A knowledge management-based intranet: asset or EBM liability?

This paper summarises the presentation given at the British Computer Society Primary Health Care Specialist Group annual conference 2004. It outlines the four years of experience gained in implementing a knowledge management-based intranet across a local health community. Consideration is given to definitions of knowledge management and evidence-based medicine. The paper outlines the potential impacts and actual results over the four-year period, with reference to the wider issues involved.     

Noninvasive biomarkers of endometriosis: myth or reality?

Endometriosis affects 10% of premenopausal women and 35–50% of women with infertility, pelvic pain, or both. At present, endometriosis can only be diagnosed with surgery, where laparoscopy is considered a gold standard. Noninvasive biomarkers are thus urgently needed. In 2010, the peripheral biomarkers of endometriosis were systematically reviewed by May et al. However, with the introduction of ‘-omics’ technologies, we have witnessed immense progress in biomarker discovery, which now calls for an overview of recent studies. This report looks at potential blood and urine biomarkers of endometriosis published in the last 3 years. The current status of noninvasive diagnostic biomarkers of endometriosis is discussed, with the limitations of these studies identified and recommendations for future biomarker discovery provided.     

Myrrh: medical marvel or myth of the Magi?

Since antiquity, the genus Commiphora is composed of more than 200 species, and has been exploited as a natural drug to treat pain, skin infections, inflammatory conditions, diarrhea, and periodontal diseases. In more recent history, products derived from Commiphora myrrha and various other species of Commiphora are becoming recognized to possess significant antiseptic, anesthetic, and antitumor properties. Traditional practice and evidence-based research have supported that these properties are directly attributable to terpenoids (especially furanosesquiterpenes), the active compounds present in myrrh essential oil. More recently, current studies have focused on applying clinical trial methodologies to validate its use as an antineoplastic, an antiparasitic agent, and as an adjunct in healing wounds.     

Clopidogrel resistance: myth or reality?

Platelets have a central role in the development of arterial thrombosis and subsequent cardiovascular events. An appreciation of this complex process has made antiplatelet therapy the cornerstone of cardiovascular disease management. Dual antiplatelet therapy with aspirin and clopidogrel has been approved for the secondary prevention of cardiovascular events and is currently part of the postpercutaneous coronary intervention treatment regimen. However, subacute stent thrombosis continues to occur in 1% to 2% of patients despite dual antiplatelet therapy. Studies have shown interindividual variations in response to clopidogrel, where a cohort of patients seems to be resistant to the antithrombotic effects of clopidogrel. Furthermore, there is an apparent link between clopidogrel resistance and clinical outcomes. Currently, there is neither a universally accepted definition of clopidogrel resistance nor an agreement on the phenomenon's mechanism. This review highlights the origins of clopidogrel resistance, the current problems that exist with its definition, and discusses the future implications and relevant challenges it poses for the clinician.     

Evidence-based nursing education: myth or reality?

This article explores the concept of evidence-based nursing education. Because nurse educators incorporate evidence-based practice as a basic tenet of their programs, they assume nursing education itself is evidence based. Nursing education has a body of knowledge on which nurse educators base teaching, educational strategies, and curricular designs, but most of this knowledge is tacit, experiential, and based on practice. This knowledge relates to the art of teaching in nursing and can warrant the practice of nurse educators. However, research is also necessary to demonstrate the effectiveness of teaching approaches and strategies. Nurse educators need to develop the science of nursing education through qualitative and quantitative research, to add to the tacit knowledge underpinning nursing education strategies. When the science of nursing education is adequately developed through rigorous research, we will truly be able to say that nursing education is evidence based. Until then, it may be only a myth.     

A review of the literature on atrial fibrillation: rate reversion or control?

Aims. The aim of this paper is to review the current literature describing the aetiology of atrial fibrillation and to examine the evidence for rate reversion and rate control. Background. Atrial fibrillation is the most commonly seen arrhythmia within the clinical setting. Treatment depends on severity of symptoms, which are predominantly palpitations and shortness of breath. The primary complications from atrial fibrillation are thrombo‐embolic events (such as a pulmonary embolus or stroke). Objectives and methods. A comprehensive literature review on atrial fibrillation, rate reversion and rate control was undertaken to examine the incidence of atrial fibrillation, to review research on management of atrial fibrillation and to determine if rate reversion was superior to rate control in the treatment of atrial fibrillation. Results. Many studies have been carried out to determine the best treatment for this condition. The choices are currently pharmacological and electrical cardioversion in conjunction with anticoagulant therapy. Drug therapies are not without their problems, especially toxicity and the need for close clinical monitoring. Transaesophageal echocardiography has been used to establish the presence of left atrial thrombi and aims to reduce the anticoagulation time and reduce the risk of thrombo‐embolic events. A randomized comparative study of transaesophageal echocardiography and conventional anticoagulation therapy prior to cardioversion demonstrated statistically significant reduction in haemorrhagic events and a shorter time to cardioversion in those in the transaesophageal echocardiography group compared with the conventional group. For those with persistent atrial fibrillation, surgery is an option with valve repair or replacement carried out in conjunction with a bi‐atrial surgical ablation. Conclusions. The management of atrial fibrillation is dependent on many factors and to date there are no proven clinical rationale for rate control or reversion. Relevance to clinical practice. Atrial fibrillation requires immediate attention in order to avoid thrombo‐embolic complications and the use of transaesophageal echocardiography and conventional anticoagulation therapy can significantly reduce these complications.     

