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This article critically analyses the concept of evidence in evidencebased policy, arguing that there is a key problem there is no existing practicable theory of evidence, one which is philosophicallygrounded and yet applicable for evidencebased policy. The article critically considers both philosophical accounts of evidence and practical treatments of evidence in evidencebased policy. It argues that both fail in different ways to provide a theory of evidence that is adequate for evidencebased policy. The article contributes to the debate about how evidence can and should be used to reduce contingency in science and in policy based on science.

The possible effects of food additives specifically artificial colours have been debated for over 30 years. The evidence accumulated suggests that for some children with attention deficit hyperactivity disorder ADHD food colours exacerbate their condition. Two studies undertaken by a research group at the University of Southampton have extended these findings to the effects on hyperactivity in children from the general population who do not show ADHD. This article reviews the response from policymakers to these findings and concludes that the failure to impose a mandatory ban on the six food colours in the Southampton study is inadequate and that such a ban would be an appropriate application of the precautionary principle when the evidence is considered to be at the margins of certainty.

The Campbell Collaboration Crime and Justice Group continues to focus on issues of evidence: what studies count in a systematic review and how many studies are needed to claim an intervention works. They are not alone. Since the mid-1990s, a number of similar efforts have sprung up to provide guidance to policy makers who wish to adopt programs to prevent violence or drug use. Many of these are particularly relevant to school-based drug prevention programs. This article describes seven efforts to produce guides to research-based programs, focusing on the standards adopted to determine what evidence counts and how much of it is necessary to determine that it worked. The author concludes with a discussion of some of the issues raised by this review.

This article describes the background to the What Works initiative launched by Barnardo's in the early 1990s, with a focus on the What Works for Children series of reports published from 1995 onwards. The author describes the intellectual and social context of the initiative, the approach taken, and some of the barriers to and levers for the adoption of research in practice are identified. The article describes more briefly the ways in which those in the Research and Development (R&D) team at Barnardo's worked towards knowledge transfer, both inside and outside the organisation. The article concludes with reflections on the impact of Barnardo's initiatives, the journey still to be travelled to strengthen the knowledge base of those providing services to children in education, health and social work, and the need for further work both to strengthen the evidence base and to increase synergies between research, policy and practice.

BACKGROUND:Excessive antibiotic use in cold and flu season is costly and contributes to antibiotic resistance. The study objective was to develop an index of excessive antibiotic use in cold and flu season and determine its correlation with other indicators of prescribing quality. METHODS AND FINDINGS:We included Medicare beneficiaries in the 40% random sample denominator file continuously enrolled in fee-for-service benefits for 2010 or 2011 (7,961,201 person-years) and extracted data on prescription fills for oral antibiotics that treat respiratory pathogens. We collapsed the data to the state level so they could be merged with monthly flu activity data from the Centers for Disease Control and Prevention. Linear regression, adjusted for state-specific mean antibiotic use and demographic characteristics, was used to estimate how antibiotic prescribing responded to state-specific flu activity. Flu-activity associated antibiotic use varied substantially across states—lowest in Vermont and Connecticut, highest in Mississippi and Florida. There was a robust positive correlation between flu-activity associated prescribing and use of medications that often cause adverse events in the elderly (0.755; P<0.001), whereas there was a strong negative correlation with beta-blocker use after a myocardial infarction (−0.413; P=0.003). CONCLUSIONS:Adjusted flu-activity associated antibiotic use was positively correlated with prescribing high-risk medications to the elderly and negatively correlated with beta-blocker use after myocardial infarction. These findings suggest that excessive antibiotic use reflects low-quality prescribing. They imply that practice and policy solutions should go beyond narrow, antibiotic specific, approaches to encourage evidence-based prescribing for the elderly Medicare population.

BACKGROUND:The integration of complementary and alternative medicine (CAM) therapies into a large organization such as the Veterans Health Administration (VHA) requires cultural change and deliberate planning to ensure feasibility and buy-in from staff and patients. At present, there is limited knowledge of VHA patient care providers’ and administrators’ viewpoints regarding CAM therapies and their implementation. OBJECTIVES:Our purpose was to qualitatively examine knowledge, attitudes, perceived value and perceived barriers, and/or facilitators to CAM program implementation among VHA providers and administrators at a large VHA facility. RESEARCH DESIGN:We are reporting the qualitative interview portion of a mixed-methods study. SUBJECTS:Twenty-eight participants (patient care providers or administrators) were purposely chosen to represent a spectrum of positions and services. Participants’ experience with and exposure to CAM therapies varied. MEASURES:Individual interviews were conducted using a semi-structured format and were digitally recorded, transcribed, and coded for themes. RESULTS:Recurrent themes includeda range of knowledge about CAM; benefits for patients and staff; and factors that can be facilitators or barriers including evidence-based practice or perceived lack thereof, prevailing culture, leadership at all levels, and lack of position descriptions for CAM therapists. Participants rated massage, meditation, acupuncture, and yoga as priorities for promotion across the VHA. CONCLUSIONS:Despite perceived challenges, providers and administrators recognized the value of CAM and potential for expansion of CAM within the VHA. Interview results could inform the process of incorporating CAM into a plan for meeting VHA Strategic Goal One of personalized, proactive, patient-driven health care across the VHA.

