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Miscommunication between health care practitioners and implementation researchers can lead to a mismatch of expectations and understandings, resulting in wasted research and frustration. Conversely, combining the expertise and knowledge of those working in health care practice and implementation research can deliver context informed research questions and appropriate study designs. Achieving this ambition requires a shared language. We sought to develop a guide to identify a common language to constructively explore nascent implementation research concepts. We set up a working group, comprising of implementation researchers, health care practitioners and operational managers, to work through ideas generation, debate and a consensus process to generate and refine a discussion guide. The resultant guide steps health care practitioners and implementation researchers through a three-phase enquiry - Question 1: What is the implementation question? Question 2: What is the proposed implementation solution? And Question 3: How can the investigation of this idea be resourced? At each step, the health care practitioner and implementation researcher collaborate to include theory and practice and rigorously work through the question to build implementation on evidence and to promote diverse stakeholder engagement. The next steps for this study will be operationalising the discussion guide, as an interactive tool. Future evaluation, to test effectiveness, acceptability and feasibility will be designed with health care practitioners and implementation researchers.

Bringing together a wide range of clinical and research experts is vital for meeting the challenges of implementing of complex health interventions. However, language and jargon can often get in the way. This mismatch can lead to missed opportunities and contribute to wasted research that fails to meet consumers' needs. We need a shared language to maximize the expertise of healthcare practitioners and implementation researchers, thereby improving care. We propose a three-phase discussion guide to assist healthcare practitioners and implementation researchers through the process of starting an implementation study. We guide them through three questions: What is the implementation question? What is the proposed implementation solution? How can this study be resourced? At each step, healthcare practitioners and implementation researchers collaborate to incorporate theory and practice, rigorously addressing the question to build implementation based on evidence and promote diverse stakeholder engagement.

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The Interprofessional Education Collaborative's (IPEC's) core competencies are accreditation standards of most, if not all, healthcare professions (Interprofessional Education Collaborative Expert Panel [2016, Core Competencies for Interprofessional Collaborative Practice: 2016 Update. Washington, DC: IPEC]). Limited literature exists on interprofessional (IP) learning outcomes in healthcare ethics; even fewer studies include debrief sessions. Interprofessional education (IPE) case discussion using web-based technology is a promising way to incorporate ethics content. This article summarizes a model for healthcare programs to create, conduct, and assess synchronous IPE ethics discussions and debrief sessions. Specifically, this article highlights debrief sessions that followed a standardized patient (SP) IP interaction with students from pharmacy and advanced practice nursing. Qualitative analysis of debrief comments identified four themes: the benefit of IP collaboration, the importance of patient-centered care, the need to adapt clinical recommendations with ethical challenges, and the importance of trust among team members. The findings indicate web-based, synchronous IP/SP ethics simulations and debrief sessions are an effective, albeit laborious, method for collaboration and reflection.

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Sport science practitioners utilise findings from peer reviewed research to inform practice. Fewer studies are conducted with high performance athletes, however, than those involving recreationally active participants. Noting that research findings from recreational athletes may not be generalisable to the elite, there is a need to engage the latter cohort in research with better potential to influence health and performance. This study identified methods used to engage and recruit highly trained, elite and world class athletes as research participants. A document analysis was conducted using a purposive sample of peer-reviewed sport science literature. All articles published in 2022 from 18 highly ranked sport science journals were screened for inclusion. Studies investigating athletes ranked as highly trained/national level or above were included. All details related to participant recruitment were extracted from included articles, with the content being coded and thematically analysed using an interpretivist approach. A total of 439 studies from the 2356 screened were included in the analysis. Five primary themes of recruitment strategies were identified, beneath an overarching strategy of purposeful, convenience sampling. Recruitment themes related to the use of a gatekeeper, the research environment providing convenient access to athletes, promoting the study electronically, utilising professional networks and recruiting at training or competition. Engaging athletes through a gatekeeper is a prominent strategy to involve elite athletes in research. It is suggested that researchers work collaboratively with team or organisation personnel to promote recruitment, creating co-designed approaches that address issues most relevant to athletes and staff.

