ORCID Profile
0000-0002-1266-7246
Current Organisation
University of Adelaide
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2016
Publisher: Wiley
Date: 20-05-2015
DOI: 10.1111/WVN.12094
Abstract: A systematic review of evidence is the research method which underpins the traditional approach to evidence-based health care. As systematic reviews follow a rigorous methodology, they can take a substantial amount of time to complete ranging in duration from 6 months to 2 years. Rapid reviews have been proposed as a method to provide summaries of the literature in a more timely fashion. The aim of this paper is to outline our experience of developing evidence summaries in the context of a point of care resource as a contribution to the emerging field of rapid review methodologies. Evidence summaries are defined as a synopsis that summarizes existing international evidence on healthcare interventions or activities. These summaries are based on structured searches of the literature and selected evidence-based healthcare databases. Following the search, all studies are assessed for internal validity using an abridged set of critical appraisal tools. Once developed, they undergo three levels of peer review by internal and external experts. As of November 2014, there are 2458 evidence summaries that have been created across a range of conditions to inform evidence-based healthcare practices. In addition, there is ongoing development of various new evidence summaries on a wide range of topics. Approximately 60-70 new evidence summaries are published every month, covering research in various medical specialty areas. All summaries are updated annually. Systematic reviews, although the ideal type of research to inform practice, often do not meet the needs of users at the point of care. This article describes the development framework for the creation of evidence summaries, a type of rapid review. Although evidence summaries may result in a less rigorous process of development, they can be useful for improving practice at the point of care.
Publisher: F1000 Research Ltd
Date: 10-05-2021
DOI: 10.12688/F1000RESEARCH.24279.2
Abstract: Background: Healthcare services, in many countries, are increasingly being provided by cadres not trained as physicians, and these substitute health workers are referred to as mid-level health providers (MLHPs). The objective of this study was to rapidly synthesise evidence on the effectiveness of MLHPs involved in the delivery of healthcare, with a perspective on low- and middle-income countries. Methods: The review team performed an overview of systematic reviews assessing various outcomes for participants receiving care from MLHPs. The team evaluated systematic reviews for methodological quality and certainty of the evidence. Also, the review team consulted relevant stakeholders in India. Results: The final report included seven systematic reviews, with six assessed as moderate to high methodological quality. Mortality outcomes concerning pregnancy and childbirth care services showed no significant differences in care provided by MLHPs when compared with doctors. Pregnancy care provided by midwives was found to improve the quality of care slightly. The risk of failure or incomplete abortion for surgical abortion procedures provided by MLHPs was twice when compared to the procedures provided by doctors. Moderate to high certainty evidence showed that initiation and maintenance of antiretroviral therapy for HIV-infected patients by a nurse or clinical officer slightly reduced mortality. High certainty evidence showed that chronic disease management by non-medical prescribers reduced some important physiological measures compared to medical prescribing by doctors. Conclusions: To date, this is the first rapid overview of the evidence on MLHPs. Low-quality evidence suggests that MLHPs might be suitable to deliver quality pregnancy care. Moderate and high-quality evidence from trials suggests that MLHPs are helpful for chronic disease management and initiation and maintenance of antiretroviral therapy in people with HIV/AIDS. However, the roles and subsequent training and regulation of MLHPs might be different for different care domains.
