The Theory of Auditing Economics: Evidence and Suggestions for Future Research

Evidence-Based Practice in AAC

Through showing the full picture of double-arm controlled clinical research and systematic review evidence in the field of orally administrated Chinese herbal medicine (CHM) for treatment of lung cancer, to provide a reference for future clinical research and to indicate a direction for future systematic reviews. A comprehensive search of clinical controlled studies was performed regarding orally administered CHM treatment for lung cancer published from January 1970 to September 2020. The language was restricted to Chinese and English. Relevant data were extracted, the quality of systematic reviews was evaluated, and the research evidence was visually displayed. Randomized controlled trials were the most common type of research design. The research sample sizes were typically small. Oral CHM showed certain curative advantages in treating lung cancer. The key stages in oral CHM intervention for lung cancer are chemotherapy, radiotherapy, and late palliative treatment. The advantageous outcomes of oral CHM treatment of lung cancer are the short-term efficacy, quality of life, and adverse reactions. The perioperative stage, overall survival, pharmacoeconomic evaluation, and Chinese medicine decoctions are weak research areas. CHM has staged and therapeutic advantages in treating lung cancer. The overall methodological quality is poor, and the level of evidence requires improvement. It is necessary to carry out large-scale, standardized, and higher-quality research in the superior and weak areas of CHM treatment of lung cancer.

Research Evidence Use in Early and Periodic Screening, Diagnostic, and Treatment Dental Medicaid Class Action Lawsuits

BackgroundCommunity-based organizations (CBOs) are important stakeholders in health systems and are increasingly called upon to use research evidence to inform their advocacy, program planning, and service delivery. To better support CBOs to find and use research evidence, we sought to assess the capacity of CBOs in the HIV/AIDS sector to acquire, assess, adapt, and apply research evidence in their work.MethodsWe invited executive directors of HIV/AIDS CBOs in Ontario, Canada (n = 51) to complete the Canadian Health Services Research Foundation's "Is Research Working for You?" survey.FindingsBased on responses from 25 organizations that collectively provide services to approximately 32,000 clients per year with 290 full-time equivalent staff, we found organizational capacity to acquire, assess, adapt, and apply research evidence to be low. CBO strengths include supporting a culture that rewards flexibility and quality improvement, exchanging information within their organization, and ensuring that their decision-making processes have a place for research. However, CBO Executive Directors indicated that they lacked the skills, time, resources, incentives, and links with experts to acquire research, assess its quality and reliability, and summarize it in a user-friendly way.ConclusionGiven the limited capacity to find and use research evidence, we recommend a capacity-building strategy for HIV/AIDS CBOs that focuses on providing the tools, resources, and skills needed to more consistently acquire, assess, adapt, and apply research evidence. Such a strategy may be appropriate in other sectors and jurisdictions as well given that CBO Executive Directors in the HIV/AIDS sector in Ontario report low capacity despite being in the enviable position of having stable government infrastructure in place to support them, benefiting from long-standing investment in capacity building, and being part of an active provincial network. CBOs in other sectors and jurisdictions that have fewer supports may have comparable or lower capacity. Future research should examine a larger sample of CBO Executive Directors from a range of sectors and jurisdictions.

Review question/objective The objective of this systematic review is to critically appraise and synthesise the best available evidence regarding the uptake of research evidence in clinical practice as experienced by nurses. This review seeks to answer the following questions: 1. What are the experiences of nurses in relation to the uptake of research into clinical practice? 2. What factors do nurses report as helpful in the uptake of research evidence into clinical practice? 3. What factors do nurses report as limiting the uptake of research evidence into clinical practice? Inclusion criteria Types of participants This review will consider qualitative studies that include all nurses working in any type of health care setting, including acute (hospitals), primary (community health), mental health and aged care. For the purpose of this review, the generic term ‘nurses’ will include registered nurses, enrolled nurses and assistants in nursing. The aim is to be as inclusive as possible and allow for global variations of nurse positions. Types of intervention(s)/phenomena of interest This review will consider studies that investigate the experience of nurses regarding the uptake of research evidence into clinical practice, including clinical decision making or clinical judgement. The term ‘clinical decision making’ for this review will describe any organisational aspects that influence decision making. The term ‘clinical judgement’ will describe the ‘different grounds for making judgements’. 20 (p. 1506) Additionally, for this review the terms research uptake or utilisations and evidence-based practice will be used interchangeably as they all represent the aspect of incorporating research evidence into clinical practice. Types of outcomes This review will consider any subjective accounts by nurses describing their experiences, either positive or negative, in relation to the uptake of research evidence into clinical practice.