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BACKGROUND: In the pursuit of improved clinical outcomes and patient experience in health care, shared decision-making (SDM) stands as a pivotal concept garnering increasing attention, but SDM utilization varies widely, often leading to confusion regarding team members' roles. This study explores knowledge, skills, and attitudes of oncology clinicians engaged in a pioneering educational initiative at a comprehensive cancer care center, aimed at enhancing frontline SDM capabilities. METHODS: Utilizing a prospective cohort qualitative approach, the team conducted interviews with 6 clinicians in a multidisciplinary oncology program who were engaged in an SDM continuing education program. In the program, participants were immersed in experiential learning activities including standardized didactic sessions and simulation-based SDM case role-play activities. RESULTS: Thematic analysis of interview data revealed 5 major categories: 1) perceptions of SDM; 2) training; 3) patient-centered care; 4) challenges and constraints; and 5) leadership buy-in. Participants perceived benefits, including adopting a better approach to integrate SDM into their practice, heightened engagement, emphasizing team collaboration, and embracing a patient-centric care model. CONCLUSIONS: This study underscores the transformative impact of education and training on enhancing SDM capabilities among oncology clinicians and is not intended for generalizability. By promoting a basic understanding and application of SDM principles, practicing clinicians can be better empowered to improve health care outcomes and experience. Our findings contribute to the broader endeavor of embedding practical SDM principles within clinical practice, thereby fostering a more patient-centered and effective health care environment.

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Children who are at risk of involvement in violence need assistance from multisector agencies such as social services, law enforcement, health, and education. The aim of this study was to understand the perceptions and experiences of parents, teachers, and service providers (i.e., counselors, psychologists, paralegals, and social workers) on collaborative support for children at risk of violence in Banda Aceh, Indonesia. Twenty-four structured interviews were conducted with ten parents whose children were victims of sexual or physical abuse or were involved in substance abuse and theft and have received support from the Integrated Service Center for the Empowerment of Women and Children in Banda Aceh, Indonesia; ten service providers; and four teachers who either worked with the concerned children or knew them. Using a thematic analysis approach, the data was systematically coded and analyzed to identify important themes. Most parents who sought help or support from governmental agencies were referred by other service providers or recommended by relatives or friends. Parents hesitated to discuss their children's problems with the teachers, worrying about stigma, particularly for sexual abuse victims. The school's lack of collaboration with external agencies was consistent with the teacher's claim that they seldom work with other agencies outside of school, resulting in a siloed system of care. It can be concluded that the biggest barrier to communication and coordination among parents, teachers, and service providers is the parents' and service providers' lack of willingness and confidence to work with teachers. Clear policies are needed to establish a cross-institutional linkage structure that promotes shared responsibilities.

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Social work in the German rehabilitation sector is practiced with great variation and its interventions lack research evidence. The SWIMMER project aims to develop a program theory of social work in rehabilitation to explain this variation and to discuss possible conditions. The dealing with ethical dilemmas by social workers is one possible influence and the focus of this paper. The social workers' practice was analyzed using the triple mandate, a German-Swiss concept that describes three possible, sometimes simultaneous directives without a concrete call to action from society, the client or the profession. This qualitative, case-comparative research project collected data from interviews with social workers and managers, participant observation and counseling sessions in ten German rehabilitation facilities. Social workers were confronted with all three mandates. They prioritized either the societal mandate or the client mandate. A consequence for social work practice was the limitation of options under social law (mandate by society). Social workers relied on their professional experience to reflect on the mandates. They used a variety of strategies when faced with conflicting mandates. The research project has succeeded in systematizing the orientations of social workers in goal conflicts. Further investigation on this topic on a broader basis would be beneficial.

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This study investigated the influence of co-regulation on public speaking self-efficacy in the context of collaborative oral presentations. A total of 237 students enrolled in an English course at a university in China took part in the research. The factor analysis findings revealed that learners' co-regulation in public speaking encompass five components: co-planning, co-monitoring, co-evaluation, effort regulation, and help-seeking. Public speaking self-efficacy, on the other hand, pertains to learners' confidence in aspects including the topic, language use, organization, and delivery during public speaking engagements. The path analysis demonstrated that co-planning was a significant predictor of students' self-efficacy in terms of the topic and organization. Moreover, the co-monitoring strategy exhibited direct and positive correlations with language and topic self-efficacy. Similarly, the co-evaluation strategy showed direct and positive relationships with language, delivery, and organization self-efficacy. Furthermore, both effort regulation and help-seeking strategies were found to have direct and positive impacts on organization self-efficacy. This study offers valuable implications for educators, trainers, and individuals aiming to enhance their public speaking self-efficacy in collaborative environments.

