Clinical trial results in context: comparison of baseline characteristics and outcomes of 38,510 RECOVERY trial participants versus a reference population of 346,271 people hospitalised with COVID-19 in England.

BACKGROUND: Randomised trials are essential to reliably assess medical interventions. Nevertheless, interpretation of such studies, particularly when considering absolute effects, is enhanced by understanding how the trial population may differ from the populations it aims to represent. METHODS: We compared baseline characteristics and mortality of RECOVERY participants recruited in England (n = 38,510) with a reference population hospitalised with COVID-19 in England (n = 346,271) from March 2020 to November 2021. We used linked hospitalisation and mortality data for both cohorts to extract demographics, comorbidity/frailty scores, and crude and age- and sex-adjusted 28-day all-cause mortality. RESULTS: Demographics of RECOVERY participants were broadly similar to the reference population, but RECOVERY participants were younger (mean age [standard deviation]: RECOVERY 62.6 [15.3] vs reference 65.7 [18.5] years) and less frequently female (37% vs 45%). Comorbidity and frailty scores were lower in RECOVERY, but differences were attenuated after age stratification. Age- and sex-adjusted 28-day mortality declined over time but was similar between cohorts across the study period (RECOVERY 23.7% [95% confidence interval: 23.3-24.1%]; vs reference 24.8% [24.6-25.0%]), except during the first pandemic wave in the UK (March-May 2020) when adjusted mortality was lower in RECOVERY. CONCLUSIONS: Adjusted 28-day mortality in RECOVERY was similar to a nationwide reference population of patients admitted with COVID-19 in England during the same period but varied substantially over time in both cohorts. Therefore, the absolute effect estimates from RECOVERY were broadly applicable to the target population at the time but should be interpreted in the light of current mortality estimates. TRIAL REGISTRATION: ISRCTN50189673- Feb. 04, 2020, NCT04381936- May 11, 2020.

The Translation of Nanomedicines in the Contexts of Spinal Cord Injury and Repair.

PURPOSE OF THIS REVIEW: Manipulating or re-engineering the damaged human spinal cord to achieve neuro-recovery is one of the foremost challenges of modern science. Addressing the restricted permission of neural cells and topographically organised neural tissue for self-renewal and spontaneous regeneration, respectively, is not straightforward, as exemplified by rare instances of translational success. This review assembles an understanding of advances in nanomedicine for spinal cord injury (SCI) and related clinical indications of relevance to attempts to design, engineer, and target nanotechnologies to multiple molecular networks. RECENT FINDINGS: Recent research provides a new understanding of the health benefits and regulatory landscape of nanomedicines based on a background of advances in mRNA-based nanocarrier vaccines and quantum dot-based optical imaging. In relation to spinal cord pathology, the extant literature details promising advances in nanoneuropharmacology and regenerative medicine that inform the present understanding of the nanoparticle (NP) biocompatibility-neurotoxicity relationship. In this review, the conceptual bases of nanotechnology and nanomaterial chemistry covering organic and inorganic particles of sizes generally less than 100 nm in diameter will be addressed. Regarding the centrally active nanotechnologies selected for this review, attention is paid to NP physico-chemistry, functionalisation, delivery, biocompatibility, biodistribution, toxicology, and key molecular targets and biological effects intrinsic to and beyond the spinal cord parenchyma. SUMMARY: The advance of nanotechnologies for the treatment of refractory spinal cord pathologies requires an in-depth understanding of neurobiological and topographical principles and a consideration of additional complexities involving the research's translational and regulatory landscapes.