Objective: The National Forum on Health in Canada in 1997 identified the promotion of research transfer and uptake and evidence-based decision making as two important priorities for the Canadian health care system. Research has determined that factors such as key stakeholders, organizational culture, individual decision-making style, the research evidence itself, and the importance of the decision to the goals of the organization significantly influence the use of research evidence. This paper will chronicle activities underway in Canada to assist public health decision makers become aware of, accept, and incorporate research evidence into policy and practice decisions. Approach: A program of research among public health decision makers has been ongoing since 1995. The studies have sought to (a) identify barriers to research utilization among decision makers (Ciliska et al. 1999), (b) identify factors that facilitate the use of research evidence for program decision making (Dobbins et al. 2001a, 2001b), and (c) understand decision makers' information needs and preferences (Dobbins et al. 2004; Thomas et al. 2004). Findings: The findings highlight the importance of factors of the organization, environment, individual, and innovation (research evidence) to the use of research evidence in decision making. Culture and decision-making style were found to be particularly important, along with perceived skill to critically appraise research evidence and social environments supportive of research evidence. Decision makers clearly articulated their information needs with respect to content, format, and method of delivery. Conclusions: The findings have been instrumental in the development of a national public health knowledge transfer strategy. The investigators contend that consultation with potential users of research evidence is crucial to ensure the conduct of relevant and timely research as well as the development of an effective knowledge transfer strategy. The results have also assisted in the development of more appropriate and objective outcome measures. Implications: Implications for future research and activity will be addressed in light of the results presented.

Orthopaedic Healthcare Worldwide: Using Clinical Practice Guidelines in Clinical Decision Making.

Disseminating behavioral health (BH) research to elected policy makers is a priority, but little is known about how they use and seek research evidence. This exploratory study aimed to identify research dissemination preferences and research-seeking practices of legislators who prioritize BH issues and to describe the role of research in determining policy priorities. The study also assessed whether these legislators differ from those who do not prioritize BH issues. A telephone-based survey was conducted with 862 state legislators (response rate, 46%). A validated survey instrument assessed priorities and the factors that determined them, research dissemination preferences, and research-seeking practices. Bivariate analyses were used to characterize and compare the two groups. Legislators who prioritized BH issues (N=125) were significantly more likely than those who did not to identify research evidence as a factor that determined policy priorities (odds ratio=1.91, 95% confidence interval=1.25-2.90, p=.002). Those who prioritized BH issues also attributed more importance to ten of 12 features of research, and the difference was significant for four features (unbiased, p=.014; presented in a concise way, p=.044; delivered by someone known or respected, p=.033; and tells a story, p=.030). Those who prioritized BH issues also engaged more often in eight of 11 research-seeking and utilization practices, and a significance difference was found for one (attending research presentations, p=.012). Legislators who prioritized BH issues actively sought, had distinct preferences for, and were particularly influenced by research evidence. Testing legislator-focused BH research dissemination strategies is an area for future research.

