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This paper describes a model developed by an interdisciplinary team of research and public engagement specialists, with backgrounds in health and social care research, higher education, evidence-based practice, leadership, commissioning research and public involvement and engagement. The model we propose combines evidence-based practice, evidence-based research, public involvement and needs led research. Our aim is to capitalise on the joining of the rationale and methods for these approaches, which have all been highlighted as important, but for which there has been a lack of models for integration. Our ambition is to argue for and show an effective and evidence-based way of working that bridges health and social care needs identification, evidence-based practice and research., Plain English Summary This paper describes a model that combines different concepts in healthcare research that the authors suggest belong together. The concepts are; Evidence Based Practice, where healthcare is based on the best research evidence, Evidence Based Research, where new research is developed in the context of what research already exists, public involvement in research, where service users, carers and health and social care professionals engage with research, and Needs Led Research, where new research addresses the needs of people that use healthcare services. Combining these important approaches in our model is new and we argue for and show a way of working that ‘builds bridges’ between health and social care needs, healthcare practice and research. The Bridge Building Model has been developed by a team of research and public involvement specialists, with a variety of backgrounds in health and social care research. These include education, healthcare leadership using evidence in healthcare and research funding.

Background Several studies have documented the production of wasteful research, defined as research of no scientific importance and/or not meeting societal needs. We argue that this redundancy in research may to a large degree be due to the lack of a systematic evaluation of the best available evidence and/or of studies assessing societal needs. Objectives The aim of this scoping review is to (A) identify meta-research studies evaluating if redundancy is present within biomedical research, and if so, assessing the prevalence of such redundancy, and (B) to identify meta-research studies evaluating if researchers had been trying to minimise or avoid redundancy. Eligibility criteria Meta-research studies (empirical studies) were eligible if they evaluated whether redundancy was present and to what degree; whether health researchers referred to all earlier similar studies when justifying and designing a new study and/or when placing new results in the context of earlier similar trials; and whether health researchers systematically and transparently considered end users’ perspectives when justifying and designing a new study. Sources of evidence The initial overall search was conducted in MEDLINE, Embase via Ovid, CINAHL, Web of Science, Social Sciences Citation Index, Arts & Humanities Citation Index, and the Cochrane Methodology Register from inception to June 2015. A 2nd search included MEDLINE and Embase via Ovid and covered January 2015 to 26 May 2021. No publication date or language restrictions were applied. Charting methods Charting methods included description of the included studies, bibliometric mapping, and presentation of possible research gaps in the identified meta-research. Results We identified 69 meta-research studies. Thirty-four (49%) of these evaluated the prevalence of redundancy and 42 (61%) studies evaluated the prevalence of a systematic and transparent use of earlier similar studies when justifying and designing new studies, and/or when placing new results in context, with seven (10%) studies addressing both aspects. Only one (1%) study assessed if the perspectives of end users had been used to inform the justification and design of a new study. Among the included meta-research studies evaluating whether redundancy was present, only two of nine health domains (medical areas) and only two of 10 research topics (different methodological types) were represented. Similarly, among the included meta-research studies evaluating whether researchers had been trying to minimise or avoid redundancy, only one of nine health domains and only one of 10 research topics were represented. Conclusions that relate to the review questions and objectives Even with 69 included meta-research studies, there was a lack of information for most health domains and research topics. However, as most included studies were evaluating across different domains, there is a clear indication of a high prevalence of redundancy and a low prevalence of trying to minimise or avoid redundancy. In addition, only one meta-research study evaluated whether the perspectives of end users were used to inform the justification and design of a new study. Systematic review registration Protocol registered at Open Science Framework: https://osf.io/3rdua/ (15 June 2021).

Contains fulltext : 225443.pdf (Publisher’s version ) (Open Access) This paper is the initial Position Statement of Evidence Synthesis International, a new partnership of organizations that produce, support and use evidence synthesis around the world. The paper (i) argues for the importance of synthesis as a research exercise to clarify what is known from research evidence to inform policy, practice and personal decision making; (ii) discusses core issues for research synthesis such as the role of research evidence in decision making, the role of perspectives, participation and democracy in research and synthesis as a core component of evidence ecosystems; (iii) argues for 9 core principles for ESI on the nature and role of research synthesis; and (iv) lists the 5 main goals of ESI as a coordinating partnership for promoting and enabling the production and use of research synthesis.

Whether university teaching on campus with infection control measures in place is associated with higher risk of COVID-19 than online instruction, is unknown. We will assess this by conducting repeated surveys among students at universities and university colleges in Norway, where some instruction is given in-person, and some is provided online (hybrid model). We will ask about the students’ COVID-19 status, and how much in-person and online instruction they are getting. We will estimate the association between in-person instruction and COVID-19-risk using multivariate regression, controlling for likely confounders. We will also assess whether type of instruction is associated with how satisfied the students are with the instruction, their quality of life, and learning outcomes.