Best evidence audit and analysis to the medication management for patients with dysphagia / 中国实用护理杂志

Objective:To review the clinical status based on the best evidence of drug administration in patients with dysphagia, systematically analyze the obstacle factors and promoting factors in the process of evidence transformation, and formulate reform strategies.Methods:Based on the evidence-based nursing research method and the guidance of the Ottawa Model of Research Use (OMRU), the review indicators were developed based on the best evidence. The current status of clinical practice behaviors of 223 patients and 75 nurses in the Neurology, Neurosurgery and Geriatric departments of the Affiliated Hospital of Jiangsu University were reviewed from July to December 2021.Based on the results of the review, qualitative interviews were conducted with 32 potential adopters, and content analysis was used to assess the barriers and contributing factors to the clinical translation of evidence in three aspects: evidence-based change, potential adopters and practice environment, so as to develop effective strategies.Results:Based on the 22 best evidence selected, the evidence-based team developed 25 review indicators to carry out clinical review, showing that the compliance rate of 16 indicators were less than 60%. By analyzing and summarizing the interview results of potential adopters, the main obstacles leading to the low compliance rate of nurses were analyzed as follows: evidence-based reform changed the traditional work mode, and the application of evidence was not convenient; at the level of potential adopters, nurses had poor knowledge and practice, heavy work burden, and low awareness of patients and caregivers; at the level of practice environment, there was lack of nursing norms and procedures for clinical transformation of evidence, and the channels of multi-disciplinary collaboration and communication were not smooth. The main promoting factors were the perfect supervision mechanism of evidence-based nursing projects, the evidence-based group had rich experience in evidence transformation, the management was willing to change, and the practitioners were good at innovation.Conclusions:There is still a large gap between the clinical practice and the best evidence of drug administration in patients with dysphagia. The promoting factors should be fully utilized to overcome the obstacles and implement improvements to promote the effective transformation of evidence into clinical practice.

An Active Model of Research Translation for the General Public: Content Analysis of a YouTube-Based Health Podcast.

BACKGROUND: Online health information seeking is changing the way people engage with health care and the health system. Recent changes in practices related to seeking, accessing, and disseminating scientific research, and in particular health information, have enabled a high level of user engagement. OBJECTIVE: This study aims to examine an innovative model of research translation, The Huberman Lab Podcast (HLP), developed by Andrew Huberman, Professor of Neurobiology and Ophthalmology at the Stanford School of Medicine. The HLP leverages social media to deliver health information translated into specific, actionable practices and health strategies directly to the general public. This research characterizes the HLP as an Active Model of Research Translation and assesses its potential as a framework for replicability and wider adoption. METHODS: We applied conventional content analysis of the YouTube transcript data and directed content analysis of viewers' YouTube comments to 23 HLP episodes released from January to October 2021, reflecting the time of data analysis. We selected 7 episodes and a welcome video, to describe and identify key characteristics of the HLP model. We analyzed viewer comments for 18 episodes to determine whether viewers found the HLP content valuable, accessible, and easy to implement. RESULTS: The key HLP features are direct-to-the-consumer, zero-cost, bilingual, and actionable content. We identified 3 main organizing categories and 10 subcategories as the key elements of the HLP: (1) Why: Educate and Empower and Bring Zero Cost to Consumer Information to the General Public; (2) What: Tools and Protocols; Underlying Mechanisms; and Grounded in Science; (3) How: Linear and Iterative Knowledge Building Process; Lecture-Style Sessions; Interactive and Consumer Informed; Easily Accessible; and Building the Community. Analysis of viewers' comments found strong consumer support for the key HLP model elements. CONCLUSIONS: This Active Model of Research Translation offers a way to synthesize scientific evidence and deliver it directly to end users in the form of actionable tools and education. Timely evidence translation using effective consumer engagement and education techniques appears to improve access and confidence related to health information use and reduces challenges to understanding and applying health information received from health providers. Framing complex content in an approachable manner, engaging the target audience, encouraging participation, and ensuring open access to the content meet current recommendations on innovative practices for leveraging social media or other digital platforms for disseminating science and research findings to the general public, and are likely key contributors to HLP impact and potential for success. The model offers a replicable framework for translating and disseminating scientific evidence. Similar active models of research translation can have implications for accessing health information and implementing health strategies for improved outcomes. Areas for further investigation are specific and measurable impacts on health, usability, and relevance of the model for reaching marginalized and high-risk populations.

Translating Research into Child Health Policy: Aligning Incentives and Building a New Discourse.

