Evidence based practice updates - 21 March 2013

New guidelines, research and other tools and updates on evidence based techniques and processes from across the UK. For more information about this theme see Quality and Safety eBulletin: evidence based practice.

Some of the resources linked to are in PDF format - see how to access PDF files.

BMC Health Services Research: Health service pathways for patients with chronic leg ulcers: identifying effective pathways for facilitation of evidence based wound care. This study, undertaken in Australia, highlights the complexities involved in accessing expertise and evidence based wound care for adults with chronic leg or foot ulcers. "Results demonstrate that access to wound management expertise can promote streamlined health services and evidence based wound care, leading to efficient use of health resources and improved health".

BMC Health Services Research: Waiting management at the emergency department – a grounded theory study. "An emergency department (ED) should offer timely care for acutely ill or injured persons that require the attention of specialized nurses and physicians". This study, undertaken in Sweden, was aimed at exploring what is actually going on at an ED. 

BMC Nursing: Conceptualizing performance of nursing care as a prerequisite for better measurement: a systematic and interpretive review. "Despite the critical role of nursing care in determining high-performing healthcare delivery, performance science in this area is still at an early stage of development and nursing’s contribution most often remains invisible to policy-makers and managers. The objectives of this study were: 1) to develop a theoretically based framework to conceptualize nursing care performance; 2) to analyze how the different components of the framework have been operationalized in the literature; and 3) to develop a pool of indicators sensitive to various aspects of nursing care that can be used as a basis for designing a performance measurement system". 

DH: Diet and nutrition surveys of infants and young children, 2011. The diet and nutrition survey of infants and young children (DNSIYC) 2011 is a one-off survey providing the only source of detailed information on the food consumption, nutrient intakes and nutritional status of infants and young children in the general UK population aged 4 to 18 months. DNSIYC was conducted between January and August 2011.  

Ehealth Insider - ehi: Physician health thyself. Dr Lawrence Weed, leading champion of health IT for 50 years, says the practice of medicine remains unscientific because knowledge tools are not used effectively. Speaking at a conference Dr Weed, emeritus professor of medicine at the University of Vermont, said that this left the medical profession "trying to memorise a volume of data equivalent to the New York telephone directory".

Implementation Science:  Developing the next generation of dissemination and implementation researchers: insights from initial trainees. "Dissemination and implementation (D&I) research is a relatively young discipline, underscoring the importance of training and career development in building and sustaining the field. As such, D&I research faces several challenges in designing formal training programs and guidance for career development. A cohort of early-stage investigators (ESI) recently involved in an implementation research training program provided a resource for formative data in identifying needs and solutions around career development". 

Implementation Science: Refining a taxonomy for guideline implementation: results of an exercise in abstract classification. A draft implementation taxonomy was developed based on the Cochrane Effective Practice and Organisation of Care (EPOC) data collection checklist. The draft taxonomy had four domains (professional, financial, organisational and regulatory) covering 49 distinct strategies. The study piloted the draft taxonomy by using it to classify the implementation strategies described in the conference abstracts of the implementation stream of the 2010 Guideline International Network Conference. 

Implementation Science: What supports physiotherapists' use of research in clinical practice? A qualitative study in Sweden. This study concludes that “supportive conditions for physiotherapists' use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients”. 

Manchester Musculoskeletal Biomedical Research Unit: Researchers find links between lifestyle and the risk of developing rheumatoid arthritis. Researchers in Manchester have found a link between several lifestyle factors and pre-existing conditions, including smoking cigarettes and diabetes, and an increased risk of developing rheumatoid arthritis.

Nesta: Doctor Know: a knowledge commons in health. "Trends in the creation and application of knowledge have huge implications for how we access, create and apply information in health, a field where knowledge held by patients, doctors, medical researchers, nurses, carers, community providers, families and others is all critical in improving our individual health and well-being". In this Paper Nesta argue that "society's growing ability to mobilise knowledge from different fields and sources is beginning to show the potential of a 'knowledge commons' in healthcare: an open system of knowledge with researchers, practicing clinicians, patients, their families and communities all involved in capturing, refining and utilising a common body of knowledge in real time". The paper sets out what this might mean in practice and steps to achieve this knowledge commons.

NHS Evidence: Eyes on Evidence March 2013. Topics included are: hypoglycaemia and risk of death in critically ill patients; Effect of telehealth on secondary and emergency care; physical punishment in children and adult mental health; case studies from the QIPP collection. 

NHS Evidence: Evidence Updates: Three new updates on:

NHS Evidence: Public Health Evidence Awareness Issue 11 – March 2013. This bulletin contains the latest public health evidence that has been added to the NHS Evidence search in the last month. This may include public health research, guidance, policy or reports from public health organisations. It does not include surveillance reports, news items or information about public health events.

NICE Clinical guidelines: Hyperphosphataemia in chronic kidney disease (CG157). This clinical guideline offers best practice advice on the care of adults, children and young people with stage 4 or 5 chronic kidney disease (CKD) who have, or are at risk of, hyperphosphataemia.
NICE pathways: Hyperphosphataemia in chronic kidney disease overview.
News.

NICE: Improving production times for guidance on new pharmaceuticals. NICE is often criticised for being too slow in developing recommendations on the use of drugs in the NHS. Recently, NICE published final guidance on use of apixaban for the prevention of stroke in patients with atrial fibrillation. The guidance comes four months after the drug was initially licensed. The process this drug went through, from referral to NICE, to licensing, and final publication of guidance, is an example of how the NICE appraisal process is timely and effective when it comes to drugs that are referred with appropriate evidence on their cost and clinical effectiveness.

NICE launches new Framework Agreement for purchasing information resources. The NICE Electronic and Print Content Framework Agreement allows NHS and partner organisations in England and Wales to buy a range of print and electronic content, from 14 approved providers, such as BMJ Publishing, Oxford University Press, Pharmaceutical Press and Waterstones. The Framework is delivered and managed by NICE through funding provided by the Strategic Health Authority Library Leads (SHALL) on behalf of the NHS.

Scottish Intercollegiate Guidelines Network (SIGN): Brain injury rehabilitation in adults (SIGN Guideline 130). The guideline will provide recommendations, where possible, about post-acute assessment for adults over 16 years of age with brain injuries and interventions for cognitive, communicative, emotional, behavioural and physical rehabilitation. Evidence is also presented on important questions relevant to patient outcomes such as optimal models and settings of care, the benefits of discharge planning and the applicability of telemedicine.

SIGN: Policy statement on the grading of recommendations in SIGN guidelines (PDF 46.6KB). This explains why SIGN has taken the decision to stop grading recommendations using the ‘ABCD’ method from 2013 onwards. An alternative based on the GRADE approach of making ‘strong’ or ‘conditional’ recommendations will be used in its place. This will be based on the approach used by NICE for the presentation of recommendations in their guidelines, which are already based on the GRADE approach. This gives a unified approach to presenting recommendations across national guidelines within the UK.

TRIP Database: New filter on Trip for controlled trials. Trip is a clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice and/or care. It has been online since 1997. As well as research evidence clinicians can search across other content types including images, videos, patient information leaflets, educational courses and news. Around 500,000 controlled trials have been imported into Trip from PubMed and Mendeley.