ORCID Profile
0000-0002-0109-9001
Current Organisation
Bond University
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Publisher: Springer Science and Business Media LLC
Date: 28-01-2020
DOI: 10.1186/S12961-019-0520-4
Abstract: Disproportionate regulation of health and medical research contributes to research waste. Better understanding of exemptions of research from ethics review in different jurisdictions may help to guide modification of review processes and reduce research waste. Our aim was to identify ex les of low-risk human health and medical research exempt from ethics reviews in Australia, the United Kingdom, the United States and the Netherlands. We examined documents providing national guidance on research ethics in each country, including those authored by the National Health and Medical Research Council (Australia), National Health Service (United Kingdom), the Office for Human Research Protections (United States) and the Central Committee on Research Involving Humans (the Netherlands). Ex les and types of research projects exempt from ethics reviews were identified, and similar ex les and types were grouped together. Nine categories of research were exempt from ethics reviews across the four countries these were existing data or specimen, questionnaire or survey, interview, post-marketing study, evaluation of public benefit or service programme, randomised controlled trials, research with staff in their professional role, audit and service evaluation, and other exemptions. Existing non-identifiable data and specimens were exempt in all countries. Four categories – evaluation of public benefit or service programme, randomised controlled trials, research with staff in their professional role, and audit and service evaluation – were exempted by one country each. The remaining categories were exempted by two or three countries. Ex les and types of research exempt from research ethics reviews varied considerably. Given the considerable costs and burdens on researchers and ethics committees, it would be worthwhile to develop and provide clearer guidance on exemptions, illustrated with ex les, with transparent underpinning rationales.
Publisher: BMJ
Date: 22-08-2017
DOI: 10.1136/JRAMC-2016-000752
Abstract: In 2015, the Australian Army commissioned a systematic review to assess the evidence on effectiveness and safety of pharmacological and biotechnological products for cognitive enhancement specifically in Army personnel. Searches for studies examining biotechnological and pharmacological products in Army populations were conducted in December 2015. Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO were searched without date or language restrictions. WHO’s International Clinical Trials Registry Platform and ClinicalTrials.gov were searched to identify ongoing trials. Studies meeting inclusion criteria were evaluated for risk of bias using Cochrane’s Risk of Bias tool. Due to heterogeneity of findings, meta-analysis could not be conducted. Findings were synthesised narratively and by vote-counting method. Sixteen pharmacological enhancement products were evaluated in 22 randomised controlled trials (RCTs), involving 1284 personnel. Only three of the studies were published since 2010. The interventions evaluated were varied, including supplements (eg, carbohydrate), stimulants (eg, caffeine) and hormones (eg, melatonin). Generally, caffeine provided an improvement in performance compared with placebo on 5/7 reported cognitive outcomes, followed by levothyroxine (four cognitive outcomes) and prazosin (three cognitive outcomes). Performance results were mixed (finding an improvement and no effect in comparison to placebo) for caffeine and melatonin on two outcomes. No evidence was found pertaining to biotechnological products. Studies rarely reported safety outcomes (eg, adverse events and addiction). Findings from this review need to be interpreted with considerable caution. Future studies should include outcomes such as acute and long-term adverse events, and should evaluate cognitive performance using cognitive tests that are specific to the Army population.
Publisher: Wiley
Date: 05-01-2023
DOI: 10.1002/JRSM.1613
Abstract: Synthesizers of evidence are increasingly likely to encounter studies published in predatory journals during the evidence synthesis process. The evidence synthesis discipline is uniquely positioned to encounter novel concerns associated with predatory journals. The objective of this research was to explore the attitudes, opinions, and experiences of experts in the synthesis of evidence regarding predatory journals. Employing a descriptive survey‐based cross‐sectional study design, these experts were asked a series of questions regarding predatory journals to explore these attitudes, opinions, and experiences. Two hundred and sixty four evidence synthesis experts responded to this survey. Most respondents agreed with the definition of a predatory journal (86%), however several (19%) responded that this definition was difficult to apply practically. Many respondents believed that studies published in predatory journals are still eligible for inclusion into an evidence synthesis project. However, this was only after the study had been determined to be ‘high‐quality’ (39%) or if the results were validated (13%). While many respondents could identify common characteristics of these journals, there was still hesitancy regarding the appropriate methods to follow when considering including these studies into an evidence synthesis project.
Publisher: JMIR Publications Inc.
Date: 14-06-2002
DOI: 10.2196/49942
Publisher: Cambridge University Press (CUP)
Date: 2017
DOI: 10.1017/S0266462317000976
Abstract: Objectives: Although there is increased awareness of patient and public involvement (PPI) among health technology assessment (HTA) organizations, evaluations of PPI initiatives are relatively scarce. Our objective as members of Health Technology Assessment International's (HTAi's) Patient and Citizen Involvement Group (PCIG) was to advance understanding of the range of evaluation strategies adopted by HTA organizations and their potential usefulness. Methods: In March 2016, a survey was sent to fifty-four HTA organizations through the International Network of Agencies for Health Technology Assessment (INAHTA) and contacts of members of HTAi's PCIG. Respondents were asked about their organizational structure how patients and members of the public are involved whether and how PPI initiatives have been evaluated, and, if so, which facilitators and challenges to evaluation were found and how results were used and disseminated. Results: Fifteen ( n = 15) programs from twelve countries responded (response rate 27.8 percent) that involved patients (14/15) and members of the public (10/15) in HTA activities. Seven programs evaluated their PPI activities, including participant satisfaction (5/7), process (5/7) and impact evaluations (4/7). Evaluation results were used to improve PPI activities, identify education and training needs, and direct strategic priorities. Facilitators and challenges revolved around the need for stakeholder buy-in, sufficient resources, senior leadership, and including patients in evaluations. Conclusions: A small but erse set of HTA organizations evaluate their PPI activities using a range of strategies that reflect the range of rationales and approaches to PPI in HTA. It will be important for HTA organizations to draw on evaluation theories and methods.
Publisher: Wiley
Date: 03-2022
Abstract: To identify challenges faced by Australian hospital healthcare staff during the COVID‐19 pandemic. We conducted an online survey (30 June–15 August 2020) of healthcare staff from Australian emergency and infectious disease departments. Participants were contacted via professional organisations and asked about preparedness, personal protective equipment (PPE), information flow, patient care, infection concerns, workload and mental health. We calculated the proportion of answers to yes/no and Likert‐style questions free‐text responses were analysed thematically. Respondents ( n = 162) were 23–67 years old, 98% worked in EDs, 68% were female, 87% from Queensland, and most worked as nurses (46%) or specialists (31%). Respondents felt their workplace was prepared for the pandemic (79%), had sufficient information about PPE (83%) none were sent home because of PPE shortages. Eighty‐five percent received sufficient information from official bodies and 50% were aware of the National COVID‐19 Clinical Evidence Taskforce guidelines. Most (83%) had sufficient information to provide optimal patient care, but 24% experienced unfair/abusive patient behaviour. Most (76%) were concerned about becoming infected by patients, 67% about infecting patients, and 78% about infecting someone at home. Workload decreased for 82% but 42% looked after more patients. Fifty‐seven percent experienced additional work‐related stress: 60% reporting experiencing anxiety and 53% experiencing burnout, with 36% and 46% continuing to experience these, respectively. Key challenges included: emotional, workplace/organisational, family/loved ones and PPE factors. The Australian system provided sufficient information and PPE. Staff experienced considerable stress, infection concerns and emotional challenges, which merit consideration in preparing for the future.
