Van Eijk-Hustings Y, Buss B, Fayet F, Moretti A, Ndosi M, Ryan S, et al. PubMed  Therefore, study questions, design, and/or methodological approaches do not necessarily represent the views of individual technical and content experts. Uncertainty (KQ 3): Health and health care evidence inherently involves some degree of uncertainty. This has been the result of our inclusion criteria. PMID: 20459779. PMID: 18951673. Overall there may be net benefit, clinical equipoise (benefit that is too close to call at the population level), or net harm. How does the comparative effectiveness of communication techniques vary by patients and clinicians? View more Module 6: Disseminating Best Practices Disseminating program results can help rural community health programs to build relationships with project partners and funders, increase visibility, and share best practices. The information should be made relevant for the target audience, patients in this case. Presenting risk information—a review of the effects of "framing" and other manipulations on patient outcomes. Strength of evidence requires a value judgment based on the risk of bias, consistency, precision, and directness of evidence (see definitions below). PMID: 19595577. Lomas J. Diffusion, dissemination, and implementation: who should do what? MB and MdW were involved in formulating the inclusion criteria, selecting the papers, assessing the levels of evidence of the papers, conducting the content analysis/data synthesis and writing this paper. The use of passive dissemination strategies, such as a leaflet or brochure, has proven to be insufficient to educate patients or change daily routine because such information does not endure in the long term [23]. This result section will, therefore, address both themes: information on dissemination to patients or patient organisations and patient involvement in dissemination. What to do 1. A systematic review of three approaches for constructing physical activity messages: what messages work and what improvements are needed? Possible moderators of interest for all key questions include: risk of bias, study size, and target audience. Nursing and Health Care Perspectives, 22(3), 124‐129. Strategies for disseminating recommendations or guidelines to patients: a systematic review. Maximov D, Lesnyak O. Findings from clinical, health services, and comparative effectiveness studies—especially as assembled for systematic reviews and similar documents—need to be communicated and disseminated effectively to influence optimal and timely practice and health policies.30, Because systematic reviews evaluate multiple studies, they are inherently complex. Appiah B, Hong Y, Ory MG, Helduser JW, Begaye D, Bollin JN, et al. Patients should be involved from an ethical point of view: involvement is needed to give patients influence on the recommendations by incorporating their experiential knowledge and perspectives. II.UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. Any literature suggested by Peer Reviewers or public comment respondents will be investigated and, if appropriate, incorporated into the final review. Stakeholder Analysis The dissemination strategy should be based on an understanding of Patient organisations can furthermore organise an annual national forum on a disease at which people share their experiences and take part in training and education programmes. These communication strategies are widely used and can be considered best practices; however, they are not included in this review given our focus on comparative effectiveness of different techniques. Dannapfel P, Poksinska B, Thomas K. PURPOSE: The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare … A four level responsive evaluation. [7–12]). The level of evidence was categorised according to the design characteristics of available studies using an established hierarchy [20] (see Table 1). Effective Health Care: What Is the Effective Health Care Program? PubMed  After the abstract and/or full-text review process, we will review the combinations of dissemination strategies, identify the most frequent combinations, and likely focus our efforts on synthesizing and analyzing the most frequent combinations. ISBN 978 92 4 150696 0 (NLM classification: W 20.5) 10(11)-EHC063-EF. Implement Sci. 1999–2009, Noar et al., 200910 Support Care Cancer. We will account for studies reported in multiple articles. Invited Peer Reviewers may not have any financial conflict of interest greater than $10,000. What is the comparative effectiveness of communication techniques to promote the use of health and health care evidence by patients and clinicians? The network should in this case include members with different backgrounds. The reference lists of articles from the search that fit the criteria were scanned for missing papers. Enhance your health!” vs. “A lack of activity increases risk for diabetes.”, Negative (loss) frame: “With drug X, you have a 5% chance of dying” vs. “With drug X, you have a 95% chance of surviving.”