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BackgroundThe successful integration of artificial intelligence (AI) into clinical practice is contingent upon physicians’ comprehension of AI principles and its applications. Therefore, it is essential for medical education curricula to incorporate AI topics and concepts, providing future physicians with the foundational knowledge and skills needed. However, there is a knowledge gap in the current understanding and availability of structured AI curriculum frameworks tailored for medical education, which serve as vital guides for instructing and facilitating the learning process. ObjectiveThe overall aim of this study is to synthesize knowledge from the literature on curriculum frameworks and current educational programs that focus on the teaching and learning of AI for medical students, residents, and practicing physicians. MethodsWe followed a validated framework and the Joanna Briggs Institute methodological guidance for scoping reviews. An information specialist performed a comprehensive search from 2000 to May 2023 in the following bibliographic databases: MEDLINE (Ovid), Embase (Ovid), CENTRAL (Cochrane Library), CINAHL (EBSCOhost), and Scopus as well as the gray literature. Papers were limited to English and French languages. This review included papers that describe curriculum frameworks for teaching and learning AI in medicine, irrespective of country. All types of papers and study designs were included, except conference abstracts and protocols. Two reviewers independently screened the titles and abstracts, read the full texts, and extracted data using a validated data extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. We adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist for reporting the results. ResultsOf the 5104 papers screened, 21 papers relevant to our eligibility criteria were identified. In total, 90% (19/21) of the papers altogether described 30 current or previously offered educational programs, and 10% (2/21) of the papers described elements of a curriculum framework. One framework describes a general approach to integrating AI curricula throughout the medical learning continuum and another describes a core curriculum for AI in ophthalmology. No papers described a theory, pedagogy, or framework that guided the educational programs. ConclusionsThis review synthesizes recent advancements in AI curriculum frameworks and educational programs within the domain of medical education. To build on this foundation, future researchers are encouraged to engage in a multidisciplinary approach to curriculum redesign. In addition, it is encouraged to initiate dialogues on the integration of AI into medical curriculum planning and to investigate the development, deployment, and appraisal of these innovative educational programs. International Registered Report Identifier (IRRID)RR2-10.11124/JBIES-22-00374

Abstract Background Refugees, asylum seekers, and migrants without status experience precarious living and working conditions that disproportionately expose them to coronavirus disease 2019 (COVID-19). In the two most populous Canadian provinces (Quebec and Ontario), to reduce the vulnerability factors experienced by the most marginalized migrants, the public and community sectors engage in joint coordination efforts called intersectoral collaboration. This collaboration ensures holistic care provisioning, inclusive of psychosocial support, assistance to address food security, and educational and employment assistance. This research project explores how community and public sectors collaborated on intersectoral initiatives during the COVID-19 pandemic to support refugees, asylum seekers, and migrants without status in the cities of Montreal, Sherbrooke, and Toronto, and generates lessons for a sustainable response to the heterogeneous needs of these migrants. Methods This theory-informed participatory research is co-created with socioculturally diverse research partners (refugees, asylum seekers and migrants without status, employees of community organizations, and employees of public organizations). We will utilize Mirzoev and Kane’s framework on health systems’ responsiveness to guide the four phases of a qualitative multiple case study (a case being an intersectoral initiative). These phases will include (1) building an inventory of intersectoral initiatives developed during the pandemic, (2) organizing a deliberative workshop with representatives of the study population, community, and public sector respondents to select and validate the intersectoral initiatives, (3) interviews (n = 80) with community and public sector frontline workers and managers, municipal/regional/provincial policymakers, and employees of philanthropic foundations, and (4) focus groups (n = 80) with refugees, asylum seekers, and migrants without status. Qualitative data will be analyzed using thematic analysis. The findings will be used to develop discussion forums to spur cross-learning among service providers. Discussion This research will highlight the experiences of community and public organizations in their ability to offer responsive services for refugees, asylum seekers, and migrants without status in the context of a pandemic. We will draw lessons learnt from the promising practices developed in the context of COVID-19, to improve services beyond times of crisis. Lastly, we will reflect upon our participatory approach—particularly in relation to the engagement of refugees and asylum seekers in the governance of our research.

Background: People with concurrent mental health and substance use disorders have complex biopsychosocial problems but risk not having their healthcare needs met. Nurses are positioned to meet these needs but often lack training in concurrent disorder management. Extension for Community Healthcare Outcomes (ECHO®, University of New Mexico Health Sciences Center, 2003) is a promising technology-enabled collaborative learning model used to implement evidence-based practice and build capacity among healthcare professionals in managing complex, chronic, health conditions. Objective: To understand how an ECHO program for concurrent disorder management impacts nurses’ competency development and clinical practice and uncover key conditions for successful uptake and implementation. Design: A convergent mixed-methods design comprising a quantitative, uncontrolled before-and-after study and a qualitative study using interpretive description methodology. Setting and participants: An ECHO program for concurrent disorder management was implemented in 2018 at a quaternary academic hospital centre in metropolitan Western Canada. All 65 nurses who registered in the program between 2018 and 2020 were invited to participate in the study. Methods: Online surveys completed by the participating nurses (N = 28) were administered at baseline and six and 12 months following entry-to-program to measure changes in nurse-related outcomes. The survey data were analyzed using descriptive statistics and repeated measures analysis. Semi-structured interviews were conducted with a nurse subgroup (n = 10) to explore how they developed and implemented competencies and what factors influenced this process. Interview transcripts were analyzed using inductive thematic analysis. Using the Pillar Integration Process, we analyzed results from both methods to provide a richer understanding of the phenomena. Results: We identified six interrelated key conditions for successful uptake and implementation of evidence-based practice in concurrent disorder nursing care with ECHO: (1) Practice and validation opportunities; (2) Reciprocal and trusting relationships in an interprofessional education context; (3) Peer-to-peer experience sharing; (4) Collaboration with experts; (5) Reinforcement of positive attitudes towards one's professional role; and (6) Organizational support. Conclusions: Outcome measures, perspectives, and experiences collected over 12 months indicated that ECHO contributed to nurses’ competency development and, under some conditions, to effective nursing practice changes. Given the challenges in implementing clinical guidelines in concurrent disorder nursing care, our results highlight the importance of understanding the key conditions for successful uptake and implementation. This informs approaches to optimally adapt implementation strategies to the needs and specificities of nurses to obtain impactful and sustainable results.

