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0000-0002-4114-9106
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Bond University Faculty of Health Sciences and Medicine
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Publisher: Elsevier BV
Date: 07-2010
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2022-062706
Abstract: Although the media can influence public perceptions and utilisation of healthcare, journalists generally receive no routine training in interpreting and reporting on medical research. Given growing evidence about the problems of medical overuse, the need for quality media reporting has become a greater priority. This study aimed to codesign and assess the feasibility of a multicomponent training intervention for journalists in Australia. A small pragmatic feasibility study using a pre- and postdesign. 90 min online workshop. Eight journalists currently working in Australia, recruited through the study’s journalist advisor and existing contacts of the researchers. The training intervention covered a range of topics, including study designs, conflicts of interest, misleading medical statistics, population screening and overdiagnosis. The intervention also provided tools to help journalists with reporting, including a Tip Sheet and list of expert contacts in health and medicine. Preworkshop and postworkshop questionnaires were administered via Qualtrics. Acceptability and feasibility of the intervention, and journalists’ knowledge of overdiagnosis and common issues with health stories. Quantitative results were analysed descriptively using SPSS. Qualitative data were thematically analysed. All participants completed preworkshop and postworkshop questionnaires, and 6 completed the 6-week follow-up (75% retention). Feasibility findings suggest the intervention is acceptable and relevant to journalists, with participants indicating the workshop increased confidence with reporting on medical research. We observed increases in knowledge preworkshop to postworkshop for all knowledge measures on overdiagnosis and common issues with media coverage of medicine. Analysis of free-text responses identified several areas for improvement, such as including more ex les to aid understanding of the counterintuitive topic of overdiagnosis and more time for discussion. Piloting suggested the multicomponent training intervention is acceptable to journalists and provided important feedback and insights to inform a future trial of the intervention’s impact on media coverage of medicine.
Publisher: Elsevier BV
Date: 06-2017
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.AMJCARD.2017.09.005
Abstract: Early administration of reperfusion therapy in acute ST-elevation myocardial infarctions (STEMI) is crucial to reduce mortality. Although female sex and old age are key factors contributing to an inadequate long prehospital delay time, little is known whether women ≥65 years are a particular risk population. Hence, we studied the interaction of sex and age (<65 years or ≥65 years) and the contribution of chest pain to delay time during STEMI. Bedside interview data were collected in 619 STEMI patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Sex and age group stratification disclosed an excess delay risk for women ≥65 years, accounting for a 2.39 (95% confidence interval (CI) 1.39 to 4.10)-fold higher odds to delay longer than 2 hours compared with all other patient groups including younger women (p ≤0.002). Median delay time was 266 minutes in women ≥65 years and 148 minutes in younger women (p <0.001). Chest pain during STEMI had the lowest frequency both in women (81%) and men ≥65 years (83%) and the highest frequency (95%) in younger women. Experiencing non-chest pain was 2.32-fold (95% CI, 1.20 to 4.46, p <0.05) higher in women ≥65 years than in all other patients. Mediation analysis disclosed that the effect accounted for only 9% of the variance. Age specific educational strategies targeting women ≥65 years at risk are urgently needed. To tailor adequate strategies, more research is required to understand age- and sex driven barriers to timely identification of ischemic symptoms.
Publisher: Springer Science and Business Media LLC
Date: 26-07-2015
DOI: 10.1007/S00392-015-0895-3
Abstract: Fear of death (FoD) is an exceptionally stressful symptom of ST-elevation myocardial infarction (STEMI), which received little scientific attention in recent years. We aimed to describe the prevalence and factors contributing to FoD among STEMI patients and assess the impact of FoD on prehospital delay. This investigation was based on 592 STEMI patients who participated in the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. Multivariate logistic regression models were used to identify factors associated with FoD. A total of 15% of STEMI patients reported FoD (n = 88), no significant gender difference was found. STEMI pain strength [OR = 2.3 (1.4-3.9)], STEMI symptom severity [OR = 3.7 (2-6.8)], risk perception pre-STEMI [OR = 1.9 (1.2-3.2)] and negative affectivity [OR = 1.9 (1.2-3.1)] were independently associated with FoD. The median delay for those who experienced FoD was 139 min compared to 218 min for those who did not (p = 0.005). Male patients with FoD were significantly more likely to delay less than 120 min [OR = 2.11(1.25-3.57) p = 0.005], whereas in women, this association was not significant. Additionally, a clear dose-response relationship between fear severity and delay was observed. Male FoD patients significantly more often used emergency services to reach the hospital (p = 0.003). FoD is experienced by a clinically meaningful minority of vulnerable STEMI patients and is strongly associated with shorter delay times in men but not in women. Patients' uses of emergency services play an important role in reducing the delay in male FoD patients.
Publisher: Elsevier BV
Date: 2020
Publisher: Elsevier BV
Date: 02-2018
Publisher: Springer Science and Business Media LLC
Date: 22-08-2019
DOI: 10.1007/S11065-019-09412-9
Abstract: This study aims to systematically review the evidence on the accuracy of the Montreal Cognitive Assessment (MoCA) test for diagnosing HIV-associated neurocognitive disorders (HAND) and to outline the quality and quantity of research evidence available about the accuracy of MoCA in populations infected with HIV. We conducted a systematic literature review, searching five databases from inception until January 2019. We extracted dichotomized positive and negative test results at various thresholds and calculated the sensitivity and specificity of MoCA. Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Eight cross-sectional studies met the inclusion criteria for meta-analysis. Overall, 1014 patients were included but most studies recruited small s les. Recruitment period ranged from 2009 to 2015. We assessed most studies as being applicable to the review question though we had concerns about the selection of participants in three studies. The accuracy of MoCA for diagnosing HAND was reported at six cut-off points (scores 22-27). The MoCA test provides information about general cognitive functioning disturbances that contribute to a diagnosis of HAND. A lower threshold than the original cut-off of 26 is probably more useful for optimal screening of HAND, as it lowers false positive rates and improves diagnostic accuracy. Nonetheless, the choice of cut-off always comes with a sensitivity-specificity trade-off, the preferred cut point depending on whether sensitivity or specificity is more valuable in a given context.
Publisher: Cold Spring Harbor Laboratory
Date: 28-10-2020
DOI: 10.1101/2020.10.26.20219352
Abstract: To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. Systematic review Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics, and therapeutics. Studies were excluded if from single-centres or studied only COVID-19 patients. PubMed, Embase, Cochrane COVID-19 Study Register, and pre-prints were searched, without language restrictions, until August 10, using detailed searches with key concepts including COVID-19, health services and impact. Risk of bias was assessed by adapting ROBINS-I and Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures, and narrative synthesis. Primary outcome was change in service utilisation between pre-pandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (e.g. triage scores). 3097 unique references were identified, and 81 studies across 20 countries included, reporting on million services pre-pandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (interquartile range −51% to −20%), comprising median reductions for visits of 42%(−53% to −32%), admissions, 28%(−40% to −17%), diagnostics, 31%(−53% to −24%), and for therapeutics, 30%(−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27(45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no change. Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health-systems prioritise higher-value care in the post-pandemic recovery. No funding was required. PROSPERO: CRD42020203729 – The review is the first broad synthesis of global studies of pandemic related changes in utilisation across all categories of healthcare services. – The review provides novel findings informing design of future studies of pandemic-related changes in utilisation and its impacts. – Limitations include the possibility of publication bias and the potential of our eligibility criteria to exclude important data sources such as studies in single-centres and unpublished datasets from health systems. – Heterogenous designs and settings precluding meta-analysis.
