Explore the vast range of titles available.

To explore the role of a four-item Global Rating Scale (GRS) that could be used in place of the Appraisal of Guidelines, Research and Evaluation II (AGREE II). A mixed four-factor design was used (User Type, Evaluation Type, Clinical Topic, Guideline). Participants were asked to read and evaluate a guideline using both the AGREE II draft and GRS or GRS only and to complete a series of questions regarding overall guideline quality, adoption, utility, and acceptability. One GRS item varied as a function of User Type. Each item was a significant predictor of participants' outcome measures. All items were rated as useful by stakeholders. The GRS rating scores, outcome measures, and usefulness scores did not vary between the two Evaluation Type conditions. Correlations between the GRS and the outcome measures were stronger compared with those between the AGREE II draft and these measures. Although the GRS is less sensitive than the AGREE II in detecting differences in guideline quality as a function of User Type, its items did predict important outcome measures related to guideline adoption. The GRS may play a role in guideline evaluation, although further study is warranted.

The purpose of the AGREE II is more explicitly stated. The new version of the instrument is designed to assess the quality of practice guidelines across the spectrum of health, provide direction on guideline development, and guide what specific information ought to be reported in guidelines. The four-point response scale was replaced by a seven-point response scale, in compliance with key methodologic principles of test construction. 5 A score of 1 indicates an absence of information or that the concept is very poorly reported. A score of 7 indicates that the quality of reporting is exceptional and all of the criteria and considerations articulated in the user's manual were met. A score between 2 and 6 indicates that the reporting of the AGREE II item does not fully meet criteria or considerations. As more criteria are met and more considerations addressed, item scores increase (see user's manual below). Finally, modifications, deletions and additions were made to approximately half of the original 23 items (Table 1). From McMaster University ([Melissa C. Brouwers PhD], [Michelle E. Kho], [Steven E. Hanna PhD], [Julie Makarski]); the Program in Evidence-based Care, Cancer Care Ontario (Brouwers), Hamilton, Ont.; British Columbia Cancer Agency (Browman), Victoria, BC; the Dutch Institute for Healthcare Improvement CBO and IQ Healthcare (Burgers), Radboud University Nijmegen Medical Centre, the Netherlands; St. George's University of London (Cluzeau), London, UK; the University of Bristol (Feder), Bristol, UK; Unité Cancer et Environement (Fervers), Université de Lyon - Centre Léon Bérard, Université Lyon 1, EA 4129, Lyon, France; the Canadian Institutes of Health Re search ([Ian D. Graham PhD]), Ottawa, Ont.; the Ottawa Hospital Research Institute ([Jeremy Grimshaw MBChB PhD]), Ottawa, Ont.; the National Institute for Health and Clinical Excellence (Littlejohns), London, UK; and the Can adian Partnership Against Cancer ([Louise Zitzelsberger PhD]), Ottawa, Ont. Members of the AGREE Next Steps Consortium: Dr. Melissa C. Brouwers, McMaster University and Cancer Care Ontario, Hamilton, Ont.; Dr. [George P. Browman MD MSc], British Columbia Cancer Agency, Vancouver Island, BC; Dr. [Jako S. Burgers MD PhD], Dutch Institute for Healthcare Improvement CBO, and Radboud University Nijmegen Medical Centre, IQ Healthcare, Netherlands; Dr. [Francoise Cluzeau], Chair of AGREE Research Trust, St. George's University of London, London, UK; Dr. Dave Davis, Association of American Medical Colleges, Washington, USA; Prof. Gene Feder, University of Bristol, Bristol, UK; Dr. Béatrice Fervers, Unité Cancer et Environement, Université de Lyon - Centre Léon Bérard, Université Lyon 1, EA 4129, Lyon, France; Dr. Ian D. Graham, Canadian Institutes of Health Research, Ottawa, Ont.; Dr. Jeremy Grimshaw, Ottawa Hospital Research Institute, Ottawa, Ont.; Dr. Steven E. Hanna, McMaster University, Hamilton, Ont.; Ms. Michelle E. Kho, McMaster University, Hamilton, Ont.; Prof. Peter Littlejohns, National Institute for Health and Clinical Excellence, London, UK; Ms. Julie Makarski, McMaster University, Hamilton, Ont.; Dr. Louise Zitzelsberger, Canadian Partnership Against Cancer, Ottawa, Ont.

