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Baker MJ, Maggio LA, Dorris CS, Uijtdehaage S, Soh M. Clinical supervision in medical education: A citation analysis. MEDICAL TEACHER 2024; 46:505-511. [PMID: 37949084 DOI: 10.1080/0142159x.2023.2257375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
PURPOSE Medical education relies on clinical supervision for critical functions, including trainee assessment and ensuring patient safety. Yet, there is substantial variance in supervision, which has led to calls for a shared definition of the concept and guidelines to inform practice. AMEE Guide No. 27 provided these desired elements and is highly cited, suggesting that translation and utilization of the Guide's knowledge is suboptimal. This study investigates utilization by systematically characterizing citations to the Guide and by describing translation of its recommendations in relation to supervision. MATERIALS AND METHODS Citations were identified using Web of Science, Scopus, and Google Scholar. The authors coded all citations and conducted a subanalysis of studies specific to supervision. RESULTS 583 studies were identified; 268 met inclusion criteria for general analysis of which 167 studies were further analyzed. Most studies reiterated the Guide's characterization of effective supervision, but few demonstrate how these recommendations inform innovations in supervisory practice. CONCLUSION Translation of the Guide's recommendations regarding clinical supervision appears limited. Future research should consider the extent of knowledge translation occurring in clinical supervision literature as well as AMEE Guides. Increased attention to knowledge translation in medical education may benefit the distribution of similar knowledge products.
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Affiliation(s)
- M J Baker
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
- Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - L A Maggio
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
| | - C S Dorris
- Dahlgren Memorial Library, Georgetown University Medical Center, Washington, DC, USA
| | - S Uijtdehaage
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
| | - M Soh
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
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Sharp MK, Baki DABA, Quigley J, Tyner B, Devane D, Mahtani KR, Smith SM, O'Neill M, Ryan M, Clyne B. The effectiveness and acceptability of evidence synthesis summary formats for clinical guideline development groups: a mixed-methods systematic review. Implement Sci 2022; 17:74. [PMID: 36303142 PMCID: PMC9615384 DOI: 10.1186/s13012-022-01243-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/23/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Clinical guideline development often involves a rigorous synthesis of evidence involving multidisciplinary stakeholders with different priorities and knowledge of evidence synthesis; this makes communicating findings complex. Summary formats are typically used to communicate the results of evidence syntheses; however, there is little consensus on which formats are most effective and acceptable for different stakeholders. METHODS This mixed-methods systematic review (MMSR) aimed to evaluate the effectiveness and acceptability (e.g. preferences and attitudes and preferences towards) of evidence synthesis summary formats for GDG members. We followed the PRISMA 2020 guideline and Joanna Briggs Institute Manual for Evidence Synthesis for MMSRs. We searched six databases (inception to April 20, 2021) for randomised controlled trials (RCTs), RCTs with a qualitative component, and qualitative studies. Screening, data extraction, and quality appraisal were performed in duplicate. Qualitative findings were synthesised using meta-aggregation, and quantitative findings are described narratively. RESULTS We identified 17,240 citations and screened 54 full-text articles, resulting in 22 eligible articles (20 unique studies): 4 articles reported the results of 5 RCTs, one of which also had a qualitative component. The other 18 articles discussed the results of 16 qualitative studies. Therefore, we had 5 trials and 17 qualitative studies to extract data from. Studies were geographically heterogeneous and included a variety of stakeholders and summary formats. All 5 RCTs assessed knowledge or understanding with 3 reporting improvement with newer formats. The qualitative analysis identified 6 categories of recommendations: 'presenting information', 'tailoring information' for end users, 'trust in producers and summary', 'knowledge required' to understand findings, 'quality of evidence', and properly 'contextualising information'. Across these categories, the synthesis resulted in 126 recommendations for practice. Nine recommendations were supported by both quantitative and qualitative evidence and 116 by only qualitative. A majority focused on how to present information (n = 64) and tailor content for different end users (n = 24). CONCLUSIONS This MMSR provides guidance on how to improve evidence summary structure and layout. This can be used by synthesis producers to better communicate to GDGs. Study findings will inform the co-creation of evidence summary format prototypes based on GDG member's needs. Trial registration The protocol for this project was previously published, and the project was preregistered on Open Science Framework (Clyne and Sharp, Evidence synthesis and translation of findings for national clinical guideline development: addressing the needs and preferences of guideline development groups, 2021; Sharp and Clyne, Evidence synthesis summary formats for decision-makers and Clinical Guideline Development Groups: A mixed-methods systematic review protocol, 2021).
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Affiliation(s)
- Melissa K Sharp
- Department of General Practice, RCSI University of Medicine and Health Sciences, 123 St Stephens Green, Dublin 2, Ireland.
| | | | - Joan Quigley
- Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
| | - Barrie Tyner
- Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
| | - Declan Devane
- School of Nursing and Midwifery, NUI Galway, Galway, Ireland
- Evidence Synthesis Ireland & Cochrane, Galway, Ireland
| | - Kamal R Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, 123 St Stephens Green, Dublin 2, Ireland
- Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Michelle O'Neill
- Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
| | - Máirín Ryan
- Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, James Street, Dublin 8, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, 123 St Stephens Green, Dublin 2, Ireland
- Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
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Feres MFN, Ruiz-Rodrigues L, Prado VDO, Vicioni-Marques F, Feres M, Nelson-Filho P, Flores-Mir C. Dentists' attitudes and practices toward evidence-based dentistry: a systematic review. JBI Evid Implement 2022; 22:02205615-990000000-00019. [PMID: 36378117 DOI: 10.1097/xeb.0000000000000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIMS Considering that attitudes toward evidence-based dentistry (EBD) may predict implementation behaviors, the objective of this systematic review was to synthesize and evaluate the existing evidence related to dentists' attitudes and practices toward EBD. METHODS We included primary studies that collected information from interviews, questionnaires, or conversation sessions with dentists. The following sources were searched: Cochrane Central Register of Controlled Trials, Embase, PubMed, Scopus, and Web of Science, in addition to gray literature. The included studies were appraised according to the assessment tools recommended by the Joanna Briggs Institute for qualitative and quantitative observational studies. Descriptive data were collected in standardized tables and descriptively synthesized. RESULTS The selection process resulted in 36 included studies. Dentists share positive opinions about EBD and predominantly report willingness to learn or adopt these practices. Despite high methodological risks and significant heterogeneity, the results collected in this review indicated that scientific journals, clinical practice guidelines, and trusted colleagues are generally perceived as influential and useful by dentists, who highly consulted these information sources. CONCLUSION Despite supportive reported attitudes toward EBD, very low certainty exists about actual EBD-related practices.
