New Page ~ Systematic Reviews

This new page contains links to resources that will get you started on preparing systematic reviews …

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Knowledge Translation – CMAJ series

This series began in 2009, when CMAJ was still an Open Access journal.  Link to free full text for Parts 1-5 below at http://tiny.cc/CMAJ_KT.

• Part 1:
  Straus SE, Tetroe J, Graham I. Defining knowledge translation. CMAJ 2009;181(3-4):165-8.
• Part 2:
  Brouwers M, Stacey D, O’Connor A. Knowledge creation: synthesis, tools and products. CMAJ 2009 Nov 2. [Epub ahead of print]
• Part 3:
  Kitson A, Straus SE. The knowledge-to-action cycle: Identifying the gaps.  CMAJ 2009 Nov 30. [Epub ahead of print]
• Part 4:
  Harrison MB, Légaré F, Graham ID, Fervers B. Adapting clinical practice guidelines to local context and assessing barriers to their use.  CMAJ 2009 Dec 7. [Epub ahead of print]
• Part 5:
  Wensing M, Bosch M, Grol R. Developing and selecting interventions for translating knowledge to action.  CMAJ 2009 Dec 21  [Epub ahead of print]
• Part 6:
  Davis D, Davis N.  Selecting educational interventions for knowledge translation. CMAJ 2010 Jan. 5 [Epub ahead of print; subscribers only]

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Interview with Dr. David Sackett, pioneer in evidence-based medicine

Here is an interesting interview from the October 30 issue of The Globe and Mail:
Picard A. ‘When we began, we were almost pariahs’ : A research pioneer [Dr. Dave Sackett] tells André Picard about the battle for evidence-based medicine

Excerpts:  Dave Sackett, a professor emeritus at McMaster University in Hamilton, has been awarded the prestigious Gairdner Wightman Award, which is given to a Canadian who has demonstrated outstanding leadership in medicine   …  Dr. Sackett is a pioneer in the field of clinical epidemiology and evidence-based medicine, which aim to teach health professionals how to separate good research from bad and apply it to the individual needs of their patients. He is also a world expert on the design and implementation of clinical trials  …  I see the Gairdner not as an individual award but as an award for clinical epidemiology and evidence-based medicine. It’s an award for a delightful bunch of talented people and the credit goes to all of them, not to me. So I accept this on their behalf.
More about the recipient

Listen to Dr. David Sackett on “The Agenda” with Steve Paikin

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Knowledge Translation: Open Access Articles

The following articles are available free online from CACHE’s Open Access Library:

• Cordero C, Delino R, Jeyaseelan L, Lansang MA, Lozano JM, Kumar S, Moreno S, Pietersen M, Quirino J, Thamlikitkul V, Welch VA, Tetroe J, Ter Kuile A, Graham ID, Grimshaw J, Neufeld V, Wells G, Tugwell P.  Funding agencies in low- and middle-income countries: Support for knowledge translation. Bull World Health Organ 2008 Jul;86(7):524-34.
• Kerner JF.  Knowledge translation versus knowledge integration: A “funder’s” perspective. J Contin Educ Health Prof 2006 Winter;26(1):72-80. 
• Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N.  Lost in knowledge translation: Time for a map? J Contin Educ Health Prof 2006 Winter;26(1):13-24.
• Straus SE, Graham ID, Mazmanian PE. Knowledge translation: Resolving the confusion [editorial]. J Contin Educ Health Prof 2006 Winter;26(1):3-4.
• Tugwell P, Robinson V, Grimshaw J, Santesso N.  Systematic reviews and knowledge translation. Bull World Health Organ 2006 Aug;84(8):643-51.
• Pablos-Mendez A, Chunharas S, Lansang MA, Shademani R, Tugwell P.  Knowledge translation in global health. Bull World Health Organ 2005 Oct;83(10):723.

Evidence-Based Health Care: Open Access Articles

The following articles are available free online from CACHE’s Open Access Library:

• De Vito C, Nobile CG, Furnari G, Pavia M, De Giusti M, Angelillo IF, Villari P.  Physicians’ knowledge, attitudes and professional use of RCTs and meta-analyses: A cross-sectional survey. Eur J Public Health 2009 Jan 7.
• Montori VM, Guyatt GH. Progress in evidence-based medicine. JAMA 2008 Oct 15;300(15):1814-6.
• Eccles MP, Johnston M, Hrisos S, Francis J, Grimshaw J, Steen N, Kaner EF.  Translating clinicians’ beliefs into implementation interventions (TRACII): A protocol for an intervention modeling experiment to change clinicians’ intentions to implement evidence-based practice. Implement Sci 2007 Aug 16;2:27.
• Jennings SF.  Personal development plans and self-directed learning for healthcare professionals: Are they evidence based? Postgrad Med J 2007; 83(982):518-24.
• White B. Making evidence-based medicine doable in everyday practice. Family Practice Management 2004;11(2):51-58.
• British Medical Journal theme issue:  BMJ October 30 2004; 329(7473)
• David Sackett, William M C Rosenberg, J A Muir Gray, R Brian Haynes, W Scott Richardson. Evidence based medicine: What it is and what it isn’t. BMJ 1996; 312: 71-2.
• Evidence-Based Medicine Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992 Nov 4;268(17):2420-5.

