Understanding youth and young adult cannabis use in Canada post-legalization: a scoping review on a public health issue.

BACKGROUND: Canada legalized recreational cannabis in 2018, and one of the primary objectives of the Cannabis Act was to protect youth by reducing their access to cannabis and providing public education. Canada has the highest prevalence of cannabis use worldwide, particularly among youth and young adults under the age of 25. Cannabis use is linked with many adverse effects for youth and young adults including psychosis, anxiety, depression, respiratory distress, cannabinoid hyperemesis syndrome, and impaired cognitive performance. Despite the high prevalence of cannabis use and the evolution of policies in Canada and globally, significant knowledge and research gaps remain regarding youth and young adult cannabis use. The aim of this scoping review is to map the extent, nature, and range of evidence available on youth and young adult cannabis use in Canada since its legalization, in order to strengthen policies, services, treatments, training, and public education strategies. METHODS: Using a scoping review framework developed by Arksey and O'Malley, along with the PRISMA-ScR guidelines, we conducted a rigorous search in five academic databases: MEDLINE, Embase, APA PsycINFO, CINAHL and Web of Science Core Collection. We included empirical studies that collected data in Canada after the legalization of recreational cannabis (October 2018) and focused on youth or young adults < 30. Two reviewers independently screened articles in two stages and extracted relevant information from articles meeting the inclusion criteria. RESULTS: Of the 47 articles meeting our inclusion criteria, 92% used quantitative methods, 6% were qualitative, and 2% used a mixed-methods approach. Over two-thirds (68%) used secondary data. These studies were categorized into six focus areas: (1) prevalence, patterns, and trends, (2) cannabis-related injuries and emergency department (ED) visits, (3) rates and patterns during the pandemic, (4) perceptions of cannabis use, (5) prevention tools, and (6) cannabis-related offenses. Key findings from the studies reviewed include an increase in cannabis use among 18-24-year-olds post-legalization, with mixed results for youth under 18. ED visits for intentional and unintentional cannabis-related injuries have increased in young children and teens. Perception studies show a mix of concern and normalization of cannabis use. Though limited, prevention studies are promising in raising awareness. A decline in cannabis-related offenses was noted by one study. The review highlights several research gaps, including the need for more qualitative data, disaggregation of demographic data, intervention research, and comprehensive studies on the physical and mental health impacts of cannabis use among youth and young adults. CONCLUSION: Maintaining a public health approach is critical, with a focus on reducing the high prevalence of cannabis use among youth and young adults. This involves implementing prevention strategies to minimize harms, enhancing public education, minimizing commercialization, reducing youth access to cannabis, promoting guidelines for lower-risk cannabis use and harm reduction strategies, and increasing training for healthcare providers.

Evaluation of the Current State of Chatbots for Digital Health: Scoping Review.