Publisher: Elsevier BV
Date: 02-2018
Publisher: Elsevier BV
Date: 06-2019
Publisher: BMJ
Date: 07-2020
Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2020-043991
Abstract: Promotional media coverage of early detection tests is an important driver of overdiagnosis. Following research evidence that global media coverage presents the benefits of testing healthy people far more frequently than harms, and gives little coverage to overdiagnosis, we sought to examine journalists’ views on media reporting of tests, overdiagnosis, and strategies to improve critical reporting on tests. Qualitative study using semistructured telephone interviews. Interviews were conducted between February and March 2020 and were audiorecorded and transcribed verbatim. Framework thematic analysis was used to analyse the data. Twenty-two journalists (mainly specialising in health reporting, average 14.5 years’ experience) based in Australia. This s le of journalists acknowledged the potential harms of medical tests but felt that knowledge of harms was low among journalists and the public at large. Most were aware of the term overdiagnosis, but commonly felt that it is challenging to both understand and communicate in light of strong beliefs in the benefits of early detection. Journalists felt that newsworthiness in the form of major public health impact was the key ingredient for stories about medical tests. The journalists acknowledged that factors, like the press release and ‘click bait culture’ in particular, can influence the framing of coverage about tests. Lack of knowledge and training, as well as time pressures, were perceived to be the main barriers to critical reporting on tests. Journalists felt that training and better access to information about potential harms would enable more critical reporting. Effectively communicating overdiagnosis is a challenge in light of common beliefs about the benefits of testing and the culture of current journalism practices. Providing journalists with training, support and better access to information about potential harms of tests could aid critical reporting of tests.
Publisher: Elsevier BV
Date: 02-2018
Publisher: BMJ
Date: 13-05-2017
DOI: 10.1136/HEARTJNL-2017-311244
Abstract: To systematically review current evidence regarding the minimum acceptable risk reduction of a cardiovascular event that patients feel would justify daily intake of a preventive medication. We used the Web of Science to track the forward and backward citations of a set of five key articles until 15 November 2016. Studies were eligible if they quantitatively assessed the minimum acceptable benefit-in absolute values-of a cardiovascular disease preventive medication among a s le of the general population and required participants to choose if they would consider taking the medication. Of 341 studies screened, we included 22, involving a total of 17 751 participants: 6 studied prolongation of life (POL), 12 studied absolute risk reduction (ARR) and 14 studied number needed to treat (NNT) as measures of risk reduction communicated to the patients. In studies framed using POL, 39%-54% (average: 48%) of participants would consider taking a medication if it prolonged life by <8 months and 56%-73% (average: 64%) if it prolonged life by ≥8 months. In studies framed using ARR, 42%-72% (average: 54%) of participants would consider taking a medication that reduces their 5-year cardiovascular disease (CVD) risk by 30 and 46%-87% (average: 71%) with an NNT of ≤30. Many patients require a substantial risk reduction before they consider taking a daily medication worthwhile, even when the medication is described as being side effect free and costless.
Publisher: Public Library of Science (PLoS)
Date: 24-07-2017
Publisher: Elsevier BV
Date: 03-2020
Publisher: Elsevier BV
Date: 07-2021
Publisher: Springer Science and Business Media LLC
Date: 06-03-2019
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.IJCARD.2015.01.067
Abstract: Scarce evidence yields conflicting results regarding the effect of prodromal chest pain (PCP) on pre-hospital delay during an acute myocardial infarction (AMI). We aimed to assess the impact of PCP on delay. Data was collected on 619 ST-elevated MI patients from the multicenter Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Patients with any PCP (which was sub ided into undefined PCP, possible and definite angina) within a year before AMI were identified using the Rose questionnaire, administered in bedside interviews. The influence of PCP and its sub isions (all compared to no PCP) was assessed using logistic regression (with cut-offs of 2 h, 6 h, and a 4-category ordinal outcome). Any type of PCP was reported by men (50.6%) more than women (34.6%) (OR=1.9 95% CI: 1.3 to 2.8 p=.001). The median delay of patients with PCP was not significantly different to delay in patients with no PCP (p=.327). Prolonged delay times were observed in women with PCPs of lesser degree of cardiac confirmation, while the opposite was observed in men. In women, possible angina was more strongly associated with delay <2 h (OR=6.8 95% CI=2 to 23.8) than any PCP (OR=2.6 95% CI=1.2 to 5.7). For men, PCPs of increasing cardiac confirmation are associated with prolonged delay. For women, PCPs of lesser cardiac confirmation are more likely to lead to prolonged delay. Future studies should investigate mediating factors.
Publisher: BMJ
Date: 24-06-2020
DOI: 10.1136/BMJEBM-2019-111210
Abstract: Perceived knowledge gaps in general practice are not well documented but must be understood to ensure relevant and timely evidence for busy general practitioners (GPs) which reflects their erse and changing needs. The aim of this study was to classify the types of questions submitted by Australian GPs to an evidence-based practice information service using established and inductive coding systems. We analysed 126 clinical questions submitted by 53 Australian GPs over a 1.5-year period. Questions were coded using the International Classification of Primary Care (ICPC-2 PLUS) and Ely and colleagues’ generic questions taxonomy by two independent coders. Inductive qualitative content analysis was also used to identify perceived knowledge gaps. Treatment (71%), diagnosis (15%) and epidemiology (9%) were the most common categories of questions. Using the ICPC-2 classification, questions were most commonly coded to the endocrine/metabolic and nutritional chapter heading, followed by general and unspecified, digestive and musculoskeletal. Seventy per cent of all questions related to the need to stay up-to-date with the evidence, or be informed about new tests or treatments (including complementary and alternative therapies). These findings suggest that current guideline formats for common clinical problems may not meet the knowledge demands of GPs and there is gap in access to evidence updates on new tests, treatments and complementary and alternative therapies. Better systems for ‘pulling’ real-time questions from GPs could better inform the ‘push’ of more relevant and timely evidence for use in the clinical encounter.
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2020-039936
Abstract: Delayed prescribing is a promising strategy to manage patient requests for unnecessary tests and treatments. The purpose of this study was to explore general practitioner (GP) and patient views of three communication tools (Overdiagnosis Leaflet, Dialogue Sheet and ‘Wait-and-see’ Note) to support delayed prescribing of diagnostic imaging. Qualitative study. Primary and emergency care in Sydney, Australia. 16 GPs and 14 patients with recent episode of low back pain. Views on the tools to delay diagnostic imaging for low back pain. Data were collected using a combination of focus groups and in idual interviews. Two researchers independently performed a thematic analysis, and the author team reviewed and refined the analysis. GP participants responded positively to the Overdiagnosis Leaflet. The Dialogue Sheet and ‘Wait-and-see’ Note raised several concerns about patient pushback, adding to time pressure and being overwhelmed with hard-to-find paper resources. GPs preferred to communicate verbally the reasons to delay an imaging test. For patients, the reactions to the tools were more positive. Patients valued written information and a signed agreement to delay the test. However, patients expressed that a strong desire for diagnostic imaging would likely over-ride any effect of written advice to delay the test. The term ‘false alarm’ to describe overdiagnosis was poorly understood by patients. GPs and patients agreed that a leaflet about overdiagnosis could support a delayed prescribing approach to imaging for low back pain. The Dialogue Sheet and ‘Wait-and-see’ Note were acceptable to patients but not to GPs.
