Searching CINAHL did not add value to clinical questions posed in NICE guidelines

ObjectivesThis study aims to quantify the unique useful yield from the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database to National Institute for Health and Clinical Excellence (NICE) clinical guidelines. A secondary objective is to investigate the relationship between this yield and different clinical question types. It is hypothesized that the unique useful yield from CINAHL is low, and this database can therefore be relegated to selective rather than routine searching.Study Design and SettingA retrospective sample of 15 NICE guidelines published between 2005 and 2009 was taken. Information on clinical review question type, number of references, and reference source was extracted.ResultsOnly 0.33% (95% confidence interval: 0.01–0.64%) of references per guideline were unique to CINAHL. Nursing- or allied health (AH)–related questions were nearly three times as likely to have references unique to CINAHL as non–nursing- or AH-related questions (14.89% vs. 5.11%), and this relationship was found to be significant (P < 0.05). No significant relationship was found between question type and unique CINAHL yield for drug-related questions.ConclusionsThe very low proportion of references unique to CINAHL strongly suggests that this database can be safely relegated to selective rather than routine searching. Nursing- and AH-related questions would benefit from selective searching of CINAHL.     

Discounting and cost-effectiveness in NICE - stepping back to sort out a confusion

Brouwer and colleagues [1] argue that the reasons for specifying an equal discount rate for health outcomes and costs in the recent guidance on methods of technology appraisal issued by the National Institute for Clinical Excellence (NICE) [2] is both opaque and wrong. They argue that a lower rate should apply to health outcomes like QALYs. It is also claimed that the guidance on discounting represents a step backwards, that is both inconsistent with current theoretical insights and will prejudice the outcome of cost-effectiveness studies of preventive interventions.The reasoning behind the use of equal discount rates for costs and health outcomes is indeed not well developed in the published guidance. Nor does it reflect the debate that underpinned the guidance. We therefore welcome the opportunity to explain more completely the rationale in the minds of the principal authors of the current guidance.     

Not at all so hard-to-reach: same-sex attracted men in Dar es Salaam

Based on research in Tanzania, this paper critically examines the widely circulating notion that African same-sex attracted men are hard-to-reach individuals and populations. Despite expectations to the contrary, it was neither time consuming nor difficult to identify and get to know same-sex attracted men in Dar es Salaam. On the contrary, a large and diverse group of such men could readily be encountered, befriended and involved in HIV-related research. The fieldwork was characterised by communicative openness and the researcher was treated with immense kindliness, hospitality and inclusivity. While we may not be in a position to say that the situation is identical everywhere else, we find reason to caution against accepting and propagating unexplained, unexamined and unverified claims to the effect that same-sex attracted men in Africa cannot be reached. We argue that such claims contribute to stigmatise same-sex attracted men and to hinder much-needed HIV-related research and programming.     

Not at all so hard-to-reach: same-sex attracted men in Dar es Salaam

Based on research in Tanzania, this paper critically examines the widely circulating notion that African same-sex attracted men are hard-to-reach individuals and populations. Despite expectations to the contrary, it was neither time consuming nor difficult to identify and get to know same-sex attracted men in Dar es Salaam. On the contrary, a large and diverse group of such men could readily be encountered, befriended and involved in HIV-related research. The fieldwork was characterised by communicative openness and the researcher was treated with immense kindliness, hospitality and inclusivity. While we may not be in a position to say that the situation is identical everywhere else, we find reason to caution against accepting and propagating unexplained, unexamined and unverified claims to the effect that same-sex attracted men in Africa cannot be reached. We argue that such claims contribute to stigmatise same-sex attracted men and to hinder much-needed HIV-related research and programming.