Health claims in the media: part of the problem Healthcare students and professionals, as well as patients and everyone else, are exposed to countless health claims—particularly claims about the effects of interventions—spreading further and faster than ever, via the Internet. Many of the claims are unreliable, such as those that conflate correlation and causation.1 2 Meanwhile, many people are unable to critically assess their reliability. For example, here in Norway, a survey conducted in 2019 among a representative sample of the population—including healthcare professionals—indicated that a majority of Norwegians are unable to apply several fundamental concepts for assessing health claims and making informed health choices, such as the importance of similar comparison groups for finding intervention effects (149 of 771 participants were able).3 The combination of unreliable claims and inability to critically assess those claims can lead to uninformed choices (including shared decisions) and be a barrier to evidence-based healthcare (EBHC). Logically, this is a major explanatory factor in the known, worldwide overuse of ineffective and harmful medical services4 and underuse of effective services.4 5 ### Part of the solution? However, can the abundance of health claims in the media also be a resource for teaching EBHC? News stories, social media posts and advertisements are simple, familiar, relatable and entertaining, by design, as opposed to scientific literature, which typically includes jargon and excludes narrative. Therefore, health claims in the media may be an appropriate place to start for inexperienced students in the health sciences, as well as other non-professionals, when learning how to think critically about health information. In this article, we describe the development and large-scale implementation of an educational intervention that systematically takes advantage of health claims in the media to help university students learn how to apply Informed Health Choices (IHC) Key Concepts.6 These concepts are as essential for making informed personal health choices, as for …

BackgroundAfter lock-down during the first wave of the COVID-19 pandemic, higher education institutions globally struggled to balance the need for infection control and educational requirements as they prepared to reopen. A particularly difficult choice was whether to offer for in-person or online teaching, since there was little or no empirical research to inform this decision. Norwegian universities and university colleges opted for a hybrid model when they reopened for the autumn semester, with some students offered more in-person teaching than others. This gave us an opportunity to study the association between different teaching modalities and COVID-19 risk, quality of life (subjective well-being), and teaching satisfaction.MethodsWe conducted a prospective, observational cohort study among students in higher education institutions in Norway. Participants were surveyed biweekly from September to December in 2020.Findings26 754 students from 14 higher education institutions provided data to our analyses. Our best estimate for the association between two weeks of in-person teaching and COVID-19 risk was −22% (95% CI −77% to 33%), compared to online teaching. Quality of life was positively associated with in-person teaching (3% relative risk difference; 95% CI 2% to 4%), as was teaching satisfaction (10%; 95% CI 8% to 11%).InterpretationThe association between COVID-19 infection and teaching modality was highly uncertain. Shifting from in-person to online teaching seems to have a negative impact on the well-being of students in higher education.FundingNone.

Objective To evaluate the state of quality of care for osteoarthritis (OA) by summarizing studies that have assessed the care provided to patients. Methods A systematic review of community-based observational studies of actual clinical practice treating people with OA compared with quality indicators (QIs) was performed. Four databases were searched from January 2000 to November 2015. Two reviewers independently determined study eligibility, assessed risk of bias, and extracted study data. The outcome was adherence to the QIs (pass rate). The overall pass rate (the total number of indicators passed divided by the total number of indicators for which the patients were eligible) was extracted from each study. When at least 50% of the studies had comparable individual QIs, the data were pooled with proportion meta-analyses. Results Fifteen studies comprising 16,103 patients were included, and the median overall pass rate across studies was 41% (range 22-65%). The pooled pass rates for individual QIs were "referral to orthopedic surgeon if no response to other therapy": 59.4% (95% confidence interval [95% CI] 47.5-70.3); "paracetamol or acetaminophen first drug used": 46.0% (95% CI 26.6-66.7); "assessed for pain and/or function": 45.5% (95% CI 33.9-57.6); "referral or recommendation to exercise": 38.7% (28.9-49.5); "offered education and self-management": 35.4% (95% CI 27.8-44.0); and "informed about potential risks if NSAIDs prescribed": 34.1% (95% CI 24.7-44.9). Conclusion There is room for improvement in community-based OA care.

