Minutes of BEG meeting 17th January 2005 Present : Beth Alder, Jane Britten, Sheina Gilmour, Jane Groves, Morag Liddell Rhona McInnes, Vivien Swanson, Liz Teiger, Jenny Warren, Kate Woodman. Apologies: Celia Gardner, Cathy Higginson, Pat Hoddinott, Lorna Hood, Una McFadyen, Monica Thompson, Drew Walker, Phil Wilson, Linda Wolfson, Peter Wright. The draft report on the qualitative papers will be circulated to the group. This is ongoing in view of the additional papers identified. All “toolbox” data extraction sheets all completed except one and (this was given to Vivien) are therefore almost ready for critical appraisal. These will require psychometric assessment and it will therefore be necessary to establish criteria for such assessment. It was discussed that as these tools are not well developed at this stage, it would be useful to have a view on what practitioners perceive as valid to try to ensure commitment to use. It was suggested that they are reviewed for use in practice in relation to their validity and cultural relevance. It was noted that the paper by Leff still requires a Data Extraction Sheet and that Julie and Rhona’s contracts need to be extended to cover this additional work. Julie, Beth and Vivien need to look at the tools to consider the psychometric properties so that only those with reasonable validity should be included. This might be the appropriate place for looking at gaps in tool development. Additional qualitative papers need to go to Phil and Peter and Pat for consideration Re Psychosocial Papers Rhona and Kate reported that the discrepancy in the database made it necessary to look at these papers again including reference lists. All “rogue” papers were dealt with by Rhona and Kate. Outstanding papers and newly identified papers have been retrieved via the HS library and each will require a data extraction sheet to be completed. It was agreed that no one will receive more than four papers to be returned by the 31 st January and that these will be posted out by Kate with copies of the criteria for inclusion. Kate and Beth agreed to deal with any additional papers that require a data extraction sheet. Reviews There was some uncertainty as to whether all the reviews are relevant. These will need a different data extraction sheet that will need to be completed before these reviews are subjected to critical appraisal by Rhona and Julie. It was noted that Sign and York have criteria for reviewing reviews that can be accessed and that these may be of use. NICU Papers 18 additional papers have been identified for inclusion, plus 1 qualitative and 3 reviews. The question was raised about outcome measures, e.g. including expressed breast milk given though a bottle. Morag suggested that breastfeeding should be an outcome as well as breast milk delivered through a bottle. Therefore data extraction sheets should include type of feeding. These papers could be distributed to Una, Morag and Linda. Feedback re the draft reports Re Psychosocial Review The group members noted their appreciation of the good work that had gone in to producing the first drafts of both reports that cover all the issues. The ease of integration of questions, tables and text was particularly noted. The table layout is clear, currently UK papers are shaded grey. We might want to shade the UK papers throughout both reviews. Papers have been ranked in order of quality rather than dates. At present there is no interval scale for each, therefore there is a need to convey how the scoring was derived. Rhona explained, how the total number of “ticked” dimensions was used to produce a total score for each paper. It was suggested that we might wish to “categorise” papers as per the HDA report to demonstrate its acceptability in terms of being good evidence to the reader. It was suggested that Rhona and Julie could revisit this for the next draft. For all included studies we might start with the most robust; i.e. good; not good etc. There was the suggestion that we might wish to adopt the same approach as the HDA. There was need for clarity about the criteria for exclusion and the number of ticks that applied to the Quality Assessment score, and/or the likelihood of the intervention being effective/ineffective. This scoring needs to be explained in the text along with how to understand the content of the tables. It might be good to rate each paper according to the quality of the paper and to additionally categorise each in terms of the likelihood of them being effective/ineffective. By doing so, when reaching conclusions it would be possible to emphasise points for discussion, derived from the better quality evidence. Therefore the recommendations should reflect the strength of evidence that underpin them. It was suggested that the detailed process of rating papers could be included in the appendix. Specifically in relation to table formatting, it was suggested that the heading on the last box needed to be clarified. It was also noted that tables require punctuation and it was suggested that the inclusion of confidence intervals or p values might be useful additions. It was anticipated that gaps may be reduced with the addition of papers that have yet to go through the data extraction stage and subsequent critical appraisal. The need for collaboration over an extensive study, rather than a series of small studies was agreed by the group. Re NICU Review The point relating to the problem of distinguishing the use of breast milk from breastfeeding (section 2 page 6) was very interesting and it was noted that the issue is not confined to breastfeeding but rather breast milk. The terminology, “supplementary” and “complementary” feeding needs to be explained/differentiated. It was considered valuable to have included consideration of nasogastric feeding. Similarly, consideration of non-nutritive sucking, i.e. the use of dummies, was commended. As this issue has not been addressed by the HDA, there is a need to define what non-nutritive sucking means and to explain its importance for the appropriate development of sucking and jaw development. It was agreed that BEG members would pass any additional comments about the 2 reports to Kate by 31st January who will then collate all comments and pass back to Rhona and Julie. It was agreed that the structure of the report will be discussed again at the next meeting, that Vivien’s psychosocial paper in press might need to be included as an addendum once submitted for publication. It was agreed that Mags Maguire, Nursing Officer Women and Children at the Scottish Executive would be informed about the work of this group and invited to the next meeting. Date of next meeting: The new dates suggested for meeting are Tuesday 19th April, Thursday 21st April, Tuesday 25h April, and Thursday 28th April 2005. .