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Affiliation(s)
| | - Larissa Ruiz-Rodrigues
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Viviane de Oliveira Prado
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Fernanda Vicioni-Marques
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, São Paulo, Brazil
- The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Carlos Flores-Mir
- Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Paez KA, Shapiro R, Thompson L. Qualitative evaluation of two
web‐based
tools to improve accessibility of evidence reports. Learn Health Syst 2022. [DOI: 10.1002/lrh2.10341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kathryn A. Paez
- American Institutes for Research, Health Division Rockville Maryland USA
| | - Rachel Shapiro
- American Institutes for Research, Health Division Rockville Maryland USA
| | - Lee Thompson
- American Institutes for Research, Health Division Rockville Maryland USA
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Pomeroy JML, Sanchez JO, Cai C, Garfinkel S, Côté P, Frontera WR, Gerber LH. Incorporating the Concept of Relevance in Clinical Rehabilitation Research and Its Reviews May Improve Uptake by Stakeholders. Am J Phys Med Rehabil 2022; 101:775-781. [PMID: 35533398 PMCID: PMC9301989 DOI: 10.1097/phm.0000000000002046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The "relevance" of research to stakeholders is an important factor in influencing the uptake of new knowledge into practice; however, this concept is neither well defined nor routinely incorporated in clinical rehabilitation research. Developing a uniform definition, measurement standards, stakeholder engagement strategies, and guiding frameworks that bolster relevance may help incorporate the concept as a key element in research planning and design. This article presents a conceptual argument for why relevance matters, proposes a working definition, and suggests strategies for operationalizing the construct in the context of clinical rehabilitation research. We place special emphasis on the importance of promoting relevance to patients, caregivers, and clinicians and provide preliminary frameworks and innovative study designs that can assist clinical rehabilitation researchers in doing so. We argue that researchers who include a direct statement regarding why and to whom a study is relevant and who incorporate considerations of relevance throughout all phases of study design produce more useful research for patients, caregivers, and clinicians, increasing its chance of uptake into practice. Consistent consideration of relevance, particularly to nonacademic audiences, during the conceptualization, study design, presentation, and dissemination of clinical rehabilitation research may promote the uptake of findings by patients, caregivers, and providers.
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Affiliation(s)
- J. Mary Louise Pomeroy
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Jonathan O. Sanchez
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Cindy Cai
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Steven Garfinkel
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Pierre Côté
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Walter R. Frontera
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Lynn H. Gerber
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
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OUP accepted manuscript. J Appl Lab Med 2022; 7:1476-1491. [DOI: 10.1093/jalm/jfac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/25/2022] [Indexed: 11/12/2022]
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Chapman E, Pantoja T, Kuchenmüller T, Sharma T, Terry RF. Assessing the impact of knowledge communication and dissemination strategies targeted at health policy-makers and managers: an overview of systematic reviews. Health Res Policy Syst 2021; 19:140. [PMID: 34865640 PMCID: PMC8645346 DOI: 10.1186/s12961-021-00780-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background The use of research evidence as an input for health decision-making is a need for most health systems. There are a number of approaches for promoting evidence use at different levels of the health system, but knowledge of their effectiveness is still scarce. The objective of this overview was to evaluate the effectiveness of knowledge communication and dissemination interventions, strategies or approaches targeting policy-makers and health managers. Methods This overview of systematic reviews used systematic review methods and was conducted according to a predefined and published protocol. A comprehensive electronic search of 13 databases and a manual search in four websites were conducted. Both published and unpublished reviews in English, Spanish or Portuguese were included. A narrative synthesis was undertaken, and effectiveness statements were developed, informed by the evidence identified. Results We included 27 systematic reviews. Three studies included only a communication strategy, while eight only included dissemination strategies, and the remaining 16 included both. None of the selected reviews provided “sufficient evidence” for any of the strategies, while four provided some evidence for three communication and four dissemination strategies. Regarding communication strategies, the use of tailored and targeted messages seemed to successfully lead to changes in the decision-making practices of the target audience. Regarding dissemination strategies, interventions that aimed at improving only the reach of evidence did not have an impact on its use in decisions, while interventions aimed at enhancing users’ ability to use and apply evidence had a positive effect on decision-making processes. Multifaceted dissemination strategies also demonstrated the potential for changing knowledge about evidence but not its implementation in decision-making. Conclusions There is limited evidence regarding the effectiveness of interventions targeting health managers and policy-makers, as well as the mechanisms required for achieving impact. More studies are needed that are informed by theoretical frameworks or specific tools and using robust methods, standardized outcome measures and clear descriptions of the interventions. We found that passive communication increased access to evidence but had no effect on uptake. Some evidence indicated that the use of targeted messages, knowledge-brokering and user training was effective in promoting evidence use by managers and policy-makers. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00780-4.
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Affiliation(s)
| | - Tomas Pantoja
- Family Medicine Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Tanja Kuchenmüller
- Evidence to Policy and Impact, Research for Health - Science Division - World Health Organization, Geneva, Switzerland
| | | | - Robert F Terry
- Manager Research Policy, The Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
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Performance-Based Executive Function Instruments Used by Occupational Therapists for Children: A Systematic Review of Measurement Properties. Occup Ther Int 2021; 2021:6008442. [PMID: 34471400 PMCID: PMC8374859 DOI: 10.1155/2021/6008442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction The use of executive function (EF) instruments to assess children's functional performance is obscured with a lack of consensus on which is most suitable to use within the occupational therapy profession. This review identifies EF instruments used by occupational therapists (OTs) for children and evaluates their measurement properties. Methods This systematic review was registered in PROSPERO (CRD42020172107). We reviewed occupational therapy-related studies published until March 2021, to identify performance-based EF instruments used among children by OTs. Two review authors independently screened, extracted, and evaluated the methodological rigor of the included studies. Adequacy of the measurement properties was determined using the COSMIN, and the Terwee criteria were used for synthesis of best evidence. Results Five EF assessments were found across eight study articles: Behavioural Assessment of the Dysexecutive Syndrome for Children, Children's Cooking Task, Children's Kitchen Task Assessment, Do-Eat, and Preschool Executive Task Assessment. Adequacy of measurement properties and synthesis of best evidence varied, leading to a low GRADE rating on the certainty of evidence for the included instruments. Conclusions There is limited evidence that supports the certainty of evidence on the measurement properties of the reviewed tools in helping OTs assess performance-based EF among children. Nevertheless, the authors conditionally suggest their use based on the critical need to measure children's EF. Further research is needed to establish the measurement properties of these measures across different childhood populations.
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Horsley T, Steinert Y, Leslie K, Oswald A, Friesen F, Ellaway RH. The use of BEME reviews in the medical education literature. MEDICAL TEACHER 2020; 42:1171-1178. [PMID: 32772602 DOI: 10.1080/0142159x.2020.1798909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Knowledge syntheses in medical education are intended to promote the translation to, and mobilization of, research knowledge into practice. Despite the effort invested in conducting them, how these knowledge syntheses are used is unclear. This study aimed to explore how knowledge syntheses published by the Best Evidence Medical Education Collaboration (BEME) have been used in a cross-section of published literature. METHODS Citation patterns for BEME reviews were explored using data drawn from Web of Science and Scopus, and a sub-sample of citing papers. RESULTS Bibliometric data on 3419 papers citing 29 BEME reviews were analysed. More detailed data were extracted from a random sample of 629 full-text papers. DISCUSSION BEME reviews were most often positioned to consolidate and summarize the current state of knowledge on a particular topic and to identify gaps in the literature; they were also used to justify current research, and less frequently to contextualize and explain results, or direct future areas of research. Their use to identify instruments or methodological approaches was relatively absent. CONCLUSION While BEME reviews are primarily used to justify and support other studies, the current literature does not demonstrate their translation to educational practice.
