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How to write a winning college essay Vermont Academy

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Knowledge translation: a case study on pneumonia research and clinical guidelines in a low- income country. © Goyet et al.; licensee BioMed Central Ltd. College Essay Vermont Academy! 2014. Received: 21 February 2014. The process and effectiveness of knowledge translation (KT) interventions targeting policymakers are rarely reported. In Cambodia, a low-income country (LIC), an intervention aiming to provide evidence-based knowledge on pneumonia to health authorities was developed to help update pediatric and how to essay adult national clinical guidelines. Through a case study, we assessed the effectiveness of this KT intervention, with the goal of identifying the write college essay Vermont barriers to KT and write essay for scholarship suggest strategies to facilitate KT in similar settings. An extensive search for all relevant sources of data documenting the write a winning college Academy processes of updating adult and pediatric pneumonia guidelines was done.

Documents included among others, reports, meeting minutes, and email correspondences. The study was conducted in The Mount, Hill successive phases: an how to a winning college Vermont Academy, appraisal of the College of Management content of both adult and pediatric pneumonia guidelines; an essay Vermont, appraisal of the quality of paper writing The Mount, Mill guidelines by independent experts, using the AGREE-II instrument; a description and modeling of the KT process within the how to a winning college Academy guidelines updating system, using the Unified Modeling Language (UML) tools 2.2; and the listing of the barriers and facilitators to KT we identified during the study. The first appraisal showed that the integration of the KT key messages in pediatric and adult guidelines varied with a better efficiency in the pediatric guidelines. The overall AGREE-II quality assessments scored 37% and writing 44% for how to write a winning Vermont Academy, adult and pediatric guidelines, respectively. Scores were lowest for the domains of ‘rigor of development’ and essay for scholarship ‘editorial independence.’ The UML analysis highlighted that time frames and constraints of the involved stakeholders greatly differed and how to college that there were several missed opportunities to paper writing The Mount, Mill International, translate on write essay, evidence into the adult pneumonia guideline. Write A Discursive Essay Montverde! Seventeen facilitating factors and how to write college 18 potential barriers to KT were identified.

Main barriers were related to the absence of a clear mandate from the Ministry of Health for the researchers and to a lack of synchronization between knowledge production and policy-making. Study findings suggest that stakeholders, both researchers and write a discursive Montverde Academy policy makers planning to update clinical guidelines in LIC may need methodological support to overcome the expected barriers. Pneumonia still imposes a major burden to populations and health systems in how to a winning Vermont low-income countries (LIC) although interventions to prevent and treat pneumonia are known [ 1 – 4 ]. In Cambodia, a tropical LIC, pneumonia is the leading cause of death among children under five [ 5 ]. From 2007 to 2010, Institut Pasteur in Cambodia (IPC), a research agency, conducted a large study on pneumonia which included more than 4,000 patients of all ages [ 6 , 7 ]. This study describes the epidemiology of write essay most acute lower respiratory infections treated in two major provincial hospitals [ 6 – 9 ]. Study findings were disseminated via various media targeting various audiences. College Essay! However, in 2011, one year after the end of this study, those study findings were neither available to write essay Goldsmiths University, the Cambodian Ministry of Health (MoH) nor to the Cambodian physician in an easily accessible format. How To A Winning College Vermont! The obsolescent clinical practice guidelines issued in 1998 were still the reference for pneumonia management in Cambodia. In August 2011, the MoH undertook the revision of the pediatric and adult guidelines for 180 diseases and health problems commonly treated in the country, including the management of community-acquired pneumonia [ 10 , 11 ]. This revision was given to two task forces of articles writing national clinicians coming from several MoH and nongovernmental organizations’ (NGO) hospitals. Updating guidelines is essay Academy a difficult task, particularly in LIC. Write A Introduction Goldsmiths! Reliable guidelines must be epidemiologically relevant and reflect state-of-the art of medical practice. They have to college Academy, be developed in a transparent way to facilitate their implementation and considering their acceptability and articles John financial implications is also important [ 12 ]. How To Write Vermont Academy! However, there is little documentation on the process of how to a introduction for an University developing or updating guidelines in LIC [ 13 – 16 ]. In September 2011, the IPC researchers were informed by write college essay Academy the World Health Organization (WHO) Cambodian office that a revision of the national guidelines was being undertaken. Although there was no official demand for it from the MoH, the IPC researchers endeavored to provide the MoH with locally relevant and write essay Academy evidence-based knowledge on pneumonia.

IPC researchers facilitated the creation of write Academy a multidisciplinary working group of national and improve critical thinking College international clinicians, biologists, health program managers and epidemiologists involved in pneumonia management in Cambodia, dubbed the CALIBAN network (‘Community-Acquired Lung Infections, Bacteria and Antimicrobial Network’) (List 1). List 1 Summary of the CALIBAN knowledge translation intervention. European epidemiologists from a Cambodian-French research agency (n = 2) Cambodian clinicians from the Ministry of Health (n = 4) Cambodian clinicians and biologists from the how to write essay Academy National Institute of Public Health (n = 1) Cambodian and international clinicians and how to essay Montverde biologists from NGO hospitals (n = 8)

International clinician affiliated with the University of Health Sciences (n = 1) European clinicians from a Cambodia-based research agencies (n = 1) Foreign health program managers from the World Health Organization (n = 1) One of them, a pulmonologist, agreed to chair the CALIBAN group. Another CALIBAN Cambodian clinician was also a member of the a winning essay Academy Task force in charge of updating the guidelines. National Health program managers, policymakers and articles writing International School clinicians, some of them belonging to the working group delivering the write essay intervention. A low- income country, with limited but improving research capacities. Build a working group of stakeholders involved in pneumonia management in write for an Goldsmiths the country.

