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Accessing and understanding the evidence

2006; World Health Organization; Volume: 84; Issue: 12 Linguagem: Inglês

10.2471/blt.06.037515

1564-0604

Trevor Duke, Harry Campbell, Philip Ayieko, Newton Opiyo, Mike English, Julian Kelly, Susanne Carai, Giorgio Tamburlini, Martin Weber,

Global Health and Surgery

WHO regularly gathers, evaluates, and cites evidence to support its recommendations. How this is done varies between departments, but highly centralized processes, complex methods and expert consultations are often used. WHO guidelines are distributed to health workers and policy-makers in developing countries, but few of these people have the opportunity to be involved in the process of choosing and weighing the evidence to formulate the guidelines that are ostensibly designed for their use. Such incomplete engagement may impede ownership of WHO recommendations, and thus be an obstacle to full implementation. In 2005 WHO published the Pocketbook of Hospital Care for Children, (1) a comprehensive clinical resource for nurses and doctors in developing countries. The Pocketbook contains recommendations on the management of all common conditions, including serious infections, malnutrition, neonatal and surgical problems, injuries, burns and poisoning. These guidelines are an extension of the Integrated Management of Childhood Illness (IMCI) to the first-referral hospital, providing consistency across all levels of health care systems. The Pocketbook aims to address many of the deficiencies in quality and safety of hospital care for children identified in recent years. (2-4) However, the mere production of high-quality guidelines will not ensure implementation, or be sufficient to improve quality of care. A comprehensive approach to the implementation of the WHO Pocketbook includes training strategies and quality assessment tools. Another key component is a process of documenting, updating and disseminating evidence which engages doctors, medical students and nurses in countries throughout the world, This process and the evidence it is collecting are described at the International Child Health Review Collaboration (ICHRC) web site: www.ichrc.org. ICHRC uses Pubmed, a database which references over 4800 journals, including publications from the Cochrane Collaboration. Pubmed is free online and has validated search filters that provide about 95% sensitivity and specificity when compared with the most comprehensive search strategies, involving multiple (often costly) databases and hand-searching of the literature. (5) Reviews given priority in this project are those addressing issues that are critical to the implementation of the guidelines, such as recommendations which challenge common practices in some countries. A reviewer's toolkit is available on the web site, and support for reviewers is provided by project coordinators. Standardized search strings are developed with the assistance of a librarian. Drafts are written by primary reviewers, further reviewed by an acknowledged expert in the field, and edited before posting on the web site. The ICHRC process is similar to that used by the Cochrane Collaboration, but there are some important differences. ICHRC has a focus that is broader than therapeutic questions (including diagnosis, etiology and implementation); search strategies prioritize randomized trials, but include other research designs when these are more appropriate. …