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Affiliation(s)
- Tanya Horsley
- Research Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Yvonne Steinert
- Institute of Health Sciences Education and Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Canada
| | - Karen Leslie
- Centre for Faculty Development and Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anna Oswald
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Farah Friesen
- Centre for Faculty Development, Faculty of Medicine, University of Toronto at St. Michael's Hospital, Toronto, Canada
| | - Rachel H Ellaway
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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South E, Lorenc T. Use and value of systematic reviews in English local authority public health: a qualitative study. BMC Public Health 2020; 20:1100. [PMID: 32660533 PMCID: PMC7359488 DOI: 10.1186/s12889-020-09223-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
Background Responsibility for public health in England transferred from the National Health Service to local authorities in 2013, representing a different decision-making environment. Systematic reviews are considered the gold standard of evidence for clinical decision-making but little is known about their use in local government public health. This study aimed to explore the extent to which public health decision-makers in local authorities engage with systematic reviews and how they do so. Methods Semi-structured interviews were conducted with senior public health practitioners (n = 14) in Yorkshire and the Humber local authorities. Sampling was purposive and involved contacting Directors of Public Health directly and snowballing through key contacts. Face-to-face or telephone interviews were digitally recorded, transcribed verbatim and analysed using the Framework Method. Results Public health practitioners described using systematic reviews directly in decision-making and engaging with them more widely in a range of ways, often through a personal commitment to professional development. They saw themselves as having a role to advocate for the use of rigorous evidence, including systematic reviews, in the wider local authority. Systematic reviews were highly valued in principle and public health practitioners had relevant skills to find and appraise them. However, the extent of use varied by individual and local authority and was limited by the complexity of decision-making and various barriers. Barriers included that there were a limited number of systematic reviews available on certain public health topics, such as the wider determinants of health, and that the narrow focus of reviews was not reflective of complex public health decisions facing local authorities. Reviews were used alongside a range of other evidence types, including grey literature. The source of evidence was often considered an indicator of quality, with specific organisations, such as Public Health England, NICE and Cochrane, particularly trusted. Conclusions Research use varies and should be considered within the specific decision-making and political context. There is a need for systematic reviews to be more reflective of the decisions facing local authority public health teams.
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Affiliation(s)
- Emily South
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK.
| | - Theo Lorenc
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
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Neuppmann Feres MF, Roscoe MG, Job SA, Mamani JB, Canto GDL, Flores-Mir C. Barriers involved in the application of evidence-based dentistry principles: A systematic review. J Am Dent Assoc 2020; 151:16-25.e16. [PMID: 31902396 DOI: 10.1016/j.adaj.2019.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The authors' objective in this systematic review was to investigate the barriers involved in the application of evidence-based dentistry principles, as reported by dentists. The authors registered the protocol in the PROSPERO database. TYPES OF STUDIES REVIEWED Eligible studies included qualitative and quantitative approaches, constituting information about barriers, collected through interviews, questionnaires, or conversation sessions. The authors searched databases and reference lists of preselected studies. After the selection process, the authors evaluated the included studies for potential risk of bias and collected either qualitative or quantitative data. RESULTS After the selection process, the authors included 35 studies, of which 16 were reported in this article. The authors synthesized and classified the barriers in 4 categories: self-related, evidence-related, context-related, and patient-related barriers. Shortage of time and financial constraints were the barriers most frequently studied. However, the quantification of these barriers, as well as others, was not possible because of the variability of the results and methodological issues of the included studies. CONCLUSIONS AND PRACTICAL IMPLICATIONS The authors suggest the development of valid questionnaires and their use in representative samples to quantify the effects of specific barriers. The authors encourage practitioners to participate in educational programs focused on training in evidence-based dentistry abilities, in addition to seeking accessible and synthesized formats of reliable scientific knowledge.
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Munthe-Kaas H, Nøkleby H, Lewin S, Glenton C. The TRANSFER Approach for assessing the transferability of systematic review findings. BMC Med Res Methodol 2020; 20:11. [PMID: 31952495 PMCID: PMC6967089 DOI: 10.1186/s12874-019-0834-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 09/12/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Systematic reviews are a key input to health and social welfare decisions. Studies included in systematic reviews often vary with respect to contextual factors that may impact on how transferable review findings are to the review context. However, many review authors do not consider the transferability of review findings until the end of the review process, for example when assessing confidence in the evidence using GRADE or GRADE-CERQual. This paper describes the TRANSFER Approach, a novel approach for supporting collaboration between review authors and stakeholders from the beginning of the review process to systematically and transparently consider factors that may influence the transferability of systematic review findings. METHODS We developed the TRANSFER Approach in three stages: (1) discussions with stakeholders to identify current practices and needs regarding the use of methods to consider transferability, (2) systematic search for and mapping of 25 existing checklists related to transferability, and (3) using the results of stage two to develop a structured conversation format which was applied in three systematic review processes. RESULTS None of the identified existing checklists related to transferability provided detailed guidance for review authors on how to assess transferability in systematic reviews, in collaboration with decision makers. The content analysis uncovered seven categories of factors to consider when discussing transferability. We used these to develop a structured conversation guide for discussing potential transferability factors with stakeholders at the beginning of the review process. In response to feedback and trial and error, the TRANSFER Approach has developed, expanding beyond the initial conversation guide, and is now made up of seven stages which are described in this article. CONCLUSIONS The TRANSFER Approach supports review authors in collaborating with decision makers to ensure an informed consideration, from the beginning of the review process, of the transferability of the review findings to the review context. Further testing of TRANSFER is needed.
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Affiliation(s)
| | - Heid Nøkleby
- Norwegian Institute of Public Health, Oslo, Norway
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Claire Glenton
- Norwegian Institute of Public Health, Oslo, Norway
- Cochrane Norway, Oslo, Norway
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Mburu G, Igbinedion E, Lim SH, Paing AZ, Yi S, Elbe S, Mwai GW. Outcomes of HIV treatment from the private sector in low-income and middle-income countries: a systematic review protocol. BMJ Open 2020; 10:e031844. [PMID: 31919124 PMCID: PMC6955520 DOI: 10.1136/bmjopen-2019-031844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/04/2019] [Accepted: 12/18/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Private sector provision of HIV treatment is increasing in low-income and middle-income countries (LMIC). However, there is limited documentation of its outcomes. This protocol reports a proposed systematic review that will synthesise clinical outcomes of private sector HIV treatment in LMIC. METHODS AND ANALYSIS This review will be conducted in accordance with the preferred reporting items for systematic review and meta-analyses protocols. Primary outcomes will include: (1) proportion of eligible patients initiating antiretroviral therapy (ART); (2) proportion of those on ART with <1000 copies/mL; (3) rate of all-cause mortality among ART recipients. Secondary outcomes will include: (1) proportion receiving Pneumocystis jiroveci pneumonia prophylaxis; (2) proportion with >90% ART adherence (based on any measure reported); (3) proportion screened for non-communicable diseases (specifically cervical cancer, diabetes, hypertension and mental ill health); (iv) proportion screened for tuberculosis. A search of five electronic bibliographical databases (Embase, Medline, PsychINFO, Web of Science and CINAHL) and reference lists of included articles will be conducted to identify relevant articles reporting HIV clinical outcomes. Searches will be limited to LMIC. No age, publication date, study-design or language limits will be applied. Authors of relevant studies will be contacted for clarification. Two reviewers will independently screen citations and abstracts, identify full text articles for inclusion, extract data and appraise the quality and bias of included studies. Outcome data will be pooled to generate aggregative proportions of primary and secondary outcomes. Descriptive statistics and a narrative synthesis will be presented. Heterogeneity and sensitivity assessments will be conducted to aid interpretation of results. ETHICS AND DISSEMINATION The results of this review will be disseminated through a peer-reviewed scientific manuscript and at international scientific conferences. Results will inform quality improvement strategies, replication of identified good practices, potential policy changes, and future research. PROSPERO REGISTRATION NUMBER CRD42016040053.