Abstract Background In primary care, patients increasingly face difficult decisions related to complex care needs (multimorbidity, polypharmacy, mental health issues, social vulnerability and structural barriers). There is a need for a pragmatic conceptual model to understand decisional needs among patients with complex care needs and outcomes related to decision. We aimed to identify types of decisional needs among patients with complex care needs, and decision-making configurations of conditions associated with decision outcomes. Methods We conducted a systematic mixed studies review. Two specialized librarians searched five bibliographic databases (Medline, Embase, PsycINFO, CINAHL and SSCI). The search strategy was conducted from inception to December 2017. A team of twenty crowd-reviewers selected empirical studies on: (1) patients with complex care needs; (2) decisional needs; (3) primary care. Two reviewers appraised the quality of included studies using the Mixed Methods Appraisal Tool. We conducted a 2-phase case-based qualitative synthesis framed by the Ottawa Decision Support Framework and Gregor’s explicative-predictive theory type. A decisional need case involved: (a) a decision (what), (b) concerning a patient with complex care needs with bio-psycho-social characteristics (who), (c) made independently or in partnership (how), (d) in a specific place and time (where/when), (e) with communication and coordination barriers or facilitators (why), and that (f) influenced actions taken, health or well-being, or decision quality (outcomes). Results We included 47 studies. Data sufficiency qualitative criterion was reached. We identified 69 cases (2997 participants across 13 countries) grouped into five types of decisional needs: ‘prioritization’ (n = 26), ‘use of services’ (n = 22), ‘prescription’ (n = 12), ‘behavior change’ (n = 4) and ‘institutionalization’ (n = 5). Many decisions were made between clinical encounters in situations of social vulnerability. Patterns of conditions associated with decision outcomes revealed four decision-making configurations: ‘well-managed’ (n = 13), ‘asymmetric encounters’ (n = 21), ‘self-management by default’ (n = 8), and ‘chaotic’ (n = 27). Shared decision-making was associated with positive outcomes. Negative outcomes were associated with independent decision-making. Conclusion Our results could extend decision-making models in primary care settings and inform subsequent user-centered design of decision support tools for heterogenous patients with complex care needs.

BackgroundHealth measurement guides policies and health care decisions are necessary to describe and attain the quintuple aim of improving patient experience, population health, care team well-being, health care costs, and equity. In the primary care setting, patient-reported outcome measurement allows outcome comparisons within and across settings and helps improve the clinical management of patients. However, these digital patient-reported outcome measures (PROMs) are still not adapted to the clinical context of primary health care, which is an indication of the complexity of integrating these tools in this context. We must then gather evidence of their impact on chronic disease management in primary health care and understand the characteristics of effective implementation. ObjectiveWe will conduct a systematic review to identify and assess the impact of electronic PROMs (ePROMs) implementation in primary health care for chronic disease management. Our specific objectives are to (1) determine the impact of ePROMs in primary health care for chronic disease management and (2) compare and contrast characteristics of effective ePROMs’ implementation strategies. MethodsWe will conduct a systematic review of the literature in accordance with the guidelines of the Cochrane Methods Group and in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for its reporting. A specific search strategy was developed for relevant databases to identify studies. Two reviewers will independently apply the inclusion criteria using full texts and will extract the data. We will use a 2-phase sequential mixed methods synthesis design by conducting a qualitative synthesis first, and use its results to perform a quantitative synthesis. ResultsThis study was initiated in June 2022 by assembling the research team and the knowledge transfer committee. The preliminary search strategy will be developed and completed in September 2022. The main search strategy, data collection, study selection, and application of inclusion criteria were completed between October and December 2022. ConclusionsResults from this review will help support implementation efforts to accelerate innovations and digital adoption for primary health care and will be relevant for improving clinical management of chronic diseases and health care services and policies. Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42022333513; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=333513 International Registered Report Identifier (IRRID)DERR1-10.2196/48155

BackgroundElectronic knowledge resources are readily available and typically target different audiences, including health professionals and the public, that is, those with lived experience and their relatives. The knowledge-to-action framework, in combination with the information assessment method (IAM), considering both the value-of-information construct and the conceptual model of acquisition-cognition-application, can be used to support the evaluation process of such resources. As an example, Stroke Engine is an evidence-based knowledge translation resource in stroke rehabilitation (assessments and interventions) for health professionals and students as well as individuals who have sustained a stroke and their relatives. According to Google Analytics, the website is perused >10,000 times per week. ObjectiveWith the overall aim to improve the content available on Stroke Engine, we documented Stroke Engine users’ perceptions of situational relevance, cognitive impact, intention to use, and expected patient and health benefits regarding the information consulted. MethodsA web-based survey anchored in the IAM was made available via an invitation tab. The IAM is a validated questionnaire that is designed to assess the value of information. Sociodemographic characteristics were also collected, and a space for free-text comments was provided. Descriptive statistics were used, and thematic analysis was used for the free-text comments. ResultsThe sample consisted of 6634 respondents. Health professionals (3663/6634, 55.22%) and students (2784/6634, 41.97%) represented 97.18% (6447/6634) of the total responses. The remaining 2.82% (187/6634) of the responses were from individuals who had sustained a stroke (87/6634, 1.31%) and their relatives (100/6634, 1.51%). Regarding situational relevance, assessments (including selecting, obtaining, and interpreting results from a test) was the main topic searched by health professionals (1838/3364, 54.64%) and students (1228/2437, 50.39%), whereas general information on stroke rehabilitation was the top-ranked topic for nearly two-thirds of the individuals with stroke (45/76, 59%) and their relatives (57/91, 63%). Cognitive impact was characterized by learning something new. Intention to use was high (4572/6379, 71.67%) among the respondents and varied in context (eg, refine a topic, research, class assignments, teaching, and education). Respondents commented on ways to improve content. Expected patient and health benefits such as improvement in health and well-being was the top-ranked category for all 4 subgroups, followed by the avoidance of unnecessary or inappropriate treatment for health professionals (183/623, 29.4%) and a feeling of being reassured for individuals with stroke (26/75, 35%) and their relatives (28/97, 29%). ConclusionsValuable feedback on Stroke Engine was obtained in terms of its accessibility, relevance for informational needs and retrieval, accuracy, and applicability; however, of utmost importance is the potential implementation of its evidence-based content in clinical practice and the perceived expected impact on patients, their relatives, and their health professionals. The feedback received allowed for corrections and the identification of key topics for further development.