Research is a key resource in a knowledge economy and governance system. In order to enable research to benefit the nation and to contribute to growing the knowledge-based economy (the aims of the Global Change Grand Challenge, and specifically the Society and Sustainability Research Programme), the gap between research, knowledge production and policy and management (i.e. the knowing-doing gap1) needs to be closed, yet closing this gap remains a complex challenge. This year's annual SANCOR (South African Network for Coastal and Oceanic Research) Forum meeting addressed this gap through consultation with a variety of stakeholders from the coastal and marine science community. Our brief was to provide for reflection and discussion on aspects of the science-policy-management interface within South Africa and this commentary provides a summary of the Forum discussions. We detail some current challenges of integrating coastal and marine science into policy and decision making in South Africa, highlight 'success stories' and provide some thoughts on maximising overlap and building a sound science-policy interface. Although couched in the context of marine and coastal sciences, our findings will resonate with other scientific disciplines. Similarly, the challenges in and opportunities for creating constructive dialogue for evidence-based decision-making are not specific to South Africa, so we draw on national, international and collective experience to provide an avenue for doing so. In this commentary we highlight current examples of mismatch between science and policy by focusing on barriers resulting from legislation, politics and a general lack of process for better integration. In particular, we focus on the complexities of evidence-based decision-making at different scales, and how international scientific engagement has helped shape policy in South Africa. We finish by providing some perspectives, directions and examples to help narrow the gap and foster better science-policy integration into the future.

Numerous factors such as sociodemographic characteristics contribute to cybercrime victimisation. Previous research suggests that neighbourhood plays a role in cybercrime perpetration. However, despite the theoretical importance and particular interest to law enforcement agencies and policymakers, local area variations in cybercrime victimisation have rarely been examined. Drawing on data from recorded cybercrime incidents within one of the largest police forces in England írom a three-year period with a victim dataset of5,270 individuals enhanced by the Census data, this research untangles the relationships between demographics of cybercrime victims and their resident area characteristics. Our work demonstrates that it is possible to apply statistical analysis to routinely collected police data to gain insight into the cybercrime victimisation that occurs across crime types in relation to demographics and area-level variations. The results of the study will provide valuable insights into policing cybercrime in England and beyond.

Purpose - The purpose of this paper is to examine an audit that was performed of all patients referred to a liaison psychiatry inpatient consultation service which sought to establish a baseline for demographics, type of referral, and management of referrals, with a view to introducing improved evidence-based treatments. It also aims to examine timeliness of response to referrals benchmarked against published standards.Design methodology approach - All inpatient referrals to a liaison psychiatry service were recorded over a six-month period, including demographics, diagnosis, management and timeliness of response to referrals. The data were retrospectively analysed and compared against international standards.Findings - A total of 172 referrals were received in the six months. Commonest referral reasons included assessments regarding depressive disorders (23.8 per cent), delirium other cognitive disorders (19.2 per cent), alcohol-related disorders (18.6 per cent), anxiety disorders (14.5 per cent), and risk management (12.2 per cent). Evidence-based practices were not utilised effectively for a number of different types of presentations. A total of 40.1 per cent of referrals were seen on the same day, 75.4 per cent by the end of the next day, and 93.4 per cent by the end of the following day.Practical implications - Use of a hospital protocol for management of delirium may improve outcomes for these patients. Evidence-based techniques, such as brief intervention therapies, may be beneficial for referrals involving alcohol dependence. Referrals were seen reasonably quickly, but there is room for improvement when compared with published standards.Originality value - This paper provides valuable information for those involved in management of liaison psychiatry consultation services, providing ideas for development and implementation of evidence based practices.

Purpose - The purpose of this article is to look at method study, as devised by the Gilbreths at the beginning of the twentieth century, which found early application in hospital quality assurance and surgical \"best practice\". It has since become a core activity in all modern methods, as applied to healthcare delivery improvement programmes.Design methodology approach - The article traces the origin of what is now currently and variously called \"business process re-engineering\", \"business process improvement\" and \"lean healthcare\" etc., by different management gurus back to the century-old pioneering work of Frank Gilbreth. The outcome is a consistent framework involving \"width\", \"length\" and \"depth\" dimensions within which healthcare delivery systems can be analysed, designed and successfully implemented to achieve better and more consistent performance.Findings - Healthcare method (saving time plus saving motion) study is best practised as co-joint action learning activity \"owned\" by all \"players\" involved in the re-engineering process. However, although process mapping is a key step forward, in itself it is no guarantee of effective re-engineering. It is not even the beginning of the end of the change challenge, although it should be the end of the beginning. What is needed is innovative exploitation of method study within a healthcare organisational learning culture accelerated via the Gilbreth Knowledge Flywheel.Research limitations implications - It is shown that effective healthcare delivery pipeline improvement is anchored into a team approach involving all \"players\" in the system especially physicians. A comprehensive process study, constructive dialogue, proper and highly professional re-engineering plus managed implementation are essential components. Experience suggests \"learning\" is thereby achieved via \"natural groups\" actively involved in healthcare processes.Originality value - The article provides a proven method for exploiting Gilbreths' outputs and their many successors in enabling more productive evidence-based healthcare delivery as summarised in the \"learn-do-learn-do\" feedback loop in the Gilbreth Knowledge Flywheel.