Synthesis Of Research Evidence Research Articles

Evidence-based medicine - an appropriate tool for evidence-based health policy? A case study from Norway.

BackgroundEvidence-based policy (EBP), a concept modelled on the principles of evidence-based medicine (EBM), is widely used in different areas of policymaking. Systematic reviews (SRs) with meta-analyses gradually became the methods of choice for synthesizing research evidence about interventions and judgements about quality of evidence and strength of recommendations. Critics have argued that the relation between research evidence and service policies is weak, and that the notion of EBP rests on a misunderstanding of policy processes. Having explored EBM standards and knowledge requirements for health policy decision-making, we present an empirical point of departure for discussing the relationship between EBM and EBP.MethodsIn a case study exploring the Norwegian Knowledge Centre for the Health Services (NOKC), an independent government unit, we first searched for information about the background and development of the NOKC to establish a research context. We then identified, selected and organized official NOKC publications as an empirical sample of typical top-of-the-line knowledge delivery adhering to EBM standards. Finally, we explored conclusions in this type of publication, specifically addressing their potential as policy decision tools.ResultsFrom a total sample of 151 SRs published by the NOKC in the period 2004–2013, a purposive subsample from 2012 (14 publications) advised major caution about their conclusions because of the quality or relevance of the underlying documentation. Although the case study did not include a systematic investigation of uptake and policy consequences, SRs were found to be inappropriate as universal tools for health policy decision-making.ConclusionsThe case study demonstrates that EBM is not necessarily suited to knowledge provision for every kind of policy decision-making. Our analysis raises the question of whether the evidence-based movement, represented here by an independent government organization, undertakes too broad a range of commissions using strategies that seem too confined. Policymaking in healthcare should be based on relevant and transparent knowledge, taking due account of the context of the intervention. However, we do not share the belief that the complex and messy nature of policy processes in general is compatible with the standards of EBM.

An overview of systematic reviews on the effectiveness of periodontal treatment to improve glycaemic control.

Several systematic reviews with meta-analyses on the effectiveness of periodontal treatment to improve glycaemic control have been published. So far no overview of these systematic reviews has been performed. The main objective of this report was to assess critically these systematic reviews to provide the reader with a high-level synthesis of research evidence. MEDLINE (via PubMed) and EMBASE databases were searched independently and in duplicate to identify systematic reviews with meta-analyses of clinical studies that assessed the relationship between diabetes mellitus and periodontitis. The last database search was performed on 10 March 2015. The reference lists of included systematic reviews were also scrutinized for further publications. The methodological quality of the included systematic reviews was assessed independently with two validated checklists (AMSTAR and OQAQ) by two authors. Disagreements in the assessment were resolved by consensus. A total of 226 potential publications were initially retrieved. Eleven systematic reviews with meta-analyses were finally included. Glycosylated haemoglobin A1c (HbA1c) was the most commonly used clinical endpoint. Meta-analytic estimates from systematic reviews generated an average reduction of 0.46% (median 0.40%) of HbA1c in patients with diabetes mellitus who received periodontal treatment. These meta-analyses had, nevertheless, methodological limitations such as inclusion of trials with different types of risk of bias that hinder more robust conclusions. A recent meta-analysis that included recently published large randomized controlled trials did not show significant change in the level of HbA1c at the 6 mo follow-up. The AMSTAR checklist generated results that were more conservative than OQAQ. Findings from this overview do not support the information that periodontal treatment may improve glycaemic control. Methodological issues described in this overview may guide further research on this topic.

A process evaluation accompanying an attempted randomized controlled trial of an evidence service for health system policymakers.