Evidence-informed Health Policy: a series from Implementation Science

Here is a new series from Implementation Science, a BioMed Central journal (Open Access):

John N Lavis, Andrew D Oxman, Ray Moynihan, Elizabeth J Paulsen. Evidence-informed health policy 1 – Synthesis of findings from a multi-method study of organizations that support the use of research evidence. Implementation Science 2008, 3:53 (17 December 2008)
Conclusions: This synthesis of findings from a multi-method study, along with the more detailed findings from each of the three phases of the study (which are reported in the three following articles in the series), provide a strong basis on which researchers, policymakers, international organizations (and networks) like WHO can respond to the growing chorus of voices calling for efforts to support the use of research evidence in developing health policy.

John N Lavis, Elizabeth J Paulsen, Andrew D Oxman, Ray Moynihan. Evidence-informed health policy 2 – Survey of organizations that support the use of research evidence. Implementation Science 2008, 3:54 (17 December 2008)
Conclusions: The findings from our survey, the most broadly based of its kind, both extend or clarify the applicability of the messages arising from previous surveys and related documentary analyses, such as how the ‘principles of evidence-based medicine dominate current guideline programs’ and the importance of collaborating with other organizations. The survey also provides a description of the history, structure, processes, outputs, and perceived strengths and weaknesses of existing organizations from which those establishing or leading similar organizations can draw.

John N Lavis, Andrew D Oxman, Ray Moynihan, Elizabeth J Paulsen. Evidence-informed health policy 3 – Interviews with the directors of organizations that support the use of research evidence. Implementation Science 2008, 3:55 (17 December 2008)
Conclusions: The findings from our interview study, the most broadly based of its kind, extend to both CPG-producing organizations and GSUs the applicability of the messages arising from previous interview studies of HTA agencies, such as to collaborate with other organizations and to be attentive to implementation considerations. Our interview study also provides a rich description of organizations supporting the use of research evidence, which can be drawn upon by those establishing or leading similar organizations in LMICs.

John N Lavis, Ray Moynihan, Andrew D Oxman, Elizabeth J Paulsen. Evidence-informed health policy 4 – Case descriptions of organizations that support the use of research evidence. Implementation Science 2008, 3:56 (17 December 2008)
Conclusions: The findings from our case descriptions, the first of their kind, intersect in interesting ways with the messages arising from two systematic reviews of the factors that increase the prospects for research use in policymaking. Strong relationships between researchers and policymakers bodes well given such interactions appear to increase the prospects for research use. The time-consuming nature of an evidence-based approach, on the other hand, suggests the need for more efficient production processes that are ‘quick and clean enough.’ Our case descriptions and accompanying video documentaries provide a rich description of organizations supporting the use of research evidence, which can be drawn upon by those establishing or leading similar organizations, particularly in low- and middle-income countries.

See also:
Jane L Hutton, Martin P Eccles, Jeremy M Grimshaw. Ethical issues in implementation research: a discussion of the problems in achieving informed consent. Implementation Science 2008, 3:52 (17 December 2008).

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Bringing important research evidence into practice: Canadian developments

This article from Family Practice describes two Canadian  initiatives that are helping to transfer research into practice [subscription required]:

CAPRE: Critically Appraised Practice Reflection Exercise [Queen’s University, Kingston ON]
GAC: Guidelines Advisory Committee [Ontario]

Rosser W. Bringing important research evidence into practice: Canadian developments. Family Practice 2008 November 12.

