ORCID Profile
0000-0002-1745-4987
Current Organisations
The University of Queensland Press
,
Monash University
,
Southern Cross University
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Publisher: Wiley
Date: 06-07-2020
DOI: 10.1111/CDOE.12556
Publisher: Informa UK Limited
Date: 2020
Publisher: Informa UK Limited
Date: 25-04-2017
DOI: 10.1080/17437199.2017.1316672
Abstract: n-of-1 studies test hypotheses within in iduals based on repeated measurement of variables within the in idual over time. Intra-in idual effects may differ from those found in between-participant studies. Using ex les from a systematic review of n-of-1 studies in health behaviour research, this article provides a state of the art overview of the use of n-of-1 methods, organised according to key methodological considerations related to n-of-1 design and analysis, and describes future challenges and opportunities. A comprehensive search strategy (PROSPERO:CRD42014007258) was used to identify articles published between 2000 and 2016, reporting observational or interventional n-of-1 studies with health behaviour outcomes. Thirty-nine articles were identified which reported on n-of-1 observational designs and a range of n-of-1 interventional designs, including AB, ABA, ABABA, alternating treatments, n-of-1 randomised controlled trial, multiple baseline and changing criterion designs. Behaviours measured included treatment adherence, physical activity, drug/alcohol use, sleep, smoking and eating behaviour. Descriptive, visual or statistical analyses were used. We identify scope and opportunities for using n-of-1 methods to answer key questions in health behaviour research. n-of-1 methods provide the tools needed to help advance theoretical knowledge and personalise/tailor health behaviour interventions to in iduals.
Publisher: Elsevier BV
Date: 12-2017
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.MATURITAS.2015.10.003
Abstract: Wearable technology is readily available for continuous assessment due to a growing number of commercial devices with increased data capture capabilities. However, many commercial devices fail to support suitable parameters (cut points) derived from the literature to help quantify physical activity (PA) due to differences in manufacturing. A simple metric to estimate cut points for new wearables is needed to aid data analysis. The purpose of this pilot study was to investigate a simple methodology to determine cut points based on ratios between sedentary behaviour (SB) and PA intensities for a new wrist worn device (PRO-Diary™) by comparing its output to a validated and well characterised 'gold standard' (ActiGraph™). Twelve participants completed a semi-structured (four-phase) treadmill protocol encompassing SB and three PA intensity levels (light, moderate, vigorous). The outputs of the devices were compared accounting for relative intensity. Count ratios (6.31, 7.68, 4.63, 3.96) were calculated to successfully determine cut-points for the new wrist worn wearable technology during SB (0-426) as well as light (427-803), moderate (804-2085) and vigorous (≥ 2086) activities, respectively. Our findings should be utilised as a primary reference for investigations seeking to use new (wrist worn) wearable technology similar to that used here (i.e., PRO-Diary™) for the purposes of quantifying SB and PA intensities. The utility of count ratios may be useful in comparing devices or SB/PA values estimated across different studies. However, a more robust examination is required for different devices, attachment locations and on larger/ erse cohorts.
Publisher: Elsevier BV
Date: 9
Publisher: Royal College of General Practitioners
Date: 21-08-2023
Abstract: Background: Stopping long-term ( months) antidepressants can be difficult for patients because of unpleasant withdrawal symptoms. Many people do not recognise withdrawal symptoms or do not know how to minimise them to safely stop antidepressants. We developed the RELEASE resources to address these gaps: a medicines information brochure, a decision aid, and drug-specific hyperbolic tapering protocols. Aim: To explore patients’ acceptability of the resources to optimise their use and impact. Design and setting: A think-aloud interview study with adults with lived experience of long-term antidepressant use conducted in south-east Queensland. Interviews were undertaken with participants face-to-face or via videoconferencing. Methods: Fourteen participants purposively s led from general practices were interviewed. Participants verbalised their thoughts, impressions and feelings whilst engaging with each resource. Interviews were analysed using a deductive coding framework including codes related to acceptability and optimisation. Interviews were analysed in a series of four tranches, with iterative modifications made to resources after each tranche. Results: Participants reported the resources were relevant, informative, motivational, and usable. Participants’ comments informed modifications including changes to wording, content order, and layout. Several participants expressed frustration that they had not had these resources earlier, with one reporting the information could have been life changing. Many participants commented on the need for these resources to be widely available to both patients and doctors. Conclusions: The RELEASE resources are acceptable, useful, and potentially life changing. The effectiveness of these consumer-informed resources in supporting safe cessation of long-term antidepressants is currently being tested in general practice.