Publisher: Springer Science and Business Media LLC
Date: 03-08-2021
DOI: 10.1186/S12913-021-06804-7
Abstract: The COVID-19 pandemic threatens to overwhelm the capacity of a vulnerable healthcare system in the occupied Palestinian territory (oPt). We aimed to evaluate the availability of personal protective equipment (PPE) and the level of preparedness among HCWs in the oPt. A cross-sectional study was conducted using a validated online questionnaire distributed through convenient s ling between March 30, 2020 and April 12, 2020. Outcomes were availability of PPE, healthcare workers (HCWs) preparedness in oPt for COVID-19 pandemic, and regional and hospital differences in oPt in terms of availability of PPE and HCWs preparedness. Descriptive statistics and univariate analysis were used in this study. Of 138 respondents, only 38 HCWs (27.5%) always had access to facemasks and 15 (10.9%) always had access to isolation gowns. Most HCWs did not find eye protection ( n = 128, 92.8%), N95 respirators ( n = 132, 95.7%), and face shields ( n = 127, 92%) always available. Compared to HCWs in West Bank, those in the Gaza Strip were significantly less likely to have access to alcohol sanitizers ( p = 0.03) and gloves ( p 0.001). On average, governmental hospitals were significantly less likely to have all appropriate PPE than non-governmental institutions ( p = 0.001). Only 16 (11.6%) surveyed felt confident in dealing with a potential COVID-19 case, 57 (41.3%) having received any COVID-19-related training, and 57 (41.3%) not having a local hospital protocol. HCWs in oPt appear to be underprepared and severely lacking adequate PPE provision. The lack of PPE provision will exacerbate spread of COVID-19 and deepen the crisis, whilst putting HCWs at risk.
Publisher: Springer Science and Business Media LLC
Date: 15-03-2018
Publisher: World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO)
Date: 09-2017
Publisher: Wiley
Date: 27-10-2017
DOI: 10.1111/JEP.12805
Abstract: Funders encourage lay-volunteer inclusion in research. There are controversy and resistance, given concerns of role confusion, exploratory methods, and limited evidence about what value lay-volunteers bring to research. This overview explores these areas. Eleven databases were searched without date or language restrictions for systematic reviews of public and patient involvement (PPI) in clinical trials design. This systematic overview of PPI included 27 reviews from which areas of good and bad practice were identified. Strengths, weaknesses, opportunities, and threats of PPI were explored through use of meta-narrative analysis. Inclusion criteria were met by 27 reviews ranging in quality from high (n = 7), medium (n = 14) to low (n = 6) reviews. Reviews were assessed using CERQUAL NICE, CASP for qualitative research and CASP for systematic reviews. Four reviews report risk of bias. Public involvement roles were primarily in agenda setting, steering committees, ethical review, protocol development, and piloting. Research summaries, follow-up, and dissemination contained PPI, with lesser involvement in data collection, analysis, or manuscript authoring. Trialists report difficulty in finding, retaining, and reimbursing volunteers. Respectful inclusion, role recognition, mutual flexibility, advance planning, and sound methods were reported as facilitating public involvement in research. Public involvement was reported to have increased the quantity and quality of patient relevant priorities and outcomes, enrollment, funding, design, implementation, and dissemination. Challenges identified include lack of clarity within common language, roles, and research boundaries, while logistical needs include extra time, training, and funding. Researchers report struggling to report involvement and avoid tokenism. Involving patients and the public in clinical trials design can be beneficial but requires resources, preparation, training, flexibility, and time. Issues to address include reporting deficits for risk of bias, study quality, and conflicts of interests. We need to address these tensions and improve dissemination strategies to increase PPI and health literacy.
Publisher: BMJ
Date: 09-2018
DOI: 10.1136/BMJOPEN-2018-025470
Abstract: To investigate men’s values and preferences regarding prostate-specific antigen (PSA)-based screening for prostate cancer. Systematic review. We searched MEDLINE, EMBASE, PsycINFO and grey literature up to 2 September 2017. Primary studies of men’s values and preferences regarding the benefits and harms of PSA screening. Two independent reviewers extracted data and assessed risk of bias with a modified version of a risk of bias tool for values and preferences studies, the International Patient Decision Aid Standards instrument V.3 and the Cochrane Collaboration risk of bias tool. We identified 4172 unique citations, of which 11 studies proved eligible. Five studies investigated PSA screening using a direct choice study design, whereas six used decisions aids displaying patient-important outcomes. The direct choice studies used different methodologies and varied considerably in the reporting of outcomes. Two studies suggested that men were willing to forego screening with a small benefit in prostate cancer mortality if it would decrease the likelihood of unnecessary treatment or biopsies. In contrast, one study reported that men were willing to accept a substantial overdiagnosis to reduce their risk of prostate cancer mortality. Among the six studies involving decision aids, willingness to undergo screening varied substantially from 37% when displaying a hypothetical reduction in mortality of 10 per 1000 men, to 44% when displaying a reduction in mortality of 7 per 1000. We found no studies that specifically investigated whether values and preferences differed among men with family history, of African descent or with lower socioeconomic levels. The variability of men’s values and preferences reflect that the decision to screen is highly preference sensitive. Our review highlights the need for shared decision making in men considering prostate cancer screening. CRD42018095585.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Elsevier BV
Date: 10-2018
Publisher: Elsevier BV
Date: 08-2017
Publisher: John Wiley & Sons, Ltd
Date: 14-03-2012
Publisher: Springer Science and Business Media LLC
Date: 10-01-2020
DOI: 10.1007/S40266-019-00736-Y
Abstract: The use of statins in the primary prevention of cardiovascular disease (CVD) is increasing in older adults. Nonetheless, good clinical evidence for the safety and tolerability of statins in this population is limited. We aimed to evaluate the safety and tolerability of statins in older adults without overt CVD, focusing on statin-related muscle symptoms. Double-blinded randomised controlled trials (RCTs) of statins published before January 2012 were identified from a Cochrane review updated to 2012. Trials published between January 2012 and July 2018 were identified through the CENTRAL, MEDLINE and EMBASE databases. Eligible trials were limited to those including in iduals aged ≥ 65 years without overt CVD, who were followed for at least 1 year. Trials had to have reported at least one of the outcomes of interest. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using random-effects models. We identified 11 trials, including 18,192 participants (mean age 73.7 years 43% females). Compared with placebo, statins neither increased the risks of muscle-related symptoms (RR 1.01 95% CI 0.90-1.12), total adverse events (AEs) and serious AEs nor led to more total permanent treatment discontinuations and discontinuations due to AEs or specifically due to muscle-related symptoms. No evidence of heterogeneity was observed in any of these outcomes. This meta-analysis of RCTs found no excess incidence of muscle-related symptoms, total AEs, serious AEs and treatment discontinuations attributable to statin treatment compared with placebo among older adults without CVD.
