scholarly journals Management of obesity in Scotland: development of the latest evidence-based recommendations

2010 ◽  
Vol 69 (2) ◽  
pp. 195-198 ◽  
Author(s):  
J. Thompson
Keyword(s):  
Young People ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Evidence Based ◽  
Healthy Weight ◽  
Guideline Adaptation ◽  
Lifestyle Measures ◽  
Scottish Government ◽  
Clinical Conditions ◽  
The Cost

The problem of obesity in Scotland has reached epidemic proportions and this reality is recognised at Scottish Government level. The financial impact of treating obesity and obesity-related disease is substantial and in Scotland the cost was estimated at £171×106 in 2001 but only a small proportion of this estimate included weight-loss interventions. The Scottish Intercollegiate Guidelines Network (SIGN) define clinical guidelines as ‘systematically developed statements to help practitioner and patient decisions’ that ‘provide recommendations for effective practice in the management of clinical conditions where variations in practice are known to occur and where effective care may be known not to occur’. The evidence base for successful interventions has progressed since the publication by SIGN of Obesity in Scotland: Integrating Prevention with Weight Management in 1996 and Management of Obesity in Children and Young People in 2003. In 2007 SIGN commissioned a review of these two publications. In 2006 the National Institute for Health and Clinical Excellence (NICE) published a comprehensive obesity guideline and to avoid duplication of effort SIGN used the ADAPTE guideline adaptation framework to utilise and update evidence tables produced by NICE (where appropriate) as a basis for considered judgement. The new SIGN guideline is due for publication in 2010 and addresses children, young people (<18 years old) and adults. It will provide evidence-based recommendations on primary prevention of obesity (defined as intervention when individuals are at a healthy weight and/or overweight to prevent or delay the onset of obesity) within the clinical setting and treatment by lifestyle measures, drugs and surgery.

scholarly journals What are Specialist Mental Health Clinician Attitudes to Guideline Recommendations for the Treatment of Depression in Young People?

2011 ◽  
Vol 45 (11) ◽  
pp. 993-1001 ◽  
Author(s):  
Sarah E. Hetrick ◽  
Magenta Simmons ◽  
Andrew Thompson ◽  
Alexandra G. Parker
Keyword(s):  
Mental Health ◽  
Young People ◽  
Focus Groups ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Service Level ◽  
Social Constructionist ◽  
Evidence Based ◽  
Complex Disorders ◽  
Individual Clinician

Objectives: We sought to examine potential barriers to the use of evidence-based guidelines for youth depression in a tertiary specialist mental health service, as part of an initiative to implement evidence based practice within the service. Methods: This was a qualitative study adopting a social constructionist perspective using focus groups. The focus groups, conducted with all clinicians (medical and allied health), were audiotaped, transcribed and thematic analysis was undertaken. Clinicians were asked about the barriers to implementing four key recommendations from the National Institute for Health and Clinical Excellence (NICE) guidelines. Results: Barriers existed at (i) the individual clinician level; (ii) the clinical level in terms of the presentation of young people; and (iii) the service level. The key individual clinician level barrier was a stated belief that the guidelines were not relevant to the young people presenting to the service, with little evidence to guide practice. Related, the main barrier with regard to the clinical presentation was the severity and complexity of this presentation, often making the delivery of interventions like cognitive behavioural therapy (CBT) difficult. At the service level, a lack of integration with primary and secondary level care meant sequencing interventions according to guideline recommendations was difficult. Conclusions: There is a clear imperative to develop the evidence base to ensure that effective treatments for young people aged up to 25 years with severe and complex disorders that include comorbid conditions, suicide risk and psychosocial difficulties are investigated and disseminated. Furthermore, this work has highlighted the need for greater investment in models of care that ensure integration between existing primary and secondary care and enhanced specialist early intervention mental health services for young people.

scholarly journals Positive Choices: Addressing the evidence-practice gap in alcohol and other drug prevention

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Nepal ◽  
L Stapinski ◽  
N Newton ◽  
L Grummitt ◽  
S Lawler ◽  
...  
Keyword(s):  
Young People ◽  
Primary Source ◽  
Evidence Base ◽  
Drug Prevention ◽  
Evidence Based ◽  
Drug Education ◽  
Health Issues ◽  
Prevention Strategies ◽  
Response Strategies ◽  
Practice Gap