BackgroundWe developed an evidence service that draws inputs from Health Systems Evidence (HSE), which is a comprehensive database of research evidence about governance, financial and delivery arrangements within health systems and about implementation strategies relevant to health systems. Our goal was to evaluate whether, how and why a ‘full-serve’ evidence service increases the use of synthesized research evidence by policy analysts and advisors in the Ontario Ministry of Health and Long-Term Care as compared to a ‘self-serve’ evidence service.MethodsWe attempted to conduct a two-arm, 10-month randomized controlled trial (RCT), along with a follow-up qualitative process evaluation, but we terminated the RCT when we failed to reach our recruitment target. For the qualitative process evaluation we modified the original interview guide to allow us to explore the (1) factors influencing participation in the trial; (2) usage of HSE, factors explaining usage patterns, and strategies to increase usage; (3) participation in training workshops and use of other supports; and (4) views about and experiences with key HSE features.ResultsWe terminated the RCT given our 15% recruitment rate. Six factors were identified by those who had agreed to participate in the trial as encouraging their participation: relevance of the study to participants’ own work; familiarity with the researchers; personal view of the importance of using research evidence in policymaking; academic background; support from supervisors; and participation of colleagues. Most reported that they never, infrequently or inconsistently used HSE and suggested strategies to increase its use, including regular email reminders and employee training. However, only two participants indicated that employee training, in the form of a workshop about finding and using research evidence, had influenced their use of HSE. Most participants found HSE features to be intuitive and helpful, although registration/sign-in and some page formats (particularly the advanced search page and detailed search results page) discouraged their use or did not optimize the user experience.ConclusionsThe qualitative findings informed a re-design of HSE, which allows users to more efficiently find and use research evidence about how to strengthen or reform health systems or in how to get cost-effective programs, services and drugs to those who need them. Our experience with RCT recruitment suggests the need to consider changing the unit of allocation to divisions instead of individuals within divisions, among other lessons.Trial registrationThis protocol for this study is published in Implementation Science and registered with ClinicalTrials.gov (HHS/FHS REB 10–267).Electronic supplementary materialThe online version of this article (doi:10.1186/s12961-015-0066-z) contains supplementary material, which is available to authorized users.

Overview of systematic reviews on the health-related effects of government tobacco control policies.

BackgroundGovernment interventions are critical to addressing the global tobacco epidemic, a major public health problem that continues to deepen. We systematically synthesize research evidence on the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force.MethodsAn overview of systematic reviews was prepared through systematic searches of five electronic databases, published up to March 2014. Additional reviews were retrieved from monthly updates until August 2014, consultations with tobacco control experts and a targeted search for reviews on mass media interventions. Reviews were assessed according to predefined inclusion criteria, and ratings of methodological quality were either extracted from source databases or independently scored.ResultsOf 612 reviews retrieved, 45 reviews met the inclusion criteria and 14 more were identified from monthly updates, expert consultations and a targeted search, resulting in 59 included reviews summarizing over 1150 primary studies. The 38 strong and moderate quality reviews published since 2000 were prioritized in the qualitative synthesis. Protecting people from tobacco smoke was the most strongly supported government intervention, with smoke-free policies associated with decreased smoking behaviour, secondhand smoke exposure and adverse health outcomes. Raising taxes on tobacco products also consistently demonstrated reductions in smoking behaviour. Tobacco product packaging interventions and anti-tobacco mass media campaigns may decrease smoking behaviour, with the latter likely an important part of larger multicomponent programs. Financial interventions for smoking cessation are most effective when targeted at smokers to reduce the cost of cessation products, but incentivizing quitting may be effective as well. Although the findings for bans on tobacco advertising were inconclusive, other evidence suggests they remain an important intervention.ConclusionWhen designing and implementing tobacco control programs, governments should prioritize smoking bans and price increases of tobacco products followed by other interventions. Additional studies are needed on the various factors that can influence a policy’s effectiveness and feasibility such as cost, local context, political barriers and implementation strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2041-6) contains supplementary material, which is available to authorized users.

Falls prevention: Identification of predictive fall risk factors

Patient falls are the most common adverse safety event in hospitals and healthcare facilities nationwide. There are many risk factors associated with inpatient falls such as medications, unsteady gait, alteration in mental status, and environmental hazards. Risk assessment is the primary intervention for falls prevention. This study aims to provide a detailed review of the literature to identify and synthesize research evidence on risk factors that may contribute to patient falls in the adult inpatient hospital setting that are not captured by current fall risk assessment tools. After the identification of those key risk factors not found on the most common fall risk assessment tools, the results of this review will be used to develop a new evidence based fall risk assessment tool.