Publisher: BMJ
Date: 24-05-2023
Publisher: Wiley
Date: 04-06-2014
Publisher: American Society of Clinical Oncology (ASCO)
Date: 12-2018
DOI: 10.1200/JGO.18.00095
Abstract: Timely detection of breast cancer (BC) is important to reduce its related deaths. Hence, high awareness of its symptoms and risk factors is required. This study aimed to assess the awareness level of BC among females in Gaza. A cross-sectional study was performed during September and October 2017 in Gaza, Palestine. Stratified s ling was used to recruit patients from four hospitals and seven high schools. The validated Breast Cancer Awareness Measure (BCAM) was used to assess confidence and behavior in relation to breast changes, awareness of BC symptoms and risk factors, barriers to seek medical help, and knowledge of BC screening. Women (age ≥ 18 years) visiting or admitted to any of the four hospitals, and female adolescents (age 15 to 17 years) in any of the seven schools, were recruited for face-to-face interviews to complete the BCAM. Of 3,055 women approached, 2,774 participants completed the BCAM questionnaire (response rate, 90.8%) 1,588 (57.2%) were adults, and 1,186 (42.8%) were adolescents. Of these, 1,781 (64.2%) rarely (or never) checked their breasts, and 909 (32.8%) were not confident to notice changes. In total, 1,675 (60.4%) were aware of the availability of BC screening programs. The overall mean ± standard deviation score for awareness of BC symptoms was 5.9 ± 2.9 of 11, and that of risk factors 7.5 ± 3.1 of 16. Feeling scared was the most reported barrier to seeking advice reported among women (n = 802 50.2%), whereas feeling embarrassed was the most reported in adolescents (n = 745 62.8%). Awareness of BC symptoms, risk factors, and screening programs is suboptimal in Gaza. Educational interventions are necessary to increase public awareness of BC and to train local female breast surgeons to address barriers to early detection.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 12-2019
DOI: 10.1200/JGO.18.00252
Abstract: Raising awareness of colorectal cancer (CRC) symptoms for early recognition, reduction of modifiable risk factors, and removing barriers to seeking medical help could lower its mortality. This study aimed to assess the level of public awareness of CRC in the Gaza Strip. This was a cross-sectional study conducted at three hospitals and 10 high schools between September and October 2017. The Arabic version of the validated Bowel Cancer Awareness Measure (BoCAM) questionnaire was used to evaluate awareness of CRC symptoms and risk factors, and barriers to seeking medical help. Adults (age ≥ 18 years) in three major hospitals and adolescents (ages 15 to 17 years) in 10 schools were recruited for face-to-face interviews to complete the BoCAM. Of 3,172 potential participants, 3,080 completed the BoCAM (response rate, 97.1%). Among these, 1,578 (51.2%) were adults and 1,614 (52.4%) were females. Persistent abdominal pain was the most commonly recognized CRC symptom (n = 1,899 61.7%), whereas anorectal pain was the least common (n = 1,056 34.3%). In total, 2,177 (70.7%) were not confident in recognizing CRC symptoms or signs. Having a bowel disease was the most frequently recognized CRC risk factor (n = 1,456 47.3%) and diabetes the least recognized (n = 591 19.2%). The overall mean scores ± standard deviations for recalling and recognizing CRC symptoms were 1.2 ± 1.3 and 4.3 ± 2.3, respectively (out of 9 points). The overall mean scores ± standard deviations for recalling and recognizing CRC risk factors were 0.7 ± 0.8 and 8.0 ± 3.1, respectively (out of 16 points). Emotional barriers were the most commonly reported barriers to seeking medical help, with feeling worried about what a doctor might find as the most common barrier (n = 1,522 49.4%). Public awareness of CRC is suboptimal in Gaza. Improving CRC awareness with educational interventions is needed, including in local schools.
Publisher: Springer Science and Business Media LLC
Date: 03-04-2019
Publisher: Springer Science and Business Media LLC
Date: 19-01-2021
DOI: 10.1186/S12875-021-01369-0
Abstract: Overuse of proton pump inhibitors (PPIs) – frequently used for relieving symptoms of gastroesophageal reflux disease (GORD) – raises long-term safety concerns, warranting evidence-based non-drug interventions. We conducted a systematic review to evaluate the effect of head-of-bed elevation on relieving symptoms of GORD in adults. We included controlled trials comparing the effect of head-of-bed elevation interventions to control in adults with GORD. Two independent reviewers screened articles, extracted data, and assessed quality of included studies. Primary outcomes were changes in GORD symptoms and use of PPIs. We screened 1206 records and included five trials (four cross-over and one factorial) comprising 228 patients. All five included trials were judged to be at high-risk of performance bias and four of selection bias. Of five included trials, two used ‘bed blocks’ under the bed legs one used ‘sleeping on a wedge’ pillow, and two used both. High heterogeneity in outcome measures and reported outcomes data precluded meta-analyses. The four studies that reported on GORD symptoms found an improvement among participants in the head-of-bed elevation a high-quality crossover trial showed a clinical important reduction in symptom scores at 6 weeks (risk ratio of 2.1 95% CI 1.2 to 3.6). These results are supported by the observed improvement in physiological intra-oesophageal pH measurements. Methodological and reporting limitations in available literature preclude definitive recommendations. However, head-of-bed elevation could be still considered as a cheap and safe alternative to drug interventions with unfavourable safety profiles. Open Science Framework: osf.io/2hz3j
Publisher: Springer Science and Business Media LLC
Date: 12-2021
DOI: 10.1186/S12877-021-02680-2
Abstract: Overtreatment in advanced age i.e. aggressive interventions that do not improve survival and are potentially harmful, can impair quality of care near the end of life (EOL). As healthcare provider perspectives on care quality may differ from that of service users, the aim of this study was to explore the views of older patients near EOL or their caregivers about the quality of health care at the EOL based on their lived experience, and to identify healthcare service improvements. Medline and backward citation searches were conducted for qualitative or quantitative studies reported on the views of patients and/or informal caregivers about EOL care quality. Thematic analysis was used to summarise qualitative data (primary analysis) narrative and tabulations were used to summarise quantitative data (secondary analysis). Thirty articles met the inclusion criteria. Five main qualitative themes regarding quality care emerged: (1) Effective communication between clinicians and patients/caregivers (2) Healthcare that values patient preferences and shared decision making (3) Models of care that support quality of life and death with dignity (4) Healthcare services that meet patient expectations and (5) Support for informal caregivers in dealing with EOL challenges. The quantitative articles supported various aspects of the thematic framework. The findings of this study show that many of the issues highlighted by patients or bereaved relatives have persisted over the past two decades. There is an urgent need for comprehensive evaluation of care across the healthcare system and targeted redesign of existing EOL care pathways to ensure that care aligns with what patients and informal caregivers consider high-quality patient-centred care at the EOL.
Publisher: BMJ
Date: 10-2022
DOI: 10.1136/BMJGH-2022-008696
Abstract: Overdiagnosis and overuse of healthcare services harm in iduals, take resources that could be used to address underuse, and threaten the sustainability of health systems. These problems are attracting increasing attention in low-income and middle-income countries (LMICs). Unaware of any review of relevant evidence, we conducted a scoping review of the evidence around overdiagnosis and overuse of diagnostic and screening tests in LMICs. Scoping review. We searched PubMed, Embase, PsycINFO, Global Index Medicus for relevant studies published until 24 May 2021, with no restrictions on date or language. We categorised included studies by major focus (overdiagnosis, overuse of tests, or both) and main themes (presence or estimates of extent drivers consequences and solutions). We identified 2763 unique records and included 162 articles reporting on 154 studies across 55 countries, involving over 2.8 million participants and/or requests for tests. Almost half the studies focused on overdiagnosis (70 45.5%), one-third on overuse of tests (61 39.6%) and one-fifth on both (23 14.9%). Common overdiagnosed conditions included malaria (61 39.6%) and thyroid cancer (25 16.2%), estimated to be % in China. Overused tests included imaging (n=25 studies) such as CT and MRI laboratory investigations (n=18) such as serological tests and tumour markers and procedures (n=14) such as colonoscopy. Drivers included fear of conflict with patients and expanding disease definitions. Common consequences included unnecessary treatments such as antimalarials, and wasted resources, with costs of malaria overdiagnosis estimated at US$86 million in Sudan in 1 year alone. Only 9% of studies discussed solutions, which included addressing inappropriately lowered diagnostic thresholds and reforming test-ordering processes. Overdiagnosis and overuse of tests are widespread in LMICs and generate significant harm and waste. Better understanding of the problems and robust evaluation of solutions is needed, informed by a new global alliance of researchers and policy-makers.
