Standardized Methodology for Actionable Nuggets
The following standardized methodology is used to create Actionable Nuggets™. This six-step process ensures maximum rigour and efficacy of the product:
1. Identify the research question:
What do family physicians need to know in order to provide excellent, evidenced-based primary care to their patients with spinal cord injury?
2. Identify the latest and best literature on primary care for people with spinal cord injury:
A survey of the international peer-reviewed literature is conducted to identify the most urgent and important issues seen in the primary care environment among patients with the condition of interest. The scoping review, conforming to the Arksey and O’Malley framework, is guided by the following criteria:
a) Specific keywords
- Spinal cord injury, paraplegia, quadriplegia, tetraplegia, paralysis
- Primary care, primary health care, family physician, medical care, health promotion, family practice, care gaps, quality of care
- Long-term health, aging, health outcomes, health promotion, disease prevention, chronic disease management, long-term care, secondary complications
- Evidence-based practice, best practice, clinical guidelines, care guidelines
Peer-reviewed journals are searched using the following electronic search engines: CINAHL, MEDLINE, EMBASE, PubMed, and the Cochrane CollaborationThe Canadian Medical Association Journal and Canadian Family Physician are searched for any articles pertaining to secondary complications and long-term health issues associated with the condition of interest, as well as best practice guidelines for any health issues associated with the disease
The interval between 2000 and present. No methodological limitations are applied to screen for levels of evidence. An inclusive approach provides the best understanding of the current knowledge and best practices associated with long-term health care of people with spinal cord injuries in primary care. The search is extended by hand searching through the included studies’ reference lists. In this way, it will be possible to follow-up on promising literature that might not have been captured by the databases used.
3. Identify most important issues for primary care in spinal cord injury
Based on a review of the abstracts identified in the preliminary scoping review (by the staff epidemiologist hired for the project), a working set of issues is identified. Pertinent articles are then read in detail, sorted and categorized to create the finite set of key topics for Nuggets. These topics are typically the most common, urgent and/or prevalent issues affecting the long-term health of people with the condition of interest. They serve as the basis for the set of Nuggets that will be developed. Typically 10-20 issues emerge that can be managed in primary care and that have important health consequences for patients. In consultation with the Expert Panel, this list of issues is finalized. A search of the grey literature is then be conducted for recent clinical guidelines or reports on each of the identified issues.
This step also includes the recruitment of an Expert Panel that serves to ensure rigour, applicability and comprehensiveness of information. The Panel is made up of 2 content experts, 2 primary care specialists and 2 knowledge translation specialists.
4. Identify “Nuggets” for each key issue
The next step is a more detailed literature review for each of the 10-20 key issues. This usually results in a set of 20 – 40 articles for each issue. These are reviewed in detail and distilled down to the “Actionable Nugget”. The Nugget must be:
- A problem that presents in primary care
- An issue where the family doctor has a key role
- An action for which there is clear evidence in the literature
- A problem that presents in primary care
In order to ensure the accuracy and comprehensiveness of each Nugget, the development process is repeated for each of the issues identified. One by one, each issue-specific body of literature is reviewed in detail by the staff epidemiologist, and in consultation with the Investigators, an Actionable Nugget is defined.
5. Design and approve the preliminary set of Nuggets
The final step is to draft each of the Nuggets and present them to the Expert Panel for ratification. The principal investigators, project coordinator and staff epidemiologist draft each Nugget. It is then reviewed in detail by the expert panel, revised based on their input and reviewed again. Prior to being considered final, each Nugget must be approved consensually by all investigators, experts, and project staff. In some instances, many rounds of reviewing are required before all key individuals were prepared to sign off.
6. Pilot Testing of Nuggets
A post-test evaluation design is used to evaluate the utility and acceptability of the new Nuggets. Within one month following dissemination, subscribers are contacted for data collection using four standardized measures. Telephone interviews with the selected subscribers also provides important feedback about how nuggets are used in practice.