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Affiliation(s)
- Gitau Mburu
- Centre for Global Health Policy, University of Sussex, Brighton, East Sussex, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Ewemade Igbinedion
- Department of Community Health, Igbinedion University Teaching Hospital, Okada, Nigeria
| | - Sin How Lim
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | | | - Siyan Yi
- Center for Global Health Research, Touro University California, Vallejo, California, USA
- Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore
- Center for Population Health Research, KHANA, Phnom Penh, Cambodia
| | - Stefan Elbe
- Centre for Global Health Policy, University of Sussex, Brighton, East Sussex, UK
| | - Grace W Mwai
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Hilal N, Harb S, Jamal D, El-Jardali F. The use of evidence in decision making by hospital managers in Lebanon: A cross-sectional study. Int J Health Plann Manage 2019; 35:e45-e55. [PMID: 31692068 DOI: 10.1002/hpm.2925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Knowledge synthesis products have emerged as support agents for decision making in clinical practice and policy. However, their use for evidence-informed decision making remains limited in health care management especially in low- and middle-income countries. This study assesses the use of evidence by middle and senior managers in Lebanese hospitals. METHODS This multihospital cross-sectional study used a self-administered web survey of middle and senior managers. Hospitals were purposively selected, and data were analyzed using descriptive statistics and thematic analysis. RESULTS Hospital participation rate was 25%, while adjusted managers' response rate was 44.8%. Prevalence of using evidence was 70%, while prevalence of evidence-seeking behavior was 90%. Evidence was mainly used in design of policies, protocols, and procedures; nursing issues; or procurement decisions. Facilitators for evidence-informed decision making included upper management support and organizational culture, whereas limited resources such as funding, time, and training hindered use of evidence. CONCLUSIONS Findings indicate that utilization of evidence was comparable with that of high-income countries. Training and continuous education were crucial for advancing evidence-informed decision making among hospital managers. However, neither the quality nor the sources of evidence used for decision making were assessed in this study. Future studies should assess the quality and sources of evidence utilized in decision making.
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Affiliation(s)
- Nadeen Hilal
- Department of Internal Medicine, Ain Wazein Medical Village, Lebanon
| | - Sara Harb
- Geriatrics Medical Center, Ain Wazein Medical Village, Lebanon
| | - Diana Jamal
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Kim M, Jeong SYS. Appraisal of International Guidelines for Cancer Pain Management. JOURNAL OF PROBLEM-BASED LEARNING 2019. [DOI: 10.24313/jpbl.2018.00129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Conway A, Dowling M, Binchy Á, Grosvenor J, Coohill M, Naughton D, James J, Devane D. Implementing an initiative to promote evidence-informed practice: part 1 - a description of the Evidence Rounds programme. BMC MEDICAL EDUCATION 2019; 19:74. [PMID: 30841893 PMCID: PMC6402167 DOI: 10.1186/s12909-019-1489-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Evidence-informed practice is fundamental to the delivery of high quality health care. Delays and gaps in the translation of research into practice can impact negatively on patient care. Previous studies have reported that problems facing health care professionals such as information overload, underdeveloped critical appraisal skills, lack of time and other individual, organisational and system-level contextual factors are barriers to the uptake of evidence. Health services research in this area has been restricted largely to the evaluation of program outcomes. This paper aims to describe the implementation process of an educational initiative for health care professionals working in midwifery, neonatology or obstetrics aimed at disseminating evidence and enhancing evidence-informed clinical care. METHODS We designed and implemented an educational initiative called Evidence Rounds for health care professionals working in the women and children's division of an urban hospital in Ireland. It consisted of three core components: (1) group educational sessions examining evidence on topics chosen by staff (2) a dedicated website and (3) facilitation, enablement and support from a knowledge translation professional. We evaluated user engagement in the educational program by monitoring attendance figures and website analytics. We followed up with staff at 3, 16 and 21-month intervals after the last educational session to find out whether evidence had been implemented. We use Lavis's organising framework for knowledge transfer and the Template for Intervention Description and Replication (TIDieR) checklist to describe the educational program and document the implementation process. RESULTS Six educational sessions presented by 18 health care professionals took place over a nine month period with 148 attendances of which 85 were unique (individuals who attended at least one session). During the period spanning from one month before, during and one month after the running of the group sessions, 188 unique visitors, 331 visits and 862 page views were recorded on our website. CONCLUSIONS Audit and feedback processes can provide quantitative data to track practice outcomes. Achieving sustainable educational programs can be challenging without dedicated resources such as staffing and funding.
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Affiliation(s)
- Aislinn Conway
- Health Research Board Trials Methodology Research Network, Galway, Ireland
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Áine Binchy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- St. Clare’s Neonatal Intensive Care Unit, Galway University Hospitals, Galway, Ireland
| | - Jane Grosvenor
- St. Clare’s Neonatal Intensive Care Unit, Galway University Hospitals, Galway, Ireland
| | - Margaret Coohill
- University Hospital Galway, Galway University Hospitals, Galway, Ireland
| | - Deirdre Naughton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- University Hospital Galway, Galway University Hospitals, Galway, Ireland
| | - Jean James
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- St. Clare’s Neonatal Intensive Care Unit, Galway University Hospitals, Galway, Ireland
| | - Declan Devane
- Health Research Board Trials Methodology Research Network, Galway, Ireland
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Munthe-Kaas H, Nøkleby H, Nguyen L. Systematic mapping of checklists for assessing transferability. Syst Rev 2019; 8:22. [PMID: 30642403 PMCID: PMC6330740 DOI: 10.1186/s13643-018-0893-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/22/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Systematic reviews of research evidence have become an expected basis for decisions about practice guidelines and policy decisions in the health and welfare sectors. Review authors define inclusion criteria to help them determine which studies to search for and include in their reviews. However, these studies may still vary in the extent to which they reflect the context of interest in the review question. While most review authors would agree that systematic reviews should be relevant and useful for decision makers, there appears to be few well known, if any, established methods for supporting review authors to assess the transferability of review findings to the context of interest in the review. With this systematic mapping and content analysis, we aim to identify whether there exists checklists to support review authors in considering transferability early in the systematic review process. The secondary aim was to develop a comprehensive list of factors that influence transferability as discussed in existing checklists. METHODS We conducted a systematic mapping of checklists and performed a content analysis of the checklist criteria included in the identified checklists. In June 2016, we conducted a systematic search of eight databases to identify checklists to assess transferability of findings from primary or secondary research, without limitations related to publication type, status, language, or date. We also conducted a gray literature search and searched the EQUATOR repository of checklists for any relevant document. We used search terms such as modified versions of the terms "transferability," "applicability," "generalizability," etc. and "checklist," "guideline," "tool," "criteria," etc. We did not include papers that discussed transferability at a theoretical level or checklists to assess the transferability of guidelines to local contexts. RESULTS Our search resulted in 11,752 titles which were screened independently by two review authors. The 101 articles which were considered potentially relevant were subsequently read by two authors, independently in full text and assessed for inclusion. We identified 31 relevant checklists. Six of these examined transferability of economic evaluations, and 25 examined transferability of primary or secondary research findings in health (n = 23) or social welfare (n = 2). The content analysis is based on the 25 health and social welfare checklists. We identified seven themes under which we grouped categories of checklist criteria: population, intervention, implementation context (immediate), comparison intervention, outcomes, environmental context, and researcher conduct. CONCLUSIONS We identified a variety of checklists intended to support end users (researchers, review authors, practitioners, etc.) to assess transferability or related concepts. While four of these checklists are intended for use in systematic reviews of effectiveness, we found no checklists for qualitative evidence syntheses or for the field of social welfare practice or policy. Furthermore, none of the identified checklists for review authors included guidance to on how to assess transferability, or present assessments in a systematic review. The results of the content analysis can serve as the basis for developing a comprehensive list of factors to be used in an approach to support review authors in systematically and transparently considering transferability from the beginning of the review process.
