title: Evidence-based practice in Interventional Radiology: A mixed methods study exploring how evidence is incorporated into practice with a particular focus on blood glucose requirements for vascular patients with peripheral artery disease undergoing peripheral angioplasty.

authors: Linton, Delia Rose

abstract: Background: Evidence-based practice was established to align patient care with the best available evidence.  At Waikato Hospital, vascular patients undergoing peripheral angioplasty are required to have a pre-procedural blood glucose level of less than 11 mmol/L.  However, there is no guideline outlining this requirement or the underlying evidence supporting this criterion, the absence of which has led to confusion amongst staff.  This research project seeks to explore how evidence for pre-procedural blood glucose requirements for vascular patients undergoing peripheral angioplasty is incorporated into practice and how the evidence is disseminated to relevant services.
Participants: The quantitative phase reviewed the clinical records of vascular patients (n=93) who had undergone a peripheral angioplasty in the 2022 – 2023 calendar year.  Due to incomplete datasets, a total of 50 patient clinical records were included in analysis.  The qualitative phase involved interviews with health professionals (n=9) involved in the care of vascular patients undergoing peripheral angioplasty.  
Methods: This mixed-methods two-phase research project involved an initial retrospective clinical records audit of vascular patients diagnosed with diabetes mellitus who had undergone a peripheral angioplasty in the 2022 – 2023 calendar year.  A regression analysis was undertaken to determine the correlation between the change in creatinine levels and (i) patient diagnoses and (ii) pre-procedural blood glucose levels.  Qualitative data were gathered through semi-structured interviews with health professionals.  These interviews were analysed using a general inductive method of inquiry to identify key overarching themes. 
Findings: There was no observed statistically significant association using ANOVA between the change in creatinine levels and patient diagnoses (p=0.31) or pre-procedural blood glucose levels in vascular patients following a peripheral angioplasty (p=0.14).  Although a one-unit increase in pre-procedural blood glucose levels was observed to result in an associated increase of 3.5 mg/dL in creatinine levels, this was not statistically significant (p=0.25).  Analysis of the qualitative interview data from interviews with health professionals produced three themes relating to the implementation of evidence-based practice: (i) Dissemination of evidence; (ii) Balancing practicality with evidence in healthcare delivery; and (iii) Enhancing evidence-based practice in clinical contexts.        
Conclusion: Although the research reported a relationship between raised pre-procedure blood glucose and creatinine levels, it was not statistically significant.  More meaningful results arose, however, from the stakeholder interviews, which indicated a lack of communication and support around the rationale for the pre-procedural blood glucose cut-off value.  It appeared that such miscommunication would be absent through the investment into staff education and the development of a clinical guideline.

text: Evidence-based practice in Interventional Radiology: A mixed methods study exploring how evidence is incorporated into practice with a particular focus on blood glucose requirements for vascular patients with peripheral artery disease undergoing peripheral angioplasty. Background: Evidence-based practice was established to align patient care with the best available evidence.  At Waikato Hospital, vascular patients undergoing peripheral angioplasty are required to have a pre-procedural blood glucose level of less than 11 mmol/L.  However, there is no guideline outlining this requirement or the underlying evidence supporting this criterion, the absence of which has led to confusion amongst staff.  This research project seeks to explore how evidence for pre-procedural blood glucose requirements for vascular patients undergoing peripheral angioplasty is incorporated into practice and how the evidence is disseminated to relevant services.
Participants: The quantitative phase reviewed the clinical records of vascular patients (n=93) who had undergone a peripheral angioplasty in the 2022 – 2023 calendar year.  Due to incomplete datasets, a total of 50 patient clinical records were included in analysis.  The qualitative phase involved interviews with health professionals (n=9) involved in the care of vascular patients undergoing peripheral angioplasty.  
Methods: This mixed-methods two-phase research project involved an initial retrospective clinical records audit of vascular patients diagnosed with diabetes mellitus who had undergone a peripheral angioplasty in the 2022 – 2023 calendar year.  A regression analysis was undertaken to determine the correlation between the change in creatinine levels and (i) patient diagnoses and (ii) pre-procedural blood glucose levels.  Qualitative data were gathered through semi-structured interviews with health professionals.  These interviews were analysed using a general inductive method of inquiry to identify key overarching themes. 
Findings: There was no observed statistically significant association using ANOVA between the change in creatinine levels and patient diagnoses (p=0.31) or pre-procedural blood glucose levels in vascular patients following a peripheral angioplasty (p=0.14).  Although a one-unit increase in pre-procedural blood glucose levels was observed to result in an associated increase of 3.5 mg/dL in creatinine levels, this was not statistically significant (p=0.25).  Analysis of the qualitative interview data from interviews with health professionals produced three themes relating to the implementation of evidence-based practice: (i) Dissemination of evidence; (ii) Balancing practicality with evidence in healthcare delivery; and (iii) Enhancing evidence-based practice in clinical contexts.        
Conclusion: Although the research reported a relationship between raised pre-procedure blood glucose and creatinine levels, it was not statistically significant.  More meaningful results arose, however, from the stakeholder interviews, which indicated a lack of communication and support around the rationale for the pre-procedural blood glucose cut-off value.  It appeared that such miscommunication would be absent through the investment into staff education and the development of a clinical guideline.

