Use of on-line evidence databases by Australian public health practitioners

Provision of Defect-Free Care: Implementation Science in Surgical Patient Safety

Implementation science is the study of the translation of evidence-based practices to real-world clinical environments. Implementation is measured with specific outcomes including acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability, and implementation cost. There are defined frameworks and models that outline implementation strategies and assist researchers in identifying barriers and facilitators to achieve implementation and conduct implementation research using methods such as qualitative analysis, parallel group, pre-/postintervention, interrupted time series, and cluster or stepped-wedge randomized trials. Deimplementation is the study of how to remove ineffective or unnecessary practices from the clinical setting and is an equally important component of implementation science.

Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda

An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.

Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda

An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of "implementation outcomes" distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working "taxonomy" of eight conceptually distinct implementation outcomes-acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability-along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.

Increasing the use of evidence in health policy: practice and views of policy makers and researchers

Background

Better communication is often suggested as fundamental to increasing the use of research evidence in policy, but little is known about how researchers and policy makers work together or about barriers to exchange. This study explored the views and practice of policy makers and researchers regarding the use of evidence in policy, including: (i) current use of research to inform policy; (ii) dissemination of and access to research findings for policy; (iii) communication and exchange between researchers and policy makers; and (iv) incentives for increasing the use of research in policy.

Methods

Separate but similar interview schedules were developed for policy makers and researchers. Senior policy makers from NSW Health and senior researchers from public health and health service research groups in NSW were invited to participate. Consenting participants were interviewed by an independent research company.

Results

Thirty eight policy makers (79% response rate) and 41 researchers (82% response rate) completed interviews. Policy makers reported rarely using research to inform policy agendas or to evaluate the impact of policy; research was used more commonly to inform policy content. Most researchers reported that their research had informed local policy, mainly by increasing awareness of an issue. Policy makers reported difficulty in accessing useful research syntheses, and only a third of researchers reported developing targeted strategies to inform policy makers of their findings. Both policy makers and researchers wanted more exchange and saw this as important for increasing the use of research evidence in policy; however, both groups reported a high level of involvement by policy makers in research.

Conclusion

Policy makers and researchers recognise the potential of research to contribute to policy and are making significant attempts to integrate research into the policy process. These findings suggest four strategies to assist in increasing the use of research in policy: making research findings more accessible to policy makers; increasing opportunities for interaction between policy makers and researchers; addressing structural barriers such as research receptivity in policy agencies and a lack of incentives for academics to link with policy; and increasing the relevance of research to policy.

The effect of training on question formulation among public health practitioners: results from a randomized controlled trial

OBJECTIVE

To improve understanding of the information-seeking behaviors of public health professionals, the authors conducted this randomized controlled trial involving sixty participants to determine whether library and informatics training, with an emphasis on PubMed searching skills, increased the frequency and sophistication of participants' practice-related questions.

METHODS

The intervention group (n = 34) received evidence-based public health library and informatics training first, whereas the control group (n = 26) received identical training two weeks later. The frequency and sophistication of the questions generated by both intervention and control groups during the interim two-week period served as the basis for comparison.

RESULTS

The intervention group reported an average of almost 1.8 times more questions than those reported by the control group (1.24 vs. 0.69 questions per participant); however, this difference did not reach statistical significance. The intervention group overall produced more sophisticated (foreground) questions than the control group (18 vs. 9); however, this difference also did not reach statistical significance.

CONCLUSION

The training provided in the current study seemed to prompt public health practitioners to identify and articulate questions more often. Training appears to create the necessary precondition for increased information-seeking behavior among public health professionals.

Identifying strategies to improve access to credible and relevant information for public health professionals: a qualitative study

BACKGROUND

Movement towards evidence-based practices in many fields suggests that public health (PH) challenges may be better addressed if credible information about health risks and effective PH practices is readily available. However, research has shown that many PH information needs are unmet. In addition to reviewing relevant literature, this study performed a comprehensive review of existing information resources and collected data from two representative PH groups, focusing on identifying current practices, expressed information needs, and ideal systems for information access.

METHODS

Nineteen individual interviews were conducted among employees of two domains in a state health department--communicable disease control and community health promotion. Subsequent focus groups gathered additional data on preferences for methods of information access and delivery as well as information format and content. Qualitative methods were used to identify themes in the interview and focus group transcripts.

RESULTS

Informants expressed similar needs for improved information access including single portal access with a good search engine; automatic notification regarding newly available information; access to best practice information in many areas of interest that extend beyond biomedical subject matter; improved access to grey literature as well as to more systematic reviews, summaries, and full-text articles; better methods for indexing, filtering, and searching for information; and effective ways to archive information accessed. Informants expressed a preference for improving systems with which they were already familiar such as PubMed and listservs rather than introducing new systems of information organization and delivery. A hypothetical ideal model for information organization and delivery was developed based on informants' stated information needs and preferred means of delivery. Features of the model were endorsed by the subjects who reviewed it.

CONCLUSION

Many critical information needs of PH practitioners are not being met efficiently or at all. We propose a dual strategy of: 1) promoting incremental improvements in existing information delivery systems based on the expressed preferences of the PH users of the systems and 2) the concurrent development and rigorous evaluation of new models of information organization and delivery that draw on successful resources already operating to deliver information to clinical medical practitioners.

Evidence-based medicine in pathology: an introduction

Evidence-based medicine (EBM) is a school of thought that has spread rapidly through medicine in the past 2 decades and is eliciting an increasing interest in Anatomic Pathology and Laboratory Medicine. It has been defined as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." The environmental factors that created a need for EBM and basic concepts of this discipline are reviewed. Methods for the accrual and critical appraisal of the validity of available evidence and its impact, applicability and usefulness in pathology practice are discussed. Basic concepts of bayesian data analysis with an emphasis on concepts such as prior and posterior probability and the use of "holdout" or "test" data are introduced. The future of EBM in pathology is discussed and potential applications of these concepts to pathology practice and research are proposed.