Being Evidence Based The Shoemaker’s Daughter gets Rollerblades Ann McKibbon MLS PhD

1. Being Evidence Based The Shoemaker’s Daughter gets Rollerblades Ann McKibbon MLS PhD McMaster University Hamilton, ON Canada

2. My Background • Librarian for 37 years • With a research department at McMaster University for 25 years • Done research (e.g., PubMed Clinical Queries) • Produced information resources • Obtained PhD in medical informatics in 2005

3. Agenda • Research production • Special challenges • Celebrate our journey • Research application or use—knowledge translation • Encourage more travel

4. Shoemakers’ children Proverb that holds true • Legal firms have no partner agreements • Accounting firms have terrible financial records • IT firms not computerized • Librarians and theology majors “borrow” more books What does proverb mean for us who deal in knowledge and research? Wikimedia Book of Trades

5. We Have been Involved in Producing New Knowledge • Summarization of existing knowledge • Production of new • Information resources • Services • Our own discoveries • PhDs are multiplying • Institutions are recognizing and rewarding

6. Summarizing Existing Knowledge • Systematic reviews and meta-analyses • Cochrane and DARE • Clinical Practice Guidelines • AHRQ and their EBP centres • Economics analyses • Health Technology Assessments • CADTH and lots of European centres • Decision analyses

7. Production of New Information Resources and Services • US National Library of Medicine • OVID and all the large databases • PubMed Clinical Queries • BMJUpdates+ and its companion products • FPIN networks • Clinical Evidence

8. Recognition of our Ability to Produce New Knowledge Expanded educational roles in academic setting • Full tutors in EBM workshops, course planning Expanded roles in research settings • Librarians sit on research ethics boards, teach grant writing Expanded job opportunities • Professional organizations, eg ACOG, • Research organizations, eg Cochrane, AHRQ, CADTH • Research groups within traditional institutions, eg more librarians working outside library than in New respect for our abilities and knowledge • From mediated searching to being part of the review team

9. Our own Discoveries Quantitative studies • Clinical medical librarian and informationist Qualitative • McKnight—nurses feel guilty about leaving ward to look up information—implications for practice? Evaluations on the job • Evaluation study of resources products • Seriously consider publishing so others can use

10. Now that we have discovered new knowledge… How do we get it applied? How do we reap benefits from it?

11. EB Steps • Question • Search • Read and extract findings • Make and carry out decision • Review process

12. Louis Pasteur “To him who devotes his life to science, nothing can give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of his studies immediately find practical applications.”

13. KT DefinitionCanadian Institute for Health Research “the exchange, synthesis, and ethically-sound application of knowledge – with a complex system of interactions among researchers and users – to accelerate the capture of the befits of research for [the people we serve] through improved health, more effective services and products, and a strengthened health care system.”

14. KT Definition: Short Getting research/evidence into practice

15. Think—Pair—Share Think—about an innovation that you adopted and what made you adopt

16. Why is KT Important in health? ~55% of patients get less than adequate care • 30% to 40% not get what they should get • 20% to 25% get what… • should not have • they do not need • If optimum cancer care for adults… • 30% improvement in cancer outcomes • 10% reduction in cancer mortality

17. Applied health research Capacity building Complex interventions Complexity science Complexity studies Co-optation Diffusion of innovations Diffusion(s) Dissemination Evidence based practice Getting knowledge into practice Implementation Implementation research Implementation science Information dissemination and utilization Innovation adaptation Innovation adoption Innovation diffusion Knowledge communication Knowledge cycle Knowledge dissemination Knowledge exchange Knowledge management Knowledge mobilization (mobilisation) Knowledge transfer Knowledge translation Knowledge transformation Knowledge uptake KT Terms

18. Knowledge utiliz(s)ation Linkage and exchange Organizational change Outcomes effectiveness research (Titler) Policy research Popularization (popularisation) of research Research into action Research into practice Research mediation Research transfer Research transformation Research translation Research utiliz(s)ation Sociology of knowledge Technology transfer Third mission Translation(al) research Translation(al) science Transmission Utilization (utilisation) Knowledge to action Knowledge development and application Knowledge diffusion Applied dissemination Effective dissemination Research implementation KT Terms

19. Disciplines Involved with KT • Pharmaceutical industry • Nursing • Medicine • Public health • Engineering (technology transfer) • Management studies (change management) • Advertising and marketing • Cognitive science…

20. Individual people Individual health professionals Groups of care givers Hospitals Local areas such as municipalities, cities States and provinces Nations Single Multiple groups Individuals Managers or decision makers Policy makers Regional National International Levels of KT

22. Knowledge Translation Applied KT • Making users aware of knowledge and facilitating their use of it • Closing the gap between what we know and what we do • Moving knowledge into action Research in KT • What methods work well to get us to make changes • What are the barriers and facilitators

23. Question What proportion of research dollars are spent on knowledge generation vs translation? 100:1 generation vs translation 10:1 generation vs translation 1:1 generation vs translation 1:10 generation vs translation 1:100 generation vs translation

24. Answer What proportion of research dollars are spent on knowledge generation vs translation? • 100:1 generation vs translation • 10:1 generation vs translation • 1:1 generation vs translation • 1:10 generation vs translation • 1:100 generation vs translation

25. Handwashing What works to get people to wash their hands—home or institution?

26. What Works for Handwashing? Strategy Reviews Effects Education 11 not much Reminders 7 modest but sustained Performance 9 effective but only audit when being done New soap/rub 2 modest with hand rub Adjusted sinks 3 unclear Multifaceted 11 some change in practice and outcomes …Grol et al. Lancet. 1999.

27. Overall—Mixed Effects Strategy Reviews Educational materials 9 Conferences, courses 4 Education with different strategies 8 (depending on strategies) Opinion leaders 3 Feedback on performance (test ordering) audit 8 Patient mediated interventions 8 Substitution of tasks-nurse 6

28. Overall—Somewhat Effective Strategy Reviews Interactive small group meetings 3 Computerized decision support 5 Introduction of computers in practice 2 Mass media campaigns 1 Total quality mgt/quality improvement 1 Financial interventions—mostly drugs 6 Combined interventions 16 (new data not as supportive of this as old data)

29. Overall—Quite Effective Strategy Reviews Educational outreach visits 8 Substitution of tasks-pharmacist 6 Mulitprofessional education 5

30. Summary

31. To Produce and Apply New Knowledge We Need: • Strong grounding in our profession and jobs • Good ideas based on reality and needs • Willingness to ask tough and important questions • Institutional support • Time, energy, resources, and money • Research culture, respect, and implementation potential • Research knowledge and skills • Within self—courses, mentors, degrees, apprenticeships • Within others—those who may collaborate on projects

32. Librarians and Librarianship:shoes to rollerblades: • Respect research • Daily jobs and within ourselves • Conference recognition and support of colleagues • Harness research • Evidence based library and information practice • Produce research • Feed into the research process • Do research—don’t be afraid to ask for help • Make changes intelligently and thoughtfully • Publish what you have learned • Have a great time and follow your heart