Enhancing the Capacity of Policy-Makers to Develop Evidence-Informed Policy Brief on Infectious Diseases of Poverty in Nigeria.

The lack of effective use of research evidence in policy-making is a major challenge in most low- and middle-income countries (LMICs). There is need to package research data into effective policy tools that will help policy-makers to make evidence-informed policy regarding infectious diseases of poverty (IDP). The objective of this study was to assess the usefulness of training workshops and mentoring to enhance the capacity of Nigerian health policy-makers to develop evidence-informed policy brief on the control of IDP. A modified "before and after" intervention study design was used in which outcomes were measured on the target participants both before the intervention is implemented and after. A 4-point Likert scale according to the degree of adequacy; 1 = "grossly inadequate," 4 = "very adequate" was employed. The main parameter measured was participants' perceptions of their own knowledge/understanding. This study was conducted at subnational level and the participants were the career health policy-makers drawn from Ebonyi State in the South-Eastern Nigeria. A one-day evidence-to-policy workshop was organized to enhance the participants' capacity to develop evidence-informed policy brief on IDP in Ebonyi State. Topics covered included collaborative initiative; preparation and use of policy briefs; policy dialogue; ethics in health policy-making; and health policy and politics. The preworkshop mean of knowledge and capacity ranged from 2.49-3.03, while the postworkshop mean ranged from 3.42-3.78 on 4-point scale. The percentage increase in mean of knowledge and capacity at the end of the workshop ranged from 20.10%-45%. Participants were divided into 3 IDP mentorship groups (malaria, schistosomiasis, lymphatic filariasis [LF]) and were mentored to identify potential policy options/recommendations for control of the diseases for the policy briefs. These policy options were subjected to research evidence synthesis by each group to identify the options that have the support of research evidence (mostly systematic reviews) from PubMed, Cochrane database and Google Scholar. After the evidence synthesis, five policy options were selected out of 13 for malaria, 3 out of 10 for schistosomiasis and 5 out of 11 for LF. The outcome suggests that an evidence-to-policy capacity enhancement workshop combined with a mentorship programme can improve policy-makers' capacity for evidence-informed policy-making (EIP).

Systematic reviews with language restrictions and no author contact have lower overall credibility: a methodology study.

BackgroundHigh-quality systematic reviews (SRs) require rigorous approaches to identify, appraise, select, and synthesize research evidence relevant to a specific question. In this study, we evaluated the association between two steps in the conduct of an SR – restricting the search to English, and author contact for missing data – and the overall credibility of a SR.MethodsAll SRs cited by the Endocrine Society’s Clinical Practice Guidelines published from October 2006 through January 2012 were included. The main outcome was the overall A Measurement Tool to Assess Systematic Reviews (AMSTAR) score, as a surrogate of SR credibility. Nonparametric Kruskal–Wallis tests and multivariable linear regression models were used to investigate the association between language restriction, author contact for missing data, and the overall AMSTAR score.ResultsIn all, 69 SRs were included in the analysis. Only 31 SRs (45%) reported searching non-English literature, with an average AMSTAR score of 7.90 (standard deviation [SD] =1.64). SRs that reported language restriction received significantly lower AMSTAR scores (mean =5.25, SD =2.32) (P<0.001). Only 30 SRs (43%) reported contacting authors for missing data, and these received, on average, 2.59 more AMSTAR points (SD =1.95) than those who did not (P<0.001). In multivariable analyses, AMSTAR score was significantly correlated with language restriction (beta =−1.31, 95% confidence interval [CI]: −2.62, −0.01, P=0.05) and author contact for missing data (beta =2.16, 95% CI: 0.91, 3.41, P=0.001). However, after adjusting for compliance with reporting guidelines, language restriction was no longer significantly associated with the AMSTAR score.ConclusionFewer than half of the SRs conducted to support the clinical practice guidelines we examined reported contacting study authors or searched non–English literature. SRs that did not conduct these two steps had lower quality scores, suggesting the importance of these two steps for overall SR credibility.

