Evidence-based implementation of evidence-based guidelines

Doherty S. Evidence-based implementation of evidence-based guidelines. Int J Health Care Qual Assur Inc Leadersh Health Serv 2006;19(1):32-41.

PURPOSE: There is evidence that some strategies for guideline implementation are
more successful than others. This paper aims to describe the process of
developing an evidence-based guideline implementation strategy for use in rural
emergency departments.
DESIGN/METHODOLOGY/APPROACH: Participation in a nationally funded, research fellowship program involved attendance at workshops run by internationally renowned experts in the field of knowledge translation. Attendance at these workshops, associated reading and a literature review allowed those implementation strategies with the most supportive evidence of effectiveness to be determined.
FINDINGS: A multi-faceted implementation strategy was developed. This strategy involved the use of an implementation team as well as addressing issues surrounding individual clinicians, the “emergency department team”, the physical structure and processes of the ED and the culture of the department as a whole. Reminders, audit and feedback, education, the use of opinion leaders, and evidence-based formatting of guidelines were all integral to the process.
PRACTICAL IMPLICATIONS: It is postulated that an evidence-based implementation strategy will lead to greater changes in clinician behaviour than other strategies used in quality improvement projects.
ORIGINALITY/VALUE: This is an important article as it describes the concept and
development of evidence-based interventions, which, if tailored to the individual hospital (as evidence-based medicine is tailored to the individual patient), has the potential to improve compliance with clinical guidelines beyond that achieved with most QI projects.  PubMed link [full text by subscription]

Medical Education April 2006; 49 (4)

Medical Education April 2006; 49 (4)

Sample titles:

  • Crafting the reflective lifelong learner: why, what and how
  • Using qualitative interviews within medical education research: why we must raise the ‘quality bar’ 
  • Perspectives on the scholarship of teaching
  • A plea for new psychometric models in educational assessment 
  • The qualitative research interview 
  • Undergraduate ethics teaching: revisiting the Consensus Statement 
  • Views, behaviours and perceived staff development needs of doctors and surgeons regarding learners in outpatient clinics 
  • The reliability and validity of a matrix to assess the completed reflective personal development plans of general practitioners 
  • Participants’ opinions on the usefulness of a teaching portfolio 
  • Students’ views of reflective learning techniques: an efficacy study at a UK medical school 

Friday Fun: A Literary Map of Manhattan

This page is so neat. I only know New York through literature and movies, and this Literary Map of Manhattan links to almost 100 situations. Just grab the red square on the right and explore  …

Friday Fun: Juggling to the Beatles and pizza ordering in the (not too far) future

[See also Friday Fun: The ArchivesJuggling to the Beatles? This one made me smile. Turn up your sound … (thanks to Sue Pelletier)


And this one is both hilarious and scary  … And keep your sound turned up … (thanks to Paul Lambiase)


A systematic review of systematic reviews of spinal manipulation [by] E. Ernst

See also  A systematic review of systematic reviews of spinal manipulation: responses 

I just came across an article about the Ernst piece, published in the London Times on April 15:
It works for me: chiropractic [by] David Mattin
Excerpt: A study by Edzard Ernst, the professor of complementary medicine at Exeter University, last month provided more ammunition for the sceptics. “There is little evidence that spinal manipulation is effective in the treatment of any medical condition,” he wrote in the Journal of the Royal Society of Medicine. His review of 16 previous studies claims that chiropractic is no better for back pain than conventional treatments. But David Reed, 40, a City banker and keen golfer, insists that chiropractic got him back on the tee after a DIY disaster in November.   Read the full article here. Here is the article by Edzard Ernst, published in the Journal of the Royal Society of Medicine
A systematic review of systematic reviews of spinal manipulation
    E Ernst and P H Canter
    J R Soc Med 2006;99 192-196.  Free full text

Objectives: To systematically collate and evaluate the evidence from recent systematic reviews of clinical trials of spinal manipulation. Design: Literature searches were carried out in four electronic databases for all systematic reviews of the effectiveness of spinal manipulation in any indication, published between 2000 and May 2005. Reviews were defined as systematic if they included an explicit and repeatable inclusion and exclusion criteria for studies. Results: Sixteen papers were included relating to the following conditions: back pain (n=3), neck pain (n=2), lower back pain and neck pain (n=1), headache (n=3), non-spinal pain (n=1), primary and secondary dysmenorrhoea (n=1), infantile colic (n=1), asthma (n=1), allergy (n=1), cervicogenic dizziness (n=1), and any medical problem (n=1). The conclusions of these reviews were largely negative, except for back pain where spinal manipulation was considered superior to sham manipulation but not better than conventional treatments. Conclusions: Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.
Correspondence to: Professor E Ernst
E-mail: Edzard.Ernst@pms.ac.uk

Free full text    View all chiropractic posts.

Welcome to Anne T-V’s Blog!


Welcome to my new blog, Anne T-V’s Blog.  I have decided to try a new way to tell you about the new resources I uncover, and will post messages to this blog instead of sending them to the Yahoo groups. I will keep these groups alive, however, as a way to alert you to new postings and for you to communicate with each other. The blog format will allow me to archive and categorize messages in a way I couldn’t in the Yahoo groups. Because of spam problems, I have had to turn off the comments feature. 

Cheers – Anne T-V
P.S. If you would like to receive notices of new entries, you can subscribe to one or both of my Yahoo groups: CE_Current_Awareness or CE_Chiro. Alternatively, you can automatically receive e-mailed updates by subscribing here.