BACKGROUND: Chatbots have become ubiquitous in our daily lives, enabling natural language conversations with users through various modes of communication. Chatbots have the potential to play a significant role in promoting health and well-being. As the number of studies and available products related to chatbots continues to rise, there is a critical need to assess product features to enhance the design of chatbots that effectively promote health and behavioral change. OBJECTIVE: This scoping review aims to provide a comprehensive assessment of the current state of health-related chatbots, including the chatbots' characteristics and features, user backgrounds, communication models, relational building capacity, personalization, interaction, responses to suicidal thoughts, and users' in-app experiences during chatbot use. Through this analysis, we seek to identify gaps in the current research, guide future directions, and enhance the design of health-focused chatbots. METHODS: Following the scoping review methodology by Arksey and O'Malley and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, this study used a two-pronged approach to identify relevant chatbots: (1) searching the iOS and Android App Stores and (2) reviewing scientific literature through a search strategy designed by a librarian. Overall, 36 chatbots were selected based on predefined criteria from both sources. These chatbots were systematically evaluated using a comprehensive framework developed for this study, including chatbot characteristics, user backgrounds, building relational capacity, personalization, interaction models, responses to critical situations, and user experiences. Ten coauthors were responsible for downloading and testing the chatbots, coding their features, and evaluating their performance in simulated conversations. The testing of all chatbot apps was limited to their free-to-use features. RESULTS: This review provides an overview of the diversity of health-related chatbots, encompassing categories such as mental health support, physical activity promotion, and behavior change interventions. Chatbots use text, animations, speech, images, and emojis for communication. The findings highlight variations in conversational capabilities, including empathy, humor, and personalization. Notably, concerns regarding safety, particularly in addressing suicidal thoughts, were evident. Approximately 44% (16/36) of the chatbots effectively addressed suicidal thoughts. User experiences and behavioral outcomes demonstrated the potential of chatbots in health interventions, but evidence remains limited. CONCLUSIONS: This scoping review underscores the significance of chatbots in health-related applications and offers insights into their features, functionalities, and user experiences. This study contributes to advancing the understanding of chatbots' role in digital health interventions, thus paving the way for more effective and user-centric health promotion strategies. This study informs future research directions, emphasizing the need for rigorous randomized control trials, standardized evaluation metrics, and user-centered design to unlock the full potential of chatbots in enhancing health and well-being. Future research should focus on addressing limitations, exploring real-world user experiences, and implementing robust data security and privacy measures.

Using Twitter-Based Data for Sexual Violence Research: Scoping Review.

BACKGROUND: Scholars have used data from in-person interviews, administrative systems, and surveys for sexual violence research. Using Twitter as a data source for examining the nature of sexual violence is a relatively new and underexplored area of study. OBJECTIVE: We aimed to perform a scoping review of the current literature on using Twitter data for researching sexual violence, elaborate on the validity of the methods, and discuss the implications and limitations of existing studies. METHODS: We performed a literature search in the following 6 databases: APA PsycInfo (Ovid), Scopus, PubMed, International Bibliography of Social Sciences (ProQuest), Criminal Justice Abstracts (EBSCO), and Communications Abstracts (EBSCO), in April 2022. The initial search identified 3759 articles that were imported into Covidence. Seven independent reviewers screened these articles following 2 steps: (1) title and abstract screening, and (2) full-text screening. The inclusion criteria were as follows: (1) empirical research, (2) focus on sexual violence, (3) analysis of Twitter data (ie, tweets or Twitter metadata), and (4) text in English. Finally, we selected 121 articles that met the inclusion criteria and coded these articles. RESULTS: We coded and presented the 121 articles using Twitter-based data for sexual violence research. About 70% (89/121, 73.6%) of the articles were published in peer-reviewed journals after 2018. The reviewed articles collectively analyzed about 79.6 million tweets. The primary approaches to using Twitter as a data source were content text analysis (112/121, 92.5%) and sentiment analysis (31/121, 25.6%). Hashtags (103/121, 85.1%) were the most prominent metadata feature, followed by tweet time and date, retweets, replies, URLs, and geotags. More than a third of the articles (51/121, 42.1%) used the application programming interface to collect Twitter data. Data analyses included qualitative thematic analysis, machine learning (eg, sentiment analysis, supervised machine learning, unsupervised machine learning, and social network analysis), and quantitative analysis. Only 10.7% (13/121) of the studies discussed ethical considerations. CONCLUSIONS: We described the current state of using Twitter data for sexual violence research, developed a new taxonomy describing Twitter as a data source, and evaluated the methodologies. Research recommendations include the following: development of methods for data collection and analysis, in-depth discussions about ethical norms, exploration of specific aspects of sexual violence on Twitter, examination of tweets in multiple languages, and decontextualization of Twitter data. This review demonstrates the potential of using Twitter data in sexual violence research.

Why do researchers co-author evidence syntheses with librarians? A mixed-methods study.