Publisher: JMIR Publications Inc.
Date: 28-07-2021
Abstract: ental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. his study aims to conduct a robust evidence synthesis to assess whether there is evidence of differences between telehealth and face-to-face care for the management of less common mental and physical health conditions requiring psychotherapy. n this systematic review, we included randomized controlled trials comparing telehealth (telephone, video, or both) versus the face-to-face delivery of psychotherapy for less common mental health conditions and physical health conditions requiring psychotherapy. The psychotherapy delivered had to be comparable between the telehealth and face-to-face groups, and it had to be delivered by general practitioners, primary care nurses, or allied health staff (such as psychologists and counselors). Patient (symptom severity, overall improvement in psychological symptoms, and function), process (working alliance and client satisfaction), and financial (cost) outcomes were included. total of 12 randomized controlled trials were included, with 931 patients in aggregate therapies included cognitive behavioral and family therapies delivered in populations encompassing addiction disorders, eating disorders, childhood mental health problems, and chronic conditions. Telehealth was delivered by video in 7 trials, by telephone in 3 trials, and by both in 1 trial, and the delivery mode was unclear in 1 trial. The risk of bias for the 12 trials was low or unclear for most domains, except for the lack of the blinding of participants, owing to the nature of the comparison. There were no significant differences in symptom severity between telehealth and face-to-face therapy immediately after treatment (standardized mean difference [SMD] 0.05, 95% CI −0.17 to 0.27) or at any other follow-up time point. Similarly, there were no significant differences immediately after treatment between telehealth and face-to-face care delivery on any of the other outcomes meta-analyzed, including overall improvement (SMD 0.00, 95% CI −0.40 to 0.39), function (SMD 0.13, 95% CI −0.16 to 0.42), working alliance client (SMD 0.11, 95% CI −0.34 to 0.57), working alliance therapist (SMD −0.16, 95% CI −0.91 to 0.59), and client satisfaction (SMD 0.12, 95% CI −0.30 to 0.53), or at any other time point (3, 6, and 12 months). ith regard to effectively treating less common mental health conditions and physical conditions requiring psychological support, there is insufficient evidence of a difference between psychotherapy delivered via telehealth and the same therapy delivered face-to-face. However, there was no includable evidence in this review for some serious mental health conditions, such as schizophrenia and bipolar disorders, and further high-quality research is needed to determine whether telehealth is a viable, equivalent treatment option for these conditions.
Publisher: F1000 Research Ltd
Date: 11-11-2019
DOI: 10.12688/F1000RESEARCH.21145.1
Abstract: Background : The impact of school holidays on influenza rates has been sparsely documented in Australia. In 2019, the early winter influenza season coincided with mid-year school breaks, enabling us the unusual opportunity to examine how influenza incidence changed during school closure dates. Methods : The weekly influenza data from five Australian state and one territory health departments for the period of week 19 (mid-May) to week 35 (early September) 2019 were compared to each state’s public school closure dates. We used segmented regression to model the weekly counts and a negative binomial distribution to account for overdispersion due to autocorrelation. The models’ goodness-of-fit was assessed by plots of observed versus expected counts, plots of residuals versus predicted values, and Pearson’s Chi-square test. The main exposure was the July two-week school vacation period, using a lag of one week. The effect is estimated as a percent change in incidence level, and in slope. We also dichotomized the change in weekly counts into decreases versus increases (or no change). The proportion of decreases were then compared for each of three periods (pre-vacation, vacation, post-vacation) using Fishers exact test. Results : School holidays were associated with significant declines in influenza incidence. The models showed acceptable goodness-of-fit. The numbers and percentages of decreases in weekly influenza counts from the previous week for all states combined were: 19 (33%) pre-vacation 11 (92%) decreases during the vacation and 19 (59%) decreases post-vacation (P=0.0002). The first decline during school holidays is seen in the school aged (5-19 years) population, with the declines in the adult and infant populations being smaller and following a week later. Conclusions : Given the significant and rapid reductions in incidence, these results have important public health implications. Closure or extension of holiday periods could be an emergency option for state governments.
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-044364
Abstract: To identify, appraise and synthesise studies evaluating the downsides of wearing face masks in any setting. We also discuss potential strategies to mitigate these downsides. Systematic review and meta-analysis. PubMed, Embase, CENTRAL and EuropePMC were searched (inception–18 May 2020), and clinical registries were searched via CENTRAL. We also did a forward–backward citation search of the included studies. We included randomised controlled trials and observational studies comparing face mask use to any active intervention or to control. Two author pairs independently screened articles for inclusion, extracted data and assessed the quality of included studies. The primary outcomes were compliance, discomforts, harms and adverse events of wearing face masks. We screened 5471 articles, including 37 (40 references) 11 were meta-analysed. For mask wear adherence, 47% (95% CI 25% to 68%, p .0001), more people wore face masks in the face mask group compared with control adherence was significantly higher (26%, 95% CI 8% to 46%, p .01) in the surgical/medical mask group than in N95/P2 group. The largest number of studies reported on the discomfort and irritation outcome (20 studies) fewest reported on the misuse of masks, and none reported on mask contamination or risk compensation behaviour. Risk of bias was generally high for blinding of participants and personnel and low for attrition and reporting biases. There are insufficient data to quantify all of the adverse effects that might reduce the acceptability, adherence and effectiveness of face masks. New research on face masks should assess and report the harms and downsides. Urgent research is also needed on methods and designs to mitigate the downsides of face mask wearing, particularly the assessment of possible alternatives. Open Science Framework website osf.io/sa6kf/ (timest 20-05-2020).
Publisher: Cold Spring Harbor Laboratory
Date: 03-02-2021
DOI: 10.1101/2021.02.01.21250961
Abstract: We conducted a survey to identify what types of health research could be exempted from research ethics reviews in Australia. We surveyed active Australian health researchers and members of Human Research Ethics Committees (HREC). We presented the respondents with eight hypothetical research scenarios, involving: N of 1 trials, no treatment studies, linked data sets, surplus s les, audits, surveys, interviews with patients, and professional opinion. We asked whether these scenarios should or should not be exempt from ethics review, and to provide (optional) explanations. We analysed the reasons thematically, to identify Top 3 reasons underlying the decisions. Most frequent reasons for requiring ethics reviews, included: the need for independent oversight, privacy/confidentiality issues, review of scientific rigour, and publishing considerations. Most frequent reasons for exempting scenarios from reviews, included: level of risk, study design, privacy/confidentiality issues, and standard clinical practice. Four research scenarios listed the same Top 3 reasons for requiring ethics reviews: need for independent oversight, review of scientific rigour, privacy/confidentiality. Reasons for exempting were less uniform, but low risk was a Top 3 reason for 7 scenarios, and study design for 4 scenarios. Privacy/confidentiality was given as a Top 3 reason for both requiring and exempting from ethics the same two scenarios. The most frequently offered reasons in support of requiring ethics reviews for research scenarios are more uniform than those for exempting them. However, considerable disagreement exists about when the risks of research are so minimal that the exemption is appropriate.
Publisher: JMIR Publications Inc.