BackgroundAlmost two-thirds of the North American population have searched for health information on the web, and the majority report searching on behalf of someone else in their social circle, a phenomenon referred to as proxy seeking. Little is known about how proxy seekers use web-based health information and the outcomes they experience. ObjectiveThe main aim of this study was to explore why proxy seekers used a parenting website on behalf of parents in their social circle and the outcomes they reported. MethodsA qualitative descriptive study was conducted in the context of a partnership with a web-based parenting resource to explore the contexts and motivations for proxy web-based health information seeking, use of information, and subsequent outcomes. A total of 14 participants who self-identified as family members, friends of parents of young children, or professionals who worked with young children were interviewed, and a thematic analysis was conducted. ResultsThe following 4 reasons for proxy seeking were uncovered: for reassurance, out of personal curiosity, as part of a professional role, or following an explicit request from the parents. Information was used to provide informational support for parents or material support for a child. Positive outcomes of using the information and some of the resulting interpersonal tensions were described. ConclusionsThis study provides an in-depth look at proxy seeking behavior and outcomes among users of a web-based parenting resource.

Abstract Background Adults with chronic conditions who also suffer from mental health comorbidities and/or social vulnerability require services from many providers across different sectors. They may have complex health and social care needs and experience poorer health indicators and high mortality rates while generating considerable costs to the health and social services system. In response, the literature has stressed the need for a collaborative approach amongst providers to facilitate the care transition process. A better understanding of care transitions is the next step towards the improvement of integrated care models. The aim of the study is to better understand care transitions of adults with complex health and social care needs across community, primary care, and hospital settings, combining the experiences of patients and their families, providers, and health managers. Methods/design We will conduct a two-phase mixed methods multiple case study (quantitative and qualitative). We will work with six cases in three Canadian provinces, each case being the actual care transitions across community, primary care, and hospital settings. Adult patients with complex needs will be identified by having visited the emergency department at least three times over the previous 12 months. To ensure they have complex needs, they will be invited to complete INTERMED Self-Assessment and invited to enroll if positive. For the quantitative phase, data will be obtained through questionnaires and multi-level regression analyses will be conducted. For the qualitative phase, semi-structured interviews and focus groups will be conducted with patients, family members, care providers, and managers, and thematic analysis will be performed. Quantitative and qualitative results will be compared and then merged. Discussion This study is one of the first to examine care transitions of adults with complex needs by adopting a comprehensive vision of care transitions and bringing together the experiences of patients and family members, providers, and health managers. By using an integrated knowledge translation approach with key knowledge users, the study’s findings have the potential to inform the optimization of integrated care, to positively impact the health of adults with complex needs, and reduce the economic burden to the health and social care systems.

BackgroundCare partners of people living with dementia may benefit from web-based education. We developed iGeriCare, an award-winning internet-based platform with 12 multimedia e-learning lessons about dementia. ObjectiveOur objective was to evaluate users’ perceptions of impact. MethodsFrom March 17, 2021 to May 16, 2022, data were collected upon lesson completion. We used the content-validated Information Assessment Method for all (IAM4all) for patients and the public adapted for dementia care partners. The IAM4all questionnaire assesses outcomes of web-based consumer health information. Responses were collected using SurveyMonkey, and data were analyzed using IBM SPSS Statistics (version 28). ResultsA total of 409 responses were collected, with 389 (95.1%) survey respondents completing the survey. Of 409 respondents, 179 (43.8%) identified as a family or friend care partner, 84 (20.5%) identified as an individual concerned they may have mild cognitive impairment or dementia, 380 (92.9%) identified the lesson as relevant or very relevant, and 403 (98.5%) understood the lesson well or very well. Over half of respondents felt they were motivated to learn more, they were taught something new, or they felt validated in what they do, while some felt reassured or felt that the lesson refreshed their memory. Of 409 respondents, 401 (98%) said they would use the information, in particular, to better understand something, discuss the information with someone else, do things differently, or do something. ConclusionsUsers identified iGeriCare as relevant and beneficial and said that they would use the information. To our knowledge, this is the first time the IAM4all questionnaire has been used to assess patient and caregiver feedback on internet-based dementia education resources. A randomized controlled trial to study feasibility and impact on caregiver knowledge, self-efficacy, and burden is in progress.

Abstract Background Chronic musculoskeletal pain (CMP) may lead to reduced physical function and is the most common cause of chronic non-cancer pain. Currently, the pharmacotherapeutic options against CMP are limited and frequently consist of pain management with non-steroidal anti-inflammatories, gabapentinoids, or opioids, which carry major adverse effects. Although the effectiveness of medical cannabis (MC) for CMP still lacks solid evidence, several patients suffering from it are exploring this therapeutic option with their physicians. Objectives Little is known about patients’ perceptions of their MC treatment for CMP. We aimed to increase this knowledge, useful for healthcare professionals and patients considering this treatment, by conducting a scoping literature review, following guidance by Arksey and O’Malley, to describe the views and perceptions of adult patients who had consumed MC to relieve chronic CMP. Methods Databases (PUBMED, EMBASE, Web of Science) and websites were searched using combinations of controlled and free vocabulary. All studies and study designs reporting on patients’ perceptions regarding MC against CMP were considered. Studies had to include adult patients reporting qualitatively or quantitatively, i.e., through questionnaires, on MC use to treat CMP or other non-cancer pain, since studies reporting exclusively on perceptions regarding CMP were very rare. Study characteristics were extracted and limitations of the study quality were assessed. The review includes patients’ demographic characteristics, patterns of MC use, perceived positive and negative effects, use of alcohol or other drugs, reported barriers to CM use, and funding sources of the studies. Results Participants of the 49 included studies reported that MC use helped them to reduce CMP and other chronic non-cancer pain, with only minor adverse effects, and some reported improved psychological well-being. In the included studies, men represent between 18 and 88% of the subjects. The mean age of participants in these studies (42/49) varied between 28.4 and 62.8 years old. The most common route of administration is inhalation. Conclusion MC users suffering from CMP or other chronic non-cancer pain perceived more benefits than harms. However, the information from these studies has several methodological limitations and results are exploratory. These user-reported experiences must thus be examined by well-designed and methodologically sound clinical or observational studies, particularly regarding CMP, where reports are very scarce.

