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Wednesday, 12 October 2011

Health-evidence.ca - Hat's off to another brilliant Canadian contribution to knowledge synthesis

I once heard the definition of a public health specialist, was "someone who was an expert on any health topic within 15 minutes". Those who have been in the field can likely relate to the cold calls from the public, media or politicians wanting immediate answers on some obscure issue and briefing notes yesterday on items of importance.

Knowledge synthesis and brokering have become the latest information management tool. The actual number of medical journals in circulation probably is a best guess, but in 2004 it was about 9000, and that had doubled in the previous decade. Keeping abreast of the literature would be more than a full time job. Managing this new knowledge is becoming a specialty in of itself.

Not surprising the vast majority of health care practitioners will begin a literature search by using a general Internet Search engine like Google. Wikipedia has become the default generalists starting point for gleaming information on new health topics and surprisingly sufficient in many cases.

There are more sophisticated approaches to literature searching which should form a basic skill set for practitioners. Databases like Medline and CINAHL provide rapid search engines for primary literature, leaving the reader with the daunting task of synthesis. Inserted between the primary literature and the lay superficial assessment have developed two layers of knowledge synthesis. The first was the meta-analysis, or attempt at quantifying multiple similar studies to improve the precision of an estimate. The second being the systematic reviews undertaken by a variety of agencies, the most notable being the Cochrane Collaborative reviews.

Within Canada, there is a synthesis site that brings together information from a variety of synthesis processes – lets call it a meta-synthesis. Reviews are rated on quality before being posted to provide some assessment of the confidence that the reader should ascribe to the quality of the synthesis review. You should become familiar with Health Evidence.ca
 http://health-evidence.ca/articles/show/21720 showing no effects of any trials to date and workplaces http://health-evidence.ca/articles/show/21746 showing some effects. Preventive efforts directed in childhood and youths for avoiding criminal behavior showing some benefit http://health-evidence.ca/articles/show/21675 . There is a nice article demonstrating that it appears that yoga is a somewhat effective intervention for stress reduction – I’ll leave it you to try to find the review.
Some recent gems

Obesity reduction efforts in schools
 http://health-evidence.ca/articles/show/21767 . We all need to be aware not only of the synthesis materials, but also the messages that they carry as others will undoubtably be reading the same literature and this finding is contrary to what would currently be considered best practice.
The one that public health professionals should look at carefully is a review of efforts of collaboration between health agencies and local governments which does not show any added benefit over standard services

http://health-evidence.ca/ and well worth bookmarking.

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