Evidence summaries: the evolution of a rapid review approach

<p>Abstract</p> <p>Background</p> <p>Rapid reviews have emerged as a streamlined approach to synthesizing evidence - typically for informing emergent decisions faced by decision makers in health care settings. Although there is growing use of rapid review 'methods', and proliferation of rapid review products, there is a dearth of published literature on rapid review methodology. This paper outlines our experience with rapidly producing, publishing and disseminating evidence summaries in the context of our Knowledge to Action (KTA) research program.</p> <p>Methods</p> <p>The KTA research program is a two-year project designed to develop and assess the impact of a regional knowledge infrastructure that supports evidence-informed decision making by regional managers and stakeholders. As part of this program, we have developed evidence summaries - our form of rapid review - which have come to be a flagship component of this project. Our eight-step approach for producing evidence summaries has been developed iteratively, based on evidence (where available), experience and knowledge user feedback. The aim of our evidence summary approach is to deliver quality evidence that is both timely and user-friendly.</p> <p>Results</p> <p>From November 2009 to March 2011 we have produced 11 evidence summaries on a diverse range of questions identified by our knowledge users. Topic areas have included questions of clinical effectiveness to questions on health systems and/or health services. Knowledge users have reported evidence summaries to be of high value in informing their decisions and initiatives. We continue to experiment with incorporating more of the established methods of systematic reviews, while maintaining our capacity to deliver a final product in a timely manner.</p> <p>Conclusions</p> <p>The evolution of the KTA rapid review evidence summaries has been a positive one. We have developed an approach that appears to be addressing a need by knowledge users for timely, user-friendly, and trustworthy evidence and have transparently reported these methods here for the wider rapid review and scientific community.</p

Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases

There is increasing evidence that high consumption of fruit and vegetables is beneficial for cardiovascular disease (CVD) prevention

Capacity building and mentorship among pan-Canadian early career researchers in community-based primary health care

Aim: To describe activities and outcomes of a cross-team capacity building strategy that took place over a five-year funding period within the broader context of 12 community-based primary health care (CBPHC) teams. Background: In 2013, the Canadian Institutes of Health Research funded 12 CBPHC Teams (12-Teams) to conduct innovative cross-jurisdictional research to improve the delivery of high-quality CBPHC to Canadians. This signature initiative also aimed to enhance CBPHC research capacity among an interdisciplinary group of trainees, facilitated by a collaboration between a capacity building committee led by senior researchers and a trainee-led working group. Methods: After the committee and working group were established, capacity building activities were organized based on needs and interests identified by trainees of the CBPHC Teams. This paper presents a summary of the activities accomplished, as well as the outcomes reported through an online semistructured survey completed by the trainees toward the end of the five-year funding period. This survey was designed to capture the capacity building and mentorship activities that trainees either had experienced or would like to experience in the future. Descriptive and thematic analyses were conducted based on survey responses, and these findings were compared with the existing core competencies in the literature. Findings: Since 2013, nine webinars and three online workshops were hosted by trainees and senior researchers, respectively. Many of the CBPHC Teams provided exposure for trainees to innovative methods, CBPHC content, and showcased trainee research. A total of 27 trainees from 10 of the 12-Teams responded to the survey (41.5%). Trainees identified key areas of benefit from their involvement in this initiative: skills training, networking opportunities, and academic productivity. Trainees identified gaps in research and professional skill development, indicating areas for further improvement in capacity building programs, particularly for trainees to play a more active role in their education and preparation

The use of rapid review methods in health technology assessments: 3 case studies.

BACKGROUND: Rapid reviews are of increasing importance within health technology assessment due to time and resource constraints. There are many rapid review methods available although there is little guidance as to the most suitable methods. We present three case studies employing differing methods to suit the evidence base for each review and outline some issues to consider when selecting an appropriate method. METHODS: Three recently completed systematic review short reports produced for the UK National Institute for Health Research were examined. Different approaches to rapid review methods were used in the three reports which were undertaken to inform the commissioning of services within the NHS and to inform future trial design. We describe the methods used, the reasoning behind the choice of methods and explore the strengths and weaknesses of each method. RESULTS: Rapid review methods were chosen to meet the needs of the review and each review had distinctly different challenges such as heterogeneity in terms of populations, interventions, comparators and outcome measures (PICO) and/or large numbers of relevant trials. All reviews included at least 10 randomised controlled trials (RCTs), each with numerous included outcomes. For the first case study (sexual health interventions), very diverse studies in terms of PICO were included. P-values and summary information only were presented due to substantial heterogeneity between studies and outcomes measured. For the second case study (premature ejaculation treatments), there were over 100 RCTs but also several existing systematic reviews. Data for meta-analyses were extracted directly from existing systematic reviews with new RCT data added where available. For the final case study (cannabis cessation therapies), studies included a wide range of interventions and considerable variation in study populations and outcomes. A brief summary of the key findings for each study was presented and narrative synthesis used to summarise results for each pair of interventions compared. CONCLUSIONS: Rapid review methods need to be chosen to meet both the nature of the evidence base of a review and the challenges presented by the included studies. Appropriate methods should be chosen after an assessment of the evidence base

What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings? A rapid evidence synthesis