Publisher: F1000 Research Ltd
Date: 16-06-2020
DOI: 10.12688/F1000RESEARCH.24279.1
Abstract: Background: Health care services, in many countries, are increasingly being provided by cadres not trained as physicians, but capable of performing several diagnostic and clinical functions. These substitute health workers are referred to as mid-level health providers (MLHPs). The health and wellness centres under India’s Comprehensive Primary Health Care programme have teams led by MLHPs who can aid doctors. The objective of this study was to rapidly synthesise evidence on the effectiveness of MLHPs for primary health care. Methods: The review team undertook a rapid overview of systematic reviews that compared MLHPs with doctors and different types of MLHPs involved in the delivery of health care were included, with a perspective on low- and middle-income countries, including India. Results: Seven systematic reviews were included in the final report. Mortality outcomes in relation to pregnancy and childbirth care services showed no significant differences in care provided by MLHPs when compared with doctors. Pregnancy care provided by midwives was found to slightly improve quality of care when compared to care delivered by doctors. The risk of failure or incomplete abortion for surgical abortion procedures provided by MLHPs was twice when compared to the procedures provided by doctors. Moderate to high certainty evidence showed that initiation and maintenance of antiretroviral therapy for HIV-infected patients by a nurse or clinical officer slightly reduced mortality. High certainty evidence showed that chronic disease management by non-medical prescribers reduced some important physiological measures when compared to medical prescribing by doctors. Conclusions: To date, this is the first rapid overview of evidence on MLHPs. Evidence suggests that MLHPs might be suitable to deliver quality care in certain areas of health and they may be relevant and feasible in countries like India. However, the roles and subsequent training and regulation of MLHPs might be different for different care domains.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
DOI: 10.11124/JBISRIR-2017-003404
Abstract: The aim of this evidence implementation project is to promote evidence-based practice in artemisinin-based combination therapy for managing uncomplicated malaria in children under five, thereby improving patient outcomes and resource utilization in the Bali Health District, Cameroon. The burden of disease attributable to malaria has significantly improved in the last three years, however morbidity and mortality risks are still present, especially for children under five. In children with uncomplicated P. falciparum malaria, there is strong evidence to suggest that artemisinin-based combination therapy (ACT) is effective in treating malaria. The World Health Organization has strong recommendations with high-quality evidence guiding practice in the “test, treat and track” approach using microscopy, rapid diagnostics tests and ACTs. This evidence implementation project used the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit and feedback tool for promoting evidence-based healthcare involving three phases of activity. We compared compliance with best practice recommendations at baseline against a follow-up compliance at four months, following implementation of strategies identified. Compliance rates improved overall by 31% (R: 20–42) for all criteria and sites, with differences noticed between sites. Nineteen barriers were identified, stratified into clinician, community health worker, patient and policy maker related barriers. Despite existing barriers to evidence implementation, getting research into practice is possible and does improve quality of care.
Publisher: Elsevier BV
Date: 05-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-09-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2010
DOI: 10.11124/01938924-201008170-00001
Abstract: Indwelling urinary catheterisation is a relatively common procedure in hospital settings, associated with potential risk of infection. Around 80% of urinary tract infections (UTIs) are associated with urinary catheters and the risk of infection increases in patients who are acutely ill. The objective of this review was to present the best available critically appraised evidence related to preventing infections associated with the use of short-term indwelling urethral catheters. This review is an update of a previous review published in 2004. The review considered randomised controlled trials that included adult patients with short-term indwelling urinary catheters. The main interventions related to catheterisation techniques, meatal care, catheter composition, bladder irrigation, drainage systems, care delivery practices and education programs. The primary outcome of interest was the difference in the rates of UTIs between the intervention group and control group. This review was limited to short-term urethral catheters, so studies that evaluated long-term or suprapubic catheters were excluded. The search included both published and unpublished studies with an initial limited search of MEDLINE and CINAHL databases undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant interventions. A second extensive search used all identified key words and index terms. The third step included a search of the reference lists and bibliographies of relevant articles. The methodological quality of the included papers was assessed using a checklist developed by the Joanna Briggs Institute. Two independent reviewers conducted critical appraisal and data extraction and any disagreements that arose were addressed through mutual discussion. The review found six new studies in relation to catheter composition and delivery care practices interventions. Studies from previous review have been reported on in the results, discussion and conclusion sections. No one type of catheter was found to be better than another in terms of reducing the risk of bacteriuria in hospitalised adults. The incidence of catheter associated bacteriuria and funguria (CABF) was lower in adult trauma patients when nitrofurazone-impregnated catheters were used. Nitrofurazone-coated and silver alloy-coated catheters reduced the development of asymptomatic bacteriuria during short-term (< 30 days) use when compared with latex or silicon control catheters. Studies that compared immediate versus delayed catheter removal following operations found that early removal of catheter after operation was safe and that there