Source Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, 4229 Qld, Australia.
OBJECTIVE: To estimate the degree of scatter of reports of randomised trials and systematic reviews, and how the scatter differs among medical specialties and subspecialties.
DESIGN: Cross sectional analysis.
DATA SOURCE: PubMed for all disease relevant randomised trials and systematic reviews published in 2009.
STUDY SELECTION: Randomised trials and systematic reviews of the nine diseases or disorders with the highest burden of disease, and the broader category of disease to which each belonged.
RESULTS: The scatter across journals varied considerably among specialties and subspecialties: otolaryngology had the least scatter (363 trials across 167 journals) and neurology the most (2770 trials across 896 journals). In only three subspecialties (lung cancer, chronic obstructive pulmonary disease, hearing loss) were 10 or fewer journals needed to locate 50% of trials. The scatter was less for systematic reviews: hearing loss had the least scatter (10 reviews across nine journals) and cancer the most (670 reviews across 279 journals). For some specialties and subspecialties the papers were concentrated in specialty journals; whereas for others, few of the top 10 journals were a specialty journal for that area. Generally, little overlap occurred between the top 10 journals publishing trials and those publishing systematic reviews. The number of journals required to find all trials or reviews was highly correlated (r=0.97) with the number of papers for each specialty/subspecialty.
CONCLUSIONS: Publication rates of speciality relevant trials vary widely, from one to seven trials per day, and are scattered across hundreds of general and specialty journals. Although systematic reviews reduce the extent of scatter, they are still widely scattered and mostly in different journals to those of randomised trials. Personal subscriptions to journals, which are insufficient for keeping up to date with knowledge, need to be supplemented by other methods such as journal scanning services or systems that cover sufficient journals and filter articles for quality and relevance. Few current systems seem adequate.
BACKGROUND: One large health region in England was experiencing difficulties in recruiting to clinical research posts which required registered nurse or allied health professional skills.
OBJECTIVES: Pre-registration preparation may influence practitioners' career choices and the study reviewed the research content in pre-registration nurse/AHP degree level programmes in the region to i) describe key features of the modules, and ii) determine the extent to which clinical research featured.
DESIGN AND SETTINGS: There are eight universities in the region. We reviewed and analysed 46 research and evidence-based practice module guides from relevant pre-registration degree level programmes. Documentary analysis was used and the findings were reviewed by the project group.
RESULTS: Modules aimed to produce practitioners who were aware of the principles of evidence based practice, and who could locate and evaluate research findings. There was some exposure to clinical research, though this was largely indirect, through considering research findings. Therapy students were more likely than nursing students to conduct a small clinical study for their final year assignment.
Source Author Affiliations: School of Nursing, Barbara and Anne Widener University (Drs Patterson and Krouse), Chester; and School of Nursing, Linda Gywnedd Mercy College (Ms Roy), Gwynedd Valley, PA.
Abstract Distance learning offers a distinctive environment to educate nursing students. While there is a significant body of evidence in the literature related to course, program, and faculty outcomes of distance education, little attention has been given by researchers to evaluate student outcomes, with the exception of student satisfaction. There is a need to evaluate and translate findings related to student outcomes in distance learning into educational practice. Integrative reviews offer one strategy to contribute to evidence-based teaching practice initiatives. A search of available published qualitative and quantitative research on student outcomes of distance learning from 1999 to 2009 was conducted using a number of databases. Astin's Input-Environment-Output conceptual model provided a framework for this review. Thirty-three studies met the inclusion criteria. Both cognitive and affective student outcomes emerged. The cognitive outcomes were student learning, learning process, and technology proficiency. Affective outcomes included personal and professional growth, satisfaction, and connectedness. Implications, recommendations, and future research are discussed.
PMID: 22592452 [PubMed - as supplied by publisher]
BACKGROUND: Government-sponsored science, technology, and innovation (STI) programs support the socioeconomic aspects of public policies, in addition to expanding the knowledge base. For example, beneficial healthcare services and devices are expected to result from investments in research and development (R&D) programs, which assume a causal link to commercial innovation. Such programs are increasingly held accountable for evidence of impact--that is, innovative goods and services resulting from R&D activity. However, the absence of comprehensive models and metrics skews evidence gathering toward bibliometrics about research outputs (published discoveries), with less focus on transfer metrics about development outputs (patented prototypes) and almost none on econometrics related to production outputs (commercial innovations). This disparity is particularly problematic for the expressed intent of such programs, as most measurable socioeconomic benefits result from the last category of outputs.