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Affiliation(s)
| | - Heid Nøkleby
- Norwegian Institute of Public Health, Oslo, Norway
| | - Lien Nguyen
- Norwegian Institute of Public Health, Oslo, Norway
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Marquez C, Johnson AM, Jassemi S, Park J, Moore JE, Blaine C, Bourdon G, Chignell M, Ellen ME, Fortin J, Graham ID, Hayes A, Hamid J, Hemmelgarn B, Hillmer M, Holmes B, Holroyd-Leduc J, Hubert L, Hutton B, Kastner M, Lavis JN, Michell K, Moher D, Ouimet M, Perrier L, Proctor A, Noseworthy T, Schuckel V, Stayberg S, Tonelli M, Tricco AC, Straus SE. Enhancing the uptake of systematic reviews of effects: what is the best format for health care managers and policy-makers? A mixed-methods study. Implement Sci 2018; 13:84. [PMID: 29929538 PMCID: PMC6014014 DOI: 10.1186/s13012-018-0779-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 06/11/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Systematic reviews are infrequently used by health care managers (HCMs) and policy-makers (PMs) in decision-making. HCMs and PMs co-developed and tested novel systematic review of effects formats to increase their use. METHODS A three-phased approach was used to evaluate the determinants to uptake of systematic reviews of effects and the usability of an innovative and a traditional systematic review of effects format. In phase 1, survey and interviews were conducted with HCMs and PMs in four Canadian provinces to determine perceptions of a traditional systematic review format. In phase 2, systematic review format prototypes were created by HCMs and PMs via Conceptboard©. In phase 3, prototypes underwent usability testing by HCMs and PMs. RESULTS Two hundred two participants (80 HCMs, 122 PMs) completed the phase 1 survey. Respondents reported that inadequate format (Mdn = 4; IQR = 4; range = 1-7) and content (Mdn = 4; IQR = 3; range = 1-7) influenced their use of systematic reviews. Most respondents (76%; n = 136/180) reported they would be more likely to use systematic reviews if the format was modified. Findings from 11 interviews (5 HCMs, 6 PMs) revealed that participants preferred systematic reviews of effects that were easy to access and read and provided more information on intervention effectiveness and less information on review methodology. The mean System Usability Scale (SUS) score was 55.7 (standard deviation [SD] 17.2) for the traditional format; a SUS score < 68 is below average usability. In phase 2, 14 HCMs and 20 PMs co-created prototypes, one for HCMs and one for PMs. HCMs preferred a traditional information order (i.e., methods, study flow diagram, forest plots) whereas PMs preferred an alternative order (i.e., background and key messages on one page; methods and limitations on another). In phase 3, the prototypes underwent usability testing with 5 HCMs and 7 PMs, 11 out of 12 participants co-created the prototypes (mean SUS score 86 [SD 9.3]). CONCLUSIONS HCMs and PMs co-created prototypes for systematic review of effects formats based on their needs. The prototypes will be compared to a traditional format in a randomized trial.
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Affiliation(s)
- Christine Marquez
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | | | - Sabrina Jassemi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Jamie Park
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Julia E. Moore
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | | | - Gertrude Bourdon
- Centre Hospitalier Universitaire de Québec (CHUQ), Quebec City, Canada
| | - Mark Chignell
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Moriah E. Ellen
- Ben Gurion University, Beer Sheva, Israel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, and Department of Political Science, McMaster University, Hamilton, Canada
| | - Jacques Fortin
- Agence de la santé et des services sociaux Montérégie, Longueuil, Quebec City Canada
| | - Ian D. Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Anne Hayes
- Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Jemila Hamid
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Brenda Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michael Hillmer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Bev Holmes
- Michael Smith Foundation for Health Research, Vancouver, Canada
- Simon Fraser University, Burnaby, BC Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Alberta Seniors Health Strategic Clinical Network, Alberta Health Services, Calgary, Canada
| | - Linda Hubert
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Quebec, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Monika Kastner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - John N. Lavis
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, and Department of Political Science, McMaster University, Hamilton, Canada
| | | | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Laure Perrier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Andrea Proctor
- Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Thomas Noseworthy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andrea C. Tricco
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sharon E. Straus
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
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Harris C, Allen K, Ramsey W, King R, Green S. Sustainability in Health care by Allocating Resources Effectively (SHARE) 11: reporting outcomes of an evidence-driven approach to disinvestment in a local healthcare setting. BMC Health Serv Res 2018; 18:386. [PMID: 29843702 PMCID: PMC5975394 DOI: 10.1186/s12913-018-3172-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 05/01/2018] [Indexed: 11/12/2022] Open
Abstract
Background This is the final paper in a thematic series reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was established to explore a systematic, integrated, evidence-based organisation-wide approach to disinvestment in a large Australian health service network. This paper summarises the findings, discusses the contribution of the SHARE Program to the body of knowledge and understanding of disinvestment in the local healthcare setting, and considers implications for policy, practice and research. Discussion The SHARE program was conducted in three phases. Phase One was undertaken to understand concepts and practices related to disinvestment and the implications for a local health service and, based on this information, to identify potential settings and methods for decision-making about disinvestment. The aim of Phase Two was to implement and evaluate the proposed methods to determine which were sustainable, effective and appropriate in a local health service. A review of the current literature incorporating the SHARE findings was conducted in Phase Three to contribute to the understanding of systematic approaches to disinvestment in the local healthcare context. SHARE differed from many other published examples of disinvestment in several ways: by seeking to identify and implement disinvestment opportunities within organisational infrastructure rather than as standalone projects; considering disinvestment in the context of all resource allocation decisions rather than in isolation; including allocation of non-monetary resources as well as financial decisions; and focusing on effective use of limited resources to optimise healthcare outcomes. Conclusion The SHARE findings provide a rich source of new information about local health service decision-making, in a level of detail not previously reported, to inform others in similar situations. Multiple innovations related to disinvestment were found to be acceptable and feasible in the local setting. Factors influencing decision-making, implementation processes and final outcomes were identified; and methods for further exploration, or avoidance, in attempting disinvestment in this context are proposed based on these findings. The settings, frameworks, models, methods and tools arising from the SHARE findings have potential to enhance health care and patient outcomes. Electronic supplementary material The online version of this article (10.1186/s12913-018-3172-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Harris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia.
