Various Forms Of Evidence Research Articles

Visitors’ views of human origins after visiting the Cradle of Humankind World Heritage Site

The Cradle of Humankind World Heritage Site, west of Johannesburg, was designated in 1999 because of its importance as a locality where numerous hominid fossils have been discovered since the 1930s. In this article, responses to questions from a survey of more than 800 adult visitors to the Cradle of Humankind visitor centres are analysed, covering their understanding of the concept of the ‘cradle’ and their views on human evolution. Findings indicated that 63% of the respondents conceptualised the cradle as the origin or birthplace of humankind, and a similar proportion thought that nowhere else could be called the Cradle of Humankind (77% of people of South African nationality thought this). Nearly 60% of respondents accepted that humans evolved from an ape-like ancestor, while 25% disagreed. South Africans were less likely to accept human evolution than their international counterparts. The great majority of participants who accepted human evolution based their agreement on various forms of evidence and their knowledge of evolution. A religious foundation was used for their rationale by 60% of those who rejected evolution, with 33% citing evidence for their rejection. The implications of the findings are discussed in the light of public awareness and human origins.

Reaching agreement in uncertain circumstances: the practice of evidence-based policy in the case of the Swedish National Guidelines for heart diseases

This paper explores the practice of evidence-based policy in a Swedish healthcare context. The study focused on how policymakers in the specific working group, the Priority-Setting Group (PSG), handled the various forms of evidence and values and their competing rationalities, when producing the Swedish National Guidelines for heart diseases that are based on both clinical and economic evidence and are established to support explicit priority-setting in healthcare. The study contributes to the theoretical and practical debate on evidence-based policy (EBP) by illustrating how the practical tensions of coming to agreement were managed, to a large extent, through deliberation and by creativity.

Cannibalized Evidence: The Problem of Over-incorporation in Zheng Yi’s Scarlet Memorial

Cannibalized EvidenceThe Problem of Over-incorporation in Zheng Yi’s Scarlet Memorial Holly E. Schreiber In the late 1980s, novelist Zheng Yi set out to investigate rumors that cannibalism had broken out in the Guangxi region of China during the Cultural Revolution (1966–76). His research was compiled from October 1990 to July 1991, while in internal exile in China. In the resulting work of literary journalism, Scarlet Memorial (hongse jinianbei, 1993), Zheng Yi attempts to document evidence of the reported instances of real-life cannibalism. As a disaffected communist on the run from the authorities, his investigation takes the form of a political polemic. But, as the title indicates, he also hopes that this effort will serve as a memorial for all of those who were persecuted during the Cultural Revolution. To this end, Zheng Yi fills Scarlet Memorial with first-hand accounts, interviews and official reports, as well as local mythology, gossip, speculation, and literary interpretation, all of which he reads on an equal level as “evidence.” First published in English translation in 1996,1 Scarlet Memorial has received mixed reviews among U.S. academics and casual readers alike. Although the English-language text is heavily abridged—several hundred pages of political commentary were excised—readers must still grapple with the text’s many excesses: too much violence, too much speculation, and too many sources. For some, these elements contribute to the text’s believability and critical impact.2 However, many critics and reviewers have argued that this over-inclusion compromises the book’s aims. Katherine E. Palmer and Richard King in particular criticize Zheng Yi’s failure to support his political analysis with concrete evidence. While Palmer acknowledges that the author has proven the occurrence of cannibalism in Guangxi, she claims that he resorts to specious explanations—such as patronizing depictions of the Zhuang ethnic group—in order to explain why. Objecting to the excess of political commentary, literary critic Gang Yue goes so far as to say “the book can and must be read as a fictional text, despite the author’s claim to historical accuracy and scientific truth” (251). Scarlet Memorial is a sprawling, protean text; one could easily argue that it exceeds the boundaries of form for investigative journalism—ostensibly the genre to which Zheng Yi aspires. A large portion of the text consists of testimony from [End Page 70] eyewitnesses and alleged perpetrators, which is then supplemented with official records. These sources of evidence, in and of themselves, are compelling proof that such atrocities were indeed committed. However, Zheng Yi does not stop there, including many other nonfiction forms such as literary interpretation, political analysis, and ethnographic description. Reading the latter as a break in generic form, Yue refers to this portion of the book as “an ‘ethnographical’ detour in the text’s transition from ‘investigative journalism’ to political polemic” (246). Yue’s use of scare quotes reflects his doubts about whether Scarlet Memorial can adequately be considered within the framework of either investigative journalism or ethnography. Yue would seem to imply that the polemic is simply masquerading as one of the other, more officially regarded genres. Ultimately, this article argues against Yue’s assumption: polemic is in fact expressed through ethnography and investigative journalism, as both forms were suppressed under Mao’s dictatorship and Zheng Yi’s use of them cannot be divorced from his political claims. With an understanding of how the author writes within and against a repressive literary history, we can explore how the various forms of evidence in Scarlet Memorial make an argument independent of simple fact claims. These types of evidence do not function simply to support an argument or bolster journalistic authority, but rather as a form of protest in their own right. Although Yue claims that “taken as a whole, [Scarlet Memorial] is not a book of investigative journalism at all” (243), I argue that the text is indeed a very specific form of the genre. As Peiqin Chen points out, the “thaw” that allowed for the blossoming of Chinese literary reportage in the 1980s helped produce a new type of investigative journalism: historical literary reportage (lishi baogao wenxue). Since many events that occurred...