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OBJECTIVE: To examine peer-reviewed literature involving undergraduate interprofessional education (IPE) focusing on musculoskeletal (MSK) healthcare professions. METHODS: Methodological searches were conducted on electronic databases PubMed, Scopus, ERIC, and ProQuest. No date restrictions were applied. English sources (qualitative and quantitative methodological studies, conference papers and proceedings, systematic reviews, grey literature, unpublished materials, theses, and dissertations) were included. A researcher, independent reviewer, and research librarian completed the search and data extraction from June to October 2023. Disagreements were resolved by discussion. ATLAS.ti was used to analyze data by generating codes linked to the text. Findings were reported in a narrative format and by using tables. RESULTS: Initially, 2894 articles were retrieved and screened for relevance. After rigorous screening procedures, 18 articles from various countries were deemed eligible for inclusion. The included studies were conducted within the date range of 2010 to 2024. The included studies employed mixed methods (n = 9), quantitative (n = 5), and qualitative (n = 4) approaches. Combined medical and physiotherapy student cohorts were prominently featured in 67% (n = 12) of the reviewed studies. All 18 studies incorporated the implementation and/or evaluation of an IPE intervention. Thematic analysis revealed 5 overarching themes, encompassing the benefits, barriers, interventions, strategies, evaluation, and general findings related to IPE. CONCLUSION: The reviewed literature emphasizes a significant gap in IPE initiatives concerning various MSK health providers, including chiropractors, podiatrists, biokineticists, and osteopaths. This paucity accentuates the need for further exploration and evaluation of IPE within MSK-specific contexts, crucial for addressing and mitigating the escalating global burden of MSK diseases.

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The Heart Valve Collaboratory is a multidisciplinary, patient-centered community of stakeholders addressing complex problems and embracing innovation to help patients with heart valve disease achieve their fullest potential for health. The Scientific Council is composed of cardiologists, surgeons, ex-officio representatives of the Food and Drug Administration and Centers for Medicare and Medicaid Services, National Heart Lung Blood Institute, and representatives from industry partners. In October 2022, this group convened a workshop that included experts from stakeholder groups to address the unmet and clinical needs of patients with pediatric and congenital heart valve disease. The following document includes the discussion and summary of the current state of valve therapy and the needs being addressed for valve development.

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PURPOSE: The Palliative Care Outcomes Collaboration (PCOC) aims to enhance patient outcomes systematically. However, identifying crucial items and accurately determining PCOC phases remain challenging. This study aims to identify essential PCOC data items and construct a prediction model to accurately classify PCOC phases in terminal patients. METHODS: A retrospective cohort study assessed PCOC data items across four PCOC phases: stable, unstable, deteriorating, and terminal. From July 2020 to March 2023, terminal patients were enrolled. A multinomial mixed-effect regression model was used for the analysis of multivariate PCOC repeated measurement data. RESULTS: The dataset comprised 1933 terminally ill patients from 4 different hospice service settings. A total of 13,219 phases of care were analyzed. There were significant differences in the symptom assessment scale, palliative care problem severity score, Australia-modified Karnofsky performance status, and resource utilization groups-activities of daily living among the four PCOC phases of care. Clinical needs, including pain and other symptoms, declined from unstable to terminal phases, while psychological/spiritual and functional status for bed mobility, eating, and transfers increased. A robust prediction model achieved areas under the curves (AUCs) of 0.94, 0.94, 0.920, and 0.96 for stable, unstable, deteriorating, and terminal phases, respectively. CONCLUSIONS: Critical PCOC items distinguishing between PCOC phases were identified, enabling the development of an accurate prediction model. This model enhances hospice care quality by facilitating timely interventions and adjustments based on patients' PCOC phases.