Abstract Issue Alcohol and other drug (AOD) use during adolescence puts young people at risk of juvenile offending, poor educational outcomes, school dropout, and mental health issues. Since parents and school teachers are the primary source of contact for adolescents, it is important that they are equipped with accurate and up-to-date response strategies. There are a number of effective drug prevention strategies, however, they are not widely implemented. Description of the practice To address this evidence-practice gap, the Positive Choices initiative was launched in 2015. Positive Choices supports implementation of evidence-based and prevention strategies through provision of training and a centralised information and resources portal for young people, their parents and teachers. The portal contains information factsheets and webinars and was developed in consultation with AOD experts and target users. Drug education resources and curriculum programs meeting pre-specified criteria for relevance, quality and evidence-base are listed in the resources database. Results Positive Choices has been accessed by one-million Australian and international users. The most popular resources are videos, factsheets, webinars. In 2019, 71% parents and 65% teachers said that they would continue using the website. Half (54%) of school staff were not currently implementing evidence-based prevention strategies, of these 89% intended to shift to evidence-based practice after using Positive Choices. The majority of the users have said they would recommend the website to their colleagues and friends. Lessons Positive Choices is effective in changing users' intentions to implement evidence-based strategies. Drug education programs need to engage parents and teachers if they are to be effective. Key messages Positive Choices has increased users’ awareness of evidence-based prevention strategies. Positive Choices has increased users’ intentions to implement evidence-based prevention strategies.

scholarly journals Transgender adolescents and genital-alignment surgery: Is age restriction justified?

2019 ◽  
Vol 14 (2) ◽  
pp. 94-103
Author(s):  
Edmund Horowicz
Keyword(s):  
Young People ◽  
Clinical Guidelines ◽  
Gender Dysphoria ◽  
Evidence Base ◽  
Cultural Norms ◽  
Evidence Based ◽  
Professional Issues ◽  
Standards Of Evidence ◽  
Current Concerns ◽  
Evidence Based Care

In the case of controversial interventions there is a need for clinical guidelines to be founded on ‘expert opinion’ and an evidence base, in order to minimise individual clinicians making subjective decisions influenced by bias or cultural norms. This paper considers international clinical guidelines that through recommendation effectively prohibit the provision of genital-alignment surgery for competent adolescents with gender dysphoria. I argue that although the rationale for this particular guideline is based on serious concerns, these need to be better understood to allow reconsideration of this unilateral prohibitive recommendation. I do not propose that genital-alignment surgery should be prima-facia provided for any adolescent with gender dysphoria. Instead I argue that by developing our understanding of the current concerns, we can allow guidelines to incorporate a margin of clinical discretion, to allow clinicians to provide genital-alignment surgery to some adolescents, where clinically appropriate. In facilitating this we can move towards establishing a solid evidence-base. The basis of this position is that clinical guidelines and medical practice should treat these young people with the same standards of evidence-based care as others who have less controversial conditions. Whilst this paper uses English law and UK professional regulation for context, many of the ethical, legal and professional issues highlighted are applicable to other jurisdictions.

scholarly journals Cognitive-behavioural therapy for schizophrenia: Filling the therapeutic vacuum

2003 ◽  
Vol 183 (2) ◽  
pp. 98-99 ◽  
Author(s):  
Douglas Turkington ◽  
David Kingdon ◽  
Paul Chadwick
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Convincing Evidence ◽  
Family Work ◽  
Standard Clinical Practice ◽  
Cognitive Behavioural ◽  
Accepted Part ◽  
The Cost

When does a therapeutic intervention become an accepted part of standard clinical practice? Is it when there is sufficient research evidence? But what constitutes ‘sufficient’? What about available resources and acceptability to patients? Do we have to wait until the National Institute for Clinical Excellence pronounces? A convincing evidence base for family work in schizophrenia (Kuipers, 2000) has existed for many years but has been poorly implemented (Anderson & Adams, 1996). Will cognitive-behavioural therapy (CBT) for psychosis suffer the same fate? Which professional group will champion such an implementation? The evidence for other psychological treatments is less robust. Psychoeducation may prolong time to relapse and improve insight but at the cost of increasing suicidal ideation (Carroll et al, 1998). Personal therapy (Hogarty et al, 1997) may be of value but is contra-indicated for patients who are living alone in the community. Psychodynamic approaches are advocated (Mace & Margison, 1997) but most psychiatrists do not support their use in practice, owing to lack of evidence of efficacy.