. Several papers confirm that dissemination requires a combination of different, mutually reinforcing strategies (e.g. This tool leads to an overall methodological rating (strong, moderate or weak) taking important elements into account such as selection bias, study design, confounders, blinding, data collection methods, withdrawals/dropouts, intervention integrity and analysis [17]. Ideally, the dissemination plan will link with a broader dissemination strategy for the overall program that encompasses the research project. Original research may take decades to become routine clinical practice or habits for large segments of the public. [6] and Allu et al. For communication and dissemination (KQs 1 and 2), we will only include health-related evidence that seeks to promote informed decisions about individual-level human health, reflecting our general interest in prevention, diagnosis, and treatment. Ensuring that research evidence is delivered to these audiences in easy-to-understand formats is critical to the success of evidence-based research. agree that dissemination strategies of EBP should be considered as a priority in improving patient care. There is less information about the impact of the use of different strategies. This process is called dissemination. Disagreements between the two reviewers will be resolved by discussion and consensus or by consulting a third, senior member of the team. 2008;17(4):296–300. Second, the original recommendations, often developed by and for professionals, need translation into a readable lay version for patients [6]. Hoens AM, Reid WD, Camp PG. 4.Translational Medical Research 5.Teaching Materials I.World Health Organization. We will systematically search, review, and synthesize the scientific evidence for each KQ. We will focus the content on original research articles that are available in full-text form, are published in English, and involve randomized trials with at least 100 total individuals in the study (e.g., 50 individuals per arm in a study with two arms). http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009. Interventions that incorporate two or more distinct strategies (i.e., that are multifaceted) are consistently more likely to work than single interventions.17. At last, we would like to thank EULAR for funding this project. Garcia-Retamero R, Galesic M. Communicating treatment risk reduction to people with low numeracy skills: a cross-culturalcComparison. A secondary objective was to examine how the effectiveness of communication and dissemination strategies varies across target audiences, including evidence translators, health educators, patients, and clinicians. For example, a study that compares targeting information to different types of audience segments (e.g., by race or ethnicity, sex or gender, and/or age groups) will be excluded. This might include tracking sheets to be given to patients and risk calculators to be used by clinicians. A multicomponent approach uses several communication techniques in concurrent combination or in sequence to increase the comprehension and understanding of evidence. Snyman’s study shows that strategies to disseminate lay versions need to be accompanied by the development of other materials. Ke CH, Casey CG, Yu CH. Lack of consistency is when studies suggest different effect sizes (have a different sign) or completely different (i.e., conflicting) effects or affects where the size of the effect is appreciably different. For studies that meet inclusion criteria, we will abstract relevant information into evidence tables. Conversely, when the overall strength of evidence is insufficient or low, uncertainty is high.28. First, the message should be customised to the target audience. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. Biological Research for … Methods Guide for Effectiveness and Comparative Effectiveness Reviews. In conclusion, in order to be as successful as possible, dissemination strategies should be characterised by developing a dissemination plan at an early stage, developing a lay version and using multiple dissemination strategies to reach the patients. For uncertainty, we will include studies from January 1966 to present because no previous reviews have addressed uncertainty. The involvement of patients is thus seen as important and as a key to success, but at the same time, it seems to be difficult to involve patients in an adequate way. Net benefit is based on a judgment call by policymakers. These can be awareness of the evidence; knowledge of the evidence; discussions about the evidence; self-efficacy about the evidence; and behavioral intentions to use or apply the evidence. Health Bucks Evaluation Toolkit pg. EULAR has chosen to involve patients from different countries because of the international context of the recommendations. Grades reflect the strength of the body of evidence to answer the KQs on the comparative effectiveness of the interventions in this review. Google ScholarÂ. Swedish healthcare is publicly funded and residents are insured by the state, with equal access for the population and fees regulated by law. We will specifically examine studies that compare ways to explain the following components of uncertainty: overall grade for strength of evidence, risk of bias, consistency, precision, and directness (see Table 7). A test of numeric formats for communicating risk probabilities. Changing provider behavior: an overview of systematic reviews of interventions. Nuanced descriptions of benefits, harms, strengths of evidence, and uncertainties make evidence reports difficult to understand for many people. The GIN toolkit suggests that the translation of the English lay version in different languages should be done by patient organisations, using a heterogeneous group of patients with different disease status and educational levels [38]. Rockville, MD: Agency for Healthcare Research and Quality; 2009. Visschers VH, Meertens RM, Passchier WW, et al. Given AHRQ’s mission, a