BackgroundArtificial intelligence (AI) has shown promising results in various fields of medicine. It has the potential to facilitate shared decision making (SDM). However, there is no comprehensive mapping of how AI may be used for SDM. ObjectiveWe aimed to identify and evaluate published studies that have tested or implemented AI to facilitate SDM. MethodsWe performed a scoping review informed by the methodological framework proposed by Levac et al, modifications to the original Arksey and O'Malley framework of a scoping review, and the Joanna Briggs Institute scoping review framework. We reported our results based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guideline. At the identification stage, an information specialist performed a comprehensive search of 6 electronic databases from their inception to May 2021. The inclusion criteria were: all populations; all AI interventions that were used to facilitate SDM, and if the AI intervention was not used for the decision-making point in SDM, it was excluded; any outcome related to patients, health care providers, or health care systems; studies in any health care setting, only studies published in the English language, and all study types. Overall, 2 reviewers independently performed the study selection process and extracted data. Any disagreements were resolved by a third reviewer. A descriptive analysis was performed. ResultsThe search process yielded 1445 records. After removing duplicates, 894 documents were screened, and 6 peer-reviewed publications met our inclusion criteria. Overall, 2 of them were conducted in North America, 2 in Europe, 1 in Australia, and 1 in Asia. Most articles were published after 2017. Overall, 3 articles focused on primary care, and 3 articles focused on secondary care. All studies used machine learning methods. Moreover, 3 articles included health care providers in the validation stage of the AI intervention, and 1 article included both health care providers and patients in clinical validation, but none of the articles included health care providers or patients in the design and development of the AI intervention. All used AI to support SDM by providing clinical recommendations or predictions. ConclusionsEvidence of the use of AI in SDM is in its infancy. We found AI supporting SDM in similar ways across the included articles. We observed a lack of emphasis on patients’ values and preferences, as well as poor reporting of AI interventions, resulting in a lack of clarity about different aspects. Little effort was made to address the topics of explainability of AI interventions and to include end-users in the design and development of the interventions. Further efforts are required to strengthen and standardize the use of AI in different steps of SDM and to evaluate its impact on various decisions, populations, and settings.

BackgroundHigh-quality online health information (OHI) can reduce unnecessary visits to health professionals and improve health. One of the ways that people use OHI is to support others with health conditions through proxy OHI seeking. Members of a person’s social circle may help them overcome information-seeking barriers and illness challenges. There are several models on proxy information seeking. Yet, we know little about the use and outcomes of OHI on behalf of someone else. ObjectiveThe objectives of this paper are to explore and revise a framework on the context and outcomes of proxy OHI seeking MethodsWe conducted a mixed studies literature review integrating qualitative and quantitative evidence with thematic analysis of the findings of 28 studies, followed by framework synthesis incorporating the derived themes. ResultsWe explored 4 main themes: (1) characteristics of proxy seekers, (2) context of proxy OHI seeking, (3) use of OHI to provide social support, and (4) outcomes of proxy OHI seeking. Our conceptual framework incorporates these themes and builds on previous work. ConclusionsBy better understanding how people use information together, information providers can adapt the information to meet all users’ needs.

Abstract Background Vaccination is a common painful procedure for children. Parents’ concern regarding vaccination pain is a significant driver of vaccine hesitancy. Despite the wealth of evidence-based practices available for managing vaccination pain, parents lack knowledge of, and access to, these strategies. Knowledge translation (KT) tools can communicate evidence-based information to parents, however little is known about what factors influence parents’ use of these tools. A two-page, electronic KT tool on psychological, physical, and pharmacological vaccination pain management strategies for children, was shared with parents as part of a larger mixed methods study, using explanatory sequential design, exploring factors related to uptake of this KT tool. The aim of this qualitative study was to understand what influenced parents’ perceptions of the relevance of the KT tool, as well as their decision as to whether to use the tool. Methods A qualitative descriptive design was used. A total of 20 parents of children aged 0–17 years (n = 19 mothers) reviewed the KT tool ahead of their child’s upcoming vaccination and participated in a semi-structured interview at follow-up. Interviews were recorded, transcribed verbatim, and analyzed with reflexive thematic analysis using an inductive approach. Results The analysis generated three interrelated themes which described factors related to parents’ use of the KT tool: (1) Relevance to parents’ needs and circumstances surrounding their child’s vaccination; (2) Alignment with parents’ personal values around, and experiences with, vaccination pain management (e.g., the importance of managing pain); and (3) Support from the clinical environment for implementing evidence-based strategies (e.g., physical clinical environment and quality of interactions with the health care provider). Conclusions Several factors were identified as central to parents’ use of the KT tool, including the information itself and the clinical environment. When the tool was perceived as relevant, aligned with parents’ values, and was supported by health care providers, parents were more inclined to use the KT tool to manage their children’s vaccination pain. Future research could explore other factors related to promoting engagement and uptake when creating parent-directed KT tools for a range of health-related contexts.

