Background : - The past two decades has seen an increasing emphasis placed on basing health care on the best available evidence. However, existing research has come under increasing scrutiny, which suggests its quality was often poor. This problem has been exacerbated by the ever increasing volume of health care literature. To address these difficulties systematic reviews have emerged as one of the most important ways by which research is summarised and communicated to its end-users. However, as these reviews have been primarily concerned with effectiveness, they have focused almost exclusively on randomised controlled trials. As a result, systematic reviews have excluded much of the research of nurses. Purpose : - The purpose of this study was to develop a process to systematically collect, appraise, summarise and synthesise the findings of a range of different types of research. Conceptual Framework : - To aid in the development of these expanded review methods, a conceptual framework was developed that addressed effectiveness, appropriateness and feasibility. Method : - A search of the literature was undertaken to identify published reviews of different types of research, and discussions in the health care literature related to the conduct of research reviews. These reviews and discussion papers served as the basis for developing the expanded review methods. Evaluation : - To evaluate the expanded review methods, two systematic reviews were conducted. The protocol and results of the first review on the use of music in hospitals are presented to demonstrate how the conceptual framework and expanded review methods enabled a broader evaluation of the topic. Selected results from the second review on the use of physical restraint are presented to demonstrate how the findings from a number of methodologically different types of research were incorporated into a systematic review. Conclusion : - The conduct of the two systematic reviews clearly demonstrated that the proposed expanded review process was able to rigorously collect and summarise a range of different types of research. Additionally, the conceptual framework underpinning these reviews enabled each of the studies to be located logically and coherently during the synthesis of data. / Thesis (Ph.D.)--Department of Clinical Nursing, 2001.

Thesis (M.S.)--Ohio State University, 2009. / Title from first page of PDF file. Includes vita. Includes bibliographical references (p. 68-76).

"May 2004" / Bibliography: leaves 172-184. / xvi, 186 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (D.Nurs.)--University of Adelaide, Dept. of Clinical Nursing, 2004

<b>Background:</b> The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach offers a transparent framework for rating the certainty of evidence in systematic reviews. Concerns, however, have been raised that use of GRADE beyond biomedical interventions frequently downgrades the 'best evidence possible' for many complex interventions. This DPhil thesis aims to (1) further investigate the challenges of using GRADE in systematic reviews of complex interventions, (2) explore how the GRADE approach can be advanced to address these challenges, and (3) inform the write-up and dissemination of a new GRADE guidance for complex interventions. <b>Methods:</b> To address the broad aims of this thesis a range of methodological approaches were employed, primarily drawing on the best-practice techniques for developing research reporting guidelines (see Chapter 2). First, a systematic literature review method was used to establish whether an adequate system already exists for rating the certainty of evidence for complex interventions and informing the need for a new guidance (Chapter 3). Further consultation with experts, including semi-structured interviews with review authors and GRADE methodologists, provided a nuanced understanding of the challenges of applying GRADE in reviews of complex interventions and suggestions for advancing the guidance on GRADE (Chapter 4). Agreement around these suggestions was explored in a Delphi-based online expert panel (Chapter 5), and the content of the new GRADE guidance for complex interventions was discussed indepth in a three-day expert meeting held in Oxford in May 2017 (Chapter 6). <b>Results:</b> The systematic literature review identified a few systems attempting to modify GRADE for public health interventions; however, there was little reporting of rigorous procedures in the development and dissemination of these systems. Qualitative interviews captured differences in views on GRADE use between review authors and GRADE methodologists. Specifically, GRADE methodologists found it critical to consider GRADE from the beginning of the review process and exercise judgment in GRADE ratings. Review authors, on the other hand, often thought of GRADE as an 'annoying add-on' at the end of the review process and felt challenged by the need to be more interpretative with evidence and sift through many publications on GRADE. Suggestions were made to enhance the GRADE guidance. No significant disagreement was found in the online expert panel on any domain of evidence, and the expert meeting provided further insights into the content of the new GRADE guidance for complex interventions. Participants agreed that the new guidance should specify the meaning of the construct of 'certainty of evidence' for complex interventions, consider revisions of the initial categorisation of evidence based on study design, and better assess the coherence of the causal pathway of complex interventions. <b>Conclusion:</b> This thesis work consolidates up-to-date methodological knowledge on reviewing complex interventions by providing critical examination of the existing approaches and new insights. In transparent reporting of the research phases, it informs development of a new GRADE guidance on rating the certainty of evidence in systematic reviews of complex interventions.