Date: 14-06-2023
Abstract: elehealth (the provision of healthcare via telephone or video) has been used for healthcare delivery for decades, but the COVID-19 pandemic greatly accelerated the uptake of telehealth in many care settings globally. Given the now widespread use of telehealth and the predominance of telephone over video consultation, it is important to compare the effectiveness and acceptability of telehealth delivered via telephone to video. o identify and synthesise randomised controlled trials, which compares synchronous telehealth consultations delivered by telephone versus video. ubMed (MEDLINE), Embase, and CENTRAL via the Cochrane Library were searched from inception until 10 Feb 2023 for randomised controlled trials. Forward and backward citation searches were conducted on included randomised controlled trials. Cochrane Risk of Bias-2 tool was used to assess the quality of the studies. ixteen randomised controlled trials – 10 in the United States, 3 in the UK, 2 in Canada, 1 in Australia involving 1719 participants were included in the qualitative and quantitative analyses. Most of the telehealth interventions were for hospital-based outpatient follow ups, monitoring, and rehabilitation (n = 13). The 3 studies that were conducted in the community all studied smoking cessation. In half of the studies, nurses delivered the care (n=8). Almost all included studies had high or unclear risk of bias, mainly due to bias in the randomization process and selection of reported results. The trials found no substantial differences between telephone and video telehealth consultations on clinical effectiveness, patient satisfaction, and healthcare use (cost effectiveness) outcomes. None of the studies reported on patient safety or adverse events. We did not find any study on telehealth interventions for diagnosis, initiating new treatment, or were set in primary care. ased on small set of erse trials, we found no important differences between telephone and video consultations for management of patients with established diagnosis. rotocol was registered on Open Science Framework osf.io/74wxf
Publisher: Springer Science and Business Media LLC
Date: 20-06-2019
Publisher: American Medical Association (AMA)
Date: 06-2022
Publisher: SAGE Publications
Date: 12-10-2022
DOI: 10.1177/15562646211048268
Abstract: We created a petition for a national inquiry into the Australian system of research ethics and governance, to inform the politicians about the problems with the existing system. We analyzed the reasons that signatories offered for why signing the petition was important to them. A total of 409 comments (by 805 signatories) focused on five major themes: (1) views on previous changes to the system of research ethics and governance (2) drawbacks of the existing system (3) suggested changes to the system (4) anticipated impacts of changing the system and (5) miscellaneous/other comments. Comments ranged from several words to over 400 words in length, and most often focused on the procedural aspects, and commented on theme 2: drawbacks of the existing system.
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.JCLINEPI.2019.09.018
Abstract: Factorial designs can allow efficient evaluation of multiple treatments within a single trial. We evaluated the design, analysis, and reporting in a s le of factorial trials. Review of 2 × 2 factorial trials evaluating health-related interventions and outcomes in humans. Using Medline, we identified articles published between January 2015 and March 2018. We randomly selected 100 articles for inclusion. Most trials (78%) did not provide a rationale for using a factorial design. Only 63 trials (63%) assessed the interaction for the primary outcome, and 39/63 (62%) made a further assessment for at least one secondary outcome. 12/63 trials (19%) identified a significant interaction for the primary outcome and 16/39 trials (41%) for at least one secondary outcome. Inappropriate methods of analysis to protect against potential negative effects from interactions were common, with 18 trials (18%) choosing the analysis method based on a preliminary test for interaction, and 13% (n = 10/75) of those conducting a factorial analysis including an interaction term in the model. Reporting of factorial trials was often suboptimal, and assessment of interactions was poor. Investigators often used inappropriate methods of analysis to try to protect against adverse effects of interactions.
Publisher: Wiley
Date: 26-02-2021
DOI: 10.1002/ASE.2049
Publisher: Elsevier BV
Date: 05-2023
Publisher: Springer Science and Business Media LLC
Date: 10-01-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2020
Publisher: Wiley
Date: 24-11-2021
DOI: 10.1002/NAU.24839
Abstract: Biological rationale suggests that parasympathomimetics (cholinergic receptor stimulating agents) could be beneficial for patients with underactive bladder. However, no systematic review with meta‐analysis addressing potential benefits or adverse effects exists. The aim of this review was to assess the effectiveness, both benefits and harms, of using parasympathomimetics for the treatment of underactive bladder. The protocol was registered in PROSPERO, and searches undertaken in PubMed, Embase, and CENTRAL, including randomized and non‐randomized controlled trials of patients with underactive bladder, comparing parasympathomimetic to placebo, no treatment, or other pharmaceuticals. Risk ratios, odds ratios, and mean differences were calculated. Twelve trials with 3024 participants were included. There was a significant difference between parasympathomimetics and comparators (favoring parasympathomimetics) in the number of patients with urinary retention (risk ratio 0.55, 95% confidence interval [CI] 0.3–0.98, p = 0.04, low quality of evidence). There was no difference in mean postvoid volume overall (MD −41.4 ml, 95% CI −92.0 to 9.1, p = 0.11, low quality of evidence). There was a significant difference at up to 1 week post‐intervention, favoring parasympathomimetics (MD −77.5 ml, 95% CI −90.9 to −64.1, p 0.001, low quality of evidence), but no difference at 1 month post‐intervention. There was no difference in adverse events (odds ratio 1.19, 95% CI 0.62–2.28, p = 0.6, moderate quality of evidence). The evidence supporting the use of parasympathomimetics is of low quality, with relatively short follow‐up durations. Overall, it is not possible to draw clear evidence‐based conclusions from the current literature, presenting the use of parasympathomimetics for treating underactive bladder as a key area that requires future well‐controlled clinical trials.
Publisher: Springer Science and Business Media LLC
Date: 27-03-2023
DOI: 10.1007/S11606-023-08166-8
Abstract: The ongoing COVID-19 pandemic has revealed gender-specific differences between general practitioners in adapting to the posed challenges. As primary care workforce is becoming increasingly female, in many countries, it is essential to take a closer look at gender-specific influences when the global health care system is confronted with a crisis. To explore gender-specific differences in the perceived working conditions and gender-specific differences in challenges facing GPs at the beginning of the COVID-19 pandemic in 2020. Online survey in seven countries. 2,602 GPs from seven countries (Austria, Australia, Switzerland, Germany, Hungary, Italy, Slovenia). Of the respondents, 44.4% (n = 1,155) were women. Online survey. We focused on gender-specific differences in general practitioners’ perceptions of working conditions at the beginning of the COVID-19 pandemic in 2020. Female GPs rated their skills and self-confidence significantly lower than male GPs (f: 7.1, 95%CI: 6.9–7.3 vs. m: 7.6, 95%CI 7.4–7.8 p .001), and their perceived risk (concerned about becoming infected or infecting others) higher than men (f: 5.7, 95%CI: 5.4–6.0 vs. m: 5.1, 95%CI: 4.8–5.5 p = .011). Among female GPs, low self-confidence in the treatment of COVID-19 patients appear to be common. Results were similar in all of the participating countries. Female and male GPs differed in terms of their self-confidence when dealing with COVID-19-related issues and their perceptions of the risks arising from the pandemic. To ensure optimal medical care, it is important that GPs realistically assess their own abilities and overall risk.