| | - Kelly Allen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Wayne Ramsey
- Medical Services and Quality, Monash Health, Melbourne, VIC, Australia
| | - Richard King
- Medicine Program, Monash Health, Melbourne, VIC, Australia
| | - Sally Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Saei Ghare Naz M, Kariman N, Ebadi A, Ozgoli G, Ghasemi V, Rashidi Fakari F. Educational Interventions for Cervical Cancer Screening Behavior of Women: A Systematic Review. Asian Pac J Cancer Prev 2018; 19:875-884. [PMID: 29693331 PMCID: PMC6031778 DOI: 10.22034/apjcp.2018.19.4.875] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Cervical cancer is the second most common cancer in women worldwide; early detection can play a key role in reducing the associated morbidity. The objective of this study was to systematically assess the effects of educational interventions on cervical cancer screening (CCS) behavior of women. Methods: In this review the Cochrane library, Web of Science, Science Direct, PubMed, Scopus and search engine of Google scholar were searched for all interventional studies (trails, pre- and post-test or quasi-experimental) published in 2000-2017 for a systematic review, The search was based on the following keywords: cervix cancer, uterine cervical neoplasms, screening, prevention and control, Papanicolaou Test, pap test, pap smear, education, intervention, systematic review. Due to the heterogeneity of the data, a qualitative analysis was performed. Results: Thirty seven articles with 15,658 female participants in different parts of world were included in the review. About three quarters of the articles covered behavior change interventions. About one fourth of the articles were based on health education methods. The heath belief model is the most popular used framework for cervical cancer screening interventions. The results of our study showed that different health education methods (such as calls, mailed postcards, mother/daughter education. consultation sessions, picture books, videos, PowerPoint slides, small group discussions, educational brochures, radio broadcast education, lecture presentations, tailored counseling and a fact sheet, Self-learning package, face-to- face interviews and etc) are effective in modifying cervical cancer screening behavior of women. Conclusions: Our results showed that the different interventions and health behavior change frameworks provide an effective base for cervical cancer prevention. Heath providers can chose educational methods based on the particular client situations.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. gozgoli@sbmu. ac.ir
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Harris C, Garrubba M, Melder A, Voutier C, Waller C, King R, Ramsey W. Sustainability in Health care by Allocating Resources Effectively (SHARE) 8: developing, implementing and evaluating an evidence dissemination service in a local healthcare setting. BMC Health Serv Res 2018; 18:151. [PMID: 29499702 PMCID: PMC5833068 DOI: 10.1186/s12913-018-2932-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 02/12/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This is the eighth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for disinvestment within a large Australian health service. One of the aims was to explore methods to deliver existing high quality synthesised evidence directly to decision-makers to drive decision-making proactively. An Evidence Dissemination Service (EDS) was proposed. While this was conceived as a method to identify disinvestment opportunities, it became clear that it could also be a way to review all practices for consistency with current evidence. This paper reports the development, implementation and evaluation of two models of an in-house EDS. METHODS Frameworks for development of complex interventions, implementation of evidence-based change, and evaluation and explication of processes and outcomes were adapted and/or applied. Mixed methods including a literature review, surveys, interviews, workshops, audits, document analysis and action research were used to capture barriers, enablers and local needs; identify effective strategies; develop and refine proposals; ascertain feedback and measure outcomes. RESULTS Methods to identify, capture, classify, store, repackage, disseminate and facilitate use of synthesised research evidence were investigated. In Model 1, emails containing links to multiple publications were sent to all self-selected participants who were asked to determine whether they were the relevant decision-maker for any of the topics presented, whether change was required, and to take the relevant action. This voluntary framework did not achieve the aim of ensuring practice was consistent with current evidence. In Model 2, the need for change was established prior to dissemination, then a summary of the evidence was sent to the decision-maker responsible for practice in the relevant area who was required to take appropriate action and report the outcome. This mandatory governance framework was successful. The factors influencing decisions, processes and outcomes were identified. CONCLUSION An in-house EDS holds promise as a method of identifying disinvestment opportunities and/or reviewing local practice for consistency with current evidence. The resource-intensive nature of delivery of the EDS is a potential barrier. The findings from this study will inform further exploration.
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Affiliation(s)
- Claire Harris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC Australia
| | - Marie Garrubba
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC Australia
| | - Angela Melder
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC Australia
| | | | - Cara Waller
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC Australia
| | - Richard King
- Medicine Program, Monash Health, Melbourne, VIC Australia
| | - Wayne Ramsey
- Medical Services and Quality, Monash Health, Melbourne, VIC Australia
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Harris C, Allen K, Waller C, Dyer T, Brooke V, Garrubba M, Melder A, Voutier C, Gust A, Farjou D. Sustainability in Health care by Allocating Resources Effectively (SHARE) 7: supporting staff in evidence-based decision-making, implementation and evaluation in a local healthcare setting. BMC Health Serv Res 2017. [PMID: 28637473 PMCID: PMC5480160 DOI: 10.1186/s12913-017-2388-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND This is the seventh in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for resource allocation within a large Australian health service. It aimed to facilitate proactive use of evidence from research and local data; evidence-based decision-making for resource allocation including disinvestment; and development, implementation and evaluation of disinvestment projects. From the literature and responses of local stakeholders it was clear that provision of expertise and education, training and support of health service staff would be required to achieve these aims. Four support services were proposed. This paper is a detailed case report of the development, implementation and evaluation of a Data Service, Capacity Building Service and Project Support Service. An Evidence Service is reported separately. METHODS Literature reviews, surveys, interviews, consultation and workshops were used to capture and process the relevant information. Existing theoretical frameworks were adapted for evaluation and explication of processes and outcomes. RESULTS Surveys and interviews identified current practice in use of evidence in decision-making, implementation and evaluation; staff needs for evidence-based practice; nature, type and availability of local health service data; and preferred formats for education and training. The Capacity Building and Project Support Services were successful in achieving short term objectives; but long term outcomes were not evaluated due to reduced funding. The Data Service was not implemented at all. Factors influencing the processes and outcomes are discussed. CONCLUSION Health service staff need access to education, training, expertise and support to enable evidence-based decision-making and to implement and evaluate the changes arising from those decisions. Three support services were proposed based on research evidence and local findings. Local factors, some unanticipated and some unavoidable, were the main barriers to successful implementation. All three proposed support services hold promise as facilitators of EBP in the local healthcare setting. The findings from this study will inform further exploration.
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Affiliation(s)
- Claire Harris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia.
| | - Kelly Allen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Cara Waller
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Tim Dyer
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Vanessa Brooke
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Marie Garrubba
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Angela Melder
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Catherine Voutier
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Anthony Gust
- Clinical Information Management, Monash Health, Melbourne, VIC, Australia
| | - Dina Farjou
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
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Dupont C, Winer N, Rabilloud M, Touzet S, Branger B, Lansac J, Gaucher L, Duclos A, Huissoud C, Boutitie F, Rudigoz RC, Colin C. Multifaceted intervention to improve obstetric practices: The OPERA cluster-randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2017. [PMID: 28649035 DOI: 10.1016/j.ejogrb.2017.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Suboptimal care contributes to perinatal morbidity and mortality. We investigated the effects of a multifaceted program designed to improve obstetric practices and outcomes. STUDY DESIGN A cluster-randomized trial was conducted from October 2008 to November 2010 in 95 French maternity units randomized either to receive an information intervention about published guidelines or left to apply them freely. The intervention combined an outreach visit with a morbidity/mortality conference (MMC) to review perinatal morbidity/mortality cases. Within the intervention group, the units were randomized to have MMCs with or without clinical psychologists. The primary outcome was the rate of suboptimal care among perinatal morbidity/mortality cases. The secondary outcomes included the rate of suboptimal care among cases of morbidity, the rate of suboptimal care among cases of mortality, the rate of avoidable morbidity and/or mortality cases, and the incidence of, morbidity and/or mortality. A mixed logistic regression model with random intercept was used to quantify the effect of the intervention on the main outcome. RESULTS The study reviewed 2459 cases of morbidity or mortality among 165,353 births. The rate of suboptimal care among morbidity plus mortality cases was not significantly lower in the intervention than in the control group (8.1% vs. 10.6%, OR [95% CI]: 0.75 [0.50-1.12], p=0.15. However, the cases of suboptimal care among morbidity cases were significantly lower in the intervention group (7.6% vs. 11.5%, 0.62 [0.40-0.94], p=0.02); the incidence of perinatal morbidity was also lower (7.0 vs. 8.1‰, p=0.01). No differences were found between psychologist-backed and the other units. CONCLUSIONS The intervention reduced the rate of suboptimal care mainly in morbidity cases and the incidence of morbidity but did not succeed in improving morbidity plus mortality combined. More clear-cut results regarding mortality require a longer study period and the inclusion of structures that intervene before and after the delivery room. (ClinicalTrials.gov ID: NCT02584166).
