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Ghosts in the Machine

clock November 18, 2011 05:21 by author Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

This blog post is reposted from Show Me the Evidence: The Blog of Lippincott's Evidence-Based Practice Network.

When you appraise research, do you look at who was the principle investigator and wrote the article? I recently attended a session at a symposium that has made me question how I review articles for credibility. Inappropriate authorship (honorary and ghost authorship) and the resulting lack of transparency and accountability have been a substantial concern for the academic community for decades (Wislar, Flanagin, Fontanarosa, & DeAngelis, 2011). For those of you who are unfamiliar with the definitions, an honorary author is someone who is named as an author but did not meet authorship criteria and did not contribute substantially to take public responsibility for the work (Wislar, et al. 2011). A ghostwriter is someone who has made substantial contributions to the writing of the article but was not named as an author (Wislar, et al. 2011). These types of authors call into question the validity and credibility of the published work due to a lack of transparency on what they did or did not contribute to the article. 

In the latest issue of BMJ, Wislar, Flanagin, Fontanarosa, and DeAngelis, explored the issue of ghost writing and honorary authorship in their study "Honorary and ghost authors in high impact biomedical journals: a cross sectional survey."  They used a sample size of 896 authors from the top 2008 high Impact Factor medical journals in the industry, Annals of Internal Medicine, JAMA, Lancet, Nature Medicine, New England Journal of Medicine, and PLoS Medicine. Of the 896 authors, 630 responded to the survey for a 70.3% response rate. The prevalence of honorary and ghost authorship in articles published in major medical journals in 2008 was 21% (Wislar, et al. 2011). This number was a decline from identical study the group did in 1996 looking at the same publications. In 1996, the prevalence of honorary and ghost authorship was 29% (Wislar, et al. 2011). 

Clearly, these results demonstrate a need for the scientific community and peer-reviewed publications to increase their efforts to promote the responsibility, accountability, and transparency in authorship, and to maintain integrity in scientific publication (Wislar, et al. 2011). As healthcare providers who depend on the research evidence to guide our practice, we must carefully appraise the evidence to make sure it is credible and trustworthy; this includes scrutinizing the authors as well as the methodology and the research results, before using the information to change our practice. I applaud the efforts of the study authors to educate the healthcare community on the important issue of inappropriate authorship. It is through their efforts and the efforts of authors, editors, and publishers that we can continue to improve the integrity of the scientific publishing industry. 

Reference:

Wislar, J., Flanagin, A., Fontanarosa, P., DeAngelis, C. 2011. Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey. BMJ.



What is your question?

clock October 29, 2011 04:56 by author Lisa Bonsall, MSN, RN, CRNP

Along the lines of my recent posts on evidence-based practice, I have one more thing I’d like to share. It’s something I wish I had known back in nursing school and especially in graduate school while working on my final research paper before graduation. It’s called a PICOT question.

PICOT is an acronym to help you formulate a clinical question and guide your search for evidence. Using this format can help you find the best evidence available in a quicker, more efficient manner. Take a look:

P = patient population

I = intervention or issue of interest

C = comparison intervention or issue of interest

O = outcome

T = time frame

Try using the PICOT format to help you formulate your next clinical question and search for relevant studies and publications. For example, if you wanted to know the effect of flu vaccination on the development of pneumonia in older adults, you could fill in the blanks like this:

In _________(P), how does __________ (I) compared to _________ (C) influence _________ (O) over ________ (T)?

In patients ages 65 and older,  how does the use of an influenza vaccine  compared to not receiving the vaccine  influence their risk of developing pneumonia during the flu season?

What’s your question? Try using the PICOT format and see how it affects your search results! You can find more information, including other templates to help you formulate your question in Asking the Clinical Question: A Key Step in Evidence-Based Practice

References

Stillwell, S., Fineout-Overholt, E.,  Melnyk, B., & Williamson, K. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question A Key Step in Evidence-Based Practice. American Journal of Nursing, 110(3), 58-61.

Woods, A. (2011). Implementing Evidence Into Practice. Webinar. Philadelphia: Lippincott Williams & Wilkins.



An equation for EBP

clock October 2, 2011 01:37 by author Lisa Bonsall, MSN, RN, CRNP

I recently had the pleasure of attending a webinar on evidence-based practice (EBP) hosted by our own Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC. Anne brought the concept of evidence-based practice into a whole new light for me with this simple equation:

Research + Clinical Expertise + Patient Preference = EBP

One research study is not sufficient to support change in practice. Nor are three research studies, or 10, or 100… Solid research is only one piece of the puzzle. Three components are essential to true EBP and are critical to improve outcomes and quality of life:

1. External evidence includes systematic reviews, randomized control trials, best practice, and clinical practice guidelines that support a change in clinical practice. 
2. Internal evidence includes health care institution based quality improvement projects, outcome management initiatives, and clinical expertise. 
3. Accounting for patient preferences and values is the third component of this critical equation.

Another approach to understanding EBP is to compare what EBP isn't with what EBP is: 

  • EBP is NOT a research project. EBP is examination of completed research studies.
  • EBP is NOT simply supporting national evidence-based practice projects. EBP is a complete review and recommendation process.
  • EBP is NOT having research articles as references for policies. EBP is critical analysis of research, in the context of your organization, and with perspectives and judgment of clinicians and patients.

How familiar are you with systematic reviews and PICOT questions? Look for upcoming posts on these topics this week. Also, coming soon is Lippincott’s Evidence-Based Practice Network! We are very excited to be close to sharing this new resource with you!

References

Russell-Babin, K.  (2009). Seeing through the clouds of evidence-based practice. Nursing Management, 40(11), 26-32.

Woods, A. (2011) Implementing Evidence into Practice. [Webinar] Philadelphia: Lippincott Williams and Wilkins.



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