Clinical governance. 1: Evidence-based practice

Bringing compassion into information systems research: A research agenda and call to action

In this article, we assert that compassion-driven approaches are the sustainable way for information and communication technologies to contribute to economic value. We urge future information systems research to emphasize, with equal vigor, the joint goals of compassion and financial gains from information and communication technologies. We present a broad agenda for future information systems research based on this premise. We also discuss how certain core assumptions underlying traditional information systems research—so far, driven primarily by economic value as outcome—would need to change in order to support this new agenda emphasizing compassion and economic value as complementary and synergistic outcomes. We provide a brief concrete illustration of this proposed agenda, and its underlying revised assumptions, by drawing on the example of a prominent field of study in information systems research, namely health information systems research.

Are complementary medicine practitioners implementing evidence based practice?

BACKGROUND

Over the past few decades the health professions have witnessed increasing pressure to shift from a culture of delivering care based on tradition and intuition, to a situation where decisions are guided and justified by the best available evidence. While there are concerns that many complementary and alternative medicine (CAM) practitioners may be cautious about embracing such an approach, no studies to date have effectively tested this assumption.

OBJECTIVE

To identify the skills, attitude, training and use of evidence-based practice (EBP) amongst CAM practitioners.

DESIGN

Descriptive survey, using the evidence-based practice attitude and utilisation survey (EBASE).

SUBJECTS

Randomly selected nationwide sample of system-based, non-medically qualified CAM practitioners practicing in a clinical capacity within Australia.

MAIN OUTCOME MEASURES

Practitioner skill, attitude, training and use of EBP.

RESULTS

Of the 351 questionnaires successfully dispatched, 126 were returned (36%). Most practitioners believed EBP was useful (92%) and necessary (73%) in CAM practice. While the majority of clinicians (>74%) reported participation in EBP activities, albeit infrequently, only a small to moderate proportion of decisions were based on evidence from clinical trials, with most practitioners relying on traditional knowledge, textbooks and clinical practice guidelines. Lack of available evidence, time, industry support and skills were perceived as barriers to EBP uptake.

CONCLUSIONS

While the small response rate limits the generalisability of these findings, the sample was considered representative of Australian CAM practitioners. What this study shows is that even though CAM practitioners may be supportive of EBP, education and training is needed to further improve clinician understanding and application of evidence-based practice.

Are community leg ulcer clinics more cost-effective than home care visits?

The literature suggests that leg ulcer clinics are more expensive than home visits, but are associated with faster healing times. Providing district nurses with better postgraduate education on wound care may make better use of this resource.

Evidence-based Practice in Radiology: Steps 3 and 4—Appraise and Apply Interventional Radiology Literature

When introducing new interventional radiology techniques or devices, it is important to learn from previous experiences and to remember that there are numerous examples of new techniques that were initially enthusiastically promoted and then subsequently abandoned when early promise was not realized. Appropriateness of new or established interventional radiology techniques to specific clinical conditions must be determined from clinical experience, from communication with experts in the field and/or careful review of available medical literature, and on an individual patient basis by means of review of clinical notes and diagnostic imaging studies. Several paradigms for evidence-based practice (EBP) exist. One model proposes that a central specialized process involving academic centers should primarily construct valid guidelines to direct practice at all levels of medical practice ("top-down" model). An alternative model integrates "the best research evidence with clinical expertise and patient values" ("bottom-up" model). This article will focus on the bottom-up model and describe the use of EBP by individual practitioners or groups of practitioners in optimizing literature review and critical appraisal. EBP is applied to two scenarios as a means of deciding the appropriateness of introducing interventional radiology techniques in a community hospital setting. The authors will also briefly discuss other applications for EBP techniques in interventional radiology, including development of practice guidelines or policy to ensure appropriate and safe practices.

Survey comparing clinicians' wound healing knowledge and practice

A cross-sectional design in the form of a self-administered postal questionnaire was sent to 238 staff of a general hospital to compare wound healing knowledge and practice. Seventy-four questionnaires were returned (response rate = 31.09%). No significant statistical differences were identified between the groups. Wound care practices demonstrated a lack of evidence-based care along with the continued use of outdated and hazardous practices. Knowledge was primarily sourced from colleagues and personal experience, with journals and courses favoured by the specialized clinicians. The clinicians rated pre-graduate training as inadequate. Medical staff dominated decision-making in specialized groups, while the responsibility was shared between the nurse and the tissue viability nurse in non-specialized areas. The clinicians identified clinical effectiveness and availability as influencing their dressing choices.

Evidence-based practice: A framework for clinical practice and research design

The evidence-based practice (EBP) framework emerged in the early 1970s as a means of improving clinical practice. This shift towards EBP allowed health professionals to move from a culture of delivering care based on tradition, intuition and authority, to a situation where decisions were guided and justified by the best available evidence. Despite the many advantages of EBP, many practitioners remain cautious about embracing the model. Part of this opposition is due to a misunderstanding of EBP, which this paper aims to address.

Clinical efficacy of horsechestnut seed extract in the treatment of venous ulceration

OBJECTIVE

To evaluate the clinical efficacy of orally administered horsechestnut seed extract in the treatment of venous leg ulcers.

METHOD

In a prospective triple-blind randomised placebo-controlled trial, 54 patients with venous leg ulcers from a large South Australian community nursing service were randomly allocated to receive horsechestnut seed extract (n=27) or placebo (n=27) for 12 weeks. Ulcers were assessed at weeks 0, 4, 8 and 12 utilising a wound assessment tool and the Alfred/Medseed Wound Imaging System.

RESULTS

The difference between groups in the number of healed leg ulcers and change in wound surface area, depth, volume, pain and exudate was not statistically significant. However, horsechestnut seed extract did have a significant effect on the percentage of wound slough over time (RM-ANOVA F=2.76, p=0.045) and on the number of dressing changes at week 12 (t=-2.71, p=0.009).

CONCLUSION

Even though horsechestnut seed extract is likely to attenuate the pathogenesis of venous insufficiency and, in turn, facilitate venous ulcer healing, the current study did not statistically support such a claim. However, taking into account the small sample and insufficient power of the trial, and the significant improvement in wound slough and visit frequency, it appears that it may be useful in the management of venous leg ulcers.