Implementing GRADE in systematic reviews that adhere to JBI methodological conduct.

GRADE is a methodological approach used to establish certainty in a body of evidence and is now widely adopted among the evidence synthesis and guideline development community. JBI is an international evidence-based health care organization that provides guidance for a range of evidence synthesis approaches. The GRADE approach is currently endorsed for use in a subset of JBI systematic reviews; however, there is some uncertainty regarding when (and how) GRADE may be implemented in reviews that follow JBI methodology.

Providing a scaffold for considering theoretical frameworks in evidence implementation projects: the JBI approach to evidence implementation.

ABSTRACT: There are many theories, models, and frameworks that have been proposed in the field of implementation science. Despite this, many evidence implementation or practice improvement projects do not consider these theories, models, or frameworks in their improvement efforts. The JBI approach is one example of an implementation theory, model, or framework. This approach has been developed particularly with health care professionals in mind and is designed to clearly guide pragmatic evidence implementation efforts based on the best available evidence. In this paper, we discuss how the JBI approach to evidence implementation can interact with and support theory-informed, pragmatic evidence implementation projects.

Dementia care behind prison walls: A descriptive study understanding nurse's knowledge and educational needs.

AIM/OBJECTIVE: To establish correctional nurses' dementia knowledge base and identify their educational needs related to caring for prisoners with dementia. BACKGROUND: The aging prison population is growing, posing a heightened risk of dementia among older inmates. This study examined the knowledge and perceived educational needs of nurses caring for prisoners with dementia. DESIGN: A descriptive study which was qualitative in nature was undertaken. METHODS: Data was collected using an online survey which included Demographics, the Dementia Knowledge Assessment Tool 2 and open-ended questions. Descriptive statistics such as percentages and frequency were used to analyse the quantitative data and a qualitative analysis was undertaken to identify common themes and extract meaningful insight from the open-ended questions. RESULTS: Nurses showed a general understanding of dementia and its environmental impact but lacked knowledge of late-stage changes. Eight main themes relating more broadly to the environmental and staffing challenges faced by nurses are presented. CONCLUSION: Although participants appeared to have a reasonable dementia knowledge base the study highlights the need for specific dementia education and support focussed on the correctional setting and collaborative partnerships with dementia experts in the community.

JBI's approach to evidence implementation: a 7-phase process model to support and guide getting evidence into practice.

ABSTRACT: In this paper, we provide an overview of JBI's approach to evidence implementation and describe the supporting process model that aligns with this approach. The central tenets of JBI's approach to implementing evidence into practice include the use of evidence-based audit and feedback, identification of the context in which evidence is being implemented, facilitation of any change, and an evaluation process. A pragmatic and practical seven-phased approach is outlined to assist with the 'planning' and 'doing' of getting evidence into practice, focusing on clinicians as change agents for implementing evidence in clinical and policy settings. Further research and development is required to formally evaluate the robustness of the approach to better understand the complex nature of evidence implementation.

Turning the flywheel: mobilizing the JBI model of evidence-based healthcare.

ABSTRACT: Since its emergence in the 1990s, evidence-based healthcare (EBHC) has made great strides in locating, synthesizing, summarizing, and disseminating evidence, but sustainable mechanisms for getting trustworthy evidence into policy and practice continues to be less well understood. We propose that there is an EBHC 'Flywheel' that begins and ends with culture and the development of adaptive but disciplined approaches that generate new 'norms' in relation to EBHC. In mechanics, a flywheel is a device that uses momentum to create rotational energy. The concept of a 'flywheel effect' has been adopted in management fields to demonstrate how change in organizations or practices rarely happen in one fell swoop; rather, sustainable change requires energy and persistent effort.This energy might be exemplified by leadership to get the wheel moving, but it needs to be guided, channelled, harnessed and supported throughout the rest of the organization. To achieve sustainable momentum, it is necessary to communicate with transparency the EBHC principles, practices, and perspectives that are considered of broad organizational value to generate cohesion and understanding about practice expectations. With a common vision, cooperation and collective identity in place, true multidisciplinary collaboration underpinned by EBHC is possible. The final component in the EBHC flywheel, capacity, is self-generating (i.e. you do not need 'more time' or 'more resource' for EBHC as EBHC is embedded in the fabric and fibre of the organization). This shifts the notion of EBHC initiatives from being 'in addition to' or being singular one-off initiatives or projects to being part of the lifeblood of how the organization functions. EBHC is, ultimately, a human-to-human endeavour. It relates to individuals connecting and committing to a common purpose. The 'four C's' that underpin the JBI Model (culture, communication, collaboration, and capacity) are the organizational navigational instruments and roadmaps required to provide the human focus/lens that is needed.