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2021-055428
Abstract: Organisations that develop clinical practice guidelines (CPGs) encourage involvement of patients and the publics in their development, however, there are no standard methodologies for doing so. To examine how CPGs report patient and public involvement (PPI), we conducted a scoping review of the evidence addressing the following four questions: (1) who are the patients and publics involved in developing the CPG? (2) from where and how are the patients and publics recruited? (3) at what stage in the CPG development process are the patients and publics involved? and (4) how do the patients and publics contribute their views? We also extracted data on the use of PPI reporting checklists by the included studies. We used the methodology developed by Arksey and O’Malley and refined by the Joanna Briggs Institute. We searched PubMed, Embase, CINAHL and PsycINFO, websites of national guideline bodies from the UK, Canada, Australia and the USA, and conducted a forward citation search. No language, date or participant demographics restrictions were applied. Data were synthesised narratively. We included 47 studies addressing 1 or more of the 4 questions. All included studies reported who the patient and publics involved (PPI members) were, and several studies reported PPI members from different groups. Patients were reported in 43/47 studies, advocates were reported in 22/47 studies, patients and advocates reported in 17/47 studies, and general public reported in 2/47 studies. Thirty-four studies reported from where the patients and publics were recruited, with patient groups being the most common (20/34). Stage of involvement was reported by 42/47 studies, most commonly at question identification (26/42) and draft review (18/42) stages. Forty-two studies reported how the patients contributed, most commonly via group meetings (18/42) or in idual interviews. Ten studies cited or used a reporting checklist to report findings. Our scoping review has revealed knowledge gaps to inform future research in several ways: replication, terminology and inclusion. First, no standard approach to PPI in CPG development could be inferred from the research. Second, inconsistent terminology to describe patients and publics reduces clarity around which patients and publics have been involved in developing CPGs. Finally, the under-representation of research describing PPI in the development of screening, as opposed to treatment, CPGs warrants further attention.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.IJANTIMICAG.2018.04.005
Abstract: Large quantities of antimicrobials are given to food animals, particularly in feed, potentially increasing antimicrobial resistance in humans. However, the magnitude of this effect is unclear. We searched PubMed, Embase and Web of Science for studies on interventions that limited antimicrobial use in food animals, in any setting and context, to reduce antimicrobial resistance 1) in those food animals and 2) in humans. We validated our strategy by testing whether it identified known relevant studies. Data from included studies were extracted into pre-designed and pilot-tested forms. We included 104 articles containing 93 studies. Heterogeneity (different animal species, environs, antimicrobial classes, interventions, administration routes, s ling, and methods), was considerable, precluding meta-analysis. The evidence was therefore synthesised narratively. A total of 89 studies (3 directly, 86 indirectly) addressed whether limiting antimicrobial exposure in food animals led to decreased antimicrobial resistance in those animals. The evidence was adequate to conclude this, although the magnitude of the effect could not be quantified. Four studies (1 directly, 3 indirectly) examined whether withdrawal of antibiotics changed resistance of potential pathogens in retail food for human consumption, and in bacteria of humans themselves. The direct (observational) study of broiler hatchery in ovo antimicrobial injection found a credible effect in terms of size reduction and time sequences. Limiting antimicrobial use in food animals reduces antimicrobial resistance in food animals, and probably reduces antimicrobial resistance in humans. The magnitude of the effect cannot be quantified.
Publisher: BMJ
Date: 11-01-2021
DOI: 10.1136/MEDETHICS-2020-106785
Abstract: We conducted a survey to identify what types of health/medical research could be exempt from research ethics reviews in Australia. We surveyed Australian health/medical researchers and Human Research Ethics Committee (HREC) members. The survey asked whether respondents had previously changed or abandoned a project anticipating difficulties obtaining ethics approval, and presented eight research scenarios, asking whether these scenarios should or should not be exempt from ethics review, and to provide (optional) comments. Qualitative data were analysed thematically quantitative data in R. We received 514 responses. Forty-three per cent of respondents to whom the question applied, reported changing projects in anticipation of obstacles from the ethics review process 25% reported abandoning projects for this reason. Research scenarios asking professional staff to provide views in their area of expertise were most commonly exempted from ethics review (to prioritise systematic review topics 84%, on software strengths/weaknesses 85%) scenarios involving surplus s les (82%) and N-of-1 (single case) studies (76%) were most commonly required to undergo ethics review. HREC members were 26% more likely than researchers to require ethics review. Need for independent oversight, and low risk, were most frequently cited in support of decisions to require or exempt from ethics review, respectively. Considerable differences exist between researchers and HREC members, about when to exempt from review the research that ultimately serves the interests of patients and the public. It is widely accepted that evaluative research should be used to reduce clinical uncertainties—the same principle should apply to ethics reviews.
Publisher: Cambridge University Press (CUP)
Date: 2016
DOI: 10.1017/S0266462316000556
Abstract: Objectives: Although consideration of ethical issues is recognized as a crucial part of health technology assessment, ethics analysis for HTA is generally perceived as methodologically underdeveloped in comparison to other HTA domains. The aim of our study is (i) to verify existing tools for quality assessment of ethics analyses for HTA, (ii) to consider some arguments for and against the need for quality assessment tools for ethics analyses for HTA, and (iii) to propose a preliminary set of criteria that could be used for assessing the quality of ethics analyses for HTA. Methods: We systematically reviewed the literature, reviewed HTA organizations’ Web sites, and solicited views from thirty-two experts in the field of ethics for HTA. Results: The database and HTA agency Web site searches yielded 420 references (413 from databases, seven from HTA Web sites). No formal instruments for assessing the quality of ethics analyses for HTA purposes were identified. Thirty-two experts in the field of ethics for HTA from ten countries, who were brought together at two workshops held in Edmonton (Canada) and Cologne (Germany) confirmed the findings from the literature. Conclusions: Generating a quality assessment tool for ethics analyses in HTA would confer considerable benefits, including methodological alignment with other areas of HTA, increase in transparency and transferability of ethics analyses, and provision of common language between the various participants in the HTA process. We propose key characteristics of quality assessment tools for this purpose, which can be applied to ethics analyses for HTA purposes.
Publisher: Wiley
Date: 12-03-2019
DOI: 10.1111/HEX.12880
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2020-046175
Abstract: To compare the effectiveness of hand hygiene using alcohol-based hand sanitiser to soap and water for preventing the transmission of acute respiratory infections (ARIs) and to assess the relationship between the dose of hand hygiene and the number of ARI, influenza-like illness (ILI) or influenza events. Systematic review and meta-analysis. Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and trial registries were searched in April 2020. We included randomised controlled trials that compared a community-based hand hygiene intervention (soap and water, or sanitiser) with a control, or trials that compared sanitiser with soap and water, and measured outcomes of ARI, ILI or laboratory-confirmed influenza or related consequences. Two review authors independently screened the titles and abstracts for inclusion and extracted data. Eighteen trials were included. When meta-analysed, three trials of soap and water versus control found a non-significant increase in ARI events (risk ratio (RR) 1.23, 95% CI 0.78 to 1.93) six trials of sanitiser versus control found a significant reduction in ARI events (RR 0.80, 95% CI 0.71 to 0.89). When hand hygiene dose was plotted against ARI relative risk, no clear dose–response relationship was observable. Four trials were head-to-head comparisons of sanitiser and soap and water but too heterogeneous to pool: two found a significantly greater reduction in the sanitiser group compared with the soap group and two found no significant difference between the intervention arms. Adequately performed hand hygiene, with either soap or sanitiser, reduces the risk of ARI virus transmission however, direct and indirect evidence suggest sanitiser might be more effective in practice.
