PubMed · 16265816
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Geoff Wood. 2005. Seeking knowledge.. https://pubmed.ncbi.nlm.nih.gov/16265816/
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BACKGROUND AND PURPOSE: Stroke care is complex, requiring input from professionals, patients and carers. Identifying and developing appropriate intervention components to meet these complex needs is difficult. The Medical Research Council (MRC) Framework for developing and evaluating 'complex' (nonpharmacological) interventions aims to improve intervention development. This study uses the Framework to review complex interventions in stroke care. METHODS: Systematic review with multiple search strategies (electronic databases, recent journals, gray literature) was used. The MRC Framework was used to guide the search strategy and assess study quality. 'Complex interventions' were defined as educational/psychosocial interventions to change knowledge, beliefs or behaviors. RESULTS: Sixty-seven studies were included: 39 randomized controlled trials (RCT) and 28 other designs. Complex interventions targeted healthcare professionals (17), and patients, carers and the general population (21 targeting primary or secondary prevention; 30 targeting adjustment and recovery after stroke). Compared with recovery studies, primary and secondary prevention studies were significantly less likely to have been evaluated in RCTs. Interventions evaluated in RCTs were significantly less likely to influence primary outcomes (26%) compared with other designs (44%). Theoretical grounding to support intervention choice was reported in 40 studies but only 14 were theoretically 'well developed'; 21 RCTs listed multiple primary outcome measures, with 10 listing 5 or more. Of these only 3 reported considering statistical power before recruitment and none was sufficiently powered. CONCLUSIONS: Few complex interventions in stroke care have been adequately developed or evaluated. This may explain failures to demonstrate efficacy. In future, greater attention is needed to theoretical development and methodological quality.
This article focuses on the gap between research and practice in substance abuse treatment, identifies some of the key findings in the technology transfer literature, and discusses their relevance to the adoption of new technology among Hispanic serving agencies and counselors. In organizing the material we present information within the categories of: (1) evidence, (2) context, and (3) facilitation. When considering the "evidence" for empirically supported substance abuse treatments for Hispanics, there is great concern about the shortage of treatments that have been adequately tested with Hispanics. In this article, we analyze the strengths and weaknesses of strategies recommended to address this problem. In terms of the "context" in which evidence-based practices will be implemented, we consider counselor characteristics and organizational structures that may facilitate or hinder the adoption of these practices and discuss how these may impact Hispanic-serving agencies. Finally, the mechanisms necessary for "facilitation" of evidence-based practices in Hispanic-serving agencies are described. Given the dearth of dissemination research with Hispanics, as well as other minorities, each area described in this article presents unique challenges that can benefit from a field-wide discussion.
This Special Series attempts to define what a high-quality healthcare system would look like for New Zealand. The Series focuses on the dimensions of a quality service - safety, access, equity, effectiveness, efficiency, and patient centeredness - not only elucidating in plain language what these dimensions are, but how they might be measured and improved. The central premise is that clinicians need to become involved in measuring and improving the quality of healthcare provided. To assist clinicians, the Series will cover ways to measure the effectiveness of care they provide with articles on clinical audit and clinical indicators, and also to examine the pros and cons of the measures of efficiency used by the funders - organisational performance indicators, and benchmarking. The Series will wrap up with a vision of how we might continue to improve quality through embedding clinical governance into District Health Boards, so that their performance is measured in both quality and fiscal terms.