Collect, appraise, analyze, synthesize data existing on pneumonia etiologies and antimicrobial profiles, in the literature and among the how to write college essay working group. Collectively produce a corpus of evidence. Produce a report and writing John F. Kennedy International a synthesis with key messages adapted to policymakers’ needs. Disseminate the report and synthesis. Push for uptake of this evidence and its translation into write a winning, guidelines recommendations. Document the articles writing John School process. Direct interactions with the intervention recipients (meetings, correspondence), Written communications (full report and synthesis translated in how to a winning essay Academy local language, all available online) Data collection, analysis and a discursive synthesis, shared with the intervention’s recipients. Limited participation of nationals while conducting the intervention. Built up of shared knowledge on pneumonia based on local evidence.

Uptake of the key messages about pneumonia etiologies and antimicrobial resistance and translation into Academy, the CPGs. The CALIBAN group then developed the intervention summarized in List 1. A systematic review and improve critical thinking synthesis of literature on pneumonia etiologies and write college antimicrobial resistance levels in Cambodia and its neighboring countries was conducted [ 17 ]. The CALIBAN group then produced a comprehensive report including and an executive summary formatted according to the recommendations of the SUPPORT group to best accommodate policymakers’ needs [ 18 ]. This summary included key messages to a discursive Academy, guide probabilistic treatment recommendations (Additional file 1 : Table S1). Documents were translated into the Khmer national language and were officially submitted by a national clinician from the CALIBAN group to the MoH in write a winning college Vermont November 2012. These documents were also posted on a freely accessible website ( ). This work describes the retrospective evaluation of this ‘knowledge translation’ (KT) intervention. How To College! KT is the process by a winning which ‘stakeholders are aware of and use research evidence to inform their health and healthcare decision making’ [ 19 ]. It involves ‘using high-quality knowledge in processes of decision making’ [ 20 ]. Several authors have developed KT theories and frameworks [ 21 – 24 ] but the effectiveness and present (ICMS) impact of KT interventions targeting policymakers are rarely reported [ 19 ]. We describe this KT intervention and assess its impact on the updating of guidelines from several angles. Our objective was to identify the barriers to KT encountered in this LIC setting, and to how to college essay Academy, suggest strategies to facilitate KT in similar settings. We retrospectively searched for all relevant sources of data documenting the CALIBAN intervention and the pneumonia guidelines. We used contact with key informants, the a introduction for an of London IPC and CALIBAN archives, the National Institute of Public Health and write college essay Academy MoH websites.

Data collected included project protocols, reports, published literature, and meeting minutes from CALIBAN. How To Write Essay University! It also included the successive drafts of guidelines, email correspondence between researchers, the how to write Academy CALIBAN network and the Task force, as well as notes taken during interviews with a key informant from the NGO who assisted the guidelines update. Queen College! The review of how to write a winning college Vermont Academy these documents enabled us to describe and model the KT intervention. Impact of the KT intervention on the updated guidelines. Firstly, we compared the CALIBAN key messages with the updated adult and pediatric guidelines released in 2013 to assess the extent to which the newly issued recommendations were in line with the key messages (Additional file 1 : Table S1).

We also assessed how well the CALIBAN KT messages were integrated by examining the rigor and transparency of the guidelines updating process. For this purpose, we used the internationally validated AGREE-II instrument [ 25 ]. Each guideline was assessed by articles John F. Kennedy three appraisers as recommended by AGREE-II for an optimum reliability. Appraisers were clinicians and public health specialists who did not participate in the CALIBAN KT intervention. The AGREE-II online tool allows appraisers to independently score six domains, i.e ., scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and how to write a winning Vermont Academy editorial independence. The tool then sums up all the scores of appraisers and computes standardized domain scores (expressed on write Academy, a scale of 0–100). Secondly, we modeled and how to Vermont analyzed the CALIBAN KT process within the ‘guidelines updating’ system, using the International Unified Modeling Language (UML) graphical tools. The purpose was to describe how this intervention worked and to write a winning college essay Vermont Academy, provide a framework for assessing its effectiveness. UML is an object-oriented modeling tool developed in articles John F. Kennedy School 1997 for documenting, designing, and evaluating complex systems [ 26 ]. It is an how to write a winning Vermont, effective medium of communication and development for improve Queen College, both theorists and practitioners [ 27 ]. It has been used to model different aspects of healthcare systems [ 28 , 29 ] including the analysis of clinical trials [ 30 ]. Use case—Knowledge translation during Clinical Practice Guidelines updating.

Class diagram—Knowledge translation and Clinical Practice Guidelines updating. Modeling was performed in several successive steps using UML 2.2 Visio® Microsoft® software. Identification of barriers and facilitators to KT. Finally, we reviewed our AGREE-II appraisal and our UML models and listed the how to a winning college essay barriers and facilitators to KT that we identified during this exercise. How To Academy! We grouped these factors following a classification recently used by de Goede [ 24 , 31 ]. Barriers at write, the process level are those encountered during the preparation phase and essay for scholarship Downside cover mutual expectations from researchers and policymakers, and those related to research findings communication (transfer). Individual factors comprise of the how to a winning college Academy specific behaviors of the KT receivers: their acceptance of the research outcome and write a introduction of London the value they give to it once they have balanced it with their own interests (interpretation).

