Communities of Practice (CoPs) are promoted in the healthcare sector as a means of generating and sharing knowledge and improving organisational performance. However CoPs vary considerably in the way they are structured and operate in the sector. If CoPs are to be cultivated to benefit healthcare organisations, there is a need to examine and understand their application to date. To this end, a systematic review of the literature on CoPs was conducted, to examine how and why CoPs have been established and whether they have been shown to improve healthcare practice.

Background While there is a considerable corpus of theoretical and empirical literature on networks within and outside of the health sector, multiple research questions are yet to be answered. Objective To conduct a systematic review of studies of professionals' network structures, identifying factors associated with network effectiveness and sustainability, particularly in relation to quality of care and patient safety. Methods The authors searched MEDLINE, CINAHL, EMBASE, Web of Science and Business Source Premier from January 1995 to December 2009. Results A majority of the 26 unique studies identified used social network analysis to examine structural relationships in networks: structural relationships within and between networks, health professionals and their social context, health collaboratives and partnerships, and knowledge sharing networks. Key aspects of networks explored were administrative and clinical exchanges, network performance, integration, stability and influences on the quality of healthcare. More recent studies show that cohesive and collaborative health professional networks can facilitate the coordination of care and contribute to improving quality and safety of care. Structural network vulnerabilities include cliques, professional and gender homophily, and over-reliance on central agencies or individuals. Conclusions Effective professional networks employ natural structural network features (eg, bridges, brokers, density, centrality, degrees of separation, social capital, trust) in producing collaboratively oriented healthcare. This requires efficient transmission of information and social and professional interaction within and across networks. For those using networks to improve care, recurring success factors are understanding your network's characteristics, attending to its functioning and investing time in facilitating its improvement. Despite this, there is no guarantee that time spent on networks will necessarily improve patient care.

Healthcare organisations seeking to manage knowledge and improve organisational performance are increasingly investing in communities of practice (CoPs). Such investments are being made in the absence of empirical evidence demonstrating the impact of CoPs in improving the delivery of healthcare. A realist evaluation is proposed to address this knowledge gap. Underpinned by the principle that outcomes are determined by the context in which an intervention is implemented, a realist evaluation is well suited to understand the role of CoPs in improving healthcare practice. By applying a realist approach, this study will explore the following questions: What outcomes do CoPs achieve in healthcare? Do these outcomes translate into improved practice in healthcare? What are the contexts and mechanisms by which CoPs improve healthcare?

To determine the role of rural background and years of rural clinical school training on subsequent rural clinical practice. Retrospective cohort study of University of Queensland (UQ) medical graduates who graduated during the period 2002-2011 (contacted via internet, telephone and mail, using information obtained from UQ, the Australian Health Practitioner Regulation Agency, and telephone directory and internet searches) who completed an online or hard copy questionnaire during the period December 2012 to October 2013. Current clinical practice in a rural location. Of 1572 graduates to whom the questionnaire was sent, 754 (48.0%) completed the questionnaire. Of the respondents, 236 (31.3%) had a rural background and 276 (36.6%) had attended the University of Queensland Rural Clinical School (UQRCS). Clinical practice location was rural for 18.8% (90/478) of UQ metropolitan clinical school attendees and 41.7% (115/276) of UQRCS attendees (P < 0.001). In the multivariate model with main effects, independent predictors of rural practice were (OR [95% CI]): UQRCS attendance for 1 year (1.84 [1.21-2.82]) or 2 years (2.71 [1.65-4.45]), rural background (2.30 [1.57-3.36]), partner with rural background (3.08 [1.96-4.84]), being single (1.98 [1.28-3.06]) and having a bonded scholarship (2.34 [1.37-3.98]). In the model with interaction between UQRCS attendance and rural background, independent predictors of rural practice were rural background and UQRCS attendance for 1 year (4.44 [2.38-8.29]) or 2 years (7.09 [3.57-14.10]), partner with rural background (3.14 [1.99-4.96]), being single (2.02 [1.30-3.12]) and bonded scholarship (2.27 [1.32-3.90]). The effects of rural background and UQRCS attendance were duration dependent. This study strengthens evidence that, after adjusting for multiple confounders, a number of exposures are independent predictors of rural medical practice. The strong positive interaction between rural background and rural clinical school exposure, and the duration-dependent relationships, could help inform policy changes aimed at enhancing the efficacy of Australia's rural clinical school program.

Background: Cancer is one of the predominant causes of morbidity and mortality in older adult populations worldwide. Among a range of barriers, comorbidity particularly poses a clinical challenge in cancer diagnosis, prognosis, and treatment owing to its heterogeneous nature. While accurate comorbidity assessments and appropriate treatment administration can result in better patient outcomes, evidence related to older adult cancer populations is limited as these individuals are often excluded from regular clinical trials due to age and comorbid conditions. Objective: To determine the prevalence of physical comorbidity and the impact of physical comorbidities and rurality on treatment and its outcomes in older adult cancer populations. Methods: Scientific databases Embase and PubMed were searched for published scientific literature on physical comorbidity and older adult cancer patients. Google Scholar was searched for scholarly literature published in nonindexed journals. Snowballing was utilized to identify research papers missed in the above searches. Included studies : (1) reported on original research involving cancer patients; (2) included patients aged 65 years or older; (3) had patients receiving cancer-related treatment and (4) cancer survivors; (5) reported on physical comorbidity as a variable; (6) were published in English; and (7) conducted from any geographical location. Results: In total, 29 studies were selected for data extraction, evidence synthesis, and quality assessment. In these, comorbidities ranged from 37.9%-74.3% in colorectal cancer, 74%-81% in head and neck cancer, and 12.6%-49% in breast cancer. Moderate comorbidities ranged from 13%-72.9%, and severe comorbidities from 2.5%-68.2%. Comorbidity increased with age, with comorbidity affecting both treatment choice and process. Physical comorbidities significantly affected treatment initiation, causing delay, toxicity, and discontinuation. Older adult cancer patients were given less vigorous and nonstandard treatments and were also less likely to be offered treatment. Where patients are given more vigorous treatment, several studies showed better survival outcomes. Appropriate treatment in older adult cancer patients increased both overall and disease-related survival rates. None of the studies noted rurality as a distinct variable. Conclusions: This systematic review concludes that there is evidence to substantiate the adverse effect of comorbidity on treatment and survival outcomes. However, the mechanism by which comorbidity impedes or impacts treatment is unknown in many cases. Some low-quality evidence is available for considering the functional status and biological age in treatment decisions. Future studies that substantiate the value of comprehensive older adult assessments before treatment initiation in cancer patients, including assessing the nature and severity of comorbidities, and additional consideration of rurality as a factor, could lessen the effect of comorbidities on the treatment process.