Librarians and information specialists are experts in designing comprehensive literature searches, such as those needed for Evidence Syntheses (ES). The contributions of these professionals to ES research teams have several documented benefits, especially when they collaborate on the project. However, librarian co-authorship is relatively rare. This study explores researcher motivations for working with librarians at the co-author level through a mixed methods design. Interviews with researchers identified 20 potential motivations that were then tested through an online questionnaire sent to authors of recently published ES. Consistent with previous findings, most respondents did not have a librarian co-author on their ES, though 16% acknowledged one in their manuscript and 10% consulted one but did not document the contribution. Search expertise was the most common motivation both to and not to co-author with librarians. Those that had or were interested in co-authoring stated that they wanted the librarians' search expertise, while those who had not or were not interested stated that they already had the necessary search expertise. Researchers who were motivated by methodological expertise and availability were more likely to have co-authored their ES with a librarian. No motivations were negatively associated with librarian co-authorship. These findings provide an overview of the motivations that influence researchers to bring a librarian into an ES investigatory team. More research is needed to substantiate the validity of these motivations.

Cannabis use among youth in Canada: a scoping review protocol.

INTRODUCTION: Canadian youth (aged 15-24) have the highest rates of cannabis use globally. There are increasing concerns about the adverse effects of cannabis use on youth physical and mental health. However, there are gaps in our understanding of risks and harms to youth. This scoping review will synthesise the literature related to youth cannabis use in Canada. We will examine the relationship between youth cannabis use and physical and mental health, and the relationship with use of other substances. We will also examine prevention strategies for youth cannabis use in Canada and how the literature addresses social determinants of health. METHODS AND ANALYSIS: Using a scoping review framework developed by Arksey and O'Malley, we will conduct our search in five academic databases: MEDLINE, Embase, APA PsycInfo, CINAHL and Web of Science's Core Collection. We will include articles published between 2000 and 2021, and articles meeting the inclusion criteria will be charted to extract relevant themes and analysed using a qualitative thematic analysis approach. ETHICS AND DISSEMINATION: This review will provide relevant information about youth cannabis use and generate recommendations and gaps in the literature. Updated research will inform policies, public education strategies and evidence-based programming. Results will be disseminated through an infographic, peer-reviewed publication and presentation at a mental health and addiction conference. Ethics approval is not required for this scoping review.

Virtual Reality or Augmented Reality as a Tool for Studying Bystander Behaviors in Interpersonal Violence: Scoping Review.

BACKGROUND: To provide participants with a more real and immersive intervening experience, virtual reality (VR) and/or augmented reality (AR) technologies have been integrated into some bystander intervention training programs and studies measuring bystander behaviors. OBJECTIVE: We focused on whether VR or AR can be used as a tool to enhance training bystanders. We reviewed the evidence from empirical studies that used VR and/or AR as a tool for examining bystander behaviors in the domain of interpersonal violence research. METHODS: Two librarians searched for articles in databases, including APA PsycInfo (Ovid), Criminal Justice Abstracts (EBSCO), Medline (Ovid), Applied Social Sciences Index & Abstracts (ProQuest), Sociological Abstracts (ProQuest), and Scopus till April 15, 2020. Studies focusing on bystander behaviors in conflict situations were included. All study types (except reviews) written in English in any discipline were included. RESULTS: The search resulted in 12,972 articles from six databases, and the articles were imported into Covidence. Eleven studies met the inclusion and exclusion criteria. All 11 articles examined the use of VR as a tool for studying bystander behaviors. Most of the studies were conducted in US young adults. The types of interpersonal violence were school bullying, dating violence, sexual violence/assault, and soccer-associated violence. VR technology was used as an observational measure and bystander intervention program. We evaluated the different uses of VR for bystander behaviors and noted a lack of empirical evidence for AR as a tool. We also discuss the empirical evidence regarding the design, effectiveness, and limitations of implementing VR as a tool in the reviewed studies. CONCLUSIONS: The reviewed results have implications and recommendations for future research in designing and implementing VR/AR technology in the area of interpersonal violence. Future studies in this area may further contribute to the use of VR as an observational measure and explore the potential use of AR to study bystander behaviors.