At the process level, we included in the existing classification some factors relating to the interactions between the stakeholders who produced the evidence on pneumonia (the CALIBAN group) and those who received and were supposed to use it (the MoH and how to a winning college Task forces). The CALIBAN project was based on essay The Mount, International, anonymized acute lower respiratory infections data – including the IPC study [ 6 , 7 ] - gathered by research studies, all of which had obtained ethical clearance from the write a winning Vermont Academy Cambodian National Ethics Committee for Human Research [ 17 ]. Our present article only examines the process through which the CALIBAN project was thought up and developed, and what obstacles were met. This paper is based on write for scholarship School, work which in no way involves interventions or research on human subjects or animals, nor do study results name any informants or stakeholders. The study did not involve research on human subjects, nor do study results name any informants or stakeholders. The integration of the CALIBAN KT key messages varies across adult and how to a winning college Vermont pediatric guidelines (Additional file 1 : Table S1). The pediatric guidelines are well in line with those messages. They recommends antibiotics which CALIBAN found effective against writing The Mount, the most prevalent bacterial pathogens responsible for pneumonia in Cambodia (penicillin A for non-severe cases; penicillin A and gentamicin as first-line treatment for severe cases, with a switch to ceftriaxone in case of no improvement or to cloxacillin if staphylococcal pneumonia is suspected). It also refers to additional guidelines to treat pneumonia due to the less frequent pathogens cited by CALIBAN and which require specific treatments.

Only one KT message is well integrated in the adult guidelines: amoxicillin with or without beta-lactamase inhibitor is cited as first-line treatment for pneumonia. The guideline cites atypical pathogens as possible pneumonia etiologies although the CALIBAN group could not firmly document their prevalence in the country. The second-line option given for non-severe pneumonia are macrolides which are not effective against the most prevalent pathogens in adult pneumonia in Cambodia. Macrolides are also inappropriately recommended as single-drug for how to write a winning college Academy, patients hospitalized in intensive care with very severe pneumonia. Moreover, the guidelines recommend fluoroquinolones for first-line treatment for severe pneumonia in Mill International hospitalized patients and for second-line or alternative treatment for how to college essay Vermont, uncomplicated cases. School! These fluoroquinolones are expensive, have side effects, and should be preserved to avoid resistance and remain a powerful tool against tuberculosis, which is highly prevalent in Cambodia. Write College Essay! Finally these guidelines do not mention the possible use of a discursive essay Academy Amikacin in essay Vermont case of severe pneumonia due to Gram-negative bacteria, although this was among the CALIBAN key messages. AGREE-II scores for how to improve Queen Ethelburga’s College, the adult and the pediatric pneumonia guidelines (standardized domain scores across appraisers), Cambodia 2013. Clinical practice guidelines.

Presentation of scope and how to a winning essay Vermont Academy purpose. Rigor of articles John School development. Clarity of presentation. The AGREE-II criteria on editorial independence scored 12% and 11% for adult and pediatric guidelines, respectively. These scores mainly reflect the non-disclosure of conflicts of interest of the guidelines authors. Potential conflicts of interest such as those from drug companies could not be assessed because they were not disclosed. Modeling analysis of the guideline updating process. By modeling UML use cases, we identified six main actors directly or indirectly interacting within the ‘guidelines updating’ system (Figure 1 ). The MoH (actor one) commissioned the task forces (actor two) to coordinate the guidelines review.

The NGO (actor three) provided logistical support to the task forces and organized the write a winning college essay Vermont Academy external review. The experts (actor four) were the clinician task forces’ members who led the work and wrote the guideline drafts. The researchers (actor five) were the CALIBAN group who produced the scientific evidence-based knowledge. Improve Thinking Queen! The external reviewers (actor six) reviewed the guidelines’ drafts. The activity diagram shows the a winning college essay Academy activities of four actors directly involved in the updating of the adult pneumonia guidelines (Additional file 3 : Figure S2). Articles Writing John F. Kennedy School! It illustrates how all four actors interacted several times. It also highlights that actors missed several opportunities to write college, base this adult guideline on evidence (n = 6 red dots in the figure). The time frames and for an essay of London constraints of the various stakeholders involved were not the same.

Researchers were only invited to present information on pneumonia six months after the how to guidelines updating process started. The experts urged researchers to communicate their results to finalize their task and meet the deadlines, while the articles John F. Kennedy International School researchers, bound to scientific methodology and ethics could not release preliminary and incomplete findings while the review was under way. Researchers issued their final report when the guidelines updating process was well engaged: a second draft of guidelines was already circulating. This draft was validated four months later without any change. Conversely to what happened with the adult guidelines, the main expert in charge of updating the pediatric guideline had a long history of collaboration with pneumonia researchers and endorsed the modifications suggested by write essay the external reviewers.The class diagram shows the dynamics and the complexity of a guideline updating process in such settings. It visualizes the 12 interconnected object classes impacting the Clinical Practice Guidelines (Figure 2 ). Among those, there are the health topics, the scientific knowledge, the international guidelines, and the treatments. This diagram shows how actors operate and write Downside School interact under certain system constraints. It brought out the write a winning college essay Academy potential role of pharmaceutical industries that produce the how to critical medicines.

These industries might influence researchers’ and experts’ judgment by supporting them. In this case study, only researchers declared no conflicts of interests. Experts did not disclose any. Facilitating and impeding factors to KT. Facilitating factors and how to write college barriers to KT during the how to essay Montverde Academy pneumonia guidelines updating, Cambodia 2013. 1. KT intervention provided relevant, accurate, robust, comprehensive and accessible information to Policymakers. 1. The Task force had not planned to request local evidence from locally-based researchers.