Publisher: Informa UK Limited
Date: 30-10-2023
Publisher: SAGE Publications
Date: 13-10-2023
Publisher: Australian Nursing and Midwifery Federation
Date: 25-08-2021
Publisher: Frontiers Media SA
Date: 06-12-2022
DOI: 10.3389/FPUBH.2022.1072515
Abstract: General practitioners (GPs) are frequently patients' first point of contact with the healthcare system and play an important role in identifying, managing and monitoring cases. This study investigated the experiences of GPs from seven different countries in the early phases of the COVID-19 pandemic. International cross-sectional online survey. General practitioners from Australia, Austria, Germany, Hungary, Italy, Slovenia and Switzerland. Overall, 1,642 GPs completed the survey. We focused on how well-prepared GPs were, their self-confidence and concerns, efforts to control the spread of the disease, patient contacts, information flow, testing procedures and protection of staff. GPs gave high ratings to their self-confidence (7.3, 95% CI 7.1–7.5) and their efforts to control the spread of the disease (7.2, 95% CI 7.0–7.3). A decrease in the number of patient contacts (5.7, 95% CI 5.4–5.9), the perception of risk (5.3 95% CI 4.9–5.6), the provision of information to GPs (4.9, 95% CI 4.6–5.2), their testing of suspected cases (3.7, 95% CI 3.4–3.9) and their preparedness to face a pandemic (mean: 3.5 95% CI 3.2–3.7) were rated as moderate. GPs gave low ratings to their ability to protect staff (2.2 95% CI 1.9–2.4). Differences were identified in all dimensions except protection of staff, which was consistently low in all surveyed GPs and countries. Although GPs in the different countries were confronted with the same pandemic, its impact on specific aspects differed. This partly reflected differences in health care systems and experience of recent pandemics. However, it also showed that the development of structured care plans in case of future infectious diseases requires the early involvement of primary care representatives.
Publisher: Public Library of Science (PLoS)
Date: 14-01-2022
DOI: 10.1371/JOURNAL.PONE.0261917
Abstract: Social and behavioural drivers of inappropriate antibiotic use contribute to antimicrobial resistance (AMR). Recent reports indicate the Australian community consumes more than twice the defined daily doses (DDD) of antibiotics per 1000 population than in Sweden, and about 20% more than in the United Kingdom (UK). We compare measures of public knowledge, attitudes and practices (KAP) surrounding AMR in Australia, the UK and Sweden against the policy approaches taken in these settings to address inappropriate antibiotic use. National antimicrobial stewardship policies in Australia, Sweden, and the UK were reviewed, supplemented by empirical studies of their effectiveness. We searched PubMed, EMBASE, PsycINFO, Web of Science and CINAHL databases for primary studies of the general public’s KAP around antibiotic use and AMR in each setting (January 1 2011 until July 30 2021). Where feasible, we meta-analysed data on the proportion of participants agreeing with identical or very similar survey questions, using a random effects model. Policies in Sweden enact tighter control of community antibiotic use reducing antibiotic use through public awareness raising is not a priority. Policies in the UK and Australia are more reliant on practitioner and public education to encourage appropriate antibiotic use. 26 KAP were included in the review and 16 were meta-analysable. KAP respondents in Australia and the UK are consistently more likely to report beliefs and behaviours that are not aligned with appropriate antibiotic use, compared to participants in similar studies conducted in Sweden. Interactions between public knowledge, attitudes and their impacts on behaviours surrounding community use of antibiotics are complex and contingent. Despite a greater focus on raising public awareness in Australia and the UK, neither antibiotic consumption nor community knowledge and attitudes are changing significantly. Clearly public education c aigns can contribute to mitigating AMR. However, the relative success of policy approaches taken in Sweden suggests that practice level interventions may also be required to activate prescribers and the communities they serve to make substantive reductions in inappropriate antibiotic use.
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPEN-2020-045406
Abstract: Transparent reporting of trials is necessary to assess their internal and external validity. Currently, little is known about the quality of reporting in antibiotics trials. Our study investigates the reporting of adverse events, conflicts of interest and funding information in trials of penicillins, cephalosporins and macrolides. A secondary analysis of trials included in a convenience s le of three systematic reviews. All randomised controlled trials included in the systematic reviews were included, although duplicates were removed. Eligible trials compared the specified antibiotics to placebo, for any indication. Author pairs independently extracted the data on reporting of adverse events from parent reviews, and data on funding and conflict of interest information from the trial reports. We calculated the overall proportion of trials reporting adverse events, conflict of interest information and funding information, and their proportion before and after the publication of the Consolidated Standards of Reporting Trials (CONSORT) 2001 Statement. We included 432 trials. Overall, 62% of trials reported adverse events of any kind, although reporting of deaths or antibiotic resistance was less frequent (20% and 37%, respectively). Conflict-of-interest information was provided in 26% of the trials, and funding information was provided in 66% of the trials. There was no significant difference in reporting of adverse events before and after the publication of CONSORT 2001 Statement (62% vs 62%, p=0.92). Conflict of interest statements were provided more frequently (2% vs 55%, p .001) and conflict was present more often (0% vs 14%, p .001). There was no difference in the provision of the information about trial funding before (62%) and after (70%) CONSORT 2001 publication. Information about adverse events, conflict of interest and funding, remains under-reported in trials of antibiotics.
Publisher: Royal College of General Practitioners
Date: 17-01-2021
Abstract: Urinary tract infections (UTIs) are often treated with antibiotics and are a source of antibiotic overuse. To systematically review randomised controlled trials (RCTs) of adult women in the community with a history of recurrent UTIs and who use methenamine hippurate prophylactically. Systematic review of women in the UK, Australia, Norway, and US (aged ≥18 years) with recurrent UTIs receiving methenamine hippurate against placebo or no treatment, and antibiotics. The authors searched three databases, clinical trial registries, and performed forward–backward citation analysis on references of included studies. Six studies involving 557 participants were included (447 were analysed). Of the six studies, five were published and one was an unpublished trial record with results, three compared methenamine hippurate against placebo or control, and three compared methenamine hippurate with antibiotics. For the number of patients who remained asymptomatic, methenamine hippurate showed a non-statistically significant trend of benefit versus antibiotics over 12 months (risk ratio [RR] 0.65, 95% confidence interval [CI] = 0.40 to 1.07, I 2 49%), versus control over 6 or 12 months (RR 0.56, 95% CI = 0.13 to 2.35, I 2 93%), and a non-statistically significant trend versus any antibiotic for abacteruria (RR 0.80, 95% CI = 0.62 to 1.03, I 2 23%). A similar non-statistically significant trend of benefits for methenamine hippurate for the number of UTI or bacteriuric episodes was found, and a non-statistically significant difference in the number of patients experiencing adverse events between methenamine hippurate and any comparator, with a trend towards benefit for the methenamine hippurate, was identified. Antibiotic use and resistance were not consistently reported. There is insufficient evidence to be certain of the benefits of methenamine hippurate to prevent UTI. Further research is needed to test the drug’s effectiveness in preventing UTIs and as an alternative for antibiotic treatment for UTI.