Adult patient and carer experiences of planning for hospital discharge after a major trauma event: a qualitative systematic review.

PURPOSE: To identify, evaluate and synthesize qualitative literature on adult patients and carer experiences of planning for discharge from an acute setting after a major trauma event. METHODS: The JBI approach to meta-aggregation was followed. Qualitative studies exploring patient and carer discharge planning experiences of major trauma were included in the systematic review. A comprehensive search was conducted in five databases, supplemented by grey literature. Eligible studies were appraised for methodological quality by two reviewers and data extracted using standardized JBI tools. RESULTS: Four synthesized findings emerged using 69 findings from sixteen papers. (i) Patients and carers feel generally unprepared to manage at home after discharge, (ii) early identification of patients' post discharge needs allows for appropriate referrals and supports to be organised prior to discharge, (iii) patients and carers value participation in the discharge planning process to facilitate a considered, organized and timely discharge from hospital (iv) the timely presentation, delivery, language used, format and relevancy of information impacts how patients and carers manage their discharge. CONCLUSION: This meta-synthesis demonstrates that patients and carers predominantly have poor experiences of discharge planning after major trauma. Adoption of patient centered principles may improve patient and carer experiences of the discharge planning process.IMPLICATIONS FOR REHABILITATIONPatients and their carers benefit from a client-centred approach where their needs are recognised and their collaboration encouraged in important decisions, and if they are adequately prepared to reintegrate into their community.Patients can benefit from having a trauma pathway healthcare professional to provide support and advocacy services throughout their hospital admission and after discharge.Discharge planning that is organised, prepared and collaborative leads to a more positive patient experience.Discharge information should be individualised and presented in an easily accessible format for patients and carers.

JBI series paper 1: Introducing JBI and the JBI Model of EHBC.

Joanna Briggs Institute (JBI) is an international research organization and collaborative network hosted in the Faculty of Health and Medical Sciences at the University Of Adelaide, South Australia. Now in its 25th year of activity, JBI is concerned with improving health outcomes in communities globally by promoting and supporting the use of the best available evidence to inform decision making in health policy and practice. The JBI Model of Evidence Based Healthcare, developed in the early 2000s, represents an articulation of the evidence ecosystem and the pragmatic approach required to navigate the complexity of health systems globally to improve health outcomes. The programs of JBI are aligned with the JBI Model and are representative of the supportive structures that facilitate the pragmatic realization of each of the elements of evidence based healthcare.

JBI series paper 4: the role of collaborative evidence networks in promoting and supporting evidence-based health care globally: reflections from 25 years across 38 countries.

Evidence-based health care (EBHC) is a worldwide movement with hundreds of organizations and thousands of individuals working to ensure that health care practice, policy, and decision-making are informed by rigorous research evidence, to improve health outcomes. The success of this global agenda, however, depends on individuals and organizations working together within a functioning evidence ecosystem. Collaborative evidence networks are a key mechanism to facilitate the synthesis, transfer, and implementation of evidence into health care policy and practice. Using the network functions approach as a framework for review, this paper explores the strategic functions and form of the JBI Collaboration to illustrate the role of a collaborative evidence network in promoting and supporting EBHC globally. It illustrates how the functions of a collaborative evidence network enable the development, exchange, and dissemination of knowledge, the building of social capital, mobilization of resources, and amplification and advocacy of members work and ideas, which increase the capacity and effectiveness of members in achieving their unified purpose. Effective and sustainable collaborative evidence networks have innovative ways of relating and mobilizing energy for action and combine formal and informal structures and relationships to successfully work together to address complex global health issues and drive the EBHC agenda forward.

JBI series paper 3: The importance of people, process, evidence, and technology in pragmatic, healthcare provider-led evidence implementation.

