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Background: Most positive antineutrophil cytoplasmic antibody (ANCA) results are associated with non-vasculitic conditions, and guidelines have been proposed for the judicious use of this test. The outcome of applying similar guidelines in a routine laboratory is reported. Methods: All immunology requests (6500) over six months were selected, and those requesting ANCA were studied for the appropriateness of the clinical data supporting the request, the presence of ANCA in those samples tested, and the final diagnosis. Antibodies were detected by indirect immunofluorescence. Results: ANCA testing was requested in 287 samples. Application of a "gating policy", which refuses analysis on requests that are not supported by clinical data suggestive of systemic vasculitis, made clinicians more selective about the patients for whom they requested ANCA testing. The percentage of "appropriate" screens for systemic vasculitis was relatively high (212 of 287 requests: 72.5%). Only one of the remainder, for whom ANCA testing was initially refused, developed an ANCA related systemic vasculitis in the two years after the study, but the delay in reporting her positive ANCA was only two days. Most of the samples tested were negative (155 of 212), but most (42 of 57) of the patients with positive ANCA results were found to have a systemic vasculitis. Conclusions: A gating policy to select requests supported by clinical data suggestive of systemic vasculitis makes ANCA testing more clinically relevant and cost effective. Studies where guidelines can be proposed and their effects measured are important in the light of clinical governance and evidence based medicine. [ABSTRACT FROM AUTHOR]

In order to give the best care to patients and families, pediatricians need to integrate the highest quality scientific evidence with clinical expertise and the opinions of the family. The journal "Archimedes," seeks to assist practicing clinicians by providing evidence based answers to common questions which are not at the forefront of research but are at the core of practice. The topic summaries are not systematic reviews, though they are as exhaustive as a practicing clinician can produce. They make no attempt to statistically aggregate the data, nor search the grey, unpublished literature. What "Archimedes," offers is practical, best evidence based answers to practical, clinical questions.

The article discusses the causation, complications and evidence-based treatment of adolescent major depression. It reports on evidence-based psychological treatment, evidence-based pharmacological treatment for major depression in adolescence. The article examines the role of cognitive-behavioral therapy in mild depression and for adolescents who refuse medication.

The article presents the future agenda for evidence-based psychopharmacology in mental health. It examines the healthcare interventions outcome and strategies developed to increase systematic review quality. It discusses the issues and give strategies to improve the clinical treatment implementation based on the best available evidence-based practice including need for reliable information on treatment effectiveness and innovation in psychopharmacology.

The article discusses the importance of evidence-based practice for children's mental health. According to the author, evidence-based practice (EBP) refers to health practitioners applying the best currently available research evidence in the provision of health services. Although EBP is widely promoted by researchers and others, controversies have emerged about defining "evidence" too narrowly, particularly in diverse fields like children's mental health. An understanding of healthy child development is central to children's mental health. Development involves continuous and dynamic interactions between children and their environments over time, and is inextricably linked to the ecological context that children develop within families, schools, and communities.

The article features some of the articles that met the inclusion criteria for the publication "Evidence-Based Mental Health" but were not abstracted due to lack of space. In "Depression prevalence: is it really increasing?" by G. Hawthorne, R. Goldney and A. W. Taylor, published in the July 2008 issue of the "Australian and New Zealand Journal of Psychiatry," the Australian repeated cross-sectional survey found no change over a six year period, in the prevalence of major depression.

The article presents the criteria for research work on evidence-based mental health practice. It discusses the two stages as benchmark for the research study like basic validity criteria and clinical relevance. It also highlights the important research in mental health including a list of all the other works and seminar information.

The article presents the purpose and procedures used in evidence-based mental health practice. It discusses the importance of the review articles including the target audience of this clinical research which covers studies of adults, children, older adults, people with psychological problems, learning disabilities, head injuries, drug and alcohol problems and personality disorders. It reports on the selection procedure and criteria with an abstract summary.

The article presents information on a new advanced information service to support clinical practitioners to keep up to date and to find current best evidence for practice. The online service, bmjupdates+, provides clinical practitioners with the best new evidence concerning important advances in health care, exactly tailored to their interests. bmjupdates+ uses the same, explicit, and reproducible quality filters as the journal Evidence-Based Medicine. Applying these criteria to each article in over 110 premier clinical journals about 3000 articles have adequate methods to support their conclusions for key aspects of clinical care.

The author comments on an article by J. Sam and colleagues which recognized Eugen Bleuler as an early pioneer of evidence-based medicine. He agrees with Bleuler that many remedies before were unproven and likely to be ineffective. He believes that contemporary observers who credit Bleuler with prefiguring conceptualisations of schizophrenia as a dysconnectivity of the brain give him too much credit. He asserts that Bleuler should be regarded as a visionary for an evidence-based psychiatry.

The article focuses on the results of various studies that analyzed the efficacy of evidence based treatments in the treatment of young people with psychological problems or maladaptive behavior. The studies examined delinquency and substance abuse, or both; conduct problems; and internalising problems. The results showed that EBTs were more effective than usual care for youths with psychological problems and maladaptive behavior.

The article alerts about forthcoming courses related to evidence-based medicine (EBM). The said courses offer a lively discussion of topics. Some recent subjects have included an explanation and history of Simpson's paradox, outcomes research, the impact of dishonest reporting of research on EBM, and perennial discussion about the relative merits of Research Corp. Technologies and observational studies.

The article presents a list of publications related to evidence-based psychiatry. The publications are categorized into various streams like, therapeutics, aetiology, prevalence, and prognosis. Some of the publications listed are: "Efficacy and Tolerability of Ziprasidone Versus Risperidone in Patients With Acute Exacerbation of Schizophrenia or Schizoaffective Disorder: An 8-Week, Double-Blind, Multicenter Trial"; and "Pathways to Comorbidity: The Transition of Pure Mood, Anxiety and Substance Use Disorders Into Comorbid Conditions in a Longitudinal Population-Based Study."

Depression is a major cause of disability worldwide. Evidence for the effectiveness of various pharmacological and psychological treatments is abundant, yet outcomes are often disappointing. This may reflect poor patient understanding of the illness, and poor concordance with antidepressant medication. Recognition of these problems has led to growing interest in the development and evaluation of pragmatic, multifaceted, patient focused interventions, often termed "collaborative care". Encouraging evidence exists that such interventions are effective for people with depression, but there is a dearth of evidence for people with depression and comorbid physical disorders.

In order to give the best care to patients and families, pediatricians need to integrate the highest quality scientific evidence with clinical expertise and opinions of the family. The section "Archimedes," of the May 2002 issue of the journal "Archives of Disease in Childhood," seeks to assist practicing clinicians by provide evidence based answers to common questions which are not at the forefront of research but are at the core of practice. They are based on an original format from the "Journal of Accident and Emergency Medicine."