Publisher: Public Library of Science (PLoS)
Date: 23-09-2022
DOI: 10.1371/JOURNAL.PONE.0274015
Abstract: Buildings account for approximately 40% of the energy consumption across the European Union, so there is a requirement to strive for better energy performance to reduce the global impact of urbanised societies. However, energy performant buildings can negatively impact building occupants (e.g., comfort, health and/or wellbeing) due to a trade-off between airtightness and air circulation. Thus, there is a need to monitor Indoor Environmental Quality (IEQ) to inform how it impacts occupants and hence redefine value within building performance metrics. An in idualised study design would enable researchers to gain new insights into the effects of environmental changes on in iduals for more targeted e.g., health interventions or nuanced and improved building design(s). This paper presents a protocol to conduct longitudinal monitoring of an in idual and their immediate environment. Additionally, a novel approach to environmental perception gathering is proposed that will monitor environmental factors at an in idual level to investigate subjective survey data pertaining to the participant’s perceptions of IEQ (e.g., perceived air quality, thermal conditions, light, and noise). This protocol has the potential to expose time-differential phenomena between environmental changes and an in idual’s behavioural and physiological responses. This could be used to support building performance monitoring by providing an interventional assessment of building performance renovations. In the future it could also provide building scientists with a scalable approach for environmental monitoring that focuses specifically on in idual health and wellbeing.
Publisher: BMJ
Date: 04-06-2020
DOI: 10.1136/BMJSPCARE-2019-002120
Abstract: To examine the effects of nurse-led interventions on the health-related quality of life, symptom burden and self-management/behavioural outcomes in women with breast cancer. Cochrane Controlled Register of Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Embase databases were searched (January 1999 to May 2019) to identify randomised controlled trials (RCTs) and controlled before-and-after studies of interventions delivered by nurses with oncology experience for women with breast cancer. Risk of bias was evaluated using the revised Cochrane risk-of-bias tool for randomised trials . Intervention effects were synthesised by cancer trajectory using The Omaha System Intervention Classification Scheme . Thirty-one RCTs (4651 participants) were included. All studies were at risk of bias mainly due to inherent limitations such as lack of blinding and self-report data. Most studies (71% n=22) reported at least one superior intervention effect. There were no differences in all outcomes between those who receive nurse-led surveillance care versus those who received physical led or usual discharge care. Compared with control interventions, there were superior teaching, guidance and counselling (63%) and case management (100%) intervention effects on symptom burden during treatment and survivorship. Effects of these interventions on health-related quality of life and symptom self-management/behavioural outcomes were inconsistent. There is consistent evidence from RCTs that nurse-led surveillance interventions are as safe and effective as physician-led care and strong evidence that nurse-led teaching, guidance and counselling and case management interventions are effective for symptom management. Future studies should ensure the incorporation of health-related quality of life and self-management/behavioural outcomes and consider well-designed attentional placebo controls to blind participants for self-report outcomes. The International Prospective Register of Systematic Reviews (PROSPERO): CRD42020134914).