Making drug policy together: Reflections on evidence, engagement and participation

This commentary considers the relationship between evidence, engagement and participation in drug policy governance. It argues that the use of various forms of evidence (for example, statistical data and service user narratives) is critical for meaningful stakeholder engagement and public participation in drug policy, as well as effective policy design and implementation. The respective roles of these different kinds of evidence in consultation processes need to be better understood. It discusses the limits of evidence, which it suggests is rarely conclusive or decisive for drug policy. This is partly because of the incompleteness of most research agendas and the lack of consensus among researchers, but also because issues in drug policy are inherently contestable, involving considerations that lie outside the competency of drug policy specialist as such. In particular, this is because they involve normative and evaluative issues that are properly political (for example, about the relative weight to be accorded to different kinds of harm and benefit). It concludes by supporting calls for a more nuanced understanding of the relationship between evidence, engagement and politics than is implicit in the term ‘evidence based policy’. It also argues that we should view the inherent contestability of drug policy not as something that can or should be resolved by ‘objective’ evidence, but as a source of vitality and creativity in policy development and evaluation.

The Active Living Research 2013 Conference: Achieving Change across Sectors: Integrating Research, Policy, and Practice

Achieving Change Across Sectors: Integrating Research, Policy, and Practice (C. D. Economos) The 2013 Active Living Research (ALR) Annual Conference brought together a network of individuals from research, policy, and practice to exchange data, experiences, and aspirations toward building a more active-friendly national landscape. There were evidence generators, evidence users, and those who do a bit of both. Primarily a generator, I also find myself at the intersection when called upon to inform policy or to implement evidence-based practice. My own approach to research has become more interdisciplinary and participatory to generate evidence that is inclusive and relevant to policy debates, so the conference theme created a comfortable atmosphere for me. The rich dialogue among attendees exemplified the commitment of many to uphold our individual roles, varied at times throughout our careers, in designing and implementing evidence-based public health strategies and policies to promote effective and sustained action. What becomes exceedingly clear when sectors are brought together is that the system is interdependent—evidence informs policy development and practice, and evaluating policy implementation and practice-based interventions generates new evidence. The cycle is continuous. Public health has several health priorities that require thoughtful and careful collaborations between researchers, practitioners, and policymakers across many sectors. Perhaps most pressing is the fact that we have an obesity epidemic caused by environments and policies that encourage overconsuming and underexpending energy. The urgency of addressing the epidemic compels a variety of policy-related actions that reach far and deep within the population. To maximize impact, these actions must be feasible, synergistic, cost-effective, free of unintended adverse consequences, and based on the best available evidence. From the perspective of an evidence generator, the following questions are contemplated on a regular basis: What is the status of the evidence? How do we go forward in the absence of complete evidence? What types of studies are required to fill the gaps and expand the evidence base? What are the disciplines that would enrich a research study? Who should participate in the research process? How do we communicate useful results to people who can use them? From the perspective of a policymaker or practitioner (or evidence user), the questions begin once a body of evidence exists: How can the data be combined and compiled to inform decision makers and stakeholders about the value and importance of evidence and how it could inform a particular policy decision? What type of methods should be used to evaluate the impact of new policy implementation? To address these questions and others, the Institute of Medicine’s Bridging the Evidence Gap report explains how various forms of evidence are used in evidence-based public health decision making. A closer look at the types of evidence and how it’s used in policymaking illustrates the range of information often taken into account by policymakers and suggests an expanded role for evidence generators. For example, when conducting a controlled trial in a community with multilevel outcomes, it is important to pay attention to the knowledge, ideas and interests, and opinions and views of the community as well as costs and resources used. A variety of distinct pieces of evidence (quantitative and qualitative) and sources of knowledge have meaning and can ultimately inform policy. This generally makes the results more meaningful for the community and their representatives. Different types of evidence can be merged with specific capacities, such as an individual’s skills, experience, and participation in networks, to influence the adoption and adaptation of evidence in practice. At the organizational levels, capacity is often visible leadership, Christina D. Economos, PhD, is at Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts. James F. Sallis, PhD, is with Active Living Research, University of California, San Diego, San Diego, California. NiCole R. Keith, PhD, is at the Department of Kinesiology, Indiana UniversityPurdue University, Indianapolis, Indiana. Jimmy Newkirk, BS, is with the National Physical Activity Society, Coats, North Carolina.