critical goal is to evaluate the effectiveness of strategies to make evidence report findings widely available and techniques to ensure that such findings are correctly understood. We will sort the studies into prevention and diagnosis/treatment categories after the abstract and/or full-text review process and confer with AHRQ about the possibility of including both the prevention and diagnosis/treatment categories based on the number of studies in each category and available resources. The study and use of communication strategies to inform and influence individual and community decisions that affect health. Ibrekk H, Morgan GM. Int J Behav Nutr Phys Act 2010 May 11;7:36. Supporting patients can be done by providing networking opportunities for individuals or by providing a buddy [38]. The search gives insight in three main factors that may make the dissemination of recommendations towards patients more successful. Our study is the first systematic literature review that provides an overview of strategies to disseminate recommendations to patients or patient organisations and how to involve patients in this process. For instance, evidence on the benefits of screening is often not directly available (i.e., there are no studies that enroll subjects and assign them to appropriate treatment or not). Expanding investment in communication, dissemination, and implementation research is critical to the identification of strategies to accelerate the translation of comparative effectiveness research into community and clinical practice and the direct benefit of patient care. Update on the methods of the U.S. Preventive Services Task Force: estimating certainty and magnitude of net benefit. It is therefore important to involve a diverse group of patients (age, gender, educational level, ethnicity), and for that aim, the adaptation of existing processes might be needed to make their participation possible. Drouin D. Dissemination and implementation of recommendations on hypertension: the Canadian experience. [ 6] and Allu et al. They find it difficult to reconcile the preferences of patients with their own views [2]. 2013;26(1):90–2. Percentage and “x/1,000” presentations are more understandable than “1 in x” presentations of probability; Using the same denominator in “x/1,000” presentations. This review suggests that patients can be involved in making this lay version [1]. Interventions that rely solely on passive information transfer are relatively ineffective, but active knowledge-translation strategies are usually effective (although the effects are modest). assertiveness) [38]. Vol 4. Patient-expert partnerships in research: how to stimulate inclusion of patient perspectives. Eular report. PMID: 10535437. We will conduct any meta-analyses we perform using random effects models, given that this is the most conservative approach. Changing provider behavior: an overview of systematic reviews of interventions. Washington, DC: The National Academies Press; 2000. In these cases, information about the recommendations may reach the patient from different sources with the benefit of mutual enforcement. dissemination plan has been successful and to help form future plans 6. Med Decis Making 2007 Sep-Oct;27(5):681-95. One way to empower patients to make more informed choices is the development and dissemination of patient or lay versions of the recommendations. Gagliardi AR, Brouwers MC. All data abstractions will be reviewed for completeness and accuracy by a second member of the team. Directness is the degree to which the evidence links the interventions directly to the question of interest. The translation into a readable, comprehensible, relevant, consistent, unambiguous and credible version [6, 7, 16, 23–25] for patients will increase the success of the dissemination. McGettigan P, Sly K, O'Connell D, et al. Dissemination and evaluation of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Health Expect. Sci Technol Hum Values. Rockville, MD; 2005. 2012;7:70. doi:10.1186/1748-5908-7-70. Cite this article. Usual care/practice for dissemination is passive dissemination— passive, uncontrolled spread of information of evidence or no spread of information. To identify articles relevant to each KQ, the EPC librarian will begin with three focused PubMed-MEDLINE searches on the comparative effectiveness of: (1) communication techniques to promote the use of health and health care evidence, (2) dissemination strategies to promote the use of health and health care evidence, and (3) different methods used to explain uncertain evidence. Methodological notions for collaborations in research agenda setting. Communication Strategies for Health Services Researchers Dissemination Strategies for Health Services Researchers. Messages framed as emphasizing the benefits of preventive action are significantly better than loss-framed messages, although the difference is small. We will exclude studies that examine interpersonal communication techniques given that these are more costly to implement and less practical when reaching large-scale audiences. Politi MC, Han PK, Col NF. 2013;20(4):271–4. Do not forget the professional—the value of the FIRST model for guiding the structural involvement of patients in rheumatology research. Communication (KQ 1): For KQ 1, we will include studies that compare two or more of the included communication techniques head to head. National Institutes of Health. Health Bucks Evaluation Toolkit pg. Ann N Y Acad Sci 1993 Dec 