METHODS: This paper proposes a conceptual framework integrating all three knowledge-generating methods into a logic model, useful for planning, obtaining, and measuring the intended beneficial impacts through the implementation of knowledge in practice. Additionally, the integration of the Context-Input-Process-Product (CIPP) model of evaluation proactively builds relevance into STI policies and programs while sustaining rigor.
RESULTS: The resulting logic model framework explicitly traces the progress of knowledge from inputs, following it through the three knowledge-generating processes and their respective knowledge outputs (discovery, invention, innovation), as it generates the intended sociobeneficial impacts. It is a hybrid model for generating technology-based innovations, where best practices in new product development merge with a widely accepted knowledgetranslation approach. Given the emphasis on evidence-based practice in the medical and health fields and "bench to bedside" expectations for knowledge transfer, sponsors and grantees alike should find the model useful for planning, implementing, and evaluating innovation processes.
CONCLUSIONS: High-cost/high-risk industries like healthcare require the market deployment of technologybased innovations to improve domestic society in a global economy. An appropriate balance of relevance and rigor in research, development, and production is crucial to optimize the return on public investment in such programs. The technology-innovation process needs a comprehensive operational model to effectively allocate public funds and thereby deliberately and systematically accomplish socioeconomic benefits.
Source Division of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Abstract Recent studies have demonstrated that the majority of physicians cannot accurately determine the predictive values of diagnostic tests. Physicians must understand the predictive probabilities associated with diagnostic testing in order to convey accurate information to patients, a key aspect of evidence-based practice. While sensitivity and specificity are widely understood, predictive values require a further understanding of conditional probabilities, pretest probabilities, and the prevalence of disease. Therefore, this third installment of the series "Evidence-Based Medicine in Otolaryngology" focuses on understanding the probabilities needed to accurately convey the results of dichotomous diagnostic tests in everyday practice.
PMID: 22588733 [PubMed - as supplied by publisher]
Source aInstitute of Gastroenterology, Nutrition and Liver Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Schneider Children's Medical Center of Israel, Clalit Health Services, Petach Tikva, Israel bDivision of Metabolic and Nutritional Medicine, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
PURPOSE OF REVIEW: Malnutrition is highly prevalent in hospitalized children and has been associated with relevant clinical outcomes. The scope of this review is to describe the five screening tools and the recent European Society for Parenteral and Enteral Nutrition (ESPEN) research project aimed at establishing agreed, evidence-based criteria for malnutrition and screening tools for its diagnosis in hospitalized children.
RECENT FINDINGS: Five nutrition screening tools have recently been developed to identify the risk of malnutrition in hospitalized children. These tools have been tested to a limited extent by their authors in the original published studies but have not been validated by other independent studies. So far, such screening tools have not been established widely as part of standard pediatric care.
SUMMARY: Although nutrition screening and assessment are recommended by European Society for Parenteral and Enteral Nutrition and the European Society for Pediatric Gastroenterology Hepatology and Nutrition and are often accepted to be required by healthcare facilities, there is no standardized approach to nutritional screening for pediatric inpatients. The near future will provide us with comparative data on the existing tools which may contribute to delineating a standard for useful nutrition screening in pediatrics.
Abstract ABSTRACT: Systematic reviews have become increasingly critical to informing healthcare policy; however, they remain a time-consuming and labor-intensive activity. The extraction of data from constituent studies comprises a significant portion of this effort, an activity which is often needlessly duplicated, such as when attempting to update a previously conducted review or in reviews of overlapping topics.In order to address these inefficiencies, and to improve the speed and quality of healthcare policy- and decision-making, we have initiated the development of the Systematic Review Data Repository, an open collaborative Web-based repository of systematic review data. As envisioned, this resource would serve as both a central archive and data extraction tool, shared among and freely accessible to organizations producing systematic reviews worldwide. A suite of easy-to-use software tools with a Web frontend would enable researchers to seamlessly search for and incorporate previously deposited data into their own reviews, as well as contribute their own.In developing this resource, we identified a number of technical and non-technical challenges, as well as devised a number of potential solutions, including proposals for systems and software tools to assure data quality, stratify and control user access effectively and flexibly accommodate all manner of study data, as well as means by which to govern and foster adoption of this new resource.Herein we provide an account of the rationale and development of the Systematic Review Data Repository thus far, as well as outline its future trajectory.