2. Being members of the KT intervention group, the Experts had a privileged access to research findings before the final results were available. 2. Limited availability of the Task force -busy with the updating of about 200 guidelines chapters at how to Vermont Academy, the same time. 3. MoH did not initially inform the how to Researchers of the guidelines review process. 4. The evidence readily available at the initiation of the guidelines updating process was not complete enough to be used by Policymakers. 5. Researchers started working on building evidence seven months after the process was initiated by how to write Vermont the MoH. 6. How To A Introduction Goldsmiths University! Policymakers expected the Researchers to provide some evidence quicker. 3. WHO facilitated the contact between Researchers and Policymakers: WHO informed the Researchers that the guidelines were updated.

7. Write College! Patients’ representatives were not associated to the process. They could not relay the need to base the write a introduction for an Goldsmiths Guidelines updating on local evidence. 4. Policymakers received support from an international NGO for some organizational aspects of the process (organization of the Task force meetings, of the External Review Committee…) 8. Limited availability of clinicians with expertise. (limited number of skilled people dealing with too many issues in parallel) 5. The NGO assisting the Policymakers successfully relayed Researchers’ demand to annex the how to write a winning college KT messages to the CPGs. 9. The Task force left the Experts deciding to accept or refuse the External Review Committee’s suggestions for improving the final drafts of guidelines. The Expert in charge of the adult pneumonia guidelines did not accept changes suggested by the External Committee. 6. The Expert who led the work on the pediatric guideline agreed to take into account the recommendations issued by the External Review Committee. 1.2 Knowledge Translation domain. 7. Research synthesis included key messages. 10.

No communication was released to the media by articles writing John School the Researchers. Therefore the how to write college essay process did not receive any media support. 8. Research synthesis was written in plain and easy English and translated into local language. 11. How To Write A Discursive Montverde Academy! Research synthesis and report did not present any logo at how to essay Academy, their front page, except the logo of the KT group. This may have limited the School identification of authors and their perceived credibility (but facilitated the easy appropriation by all co authors) 9. Research synthesis was short and compliant with the SUPPORT recommendations.

10. How To Write A Winning Essay Vermont Academy! Research synthesis was widely made permanently available online. 1.3 Interactions between policymakers and researchers. 1.3.1 Initiated by write a discursive essay Montverde Academy Policymakers during Guidelines Updating process. 11. Policymakers invited the Researchers to participate in one of how to a winning Vermont Academy their meetings.

12. Participation of Researchers in how to essay University of London the Task force was limited to one meeting. 12. A clinician who was familiar with Research was appointed by the Task force to update the pediatric pneumonia guidelines. This clinician had a long lasting history of collaboration with pneumonia researchers.

13. How To! The Expert appointed for the adult pneumonia guideline review had no or limited previous interactions with Researchers. 1.3.2 Initiated by Researchers during the KT intervention. 13. Researchers invited national clinicians and Experts appointed by the Task force to participate in F. Kennedy the KT intervention. 14.

Meetings organized during the KT intervention were conducted in how to write a winning college essay Vermont Academy English which is present articles College (ICMS) not the working language of most clinicians in Cambodia. 15. How To College Vermont! Researchers’ attempts to alert on inappropriate recommendations published in the adult pneumonia guidelines remained unanswered. 2.1.1 Perceived robustness of evidence. 14. Researchers clearly stated the writing International limitations of their Evidence review in their synthesis. 16.

Researchers do not know how the robustness of their findings was perceived by Policymakers. 2.1.2 Perceived credibility of source. 15. College! Data contributing to Downside, the KT intervention were provided bystakeholders known by a winning Academy the policymakers. 16. Researchers analyzed data in the light of current challenges for for scholarship Downside, the national health system (prevention of how to write Academy development of antibiotic resistance, cost effectiveness) 17.

There is not much mutual knowledge on values, belief systems, preference and traditions between Researchers and Policymakers. Connection with own personal or institutional interests. 17. Researchers declared no conflicts of interest in their evidence review. 18. Policymakers did not disclose potential conflicts of write for scholarship Downside interest in the guidelines. Most barriers to KT encountered were related to the lack of synchronization between knowledge production and policy making (Point 1.1.2, Table 2 , n = 5 barriers): researchers were informed of the guidelines’ revision several months after it had started. They had no formal mandate from the MoH. Working intensely, they provided a comprehensive and locally relevant review of evidence within eight months.

However, this pace did not match the policymaker’s time constraints. We also identified barriers at the policy-making process (Point 1.1.3, Table 2 , n = 3 barriers). Those factors are intrinsic to the current situation in write essay Vermont Cambodia, such as the limited availability of clinicians with expertise, or are more individual-dependent ( e.g ., barrier n.9, Table 2 ). The lack of write a discursive interactions between researchers and policymakers is also highlighted (Point 1.4, Table 2 , n = 3 barriers), especially regarding the updating of the adult clinical guideline. One-third of the identified facilitating factors relate to the expectation domain (Point 1.1, Table 2 , n = 6 factors). In particular, the policy process received help from several external stakeholders: the WHO, NGO and the External review committee (Point 1.1.3, Table 2 , n = 4 facilitators). Other facilitating factors relate to the knowledge translation domain (Point 1.2, Table 2 , n = 4 facilitators). The difference between the write essay process of updating the pediatric and the adult guidelines bears on only two points: the pediatric expert had a long term collaborative experience of with researchers in pneumonia research projects, while the expert working on the adult guideline had very little or none; the pediatric expert agreed to take into how to write a discursive essay Montverde Academy, account the suggestions made by how to write essay the external review committee while the adult expert argued that those suggestions came too late in the process. This case-study describes a KT intervention about pneumonia in a LIC and assessed its impact on articles John F. Kennedy International, the updating of write college Vermont Academy two national guidelines for clinical practice using various methods. Such studies are needed since these interventions are rarely reported. Moreover, there is no consensual guidance to date on how to update national guidelines in such countries [ 13 , 19 ]. We showed that this KT process, although partially successful, occurred in a dynamic and complex way.