BackgroundOne of the largest groups of consumers who seek health information on the internet are parents of young children, as well as people in their social circle. The concept of proxy seeking (on behalf of others) has been explored in the literature, yet little is known about the outcomes. ObjectiveThe main aim of this study was to describe consumer health information outcomes reported by proxy seekers using a parenting website. MethodsWe conducted a 2-year quantitative observational study. Participants were parents of 0- to 8-year-old children and members of their entourage in Canada who had accessed Naître et Grandir through the website or through a weekly newsletter. For each Naître et Grandir webpage, participants’ perceptions regarding the outcomes of seeking and using specific webpages were gathered using a content-validated Information Assessment Method questionnaire. We compared the outcomes reported by parents with those reported by members of their entourage after consulting a parenting information website and explored if the method of accessing the information by the proxy seekers (website or weekly newsletter) changed the outcomes reported. For key primary survey items, the chi-square test was conducted, and differences in relative frequencies of responses were computed along with confidence intervals. ResultsA total of 51,325 completed questionnaires were included in the analysis, pertaining to 1079 Naître et Grandir webpages (mean 48; range 1-637). Compared to parents, individuals in the entourage are more likely to report using the information in discussion with others (mean difference 0.166, 95% CI 0.155-0.176). Parents, on the other hand, were more likely than the entourage to report using the information to better understand (mean difference 0.084, 95% CI 0.073-0.094), to decide to do something (mean difference 0.156, 95% CI 0.146-0.166), or to do something in a different manner (mean difference 0.052, 95% CI 0.042-0.061). In addition, results suggest that the differences in perceived benefits of parenting information by the entourage depend on how they access the information. Respondents who were actively seeking the information (through the website) were more likely to report that the information would help them be less worried (mean difference 0.047; 95% CI 0.024-0.069), handle a problem (mean difference 0.083; 95% CI 0.062-0.104), and decide what to do with someone else (mean difference 0.040, 95% CI 0.020-0.058). Respondents who passively acquired the information (through the newsletter) were more likely to report that the information would help improve the health or well-being of a child (mean difference 0.090; 95% CI 0.067-0.112). ConclusionsBy better understanding how consumers and their entourages use information, information providers can adapt information to meet both individual and group needs, and health care practitioners can target patients’ entourages with web-based health information resources for dissemination and use.

Objective: Transculturally translate and adapt the Mixed Methods Appraisal Tool to the Brazilian reality. Methods: The methodology followed the 10 steps determined by the transcultural translation and adaptation process conducted by one of the Working Groups of the Special Interest Group on Quality of Life and the Cultural Translation and Adaptation Group. Results: o The test with the instrument was carried out from the development of two systematic systematic reviews. The translated version obtained a strong / substantial Kappa coefficient (k = 0.67), and was titled "Method of evaluating the quality of researches with mixed methods - Version 2011". The produced version presents structural and semantic components compatible with those of the original version, allowing good understanding and brings clarity in its content. Conclusion: the translated and adapted instrument can be an important tool for scientific production in Brazil, optimizing the production of systematic reviews in the different areas of knowledge.

Abstract Background Chronic conditions such as diabetes and chronic obstructive pulmonary disease (COPD) are common and burdensome diseases primarily managed in primary care. Yet, evidence points to suboptimal quality of care for these conditions in primary care settings. Quality improvement collaboratives (QICs) are organized, multifaceted interventions that can be effective in improving chronic disease care processes and outcomes. In Quebec, Canada, the Institut national d’excellence en santé et en services sociaux (INESSS) has developed a large-scale QIC province-wide program called COMPAS+ that aims to improve the prevention and management of chronic diseases in primary care. This paper describes the protocol for our study, which aims to evaluate implementation and impact of COMPAS+ QICs on the prevention and management of targeted chronic diseases like diabetes and COPD. Methods This is a mixed-methods, integrated knowledge translation study. The quantitative component involves a controlled interrupted time series involving nine large integrated health centres in the province. Study sites will receive one of two interventions: the multifaceted COMPAS+ intervention (experimental condition) or a feedback only intervention (control condition). For the qualitative component, a multiple case study approach will be used to achieve an in-depth understanding of individual, team, organizational and contextual factors influencing implementation and effectiveness of the COMPAS+ QICs. Discussion COMPAS+ is a QI program that is unique in Canada due to its integration within the governance of the Quebec healthcare system and its capacity to reach many primary care providers and people living with chronic diseases across the province. We anticipate that this study will address several important gaps in knowledge related to large-scale QIC projects and generate strong and useful evidence (e.g., on leadership, organizational capacity, patient involvement, and implementation) having the potential to influence the design and optimisation of future QICs in Canada and internationally.

Introduction: Interprofessional collaboration (IPC) is becoming more widespread in primary care due to the increasing complex needs of patients. However, its implementation can be challenging. We aimed to identify barriers and facilitators of IPC in primary care settings. Methods: An overview of reviews was carried out. Nine databases were searched, and two independent reviewers took part in review selection, data extraction and quality assessment. A thematic synthesis was carried out to highlight the main barriers and facilitators, according to the type of IPC and their level of intervention (system, organizational, inter-individual and individual). Results: Twenty-nine reviews were included, classified according to six types of IPC: IPC in primary care (large scope) (n = 11), primary care physician (PCP)-nurse in primary care (n = 2), PCP-specialty care provider (n = 3), PCP-pharmacist (n = 2), PCP-mental health care provider (n = 6), and intersectoral collaboration (n = 5). Most barriers and facilitators were reported at the organizational and inter-individual levels. Main barriers referred to lack of time and training, lack of clear roles, fears relating to professional identity and poor communication. Principal facilitators included tools to improve communication, co-location and recognition of other professionals’ skills and contribution. Conclusions: The range of barriers and facilitators highlighted in this overview goes beyond specific local contexts and can prove useful for the development of tools or guidelines for successful implementation of IPC in primary care.

Introduction: Interprofessional collaboration (IPC) is increasingly used but diversely implemented in primary care. We aimed to assess the effectiveness of IPC in primary care settings. Methods: An overview (review of systematic reviews) was carried out. We searched nine databases and employed a double selection and data extraction method. Patient-related outcomes were categorized, and results coded as improvement (+), worsening (–), mixed results (?) or no change (0). Results: 34 reviews were included. Six types of IPC were identified: IPC in primary care (large scope) (n = 8), physician-nurse in primary care (n = 1), primary care physician (PCP)-specialty care provider (n = 5), PCP-pharmacist (n = 3), PCP-mental healthcare provider (n = 15), and intersectoral collaboration (n = 2). In general, IPC in primary care was beneficial for patients with variation between types of IPC. Whereas reviews about IPC in primary care (large scope) showed better processes of care and higher patient satisfaction, other types of IPC reported mixed results for clinical outcomes, healthcare use and patient-reported outcomes. Also, reviews focusing on interventions based on pre-existing and well-defined models, such as collaborative care, overall reported more benefits. However, heterogeneity between the included primary studies hindered comparison and often led to the report of mixed results. Finally, professional- and organizational-related outcomes were under-reported, and cost-related outcomes showed some promising results for IPC based on pre-existing models; results were lacking for other types. Conclusions: This overview suggests that interprofessional collaboration can be effective in primary care. Better understanding of the characteristics of IPC processes, their implementation, and the identification of effective elements, merits further attention.