BACKGROUND Clinical practice patterns greatly diverge from evidence-based recommendations to manage knee osteoarthritis conservatively before resorting to surgery. OBJECTIVE This study aimed to tailor a guideline-based computerized decision support (CDS) intervention that facilitates the conservative management of knee osteoarthritis. METHODS Experts with backgrounds in clinical medicine, research, implementation, or health informatics suggested the most important recommendations for implementation, how to develop an implementation strategy, and how to form the CDS algorithms. In 6 focus group sessions, 8 general practitioners and 22 patients from Norway, Belgium, and Finland discussed the suggested CDS intervention and identified factors that would be most critical for the success of the intervention. The focus group moderators used the GUideline Implementation with DEcision Support checklist, which we developed to support consideration of CDS success factors. RESULTS The experts prioritized 9 out of 22 recommendations for implementation. We formed the concept for 6 CDS algorithms to support implementation of these recommendations. The focus group suggested 59 unique factors that could affect the success of the presented CDS intervention. Five factors (out of the 59) were prioritized by focus group participants in every country, including the perceived potential to address the information needs of both patients and general practitioners; the credibility of CDS information; the timing of CDS for patients; and the need for personal dialogue about CDS between the general practitioner and the patient. CONCLUSIONS The focus group participants supported the CDS intervention as a tool to improve the quality of care for patients with knee osteoarthritis through shared, evidence-based decision making. We aim to develop and implement the CDS based on these study results. Future research should address optimal ways to (1) provide patient-directed CDS, (2) enable more patient-specific CDS within the context of patient complexity, and (3) maintain user engagement with CDS over time.

BACKGROUND: Clinical practice patterns greatly diverge from evidence-based recommendations to manage knee osteoarthritis conservatively before resorting to surgery. OBJECTIVE: This study aimed to tailor a guideline-based computerized decision support (CDS) intervention that facilitates the conservative management of knee osteoarthritis. METHODS: Experts with backgrounds in clinical medicine, research, implementation, or health informatics suggested the most important recommendations for implementation, how to develop an implementation strategy, and how to form the CDS algorithms. In 6 focus group sessions, 8 general practitioners and 22 patients from Norway, Belgium, and Finland discussed the suggested CDS intervention and identified factors that would be most critical for the success of the intervention. The focus group moderators used the GUideline Implementation with DEcision Support checklist, which we developed to support consideration of CDS success factors. RESULTS: The experts prioritized 9 out of 22 recommendations for implementation. We formed the concept for 6 CDS algorithms to support implementation of these recommendations. The focus group suggested 59 unique factors that could affect the success of the presented CDS intervention. Five factors (out of the 59) were prioritized by focus group participants in every country, including the perceived potential to address the information needs of both patients and general practitioners; the credibility of CDS information; the timing of CDS for patients; and the need for personal dialogue about CDS between the general practitioner and the patient. CONCLUSIONS: The focus group participants supported the CDS intervention as a tool to improve the quality of care for patients with knee osteoarthritis through shared, evidence-based decision making. We aim to develop and implement the CDS based on these study results. Future research should address optimal ways to (1) provide patient-directed CDS, (2) enable more patient-specific CDS within the context of patient complexity, and (3) maintain user engagement with CDS over time. ispartof: JMIR RESEARCH PROTOCOLS vol:7 issue:6 ispartof: location:Canada status: published

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the effects of physical exercise interventions on behavioural and cognitive symptoms, and on family functioning, in children and adolescents diagnosed with ODD or CD.

Accepted author manuscript version (post-print). Background Simulation-based training is a widespread strategy to improve health-care quality. However, its effect on registered nurses has previously not been established in systematic reviews. The aim of this systematic review is to evaluate effect of simulation-based training on nurses' skills and knowledge. Methods We searched CDSR, DARE, HTA, CENTRAL, CINAHL, MEDLINE, Embase, ERIC, and SveMed + for randomised controlled trials (RCT) evaluating effect of simulation-based training among nurses. Searches were completed in December 2016. Two reviewers independently screened abstracts and full-text, extracted data, and assessed risk of bias. We compared simulation-based training to other learning strategies, high-fidelity simulation to other simulation strategies, and different organisation of simulation training. Data were analysed through meta-analysis and narrative syntheses. GRADE was used to assess the quality of evidence. Results Fifteen RCTs met the inclusion criteria. For the comparison of simulation-based training to other learning strategies on nurses' skills, six studies in the meta-analysis showed a significant, but small effect in favour of simulation (SMD − 1.09, CI − 1.72 to − 0.47). There was large heterogeneity (I2 85%). For the other comparisons, there was large between-study variation in results. The quality of evidence for all comparisons was graded as low. Conclusion The effect of simulation-based training varies substantially between studies. Our meta-analysis showed a significant effect of simulation training compared to other learning strategies, but the quality of evidence was low indicating uncertainty. Other comparisons showed inconsistency in results. Based on our findings simulation training appears to be an effective strategy to improve nurses' skills, but further good-quality RCTs with adequate sample sizes are needed.