Research has led to major achievements in public policy and child health. Despite the gains, the need for research to inform policy remains paramount against a backdrop of inadequate public health investments, health inequities, and public skepticism toward science. However, the translation of research into child health policy has often been slow due to misalignments in incentives between researchers and policy makers and a paucity of conceptual models to inform translation. This article outlines barriers to translation, provides examples of discordance between evidence and policy, summarizes models to inform translation, and offers strategies to improve translation of research to policy.

Enablers and barriers to evidence implementation in complementary medicine: A systematic review.

Background: Despite the push for complementary medicine (CM) practitioners to engage in evidence implementation, and arguments in support of evidence-based practice (EBP), uptake of EBP amongst most CM professions remains low. This review aimed to synthesise the evidence examining the barriers and enablers to evidence implementation in CM. Methods: Any primary study examining enablers and barriers to evidence implementation in CM were eligible for inclusion. Eight databases and search engines were searched for eligible studies. Reference lists of included studies were screened, and authors of included studies were contacted to identify current or unpublished studies that met the inclusion criteria. Results: Thirty-nine published and unpublished studies were included in this review. The seven published qualitative studies and 25 published quantitative studies were rated as moderate to high quality. Fifty-two distinct barriers and 62 discrete enablers were identified. Reported barriers were predominantly structural (e.g. limited availability of time and clinical evidence) and cognitive (e.g. skills deficits), with relatively fewer studies reporting cultural (e.g. lack of industry support) or attitudinal barriers (e.g. lack of interest in, or relevance to CM). Enablers of evidence implementation largely focussed on improving access to bibliographic databases and evidence reviews, supporting skills acquisition, and cultivating leadership and interprofessional/interagency collaboration. Conclusion: The findings of this review highlight the diverse barriers and enablers to evidence implementation in CM that span multiple dimensions. The interplay between these various factors highlights the complexity of evidence implementation, and the need for a targeted multistakeholder, multidimensional solution to optimise evidence-based practice in CM.

Using the Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM) Approach to Assess the Strength of Evidence on Associations between Dietary Patterns and All-Cause Mortality.

Dietary guidelines should be underpinned by high-quality evidence. Quality assessment methods that reflect traditional evidence hierarchies prioritise evidence from randomised controlled trials (RCTs). The Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM) approach is an alternative quality assessment method for research questions that for practical and/or ethical reasons, cannot be answered using RCTs. The aim of this study was to investigate how the HEALM approach could be used to assess the strength of evidence on associations between dietary patterns and all-cause mortality (a research question that is difficult to answer using RCTs). Two data sources were used: an existing systematic review of dietary patterns and all-cause mortality that synthesised evidence from observational studies; and an overview of reviews that was conducted to summarise relevant evidence from mechanistic and intervention studies. A set of four criteria were developed and used in the application of HEALM. Using different datasets in combination, the strength of evidence was rated as 'Grade B: moderate/suggestive' or 'Grade C: insufficient/inconclusive'. HEALM is a novel approach for integrating and assessing the strength of evidence from mechanistic, intervention, and observational studies. Further research is needed to address the practical challenges that were identified in the application of HEALM.

Identifying barriers and facilitators of translating research evidence into clinical practice: A systematic review of reviews.

Translating research into clinical practice is a global priority because of its potential impact on health services delivery and outcomes. Despite the ever-increasing depth and breadth of health research, most areas across the globe seem to be slow to translate relevant research evidence into clinical practice. Thus, this review sought to synthesise existing literature to elucidate the barriers and facilitators to the translation of health research into clinical practice. A systematic review of reviews approach was utilised. Review studies were identified across PubMed, Scopus, Embase, CINAHL and Web of Science databases, from their inception to 15 March 2021. Searching was updated on 30 March 2022. All retrieved articles were screened by two authors; reviews meeting the inclusion criteria were retained. Based on the review type, two validated tools were employed to ascertain their quality: A Measurement Tool to Assess Systematic Reviews-2 and International Narrative Systematic assessment. The framework synthesis method was adopted to guide the analysis and narrative synthesis of data from selected articles. Ten reviews met the inclusion criteria. The study revealed that the translation of new evidence was limited predominantly by individual-level issues and less frequently by organisational factors. Inadequate knowledge and skills of individuals to conduct, organise, utilise and appraise research literature were the primary individual-level barriers. Limited access to research evidence and lack of equipment were the key organisational challenges. To circumvent these barriers, it is critical to establish collaborations and partnerships between policy makers and health professionals at all levels and stages of the research process. The study concluded that recognising barriers and facilitators could help set key priorities that aid in translating and integrating research evidence into practice. Effective stakeholder collaboration and co-operation should improve the translation of research findings into clinical practice.