Given the limits of human memory, clinicians have trouble recalling therapeutic recommendations, even when the clinician previously judged that the information relevant for the care of a specific patient. To tackle this problem, we present a knowledge-based recommender system prototype that links the electronic patient records to clinical information, previously delivered to the target physician and judged to be potentially beneficial. We developed this prototype within the context of RxTx, a Canadian continuing medical education program. We apply a constraint-based recommendation strategy as follows: (1) clinical experts (taggers) map a set of therapeutic recommendations (called Highlights) to a requirement statement built from the standard clinical codes and supplementary demographic information, when applicable; (2) a matching system identifies patient-Highlights recommendation pairs through requirement satisfaction; and (3) given a patient record being examined, the recommended Highlights can be retrieved online at the point of care. We tested this prototype using electronic medical records from the Canadian Primary Care Sentinel Surveillance Network and 87 therapeutic Highlights from the RxTx collection, evaluating the system's performance against a gold standard consisting of a two-expert consolidated patient-Highlight matching set for 150 patient records. The requirements-based recommendation system exhibits very high precision (mode: 1.0, 89% of the time; average precision: 0.95) and moderate recall (mode 1.0, 48.7% of the time; average recall: 0.61). The near-perfect precision minimizes the possibility of generating alert fatigue in physicians using the system. We note that more than half of the false negative results from the information being available in the text of the electronic medical records, but unavailable as a clinical code. The near-perfect precision over the tested patient set suggests that the system has the potential to deliver high-quality recommendations of clinical information at the point of care while being easily integrated within a continuing medical education program and the clinician's workflow.

Purpose: The importance of patient-oriented research (POR) has been recognized by the scientific community and governmental agencies, and its development is exponential across most health-related disciplines. The current Canadian Institutes of Health Research (CIHR) definition of POR is overly broad and hinders the reliable selection of POR-related publications from bibliographic databases. The present study was aimed to adapt CIHR’s definition of POR into an operational definition that can be used by stakeholders for selecting POR publications. Methods: Eighteen POR experts in Québec, Canada, were invited to participate in a modified e-Delphi study. Two rounds of Delphi surveys were undertaken to reach consensus. Round-1 sought consensus on clarity and indispensability of POR characteristics. Round-2 included modifications planned in POR characteristics and obtained final consensus leading to an adapted POR definition. Finally, POR experts across Canada were consulted to assess generalizability of this adapted POR definition. Results: The item that achieved 75% of consensus was removal of the POR characteristic “POR can be conducted in partnership with relevant stakeholders,” because it was considered redundant and confusing. Additionally, participants suggested defining unclear concepts such as “continuum,” “direct impact,” and “patient.” Finally, based on results of Round-1 and Round-2 and the consultation with POR experts across Canada, an operational POR definition was developed. Conclusions: This study was a novel attempt to adapt an operational POR definition to help patients and POR stakeholders have a common understanding of what POR is, focus on important outcomes that matter to patients, and improve care quality.

Abstract Background Organizational Participatory Research (OPR) seeks organizational learning and/or practice improvement. Previous systematic literature reviews described some OPR processes and outcomes, but the link between these processes and outcomes is unknown. We sought to identify and sequence the key processes of OPR taking place with and within healthcare organizations and the main outcomes to which they contribute, and to define ideal-types of OPR. Methods This article reports a participatory systematic mixed studies review with qualitative synthesis A specialized health librarian searched MEDLINE, CINAHL, Embase Classic + Embase, PsycINFO, the Cochrane Library, Social Work Abstracts and Business Source Complete, together with grey literature data bases were searched from inception to November 29, 2012. This search was updated using forward citation tracking up to June 2014. Reporting quality was appraised and unclear articles were excluded. Included studies clearly reported OPR where the main research related decisions were co-constructed among the academic and healthcare organization partners. Included studies were distilled into summaries of their OPR processes and outcomes, which were subsequently analysed using deductive and inductive thematic analysis. All summaries were analysed; that is, data analysis continued beyond saturation. Results Eighty-three studies were included from the 8873 records retrieved. Eight key OPR processes were identified. Four follow the phases of research: 1) form a work group and hold meetings, 2) collectively determine research objectives, 3) collectively analyse data, and 4) collectively interpret results and decide how to use them. Four are present throughout OPR: 1) communication, 2) relationships; 3) commitment; 4) collective reflection. These processes contribute to extra benefits at the individual and organizational levels. Four ideal-types of OPR were defined. Basic OPR consists of OPR processes leading to achieving the study objectives. This ideal-type and may be combined with any of the following three ideal-types: OPR resulting in random additional benefits for the individuals or organization involved, OPR spreading to other sectors of the organization and beyond, or OPR leading to subsequent initiatives. These results are illustrated with a novel conceptual model. Conclusion The model provides operational guidance to help OPR stakeholders collaboratively address organizational issues and achieve desired outcomes and more. Review registration As per PROSPERO inclusion criteria, this review is not registered.

Objective: Transculturally translate and adapt the Mixed Methods Appraisal Tool to the Brazilian reality. Methods: The methodology followed the 10 steps determined by the transcultural translation and adaptation process conducted by one of the Working Groups of the Special Interest Group on Quality of Life and the Cultural Translation and Adaptation Group. Results: o The test with the instrument was carried out from the development of two systematic systematic reviews. The translated version obtained a strong / substantial Kappa coefficient (k = 0.67), and was titled "Method of evaluating the quality of researches with mixed methods - Version 2011". The produced version presents structural and semantic components compatible with those of the original version, allowing good understanding and brings clarity in its content. Conclusion: the translated and adapted instrument can be an important tool for scientific production in Brazil, optimizing the production of systematic reviews in the different areas of knowledge.

