Evidence Based Child Health
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The Evidence Based Child Health Group

The Evidence Based Child Health Group is focussed on ensuring that clinical decisions in the field of paediatrics are supported by the best available evidence.

We work together with patients, clinicians and other stakeholders to encourage an evidence based approach to child health, and an evidence based systematic approach to setting the future research agenda and establishing research priorities

 

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Research issues

Currently, we are targeting evidence synthesis in the field of Cystic Fibrosis (CF), but we will expand into other areas of Paediatrics as our group grows.

We work closely with the Cochrane CF and Genetic Disorders group of which Professor Alan Smyth is the co-ordiinating editor. Our priority setting work in CF helps to ensure that Cochrane review titles are those which are important to the CF community. Go to the website to see a list of priority titles.

 Cochrane CFGD logo

What are we doing about

1. Assessing the evidence base to inform decision making in clinical care

A systematic review attempts to identify, appraise and synthesise all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question.

To do this we use explicit methods aimed at minimising bias, in order to produce more reliable findings that can be used to inform decision making. At present the following Cochrane systematic reviews are being undertaken within Evidence Based Child Health:

  • Inhaled antibiotics for pulmonary exacerbations in cystic fibrosis
  • Inhaled corticosteroids for cystic fibrosis
  • Inhaled anti-pseudomonal antiobiotics for long-term therapy in cystic fibrosis
  • Therapies for preventing recurrence of Pseudomonas aeruginosa in people with cystic fibrosis

Members of the group are also authors on other reviews which are going through the routine update cycle, including percutaneous lines for intravenous antibiotics in cystic fibrosis, intravenous antibiotics in cystic fibrosis, and antibiotic adjuncts in cystic fibrosis.

Prof Alan Smyth is coordinating editor of the Cochrane Cystic Fibrosis and Genetic Disorders Group

 
2.Identifying evidence gaps in treatment decisions in CF

We do not always have the evidence to support treatment decisions. We have conducted a systematic review to identify the known evidence gaps in treatment decisions in CF. These evidence gaps will be used to guide both researchers and funding bodies to priority areas.

Rowbotham NJ, Smith S, Prayle AP, et al. Gaps in the evidence for treatment decisions in cystic fibrosis: A systematic review. Thorax. 2018;74:229-36. doi: http://dx.doi.org/10.1136/thoraxjnl-2017-210858.

 
3.Shaping the future research agenda in partnership with the CF community

Presently there is no cohesive strategy to fill the above-mentioned evidence gaps, with research being driven by financial interests or those of investigators. Traditionally patient views have not been considered when setting research agendas. In partnership with the CF community we have collected and prioritised these uncertainties for future research questions.

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In 2016-17 we undertook a James Lind Alliance Priority Setting Partnership (JLA PSP) in CF. This brought together patients, families, healthcare professionals and commissioners to agree shared priorities for research. 

Top 10 priorities for clinical research in CF

Here are our final top ten questions as agreed by the CF community:

  1. What are the effective ways of simplifying the treatment burden of people with CF?
  2. How can we relieve gastro-intestinal symptoms, such as stomach pain, bloating and nausea?
  3. What is the best treatment for non-tuberculous mycobacterium (including when to start and what medication)?
  4. Which therapies are effective in delaying or preventing progression of lung disease in early life?
  5. Is there a way of preventing CF related diabetes?
  6. What effective ways of motivation, support and technologies help people with CF improve and sustain adherence to treatment?
  7. Can exercise replace chest physiotherapy?
  8. Which antibiotic combinations and dosing plans should be used for CF exacerbations and should antibiotic combinations be rotated?
  9. Is there a way of reducing the negative effects of antibiotics e.g. resistance risk and adverse symptoms in people with CF?
  10. What is the best way of eradicating Pseudomonas aeruginosa? 

We have addressed the challenges of infection control by running the PSP steering group (and also our outreach to the CF community) through web-based conferencing systems.

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James Lind CF 2

We are currently working on phase 2 of our James Lind priority setting work.  We will be taking four of the top ten priorities which are broad in their nature. We want to delve a bit deeper to find out what the CF community understand by them and at the same time to try and identify more specific questions that can be answered by research.