Commentary: evidence to guide gun violence prevention in America.

Gun violence is a major threat to the public's health and safety in the United States. The articles in this volume's symposium on gun violence reveal the scope of the problem and new trends in mortality rates from gunfire. Leading scholars synthesize research evidence that demonstrates the ability of numerous policies and programs-each consistent with lessons learned from successful efforts to combat public health problems-to prevent gun violence. Each approach presents challenges to successful implementation. Future research should inform efforts to assess which approaches are most effective and how to implement evidence-based interventions most effectively.

Participation of Children and Youth with Autism Spectrum Disorder: A Scoping Review

IntroductionParticipation in leisure activities is beneficial for children’s health and development, including those living with Autism Spectrum Disorder (ASD). Available syntheses of knowledge about participation have focused primarily on children with physical disabilities; however, little attention is directed to children with ASD. The purpose of this study was therefore to synthesize research evidence regarding the patterns and determinants of leisure participation in this population.MethodsA scoping review of peer-reviewed studies published between 2000 and 2013 was performed. Two reviewers independently selected studies based on a systematic procedure. Inclusion criteria for studies were participants with ASD, aged 5–17 years, and description of participation in leisure activities outside of school. Data were organized and synthesized based on domains of the International Classification of Functioning, Disability and Health (ICF): Body Functions, Activity Limitations, and Environmental factors.ResultsSixteen articles (out of 920) met the inclusion criteria and majority of those were descriptive in nature (69 %), whereas information about the factors that affect participation was reported in only 31 %. Overall, children with ASD participate in fewer leisure activities, mostly in the home setting, either with adults or on their own. Factors identified as associated with participation involved family support and social attitudes (environmental factors), sensitivity and behavioral challenges (body functions), and communication and interpersonal relationships problems (activity limitations).DiscussionKnowledge derived from this review provides preliminary understanding of and justifies greater attention towards the concept of participation in this population. Further research directions are suggested to address the identified gaps in the literature.

How might educational research into children’s ideas about light be of use to teachers?

This paper offers a synthesis of research evidence around teaching light to primary and secondary school pupils as part of the Institute of Physics Promoting and Interpreting Physics Education Research (PIPER) project. Conceptual change literature describes many of the difficulties young people can have understanding the phenomenon of light, and this knowledge can be useful in the classroom. Pupil–teacher dialogue is used to illustrate some of the pedagogical challenges teachers face in this topic. This paper also highlights the range of influences on pupils from everyday life and from the classroom, with a view to promoting teacher awareness of conceptual change research evidence.

A scoping review of scoping reviews: advancing the approach and enhancing the consistency.

BackgroundThe scoping review has become an increasingly popular approach for synthesizing research evidence. It is a relatively new approach for which a universal study definition or definitive procedure has not been established. The purpose of this scoping review was to provide an overview of scoping reviews in the literature.MethodsA scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in four bibliographic databases and the gray literature to identify scoping review studies. Review selection and characterization were performed by two independent reviewers using pretested forms.ResultsThe search identified 344 scoping reviews published from 1999 to October 2012. The reviews varied in terms of purpose, methodology, and detail of reporting. Nearly three-quarter of reviews (74.1%) addressed a health topic. Study completion times varied from 2 weeks to 20 months, and 51% utilized a published methodological framework. Quality assessment of included studies was infrequently performed (22.38%).ConclusionsScoping reviews are a relatively new but increasingly common approach for mapping broad topics. Because of variability in their conduct, there is a need for their methodological standardization to ensure the utility and strength of evidence. © 2014 The Authors. Research Synthesis Methods published by John Wiley & Sons, Ltd.