Publisher: Springer Science and Business Media LLC
Date: 17-10-2015
Publisher: BMJ
Date: 22-05-2017
DOI: 10.1136/BMJ.J2398
Publisher: Elsevier BV
Date: 05-2020
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: BMJ
Date: 10-2020
DOI: 10.1136/BMJOPEN-2020-037327
Abstract: Clinical practice guidelines (CPGs) are intended to optimise patient care by recommending care pathways based on the best available research evidence and practice experience. Patient and public involvement (PPI) in healthcare is recommended based on the expectation that it will improve the quality and relevance of outcomes. There is no consensus on what constitutes meaningful and effective PPI in CPG. We will conduct a scoping review to identify and synthesise knowledge in four key areas: who have been the patients and public previously involved in CPG development, how were they recruited, at what stage in the CPG process were they involved and how were they involved. This knowledge will inform a general model of PPI in CPG to inform CPGs development. We will conduct a scoping review using the Methodology for Scoping Reviews refined by the Joanna Briggs Institute. Searches will be conducted in electronic databases (PubMed, Embase, CINAHL and PsycINFO). National standards for developing CPGs from Australia, UK, Canada and the USA will also be identified. A forward and backward citation search will be conducted on the included studies and national standards. Abstracts and full-text studies will be independently screened by two researchers. Extracted data will include study details, type of clinical guideline and the four key areas, which patients and public were involved, how were they recruited, at what stage were they included and how they were involved. Data will be narratively synthesised. As a scoping review, this study does not require ethics approval. We intend to disseminate the results through publication in a peer-reviewed journal and conference presentations. Furthermore, we will use the findings from our scoping review to inform future research to fill key evidence gaps identified by this review.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Springer Science and Business Media LLC
Date: 25-05-2023
Publisher: Wiley
Date: 31-01-2018
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.JCLINEPI.2018.05.016
Abstract: Cochrane acute respiratory infections (ARIs) group conducts systematic reviews of the evidence for treatment and prevention of ARIs. We report the results of a prioritization project, aiming to identify highest priority systematic review topics. The project consisted of two phases. Phase 1 analyzed the gap between existing randomized controlled trials and Cochrane systematic reviews (reported previously). Phase 2 (reported here) consisted of a two-round survey. In round 1, respondents prioritized 68 topics and suggested up to 10 additional topics in round 2, respondents prioritized top 25 topics from round 1. Respondents included clinicians, researchers, systematic reviewers, allied health, patients, and carers, from 33 different countries. In round 1, 154 respondents identified 20 priority topics, most commonly selecting topics in nonspecific ARIs, influenza, and common cold. Fifty respondents also collectively suggested 134 additional topics. In round 2, 78 respondents prioritized top 25 topics, most commonly in the areas of nonspecific ARIs, pneumonia, and influenza. We generated a list of priority systematic review topics to guide the Cochrane ARI group's systematic review work for the next 24 months. Stakeholder involvement enhanced the transparency of the process and will increase the usability and relevance of the group's work to stakeholders.
Publisher: Wiley
Date: 21-06-2021
DOI: 10.1111/HEX.13286
Abstract: Current guidelines recommend that patients attending general practice should be screened for excess weight, and provided with weight management advice. This study sought to elicit the views of people with overweight and obesity about the role of GPs in initiating conversations about weight management. Participants with a body mass index ≥25 were recruited from a region in Australia to take part in a Community Jury. Over 2 days, participants (n = 11) deliberated on two interconnected questions: ‘Should GPs initiate discussions about weight management?’ And ‘if so, when: (a) opportunistically, (b) in the context of disease prevention, (c) in the context of disease management or (d) other?’ The jury deliberations were analysed qualitatively to elicit their views and recommendations. The jury concluded GPs should be discussing weight management, but within the broader context of general health. The jury were ided about the utility of screening. Jurors felt GPs should initiate the conversation if directly relevant for disease prevention or management, otherwise GPs should provide opportunities for patients to consent to the issue being raised. The jury's verdict suggests informed people affected by overweight and obesity believe GPs should discuss weight management with their patients. GPs should feel reassured that discussions are likely to be welcomed by patients, particularly if embedded within a more holistic focus on person‐centred care. Members of the public took part in the conduct of this study as jurors, but were not involved in the design, analysis or write‐up.
Publisher: Cambridge University Press (CUP)
Date: 12-08-2022
DOI: 10.1017/S0033291722002331
Abstract: Ensuring continuity of care for patients with major depressive disorders poses multiple challenges. We conducted a systematic review and meta-analysis of randomised controlled trials comparing real-time telehealth to face-to-face therapy for in iduals with depression. We searched Medline, Embase, and Cochrane Central (to November 2020), conducted a citation analysis (January 2021), and searched clinical trial registries (March 2021). We included randomised controlled trials comparing similar or identical care, delivered via real-time telehealth (phone, video) to face-to-face. Outcomes included: depression severity, quality of life, therapeutic alliance, and care satisfaction. Where data were sufficient, mean differences were calculated. Nine trials (1268 patients) were included. There were no differences between telehealth and face-to-face care for depression severity at post-treatment (SMD −0.04, 95% CI −0.21 to 0.13, p = 0.67) or at other time points, except at 9 months post-treatment (SMD −0.39, 95% CI −0.75 to −0.02, p = 0.04). One trial reported no differences in quality-of-life scores at 3- or 12-months post-treatment. One trial found no differences in therapeutic alliance at weeks 4 and 14 of treatment. There were no differences in treatment satisfaction between telehealth and face-to-face immediately post-treatment (SMD −0.14, 95% CI −0.56 to 0.28, p = 0.51) or at 3 or 12-months. Evidence suggests that for patients with depression or depression symptoms, the provision of care via telehealth may be a viable alternative to the provision of care face-to-face. However, additional trials are needed with longer follow-up, conducted in a wider range of settings, and with younger patients.
Publisher: Wiley
Date: 03-02-2019
DOI: 10.1111/HEX.12871
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.JCLINEPI.2018.11.002
Abstract: Cochrane systematic reviews require more methodological support from Cochrane Review Groups (CRGs) than is customarily received by authors from journals CRGs must therefore prioritize reviews to conserve resources. The TRIP database provided a data set of questions to guide prioritization for the acute respiratory infections (ARIs) CRG. We extracted the ARI searches from the TRIP database (2010 to 2017) that contained at least one disease and one clinical management term, (defined as a "search"), and tabulated these by frequency. There were 314,346 ARI searches from which we inferred 45,497 clinical questions, covering 365 topics. Two-thirds (30,541) of these addressed 20 clinical questions, of which treatment were the most frequent, followed by diagnosis, mortality, and prognosis. The five most frequent clinical questions were "Influenza + Vaccination" 4,989 (12.1%), "acute otitis media + antibiotics" 3,578 (8.7%), "common cold + vitamin C" 3,528 (8.6%), "meningitis + corticosteroids" 1,910 (4.6%), and "pneumonia + general treatment" 1,765 (4.3%). The 20 most frequent clinical questions were addressed by Cochrane reviews or protocols. ARI questions are common and repeated often. Most may have been addressed by Cochrane reviews. The remainder form the basis of a priority list to assign resources for future Cochrane topics.
Publisher: Annals of Family Medicine
Date: 11-2019
DOI: 10.1370/AFM.2445
Publisher: Elsevier BV
Date: 10-2024
Publisher: F1000 Research Ltd
Date: 13-04-2022
DOI: 10.12688/F1000RESEARCH.109490.1
Abstract: Risk prediction models are potentially useful tools for health practitioners and policy makers. When new predictors are proposed to add to existing models, the improvement of discrimination is one of the main measures to assess any increment in performance. In assessing such predictors, we observed two paradoxes: 1) the discriminative ability within all in idual risk strata was worse than for the overall population 2) incremental discrimination after including a new predictor was greater within each in idual risk strata than for the whole population. We show two ex les of the paradoxes and analyse the possible causes. The key cause of bias is use of the same prediction model as for both stratifying the population, and as the base model to which the new predictor is added.