31;703:226-35; discussion 35-7. Technical experts constitute a multidisciplinary group of clinical, content, and methodological experts who provide input regarding methodological issues and scoping the reviews. U.S. Department of Health and Human Services. We will also consider studies that compare ways to explain net benefit (of prevention or therapeutic services). The use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings. For example, an evidence developer might train/enlist the help of a local champion to promote evidence within his or her organization. The last step is the patient test phase. The Centers for Disease Control and Prevention Examples include the following: We will abstract and report key characteristics that may affect applicability into evidence tables. Once those who are synthesizing evidence determine strength of evidence, net benefit, and applicability, various groups must communicate the information to consumers. To recap, our review has three Key Questions (KQs), listed below. (DOC 47 kb). Patients involved in the dissemination process have specific needs that should be taken into account. Success in one country does not guarantee success in other countries [34], or even within countries if there are significant cultural differences within countries. A meta-analysis of web-delivered, tailored health behavior change interventions. We will also examine relevant communication techniques described, including the ones for KQ 1 and hypothetical situations, if the technique is used to communicate uncertainty. 2012;27(10):1361–7. Reasons for exclusion will be tracked and reported along with the main reason(s) for exclusion in a report appendix. More attention should however be given to making a lay version which takes the diversity of the target group, patients, into account. Majumdar SR, Soumerai SB. PMID: 19180369. Dissemination strategy Steps in developing a dissemination strategy Barriers Conclusion . Wider adoption of evidence-based, health promotion practices depends on developing and testing effective dissemination approaches. What constitutes a “sufficient” margin of benefit for evidence to provide “net benefit” is open to interpretation and constitutes another important source of uncertainty. Abstracts that met the inclusion criteria were selected for detailed, full text review. These can be the following: for patients—health-related decisions or behavior and clinical outcomes; and for clinicians—behavior. Boulet LP, Becker A, Bowie D, Hernandez P, McIvor A, Rouleau M, et al. Champions help overcome social and political pressures imposed by an organization, role model personal commitment to the program, and involve others in its use. In: Methods Guide for Effectiveness and Comparative Effectiveness Reviews. We distinguish dissemination strategies from implementation strategies, with the latter focusing on actually undertaking the process to institutionalize the new evidence in clinical practice. Knowledge brokers are persons who bridge the gap between researchers and the end users [32]. Key factors of success were a dissemination plan, written at the start of the recommendation development process, involvement of patients in this development process and the use of a combination of traditional and innovative dissemination tools. 2014;28(1):CD001431. Roy C. (1999). Jensen JL, Blanchard IE, Bigham BL, Carter A, Brown R, Socha D, et al. The GIN toolkit suggests that patients who have participated in the development of the recommendations can also actively contribute to the dissemination process [38]. To assess the applicability of a body of evidence, we will consider the consistency of results across studies that represent an array of different populations. © 2020 BioMed Central Ltd unless otherwise stated. For clinicians, ultimate outcomes may include behavior. 1.Research. Owens DK, Lohr KN, Atkins D, et al. Knapp JF, Simon SD, Sharma V. Does active dissemination of evidence result in faster knowledge transfer than passive diffusion? Without communicating workplace policies, processes and the company's mission and principles, employers cannot reasonably expect employees to perform their job functions, much less enjoy working for the company. PubMed Central  Development of the RTI item bank on risk of bias and precision of observational studies. Grimshaw JM, Shirran L, Thomas R, et al. Block 2 countries include: Austria, Belgium-Luxembourg, Brazil, Denmark, Finland, Greece, Ireland, Israel, Norway, Poland, Portugal, Spain, Sweden, Switzerland, and Turkey. Disseminating and implementing the results of back pain research in primary care. The strength of this systematic review is the fact that it for the first time focuses solely on the target group of patients and patient organisations, a target group previously often ignored. Article  The overview has two specific research questions: (1) to determine the most effective strategies that have been used to disseminate knowledge to healthcare recipients, and (2) to determine the barriers (and facilitators) to dissemination of knowledge to this … Communication of uncertainty regarding individualized cancer risk estimates: effects and influential factors. This process is called dissemination. A secondary objective was to examine how the effectiveness of communication and dissemination strategies varies across target audiences, including evidence translators, health educators, patients, and clinicians. Therefore, recommendations about screening are derived indirectly from