Publisher: Springer Science and Business Media LLC
Date: 04-06-2019
Publisher: Public Library of Science (PLoS)
Date: 29-08-2011
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Informa UK Limited
Date: 03-07-2017
DOI: 10.1080/17437199.2017.1343680
Abstract: N-of-1 studies are based on repeated observations within an in idual or unit over time and are acknowledged as an important research method for generating scientific evidence about the health or behaviour of an in idual. Statistical analyses of n-of-1 data require accurate modelling of the outcome while accounting for its distribution, time-related trend and error structures (e.g., autocorrelation) as well as reporting readily usable contextualised effect sizes for decision-making. A number of statistical approaches have been documented but no consensus exists on which method is most appropriate for which type of n-of-1 design. We discuss the statistical considerations for analysing n-of-1 studies and briefly review some currently used methodologies. We describe dynamic regression modelling as a flexible and powerful approach, adaptable to different types of outcomes and capable of dealing with the different challenges inherent to n-of-1 statistical modelling. Dynamic modelling borrows ideas from longitudinal and event history methodologies which explicitly incorporate the role of time and the influence of past on future. We also present an illustrative ex le of the use of dynamic regression on monitoring physical activity during the retirement transition. Dynamic modelling has the potential to expand researchers' access to robust and user-friendly statistical methods for in idualised studies.
Publisher: Springer Science and Business Media LLC
Date: 21-02-2015
Publisher: American Medical Association (AMA)
Date: 03-2019
Publisher: Springer Science and Business Media LLC
Date: 09-08-2022
DOI: 10.1007/S40271-021-00540-0
Abstract: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic condition of unknown aetiology associated with a range of disabling symptoms, including post-exertional malaise, chronic fatigue, musculoskeletal pain, orthostatic intolerance, unrefreshing sleep, and cognitive dysfunction. ME/CFS is a heterogeneous disorder, with significant variation in symptom type and severity between in iduals, as well as within in iduals over time. The ersity of ME/CFS symptom presentation makes management challenging treatments supported by data from randomised controlled trials may not work for all in iduals due to the variability in experienced symptoms. Studies using quantitative N-of-1 observational designs involve repeated outcome measurements in an in idual over time and can generate rigorous in idual-specific conclusions about symptom patterns and triggers in in iduals with ME/CFS. This study aims to explore the feasibility and acceptability of using novel patient-centred N-of-1 observational designs to explore symptom fluctuations and triggers in ME/CFS at the in idual level. In iduals with a medical diagnosis of ME/CFS will be recruited through ME/CFS patient organisations to participate in a series of patient-centred N-of-1 observational studies. Using a wrist-worn electronic diary, participants will complete ecological momentary assessments of fatigue, stress, mood, and cognitive demand, three times per day for a period of 6-12 weeks. Personally relevant symptoms and triggers will also be incorporated into the questionnaire design. Physical activity will be objectively measured via an integrated accelerometer. Feasibility and acceptability outcomes will be assessed including the percentage of diary entries completed, as well as recruitment and retention rate, feasibility of analysing and interpreting the data collected, and participant views about participation elicited via a post-study semi-structured interview. This study will assess the feasibility and acceptability of patient-centred N-of-1 observational studies to assess diseases with complex presentations such as ME/CFS, as well as provide in idual-level evidence about fluctuations and triggers of ME/CFS symptoms that may aid self-management. Australian and New Zealand Clinical Trials Registry: ACTRN12618001898246. Registered on 22 November 2018.
