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Hi everyone, I'm a postdoc fellow at the Li Ka Shing Knowledge Institute of St. Michael's hospital (University of Toronto), working with a group of researchers who are part of a collective called Knowledge Translation (KT) Canada. I have recently joined the RAMESES listserv and have read with great interest the many posts related to realist review/meta-narrative review methods. I wanted to express a big thank you for providing such a great learning forum for our group! We have also embarked on a realist review, and would now like to jump in and describe what we are doing to hopefully advance knowledge around conducting realist reviews, and also to ask a few question related to our work. Briefly, we are investigating the concept of guideline implementability by identifying the perceived characteristics of guidelines that affect uptake of recommendations, and then figuring out what works for whom in what circumstances and why. We have completed an iterative, multi-level search strategy (which was an incredibly arduous and lengthy process) and are now gleefully looking at our data. My questions to the group are related to our synthesis methods, which are slightly unconventional as we decided to extend the realist review analysis to include techniques borrowed from other analysis techniques such as those from qualitative methods. We did this because we felt that the realist review could sort out our underlying theory (ie, what works for whom and in what circumstances) but may not work so well for interpreting specific attributes of guideline recommendations that may facilitate uptake, and to build a framework of guideline implementability. We searched for other potential methods that may help us do this and felt that techniques from meta-ethnography (eg., reciprocal translation analysis) could help us generate a compete list of unique attributes and their definitions, and then use both an integrative and interpretive approach (to come up with first, second and third order interpretations) to reveal the relationships between guideline attributes and their uptake. At this point we used these techniques to classify ~700 unique guideline attributes (from 215 articles) into 28 categories and 6 major categories (this was done in duplicate among 2 groups of researchers within KT Canada). Our next steps are to develop a codebook of definitions for the attributes/subcategories/categories, which we believe will help us reveal relationships within/between categories to provide a better understanding of guideline implementability and the tradeoffs between their attributes. Our specific questions are: 1. What does everyone think about the idea of borrowing other techniques to supplement analysis of a realist review (or other synthesis methods)? 2. At one point, we decided to stop data extraction because we felt that we were not finding anything new to add to our understanding. However, we still have about 200 articles that were identified as potentially relevant (by experts and other search strategies) but feel that the potential for these articles to add anything new did not outweigh the effort to review them. Thus, we came up with the idea of developing a codebook of definitions (which we were going to do at the conclusion of data extraction anyway) and use this as a way of testing saturation for the remainder of these potentially relevant articles. We thought that this technique would be less effort with greater potential to identify anything new... plus this process fits nicely with the idea that realist reviews are not supposed to be “exhaustive” – is this a legitimate technique for deciding saturation, etc? Would operationalization of this saturation process help others doing such reviews? 3. We are thinking that developing a framework of categories/subcategories of guideline attributes (and the codebook of definitions) may become “live” documents that other researchers interested in this area could use as a repository of information to help answer other research questions, and to allow them to add to it as the field expands – what do you think of this? Your thoughts on these issues are much appreciated (and apologies for the long message), and thanks again for creating this forum so that we can collectively advance this knowledge as these new synthesis methods evolve. Monika