Implementation strategies for the use of clinical practice guidelines are an integral component in bridging the gap between the best research evidence and clinical practice. However, despite some remarkable investments in health research regarding clinical practice guidelines implementation strategies, it is not yet known which of these are the most effective for intensive care units. The purpose of this research study was to systematically identify and /or search, appraise, extract and synthesize the best available evidence for clinical practice guidelines implementation strategies in intensive care units, in order to develop a draft guideline for clinical practice guidelines implementation strategies in the intensive care units. A systematic review design was used to systematically identify and /or search, appraise, extract and synthesize the best available evidence from the eligible included Level 2 studies (randomized controlled trials and quasi-experimental studies). Level 2 studies were applicable because they present robust evidence in the research results regarding effectiveness of clinical practice guideline implementation strategies. Furthermore, although other systematic reviews conducted in this area before, they included studies of In addition, no systematic review was identified that reviewed Level 2 studies and developed a guideline for clinical practice guideline implementation strategies in the intensive care units. Hence, including only Level 2 studies was distinctive to this research study. Databases searched included: CINAHL with full text, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials Issue 8 of 12, August 2013, and MEDLINE via PUBMED. Hand search in bound journals was also done. The search strategy identified 315 potentially relevant studies. After the process of critical appraisal, thirteen Level 2 studies were identified as relevant for the review. Of the 13 relevant studies, 10 were randomized controlled trials and three were quasi experimental studies. After the critical appraisal ten RCTs were included in the systematic review. Three studies (quasi-experimental) were excluded on the basis of methodological quality after the critical appraisal and agreement by the two independent reviewers. The Joanna Briggs Institute Critical Appraisal MASTARI Instrument for Randomized Controlled trials/ Experimental studies, and The Joanna Briggs Institute data extraction tools were used to critically appraise, and extract data from the ten included randomized controlled trials. The two reviewers who performed the critical appraisal were qualified critical care professional nurses and experts in research methodology. These reviewers conducted the critical appraisal independently to ensure the objectivity of the process. Appropriate ethical considerations were maintained throughout the process of the research study. The results indicated that 80 percent of the included studies were conducted in adult intensive care units while 20 percent were conducted in the neonatal intensive care units. Furthermore, 60 percent of the studies were conducted in the United States of America, 10 percent in France, a further 10 percent in Taiwan, another 10 percent in England and yet another 10 percfent was conducted in Australia and Newzealand. The included studies utilized more than one (multifaceted) implementation strategies to implement clinical practice guidelines in the intensive care units. The first most utilized were: printed educational materials; Information/ educational sessions/meetings; audit and feedback and champion/local opinion leaders; seconded by educational outreach visits; and computer or internet usage. Third most used were active/passive reminders; systems support; academic detailing/ one-on-one sessions teleconferences/videoconferences and workshops/in services. Fourth most used were ollaboration/interdisciplinary teams; slide shows, teleconferences/videoconferences and discussions. Fifth most used were practical training; monitoring visits and grand rounds. However all the strategies were of equal importance. Conclusively, the included studies utilized multifaceted implementation strategies. However, no study indicated the use of a guideline for the implementation strategies in the process of clinical practice guidelines implementation. The systematic review developed a draft guideline for clinical practice guideline implementation strategies in the intensive care units. The guideline will enhance effective implementation of clinical practice guidelines in such a complex environment.

Background Selective reporting of outcomes within a published study based on their nature or direction can result in systematic differences between reported and unreported data. Direct evidence of outcome reporting bias is limited to case reports. Objective To study empirically the nature of outcome reporting bias in randomised controlled trials (RCTs). Methods Three cohorts of RCTs were identified: PubMed-indexed RCTs published in December 2000; trial protocols approved by a Danish ethics committee from 1994-95; and trial protocols funded by a government agency in Canada from 1990-98. Data on reported and unreported outcomes were recorded from all trial publications and a survey of authors. An outcome was considered incompletely reported if insufficient data were presented for meta-analysis. Odds ratios relating the completeness of outcome reporting to statistical significance were calculated for each trial, and then pooled using a random effects meta-analysis. Protocols and publications were also reviewed for discrepancies in primary outcome reporting. Results 519 trials with 10,557 outcomes, 102 trials with 3613 outcomes, and 48 trials with 1390 outcomes were identified for the PubMed, ethics committee, and funding agency cohorts respectively. 22%-35% of outcomes per parallel group study were, on average, incompletely reported for meta-analysis. Fully reported outcomes had a two- to three-fold higher odds of being statistically significant compared to incompletely reported outcomes. The most common reasons given for omitting outcomes included a lack of clinical importance, lack of statistical significance, and space constraints. Major discrepancies between primary outcomes in protocols and publications were found in one half of trials. Discussion and conclusions The reporting of trial outcomes is frequently inadequate for meta-analysis; is biased to favour statistical significance; and is inconsistent with pre-specified protocol outcomes. Unacknowledged modifications to outcomes specified in trial protocols constitute scientific misconduct. Meta-analyses may therefore produce inflated and unreliable estimates of treatment effect.