NICE Guidelines on Treatment of Depression in Childhood and Adolescence: Implications from a CBT Perspective

2006 ◽  
Vol 34 (2) ◽  
pp. 129-137 ◽  
Author(s):  
James Murray ◽  
Sam Cartwright-Hatton
Keyword(s):  
Young People ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Childhood And Adolescence ◽  
Wait List ◽  
Limited Information ◽  
Nice Guidelines ◽  
Children And Young People ◽  
Psychological Therapies ◽  
Treatment Of Depression

The National Institute for Clinical Excellence recently published their guidelines on the treatment of depression in children and young people. This article critically reviews these guidelines in terms of their likely impact on BABCP members and the services in which they work. The evidence base that underpins the guideline is very sparse. There is particularly limited information on which to base guidance to therapists working with younger children. The use that has been made of this evidence is discussed, and some controversial interpretations are criticized. Implications for services and therapists are outlined. In particular, attention is drawn to the pressing need for very substantial additional training if the guidelines are to be implemented correctly. Some suggestions for deployment of staff with differing levels of knowledge and expertise in CBT are offered. Finally, challenges for the field as a whole are discussed. In particular, a great deal more research is needed into the effectiveness of psychological therapies versus wait list and versus each other and medications, and into the levels of training required to provide competent CBT to children and adolescents.

scholarly journals Sleep promotion for hospitalised children: Developing an evidence-based guideline for nurses

Curationis ◽  
2021 ◽  
Vol 44 (1) ◽  
Author(s):  
Elijeshca C. Crous ◽  
Natasha North
Keyword(s):  
South African ◽  
Clinical Care ◽  
Evidence Base ◽  
Poor Sleep ◽  
Healthcare Team ◽  
Hospital Nurses ◽  
Evidence Based ◽  
The South ◽  
Guideline Adaptation ◽  
Evidence Based Guideline

Background: Adequate sleep in hospitalised children is important for a variety of physiological and psychological processes associated with growth, development, and recovery from illness and injury. Hospitalisation often prioritises clinical care activities at the expense of age-appropriate sleep. Nurses and the wider healthcare team contribute to this paradox. However, through conscious practice and partnering with mothers, nurses are able to enact change and promote sleep.Objectives: To adopt, adapt or contextualise existing guidelines to develop an evidence-based practice guideline to promote sleep-friendly ward environments and routines facilitated by nurses, and in partnership with mothers.Method: A six-step methodology for guideline adaptation was followed, as recommended by the South African Guidelines Excellence project: (1) existing guidelines and protocols were identified and (2) appraised using the AGREE II instrument; (3) an evidence base was developed; (4) recommendations were modified, (5) assigned levels of evidence and grades of recommendation; and (6) end user guidance was developed. Expert consultation was sought throughout.Results: Existing relevant guidance comprised 61 adult-centric recommendations. Modification of the evidence base led to six composited recommendations that facilitate sleep in hospitalised children: (1) prioritising patient safety; (2) collaborating with the mother or caregiver to promote sleep; (3) coordinating ward routine and (4) environment to improve sleep; (5) work with clinical and non-clinical staff; and (6) performing basic sleep assessments. Practice recommendations were aligned to the South African regulatory framework for nursing.Conclusion: Hospitalisation is a time of physiological and psychological dysregulation for children, which is amplified by poor sleep in a hospital. Nurses have the opportunity to promote sleep during hospitalisation by implementing this African-centric guideline in partnership with mothers.

Virtual Dementia Tour®: limitations and ethics

2018 ◽  
Vol 19 (2) ◽  
pp. 146-155 ◽  
Author(s):  
Alessandra Merizzi
Keyword(s):  
Quality Of Life ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Standards Of Care ◽  
Original Research ◽  
Evidence Based ◽  
Supporting Evidence ◽  
National Guidelines ◽  
Content Type

Purpose Dementia care is an important aspect affecting the quality of life of people living with dementia. There are many studies that test the efficacy of methods of care in order to support and even increase the quality of life of dementia patients (e.g. Gridley et al., 2016; Thyrian et al., 2017). A novel approach developed by Beville (2002) called Virtual Dementia Tour® (VDT®) also aims to improve the care of people living with dementia in their middle and late stages of deterioration. VDT® is now becoming popular internationally (see www.provdt.co.uk/) and it is sold to the general public as an evidence-based method through which people can experience what it is like to live with dementia, aiming to increase empathy and improve the delivery of care. The purpose of this paper is to explore the validity of the VDT® intervention. Design/methodology/approach The author explores the original research article upon which the VDT® was developed, highlighting critical points and reviewing these through a rigorous selection of references. Findings The supporting evidence base is consistently weak on closer scrutiny, and in combination with anecdotal evidence of distress related to the VDT® experience, this analysis suggests a need for caution in implementation. Originality/value Although high-quality standards of care from the national guidelines (National Institute for Health and Clinical Excellence, 2010) ensure that health services implement evidence-based interventions, it may be important to discern that which is empirically based from that which is not.