Comparing the KT process during the updating of both pediatric and adult pneumonia guidelines allowed us to identify possible facilitating and essay paper Mill Hill International impeding factors to KT in similar situations. The pneumonia knowledge produced by the CALIBAN group was successfully translated into the pediatric guidelines. One reason might be that those were prepared by a clinician who used to collaborate with pneumonia researchers. Findings are consistent with what was described elsewhere: when policymakers have a long and strong experience of collaboration with researchers, knowledge utilization is most likely to college essay Vermont Academy, occur [ 32 , 33 ]. This principle drives the how to improve thinking College KT ‘interaction model’ considered as an effective model for optimizing research use [ 31 ]. When policymakers are aware of research constraints, limitations, and strengths, they likely incorporate these into write essay, policies [ 33 ]. Interactions with policymakers may also help researchers to better understand the process of policymaking and its constraints. This ‘interaction model’ takes into write essay for scholarship, account the complexity of the health systems in their context and the interactive and how to a winning college essay Vermont incremental nature of policy development. The researchers who initiated the KT intervention developed several strategies to increase their chances of success. First, they invited the clinicians in charge of writing the guidelines to chair and participate in developing the KT intervention. We found, however, that this was not sufficient to how to critical thinking, impact the adult pneumonia guidelines. Similarly, a study in Canada showed that when policymakers are only involved in the synthesis of essay Vermont Academy research findings, they better understand these findings but do not necessarily use them [ 33 ].

Second, CALIBAN researchers worked on paper writing The Mount, Mill Hill, the quality of the evidence they intended to transfer. They naively expected that providing only a winning relevant, comprehensive, and robust evidence to the right persons would be sufficient to influence the policymaking. This assumption drives the ‘KT push-model’ [ 34 ] that was found to be inefficient: knowledge utilization does not only depend on supply of essay paper writing The Mount, Hill research findings [ 21 , 22 , 24 ]. Write A Winning! Indeed, we showed that the scientific knowledge supplied by the researchers did not spontaneously and simply climb what is called the ‘ladder of how to essay Goldsmiths of London knowledge utilization’ [ 34 ]. CALIBAN findings were transmitted to relevant stakeholders (first stage of the write a winning Academy ladder). Then it reached the ‘cognition’ level which is when research reports are read and understood. But those reports only essay paper writing Hill International reached the ‘reference’ echelon (reports are cited) after a strong encouragement from various stakeholders. Next, the ‘efforts’ step is reached when policymakers show intent to adopt research findings. In this case study, we showed that the write Academy ‘influence’ level (when results have influenced choices and essay paper writing Mill decisions) was actually reached only in the case of the pediatric guideline. ‘Application,’ the how to a winning Vermont ultimate step, is reached when the evidence gives rise to application and extension by program managers. This ultimate step may never be reached. The last strategy developed by the researchers was to format their messages to meet the expected needs of the health policymakers following international and critical thinking Queen Ethelburga’s recognized recommendations [ 18 ]. Indeed, this strategy is reported as a major facilitating factor by policymakers by Innvaer’s systematic review of 24 studies [ 32 ]. Researchers also ensured a wide dissemination of their findings as in the KT ‘institutional dissemination model.’ However, as shown elsewhere, it probably increased the chances of the how to write college essay Vermont Academy CALIBAN messages being integrated into the guidelines, but was not sufficient [ 34 ]. Most barriers to KT we identified were related to International of Management (ICMS), the poor synchronization between knowledge production and Academy policy making, and to the lack of mutual understanding between researchers and policymakers. The timing of activities was a major issue in this KT intervention.

The lack of timeliness on write essay Goldsmiths of London, the production of research evidence is frequently perceived as an important barrier for the effective use of essay Vermont Academy research data, even in developed countries [ 32 ]. Developing long-term collaborations between researchers and policymakers would probably help overcoming this barrier. Study results also suggest that some health policymakers in Cambodia may ignore or mistrust the local research capacity or quality: Western medical textbooks were cited as references, instead of local data. This may be due to the lack of appreciation of the write for scholarship School value of locally generated evidence, emerging from poor interactions between researchers and policymakers. In other settings, policymakers have expressed that developing good relationships with researchers reduced the mutual mistrust and was a significant way to how to a winning college Academy, facilitate KT [ 32 ]. Many of the Cambodian MoH staff are highly skilled public health specialists among the Cambodian MoH staff. Involving these Cambodian public health specialists may have prevented the a introduction for an essay Goldsmiths University recommendations of write a winning non-adapted and expensive treatments that can jeopardize public health, as observed in the adult pneumonia guidelines [ 35 ]. It was difficult to assess the relative importance of the barriers to how to write a introduction for an of London, KT and what determines them, mostly because of the limited transparency in the updating of the guidelines. The AGREE-II appraisal highlighted the possible lack of rigor of development and write college essay Vermont of ‘editorial independence.’ Potential conflicts of interest particularly those related to associations with pharmaceutical companies should always be disclosed. Those companies might be tempted to use guidelines to promote the use of critical thinking Queen Ethelburga’s their products and therefore to influence expert judgment [ 36 ]. Vermont Academy! Previous studies using AGREE-II showed that guidelines on ‘big-programs’ ( e.g ., HIV, malaria) scored better, demonstrating the positive effect of funding and international attention [ 15 , 37 ]. The role of external stakeholders such as the WHO and, the NGO who assisted the task forces and the external review committee was noted as a key facilitating factor of KT in this study.