The Mental Health Professional in Court: A Survival Guideby Gutheil Thomas G. , M.D., and Drogin Eric Y. , J.D., Ph.D. Washington DC , American Psychiatric Publishing , 2013 , 129 pp., $59.00 (paper).

The Mental Health Professional in Court: A Survival Guideby Gutheil Thomas G. , M.D., and Drogin Eric Y. , J.D., Ph.D. Washington DC , American Psychiatric Publishing , 2013 , 129 pp., $59.00 (paper).

Evidence for and against the existence of alternate attractors on coral reefs

SynthesisCoral reefs are widely thought to exhibit multiple attractors which have profound implications for people that depend on them. If reefs become ‘stuck’ within a self‐reinforcing state dominated by seaweed, it becomes disproportionately difficult and expensive for managers to shift the system back towards its natural, productive, coral state.The existence of multiple attractors is controversial. We assess various forms of evidence and conclude that there remains no incontrovertible proof of multiple attractors on reefs. However, the most compelling evidence, which combines ecological models and field data, is far more consistent with multiple attractors than the competing hypothesis of only a single, coral attractor. Managers should exercise caution and assume that degraded reefs can become stuck there.Testing for the existence of alternate attractors in ecosystems that possess slow dynamics and frequent pulse perturbation is exceptionally challenging. Coral reefs typify such conditions and the existence of alternate attractors is controversial. We analyse different forms of evidence and assess whether they support or challenge the existence of multiple attractors on Caribbean reefs, many of which have shown profound phase shifts in community structure from coral to algal dominance. Field studies alone provide no insight into multiple attractors because the non‐equilibrial nature of reef dynamics prevents equilibria from being observed. Statistical models risk failing to sample the parameter space in which multiple attractors occur, and have failed to account for the confounding effects of heterogeneous environments, anthropogenic drivers (e.g. fishing), and major disturbances (e.g. hurricanes). Simple and complex models all find multiple attractors over some – though not all – regions of a system driver (fishing). Tests of model predictions with field data closely match theory of alternate attractors but a forward‐leaning monotonic curve with only a single attractor can also be fitted to these data. Deeper consideration of the assumptions of this monotonic relationship reveal significant ecological problems which disappear under a model of multiple attractors. To date, there is no evidence against the existence of multiple attractors on Caribbean reefs and while there remains no definitive proof, the balance of evidence and ecological reasoning favours their existence. Theory predicts that Caribbean reefs do not exhibit alternate attractors in their natural state but that disease‐induced loss of two key functional groups has generated bistability. Whether alternate attractors becomes a persistent element of reef dynamics or a brief moment in their geological history will depend, in part, on the ability of functional groups to recover and the impacts of climate change and ocean acidification on coral growth and mortality.