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Affiliation(s)
- Corinne Dupont
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France; Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France.
| | - Norbert Winer
- Service de gynécologie-obstétrique/maternité, Centre Hospitalo-universitaire de Nantes, F-44300, Nantes, France
| | - Muriel Rabilloud
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | - Sandrine Touzet
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Pôle IMER, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69100, Lyon, France
| | - Bernard Branger
- Réseau Sécurité Naissance, Pays-de-la-Loire, F-44000, Nantes, France
| | - Jacques Lansac
- Réseau périnatal de la Région Centre, F-37000, Tours, France
| | - Laurent Gaucher
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Lyon, France
| | - Antoine Duclos
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Pôle IMER, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69100, Lyon, France
| | - Cyril Huissoud
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France
| | - Florent Boutitie
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | | | - Cyrille Colin
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
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Tucker S. People, Practices, and Places: Realities That Influence Evidence-Based Practice Uptake. Worldviews Evid Based Nurs 2017; 14:87-89. [DOI: 10.1111/wvn.12216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 11/30/2022]
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25
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Conway A, Clarke MJ, Treweek S, Schünemann H, Santesso N, Morgan RL, Darragh M, Maguire LK, Devane D. Summary of findings tables for communicating key findings of systematic reviews. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.mr000044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Aislinn Conway
- National University of Ireland, Galway; School of Nursing and Midwifery; University Road Galway Ireland
| | - Mike J Clarke
- Queen's University Belfast; Centre for Public Health; Institute of Clinical Sciences, Block B, Royal Victoria Hospital Grosvenor Road Belfast Northern Ireland UK BT12 6BJ
| | - Shaun Treweek
- University of Aberdeen; Health Services Research Unit; Foresterhill Aberdeen UK AB25 2ZD
| | - Holger Schünemann
- McMaster University; Departments of Clinical Epidemiology and Biostatistics and of Medicine; 1280 Main Street West Hamilton ON Canada L8N 4K1
| | - Nancy Santesso
- McMaster University; Department of Clinical Epidemiology and Biostatistics; 1200 Main Street West Hamilton ON Canada L8N 3Z5
| | - Rebecca L Morgan
- McMaster University; Department of Clinical Epidemiology & Biostatistics; 1280 Main Street West Hamilton ON Canada L8S 4L8
| | - Mark Darragh
- Queen's University Belfast; Centre for Public Health; Institute of Clinical Sciences, Block B, Royal Victoria Hospital Grosvenor Road Belfast Northern Ireland UK BT12 6BJ
| | - Lisa K Maguire
- Queen's University Belfast; Centre for Effective Education; 69-71 University Street Belfast Northern Ireland UK BT7 1HL
| | - Declan Devane
- National University of Ireland Galway; School of Nursing and Midwifery; University Road Galway Ireland
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26
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Barriers to Primary Care Clinician Adherence to Clinical Guidelines for the Management of Low Back Pain. Clin J Pain 2016; 32:800-16. [DOI: 10.1097/ajp.0000000000000324] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Haby MM, Chapman E, Clark R, Barreto J, Reveiz L, Lavis JN. Designing a rapid response program to support evidence-informed decision-making in the Americas region: using the best available evidence and case studies. Implement Sci 2016; 11:117. [PMID: 27538384 PMCID: PMC4990866 DOI: 10.1186/s13012-016-0472-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 07/15/2016] [Indexed: 01/08/2023] Open
Abstract
Background The objective of this work was to inform the design of a rapid response program to support evidence-informed decision-making in health policy and practice for the Americas region. Specifically, we focus on the following: (1) What are the best methodological approaches for rapid reviews of the research evidence? (2) What other strategies are needed to facilitate evidence-informed decision-making in health policy and practice? and (3) How best to operationalize a rapid response program? Methods The evidence used to inform the design of a rapid response program included (i) two rapid reviews of methodological approaches for rapid reviews of the research evidence and strategies to facilitate evidence-informed decision-making, (ii) supplementary literature in relation to the “shortcuts” that could be considered to reduce the time needed to complete rapid reviews, (iii) four case studies, and (iv) supplementary literature to identify additional operational issues for the design of the program. Results There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting them. Better reporting of rapid review methods is needed. The literature found in relation to shortcuts will be helpful in choosing shortcuts that maximize timeliness while minimizing the impact on quality. Evidence for other strategies that can be used concurrently to facilitate the uptake of research evidence, including evidence drawn from rapid reviews, is presented. Operational issues that need to be considered in designing a rapid response program include the implications of a “user-pays” model, the importance of recruiting staff with the right mix of skills and qualifications, and ensuring that the impact of the model on research use in decision-making is formally evaluated. Conclusions When designing a new rapid response program, greater attention needs to be given to specifying the rapid review methods and reporting these in sufficient detail to allow a quality assessment. It will also be important to engage in other strategies to facilitate the uptake of the rapid reviews and to evaluate the chosen model in order to make refinements and add to the evidence base for evidence-informed decision-making. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0472-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle M Haby
- Department of Chemical and Biological Sciences, Universidad de Sonora, Hermosillo, Sonora, México. .,Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
| | | | - Rachel Clark
- Centre of Excellence in Intervention and Prevention Science, Melbourne, Australia
| | - Jorge Barreto
- Fundação Oswaldo Cruz, Diretoria de Brasília, Brazil
| | - Ludovic Reveiz
- Knowledge Management, Bioethics and Research, Pan American Health Organization, Washington, DC, USA
| | - John N Lavis
- McMaster Health Forum, Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, and Department of Political Science, McMaster University, Hamilton, Canada.,Department of Global Health and Population Boston, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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28
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Gerber LH, Nava A, Garfinkel S, Goel D, Weinstein AA, Cai C. A need for an augmented review when reviewing rehabilitation research. Disabil Health J 2016; 9:559-66. [PMID: 27522302 DOI: 10.1016/j.dhjo.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/14/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
There is a need for additional strategies for performing systematic reviews (SRs) to improve translation of findings into practice and to influence health policy. SRs critically appraise research methodology and determine level of evidence of research findings. The standard type of SR identifies randomized controlled trials (RCTs) as providing the most valid data and highest level of evidence. RCTs are not among the most frequently used research design in disability and health research. RCTs usually measure impairments for the primary research outcome rather than improved function, participation or societal integration. It forces a choice between "validity" and "utility/relevance." Other approaches have effectively been used to assess the validity of alternative research designs, whose outcomes focus on function and patient-reported outcomes. We propose that utilizing existing evaluation tools that measure knowledge, dissemination and utility of findings, may help improve the translation of findings into practice and health policy.
