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Patients and professionals need, and have a right to, clean, clear knowledge just as they need clean clear knowledge. User needs assessment Production & Procurement Organisation Localisation & Mobilisation Utilisation. Question Answering Service. National

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Better Decisions

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Better decisions

Patients and professionals need, and have a right to, clean, clear knowledge just as they need clean clear knowledge


Better decisions

User needs assessment

Production & Procurement

Organisation

Localisation & Mobilisation

Utilisation

Question

Answering

Service

National

Knowledge

Service

Better Decisions


Better decisions

Best Current Knowledge Service

National Library for Public Health

National Public Health Knowledge Network

Public and professionals


Better decisions

The aim of the Best Current Knowledge Service is to ensure that a common core of knowledge from research, data and experience based on explicit quality standards and user needs is collected and regularly updated


What we know 3 types of generalisable knowledge

What we know -3 types of generalisable knowledge

Knowledge from research - Evidence

Knowledge from measurement of healthcare performance-Statistics

Knowledge from experience-Of patients and clinicians

These need to be linked to 2 types of particular knowledge

Knowledge about this population

Knowledge about this public health service


Better decisions

“For 28,737 original and review articles published in 110 journals in 2004 [ 556 (1.93%)] met critical appraisal criteria and were rated…for relevance”“most articles in clinical journals are not appropriate for direct application by individual clinicians”

Haynes RB et al (2006)

Second order peer review of the medical literature for clinical practitioners

JAMA 295:1801-1808


Better decisions

“40% [of 186 trials that were published in 10 prestigious journals] neglected to declare the nature and success of follow-up of patients”

Hall JC et al (1998)

Surgery on trial; an account of trials evaluating surgical operations

Surgery 124;22-27


Better decisions

“ our data suggest that reported applications [of molecular genetics] in clinical journals often have troubling omissions, deficiencies and lack of attention to the different but necessary, principles of clinical epidemiological science”

Bogardus ST et al (2006)

Clinical epidemiological quality in molecular genetic research

JAMA 281; 1919-1926


Better decisions

“reliability and relevance of current systematic reviews of diagnostic tests is compromised by poor reporting and review methods”

Mallett S et al (2006)

Systematic reviews of diagnostic tests in cancer; review of methods and reporting

Brit Med J doi;10.1136/bmj.38895.467130.55 18 july


Better decisions

“50% of efficacy and 65% of harm outcomes were incompletely reported.86% of survey respondents (42/49) denied the existence of unreported outcomes despite evidence to the contrary…Published articles, as well as the reviews that incorporate them, may therefore be unreliable and over estimate the benefits of an intervention”

Chan AW et al (2004)

Empirical evidence of selective reporting for outcomes in controlled trials

JAMA 291; 2457-65


Better decisions

“our data suggest that 40 reported [medical] applications [of molecular genetics] in [4 general] clinical journals often have troubling omissions, deficiencies and lack of attention to the different,but necessary, principles of clinical epidemiological science”

Bogardus ST et al (1999)

Clinical epidemiological quality in molecular genetic research; the need for methodological standards

JAMA 281; 1919-1926


Better decisions

Study (research) protocols

Study reports (journal articles)

Systematic reviews & Guidelines based on systematic reviews

Synopses

(structured abstracts)

Summaries

Systems:

clinical

tools


Better decisions

Study (research) protocols

Study reports (journal articles)

Systematic reviews & Guidelines based on systematic reviews

Synopses

(structured abstracts)

Summaries

Systems:

clinical

tools

Procured

Produced


Better decisions

The NLH consists of 3 key resources:

The National Knowledge Management Network+The National Digital Knowledge Base +the community of readers= National Library for Health.


Better decisions

The aim National Clinical Decision Support Service is to ensure that any computer based decision support system for clinicians and patients not only use best current knowledge but also have been demonstrated as doing more good than harm in ordinary service settings


Booth jcl et al 2001 gut 49 suppl 1 i4 column 1 section 3 1 lines 23 27

“The false positive rate [for Hepititis C] is especially important in low prevalence settings where the number of false positives may exceed the number of true positives”

Booth JCL et al (2001)

Gut 49 (Suppl 1) i4 column 1 Section 3.1 lines 23-27


Better decisions

What it really looks like


Royal cornwall lab service

Royal Cornwall Lab Service

Muir Gray 21/06/1944 NHS number 400 186 6897

ELISA25.5

Hepatitis C is of low prevalence in Cornwall. National guidance is that diagnosis should be confirmed by PCR test in low prevalence populations

For PCR test click here

For access to full text of guidance click here

To test your knowledge in one minute click here


Better decisions

The National Knowledge Service will organise National Knowledge Weeks which will deliver Annual Reviews of Evidence, Process, Outcome and Configuration


Better decisions

The Annual Evidence Analysis will be prepared by the relevant National Specialist Library and will present the knowledge produced in the preceding year which conforms to explicit quality standards, priority will be given to a National Library of Systematic Reviews


Better decisions

Ignorance is like cholera; it cannot be controlled by the individual alone it requires the organised efforts of society; ensuring equal access to pure knowledge is a public health responsibility


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