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AIM: To provide insight into the characteristics of chronic disease self-management by mapping publication status and exploring hotspots. BACKGROUND: Chronic disease is becoming a major public health issue worldwide, highlighting the importance of self-management in this area. Despite the volume and variety of publications, little is known about how 'chronic disease self-management'has developed, since the first publication 40 years ago. Such is the number of publications in the area, that there is a need for a systematic bibliographic examination to enable clinicians and researchers to navigate this literature. DESIGN: A bibliometric analysis of publications was used. METHODS: Publication status was achieved using BICOMB software, whereas hotspots were identified with Ucinet software. A search of PubMed was conducted for papers published between 1971-2012. RESULTS: By 2011, the number of publications reached 696, a fourfold increase from the previous 10 years, of which 75% came from the USA and UK. There were 1284 journals, which published chronic disease self-management research, involving various disciplines. The research hotspots highlighted various self-management strategies for the following: diabetes; cardiac vascular and pulmonary chronic disease; pain relief for neoplasms; and obesity. Psychological adjustment was a permeating theme in self-management processes as was using internet-based interventions. CONCLUSION: Self-management in chronic disease publication has been most evident in developed countries. The bibliographic mapping and identification of publication hotspots provides scholars and practitioners with key target journals, as well as a rigorous overview of the field for use in further research, evidence-based practice and health policy development.
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BACKGROUND: Evidence maps are a new method that systematically characterize the range of research activity in broad topic areas and are used to guide research priority setting, systematic reviews, and meta-analyses. OBJECTIVE: We expanded evidence mapping methods by demonstrating their usefulness as a tool for organizing epidemiologic research on sugar-sweetened beverage (SSB) intake and health outcomes: obesity, type 2 diabetes, metabolic syndrome, and coronary heart disease/stroke. DESIGN: We performed a search of the PubMed, Scopus, and Cochrane databases and a hand search of references. Studies selected were reviews and longitudinal studies (intervention and cohort) published between 1 January 1966 and 31 October 2012. RESULTS: We identified and mapped 77 studies (18 review and 59 primary research articles); most of the research focused on obesity (n = 47). For all outcomes, >30% (n = 18) of the primary research studies we identified were not referenced in published reviews. We found considerable variability among primary research studies of SSBs and the 4 health outcomes in terms of designs, definitions of SSBs, and definitions of outcomes, which renders these studies difficult to interpret collectively. For example, we counted 14 different definitions of weight/obesity in 29 observational cohort studies, and =6 studies reported the use of the same outcome measure. CONCLUSIONS: Establishing field standards in the study of SSB intake and health outcomes would facilitate interpretation across research studies and thereby increase the utility of systematic reviews/meta-analyses and ultimately the efficiency of research efforts. Rapid publication of new data suggests the need for regular updates and caution when reading reviews.
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OBJECTIVES: To use an "evidence-mapping" approach to assess the usefulness of Cochrane reviews in identifying research gaps in the maternal health. STUDY DESIGN AND SETTING: The article describes the general mapping, prioritizing, reconciling, and updating approach: (1) identifying gaps in the maternal health research using published systematic reviews and formulating research questions, (2) prioritizing questions using Delphi method, (3) reconciling identified research priorities with the existing literature (i.e., searching of ongoing trials in trials registries), (4) updating the process. A comprehensive search of Cochrane systematic reviews published or updated from January 2006 to March 2011 was performed. We evaluated the "Implications for Research" section to identify gaps in the research. RESULTS: Our search strategy identified 695 references; 178 systematic reviews identifying at least one research gap were used. We formulated 319 research questions, which were classified into 11 different categories based on the direct and indirect causes of maternal mortality: postpartum hemorrhage, abortion, hypertensive disorders, infection/sepsis, caesarean section, diabetes, pregnancy prevention, preterm labor, other direct causes, indirect causes, and health policies and systems. Most research questions concerned the effectiveness of clinical interventions, including drugs (42.6%), nonpharmacologic interventions (16.3%), and health system (14.7%). CONCLUSION: It is possible to identify gaps in the maternal health research by using this approach.