The WHO and the NGO played a crucial communication role, first of writing Hill International all by how to a winning college Academy informally informing the researchers about the MoH agenda to John F. Kennedy School, update guidelines and college Vermont Academy later by write for scholarship liaising between researchers and write college essay Vermont policymakers. In this case study, the external review committee gave feedback and comments to both task forces. These were accepted and incorporated by the pediatric task force, but the adult task force did not accept them. Recent recommendations on development of guidelines indicate that a review of the a final drafts must be conducted by clinicians and methodological experts not involved in essay paper The Mount, Mill preparing the guidelines [ 13 ]. From the discussion above, we draw a few lessons and tentatively make recommendations to researchers and policymakers seeking to facilitate the how to write college essay Vermont KT from research to Academy, health policies and guidelines. Consult policymakers about their public health priorities to define research questions and do not only base research questions on literature reviews or the advancement of science. Build networks around research thematics, involving stakeholders from college Academy different backgrounds: epidemiologists, clinicians, technicians, program managers, policymakers, civil society, local NGOs, and other relevant partners.

Work on the timeliness and the relevance of evidence shared with policymakers in articles International of Management addition to accuracy and robustness. Besides scientific articles and progress/finding reports, prepare findings synthesis, following the SUPPORT format . Structured summaries must include key messages, sources and methodology, scope and how to write limits of the results and conclusions. Summaries should be presented in articles International of Management person to key stakeholders, with time for discussion, rather than simply handed out. Plan the work on the national clinical guidelines ahead of write essay time and how to a introduction University of London formally request data from researchers. A Winning College Essay Vermont Academy! Consider the time it takes to obtain the write for scholarship most robust, comprehensive, and therefore relevant data on which the guidelines must rely.

Publicize the college process for developing/updating of write a discursive essay Academy guidelines. The worst way to develop guidelines is to hold what Agweyu described as: ‘small meetings of experts [making policies] behind closed doors’ [ 16 ]. Seek methodological support. Guidelines for development/update of guidelines are rare but nevertheless do exist. In 2007, the ADAPTE collaboration developed a systematic approach, a manual and tools to facilitate the adaptation of existing guidelines to different contexts ( ). In 2011, WHO published a handbook for guidelines development in LMIC, based on the experience of a European low-resource setting [ 38 ]. Other references can be found in the systematic review of 38 methodological handbooks published in January 2014 [ 13 ]. Involve external experts and write a winning essay officially mandate an External Review Committee. Define a roadmap for how to write Goldsmiths of London, the Experts in charge of drafting the guidelines, describing the way to interact with other stakeholders involved in the process (in particular the external review committee). To both policymakers and a winning Academy researchers.

Prior to the KT intervention or at its early implementation stage, organize, and facilitate interactions between researchers and policymakers. This potentially makes policymaking and research more compatible. ‘Blur the boundaries’ [ 23 ], constitute multidisciplinary committees and foster KT platforms where various stakeholders can learn and make decisions together [ 38 ]. Present Articles International College Of Management (ICMS)! Make policymakers and the researchers aware of how to write college essay each other’s agendas, constraints, and objectives. Make clinicians with experience in research participate actively in the policy-making process. Identify and involve effective KT coordinators/facilitators—sometimes called ‘knowledge brokers’ [ 39 ]. Their tasks could be to organize meetings, liaise with involved stakeholders, retrieve and format the evidence needed to support the guidelines, prepare recommendation matrices, facilitate consensus, prepare guideline drafts, and coordinate internal and external reviews [ 40 ]. Document and report additional case reports to essay writing, further support the development of guidelines for developing/updating guidelines. Declaring conflicts of how to a winning college essay interest should be mandatory for researchers, tasks forces, and expert committees involved in paper Mill guideline development, especially with regard to guidelines that make recommendations on how to a winning college essay, medication alternatives. There must be guidelines or standard operating procedures for guidelines development that all guidelines committees should follow. The use of available evidence as well as the grading of how to evidence should be part of the above guidelines. Task forces should be provided with tools to grade locally acquired evidence.

Otherwise they may overstate the contribution of western textbooks. The main limitation of this analysis is that it was conducted from the write a winning Vermont Academy perspective of those who designed and implemented the KT intervention since it was the only source available. We used the quality and write essay Downside content appraisals of the updated pneumonia guidelines as a proxy for KT impact. Those appraisals were performed by external independent researchers to limit the interpretation bias. The modeling analysis was conducted by five professionals from various backgrounds to also limit potential bias of analysis. Three of them did not participate to college essay Vermont, any stage of the CALIBAN KT intervention (HB, RF, TL). Essay Mill Hill International! Interviews of the task forces’ members would have given a more detailed understanding of the how to write a winning Academy rationale behind individual decisions. Unfortunately, due to technical and institutional reasons we could not have access to John F. Kennedy, this information, However, such an understanding is how to college readily available through studies exploring policymakers perspectives on KT interventions [ 32 ]. An additional element of complexity is that some persons with a key role in the guidelines updating process were also knowledge dispensers. This case study provides an overview of a partly successful collaboration between researchers and policymakers in a LIC and highlights the main missed opportunities of a KT experience. Longterm and close interaction between researchers and policymakers was the main facilitating factor of KT. How To Of London! Other efforts made by the researchers such as building accurate robust local evidence, formatting it to the needs of policymakers, inviting policymakers to write a winning college Vermont Academy, participate in the KT intervention were not sufficient.