A Systematic Review of the Methods Used to Assess and Report Dietary Patterns.

The use of dietary pattern assessment methods has increased over time. However, data from individual studies can be difficult to compare and synthesize when the dietary pattern assessment methods, and the dietary patterns that are identified are not described sufficiently. The aims of this systematic review were to analyze the application and reporting of dietary pattern assessment methods, and the reporting of the dietary patterns that were analyzed with health outcomes. Three electronic databases were searched (Medline, Embase, and Global Health). Cohort and nested case control studies published in English between January 1980 and March 2019 that examined associations between dietary patterns and health outcomes (including cardiovascular disease, cancer, diabetes and metabolic syndrome, and body weight) in apparently healthy, community dwelling adults (aged over 18 years) or children (aged 2-18 years) were eligible for inclusion. A narrative synthesis was conducted and descriptive statistics were used to summarize the application and reporting of each dietary pattern assessment method, and the reporting of the identified dietary patterns. Analysis of associations between dietary patterns and health outcomes was beyond the scope of this review. Of the included studies (n = 410), 62.7% used index-based methods, 30.5% used factor analysis or principal component analysis, 6.3% used reduced rank regression, and 5.6% used cluster analysis. Some studies (4.6%) used more than one method. There was considerable variation in the application and reporting of dietary pattern assessment methods. For example, the application of Mediterranean diet indices varied in terms of the nature of dietary components (foods only or foods and nutrients) and the rationale behind the cut-off points (absolute and/or data driven). In some cases, important methodological details were omitted. The level of detail used to describe the dietary patterns also varied, and food and nutrient profiles were often not reported. To ensure dietary patterns evidence can be synthesized and translated into dietary guidelines, standardized approaches for the application and reporting of dietary pattern assessment methods and the reporting of the identified dietary patterns would be beneficial.

Implementation science: A critical but undervalued part of the healthcare innovation ecosystem.

Healthcare systems face many competing demands and insufficient resources. Service innovations to improve efficiency are important to address this challenge. Innovations can range from new pharmaceuticals, alternate models of care, novel devices, and the use other technologies. Suboptimal implementation can mean lost benefits. This review article aims to highlight the role of implementation science, summarize how settings have leveraged this methodology to promote translation of innovation into practice, and describe our own experience of embedding implementation science into an academic medical center in Singapore. Implementation science offers a range of methods to promote systematic uptake of research findings about innovations and is gaining recognition worldwide as an important discipline for health services researchers. Health systems around the world have tried to promote implementation research in their settings by establishing (1) dedicated centers/programs, (2) offering funding, and (3) building knowledge and capacity among staff. Implementation science is a critical piece in the translational pathway of "evidence to innovation." The three efforts we describe should be strengthened to integrate implementation science into the innovation ecosystem around the world.

Embracing policy implementation science to ensure translation of evidence to cancer control policy.