Despite large investments during past decades in health-care research, evidence synthesis, and clinical practice guidelines, too much research is wasted and too many decisions are still not well informed. Why is this, and what can we do about it? The following four conditions must be met. First, relevant and reliable health-care research must exist and be disseminated. Often research is lacking— eg, there is no substantial research for between 2% and 53% (median 19%) of treatments off ered to patients (summarised in the appendix). At the same time, resources are used on unnecessary research, which does not address the right questions, nor use the right methods or provide suffi cient description of interventions. Research is sometimes also inapplicable because it does not address multimorbidity. Second, decision makers and patients must have access to reliable and relevant evidence synthesis. The over whelming volume of primary clinical research and the temptation to rely on single studies makes systematic reviews and health technology assessments (HTAs) prerequisites for well informed decisions (appendix). Epistemonikos, a database of all systematic reviews, contains more than 58 000 reviews, and although some independent replication of synthesis might be useful there are unnecessary duplications. As many as 11 meta-analyses for statins in the prevention of atrial fi brillation after cardiac surgery including almost the same primary studies have been published, and several HTAs were produced across Europe when human papillomavirus vaccination was introduced. At the same time, reviews addressing important questions are missing, and reviews are misleading because they are not updated when new trials are published. Access to reliable knowledge is often restricted for economic reasons. Third, patients, clinicians, and policy makers must be encouraged to ask for and use evidence synthesis. On average, clinicians have one question for every two patients they see, pursue only half of those questions, and fi nd answers to about 80%. Despite improved availability of online resources, this situation has changed little in the past 20 years. Patients frequently seek health information online. Worldwide, about 4·5% of all internet searches are for health-related information. However, patients’ search and evaluation skills are limited, and relevant and evidence-based health information is often not accessible to patients. Among policy makers, frequently reported barriers to evidence use are scarcity of timely, relevant research and poor access. Fourth, to improve patient outcomes, recommendations and decisions must be put into action and be implemented in policy and practice. Studies of the implementation of evidence-based recommendations indicate large gaps between the care that patients should receive and the care they do receive. Medical practice in Organisation for Economic Co-operation and Development countries varies widely across regions, hospitals, and physicians for almost every disorder. This situation indicates that many patients do not receive optimum care. Production of trustworthy guidelines is not in itself a solution. Health decisions are complex and many eff orts are needed to ensure that they are well informed. Clinicians and patients need to develop attitudes and skills to use evidence synthesis and resources for shared decision making. However, although indiv iduals, patients, and clinicians can address some barriers to well informed decisions, collective action is needed in many, if not most, cases. This statement is particularly true for low-income and middle-income settings where fi nancial barriers restrict people’s access to eff ective health care. Many stakeholders have responsibilities and they are accountable for a range of groups (appendix). Researchers and research organisations are responsible for using systematic reviews to inform their research, only doing research that is relevant, reliable, and needed, engaging stakeholders (including patients and health professionals) in their research, publishing all studies, and contributing to systematic reviews, HTAs, and guidelines production. They are accountable to patients, research participants, research funders, and peers for their use of resources and the quality of their research. Systematic review authors and editors, HTA agencies, and guideline developers are responsible for producing relevant, reliable, transparent, and up-to-date evidence synthesis and recommendations, avoiding unnecessary duplication, making their work accessible to decision makers, and engaging stakeholders. The academic community and journal editors must acknowledge the importance of evidence synthesis and open access. They are accountable to their funders and decision makers who use their products. Health-care professionals and managers are responsible for seeking reliable information and learning suffi cient skills to use evidence-based resources appropriately to provide optimum patient care, and to participate in research and guideline development. They are accountable to their patients, governments, and third party payers (as public representatives) for their use of health-care resources. Lancet 2015; 386: 826–28

Background: The geriatric nursing home population is frail and vulnerable to sudden changes in their health condition. Very often, these incidents lead to hospitalization, in which many cases represent an unfavourable discontinuity of care. Analysis of variation in hospitalization rates among nursing homes where similar rates are expected may identify factors associated with unwarranted variation. Objectives: To 1) quantify the overall and diagnosis specific variation in hospitalization rates among nursing homes in a well-defined area over a two-year period, and 2) estimate the associations between the hospitalization rates and characteristics of the nursing homes. Method: The acute hospital admissions from 38 nursing homes to two hospitals were identified through ambulance records and linked to hospital patient journals ( n = 2451). Overall variation in hospitalization rates for 2 consecutive years was tested using chi-square and diagnosis-specific variation using Systematic Component of Variation. Associations between rates and nursing home characteristics were tested using multiple regression and ANOVA. Results: Annual hospitalization rates varied significantly between 0.16 and 1.49 per nursing home. Diagnoses at discharge varied significantly between the nursing homes. The annual hospitalization rates correlated significantly with size ( r = −0.38) and percentage short-term beds ( r = 0.41), explaining 32% of the variation observed ( R2 = 0.319). No association was found for ownership status ( r = 0.05) or location of the nursing home ( p = 0.52). Conclusion: A more than nine-fold variation in annual hospitalization rates among the nursing homes in one municipality suggests the presence of unwarranted variation. This finding demands for political action to improve the premises for a more uniform practice in nursing homes.

