Sharon E. Straus

Lost in Knowledge Translation: Time for a Map?

&NA; There is confusion and misunderstanding about the concepts of knowledge translation, knowledge transfer, knowledge exchange, research utilization, implementation, diffusion, and dissemination. We review the terms and definitions used to describe the concept of moving knowledge into action. We also offer a conceptual framework for thinking about the process and integrate the roles of knowledge creation and knowledge application. The implications of knowledge translation for continuing education in the health professions include the need to base continuing education on the best available knowledge, the use of educational and other transfer strategies that are known to be effective, and the value of learning about planned‐action theories to be better able to understand and influence change in practice settings.

The case for knowledge translation: shortening the journey from evidence to effect

A large gulf remains between what we know and what we practise. Eisenberg and Garzon point to widespread variation in the use of aspirin, calcium antagonists, βblockers, and anti-ischaemic drugs in the United States, Europe, and Canada despite good evidence on their best use.1 Such variation is common not only internationally but within countries.2 Large gaps also exist between best evidence and practice in the implementation of guidelines. Failure to follow best evidence highlights issues of underuse, overuse, and misuse of drugs3 and has led to widespread interest in the safety of patients.4nn ![][1] nnCredit: SUE SHARPLESnnNot surprisingly, many attempts have been made to reduce the gap between evidence and practice. These have included educational strategies to alter practitioners behaviour5 and organisational and administrative interventions. We explore three constructs: continuing medical education (CME), continuing professional development (CPD), and (the newest of the three) knowledge translation (box). Knowledge translation both subsumes and broadens the concepts of CME and CPD and has the potential to improve understanding of, and overcome the barriers to, implementing evidence based practice.nn### Continuing medical educationnnCME refers to education after certification and licensure. It is arguably the most complex, and clearly the longest, phase of medical education. Most physicians think of continuing medical education in terms of the traditional medical conference, with rows of tables, pitchers of ice water, green table cloths, and a lecturer at the front of the room.7 Many accreditation systems in the United States, United Kingdom, and Canada value attendance at such activities. This reinforces the teacher driven nature of continuing medical education, which gives little attention to the concept of professional development.nn“Knowledge translation is defined as the exchange, synthesis and ethically sound application of knowledge—within a complex system of interactions among researchers and users—to accelerate the capture of …nn [1]: /embed/graphic-1.gif

Defining knowledge translation

We cannot pick up a magazine or surf the Internet without facing reminders of the challenges to health care and the “sorry state” of health systems. [1][1] All health care systems are faced with the challenges of improving quality of care and reducing the risk of adverse events. [2][2] Globally

Scoping reviews: time for clarity in definition, methods, and reporting

OBJECTIVESnThe scoping review has become increasingly popular as a form of knowledge synthesis. However, a lack of consensus on scoping review terminology, definition, methodology, and reporting limits the potential of this form of synthesis. In this article, we propose recommendations to further advance the field of scoping review methodology.nnnSTUDY DESIGN AND SETTINGnWe summarize current understanding of scoping review publication rates, terms, definitions, and methods. We propose three recommendations for clarity in term, definition and methodology.nnnRESULTSnWe recommend adopting the terms scoping review or scoping study and the use of a proposed definition. Until such time as further guidance is developed, we recommend the use of the methodological steps outlined in the Arksey and OMalley framework and further enhanced by Levac et al. The development of reporting guidance for the conduct and reporting of scoping reviews is underway.nnnCONCLUSIONnConsistency in the proposed domains and methodologies of scoping reviews, along with the development of reporting guidance, will facilitate methodological advancement, reduce confusion, facilitate collaboration and improve knowledge translation of scoping review findings.

Knowledge translation is the use of knowledge in health care decision making

OBJECTIVEnTo provide an overview of the science and practice of knowledge translation.nnnSTUDY DESIGNnNarrative review outlining what knowledge translation is and a framework for its use.nnnRESULTSnKnowledge translation is defined as the use of knowledge in practice and decision making by the public, patients, health care professionals, managers, and policy makers. Failures to use research evidence to inform decision making are apparent across all these key decision maker groups. There are several proposed theories and frameworks for achieving knowledge translation. A conceptual framework developed by Graham etxa0al., termed the knowledge-to-action cycle, provides an approach that builds on the commonalities found in an assessment of planned action theories.nnnCONCLUSIONSnReview of the evidence base for the science and practice of knowledge translation has identified several gaps including the need to develop valid strategies for assessing the determinants of knowledge use and for evaluating sustainability of knowledge translation interventions.

