Green Lawrence W
Department of Epidemiology and Biostatistics, School of Medicine, University of California at San Francisco, 185 Berry Street, PO Box 0981, San Francisco, CA 9414-0981, USA.
Fam Pract. 2008 Dec;25 Suppl 1:i20-4. doi: 10.1093/fampra/cmn055. Epub 2008 Sep 15.
The usual search for explanations and solutions for the research-practice gap tends to analyze ways to communicate evidence-based practice guidelines to practitioners more efficiently and effectively from the end of a scientific pipeline. This examination of the pipeline looks upstream for ways in which the research itself is rendered increasingly irrelevant to the circumstances of practice by the process of vetting the research before it can qualify for inclusion in systematic reviews and the practice guidelines derived from them. It suggests a 'fallacy of the pipeline' implicit in one-way conceptualizations of translation, dissemination and delivery of research to practitioners. Secondly, it identifies a 'fallacy of the empty vessel' implicit in the assumptions underlying common characterizations of the practitioner as a recipient of evidence-based guidelines. Remedies are proposed that put emphasis on participatory approaches and more practice-based production of the research and more attention to external validity in the peer review, funding, publication and systematic reviews of research in producing evidence-based guidelines.
通常对于研究与实践差距的解释和解决方案的探寻,倾向于从科学流程的末端分析如何更高效、更有效地将循证实践指南传达给从业者。对这一流程的审视则向上游探寻,即在研究有资格纳入系统评价及由此衍生的实践指南之前,对其进行审查的过程中,研究本身如何变得越来越与实践情况无关。它揭示了在将研究翻译、传播和交付给从业者的单向概念化过程中隐含的“流程谬误”。其次,它识别出在将从业者视为循证指南接受者的常见特征背后的假设中隐含的“空容器谬误”。文中提出了补救措施,强调采用参与式方法,开展更多基于实践的研究,并在循证指南制定过程中的研究同行评审、资金投入、出版及系统评价中,更多地关注外部效度。