Recovery-oriented social work practice in mental health and addictions: a scoping review protocol.

INTRODUCTION: Social work is a key profession in the field of mental health worldwide and the profession has values that are aligned with a recovery paradigm. However, there are gaps in understanding how social workers are applying the recovery paradigm in practice. This study will scope and synthesise the literature related to recovery and social work practice in mental health and addictions. There will also be an exploration of best practices and gaps in recovery-oriented social work practice. METHODS AND ANALYSIS: Using a scoping review framework developed by Arksey and O'Malley, we will conduct our search in five academic databases: PsycINFO, Medline, CINAHL Plus, Sociological Abstracts and Social Services Abstracts. Articles meeting inclusion criteria will be charted to extract relevant themes and analysed using a qualitative thematic analysis approach. ETHICS AND DISSEMINATION: This review will provide relevant information about best practices and gaps in recovery-oriented social work practice in mental health and addictions. The study will inform the development of mental health curricula in social work programmes and clinical settings. Results will be disseminated through a peer-reviewed journal and at conferences focusing on mental health, addictions, and social work education. Ethics approval is not required for this scoping review.

Social work education and training in mental health, addictions and suicide: a scoping review protocol.

INTRODUCTION: Social workers are among the largest group of professionals in the mental health workforce and play a key role in the assessment of mental health, addictions and suicide. Most social workers provide services to individuals with mental health concerns, yet there are gaps in research on social work education and training programmes. The objective of this scoping review is to examine literature on social work education and training in mental health, addictions and suicide. METHODS AND ANALYSIS: Using a scoping review framework developed by Arksey and O'Malley, we will search for literature through seven academic databases: PsycINFO, Sociological Abstracts, CINAHL Plus, Social Sciences Abstracts, Education Source, ERIC and Social Work Abstracts. Two independent reviewers will screen articles utilising a two-stage process. Titles and abstracts will be reviewed in the first stage and full texts will be reviewed in the second stage. Selected articles that meet inclusion criteria will be charted to extract key themes and they will be analysed using a qualitative thematic analysis approach. ETHICS AND DISSEMINATION: This review will fill a knowledge gap in social work education and training in mental health, addictions and suicide. Ethics approval is not required for this scoping review. Through dissemination in publications and relevant conferences, the results may guide future research and education in social work.

Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network.

PURPOSE: Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings. METHODS: The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites. RESULTS: No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P < .0001). Resected polyps were less likely to be retrieved (84.7% vs 91.6%; P < .0001) and sent to pathology (77.1% vs 91.3%; P < .0001) at ORPRN practices compared to nonrural sites. The overall polyp detection (39.0% vs 40.3%) was similar (P = .217) between ORPRN and nonrural practices. Of exams with polyps, the rate for largest polyp on exam 6-9 mm was 20.8% at ORPRN sites, compared to 26.8% at nonrural sites (P < .0001), and for polyps >9mm 16.6% vs 18.7% (P = .106). CONCLUSION: ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings.

Race, ethnicity, and sex affect risk for polyps >9 mm in average-risk individuals.

