I am honoured and delighted to be asked to write this editorial as I leave the Editorial Board after a number of years. I note the range of articles in this edition and again am amazed how far we have come, not only in terms of this journal, but also on the role of evidence and its importance in health care. My career path has paralleled this. As a midwife originally, and a midwife teacher, we had some of the early work around Cochrane carried out in my field and in obstetrics. My frustration then was how difficult it was to get the evidence applied to practice. At that stage, even if you had access to libraries and searching techniques, no one would listen to the evidence that was beginning to be produced and there was no thought of research meta-analysis or synthesis!!
I happened to find the abstract of my first ever international conference presentation when tidying out my desk last Christmas. This conference, the triennial International Confederation of Midwives was held in 1978 in Jerusalem. I quote:
[This is a brief paper that describes streams of research desirable in Australia today firstly as an evaluation of present midwifery practice and secondly to access new techniques and methods being introduced in areas in which the midwife is the specialist. Australia has neglected this facet of midwifery [horizontal ellipsis] and standards have fallen in some areas as a result[horizontal ellipsis]. Australian studies are needed and just beginning. The author sees research as giving confidence in a time of change and pressure. Our practice must be in the best interest of mother and child psychologically and physiologically: if it is not, research can indicate areas for change.
I actually think I was a little optimistic in stating that studies were just beginning. For example, I had not yet started my PhD and these awards and the research training they represent were very thin on the ground in midwifery, nursing or medicine. Now, in Australia, we have around 14 professors of midwifery or closely allied chairs in a relatively small profession.
The skills and techniques necessary to get the full benefit of research were also not well developed or efficient. For example, we could not have dreamed about the software and hardware that we now have that assist in not only finding research, but also allow us to store and process data. This, in turn, has spawned not only techniques, but our research training has changed. We now often require a formal meta-analysis or synthesis to be the first step either in a quantitative or, more recently, a qualitative doctorate.
This edition reminds us how valuable these skills have become. The first paper by Zeni in the issue describes how searching for an important concept such as health literacy in published studies can remind researchers and clinicians how important this is in relation to designing interventions.1 The second paper by Chan, Mackey and Hegney in this section again uses synthesis well to demonstrate some of the complexities and issues that need to be thought through in relation to obtaining consent for the use of residual samples of body tissues.2
Next up, for those interested in the vexed issue of measuring quality of life, is a comprehensive review by Yip, Mordiffi and Ang of the instruments that can be used in patents receiving cancer treatment using chemotherapy.3 A total of 3149 references were retrieved during the initial search which is well described and illustrates techniques and methods only dreamed of a few decades ago.
Strand and Parker found only four articles out of 927 originally sourced that could be reviewed to compare the effectiveness of multidisciplinary care with traditional medical care on the progression of chronic kidney disease in adult pre-dialysis patients.4 While a number of these papers might not have set out to establish generalisability and were qualitative in nature, it is disturbing that so few were actually open to being assessed according to established systematic review guidelines.
Under the section Evidence Transfer, the paper by Ith, Dawson and Homer exposes practices inconsistent with evidence-based guidelines.5 The findings that current SBA practices during labour, birth and the immediate postpartum period in one province of Cambodia do not reflect the evidence and reveal problems with teaching as well as service delivery models and supervision.
Under the heading of Evidence Utilisation, Hirsch, Keller, Krones and Donner-Banzhoff examined and found that arriba-lib has positive associations with the decision making process in patients and physicians.6
Finally, in this issue is a paper by Ross-Adjie, McAllister and Bradshaw which reported encouraging findings in a study designed to assess changes in practice and subsequent improvements in the management of this high-risk patient cohort in a private hospital.7
We have come a long way - as I feel I have come a long way on a professional journey encompassing a passion for research. I developed my skills through my part-time undergraduate degree, part-time Masters by research and part-time doctoral studies. All in all, it took 18 years of simultaneous employment, children and career before I could lay claim to being a researcher. None of my students have this road to travel now; they come to me with degrees, we mostly provide a salary for them or position them on grants or assist them to get scholarship and they complete in a timely fashion. They learn to publish and share their work along the way and make a significant difference to health care.
This journal exemplifies the great progress we have made. Congratulations on the leadership and purpose demonstrated over recent years and I wish you well for the future.
1Professor and Director, University Centre for Rural Health, North Coast, Sydney Medical School, University of Sydney, Sydney, Southern Cross University, University of Western Sydney, University of Wollongong, Wollongong, NSW, Australia, with the Northern NSW Local Health Network
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