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The decision of where to start a research project has been influenced by many factors over the years. Tradition has a large impact, but the individual researchers'or clinicians'personal interest has also played a major role. The pharmaceutical industries'interest has without doubt initiated and sponsored many projects in order to get new products onto the market. The lack of an overview and control has led to an abundance of evidence within certain areas of our specialty, whereas other areas are scarcely, or not at all, researched. One way of 'mapping'the evidence in order to find out what we know and what we do not know is the production of systematic reviews. Although systematic reviews are considered top of the evidence hierarchy, they are not flawless. The aim of this article is to explain the systematic review and point to some of the challenges in the development and use of systematic reviews.
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BACKGROUND: Evidence mapping describes the quantity, design and characteristics of research in broad topic areas, in contrast to systematic reviews, which usually address narrowly-focused research questions. The breadth of evidence mapping helps to identify evidence gaps, and may guide future research efforts. The Global Evidence Mapping (GEM) Initiative was established in 2007 to create evidence maps providing an overview of existing research in Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI). METHODS: The GEM evidence mapping method involved three core tasks:1. Setting the boundaries and context of the map: Definitions for the fields of TBI and SCI were clarified, the prehospital, acute inhospital and rehabilitation phases of care were delineated and relevant stakeholders (patients, carers, clinicians, researchers and policymakers) who could contribute to the mapping were identified. Researchable clinical questions were developed through consultation with key stakeholders and a broad literature search. 2. Searching for and selection of relevant studies: Evidence search and selection involved development of specific search strategies, development of inclusion and exclusion criteria, searching of relevant databases and independent screening and selection by two researchers. 3. Reporting on yield and study characteristics: Data extraction was performed at two levels - 'interventions and study design'and 'detailed study characteristics'. The evidence map and commentary reflected the depth of data extraction. RESULTS: One hundred and twenty-nine researchable clinical questions in TBI and SCI were identified. These questions were then prioritised into high (n = 60) and low (n = 69) importance by the stakeholders involved in question development. Since 2007, 58 263 abstracts have been screened, 3 731 full text articles have been reviewed and 1 644 relevant neurotrauma publications have been mapped, covering fifty-three high priority questions. CONCLUSIONS: GEM Initiative evidence maps have a broad range of potential end-users including funding agencies, researchers and clinicians. Evidence mapping is at least as resource-intensive as systematic reviewing. The GEM Initiative has made advancements in evidence mapping, most notably in the area of question development and prioritisation. Evidence mapping complements other review methods for describing existing research, informing future research efforts, and addressing evidence gaps.
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Introduction: Achieving MDG-5A requires a concerted effort and political will for the implementation of strategies and cost-effective interventions based on scientific evidence to improve the health of women. Cochrane reviews could be useful to the identification of research priorities. Objective: To assist research sponsors and developers in achieving MDG-5A by mapping and prioritizing relevant research gaps identified in the 'Implication for Research'section of Cochrane reviews. Methods: Phase 1: We used an advanced search strategy in PUBMed limited to the Cochrane Database of Systematic reviews, and included reviews assessing interventions likely to reduce maternal mortality if they were published or updated during or after 2006. We evaluated the 'Implication for Research'section of each review and developed questions in 'PICO'(spell out) format according to what Cochrane reviewers presented, then categorized questions according to intervention type. Phase 2: A group of experts will prioritize the list of identified questions by selecting and ranking each question based on specific criteria. We will verify that no new clinical trials address these questions, by identifying randomized clinical trials listed in PUBMED, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP). We will provide a list of unanswered questions that remain relevant to the achievement of MDG5-A (maternal mortality). Results: We identified 695 references during phase 1 and included 203 reviews that met our inclusion criteria. More than 300 questions were structured and classified by intervention type (Table 1). An analysis of advanced phases of this study will be presented at the Cochrane Colloquium. Conclusion: By organizing and presenting pre-identified knowledge gaps, we will provide helpful information for research sponsors, funding and development agencies, and researchers interested in addressing MDG-5A. We expect this contribution to act as a catalyst for the development of the essential research needed for the reduction of maternal mortality.