A Mixed-Methods Evaluation of School-Based Active Living Programs

School-based programs to combat childhood obesity often lack resources to incorporate strong evaluation components. This paper describes a collaborative evaluation conducted by partners implementing Active Living by Design (ALbD) programs at one Chicago elementary school. To assess ALbD program outcomes by triangulating various forms of evidence gathered while implementing these programs. An exploratory, mixed-methods design was used to collect and analyze data from numerous physical activity initiatives implemented at the school from 2004 to 2009. The researchers triangulated quantitative (student BMI data, student standardized test and discipline data, classroom physical activity logs, and student physical activity knowledge surveys) and qualitative (classroom physical activity logs and open-ended teacher surveys questions) findings to assess outcomes. Students continuously enrolled at this school from Grades 1 through 4, those most exposed to ALbD activities over time, had significantly lower BMI after 4 years, compared with peers who transferred to the school after Grade 1. Student achievement on standardized tests improved between 2004 (prior to initiating ALbD activities) and 2008. Visits to the Disciplinary Office dropped dramatically over the 4-year period. Teacher interviews and surveys and classroom Take 10! Program activity logs revealed that the program was implemented enthusiastically by all grades. The Physical Activity Knowledge Survey revealed a significant increase in physical activity knowledge after instituting these activities. Collaborative efforts to amass and analyze a variety of data demonstrated the effects of implementing a variety of health promotion activities in one school, documenting the growth of a "culture of health" in that school community.

Examining the evidence base used by optometrists in Australia and New Zealand

Background: The optometrist's role in primary eye care is expanding to include not only diagnosis but also management and co‐management of a range of eye diseases and visual disorders. This role calls for evidence‐based practice, including an ability to source and reliably assess the various forms of evidence, on which eye care might be based. It is not known whether optometrists registered to practise in Australasia use high or low quality evidence as a basis for their clinical decisions.Methods: The present study addressed this question by surveying 3,589 optometrists registered to practise in Australia and New Zealand. A 16‐item questionnaire was made available for completion online.Results: Responses from the 279 optometrists who completed the questionnaire (response rate 7.8 per cent) indicate that, after the patient's history, symptoms and signs, optometrists in our sample place most weight on knowledge and information gained via undergraduate and postgraduate education, including continuing education, as a basis for clinical decision‐making.Conclusion: These findings highlight the need for current, critically evaluated content in optometric education and suggest that optometrists currently prefer to receive information and knowledge from an educator rather than sourcing and assessing the material independently.

Some methodological points to consider when performing systematic reviews in comparative effectiveness research

The purpose of comparative effectiveness research (CER) is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels. There is an ongoing discussion as to what types of evidence are appropriate to inform CER and how best to interpret various forms of evidence. The purpose of this article is primarily to highlight several interesting methodological issues in the conduct of CER reviews. We describe several key challenges related to randomized trials, with a particular focus on noninferiority studies, which include active comparators used to assess 'assay sensitivity' (defined below), and on the use of randomized studies to perform indirect comparisons between therapies. We touch briefly on the use of observational studies in CER, particularly because of the importance of observational studies in assessing infrequently occurring harms. We argue that studies that may be perceived as unsuitable to address some CER questions may well be appropriate to address others. As an example, noninferiority studies (assuming they include an appropriate comparator at an appropriate dose), are sometimes discounted or excluded from consideration because of concerns that the sponsor's incentive is to conduct a study that is biased toward showing no difference between the treatment groups. If the purpose of a systematic review of CER is to show superiority with respect to a purported benefit, including studies that may be biased toward equality of treatments would tend to underestimate the proposed benefit, that is, the bias works against the sponsor. This is not a comprehensive review of all methodological issues related to CER, and we recognize that there may be dissenting opinions regarding some of the points we raise. In considering the use of systematic reviews, we believe it is sound advice to perform the head-to-head comparison when possible, in the relevant populations, using endpoints relevant to patients, caregivers, physicians, or payers. These endpoints should include patient-reported outcomes (e.g., symptoms), when relevant. Indirect comparisons and mixed treatment meta-analyses may be useful for simultaneously comparing multiple treatments, provided the assumptions underlying such analyses are plausible.

Evidence and policymaking: The introduction of MMR vaccine in the Netherlands.

Based on a case-study of the introduction of measles-mumps-rubella (MMR) vaccine in the Netherlands two decades ago, using documentary and archival sources, this paper examines the way evidence is used in policymaking. Starting from the question of ‘what counts as evidence’, two central claims are developed. First, the decision to introduce MMR was not one but a series of decisions going back at least seven years, over the course of which the significance attached to various forms of evidence changed. Second, results of international studies were coming gradually to be of greater significance than evidence gathered from within the Netherlands itself. These developments had, and continue to have, major consequences for national scientific competences.

