Cargando…

Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada

BACKGROUND: Administration of magnesium sulphate (MgSO(4)) to women with imminent preterm birth at <34 weeks is an evidence-based antenatal neuroprotective strategy to prevent cerebral palsy. Although a Society of Obstetricians and Gynaecologists of Canada (SOGC) national guideline with practice...

Descripción completa

Detalles Bibliográficos
Autores principales: Teela, Katherine C., De Silva, Dane A., Chapman, Katie, Synnes, Anne R., Sawchuck, Diane, Basso, Melanie, Liston, Robert M., von Dadelszen, Peter, Magee, Laura A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688933/
https://www.ncbi.nlm.nih.gov/pubmed/26694323
http://dx.doi.org/10.1186/s12884-015-0785-8
_version_ 1782406761726083072
author Teela, Katherine C.
De Silva, Dane A.
Chapman, Katie
Synnes, Anne R.
Sawchuck, Diane
Basso, Melanie
Liston, Robert M.
von Dadelszen, Peter
Magee, Laura A.
author_facet Teela, Katherine C.
De Silva, Dane A.
Chapman, Katie
Synnes, Anne R.
Sawchuck, Diane
Basso, Melanie
Liston, Robert M.
von Dadelszen, Peter
Magee, Laura A.
author_sort Teela, Katherine C.
collection PubMed
description BACKGROUND: Administration of magnesium sulphate (MgSO(4)) to women with imminent preterm birth at <34 weeks is an evidence-based antenatal neuroprotective strategy to prevent cerebral palsy. Although a Society of Obstetricians and Gynaecologists of Canada (SOGC) national guideline with practice recommendations based on relevant clinical evidence exists, ongoing controversies about aspects of this treatment remain. Given this, we anticipated managed knowledge translation (KT) would be needed to facilitate uptake of the guidelines into practice. As part of the Canadian Institutes of Health Research (CIHR)-funded MAG-CP (MAGnesium sulphate to prevent Cerebral Palsy) project, we aimed to compare three KT methods designed to impact both individual health care providers and the organizational systems in which they work. METHODS: The KT methods undertaken were an interactive online e-learning module available to all SOGC members, and at MAG-CP participating sites, on-site educational rounds and focus group discussions, and circulation of an anonymous ‘Barriers and Facilitators’ survey for the systematic identification of facilitators and barriers for uptake of practice change. We compared these strategies according to: (i) breadth of respondents reached; (ii) rates and richness of identified barriers, facilitators, and knowledge needed; and (iii) cost. RESULTS: No individual KT method was superior to the others by all criteria, and in combination, they provided richer information than any individual method. The e-learning module reached the most diverse audience of health care providers, the site visits provided opportunity for iterative dialogue, and the survey was the least expensive. Although the site visits provided the most detailed information around individual and organizational barriers, the ‘Barriers and Facilitators’ survey provided more detail regarding social-level barriers. The facilitators identified varied by KT method. The type of knowledge needed was further defined by the e-learning module and surveys. CONCLUSIONS: Our findings suggest that a multifaceted approach to KT is optimal for translating national obstetric guidelines into clinical practice. As audit and feedback are essential parts of the process by which evidence to practice gaps are closed, MAG-CP is continuing the iterative KT process described in this paper concurrent with tracking of MgSO(4) use for fetal neuroprotection and maternal and child outcomes until September 2015; results are anticipated in 2016. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-015-0785-8) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-4688933
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-46889332015-12-24 Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada Teela, Katherine C. De Silva, Dane A. Chapman, Katie Synnes, Anne R. Sawchuck, Diane Basso, Melanie Liston, Robert M. von Dadelszen, Peter Magee, Laura A. BMC Pregnancy Childbirth Research Article BACKGROUND: Administration of magnesium sulphate (MgSO(4)) to women with imminent preterm birth at <34 weeks is an evidence-based antenatal neuroprotective strategy to prevent cerebral palsy. Although a Society of Obstetricians and Gynaecologists of Canada (SOGC) national guideline with practice recommendations based on relevant clinical evidence exists, ongoing controversies