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[...] a formal system for accrediting producers of guidance that will enable the best and most trusted sources to be easily recognisable through an accreditation mark.

The report recommended that: ‘NICE will manage the synthesis and spread of knowledge through NHS Evidence - a new single portal through which anyone will be able to access clinical and non-clinical evidence and best practice, both what high quality care looks like and how to deliver it’. Table 1 Clinically relevant information sources Clinical* Guidelines * Systematic reviews * Other synthesised content (summaries and overviews) * Primary research and on-going trialsCommissioning and improvement* Service guidance * Tools and models * Care pathways * Indicators and metrics * Improvement informationDrugs and technologies* Prescribing and safety information * Technology appraisals * New drug information * Devices, diagnostics and interventional procedure guidance To achieve the ambition of managing the synthesis and spread of knowledge to this range of audiences, there are three main challenges that NHS Evidence needs to be able to address: (i) identifying the most relevant, high-quality information; (ii) making it readily accessible; and (iii) supporting the use of evidence in practice. Producers are formally invited to provide the NHS Evidence Advisory Committee with a submission against internationally agreed criteria for guideline development.3 The accreditation scheme may in future be extended to other types of information, such as systematic reviews. 2.

The aim of this study was to determine whether plasma and red cell fatty acid levels were associated with cardiovascular disease, and whether any association was independent of other major risk factors. Over 1100 subjects were examined in a random sample survey of the general population (the Edinburgh Artery Study). Fatty acids were measured in three plasma fractions (triglyceride, cholesteryl ester and phospholipid) and in red cell phospholipids. Fatty acid levels in groups with cardiovascular disease (myocardial infarction (MI), angina and lower limb disease) were compared with a no disease group. In the cholesteryl ester and phospholipid fractions there were significantly lower levels of eicosapentaenoic acid in the MI group on univariate analysis (p,0.05), but not when adjusted for age, sex, smoking and systolic blood pressure using logistic regression. In the red cell fraction, alpha-linolenic acid was significantly lower in those with stroke (p,0.01) and lower limb disease (p,0.05). Linoleic acid was significantly raised in the triglyceride fraction in those with MI, probably reflecting recent dietary changes. There were significant increases in dihomo-gamma-linolenic acid in the phospholipid and red cell fractions in those with MI, and in the phospholipid fraction in the stroke group. These results do not support the hypothesis that n-6 fatty acids are protective against cardiovascular disease, although there may be some beneficial effects of the n-3 fatty acid, alpha-linolenic acid. Results from cross-sectional surveys must, however, be interpreted with caution because the presence of disease may affect dietary intake.

The most important factors in the development of depression after a myocardial infarction are discussed. The results of one study suggest that post-infarction depression is related to subsequent morbidity and quality of life.

Acupuncture has increasingly gained popularity as alternative approach to conventional care for knee osteoarthritis (KOA) management. We conducted a pragmatic randomized controlled study to evaluate the clinical and health utility outcomes of acupuncture and heat therapy in conjunction with standard care for KOA. Community-ambulating KOA patients of 45 years or older were randomly assigned to the intervention or control (SC) group. The HARMOKnee group received 12 acupuncture and heat treatments in addition to standard care for six weeks. We evaluated the Knee Injury and Osteoarthritis and Outcome Score-12 (KOOS-12) at baseline, 6-, 12- and 24-week. Secondary outcomes including Pain, Enjoyment of Life and General Activity (PEG) scores, Patient Health Questionnaire-4 (PHQ-4), and TCM syndrome differentiation were evaluated. Comparative analysis was performed using mixed-effect models. Among 101 participants (HARMOKnee=50; SC=51), the mean age was 63.99 ± 7.03 years, and KOA duration was 5.07 ± 6.35 years. There was a significant intervention-time interaction, favouring HARMOKnee group, for the KOOS-12 total score [Coef= 6.43, 95 %CI: 0.72, 12.14; p = 0.027], KOOS-12 quality of life (QOL) domain-score [Coef= 8.50, 95 %CI: 1.28, 15.73; p = 0.021], and PEG overall score [Coef= −1.32, 95 %CI: −2.14, −0.49; p = 0.002] at 6-week. No between-group differences were identified at other time-points. The HARMOKnee group demonstrated considerable pain reduction and improved knee flexion and extension after 12 treatments (0.001 < p < 0.014). This treatment approach markedly enhanced knee flexion in patients with Kidney yang deficiency with phlegm and blood stasis syndrome. HARMOKnee provides short-term pain-management benefits to KOA patients compared to standard care alone, particularly in patients with Kidney yang deficiency with phlegm and blood stasis syndrome. •Combining standard care with acupuncture and heat therapy (HARMOKnee) improves the quality of life of KOA patients.•HARMOKnee provides short-term pain-management benefits to KOA patients compared to standard care alone.•HARMOKnee enhances knee flexion particularly in patients with Kidney yang deficiency with phlegm and blood stasis syndrome.

