Acupuncture:Effective and Recommended but More Implementation Needed

Acupuncture enjoys a robust evidence base for dozens of clinical conditions and decades of research exploring its mechanisms of action. It has over 9,000 positive recommendations from official government and clinical guidelines. However, it still remains relatively inaccessible in the United States, Europe and elsewhere, especially compared to the strength of evidence-based recommendations for its use. Acupuncture would benefit from robust implementation strategies, utilizing insights and approaches from implementation science. The clinical use of Botox for migraine suffered from weaker evidence of effectiveness and greater evidence of harm, but using a streamlined and robust implementation strategy, Allergan was able to achieve widespread implementation from when it began its efforts around 2010. Such a systematic approach that identifies and overcomes barriers to implementation for acupuncture would benefit millions of people who currently are offered less effective and more invasive treatments, contrary to the recommendations of clinical guidelines.

A cluster-randomized trial comparing two SWITCH implementation support strategies for school wellness intervention effectiveness

Background:The School Wellness Integration Targeting Child Health(SWITCH)intervention has demonstrated feasibility as an implementation approach to help schools facilitate changes in students’physical activity(PA),sedentary screen time(SST),and dietary intake(DI).This study evaluated the comparative effectiveness of enhanced(individualized)implementation and standard(group-based)implementation.Methods:Twenty-two Iowa elementary schools participated,with each receiving standardized training(wellness conference and webinars).Schools were matched within region and randomized to receive either individualized or group implementation support.The PA,SST,and DI outcomes of 1097 students were assessed at pre-and post-intervention periods using the Youth Activity Profile.Linear mixed models evaluated differential change in outcomes by condition,for comparative effectiveness,and by gender.Results:Both implementation conditions led to significant improvements in PA and SST over time(p<0.01),but DI did not improve commensurately(p value range:0.02‒0.05).There were no differential changes between the group and individualized conditions for PA(p=0.51),SST(p=0.19),or DI(p=0.73).There were no differential effects by gender(i.e.,non-significant condition-by-gender interactions)for PA(p_(for interaction)=0.86),SST(p_(for interaction)=0.46),or DI(p_(for interaction)=0.15).Effect sizes for both conditions equated to approximately 6 min more PA per day and approximately 3 min less sedentary time.Conclusion:The observed lack of difference in outcomes suggests that group implementation of SWITCH is equally effective as individualized implementation for building capacity in school wellness programming.Similarly,the lack of interaction by gender suggests that SWITCH can be beneficial for both boys and girls.Additional research is needed to understand the school-level factors that influence implementation(and outcomes)of SWITCH.

Implementation strategies to improve evidence-based practice for post-stroke dysphagia identification and management:A before-andafter study

Objectives Even though guidelines are available to guide dysphagia identification and management practice,there is still a gap between evidence and practice,which requires improvement.The purpose of this study was to determine the effect of using tailored,multifaceted strategies to improve evidence-based post-stroke dysphagia identification and management practice in a community hospital.Methods Guided by the Knowledge to Action framework,the tailored,multifaceted strategies were developed and implemented for 5 months in a community hospital using a before-and-after study design.These strategies consisted of training intervention,policy intervention,and audit and feedback intervention.Nurses’level of knowledge and adherence,were collected in March 2019 and again in January 2020.Patients’quality of life and satisfaction were evaluated during the pre-intervention period(between February 2019 and April 2019)and the post-intervention period(between November 2019 and January 2020).Results A total of 55 patients with post-stroke dysphagia(28 in the pre-intervention period and 27 in the post-intervention period)and 17 registered nurses were recruited.Following implementation,there were statistically significant improvements in patients’outcomes(quality of life and satisfaction)and nurses’outcomes(level of knowledge and adherence).Conclusions This study assists in closing the research-practice gap by using tailored,multifaceted strategies to increase the use of evidence-based nursing care for dysphagia identification and management practices.

Global Community of Disaster Risk Reduction Scientists and Decision Makers Endorse a Science and Technology Partnership to Support the Implementation of the Sendai Framework for Disaster Risk Reduction 2015–2030

At the first gathering of its kind on the role of science in implementing the Sendai Framework for Disaster Risk Reduction 2015–2030,over 750 scientists,policymakers,business people,and practitioners met in Geneva from January 27–29,2016.The UNISDR Science and Technology Conference on the Implementation of the Sendai Framework for Disaster Risk Reduction 2015–2030 fea-

Exploring social movement concepts and actions in a knowledge uptake and sustainability context: A concept analysis

Objectives:To share a concept analysis of social movement aimed at advancing its application to evidence uptake and sustainability in health-care.Methods:We applied Walker and Avant method to clarify the concept of social movement in the context of knowledge uptake and sustainability.Peer-reviewed and grey literature databases were systematically searched for relevant reports that described how social movement action led to evidence-based practice changes in health and community settings.Titles,abstracts and full texts were reviewed independently and in duplicate,resulting in 38 included articles.Results:Social movement action for knowledge uptake and sustainability can be defined as individuals,groups,or organizations that,as voluntary and intrinsically motivated change agents,mobilize around a common cause to improve outcomes through knowledge uptake and sustainability.The 10 defining attributes,three antecedents and three consequences that we identified are dynamic and interrelated,often mutually reinforcing each other to fortify various aspects of the social movement.Examples of defining attributes include an urgent need for action,collective action and collective identity.The concept analysis resulted in the development of the Social Movement Action Framework.Conclusions:Social movement action can provide a lens through which we view implementation science.Collective action and collective identity e concepts less frequently canvassed in implementation science literature e can lend insight into grassroots approaches to uptake and sustainability.Findings can also inform providers and change leaders on the practicalities of harnessing social movement action for realworld change initiatives.By mobilizing individuals,groups,or organizations through social movement approaches,they can engage as powered change agents and teams that impact the individual,organizational and health systems levels to facilitate knowledge uptake and sustainability.

Implementing a new tuberculosis surveillance system in Zhejiang,Jilin and Ningxia:improvements,challenges and implications for China’s National Health Information System

Background:China is still faced with the public health challenge of tuberculosis(TB),and a robust surveillance system is critical for developing evidence-based TB control policies.The Tuberculosis Information Management System(TBIMS),an independent system launched in 2005,has encountered several challenges in meeting the current needs ofTB control.The Chinese government also planned to establish the National Health Information System(NHIS)aggregating data in different areas.The China National Health Commission-Gates TB Project Phase III launched a new TB surveillance system to address these challenges and also as a pilot for the countrywide implementation of the NHIS.This commentary highlights the improvements and challenges in implementing the newTB system and also discusses the implications for the roll-out of the NHIS.