evidence that a preclinical disease can be detected and that there is benefit in treating that same disease once symptomatic. Sometimes there are problem or group-specific social networks for professional organizations and patient subgroups; these would also fall into social media as long as they have a “social” network component as described above. Rockville, MD: Agency for Healthcare Research and Quality; April 2011. A conceptual framework of implementability. Knowledge brokering: an innovative model for supporting evidence-informed practice in respiratory care. Table 9 displays data items that will be extracted. We will design data abstraction forms to gather pertinent information from each article, including characteristics of study populations, settings, interventions, comparators, study designs, methods, and results. Milbank Q 2007 Dec;85(4):729-68. We thank the members of the EULAR Task Force for their comments on the preliminary results of this systematic literature review and their suggestions for making the search better. 2005;66:124–97. Strategies where health professionals and patient organisations join forces will probably be even better. dissemination plan has been successful and to help form future plans 6. mention, based on their own experiences, the combination of the following strategies: organising press conferences, providing lay versions through Public Libraries, developing books to reach children and developing posters with ‘trigger’ stickers or making a website endorsed by a VIP [6]. Google ScholarÂ. A secondary objective was to examine how the effectiveness of communication and dissemination strategies varies across target audiences, including evidence translators, health educators, patients, and clinicians. Furthermore, the information in the recommendations should be consistent, unambiguous and credible [6]. Probability information in risk communication: a review of the research literature. An adequate strategy requires, according to Boulet et al. The Quality Assessment Tool for Quantitative Studies was used for assessing the quality of the quantitative studies [17] (see Additional file 2). A lay version enables patients to better understand the goals of treatment, the different treatment options and the benefits and risks of each option. In examining influences that help spread innovations 2010;26(5):261–4. Our findings provide the first systematic overview of tools and strategies to disseminate recommendations to patients and patient organisations. Allu et al. Most of the 21 papers can be described as opinion papers or papers that describe strategies that have been used or might be effective. Guidelines developed for resource-rich countries are often inapplicable in resource-poor countries [35]. We will remove duplications in our EndNote database and track the yield from each search. We list three key definitions to help readers understand the scope of our review, which focuses on the communication and dissemination of health and health care evidence and effective ways to present associated uncertainty (see Table 1). An example of implementation is when a clinical practice adopts or tries out a new treatment approach that is based on newly available health or health care evidence. Available at. Two reviewers independently assessed the methodological quality of included studies (KS, MB). Securing a long term societal, political, economic, environmental and scientific impact through dissemination efforts can lead to broader societal changes. Second, involve patients in less traditional ways (e.g. Larger organisations run national campaigns and are able to generate funds to promote education on the disease management of their members. Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, et al. Results of a multinational survey among nurses rheumatologists and patients. Dissemination of data is a critical step in completion of any research study. Covey J. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. 49. [6, 21, 26, 27]), for example, the repetition of key messages from different credible sources such as well-known professionals. Five aspects were taken into account: the aims of the research; research methods and design; sampling; data collection and analysis and results, discussion and conclusions. Although the findings of our study regarding the value of a multifaceted and active strategies are much in line with studies on dissemination towards professionals [43, 44], the applied tools and methods are different. NIH Conference. … 2008;14:150–4. The settings must be countries located in Blocks 1 or 2 based on a recent world-system analysis by Kick et al. Lay versions, as described above, are expected to reach individual patients. 