Ptolemy II Philadelphus and the Dionysiac Model of Political Authority

Throughout the Ptolemaic era, the Greek rulers of Egypt had to tackle complex issues pertaining to the nature of their dominion over peoples who were in many ways culturally, socially, and politically distinct. This paper examines how, despite these differences, Ptolemy II Philadelphus found a way to connect with both the Greek and Egyptian segments of his population by identifying himself with the god Dionysus. Although a Greek deity, Dionysus possessed specific associations that would have resonated with elements of Egyptian religion and culture. These connotations would have promoted the perception of Philadelphus as a legitimate and benevolent ruler capable of transcending cultural boundaries. The grand procession in the Ptolemaia festival has been characterized by Dorothy J. Thompson as a form of propaganda for the ruling family. Similarly, the various forms of evidence presented in this paper suggest that Dionysus would have been a convenient political vehicle in this syncretic environment. Such an approach on the part of Philadelphus was highly innovative and effective, and influenced the political identity assumed by later Ptolemaic rulers.

When a Crime Committed by a Teenager Becomes a Hate Crime

This article examines the conditions under which a crime committed by a teenager comes to be viewed as a hate-motivated offense. In Study 1, the age of the perpetrator and the level of evidence were experimentally manipulated for male and female subjects. The dependent variable consisted of the likelihood that an interracial encounter was a hate crime. Our results suggest that female subjects were significantly more likely than their male counterparts to view the offense as a hate crime. In addition, we found significant differences in the influence of various forms of evidence. The difference was nonsignificant between the teenage and adult offenders. In Study 2, we content analyzed hate crime prosecutions as reported in major newspapers. Surprisingly, our results indicate that many teens were prosecuted and convicted on a hate crime charge. Studies 1 and 2 collectively suggest that teenage hate crime defendants are no longer the recipients of lenient treatment by the courts or in the court of public opinion.

A new method of analysis enabled a better understanding of clinical practice guideline development processes

Objective To describe the process by which various forms of evidence are discussed, valued, and interpreted within the process of developing evidence-based clinical practice guidelines and, in so doing, to develop a method for such studies. Study Design and Setting An observational study. Two guideline development groups were observed by a nonparticipant observer. The 21 meetings were recorded, transcribed, and analyzed using grounded theory and frame analysis. Qualitative analysis was complemented with descriptive statistics. Results The groups organized their discussion around four domains—‘science’, ‘practice’, politics', and ‘process’—and used boundary work to mediate between these domains. Both groups spent most time discussing ‘science’, followed by ‘practice’ or its relation with ‘science’. Conclusion Our analysis offers an innovative, replicable method of analysis of guideline development that permits the identification of the proportions and interrelations between knowledge domains deployed by guideline groups. This analysis also suggests that the participation hierarchy observed here and by others might be an effect of the imbalanced use of knowledge domains in the construction of clinical guidance. This constitutes an important framework to understand the interplay of participants and knowledge in guideline development.

Regulation and termination of NADPH oxidase activity.

NADPH oxidase of phagocytes plays a crucial role in host defense by producing reactive oxygen species (ROS) that are intended to kill invading microbes. Many other cells produce ROS for signaling purposes. The respiratory burst oxidase in human neutrophils is the main but not exclusive subject of this review, because it is archetypical and has been studied most extensively. The activity of this enzyme must be controlled in phagocytes to prevent collateral damage, and in non-phagocytic cells to perform its signaling role. With many stimuli, NADPH oxidase activity is transient. Various forms of evidence indicate that sustained NADPH oxidase activity requires continuous renewal of the enzyme complex, without which rapid deactivation occurs. This review considers mechanisms that have been proposed to terminate the phagocyte respiratory burst. Changes in the phosphorylation state of p47(phox) and in the species of nucleotide bound to Rac seem to be the dominant factors in deactivation.

A Model of Toxoplasmosis Incidence in the UK: Evidence Synthesis and Consistency of Evidence

SummaryWe present a Bayesian evidence synthesis model combining data on seroprevalence, seroconversion and tests of recent infection, to produce estimates of current incidence of toxoplasmosis in the UK. The motivation for the study was the need for an estimate of current average incidence in the UK, with a realistic assessment of its uncertainty, to inform a decision model for a national screening programme to prevent congenital toxoplasmosis. The model has a hierarchical structure over geographic region, a random-walk model for temporal effects and a fixed age effect, with one or more types of data informing the regional estimates of incidence. Inference is obtained by using Markov chain Monte Carlo simulations. A key issue in the synthesis of evidence from multiple sources is model selection and the consistency of different types of evidence. Alternative models of incidence are compared by using the deviance information criterion, and we find that temporal effects are region specific. We assess the consistency of the various forms of evidence by using cross-validation where practical, and posterior and mixed prediction otherwise, and we discuss how these measures can be used to assess different aspects of consistency in a complex evidence structure. We discuss the contribution of the various forms of evidence to estimated current average incidence.

