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Culture, evidence and implementation

7 Apr, 16 | by BMJ Clinical Evidence

James Cave croppedBy James A. H. Cave

Over two decades ago I joined a practice in the rolling Berkshire Downs. As a young thrusting, straight-out-of-VTS GP I was keen to do a new activity called “an audit”. This was a completely new thing to my partners and it took some explaining to them why it might be useful. “But I always check the electrolytes on my patients on an ACEI “ the senior partner replied when I suggested we could audit this, “you’ll just be wasting your time”. more…

PACK: Practical Approach to Care Kit – Bridging the EBM/local policy divide in Primary Care

14 Jan, 16 | by BMJ Clinical Evidence

Tracy Eastmanx150By Tracy Eastman

Primary health care is key to achieving the Millennium Development Goals and the broader goal of “health for all” by providing accessible, affordable and effective health care. Yet in many low and middle income countries (LMIC’s), primary health care is constrained by a lack of adequately skilled and supervised health workers.

The Knowledge Translation Unit (“KTU”) is a clinical research unit within the University of Cape Town Lung Institute (“UCTLI”) which has spent 15 years developing the Practical Approach to Care Kit (“PACK programme”) to support and empower nurses, doctors and other health workers working in primary healthcare. The programme has been scaled up countrywide in South Africa and is now used across more than 2000 clinics by more than 20,000 clinical staff. BMJ has partnered with the KTU to make the PACK programme available to assist in improving primary care services world-wide, and especially in underserved communities. more…

GATE – a Graphic Appraisal Tool for Epidemiological studies

12 Nov, 15 | by BMJ Clinical Evidence

Rod Jackson head shotBy Rod Jackson

The Graphic Appraisal Tool for Epidemiological studies (GATE) is a simple, easily remembered toolkit to help you critically appraise epidemiological studies that includes one picture, two equations and three acronyms. GATE uses a picture of a triangle, circle, square and two arrows to represent the generic structure of epidemiological studies. We call this picture ‘the GATE frame.’ All common epidemiological study designs, from randomised controlled trials to case-control studies, can be illustrated using a GATE frame. While the GATE approach to critical appraisal covers the same ground as other critical appraisal guides, its point of difference is its generic graphic framework that emphasises the similarities between all study designs. With GATE, your goal is to ‘hang’ a study on the GATE frame as follows: more…

“One of the Most Fascinating Stories in the History of Medicine”

15 Sep, 15 | by BMJ Clinical Evidence

By Nóirín O’Neill  Noirin O'Neill

The history of Acute Promyelocytic Leukaemia (APL) is one of the most fascinating stories in the history of medicine.” Dr Francesco Lo-Coco, Professor of Haematology.

APL is a rare form of leukaemia that affects one in a million people in Europe. Dr Leaft Hillestad first described APL in 1957. Dr Hillestad identified APL as a distinctive subtype of AML and one that is aggressive and rapidly fatal if not correctly diagnosed and treated immediately. Morphologically, it is identified as the M3 subtype of acute myeloid leukemia by the French-American-British classification and cytogenetically is characterised by a balanced reciprocal translocation between chromosomes 15 and 17, which results in the fusion between promyelocytic leukaemia (PML) gene and retinoic acid receptor α (RARα). Further research was carried out by French and American scientists into the disease but it was Chinese doctors (Dr Zhen-yi Wang, Dr Zhu Chen) who made the revolutionary discovery that APL was responsive to all trans-retinoic acid (ATRA), a Vitamin A derivative. The drug ATRA causes leukaemic cells to abandon their relentless growth and mature into white blood cells. ATRA makes the leukemic cells “behave”. APL was transformed from a highly fatal disease to a highly curable disease. Dr Zhen-yi Wang’s group introduced ATRA in treating APL in 1985, and APL patients like me have benefited from his achievement. more…

The Skeptics’ Guide to Emergency Medicine (SGEM)

16 Jul, 15 | by BMJ Clinical Evidence

By Ken Milne

Ken Milne

“It takes 50 years to get a wrong idea out of medicine, and 100 years a right one into medicine”. (Dr. John Hughlings Jackson – British Neurologist)

Dr. Jackson’s quote points out how long it can take for knowledge translation (KT) in medicine. More recent data suggests it can take an average of 17 years for 14% of medical information to reach the patient’s bedside.

This is far too long in the age of social media. Don’t panic! The goal of the Skeptics’ Guide to Emergency Medicine (SGEM) is to shorten that KT window down from over ten years to less than one year. more…

Evidence-Based Practice in Nursing in 2015: The Challenges

30 Apr, 15 | by BMJ Clinical Evidence

Alison Twycrossby Alison Twycross

I have been editor of Evidence-Based Nursing for the past five years.

Earlier this month I presented a paper at Evidence Live 2015 reflecting on my views about the challenges for evidence-based nursing in 2015. This Blog is a summary of that paper. more…

Simply making evidence simple

20 Mar, 15 | by BMJ Clinical Evidence

by James McCormack and Mike Allan

James McCormackMike Allan

In an ideal world in which shared decision making is practiced with impunity, health care providers need—at their fingertips—an appreciation and understanding of (as well as access to) the best available evidence for the main medical conditions they see on a day-to-day basis. more…

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