Social, biological and environmental factors in early-life, defined as the period from preconception until age 18, play a role in shaping the risk of multiple long-term condition multimorbidity. However, there is a need to conceptualise these early-life factors, how they relate to each other, and provide conceptual framing for future research on aetiology and modelling prevention scenarios of multimorbidity. We develop a conceptual framework to characterise the population-level domains of early-life determinants of future multimorbidity. This work was conducted as part of the Multidisciplinary Ecosystem to study Lifecourse Determinants and Prevention of Early-onset Burdensome Multimorbidity (MELD-B) study. The conceptualisation of multimorbidity lifecourse determinant domains was shaped by a review of existing research evidence and policy, and co-produced with public involvement via two workshops. Early-life risk factors incorporate personal, social, economic, behavioural and environmental factors, and the key domains discussed in research evidence, policy, and with public contributors included adverse childhood experiences, socioeconomics, the social and physical environment, and education. Policy recommendations more often focused on individual-level factors as opposed to the wider determinants of health discussed within the research evidence. Some domains highlighted through our co-production process with public contributors, such as religion and spirituality, health screening and check-ups, and diet, were not adequately considered within the research evidence or policy. This co-produced conceptualisation can inform research directions using primary and secondary data to investigate the early-life characteristics of population groups at risk of future multimorbidity, as well as policy directions to target public health prevention scenarios of early-onset multimorbidity.

BackgroundDespite evidence of the benefits of research use in post-acute stroke rehabilitation where compliance with clinical practice guidelines has been associated with functional recovery and patient satisfaction, the rate of reliance on the research literature in clinical decision making among physical therapists is low. More research examining factors that motivate physical therapists to consider research findings in neurological practice is needed to inform efforts to intervene. The objective of this study was to identify practitioner, organizational, and research characteristics associated with research use among physical therapists providing services post-stroke.MethodsA cross-sectional mail survey of physical therapists providing services to people with stroke in Ontario, Canada was conducted. The survey questionnaire contained items to evaluate practitioner and organizational characteristics and perceptions of research considered to influence evidence-based practice (EBP), as well as the frequency of using research evidence in clinical decision making in a typical month. Ordinal regression was used to identify factors associated with research use.ResultsThe percentage of respondents reporting research use in clinical decision making 0 to 1, 2 to 5, or 6+ times in a typical month was 33.8%, 52.9%, and 13.3%, respectively (n = 263). Academic preparation in the principles of EBP, research participation, service as a clinical instructor, self-efficacy to implement EBP, a positive attitude towards research, perceived organizational support of research use, and Internet access to bibliographic databases at work were each associated with research use and placed in the final regression model. In the final model (n = 244), academic preparation in EBP, EBP self-efficacy, agreement that research findings are useful, and research participation each remained significantly associated with research use after adjusting for the effects of the other variables in the model.ConclusionsA third of therapists rarely use research evidence in clinical decision making. Education in the principles of EBP, EBP self-efficacy, a positive attitude towards research, and involvement in research at work may promote research use in neurological physical therapy practice. Future research is needed to confirm these findings and to determine the type of research participation that may promote research use.

Background:The use of evidence-based practice (EBP) is often not reflected in allied health (AH) practitioners’ day-to-day practice (the research-practice gap). Research suggests that considerable differences between and within AH disciplines exist, which require different approaches in order to influence practice behavior. It is therefore important to develop a better understanding of what influences individual AH practitioners’ adoption of evidence into daily practice.Objective:This systematic review aims to examine the individual characteristics of AH practitioners which determine their uptake of evidence into practice.Methods:Studies which examined individual factors or variables that influence research evidence use by any AH practitioner were included in the review. The methodological quality of the included papers was assessed using the Quality Assessment and Validity Tool for Cross-sectional Studies. A narrative summary of the findings was presented.Results:Six studies were included and the methodological quality scores indicated that two were weak and the remainder had moderate–weak quality. The review demonstrated that factors such as educational degree or academic qualification, involvement in research or EBP-related activities, and practitioners’ perceptions, attitudes and beliefs about research and EBP are significant predictors of self-reported research evidence use in AH. The effect of other factors such as professional characteristics, clinical setting/work environment, information-seeking behavior and sociodemographic variables are less clear. Whether there is an interaction effect between evidence-uptake factors has not been tested.Conclusion:Improving the research knowledge of clinicians and overcoming negative attitudes toward EBP have the potential to move AH practitioners towards regularly utilizing evidence in practice. Allied health practitioners may benefit from participation in regular educational opportunities such as case studies or journal clubs which can put them at the same level of thinking and awareness of research evidence. Future research should aim to review organizational and contextual factors and explore their interaction with individual determinants of research evidence use.