Making sense of the development of inclusive practices

Schools in England are currently being asked to pay greater attention to the issue of educational inclusion. This paper reports some of the findings of a collaborative action research Network that was set up to address the implications of this trend. The Network involves teams of university researchers in working with practitioners in order to encourage the development of inclusive practices. As a result of this work, it is argued that the development of such practices is not about adopting ‘recipes’ of the sort described in much of the existing literature. Rather, it involves social learning processes that occur within a given workplace. The paper attempts to provide deeper understandings of what these processes involve. To assist in this analysis use is made of the idea of ‘communities of practice’, as developed by Etienne Wenger, focusing specifically on the way he sees learning as a characteristic of practice. It is argued that the development of inclusive practices involves collaborative working arrangements; that they can be encouraged by engagement with various forms of evidence that interrupt ways of thinking; and that the space that is created through such interruptions can enable those involved to recognize overlooked or, indeed, new possibilities for moving practice forward.

An integrated, dual learner for grammars and ontologies

We introduce a dual-use methodology for automating the maintenance and growth of two types of knowledge sources, which are crucial for natural language text understanding—background knowledge of the underlying domain and linguistic knowledge about the lexicon and the grammar of the underlying natural language. A particularity of this approach is that learning occurs simultaneously with the on-going text understanding process. The knowledge assimilation process is centered around the linguistic and conceptual `quality' of various forms of evidence underlying the generation, assessment and on-going refinement of lexical and concept hypotheses. On the basis of the strength of evidence, hypotheses are ranked according to qualitative plausibility criteria, and the most reasonable ones are selected for assimilation into the already given lexical class hierarchy and domain ontology.

PHP16: THE VALUE OF VARIOUS FORMS OF EVIDENCE IN DRUG FORMULARY DECISION MAKING

INTRODUCTION: The study examined the perceived value of different forms of evidence (i.e., randomized controlled trials and retrospective cohort analyses study designs) among physicians and pharmacists (N = 780). Research participants read three abstracts (for each of three fictitious drugs) that varied type of claim (cost, cost-effectiveness, and effectiveness) and study design. They rated the perceived value of the study in determining formulary recommendations on seven items. METHODS: Factor analysis was used to derive weights for a single measure of value that ranged from 0.735 (low value) to 5.145 (high value). RESULTS: Four-way ANOVAs indicated that cost-effectiveness (mean = 3.19) and effectiveness (mean = 3.11) data were of more value than cost data (mean = 2.84, p < .0001). Also, formulary-affiliated physicians (mean = 3.10) found the studies to be of more value than hospital pharmacy directors (mean = 2.93, p < .02). A significant two-way interaction indicated that pharmacy directors valued retrospective cohort analyses more than randomized trials regardless of type of claim. In contrast, physicians valued randomized trials more than retrospective cohort analyses (p < .001). Manipulation checks indicated some difficulty identifying the purpose of individual studies. While most respondents could correctly identify cost-effectiveness and effectiveness studies (between 77% and 92% correctly identified these studies), there was confusion regarding cost studies. Almost half of the participants (between 42% and 57%) characterized these studies (which were described as “cost-minimization” analyses) as cost-effectiveness studies. Pharmacy directors (49%) were more likely to mischaracterize the cost-minimization studies compared to the physician groups (approximately 40% of these groups) (chi square = 20.29, p < .02). CONCLUSIONS: The results suggest that the multidisciplinary make-up of formulary committees is important to assure the incorporation of multiple forms of evidence in decision-making. Also, more attention to the study design is essential to evaluate the value of various forms of evidence for formulary decisions.

Managing the complexity of best practice health care.

Best Practice Health Care is a designed product. Various types of evidence must be accessed, interpreted, and integrated into care design. This integration requires thoughtful organizational planning. The Best Practice Health Care Map provides a model for managing the characteristics of quality clinical care within the framework of multi-disciplinary professional practice. The model incorporates the contributions of various forms of evidence into pre-specification design and point-of-care design.