How much effort is needed to keep up with the literature relevant for primary care?

OBJECTIVES: Medicine must keep current with the research literature, and keeping current requires continuously updating the clinical knowledge base (i.e., references that provide answers to clinical questions). The authors estimated the volume of medical literature potentially relevant to primary care published in a month and the time required for physicians trained in medical epidemiology to evaluate it for updating a clinical knowledge base. METHODS: We included journals listed in five primary care journal review services (ACP Journal Club, DynaMed, Evidence-Based Practice, Journal Watch, and QuickScan Reviews). Finding little overlap, we added the 2001 "Brandon/Hill Selected List of Print Books and Journals for the Small Medical Library." We counted articles (including letters, editorials, and other commentaries) published in March 2002, using bibliographic software where possible and hand counting when necessary. For journals not published in March 2002, we reviewed the nearest issue. Five primary care physicians independently evaluated fifty randomly selected articles and timed the process. RESULTS: The combined list contained 341 currently active journals with 8,265 articles. Adjusting for publication frequency, we estimate 7,287 articles are published monthly in this set of journals. Physicians trained in epidemiology would take an estimated 627.5 hours per month to evaluate these articles. CONCLUSIONS: To provide practicing clinicians with the best current evidence, more comprehensive and systematic literature surveillance efforts are needed.     

Lifesource XL-18 pedometer for measuring steps under controlled and free-living conditions

The primary aim was to examine the criterion and construct validity and test–retest reliability of the Lifesource XL-18 pedometer (A&D Medical, Toronto, ON, Canada) for measuring steps under controlled and free-living activities. The influence of body mass index, waist size and walking speed on the criterion validity of XL-18 was also explored. Forty adults (35–74 years) performed a 6-min walk test in the controlled condition, and the criterion validity of XL-18 was assessed by comparing it to steps counted manually. Thirty-five adults participated in the free-living condition and the construct validity of XL-18 was assessed by comparing it to Yamax SW-200 (YAMAX Health & Sports, Inc., San Antonio, TX, USA). During the controlled condition, XL-18 did not significantly differ from criterion (P > 0.05) and no systematic error was found using Bland–Altman analysis. The accuracy of XL-18 decreased with slower walking speed (P = 0.001). During the free-living condition, Bland–Altman analysis revealed that XL-18 overestimated daily steps by 327 ± 118 than Yamax (P = 0.004). However, the absolute percent error (APE) (6.5 ± 0.58%) was still within an acceptable range. XL-18 did not differ statistically between pant pockets. XL-18 is suitable for measuring steps in controlled and free-living conditions. However, caution may be required when interpreting the steps recorded under slower speeds and free-living conditions.     

In search of systemic innovation for sustainable development: A design praxis emerging from a decade of social learning inquiry

Processes of designing for systemic innovation for sustainable development (SD) through the lens of three long-term case studies are reported. All case studies, which originated from the SLIM (Social Learning for the Integrated Management and Sustainable Use of Water at Catchment Scale) Project, funded within the EU Fifth Framework Program (2001–2004), constitute inquiry pathways that are explored using a critical incident approach. The initial starting conditions for each inquiry pathway are compared; significant pathway dependencies are identified which foster the development of social learning processes locally, but constrain their uptake and embedding across the wider system of interest. In the first case study, in England & Wales, promising developments in the application of social learning approaches to river basin planning over an initial 3-year period were subsequently marginalised, only to resurface towards the end of the 10-year period of study. In the second, South African case study, significant spaces for social learning and innovation in integrated water resources management were opened up over a five year period but closed down again, primarily as the result of lack of policy support by national government. The third, Italian, case study was designed to assess options for adapting to climate change by opening up new learning spaces between researchers, stakeholders and policy makers. A case for investing in local level systemic innovation through social-learning praxis design approaches and in learning processes around well contextualised case-studies is supported. However, concomitant investment by policy makers in social learning as an alternative, but complementary, governance mechanism for systemic innovation for SD is needed.