Discrimination of GutCheckNEC: a clinical risk index for necrotizing enterocolitis

BackgroundBetter measures are needed to identify infants at risk for developing necrotizing enterocolitis (NEC) and facilitate communication about risk across transitions. Although NEC is multi-factorial, quantification of composite risk for NEC in an individual infant is not clearly defined.ObjectiveThis study’s objective was to describe the derivation, validation and calibration testing of a novel clinical NEC risk index, GutCheckNEC. Individual risk factors were weighted to assess composite odds of developing NEC. GutCheckNEC is designed to improve communication about NEC risk and coordination of care among clinicians across an infant’s clinical course.MethodsBased on a synthesis of research evidence about NEC risk and an e-Delphi study including 35 neonatal experts, we identified NEC risk factors believed by the experts to be most relevant for a NEC risk index then applied a logistic model building process to derive and validate GutCheckNEC. De-identified data from the Pediatrix BabySteps Clinical Data Warehouse (discharge date 2007-2011) were split into three samples for derivation, validation and calibration. By comparing infants with medical NEC, surgical NEC, and those who died to infants without NEC, we derived the logistic model using the un-matched derivation set. Discrimination was then tested in a case-control matched validation set and an un-matched calibration set using ROC curves.ResultsSampled from a cohort of 58 820 infants, the randomly selected derivation set (n= 35 013) revealed 9 independent risk factors (gestational age, history of packed red blood cell transfusion, unit NEC rate, late onset sepsis, multiple infections, hypotension treated with inotropic medications, Black or Hispanic race, outborn status, and metabolic acidosis) and 2 risk reducers (human milk feeding on both days 7 and 14 of life, and probiotics). Unit NEC rate carried the most weight in the summed score. Validation using a 2: 1 matched case-control sample (n=360) demonstrated fair to good discrimination. In the calibration set (n= 23 447), GutCheckNEC scores (range 0-58) discriminated those infants who developed surgical NEC (AUC=0.84, 95% CI 0.82-0.84) and NEC leading to death (AUC=0.83, 95% CI 0.81-0.85), more accurately than medical NEC (AUC= 0.72, 95% CI 0.70-0.74).ConclusionGutCheckNEC represents weighted composite risk for NEC and discriminated infants who developed NEC from those who did not with very good accuracy. We speculate that targeting modifiable NEC risk factors could reduce national NEC prevalence.

Clinimetric Properties of Sitting Balance Measures for Children with Cerebral Palsy: A Systematic Review

ABSTRACTAssessment of sitting balance in children and youth with cerebral palsy (CP) is critical in order to design appropriate interventions to enhance activities and participation. This systematic review synthesized research evidence on the reliability, validity, responsiveness to change, and clinical utility of sitting balance measures for children and youth with CP. A two-tiered search in August 2012 using nine peer-reviewed electronic databases yielded nine articles with relevant information on seven clinical measures. Four of seven clinical measures: the Pediatric Reach Test (PRT), Sitting Assessment for Children with Neuromotor Dysfunction (SACND), Segmental Assessment of Trunk Control (SATCo), and Trunk Control Measurement Scale (TCMS), demonstrate acceptable overall applicability (at least one study supporting clinical utility, reliability, and validity) and are thus recommended for use in practice. Ongoing research on responsiveness to change, however, is warranted to support validity for outcomes measurement.

Engagement in research: an innovative three-stage review of the benefits for health-care performance

