Attitudes and other barriers to the utilization of clinical research findings by American physicians: A systematic review

Background: The Institute of Medicine estimates that only a maximum of 25% of clinical research findings are incorporated into practice by physicians. To improve clinical practice, efforts have been made to promote evidence-based medicine and the use of clinical guidelines. Despite these efforts, the gap between research and clinical practice remains wide.^ Objective: To systematically review the literature describing the factors which influence the use of clinical research recommendations by American physicians.^ Hypothesis: Barriers exist in the application of clinical research into clinical practice, and are multifactorial. The establishment of the Clinical and Translational Awards (CTSA; special federal grants awarded to selected institutions to support clinical and translational research) has reduced the effect of these barriers and improved the process of clinical research translation into practice among American physicians.^ Aims: Identify barriers and facilitators of the use of research findings in clinical practice by American physicians. Contrast studies published six years before and after the creation of the CTSA.^ Methods: The sources of data include published literature from Medline, PubMed and PsycINFO. Selected studies must be qualitative, a survey of American clinicians, based on evidence-based medicine practice, clinical guidelines or treatment pathways. Systematic reviews and reports were excluded, as well as studies with less than 100 respondents.^ Results: In total, 1036 abstracts were reviewed; 115 full text potential articles were identified and reviewed, and a total of 31 studies met all criteria for inclusion in the final review.^ Conclusions: The barriers against the application of clinical research findings, in the forms of clinical guidelines, evidence-based medicine guides and clinical pathways, can be divided broadly into physician barriers, practice/system barriers and patient barriers. Physician barriers are the most common barriers, especially the lack of familiarity with guidelines and the lack of time. Of the factors which improve the use of research based guidelines, physician factors such as younger age, lower duration of clinical practice, specialty training, and practice in large group Health Maintenance Organization (HMO) settings with fewer patients seen were the most commonly cited.^

Northern Research Farm Summary

Includes Farm and Weather Summary, Information on Experiments in Previous Annual Progress Reports and Research Farm Projects.

Northwest Iowa On-farm Research Soybean Yield Response to Headline Fungicide

Six years ago the Northwest Iowa On-Farm Research Project was started to cooperate with local farmers to compare crop production methods on a field scale size. Through this project, over 300 replicated comparisons have been done. Beginning in 2012, the Northwest Iowa On-Farm Research project will be recognized as a part of Iowa State University Farmer Assisted Research and Management (FARM) program. This program will also expand to southwest Iowa, north central Iowa, and central Iowa.

BioCentury Research Farm Update

The BioCentury Research Farm (BCRF) had a diversity of users in 2011. Iowa State faculty and staff from agricultural and biosystems engineering (ABE), agricultural systems technology (AST), agronomy, chemical and biological engineering (CBE), civil, construction, and environmental engineering (CCEE), food science and human nutrition (FSHN), horticulture, mechanical engineering (ME), and natural resource ecology and management (NREM) conducted research, teaching, and outreach at the BCRF. Private industry users included Avello Bioenergy, DCE, Frontline BioEnergy, and Virent, Inc.

Southeast Research Farm Summary

Includes Farm and Weather Summary and Research Farm Projects.

Comparison of Organic and Conventional Crops at the Neely-Kinyon Long-term Agroecological Research Site

The Neely-Kinyon Long-term Agroecological Research (LTAR) site was established in 1998 to study the long-term effects of organic production in Iowa. Treatments at the LTAR site, replicated four times in a completely randomized design, include the following rotations: conventional Corn-Soybean (C-S), organic Corn-Soybean-Oats/Alfalfa (C-SO/A), organic Corn-Soybean-Oats/AlfalfaAlfalfa (C-S-O/A-A) and Corn-SoybeanCorn-Oats/Alfalfa (C-SB-C-O/A). On April 13, 2011, Badger oats were underseeded with BR Goldfinch alfalfa at a rate of 90 lb/acre and 15 lb/acre, respectively. Following harvest of the organic corn plots in 2010, winter rye was no-till drilled at a rate of 75 lb/acre on October 20, 2010.

Aphids in Corn Research

Corn, Zea mays L., is the most abundant field crop in Iowa, and there are many insect pests associated with this field crop. Although aphids are not typically economically important in corn, recent observations have indicated several aphid species developing heavy populations in northwest Iowa and southwest Minnesota. Historically, the corn leaf aphid, Rhopalosiphum maidis (Hemiptera: Aphididae), has been the most abundant aphid species in corn; however, the bird cherry oat aphid, R. padi (Hemiptera: Aphididae), and several other species have also been detected. Recent observations show a shift to populations peaking later in the summer. Damage potential and management guidelines for aphids in corn are not well defined and this research is aimed at developing economic threshold and sampling protocols.

Armstrong and Neely-Kinyon Research Farms Summary

Includes Farm and Weather Summary, Research Farm Projects, Acknowledgements and Information on Experiments in Previous Annual Progress Reports.

Western Research Farm Summary

Includes Farm Summary and Research Farm Projects.

Horticulture Research Station Summary

Includes Farm Staff, Farm and Weather Summary and Research Station Projects.

Muscatine Island Research Farm Summary

Includes Farm and Weather Summary and Research Farm Projects.