was a tendency for increased infection with longer duration of catheterisation. Stop (prewritten) orders for urinary catheters resulted in a significant reduction in duration of inappropriate catheterisation days.There was no significant difference in infection rate using either sterile surgical or non-sterile insertion technique. The use of water for cleansing prior to catheter insertion was recommended. There was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris. Infection rates were similar for both latex and silicone catheters. Comparisons between silver and Teflon coating clearly favoured the silver alloy coating.The use of a complex closed drainage system in the intensive care environment did not confer any additional benefit. Studies comparing types of junction seals and use of junction seals either prior to or following catheterisation found no clear benefit from using either preconnected sealed systems or sealed systems with the addition of silver releasing devices. Neither the addition of chlorhexidine nor hydrogen peroxide to the drainage bag was found to be effective at reducing UTI rates. The findings indicated there was a higher incidence of bacteriuria associated with Foley catheters compared with intermittent catheterisation (P < 0.025). A single RCT examined the effect on UTI rates of routine bag changes against no routine bag change. Routine bag changes were not advantageous in reducing the risk of infection. Current RCT evidence suggests the use of a surgical sterile catheterisation technique is not required, and that tap water is sufficient for cleaning genitalia. Following insertion, daily hygiene around the meatal area is as effective as catheter toilets and catheters impregnated with silver may reduce the incidence of catheter associated bacteriuria. Sealed (e.g. taped, presealed) drainage systems should not be relied upon as the sole mechanism for prevention of bacteriuria. The addition of antibacterial solutions to drainage bags and the routine change of drainage bags had no effect on catheter associated infection.Identified evidence consistently supported early removal of catheter after operations. New evidence was also identified to support the use of "stop orders" for urinary catheters in reducing prolonged unnecessary catheterisation. However, most of the recommendations arising from this review were based on single studies, often with limited numbers of participants. The following are some of the recommendations based on the best available clinical evidence.Use of stop order approach to physicians by nurses can be recommended to reduce prolonged unnecessary catheterisations. Most of the recommendations arising from this review were based on single studies, often with limited numbers of participants. There is an urgent need to replicate these studies in other clinical settings.Further high quality RCTs with adequate allocation concealment and blinding are required with a focus on examining current techniques and methods in catheterisation and management. In addition, there are cost implications associated with new technologies for indwelling urethral catheter management that have not yet been adequately addressed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-12-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
DOI: 10.11124/01938924-201109180-00001
Abstract: Dental anxiety has been identified as a significant and common problem in both children and adults and is considered an obstacle for dental care providers in the delivery of quality oral care. Patients with dental anxiety tend to avoid professional dental care which poses a problem for dentists and patients alike.There are various treatment options for reducing dental anxiety. Music has been used in different medical fields to meet physiological, psychological, and spiritual needs of patients. Music interventions can either be passive (music listening) or active music (therapy).There was a significant gap in the literature on the effectiveness of music therapy and music listening in reducing dental anxiety in patients undergoing various dental treatments rocedures. This systematic review specifically examined the effectiveness of music interventions in reducing dental anxiety in both paediatric and adult patients. The objective of this systematic review was to critically appraise, synthesise and present the best available evidence related to the effectiveness of music interventions on dental anxiety in paediatric and adult patients. A comprehensive search was undertaken on major electronic databases from their inception to October 2010. The search was restricted to English language and other languages where a translation was available from colleagues (for e.g. Chinese, Japanese, and Italian). Randomised controlled trials, quasi-randomised controlled trials and quasi-experimental studies were included in the review. Critical appraisal and data extraction were undertaken using the Joanna Briggs Institute critical appraisal instrument and the standard data extraction form for evidence of effectiveness. Seven studies with a combined total of 598 patients were included. Two out of the seven studies were RCTs, four quasi-randomised and one quasi-experimental study. There were 513 adult patients as participants from five studies and 85 paediatric patients from two studies. The results were classified into two categories.Two studies had paediatric patients as population group. One study found that music listening did not result in any reduction of anxiety during dental procedures on young patients therefore the authors concluded that music alone is ineffective as a distraction during dental procedures. However, another study found that music reduced anxiety to some extent, although it was not significant.Five studies included in this review had adult patients as population group. Two studies concluded that relaxation when compared to music is an effective method of reducing patient's anxiety. One study concluded that music listening significantly lowered levels of anxiety and stress of females during dental procedures. Authors of the study concluded that there was a strong physiological (increased secretory immunoglobulins level) response to music by females. Two other studies provided conclusive evidence on effectiveness of music in reducing dental anxiety in this population group. This systematic review concluded that there was enough evidence to suggest that adult patients may benefit from a procedural music-listening program. There was inconclusive evidence on the effectiveness of music in reducing dental anxiety in children. It is recommended that pre-recorded music be offered through headphones during the dental procedure to adult patients to reduce their dental anxiety. The evidence on the effectiveness of music in reducing dental anxiety in children is inconclusive. More research needs to be performed before it is possible to show, with a higher degree of certainty, that music listening does have a significant effect on the reduction of dental anxiety. Future studies, most likely randomised controlled trials should evaluate music therapy as an intervention for managing dental anxiety.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2018