BackgroundThere is a widely held assumption that research engagement improves health-care performance at various levels, but little direct empirical evidence.ObjectivesTo conduct a theoretically and empirically grounded synthesis to map and explore plausible mechanisms through which research engagement might improve health services performance. A review of the effects on patients of their health-care practitioner's or institution's participation in clinical trials was published after submission of the proposal for this review. It identified only 13 relevant papers and, overall, suggested that the evidence that research engagement improves health-care performance was less strong than some thought. We aimed to meet the need for a wider review.MethodsAn hourglass review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves health care; and (3) a wider (but less systematic) review of papers identified during the two earlier stages. Studies were included inthe focused review if the concept of ‘engagementinresearch’ was an input and some measure of ‘performance’ an output. The search strategy covered the period 1990 to March 2012. MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and other relevant databases were searched. A total of 10,239 papers were identified through the database searches, and 159 from other sources. A further relevance and quality check on 473 papers was undertaken, and identified 33 papers for inclusion in the review. A standard meta-analysis was not possible on the heterogeneous mix of papers in the focused review. Therefore an explanatory matrix was developed to help characterise the circumstances in which research engagement might improve health-care performance and the mechanisms that might be at work, identifying two main dimensions along which to categorise the studies:the degree of intentionalityandthe scope of the impact.ResultsOf the 33 papers in the focused review, 28 were positive (of which six were positive/mixed) in relation to the question of whether or not research engagement improves health-care performance. Five papers were negative (of which two were negative/mixed). Seven out of 28 positive papers reported some improvement in health outcomes. For the rest, the improved care took the form of improved processes of care. Nine positive papers were at a clinician level and 19 at an institutional level. The wider review demonstrated, for example, how collaborative and action research can encourage some progress along the pathway from research engagement towards improved health-care performance. There is also evidence that organisations in which the research function is fully integrated into the organisational structure out-perform other organisations that pay less formal heed to research and its outputs. The focused and wider reviews identified the diversity in the mechanisms through which research engagement might improve health care: there are many circumstances and mechanisms at work, more than one mechanism is often operative, and the evidence available for each one is limited.LimitationsTo address the complexities of this evidence synthesis of research we needed to spend significant time mapping the literature, and narrowed the research question to make it feasible. We excluded many potentially relevant papers (though we partially addressed this by conducting a wider additional synthesis). Studies assessing the impact made on clinician behaviour by small, locally conducted pieces of research could be difficult to interpret without full knowledge of the context.ConclusionsDrawing on the focused and wider reviews, it is suggested that when clinicians and health-care organisations engage in research there is the likelihood of a positive impact on health-care performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved health-care performance. Further explorations are required of research networks and schemes to promote the engagement of clinicians and managers in research. Detailed observational research focusing on research engagement within organisations would build up an understanding of mechanisms.Study registrationPROSPERO: CRD42012001990.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Cochrane methods--twenty years experience in developing systematic review methods.

This year, The Cochrane Collaboration reached its 20th anniversary. It has played a pivotal role in the scientific development of systematic reviewing and in the development of review methods to synthesize research evidence, primarily from randomized trials, to answer questions about the effects of healthcare interventions. We introduce a series of articles, which form this special issue describing the development of systematic review methods within The Cochrane Collaboration. We also discuss the impact of Cochrane Review methods, and acknowledge the breadth and depth of methods development within The Cochrane Collaboration as part of the wider context of evidence synthesis. We conclude by considering the future development of methods for Cochrane Reviews.

Improving workplace learning of lifelong learning sector trainee teachers in the UK

Learning in the teaching workplace is crucial for the development of all trainee teachers. Workplace learning is particularly important for trainee teachers in the lifelong learning sector (LLS) in the UK, the majority of whom are already working as teachers, tutors, trainers or lecturers while undertaking initial teacher education. However, literature indicates that LLS workplace conditions often inhibit teacher learning. This article reviews the research base on LLS trainees’ workplace learning. Billett’s (2008) concept of relational interdependence, between the affordances (activities and interactions) that workplaces offer for learning and the ways in which individuals perceive and engage with these, is used as a framework to synthesise research evidence. Support and experience of teaching were found to be crucial affordances for trainees’ learning. The nature and availability of these affordances were shaped by workplace culture, organisational strategy, process and structures and the allocation and structuring of work. The ways in which trainees perceived and interacted with workplace affordances for learning were influenced by their prior experiences, confidence and self-esteem, career intentions, workplace position and status and orientation toward theoretical tools. The key properties of support and teaching experience and the workplace conditions needed to promote trainees’ learning are proposed. These provide a starting point for employers, mentors, teacher educators, policy makers and trainees to improve workplace learning. The findings and proposals are also relevant to HE and school initial teacher education. Proposals are made for addressing the gaps in the scale and scope of research into LLS trainees’ workplace learning.