In this paper, we describe and discuss evidence implementation as a venture in global human collaboration within the framework of "people, process, evidence, and technology" as a roadmap for navigating implementation. At its core implementation is not a technological, or theoretical process, it is a human process. That health professionals central to implementation activities may not have had formal training in implementation, highlights the need for processes and programs that can be integrated within healthcare organization structures. Audit with feedback is an accessible implementation approach that includes the capacity to embed theory, frameworks, and bottom-up change processes to improve the quality of care. In this third paper in the JBI series, we discuss how four overarching principals necessary for sustainability (Culture, Capacity, Communication, and Collaboration) are combined with evidence, technology, and resources for evidence-based practice change. This approach has been successfully used across hundreds of evidence implementation projects around the globe for over 15 years. We present healthcare practitioner-led evidence-based practice improvement as sustainable and achievable in collaborative environments such as the global JBI network as a primary interest of the practicing professions and provide an overview of the JBI approach to evidence implementation.

Correctional nurse education and training to care for and support prisoners with dementia: a systematic review of text and opinion.

OBJECTIVE: The objective of this review was to synthesize the best available evidence on the training required for correctional nurses to care for and support prisoners with dementia. INTRODUCTION: Nurses caring for people in aged care facilities receive training related to aging and dementia; however, this has not carried across to training for the increasing aging population within correctional settings. Most research related to dementia care is focused on the aged and acute care sectors, and there is an absence of research in the correctional setting. Therefore, this systematic review was based on expert opinion and synthesizes information related to correctional nurse training for the support and care of prisoners with dementia. INCLUSION CRITERIA: Articles focusing on correctional nurses, regardless of gender, who were responsible for the health care of adult prisoners were considered for this review. The primary phenomenon of interest was the training needs and requirements for correctional nurses to support prisoners with dementia. The secondary phenomenon of interest was how the delivery of the training could be facilitated. The context of this review was the adult correctional setting. The sources of information considered for this review included text and narratives describing expert opinion, expert opinion-based guidelines, expert consensus, published discussion papers, unpublished dissertations, reports accessed from professional organization websites, and government policy documents. METHODS: A three-step search strategy was employed to look for both published and unpublished articles as recommended by JBI. The search was conducted for English-only articles, and from database inception to November 2020. All included articles were assessed by two independent reviewers for methodological quality. The data were extracted and pooled. Categories were developed and assigned based on similarity of meaning, and a set of synthesized conclusions was developed after subjecting the categories to meta-synthesis. RESULTS: Sixteen papers met the inclusion criteria and underwent critical appraisal and data extraction. Five synthesized findings were generated from 103 findings, which were aggregated into 15 categories. As expected, the rating was very low due to the nature of the included papers (ie, non-research), and the mix of unequivocal, credible, and unsupported findings. CONCLUSIONS: The review highlighted gaps in correctional nurse training related to caring for prisoners with dementia. Training for correctional nurses should incorporate information on general aging, alterations in aging, and dementia screening and management. Other findings included the need for policy and procedures related to training nurses to become dementia experts, and the development of partnerships with experts in the community to adapt training to the correctional setting.

Diagnostic test accuracy of serum procalcitonin compared with C-reactive protein for bone and joint infection in children and adolescents: a systematic review and meta-analysis.