Stakeholders—policymakers and researchers—planning to update clinical guidelines in LIC should receive methodological support to overcome the expected barriers. World Health Organization. Ministry of Health. Clinical practice guidelines. We wish to acknowledge the clinicians who participated in the content and essay Downside School quality appraisals of the pneumonia guidelines. The knowledge translation intervention described in Vermont this manuscript was supported by a grant from the Agence Francaise de developpement. The assessment of essay paper writing Mill this intervention was not funded by any sponsor. Electronic supplementary material. All authors declare that they have no competing interests. SG led the data collection and analysis and wrote the manuscript. RF, HB, and Vermont Academy AT iteratively commented the manuscript drafts and oversaw its development.

HB, TL, JvG, RF, and critical Queen Ethelburga’s College AT were involved in the data analysis. TL oversaw the UML data modeling. AT and SG initiated and led the CALIBAN intervention. College Essay Vermont! JvG was a CALIBAN member. All authors critically read the manuscript and have given final approval. The views expressed in this article are those of the present (ICMS) authors and not necessarily those of their institutions. All authors declared no conflicts of interest. Chopra M, Mason E, Borrazzo J, Campbell H, Rudan I, Liu L, Black RE, Bhutta ZA: Ending of how to write essay Vermont preventable deaths from pneumonia and diarrhoea: an essay paper writing Mill Hill, achievable goal. How To Essay Vermont Academy! Lancet.

2013, 381: 1499-1506. View ArticlePubMedGoogle Scholar Kabra SK, Lodha R, Pandey RM: Antibiotics for how to write Goldsmiths University of London, Community-Acquired Pneumonia in Children. Cochrane Database of Systematic Reviews. Edited by: The Cochrane Collaboration, Kabra SK. 2010, Chichester, UK: John Wiley Sons, Ltd Google Scholar Zhang Y, Fang C, Dong BR, Wu T, Deng JL: Oxygen Therapy for Pneumonia in Adults. Cochrane Database of Systematic Reviews. How To A Winning College Essay! Edited by: The Cochrane Collaboration, Dong BR. 2012, Chichester, UK: John Wiley Sons, Ltd Google Scholar Bhutta ZA, Das JK, Walker N, Rizvi A, Campbell H, Rudan I, Black RE: Lancet diarrhoea and pneumonia interventions study group: interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost?. How To Thinking Ethelburga’s College! Lancet. 2013, 381: 1417-1429. View ArticlePubMedGoogle Scholar WHO/WPRO: Cambodia - Country health information profile - Country health information profile.

2011, , Google Scholar Guerrier G, Goyet S, Chheng ET, Rammaert B, Borand L, Te V, Try PL, Sareth R, Cavailler P, Mayaud C, Guillard B, Vong S, Buchy P, Tarantola A: Acute viral lower respiratory tract infections in Cambodian children: clinical and epidemiologic characteristics. How To Write College Essay! Pediatr Infect Dis J. 2013, 32: e8-e13. View ArticlePubMedGoogle Scholar Vong S, Guillard B, Borand L, Rammaert B, Goyet S, Te V, Lorn Try P, Hem S, Rith S, Ly S, Cavailler P, Mayaud C, Buchy P: Acute lower respiratory infections in ? 5 year -old hospitalized patients in Cambodia, a low-income tropical country: clinical characteristics and pathogenic etiology. BMC Infect Dis. 2013, 13: 97- View ArticlePubMedPubMed CentralGoogle Scholar Arnott A, Vong S, Mardy S, Chu S, Naughtin M, Sovann L, Buecher C, Beaute J, Rith S, Borand L, Asgari N, Frutos R, Guillard B, Touch S, Deubel V, Buchy P: A study of the genetic variability of human respiratory syncytial virus (HRSV) in Cambodia reveals the existence of a new HRSV group B genotype. J Clin Microbiol. 2011, 49: 3504-3513.

View ArticlePubMedPubMed CentralGoogle Scholar Arnott A, Vong S, Sek M, Naughtin M, Beaute J, Rith S, Guillard B, Deubel V, Buchy P: Genetic variability of human metapneumovirus amongst an all ages population in how to write a discursive essay Montverde Cambodia between 2007 and how to Vermont Academy 2009. Infect Genet Evol. 2011 Google Scholar Clinical practice guidelines for medicine, Cambodia. , Clinical practice guidelines for paediatric, Cambodia. , Davino-Ramaya C, Krause LK, Robbins CW, Harris JS, Koster M, Chan W, Tom GI: Transparency matters: Kaiser Permanente’s National Guideline Program methodological processes. Articles International School! Perm J. How To Write A Winning Vermont Academy! 2012, 16: 55-62. View ArticlePubMedPubMed CentralGoogle Scholar Vernooij RW, Sanabria AJ, Sola I, Alonso-Coello P, Garcia LM: Guidance for how to write essay Academy, updating clinical practice guidelines: a systematic review of methodological handbooks. Implement Sci. 2014, 9: 3- View ArticlePubMedPubMed CentralGoogle Scholar Bero LA, Hill S, Habicht J, Mathiesen M, Starkopf J: The updated clinical guideline development process in Estonia is an efficient method for developing evidence-based guidelines. J Clin Epidemiol. 2013, 66: 132-139.

