Putting Implementation Science into Practice: Lessons from the Creation of the National Maternal and Child Health Workforce Development Center

Abstract

Purpose This article describes how implementation science informed the design of a national training and technical assistance (TA) center, and how implementation best practices have been used to improve the quality of training and technical assistance services offered to states/jurisdictions. Description An existing tool, based on the Implementation Drivers Framework (in: Fixsen et al., Implementation research: a synthesis of the literature, University of South Florida, The National Implementation Research Network, Tampa, 2005), was adapted to assess efforts of the National MCH Workforce Development Center (the Center) against known implementation best practices. Staff identified specific examples of effective practice and gaps for inclusion in this article. Assessment Using implementation science to establish, assess and improve Center practice was both feasible and practical, requiring intentionality, dedicated time, and staff committed to deepening their understanding of implementation science. The Implementation Drivers framework proved useful for creating a shared approach to analysis and identification of opportunities for improvement of Center practice. Conclusion Policymakers and funding agencies should consider how training and technical assistance programs demonstrate knowledge and use of implementation science best practices among other evidence based practices in their work. Increasing attention to the use of implementation science can contribute to a higher quality of service among technical assistance centers, with the long term goal of improving outcomes for training and assistance recipients and the communities they serve. Establishing the link between customer satisfaction and quality of technical assistance, on the one hand, and long term outcomes, on the other, remains a challenge and an area of focus and learning for the Center.

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Eradicating MRSA carriage: the impact of throat carriage and Panton-Valentine leukocidin genes on success rates

Abstract

In Denmark, eradication treatment is recommended for methicillin-resistant Staphylococcus aureus (MRSA) carriers. Here, we analyze factors associated with eradication outcome. MRSA carriers referred to the MRSA Knowledge Center at Hvidovre Hospital in 2013 were included. Carriers were sampled from nose, throat, and perineum. Eradication regimen was 5 days of mupirocin nasal ointment and chlorhexidine whole-body wash. Oral antibiotics were sometimes added. Factors associated with eradication after the first eradication attempt were analyzed by logistic regression and expressed as odds ratio (OR) with 95% confidence interval (95% CI). Of 164 individuals, 143 completed 1- and 6-month follow-up after 1st treatment. Eradication was achieved in 63 (38.4%) patients after one treatment and 101 (61.6%) individuals became MRSA free after up to 4 eradication treatments. Throat carriage was associated with a higher failure rate (OR 0.29 (0.10–0.80)), while the presence of Panton-Valentine leukocidin (PVL) genes (37%) was associated with higher success rate (OR 3.52 (1.44–8.57)). Other factors analyzed were not significantly associated with eradication outcome. None of the 26 patients lost to follow-up developed later MRSA infections. This study estimates the efficacy of treatment of MRSA carriage with an eradication rate of 38.4% after the first treatment and a total eradication rate of 61.6% after several treatments. Throat carriers had a lower eradication success rate. Adding oral antibiotics to the first treatment did not increase success. The finding of a significant higher success rate when having a PVL-positive clone should be further investigated.

http://bit.ly/2UhyWgk

Population-based estimates of the burden of pneumonia hospitalizations in Hong Kong, 2011–2015

Abstract

Up-to-date data on the burden of disease are important to identify patients with unmet needs and to optimize healthcare resources. We aimed to characterize the burden of pneumonia hospitalizations in Hong Kong and inform targeted healthcare policies for pneumonia control in the era of global aging. This was a population-based study using a territory-wide administrative electronic health record system that covers all public hospitals of Hong Kong. Patients admitted to public hospitals, from 2011 to 2015, with a diagnosis of pneumonia at discharge were identified based on the International Classification of Diseases-Ninth Revision-Clinical Modification Codes (480–486 and 487.0). Incidence, inpatient case-fatality, all-cause fatality, 28-day readmission, hospital length of stay, and healthcare costs were assessed for seven age strata. We identified 323,992 patients (median age 80 years, 44.4% female) with hospitalized pneumonia (organism unspecified 84.2%; bacterial pneumonia 12.3%; viral pneumonia 2.5%; others 1.0%). Annual incidence was 955.1 per 100,000 population, with a 10.6% decrease from 2011 to 2015. Case-fatality, all-cause fatality, and 28-days readmission risks were 13.8, 21.6, and 19.5%, respectively. The average hospital length of stay was 14.1 days with corresponding direct costs of $9348 USD per episode in the monetary value of 2015. Individuals aged ≥ 65 years accounted for over 75% of pneumonia-related hospitalizations, 90% of deaths, and the majority of healthcare costs. Hospitalized pneumonia represents a considerable health and economic burden in Hong Kong, especially in older adults. The study provides a population-level baseline estimate for further cost-effective evaluation of targeted strategies for pneumonia control.

http://bit.ly/2Dxat0O

Comparison between Vitek MS, Bruker Biotyper, Vitek2, and API20E for differentiation of species of the genus Raoultella