OBJECTIVE: The objective of this review was to synthesize the best available evidence for the diagnostic test accuracy of serum procalcitonin compared with serum C-reactive protein for suspected osteomyelitis and septic arthritis in hospitalized children and adolescents. INTRODUCTION: Measurement of serum C-reactive protein remains a routine investigation for the diagnosis of osteoarticular infection in children and adolescents. Measurement of serum procalcitonin has been shown to outperform C-reactive protein in adults with osteomyelitis and septic arthritis. Before procalcitonin can be considered as a potential replacement or add-on test in children and adolescents, a systematic review and meta-analysis targeting this population should be conducted. INCLUSION CRITERIA: Original studies reporting the diagnostic accuracy of procalcitonin and/or C-reactive protein in children and adolescents between one month and 18 years of age admitted to hospital with suspected osteoarticular infection were included. Studies must have compared the index test to at least one reference test. Reference test was defined as positive culture or polymerase chain reaction confirmation of a pathogen from blood, bone biopsy, or joint fluid aspirate in combination with at least two of the following: i) purulent material from sterile site, ii) positive radiological findings consistent with osteoarticular infection, and ii) symptoms and signs consistent with osteomyelitis and/or septic arthritis. METHODS: The JBI methodology for systematic reviews of diagnostic test accuracy was followed. Information was sourced from four databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) and four gray literature sources (MedNar, OpenGrey, Google Scholar, and ProQuest Dissertations and Theses). Only studies published in English were considered. The methodological quality of selected studies was formally evaluated, sensitivity and specificity data were extracted, and 95% confidence intervals determined. Meta-analysis was performed to estimate summary points using a bivariate model and to generate a hierarchical summary receiver operating characteristic (HSROC) curve with global measures of test accuracy performance, such as likelihood ratio and diagnostic odds ratio. A narrative was provided where meta-analysis was not appropriate. RESULTS: Eight studies were included in the review. Four of these studies used a common C-reactive protein test threshold of 20 mg/L. At this threshold, the estimated pooled sensitivity of C-reactive protein was 0.86 (0.68-0.96) and the pooled specificity was 0.9 (0.83-0.94). Using a hierarchical summary receiver operating characteristic model from six studies, the diagnostic odds ratio for C-reactive protein was estimated to be 39.4 (14.8-104.9) with a positive likelihood ratio 5.3 (2.3-11.9) and a negative likelihood ratio 0.1 (0.07-0.2). There were insufficient studies from this review to statistically evaluate the diagnostic accuracy of procalcitonin. CONCLUSION: Clinicians should continue to measure serum C-reactive protein as the preferred inflammatory marker in hospitalized children and adolescents with suspected osteomyelitis or septic arthritis. More evidence is needed before incorporating procalcitonin routinely into clinicians' diagnostic test strategy. Improvements with the design, quality, and reporting of procalcitonin diagnostic test assays in children and adolescents with osteoarticular infection is needed. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019140276.

Mapping Clinical Barriers and Evidence-Based Implementation Strategies in Low-to-Middle Income Countries (LMICs).

BACKGROUND: Low-to-middle income countries (LMICs) experience a high burden of disease from both non-communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice. AIM: To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies. METHODS: A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6-month, multi-phase, intensive evidence-based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy. RESULTS: A total of 60 implementation projects reporting 58 evidence-based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process-related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence-based practice; most strategies were categorized as educational meetings for healthcare workers. LINKING EVIDENCE TO ACTION: Context-specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low-cost resources. Education for healthcare workers in LMICs is an effective awareness-raising, workplace culture, and practice-transforming strategy for evidence implementation.

The "quality" of JBI qualitative research synthesis: a methodological investigation into the adherence of meta-aggregative systematic reviews to reporting standards and methodological guidance.

INTRODUCTION: Approaches to the synthesis of qualitative research have existed for more than 20 years and have evolved significantly during that time. One common approach is meta-aggregation, as advocated by JBI. There is now a considerable number of published reviews that claim to follow the JBI approach to meta-aggregation. This methodological review sought to determine the extent to which a selection of these reviews follow the available guidance, with a view to establishing compliance and identifying potential areas for improvement. METHODS: The JBI Database of Systematic Reviews and Implementation Reports (JBISRIR) was searched from 2015 to 2017 to identify all qualitative systematic reviews following the JBI approach. Citations were screened by two independent reviewers, and data extraction was conducted independently by at least two reviewers. Eligible reviews were then assessed against the JBI methodological guidance and ENTREQ statement to determine compliance. RESULTS: From the search, 33 health care-related reviews that met the inclusion criteria were identified. Several areas were identified where reviewers consistently made errors or did not clearly report their findings, including study screening and selection issues (particularly how this was done and by whom), transparent rationale for study exclusion, who performed data extraction and how, processes for developing synthesized findings, and the development and presentation of recommendations. CONCLUSION: Although qualitative synthesis has come a long way, there are still some areas for improvement in conduct and reporting. This has implications for those who develop guidance and provide education to systematic reviewers.

Effect of preoperative nutritional supplementation on postoperative outcomes for patients undergoing pancreaticoduodenectomy for cancer: a systematic review protocol.