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OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic disrupted educational frameworks worldwide, particularly affecting health professions education. The impact on students varied based on local pandemic severity, public health policies, and institutional capacities. Our observational, retrospective study evaluated the impact of the COVID-19 pandemic on senior dental students' performance during community rotations at Indiana University School of Dentistry. METHODOLOGY: Data from student self-assessments and faculty evaluations, collected as part of the Community-Based Dental Education (CBDE) course between 2018 to 2022 was utilized. Five key domains of patient care: diagnosis and treatment planning, clinical skills, time management, interprofessional collaboration, and professionalism was assesed using a 5-point Likert scale. Pre- and post-pandemic comparisons of self-reported student evaluation and faculty assessment scores were conducted using two-sample t-tests, with ANOVA used to analyze cohort differences. RESULTS: Significant declines were observed in mean scores for diagnosis and treatment planning, clinical skills, time management, and interprofessional collaboration during the post-COVID period compared to pre-COVID levels (p < 0.05). Conversely, an increase in average scores related to students' professionalism was noted, although this difference was not statistically significant (p > 0.05). Class cohort-wise analysis showed similar patterns, with all cohorts experiencing significant declines in the aforementioned areas (p < 0.05) and non-significant increases in professionalism scores (p > 0.05). CONCLUSION: This study findings underscore the challenges faced by dental education in adapting to pandemic-induced disruptions and highlight the importance of adaptive approaches and support systems to address these challenges. Moving forward, resolving disparities in assessments and comprehending the various factors influencing student performance will be crucial to preserving the adaptability and effectiveness of dentistry education in the face of adversity.

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The Zero discharge technology has become an important pathroute for sustainable development of high salt wastewater treatment. However, the cohabitation of organic and inorganic debris can cause serious problems such membrane clogging and the formation of hazardous impurity salts that further restrict the recovery of all salt varieties by evaporating and crystallizing. In highly salinized wastewater, biological treatments offer advantages in terms of cost and sustainability when used as a pre-treatment step to eliminate organic debris. On the other hand, high salinity is always a major obstacle to microbial diversity, abundance, and activity, which can result in low organic matter removal effectiveness or the failure of the microbial treatment system. Biofortification techniques can attenuate the negative effects of salt stress and other unfavourable conditions on microorganisms, while the regulation mechanisms of microbial and community collaboration by fortification methods have been an open question. Therefore, a comprehensive summary of the types, mechanisms, and effects of the major biofortification techniques is proposed. This review dialyzes the characteristics and sources of hypersaline wastewater and the main treatment methods. Then, the mechanisms of microbial salt tolerance are summarized and discussed based on microbial characteristics and the protective effects provided by the processes. Finally, the research and application of the main bioaugmentation methods are developed in detail, describing the characteristics, advantages and disadvantages of the different enhancement methods in their implementation. This review provides a more comprehensive perspective on the future engineering applications of bioaugmentation technology, and explores in depth the possibilities of applying biological methods to high-salinity wastewater treatment.

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Anorectal malformations (ARM) encompass a spectrum of rare congenital defects of the rectum and anus, requiring specialized reconstructive surgery. To improve epidemiological and clinical research in rare diseases such as ARM, collaborative efforts and patient registries are key. This retrospective study pools clinical data over a 30-year period from two ARM patient registries (The Royal Children's Hospital (RCH) in Melbourne, Australia, and the ARM-Network Consortium in Europe). It aims to draw comparisons on demographics, management, and outcomes between ARM patients in Australia and Europe. A total of 2947 ARM patients were included in the analyses. The RCH cohort had more complex ARM types (including rectal atresia and recto-vaginal fistula) and more associated anomalies, specifically skeletal, cardiac, and/or trachea-esophageal, than ARM-Net patients. Other patient characteristics were similar. Treatments clearly differed between the groups. European surgeons favoured the PSARP approach for both less complex and more complex ARM types, where Australian surgeons opted more often for cutback surgery in less complex, and laparoscopic assistance in more complex types. Complications were differently distributed, with less complications after LAARP and more after PSARP at RCH, compared to ARM-Net. While RCH patients more often required a redo, ARM-Net patients more commonly underwent anal dilatations. Anorectal malformation patients in Australia and Europe had minor differences in disease characteristics, and both operative and medical approaches differed. Joint efforts such as the present study emphasize the importance of collaboration to elucidate areas of improvement where surgeons may learn from each other across the world, ultimately improving patient outcomes. TYPE OF STUDY: Original Research. LEVEL OF EVIDENCE: III.