BACKGROUND & AIMS: Colorectal cancer risk differs based on patient demographics. We aimed to measure the prevalence of significant colorectal polyps in average-risk individuals and to determine differences based on age, sex, race, or ethnicity. METHODS: In a prospective study, colonoscopy data were collected, using an endoscopic report generator, from 327,785 average-risk adults who underwent colorectal cancer screening at 84 gastrointestinal practice sites from 2000 to 2011. Demographic characteristics included age, sex, race, and ethnicity. The primary outcome was the presence of suspected malignancy or large polyp(s) >9 mm. The benchmark risk for age to initiate screening was based on white men, 50-54 years old. RESULTS: Risk of large polyps and tumors increased progressively in men and women with age. Women had lower risks than men in every age group, regardless of race. Blacks had higher risk than whites from ages 50 through 65 years and Hispanics had lower risk than whites from ages 50 through 80 years. The prevalence of large polyps was 6.2% in white men 50-54 years old. The risk was similar among the groups of white women 65-69 years old, black women 55-59 years old, black men 50-54 years old, Hispanic women 70-74 years old, and Hispanic men 55-59 years old. The risk of proximal large polyps increased with age, female sex, and black race. CONCLUSIONS: There are differences in the prevalence and location of large polyps and tumors in average-risk individuals based on age, sex, race, and ethnicity. These findings could be used to select ages at which specific groups should begin colorectal cancer screening.

Low rate of large polyps (>9 mm) within 10 years after an adequate baseline colonoscopy with no polyps.

BACKGROUND & AIMS: Guidelines recommend a 10-year interval between screening colonoscopies with negative results for average-risk individuals. However, many patients are examined at shorter intervals. We investigated outcomes of individuals with no polyps who had repeat colonoscopy in <10 years. METHODS: Data were collected using the National Endoscopic Database, from 69 gastroenterology centers, on 264,184 asymptomatic subjects who underwent screening colonoscopies from 2000 through 2006, were found to have no polyps, and received another colonoscopy examination within <10 years. RESULTS: No polyps were found in 147,375 patients during a baseline colonoscopy; 17,525 patients (11.9%) had a follow-up colonoscopy within <10 years, including 1806 (10.3%) who received the follow-up colonoscopy within <1 year. The most common reason for repeating the examination within 1 year was that the first was compromised by inadequate bowel preparation or incomplete examination. Of these patients, 6.5% (95% confidence interval: 5.3-7.6) had large polyp(s) >9 mm-a proportion similar to the prevalence in the average-risk screening population. Reasons that examinations were repeated within 1-5 years included average-risk screening (15.7%), family history of colon polyps or cancer (30.1%), bleeding (31.2%), gastrointestinal symptoms (11.8%), or a positive result from a fecal blood test (5.5%). If the baseline examination was adequate, the incidence of large polyps within 1-5 years after baseline colonoscopy was 3.1% (95% confidence interval: 2.7-3.5) and within years 5-10 years was 3.7% (95% confidence interval: 3.3-4.1). CONCLUSIONS: Repeat colonoscopies within 10 years are of little benefit to patients who had adequate examinations and were found to have no polyps. Repeat colonoscopies are beneficial to patients when the baseline examination was compromised.

Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness.

BACKGROUND: Establishing a threshold of bowel cleanliness below which colonoscopies should be repeated at accelerated intervals is important, yet there are no standardized definitions for an adequate preparation. OBJECTIVE: To determine whether Boston Bowel Preparation Scale (BBPS) scores could serve as a standard definition of adequacy. DESIGN: Cross-sectional observational analysis of colonoscopy data from 36 adult GI endoscopy practices and prospective survey showing 4 standardized colonoscopy videos with varying degrees of bowel cleanliness. SETTING: The Clinical Outcomes Research Initiative. PATIENTS: Average-risk patients attending screening colonoscopy. INTERVENTIONS: Colonoscopy. MAIN OUTCOME MEASUREMENTS: Recommended follow-up intervals among average-risk, screening colonoscopies without polyps stratified by BBPS scores. RESULTS: We evaluated 2516 negative screening colonoscopies performed by 74 endoscopists. If the BBPS score was ≥2 in all 3 segments (N = 2295), follow-up was recommended in 10 years in 90% of cases. Examinations with total BBPS scores of 3 to 5 (N = 167) had variable recommendations. Follow-up within 1 year was recommended for 96% of examinations with total BBPS scores of 0 to 2 (N = 26). Similar results were noted among 167 participants in a video survey with pre-established BBPS scores. LIMITATIONS: Retrospective study. CONCLUSION: BBPS scores correlate with endoscopist behavior regarding follow-up intervals for colonoscopy. A total BBPS score ≥6 and/or all segment scores ≥2 provides a standardized definition of adequate for 10-year follow-up, whereas total scores ≤2 indicate that a procedure should be repeated within 1 year. Future work should focus on finding consensus for management of examinations with total scores of 3 to 5.