BackgroundDeveloping and updating high-quality guidelines requires substantial time and resources. To reduce duplication of effort and enhance efficiency, we developed a process for guideline adaptation and assessed initial perceptions of its feasibility and usefulness.MethodsBased on preliminary developments and empirical studies, a series of meetings with guideline experts were organised to define a process for guideline adaptation (ADAPTE) and to develop a manual and a toolkit made available on a website (http://www.adapte.org). Potential users, guideline developers and implementers, were invited to register and to complete a questionnaire evaluating their perception about the proposed process.ResultsThe ADAPTE process consists of three phases (set-up, adaptation, finalisation), 9 modules and 24 steps. The adaptation phase involves identifying specific clinical questions, searching for, retrieving and assessing available guidelines, and preparing the draft adapted guideline. Among 330 registered individuals (46 countries), 144 completed the questionnaire. A majority found the ADAPTE process clear (78%), comprehensive (69%) and feasible (60%), and the manual useful (79%). However, 21% found the ADAPTE process complex. 44% feared that they will not find appropriate and high-quality source guidelines.DiscussionA comprehensive framework for guideline adaptation has been developed to meet the challenges of timely guideline development and implementation. The ADAPTE process generated important interest among guideline developers and implementers. The majority perceived the ADAPTE process to be feasible, useful and leading to improved methodological rigour and guideline quality. However, some de novo development might be needed if no high quality guideline exists for a given topic.

Background Practice guideline (PG) implementability refers to PG features that promote their use. While there are tools and resources to promote PG implementability, none are based on an evidence-informed and multidisciplinary perspective. Our objectives were to (i) create a comprehensive and evidence-informed model of PG implementability, (ii) seek support for the model from the international PG community, (iii) map existing implementability tools on to the model, (iv) prioritize areas for further investigation, and (v) describe how the model can be used by PG developers, users, and researchers. Methods A mixed methods approach was used. Using our completed realist review of the literature of seven different disciplines as the foundation, an iterative consensus process was used to create the beta version of the model. This was followed by (i) a survey of international stakeholders (guideline developers and users) to gather feedback and to refine the model, (ii) a content analysis comparing the model to existing PG tools, and (iii) a strategy to prioritize areas of the model for further research by members of the research team. Results The Gu ideline I mplementability for D ecision E xcellence M odel (GUIDE-M) is comprised of 3 core tactics, 7 domains, 9 subdomains, 44 attributes, and 40 subattributes and elements. Feedback on the beta version was received from 248 stakeholders from 34 countries. The model was rated as logical, relevant, and appropriate. Seven PG tools were selected and compared to the GUIDE-M: very few tools targeted the Contextualization and Deliberations domain. Also, fewer of the tools addressed PG appraisal than PG development and reporting functions. These findings informed the research priorities identified by the team. Conclusions The GUIDE-M provides an evidence-informed international and multidisciplinary conceptualization of PG implementability. The model can be used by PG developers to help them create more implementable recommendations, by clinicians and other users to help them be better consumers of PGs, and by the research community to identify priorities for further investigation.

Cancer Care Ontario's Systemic Therapy Task Force recently reviewed the medical oncology system in the province. There has been growing concern about anecdotal reports of burnout, high levels of stress and staff leaving or decreasing their work hours. However, no research has systematically determined whether there is evidence to support or refute these reports. To this end, a confidential survey was undertaken. A questionnaire was mailed to all 1016 personnel of the major providers of medical oncology services in Ontario. The questionnaire consisted of the Maslach Burnout Inventory, the 12-item General Health Questionnaire, a questionnaire to determine job satisfaction and stress, and questions to obtain demographic characteristics and to measure the staff's consideration of alternative work situations. The overall response rate was 70.9% (681 of 961 eligible subjects): by group it was 63.3% (131/207) for physicians, 80.9% (314/388) for allied health professionals and 64.5% (236/366) for support staff. The prevalence of emotional exhaustion were significantly higher among the physicians (53.3%) than among the allied health professionals (37.1%) and the support staff (30.5%) (p < or = 0.003); the same was true for feelings of depersonalization (22.1% v. 4.3% and 5.5% respectively) (p < or = 0.003). Feelings of low personal accomplishment were significantly higher among physicians (48.4%) and allied health professionals (54.0%) than among support staff (31.4%) (p < or = 0.002). About one-third of the respondents in each group reported that they have considered leaving for a job outside the cancer care system. Significantly more physicians (42.6%) than allied health professionals (7.6%) or support staff (4.5%) stated that they have considered leaving for a job outside the province. The findings support the concern that medical oncology personnel are experiencing burnout and high levels of stress and that large numbers are considering leaving or decreasing their work hours. This is an important finding for the cancer care system, where highly trained and experienced health care workers are already in short supply.

Increasing cancer rates are a world wide problem. Efforts towards controlling cancer are most effectively implemented through national cancer control programs. The literature has emphasized prevention and screening as main starting points; by applying what we know a substantial amount of cancer could be prevented. As well, in the areas of access to care, treatment and palliation, there are also many gains to be made. However, despite advances in fundamental and applied research across the cancer continuum, there continue to be delays between research discovery and application. Translation of research knowledge has focused on means traditionally part of the research process such as publication in journals. While knowledge may be disseminated via these methods, they appear to have little impact on implementation of new approaches in practice or policy. Research in the area of knowledge translation identifies important elements and strategies most effective in the translation of research findings. Adding a knowledge translation component to national cancer control programs can help ensure that even small efforts directed at cancer control can have maximum impact.

