Open access from the perspective of the NHS

Sir Muir GrayDirector 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

Better Decisions

User needs assessment

Production & Procurement

Organisation

Localisation & Mobilisation

Utilisation

National Knowledge Service

QuestionAnsweringService

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 clinicians”Haynes RB et al (2006)

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 reportingBrit 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

Synopses (structured abstracts)

Summaries

Systems: clinical tools

Procured Produced

The National Knowledge Management Network

+The National Digital Knowledge

Base +

the community of readers

= National Library for Health.

The NLH consists of 3 key resources:

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

ELISA25.5Hepatitis 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