Publisher: SAGE Publications
Date: 09-04-2021
DOI: 10.1177/00494755211005203
Abstract: Leptospirosis is a zoonotic disease of public health importance in India. A country-level evidence gap map was developed to identify gaps on epidemiology of leptospirosis. It is the first such on leptospirosis globally and on any single disease condition in India. The steps for development of evidence gap map were development of a framework to map evidence, retrieval of evidence, data extraction parameters and mapping of available evidence in evidence gap map framework. The prevalence evidence gap map consisted of 157 studies (102 in humans, 55 in animals, and 12 in both). The evidence gap map on risk factors had 120 studies (102 in humans, 11 in animals and 7 in both). There were inter-state differences in availability of research and disparity between animal and human research. Research on high-risk groups was limited and studies did not use the One Health approach to identify epidemiology, which can help understand the issue more comprehensively. The study demonstrates the potential of evidence gap maps to inform research priorities.
Publisher: Oxford University Press (OUP)
Date: 09-03-2021
Abstract: Leptospirosis is an emerging public health problem in India. We developed an evidence gap map (EGM) on prevention, control and management of leptospirosis in India to inform research priorities. The EGM framework was developed in consultation with stakeholders and noted key parameters to influence state and national level research priorities. We searched six electronic databases and three relevant websites and included 27 studies (humans, 23 animals, 4 both, 0). Most studies (17/27 [63%]) were from three high-burden states. Controlled clinical trials (non-randomised, 6/27 [22%] randomised, 2/27 [7%]) and pre–post studies (6/27 [22%]) suitable for evaluating interventions were sparse. Only 26% studies (6/23 human studies) included high-risk groups like animal caretakers, tribal people, relief/sanitation workers, pregnant women and people from slums. Nearly 56% of studies (15/27) evaluated pharmacological interventions at an in idual level. Community-level interventions were limited (4/27 [15%]) with no studies on vaccination, personal protection, antibiotic policy or water, sanitation and hygiene interventions. Health systems and policy or multicomponent studies were rare (5/27 [19%]) with no reporting of key outcomes like healthcare coverage, quality of care and other relevant outcomes to evaluate interventions. There is a need for prioritising research to evaluate prevention and control interventions, including the One Health approach. Embedding national-level EGMs for research prioritisation exercises should be considered.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2011
DOI: 10.1111/J.1744-1609.2011.00227.X
Abstract: Inadvertent hypothermia is common in patients undergoing surgical procedures with a reported prevalence of perioperative hypothermia ranging from 50% to 90%. Hypothermia within the perioperative environment may have many undesired physiological effects that are associated with postoperative morbidity. There are different options for treating and/or preventing hypothermia within the adult perioperative environment, which include active and passive warming methods. This systematic review was undertaken to provide comprehensive evidence on the most effective strategies for prevention and management of inadvertent hypothermia in the perioperative environment. The objective of this review was to identify the most effective methods for the treatment and/or preventions of hypothermia in intraoperative or postoperative patients. Adult patients ≥ 18 years of age, who underwent any type of surgery were included in this review. Types of interventions included were any type of linen or cover, aluminium foil wraps, forced-air warming devices, radiant warming devices and fluid warming devices. This review considered all identified prospective studies that used a clearly described process for randomisation, and/or included a control group. The primary outcome of interest was change in core body temperature. Two independent reviewers assessed methodological validity of papers selected for retrieval and any disagreements were resolved through discussion. Nineteen studies with a combined 1451 patients who underwent different surgical procedures were included in this review. Meta-analysis was not possible. Forced-air warming in pregnant women scheduled for caesarean delivery under regional anaesthesia prevented maternal and foetal hypothermia. Intravenous and irrigating fluids warmed (38-40°C) to a temperature higher than that of room temperature by different fluid warming devices (both dry and water heated) proved significantly beneficial to patients in terms of stable haemodynamic variables, and higher core temperature at the end of the surgery. Water garment warmer was significantly (P < 0.05) effective than forced-air warming in maintaining intraoperative normothermia in orthotopic liver transplantation patients. Extra warming with forced air compared to routine thermal care was effective in reducing the incidence of surgical wound infections and postoperative cardiac complications. Passive warming with reflective heating blankets or elastic bandages wrapped around the legs tightly were found to be ineffective in reducing the incidence or magnitude of hypothermia. There are significant benefits associated with forced-air warming. Evidence supports commencement of active warming preoperatively and monitoring it throughout the intraoperative period. Single strategies such as forced-air warming were more effective than passive warming however, combined strategies, including preoperative commencement, use of warmed fluids plus forced-air warming as other active strategies were more effective in vulnerable groups (age or durations of surgeries).