Background Co-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings. Aims To identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings. Design Rapid evidence synthesis. Data sources Medline, Cinahl, Web of Science, Embase, HMIC, Cochrane Database of Systematic Reviews, SCIE, Proquest Dissertation and Theses, EThOS, OpenGrey; CoDesign; The Design Journal; Design Issues. Study selection Studies reporting patient, staff or organisational outcomes associated with using co-production in an acute healthcare setting. Findings 712 titles and abstracts were screened; 24 papers underwent full-text review, and 11 papers were included in the evidence synthesis. One study was a feasibility randomised controlled trial, three were process evaluations and seven used descriptive qualitative approaches. Reported outcomes related to (a) the value of patient and staff involvement in co-production processes; (b) the generation of ideas for changes to processes, practices and clinical environments; and (c) tangible service changes and impacts on patient experiences. Only one study included cost analysis; none reported an economic evaluation. No studies assessed the sustainability of any changes made. Conclusions Despite increasing interest in and advocacy for co-production, there is a lack of rigorous evaluation in acute healthcare settings. Future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Potentially broader impacts on the values and behaviours of participants should also be considered

A critical analysis of evidence about the impacts of Faculty Development in systematic reviews : a systematic rapid evidence assessment

INTRODUCTION: Faculty Development (FD) encompasses a range of learning activities undertaken to prepare clinical teachers for their various roles as educators, leaders, and scholars. This article presents the findings of a systematic rapid evidence assessment that aimed to investigate the impact of FD on clinical teachers. METHODS: We searched the published and gray literature for systematic reviews of FD to identify evidence to help inform judgments about which kinds of FD activities are effective for which groups of clinical teachers. RESULTS: After screening the literature, we found seven systematic reviews met our inclusion criteria. Following a critical analysis of these reviews, we found that they contained a number of limitations in relation to their use of review methods and reporting of results. DISCUSSION: On the basis of the analysis presented in this systematic rapid evidence assessment, we conclude that the included reviews do not provide high-quality evidence to effectively support decisions about choices of FD activities, even where the review authors made positive claims about impact. Suggestions are provided to improve the quality of systematic reviews in this area

Ask Me! Self-reported features of adolescents experiencing neglect or emotional maltreatment: a rapid systematic review

Neglect is often overlooked in adolescence, due in part to assumptions about autonomy and misinterpretation of behaviors being part of normal adolescent development. Emotional maltreatment (abuse or neglect) has a damaging effect throughout the lifespan, but is rarely recognized amongst adolescents. Our review aims to identify features that adolescents experiencing neglect and/ or emotional maltreatment report. METHOD: A rapid review methodology searched 8 databases (1990-2014), supplemented by hand searching journals, and references, identifying 2,568 abstracts. Two independent reviews were undertaken of 279 articles, by trained reviewers, using standardised critical appraisal. Eligible studies: primary studies of children aged 13-17 years, with substantiated neglect and/ or emotional maltreatment, containing self-reported features. RESULTS: 19 publications from 13 studies were included, demonstrating associations between both neglect and emotional maltreatment with internalising features (9 studies) including depression, post traumatic symptomatology and anxiety; emotional maltreatment was associated with suicidal ideation, while neglect was not (1 study); neglect was associated with alcohol related problems (3 studies), substance misuse (2 studies), delinquency for boys (1 study), teenage pregnancy (1 study), and general victimization for girls (1 study), while emotionally maltreated girls reported more externalising symptoms (1 study). Dating violence victimization was associated with neglect and emotional maltreatment (2 studies), while emotional abuse of boys, but not neglect, was associated with dating violence perpetration (1 study), and neither neglect nor emotional maltreatment had an association with low self-esteem (2 studies). Neither neglect nor emotional maltreatment had an effect on school performance (1 study), but neglected boys showed greater school engagement than neglected girls (1 study). CONCLUSIONS: If asked, neglected or emotionally maltreated adolescents describe significant difficulties with their mental health, social relationships, and alcohol or substance misuse. Practitioners working with youths who exhibit these features should recognize the detrimental impact of maltreatment at this developmental stage, and identify whether maltreatment is a contributory factor that should be addressed

Maximising the availability and use of high quality evidence for policymaking:Collaborative, targeted and efficient evidence reviews

Abstract A number of barriers have been identified to getting evidence into policy. In particular, a lack of policy relevance and lack of timeliness have been identified as causing tension between researchers and policy makers. Rapid reviews are used increasingly as an approach to address timeliness, however, there is a lack of consensus on the most effective review methods and they do not necessarily address the need of policy makers. In the course of our work with the Scottish Government’s Review of maternity and neonatal services we developed a new approach to evidence synthesis, which this paper will describe. We developed a standardised approach to produce collaborative, targeted and efficient evidence reviews for policy making. This approach aimed to ensure the reviews were policy relevant, high quality and up-to-date, and which were presented in a consistent, transparent, and easy to access format. The approach involved the following stages: 1) establishing a review team with expertise both in the topic and in systematic reviewing, 2) clarifying the review questions with policy makers and subject experts (i.e., health professionals, service user representatives, researchers) who acted as review sponsors, 3) developing review protocols to systematically identify quantitative and qualitative review-level evidence on effectiveness, sustainability and acceptability; if review level evidence was not available, primary studies were sought, 4) agreeing a framework to structure the analysis of the reviews around a consistent set of key concepts and outcomes; in this case a published framework for maternal and newborn care was used, 5) developing an iterative process between policy makers, reviewers and review sponsors, 6) rapid searches and retrieval of literature, 7) analysis of identified literature which was mapped to the framework and included review sponsor input, 8) production of recommendations mapped to the agreed framework and presented as ‘summary topsheets’ in a consistent and easy to read format. Our approach has drawn on different components of pre-existing rapid review methodology to provide a rigorous and pragmatic approach to rapid evidence synthesis. Additionally, the use of a framework to map the evidence helped structure the review questions, expedited the analysis and provided a consistent template for recommendations, which took into account the policy context. We therefore propose that our approach (described in this paper) can be described as producing collaborative, targeted and efficient evidence reviews for policy makers