Increasing engagement with evidence in healthcare ; a case study in capacity development

Healthcare professionals are expected to be self-directed learners. Ample evidence suggests that healthcare professionals generate plenty of clinical questions during clinical practice. Unfortunately, lack of time and readily accessible knowledge capturing and organizing platform hinders the perusal of answers to these complex clinical questions. Currently, there is no such knowledge management platform to capture point of care knowledge needs of clinicians. OBJECTIVE: The objective of this study was to propose an organizational centered clinical knowledge base development tool for a collaborative learning and continuous professional development activities. METHOD: We designed and implemented a Clinical knowledge management platform both in web based and IOS platform, hosted at www.Clinicalpearl.Com. The application was implemented as a SaaS-based model, using 4.5 .net version Microsoft network in C++ language. A built-in editorial flow provides an authentic local evidence-based practice knowledge repository for clinicians and organizations. RESULTS: A beta testing of this web based point of care clinical knowledge management platform was performed from 2016 to date. Preliminary usability beta study results showed that a point of care clinical tool to identify knowledge needs and gaps may not only fulfill a reflective learning activity but also encourage users to practice more evidence-based medicine for better patient outcome. CONCLUSION: We have designed a comprehensive web-based clinical knowledge management platform with integrated literature appraisal tools. Our platform has provided preliminary supportive evidence of enhancing reflective learning, knowledge gaps and needs assessment among healthcare professionals. A personal knowledge repository for lifelong self-directed learning would benefit all healthcare professionals. We plan to conduct a randomized clinical trial to assess the role of clinical pearl in providing granular insights about clinicians’ daily clinical knowledge needs and its impact in enhancing self-directed learning activities and professional competence. Temporal characteristics of effect size in the placebo arm of surgical randomized controlled trials a meta-analysis. Karolina Wartolowska, Stephen Gerry, Benjamin Feakins, Gary Collins, Jonathan Cook, Andrew Judge, Andrew Carr University of Oxford, Oxford, UK OBJECTIVE: To investigate how the response in the placebo arm of surgical randomised controlled trials (RCTs) changes with time. METHODS: We used data from a systematic review of surgical trials published in 2014. We calculated effect size in the placebo arm as the Cohen’s d standardised mean difference (SMD) between baseline and follow-up values. Trials were included into the analysis if the outcomes were continuous measures for which a SMD could be calculated. We performed a mixed effects meta-analysis incorporating withinand between-trial effects. We investigated temporal changes by looking at the effect of the timing and number of follow-up visits. This analysis was performed for all trials as well as after sub-grouping trials by the type of outcome (subjective, i.e. patient-reported symptoms; assessed, i.e. third-party-assessed signs; and objective, i.e. measured). RESULTS: Across the 47 trials available for analysis, time (β=-0.0070, 95%CI -0.024, 0.010) and visit (β=-0.033, 95%CI -0.082, 0.017) did not significantly affect the magnitude of effect size in the placebo arm. For trials with subjective outcomes (n=31/47, 66%) the response was constant across time (β=-0.0042, 95%CI -0.024, 0.016) and visits (β=-0.029, 95%CI -0.089, 0.031). The response in trials with objective outcomes (n=10/47, 21%) diminished with time (β=-0.030, 95%CI -0.050, -0.010) with a non-significant effect of visit number (β=-0.099, 95%CI -0.30, 0.11). The effect of time and visit in trials with assessed outcomes was not significant; however, few studies (n=6/47, 13%) of assessed outcomes were available and there was substantial heterogeneity. CONCLUSION: Time and visit number do not appear to significantly affect the magnitude of effect size in the placebo arm of trials with subjective outcomes, suggesting that it is constant throughout follow-up. In trials with objective outcomes there is a reduction in the effect with time. Regulation, Policy & Accountability Lecture Theatre Two 15:15 Wednesday June 21st Quality and trustworthiness of clinical practice guidelines developed by Italian medical specialty societies: a cross sectional study Antonino Cartabellotta1, Antonio Simone Laganà3, Primiano Iannone2, Walter Ricciardi2 1GIMBE Foundation, Bologna, Italy, 2National Institute of Health Istituto Superiore di Sanità, Rome, Italy, 3University of Messina, Messina, Italy The Italian Parliament has recently approved a law to link medical responsibility to clinical practice guidelines (CPGs) developed by medical specialty societies (MSS) and other organizations