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Objective To use visualization methods to illustrate and compare major subjects, domains, and developments in evidence-based medicine (EBM) in recent years. Method We analyzed MeSH terms and keywords in EBM articles in the MEDLINE and CNKI databases, and developed subject charts, research field relationship charts, and strategy coordination charts using word co-occurrence, PFNET algorithms, and visualization methods. Result Rapid developments and growth are taking place in EBM in China and around the world. Studies on humans comprised 94.4% of the EBM studies that we identified, while animal studies accounted for 2.6% (three quarters of these animal studies were on primates). The six countries with the largest number of EBM articles and the eight host nations for the 108 journals with the most EBM publications were from high-income countries. In China, 31 provinces, municipalities, and autonomous regions have published EBM articles, although most of these publications come from the more highly-developed areas of the country. The investigation of word co-occurrence showed that EBM articles outside of China involve seven main fields: "Therapy", "Methods", "Standards", "Research", "Education", "Nursing" and "Organization and Administration". Five of these fields ("Therapy", "Nursing", "Research", "Education" and "Management") were common to China but the top seven fields for this country included "Traditional Chinese Medicine (TCM)" and "Information resources"; and did not include "Methods" and "Standards". Furthermore, studies on "Nursing" and "Research" were not as advanced in China as in other countries. Conclusion There are similarities between China and the rest of the world in several areas in the EBM literature but also some important differences. Throughout the world, the most resource-rich regions or organizations tend to have the most well-developed EBM. These regions and organizations are prodocuing more evidence and conducting more methodology research than the less resourced regions and organizations. There is an urgent need for these regions and organizations to strengthen their use of evidence, to learn more about the philosophy that underpins EBM, and to improve accessibility to, and use of, evidence in choices about health care.
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The Cochrane Cystic Fibrosis and Genetic Disorders Group publishes systematic reviews of randomized trials for many genetic disorders. Given the rarity of these disorders, there are often few relevant trials to be included. Therefore, it is common for the reviews to be 'empty'and unable to present evidence which aids decision-making in clinical practice. However, we do not regard this as negative; rather we see this as a challenge and an opportunity to influence the research agenda. We have several reviews which clearly illustrate the cycle of assessing the evidence base, identifying the lack of data, generating high quality research and incorporating the resulting data into the original systematic review. © 2013 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.
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OBJECTIVE: To describe the methodology used to conduct a scoping review of spinal cord injury (SCI) rehabilitation service delivery in Canada, and to explain the reporting process intended to advance future service delivery. Evidence acquisition: A SCI rehabilitation framework derived from the International Classification of Function, Disability and Health was developed to describe the goals and interprofessional processes of rehabilitation. An adapted Arksey and O'Malley (2005) methodological framework was used to conduct a scoping review of SCI rehabilitation services in Canada. Data were obtained from multiple relevant sources via survey (N = 3572 data fields) from 13 of 15 Canadian tertiary SCI rehabilitation sites, systematic reviews, white papers, literature reviews, clinical practice resources, and clinicians. Multidisciplinary teams of content experts (N = 17), assisted with data interpretation and validation by articulating practice trends, gaps, and priorities. Evidence synthesis: The findings will be presented in an atlas, which includes aggregate national data regarding impairment and demographic characteristics, service utilization, available resources (staff and capital equipment), specialized services, local expertise, and current best practice indicators, outcome measures, and clinical guidelines. Data were collated and synthesized relative to specific rehabilitation goals. The current state of SCI rehabilitation service delivery (specific to each rehabilitation goal) is summarized in a report card within three domains, knowledge generation, clinical application, and policy change, and specifies key 2020 priorities. CONCLUSION: These findings should prompt critical evaluation of current Canadian SCI rehabilitation service delivery while specifying enhancements in knowledge generation, clinical application and policy change domains likely to assist with achievement of best practices by 2020.