Publisher: American Medical Association (AMA)
Date: 22-06-2018
DOI: 10.1001/JAMANETWORKOPEN.2018.0281
Abstract: Evidence-based practice (EBP) is necessary for improving the quality of health care as well as patient outcomes. Evidence-based practice is commonly integrated into the curricula of undergraduate, postgraduate, and continuing professional development health programs. There is, however, inconsistency in the curriculum content of EBP teaching and learning programs. A standardized set of minimum core competencies in EBP that health professionals should meet has the potential to standardize and improve education in EBP. To develop a consensus set of core competencies for health professionals in EBP. For this modified Delphi survey study, a set of EBP core competencies that should be covered in EBP teaching and learning programs was developed in 4 stages: (1) generation of an initial set of relevant EBP competencies derived from a systematic review of EBP education studies for health professionals (2) a 2-round, web-based Delphi survey of health professionals, selected using purposive s ling, to prioritize and gain consensus on the most essential EBP core competencies (3) consensus meetings, both face-to-face and via video conference, to finalize the consensus on the most essential core competencies and (4) feedback and endorsement from EBP experts. From an earlier systematic review of 83 EBP educational intervention studies, 86 unique EBP competencies were identified. In a Delphi survey of 234 participants representing a range of health professionals (physicians, nurses, and allied health professionals) who registered interest (88 [61.1%] women mean [SD] age, 45.2 [10.2] years), 184 (78.6%) participated in round 1 and 144 (61.5%) in round 2. Consensus was reached on 68 EBP core competencies. The final set of EBP core competencies were grouped into the main EBP domains. For each key competency, a description of the level of detail or delivery was identified. A consensus-based, contemporary set of EBP core competencies has been identified that may inform curriculum development of entry-level EBP teaching and learning programs for health professionals and benchmark standards for EBP teaching.
Publisher: Springer Science and Business Media LLC
Date: 08-2018
Publisher: Annals of Family Medicine
Date: 03-2021
DOI: 10.1370/AFM.2609
Publisher: Elsevier BV
Date: 02-2018
Publisher: BMJ
Date: 30-08-2020
DOI: 10.1136/BMJEBM-2019-111220
Abstract: Shared decision-making (SDM) has emerged as a key skill to assist clinicians in applying evidence-based practice (EBP). We aimed to develop and pilot a new approach to teaching EBP, which focuses on teaching knowledge and skills about SDM and pre-appraised evidence. We designed a half-day workshop, informed by an international consensus on EBP core competencies and invited practicing clinicians to participate. Skills in SDM and communicating evidence were assessed by audio-recording consultations between clinicians and standardised patients (immediately pre-workshop and post-workshop). These were rated by two independent assessors using the OPTION (Observing Patient Involvement, 0 to 100 points) and ACEPP (Assessing Communication about Evidence and Patient Preferences, 0 to 5 points) tools. Participants also completed a feedback questionnaire (9 Likert scale and four open-ended questions). Fourteen clinicians participated. Skills in SDM and communicating research evidence improved from pre-workshop to post-workshop (mean increase in OPTION score=5.5, 95% CI 1.0 to 9.9 increase in ACEPP score=0.5, 95% CI 0.02 to 1.06). Participant feedback was positive, with most indicating ‘agree’ or ‘strongly agree’ to the questions. A contemporary approach to teaching clinicians EBP, with a focus on SDM and pre-appraised evidence, was feasible, perceived as useful, and showed modest improvements in skills. Results should be interpreted cautiously because of the small study size and pre-post design.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.PEC.2016.06.007
Abstract: We aimed to assess whether patients' knowledge about acute myocardial infarction (AMI) has an impact on the prehospital delay-time. This investigation was based on 486 AMI patients who participated in the cross-sectional Munich-Examination-of-Delay-in-Patients-Experiencing-Acute-Myocardial-Infarction (MEDEA) study. A modified German-version of the ACS-Response-Index Questionnaire was used. Multivariate logistic-regression models were used to identify factors associated with knowledge-level as well as the impact of knowledge-level on delay-time. High AMI-knowledge shortened median delay-time in men (168[92-509] vs. 276[117-1519] mins, p=0.0069), and in women (189[101-601] vs. 262[107-951]mins, p=0.34). Almost half-of-patients (n=284,58%) demonstrated high AMI-knowledge. High-knowledge were independently associated with male-gender (OR=1.47[1.17-1.85]) and General-Practitioner as a knowledge-source (OR=1.42[1.14-1.77]). Old-age (OR=0.87[0.86-0.89]) and previous AMI-history/stent-placement (OR=0.65[0.46-0.93]) were significantly associated with lower-knowledge. Although the majority (476,98%) correctly recognized at least one AMI-symptom, 69(14.2%) patients correctly identified all AMI-symptoms. Additionally, one-in-three believed that heart-attack is always accompanied with severe chest-pain. Elderly-patients and women were more likely to be less-knowledgeable about atypical-symptoms (p=0.006), present with atypical AMI-presentation (p<0.001) and subsequently experience protracted delay-times (p<0.001). Knowledge of AMI-symptoms remains to be substandard, especially knowledge of atypical-symptoms. Knowledge is essential to reduce delay-times, but it is not a panacea, since it is not sufficient alone to optimize prehospital delay-times.
Publisher: Elsevier BV
Date: 08-2017
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJMED-2022-000130
Abstract: To assess whether recommendations of in idually oriented lifestyle interventions (IOLIs) in guidelines from the National Institute for Health and Care Excellence (NICE) were underpinned by evidence of benefit, and whether harms and opportunity costs were considered. Cross sectional survey. UK. NICE guidelines and supporting evidence. All NICE pathways for IOLI recommendations (ie, non-drug interventions that healthcare professionals administer to adults to achieve a healthier lifestyle and improve health) were searched systematically on 26 August 2020. One author screened all retrieved pathways for candidate guidelines, while a second author verified these judgments. Two authors independently and in duplicate screened all retrieved guidelines and recommendations for eligibility, extracted data, and evaluated the evidence cited and the outcomes considered. Disagreements were noted and resolved by consensus. Within 57 guidelines, 379 NICE recommendations were found for IOLIs almost all (n=374 99%) recommended the lifestyle intervention and five (1%) recommended against the intervention. Of the 379 recommendations, 13 (3%) were supported by moderate or high certainty evidence of a beneficial effect on patient relevant outcomes (n=7 2%) or surrogate outcomes (n=13 3%). 19 (5%) interventions considered psychosocial harms, 32 (8%) considered physical harms, and one ( %) considered the opportunity costs of implementation. No intervention considered the burden placed on in iduals by these recommendations. Few NICE recommendations of lifestyle interventions are supported by reliable evidence. While this finding does not contest the beneficial effects of healthy habits, guidelines recommending clinicians to try to change people’s lifestyle need to be reconsidered given the substantial uncertainty about the effectiveness, harms, and opportunity costs of such interventions.
