RESEARCH LETTER: Uptake of research findings into clinical practice: a controlled study of the impact of a brief external intervention on the use of corticosteroids in preterm delivery

To the Editor: There are a large number of studies addressing the impact of continuing medical education (Davis et al. 1995) and clinical guidelines (Grimshaw & Russell 1993) on changing clinical practice, but comparatively little on the impact of purchasers of health care. There is some evidence that financial incentives and penalties can influence practice (Greco & Eisenberg 1993). It has been suggested that purchasers can play an important role in implementing research findings (Haines & Jones 1994). Indeed, the separation of purchasers and providers has been viewed as an opportunity to use knowledge about effectiveness to improve health services (Dunning et al. 1994). We report a study the aim of which was to explore the impact that a specific brief external intervention might have on a detailed aspect of clinical practice: the use of corticosteroids in preterm labour. The intervention was initiated by public health physicians on behalf of a Health Authority. It formed a part of the Getting Research Into Practice (GRIP) initiative in the old Oxford Health Region, UK.  The administration of corticosteroids to mothers expected to deliver prematurely reduces neonatal mortality and morbidity (Crowley et al. 1990). The first trial which suggested that corticosteroids were effective in this role was published in 1972, and evidence from 12 trials was assembled in a systematic review published in January 1990 (Crowley et al. 1990). Despite the accumulating evidence, in 1991 many women delivering prematurely in the UK and elsewhere were not receiving corticosteroids (Anon 1992;Donaldson 1992). The apparent failure of obstetricians to make full use of this treatment has been cited as an example of the delayed implementation of research findings that can occur in clinical practice (Haines & Jones 1994; Enkin 1996).     

Reproducibility and validity of a food frequency questionnaire in European and polynesian New Zealanders

The reproducibility and validity of a self‐administered 142‐item food‐frequency questionnaire (FFQ) was assessed in a population comprising 124 European and 52 Polynesian (17 Maori and 35 Pacific Island) New Zealanders aged 40–65 years. Reproducibility correlation coefficients, determined by administration of the same questionnaire on two occasions 3 years apart, were higher in European than Maori and Pacific Island. participants, ranging from 0.47 to 0.87 in Europeans (median 0.66) and from 0.41 to 0.79 in Maori and Pacific Island people (median 0.44). In general, there were no significant differences in mean nutrient intakes calculated from the two FFQs by Europeans or Maori and Pacific Island participants despite their cultural and language differences. When the FFQ was compared with a 3‐day food diary in a sub sample of 101 Europeans, 15 Maori and 22 Pacific Islanders, the validity was good for most nutrients, with overestimation of a few nutrients in each ethnic group. Correlation coefficients between the 3‐day food diary and FFQ ranged from 0.41 to 0.81 in Europeans (median 0.48) and from 0.36 to 0.56 in Maori and Pacific Island people (median 0.55). Ratios of energy intake to resting metabolic rate suggested that Maori and Pacific Island people were more likely to underestimate their habitual energy intake by the 3‐day diet diary method compared to Europeans, but that Europeans were more likely to underestimate total energy intake by the food frequency method and Pacific Island participants to overestimate it. Obese Europeans and Maori were more likely to under‐report dietary intakes by the 3‐day diary method. We conclude that our FFQ performed better in European than Maori and Pacific Island participants.     

Can one stop nucleic acid sampling (OSNA) predict nodal positivity following neoadjuvant chemotherapy? A prospective cohort study of 293 patients

Until recently, axillary node clearance had long been the standard of care in patients with axillary node-positive disease. One stop nucleic acid sampling (OSNA) has been used to guide intraoperative decision-making regarding suitability for axillary node clearance (ANC). The aim of this study is to evaluate the use of OSNA following neoadjuvant chemotherapy (NACT) and whether it can predict lymph node burden in ANC. A single center, prospective cohort study was performed on 297 patients having OSNA between 2016 and 2019. Patients were sub-classified according to node positivity at diagnosis and those treated with NACT and outcomes included copy number and lymph node harvest. Axillary complete pathological response was observed in 24/36 patients (67%) following NACT. 14/16 patients (87%) having axillary node clearance had axillary node disease limited to 4 nodes. OSNA copy numbers were significantly higher in patients showing disease progression following NACT. Overall, 73% of patients with lymph node positivity at diagnosis could be successfully treated with a combination of NACT and lymph node excision of four nodes. De-escalating axillary surgical treatment to resection of four nodes following NACT may be effective in balancing oncological resection and limiting treatment morbidity. ONSA can correctly identify patients experiencing disease progression who would benefit from traditional three-level ANC.