Issue 4.
Health Evidence Bulletins - Wales
The Health Evidence Bulletins for Wales are a new
initiative in the field of health information, not just in Wales, but in the UK. The first
of the Bulletins, on Maternal and Early Child Health was launched on the 10th
March 1998 in Cardiff.
The Bulletins act as signposts to the best current evidence across a
broad range of evidence types and subject areas. Where information from randomised
controlled trials and meta-analyses are available they are included. However, many health
issues do not easily lend themselves to investigation, or have not yet been studied, by
this method. In these cases, high quality evidence has been sought from observational and
other studies.
The Bulletins are applicable to a wide variety of settings:
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to assist Health Authorities with the planning and commissioning of healthcare;
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to inform clinical practice;
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to assist continuing education and audit;
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to inform the development of the undergraduate and other curricula; and
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to identify potential areas for further research.
The authors have collected data from all available sources and the
results have been internally and externally reviewed by the experts in the field.
Topics shortly to be released are:
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Cancers
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Cardiovascular diseases
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Healthy environments
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Healthy living
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Injury prevention
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Learning disabilities
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Mental health
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Oral health
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Pain, discomfort and palliative care
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Physical disability and discomfort
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Respiratory diseases
These can be obtained from your local Department of Public Health or
Sir Herbert Duthie Library, UWCM - 01222 742874. Or e-mail brattelra@cf.ac.uk
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Free telephone quitline for smokers
This free quitline for smokers seemed such a good idea that we
recommend it on only the flimsiest evidence of effectiveness (The Independent on Sunday
staff). However if it worked for journalists it will surely work for anyone.
The number is 0800 00 20 00. The number appears to be available 24
hours a day, seven days a week.
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FIRMS
An interesting approach to improving clinical effectiveness is that of
firms. The idea of firms is for a care-giving institution such as a hospital to form
itself into two or more equivalent parallel organisations. They are equivalent in the
sense that they have about the same composition in number of beds, nursing staff,
residents, and senior physicians and specialists. Patients entering the institution are
assigned to the firms at random. We have therefore an arrangement that offers equivalent
facilities in each firm within an institution.
The firms offer ways of making studies that can improve care. Hospital
policies can be compared by assigning different policies to the different firms. This
approach allows the hospital to set up a culture of continuous evaluation and improvement.
In these days of clinical governance this may be an interesting idea for chief executives
and medical directors to set up. The firm approach makes possible the use of the idea of
the randomised trial for general evaluation. And it has the advantage that it deals with
patients as they appear and so has the possibility of carrying out effectiveness research
in the sense of dealing with all patients or average patients rather than highly selected
patients. Similarly it uses the physician and staff of the institution rather than an
elite subset of them.
Some institutions that have developed such firms in the USA are the
Regenstreif Medical Center, Indianapolis; Brook Army Medical Center; University Hospitals
of Cleveland; Worcester Memorial Hospital; Henry Ford Medical Center, Detroit; Harborview
Hospital, Seattle; and the St. Louis Veterans Administration hospital.
Firms research has addressed such topics as promoting preventive
efforts, lab tests, X-ray usage, patient education, and staff and patient satisfaction.
Because firms are set up in parallel, the opportunity for reduced costs for randomised
trials is already built into the system. When several institutions with firms join
together, they have the capability of carrying out multi-centre trials.
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Welsh Office Small Grants
The half-day conference at Hensol on the 26th January was a
great success. The audience was treated to a wide range of fascinating topics from a
diverse range of disciplines. They all had in common a commitment to improving their own
practice while maintaining busy professional practices.
The day was such a success that it is hoped to collect the
contributions together in a monograph, together with outlines of those projects, which
received grants, but were unable to take part in the conference.
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We shall never have all we need. Expectations will always exceed
capacity. The service must always be changing, growing and improving. It must always
appear inadequate
Nye Bevan on the NHS
Contact Dr N J Vetter, the editor of this newsletter (01222 –
744196) for an up-to date list, or to add to the list, or if you want more or less copies
of The Quince.
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