Background: Dialysis is an intervention that involves the use of fairly advanced technology and is fairly expensive. Patients and health care funders are increasingly demanding evidence for the effectiveness for such high technology high cost interventions. While dialysis therapy has improved immediate prognosis in patients with kidney failure, the long-term survival of patients on chronic renal replacement therapy (dialysis or renal transplantation) is much lower than that of the general population and the mortality rates remain high for patients with acute renal failure needing dialysis. There are considerable variations between different countries and even between the dialysis centres within the same country with regards to the selection of the primary type of dialysis (haemodialysis or peritoneal dialysis) and in the different methods or equipment used to perform the various components of these various modalities. It is possible that variations in clinical practice are associated with variations in clinical outcomes such as mortality and morbidity. It is then important to identify the best practices from the various variations in current use and implementing these best practices may reduce morbidity and mortality of these patients. Methods: Systematic reviews, identifying and including only randomised trials, focusing on key clinical policy decision points in the dialysis process were undertaken. The review of literature was done in a systematic way according to a detailed scientific methodology. For all of the systematic reviews, a detailed protocol was written and agreed to by the authors of the review. The protocol detailed the clinical question, the types of studies, participants, interventions and outcomes to be included, search strategy and the statistical methods to be employed. Relevant randomised studies were then identified by systematically searching the electronic medical databases and reference lists of published studies; data relevant to predetermined outcome measures were extracted and where appropriate summary statistics were derived from meta-analysis. Recommendations and implications for clinical practice and future research studies were made following each review. The areas of dialysis policy reviewed were (1) Comparison of high-flux versus low-flux haemodialysis (HD) membranes for patients with end-stage renal disease (ESRD), (2) Comparison of extracorporeal renal replacement therapy technologies for patients with ESRD, (3) Comparison of intermittent (IRRT) and continuous renal replacement therapy (CRRT) for acute renal failure (ARF) in adults, (4) Comparison of antimicrobial interventions for the prevention of HD catheter related infections, (5) Comparison of continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) for patients with ESRD, and (6) Comparison of treatment measures for depression in dialysis patients. Conclusions: As the currently available evidence has not demonstrated superiority with high-flux membranes with respect to important clinical outcomes such as mortality, quality of life and hospitalisation, it is not possible to recommend the use of these membranes in preference to low-flux membranes. It has not been possible at present to demonstrate with the current evidence available that convective modalities (HF, HDF or AFB) have significant advantages over HD with regard to clinically important outcomes of mortality, dialysis-related hypotension and hospitalisation. It is not therefore possible to recommend the use of one modality in preference to the other. In ARF patients who are haemodynamically stable, the RRT modality does not appear to influence important patient outcomes, and therefore the preference for CRRT over IRRT in such patients does not appear justified in the light of available evidence. CRRT was shown to achieve better haemodynamic parameters such as MAP. APD appears to be more beneficial than CAPD, in terms of reducing peritonitis rates and with respect to certain social issues that impact on patients' quality of life. Further, adequately powered trials are required to confirm the benefits for APD found in this review and detect differences with respect to other clinically important outcomes that may have been missed by the trials included in this review due to their small size and short follow-up periods. APD may however be considered advantageous in select group of patients such as in the younger PD population and those in employment or education due to its psychosocial advantages. Firm conclusions on the efficacy of treatment measures for depression in chronic dialysis patients cannot be made as we identified only one small RCT that was of short duration. Current screening tools for depression are recognised to have poor specificity in the medically ill due to overlap of somatic symptoms of the medical illness. The development of a valid diagnostic tool would be helpful. The systematic reviews in general highlighted the paucity of large-scale randomised trials in nephrology even on topics of great practical relevance such as depression in dialysis. In many of the areas assessed adequate conclusions could not be reached as there was a lack of large-scale well designed randomised controlled trials raising the possibility that important clinical differences between the interventions assessed may have been missed due to Type 2 statistical error. We identified numerous RCTs which were small in size looking at surrogate end-points such as molecular markers of inflammation, especially in the areas of membrane flux and extracorporeal RRT technologies. Unfortunately benefits with surrogate end-points do not necessarily translate to better clinical outcomes. The urgent need of the hour is to conduct well-designed large scale RCTs in major areas of clinical importance such as the use of extracorporeal renal replacement therapy technologies looking at hard clinical end-points such as mortality, hospitalisation and quality of life.

Source: Masters Abstracts International, Volume: 47-06, page: 3373. Advisers: Kelly Volcik; Sarah Baraniuk. Includes bibliographical references.

Thesis (M.N.(Clinical))--Victoria University of Wellington, 2009. / Includes bibliographical references.

Thesis (M.Sc.)--University of Alberta, 2010. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science in Clinical Epidemiology, Department of Public Health Sciences. Title from pdf file main screen (viewed on February 23, 2010). Includes bibliographical references.