Publisher: Springer Science and Business Media LLC
Date: 30-01-2018
DOI: 10.1007/S00392-018-1208-4
Abstract: Anxiety has been identified as a cardiac risk factor. However, less is known about the impact of generalized anxiety disorder (GAD) on prehospital delay during an acute myocardial infarction (AMI). This study assessed the impact of GAD on prehospital delay and delay related cognition and behavior. Data were from the cross-sectional Munich examination of delay in patients experiencing acute myocardial infarction (MEDEA) study with a total of 619 ST-elevated myocardial infarction (STEMI) patients. Data on socio-demographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed with the Generalized Anxiety Disorder scale (GAD-7). A GAD-7 score greater than or equal to 10 indicates general anxiety disorder. A total of 11.47% (n = 71) MI patients suffered from GAD. GAD was associated with decreased odds of delay compared to patients without GAD (OR 0.58, 95% CI 0.35-0.96), which was more significant in women (112 vs. 238 min, p = 0.02) than in men (150 vs. 198 min, p = 0.38). GAD was highly correlated with acute anxiety (p = 0.004) and fear of death (p = 0.005). Nevertheless, the effect remained significant after controlling for these two covariates. GAD patients were more likely to perceive a higher cardiovascular risk (OR 2.56, 95% CI 1.37-4.76) in 6 months before MI, which leads to the higher likelihood of making self-decision to go to the hospital (OR 2.68, 95% CI 1.48-4.85) in the acute phase. However, GAD was also highly associated with impaired psychological well-being, stress and fatigue (p < 0.0001). In AMI patients, GAD was independently associated with less prehospital delay, but led to an impaired psychological state.
Publisher: American Medical Association (AMA)
Date: 02-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2018
Publisher: Wiley
Date: 02-11-2018
DOI: 10.1111/MEDU.13410
Abstract: Complete reporting of intervention details in trials of evidence-based practice (EBP) educational interventions is essential to enable clinical educators to translate research evidence about interventions that have been shown to be effective into practice. In turn, this will improve the quality of EBP education. This study was designed to examine the completeness of reporting of EBP educational interventions in published studies and to assess whether missing details of educational interventions could be retrieved by searching additional sources and contacting study authors. A systematic review of controlled trials that had evaluated EBP educational interventions was conducted using a citation analysis technique. Forward and backward citations of the index articles were tracked until March 2016. The TIDieR (template for intervention description and replication) checklist was used to assess the completeness of intervention reporting. Missing details were sought from: (i) the original publication (ii) additional publicly available sources, and (iii) the study authors. Eighty-three articles were included 45 (54%) were randomised controlled trials (RCTs) and 38 (46%) were non-RCTs. The majority of trials (n = 62, 75%) involved medical professionals. None of the studies completely reported all of the main items of the educational intervention within the original publication or in additional sources. However, details became complete for 17 (20%) interventions after contact with the respective authors. The item most frequently missing was 'intervention materials', which was missing in 80 (96%) of the original publications, in additional sources for 77 (93%) interventions, and in 59 (71%) studies after contact with the authors. Authors of 69 studies were contacted 33 provided the details requested. The reporting of EBP educational interventions is incomplete and remained so for the majority of studies, even after study authors had been contacted for missing information. Collaborative efforts involving authors and editors are required to improve the completeness of reporting of EBP educational interventions.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.JPSYCHORES.2016.10.008
Abstract: During an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). However, empirical evidences are still sparse. This cross-sectional study included 533 ST-elevated myocardial infarction (STEMI) patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed using the Cardiac Denial of Impact Scale (CDIS) with the median split as cutoff point. A total of 206 (41.8%) STEMI patients were thus classified as deniers. Deniers were less likely to suffer from major depression (p=0.04), anxiety (p=0.01) and suboptimal well-being (p=0.01) compared to non-deniers during the last six months prior to STEMI. During STEMI, they were less likely to perceive severe pain strength (p=0.04) and racing heart (p=0.02). Male deniers were also less likely to perceive shortness of breath (p=0.03) and vomiting (p=0.01). Denial was not associated with overall delay time. However, in the time window of 3 to 24h, denial accounted for roughly 40min extra delay (356 vs. 316.5min p=0.02 n=196). Denial not only contributes to less suffering from acute heart related symptoms and negative affectivity but also leads to a clinically significant delay in the prevalent group.
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/OPENHRT-2019-001175
Abstract: Interventions aiming at reducing prehospital delay (PHD) in patients with acute coronary syndrome (ACS) have yielded inconsistent findings. Therefore, we aimed to systematically review studies which investigated the impact of educational interventions on reducing PHD in patients with ACS. We searched four electronic databases (Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Embase, Cochrane) from inception throughout December 2016 for studies that reported the impact of either mass-media or personalised intervention on PHD. Reporting quality was assessed with the Template for Intervention Description and Replication checklist for interventional trials. Two reviewers screened 12 184 abstracts and performed full-text screening on 86 articles, leading to 34 articles which met our inclusion criteria. We found 18 educational interventions with a total of 180 914 participants (range: n=100–125 161) and a median of 1342 participants. Among these educational interventions, 13 c aigns employed a mass-media approach and five a personalised approach. Ten studies yielded no significant effects on the primary outcome while the remaining interventions reported a significant reduction with a decrease between 17 and 324 min (median reduction: 40 min, n=5). The success was partly driven by an increase in emergency medical services use. Two studies reported an increase in acute myocardial infarction knowledge. We observed no superiority of the personalised over the mass-media approach. Although methodological shortcomings and the heterogeneity of included interventions still do not allow definite recommendations for future c aigns, it becomes evident that either mass media or personalised interventions can be successful in reducing PHD, especially those who address behavioural consequences and psychological barriers (eg, denial) and provide practical action plan considerations as part of their c aign messages. CRD42017055684 (PROSPERO registration number).
Publisher: Elsevier BV
Date: 03-2019
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.JCLINEPI.2016.11.013
Abstract: To explore indirect evidence of reporting biases by examining the distribution of P-values reported in published medical articles and to compare P-values distributions across different contexts. We selected a random s le (N = 1,500) of articles published in PubMed in March 2014. We extracted information on study type, design, medical discipline, and P-values for the first reported outcome and primary outcome (if specified) from each article. We plotted the P-values transformed to the z-score scale and used caliper tests to investigate threshold effects. Out of the 1,500 randomly selected records, 758 (50.5%) were included. We retrieved or calculated 758 P-values for first reported outcomes and 389 for primary outcomes (specified in only 51% of included studies). The first reported and the primary outcome differed in 28% (110/389) of the included studies. The distributions of P-values for first reported outcomes and primary outcomes showed a notable discontinuity at the common thresholds of statistical significance (P-value = 0.05 and P-value = 0.01). We also found marked discontinuities in the distributions of z-scores across various medical disciplines, study designs, and types. Reporting biases are still common in medical research. We discuss their implications, strategies to detect them, and recommended practices to avoid them.
Publisher: BMJ
Date: 27-05-2020
DOI: 10.1136/BMJ.M1505
Abstract: To investigate the nature and extent of financial relationships between leaders of influential professional medical associations in the United States and pharmaceutical and device companies. Cross sectional study. Professional associations for the 10 costliest disease areas in the US according to the US Agency for Healthcare Research and Quality. Financial data for association leadership, 2017-19, were obtained from the Open Payments database. 328 leaders, such as board members, of 10 professional medical associations: American College of Cardiology, Orthopaedic Trauma Association, American Psychiatric Association, Endocrine Society, American College of Rheumatology, American Society of Clinical Oncology, American Thoracic Society, North American Spine Society, Infectious Diseases Society of America, and American College of Physicians. Proportion of leaders with financial ties to industry in the year of leadership, the four years before and the year after board membership, and the nature and extent of these financial relationships. 235 of 328 leaders (72%) had financial ties to industry. Among 293 leaders who were medical doctors or doctors of osteopathy, 235 (80%) had ties. Total payments for 2017-19 leadership were almost $130m (£103m €119m), with a median amount for each leader of $31 805 (interquartile range $1157 to $254 272). General payments, including those for consultancy and hospitality, were $24.8m and research payments were $104.6m—predominantly payments to academic institutions with association leaders named as principle investigators. Variation was great among the associations: median amounts varied from $212 for the American Psychiatric Association leaders to $518 000 for the American Society of Clinical Oncology. Financial relationships between the leaders of influential US professional medical associations and industry are extensive, although with variation among the associations. The quantum of payments raises questions about independence and integrity, adding weight to calls for policy reform.