Source Centre for Medical Education, St Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary University London, London, UK.
BACKGROUND: Patient safety concerns have focused attention on organisational and safety cultures, in turn directing attention to the measurement of organisational and safety climates.
OBJECTIVES: First, to compare levels of agreement between survey- and observation-based measures of organisational and safety climates/cultures and to compare both measures with criterion-based audits of the quality of care, using evidence-based markers drawn from national care standards relating to six common clinical conditions. (This required development of an observation-based instrument.) Second, to examine whether observation-based evaluations could replace or augment survey measurements to mitigate concerns about declining response rates and increasing social desirability bias. Third, to examine mediating factors in safety and organisational climate scores.
SETTING AND PARTICIPANTS: Eight emergency departments and eight maternity units in England, UK.
MAIN OUTCOME MEASURES: Examination of feasibility, correlation and agreement.
RESULTS: Strand A: the overall response rate was 27.6%, whereas site-specific rates ranged from 9% to 47%. We identified more mediating factors than previous studies; variable response rates had little effect on the results. Organisational and safety climate scores were strongly correlated (r = 0.845) and exhibited good agreement [standard deviation (SD) differences 0.449; 14 (88%) within ± 0.5; one large difference]. Two commonly used scales had high levels of positive responses, suggesting positive climates or social desirability bias. Strand B: scoring on a four-point scale was feasible. Observational evaluation of teamwork culture was good but too limited for evaluating organisational culture. Strand C: a total of 359-399 cases were audited per condition. The results varied widely between different markers for the same condition, so selection matters. Each site performed well on some markers but not others, with few consistent patterns. Some national guidelines were contested. Comparisons: the comparison of safety climate (survey) and teamwork culture (observation) revealed a moderately low correlation (r = 0.316) and good agreement [SD differences 1.082; 7 (44%) within ±0.5; one large difference]. The comparison of safety climate (survey) and performance (audit) revealed lower correlation (r = 0.150, i.e. relationship not linear) but reasonably good agreement [SD differences 0.992; 9 (56%) within ± 0.5; two large differences]. Comparisons between performance (audit) and both organisational climate (survey) and teamwork culture (observation) showed negligible correlations (< 0.1) but moderately good agreement [SD differences 1.058 and 1.241; 6 (38%) and 7 (44%) within ± 0.5; each with two large differences (at different sites)]. Field notes illuminated large differences.
CONCLUSIONS: Climate scores from staff surveys are not unduly affected by survey response rates, but increasing use risks social desirability bias. Safety climate provides a partial indicator of performance, but qualitative data are needed to understand discrepant results. Safety climate (surveys) and, to a lesser degree, teamwork culture (observations) are better indicators of performance than organisational climate (surveys) or attempts to evaluate organisational culture from time-limited observations. Scoring unobtrusive, time-limited observations to evaluate teamwork culture is feasible, but the instrument developed for this study needs further testing. A refined observation-based measure would be useful to augment or replace surveys.
FUNDING: The National Institute for Health Research Health Technology Assessment programme.
Abstract Nurses are not averse to applying research findings to their clinical practice; however, there appears to be a number of barriers to achieving this. Generally, barriers include lack of time and the need to provide more education surrounding the use of research. While these are both valid points, the authors suggest that perhaps the solution to the problem is looking at how research is 'sold' to practitioners. For example, the use of jargon in research is off-putting to many practitioners, which creates an impression that research is associated with academia, rather than a tool for practitioners. Also, there may be an unrealistic expectation of what 'using research' might mean. Research is seen as the pinnacle of evidence, and not a part of evidence-based practice. In this article, the authors propose that teaching and expectations of research should focus on the application of research to practice. Reviewing and critiquing of research should serve the purpose of helping to make decisions about its practical applications, rather than for academic use.