Colonoscopy utilization and outcomes 2000 to 2011.

BACKGROUND: Understanding colonoscopy utilization and outcomes can help determine when the procedure is most effective. OBJECTIVE: To study trends in utilization and outcomes of colonoscopy in the United States from 2000 to 2011. DESIGN: Prospective collection of colonoscopy data. SETTING: A total of 84 adult diverse GI practices. PATIENTS: All adult patients receiving colonoscopy for any reason. INTERVENTION: Colonoscopy. MAIN OUTCOME MEASUREMENTS: Polyps >9 mm or suspected malignant tumor. RESULTS: We analyzed 1,372,838 reports. The most common reason for colonoscopy in patients aged <50 years is evaluation of symptoms such as irritable bowel syndrome (IBS) (28.7%) and bleeding or anemia (35.3%). In patients aged 50 to 74 years, colorectal cancer screening accounts for 42.9% of examinations. In patients aged >74 years, surveillance for cancer or polyps is the most common indication. The use of colonoscopy for average-risk screening increased nearly 3-fold during the study period. The prevalence of large polyps increases with age and is higher in men for every procedure indication. The prevalence of large polyps in patients with symptoms of IBS was lower than in those undergoing average-risk screening (odds ratio [OR] 0.85; 95% confidence interval [CI], 0.83-0.87). With increasing age, there was a shift from distal to proximal large polyps. The rate of proximal large polyps is higher in the black population compared with the white population (OR 1.19; 95% CI, 1.13-1.25). LIMITATIONS: In the absence of pathology data, use of surrogate as the main outcome. CONCLUSION: Colonoscopy utilization changed from 2000 to 2011, with an increase in primary screening. The proximal location of large polyps in the black population and with advancing age has implications for screening and surveillance.

Validity of a Web-based educational program to disseminate a standardized bowel preparation rating scale.

GOALS: Our goal was to assess the validity of a Web-based educational program on the Boston Bowel Preparation Scale (BBPS). BACKGROUND: Data on Web-based education for improving the practice and quality of colonoscopy are limited. STUDY: Endoscopists worldwide participated in the BBPS Educational Program. We assessed program completion rates, satisfaction, short-term (0 to 90 d) and long-term (91 to 180 d) uptake of the BBPS, and the validity of the program by measuring the reliability of the BBPS among participants. RESULTS: A total of 207 endoscopists completed the program. Overall, 93% found the content relevant, 89% felt confident in using the BBPS, and 97% thought the quality was good or excellent. Uptake of the BBPS into clinical practice was robust with 91% and 98% of colonoscopy reports containing the BBPS at short-term and long-term follow-up, respectively. The interobserver and test-retest reliability of BBPS segment and total scores were both substantial. CONCLUSIONS: A BBPS Web-based educational program facilitates adoption into clinical practice and teaches the BBPS to be used reliably by a diverse group of endoscopists worldwide.

Evaluating the accuracy of electronic pediatric drug dosing rules.