A cross-sectional study of the number and frequency of terms used to refer to knowledge translation in a body of health literature in 2006: a Tower of Babel?

BackgroundThe study of implementing research findings into practice is rapidly growing and has acquired many competing names (e.g., dissemination, uptake, utilization, translation) and contributing disciplines. The use of multiple terms across disciplines pose barriers to communication and progress for applying research findings. We sought to establish an inventory of terms describing this field and how often authors use them in a collection of health literature published in 2006.MethodsWe refer to this field as knowledge translation (KT). Terms describing aspects of KT and their definitions were collected from literature, the internet, reports, textbooks, and contact with experts. We compiled a database of KT and other articles by reading 12 healthcare journals representing multiple disciplines. All articles published in these journals in 2006 were categorized as being KT or not. The KT articles (all KT) were further categorized, if possible, for whether they described KT projects or implementations (KT application articles), or presented the theoretical basis, models, tools, methods, or techniques of KT (KT theory articles). Accuracy was checked using duplicate reading. Custom designed software determined how often KT terms were used in the titles and abstracts of articles categorized as being KT.ResultsA total of 2,603 articles were assessed, and 581 were identified as KT articles. Of these, 201 described KT applications, and 153 included KT theory. Of the 100 KT terms collected, 46 were used by the authors in the titles or abstracts of articles categorized as being KT. For all 581 KT articles, eight terms or term variations used by authors were highly discriminating for separating KT and non-KT articles (p < 0.001): implementation, adoption, quality improvement, dissemination, complex intervention (with multiple endings), implementation (within three words of) research, and complex intervention. More KT terms were associated with KT application articles (n = 13) and KT theory articles (n = 18).ConclusionsWe collected 100 terms describing KT research. Authors used 46 of them in titles and abstracts of KT articles. Of these, approximately half discriminated between KT and non-KT articles. Thus, the need for consolidation and consistent use of fewer terms related to KT research is evident.

The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence

BACKGROUNDnThe electronic medical record (EMR)/electronic health record (EHR) is becoming an integral component of many primary-care outpatient practices. Before implementing an EMR/EHR system, primary-care practices should have an understanding of the potential benefits and limitations.nnnOBJECTIVEnThe objective of this study was to systematically review the recent literature around the impact of the EMR/EHR within primary-care outpatient practices.nnnMATERIALS AND METHODSnSearches of Medline, EMBASE, CINAHL, ABI Inform, and Cochrane Library were conducted to identify articles published between January 1998 and January 2010. The gray literature and reference lists of included articles were also searched. 30 studies met inclusion criteria.nnnRESULTS AND DISCUSSIONnThe EMR/EHR appears to have structural and process benefits, but the impact on clinical outcomes is less clear. Using Donabedians framework, five articles focused on the impact on healthcare structure, 21 explored healthcare process issues, and four focused on health-related outcomes.

Interventions to improve the use of systematic reviews in decision-making by health system managers, policy makers and clinicians