Source Molina Healthcare of Virginia, Reston, VA, USA; formerly with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services.
BACKGROUND: The North County Health Centre in Reston, Virginia, recently enhanced the quality and accessibility of physician-coordinated behavioural counselling.
METHODS: A patient survey confirmed that the clinic could improve behaviour change support. Physician time constraints, practice productivity issues and treatment priorities were identified barriers to systems change. Systems changes included teamwork, group visits, community engagement and trusted online consumer resources. Validated statistical process control (SPC) techniques evaluated variation in monthly 90-minute group visits for Spanish- and English-speaking patients during which we reviewed evidence-based recommendations, hosted community speakers and held brief individual encounters using encounter forms with built-in motivational interviewing techniques Results: On average, four English-speaking patients attended, with 42% of the participants who attended more than one meeting successfully achieving their self-reported goal. On average, nine Spanish-speaking patients attended, with eight (86%) of the participants achieving their goals. Documentation of recorded prevention counselling improved from 15% to 67%. Patients indicated that they found that what they learned is transferable to their everyday l1ives.
CONCLUSION: The total number of patient encounters in a clinical session did not dramatically change. Language preference was not a hurdle. Teamwork among patients, providers, staff and community members was a key to success. Group visits improved the amount of prevention counselling and helped patients with limited health literacy achieve their prevention goals.
Source a School of Social Work , The University of Texas at Austin , Austin , Texas , USA.
Abstract Screening and brief intervention (SBI) in health care settings is an evidence-based practice for substance misuse. The Uniform Accident and Sickness Policy Provision Law (UPPL) discourages providers from carrying out SBI by allowing insurers in 26 states to refuse coverage for injuries resulting from intoxication. This project used a qualitative case study methodology to understand how policy-advocacy communication may have impacted the success of UPPL repeal efforts in Texas. Results showed bill progress could have been impeded due to less-effective communication from advocates. These findings suggest the quality of communication may influence the success of evidence-based policy-advocacy for UPPL repeal.
Source Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
Abstract IntroductionThe Cochrane Library is the most important online evidence retrieval database of systematic reviews. Since 2007, the National Health Research Institutes has offered Taiwan's regional hospitals free access to the Cochrane Library. This study investigated how these hospitals disseminate its utilisation.MethodsThe usage rate of Cochrane reviews was measured in the participating hospitals from January 2008 to December 2009. Thereafter, a questionnaire survey was conducted for each regional hospital disseminator at the beginning of 2010 to analyse their methods of disseminating Cochrane reviews.ResultsThe hospitals were stratified into three groups according to the relative rate of access: high (n=15), medium (n=16) and low (n=13). In comparison with the low-usage hospitals, the high-usage hospitals tended to assign a disseminator of evidence-based medicine to take charge of the dissemination of Cochrane reviews (p<0.001). In addition, the high-usage hospitals more often used the following six METHODS: providing relevant information via email (p<0.05), investing in early adopters (p<0.05), using assistance from designated personnel (p<0.05), highlighting the activity of early adopters (p<0.05), conducting workshops (p=0.001), and inviting experts to speak (p<0.001). There was no significant difference between high- and low-usage hospitals in organisational barriers.ConclusionThis study has identified several helpful strategies used by Taiwan's hospitals to enhance dissemination of the Cochrane Library, including raising of awareness, active delivery of information, mentoring relationships, and educational training. The data suggest that disseminating evidence-based medicine simultaneously is a key element.
PMID: 22582179 [PubMed - as supplied by publisher]
Source Office of Nursing Service, Veterans Healthcare Administration, 810 Vermont Avenue NW, Washington, DC 20420, USA; Rocky Mountain University of Health Professions, 561 East 1860 South, Provo, UT 84606, USA.
Abstract The advanced practice registered nurse (APRN) is vital in role-modeling and ensuring evidence-based practice (EBP) engagement and application at the point of care. This article describes the formulation of national competencies for EBP, specific to the APRN level. The application of selected competencies is delineated and the creation of an APRN action plan to identify necessary EBP competencies is discussed. If EBP skills are lacking, the action plan is used for development of skills in the required areas. Published by Elsevier Inc.
Source Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW 2052, Australia. email@example.com
OBJECTIVE: To measure the relative influence that industry authors have on collaborative research communities and evidence production.
