Identifying quality improvement intervention publications - A comparison of electronic search strategies

Abstract Background The evidence base for quality improvement (QI) interventions is expanding rapidly. The diversity of the initiatives and the inconsistency in labeling these as QI interventions makes it challenging for researchers, policymakers, and QI practitioners to access the literature systematically and to identify relevant publications. Methods We evaluated search strategies developed for MEDLINE (Ovid) and PubMed based on free text words, Medical subject headings (MeSH), QI intervention components, continuous quality improvement (CQI) methods, and combinations of the strategies. Three sets of pertinent QI intervention publications were used for validation. Two independent expert reviewers screened publications for relevance. We compared the yield, recall rate, and precision of the search strategies for the identification of QI publications and for a subset of empirical studies on effects of QI interventions. Results The search yields ranged from 2,221 to 216,167 publications. Mean recall rates for reference publications ranged from 5% to 53% for strategies with yields of 50,000 publications or fewer. The 'best case' strategy, a simple text word search with high face validity ('quality' AND 'improv*' AND 'intervention*') identified 44%, 24%, and 62% of influential intervention articles selected by Agency for Healthcare Research and Quality (AHRQ) experts, a set of exemplar articles provided by members of the Standards for Quality Improvement Reporting Excellence (SQUIRE) group, and a sample from the Cochrane Effective Practice and Organization of Care Group (EPOC) register of studies, respectively. We applied the search strategy to a PubMed search for articles published in 10 pertinent journals in a three-year period which retrieved 183 publications. Among these, 67% were deemed relevant to QI by at least one of two independent raters. Forty percent were classified as empirical studies reporting on a QI intervention. Conclusions The presented search terms and operating characteristics can be used to guide the identification of QI intervention publications. Even with extensive iterative development, we achieved only moderate recall rates of reference publications. Consensus development on QI reporting and initiatives to develop QI-relevant MeSH terms are urgently needed

Radical Pedagogy in Doris Lessing’s Mara and Dann

This article considers pedagogy as a consistent theme in Doris Lessing’s fiction. It draws on a deleted prefatory note in the typescript to Mara and Dann, which states that the heroine is ‘consumed with a passion to learn and go to school’. The article explores how Mara learns, in a re-imagined Africa after a future ice age. In the absence of formal schooling, a game is used, in which children are asked repeatedly ‘What did you see?’ This game is compared to Henry James’s use of a child’s perspective in What Maisie Knew, to strategies for unveiling and ‘naming’ the world in Paulo Freire’s Pedagogy of the Oppressed and to ideas about teaching in Idries Shah’s The Sufis and Learning How to Learn. The article thus argues that radical and anticolonial approaches to learning are figured in Lessing’s fiction, and in her Nobel lecture, as essential for human survival

Warrior queens and women’s history: deconstructing stereotypes in Margaret Drabble’s A Natural Curiosity

In A Natural Curiosity (1989), Margaret Drabble evokes history and myth, especially the Celtic people of the east and north during Britain’s Roman period, through language and images, and suggests that the past informs contemporary life, that history cannot necessarily be understood as separate from or unconnected to the present. To invoke the past, Drabble employs and critiques the dichotomous stereotypes that typically inform representations of warrior women: the savage female versus the patriotic (and maternal) leader, and the voracious woman versus the chaste maiden. She also demonstrates that the characteristics upon which understandings of warrior women rest are not necessarily negative, not necessarily fixed, and not necessarily gendered. Ultimately, by blurring past and present, Drabble articulates an understanding of women that defies a singular or fixed definition while she simultaneously emphasizes the cyclical rather than linear nature of women’s history