Introduction Extension for Community Healthcare Outcomes (Project ECHO©) is an innovative model for continuing professional development that uses videoconferencing technology to support and train general practitioners remotely. The model has been replicated to a variety of settings and locations for capacity building in healthcare professionals caring for patients with chronic and complex health conditions. Limited research has been conducted so far on the impact of ECHO in the field of concurrent mental health and substance use disorders (ie, concurrent disorders (CDs)). Therefore, this mixed methods study aims to develop a comprehensive understanding of an ECHO programme impact for CD management on nurses’ competency development and clinical practice.Methods and analysis The proposed mixed methods study, based on a convergent parallel design, will be conducted in the province of Quebec, Canada, to collect, analyse and interpret quantitative (QUAN) and qualitative (QUAL) data from a specific ECHO Program on CDs. In the QUAN component, an observational prospective cohort study will be conducted over a 12-month period. All nurses who participated in the programme between 2018 and 2020 and who consent to research will be recruited to collect data on the extent of their learning and practice outcomes at three time points. Alongside the surveys, nurses will be invited to participate in individual semistructured interviews. In-depth QUAL data will be subjected to a thematic analysis and will assist in exploring how and in which conditions nurses developed and mobilised their competencies in clinical practice. A comparison-of-results strategy will be used in the final integration component of the study.Ethics and dissemination This study protocol was approved by the Ethics Committee of the Université de Montréal Hospital Center (#19.295) and the Université de Montréal Ethics Committee (CERSES-20–017 R). We aim to disseminate the findings through international academic conferences, international peer-reviewed journals and professional media.

Abstract. Introduction:. Although several evidence-based strategies for managing children's vaccination pain exist, many parents report being unaware of them. Knowledge translation (KT) tools present evidence-based information in plain language. Objectives:. This two-phase study assessed parents/caregivers' uptake of evidence-based pain management strategies via a KT tool and considered factors related to parents' planned, actual, and future use of these strategies. Methods:. In phase 1, parents were exposed to an online KT tool on physical, psychological, and pharmacological vaccination pain management strategies, and their impressions were assessed by questionnaires including the Information Assessment Method for Parents. In phase 2, after vaccination, parents completed a follow-up survey on their uptake and experiences using the information. Results:. A total of 312 participants reported their plans for KT tool use. Parents who found the KT tool relevant were more likely to plan to use it at their child's upcoming vaccination. A total of 128 parents (93% mothers) completed both surveys. Nearly all parents who planned to use the information did so during their child's subsequent vaccination (90%). When the KT tool was relevant to their needs, parents were more likely to use the information during their child's vaccination. Parents who felt confident using the tool were significantly more likely to report plans for future tool use. Discussion:. This study demonstrates the effectiveness of a KT tool that was relevant to parents' needs and built confidence to increase parent-reported uptake of evidence-based strategies. Proper pain management could positively impact parents' uptake of vaccinations for children.

Background: The McGill Primary Health Care Research Network (the Network) is a Practice-Based Research Network (PBRN) that promotes the collaboration between researchers and clinicians in research. The Network follows an approach called Organizational Participatory Research (OPR). Purpose: To discover the processes and outcomes associated with the Network, to learn about researcher and clinician collaboration within the Network and to propose recommendations and a revised questionnaire. Methods: A thematic qualitative data analysis was conducted. The data that was analyzed consisted of the diaries of two diaries of two Network coordinators, email correspondence between the core group members and the coordinators, and the minutes of 12 core group meetings. The data were interpreted according to the Capacity Building Framework. Then, codes were organized according to 10 framework-based meta-themes (5 domain-related processes, and 5 domain-related outcomes) and grouped in 24 key-themes (key processes and outcomes). Results: A leadership process was researchers promoting communication within the Network which resulted in clinicians becoming project leaders. An organizational development outcome was members' research projects being completed. Partnership processes involved researchers and clinicians identifying their respective challenges to partnerships. The main outcome was collaboration. Resource allocation processes included time and funding management, with accommodation to time constraints as an outcome. Workforce development processes included researchers educating clinicians, which resulted in networking core group members and positive learning experiences. Conclusions: The results suggested practice and policy recommendations. Based on the results, an improved mailing policy, a wiki/blog, a more humble approach for researchers and a questionnaire were proposed.

Objetivo avaliar as metodologias de ensino-aprendizagem adotadas por docentes de um curso de Enfermagem, sob a perspectiva discente.Métodos pesquisa com métodos mistos do tipo convergente. Recorte de projeto amplo de avaliação de programa, com uso do modelo Contexto, Insumos, Processo e Produto. Dados quantitativos (estudo transversal com dados secundários) e qualitativos coletados concomitantes e, posteriormente, triangulados.Resultados sobre as metodologias de ensino adotadas por docentes, os discentes participantes referiram maior utilização de aulas expositivas e dialogadas, 161 (67,6%), entre professores das disciplinas básicas; e de aulas expositivas e não dialogadas, 226 (92,6%), por docentes de disciplinas específicas da enfermagem. Em todas as disciplinas, predominaram metodologias tradicionais de ensino e avaliação.Conclusão os discentes participantes consideraram as metodologias predominantemente tradicionais e desejaram vivenciar métodos ativos, destacando a necessidade da interdisciplinaridade e maior integração ensino-serviço-comunidade.

Qualitative comparative analysis (QCA) is a hybrid method designed to bridge the gap between qualitative and quantitative research in a case-sensitive approach that considers each case holistically as a complex configuration of conditions and outcomes. QCA allows for multiple conjunctural causation, implying that it is often a combination of conditions that produces an outcome, that multiple pathways may lead to the same outcome, and that in different contexts, the same condition may have a different impact on the outcome. This approach to complexity allows QCA to provide a practical understanding for complex, real-world situations, and the context of implementing interventions. There are guides for conducting QCA in primary research and quantitative systematic reviews yet, to our knowledge, no guidance for conducting QCA in systematic mixed studies reviews (SMSRs). Thus, the specific objectives of this paper are to (1) describe a step-by-step approach for novice researchers for using QCA to integrate qualitative and quantitative evidence, including guidance on how to use software; (2) highlight specific challenges; (3) propose potential solutions from a worked example; and (4) provide recommendations for reporting.

