Ann McKibbon

The Impact of CME A Methodological Review of the Continuing Medical Education Literature

A review of the literature evaluating the effectiveness of Continuing Medical Education (CME) was undertaken using articles from 1935 to 1982.238 studies were reviewed and annotated using previously established and tested assessment criteria. These criteria included the following areas: the study design; the educational or administrative intervention; the evaluation maneuver used to assess the interventions outcome; the health professionals used as subjects; andfinally, the educational and statistical significance of the study. It would appear that CMEinterventions when broadly defied, have an impact on physician competence and (less consistently though still in a positive direction) on physician performance and patient outcomes. Further research in both the methods and evaluation of CME is necessary.

Sustainability of knowledge translation interventions in healthcare decision-making: a scoping review

BackgroundKnowledge translation (KT, also known as research utilization, and sometimes referring to implementation science) is a dynamic and iterative process that includes the synthesis, dissemination, exchange, and ethically sound application of knowledge to improve health. A KT intervention is one which facilitates the uptake of research. The long-term sustainability of KT interventions is unclear. We aimed to characterize KT interventions to manage chronic diseases that have been used for healthcare outcomes beyond 1xa0year or beyond the termination of initial grant funding.MethodsWe conducted a scoping review by searching MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Campbell from inception until February 2013. We included experimental, quasi-experimental, and observational studies providing information on the sustainability of KT interventions for managing chronic diseases in adults and focusing on end-users including patients, clinicians, public health officials, health service managers, and policy-makers. Articles were screened and abstracted by two reviewers, independently. The data were charted and results described narratively.ResultsWe included 62 studies reported in 103 publications (total 260,688 patients) plus 41 companion reports after screening 12,328 titles and abstracts and 464 full-text articles. More than half of the studies were randomized controlled trials (RCTs). The duration of the KT intervention ranged from 61 to 522xa0weeks. Nine chronic conditions were examined across the studies, such as diabetes (34xa0%), cardiovascular disease (28xa0%), and hypertension (16xa0%). Thirteen KT interventions were reported across the studies. Patient education was the most commonly examined (20xa0%), followed by self-management (17xa0%). Most studies (61xa0%) focused on patient-level outcomes (e.g. disease severity), while 31xa0% included system-level outcomes (e.g. number of eye examinations), and 8xa0% used both. The interventions were aimed at the patient (58xa0%), health system (28xa0%), and healthcare personnel (14xa0%) levels.ConclusionsWe found few studies focusing on the sustainability of KT interventions. Most of the included studies focused on patient-level outcomes and patient-level KT interventions. A future systematic review can be conducted of the RCTs to examine the impact of sustainable KT interventions on health outcomes.

Kidney transplantation search filters for PubMed, Ovid Medline, and Embase.

Background. Clinicians commonly search bibliographic databases such as Medline to find sound evidence to guide patient care. Unfortunately, this can be a frustrating experience because database searches often miss relevant articles. We addressed this problem for transplant professionals by developing kidney transplantation search filters for use in Medline through PubMed and Ovid Technologies, and Embase. Methods. We began by reading the full-text versions of 22,992 articles from 39 journals published across 5 years. These articles were labeled relevant to kidney transplantation or not forming our “gold standard.” We then developed close to five million kidney transplantation filters using different terms and their combinations. Afterward, these filters were applied to development and validation subsets of the articles to determine their accuracy and reliability in identifying articles with kidney transplantation content. The final kidney transplantation filters used multiple terms in combination. Results. The best performing filters achieved 97.5% sensitivity (95% confidence interval, 96.4%–98.5%), and 98.0% specificity (95% confidence interval, 97.8%–98.3%). Similar high performance was achieved for filters developed for Ovid Medline and Embase. Proof-of-concept searches confirmed more relevant articles are retrieved using these filters. Conclusions. These kidney transplantation filters can now be used in Medline and Embase databases to improve clinician searching.