SummaryDuring the past decade, there has been an explosion in the literature on performance‐oriented reforms around the globe. What are the major topics discussed in this literature? What can scholars and practitioners learn from it? This study provides an overview of the major themes, strategies, challenges, and outcomes of performance measurement and management reforms by reviewing the literature produced during this period. It shows that useful strategies and tools have been developed for public sector organizational performance improvement. Apart from continuing efforts to examine the role of measurement per se, there has been a shift in focus from performance measurement to performance management in this literature. Nevertheless, research evidence from both developed and developing countries shows that most reforms achieve only mixed results, with both costs and gains and with daunting challenges, such as gaming, remaining. The paper concludes by discussing issues that deserve attention from future research. Copyright © 2015 John Wiley & Sons, Ltd.

Antiadhesion barrier gels: time for evidence-informed practice in gynecologic surgery?

There is a pressing need for occupational therapists to provide research-based practice, yet there is little understanding of the specific strategies and processes individual practitioners use to integrate research evidence into their clinical practice. Using grounded theory method, the self-reported research utilization strategies of a sample of 11 elite occupational therapists practicing in adult stroke rehabilitation were examined. The triangulation of the interview data, the organizational policies of their workplaces, and existing theoretical concepts and processes of research utilization resulted in the development of a theory and a practice model to guide research utilization in occupational therapy. The Theory of Research Utilization Enhancement for Occupational Therapists, and the Model of Research Utilization in Occupational Therapy are presented, and their implications for practice, policy, education and future research are discussed. Built upon the Occupational Performance Process Model, the theory and model are proposed as guides to enhance therapists' ability to maintain a client-centred approach while informing clinical practices with research evidence. The application of structured reflection, case application and peer consultation facilitate the integration of research evidence into clinical practices.

BackgroundThe use of routine immunization data by health care professionals in low- and middle-income countries remains an underutilized resource in decision-making. Despite the significant resources invested in developing national health information systems, systematic reviews of the effectiveness of data use interventions are lacking. Applying a realist review methodology, this study synthesized evidence of effective interventions for improving data use in decision-making.MethodsWe searched PubMed, POPLINE, Centre for Agriculture and Biosciences International Global Health, and African Journals Online for published literature. Grey literature was obtained from conference, implementer, and technical agency websites and requested from implementing organizations. Articles were included if they reported on an intervention designed to improve routine data use or reported outcomes related to data use, and targeted health care professionals as the principal data users. We developed a theory of change a priori for how we expect data use interventions to influence data use. Evidence was then synthesized according to data use intervention type and level of the health system targeted by the intervention.ResultsThe searches yielded 549 articles, of which 102 met our inclusion criteria, including 49 from peer-reviewed journals and 53 from grey literature. A total of 66 articles reported on immunization data use interventions and 36 articles reported on data use interventions for other health sectors. We categorized 68 articles as research evidence and 34 articles as promising strategies. We identified ten primary intervention categories, including electronic immunization registries, which were the most reported intervention type (n = 14). Among the research evidence from the immunization sector, 32 articles reported intermediate outcomes related to data quality and availability, data analysis, synthesis, interpretation, and review. Seventeen articles reported data-informed decision-making as an intervention outcome, which could be explained by the lack of consensus around how to define and measure data use.ConclusionsFew immunization data use interventions have been rigorously studied or evaluated. The review highlights gaps in the evidence base, which future research and better measures for assessing data use should attempt to address.