Measurement of communication skills in cancer care: myth or reality?

Despite wide agreement about the importance of effective communication in cancer care there is continuing evidence of the need for nurses, doctors and colleagues to be helped to improve their communication skills. Consequently, there has been a growing demand for effective methods for evaluation of communication training programmes. This paper discusses theoretical perspectives in this field and describes the rationale underpinning the development of a detailed objective method of assessing interviews between health professionals and cancer patients. The method enables an utterance by utterance rating of transcribed interviews to be made which can be used to construct profiles of interviewer and patient behaviours and interactions. All categories were developed from interviews drawn from a large sample of participants (n=206) at counselling skills workshops. Six domains have been identified and these are: grammatical style; the purpose of each technique; what is being discussed, the degree of feeling expressed; explicit avoidance; and the use made of patients' cues. Each domain contains a mutually exclusive set of categories. In addition the method enables the sequence of events to be plotted. Using these methods, examples from published studies will be given to show how the processes of interaction within a health care interview can be better understood, thus enabling the most effective techniques to be taught, the effectiveness of different teaching methods to be assessed and how changes brought about by training have the potential to make a significant clinical difference to patients.     

Synchronous work: myth or reality? A critical study of teams in health and medical care

Rationale, aims and objectives In this article, ideal conceptions about teamwork are tested. The research question posed is: How are teams in psychiatry formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while the parallel work mode is a transitional form between group and team. Methods Three psychiatric outpatient teams at a university hospital specialist clinic were studied. Data were collected through 25 personal interviews and 82 hours of observations. The data collection was carried out over 18 months (2008–2009). Results Results show: (1) that the three theoretical distinctions between group and team need to be supplemented with two intermediate forms, semiparallel and semisynchronous teamwork; and (2) that teamwork is not characterized by striving towards a synchronous ideal but instead is marked by an adaptive interaction between sequential, parallel and synchronous working modes. Conclusions The article points to a new intermediate stage between group and team. This intermediate stage is called semiparallel teamwork. The study shows that practical teamwork is not characterized by a synchronous ideal, but rather is about how to adaptively find acceptable solutions to a series of practical problems. The study emphasizes the importance of the team varying between different working modes, so‐called semisystematics.     

Research-based practice: myth or reality? A review of the barriers affecting research utilisation in practice

A research-practice gap still exists despite the promotion and strategies for research-based practice by governments and nursing organisations. Hunt (1981 Journal of Advanced Nursing 12:101–110) and Walsh and Ford (1989 Nursing rituals: research and rati onal action. Butterworth-Heinemann) report a wealth of anecdotal evidence to support the failure of nurses to use research in practice. A body of evidence confirms that the number of identified barriers to research utilisation is great. Drawing on the wo rk of Rogers (1983 Diffusion of innovations. The Free Press, New York) or the Barriers Scale (Funk et al. 1991a Applied Nursing Research 4(1):39–45), many authors (Dunn et al. 1997 Emergency Nurse 5(2):24–27; Walsh 1997a 1997b Nursing Standard 11(19):34– 37; 1997c Nursing Standard 11(29):34–39; Kajermo et al. 1998 Journal of Advanced Nursing 27(4):798–807; 2000 Journal of Advanced Nursing 31(1):99–109; Parahoo 2000 Journal of Advanced Nursing 31(1):89–98) have structured the barriers into sub-groups: the characteristics of the organisation, of the adopter, of the communication and of the research. Several studies reveal that the actual 'setting' poses the greatest barrier to the utilisation of research. Walsh (1997b) describes this as a paradox, in othe r words: practice is perceived as the biggest obstacle to change in practice. A systematic approach to research utilisation is outlined aimed at targeting these specific identified barriers, and third level institutes and practice settings are urged to c onsider strategic and focused approaches to the development of research plans.