View ArticlePubMedGoogle Scholar Alonso-Coello P, Martinez Garcia L, Carrasco JM, Sola I, Qureshi S, Burgers JS: The updating of clinical practice guidelines: insights from an international survey. Implement Sci. 2011, 6: 107- View ArticlePubMedPubMed CentralGoogle Scholar Agweyu A, Opiyo N, English M: Experience developing national evidence-based clinical guidelines for childhood pneumonia in a low-income setting–making the write college essay GRADE?. BMC Pediatr. 2012, 12: 1- View ArticlePubMedPubMed CentralGoogle Scholar Goyet S, Vlieghe E, Kumar V, Newell S, Moore CE, Bousfield R, Leang HC, Chuop S, Thong P, Rammaert B, Hem S, van Griensven J, Rachmat A, Fassier T, Lim K, Tarantola A: Etiologies and resistance profiles of bacterial community-acquired pneumonia in cambodian and neighboring countries’ health care settings: a systematic review (1995 to 2012). PLoS One. 2014, 9: e89637- View ArticlePubMedPubMed CentralGoogle Scholar Rosenbaum SE, Glenton C, Wiysonge CS, Abalos E, Mignini L, Young T, Althabe F, Ciapponi A, Marti SG, Meng Q, Wang J, Bradford HAMDLA, Kiwanuka SN, Rutebemberwa E, Pariyo GW, Flottorp S, Oxman AD: Evidence summaries tailored to health policy-makers in write essay for scholarship School low- and middle-income countries. Write Essay Academy! Bull World Health Organ. 2011, 89: 54-61. View ArticlePubMedGoogle Scholar Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE: Knowledge translation of how to write for an of London research findings.

Implement Sci. 2012, 7: 50- View ArticlePubMedPubMed CentralGoogle Scholar Straus SE, Tetroe J, Graham I: Defining knowledge translation. Can Med Assoc J. Write College Essay Academy! 2009, 181: 165-168. View ArticleGoogle Scholar Hanney SR, Gonzalez-Block MA, Buxton MJ, Kogan M: The utilisation of articles writing International School health research in policy-making: concepts, examples and methods of assessment. Health Res Policy Syst. 2003, 1: 2- View ArticlePubMedPubMed CentralGoogle Scholar Landry R: The knowledge-value chain: a conceptual framework for knowledge translation in a winning Vermont Academy health. Improve Thinking Queen! Bull World Health Organ. 2006, 84: 597-602. View ArticlePubMedPubMed CentralGoogle Scholar De Leeuw E, McNess A, Crisp B, Stagnitti K: Theoretical reflections on the nexus between research, policy and practice. Crit Public Health.

2008, 18: 5-20. View ArticleGoogle Scholar De Goede J, Putters K, van der Grinten T, van Oers HA: Knowledge in how to write college Vermont Academy process? Exploring barriers between epidemiological research and local health policy development. Health Res Policy Syst. 2010, 8: 26- View ArticlePubMedPubMed CentralGoogle Scholar The original AGREE Instrument | AGREE Enterprise website. , Roques P: UML 2 par la Pratique: Etudes de cas et Exercices Corriges. 2009, Editions Eyrolles Google Scholar Bersini H, Klatzmann D, Six A, Thomas-Vaslin V: State-transition diagrams for biologists.

PLoS One. 2012, 7: e41165- View ArticlePubMedPubMed CentralGoogle Scholar Vasilakis C, Lecnzarowicz D, Lee C: Application of improve thinking Queen College Unified Modelling Language (UML) to the Modelling of Health Care Systems. Int J Healthc Inf Syst Inform. 2008, 3: 39-52. View ArticleGoogle Scholar Goossen WTF, Ozbolt JG, Coenen A, Park H-A, Mead C, Ehnfors M, Marin HF: Development of a provisional domain model for the nursing process for how to write a winning college, Use within the health level 7 reference information model. J Am Med Inform Assoc. 2004, 11: 186-194. View ArticlePubMedPubMed CentralGoogle Scholar de Carvalho ECA, Jayanti MK, Batilana AP, Kozan AMO, Rodrigues MJ, Shah J, Loures MR, Patil S, Payne P, Pietrobon R: Standardizing clinical trials workflow representation in essay for scholarship Downside School UML for how to college Academy, international site comparison. PLoS One. 2010, 5: e13893- View ArticlePubMedPubMed CentralGoogle Scholar De Goede J, van Bon-Martens MJH, Putters K, van Oers HAM: Looking for write essay for scholarship, interaction: quantitative measurement of research utilization by Dutch local health officials. Health Res Policy Syst.

2012, 10: 9- View ArticlePubMedPubMed CentralGoogle Scholar Innvaer S, Vist G, Trommald M, Oxman A: Health policy-makers’ perceptions of their use of evidence: a systematic review. A Winning College Essay Vermont Academy! J Health Serv Res Policy. 2002, 7: 239-244. View ArticlePubMedGoogle Scholar Kothari A, Birch S, Charles C: “Interaction” and research utilisation in write essay health policies and programs: does it work?. Health Policy. 2005, 71: 117-125. View ArticlePubMedGoogle Scholar Landry R, Amara N, Lamari M: Climbing the write a winning Vermont Academy ladder of research utilization evidence from present College of Management social science research. Sci Commun. 2001, 22: 396-422. View ArticleGoogle Scholar Goyet S, Vlieghe E, Lim K, van Griensven J, Borand L, Thong P, Rammaert B, Marcy O, Tarantola A: Fluoroquinolone resistance and Mycobacterium tuberculosis: CAP guidelines play an important role.

Int J Tuberc Lung Dis. How To! 2014, 18: 628-630. View ArticlePubMedGoogle Scholar Hirsh J, Guyatt G: Clinical experts or methodologists to International School, write clinical guidelines?. Lancet. How To A Winning College Vermont Academy! 2009, 374: 273-275. View ArticlePubMedGoogle Scholar Kredo T, Gerritsen A, van Heerden J, Conway S, Siegfried N: Clinical practice guidelines within the Southern African Development Community: a descriptive study of the quality of guideline development and essay writing Hill concordance with best evidence for a winning essay Vermont Academy, five priority diseases. Health Res Policy Syst.

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