STUDY DESIGN AND SETTING: Using 22 commonly prescribed drugs, 6,711 randomized controlled trials (RCTs), and 28,104 authors, 22 collaboration networks were constructed and analyzed. The directly industry-affiliated (DIA) authors were identified in the networks according to their published affiliations. Measures of influence (network centrality) and impact (citations) were determined for every author. Network-level measures of community structure and collaborative preference were used to further characterize the groups.
RESULTS: Six percent (1,741 of 28,104) of authors listed a direct affiliation with the manufacturer of a drug evaluated in the RCT. These authors received significantly more citations (P<0.05 in 19 networks) and were significantly more central in the networks (P<0.05 in 20 networks). The networks show that DIA authors tend to have greater reach in the networks and collaborate more often with non-DIA authors despite a preference toward their own group. Potential confounders include publication bias, trial sizes, and conclusions.
Source United Nations International Children's Emergency Fund/United Nations Development Programme/World Bank/ World Health Organization Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland. firstname.lastname@example.org
Abstract Using the example of an international collaboration on tuberculosis (TB) diagnostics, we mapped the key stages and stakeholders involved in translating research into global policies. In our experience, the process begins with advocacy for high-quality, policy-relevant research and appropriate funding. Following the assessment of current policy and the identification of key study areas, policy-relevant research questions need to be formulated and prioritised. It is important that a framework for translating evidence into policy at the target policymaking level, in this case global, is available to researchers. This ensures that research questions, study designs and research standards are appropriate to the type and quality of evidence required. The framework may evolve during the period of research and, as evidence requirements may change, vigilance is required. Formal and informal multi-stakeholder partnerships, as well as information sharing through extensive networking, facilitate efficient building of a broad evidence base. Coordination of activities by an international, neutral body with strong convening powers is important, as is regular interaction with policy makers. It is recognised that studies on diagnostic accuracy provide weak evidence that a new diagnostic will improve patient care when implemented to scale in routine settings. This may be one reason why there has been poor uptake of new tools by national TB control programmes despite global policy recommendations. Stronger engagement with national policy makers and donors during the research-intopolicy process may be needed to ensure that their evidence requirements are met and that global policies translate into national policies. National policies are central to translating global policies into practice.
Source Department of Medical Microbiology, University of Manitoba, Nairobi, Kenya.
Abstract mHealth is a term used to refer to mobile technologies such as personal digital assistants and mobile phones for healthcare. mHealth initiatives to support care and treatment of patients are emerging globally and this workshop brought together researchers, policy makers, information, communication and technology programmers, academics and civil society representatives for one and a half days synergy meeting in Kenya to review regional evidence based mHealth research for HIV care and treatment, review mHealth technologies for adherence and retention interventions in anti-retroviral therapy (ART) programs and develop a framework for scale up of evidence based mHealth interventions. The workshop was held in May 2011 in Nairobi, Kenya and was funded by the Canadian Global Health Research Initiatives (GHRI) and the US Centre for Disease Control and Prevention (CDC). At the end of the workshop participants came up with a framework to guide mHealth initiatives in the region and a plan to work together in scaling up evidence based mHealth interventions. The participants acknowledged the importance of the meeting in setting the pace for strengthening and coordinating mHealth initiatives and unanimously agreed to hold a follow up meeting after three months.
Source University of Washington, Health Promotion Research Center, Seattle, Washington, USA.
Abstract Wider adoption of evidence-based, health promotion practices depends on developing and testing effective dissemination approaches. To assist in developing these approaches, we created a practical framework drawn from the literature on dissemination and our experiences disseminating evidence-based practices. The main elements of our framework are 1) a close partnership between researchers and a disseminating organization that takes ownership of the dissemination process and 2) use of social marketing principles to work closely with potential user organizations. We present 2 examples illustrating the framework: EnhanceFitness, for physical activity among older adults, and American Cancer Society Workplace Solutions, for chronic disease prevention among workers. We also discuss 7 practical roles that researchers play in dissemination and related research: sorting through the evidence, conducting formative research, assessing readiness of user organizations, balancing fidelity and reinvention, monitoring and evaluating, influencing the outer context, and testing dissemination approaches.