Publisher: Wiley
Date: 19-01-2017
DOI: 10.1002/JCLA.22142
Publisher: SAGE Publications
Date: 11-11-2021
Publisher: Wiley
Date: 18-01-2019
Publisher: Elsevier BV
Date: 10-2021
Publisher: Springer Science and Business Media LLC
Date: 10-01-2017
Publisher: Springer Science and Business Media LLC
Date: 27-11-2018
Publisher: WHO Press
Date: 2023
Publisher: AMPCo
Date: 23-10-2017
DOI: 10.5694/MJA17.00574
Abstract: In Australia, the antibiotic resistance crisis may be partly alleviated by reducing antibiotic use in general practice, which has relatively high prescribing rates - antibiotics are mostly prescribed for acute respiratory infections, for which they provide only minor benefits. Current surveillance is inadequate for monitoring community antibiotic resistance rates, prescribing rates by indication, and serious complications of acute respiratory infections (which antibiotic use earlier in the infection may have averted), making target setting difficult. Categories of interventions that may support general practitioners to reduce prescribing antibiotics are: regulatory (eg, changing the default to "no repeats" in electronic prescribing, changing the packaging of antibiotics to facilitate tailored amounts of antibiotics for the right indication and restricting access to prescribing selected antibiotics to conserve them), externally administered (eg, academic detailing and audit and feedback on total antibiotic use for in idual GPs), interventions that GPs can in idually implement (eg, delayed prescribing, shared decision making, public declarations in the practice about conserving antibiotics, and self-administered audit), supporting GPs' access to near-patient diagnostic testing, and public awareness c aigns. Many unanswered clinical research questions remain, including research into optimal implementation methods. Reducing antibiotic use in Australian general practice will require a range of approaches (with various intervention categories), a sustained effort over many years and a commitment of appropriate resources and support.
Publisher: Springer Science and Business Media LLC
Date: 07-08-2018
Publisher: Wiley
Date: 21-09-2022
DOI: 10.1111/JHN.13082
Abstract: There is little known about nutrition intervention research involving consumer co‐design. The aim of this scoping review was to identify and synthesise the existing evidence on the current use and extent of consumer co‐design in nutrition interventions. This scoping review is in line with the methodological framework developed by Arksey and O'Malley and refined by the Joanna Briggs Institute using an adapted 2weekSR approach. We searched Medline, EMBASE, PsycInfo, CINAHL and Cochrane. Only studies that included consumers in the co‐design and met the ‘Collaborate’ or ‘Empower’ levels of the International Association of Public Participation's Public Participation Spectrum were included. Studies were synthesised according to two main concepts: (1) co‐design for (2) nutrition interventions. The initial search yielded 8157 articles, of which 19 studies were included (comprising 29 articles). The studies represented a range of intervention types and participants from seven countries. Sixteen studies were published in the past 5 years. Co‐design was most often used for intervention development, and only two studies reported a partnership with consumers across all stages of research. Overall, consumer involvement was not well documented. No preferred co‐design framework or approach was reported across the various studies. Consumer co‐design for nutrition interventions has become more frequent in recent years, but genuine partnerships with consumers across all stages of nutrition intervention research remain uncommon. There is an opportunity to improve the reporting of consumer involvement in co‐design and enable equal partnerships with consumers in nutrition research.
Publisher: Wiley
Date: 23-02-2020
DOI: 10.1111/HEX.13036
Publisher: German Medical Science GMS Publishing House
Date: 2017
DOI: 10.3205/HTA000128
Publisher: Cambridge University Press (CUP)
Date: 2017
DOI: 10.1017/S0266462317000241
Abstract: Objectives: Some countries make considerable effort to involve patients and patient groups in their health technology assessment (HTA) processes others are only just considering or are yet to consider patient involvement in HTA. Methods: This commentary offers four arguments why patient involvement should be prioritized by those HTA agencies that do not yet involve patients: (1) from a patients’ rights perspective, (2) based on patient and community values, (3) centering on evidentiary contributions, and (4) from a methodological perspective. Results: The first argument builds on the Alma-Ata Declaration, which holds that patients have a right and duty to have a say in the planning and delivery of their health care, in idually and collectively. Where HTA is used to determine access to technologies and services, we argue that patients have a right to be heard. The second argues that decisions about treatments and services need to be aligned with the core values and morals of the patients whom the health system serves. The third argues that patients have unique knowledge and insights about living with a health condition and their needs for services and treatments regarding that condition, which can add to the knowledge base and value of the HTA process. The fourth argues that involvement of patients can facilitate methodological advancement of HTA, in areas such as early scientific advice and managed entry with evidence development. Conclusions: An HTA process that includes patient perspectives can, therefore, provide added value to patients, policy makers and healthcare professionals alike.
Publisher: F1000 Research Ltd
Date: 26-05-2021
DOI: 10.12688/F1000RESEARCH.21145.3
Abstract: Background : The impact of school holidays on influenza rates has been sparsely documented in Australia. In 2019, the early winter influenza season coincided with mid-year school breaks, enabling us the unusual opportunity to examine how influenza incidence changed during school holiday closure dates. Methods : The weekly influenza data from five Australian state and one territory health departments for the period of week 19 (mid-May) to week 39 (early October) 2019 were compared to each state’s public-school holiday closure dates. We used segmented regression to model the weekly counts and a negative binomial distribution to account for overdispersion due to autocorrelation. The models’ goodness-of-fit was assessed by plots of observed versus expected counts, plots of residuals versus predicted values, and Pearson’s Chi-square test. The main exposure was the July two-week school holiday period, using a lag of one week. The effect is estimated as a percent change in incidence level, and in slope. Results : School holidays were associated with significant declines in influenza incidence in three states and one territory by between 41% and 65%. Two states did not show evidence of declines although one of those states had already passed its peak by the time of the school holidays. The models showed acceptable goodness-of-fit. The first decline during school holidays is seen in the school aged (5-19 years) population, with the declines in the adult and infant populations being smaller and following a week later. Conclusions : Given the significant and rapid reductions in incidence, these results have important public health implications. Closure or extension of holiday periods could be an emergency option for state governments.
Publisher: Springer Science and Business Media LLC
Date: 25-11-2017
Publisher: F1000 Research Ltd
Date: 08-10-2020
DOI: 10.12688/F1000RESEARCH.21145.2
Abstract: Background : The impact of school holidays on influenza rates has been sparsely documented in Australia. In 2019, the early winter influenza season coincided with mid-year school breaks, enabling us the unusual opportunity to examine how influenza incidence changed during school holiday closure dates. Methods : The weekly influenza data from five Australian state and one territory health departments for the period of week 19 (mid-May) to week 39 (early October) 2019 were compared to each state’s public-school holiday closure dates. We used segmented regression to model the weekly counts and a negative binomial distribution to account for overdispersion due to autocorrelation. The models’ goodness-of-fit was assessed by plots of observed versus expected counts, plots of residuals versus predicted values, and Pearson’s Chi-square test. The main exposure was the July two-week school holiday period, using a lag of one week. The effect is estimated as a percent change in incidence level, and in slope. Results : School holidays were associated with significant declines in influenza incidence in three states and one territory by between 41% and 65%. Two states did not show evidence of declines although one of those states had already passed its peak by the time of the school holidays. The models showed acceptable goodness-of-fit. The first decline during school holidays is seen in the school aged (5-19 years) population, with the declines in the adult and infant populations being smaller and following a week later. Conclusions : Given the significant and rapid reductions in incidence, these results have important public health implications. Closure or extension of holiday periods could be an emergency option for state governments.