OBJECTIVE: To determine the accuracy of vendor-supplied dosing eRules for pediatric medication orders. Inaccurate or absent dosing rules can lead to high numbers of false alerts or undetected prescribing errors and may potentially compromise safety in this already vulnerable population. MATERIALS AND METHODS: 7 months of medication orders and alerts from a large pediatric hospital were analyzed. 30 medications were selected for study across 5 age ranges and 5 dosing parameters. The resulting 750 dosing rules from a commercial system formed the study corpus and were examined for accuracy against a gold standard created from traditional clinical resources. RESULTS: Overall accuracy of the rules in the study corpus was 55.1% when the rules were transformed to fit a priori age ranges. Over a pediatric lifetime, the dosing rules were accurate an average of 57.6% of the days. Dosing rules pertaining to the newborn age range were as accurate as other age ranges on average, but exhibited more variability. Daily frequency dosing parameters showed more accuracy than total daily dose, single dose minimum, or single dose maximum. DISCUSSION: The accuracy of a vendor-supplied set of dosing eRules is suboptimal when compared with traditional dosing sources, exposing a gap between dosing rules in commercial products and actual prescribing practices by pediatric care providers. More research on vendor-supplied eRules is warranted in order to understand the effects of these products on safe prescribing in children.

Developing a survey to assess factors that contribute to physician involvement in clinical research.

BACKGROUND: Investment in research, including clinical research, has positive effects both on health of a population and economic growth of a country. Several factors have been suggested as being related to the performance of clinical research. The goal of this work was to develop and perform initial validation of a survey that measures both current research involvement of physicians, as well as previously noted factors and additional informatics factors affecting this involvement. The survey was developed in both English and Spanish with the goal of its use in Latin America. METHODS: The initial survey was developed primarily from experience with other validated surveys developed for similar purposes. It was validated in three stages with modification or elimination of questions as indicated by this testing. RESULTS: The final survey contains 33 questions in the categories of research experience, education in research, environmental factors, computer experience, and collaboration.

Caveats for the use of operational electronic health record data in comparative effectiveness research.

The growing amount of data in operational electronic health record systems provides unprecedented opportunity for its reuse for many tasks, including comparative effectiveness research. However, there are many caveats to the use of such data. Electronic health record data from clinical settings may be inaccurate, incomplete, transformed in ways that undermine their meaning, unrecoverable for research, of unknown provenance, of insufficient granularity, and incompatible with research protocols. However, the quantity and real-world nature of these data provide impetus for their use, and we develop a list of caveats to inform would-be users of such data as well as provide an informatics roadmap that aims to insure this opportunity to augment comparative effectiveness research can be best leveraged.

Recommendations for the use of operational electronic health record data in comparative effectiveness research.

There is an increasing amount of clinical data in operational electronic health record (EHR) systems. Such data provide substantial opportunities for their re-use for many purposes, including comparative effectiveness research (CER). In a previous paper, we identified a number of caveats related to the use of such data, noting that they may be inaccurate, incomplete, transformed in ways that undermine their meaning, unrecoverable for research, of unknown provenance, of insufficient granularity, or incompatible with research protocols. In this paper, we provide recommendations for overcoming these caveats with the goal of leveraging such data to benefit CER and other health care activities. These recommendations include adaptation of "best evidence" approaches to use of data; processes to evaluate availability, completeness, quality, and transformability of data; creation of tools to manage data and their attributes; determination of metrics for assessing whether data are "research grade"; development of methods for comparative validation of data; construction of a methodology database for methods involving use of clinical data; standardized reporting methods for data and their attributes; appropriate use of informatics expertise; and a research agenda to determine biases inherent in operational data and to assess informatics approaches to their improvement.

The use of databases and registries to enhance colonoscopy quality.

Administrative databases, registries, and clinical databases are designed for different purposes and therefore have different advantages and disadvantages in providing data for enhancing quality. Administrative databases provide the advantages of size, availability, and generalizability, but are subject to constraints inherent in the coding systems used and from data collection methods optimized for billing. Registries are designed for research and quality reporting but require significant investment from participants for secondary data collection and quality control. Electronic health records contain all of the data needed for quality research and measurement, but that data is too often locked in narrative text and unavailable for analysis. National mandates for electronic health record implementation and functionality will likely change this landscape in the near future.