To avoid waste of research, no new studies should be done without a systematic review of existing evidence, argue Hans Lund and colleagues

Background and Purpose. Patients with knee osteoarthritis (OA) are commonly treated by physiotherapists in primary care. The physiotherapists use different treatment modalities. In a previous study, we identified variation in the use of transcutaneous electrical nerve stimulation (TENS), low level laser or acupuncture, massage and weight reduction advice for patients with knee OA. The purpose of this study was to examine factors that might explain variation in treatment modalities for patients with knee OA. Methods. Practising physiotherapists prospectively collected data for one patient with knee osteoarthritis each through 12 treatment sessions.We chose to examine factors that might explain variation in the choice of treatment modalities supported by high or moderate quality evidence, and modalities which were frequently used but which were not supported by evidence from systematic reviews. Experienced clinicians proposed factors that they thought might explain the variation in the choice of these specific treatments. We used these factors in explanatory analyses. Results. Using TENS, low level laser or acupuncture was significantly associated with having searched databases to help answer clinical questions in the last six months (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.08–3.42). Not having Internet access at work and using more than four treatment modalities were significant determinants for giving massage (OR = 0.36, 95% CI = 0.19–0.68 and OR = 8.92, 95% CI = 4.37–18.21, respectively). Being a female therapist significantly increased the odds for providing weight reduction advice (OR = 3.60, 95% CI = 1.12–11.57). No patient characteristics, such as age, pain or co-morbidity, were significantly associated with variation in practice. Conclusions. Factors related to patient characteristics, such as pain severity and co-morbidity, did not seem to explain variation in treatment modalities for patients with knee OA. Variation was associated with the following factors: physiotherapists having Internet access at work, physiotherapists having searched databases for the last six months and the gender of the therapist. There is a need for more studies of determinants for physiotherapy practice. Copyright © 2009 John Wiley & Sons, Ltd.

Patients with osteoarthritis of the knee are commonly treated by physical therapists. Practice should be informed by updated evidence from systematic reviews. The purpose of this article is to summarize the evidence from systematic reviews on the effectiveness of physical therapy for patients with knee osteoarthritis. Systematic reviews published between 2000 and 2007 were identified by a comprehensive literature search. We graded the quality of evidence across reviews for each comparison and outcome. Twenty-three systematic reviews on physical therapy interventions for patients with knee osteoarthritis were included. There is high-quality evidence that exercise and weight reduction reduce pain and improve physical function in patients with osteoarthritis of the knee. There is moderate-quality evidence that acupuncture, transcutaneous electrical nerve stimulation, and low-level laser therapy reduce pain and that psychoeducational interventions improve psychological outcomes. For other interventions and outcomes, the quality of evidence is low or there is no evidence from systematic reviews.

To evaluate the state of quality of care for osteoarthritis (OA) by summarizing studies that have assessed the care provided to patients.A systematic review of community-based observational studies of actual clinical practice treating people with OA compared with quality indicators (QIs) was performed. Four databases were searched from January 2000 to November 2015. Two reviewers independently determined study eligibility, assessed risk of bias, and extracted study data. The outcome was adherence to the QIs (pass rate). The overall pass rate (the total number of indicators passed divided by the total number of indicators for which the patients were eligible) was extracted from each study. When at least 50% of the studies had comparable individual QIs, the data were pooled with proportion meta-analyses.Fifteen studies comprising 16,103 patients were included, and the median overall pass rate across studies was 41% (range 22-65%). The pooled pass rates for individual QIs were "referral to orthopedic surgeon if no response to other therapy": 59.4% (95% confidence interval [95% CI] 47.5-70.3); "paracetamol or acetaminophen first drug used": 46.0% (95% CI 26.6-66.7); "assessed for pain and/or function": 45.5% (95% CI 33.9-57.6); "referral or recommendation to exercise": 38.7% (28.9-49.5); "offered education and self-management": 35.4% (95% CI 27.8-44.0); and "informed about potential risks if NSAIDs prescribed": 34.1% (95% CI 24.7-44.9).There is room for improvement in community-based OA care.

