title: Magnesium sulphate for fetal neuroprotection: benefits and challenges of a systematic knowledge translation project in Canada.
abstract: BACKGROUND
  Administration of magnesium sulphate (MgSO4) 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 MgSO4 use for fetal neuroprotection and maternal and child outcomes until September 2015; results are anticipated in 2016.
authors.affiliation: Seattle University College of Nursing, Seattle, Washington, USA. kateteela@gmail.com.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Teela
authors.affiliation: Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada. Dane.DeSilva@cw.bc.ca.|Child and Family Research Institute, University of British Columbia, Vancouver, Canada. Dane.DeSilva@cw.bc.ca.
authors.forename: Dane A
authors.initials: DA
authors.lastname: De Silva
authors.affiliation: Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada. kc.healthsci@gmail.com.
authors.forename: Katie
authors.initials: K
authors.lastname: Chapman
authors.affiliation: Division of Neonatology, Department of Paediatrics, University of British Columbia, Vancouver, Canada. asynnes@cw.bc.ca.
authors.forename: Anne R
authors.initials: AR
authors.lastname: Synnes
authors.affiliation: Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada. Diane.Sawchuck@viha.ca.
authors.forename: Diane
authors.initials: D
authors.lastname: Sawchuck
authors.affiliation: Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada. mbasso@cw.bc.ca.
authors.forename: Melanie
authors.initials: M
authors.lastname: Basso
authors.affiliation: Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada. robertliston@shaw.ca.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Liston
authors.affiliation: Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada. pvondade@sgul.ac.uk.|Child and Family Research Institute, University of British Columbia, Vancouver, Canada. pvondade@sgul.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada. LMagee@sgul.ac.uk.|Child and Family Research Institute, University of British Columbia, Vancouver, Canada. LMagee@sgul.ac.uk.|Department of Medicine, University of British Columbia and British Columbia Women's Hospital and Health Centre, Vancouver, Canada. LMagee@sgul.ac.uk.|University of London, Cranmer Terrace, Rm J0.27, Jenner Wing, St. George's, SW17, London, 0RE, UK. LMagee@sgul.ac.uk.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
mesh_terms: D002170:Canada; D002547:Cerebral Palsy / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006282:Health Personnel; D006801:Humans; D007231:Infant, Newborn; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D011247:Pregnancy; D047928:Premature Birth / Q000188:drug therapy; D012955:Societies, Medical; D057170:Translational Research, Biomedical
chemical_list: D018696:Neuroprotective Agents; D008278:Magnesium Sulfate