2006;14:548–57. Involving good-informed patients in their treatment decisions is assumed to lead to more personal comfort with the treatment decision [2], better treatment adherence and motivation, reduction of the number of interventions in some cases [4] and more control by patients [5]. PMID: 8192299. Gagliardi AR, Marshall C, Huckson S, James R, Moore V. Developing a checklist for guideline implementation planning: review and synthesis of guideline development and implementation advice. Dissemination and implementation research is important to generate evidence-informed, cost-effective and context-specific strategies for implementation partners and stakeholders to effectively apply and sustain the best research evidence in public health and clinical practice. Health.gov. 2009;19(3):401–15. Nominations. The first suggestion is the use of selection criteria in choosing patient representatives [22]. Both reviewers (KS and MB) conducted the analysis separately and then explored similarities and differences between the studies. The Agency for Healthcare Research and Quality (AHRQ) Effective Healthcare (EHC) Program funds individual researchers, research centers, and academic organizations to work with AHRQ to produce effectiveness and comparative effectiveness research for clinicians and consumers.1 Comparative effectiveness research (CER) compares the benefits, harms, and effectiveness of health interventions for the prevention, diagnosis, treatment, and management of clinical conditions and the improvement of health care delivery. The first factor concerns the development of a dissemination plan [21, 22]. Existing systematic reviews and dissemination research show that passive dissemination strategies are not as effective as active strategies. Syst Rev. 2011;70(5):722–6. Winterbottom A, Bekker HL, Conner M, et al. The initial search revealed 3753 unique publications. Kick EL, McKinney LA, McDonald S, et al. The hand search and grey literature resulted in four relevant articles. These reviews highlight evidence for their support, although none of these reviews examine the comparative effectiveness of different techniques and strategies (see background section). Cochrane Database Syst Rev. PMID: 18087058. Finally, we will look at the issue of applicability (i.e., generalizability or what is sometimes termed external validity). Cuite CL, Weinstein ND, Emmons K, et al. PMID: 19000070. Studies evaluating dissemination strategies, involving patients and/or reaching patients, were included. The selection of patients may be challenging. Duplicate articles were excluded. We will limit the searches to studies published in English given the scope of this review. Development of a Planning Tool to Guide Dissemination of Research Results. In this Cyberseminar, we will discuss the science of dissemination, describe evidence-based dissemination strategies, cover important dissemination lessons … Major flaws preclude the ability to draw causal inferences between the intervention and the outcome. Patients as research partners in responsive research. A lack of attention to cultural differences can lead to products or programmes that do not meet the needs or possibilities of the target audience. Net benefit describes the balance or trade-offs in benefits and harms for prevention or treatment services. Google ScholarÂ. How patients and their organisations can be involved is described below. To assess the risk of bias of studies, we will use criteria described in the AHRQ Methods Guide for Effectiveness and Comparative Effectiveness Reviews.38 We will use questions adapted from the RTI Item Bank,39 the Cochrane Risk of Bias tool, and previous work by the USPSTF.40 We will assess the potential for selection bias (including attrition bias), measurement bias (such as performance bias, detection bias), confounding, and power. Identify dissemination goals and indicators. Effectiveness of guideline dissemination and Implementation strategies on health care professionals’ behaviour and patient outcomes in the cancer care context: a systematic review protocol. Qual Health Res. Patients have therefore limited access to information to get an adequate understanding of their disease and treatment options. Further, no overview of the literature on dissemination strategies aimed at healthcare users and their caregivers has been conducted. Coupled with these mandates is the fact that the ad hoc Uncertainty Committee of the EHC Stakeholder Group is interested in promoting effective ways to communicate uncertainty about health and health care evidence to end-users. However, dissemination strategies to patients versus health professionals have to be different when it comes to the development process of recommendations, the language used and the methods and tools that are used for dissemination. J Eval Clin Pract. Diffusion of innovations in service organizations: systematic review and recommendations. health departments, researchers, policy makers, and health advocacy groups. Dissemination strategies are concerned with the packaging of the information about the intervention and the communication channels that are used to reach potential adopters and target audience. PubMed  First, recommendations should not be developed without the active involvement of patients. Epub 2015 Feb 12. Retrieved May 22, 2019, from https://effectivehealthcare.ahrq.gov/topics /medical-evidence- communication/research-protocol. It should take the needs and preferences of the target audience into account as well as contextual factors [7]. The US Agency for Health Research and Quality supported development of a very brief planning tool that walks though dissemination step by step visual guidance for thinking though dissemination, brainstorming audiences and thinking through the tools needed to reach those audiences. INTRODUCTION It is commonly recognized that research is now an activity undertaken by many health care professionals. PMID: 11317424. The disposition of all items, (starting with the initial yields of the searches) through to articles finally retained for synthesis, will be reported in a flow diagram conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards.

dissemination strategies in healthcare

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