Background: Many people advocate audit and feedback as a strategy for improving professional practice. The main results of an update of a Cochrane review on the effects of audit and feedback are reported. Data sources: The Cochrane Effective Practice and Organisation of Care Group’s register up to January 2004 was searched. Randomised trials of audit and feedback that reported objectively measured professional practice in a healthcare setting or healthcare outcomes were included. Review methods: Data were independently extracted and the quality of studies were assessed by two reviewers. Quantitative, visual and qualitative analyses were undertaken. Main results: 118 trials are included in the review. In the primary analysis, 88 comparisons from 72 studies were included that compared any intervention in which audit and feedback was a component to no intervention. For dichotomous outcomes, the median-adjusted risk difference of compliance with desired practice was 5% (interquartile range 3–11). For continuous outcomes, the median-adjusted percentage change relative to control was 16% (interquartile range 5–37). Low baseline compliance with recommended practice and higher intensity of audit and feedback appeared to predict the effectiveness of audit and feedback. Conclusions: Audit and feedback can be effective in improving professional practice. The effects are generally small to moderate. The absolute effects of audit and feedback are likely to be larger when baseline adherence to recommended practice is low and intensity of audit and feedback is high.

STUDY DESIGN: A systematic review within the Cochrane Collaboration Back Review Group. OBJECTIVES: To report the main results from the updated version of the Cochrane Review on bed rest for low back pain. SUMMARY OF BACKGROUND DATA: There has been a growing amount of evidence showing that bed rest is not beneficial for people with low back pain. However, existing systematic reviews are unclear regarding the effects of bed rest for different types of low back pain. METHODS: All randomized studies available in systematic searches up to March 2003 were included. Two reviewers independently selected trials for inclusion assessed the validity of included trials and extracted data. Investigators were contacted to obtain missing information. RESULTS: Two new trials comparing advice to rest in bed with advice to stay active were included. There is high quality evidence that people with acute low back pain who are advised to rest in bed have a little more pain (standardized mean difference 0.22, 95% confidence interval: 0.02-0.41) and a little less functional recovery (standardized mean difference 0.29, 95% confidence interval: 0.05-0.45) than those advised to stay active. For patients with sciatica, there is moderate quality evidence of little or no difference in pain (standardized mean difference -0.03, 95% confidence interval: -0.24-0.18) or functional status (standardized mean difference 0.19, 95% confidence interval: -0.02-0.41) between bed rest and staying active. CONCLUSION: For people with acute low back pain, advice to rest in bed is less effective than advice to stay active. For patients with sciatica, there is little or no difference between advice to rest in bed and advice to stay active.

Study design A systematic review was conducted within the Cochrane Collaboration Back Review Group. Objectives To assess the effects of advice to stay active as a single treatment for patients with acute low back pain or sciatica. Summary of background data Low back pain is a common reason for consulting a health care provider, and advice on daily activities constitutes an important part in the primary care management of low back pain. Methods All randomized studies available in systematic searches (electronic databases, contact with authors, reference lists) were included. Two reviewers independently selected trials for inclusion, assessed the validity of the included trials, and extracted data. Investigators were contacted to obtain missing information. Results Four trials, with a total of 491 patients, were included. In all the trials, advice to stay active was compared with advice for bed rest. Two trials were assessed as having a low risk of bias, and two as having a moderate to high risk of bias. The results were heterogeneous. The results from one high-quality trial of patients with acute, simple low back pain found small differences in functional status (weighted mean difference on a 0 to 100 scale, 6.0; 95% CI, 1.5-10.5) and length of sick leave (weighted mean difference, 3.4 days; 95% CI, 1.6-5.2) in favor of staying active, as compared with advice to stay in bed 2 days. The other high-quality trial compared advice to stay active with advice to rest in bed 14 days for patients with sciatic syndrome, and found no differences between the groups. One of the high-quality trials also compared advice to stay active with advice to engage in exercises for patients with acute, simple low back pain, and found improvement in functional status and reduced sick leave in favor of advice to stay active. Conclusion The best available evidence suggests that advice to stay active alone has little beneficial effect for patients with acute, simple low back pain, and little or no effect for patients with sciatica. There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica. Because there is no considerable difference between advice to stay active and advice for bed rest, and there are potential harmful effects of prolonged bed rest, it is reasonable to advise people with acute low back pain and sciatica to stay active. These conclusions are based on single trials.

