Open access from the perspective of the NHS
Sir Muir Gray Director of Clinical Knowledge, Process and Safety for NHS Connecting for Health
BioMed Central Colloquium Thursday 8th February 2007, The Royal College of Physicians, London, UK
Patients and professionals need, and have a right to, clean, clear knowledge just as they need clean clear knowledge
User needs assessment
Production & Procurement
Question Answering Service
Organisation
Localisation & Mobilisation
National Knowledge Service
Utilisation
Better Decisions
Best Current Knowledge Service
National Library for Public Health
National Public Health Knowledge Network
Public and professionals
The aim of the Best Current Knowledge Service is to ensure that a common core of knowledge from research, data and experience based on explicit quality standards and user needs is collected and regularly updated
What we know 3 types of generalisable knowledge
Knowledge from research - Evidence
Knowledge from measurement of healthcare performance-Statistics Knowledge from experience-Of patients and clinicians
These need to be linked to 2 types of particular knowledge
Knowledge about this population Knowledge about this public health service
“For 28,737 original and review articles published in 110 journals in 2004 [ 556 (1.93%)] met critical appraisal criteria and were rated…for relevance” “most articles in clinical journals are not appropriate for direct application by individual al (2006) clinicians” Haynes RB et
Second order peer review of the medical literature for clinical practitioners JAMA 295:1801-1808
“40% [of 186 trials that were published in 10 prestigious journals] neglected to declare the nature and success of follow-up of patients”
Hall JC et al (1998) Surgery on trial; an account of trials evaluating surgical operations Surgery 124;22-27
“ our data suggest that reported applications [of molecular genetics] in clinical journals often have troubling omissions, deficiencies and lack of attention to the different but necessary, principles of clinical epidemiological science”
Bogardus ST et al (2006) Clinical epidemiological quality in molecular genetic research JAMA 281; 1919-1926
“reliability and relevance of current systematic reviews of diagnostic tests is compromised by poor reporting and review methods”
Mallett S et al (2006) Systematic reviews of diagnostic tests in cancer; review of methods and reporting Brit Med J doi;10.1136/bmj.38895.467130.55 18 july
“50% of efficacy and 65% of harm outcomes were incompletely reported.86% of survey respondents (42/49) denied the existence of unreported outcomes despite evidence to the contrary…Published articles, as well as the reviews that incorporate them, may therefore be unreliable and over estimate the benefits of an intervention”
Chan AW et al (2004) Empirical evidence of selective reporting for outcomes in controlled trials JAMA 291; 2457-65
“our data suggest that 40 reported [medical] applications [of molecular genetics] in [4 general] clinical journals often have troubling omissions, deficiencies and lack of attention to the different,but necessary, principles of clinical epidemiological science”
Bogardus ST et al (1999) Clinical epidemiological quality in molecular genetic research; the need for methodological standards JAMA 281; 1919-1926
Study (research) protocols
Study reports (journal articles)
Systematic reviews & Guidelines based on systematic reviews
Synopses (structured abstracts) Summaries
Systems: clinical tools
Study (research) protocols
Study reports (journal articles)
Systematic reviews & Guidelines based on systematic reviews
Procured
Synopses (structured abstracts) Summaries
Produced
Systems: clinical tools
The NLH consists of 3 key resources:
The National Knowledge Management Network + The National Digital Knowledge Base + the community of readers = National Library for Health.
The aim National Clinical Decision Support Service is to ensure that any computer based decision support system for clinicians and patients not only use best current knowledge but also have been demonstrated as doing more good than harm in ordinary service settings
“The false positive rate [for Hepititis C] is especially important in low prevalence settings where the number of false positives may exceed the number of true positives”
Booth JCL et al (2001) Gut 49 (Suppl 1) i4 column 1 Section 3.1 lines 23-27
What it really looks like
Royal Cornwall Lab Service
Muir Gray 21/06/1944 NHS number 400 186 6897
ELISA25.5 Hepatitis C is of low prevalence in Cornwall. National guidance is that diagnosis should be confirmed by PCR test in low prevalence populations For PCR test click here For access to full text of guidance click here To test your knowledge in one minute click here
The National Knowledge Service will organise National Knowledge Weeks which will deliver Annual Reviews of Evidence, Process, Outcome and Configuration
The Annual Evidence Analysis will be prepared by the relevant National Specialist Library and will present the knowledge produced in the preceding year which conforms to explicit quality standards, priority will be given to a National Library of Systematic Reviews
Ignorance is like cholera; it cannot be controlled by the individual alone it requires the organised efforts of society; ensuring equal access to pure knowledge is a public health responsibility