The importance of practice based on best available evidence cannot be over-emphasised, especially when there is increasing pressure for effective interventions to overcome population health concerns. The management of overweight and obese children is a current example of an aspect of population health that stands in need of a much firmer evidence base. In this issue, Collins et al. review the best available evidence on the optimum dietetic treatment and management of children and adolescents with obesity. Their conclusion that there is an urgent need for high quality studies to identify optimum dietary approaches to promote maintenance of weight loss in the longer term comes as no surprise and will encourage more refined studies capable of contributing to this significant population health goal.

Harrison and her colleagues explain why more than practice guidelines are required if health outcomes are to be improved. Although concerned with heart failure self-management, the conclusions of Harrison and her team have wider relevance. The take-home message is that purposefully designed resources are needed if the obstacles of time constraints and staff turnover are to be overcome. More specifically, Harrison et al. confirm that the resource materials developed for the Partners in Care for Congestive Cardiac Failure Program (PCCHFP) are effective in promoting better self-care and in encouraging patients and families to accept more responsibility for self-management. As a result, the copyright for the PCCHF package has been transferred to the Canadian Heart and Stroke Foundation for widespread dissemination.

Moving to high care residential facilities, Knox reports on approaches to reducing the prevalence of physical restraint in these areas. Knox compares the use of physical restraint as a care strategy with best practice and reports discrepancies in the areas of documentation and gaps in staff education. However, once these short-comings were known, the facilities were able to implement changes that have improved practice. Knox discusses her findings in the context of the organisational goal of achieving a restraint-free care environment.

Also in this issue, Pearson et al. report on their review of culturally competent workplace practices, a topic of increasing relevance as we struggle to embrace diversity in healthcare delivery. If ever there was an area of practice crying out for a best available evidence approach, culturally safe practice must be it. However, Pearson et al. were able to select only a little more than 10% of the papers for full review, and of those less than one-third met the inclusion criteria for review. Consequently, there is little robust evidence a healthcare provider can go on when striving to develop a culturally competent workforce as part of a sustainable healthy work environment. However, there is good news in that there is at least one strategy likely to achieve positive results - partnering with organisations that can help to address cultural diversity in recruitment, organisational change, and staff education.

Michael Clinton, RN PhD

Faculty of Nursing, The University of Calgary, Calgary, Canada