.gov NCT03713515, date of registration: October 19, 2018.
| S-EPMC7888171 | biostudies-literature
Project description:Practice Programmatic Submission
| PRJEB26575 | ENA
Project description:The interplay of positive and negative interactions between drug sensitive and resistant cells determines the efficacy of treatment in heterogeneous cancer cell populations. We studied isogenic estrogen receptor positive (ER+) breast cancer cell lineages sensitive and resistant to ribociclib-induced CDK4/6 inhibition in monoculture and coculture, finding that sensitive cells grow and compete more effectively in the absence of treatment. During treatment with ribociclib, sensitive cells survive and proliferate better when grown together with resistant cells than when grown in monoculture, termed facilitation in ecology. Several lines of evidence indicate estradiol production by resistant cells as the mechanism of facilitation, with both liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays and single cell RNA-seq showing higher production by resistant cells, and sensitive cells shifting phenotype to become more like resistant cells when grown in coculture. Adding estradiol in monoculture provides sensitive cells with partial resistance, and cancels facilitation in coculture. Mathematical modeling quantifies the strength of competition and facilitation, and predicts that blocking facilitation has the potential to control both resistant and sensitive cell populations and inhibit the emergence of a refractory population.
2023-01-18 | GSE193278 | GEO
Project description:Ecological facilitation in soil microbial communities
| PRJEB22584 | ENA
Project description:The standard clinical coagulation assays, activated partial thromboplastin time (aPTT) and prothrombin time (PT) cannot predict thrombotic or bleeding risk. Since thrombin generation is central to haemorrhage control and when unregulated, is the likely cause of thrombosis, thrombin generation assays (TGA) have gained acceptance as "global assays" of haemostasis. These assays generate an enormous amount of data including four key thrombin parameters (lag time, maximum rate, peak and total thrombin) that may change to varying degrees over time in longitudinal studies. Currently, each thrombin parameter is averaged and presented individually in a table, bar graph or box plot; no method exists to visualize comprehensive thrombin generation data over time. To address this need, we have created a method that visualizes all four thrombin parameters simultaneously and can be animated to evaluate how thrombin generation changes over time. This method uses all thrombin parameters to intrinsically rank individuals based on their haemostatic status. The thrombin generation parameters can be derived empirically using TGA or simulated using computational models (CM). To establish the utility and diverse applicability of our method we demonstrate how warfarin therapy (CM), factor VIII prophylaxis for haemophilia A (CM), and pregnancy (TGA) affects thrombin generation over time. The method is especially suited to evaluate an individual's thrombotic and bleeding risk during "normal" processes (e.g pregnancy or aging) or during therapeutic challenges to the haemostatic system. Ultimately, our method is designed to visualize individualized patient profiles which are becoming evermore important as personalized medicine strategies become routine clinical practice.
| S-EPMC3556038 | biostudies-literature
Project description:Evidence-based practice is a systematic approach to decision-making developed in the 1990s to help healthcare professionals identify and use the best available evidence to guide clinical practice and patient outcomes amid a plethora of information in often challenging, time-constrained circumstances. Today's sports nutrition practitioners face similar challenges, as they must assess and judge the quality of evidence and its appropriateness to their athlete, in the often chaotic, time-pressed environment of professional sport. To this end, we present an adapted version of the evidence-based framework to support practitioners in navigating their way through the deluge of available information and guide their recommendations to athletes whilst also reflecting on their practice experience and skills as evidence-based practitioners, thus, helping to bridge the gap between science and practice in sport and exercise nutrition.
| S-EPMC10090397 | biostudies-literature
Project description:BACKGROUND:The theory-practice gap is one of the important challenges of treatment, health, and educational systems. It is affected by different factors like students, teachers, and the clinical environment. This gap has consequences for education, as well as the treatment and health services systems. Thus, it is necessary to find effective strategies to reduce it. Therefore, the present study was conducted with the aim to find strategies to reduce the theory-practice gap in emergency nursing education in the view of stakeholders. METHODS:A qualitative research was conducted, including 18 semi-structured interviews and 3 focus group sessions with the stakeholders in a school of nursing and an educational hospital. Content analysis method was used to analyze the collected data. RESULTS:The strategies to reduce the theory-practice gap in emergency nursing education were divided into 6 primary categories, 2 main categories and 1 theme of action to change. From among the 69 strategies presented to the focus groups, the participants acknowledged 28 strategies as practical and effective. Furthermore, the participants held that it was necessary to have reformative and developmental actions in line with care, supervision, evaluation, and educational processes in order to reduce the gap between theory and practice in emergency nursing education. CONCLUSION:The theory-practice gap is affected by many different factors. Thus, the people involved must pay attention to every influential factor in order to reduce the consequences, and use effective cooperative strategies by taking into consideration the human resources, infrastructures, processes, and the administrative culture in faculty and clinical environments.
| S-EPMC6191575 | biostudies-other
Project description:BackgroundTraining programs for advanced practice providers (APP) often have significant variability in their curriculum, including electrocardiogram (ECG) education. Despite limitations in formal ECG training, APPs in the emergency department (ED) may be the first practitioner to interpret an ECG. Foundations of Emergency Medicine (FoEM) offers free, open-access curricula that are widely used for resident education. We sought to improve APP ECG interpretation skills by implementing the FoEM ECG I course.MethodsThis was a single-site, pre- and post-intervention study of 23 APPs at our high-acuity, urban ED. In the fall of 2020, APP learners enrolled in a FoEM ECG I course led by faculty and senior resident instructors. The course consisted of six virtual, small-group, active-learning ECG workshops. Participants completed a 15-question multiple-choice test before, immediately after, and six months post-intervention to quantify knowledge acquisition. Additionally, a pre- and post-intervention knowledge, attitudes, and practices survey was administered on ECG interpretation skills and to evaluate the course. We evaluated change in ECG knowledge scores using a Wilcoxon signed-rank test. Changes in self-assessed knowledge were evaluated using an ordinal logistic mixed-effects regression.ResultsA total of 23 APPs enrolled in the course. Knowledge assessments showed APPs improved from the pre-test (median 9/15, interquartile range [IQR] 7-11) to the post-test (median 12/15, IQR 10-13; P = 0.001). Test scores did not significantly change from the post-test to the delayed post-test (median 12/15, IQR 12-13; P = 0.30). Respondents' subjective rating of their skill did not significantly change (P = 0.06). Respondents reported no change in their likelihood of approaching an attending when uncertain of the correct interpretation of an ECG (P = 0.16). Overall, 91% were satisfied with the course and 96% agreed that the course difficulty was appropriate.ConclusionThe FoEM ECG course provided a standardized curriculum that improved APP knowledge for interpreting ECGs. Despite this, the course did not alter APPs' willingness to approach physicians for guidance with interpretation of abnormal ECGs. These findings may inform expansion of this concept for other programs who desire formalized APP ECG education.
| S-EPMC11000549 | biostudies-literature