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In times of information overload, researchers have found ways to synthesise a large amount of data from numerous studies bearing on the effectiveness of treatment for alcohol problems. Two of these ways are discussed: formal meta‐analysis and the box‐score ‘mesa grande’. It is concluded that meta‐analysis cannot answer questions regarding which treatments give the best results in the alcohol field. The mesa grande has certain limitations, which are described, but is useful for the formation of treatment policies when a clear summary of the research evidence on treatment effectiveness is needed. By contrast, large multi‐centre randomised controlled trials with enough statistical power to detect small effects of treatment should normally be preferred when a decision has to be made as to which of two or more specified treatments should be implemented in practice. Unfortunately, two multi‐centre trials, one in the USA and one in the UK, have given rise to the ‘dodo bird’ verdict of equivalent effectiveness of four treatment modalities. The findings of the UK Alcohol Treatment Trial cannot be used to advise treatment providers and practitioners which one of two treatments, MET or SBNT, should be preferred in practice. In the absence of relevant research findings, four possible ways of making this decision are outlined, including the suggestion that MET should serve as the first step in a stepped‐care model of treatment provision.

To examine the availability and quality of clinical guidelines on perioperative diabetes care in hospital units before and after a randomised clinical trial (RCT) and international accreditation.

Interventional “before‐after” study in 51 units (38 surgical and 13 anaesthetic) in nine hospitals participating in a RCT in the greater Copenhagen area; 27 of the units also underwent international accreditation.

The proportion of units with guidelines increased from 24/51 (47 percent) units before to 38/51 (75 percent) units after the trial. Among the 27 units without guidelines before the trial, significantly more accredited units compared to non‐accredited units had a guideline after the trial (9/10 (90 percent) compared to 5/17 (29 percent). The quality of the systematic development scale and the clinical scales improved significantly after the trial in both accredited units (both p<0.001) and in non‐accredited units (both p<0.02). The improvement of the systematic development scale was significantly higher in accredited than in non‐accredited units (p<0.01).

The combination of conducting both the DIPOM Trial and international accreditation led to a significant improvement of both dissemination and quality of guidelines on perioperative diabetic care.

We review the conceptualization of quality of life (QOL) past and present, providing a new definition that transcends the traditional approach. We discuss the importance of QOL as a mandatory assessment in patient care and clinical trials, concurring with the need for disease-specific tools and focusing on a nerve fiber-specific tool for assessing impacts of diabetic neuropathies on QOL and activities of daily living (ADLs) used in multi-center clinical trials and translated into different languages. By relating neuropathic disabilities to different nerve fibers, the Norfolk Quality of Life – Diabetic Neuropathy (QOL-DN) is able to measure impacts of nerve-fiber-specific neurotrophic therapies, providing pertinent endpoints to changes in health status and QOL.

This presentation argues that improvements in the quality of care are perfectly compatible with resource saving — but, in order to achieve these desirable aims, doctors' performance must change. An example is cited relating to acute abdominal pain. In a recent multi‐centre study, doctors aided by a small desk‐top computer system appeared both to improve clinical care and save resources. It is argued that quite profound resource savings and improvements in care can be achieved by relatively simple changes in doctors' behaviour. More attention should be paid to this aspect of health care management.

This paper aims to compare anticoagulant management in secondary care for the year prior to the introduction of near‐patient testing in a general practice, and in the subsequent year after it was introduced.

This paper is a retrospective, paired before‐after study. Details of test results in the two‐year‐long periods on the 46 patients who met the inclusion criteria were collected and analysed pairwise.

Despite an increase in the frequency of testing this set of patients were controlled as well in general practice as they had been with a secondary‐care service, and better that in a number of studies in the literature.

This research reviews a recently introduced service at a single centre. Further research of patient satisfaction and adverse events in a multi‐centre longer‐term trial are desirable.

Technology now allows the increasing amount of individuals on anticoagualtion to be controlled with near‐patient testing in general practice. This study shows that satisfactory control can be maintained in patients who transfer from a secondary care‐based to a primary care‐based service.

This paper demonstrates that a single general practice can provide a high quality anticoagulant service using near‐patient testing and computer‐based decision support. This adds to the already available evidence and will hopefully encourage other practices to adopt the same.

Purpose – The purpose of the paper is to examine the evidence behind breast self examination recommendations. Design/methodology/approach – In this paper the recommendations of various professional and specialty organizations are reviewed along with an analysis of the randomized controlled trials that provided data for these recommendations. Methodological issues regarding these trials and the conclusions that can be drawn are evaluated and presented here. Findings – The paper finds that the current evidence is not sufficient to make recommendations to western women for or against breast self‐examination. Practical implications – The paper implies that breast cancer is a leading cause of morbidity and mortality in women in the USA. Originality/value – The paper shows that, while mammography and clinical breast examination remain the standard of care in screening for breast cancer, much controversy has surrounded recommendations for breast self‐examination in breast cancer screening.

This article examines the history of social work research within the UK from a perspective of evidence‐based practice, as originally advocated in the 1990s. It reviews the progress made to date in relation to the use of experimental studies in the field of children and families, and the reasons why this remains limited. It sets this in the broader context of evidence‐based practice and the education and training of qualifying and post‐qualifying social workers, including postgraduate training.

Improvements in the quality of care are com‐patible with resource saving — but to achieve these desirable aims, doctors' performance must change. More attention should be paid to this aspect of health care management. However, interest is far greater overseas than in the UK at regional or national level. The current UK lack of interest (at Government level) in the potential of information technology for clinical decision‐support is already prevent‐ing patient, physician and the public purse front benefiting from a concept originally promoted in the UK but now more widely adopted abroad. Unless some sensible means can be devised for coordinating clinical decision support systems with audit, resource management initiatives and HISS — and ensuring some structure which will offer both clinicians and managers some practical benefit — the present vast expenditure on IT in the National Health Service may merely repeat (at a hundred times the cost) the unfortunate 1960s experiments with computers and public money.