Although health-related policies are abundant, efforts to understand how to ensure that these policies serve as an effective vehicle for translating scientific evidence are relatively sparse. This paper explores how policy-focused implementation science (IS) may contribute to understanding the translation of scientific evidence to health-related policy in governmental and nongovernmental sectors. Expanding the focus of implementation science in cancer control could systematically address policy to both increase the use of scientific evidence in general and to address health equity. In this Commentary, we look to relevant work outside of IS that could be informative, most notably from the field of political science. We propose several ideas for future research that could help move the field of policy implementation science in cancer control in the USA forward. Although most efforts to increase uptake of the scientific evidence base reference translation to "practice and policy," there has been relatively little emphasis in the USA on implementation at the policy level, especially related to cancer control. If we are to achieve the full benefits of scientific discovery on population and public health, we will need to consider policy as a critical mechanism by which evidence can be translated to practice. We have a robust set of methods within implementation science that are increasing the pace of adoption and maintenance of evidence-based programs in a variety of settings. Building on these efforts, the time is right to expand our focus to include policy implementation.

Although health-related policies are abundant, relatively few efforts have been undertaken to ensure that they are used as a way to translate scientific evidence to promote health. This paper explores how policy-focused implementation science (IS) may contribute to understanding the translation of scientific evidence to health-related policy in governmental and nongovernmental sectors. We propose several ideas for future research that could help move the field of policy implementation science in cancer control in the USA forward. We have a robust set of methods within implementation science that are increasing the pace of adoption and maintenance of evidence-based programs in a variety of settings. Building on these efforts, the time is right to expand our methods to include policy implementation.

Evidence Use in the Development of the Australian Dietary Guidelines: A Qualitative Study.

Dietary guidelines are important nutrition policy reference standards that should be informed by the best available evidence. The types of evidence that are reviewed and the evidence review methods that are used have implications for evidence translation. The aim of this study was to explore perceived advantages, disadvantages, and practicalities associated with the synthesis and translation of evidence from nutrient-based, food-based, and dietary patterns research in dietary guideline development. A qualitative descriptive study was conducted. Twenty-two semi-structured interviews were conducted with people involved in the development of the 2013 Australian Dietary Guidelines (ADGs). Transcripts were analysed thematically. To inform future ADGs, there was support for reviewing evidence on a range of dietary exposures (including dietary patterns, foods and food groups, nutrients and food components, and eating occasions) and health outcomes, as well as evidence on environmental sustainability and equity. At the evidence synthesis stage, practicalities associated with planning the evidence review and conducting original systematic reviews were discussed. At the evidence translation stage, practicalities associated with integrating the evidence and consulting stakeholders were described. To ensure that the best available evidence is translated into future ADGs, evidence review methods should be selected based on the exposures and outcomes of interest.

Challenges and enablers of the embedded researcher model.

PURPOSE: The embedded researcher is a healthcare-academic partnership model in which the researcher is engaged as a core member of the healthcare organisation. While this model has potential to support evidence translation, there is a paucity of evidence in relation to the specific challenges and strengths of the model. The aim of this study was to map the barriers and enablers of the model from the perspective of embedded researchers in Australian healthcare settings, and compare the responses of embedded researchers with a primary healthcare versus a primary academic affiliation. DESIGN/METHODOLOGY/APPROACH: 104 embedded researchers from Australian healthcare organisations completed an online survey. Both purposive and snowball sampling strategies were used to identify current and former embedded researchers. This paper reports on responses to the open-ended questions in relation to barriers and enablers of the role, the available support, and recommendations for change. Thematic analysis was used to describe and interpret the breadth and depth of responses and common themes. FINDINGS: Key barriers to being an embedded researcher in a public hospital included a lack of research infrastructure and funding in the healthcare organisation, a culture that does not value research, a lack of leadership and support to undertake research, limited access to mentoring and career progression and issues associated with having a dual affiliation. Key enablers included supportive colleagues and executive leaders, personal commitment to research and research collaboration including formal health-academic partnerships. RESEARCH LIMITATIONS/IMPLICATIONS: To support the embedded researcher model, broader system changes are required, including greater investment in research infrastructure and healthcare-academic partnerships with formal agreements. Significant changes are required, so that healthcare organisations appreciate the value of research and support both clinicians and researchers to engage in research that is important to their local population. ORIGINALITY/VALUE: This is the first study to systematically investigate the enablers and challenges of the embedded researcher model.