BACKGROUNDnSystematic reviews provide a transparent and robust summary of existing research. However, health system managers, national and local policy makers and healthcare professionals can face several obstacles when attempting to utilise this evidence. These include constraints operating within the health system, dealing with a large volume of research evidence and difficulties in adapting evidence from systematic reviews so that it is locally relevant. In an attempt to increase the use of systematic review evidence in decision-making a number of interventions have been developed. These include summaries of systematic review evidence that are designed to improve the accessibility of the findings of systematic reviews (often referred to as information products) and changes to organisational structures, such as employing specialist groups to synthesise the evidence to inform local decision-making.nnnOBJECTIVESnTo identify and assess the effects of information products based on the findings of systematic review evidence and organisational supports and processes designed to support the uptake of systematic review evidence by health system managers, policy makers and healthcare professionals.nnnSEARCH METHODSnWe searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, Web of Science, and Health Economic Evaluations Database. We also handsearched two journals (Implementation Science and Evidence and Policy), Cochrane Colloquium abstracts, websites of key organisations and reference lists of studies considered for inclusion. Searches were run from 1992 to March 2011 on all databases, an update search to March 2012 was run on MEDLINE only.nnnSELECTION CRITERIAnRandomised controlled trials (RCTs), interrupted time-series (ITS) and controlled before-after studies (CBA) of interventions designed to aid the use of systematic reviews in healthcare decision-making were considered.nnnDATA COLLECTION AND ANALYSISnTwo review authors independently extracted the data and assessed the study quality. We extracted the median value across similar outcomes for each study and reported the range of values for each median value. We calculated the median of the two middlemost values if an even number of outcomes were reported.nnnMAIN RESULTSnWe included eight studies evaluating the effectiveness of different interventions designed to support the uptake of systematic review evidence. The overall quality of the evidence was very low to moderate.Two cluster RCTs evaluated the effectiveness of multifaceted interventions, which contained access to systematic reviews relevant to reproductive health, to change obstetric care; the high baseline performance in some of the key clinical indicators limited the findings of these studies. There were no statistically significant effects on clinical practice for all but one of the clinical indicators in selected obstetric units in Thailand (median effect size 4.2%, range -11.2% to 18.2%) and none in Mexico (median effect size 3.5%, range 0.1% to 19.0%). In the second cluster RCT there were no statistically significant differences in selected obstetric units in the UK (median effect RR 0.92; range RR 0.57 to RR 1.10). One RCT evaluated the perceived understanding and ease of use of summary of findings tables in Cochrane Reviews. The median effect of the differences in responses for the acceptability of including summary of findings tables in Cochrane Reviews versus not including them was 16%, range 1% to 28%. One RCT evaluated the effect of an analgesic league table, derived from systematic review evidence, and there was no statistically significant effect on self-reported pain. Only one RCT evaluated an organisational intervention (which included a knowledge broker, access to a repository of systematic reviews and provision of tailored messages), and reported no statistically significant difference in evidence informed programme planning.Three interrupted time series studies evaluated the dissemination of printed bulletins based on evidence from systematic reviews. A statistically significant reduction in the rates of surgery for glue ear in children under 10 years (mean annual decline of -10.1%; 95% CI -7.9 to -12.3) and in children under 15 years (quarterly reduction -0.044; 95% CI -0.080 to -0.011) was reported. The distribution to general practitioners of a bulletin on the treatment of depression was associated with a statistically significant lower prescribing rate each quarter than that predicted by the rates of prescribing observed before the distribution of the bulletin (8.2%; P = 0.005).nnnAUTHORS CONCLUSIONSnMass mailing a printed bulletin which summarises systematic review evidence may improve evidence-based practice when there is a single clear message, if the change is relatively simple to accomplish, and there is a growing awareness by users of the evidence that a change in practice is required. If the intention is to develop awareness and knowledge of systematic review evidence, and the skills for implementing this evidence, a multifaceted intervention that addresses each of these aims may be required, though there is insufficient evidence to support this approach.

The knowledge-to-action cycle: identifying the gaps

In a large study in the United States, 20% of people with type 2 diabetes mellitus had poor control of blood glucose (i.e., a hemoglobin A1c concentration greater than 9%), only one third achieved a target rate of blood pressure (i.e., 130/80 mm Hg) and half had low-density lipoprotein cholesterol

Core competencies in the science and practice of knowledge translation: description of a Canadian strategic training initiative

BackgroundGlobally, healthcare systems are attempting to optimize quality of care. This challenge has resulted in the development of implementation science or knowledge translation (KT) and the resulting need to build capacity in both the science and practice of KT.FindingsWe are attempting to meet these challenges through the creation of a national training initiative in KT. We have identified core competencies in this field and have developed a series of educational courses and materials for three training streams. We report the outline for this approach and the progress to date.ConclusionsWe have prepared a strategy to develop, implement, and evaluate a national training initiative to build capacity in the science and practice of KT. Ultimately through this initiative, we hope to meet the capacity demand for KT researchers and practitioners in Canada that will lead to improved care and a strengthened healthcare system.