OBJECTIVE: This review aims to present the best available evidence related to the effect of preoperative nutritional supplementation on postoperative outcomes for patients undergoing pancreaticoduodenectomy for cancer. INTRODUCTION: Pancreaticoduodenectomy surgery is the only curative option for early head of pancreas and periampullary cancers. This complex, high-risk procedure is associated with significant morbidity, making opportunities to improve outcomes paramount. Nutritional supplementation in the preoperative period may enhance the body's ability to withstand the stress of major surgery and reduce postoperative complications. INCLUSION CRITERIA: This review will consider studies of patients undergoing pancreaticoduodenectomy for cancer who are provided preoperative nutritional supplementation in any form for a minimum of 48 hours. Randomized and quasi-randomized trials that compare any form of preoperative nutritional supplementation to standard care in these patients will be included. Outcome data will include hospital length of stay, mortality, infections, delayed gastric emptying, pancreatic fistula, anastomotic leak, hemorrhage, weight loss, body mass index, serum albumin, lymphocyte levels, and nutrition risk index score. METHODS: Electronic databases (PubMed, Scopus, CINAHL, and Cochrane Library) and trial registers will be searched for published and unpublished articles. All articles from database inception to present, published in any language will be included. One reviewer will perform the literature search, screen texts for inclusion, and extract data. Two authors will assess methodological quality of the literature using the JBI critical appraisal tool. Authors will be contacted where additional data or clarification is required. Statistical meta-analysis through synthesis and pooling of data for each intervention will be completed where meaningful. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020215307.

Guidelines rarely used GRADE and applied methods inconsistently: A methodological study of Australian guidelines.

OBJECTIVES: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach is accepted methodology to assess the certainty of the evidence included in systematic reviews and clinical practice guidelines. The GRADE approach is endorsed globally, in Australia, the National Health and Medical Research Council advocated for the use of the GRADE approach in 2011. The purpose of this methodological review was to assess how GRADE has been adopted for Australian practice guidelines. STUDY DESIGN AND SETTING: This methodological review searched of the National Health and Medical Research Council Clinical Practice Guidelines Portal from 2011 to 2018, in an effort to retrieve all practice guidelines available via this medium. RESULTS: 240 guidelines were retrieved authored by 51 different organizations. 15 guidelines followed GRADE methodology. Application of GRADE methods varied between guidelines, some misreported and altered aspects of the GRADE process. Guidelines that closely adhered to the guidance from the GRADE Working Group scored higher in domain 3 (rigor of development) of the Appraisal of Guidelines for Research and Evaluation II tool, indicating a positive linear relationship between GRADE adherence and rigor of development scores. CONCLUSION: The results of our project suggest that the use of GRADE in Australian guidelines is increasing, however, strategies to increase uptake and reporting within the guideline community need to be explored.

Patient, parent/carer, and health care professional experience of medication adherence in children and adolescents with asthma: a qualitative systematic review protocol.

OBJECTIVE: This systematic review aims to identify and synthesize available qualitative evidence related to patient, parent/carer, and health care professional experiences of medication adherence in children and adolescents with asthma. INTRODUCTION: Poor medication adherence is a common cause of treatment failure in children with asthma. Research into promoting treatment adherence has found that the most effective interventions are complex. In a child with asthma, the child, the parents/carers, and the health care professional all have important roles in adhering to medication regimens. This review aims to explore the experiences of the patient, parent/carer, and health care professional in managing a child's asthma. INCLUSION CRITERIA: This review will consider children and adolescents between the ages of three and 19 years with asthma, as well as the parent/carer and health care professionals who care for a child with asthma. Qualitative studies exploring the experiences of adherence or nonadherence to asthma medication will be included. METHODS: A three-stage search will be conducted and will include published and gray literature. Databases to be searched include CINAHL, Embase, PubMed, PyscINFO, Scopus, and Web of Science. Only studies published in English will be considered, with no date limitation. Identified studies will be screened for inclusion by two independent reviewers. Data will be extracted using a standardized tool, and reviewers will discuss any disagreement. Data synthesis will adhere to the meta-aggregative approach to categorize findings. The categories will be synthesized into a set of findings that can be applied as evidence-based practice.