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: JMIR Publications Inc.
Date: 11-03-2022
DOI: 10.2196/31780
Abstract: Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. This study aims to conduct a robust evidence synthesis to assess whether there is evidence of differences between telehealth and face-to-face care for the management of less common mental and physical health conditions requiring psychotherapy. In this systematic review, we included randomized controlled trials comparing telehealth (telephone, video, or both) versus the face-to-face delivery of psychotherapy for less common mental health conditions and physical health conditions requiring psychotherapy. The psychotherapy delivered had to be comparable between the telehealth and face-to-face groups, and it had to be delivered by general practitioners, primary care nurses, or allied health staff (such as psychologists and counselors). Patient (symptom severity, overall improvement in psychological symptoms, and function), process (working alliance and client satisfaction), and financial (cost) outcomes were included. A total of 12 randomized controlled trials were included, with 931 patients in aggregate therapies included cognitive behavioral and family therapies delivered in populations encompassing addiction disorders, eating disorders, childhood mental health problems, and chronic conditions. Telehealth was delivered by video in 7 trials, by telephone in 3 trials, and by both in 1 trial, and the delivery mode was unclear in 1 trial. The risk of bias for the 12 trials was low or unclear for most domains, except for the lack of the blinding of participants, owing to the nature of the comparison. There were no significant differences in symptom severity between telehealth and face-to-face therapy immediately after treatment (standardized mean difference [SMD] 0.05, 95% CI −0.17 to 0.27) or at any other follow-up time point. Similarly, there were no significant differences immediately after treatment between telehealth and face-to-face care delivery on any of the other outcomes meta-analyzed, including overall improvement (SMD 0.00, 95% CI −0.40 to 0.39), function (SMD 0.13, 95% CI −0.16 to 0.42), working alliance client (SMD 0.11, 95% CI −0.34 to 0.57), working alliance therapist (SMD −0.16, 95% CI −0.91 to 0.59), and client satisfaction (SMD 0.12, 95% CI −0.30 to 0.53), or at any other time point (3, 6, and 12 months). With regard to effectively treating less common mental health conditions and physical conditions requiring psychological support, there is insufficient evidence of a difference between psychotherapy delivered via telehealth and the same therapy delivered face-to-face. However, there was no includable evidence in this review for some serious mental health conditions, such as schizophrenia and bipolar disorders, and further high-quality research is needed to determine whether telehealth is a viable, equivalent treatment option for these conditions.
Publisher: Royal College of General Practitioners
Date: 27-01-2020
Abstract: Approximately 15% of community-prescribed antibiotics are used in treating urinary tract infections (UTIs). Increase in antibiotic resistance necessitates considering alternatives. To assess the impact of increased fluid intake in in iduals at risk for UTIs, for impact on UTI recurrence (primary outcome), antimicrobial use, and UTI symptoms (secondary outcomes). A systematic review. The authors searched PubMed, Cochrane CENTRAL, EMBASE, two trial registries, and conducted forward and backward citation searches of included studies in January 2019. Randomised controlled trials of in iduals at risk for UTIs were included comparisons with antimicrobials were excluded. Different time-points (≤6 months and 12 months) were compared for the primary outcome. Risk of bias was assessed using Cochrane Risk of Bias tool. Meta-analyses were undertaken where ≥3 studies reported the same outcome. Eight studies were included seven were meta-analysed. There was a statistically non-significant reduction in the number of patients with any UTI recurrence in the increased fluid intake group compared with control after 12 months (odds ratio [OR] 0.39, 95% confidence interval [CI] = 0.15 to 1.03, P = 0.06) reduction was significant at ≤6 months (OR 0.13, 95% CI = 0.07 to 0.25, P .001). Excluding studies with low volume of fluid ( ml) significantly favoured increased fluid intake (OR 0.25, 95% CI = 0.11 to 0.59, P = 0.001). Increased fluid intake reduced the overall rate of all recurrent UTIs (rate ratio [RR] 0.46, 95% CI = 0.40 to 0.54, P .001) there was no difference in antimicrobial use (OR 0.52, 95% CI = 0.25 to 1.07, P = 0.08). Paucity of data precluded meta-analysing symptoms. Given the minimal potential for harm, patients with recurrent UTIs could be advised to drink more fluids to reduce recurrent UTIs. Further research is warranted to establish the optimal volume and type of increased fluid.
Publisher: Informa UK Limited
Date: 04-03-2023
Publisher: Elsevier BV
Date: 09-2021
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH15109
Abstract: Objective Health technology assessment (HTA) is a process of assessing evidence to inform policy decisions about public subsidy of new drugs and medical procedures. Where evidence is uncertain but the technology itself is promising, funders may recommend funding on an interim basis. It is unknown whether evidence from clinical registries is used to resolve uncertainties identified in interim-funded decisions made by Australian HTA bodies. Therefore, the present study evaluated the role of evidence from clinical registries in resolving evidence uncertainties identified by the Medical Services Advisory Committee (MSAC). Methods All HTAs considered by MSAC between 1998 and 2015 were reviewed and assessments that recommended interim funding were identified. The MSAC website was searched to identify reassessments of these recommendations and sources of evidence used to resolve the uncertainties were identified. Results Of 173 HTA reports considered by MSAC, 17 (10%) contained an interim funding recommendation. Eight recommendations cited uncertainty around safety, 15 cited uncertainty around clinical effectiveness and 13 cited uncertainty around economics (cost-effectiveness and/or budget impact). Of the 17 interim funding recommendations, 11 (65%) have been reassessed. Only two reassessments relied on clinical registry evidence to resolve evidence gaps identified at the time of the interim funding recommendation. Conclusions Clinical registries are underused as a source of evidence for resolving uncertainties around promising new health technologies in Australia. An open dialogue between stakeholders on the role of registries in this context is needed. What is known about the topic? HTA is a process of assessing the evidence to inform policy decisions about public subsidy of new health technologies (e.g. pharmaceuticals, diagnostic tests, medical procedures). Where evidence is uncertain but the technology under evaluation is promising, funders may recommend the funding of the technology on a temporary basis while additional evidence is collected. Clinical registries have been suggested as a means of collecting additional evidence in these situations. What is does this paper add? It is currently unknown whether evidence from clinical registries is used to resolve uncertainties identified at the time that temporary (interim) funding decisions are made by Australia’s HTA bodies, in particular MSAC. The present study found that MSAC rarely relies on the interim funding mechanism (17/173 assessments). Of the 11 subsequent reassessments of interim recommendations, two relied on registry evidence to provide Australian-specific data for addressing uncertainties around long-term safety, effectiveness and cost-effectiveness. These findings suggest that clinical registries, although a feasible source of evidence for HTAs, are rarely used for this purpose. What are the implications for practitioners? Given the registries’ ability to resolve both a wider range of questions than those typically addressed by randomised control trials and applicability to a wider group of patients (and, hence, providing estimates of outcomes that are more generalisable), the potential of clinical registries to resolve HTA issues needs more attention from both researchers and decision makers. Stakeholder collaboration to define the evidence requirements for new technologies early in their development phase would be valuable to determine the potential role for clinical registries.
No related grants have been discovered for Anna Mae Scott.