Publisher: Wiley
Date: 27-11-2020
DOI: 10.1111/JOCN.15096
Abstract: To describe the prostate cancer survivorship experience and priorities from the perspective of prostate cancer specialist nurses. Specialist nurses are providing long-term survivorship care to men and their partners however, few prostate cancer survivorship interventions are effective and priorities for nurse-led survivorship care are poorly understood. A three-round modified Delphi approach. The study was conducted between 1 December 2018 and 28 February 2019 to develop a consensus view from an expert nurse cohort (43 prostate cancer specialist nurses: 90% response). First, participants described men's prostate cancer survivorship experience and priorities for improving care for men and partners. In subsequent rounds, participants identified key descriptors of the survivorship experience rated priorities for importance and feasibility and identified a top priority action for men and for partners. Thematic analysis and descriptive statistics were applied. Guidelines for Reporting Reliability and Agreement Studies informed the conduct of the study. Prostate cancer specialist nurses characterised the prostate cancer survivorship experience of men as under-resourced, disjointed and distressing. In all, 11 survivorship priorities for men and three for partners were identified within five broad areas: capacity building care coordination physical and psychosocial care community awareness and early detection and palliative care. However, feasibility for in idual items was frequently described as low. Internationally, prostate cancer survivorship care for men and their partners requires urgent action to meet future need and address gaps in capacity and care coordination. Low feasibility of survivorship priorities may reflect translational challenges related to capacity. Prostate cancer survivorship care guidelines connected to practice priorities are urgently needed. These findings address key gaps in the evidence for developing national nurse-led prostate cancer survivorship priorities. These priorities can be used to inform survivorship guidelines including nursing care for men with prostate cancer and their partners.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.BREAST.2016.11.015
Abstract: UK best practice guidelines for oncoplastic breast reconstruction were published in 2012. Implant-based reconstruction quality indicator (QI) targets for readmission, return to theatre and implant loss rates were set at 5% by 3 months, along with guidance to achieve these targets. The aims of this study were to quantify complication rates following implant-based reconstruction before and after the implementation of the guidelines. A retrospective audit of 86 patients with 106 implants in the 12 months to June 2013 was performed, C1. Following institutional changes including reducing antibiotic usage, a prospective audit was performed on 89 patients with 105 implants to June 2014, C2. Extended follow-up of salvaged implants was also performed. Demographics were not significantly different between the two cohorts apart from smoking. Implant loss rates fell from 7.5%(C1) to 1.9%(C2), p = 0.054 but at the cost of an increase in the return to theatre rate (14.2%-18%, p > 0.05). The implant salvage rate increased from 47% in C1 to 89.5% in C2, however, 3 of the implants that were salvaged were lost in the long term giving an overall salvage rate of 82.4% in C2. While an implant loss rate of <5% at 3 months appears achievable with less antibiotic use, this was made possible by the institution of an aggressive readmission and salvage policy. We would question the QI standards for readmission and return to theatre for immediate implant-based breast reconstruction, given that our implant loss rate of 1.9% was achieved with a return to theatre rate of 18%.
Publisher: Royal College of General Practitioners
Date: 03-06-2021
Abstract: Obesity is thought to be one of the most serious global public health challenges of the 21st century. The primary care setting is important in terms of the diagnosis, education, and management of obesity in children and young people. This study explored the views of primary care clinicians on the implementation of a quality-of-life (QoL) tool to help young people and their families identify the impact of weight on QoL. To assess the acceptability and feasibility of implementing the Weight-specific Adolescent Instrument for Economic-evaluation (WAItE) QoL tool for young people aged 11–18 years in primary care. Qualitative study in Northern England, UK One-to-one, semi-structured interviews were conducted with a purposive s le of primary healthcare clinicians working in practices located in areas of varying deprivation in Northern England, UK. Interview transcripts were coded and analysed using framework analysis in NVivo (version 10). Participants ( n = 16 GPs n = 4 practice nurses) found the WAItE tool acceptable for them and their patients, and believed it was feasible for use in routine clinical practice. It was important to primary care clinicians that the tool would provide an overall QoL score that would be easy for GPs and nurses to interpret, to help them identify patients most in need of specialist help. This study has developed a platform for further research around QoL in young people who are overweight and obese. A future feasibility study will focus on implementing the tool in a small number of primary healthcare practices.
Publisher: MDPI AG
Date: 06-11-2019
DOI: 10.3390/HEALTHCARE7040137
Abstract: Background: N-of-1 trials offer an innovative approach to delivering personalized clinical care together with population-level research. While increasingly used, these methods have raised some statistical concerns in the healthcare community. Methods: We discuss concerns of selection bias, carryover effects from treatment, and trial data analysis conceptually, then rigorously evaluate concerns of effect sizes, power and s le size through simulation study. Four variance structures for patient heterogeneity and model error are considered in a series of 5000 simulated trials with 3 cycles, which compare aggregated N-of-1 trials to parallel randomized controlled trials (RCTs) and crossover trials. Results: Aggregated N-of-1 trials outperformed both traditional parallel RCT and crossover designs when these trial designs were simulated in terms of power and required s le size to obtain a given power. N-of-1 designs resulted in a higher type-I error probability than parallel RCT and cross over designs when moderate-to-strong carryover effects were not considered or in the presence of modeled selection bias. However, N-of-1 designs allowed better estimation of patient-level random effects. These results reinforce the need to account for these factors when planning N-of-1 trials. Conclusion: N-of-1 trial designs offer a rigorous method for advancing personalized medicine and healthcare with the potential to minimize costs and resources. Interventions can be tested with adequate power with far fewer patients than traditional RCT and crossover designs. Operating characteristics compare favorably to both traditional RCT and crossover designs.