In our society, there are few positive images of women living with facial and physical differences and disabilities. While contending with discriminations faced by many women, women with physical differences and disabilities also are subjected to the stigma of a body which is perceived as not quite female, (Garland Thomson) \"less than whole,\" (DiMarco) and \"not quite human\" (Goffman). Women's experiences are directly related to western society's homogenized, naturalized, and patriarchal notions of body and appearance. Despite growing discourses about diversity issues, ideologies of the body remain embedded within binary oppositions of \"normal\" and \"abnormal\" (Davis 1995, 1997). Physical differences and disabilities frequently are positioned as personal tragedy, a burden to self and others, deformity, and inferiority (Rogers and Swadener). Because of medicalization, differences in appearance and ability typically are interpreted as illness or disease. As a result, public dialogue and medical discourse tend to focus on physical difference and disability as something to be shunned or overcome ([Hilde Zitzelsberger], Odette, Rice, and Whittington-Walsh). While we began workshop and support group sessions using traditional \"skills development\" and \"solutionsfocused\" methods (Fiske; Metcalf), we increasingly adopted a \"narrative approach\" in our facilitation (Drewery and Winslade; White and Epston). This method is a therapeutic application of postmodern theory. Within health promotion, it has emerged as an effective approach for facilitating alternative meanings, identities, and worldviews excluded by dominant accounts and for fostering affinities and actions among marginalized people (Williams, LaBonte, and O'Brien). Facilitators working from a narrative perspective view participants as having expertise and skills in the challenges of living with body differences, but understand that this knowledge may be hidden by dominant stories that portray them as inadequate or incapable (Silvester). For example, individuals with disabilities and differences often hold important insights about their bodies, health care, needs, and lives that are derived from their everyday experiences but which may be devalued by greater authority given to expert knowledge. From our perspective, because a narrative stance views participants as possessing unrecognized skills in living with difference, it more fully supports them in discovering their own knowledges, and in building on capacities for action that may already work for them in their own lives. In our art and image making groups, participants are introduced to a process for witnessing and participating in the group. Facilitators introduce this process by telling group members that it is not their role to give opinions, or place positive or negative judgements on other participants' art or images. As witnesses, their task is to engage with others about what they have heard and seen, and link and build on each other's expressions. Participants are also encouraged to reflect on what they have learned and/or how they have shifted as a result of viewing others' artwork and listening to them talk about their expressions of creativity. This approach helps facilitators and participants to shift from evaluating or interpreting the artwork to allowing themselves to be affected and moved by each other's art making. For example, one participant who created two clay sculptures of her body differences said about her art pieces, \"my nose and my spine are issues that are very hard for me to look at.\" Once her pieces were done she expressed to the group: \"it felt so liberating to feel the clay nose, and to trace my clay spine with my finger.\" Another participant who depicted a woman in a wheelchair voiced of her work, \"that woman is in action, with her arm out showing movement.\"

The purpose of this study was to explore the effect of occupational demands on partner/family relationships of Canadian elite-level coaches. Twenty full-time national team coaches were interviewed in order to determine the nature of the occupational demands at this level and to examine the perceived impact of these demands on personal relationships. Coaching full-time as a national team coach requires a huge time, energy and travel commitment. Coaches, on the whole, felt that this commitment was necessary in order to perform the job with excellence. Coaching was seen as a passion or an obsession. As a result, coaches did perceive that the demands of their occupation had an effect on their relationships. Effects were described as both positive and negative in nature. Themes such as priorities, family functioning, leaving and returning, role in the family, family involvement in the occupation, partner qualities and the partner relationship arose from the interviews. The underlying question of this study was whether coaches believe that a balance between excellence in their occupation and excellence in their personal lives can be achieved. This question was discussed and recommendations for achieving a balance, through both lifestyle and institutional modifications, were suggested by coaches.

The definition and scope of cancer control has been evolving since its inception. The most recent model of cancer control in Canada has acknowledged the importance of knowledge translation to ensure that research results are implemented in practice and will be used to inform policy. However, without effort, the process of translation does not happen on a consistent basis. Knowledge translation focusses on improving the adoption of an innovation, e.g., research results. A number of health organizations in Canada have identified knowledge translation as an important activity and have begun to develop departments or initiatives dedicated to its achievement. As the emphasis in cancer control is on the application of knowledge, knowledge translation has a role to play in attaining the objectives of cancer control in Canada. It is an ideal time for the Canadian Strategy for Cancer Control and other Canadian cancer control initiatives to determine where they will locate knowledge translation in relation to their objectives.