The Cochrane collaboration and its possible impact on diabetes care

Web resource appraisal process (WRAP): A framework to establish critically appraised nursing knowledge-an active web based learning exercise

There have been dramatic advances in Internet technology in the past 10 years. However, for the Internet to reach its full potential for nursing practice and education, improvements in the quality and accessibility of health care information on the Internet are needed. This paper describes the development of a Web Resource Appraisal Process (WRAP). The WRAP consists of a template and series of online tutorials designed to facilitate the development of online resources for nursing. The WRAP can be described as a content focused authoring tool. The WRAP directs users through a range of high quality international health websites and databases in order to collect information related to specific practice areas. The WRAP then provides an ordered structure for the presentation of this information in an online format. The WRAP is a website with three main functions. Firstly, it is a teaching and learning resource promoting interactive learning using online resources. Secondly, the WRAP promotes the application of research evidence to practice by providing a standardised framework for the critical review of information resources. Thirdly, the WRAP provides a mechanism for the collaborative documentation of nursing knowledge. This paper concludes by discussing implications of the WRAP for the development, documentation and dissemination of knowledge across the health professions.

Evidence-Based Endocrinology

Evidence-based medicine is the judicious, conscientious, and explicit use of the best available evidence from clinical research in making clinical decisions. This definition recognizes a hierarchy of evidence that arranges study designs by their susceptibility to bias. The top of the hierarchy includes n-of-1 trials, systematic reviews of randomized trials, and single randomized trials reporting patient-important outcomes. The bottom of the hierarchy includes physiologic studies and unsystematic clinical observations. The definition posits that evidence alone is never enough to guide clinical decisions. In addition to evidence from clinical research, decision making requires careful and expert assessment of the patient's circumstances and elicitation of the patient's values and preferences. The latter should drive decisions, particularly when the trade-offs (of benefit and risk) are close or unclear. The evidence-based medicine process involves: (i) asking an answerable question; (ii) acquiring the best available evidence; (iii) appraising the evidence to judge the strength of inference of its results; and (iv) applying the results to the individual patient. Evidence-based endocrinology is hindered by limited high-level evidence assessing patient-important outcomes, limited systematic summaries of this evidence, lack of time, and lack of systematic training of endocrinologists in evidence-based medicine. Current endocrine practice may require a redesign to enhance the role of endocrinologists as information brokers for colleagues and patients. In the last 10 years, evidence-based medicine has matured as a philosophy of clinical care and medical education. An appraisal of its role in endocrinology awaits the pervasion of its principles into all of endocrine practice.