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Evidence-based problem solving: What is the efficacy of pneumococcal vaccination in people with asthma?
Aims: To determine the efficacy of pneumococcal vaccination in asthmatic patients using a pragmatic evidence-based approach to solve therapeutic problems. Methods: Use of local information, expert-opinion guidelines, evidence-based guidelines and a systematic literature search of the Medline database to identify clinical trials designed to assess vaccine efficacy among asthmatics. Results: Expert-opinion guidelines advocating the use of pneumococcal vaccine among asthmatics were found, but there was no evidence-based assessment of vaccine efficacy among asthmatics. The Medline database described no clinical trials that specifically addressed our question, although a number of studies assessing broader question of overall vaccine efficacy were identified, with conflicting results. Conclusions: Current UK expert opinion recommends that people with asthma receive pneumococcal vaccination, but there is little high-quality evidence to support this. The search strategy used may be adapted to address other therapeutic questions that may arise in primary care consultations.
Writing research protocols: An innovative approach
Aims: To develop a mechanism to write three research protocols within 10 hours while simultaneously enhancing the research protocol writing skills of participants. Method: Members of the General Practitioners In Asthma Group (GPIAG) were invited to attend a research protocol workshop with pre- and post-workshop questionnaires. The main outcome measures were the development of three detailed research protocols and improvement in participants' perceived research protocol writing skills. Results: Three detailed research protocols were completed within the time allocated. Thirty (88%) participants completed pre- and post-workshop questionnaires. Participants believed there were improvements in their ability to formulate an answerable research question (p < 0.01), choose an appropriate methodology to answer the question (p < 0.01), choose appropriate outcome measures (p = 0.03), choose appropriate statistical methods (p = 0.01), devise a research timetable (p < 0.01), and improve their overall ability to write a research protocol (p < 0.01). Conclusion: It is possible to identify a mechanism, based on a weekend workshop, to write accelerated research protocols whilst simultaneously significantly increasing the research protocol writing skills of participants. This approach has potential to promote the development of research skills within primary care.
Pneumococcal vaccination: A practice based audit
Objective: To audit the use of pneumococccal vaccine in patients at increased risk of pneumococcal infection, in a general practice setting. Design: Computer and manual search of patient records - before and one year after intervention. Setting and subjects: All patients registered at a four partner, inner-city, training practice in Wembley. Intervention: Practice based pneumococcal vaccination campaign, with implementation of practice protocol, and clinical guidelines issued to all members of the primary health care team. Outcome Measures: Proportion of patients at risk of pneumococcal infection that had been vaccinated on 16th May 1998, compared with proportion vaccinated on 1st April 1997. Results: Significant increase in the proportion of patients that had been vaccinated from 2 (0%) before the intervention to 60 (7.6%) one year later (p < 0.001, 95% CI 5.4 - 9.2%). Conclusions: A practice based campaign can deliver significant improvements in pneumococcal vaccination uptake in patients considered to be at risk of pneumococcal disease.