BACKGROUND: The transfer of evidence from research into clinical practice is made almost impossible by enormous volume of literature on any topic. Consolidated evidence into guidelines is not very helpful as there are usually 50 guidelines existing on common clinical topics. Clinicians need assistance in identifying the best available evidence. This paper describes two strategies to transfer research evidence into clinical practice.
METHODS: The Guideline Advisory Committee (GAC) in Ontario has assessed all available guidelines on 70 clinical topics using a validated and transparent process involving community-based physicians as assessors. A single best guideline is selected and a summary of its evidence-based recommendations are produced for easy use by practitioners (http://www.gacguidelines.ca). The Critically Appraised Practice Reflection Exercise (CAPRE) programme takes the best available evidence on 40 common practice problems, presents a summary for clinician and patient, has a strategy for physician and patient to find common ground in applying the evidence and has the practitioner to carry out a reflection exercise to gain continuing education credits (http://www.capre.ca). Distribution of these strategies in practice-based research networks is a further step in making research more relevant to practice.
RESULTS: The GAC website has more than 100 000 ‘hits’ per month and 4500 identified regular users from Canada and the world. The numbers are steadily increasing. The CAPRE programme has not been formally evaluated but over 150 clinicians have used the programme with patients. With a national launch, the programme there between 60 000 and 80 000 hits per week with 100 physicians completing the programme for continuing medical education (CME) credits in the first month. Physicians report that their patients are very pleased with their physician using the latest evidence to address their problem. This is true even if the patient does not agree to follow the evidence-based recommendations. Using these programmes in practice-based research, networks should further promote making research more relevant to practice.
CONCLUSIONS: Transferring research-based evidence into clinical practice has many challenges. Two programmes developed to address these challenges are described. Although not fully evaluated, there is some evidence of success.

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Progress in evidence-based medicine: JAMA articles

The  October 15 issue of JAMA contains a commentary on the article on EBM published in 1992. Both are available free online.

Montori VM, Guyatt GH. Progress in evidence-based medicine. JAMA. 2008 Oct 15;300(15):1814-6.

In 1992 JAMA published an article by the Evidence-Based Medicine Working Group focusing on the role of evidence-based medicine (EBM) in medical education.1 Although the term evidence-based medicine first appeared in the published literature the prior year,2 the JAMA publication brought both the label and the underlying philosophy to the attention of a wider medical community.

The article was audacious in suggesting that EBM represented a new paradigm in the teaching and practice of medicine by deemphasizing unsystematic clinical observations, pathophysiological inference, and authority. The article honored traditional skills (eg, understanding biology, demonstrating empathy), but emphasized new skills that learners must acquire and use: question formulation, search and retrieval of the best available evidence, and critical appraisal of the study methods to ascertain the validity of results. The article aggressively presented EBM as a fundamentally new approach.

The original article:

Evidence-Based Medicine Working Group. Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA 1992;268(17):2420-2425.

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eScholarship Respository (California Digital Library)

   Here is an Open Access resource I just discovered, from the California Digital Library (CDL).

The repository is a service of the eScholarship initiative of the California Digital Library, and is an open-access publishing platform that offers UC [Universiy of California] departments, centers, and research units direct control over the creation and dissemination of the full range of their scholarship, including pre-publication materials, journals and peer-reviewed series, postprints, and seminar papers. These materials are freely available to the public online. As of today there are  21,040 papers in the repository.  Advanced search   

Sample paper:
Kravitz RL, Duan N, Braslow J. Evidence-based medicine, heterogeneity of treatment effects, and the trouble with averages. Milbank Q. 2004;82(4):661-87.
(View all articles with evidence-based in the title.)

The 10 Most Popular Papers in the eScholarship Repository; The 10 Most Popular Recent Papers in the eScholarship Repository

Other services:
eScholarship Editions:  includes almost 2000 books from academic presses on a range of topics, including art, science, history, music, religion, and fiction.
Mark Twain Project Online: a groundbreaking digital critical edition of Mark Twain’s works that applies innovative search, display and citation technology to more than four decades of archival research by expert editors at the Mark Twain Project.

Cochrane Library: Free access for all?

  In an ideal world, all health information would be available to all people. The databases contained in the Cochrane Library are an invaluable resource for health professionals, particularly the Cochrane Database of Systematic Reviews, and there is a global movement to make the Cochrane Library available to all.

A number of countries now offer their citizens free access to the Cochrane Library because they have obtained national provisions. Currently there are two online petitions to receive national provisions, one in Canada and one in Europe.

In Canada, people residing in New Brunswick, Northwest Territories, Nunavut, Yukon, Nova Scotia and Saskatchewan have free access to Cochrane. Other Canadians who wish to have this access are encouraged to sign this petition, entitled A National License to The Cochrane Library for Canada. The petition is administered by the Canadian Health Libraries Association / Association des bibliothèques de la santé du Canada.

In Europe the petition is entitled Petition to the European Commission to finance EU Provision to the Cochrane Library.

In the United States, Wyoming is the only state with free access. I haven’t been able to find an online Cochrane petition for the United States. (Create your own online petition here.)

Here is a sampling of countries that offer free access to the Cochrane Library:
Australia; Denmark; England; Finland; Island of Ireland (Health Research Board in Dublin and The Research and Development Office in Belfast); Scotland; South Africa; New Zealand; Norway (Norwegian Health Services Research Centre); Sweden; Wales (Welsh Assembly Government).

There are also several programmes that provide free access in Latin America and low-income countries.  For more information see this link.

Click on this image to see a list of countries with free access: