Implementation strategies for health systems in low-income countries: an overview of systematic reviews
Identifieur interne : 000180 ( Pmc/Checkpoint ); précédent : 000179; suivant : 000181Implementation strategies for health systems in low-income countries: an overview of systematic reviews
Auteurs : Tomas Pantoja [Chili] ; Newton Opiyo [Royaume-Uni] ; Simon Lewin [Norvège, Afrique du Sud] ; Elizabeth Paulsen [Norvège] ; Agustín Ciapponi [Argentine] ; Charles S. Wiysonge [Afrique du Sud] ; Cristian A. Herrera [Chili] ; Gabriel Rada [Chili] ; Blanca Pe Aloza [Chili] ; Lilian Dudley [Afrique du Sud] ; Marie-Pierre Gagnon [Canada] ; Sebastian Garcia Marti [Argentine] ; Andrew D. Oxman [Norvège]Source :
- The Cochrane Database of Systematic Reviews [ 1469-493X ] ; 2017.
Abstract
A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness.
To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview.
We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries.
We identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high-income countries. There were no studies from low-income countries in eight reviews.
Implementation strategies addressed in the reviews were grouped into four categories – strategies targeting:
1. healthcare organisations (e.g. strategies to change organisational culture; 1 review);
2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews);
3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews);
4. healthcare recipients (e.g. medication adherence; 15 reviews).
Overall, we found the following interventions to have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.
1.
2.
3.
Reliable systematic reviews have evaluated a wide range of strategies for implementing evidence-based interventions in low-income countries. Most of the available evidence is focused on strategies targeted at healthcare workers and healthcare recipients and relates to process-based outcomes. Evidence of the effects of strategies targeting healthcare organisations is scarce.
The aim of this Cochrane Overview is to provide a broad summary of what is known about the effects of strategies for implementing interventions to improve health in low-income countries.
This overview is based on 39 relevant systematic reviews. Each of these reviews searched for studies that evaluated the different types of implementation strategies within the scope of the question addressed by the review. The reviews included a total of 1332 studies.
This overview is one of a series of four Cochrane Overviews that evaluate different health system arrangements.
A key function of health systems is implementing interventions to improve health. Coverage of essential health interventions remains low in low-income countries. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness.
The following implementation strategies had desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.
- Educational meetings.
- Nutrition training of health workers.
- Educational outreach (vs. no intervention).
- Practice facilitation.
- Local opinion leaders.
- Audit and feedback.
- Tailored interventions (vs. no intervention).
- Training healthcare workers to be more patient-centred in clinical consultations.
- Use of birth kits.
- Clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings.
- In-service neonatal emergency care training.
- Mass media interventions to increase immediate uptake of HIV testing (leaflets and gain-framed videos).
- Intensive self-management and adherence, intensive disease management to improve health literacy.
- Behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy.
- A one-time incentive to start or continue tuberculosis prophylaxis.
- Default reminders for patients being treated for active tuberculosis.
- Use of sectioned polythene bags for adherence to malaria medication.
- Community-based health education, and reminders and recall strategies for vaccination uptake.
- Providing free insecticide-treated bednets.
- Interventions to improve uptake of cervical screening (invitations, education, counselling, access to health promotion nurse, and intensive recruitment).
- Health insurance information and application support.
The following implementation strategies had low- or very low-certainty evidence (or no studies available) for all the outcomes that were considered.
- Strategies to improve organisational culture.
- Printed educational materials.
- Internet-based learning.
- Interprofessional education.
- Teaching critical appraisal.
- Educational outreach (vs. another intervention).
- Pharmacist-provided services.
- Safety checklists for use by medical care teams in acute hospital settings.
- Tailored interventions (vs. non-tailored interventions, and interventions targeted at organisational and individual barriers vs. interventions targeted at individual barriers only).
- Interventions to encourage the use of systematic reviews in clinical decision-making.
- Interventions to improve handwashing.
- Interventions to reduce unnecessary caesarean section rates.
- Training of traditional birth attendants.
- Skilled birth attendance.
- Training of traditional healers about STD and HIV medicine.
- Providing information/education for promoting HIV testing (multimedia).
- Providing written medicine information.
- Single interventions to improve health literacy.
- Interventions to improve medication adherence.
- Adherence – TB (immediate versus deferred incentives; cash vs. non-cash incentive; different levels of cash incentives; incentives vs. other interventions).
- Adherence – malarial medication (blister packed tablets and capsules compared to tablets and capsules in paper envelopes; tablets in sectioned polythene bags compared to bottled syrup).
- Training of healthcare workers, home visits, and monetary incentives to improve immunisation coverage.
- Risk factor assessment to improve the uptake of cervical cancer screening.
The overview authors searched for systematic reviews that had been published up to 17 December 2016.
Url:
DOI: 10.1002/14651858.CD011086.pub2
PubMed: 28895659
PubMed Central: 5621088
Affiliations:
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PMC:5621088Le document en format XML
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<author><name sortKey="Herrera, Cristian A" sort="Herrera, Cristian A" uniqKey="Herrera C" first="Cristian A" last="Herrera">Cristian A. Herrera</name>
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<author><name sortKey="Rada, Gabriel" sort="Rada, Gabriel" uniqKey="Rada G" first="Gabriel" last="Rada">Gabriel Rada</name>
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<author><name sortKey="Pe Aloza, Blanca" sort="Pe Aloza, Blanca" uniqKey="Pe Aloza B" first="Blanca" last="Pe Aloza">Blanca Pe Aloza</name>
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<addr-line>Santiago, Chile</addr-line>
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<author><name sortKey="Dudley, Lilian" sort="Dudley, Lilian" uniqKey="Dudley L" first="Lilian" last="Dudley">Lilian Dudley</name>
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</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
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<author><name sortKey="Gagnon, Marie Pierre" sort="Gagnon, Marie Pierre" uniqKey="Gagnon M" first="Marie-Pierre" last="Gagnon">Marie-Pierre Gagnon</name>
<affiliation wicri:level="1"><nlm:aff id="au12"><institution>Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre</institution>
<addr-line>Québec City, Canada</addr-line>
</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>Québec City</wicri:regionArea>
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<author><name sortKey="Garcia Marti, Sebastian" sort="Garcia Marti, Sebastian" uniqKey="Garcia Marti S" first="Sebastian" last="Garcia Marti">Sebastian Garcia Marti</name>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness.</p>
</sec>
<sec><title>Objectives</title>
<p>To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview.</p>
</sec>
<sec><title>Methods</title>
<p>We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries.</p>
</sec>
<sec><title>Main results</title>
<p>We identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high-income countries. There were no studies from low-income countries in eight reviews.</p>
<p>Implementation strategies addressed in the reviews were grouped into four categories – strategies targeting:</p>
<p>1. healthcare organisations (e.g. strategies to change organisational culture; 1 review);</p>
<p>2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews);</p>
<p>3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews);</p>
<p>4. healthcare recipients (e.g. medication adherence; 15 reviews).</p>
<p>Overall, we found the following interventions to have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.</p>
<p>1.<bold>Strategies targeted at healthcare workers</bold>
: educational meetings, nutrition training of health workers, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions.</p>
<p>2.<bold>Strategies targeted at healthcare workers for specific types of problems</bold>
: training healthcare workers to be more patient-centred in clinical consultations, use of birth kits, strategies such as clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings, and in-service neonatal emergency care training.</p>
<p>3. <bold>Strategies targeted at healthcare recipients</bold>
: mass media interventions to increase uptake of HIV testing; intensive self-management and adherence, intensive disease management programmes to improve health literacy; behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy; a one time incentive to start or continue tuberculosis prophylaxis; default reminders for patients being treated for active tuberculosis; use of sectioned polythene bags for adherence to malaria medication; community-based health education, and reminders and recall strategies to increase vaccination uptake; interventions to increase uptake of cervical screening (invitations, education, counselling, access to health promotion nurse and intensive recruitment); health insurance information and application support.</p>
</sec>
<sec><title>Authors' conclusions</title>
<p>Reliable systematic reviews have evaluated a wide range of strategies for implementing evidence-based interventions in low-income countries. Most of the available evidence is focused on strategies targeted at healthcare workers and healthcare recipients and relates to process-based outcomes. Evidence of the effects of strategies targeting healthcare organisations is scarce.</p>
</sec>
<sec><title>Implementation strategies for health systems in low-income countries</title>
<p><bold>What is the aim of this overview?</bold>
</p>
<p>The aim of this Cochrane Overview is to provide a broad summary of what is known about the effects of strategies for implementing interventions to improve health in low-income countries.</p>
<p>This overview is based on 39 relevant systematic reviews. Each of these reviews searched for studies that evaluated the different types of implementation strategies within the scope of the question addressed by the review. The reviews included a total of 1332 studies.</p>
<p>This overview is one of a series of four Cochrane Overviews that evaluate different health system arrangements.</p>
<p><bold>What was studied in the overview?</bold>
</p>
<p>A key function of health systems is implementing interventions to improve health. Coverage of essential health interventions remains low in low-income countries. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness.</p>
<p><bold>What are the main results of the overview?</bold>
</p>
<p>The following implementation strategies had desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.</p>
<p><bold>Strategies targeted at healthcare workers</bold>
</p>
<p>- Educational meetings.</p>
<p>- Nutrition training of health workers.</p>
<p>- Educational outreach (vs. no intervention).</p>
<p>- Practice facilitation.</p>
<p>- Local opinion leaders.</p>
<p>- Audit and feedback.</p>
<p>- Tailored interventions (vs. no intervention).</p>
<p><bold>Strategies targeted at healthcare workers for specific types of problems</bold>
</p>
<p>- Training healthcare workers to be more patient-centred in clinical consultations.</p>
<p>- Use of birth kits.</p>
<p>- Clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings.</p>
<p>- In-service neonatal emergency care training.</p>
<p><bold>Strategies targeted at healthcare recipients</bold>
</p>
<p>- Mass media interventions to increase immediate uptake of HIV testing (leaflets and gain-framed videos).</p>
<p>- Intensive self-management and adherence, intensive disease management to improve health literacy.</p>
<p>- Behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy.</p>
<p>- A one-time incentive to start or continue tuberculosis prophylaxis.</p>
<p>- Default reminders for patients being treated for active tuberculosis.</p>
<p>- Use of sectioned polythene bags for adherence to malaria medication.</p>
<p>- Community-based health education, and reminders and recall strategies for vaccination uptake.</p>
<p>- Providing free insecticide-treated bednets.</p>
<p>- Interventions to improve uptake of cervical screening (invitations, education, counselling, access to health promotion nurse, and intensive recruitment).</p>
<p>- Health insurance information and application support.</p>
<p>The following implementation strategies had low- or very low-certainty evidence (or no studies available) for all the outcomes that were considered.</p>
<p><bold>Strategies targeted at healthcare organisations</bold>
</p>
<p>- Strategies to improve organisational culture.</p>
<p><bold>Strategies targeted at healthcare workers</bold>
</p>
<p>- Printed educational materials.</p>
<p>- Internet-based learning.</p>
<p>- Interprofessional education.</p>
<p>- Teaching critical appraisal.</p>
<p>- Educational outreach (vs. another intervention).</p>
<p>- Pharmacist-provided services.</p>
<p>- Safety checklists for use by medical care teams in acute hospital settings.</p>
<p>- Tailored interventions (vs. non-tailored interventions, and interventions targeted at organisational and individual barriers vs. interventions targeted at individual barriers only).</p>
<p>- Interventions to encourage the use of systematic reviews in clinical decision-making.</p>
<p><bold>Strategies targeted at healthcare workers for specific types of problems</bold>
</p>
<p>- Interventions to improve handwashing.</p>
<p>- Interventions to reduce unnecessary caesarean section rates.</p>
<p>- Training of traditional birth attendants.</p>
<p>- Skilled birth attendance.</p>
<p>- Training of traditional healers about STD and HIV medicine.</p>
<p><bold>Strategies targeted at healthcare recipients</bold>
</p>
<p>- Providing information/education for promoting HIV testing (multimedia).</p>
<p>- Providing written medicine information.</p>
<p>- Single interventions to improve health literacy.</p>
<p>- Interventions to improve medication adherence.</p>
<p>- Adherence – TB (immediate versus deferred incentives; cash vs. non-cash incentive; different levels of cash incentives; incentives vs. other interventions).</p>
<p>- Adherence – malarial medication (blister packed tablets and capsules compared to tablets and capsules in paper envelopes; tablets in sectioned polythene bags compared to bottled syrup).</p>
<p>- Training of healthcare workers, home visits, and monetary incentives to improve immunisation coverage.</p>
<p>- Risk factor assessment to improve the uptake of cervical cancer screening.</p>
<p><bold>How up to date is this overview?</bold>
</p>
<p>The overview authors searched for systematic reviews that had been published up to 17 December 2016.</p>
</sec>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Augustincic Polec, L" uniqKey="Augustincic Polec L">L Augustincic Polec</name>
</author>
<author><name sortKey="O Neill, J" uniqKey="O Neill J">J O'Neill</name>
</author>
<author><name sortKey="Welch, V" uniqKey="Welch V">V Welch</name>
</author>
<author><name sortKey="Ueffing, E" uniqKey="Ueffing E">E Ueffing</name>
</author>
<author><name sortKey="Tanjong Ghogomu, E" uniqKey="Tanjong Ghogomu E">E Tanjong Ghogomu</name>
</author>
<author><name sortKey="Pardo Pardo, J" uniqKey="Pardo Pardo J">J Pardo Pardo</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Baker, R" uniqKey="Baker R">R Baker</name>
</author>
<author><name sortKey="Camosso Stefinovic, J" uniqKey="Camosso Stefinovic J">J Camosso-Stefinovic</name>
</author>
<author><name sortKey="Gillies, C" uniqKey="Gillies C">C Gillies</name>
</author>
<author><name sortKey="Shaw, Ej" uniqKey="Shaw E">EJ Shaw</name>
</author>
<author><name sortKey="Cheater, F" uniqKey="Cheater F">F Cheater</name>
</author>
<author><name sortKey="Flottorp, S" uniqKey="Flottorp S">S Flottorp</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Baskerville, Nb" uniqKey="Baskerville N">NB Baskerville</name>
</author>
<author><name sortKey="Liddy, C" uniqKey="Liddy C">C Liddy</name>
</author>
<author><name sortKey="Hogg, W" uniqKey="Hogg W">W Hogg</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Berkman, Nd" uniqKey="Berkman N">ND Berkman</name>
</author>
<author><name sortKey="Sheridan, Sl" uniqKey="Sheridan S">SL Sheridan</name>
</author>
<author><name sortKey="Donahue, Ke" uniqKey="Donahue K">KE Donahue</name>
</author>
<author><name sortKey="Halpern, Dj" uniqKey="Halpern D">DJ Halpern</name>
</author>
<author><name sortKey="Viera, A" uniqKey="Viera A">A Viera</name>
</author>
<author><name sortKey="Crotty, K" uniqKey="Crotty K">K Crotty</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Cook, Da" uniqKey="Cook D">DA Cook</name>
</author>
<author><name sortKey="Levinson, Aj" uniqKey="Levinson A">AJ Levinson</name>
</author>
<author><name sortKey="Garside, S" uniqKey="Garside S">S Garside</name>
</author>
<author><name sortKey="Dupras, Dm" uniqKey="Dupras D">DM Dupras</name>
</author>
<author><name sortKey="Erwin, Pj" uniqKey="Erwin P">PJ Erwin</name>
</author>
<author><name sortKey="Montori, Vm" uniqKey="Montori V">VM Montori</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Jorgenson, S" uniqKey="Jorgenson S">S Jorgenson</name>
</author>
<author><name sortKey="Sadigh, G" uniqKey="Sadigh G">G Sadigh</name>
</author>
<author><name sortKey="Sikorskii, A" uniqKey="Sikorskii A">A Sikorskii</name>
</author>
<author><name sortKey="Lewin, S" uniqKey="Lewin S">S Lewin</name>
</author>
<author><name sortKey="Smith, Rc" uniqKey="Smith R">RC Smith</name>
</author>
<author><name sortKey="Coffey, J" uniqKey="Coffey J">J Coffey</name>
</author>
<author><name sortKey="Olomu, A" uniqKey="Olomu A">A Olomu</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Everett, T" uniqKey="Everett T">T Everett</name>
</author>
<author><name sortKey="Bryant, A" uniqKey="Bryant A">A Bryant</name>
</author>
<author><name sortKey="Griffin, Mf" uniqKey="Griffin M">MF Griffin</name>
</author>
<author><name sortKey="Martin Hirsch, Ppl" uniqKey="Martin Hirsch P">PPL Martin-Hirsch</name>
</author>
<author><name sortKey="Forbes, Ca" uniqKey="Forbes C">CA Forbes</name>
</author>
<author><name sortKey="Jepson, Rg" uniqKey="Jepson R">RG Jepson</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Flodgren, G" uniqKey="Flodgren G">G Flodgren</name>
</author>
<author><name sortKey="Parmelli, E" uniqKey="Parmelli E">E Parmelli</name>
</author>
<author><name sortKey="Doumit, G" uniqKey="Doumit G">G Doumit</name>
</author>
<author><name sortKey="Gattellari, M" uniqKey="Gattellari M">M Gattellari</name>
</author>
<author><name sortKey="O Brien, Ma" uniqKey="O Brien M">MA O'Brien</name>
</author>
<author><name sortKey="Grimshaw, J" uniqKey="Grimshaw J">J Grimshaw</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Forsetlund, L" uniqKey="Forsetlund L">L Forsetlund</name>
</author>
<author><name sortKey="Bj Rndal, A" uniqKey="Bj Rndal A">A Bjørndal</name>
</author>
<author><name sortKey="Rashidian, A" uniqKey="Rashidian A">A Rashidian</name>
</author>
<author><name sortKey="Jamtvedt, G" uniqKey="Jamtvedt G">G Jamtvedt</name>
</author>
<author><name sortKey="O Brien, Ma" uniqKey="O Brien M">MA O'Brien</name>
</author>
<author><name sortKey="Wolf, F" uniqKey="Wolf F">F Wolf</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Giguere, A" uniqKey="Giguere A">A Giguère</name>
</author>
<author><name sortKey="Legare, F" uniqKey="Legare F">F Légaré</name>
</author>
<author><name sortKey="Grimshaw, J" uniqKey="Grimshaw J">J Grimshaw</name>
</author>
<author><name sortKey="Turcotte, S" uniqKey="Turcotte S">S Turcotte</name>
</author>
<author><name sortKey="Fiander, M" uniqKey="Fiander M">M Fiander</name>
</author>
<author><name sortKey="Grudniewicz, A" uniqKey="Grudniewicz A">A Grudniewicz</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Gould, Dj" uniqKey="Gould D">DJ Gould</name>
</author>
<author><name sortKey="Moralejo, D" uniqKey="Moralejo D">D Moralejo</name>
</author>
<author><name sortKey="Drey, N" uniqKey="Drey N">N Drey</name>
</author>
<author><name sortKey="Chudleigh, Jh" uniqKey="Chudleigh J">JH Chudleigh</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Haynes, Rb" uniqKey="Haynes R">RB Haynes</name>
</author>
<author><name sortKey="Ackloo, E" uniqKey="Ackloo E">E Ackloo</name>
</author>
<author><name sortKey="Sahota, N" uniqKey="Sahota N">N Sahota</name>
</author>
<author><name sortKey="Mcdonald, Hp" uniqKey="Mcdonald H">HP McDonald</name>
</author>
<author><name sortKey="Yao, X" uniqKey="Yao X">X Yao</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Horsley, T" uniqKey="Horsley T">T Horsley</name>
</author>
<author><name sortKey="Hyde, C" uniqKey="Hyde C">C Hyde</name>
</author>
<author><name sortKey="Santesso, N" uniqKey="Santesso N">N Santesso</name>
</author>
<author><name sortKey="Parkes, J" uniqKey="Parkes J">J Parkes</name>
</author>
<author><name sortKey="Milne, R" uniqKey="Milne R">R Milne</name>
</author>
<author><name sortKey="Stewart, R" uniqKey="Stewart R">R Stewart</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Hundley, Va" uniqKey="Hundley V">VA Hundley</name>
</author>
<author><name sortKey="Avan, Bi" uniqKey="Avan B">BI Avan</name>
</author>
<author><name sortKey="Braunholtz, D" uniqKey="Braunholtz D">D Braunholtz</name>
</author>
<author><name sortKey="Graham, Wj" uniqKey="Graham W">WJ Graham</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Ivers, N" uniqKey="Ivers N">N Ivers</name>
</author>
<author><name sortKey="Jamtvedt, G" uniqKey="Jamtvedt G">G Jamtvedt</name>
</author>
<author><name sortKey="Flottorp, S" uniqKey="Flottorp S">S Flottorp</name>
</author>
<author><name sortKey="Young, Jm" uniqKey="Young J">JM Young</name>
</author>
<author><name sortKey="Odgaard Jensen, J" uniqKey="Odgaard Jensen J">J Odgaard-Jensen</name>
</author>
<author><name sortKey="French, Sd" uniqKey="French S">SD French</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Jacobson Vann, Jc" uniqKey="Jacobson Vann J">JC Jacobson Vann</name>
</author>
<author><name sortKey="Szilagyi, P" uniqKey="Szilagyi P">P Szilagyi</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Jia, L" uniqKey="Jia L">L Jia</name>
</author>
<author><name sortKey="Yuan, B" uniqKey="Yuan B">B Yuan</name>
</author>
<author><name sortKey="Lu, Y" uniqKey="Lu Y">Y Lu</name>
</author>
<author><name sortKey="Garner, P" uniqKey="Garner P">P Garner</name>
</author>
<author><name sortKey="Meng, Q" uniqKey="Meng Q">Q Meng</name>
</author>
<author><name sortKey="Huang, F" uniqKey="Huang F">F Huang</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Khunpradit, S" uniqKey="Khunpradit S">S Khunpradit</name>
</author>
<author><name sortKey="Tavender, E" uniqKey="Tavender E">E Tavender</name>
</author>
<author><name sortKey="Lumbiganon, P" uniqKey="Lumbiganon P">P Lumbiganon</name>
</author>
<author><name sortKey="Laopaiboon, M" uniqKey="Laopaiboon M">M Laopaiboon</name>
</author>
<author><name sortKey="Wasiak, J" uniqKey="Wasiak J">J Wasiak</name>
</author>
<author><name sortKey="Gruen, Rl" uniqKey="Gruen R">RL Gruen</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Ko, Hc" uniqKey="Ko H">HC Ko</name>
</author>
<author><name sortKey="Turner, Tj" uniqKey="Turner T">TJ Turner</name>
</author>
<author><name sortKey="Finnigan, Ma" uniqKey="Finnigan M">MA Finnigan</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Liu, Q" uniqKey="Liu Q">Q Liu</name>
</author>
<author><name sortKey="Abba, K" uniqKey="Abba K">K Abba</name>
</author>
<author><name sortKey="Alejandria, Mm" uniqKey="Alejandria M">MM Alejandria</name>
</author>
<author><name sortKey="Sinclair, D" uniqKey="Sinclair D">D Sinclair</name>
</author>
<author><name sortKey="Balanag, Vm" uniqKey="Balanag V">VM Balanag</name>
</author>
<author><name sortKey="Lansang, Mad" uniqKey="Lansang M">MAD Lansang</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Lutge, Ee" uniqKey="Lutge E">EE Lutge</name>
</author>
<author><name sortKey="Wiysonge, Cs" uniqKey="Wiysonge C">CS Wiysonge</name>
</author>
<author><name sortKey="Knight, Se" uniqKey="Knight S">SE Knight</name>
</author>
<author><name sortKey="Sinclair, D" uniqKey="Sinclair D">D Sinclair</name>
</author>
<author><name sortKey="Volmink, J" uniqKey="Volmink J">J Volmink</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Mbuagbaw, L" uniqKey="Mbuagbaw L">L Mbuagbaw</name>
</author>
<author><name sortKey="Van Derkop, Ml" uniqKey="Van Derkop M">ML van derKop</name>
</author>
<author><name sortKey="Lester, Rt" uniqKey="Lester R">RT Lester</name>
</author>
<author><name sortKey="Thirumurthy, H" uniqKey="Thirumurthy H">H Thirumurthy</name>
</author>
<author><name sortKey="Pop Eleches, C" uniqKey="Pop Eleches C">C Pop-Eleches</name>
</author>
<author><name sortKey="Ye, C" uniqKey="Ye C">C Ye</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Nicolson, Dj" uniqKey="Nicolson D">DJ Nicolson</name>
</author>
<author><name sortKey="Knapp, P" uniqKey="Knapp P">P Knapp</name>
</author>
<author><name sortKey="Raynor, Dk" uniqKey="Raynor D">DK Raynor</name>
</author>
<author><name sortKey="Spoor, P" uniqKey="Spoor P">P Spoor</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="O Brien, Ma" uniqKey="O Brien M">MA O'Brien</name>
</author>
<author><name sortKey="Rogers, S" uniqKey="Rogers S">S Rogers</name>
</author>
<author><name sortKey="Jamtvedt, G" uniqKey="Jamtvedt G">G Jamtvedt</name>
</author>
<author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Odgaard Jensen, J" uniqKey="Odgaard Jensen J">J Odgaard-Jensen</name>
</author>
<author><name sortKey="Kristoffersen, Dt" uniqKey="Kristoffersen D">DT Kristoffersen</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Opiyo, N" uniqKey="Opiyo N">N Opiyo</name>
</author>
<author><name sortKey="English, M" uniqKey="English M">M English</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Orton, Lc" uniqKey="Orton L">LC Orton</name>
</author>
<author><name sortKey="Barnish, G" uniqKey="Barnish G">G Barnish</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Oyo Ita, A" uniqKey="Oyo Ita A">A Oyo-Ita</name>
</author>
<author><name sortKey="Wiysonge, C" uniqKey="Wiysonge C">C Wiysonge</name>
</author>
<author><name sortKey="Oringanje, C" uniqKey="Oringanje C">C Oringanje</name>
</author>
<author><name sortKey="Nwachukwu, Ce" uniqKey="Nwachukwu C">CE Nwachukwu</name>
</author>
<author><name sortKey="Oduwole, O" uniqKey="Oduwole O">O Oduwole</name>
</author>
<author><name sortKey="Meremikwu, Mm" uniqKey="Meremikwu M">MM Meremikwu</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Pande, S" uniqKey="Pande S">S Pande</name>
</author>
<author><name sortKey="Hiller, Je" uniqKey="Hiller J">JE Hiller</name>
</author>
<author><name sortKey="Nkansah, N" uniqKey="Nkansah N">N Nkansah</name>
</author>
<author><name sortKey="Bero, L" uniqKey="Bero L">L Bero</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Parmelli, E" uniqKey="Parmelli E">E Parmelli</name>
</author>
<author><name sortKey="Flodgren, G" uniqKey="Flodgren G">G Flodgren</name>
</author>
<author><name sortKey="Schaafsma, Me" uniqKey="Schaafsma M">ME Schaafsma</name>
</author>
<author><name sortKey="Baillie, N" uniqKey="Baillie N">N Baillie</name>
</author>
<author><name sortKey="Beyer, Fr" uniqKey="Beyer F">FR Beyer</name>
</author>
<author><name sortKey="Eccles, Mp" uniqKey="Eccles M">MP Eccles</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Perrier, L" uniqKey="Perrier L">L Perrier</name>
</author>
<author><name sortKey="Mrklas, K" uniqKey="Mrklas K">K Mrklas</name>
</author>
<author><name sortKey="Shepperd, S" uniqKey="Shepperd S">S Shepperd</name>
</author>
<author><name sortKey="Dobbins, M" uniqKey="Dobbins M">M Dobbins</name>
</author>
<author><name sortKey="Mckibbon, Ka" uniqKey="Mckibbon K">KA McKibbon</name>
</author>
<author><name sortKey="Straus, Se" uniqKey="Straus S">SE Straus</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Ranji, Sr" uniqKey="Ranji S">SR Ranji</name>
</author>
<author><name sortKey="Steinman, M" uniqKey="Steinman M">M Steinman</name>
</author>
<author><name sortKey="Shojania, K" uniqKey="Shojania K">K Shojania</name>
</author>
<author><name sortKey="Gonzalez, R" uniqKey="Gonzalez R">R Gonzalez</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Reeves, S" uniqKey="Reeves S">S Reeves</name>
</author>
<author><name sortKey="Perrier, L" uniqKey="Perrier L">L Perrier</name>
</author>
<author><name sortKey="Goldman, J" uniqKey="Goldman J">J Goldman</name>
</author>
<author><name sortKey="Freeth, D" uniqKey="Freeth D">D Freeth</name>
</author>
<author><name sortKey="Zwarenstein, M" uniqKey="Zwarenstein M">M Zwarenstein</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Sibley, Lm" uniqKey="Sibley L">LM Sibley</name>
</author>
<author><name sortKey="Sipe, Ta" uniqKey="Sipe T">TA Sipe</name>
</author>
<author><name sortKey="Barry, D" uniqKey="Barry D">D Barry</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Simoni, Jm" uniqKey="Simoni J">JM Simoni</name>
</author>
<author><name sortKey="Pearson, Cr" uniqKey="Pearson C">CR Pearson</name>
</author>
<author><name sortKey="Pantalone, Dw" uniqKey="Pantalone D">DW Pantalone</name>
</author>
<author><name sortKey="Marks, G" uniqKey="Marks G">G Marks</name>
</author>
<author><name sortKey="Crepaz, N" uniqKey="Crepaz N">N Crepaz</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Simoni, Jm" uniqKey="Simoni J">JM Simoni</name>
</author>
<author><name sortKey="Amico, Kr" uniqKey="Amico K">KR Amico</name>
</author>
<author><name sortKey="Smith, L" uniqKey="Smith L">L Smith</name>
</author>
<author><name sortKey="Nelson, K" uniqKey="Nelson K">K Nelson</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Sorsdahl, K" uniqKey="Sorsdahl K">K Sorsdahl</name>
</author>
<author><name sortKey="Ipser, Jc" uniqKey="Ipser J">JC Ipser</name>
</author>
<author><name sortKey="Stein, Dj" uniqKey="Stein D">DJ Stein</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Sunguya, Bf" uniqKey="Sunguya B">BF Sunguya</name>
</author>
<author><name sortKey="Poudel, Kc" uniqKey="Poudel K">KC Poudel</name>
</author>
<author><name sortKey="Mlunde, Lb" uniqKey="Mlunde L">LB Mlunde</name>
</author>
<author><name sortKey="Shakya, P" uniqKey="Shakya P">P Shakya</name>
</author>
<author><name sortKey="Urassa, Dp" uniqKey="Urassa D">DP Urassa</name>
</author>
<author><name sortKey="Jimba, M" uniqKey="Jimba M">M Jimba</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Vidanapathirana, J" uniqKey="Vidanapathirana J">J Vidanapathirana</name>
</author>
<author><name sortKey="Abramson, Mj" uniqKey="Abramson M">MJ Abramson</name>
</author>
<author><name sortKey="Forbes, A" uniqKey="Forbes A">A Forbes</name>
</author>
<author><name sortKey="Fairley, C" uniqKey="Fairley C">C Fairley</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Yakoob, My" uniqKey="Yakoob M">MY Yakoob</name>
</author>
<author><name sortKey="Ali, Ma" uniqKey="Ali M">MA Ali</name>
</author>
<author><name sortKey="Ali, Mu" uniqKey="Ali M">MU Ali</name>
</author>
<author><name sortKey="Imdad, A" uniqKey="Imdad A">A Imdad</name>
</author>
<author><name sortKey="Lawn, Je" uniqKey="Lawn J">JE Lawn</name>
</author>
<author><name sortKey="Van Denbroek, N" uniqKey="Van Denbroek N">N Van DenBroek</name>
</author>
<author><name sortKey="Bhutta, Za" uniqKey="Bhutta Z">ZA Bhutta</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Arditi, C" uniqKey="Arditi C">C Arditi</name>
</author>
<author><name sortKey="Rege Walther, M" uniqKey="Rege Walther M">M Rège-Walther</name>
</author>
<author><name sortKey="Wyatt, Jc" uniqKey="Wyatt J">JC Wyatt</name>
</author>
<author><name sortKey="Durieux, P" uniqKey="Durieux P">P Durieux</name>
</author>
<author><name sortKey="Burnand, B" uniqKey="Burnand B">B Burnand</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Beilby, Jj" uniqKey="Beilby J">JJ Beilby</name>
</author>
<author><name sortKey="Silagy, Ca" uniqKey="Silagy C">CA Silagy</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Bordley, Wc" uniqKey="Bordley W">WC Bordley</name>
</author>
<author><name sortKey="Chelminski, A" uniqKey="Chelminski A">A Chelminski</name>
</author>
<author><name sortKey="Margolis, Pa" uniqKey="Margolis P">PA Margolis</name>
</author>
<author><name sortKey="Kraus, R" uniqKey="Kraus R">R Kraus</name>
</author>
<author><name sortKey="Szilagyi, Pg" uniqKey="Szilagyi P">PG Szilagyi</name>
</author>
<author><name sortKey="Vann, Jj" uniqKey="Vann J">JJ Vann</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Chaillet, N" uniqKey="Chaillet N">N Chaillet</name>
</author>
<author><name sortKey="Dube, E" uniqKey="Dube E">E Dubé</name>
</author>
<author><name sortKey="Dugas, M" uniqKey="Dugas M">M Dugas</name>
</author>
<author><name sortKey="Audibert, F" uniqKey="Audibert F">F Audibert</name>
</author>
<author><name sortKey="Tourigny, C" uniqKey="Tourigny C">C Tourigny</name>
</author>
<author><name sortKey="Fraser, Wd" uniqKey="Fraser W">WD Fraser</name>
</author>
<author><name sortKey="Dumont, A" uniqKey="Dumont A">A Dumont</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Fudickar, A" uniqKey="Fudickar A">A Fudickar</name>
</author>
<author><name sortKey="Horle, K" uniqKey="Horle K">K Hörle</name>
</author>
<author><name sortKey="Wiltfang, J" uniqKey="Wiltfang J">J Wiltfang</name>
</author>
<author><name sortKey="Bein, B" uniqKey="Bein B">B Bein</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Grilli, R" uniqKey="Grilli R">R Grilli</name>
</author>
<author><name sortKey="Ramsay, C" uniqKey="Ramsay C">C Ramsay</name>
</author>
<author><name sortKey="Minozzi, S" uniqKey="Minozzi S">S Minozzi</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Grimshaw, Jm" uniqKey="Grimshaw J">JM Grimshaw</name>
</author>
<author><name sortKey="Thomas, Re" uniqKey="Thomas R">RE Thomas</name>
</author>
<author><name sortKey="Maclennan, G" uniqKey="Maclennan G">G MacLennan</name>
</author>
<author><name sortKey="Fraser, C" uniqKey="Fraser C">C Fraser</name>
</author>
<author><name sortKey="Ramsay, Cr" uniqKey="Ramsay C">CR Ramsay</name>
</author>
<author><name sortKey="Vale, L" uniqKey="Vale L">L Vale</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Horvath, T" uniqKey="Horvath T">T Horvath</name>
</author>
<author><name sortKey="Azman, H" uniqKey="Azman H">H Azman</name>
</author>
<author><name sortKey="Kennedy, Ge" uniqKey="Kennedy G">GE Kennedy</name>
</author>
<author><name sortKey="Rutherford, Gw" uniqKey="Rutherford G">GW Rutherford</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Hulscher, Me" uniqKey="Hulscher M">ME Hulscher</name>
</author>
<author><name sortKey="Wensing, M" uniqKey="Wensing M">M Wensing</name>
</author>
<author><name sortKey="Van Derweijden, T" uniqKey="Van Derweijden T">T van DerWeijden</name>
</author>
<author><name sortKey="Grol, R" uniqKey="Grol R">R Grol</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Ioannidis, Jp" uniqKey="Ioannidis J">JP Ioannidis</name>
</author>
<author><name sortKey="Lau, J" uniqKey="Lau J">J Lau</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Jayaraman, S" uniqKey="Jayaraman S">S Jayaraman</name>
</author>
<author><name sortKey="Sethi, D" uniqKey="Sethi D">D Sethi</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Jayaraman, S" uniqKey="Jayaraman S">S Jayaraman</name>
</author>
<author><name sortKey="Sethi, D" uniqKey="Sethi D">D Sethi</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Kendrick, D" uniqKey="Kendrick D">D Kendrick</name>
</author>
<author><name sortKey="Hewitt, M" uniqKey="Hewitt M">M Hewitt</name>
</author>
<author><name sortKey="Dewey, M" uniqKey="Dewey M">M Dewey</name>
</author>
<author><name sortKey="Elkan, R" uniqKey="Elkan R">R Elkan</name>
</author>
<author><name sortKey="Blair, M" uniqKey="Blair M">M Blair</name>
</author>
<author><name sortKey="Robinson, J" uniqKey="Robinson J">J Robinson</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Lam Antoniades, M" uniqKey="Lam Antoniades M">M Lam-Antoniades</name>
</author>
<author><name sortKey="Ratnapalan, S" uniqKey="Ratnapalan S">S Ratnapalan</name>
</author>
<author><name sortKey="Tait, G" uniqKey="Tait G">G Tait</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Lee, Acc" uniqKey="Lee A">ACC Lee</name>
</author>
<author><name sortKey="Lawn, Je" uniqKey="Lawn J">JE Lawn</name>
</author>
<author><name sortKey="Cousens, S" uniqKey="Cousens S">S Cousens</name>
</author>
<author><name sortKey="Kumar, V" uniqKey="Kumar V">V Kumar</name>
</author>
<author><name sortKey="Osrin, D" uniqKey="Osrin D">D Osrin</name>
</author>
<author><name sortKey="Bhutta, Za" uniqKey="Bhutta Z">ZA Bhutta</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Legare, F" uniqKey="Legare F">F Legare</name>
</author>
<author><name sortKey="Ratte, S" uniqKey="Ratte S">S Ratte</name>
</author>
<author><name sortKey="Stacey, D" uniqKey="Stacey D">D Stacey</name>
</author>
<author><name sortKey="Kryworuchko, J" uniqKey="Kryworuchko J">J Kryworuchko</name>
</author>
<author><name sortKey="Gravel, K" uniqKey="Gravel K">K Gravel</name>
</author>
<author><name sortKey="Graham, Id" uniqKey="Graham I">ID Graham</name>
</author>
<author><name sortKey="Turcotte, S" uniqKey="Turcotte S">S Turcotte</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Minkman, M" uniqKey="Minkman M">M Minkman</name>
</author>
<author><name sortKey="Ahaus, K" uniqKey="Ahaus K">K Ahaus</name>
</author>
<author><name sortKey="Huijsman, R" uniqKey="Huijsman R">R Huijsman</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Naikoba, S" uniqKey="Naikoba S">S Naikoba</name>
</author>
<author><name sortKey="Hayward, A" uniqKey="Hayward A">A Hayward</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Nglazi, Md" uniqKey="Nglazi M">MD Nglazi</name>
</author>
<author><name sortKey="Bekker, Lg" uniqKey="Bekker L">LG Bekker</name>
</author>
<author><name sortKey="Wood, R" uniqKey="Wood R">R Wood</name>
</author>
<author><name sortKey="Hussey, Gd" uniqKey="Hussey G">GD Hussey</name>
</author>
<author><name sortKey="Wiysonge, Cs" uniqKey="Wiysonge C">CS Wiysonge</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Pattinson, Rc" uniqKey="Pattinson R">RC Pattinson</name>
</author>
<author><name sortKey="Say, L" uniqKey="Say L">L Say</name>
</author>
<author><name sortKey="Makin, Jd" uniqKey="Makin J">JD Makin</name>
</author>
<author><name sortKey="Bastos, Mh" uniqKey="Bastos M">MH Bastos</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Pearce, J" uniqKey="Pearce J">J Pearce</name>
</author>
<author><name sortKey="Mann, Mk" uniqKey="Mann M">MK Mann</name>
</author>
<author><name sortKey="Jones, C" uniqKey="Jones C">C Jones</name>
</author>
<author><name sortKey="Vanbuschbach, S" uniqKey="Vanbuschbach S">S vanBuschbach</name>
</author>
<author><name sortKey="Olff, M" uniqKey="Olff M">M Olff</name>
</author>
<author><name sortKey="Bisson, Ji" uniqKey="Bisson J">JI Bisson</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Rowe, Re" uniqKey="Rowe R">RE Rowe</name>
</author>
<author><name sortKey="Garcia, J" uniqKey="Garcia J">J Garcia</name>
</author>
<author><name sortKey="Macfarlane, Aj" uniqKey="Macfarlane A">AJ Macfarlane</name>
</author>
<author><name sortKey="Davidson, Ll" uniqKey="Davidson L">LL Davidson</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Rueda, S" uniqKey="Rueda S">S Rueda</name>
</author>
<author><name sortKey="Park Wyllie, Ly" uniqKey="Park Wyllie L">LY Park-Wyllie</name>
</author>
<author><name sortKey="Bayoumi, Am" uniqKey="Bayoumi A">AM Bayoumi</name>
</author>
<author><name sortKey="Tynan, Am" uniqKey="Tynan A">AM Tynan</name>
</author>
<author><name sortKey="Antoniou, Ta" uniqKey="Antoniou T">TA Antoniou</name>
</author>
<author><name sortKey="Rourke, Sb" uniqKey="Rourke S">SB Rourke</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Safdar, N" uniqKey="Safdar N">N Safdar</name>
</author>
<author><name sortKey="Abad, C" uniqKey="Abad C">C Abad</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Shea, B" uniqKey="Shea B">B Shea</name>
</author>
<author><name sortKey="Andersson, N" uniqKey="Andersson N">N Andersson</name>
</author>
<author><name sortKey="Henry, D" uniqKey="Henry D">D Henry</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Shojania, Kg" uniqKey="Shojania K">KG Shojania</name>
</author>
<author><name sortKey="Jennings, A" uniqKey="Jennings A">A Jennings</name>
</author>
<author><name sortKey="Mayhew, A" uniqKey="Mayhew A">A Mayhew</name>
</author>
<author><name sortKey="Ramsay, Cr" uniqKey="Ramsay C">CR Ramsay</name>
</author>
<author><name sortKey="Ecclesmp" uniqKey="Ecclesmp">EcclesMp</name>
</author>
<author><name sortKey="Grimshaw, J" uniqKey="Grimshaw J">J Grimshaw</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Smith, La" uniqKey="Smith L">LA Smith</name>
</author>
<author><name sortKey="Jones, C" uniqKey="Jones C">C Jones</name>
</author>
<author><name sortKey="Meek, S" uniqKey="Meek S">S Meek</name>
</author>
<author><name sortKey="Webster, J" uniqKey="Webster J">J Webster</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Smits, Pb" uniqKey="Smits P">PB Smits</name>
</author>
<author><name sortKey="Verbeek, Jh" uniqKey="Verbeek J">JH Verbeek</name>
</author>
<author><name sortKey="Debuisonje, Cd" uniqKey="Debuisonje C">CD deBuisonjé</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Sowden, Aj" uniqKey="Sowden A">AJ Sowden</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Turner, T" uniqKey="Turner T">T Turner</name>
</author>
<author><name sortKey="Harris, C" uniqKey="Harris C">C Harris</name>
</author>
<author><name sortKey="Molyneux, E" uniqKey="Molyneux E">E Molyneux</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Wafula, Fn" uniqKey="Wafula F">FN Wafula</name>
</author>
<author><name sortKey="Goodman, Ca" uniqKey="Goodman C">CA Goodman</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Zedler, Bk" uniqKey="Zedler B">BK Zedler</name>
</author>
<author><name sortKey="Kakad, P" uniqKey="Kakad P">P Kakad</name>
</author>
<author><name sortKey="Colilla, S" uniqKey="Colilla S">S Colilla</name>
</author>
<author><name sortKey="Murrelle, L" uniqKey="Murrelle L">L Murrelle</name>
</author>
<author><name sortKey="Shah, Nr" uniqKey="Shah N">NR Shah</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Abraham, C" uniqKey="Abraham C">C Abraham</name>
</author>
<author><name sortKey="Michie, S" uniqKey="Michie S">S Michie</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Althabe, F" uniqKey="Althabe F">F Althabe</name>
</author>
<author><name sortKey="Bergel, E" uniqKey="Bergel E">E Bergel</name>
</author>
<author><name sortKey="Cafferata, Ml" uniqKey="Cafferata M">ML Cafferata</name>
</author>
<author><name sortKey="Gibbons, L" uniqKey="Gibbons L">L Gibbons</name>
</author>
<author><name sortKey="Ciapponi, A" uniqKey="Ciapponi A">A Ciapponi</name>
</author>
<author><name sortKey="Aleman, A" uniqKey="Aleman A">A Alemán</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Arnold, Sr" uniqKey="Arnold S">SR Arnold</name>
</author>
<author><name sortKey="Straus, Se" uniqKey="Straus S">SE Straus</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Baldwin, K" uniqKey="Baldwin K">K Baldwin</name>
</author>
<author><name sortKey="Namdari, S" uniqKey="Namdari S">S Namdari</name>
</author>
<author><name sortKey="Donegan, D" uniqKey="Donegan D">D Donegan</name>
</author>
<author><name sortKey="Kamath, Af" uniqKey="Kamath A">AF Kamath</name>
</author>
<author><name sortKey="Mehta, S" uniqKey="Mehta S">S Mehta</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Bero, La" uniqKey="Bero L">LA Bero</name>
</author>
<author><name sortKey="Grilli, R" uniqKey="Grilli R">R Grilli</name>
</author>
<author><name sortKey="Grimshaw, Jm" uniqKey="Grimshaw J">JM Grimshaw</name>
</author>
<author><name sortKey="Harvey, E" uniqKey="Harvey E">E Harvey</name>
</author>
<author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Thomson, Ma" uniqKey="Thomson M">MA Thomson</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Bloom, Bs" uniqKey="Bloom B">BS Bloom</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Boaz, A" uniqKey="Boaz A">A Boaz</name>
</author>
<author><name sortKey="Baeza, J" uniqKey="Baeza J">J Baeza</name>
</author>
<author><name sortKey="Fraser, A" uniqKey="Fraser A">A Fraser</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Brennan, S" uniqKey="Brennan S">S Brennan</name>
</author>
<author><name sortKey="Mckenzie, J" uniqKey="Mckenzie J">J McKenzie</name>
</author>
<author><name sortKey="Whitty, P" uniqKey="Whitty P">P Whitty</name>
</author>
<author><name sortKey="Buchan, H" uniqKey="Buchan H">H Buchan</name>
</author>
<author><name sortKey="Green, S" uniqKey="Green S">S Green</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Chan, Wv" uniqKey="Chan W">WV Chan</name>
</author>
<author><name sortKey="Pearson, Ta" uniqKey="Pearson T">TA Pearson</name>
</author>
<author><name sortKey="Bennett, Gc" uniqKey="Bennett G">GC Bennett</name>
</author>
<author><name sortKey="Castillo, G" uniqKey="Castillo G">G Castillo</name>
</author>
<author><name sortKey="Cushman, Wc" uniqKey="Cushman W">WC Cushman</name>
</author>
<author><name sortKey="Gaziano, Ta" uniqKey="Gaziano T">TA Gaziano</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Cheung, A" uniqKey="Cheung A">A Cheung</name>
</author>
<author><name sortKey="Weir, M" uniqKey="Weir M">M Weir</name>
</author>
<author><name sortKey="Mayhew, A" uniqKey="Mayhew A">A Mayhew</name>
</author>
<author><name sortKey="Kozloff, N" uniqKey="Kozloff N">N Kozloff</name>
</author>
<author><name sortKey="Brown, K" uniqKey="Brown K">K Brown</name>
</author>
<author><name sortKey="Grimshaw, J" uniqKey="Grimshaw J">J Grimshaw</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Ciapponi, A" uniqKey="Ciapponi A">A Ciapponi</name>
</author>
<author><name sortKey="Lewin, S" uniqKey="Lewin S">S Lewin</name>
</author>
<author><name sortKey="Bastias, G" uniqKey="Bastias G">G Bastías</name>
</author>
<author><name sortKey="Dudley, L" uniqKey="Dudley L">L Dudley</name>
</author>
<author><name sortKey="Flottorp, S" uniqKey="Flottorp S">S Flottorp</name>
</author>
<author><name sortKey="Gagnon, Mp" uniqKey="Gagnon M">MP Gagnon</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Davey, P" uniqKey="Davey P">P Davey</name>
</author>
<author><name sortKey="Brown, E" uniqKey="Brown E">E Brown</name>
</author>
<author><name sortKey="Charani, E" uniqKey="Charani E">E Charani</name>
</author>
<author><name sortKey="Fenelon, L" uniqKey="Fenelon L">L Fenelon</name>
</author>
<author><name sortKey="Gould, Im" uniqKey="Gould I">IM Gould</name>
</author>
<author><name sortKey="Holmes, A" uniqKey="Holmes A">A Holmes</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Dolan, P" uniqKey="Dolan P">P Dolan</name>
</author>
<author><name sortKey="Hallsworth, M" uniqKey="Hallsworth M">M Hallsworth</name>
</author>
<author><name sortKey="Halpern, D" uniqKey="Halpern D">D Halpern</name>
</author>
<author><name sortKey="King, D" uniqKey="King D">D King</name>
</author>
<author><name sortKey=" Vlaev, I" uniqKey=" Vlaev I">I Vlaev</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Dudley, L" uniqKey="Dudley L">L Dudley</name>
</author>
<author><name sortKey="Hviding, K" uniqKey="Hviding K">K Hviding</name>
</author>
<author><name sortKey="Paulsen, E" uniqKey="Paulsen E">E Paulsen</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Cochrane Effective, Practice" uniqKey="Cochrane Effective P">Practice Cochrane Effective</name>
</author>
<author><name sortKey="Organisation Of Care, Epoc" uniqKey="Organisation Of Care ">(EPOC) Organisation of Care</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Flottorp, Sa" uniqKey="Flottorp S">SA Flottorp</name>
</author>
<author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Krause, J" uniqKey="Krause J">J Krause</name>
</author>
<author><name sortKey="Musila, Nr" uniqKey="Musila N">NR Musila</name>
</author>
<author><name sortKey="Wensing, M" uniqKey="Wensing M">M Wensing</name>
</author>
<author><name sortKey="Godycki Cwirko, M" uniqKey="Godycki Cwirko M">M Godycki-Cwirko</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="French, Sd" uniqKey="French S">SD French</name>
</author>
<author><name sortKey="Green, Se" uniqKey="Green S">SE Green</name>
</author>
<author><name sortKey="O Connor, Da" uniqKey="O Connor D">DA O'Connor</name>
</author>
<author><name sortKey="Mckenzie, Je" uniqKey="Mckenzie J">JE McKenzie</name>
</author>
<author><name sortKey="Francis, Jj" uniqKey="Francis J">JJ Francis</name>
</author>
<author><name sortKey="Michie, S" uniqKey="Michie S">S Michie</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Fretheim, A" uniqKey="Fretheim A">A Fretheim</name>
</author>
<author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Lavis, Jn" uniqKey="Lavis J">JN Lavis</name>
</author>
<author><name sortKey="Lewin, S" uniqKey="Lewin S">S Lewin</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="F Nhus, Ms" uniqKey="F Nhus M">MS Fønhus</name>
</author>
<author><name sortKey="Dalsb, Tk" uniqKey="Dalsb T">TK Dalsbø</name>
</author>
<author><name sortKey="Johansen, M" uniqKey="Johansen M">M Johansen</name>
</author>
<author><name sortKey="Fretheim, A" uniqKey="Fretheim A">A Fretheim</name>
</author>
<author><name sortKey="Skirbekk, H" uniqKey="Skirbekk H">H Skirbekk</name>
</author>
<author><name sortKey="Flottorp, S" uniqKey="Flottorp S">S Flottorp</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Graham, W" uniqKey="Graham W">W Graham</name>
</author>
<author><name sortKey="Davidson, L" uniqKey="Davidson L">L Davidson</name>
</author>
<author><name sortKey="Campbell, S" uniqKey="Campbell S">S Campbell</name>
</author>
<author><name sortKey="Clar, C" uniqKey="Clar C">C Clar</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Grimshaw, Jm" uniqKey="Grimshaw J">JM Grimshaw</name>
</author>
<author><name sortKey="Shirran, L" uniqKey="Shirran L">L Shirran</name>
</author>
<author><name sortKey="Thomas, R" uniqKey="Thomas R">R Thomas</name>
</author>
<author><name sortKey="Mowatt, G" uniqKey="Mowatt G">G Mowatt</name>
</author>
<author><name sortKey="Fraser, C" uniqKey="Fraser C">C Fraser</name>
</author>
<author><name sortKey="Bero, L" uniqKey="Bero L">L Bero</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Grol, R" uniqKey="Grol R">R Grol</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Grol, R" uniqKey="Grol R">R Grol</name>
</author>
<author><name sortKey="Grimshaw, Jm" uniqKey="Grimshaw J">JM Grimshaw</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Grol, R" uniqKey="Grol R">R Grol</name>
</author>
<author><name sortKey="Wensing, M" uniqKey="Wensing M">M Wensing</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Grol, Rp" uniqKey="Grol R">RP Grol</name>
</author>
<author><name sortKey="Bosch, Mc" uniqKey="Bosch M">MC Bosch</name>
</author>
<author><name sortKey="Hulscher, Me" uniqKey="Hulscher M">ME Hulscher</name>
</author>
<author><name sortKey="Eccles, Mp" uniqKey="Eccles M">MP Eccles</name>
</author>
<author><name sortKey="Wensing, M" uniqKey="Wensing M">M Wensing</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Guyatt, Gh" uniqKey="Guyatt G">GH Guyatt</name>
</author>
<author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Kunz, R" uniqKey="Kunz R">R Kunz</name>
</author>
<author><name sortKey="Vist, Ge" uniqKey="Vist G">GE Vist</name>
</author>
<author><name sortKey="Falck Ytter, Y" uniqKey="Falck Ytter Y">Y Falck-Ytter</name>
</author>
<author><name sortKey="Schunemann, Hj" uniqKey="Schunemann H">HJ Schunemann</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Hall, Ak" uniqKey="Hall A">AK Hall</name>
</author>
<author><name sortKey="Cole Lewis, H" uniqKey="Cole Lewis H">H Cole-Lewis</name>
</author>
<author><name sortKey="Bernhardt, Jm" uniqKey="Bernhardt J">JM Bernhardt</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Herrera, Ca" uniqKey="Herrera C">CA Herrera</name>
</author>
<author><name sortKey="Ciapponi, A" uniqKey="Ciapponi A">A Ciapponi</name>
</author>
<author><name sortKey="Bastias, G" uniqKey="Bastias G">G Bastías</name>
</author>
<author><name sortKey="Lewin, S" uniqKey="Lewin S">S Lewin</name>
</author>
<author><name sortKey="Garcia Marti, S" uniqKey="Garcia Marti S">S Garcia Marti</name>
</author>
<author><name sortKey="Okwundu, Ci" uniqKey="Okwundu C">CI Okwundu</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Krause, J" uniqKey="Krause J">J Krause</name>
</author>
<author><name sortKey="Vanlieshout, J" uniqKey="Vanlieshout J">J VanLieshout</name>
</author>
<author><name sortKey="Klomp, R" uniqKey="Klomp R">R Klomp</name>
</author>
<author><name sortKey="Huntink, E" uniqKey="Huntink E">E Huntink</name>
</author>
<author><name sortKey="Aakhus, E" uniqKey="Aakhus E">E Aakhus</name>
</author>
<author><name sortKey="Flottorp, S" uniqKey="Flottorp S">S Flottorp</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Lavis, Jn" uniqKey="Lavis J">JN Lavis</name>
</author>
<author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Souza, Nm" uniqKey="Souza N">NM Souza</name>
</author>
<author><name sortKey="Lewin, S" uniqKey="Lewin S">S Lewin</name>
</author>
<author><name sortKey="Gruen, Rl" uniqKey="Gruen R">RL Gruen</name>
</author>
<author><name sortKey="Fretheim, A" uniqKey="Fretheim A">A Fretheim</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Lavis, Jn" uniqKey="Lavis J">JN Lavis</name>
</author>
<author><name sortKey="Wilson, Mg" uniqKey="Wilson M">MG Wilson</name>
</author>
<author><name sortKey="Moat, Ka" uniqKey="Moat K">KA Moat</name>
</author>
<author><name sortKey="Hammill, Ac" uniqKey="Hammill A">AC Hammill</name>
</author>
<author><name sortKey="Boyko, Ja" uniqKey="Boyko J">JA Boyko</name>
</author>
<author><name sortKey="Grimshaw, Jm" uniqKey="Grimshaw J">JM Grimshaw</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Lewin, S" uniqKey="Lewin S">S Lewin</name>
</author>
<author><name sortKey="Lavis, Jn" uniqKey="Lavis J">JN Lavis</name>
</author>
<author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Bastias, G" uniqKey="Bastias G">G Bastías</name>
</author>
<author><name sortKey="Chopra, M" uniqKey="Chopra M">M Chopra</name>
</author>
<author><name sortKey="Ciapponi, A" uniqKey="Ciapponi A">A Ciapponi</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Mahtani, Kr" uniqKey="Mahtani K">KR Mahtani</name>
</author>
<author><name sortKey="Heneghan, Cj" uniqKey="Heneghan C">CJ Heneghan</name>
</author>
<author><name sortKey="Glasziou, Pp" uniqKey="Glasziou P">PP Glasziou</name>
</author>
<author><name sortKey="Perera, R" uniqKey="Perera R">R Perera</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Mauger Rothenberg, B" uniqKey="Mauger Rothenberg B">B Mauger Rothenberg</name>
</author>
<author><name sortKey="Marbella, A" uniqKey="Marbella A">A Marbella</name>
</author>
<author><name sortKey="Pines, E" uniqKey="Pines E">E Pines</name>
</author>
<author><name sortKey="Chopra, R" uniqKey="Chopra R">R Chopra</name>
</author>
<author><name sortKey="Black, Er" uniqKey="Black E">ER Black</name>
</author>
<author><name sortKey="Aronson, N" uniqKey="Aronson N">N Aronson</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Mcglynn, Ea" uniqKey="Mcglynn E">EA McGlynn</name>
</author>
<author><name sortKey="Asch, Sm" uniqKey="Asch S">SM Asch</name>
</author>
<author><name sortKey="Adams, J" uniqKey="Adams J">J Adams</name>
</author>
<author><name sortKey="Keesey, J" uniqKey="Keesey J">J Keesey</name>
</author>
<author><name sortKey="Hicks, J" uniqKey="Hicks J">J Hicks</name>
</author>
<author><name sortKey="Decristofaro, A" uniqKey="Decristofaro A">A DeCristofaro</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Michie, S" uniqKey="Michie S">S Michie</name>
</author>
<author><name sortKey="Johnston, M" uniqKey="Johnston M">M Johnston</name>
</author>
<author><name sortKey="Abraham, C" uniqKey="Abraham C">C Abraham</name>
</author>
<author><name sortKey="Lawton, R" uniqKey="Lawton R">R Lawton</name>
</author>
<author><name sortKey="Parker, D" uniqKey="Parker D">D Parker</name>
</author>
<author><name sortKey="Walker, A" uniqKey="Walker A">A Walker</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Michie, S" uniqKey="Michie S">S Michie</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Michie, S" uniqKey="Michie S">S Michie</name>
</author>
<author><name sortKey="Vanstralen, Mm" uniqKey="Vanstralen M">MM vanStralen</name>
</author>
<author><name sortKey="West, R" uniqKey="West R">R West</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Mostofian, F" uniqKey="Mostofian F">F Mostofian</name>
</author>
<author><name sortKey="Ruban, C" uniqKey="Ruban C">C Ruban</name>
</author>
<author><name sortKey="Simunovic, N" uniqKey="Simunovic N">N Simunovic</name>
</author>
<author><name sortKey="Bhandari, M" uniqKey="Bhandari M">M Bhandari</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Mundell, Wc" uniqKey="Mundell W">WC Mundell</name>
</author>
<author><name sortKey="Kennedy, Cs" uniqKey="Kennedy C">CS Kennedy</name>
</author>
<author><name sortKey="Szostek, Jh" uniqKey="Szostek J">JH Szostek</name>
</author>
<author><name sortKey="Cook, Da" uniqKey="Cook D">DA Cook</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Murthy, L" uniqKey="Murthy L">L Murthy</name>
</author>
<author><name sortKey="Shepperd, S" uniqKey="Shepperd S">S Shepperd</name>
</author>
<author><name sortKey="Clarke, Mj" uniqKey="Clarke M">MJ Clarke</name>
</author>
<author><name sortKey="Garner, Se" uniqKey="Garner S">SE Garner</name>
</author>
<author><name sortKey="Lavis, Jn" uniqKey="Lavis J">JN Lavis</name>
</author>
<author><name sortKey="Perrier, L" uniqKey="Perrier L">L Perrier</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Nieuwlaat, R" uniqKey="Nieuwlaat R">R Nieuwlaat</name>
</author>
<author><name sortKey="Wilczynski, N" uniqKey="Wilczynski N">N Wilczynski</name>
</author>
<author><name sortKey="Navarro, T" uniqKey="Navarro T">T Navarro</name>
</author>
<author><name sortKey="Hobson, N" uniqKey="Hobson N">N Hobson</name>
</author>
<author><name sortKey="Jeffery, R" uniqKey="Jeffery R">R Jeffery</name>
</author>
<author><name sortKey="Keepanasseril, A" uniqKey="Keepanasseril A">A Keepanasseril</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Oluoch, T" uniqKey="Oluoch T">T Oluoch</name>
</author>
<author><name sortKey="Santas, X" uniqKey="Santas X">X Santas</name>
</author>
<author><name sortKey="Kwaro, D" uniqKey="Kwaro D">D Kwaro</name>
</author>
<author><name sortKey="Were, M" uniqKey="Were M">M Were</name>
</author>
<author><name sortKey="Biondich, P" uniqKey="Biondich P">P Biondich</name>
</author>
<author><name sortKey="Bailey, C" uniqKey="Bailey C">C Bailey</name>
</author>
<author><name sortKey="Abu Hanna, A" uniqKey="Abu Hanna A">A Abu-Hanna</name>
</author>
<author><name sortKey="Dekeizer, N" uniqKey="Dekeizer N">N deKeizer</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Lavis, Jn" uniqKey="Lavis J">JN Lavis</name>
</author>
<author><name sortKey="Lewin, S" uniqKey="Lewin S">S Lewin</name>
</author>
<author><name sortKey="Fretheim, A" uniqKey="Fretheim A">A Fretheim</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Fretheim, A" uniqKey="Fretheim A">A Fretheim</name>
</author>
<author><name sortKey="Lavis, Jn" uniqKey="Lavis J">JN Lavis</name>
</author>
<author><name sortKey="Lewin, S" uniqKey="Lewin S">S Lewin</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Pantoja, T" uniqKey="Pantoja T">T Pantoja</name>
</author>
<author><name sortKey="Green, Me" uniqKey="Green M">ME Green</name>
</author>
<author><name sortKey="Grimshaw, J" uniqKey="Grimshaw J">J Grimshaw</name>
</author>
<author><name sortKey="Denig, P" uniqKey="Denig P">P Denig</name>
</author>
<author><name sortKey="Durieux, P" uniqKey="Durieux P">P Durieux</name>
</author>
<author><name sortKey="Gill, P" uniqKey="Gill P">P Gill</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Petry, Nm" uniqKey="Petry N">NM Petry</name>
</author>
<author><name sortKey="Rash, Cj" uniqKey="Rash C">CJ Rash</name>
</author>
<author><name sortKey="Byrne, S" uniqKey="Byrne S">S Byrne</name>
</author>
<author><name sortKey="Ashraf, S" uniqKey="Ashraf S">S Ashraf</name>
</author>
<author><name sortKey="White, Wb" uniqKey="White W">WB White</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Rada, G" uniqKey="Rada G">G Rada</name>
</author>
<author><name sortKey="Perez, D" uniqKey="Perez D">D Pérez</name>
</author>
<author><name sortKey="Capurro, D" uniqKey="Capurro D">D Capurro</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Rolfe, A" uniqKey="Rolfe A">A Rolfe</name>
</author>
<author><name sortKey="Cash Gibson, L" uniqKey="Cash Gibson L">L Cash-Gibson</name>
</author>
<author><name sortKey="Car, J" uniqKey="Car J">J Car</name>
</author>
<author><name sortKey="Sheikh, A" uniqKey="Sheikh A">A Sheikh</name>
</author>
<author><name sortKey="Mckinstry, B" uniqKey="Mckinstry B">B McKinstry</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Rosen, Ma" uniqKey="Rosen M">MA Rosen</name>
</author>
<author><name sortKey="Hunt, Ea" uniqKey="Hunt E">EA Hunt</name>
</author>
<author><name sortKey="Pronovost, Pj" uniqKey="Pronovost P">PJ Pronovost</name>
</author>
<author><name sortKey="Federowicz, Ma" uniqKey="Federowicz M">MA Federowicz</name>
</author>
<author><name sortKey="Weaver, Sj" uniqKey="Weaver S">SJ Weaver</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Rosenbaum, Se" uniqKey="Rosenbaum S">SE Rosenbaum</name>
</author>
<author><name sortKey="Glenton, C" uniqKey="Glenton C">C Glenton</name>
</author>
<author><name sortKey="Wiysonge, Cs" uniqKey="Wiysonge C">CS Wiysonge</name>
</author>
<author><name sortKey="Abalos, E" uniqKey="Abalos E">E Abalos</name>
</author>
<author><name sortKey="Mignini, L" uniqKey="Mignini L">L Mignini</name>
</author>
<author><name sortKey="Young, T" uniqKey="Young T">T Young</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Rowe, Ak" uniqKey="Rowe A">AK Rowe</name>
</author>
<author><name sortKey="Sy, Rowe" uniqKey="Sy R">Rowe Sy</name>
</author>
<author><name sortKey="Peters, Ka" uniqKey="Peters K">KA Peters</name>
</author>
<author><name sortKey="Holloway, Jc" uniqKey="Holloway J">JC Holloway</name>
</author>
<author><name sortKey="Ross Degnan, D" uniqKey="Ross Degnan D">D Ross-Degnan</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Ryman, Tk" uniqKey="Ryman T">TK Ryman</name>
</author>
<author><name sortKey="Dietz, V" uniqKey="Dietz V">V Dietz</name>
</author>
<author><name sortKey="Cairns, Kl" uniqKey="Cairns K">KL Cairns</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Schunemann, Hj" uniqKey="Schunemann H">HJ Schünemann</name>
</author>
<author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Higgins, Jpt" uniqKey="Higgins J">JPT Higgins</name>
</author>
<author><name sortKey="Vist, Ge" uniqKey="Vist G">GE Vist</name>
</author>
<author><name sortKey="Glasziou, P" uniqKey="Glasziou P">P Glasziou</name>
</author>
<author><name sortKey="Guyatt, Gh" uniqKey="Guyatt G">GH Guyatt</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Schunemann, Hj" uniqKey="Schunemann H">HJ Schünemann</name>
</author>
<author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Vist, Ge" uniqKey="Vist G">GE Vist</name>
</author>
<author><name sortKey="Higgins, Jpt" uniqKey="Higgins J">JPT Higgins</name>
</author>
<author><name sortKey="Deeks, Jj" uniqKey="Deeks J">JJ Deeks</name>
</author>
<author><name sortKey="Glasziou, P" uniqKey="Glasziou P">P Glasziou</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Scott, Sd" uniqKey="Scott S">SD Scott</name>
</author>
<author><name sortKey="Albretch, L" uniqKey="Albretch L">L Albretch</name>
</author>
<author><name sortKey="O Leary, K" uniqKey="O Leary K">K O'Leary</name>
</author>
<author><name sortKey="Ball, Gd" uniqKey="Ball G">GD Ball</name>
</author>
<author><name sortKey="Hartling, L" uniqKey="Hartling L">L Hartling</name>
</author>
<author><name sortKey="Hofmeyer, A" uniqKey="Hofmeyer A">A Hofmeyer</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Squires, Je" uniqKey="Squires J">JE Squires</name>
</author>
<author><name sortKey="Sullivan, K" uniqKey="Sullivan K">K Sullivan</name>
</author>
<author><name sortKey="Eccles, Mp" uniqKey="Eccles M">MP Eccles</name>
</author>
<author><name sortKey="Worswick, J" uniqKey="Worswick J">J Worswick</name>
</author>
<author><name sortKey="Grimshaw, Jm" uniqKey="Grimshaw J">JM Grimshaw</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Steinman, Ma" uniqKey="Steinman M">MA Steinman</name>
</author>
<author><name sortKey="Ranji, Sr" uniqKey="Ranji S">SR Ranji</name>
</author>
<author><name sortKey="Shojania, Kg" uniqKey="Shojania K">KG Shojania</name>
</author>
<author><name sortKey="Gonzales, R" uniqKey="Gonzales R">R Gonzales</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Tannenbaum, Si" uniqKey="Tannenbaum S">SI Tannenbaum</name>
</author>
<author><name sortKey="Cerasoli, Cp" uniqKey="Cerasoli C">CP Cerasoli</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Wensing, M" uniqKey="Wensing M">M Wensing</name>
</author>
<author><name sortKey="Bosch, M" uniqKey="Bosch M">M Bosch</name>
</author>
<author><name sortKey="Foy, R" uniqKey="Foy R">R Foy</name>
</author>
<author><name sortKey="Van Derweijden, T" uniqKey="Van Derweijden T">T van derWeijden</name>
</author>
<author><name sortKey="Eccles, M" uniqKey="Eccles M">M Eccles</name>
</author>
<author><name sortKey="Grol, R" uniqKey="Grol R">R Grol</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Wensing, M" uniqKey="Wensing M">M Wensing</name>
</author>
<author><name sortKey="Wollersheim, H" uniqKey="Wollersheim H">H Wollersheim</name>
</author>
<author><name sortKey="Grol, R" uniqKey="Grol R">R Grol</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Wensing, M" uniqKey="Wensing M">M Wensing</name>
</author>
<author><name sortKey="Oxman, Ad" uniqKey="Oxman A">AD Oxman</name>
</author>
<author><name sortKey="Baker, R" uniqKey="Baker R">R Baker</name>
</author>
<author><name sortKey="Godycki Cwirko, M" uniqKey="Godycki Cwirko M">M Godycki-Cwirko</name>
</author>
<author><name sortKey="Flottorp, S" uniqKey="Flottorp S">S Flottorp</name>
</author>
<author><name sortKey="Szecsenyi, J" uniqKey="Szecsenyi J">J Szecsenyi</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Wiysonge, Cs" uniqKey="Wiysonge C">CS Wiysonge</name>
</author>
<author><name sortKey="Herrera, Ca" uniqKey="Herrera C">CA Herrera</name>
</author>
<author><name sortKey="Ciapponi, A" uniqKey="Ciapponi A">A Ciapponi</name>
</author>
<author><name sortKey="Lewin, S" uniqKey="Lewin S">S Lewin</name>
</author>
<author><name sortKey="Garcia Marti, S" uniqKey="Garcia Marti S">S Garcia Marti</name>
</author>
<author><name sortKey="Opiyo, N" uniqKey="Opiyo N">N Opiyo</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Wong, Ca" uniqKey="Wong C">CA Wong</name>
</author>
<author><name sortKey="Cummings, Gg" uniqKey="Cummings G">GG Cummings</name>
</author>
<author><name sortKey="Ducharme, L" uniqKey="Ducharme L">L Ducharme</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Pantoja, T" uniqKey="Pantoja T">T Pantoja</name>
</author>
<author><name sortKey="Opiyo, N" uniqKey="Opiyo N">N Opiyo</name>
</author>
<author><name sortKey="Ciapponi, A" uniqKey="Ciapponi A">A Ciapponi</name>
</author>
<author><name sortKey="Dudley, L" uniqKey="Dudley L">L Dudley</name>
</author>
<author><name sortKey="Gagnon, Mp" uniqKey="Gagnon M">MP Gagnon</name>
</author>
<author><name sortKey="Herrera, Ca" uniqKey="Herrera C">CA Herrera</name>
</author>
</analytic>
</biblStruct>
</listBibl>
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</back>
</TEI>
<pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Cochrane Database Syst Rev</journal-id>
<journal-id journal-id-type="iso-abbrev">Cochrane Database Syst Rev</journal-id>
<journal-id journal-id-type="publisher-id">cd</journal-id>
<journal-title-group><journal-title>The Cochrane Database of Systematic Reviews</journal-title>
</journal-title-group>
<issn pub-type="epub">1469-493X</issn>
<publisher><publisher-name>John Wiley & Sons, Ltd</publisher-name>
<publisher-loc>Chichester, UK</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">28895659</article-id>
<article-id pub-id-type="pmc">5621088</article-id>
<article-id pub-id-type="doi">10.1002/14651858.CD011086.pub2</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Review</subject>
</subj-group>
</article-categories>
<title-group><article-title>Implementation strategies for health systems in low-income countries: an overview of systematic reviews</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Pantoja</surname>
<given-names>Tomas</given-names>
</name>
<xref ref-type="aff" rid="au1">1</xref>
<xref ref-type="aff" rid="au2">2</xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Opiyo</surname>
<given-names>Newton</given-names>
</name>
<xref ref-type="aff" rid="au3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lewin</surname>
<given-names>Simon</given-names>
</name>
<xref ref-type="aff" rid="au4">4</xref>
<xref ref-type="aff" rid="au5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Paulsen</surname>
<given-names>Elizabeth</given-names>
</name>
<xref ref-type="aff" rid="au4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ciapponi</surname>
<given-names>Agustín</given-names>
</name>
<xref ref-type="aff" rid="au6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Wiysonge</surname>
<given-names>Charles S</given-names>
</name>
<xref ref-type="aff" rid="au7">7</xref>
<xref ref-type="aff" rid="au8">8</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Herrera</surname>
<given-names>Cristian A</given-names>
</name>
<xref ref-type="aff" rid="au2">2</xref>
<xref ref-type="aff" rid="au9">9</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rada</surname>
<given-names>Gabriel</given-names>
</name>
<xref ref-type="aff" rid="au2">2</xref>
<xref ref-type="aff" rid="au10">10</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Peñaloza</surname>
<given-names>Blanca</given-names>
</name>
<xref ref-type="aff" rid="au1">1</xref>
<xref ref-type="aff" rid="au2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dudley</surname>
<given-names>Lilian</given-names>
</name>
<xref ref-type="aff" rid="au11">11</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gagnon</surname>
<given-names>Marie-Pierre</given-names>
</name>
<xref ref-type="aff" rid="au12">12</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Garcia Marti</surname>
<given-names>Sebastian</given-names>
</name>
<xref ref-type="aff" rid="au13">13</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Oxman</surname>
<given-names>Andrew D</given-names>
</name>
<xref ref-type="aff" rid="au4">4</xref>
</contrib>
<aff id="au1"><label>1</label>
<institution>Department of Family Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile</institution>
<addr-line>Santiago, Chile</addr-line>
</aff>
<aff id="au2"><label>2</label>
<institution>Evidence Based Health Care Program, Pontificia Universidad Católica de Chile</institution>
<addr-line>Santiago, Chile</addr-line>
</aff>
<aff id="au3"><label>3</label>
<institution>Cochrane Editorial Unit, Cochrane</institution>
<addr-line>London, UK</addr-line>
</aff>
<aff id="au4"><label>4</label>
<institution>Norwegian Institute of Public Health</institution>
<addr-line>Oslo, Norway</addr-line>
</aff>
<aff id="au5"><label>5</label>
<institution>Health Systems Research Unit, South African Medical Research Council</institution>
<addr-line>Tygerberg, South Africa</addr-line>
</aff>
<aff id="au6"><label>6</label>
<institution>Argentine Cochrane Centre, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET)</institution>
<addr-line>Buenos Aires, Argentina</addr-line>
</aff>
<aff id="au7"><label>7</label>
<institution>Cochrane South Africa, South African Medical Research Council</institution>
<addr-line>Cape Town, South Africa</addr-line>
</aff>
<aff id="au8"><label>8</label>
<institution>Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University</institution>
<addr-line>Cape Town, South Africa</addr-line>
</aff>
<aff id="au9"><label>9</label>
<institution>Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile</institution>
<addr-line>Santiago, Chile</addr-line>
</aff>
<aff id="au10"><label>10</label>
<institution>Department of Internal Medicine and Evidence-Based Healthcare Program, Faculty of Medicine, Pontificia Universidad Católica de Chile</institution>
<addr-line>Santiago, Chile</addr-line>
</aff>
<aff id="au11"><label>11</label>
<institution>Division of Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University</institution>
<addr-line>Cape Town, South Africa</addr-line>
</aff>
<aff id="au12"><label>12</label>
<institution>Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre</institution>
<addr-line>Québec City, Canada</addr-line>
</aff>
<aff id="au13"><label>13</label>
<institution>Institute for Clinical Effectiveness and Health Policy</institution>
<addr-line>Buenos Aires, Argentina</addr-line>
</aff>
</contrib-group>
<author-notes><corresp id="cor1">Department of Family Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Centro Medico San Joaquin, Vicuña Mackenna 4686, Macul, Santiago, Chile. <email>tpantoja@gmail.com</email>
, <email>tpantoja@med.puc.cl</email>
.</corresp>
</author-notes>
<pub-date pub-type="epub"><day>12</day>
<month>9</month>
<year>2017</year>
</pub-date>
<issue>9</issue>
<elocation-id>CD011086</elocation-id>
<permissions><copyright-statement>Copyright © 2016 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.</copyright-statement>
<copyright-year>2016</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0"><license-p>This is an open access article under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0">Creative Commons Attribution-Non-Commercial</ext-link>
Licence, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.</license-p>
</license>
</permissions>
<abstract><sec><title>Background</title>
<p>A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness.</p>
</sec>
<sec><title>Objectives</title>
<p>To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview.</p>
</sec>
<sec><title>Methods</title>
<p>We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries.</p>
</sec>
<sec><title>Main results</title>