BACKGROUND This paper extends the findings of the Cochrane systematic review of audit and feedback on professional practice to explore the estimate of effect over time and examine whether new trials have added to knowledge regarding how optimize the effectiveness of audit and feedback. METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for randomized trials of audit and feedback compared to usual care, with objectively measured outcomes assessing compliance with intended professional practice. Two reviewers independently screened articles and abstracted variables related to the intervention, the context, and trial methodology. The median absolute risk difference in compliance with intended professional practice was determined for each study, and adjusted for baseline performance. The effect size across studies was recalculated as studies were added to the cumulative analysis. Meta-regressions were conducted for studies published up to 2002, 2006, and 2010 in which characteristics of the intervention, the recipients, and trial risk of bias were tested as predictors of effect size. RESULTS Of the 140 randomized clinical trials (RCTs) included in the Cochrane review, 98 comparisons from 62 studies met the criteria for inclusion. The cumulative analysis indicated that the effect size became stable in 2003 after 51 comparisons from 30 trials. Cumulative meta-regressions suggested new trials are contributing little further information regarding the impact of common effect modifiers. Feedback appears most effective when: delivered by a supervisor or respected colleague; presented frequently; featuring both specific goals and action-plans; aiming to decrease the targeted behavior; baseline performance is lower; and recipients are non-physicians. DISCUSSION There is substantial evidence that audit and feedback can effectively improve quality of care, but little evidence of progress in the field. There are opportunity costs for patients, providers, and health care systems when investigators test quality improvement interventions that do not build upon, or contribute toward, extant knowledge.

Background: The geriatric nursing home population is vulnerable to acute and deteriorating illness due to advanced age, multiple chronic illnesses and high levels of dependency. Although the detriments of hospitalising the frail and old are widely recognised, hospital admissions from nursing homes remain common. Little is known about what alternatives exist to prevent and reduce hospital admissions from this setting. The objective of this study, therefore, is to summarise the effects of interventions to reduce acute hospitalisations from nursing homes. Methods: A systematic literature search was performed in Cochrane Library, PubMed, MEDLINE, EMBASE and ISI Web of Science in April 2013. Studies were eligible if they had a geriatric nursing home study population and were evaluating any type of intervention aiming at reducing acute hospital admission. Systematic reviews, randomised controlled trials, quasi randomised controlled trials, controlled before-after studies and interrupted time series were eligible study designs. The process of selecting studies, assessing them, extracting data and grading the total evidence was done by two researchers individually, with any disagreement solved by a third. We made use of meta-analyses from included systematic reviews, the remaining synthesis is descriptive. Based on the type of intervention, the included studies were categorised in: 1) Interventions to structure and standardise clinical practice, 2) Geriatric specialist services and 3) Influenza vaccination. Results: Five systematic reviews and five primary studies were included, evaluating a total of 11 different interventions. Fewer hospital admissions were found in four out of seven evaluations of structuring and standardising clinical practice; in both evaluations of geriatric specialist services, and in influenza vaccination of residents. The quality of the evidence for all comparisons was of low or very low quality, using the GRADE approach. Conclusions: Overall, eleven interventions to reduce hospital admissions from nursing homes were identified. None of them were tested more than once and the quality of the evidence was low for every comparison. Still, several interventions had effects on reducing hospital admissions and may represent important aspects of nursing home care to reduce hospital admissions. publishedVersion

Systematiske oversikter er en forutsetning for kunnskapsbaserte beslutninger fordi de gir en samlet oversikt over forskningsstatus for den aktuelle problemstillingen. En systematisk gjennomgang av eksisterende forskning kan generere ny innsikt, identifisere kunnskapshull og vise vei for videre forskning. Fremgangsmåten for å utarbeide en systematisk oversikt kjennetegnes av 1) et klart formål med forhåndsdefinerte kriterier for inklusjon av studier, 2) en eksplisitt, reproduserbar framgangsmåte (metode), 3) en omfattende søkestrategi der målet er å identifisere alle studier som tilfredsstiller inklusjonskriteriene, 4) en vurdering av validiteten til resultatene i inkluderte studier, og 5) en systematisk framstilling og sammenstilling av kjennetegn og resultater fra de inkluderte studiene. Randomiserte kontrollerte studier har en sentral plass i systematiske oversikter om effekt av tiltak, men også andre typer effektforskning kan være aktuelle å inkludere. Nasjonalt kunnskapssenter for helsetjenesten produserer systematiske oversikter til støtte for helsepolitiske beslutninger, nasjonale retningslinjer og kunnskapsbasert praksis. Fremgangsmåten er beskrevet i håndboka ”Slik oppsummerer vi forskning” som er tilgjengelig på Kunnskapssenterets nettside. Kunnskapssenteret bidrar også i det internasjonale arbeidet med å utarbeide systematiske oversikter gjennom publisering i Cochrane- og Campbell-databasene og i vitenskapelige tidsskrift.Jamtvedt G. Systematic reviews on the effect of interventions. Nor J Epidemiol 2013; 23 (2): 119-124.ENGLISH SUMMARY Systematic reviews are a prerequisite for evidence informed decisions because they provide a comprehensive review of what is known on the particular topic in question. By systematically reviewing existing research findings, new insights can be generated, knowledge gaps identified, and directions for future research found. The methods for developing a systematic review are characterised by 1) a clearly stated objective and pre-defined eligibility criteria for studies, 2) the use of explicit, reproducible methods, 3) a systematic search to identify all studies that would meet the eligibility criteria, 4) an assessment of the validity of the findings of the included studies, 5) a systematic presentation and synthesis of the characteristics and findings of the included studies. Randomized controlled trials play a key role in systematic reviews of the effectiveness of interventions, but other types of effectiveness-studies may also be relevant to include. The Norwegian Knowledge Centre for the Health Services produces systematic reviews to support well informed health policy making, clinical practice guidelines-development, and to contribute to evidence-based practices. The methods are described in the handbook ”Slik oppsummerer vi forskning” [“This is how we summarise research”], which is available online. The Knowledge Centre is also engaged in the wider global effort to produce systematic reviews, by preparing Cochrane- and Campbell-reviews, as well as systematic reviews that are published through regular scientific journals.