Direct supervision of physiotherapists improves compliance with clinical practice guidelines for patients with hip fracture: a controlled before-and-after study.

Purpose: To determine if the addition of direct supervision to usual clinical supervision practice of physiotherapists can improve compliance with clinical practice guidelines and post-surgical outcomes for inpatients with hip fracture.Methods: A controlled before-and-after study was conducted on two acute orthopedic wards. Junior and mid-level physiotherapists on one ward were provided with direct supervision during their post-operative management of patients with hip fracture. Physiotherapists on the comparison ward received usual reflective supervision. The primary outcome was patient compliance with the hip fracture guideline to mobilize on the day following surgery. Secondary patient outcomes included physical function on the fifth post-operative day.Results: Data were collected from 290 patients with acute hip fracture. Patients at the direct supervision site were more likely to mobilize on the day after surgery [OR 3.14, 95% confidence interval (CI) 1.41-7.01; p = 0.005] and by the second post-operative day (OR 4.62, 95% CI 2.31-9.23; p < 0.001) compared to patients at the comparison site. Patients walked further on the fifth post-operative day (p < 0.001) with less assistance from therapists (p = 0.044).Conclusions: The addition of direct supervision improved physiotherapists' compliance with hip fracture guidelines and walking endurance and independence in hospitalized patients with hip fracture.Implications for rehabilitationThe addition of a direct supervision model, where physiotherapists are directly observed in their management of patients with hip fracture, to usual practice supervision improved early mobilization of patients with hip fractureDirect supervision appears to be an effective guideline implementation strategy that can improve care and outcomes for hospitalized patients with hip fracture.

Locating "gold standard" evidence for simulation as a substitute for clinical practice in prelicensure health professional education: A systematic review.

AIMS AND OBJECTIVES: To extract, examine and report the highest available levels of evidence from healthcare disciplines in the use of simulation-based education as substitution for clinical placement in prelicensure programmes. BACKGROUND: Simulation is widely employed across prelicensure health professional education to create safe, realistic clinical learning experiences for students. Whether simulation can be employed to substitute for actual clinical placement, and if so, in what proportion, replacement ratio and duration, is unclear. METHODS: A systematic review and quality appraisal of primary studies related to prelicensure students in all health disciplines, guided by the PRISMA checklist. RESULTS: Ten primary studies were included, representing 2,370 students from three health disciplines in four countries. Nine studies were experimental and quasi-experimental and methodological quality was assessed as moderate to high with good to very good inter-rater agreement. Direct substitution of simulation for clinical practice ranged from 5% to 50%. With one exception, replacement ratios were 1:1 and duration of replacement ranged from 21 hr-2 years. Levels of evaluation included measures of reaction, knowledge and behaviour transfer; no negative outcomes were reported. We appraised practicalities for design of substitution, design limitations and knowledge transfer to accreditation standards for prelicensure programmes. CONCLUSIONS: This review synthesised highest levels and quality of available evidence for substitution of simulation for clinical placement in health professional education. Included studies were heterogenous in simulation interventions (proportion, ratio and duration) and in the evaluation of outcomes. Future studies should incorporate standardised simulation curricula, widen the health professions represented and strengthen experimental designs. RELEVANCE TO CLINICAL PRACTICE: Current evidence for clinical educational preparation does not appear to be translated into programme accreditation standards governing clinical practice experience for prelicensure programmes in relevant jurisdictions. Overall, a stronger evidence base is necessary to inform future curricula and policy development, to strengthen clinical practice in health.

Translating evidence in complex systems: a comparative review of implementation and improvement frameworks.