Publisher: Wiley
Date: 21-10-2019
DOI: 10.1111/ANAE.14826
Abstract: Pre-operative intervention to improve general health and readiness for surgery is known as prehabilitation. Modification of risk factors such as physical inactivity, smoking, hazardous alcohol consumption and an unhealthy weight can reduce the risk of peri-operative morbidity and improve patient outcomes. Interventions may need to target multiple risk behaviours. The acceptability to patients is unclear. We explored motivation, confidence and priority for changing health behaviours before surgery for short-term peri-operative health benefits in comparison with long-term general health benefits. A total of 299 participants at three UK hospital Trusts completed a structured questionnaire. We analysed participant baseline characteristics and risk behaviour profiles using independent s le t-tests and odds ratios. Ratings of motivation, confidence and priority were analysed using paired s le t-tests. We identified a substantial prevalence of risk behaviours in this surgical population, and clustering of multiple behaviours in 42.1% of participants. Levels of motivation, confidence and priority for increasing physical activity, weight management and reducing alcohol consumption were higher for peri-operative vs. longer term benefits. There was no difference for smoking cessation, and participants reported lower confidence for achieving this compared with other behaviours. Participants were also more confident than motivated in reducing their alcohol consumption pre-operatively. Overall, confidence ratings were lower than motivation levels in both the short- and long-term. This study identifies both substantial patient desire to modify behaviours for peri-operative benefit and the need for structured pre-operative support. These results provide objective evidence in support of a 'pre-operative teachable moment', and of patients' desire to change behaviours for health benefits in the short term.
Publisher: Informa UK Limited
Date: 03-07-2015
DOI: 10.1080/17437199.2015.1012177
Abstract: Content, delivery and effects of physical activity (PA) interventions are heterogeneous. There is a need to identify intervention features (content and delivery) related to long-term effectiveness. Behaviour change techniques (BCTs) and modes of intervention delivery were coded in 19 randomised controlled trials included in a systematic review of PA interventions for adults aged 55-70 years, published between 2000 and 2010, with PA outcomes ≥ 12 months after randomisation protocol registration: PROSPERO CRD42011001459. Meta-analysis, moderator analyses and meta-regression were conducted. Meta-analysis revealed that interventions were effective in promoting PA compared with no/minimal intervention comparators [d = 0.29, 95% CI = 0.19-0.40, I(2) = 79.8%, Q-value = 89.16 (df = 18, p < 0.01)]. Intervention features often concurred and goal setting was the most commonly used BCT. Subgroup analyses suggested that interventions using the BCT feedback may be more effective, whilst interventions using printed materials or the BCTs information on where and when to perform the behaviour and information on consequences of behaviour to the in idual may be less effective. Meta-regression revealed that neither the number of BCTs nor self-regulatory BCTs significantly related to effect size. Feedback appears to be a potentially effective candidate BCT for future interventions promoting long-term PA. Considering concurrence of intervention features alongside moderator analyses is important.
Publisher: Frontiers Media SA
Date: 24-02-2021
Publisher: MDPI AG
Date: 15-03-2021
DOI: 10.3390/HEALTHCARE9030330
Abstract: Interest in N-of-1 trials and single-case designs is increasing worldwide, particularly due to the movement towards personalised medicine and patient-centred healthcare [...]
Publisher: Informa UK Limited
Date: 16-02-2016
Publisher: Springer Science and Business Media LLC
Date: 25-09-2022
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Suzanne McDonald.