Abstract Background In health, organizational participatory research (OPR) refers to health organization members participating in research decisions, with university researchers, throughout a study. This non-academic partner contribution to the research may take the form of consultation or co-construction. A drawback of OPR is that it requires more time from all those involved, compared to non-participatory research approaches; thus, understanding the added value of OPR, if any, is important. Thus, we sought to assess whether the OPR approach leads to benefits beyond what could be achieved through traditional research. Methods We identified, selected, and appraised OPR health literature, and at each stage, two team members independently reviewed and coded the literature. We used quantitative content analysis to transform textual data into reliable numerical codes and conducted a logistic regression to test the hypothesis that a co-construction type OPR study yields extra benefits with a greater likelihood than consultation-type OPR studies. Results From 8873 abstracts and 992 full text papers, we distilled a sample of 107 OPR studies. We found no difference between the type of organization members’ participation and the likelihood of exhibiting an extra benefit. However, the likelihood of an OPR study exhibiting at least one extra benefit is quadrupled when the impetus for the study comes from the organization, rather than the university researcher(s), or the organization and the university researcher(s) together (OR = 4.11, CI = 1.12–14.01). We also defined five types of extra benefits. Conclusions This review describes the types of extra benefits OPR can yield and suggests these benefits may occur if the organization initiates the OPR. Further, this review exposes a need for OPR authors to more clearly describe the type of non-academic partner participation in key research decisions throughout the study. Detailed descriptions will benefit others conducting OPR and allow for a re-examination of the relationship between participation and extra benefits in future reviews.

ABSTRACT OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.

A mixed methods research (sequential explanatory design) studied the potential of mining the data from the consumers of continuing medical education (CME) programs, for the developers of CME programs. The quantitative data generated by family physicians, through applying the information assessment method to CME content, was presented to key informants from the CME planning community through a qualitative description study.The data were revealed to have many potential applications including supporting the creation of CME content, CME program planning and personal learning portfolios.

Objective: Mixed studies reviews include empirical studies with diverse designs. Given that identifying relevant studies for such reviews is time consuming, a mixed filter was developed. Methods: The filter was used for six journals from three disciplines. For each journal, database records were coded ‘‘empirical’’ (relevant) when they mentioned a research question or objective, data collection, analysis, and results. We measured precision (proportion of retrieved documents being relevant), sensitivity (proportion of relevant documents retrieved), and specificity (proportion of nonrelevant documents not retrieved). Results: Records were coded with and without the filter, and descriptive statistics were performed, suggesting the mixed filter has high sensitivity.

Background In a prospective study to explore connections between clinical information delivery and information retrieval, 41 Canadian family physicians searched an electronic knowledge resource (EKR) as needed for practice. Research software, called the Information Assessment Method (IAM), prompted family physicians to report on the situational relevance, perceived cognitive impact and application of their retrieved information hits. Both the IAM and the EKR needed periodic updating to properly address our research questions. Objective To determine the frequency of software updating when manual or semi-automatic approaches are used by family physicians. Methods Each family physician received a handheld computer (PDA) that ran the Windows Mobile 6 operating system. For technical reasons, both the IAM and the EKR were accessed offline on PDA. To update the EKR and the IAM, family physicians were asked to synchronise their PDA to their PC. Updating the IAM was a manual process, whereas updating the EKR was semi-automatic. Results We found: (1) about 25% of family physicians never or rarely updated PDA software on their own, (2) a large number of software updates were never installed and (3) the semi-automatic method was associated with a small increase in the proportion of installed software updates (58.9% versus 48.6% for the manual method). Conclusions When a wireless internet connection is not used to update PDA software, sociotechnical issues complicate mobile data collection and data transfer.

Background Effective information transfer in primary care is becoming more difficult as the volume of medical information expands. Emailed research synopses are expected to raise awareness and thereby permit more effective information retrieval. Objective To identify key factors that influence physicians' self-reported cognitive impact of emailed research synopses. Method In this prospective observational study, research synopses sent by email between 8 September 2006 and 30 May 2007 were analysed. Seven characteristics of synopses (number of characters, research design, study setting, number of types of patient populations studied, number of comparisons, number of outcomes, and number of results) were analysed. Each synopsis was classified as either positive or negative based on physician-reported impacts. Logistic regression analysis was used to evaluate the association between a negative impact and the synopsis' characteristics. Results A total of 1960 Canadian physicians submitted 159 442 ratings on 193 synopses. Each synopsis was assessed on average by 826.1 physicians. On average there were 28.3 negative ratings per research synopsis, 146.3 neutral, and 656.2 positive. Out of the seven characteristics analysed, only the number of comparisons (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.23_0.93) and the number of results (OR = 0.64, 95% CI = 0.44_0.93) had a statistically significant influence on physician ratings. An increase in the number of comparisons (P = 0.03) or the number of results (P = 0.02) decreased the likelihood of a negative impact. Conclusions Characteristics of the synopses appear to influence cognitive impact, and there might be lexical patterns specific to these factors. Further research is recommended in order to understand the mechanism for the influence of these characteristics.

Background Information retrieval in primary care is becoming more difficult as the volume of medical information held in electronic databases expands. The lexical structure of this information might permit automatic indexing and improved retrieval. Objective To determine the possibility of identifying the key elements of clinical studies, namely Patient_Population_Problem, Exposure_Intervention, Comparison, Outcome, Duration and Results (PECODR), from abstracts of medical journals. Methods We used a convenience sample of 20 synopses from the journal Evidence-Based Medicine (EBM) and their matching original journal article abstracts obtained from PubMed. Three independent primary care professionals identified PECODR-related extracts of text. Rules were developed to define each PECODR element and the selection process of characters, words, phrases and sentences. From the extracts of text related to PECODR elements, potential lexical patterns that might help identify those elements were proposed and assessed using NVivo software. Results A total of 835 PECODR-related text extracts containing 41 263 individual text characters were identified from 20 EBM journal synopses. There were 759 extracts in the corresponding PubMed abstracts containing 31 947 characters. PECODR elements were found in nearly all abstracts and synopses with the exception of duration. There was agreement on 86.6%of the extracts from the 20 EBM synopses and 85.0% on the corresponding PubMed abstracts. After consensus this rose to 98.4% and 96.9% respectively. We found potential text patterns in the Comparison, Outcome and Results elements of both EBM synopses and PubMed abstracts. Some phrases and words are used frequently and are specific for these elements in both synopses and abstracts. Conclusions Results suggest a PECODR-related structure exists in medical abstracts and that there might be lexical patterns specific to these elements. More sophisticated computer-assisted lexical-semantic analysis might refine these results, and pave the way to automating PECODR indexing, and improve information retrieval in primary care.