Publisher: WHO Press
Date: 2023
Publisher: American Medical Association (AMA)
Date: 06-09-2022
Publisher: Cold Spring Harbor Laboratory
Date: 13-05-2020
DOI: 10.1101/2020.05.09.20096099
Abstract: Background: The coronavirus disease 19 (COVID-19) pandemic threatens to overwhelm the capacity of the vulnerable healthcare system in the occupied Palestinian territory (oPt). Sufficient training of healthcare workers (HCWs) in how to manage COVID-19 and the provision of personal protective equipment (PPE) to enable them to do so will be key tools in allowing oPt to mount a credible response to the crisis. Methods: A cross-sectional study was conducted using a validated online questionnaire. Data collection occurred between March 30, 2020 and April 12, 2020. The primary outcomes were the availability of PPE and HCWs preparedness in oPt for COVID-19 pandemic and the secondary outcome was regional and hospital differences in oPt in terms of PPE availability and HCWs preparedness. Results: Of 138 respondents, only 38 HCWs (27.5%) always had access to facemasks when needed and 15 (10.9%) for isolation gowns. The vast majority of HCWs did not find eye protection (n=128, 92.8%), N95 respirators (n=132, 95.7%), and face shields (n=127, 92%) always available. Compared to HCWs in West Bank, those in the Gaza Strip were significantly less likely to have access to alcohol sanitizers (p=0.026) and gloves (p .001). On average, governmental hospitals were significantly less likely to have all appropriate PPE measures than non-governmental institutions (p = 0.001). As for preparedness, only 16 (11.6%) surveyed felt confident in dealing with a potential COVID-19 case. With 57 (41.3%) having received any COVID-19 related training and 57 (41.3%) not having a local hospital protocol. Conclusion: HCWs in oPt are underprepared and severely lacking adequate PPE provision. The lack of local protocols and training has left HCWs' confidence exceedingly low. The lack of PPE provision will exacerbate the spread of COVID-19 and deepen the crisis, whilst putting HCWs at risk.
Publisher: Center for Open Science
Date: 17-08-2021
Abstract: The primary objective of the MSK DI AF trial is to estimate the effectiveness of audit and feedback for reducing diagnostic imaging requests for 11 musculoskeletal imaging services in high requesting GPs in Australia compared with control. It is a 5-arm partial 2 x 2 factorial cluster randomised trial testing variations in the design and delivery of audit and feedback for reducing musculoskeletal diagnostic imaging requests in Australian general practice. This statistical analysis plan pre-specifies all analyses and was prepared while blinded to the randomised allocation.
Publisher: Elsevier BV
Date: 03-2019
Publisher: Cold Spring Harbor Laboratory
Date: 12-07-2022
DOI: 10.1101/2022.07.11.22277498
Abstract: Independent systematic reviewers may arrive at different conclusions when analyzing evidence addressing the same clinical questions. Similarly, independent expert panels may arrive at different recommendations addressing the same clinical topics. When faced with a multiplicity of reviews or guidelines on a given topic, users are likely to benefit from a structured approach to evaluate concordance, and to explain discordant findings and recommendations. This protocol proposes a methodological survey to evaluate the prevalence of concordance between reviews addressing similar clinical questions, and between clinical practice guidelines addressing similar topics and to identify methodological frameworks for the evaluation of concordance between related reviews and between related guidelines.
Publisher: American Medical Association (AMA)
Date: 28-08-2018
Publisher: SAGE Publications
Date: 03-04-2018
Abstract: Introduction: Stomach cancer, historically, has a low survival rate advances in curative resection procedures. Objectives: To assess the potential benefits of traditional herbal medicines in conjunction with chemotherapy in postoperative gastric cancer patients in terms of overall survival and disease-free survival. Data Sources: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, a Chinese database (CNKI), a Korean database, a Japanese database, AMED, and CINAHL up to September 2016. We summarized survival data from all RCTs. Study Selection: All RCTs of oral traditional medicines for resectable gastric cancer compared with chemotherapy alone were eligible. Data Extraction: Thirteen eligible trials with survival data (1075 patients) were deemed eligible for inclusion. Results: There were 217 documented deaths of the 574 patients assigned to adjuvant traditional medicines groups and 319 documented deaths of the 501 patients assigned to the chemotherapy-only groups. Adjuvant traditional medicines were associated with a statistically significant benefit in terms of overall survival rate (hazard ratio = 0.56 95% confidence interval = 0.47-0.66 P .00001) and disease-free survival (hazard ratio = 0.54 95% confidence interval = 0.43-0.66 P .00001). Conclusion: Among the RCTs included, the inclusion of postoperative adjuvant traditional medicines was associated with reduced risk of death in gastric cancer patients, when survival rates were compared with the group of patients who received chemotherapy alone. However, most of the included studies utilized are thought to be of low quality, so it would certainly appear that more trials are both advisable and necessary to arrive at correct and convincing conclusions.
Publisher: Wiley
Date: 13-11-2020
Publisher: Springer Science and Business Media LLC
Date: 25-11-2017
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-045343
Abstract: To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. Systematic review. Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19. PubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact. Risk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis. Primary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores). 3097 unique references were identified, and 81 studies across 20 countries included, reporting on million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference. Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery. CRD42020203729.
Publisher: F1000 Research Ltd
Date: 05-02-2020
DOI: 10.12688/F1000RESEARCH.22182.1
Abstract: Background : Recruitment to trials can be challenging. Currently, non-randomised evaluations of trial recruitment interventions are rejected due to poor methodological quality, but systematic assessment of this substantial body of work may inform trialists’ decision-making about recruitment methods. Our objective was to quantify the effects of strategies to improve participant recruitment to randomised trials evaluated using non-randomised study designs. Methods : We searched relevant databases for non-randomised studies that included two or more interventions evaluating recruitment to trials. Two reviewers screened abstracts and full texts for eligible studies, then extracted data on: recruitment intervention, setting, participant characteristics, number of participants in intervention and comparator groups. The ROBINS-I tool was used to assess risk of bias. The primary outcome was the number of recruits to a trial. Results : We identified 92 studies for inclusion 90 studies aimed to improve the recruitment of participants, one aimed to improve the recruitment of GP practices, and one aimed to improve recruitment of GPs. Of the 92 included studies, 20 were at high risk of bias due to confounding the remaining 72 were at high risk of bias due to confounding and at least one other category of the ROBINS-I tool. The 20 studies at least risk of bias were synthesised narratively based on seven broad categories Face to face recruitment initiatives, postal invitations and responses, language adaptations, randomisation methods, trial awareness strategies aimed at the recruitee, trial awareness strategies aimed at the recruiter, and use of networks and databases. The utility of included studies is substantially limited due to small s le sizes, inadequate reporting, and a lack of coordination around deciding what to evaluate and how. Conclusions : Careful thought around planning, conduct, and reporting of non-randomised evaluations of recruitment interventions is required to prevent future non-randomised studies contributing to research waste. Registration : PROSPERO CRD42016037718
Publisher: AMPCo
Date: 18-01-2019
DOI: 10.5694/MJA2.12061
Abstract: To evaluate the performance of the 2013 Pooled Cohort Risk Equation (PCE-ASCVD) for predicting cardiovascular disease (CVD) in an Australian population to compare this performance with that of three frequently used Framingham-based CVD risk prediction models. Prospective national population-based cohort study. 42 randomly selected urban and non-urban areas in six Australian states and the Northern Territory. 5453 adults aged 40-74 years enrolled in the Australian Diabetes, Obesity and Lifestyle study and followed until November 2011. We excluded participants who had CVD at baseline or for whom data required for risk model calculations were missing. Predicted and observed 10-year CVD risks (adjusted for treatment drop-in) performance (calibration and discrimination) of four CVD risk prediction models: 1991 Framingham, 2008 Framingham, 2008 office-based Framingham, 2013 PCE-ASCVD. The performance of the 2013 PCE-ASCVD model was slightly better than 1991 Framingham, and each was better the two 2008 Framingham risk models, both in men and women. However, all four models overestimated 10-year CVD risk, particularly for patients in higher deciles of predicted risk. The 2013 PCE-ASCVD (7.5% high risk threshold) identified 46% of men and 18% of women as being at high risk the 1991 Framingham model (20% threshold) identified 17% of men and 2% of women as being at high risk. Only 16% of men and 11% of women identified as being at high risk by the 2013 PCE-ASCVD experienced a CV event within 10 years. The 2013 PCE-ASCVD or 1991 Framingham should be used as CVD risk models in Australian. However, the CVD high risk threshold for initiating CVD primary preventive therapy requires reconsideration.