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJGH-2020-002769
Abstract: Coronavirus disease (COVID-19), affects 213 countries or territories globally. We received a request from National Health Systems Resource Centre, a public agency in India, to conduct rapid evidence synthesis (RES) on community health workers (CHWs) for COVID-19 prevention and control in 3 days. We searched PubMed, websites of ministries (n=3), public agencies (n=6), multilateral institutions (n=3), COVID-19 resource aggregators (n=5) and preprints (n=1) (without language restrictions) for articles on CHWs in pandemics. Two reviewers screened the records independently with a third reviewer resolving disagreements. One reviewer extracted data with another reviewer cross-checking it. A framework on CHW performance in primary healthcare not specific to pandemic was used to guide data extraction and narrative analysis. We retrieved 211 records and finally included 36 articles. Most of the evidence was from low-and middle-income countries with well-established CHW programmes. Evidence from CHW programmes initiated during pandemics and for CHW involvement in pandemic response in high-income countries was scant. CHW roles and tasks change substantially during pandemics. Clear guidance, training for changed roles and definition of what constitutes essential activities (ie, those that must to be sustained) is required. Most common additional activities during pandemics were community awareness, engagement and sensitisation (including for countering stigma) and contact tracing. CHWs were reported to be involved in all aspects of contact tracing - this was reported to affect routine service delivery. CHWs have often been stigmatised or been socially ostracised during pandemics. Providing PPE, housing allowance, equal training opportunities, transportation allowance, improving salaries (paid on time and for a broad range of services) and awards in high-profile public events contributed to better recruitment and retention. We also created inventories of resources with guiding notes on guidelines for health workers (n=24), self-isolation in the community (n=10) and information, education and counselling materials on COVID-19 (n=16). CHWs play a critical role in pandemics. It is important to ensure role clarity, training, supportive supervision, as well as their work satisfaction, health and well-being. More implementation research on CHWs in pandemics is required.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2015
Publisher: Maad Rayan Publishing Company
Date: 2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2016
DOI: 10.11124/JBISRIR-2016-002948
Abstract: The objective of the review will be to identify, assess and synthesize the evidence that examines the magnitude and scope of disability including impairments, activity limitations and participation restrictions associated with four main non-communicable diseases (NCDs): cardiovascular diseases (CVDs), cancers, diabetes and chronic respiratory diseases. To systematically examine the magnitude of disability associated with CVDs, cancers, diabetes and chronic lung diseases, the questions that this review will specifically address are: What is the prevalence of disability related to each of the four NCDs (presented by country and NCD where possible)? What is the prevalence of co-existing diseases/conditions (comorbidity) in persons with disabilities related to the four NCDs? To systematically examine the scope of disability associated with CVDs, cancers, diabetes and chronic respiratory diseases, the questions that this review will address are: What is the impact of disability on a person's life (measured using patient reported outcomes including quality of life measures)? What are the unmet needs in persons with disabilities related to the four NCDs?
No related grants have been discovered for Sandeep Moola.