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Evidence into Practice

Beyond the App – a novel take on personalizing digital health can increase its effectiveness

7 Oct, 16 | by BMJ Clinical Evidence

talya-miron-shatz_croppedBy Talya Miron-Shatz

As a health professional, you know that digital health tools, such as wearables and apps, abound. You hope these help patients adhere to medication, monitor their blood pressure, manage their diet and other treatment, maintenance and prevention tasks which take place outside of the clinical encounter, and have an effect on health outcomes. You also know that these tools are not always effective. In fact, a systematic review found that only 39% of randomized control trials using mobile health to promote adherence to medication reported significant improvements between groups. more…

Meningitis: can we afford not to vaccinate?

25 Apr, 16 | by BMJ Clinical Evidence

BKampmannBy Beate Kampmann

As I complete my ward round in a London Teaching Hospital with a visit to the 7 year old boy who has already lost both lower limbs due to meningococcal disease and who is staring at his black, necrotic fingers, I remind myself that this child was actually vaccinated as a baby with a vaccine against Meningococcus Type C (MenC). more…

Policy, practice, and politics

21 Apr, 16 | by BMJ Clinical Evidence

Van photoBy Van Charles Lansingh

In the advent of the Zika scare, it is clear that the need for evidence and sensationalism are difficult to balance, and due to the pressure from the media, many governments and various entities, responded in haste and with probably very little time to analyze their recommendations. A similar case was seen in the wake of the Ebola outbreak. The global community has seen and experienced the consequences: fear and confusion of managing and controlling a disease that has limited evidence and knowledge base, and lack of historical antecedents to support the actions taken.

However, we often do have the evidence more or less readily available to respond to the health information needs and to the requests from policy makers. Unfortunately, more often than not, this information is too complex and difficult to determine what is correct and what is simply popular belief. The plethora of publications makes it difficult to sift through and summarize, so that there is an adequate process of translation from evidence generated by researchers, to policy and practice. more…

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…

The PrEP debate gains momentum

29 Mar, 16 | by BMJ Clinical Evidence

Mags Portman_imageBy Mags Portman

This week has seen a landmark shift in the pre-exposure prophylaxis for HIV (PrEP) debate in England. Following 18 months of work with key stakeholders, including clinicians, commissioners and community advocates, NHS England (NHSE) announced that it was no longer able to fund a significant PrEP rollout; the outcome the Clinical Reference Group (CRG) thought that they had been working towards. The rationale given for this late stage decision is that NHSE do not commission HIV prevention. NHSE will be making available up to £2m over the next two years to run a number of early implementer test sites. Local authorities have to bid to become an early implementer test site.

Truvada for use as pre-exposure prophylaxis for HIV (PrEP) was licensed for use in the United States in July 2012. There is evidence from San Francisco that a combination HIV prevention approach with PrEP, Treatment as Prevention plus condoms and behavioural intervention is having an impact upon HIV incidence. more…

Health research into practice – the role of social media

4 Feb, 16 | by BMJ Clinical Evidence

Stephen MaloneyBy Stephen Maloney

I found it interesting to  learn that the inspiration behind Twitter was when one of the founders, Jack Dorsey, thought it would be revolutionary to be able to send a text message to one number, and have it broadcast to many. I wonder if he could have envisaged the range of content that Twitter would end up disseminating, from valuable clinical evidence, to what celebrities are considering for breakfast. more…

Dabigatran Reversal

28 Jan, 16 | by BMJ Clinical Evidence

Ken MilneBy Ken Milne

Case: A 62-year-old woman presents to the emergency department with a history of atrial fibrillation and gastroesophageal reflux. She is on metoprolol 25mg twice daily, dabigatran 150mg twice daily, and omeprazole 20mg once daily. She noted some mild epigastric pain over the last week and had a coffee ground emesis that morning. She arrives via EMS with a blood pressure of 110/60, heart rate of 64bmp and O2 saturation of 97% on room air. You wonder if there is a specific agent that can safely and effectively reverse dabigatran? 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…

High Flow Nasal Oxygen

4 Dec, 15 | by BMJ Clinical Evidence

Ken Milne

By Ken Milne

Case: A 55-year-old woman presents to the emergency department with a 48-hour history of cough, fever and increasing shortness of breath. She has no history of chronic respiratory problems. On examination, she febrile, tachycardic, tachypneic, and her oxygen saturation is 88% despite facemask oxygen. You wonder if you should try out the new high flow nasal oxygen (HFNO) machine? more…

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