Publisher: BMJ
Date: 10-11-2020
Publisher: Elsevier BV
Date: 02-2018
Publisher: BMJ
Date: 24-01-2018
DOI: 10.1136/EBMED-2017-110829
Abstract: Many claims about the effects of treatments, though well intentioned, are wrong. Indeed, they are sometimes deliberately misleading to serve interests other than the well-being of patients and the public. People need to know how to spot unreliable treatment claims so that they can protect themselves and others from harm. The ability to assess the trustworthiness of treatment claims is often lacking. Acquiring this ability depends on being familiar with, and correctly applying, some key concepts, for ex le, that’ association is not the same as causation.’ The Informed Health Choices (IHC) Project has identified 36 such concepts and shown that people can be taught to use them in decision making. A randomised trial in Uganda, for ex le, showed that primary school children with poor reading skills could be taught to apply 12 of the IHC Key Concepts. The list of IHC Key Concepts has proven to be effective in providing a framework for developing and evaluating IHC resources to help children to think critically about treatment claims. The list also provides a framework for retrieving, coding and organising other teaching and learning materials for learners of any age. It should help teachers, researchers, clinicians, and patients to structure critical thinking about the trustworthiness of claims about treatment effects.
Publisher: BMJ
Date: 09-2017
DOI: 10.1136/BMJOPEN-2017-017587
Abstract: Although statins are commonly used for prevention of cardiovascular disease, there is limited evidence about statin-related adverse effects in older people. Statin-related adverse events (AEs), especially the statin-associated muscle symptoms (SAMS), are the most common reasons for their discontinuation. Therefore, it is important to determine the risk of SAMS in the older population. We will undertake a systematic review and meta-analysis primarily focusing on the risk of SAMS and secondarily targeting myopathy, rhabdomyolysis, AEs and serious AEs, dropouts due to SAMS in run-in period, related permanent discontinuation rate of statins and creatine kinase level, among older people who received statins for primary prevention. This study has been developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. We will include randomised controlled trials in which statin was compared with placebo with at least 1 year follow-up among older adults aged ≥65. This review is an update of a Cochrane systematic review that included the articles published before 2012. Cochrane Central Register of Controlled Trials, Medline OvidSP and Embase electronic database searches will be performed to identify relevant articles, limiting the publication date from 1 January 2012 to 13 February 2017. There will be no language limitation. Two independent reviewers will screen titles and abstracts and full text in duplicate. Risk of bias and evidence quality will be assessed using the Cochrane Collaboration’s tool and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively. A meta-analysis using pooled data will be undertaken, if appropriate. We will also perform metaregression and subgroup analyses to identify sources of heterogeneity. This study is exempt from ethics approval due to the anonymous and aggregated data used. The outcomes will be disseminated by conference presentations and published in a peer-reviewed journal. CRD42017058436.
Publisher: American Association for Cancer Research (AACR)
Date: 07-2018
DOI: 10.1158/1538-7445.AM2018-5284
Abstract: Introduction: Colorectal cancer (CRC) is a major cause of cancer deaths worldwide. Raising the awareness of CRC symptoms for early recognition, prevention via reduction of lifestyle risk factors, and removing barriers to seek medical help could lower its mortality. This study aimed to assess the level of public awareness of CRC in the Gaza Strip, and compare it between adults and high-school students (HSS). Methods: This is a cross-sectional study conducted at 3 major hospitals and 10 high schools (recruitment used stratified s ling) in the Gaza Strip between September and October 2017. A previously pilot-tested, Arabic version of the Bowel Cancer/CRC Awareness Measure (CAM) questionnaire, a validated standardized questionnaire to measure public CRC awareness, was used. It consists of four sections: sociodemographic data, awareness of CRC symptoms, awareness of CRC risk factors, and barriers to seek medical help. Adults (aged ≥18 years) visiting or admitted to any of the three hospitals, and high-school students (aged 15-17 years) in any of the ten schools were recruited for face-to-face interviews to complete the CAM. Patients and visitors to oncology departments were ineligible. Informed consent and ethical approval were obtained. Results: A total of 3080 participants completed the CAM questionnaire (of 3236 approached response rate was 97.3% in HSS and 92.8% in adults). 1502 (48.8%) were HSS (730 males 48.6%) and 1578 (51.2%) adults (736 males 46.6%). Overall, 1391 (45.2%) reported that the chance of getting CRC is not related to age. A persistent abdominal pain was the most commonly recognized cancer symptom (n=1899, 61.7%) while pain in back passage was the least (n=1056, 34.3%). 2177 (70.7%) reported that they are not confident in recognizing CRC symptom/sign. Having a bowel disease (e.g, ulcerative colitis) was the most frequently recognized CRC risk factor (n= 1456, 47.3%) and having diabetes was the least (n=591, 19.2%). In general, adults have better awareness than HSS in terms of: recognizing CRC symptoms (mean score = 20.8 vs 18.7 of 24 total score, p& 0.0001) and its risk factors (mean score= 27.2 vs 25.4 of 45 total score, p& 0.0001). Worry about what a doctor might find was the most reported barrier to seek medical help among adults (n= 773, 49%), whereas, lack of confidence to talk about symptoms with the doctor was the most commonly reported one in HSS (n= 777, 51.7%). Conclusions:The public awareness of CRC is suboptimal in the Gaza Strip. Interventions to improve the public awareness of CRC (e.g., educational outreach) is warranted. School curriculums should include awareness sessions on cancer symptoms and risk factors, including CRC. Citation Format: MohamedRaed Elshami, Tamer Abdalghafoor, Maha Alfaqawi, Ayoub AbuNemer, Mohammed Ghuneim, Hussien Lubbad, Batool Almahallawi, Mosab Samaan, Abdallah Alwali, Ahmad Alborno, Deyaa Al-kafarna, Aseel Salah, Karam Shihada, Mohammed Abo Amona, Amira Al-Najjar, Rana Abu Subha, Basma Alhelu, Israa Abujayyab, Loai Albarqouni, Bettina Bottcher. Public awareness of colorectal cancer in the Gaza Strip: A comparative cross-sectional study between adults and high school students [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018 2018 Apr 14-18 Chicago, IL. Philadelphia (PA): AACR Cancer Res 2018 (13 Suppl):Abstract nr 5284.
Publisher: BMJ
Date: 06-2017
Publisher: Public Library of Science (PLoS)
Date: 30-01-2019
Location: Australia
No related grants have been discovered for Loai Albarqouni.