Evidence in seconds? Format and design considerations in the provision of reliable information to support evidence‐based practice

Evidence‐based practice is gaining support amongst health professionals. However, the major barrier remains the lack of time to read the literature. There are also problems with the take‐up and use of evidence‐based information sources such as Cochrane reviews and Effective Health Care bulletins. If such evidence is to be incorporated into local guidelines and used in day‐to‐day practice, practitioners request that these and other reliable publications be further summarized in short packages and available within seconds. The Health Evidence Bulletins Wales offer a model for this approach. The Bulletins have gone through several developmental stages leading to a novel two‐column format. In the first column, brief statements summarize the best available evidence within a topic area. In the second, full details are provided of the supporting publications (and the evidence type, or research design) with links to the full text of documents, where possible from the electronic versions of each Bulletin. Results from a questionnaire study using a random sample and unsolicited feedback suggest that this ‘two‐tier’ approach to information provision is valued by users and has implications for information services currently under development to support clinical governance.     

A first class knowledge service: developing the National electronic Library for Health

With the introduction of clinical governance and the move towards evidence-based practice, there is a growing need to provide health professionals and patients, and the public, with high quality information. Developments in the health service have added weight and urgency to this need. The National electronic Library for Health (NeLH) has a key role to play in providing health professionals with a core knowledge base of accredited and evaluated information. The Pilot NeLH was launched in November and this article outlines the progress and achievements made during this time. The NeLH is based around a central website featuring core resources and links to commissioned specialist collections. Over 70 information resources, including bibliographic databases and full text publications, are accessible via the NeLH, which aims to act as a one-stop shop to support evidence-based decision-making. Much work has been undertaken on national procurement and licensing, particularly in partnership with National Health Service (NHS) libraries. Partnerships as a whole are crucial to ensure true seamless access for health professionals. Key partners include NHS libraries, NHS Direct Online and the electronic Library for Social Care. A short glossary is included for those readers less familiar with current health service developments in the UK.     

Inspiratory muscle fatigue in swimmers after a single 200 m swim

Inspiratory muscle fatigue may occur in as little as 6 min during high-intensity spontaneously breathing exercise. The aims of this study were to determine whether inspiratory muscle fatigue occurs during swimming exercise and whether inspiratory muscle strength differs between the supine and standing body positions. Seven competitive swimmers were recruited to perform a single 200 m front-crawl swim, corresponding to 90-95% of race pace. Inspiratory muscle strength was measured at residual volume using a hand-held mouth pressure meter that measured maximal inspiratory pressure in the upright and supine positions. At baseline, maximal inspiratory pressure in the supine position was significantly lower than maximal inspiratory pressure in the upright position (112 +/- 20.4 and 133 +/- 16.7 cmH2O, respectively; P < or = 0.01). Post-exercise maximal inspiratory pressure in the supine position (80 +/- 15.7 cmH2O) was significantly lower than baseline maximal inspiratory pressure in the supine position (P < or = 0.01). The results indicate that a single 200 m front-crawl swim corresponding to 90-95% of race pace was sufficient to induce inspiratory muscle fatigue in less than 2.7 min. Furthermore, although diaphragm muscle length is optimized when supine, our results indicate that the force output of the diaphragm and inspiratory accessory muscles is greater when upright than when supine.