PURPOSE: An increasing number of implementation and improvement frameworks seek to describe and explain how change is made in healthcare. This paper aims to explore how existing frameworks conceptualize the influence of complexity in translating evidence into practice in healthcare. DATA SOURCES: A database was interrogated using a search strategy to identify publications that present frameworks and models for implementation and improvement. STUDY SELECTION: Ten popular implementation and improvement frameworks were purposively selected. DATA EXTRACTION: Comparative analysis was conducted using an analytical framework derived from SHIFT-Evidence, a framework that conceptualizes complexity in implementation and improvement initiatives. RESULTS: Collectively the frameworks accounted for key concepts of translating evidence in complex systems: understanding the uniqueness of each setting; the interdependency of practices/processes and the need to respond to unpredictable events and emergent learning. The analysis highlighted heterogeneity of the frameworks in their focus on different aspects of complexity. Differences include the extent to which problems and solutions are investigated or assumed; whether endpoints are defined as the uptake of interventions or achievement of goals; and emphasis placed on fixed-term interventions versus continual improvement. None of the individual frameworks reviewed incorporated all the implications of complexity, as described by SHIFT-Evidence. CONCLUSION: This research identifies the differences in how implementation and improvement frameworks consider complexity, suggesting that SHIFT-Evidence offers a more comprehensive overview compared with the other frameworks. The similarity of concepts across the frameworks suggests growing consensus in the literature, with SHIFT-Evidence providing a conceptual bridge between the implementation and improvement fields.

Successful Healthcare Improvements From Translating Evidence in complex systems (SHIFT-Evidence): simple rules to guide practice and research.

BACKGROUND: Evidence translation and improvement research indicate that healthcare contexts are complex systems, characterized by uncertainty and surprise, which often defy orchestrated intervention attempts. This article reflects on the implications of complexity on attempts to translate evidence, and on a newly published framework for Successful Healthcare Improvements From Translating Evidence in complex systems (SHIFT-Evidence). DISCUSSION: SHIFT-Evidence positions the challenge of evidence translation within the complex and evolving context of healthcare, and recognizes the wider issues practitioners routinely face. It is empirically grounded, and designed to be comprehensive, practically relevant and actionable. SHIFT-evidence is summarized by three principles designed to be intuitive and memorable: 'act scientifically and pragmatically'; 'embrace complexity'; and 'engage and empower'. Common challenges and strategies to overcome them are summarized in 12 'simple rules' that provide actionable guidance. CONCLUSION: SHIFT-Evidence provides a practical tool to guide practice and research of evidence translation and improvement within complex dynamic healthcare settings. Implications are that improvement initiatives and research study designs need to take into account the unique initial conditions in each local setting; conduct needs to respond to unpredictable effects and address dependent problems; and evaluation needs to be sensitive to evolving priorities and the emergent range of activities required to achieve improvement.

Reporting quality of European and Croatian health practice guidelines according to the RIGHT reporting checklist.

BACKGROUND: Health practice guidelines (HPGs) are important tools for the translation of evidence into practice. Reporting Items for Practice Guidelines in HealThcare (RIGHT) checklist provides guidance on reporting health practice guidelines (HPGs). We assessed the reporting completeness and quality of a set of national (Croatian) and relevant transnational (European) HPGs. METHODS: The national sample included all HPGs published in the official journal of the Croatian Medical Association in 2014-2016. We searched PubMed to identify relevant European guidelines (n = 24). Two independent reviewers assessed the adherence with the items on the RIGHT checklist. Kappa score was used to measure the level of agreement. Frequentist and Bayes statistics Bayes factor (BF10) was used to evaluate the differences between the national and transnational HPGs. RESULTS: Overall, Croatian and European HPGs adhered to less than 50% of RIGHT checklist items. Croatian HPGs reported a median of 14.0 (95% CI 13.0-15.0) RIGHT reporting items, and European counterparts reported a median of 16.0 (95% CI 14.0-17.2) out of the total of 35 checklist items (Mann Whitney U test, P = 0.048; BF10 = 1.543). European HPGs were better than Croatian HPGs in reporting stakeholder involvement and values and preferences (BF10 = 80.63), as well as describing the implications of costs and resources (BF10 = 55.15). Croatian HPGs better reported HPGs specified aims (BF10 = 16.90), primary intended users (BF10 = 8.70), and sources of funding (BF10 = 122.90). Most insufficiently reported items for both HPG sets were defining the guideline questions and clear outcomes, quality assurance, management of funding and conflicts of interest, and guideline limitations. CONCLUSIONS: Important methodological details are missing from most published HPGs at national and transnational levels. To ensure better quality and adequate use of HPGs, reporting guidelines should be endorsed and used by developers and users alike.