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OBJECTIVE: We describe a new methodology, the systematic review and bibliometric network analysis (SeBriNA), to contextualize the quality and quantity of patient-centered outcomes evidence relative to complementary documents such as reviews, practice guidelines, editorials, and media reports. STUDY DESIGN AND SETTING: The SeBriNA is informed by systematic review and bibliometric analysis methodologies. It focuses on two key concepts: 1) quality of evidence for patient-centered outcomes using cumulative meta-analysis and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) appraisal approach; 2) quantity of original research and its citation relationships to related documents. It includes four steps: 1) research questions and document selection; 2) data extraction and analysis; 3) document network relationships; and 4) document network visualization. RESULTS: The primary output from the SeBriNA is an analysis of 1) evidence-the annual cumulative meta-analysis estimate of effect juxtaposed against quality of evidence by patient-centered outcomes (GRADE), and 2) context-the network of relationships between related documents and original research. This analysis can be represented as a single figure. CONCLUSIONS: The SeBriNA may help decision makers conceptualize, interpret, and visualize the quantity, quality, and relevance of original research within a network of related documents. Applications include prospective support for clinical and policy decisions and identification of research gaps. Copyright © 2012 Elsevier Inc. All rights reserved.
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BACKGROUND: To report the results of an audit concerning research gaps in clinical trials that were accepted for appraisal in authored and published systematic reviews regarding the application of glass-ionomer cements (GIC) in dental practice METHODS: Information concerning research gaps in trial precision was extracted, following a framework that included classification of the research gap reasons: 'imprecision of information (results)', 'biased information', 'inconsistency or unknown consistency'and 'not the right information', as well as research gap characterization using PICOS elements: population (P), intervention (I), comparison (C), outcomes (O) and setting (S). Internal trial validity assessment was based on the understanding that successful control for systematic error cannot be assured on the basis of inclusion of adequate methods alone, but also requires empirical evidence about whether such attempt was successful. RESULTS: A comprehensive and interconnected coverage of GIC-related clinical topics was established. The most common reasons found for gaps in trial precision were lack of sufficient trials and lack of sufficient large sample size. Only a few research gaps were ascribed to 'Lack of information'caused by focus on mainly surrogate trial outcomes. According to the chosen assessment criteria, a lack of adequate randomisation, allocation concealment and blinding/masking in trials covering all reviewed GIC topics was noted (selection- and detection/performance bias risk). Trial results appear to be less affected by loss-to-follow-up (attrition bias risk). CONCLUSION: This audit represents an adjunct of the systematic review articles it has covered. Its results do not change the systematic review's conclusions but highlight existing research gaps concerning the precision and internal validity of reviewed trials in detail. These gaps should be addressed in future GIC-related clinical research.
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Health technology assessments (HTAs) are an as yet unexploited source of comprehensive, systematically generated information that could be used by research funding agencies to formulate researchable questions that are relevant to decision-makers. We describe a process that was developed for distilling evidence gaps identified in HTAs into researchable questions that a provincial research funding agency can use to inform its research agenda. The challenges of moving forward with this initiative are discussed. Using HTA results to identify research gaps will allow funding agencies to reconcile the different agendas of researchers who conduct clinical trials and healthcare decision-makers, and will likely result in more balanced funding of pragmatic and explanatory trials. This initiative may require a significant cultural shift from the current, mostly reactive, funding environment based on an application-driven, competitive approach to allocating scarce research resources to a more collaborative, contractual one that is proactive, targeted and outcomes-based.
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