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BACKGROUND: Communication is considered an inherent element of nearly every implementation strategy. Often it is seen as a means for imparting new information between stakeholders, representing a Transaction orientation to communication. From a Process orientation, communication is more than information-exchange and is acknowledged as being shaped by (and shaping) the individuals involved and their relationships with one another. As the field of Implementation Science (IS) works to strengthen theoretical integration, we encourage an interdisciplinary approach that engages communication theory to develop richer understanding of strategies and determinants of practice. METHODS: We interviewed 28 evaluators, 12 implementors, and 12 administrators from 21 Enterprise-Wide Initiatives funded by the Department of Veteran Affairs Office of Rural Health. Semi-structured interviews focused on experiences with implementation and evaluation strategies. We analyzed the interviews using thematic analysis identifying a range of IS constructs. Then we deductively classified those segments based on a Transaction or Process orientation to communication. RESULTS: We organized findings using the two IS constructs most commonly discussed in interviews: Collaboration and Leadership Buy-in. The majority of segments coded as Collaboration (n = 34, 74%) and Leadership Buy-in (n = 31, 70%) discussed communication from a Transaction orientation and referred to communication as synonymous with information exchange, which emphasizes the task over the relationships between the individuals performing the tasks. Conversely, when participants discussed Collaboration and Leadership Buy-in from a Process orientation, they acknowledged both constructs as the result of long-term efforts to develop positive relationships based on trust and respect, and emphasized the time costliness of such strategies. Our findings demonstrate that participants who discussed communication from a Process orientation recognized the nuance and complexity of interpersonal interactions, particularly in the context of IS. CONCLUSIONS: Efficient, reliable information exchange is a critical but often overemphasized element of implementation. Practitioners and researchers must recognize and incorporate the larger role of communication in IS. Two suggestions for engaging a Process orientation to communication are to: (a) use interview probes to learn how communication is enacted, and (b) use process-oriented communication theories to develop interventions and evaluation tools.

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OBJECTIVES: This case report delves into the intricate management of a newborn with transient neonatal diabetes mellitus (TNDM), shedding light on the complexities and challenges in treatment decisions. CASE PRESENTATION: Born prematurely with a low birth weight and a maternal background of gestational diabetes, the infant developed hyperglycaemia necessitating intravenous insulin therapy. Subsequent genetic testing confirmed 6q24-TNDM, due to the uniparental disomy of the whole of chromosome 6. Glibenclamide, a second-generation sulfonylurea, was cautiously introduced but discontinued due to adverse effects. Despite post-meal hyperglycaemia, blood glucose levels stabilised over subsequent weeks. Regular follow-ups demonstrated appropriate growth and development and the resolution of diabetes. CONCLUSIONS: This unique case highlights the need for multidisciplinary collaboration, tailored treatment strategies, and vigilant monitoring in managing 6q24-TNDM.

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The endocannabinoid system (ECS) is a critical regulatory network composed of endogenous cannabinoids (eCBs), their synthesizing and degrading enzymes, and associated receptors. It is integral to maintaining homeostasis and orchestrating key functions within the central nervous and immune systems. Given its therapeutic significance, we have launched a series of drug discovery endeavors aimed at ECS targets, including peroxisome proliferator-activated receptors (PPARs), cannabinoid receptors types 1 (CB1R) and 2 (CB2R), and monoacylglycerol lipase (MAGL), addressing a wide array of medical needs. The pursuit of new therapeutic agents has been enhanced by the creation of specialized labeled chemical probes, which aid in target localization, mechanistic studies, assay development, and the establishment of biomarkers for target engagement. By fusing medicinal chemistry with chemical biology in a comprehensive, translational end-to-end drug discovery strategy, we have expedited the development of novel therapeutics. Additionally, this strategy promises to foster highly productive partnerships between industry and academia, as will be illustrated through various examples.

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A global biopharma company, GSK, and the University of Strathclyde have developed an expansive and transformative research and training partnership originating in chemistry-aligned disciplines, with subsequent extensive expansion across further areas of the company. This has opened unique approaches for the delivery of collaborative research innovations while also enhancing the professional development and learning of GSK personnel, in addition to other embedded researchers and collaborating scientists, on a pathway towards more rapid and efficient discovery of new medicines.