year: 2023

title: EDTA in dairy wastewater and removal efficiency - A case study

authors: Xie, Congmin Zoe

subjects: EDTA cleaning

abstract: EDTA is the most widely used chelating agent for removal of undesirable cations in many industrial applications such as the dairy industry. It is generally considered to be non-biodegradable by conventional wastewater treatment, thereby potentially producing an environmental health risk. Under suitable conditions, however, EDTA has been reported to be effectively degraded by micro organisms during wastewater treatment. This study examined degradation of EDTA from a dairy wastewater treatment process in New Zealand operated at pH 8.0-8.2, with a three-week sludge retention time. An HPLC-UV analytical method was used to measure EDTA. A wide range of EDTA concentrations (93 to 5194 μg/L) was measured in the influent entering the wastewater treatment plant, while concentrations of 72-260 μg/L were measured in dairy effluent discharged into the local stream. About 93% of EDTA was degraded by the wastewater treatment. This study demonstrates that the wastewater treatment process at a dairy plant in New Zealand was very effective in removing EDTA.

text: EDTA in dairy wastewater and removal efficiency - A case study EDTA is the most widely used chelating agent for removal of undesirable cations in many industrial applications such as the dairy industry. It is generally considered to be non-biodegradable by conventional wastewater treatment, thereby potentially producing an environmental health risk. Under suitable conditions, however, EDTA has been reported to be effectively degraded by micro organisms during wastewater treatment. This study examined degradation of EDTA from a dairy wastewater treatment process in New Zealand operated at pH 8.0-8.2, with a three-week sludge retention time. An HPLC-UV analytical method was used to measure EDTA. A wide range of EDTA concentrations (93 to 5194 μg/L) was measured in the influent entering the wastewater treatment plant, while concentrations of 72-260 μg/L were measured in dairy effluent discharged into the local stream. About 93% of EDTA was degraded by the wastewater treatment. This study demonstrates that the wastewater treatment process at a dairy plant in New Zealand was very effective in removing EDTA.

year: 2012

title: He Pikinga Waiora Implementation Framework: A tool for chronic disease intervention effectiveness in Maori and other indigenous communities

authors: Oetzel, John G.

subjects: Science & Technology

abstract: Introduction: Health outcomes for Māori are significantly worse than non-Maori in New Zealand; these inequities mirror those found in indigenous communities elsewhere. Evidence-based interventions with established efficacy may not be effective in indigenous communities without addressing specific implementation challenges. We present an implementation framework for chronic condition interventions for Māori.

Theory/Methods: The He Pikinga Waiora Implementation Framework has indigenous self-determination at its core and consists of four elements: cultural-centeredness, community engagement, systems thinking, and integrated knowledge translation.  All elements have demonstrated evidence of positive implementation outcomes.  A coding scheme derived from the Framework was applied to 13 studies of diabetes prevention in indigenous communities from a systematic review.

Results: Cross-tabulations demonstrated that culture-centeredness (p=.008) and community engagement (p=.009) explained differences in diabetes outcomes and community engagement (p=.098) explained difference in blood pressure outcomes.

Discussion and Conclusions: The He Pikinga Waiora Implementation Framework is well suited to advance implementation science for Māori and other indigenous communities. The framework has promise as a policy and planning tool to evaluate and design effective interventions for chronic disease prevention.

Lessons Learned: We needed to revise the coding framework in order to make the implication framework concrete.

Limitations: This study has a limitation in that we coded information about interventions from the published articles and not the interventions themselves. Additionally, the study only included 13 interventions.

Suggestions for Future Direction: Further research should provide stronger evidence of the usefulness of the framework particularly with Māori end-users. There will also be a need to understand the differential contribution of each of the four elements to health outcomes.

text: He Pikinga Waiora Implementation Framework: A tool for chronic disease intervention effectiveness in Maori and other indigenous communities Introduction: Health outcomes for Māori are significantly worse than non-Maori in New Zealand; these inequities mirror those found in indigenous communities elsewhere. Evidence-based interventions with established efficacy may not be effective in indigenous communities without addressing specific implementation challenges. We present an implementation framework for chronic condition interventions for Māori.

Theory/Methods: The He Pikinga Waiora Implementation Framework has indigenous self-determination at its core and consists of four elements: cultural-centeredness, community engagement, systems thinking, and integrated knowledge translation.  All elements have demonstrated evidence of positive implementation outcomes.  A coding scheme derived from the Framework was applied to 13 studies of diabetes prevention in indigenous communities from a systematic review.

Results: Cross-tabulations demonstrated that culture-centeredness (p=.008) and community engagement (p=.009) explained differences in diabetes outcomes and community engagement (p=.098) explained difference in blood pressure outcomes.

Discussion and Conclusions: The He Pikinga Waiora Implementation Framework is well suited to advance implementation science for Māori and other indigenous communities. The framework has promise as a policy and planning tool to evaluate and design effective interventions for chronic disease prevention.

Lessons Learned: We needed to revise the coding framework in order to make the implication framework concrete.

Limitations: This study has a limitation in that we coded information about interventions from the published articles and not the interventions themselves. Additionally, the study only included 13 interventions.

Suggestions for Future Direction: Further research should provide stronger evidence of the usefulness of the framework particularly with Māori end-users. There will also be a need to understand the differential contribution of each of the four elements to health outcomes.

year: 2018