<p>We identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high-income countries. There were no studies from low-income countries in eight reviews.</p>
<p>Implementation strategies addressed in the reviews were grouped into four categories – strategies targeting:</p>
<p>1. healthcare organisations (e.g. strategies to change organisational culture; 1 review);</p>
<p>2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews);</p>
<p>3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews);</p>
<p>4. healthcare recipients (e.g. medication adherence; 15 reviews).</p>
<p>Overall, we found the following interventions to have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.</p>
<p>1.<bold>Strategies targeted at healthcare workers</bold>
: educational meetings, nutrition training of health workers, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions.</p>
<p>2.<bold>Strategies targeted at healthcare workers for specific types of problems</bold>
: training healthcare workers to be more patient-centred in clinical consultations, use of birth kits, strategies such as clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings, and in-service neonatal emergency care training.</p>
<p>3. <bold>Strategies targeted at healthcare recipients</bold>
: mass media interventions to increase uptake of HIV testing; intensive self-management and adherence, intensive disease management programmes to improve health literacy; behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy; a one time incentive to start or continue tuberculosis prophylaxis; default reminders for patients being treated for active tuberculosis; use of sectioned polythene bags for adherence to malaria medication; community-based health education, and reminders and recall strategies to increase vaccination uptake; interventions to increase uptake of cervical screening (invitations, education, counselling, access to health promotion nurse and intensive recruitment); health insurance information and application support.</p>
</sec>
<sec><title>Authors' conclusions</title>
<p>Reliable systematic reviews have evaluated a wide range of strategies for implementing evidence-based interventions in low-income countries. Most of the available evidence is focused on strategies targeted at healthcare workers and healthcare recipients and relates to process-based outcomes. Evidence of the effects of strategies targeting healthcare organisations is scarce.</p>
</sec>
<sec><title>Implementation strategies for health systems in low-income countries</title>
<p><bold>What is the aim of this overview?</bold>
</p>
<p>The aim of this Cochrane Overview is to provide a broad summary of what is known about the effects of strategies for implementing interventions to improve health in low-income countries.</p>
<p>This overview is based on 39 relevant systematic reviews. Each of these reviews searched for studies that evaluated the different types of implementation strategies within the scope of the question addressed by the review. The reviews included a total of 1332 studies.</p>
<p>This overview is one of a series of four Cochrane Overviews that evaluate different health system arrangements.</p>
<p><bold>What was studied in the overview?</bold>
</p>
<p>A key function of health systems is implementing interventions to improve health. Coverage of essential health interventions remains low in low-income countries. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness.</p>
<p><bold>What are the main results of the overview?</bold>
</p>
<p>The following implementation strategies had desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.</p>
<p><bold>Strategies targeted at healthcare workers</bold>
</p>
<p>- Educational meetings.</p>
<p>- Nutrition training of health workers.</p>
<p>- Educational outreach (vs. no intervention).</p>
<p>- Practice facilitation.</p>
<p>- Local opinion leaders.</p>
<p>- Audit and feedback.</p>
<p>- Tailored interventions (vs. no intervention).</p>
<p><bold>Strategies targeted at healthcare workers for specific types of problems</bold>
</p>
<p>- Training healthcare workers to be more patient-centred in clinical consultations.</p>
<p>- Use of birth kits.</p>
<p>- Clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings.</p>
<p>- In-service neonatal emergency care training.</p>
<p><bold>Strategies targeted at healthcare recipients</bold>
</p>
<p>- Mass media interventions to increase immediate uptake of HIV testing (leaflets and gain-framed videos).</p>
<p>- Intensive self-management and adherence, intensive disease management to improve health literacy.</p>
<p>- Behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy.</p>
<p>- A one-time incentive to start or continue tuberculosis prophylaxis.</p>
<p>- Default reminders for patients being treated for active tuberculosis.</p>
<p>- Use of sectioned polythene bags for adherence to malaria medication.</p>
<p>- Community-based health education, and reminders and recall strategies for vaccination uptake.</p>
<p>- Providing free insecticide-treated bednets.</p>
<p>- Interventions to improve uptake of cervical screening (invitations, education, counselling, access to health promotion nurse, and intensive recruitment).</p>
<p>- Health insurance information and application support.</p>
<p>The following implementation strategies had low- or very low-certainty evidence (or no studies available) for all the outcomes that were considered.</p>
<p><bold>Strategies targeted at healthcare organisations</bold>
</p>
<p>- Strategies to improve organisational culture.</p>
<p><bold>Strategies targeted at healthcare workers</bold>
</p>
<p>- Printed educational materials.</p>
<p>- Internet-based learning.</p>
<p>- Interprofessional education.</p>
<p>- Teaching critical appraisal.</p>
<p>- Educational outreach (vs. another intervention).</p>
<p>- Pharmacist-provided services.</p>
<p>- Safety checklists for use by medical care teams in acute hospital settings.</p>
<p>- Tailored interventions (vs. non-tailored interventions, and interventions targeted at organisational and individual barriers vs. interventions targeted at individual barriers only).</p>
<p>- Interventions to encourage the use of systematic reviews in clinical decision-making.</p>
<p><bold>Strategies targeted at healthcare workers for specific types of problems</bold>
</p>
<p>- Interventions to improve handwashing.</p>
<p>- Interventions to reduce unnecessary caesarean section rates.</p>
<p>- Training of traditional birth attendants.</p>
<p>- Skilled birth attendance.</p>
<p>- Training of traditional healers about STD and HIV medicine.</p>
<p><bold>Strategies targeted at healthcare recipients</bold>
</p>
<p>- Providing information/education for promoting HIV testing (multimedia).</p>
<p>- Providing written medicine information.</p>
<p>- Single interventions to improve health literacy.</p>
<p>- Interventions to improve medication adherence.</p>
<p>- Adherence – TB (immediate versus deferred incentives; cash vs. non-cash incentive; different levels of cash incentives; incentives vs. other interventions).</p>
<p>- Adherence – malarial medication (blister packed tablets and capsules compared to tablets and capsules in paper envelopes; tablets in sectioned polythene bags compared to bottled syrup).</p>
<p>- Training of healthcare workers, home visits, and monetary incentives to improve immunisation coverage.</p>
<p>- Risk factor assessment to improve the uptake of cervical cancer screening.</p>
<p><bold>How up to date is this overview?</bold>
</p>
<p>The overview authors searched for systematic reviews that had been published up to 17 December 2016.</p>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Afrique du Sud</li>
<li>Argentine</li>
<li>Canada</li>
<li>Chili</li>
<li>Norvège</li>
<li>Royaume-Uni</li>
</country>
</list>
<tree><country name="Chili"><noRegion><name sortKey="Pantoja, Tomas" sort="Pantoja, Tomas" uniqKey="Pantoja T" first="Tomas" last="Pantoja">Tomas Pantoja</name>
</noRegion>
<name sortKey="Herrera, Cristian A" sort="Herrera, Cristian A" uniqKey="Herrera C" first="Cristian A" last="Herrera">Cristian A. Herrera</name>
<name sortKey="Herrera, Cristian A" sort="Herrera, Cristian A" uniqKey="Herrera C" first="Cristian A" last="Herrera">Cristian A. Herrera</name>
<name sortKey="Pantoja, Tomas" sort="Pantoja, Tomas" uniqKey="Pantoja T" first="Tomas" last="Pantoja">Tomas Pantoja</name>
<name sortKey="Pe Aloza, Blanca" sort="Pe Aloza, Blanca" uniqKey="Pe Aloza B" first="Blanca" last="Pe Aloza">Blanca Pe Aloza</name>
<name sortKey="Pe Aloza, Blanca" sort="Pe Aloza, Blanca" uniqKey="Pe Aloza B" first="Blanca" last="Pe Aloza">Blanca Pe Aloza</name>
<name sortKey="Rada, Gabriel" sort="Rada, Gabriel" uniqKey="Rada G" first="Gabriel" last="Rada">Gabriel Rada</name>
<name sortKey="Rada, Gabriel" sort="Rada, Gabriel" uniqKey="Rada G" first="Gabriel" last="Rada">Gabriel Rada</name>
</country>
<country name="Royaume-Uni"><noRegion><name sortKey="Opiyo, Newton" sort="Opiyo, Newton" uniqKey="Opiyo N" first="Newton" last="Opiyo">Newton Opiyo</name>
</noRegion>
</country>
<country name="Norvège"><noRegion><name sortKey="Lewin, Simon" sort="Lewin, Simon" uniqKey="Lewin S" first="Simon" last="Lewin">Simon Lewin</name>
</noRegion>
<name sortKey="Oxman, Andrew D" sort="Oxman, Andrew D" uniqKey="Oxman A" first="Andrew D" last="Oxman">Andrew D. Oxman</name>
<name sortKey="Paulsen, Elizabeth" sort="Paulsen, Elizabeth" uniqKey="Paulsen E" first="Elizabeth" last="Paulsen">Elizabeth Paulsen</name>
</country>
<country name="Afrique du Sud"><noRegion><name sortKey="Lewin, Simon" sort="Lewin, Simon" uniqKey="Lewin S" first="Simon" last="Lewin">Simon Lewin</name>
</noRegion>
<name sortKey="Dudley, Lilian" sort="Dudley, Lilian" uniqKey="Dudley L" first="Lilian" last="Dudley">Lilian Dudley</name>
<name sortKey="Wiysonge, Charles S" sort="Wiysonge, Charles S" uniqKey="Wiysonge C" first="Charles S" last="Wiysonge">Charles S. Wiysonge</name>
<name sortKey="Wiysonge, Charles S" sort="Wiysonge, Charles S" uniqKey="Wiysonge C" first="Charles S" last="Wiysonge">Charles S. Wiysonge</name>
</country>
<country name="Argentine"><noRegion><name sortKey="Ciapponi, Agustin" sort="Ciapponi, Agustin" uniqKey="Ciapponi A" first="Agustín" last="Ciapponi">Agustín Ciapponi</name>
</noRegion>
<name sortKey="Garcia Marti, Sebastian" sort="Garcia Marti, Sebastian" uniqKey="Garcia Marti S" first="Sebastian" last="Garcia Marti">Sebastian Garcia Marti</name>
</country>
<country name="Canada"><noRegion><name sortKey="Gagnon, Marie Pierre" sort="Gagnon, Marie Pierre" uniqKey="Gagnon M" first="Marie-Pierre" last="Gagnon">Marie-Pierre Gagnon</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>
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