We will be reaching out to the whole CF community via online surveys and focus groups. We will be making use of videoconferencing so that we can include as many people as possible without cross-infection risks.

The four questions we will be focussing on are:CF 4 questions

The first question we looked at is Q1 which is exploring the treatment burden for people with CF and their families.  We sent out a survey via Twitter to help us get a better understanding of what is meant by treatment burden and followed this up with a focus group in the autumn of 2018.

We have also sent surveys out to help us answer Q2, Q6 and Q7, asking how we can relieve gastro-intestinal symptoms, about effective ways of motivation, support & technology, and whether chest physiotherapy can be repoaced with exercise. The data has been collated and refined to produce some answerable research questions,

A final survey to get the CF community's opinion on these refined questions will be coming soon…

Read our privacy notice here 

Here is a short video which explains what we’re doing for phase 2

 
4. Understanding the blocks to evidence medicine

There are a number of blocks in the path from evidence to change in clinical practice. We are engaged in a number of studies to systematically study these blocks. We have found that in the field of cystic fibrosis, up to half of registered clinical trials are not published within 5 years of trial completion.

Our studies on trial registration and trial summary level data publication have informed UK and international policy development in the area of trial publication and dissemination regulations. Our research has been used by important international campaigns, such as the AllTrials.net.

Blocks to incorporating the best evidence in clinical trials

When a health professional prescribes a treatment, they use guidelines to help decide which treatments to recommend.  These guidelines should be informed by the best available evidence. The Cochrane collaboration are well known for producing high quality clinical evidence which can inform guidelines – they write Cochrane Reviews which systematically look for all the available evidence on a narrow topic and then judge if a treatment works or not. 

We studied all the United Kingdom guidelines for children’s respiratory disease, and found that some or all of the relevant Cochrane reviews were not used in preparing guideline recommendations 40% of the time. 

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We have made an interactive figure to illustrate our data, and you can also read the open access paper.

 

 

Current projects

Key publications

Gichuru W, Ojha S, Smith S, et al. Is microfinance associated with changes in women's well-being and children's nutrition? A systematic review and meta-analysis. BMJ Open 2019;9:e023658

Nasuf AWA, Ojha S, Dorling J.Oropharyngeal colostrum in preventing mortality and morbidity in preterm infants.Cochrane Database of Systematic Reviews2018, Issue 9. Art. No.: CD011921.

Rowbotham NJ,Smith S, Prayle AP, et al. Gaps in the evidence for treatment decisions in cystic fibrosis: a systematic review. Thorax 2019;74(3):229-36 doi:10.1136/thoraxjnl-2017-210858

Rowbotham NR, Smith S, Leighton P et al (2018) The top 10 research priorities in cystic fibrosis developed by a partnership between people with CF and healthcare providers. Thorax 73(4): 388-90 DOI: 10.1136/thoraxjnl-2017-210473

Hurley MN, Fogarty A, McKeever TM, Goss CH, Rosenfeld M, Smyth AR. Early Respiratory Bacterial Detection and Antistaphylococcal Antibiotic Prophylaxis in Young Children with Cystic Fibrosis. Ann Am Thorac Soc. 2018;15(1):42-48

Kwok TC, Ojha S, Dorling J (2017) Feed thickener for infants up to six months of age with gastro-oesophageal reflux. Cochrane Database of Systematic Reviews DOI: 10.1002/14651858.CD003211.pub2

Nicola J Rowbotham, Sally C Palser, Sherie J Smith & Alan R Smyth (2019)Infection prevention and control in cystic fibrosis: a systematic review of interventions, ExpertReview of Respiratory Medicine, 13:5, 425-434, DOI: 10.1080/17476348.2019.1595594

Cochrane library

Cochrane CF and Genetic Disorders webpage

 

 

 

The Evidence Based Child Health Group

Division of Child Health, Obstetrics & Gynaecology
The University of Nottingham
E Floor, East Block, QMC
Nottingham, NG7 2UH


telephone: +44 (0) 115 82 30611
email:childhealth@nottingham.ac.uk