Abstract Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations. Systematic and explicit methods of making judgments can reduce errors and improve communication. We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts. In this article we present a summary of our approach from the perspective of a guideline user. Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk. It is also important to consider costs (resource utilisation) before making a recommendation. Inconsistencies among systems for grading the quality of evidence and the strength of recommendations reduce their potential to facilitate critical appraisal and improve communication of these judgments. Our system for guiding these complex judgments balances the need for simplicity with the need for full and transparent consideration of all important issues. Clinical guidelines are only as good as the evidence and judgments they are based on. The GRADE approach aims to make it easier for users to assess the judgments behind recommendations

Knee osteoarthritis (KOA) is one of most prevalent and fastest-growing causes of pain, impaired mobility, and poor quality of life in the rapidly aging population worldwide. There is a lack of high-quality evidence on the efficacy of traditional Chinese medicine (TCM), particularly acupuncture, and a lack of KOA practice guidelines that are tailored to unique population demographics and tropical climates. Our HARMOKnee (Heat and Acupuncture to Manage Osteoarthritis of the Knee) trial aims to address these gaps by evaluating the short- and medium-term clinical and cost-effectiveness of acupuncture with heat therapy in addition to standard care, compared to standard care alone. Through a robust process and economic evaluation, we aim to inform evidence-based practice for patients with KOA to facilitate the large-scale implementation of a comprehensive and holistic model of care that harmonizes elements of Western medicine and TCM. We hypothesize that acupuncture with heat therapy as an adjunct to standard care is clinically more effective than standard care alone. A multicenter, pragmatic, parallel-arm, single-blinded, effectiveness-implementation hybrid randomized controlled trial will be conducted. We intend to recruit 100 patients with KOA randomized to either the control arm (standard care only) or intervention arm (acupuncture with heat therapy, in addition to standard care). The inclusion criteria are being a community ambulator and having primary KOA, excluding patients with secondary arthritis or previous knee replacements. The primary outcome measure is the Knee Osteoarthritis Outcome Score at 6 weeks. Secondary outcome measures include psychological, physical, quality of life, satisfaction, and global outcome measures at 6, 12, and 26 weeks. A mixed method approach through an embedded process evaluation will facilitate large-scale implementation. An economic evaluation will be performed to assess financial sustainability. Patient enrollment has been ongoing since August 2022. The recruitment process is anticipated to conclude by July 2024, and the findings will be analyzed and publicized as they are obtained. As of November 6, 2023, our patient enrollment stands at 65 individuals. The findings of our HARMOKnee study will contribute substantial evidence to the current body of literature regarding the effectiveness of acupuncture treatment for KOA. Additionally, we aim to facilitate the creation of standardized national guidelines for evidence-based practice that are specifically tailored to our unique population demographics. Furthermore, we seek to promote the adoption and integration of acupuncture and heat therapy into existing treatment models. ClinicalTrials.gov NCT05507619; https://clinicaltrials.gov/study/NCT05507619. DERR1-10.2196/54352.