accredited by the MoH. However, in Italy a national guidelines program has really never taken off, there are hundreds of MSS with inadequate transparency on financial issues and competing interests and there is no evidence about quality and trustworthiness of their CPGs. For this reasons GIMBE funded and conducted this study to verify if Italian CPGs match Guidelines International Network (G-I-N) standards for developing CGPs (G-I-N 1) and for disclosure and management of conflicts of interest (COIs) (G-I-N 2). The study was endorsed by G-I-N and Italian National Institute of Health (NIH). The study was developed in 5 step: 1) Identification of developers: in this first phase the study assessed CPGs developed by MSS. 2) Identification of CPGs through web sites of MSS. 3) Sample selection: CPGs published in 2015-2016. 4) Evaluation of adherence to G-I-N 1. 5) Evaluation of adherence to G-I-N 2. 80% of the identified MSS (322/403) were not eligible for lack of website (n. 6), lack of CPGs webpage (n. 289), CPGs webpage with restricted access (n. 14), and links to other CPGs developers (n. 13). 712 documents were retrieved: 359 (50,4%) were classified as CPGs; the remaining were not accessible files (n. 9), other types of documents (n. 71) and CPGs developed by other organizations (n. 273). 75/359 CPGs (21%) were included for final evaluation. According to G-I-N 1 standards the overall quality is adequate, except for disclosure of COIs available only for 17% of CPGs: for this reason the adherence to G-I-N 2 was not assessed. 42/75 evaluated CPGs were developed by 2 MSS only. In Italy the law on medical responsibility relies a key role on CPGs, but our study shows that few CPGs developed by MSS are trustworthy. Therefore a governance revolution in CPGs development is recommended, with a pivotal role of the Italian NIH that should set priorities, avoid duplication, promote multi-professional and multi-disciplinary CGPs, standardize quality criteria and define strategies for managing COIs. How is musculoskeletal evidence embedded within NHS practice? Commissioners' perspectives Jennifer Pearson1, Sian Jones2, Nicola Walsh1 1University of the West of England, Bristol, UK, 2West of England Academic Health Science Network, Bristol, UK OBJECTIVE: Over the last two decades there has been an exponential increase in musculoskeletal (MSK) research, in particular, research of physiotherapy interventions. However, there is a recognised and growing gap between what is known in terms of evidence and what is delivered in clinical practice. Notably, there is an increasing length of time between research that is proven to be effective and included in guidelines, with research that is embedded into routine care. NHS commissioning managers are directly involved in high-level service re-design, yet little is known about how these managers use evidence to support their decision making. This qualitative study aimed to explore how NHS commissioners in the West of England use evidence when commissioning MSK services. METHODS: An online survey was distributed to NHS commissioning groups in three local Sustainability and Transformation Plan (STP) footprints (Bristol, North Somerset, South Gloucestershire, Gloucestershire, Wiltshire, Swindon and Bath & North east Somerset). Followup semi-structured interviews were also conducted. Thematic analysis was used to analyse the qualitative data. RESULTS: Commissioners across all CCGs within the boundary of the West of England were represented (n=10). Two of the respondents were GP clinical commissioners, and the remainder (n=8) were NHS commissioning managers (n=2) with professional clinical training. Several key themes emerged from the qualitative data analysis: complexity of the commissioning process; NHS pressures and competing demands; relevant and appropriateness of evidence for commissioning decisions; formal and informal mechanisms to support the use of research evidence; and undefined responsibilities and ownership of commissioning research evidence-based interventions. CONCLUSION: NHS commissioners in the West of England contend with a range of complexities when commissioning MSK services. To support their decisions, they use a number of different evidence sources. For more evidence-based MSK research to be used researchers should provide NHS commissioners with meaningful contextual research supported by relevant cost utilisation evidence. The benefits and harms of centrally-acting anti-obesity medicines IGHO ONAKPOYA, DYLAN COLLINS, JEFFREY ARONSON, CARL HENEGHAN UNIVERSITY OF OXFORD, OXFORDSHIRE, UK OBJECTIVE: To evaluate the evidence for benefits and harms in pivotal clinical trials used to gain marketing authorization for centrally-acting anti-obesity medicinal products. METHODS: For this systematic review and meta-analysis we searched the EMA and FDA websites to identify pivotal phase III trials used to gain marketing authorizations between January 1995 and June 2016. Using the trial ID from the pivotal trials, we then sear