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BACKGROUND: Stroke patients often experience limb dysfunction, which can significantly impact their quality of life and daily living abilities. This study aimed to explore the effectiveness of nursing programs that incorporate multidisciplinary continuing care with the participation of nursing staff for patients with stroke and limb dysfunction. METHODS: This was a randomized controlled trial (RCT) conducted from August 2021 to August 2023. Ninety stroke patients were randomly assigned to a control group (n = 45) and an observation group (n = 45). The control group received routine discharge care, while the observation group received multidisciplinary continuing care with the participation of nursing staff. Outcomes measured included Fugl-Meyer Assessment (FMA) scores for upper and lower limb function, quality of life, daily living ability (Barthel Index, MBI), and adverse reactions. RESULTS: The FMA scores for upper and lower limbs were significantly higher in the observation group compared to the control group. The observation group also had significantly higher scores in all quality of life dimensions and MBI scores compared to the control group. There were 10 adverse reactions reported in the observation group and 22 in the control group. CONCLUSIONS: Implementing multidisciplinary continuing care with the participation of nursing staff for stroke patients with limb dysfunction has a positive effect on improving limb function, quality of life, and daily living abilities, while also being relatively safe.

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The quest for groundbreaking discoveries in healthcare research faces significant challenges, not just technical but also political. Political landmines, such as controversies, regulations, and policies influenced by political agendas, affect healthcare research. These landmines can derail studies, stifle innovation, and impede the advancement of medical knowledge and public health. Political agendas often impose narratives that contradict scientific evidence, influencing research areas like reproductive health, climate change, and vaccinations. Funding volatility due to political shifts creates uncertainty, discouraging long-term projects and slowing healthcare innovation. Ethical and regulatory barriers shaped by political considerations further limit research scope and delay breakthroughs. Political influences also result in censorship and misinformation, undermining informed decision-making and public trust. Geopolitical tensions hinder international collaboration, reducing the capacity to address global health challenges. To mitigate these effects, the scientific community must advocate for evidence-based policies, communicate transparently with policymakers, and build robust alliances to support research independence. Fostering resilience within the research community is crucial for adapting to changing political climates and ensuring the continuity of essential projects. Healthcare research can continue to advance and improve global health outcomes by addressing these political challenges.

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AIM: To explore the effect of a multidisciplinary team (MDT) nursing model based on enhanced recovery after surgery (ERAS) in total hip arthroplasty (THA)/total knee arthroplasty (TKA) and evaluate its application in the perioperative period of patients. METHODS: A retrospective analysis was conducted on 100 patients with THA/TKA treated at Shaoxing Second Hospital Medical Community General Hospital from January 2021 to December 2023. The patients were divided into an observation group (n = 50) and a control group (n = 50) based on the nursing method employed. The control group received traditional perioperative nursing, while the observation group received an MDT nursing model intervention based on the ERAS concept. Visual analogue scale (VAS) scores were recorded at 6, 24, and 72 hours post-surgery. Additionally, postoperative activities, hospitalization duration, and postoperative complications were documented. Differences in knee joint range of motion (ROM), hip Harris score, psychological stress response score, and quality of life score between the two groups before and one month after surgery were analyzed. RESULTS: At 6, 24, and 72 hours post-surgery, patients in the observation group had significantly lower VAS scores compared to those in the control group (all P < 0.05). The observation group had an earlier first-time mobilization (P < 0.05). The length of hospitalization and hospitalization cost were significantly lower in the observation group than in the control group (both P < 0.05). The incidence rates of postoperative adverse reactions were 22.00% in the control group and 6.00% in the observation group (P < 0.05). One month post-surgery, the observation group showed significantly greater ROM, lower psychological stress and reaction scores, and higher Harris score and quality of life score compared to the control group (all P < 0.05). CONCLUSION: The MDT nursing model based on ERAS concept for THA/TKA perioperative patients effectively alleviates postoperative pain, promotes early activity, shortens hospital stay, reduces hospital cost, decreases the incidence of complications, restores joint function, enhances quality of life, and reduces psychological stress.