Simple rules for evidence translation in complex systems: A qualitative study.

BACKGROUND: Ensuring patients benefit from the latest medical and technical advances remains a major challenge, with rational-linear and reductionist approaches to translating evidence into practice proving inefficient and ineffective. Complexity thinking, which emphasises interconnectedness and unpredictability, offers insights to inform evidence translation theories and strategies. Drawing on detailed insights into complex micro-systems, this research aimed to advance empirical and theoretical understanding of the reality of making and sustaining improvements in complex healthcare systems. METHODS: Using analytical auto-ethnography, including documentary analysis and literature review, we assimilated learning from 5 years of observation of 22 evidence translation projects (UK). We used a grounded theory approach to develop substantive theory and a conceptual framework. Results were interpreted using complexity theory and 'simple rules' were identified reflecting the practical strategies that enhanced project progress. RESULTS: The framework for Successful Healthcare Improvement From Translating Evidence in complex systems (SHIFT-Evidence) positions the challenge of evidence translation within the dynamic context of the health system. SHIFT-Evidence is summarised by three strategic principles, namely (1) 'act scientifically and pragmatically' - knowledge of existing evidence needs to be combined with knowledge of the unique initial conditions of a system, and interventions need to adapt as the complex system responds and learning emerges about unpredictable effects; (2) 'embrace complexity' - evidence-based interventions only work if related practices and processes of care within the complex system are functional, and evidence-translation efforts need to identify and address any problems with usual care, recognising that this typically includes a range of interdependent parts of the system; and (3) 'engage and empower' - evidence translation and system navigation requires commitment and insights from staff and patients with experience of the local system, and changes need to align with their motivations and concerns. Twelve associated 'simple rules' are presented to provide actionable guidance to support evidence translation and improvement in complex systems. CONCLUSION: By recognising how agency, interconnectedness and unpredictability influences evidence translation in complex systems, SHIFT-Evidence provides a tool to guide practice and research. The 'simple rules' have potential to provide a common platform for academics, practitioners, patients and policymakers to collaborate when intervening to achieve improvements in healthcare.

Common issues raised during the quality assurance process of WHO guidelines: a cross-sectional study.

BACKGROUND: In 2007, WHO established the Guidelines Review Committee (GRC) to ensure that WHO guidelines adhere to the highest international standards. The GRC reviews guideline proposals and final guidelines. The objectives of this study were to examine the rates of and reasons for conditional approval and non-approval of documents submitted for the first time to the GRC, and calculate the time intervals and numbers of submissions to achieve approval for documents conditionally approved or not approved at first submission. METHODS: All initial submissions to the GRC between 2014 and 2017 were examined. Data were extracted from the GRC's records of written comments and discussions. RESULTS: Of a total of 85 proposals and 88 final guidelines, 32 (37.6%) proposals and 37 (42.0%) final guidelines were conditionally approved, and 15 (17.6%) proposals and 28 (31.8%) final guidelines were not. For both conditionally approved and not approved proposals, the most frequent reasons were suboptimal composition or inadequate description of the guideline contributor groups (in all proposals), followed by inadequate formulation of key questions (in 90.6% of conditionally approved proposals and all not approved proposals). For both conditionally approved and not approved final guidelines, the most frequent reasons were problems with recommendations (in all final guidelines), followed by inappropriate methods for evidence retrieval or an inadequate description thereof (in all conditionally approved final guidelines and 75.0% of not approved final guidelines). The median time to achieve approval was 2 months for proposals and 1-2 months for final guidelines. The median number of submissions was 2 for proposals and 2-2.5 for final guidelines. CONCLUSION: The GRC implements a rigorous quality assurance process and identifies problems with a significant percentage of initial submissions. WHO needs to continuously evaluate its guideline development processes to inform effective quality improvement measures and optimise the quality of its guidelines.