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Affiliation(s)
- Lynn H Gerber
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA.
| | - Andrew Nava
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA
| | | | - Divya Goel
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA
| | - Ali A Weinstein
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA, USA
| | - Cindy Cai
- American Institutes for Research, Washington DC, USA
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29
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Tricco AC, Cardoso R, Thomas SM, Motiwala S, Sullivan S, Kealey MR, Hemmelgarn B, Ouimet M, Hillmer MP, Perrier L, Shepperd S, Straus SE. Barriers and facilitators to uptake of systematic reviews by policy makers and health care managers: a scoping review. Implement Sci 2016; 11:4. [PMID: 26753923 PMCID: PMC4709874 DOI: 10.1186/s13012-016-0370-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 01/06/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We completed a scoping review on the barriers and facilitators to use of systematic reviews by health care managers and policy makers, including consideration of format and content, to develop recommendations for systematic review authors and to inform research efforts to develop and test formats for systematic reviews that may optimise their uptake. METHODS We used the Arksey and O'Malley approach for our scoping review. Electronic databases (e.g., MEDLINE, EMBASE, PsycInfo) were searched from inception until September 2014. Any study that identified barriers or facilitators (including format and content features) to uptake of systematic reviews by health care managers and policy makers/analysts was eligible for inclusion. Two reviewers independently screened the literature results and abstracted data from the relevant studies. The identified barriers and facilitators were charted using a barriers and facilitators taxonomy for implementing clinical practice guidelines by clinicians. RESULTS We identified useful information for authors of systematic reviews to inform their preparation of reviews including providing one-page summaries with key messages, tailored to the relevant audience. Moreover, partnerships between researchers and policy makers/managers to facilitate the conduct and use of systematic reviews should be considered to enhance relevance of reviews and thereby influence uptake. CONCLUSIONS Systematic review authors can consider our results when publishing their systematic reviews. These strategies should be rigorously evaluated to determine impact on use of reviews in decision-making.
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Affiliation(s)
- Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada.
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Roberta Cardoso
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada.
| | - Sonia M Thomas
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada.
| | - Sanober Motiwala
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada.
| | - Shannon Sullivan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada.
| | - Michael R Kealey
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada.
- Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON, M5S 3G8, Canada.
| | - Brenda Hemmelgarn
- Departments of Medicine and Community Health Sciences, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Mathieu Ouimet
- Département de science politique, Pavillon Charles-De Koninck, Université Laval, Quebec City, Canada.
| | - Michael P Hillmer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
- Research, Evaluation, and Analysis Branch, Ontario Ministry of Health and Long-Term Care, 80 Grosvenor Street, Toronto, ON, M7A 1R3, Canada.
| | - Laure Perrier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Rd Campus, Headington, Oxford, Oxfordshire, OX3 7LF, UK.
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada.
- Department of Geriatric Medicine, University of Toronto, 27 Kings College Circle, Toronto, ON, M5S 1A1, Canada.
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Fordis M, King JE, Bonaduce de Nigris F, Morrow R, Baron RB, Kues JR, Norton JC, Kessler H, Mazmanian PE, Colburn L. Dissemination of Evidence From Systematic Reviews Through Academic CME Providers: A Feasibility Study. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2016; 36:104-112. [PMID: 27262153 DOI: 10.1097/ceh.0000000000000074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Although systematic reviews represent a source of best evidence to support clinical decision-making, reviews are underutilized by clinicians. Barriers include lack of awareness, familiarity, and access. Efforts to promote utilization have focused on reaching practicing clinicians, leaving unexplored the roles of continuing medical education (CME) directors and faculty in promoting systematic review use. This study explored the feasibility of working with CME directors and faculty for that purpose. METHODS A convenience sample of five academic CME directors and faculty agreed to participate in a feasibility study exploring use in CME courses of systematic reviews from the Agency for Healthcare Research and Quality (AHRQ-SRs). AHRQ-SR topics addressed the comparative effectiveness of health care options. Participants received access to AHRQ-SR reports, associated summary products, and instructional resources. The feasibility study used mixed methods to assess 1) implementation of courses incorporating SR evidence, 2) identification of facilitators and barriers to integration, and 3) acceptability to CME directors, faculty, and learners. RESULTS Faculty implemented 14 CME courses of varying formats serving 1700 learners in urban, suburban, and rural settings. Facilitators included credibility, conciseness of messages, and availability of supporting materials; potential barriers included faculty unfamiliarity with SRs, challenges in maintaining review currency, and review scope. SR evidence and summary products proved acceptable to CME directors, course faculty, and learners by multiple measures. DISCUSSION This study demonstrates the feasibility of approaches to use AHRQ-SRs in CME courses/programming. Further research is needed to demonstrate generalizability to other types of CME providers and other systemic reviews.
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Affiliation(s)
- Michael Fordis
- Dr. Fordis: Director, Center for Collaborative and Interactive Technologies, Senior Associative Dean of Continuing Medical Education, Baylor College of Medicine, Houston, TX. Dr. King: Associate Director, Center for Collaborative and Interactive Technologies, Baylor College of Medicine, Houston, TX. Dr. Bonaduce de Nigris: Research Associate, Center for Collaborative and Interactive Technologies, Baylor College of Medicine, Houston, TX. Dr. Morrow: Associate Clinical Professor, Department of Family and Social Medicine, Montefiore Medical Center, Bronx, NY. Dr. Baron: Professor of Medicine, Department of Medicine, University of California, San Francisco, CA. Dr. Kues: Professor Emeritus of Family and Community Medicine, Center for Continuous Professional Development, University of Cincinnati College of Medicine, Cincinnati, OH. Dr. Norton: Director, Center for Interprofessional Health Education, and Professor of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY. Dr. Kessler: Professor, Departments of Medicine and Immunology/Microbiology, Rush University Medical Center, Chicago, IL. Dr. Mazmanian: Associate Dean, Office of Assessment and Evaluation Studies, Department of Family Medicine and Population Health, VCU School of Medicine, Richmond, VA. Dr. Colburn: Executive Director, Center for Continuing Education, University of Nebraska Medical Center, Omaha, NE
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McGill E, Egan M, Petticrew M, Mountford L, Milton S, Whitehead M, Lock K. Trading quality for relevance: non-health decision-makers' use of evidence on the social determinants of health. BMJ Open 2015; 5:e007053. [PMID: 25838508 PMCID: PMC4390684 DOI: 10.1136/bmjopen-2014-007053] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Local government services and policies affect health determinants across many sectors such as planning, transportation, housing and leisure. Researchers and policymakers have argued that decisions affecting wider determinants of health, well-being and inequalities should be informed by evidence. This study explores how information and evidence are defined, assessed and utilised by local professionals situated beyond the health sector, but whose decisions potentially affect health: in this case, practitioners working in design, planning and maintenance of the built environment. DESIGN A qualitative study using three focus groups. A thematic analysis was undertaken. SETTING The focus groups were held in UK localities and involved local practitioners working in two UK regions, as well as in Brazil, USA and Canada. PARTICIPANTS UK and international practitioners working in the design and management of the built environment at a local government level. RESULTS Participants described a range of data and information that constitutes evidence, of which academic research is only one part. Built environment decision-makers value empirical evidence, but also emphasise the legitimacy and relevance of less empirical ways of thinking through narratives that associate their work to art and philosophy. Participants prioritised evidence on the acceptability, deliverability and sustainability of interventions over evidence of longer term outcomes (including many health outcomes). Participants generally privileged local information, including personal experiences and local data, but were less willing to accept evidence from contexts perceived to be different from their own. CONCLUSIONS Local-level built environment practitioners utilise evidence to make decisions, but their view of 'best evidence' appears to prioritise local relevance over academic rigour. Academics can facilitate evidence-informed local decisions affecting social determinants of health by working with relevant practitioners to improve the quality of local data and evaluations, and by advancing approaches to improve the external validity of academic research.
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Affiliation(s)
- Elizabeth McGill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Matt Egan
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Mark Petticrew
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Lesley Mountford
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
- Stoke-on-Trent City Council, Stoke-on-Trent, UK
| | - Sarah Milton
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, NIHR School for Public Health Research, Liverpool, UK
| | - Karen Lock
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
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