Bakgrunn: Forskningsresultater kan formidles på ulike måter, både gjennom tall, tekst og kombinasjoner av disse. Utover et effektestimat er det i klinisk forskning også ønskelig å si noe om hvor sikker man er på resultatet, for eksempel ved å oppgi konfidensintervall og gjøre en vurdering av kvaliteten på dokumentasjonen. Vår hensikt med denne undersøkelsen var å få en indikasjon på hvordan våre måter å formidle resultater på, blir oppfattet blant våre lesere.Materiale og metoder: Vi hentet 17 resultatformuleringer fra Kunnskapssenterets rapporter og utførte en nettbasert spørreundersøkelse. Leserne skulle svare på hva de trodde forfatterne forsøkte å formidle. Åpen invitasjon til å delta i undersøkelsen ble sendt som del av Kunnskapssenterets nyhetsbrev til over 3 000 epostmottakere.Resultater: Vi mottok 173 utfylte spørreskjemaer. For samtlige formuleringer var det flertall (mer enn 50 %) for den tolkningen som etter vår vurdering var mest i tråd med forfatternes intensjoner, men andelen varierte fra 54,1 % til 93,4 %.Konklusjon: Respondentenes tolkninger av Kunnskapssenterets resultatformuleringer samsvarte i hovedsak med intensjonene. Variasjonen i tolkning viste imidlertid at vi må fortsette arbeidet med å finne lettfattelige, men likevel tilstrekkelig presise formuleringer.Ringerike T, Glenton C, Vist GE, Jamtvedt G, Nylenna M. Do readers interpret research results in line with the authors' intentions? Nor J Epidemiol 2013; 23 (2): 231-236.ENGLISH SUMMARYBackground: Research results can be communicated in various ways, for instance through numbers, words, and combinations of these. Within clinical research, in addition to presenting the estimate of effect, it is also desirable to say something about our confidence in this result, for example by presenting a confidence interval and making an assessment of the quality of the evidence. The purpose of this study was to assess how the ways in which we communicate results are perceived by our readers.Material and methods: We selected 17 results-statements taken from reports published by the Norwegian Knowledge Centre for the Health Services, and conducted an online survey. Participants were asked to respond to what they thought the writers were trying to convey. An open invitation to participate in the survey was sent with the biweekly newsletter for the Norwegian Knowledge Centre for the Health Services, which is delivered to over 3,000 e-mail recipients.Results: We received 173 completed questionnaires. For all statements, the majority (over 50 %) chose the interpretation that in our assessment was most in line with the authors’ intentions, but the proportion varied from 54.1 % to 93.4 %.Conclusion: Respondents’ interpretations of the Knowledge Centre’s statements of results corresponded largely with the authors’ intentions. The variation in interpretations shows that we must continue to work to find formulations that are easy to understand, yet sufficiently precise.

Background Nursing home residents are prone to acute illness due to their high age, underlying illnesses and immobility. We examined the incidence of acute hospital admissions among nursing home residents versus the age-matched community dwelling population in a geographically defined area during a two years period. The hospital stays of the nursing home population are described according to diagnosis, length of stay and mortality. Similar studies have previously not been reported in Scandinavia. Methods The acute hospitalisations of the nursing home residents were identified through ambulance records. These were linked to hospital patient records for inclusion of demographics, diagnosis at discharge, length of stay and mortality. Incidence of hospitalisation was calculated based on patient-time at risk. Results The annual hospital admission incidence was 0.62 admissions per person-year among the nursing home residents and 0.26 among the community dwellers. In the nursing home population we found that dominant diagnoses were respiratory diseases, falls-related and circulatory diseases, accounting for 55% of the cases. The median length of stay was 3 days (interquartile range = 4). The in-hospital mortality rate was 16% and 30 day mortality after discharge 30%. Conclusion Acute hospital admission rate among nursing home residents was high in this Scandinavian setting. The pattern of diagnoses causing the admissions appears to be consistent with previous research. The in-hospital and 30 day mortality rates are high.