Abstract

Rapid and reliable identification of microorganisms in the clinical laboratory is essential for an early and accurate diagnosis guiding timely therapy. However, conventional methods are sometimes unreliable and show controversial outcomes. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been reported as a rapid and reliable method for identification of bacteria and fungi isolated from clinical samples. Members of the genus Raoultella are increasingly recognized as clinically relevant. There are difficulties in their identification at the species level since sequencing the 16S rRNA or the rpoB genes does not show conclusive results. The aim of this study has been to compare two MALDI-TOF MS systems (Vitek MS and Bruker Biotyper) with Vitek2 and API20E systems for differentiation of Raoultella species. A collection of 97 clinical isolates of Raoultella species was identified with Vitek MS, in parallel with Vitek2 and API, and finally with Bruker Biotyper. Among the two most widely used MALDI-TOF MS platforms, results obtained with Vitek MS were slightly superior to those obtained with the Bruker Biotyper system, with sensitivities and specificities of 98.9/57.9% and 98.8/37.0%, respectively. The current commercial phenotypic identification systems are not optimized for the identification of Raoultella species. Our results indicate that MALDI-TOF-based identification is more accurate and sensitive than that provided by phenotypic methods.

http://bit.ly/2UjUvNn

Clinical features and cause analysis of false positive results of Aspergillus galactomannan assay in pulmonary cryptococcosis patients

Abstract

There have been conflicting reports of false positive galactomannan assay results in patients with systemic cryptococcosis. We sought to determine the frequency of GM positivity in patients with pulmonary cryptococcosis and confirm the source of this cross-reactivity in vitro. We conducted a retrospective study to elucidate the rate of galactomannan (GM) false positivity and cause in a cohort of 29 patients with pulmonary cryptococcal disease. The production of GM cross-reacting substances by clinical isolates and laboratory isolates of C. neoformans was tested in vitro. The mean serum GM index (Platelia Aspergillus) in patients with pulmonary cryptococcosis was 1.06, with 16 (55.2%) of patients having values above the positive cutoff value of 0.5. GM index values significantly decreased after treatment of cryptococcosis. There was no significant correlation between galactomannan and cryptococcal glucuronoxylomannan antigen (Eiken Latex test) results. Culture supernatants from clinical isolates and wild-type C. neoformans did not react in the GM assay; however, growth in the presence of 6% sodium chloride induced the production of cross-reacting GM antigens in culture supernatants from clinical isolates, wild type and a glucuronoxylomannan-deficient mutant of C. neoformans, but not in culture supernatants from a galactoxylomannan-deficient strain. Our results support the cross-reactivity of cryptococcal galactoxylomannan with the serum GM assay in vitro and in patients with pulmonary cryptococcal infection.

http://bit.ly/2DzhbDD

Input Training Matters in L2 Syntactic Representation Entrenchment: Evidence from a Follow-Up ERP Study

Abstract

The usage-based theory highlights the important role of linguistic input in language acquisition, and assumes that syntactic representations could be entrenched through usage or exposure. In the present study, we used the event-related potential technique to investigate the long-term effect of input training on second language (L2) syntactic representations entrenchment, using English subject-verb agreement structures as the stimuli. Results showed that 3 months after the training of the specific subject-verb agreement structures, a significant P600 was observed in the key region (the verb) of the sentences with syntactic violations in the experimental group, but not in the control group. This indicates that linguistic input training contributes to syntactic representations entrenchment, which can be sustained for a relatively long period, indicating a long-term effect of input training. The results suggest that linguistic input is a causal variable in L2 online syntactic processing, supporting the usage-based theory.

http://bit.ly/2S6ZNy5

Exploring the Justifications for Selecting a Drop Landing Task to Assess Injury Biomechanics: A Narrative Review and Analysis of Landings Performed by Female Netball Players

Abstract

When assessing biomechanics in a laboratory setting, task selection is critical to the production of accurate and meaningful data. The injury biomechanics of landing is commonly investigated in a laboratory setting using a drop landing task. However, why this task is so frequently chosen is unclear. Therefore, this narrative review aimed to (1) identify the justification/s provided within the published literature as to why a drop landing task was selected to investigate the injury biomechanics of landing in sport and (2) use current research evidence, supplemented by a new set of biomechanical data, to evaluate whether the justifications are supported. To achieve this, a comprehensive literature search using Scopus, PubMed, and SPORTDiscus online databases was conducted for studies that had collected biomechanical data relating to sport injuries using a drop landing task. In addition, kinematic and kinetic data were collected from female netball players during drop landings and maximum-effort countermovement jumps from the ground to grab a suspended ball. The literature search returned a total of 149 articles that were reviewed to determine the justification for selecting a drop landing task. Of these, 54% provided no explicit justification to explain why a drop landing task was chosen, and 15% stated it was selected because it had been used in previous research. Other reasons included that the drop landing provides high experimental control (16%), is a functional sports task (11%), and is a dynamic task (6%). Evidence in the literature suggests that the biomechanical data produced with drop landings may not be as externally valid as more sport-specific tasks. Biomechanical data showed that the drop landing may not control center of mass fall height any better than maximum-effort countermovement jumps from the ground. Further, the frequently used step-off technique to initiate drop landings resulted in kinematic and kinetic asymmetries between lower limbs, which would otherwise be symmetrical when performing a countermovement jump from the ground. Researchers should consider the limitations of a drop landing task and endeavor to improve the laboratory tasks used to collect biomechanical data to examine the injury biomechanics of landing.

http://bit.ly/2WirBPb