scholarly journals Building the evidence base for waterpipe regulation and policy

2019 ◽  
Vol 29 (Suppl 2) ◽  
pp. s59-s61 ◽  
Author(s):  
Wasim Maziak ◽  
Eva Sharma
Keyword(s):  
Young People ◽  
Health Risks ◽  
Evidence Base ◽  
Evidence Based ◽  
Toxic Substances ◽  
Waterpipe Smoking ◽  
Special Issue ◽  
The Us ◽  
The Usa ◽  
Smoking Patterns

Waterpipe (hookah, shisha, narghileh) smoking is emerging as an epidemic, particularly among young people in the USA and globally. Unlike cigarettes, waterpipe smoking involves several components (eg, tobacco, charcoal, device and venues) and is characterised by unique smoking patterns that expose smokers to significant amounts of nicotine and other toxic substances. With the rising prevalence of use among young people and continuing misperceptions about waterpipe’s harmful nature, a better understanding of health risks associated with waterpipe smoking is warranted. In response to waterpipe’s rising trends, a Deeming Rule that extended the US Food and Drug Administration’s (FDA) regulatory authority to all tobacco products was issued in 2016. This rule includes waterpipe tobacco, components and parts. This development created the need for evidence to guide the FDA into best evidence-based strategies to limit waterpipe’s spread among young people and harm to public health. This special issue presents some of the studies that were funded under the ‘Chemistry, Toxicology, and Addiction Research on Waterpipe Tobacco’ programme to inform promising regulatory action on waterpipe products. In this preamble, we briefly summarise findings from these studies and discusses their policy and regulatory implications for different waterpipe products and components.

Towards evidence-based clinical supervision: the development and evaluation of four CBT guidelines

2010 ◽  
Vol 3 (2) ◽  
pp. 43-57 ◽  
Author(s):  
Derek Milne ◽  
Chris Dunkerley
Keyword(s):  
Clinical Supervision ◽  
Ad Hoc ◽  
Reference Group ◽  
Guideline Development ◽  
Continuing Professional Development ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Evidence Based ◽  
Evaluation Tool

AbstractClinical supervision is central to evidence-based practice (EBP) and continuing professional development (CPD), but the evidence base has made little impact on supervision, a major form of CPD. We unite the two by developing four evidence-based guidelines for cognitive behavioural therapy (CBT) supervision. The guidelines were designed to address the supervision cycle (i.e. collaborative goal-setting; methods of facilitating learning; evaluation and feedback) within the context of the supervision alliance. Guideline development followed the National Institute for Clinical Excellence approach, including a representative stakeholder working group (with local service users and supervisees), a national group of supervisors and supervisor trainers, plus an expert reference group. A total of 106 such participants completed an ad-hoc guideline evaluation tool, designed to provide a multi-dimensional reaction evaluation of the guidelines. The guidelines were all rated favourably, satisfying the key initial criteria of accuracy and acceptability, and were judged to represent a CBT approach to supervision. It is concluded that the use of the guidelines might help CBT supervisors to better meet demands for CPD (including specialization in supervision) and EBP.

Dissemination and Implementation Research in Health

2017 ◽  
Keyword(s):  
Evidence Base ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Collaborative Partnerships ◽  
Social Service Agencies ◽  
Effective Interventions ◽  
Health Related Research ◽  
Health Related ◽  
Dissemination And Implementation Research ◽  
Policies And Programs

Fifteen to twenty years is how long it takes for the billions of dollars of health-related research to translate into evidence-based policies and programs suitable for public use. Over the past 15 years, an exciting science has emerged that seeks to narrow the gap between the discovery of new knowledge and its application in public health, mental health, and health care settings. Dissemination and implementation (D&I) research seeks to understand how to best apply scientific advances in the real world, by focusing on pushing the evidence-based knowledge base out into routine use. To help propel this crucial field forward, leading D&I scholars and researchers have collaborated to put together this volume to address a number of key issues, including: how to evaluate the evidence base on effective interventions; which strategies will produce the greatest impact; how to design an appropriate study; and how to track a set of essential outcomes. D&I studies must also take into account the barriers to uptake of evidence-based interventions in the communities where people live their lives and the social service agencies, hospitals, and clinics where they receive care. The challenges of moving research to practice and policy are universal, and future progress calls for collaborative partnerships and cross-country research. The fundamental tenet of D&I research—taking what we know about improving health and putting it into practice—must be the highest priority. This book is nothing less than a roadmap that will have broad appeal to researchers and practitioners across many disciplines.

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