A protocol for a systematic review of research on managing behavioural and psychological symptoms in dementia for community-dwelling older people: evidence mapping and syntheses

BackgroundNon-cognitive behavioural and psychological symptoms of dementia affect up to 90% of people with dementia during the disease course and result in distress, increased carer burden, high service utilization and unwanted moves to care homes. Research has focused on long-term settings and has not considered people with dementia living at home and at different stages of the disease trajectory. Our aim is to review systematically the evidence concerning non-pharmacological strategies to minimise behavioural and psychological symptoms in community-dwelling older people with dementia.Methods/DesignOur approach is a two-stage co-design: a systematic mapping of the broad evidence around behavioural and psychological symptoms followed by an in-depth systematic review of studies of non-pharmacological interventions for behavioural and psychological symptoms from the perspective of their impact on community-dwelling older people with dementia and their carers. The review will include published literature involving a wide range of electronic databases using sensitive and comprehensive searches and lateral searching including checking citations.We will produce a descriptive map of the studies by design and by the focus of interventions and apply further inclusion criteria, developed in conjunction with lay experts, to select studies for an in-depth systematic review that will include independent quality assessment and detailed data extraction by two reviewers.The review process will be integrated with stakeholder meetings and a multidisciplinary expert advisory group to guide the review parameters and shape the research questions on the management of behavioural and psychological symptoms in people with dementia. Because studies are likely to be diverse in methodology and interventions, we will conduct a narrative synthesis of the in-depth systematic review. If appropriate, we will pool studies in a meta-analysis. We will explore review findings at both stages through focus groups and interviews with service providers, practitioners, people with dementia and carers.DiscussionThis integrated review in collaboration with key stakeholders will synthesise research evidence to identify appropriate interventions for effective management of behavioural and psychological symptoms that supports people with dementia living at home and their carers, and which reflects their priorities. It will make recommendations for research and practice.Study registrationPROSPERO registration number: CRD42013004344

How to appraise a systematic review

Systematic reviews are a vital tool in evidence-based practice, allowing a comprehensive synthesis of research evidence. This article provides guidance for appraising systematic reviews and resources for more detailed assessments.

Synthesizing Research Evidence for Therapists Providing Home-Based Rehabilitative Care

ABSTRACTBackground: Accessible and relevant summaries of research findings can facilitate therapists’ ability to practice evidence-informed care. Purpose: Our study used a knowledge translation framework to explore what topics of research evidence rehabilitation therapists who provided home-based care for older adults would like summarized, and whether a short narrative summary was an acceptable format. Methods: An online survey was administered to community-based occupational therapists and physiotherapists who worked for district health authorities across one province. Findings: Respondents identified topics such as effective ways to educate clients and families and how interventions in rural settings differed from urban settings. The short narrative format was not sufficient for therapists to evaluate the strength of the research evidence. Implications: Researchers trying to disseminate research evidence to home-based therapists need to create short summaries that have sufficient details to assess the strength of the evidence which are pertinent to therapists delivering services in the home.

Developing Nurse Educator Competency in the Pedagogy of Simulation

Faculty development is needed for nurse educators to effectively use simulation as a learning tool. A synthesis of research evidence regarding current practices in preparing educators to use simulation provided a foundation for faculty development. Implementation of a two-pronged approach within a regional collaboration of four schools of nursing is described; results of the evaluation of the approaches are presented. Use of the National League for Nursing Core Competencies of Nurse Educators as the organizing framework and Roger's Diffusion of Innovations Model as the theoretical framework is discussed. An overview is provided of the two prongs: (a) a short course for novice educators, and (b) examples of continuing education programming for experienced faculty members new to simulation to enhance effective application of this pedagogy. Recommendations include designing faculty development for simulation within a framework for systems change, maintaining flexibility to meet diverse needs, and using existing online resources.