about aspects of this treatment remain. Given this, we anticipated managed knowledge translation (KT) would be needed to facilitate uptake of the guidelines into practice. As part of the Canadian Institutes of Health Research (CIHR)-funded MAG-CP (MAGnesium sulphate to prevent Cerebral Palsy) project, we aimed to compare three KT methods designed to impact both individual health care providers and the organizational systems in which they work. METHODS: The KT methods undertaken were an interactive online e-learning module available to all SOGC members, and at MAG-CP participating sites, on-site educational rounds and focus group discussions, and circulation of an anonymous ‘Barriers and Facilitators’ survey for the systematic identification of facilitators and barriers for uptake of practice change. We compared these strategies according to: (i) breadth of respondents reached; (ii) rates and richness of identified barriers, facilitators, and knowledge needed; and (iii) cost. RESULTS: No individual KT method was superior to the others by all criteria, and in combination, they provided richer information than any individual method. The e-learning module reached the most diverse audience of health care providers, the site visits provided opportunity for iterative dialogue, and the survey was the least expensive. Although the site visits provided the most detailed information around individual and organizational barriers, the ‘Barriers and Facilitators’ survey provided more detail regarding social-level barriers. The facilitators identified varied by KT method. The type of knowledge needed was further defined by the e-learning module and surveys. CONCLUSIONS: Our findings suggest that a multifaceted approach to KT is optimal for translating national obstetric guidelines into clinical practice. As audit and feedback are essential parts of the process by which evidence to practice gaps are closed, MAG-CP is continuing the iterative KT process described in this paper concurrent with tracking of MgSO(4) use for fetal neuroprotection and maternal and child outcomes until September 2015; results are anticipated in 2016. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-015-0785-8) contains supplementary material, which is available to authorized users. BioMed Central 2015-12-22 /pmc/articles/PMC4688933/ /pubmed/26694323 http://dx.doi.org/10.1186/s12884-015-0785-8 Text en © Teela et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Teela, Katherine C.
De Silva, Dane A.
Chapman, Katie
Synnes, Anne R.
Sawchuck, Diane
Basso, Melanie
Liston, Robert M.
von Dadelszen, Peter
Magee, Laura A.
Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada
title Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada
title_full Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada
title_fullStr Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada
title_full_unstemmed Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada
title_short Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada
title_sort magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in canada
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688933/
https://www.ncbi.nlm.nih.gov/pubmed/26694323
http://dx.doi.org/10.1186/s12884-015-0785-8
work_keys_str_mv AT teelakatherinec magnesiumsulphateforfetalneuroprotectionbenefitsandchallengesofasystematicknowledgetranslationprojectincanada
AT desilvadanea magnesiumsulphateforfetalneuroprotectionbenefitsandchallengesofasystematicknowledgetranslationprojectincanada
AT chapmankatie magnesiumsulphateforfetalneuroprotectionbenefitsandchallengesofasystematicknowledgetranslationprojectincanada
AT synnesanner magnesiumsulphateforfetalneuroprotectionbenefitsandchallengesofasystematicknowledgetranslationprojectincanada
AT sawchuckdiane magnesiumsulphateforfetalneuroprotectionbenefitsandchallengesofasystematicknowledgetranslationprojectincanada
AT bassomelanie magnesiumsulphateforfetalneuroprotectionbenefitsandchallengesofasystematicknowledgetranslationprojectincanada
AT listonrobertm magnesiumsulphateforfetalneuroprotectionbenefitsandchallengesofasystematicknowledgetranslationprojectincanada
AT vondadelszenpeter magnesiumsulphateforfetalneuroprotectionbenefitsandchallengesofasystematicknowledgetranslationprojectincanada
AT mageelauraa magnesiumsulphateforfetalneuroprotectionbenefitsandchallengesofasystematicknowledgetranslationprojectincanada
AT magnesiumsulphateforfetalneuroprotectionbenefitsandchallengesofasystematicknowledgetranslationprojectincanada