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Starr M. Towards national paediatric clinical practice guidelines. Med J Aust 2024; 220:392-393. [PMID: 38532300 DOI: 10.5694/mja2.52272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/22/2023] [Indexed: 03/28/2024]
Affiliation(s)
- Mike Starr
- Royal Children's Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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2
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Varisco TJ, Fish H, Bolin J, Dadiomov D, Hill LG, Essien EJ, Wanat MA, Ginsburg D, Waggener J, Yazdanfard S, Song J, Chi W, Thornton D. Protocol for the development of a consensus practice guideline To address clinical and regulatory barriers to buprenorphine dispensing in community pharmacy. Arch Public Health 2024; 82:58. [PMID: 38664777 PMCID: PMC11044383 DOI: 10.1186/s13690-024-01287-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Less than half of community pharmacies in the United States stock buprenorphine products indicated for the treatment of opioid use disorder. This lack of access to buprenorphine in community pharmacies is a significant barrier to care. To address this issue, this protocol outlines a comprehensive approach to develop a practice guideline aimed at improving access to safe and effective opioid use disorder treatment in community pharmacies. METHODS The guideline development process will proceed in three phases, following a technique closely aligned with the Institute of Medicine's guidance on guideline development. The first phase will involve conducting qualitative interviews with pharmacists in three states to identify their beliefs toward buprenorphine dispensing. As limitations on buprenorphine supply are related to constraints at all levels of the drug supply and regulatory system, the second phase, we will recruit representatives from regulatory agencies, pharmacy organizations, the Drug Enforcement Administration, pharmaceutical wholesalers as well as addiction medicine physicians and psychiatric pharmacists to develop consensus recommendations through a modified Delphi design. This will be followed by a public comment period and external expert review of the recommendations led by the National Association of Boards of Pharmacy. Finally, in the third phase, a national, mixed media dissemination campaign will be led by the National Community Pharmacists Association (NCPA) to convey recommendations to practicing pharmacists. DISCUSSION The guideline development process aims to incorporate the perspectives of multiple stakeholders and emphasize the importance of addressing the regulatory and pharmacy-specific aspects of care in addition to clinical evidence and guidance. The development of this guideline will provide targeted, multidisciplinary guidance for pharmacists, improving access to safe and effective opioid use disorder treatment in the community setting. PREREGISTRATION This protocol was registered with the Open Science Framework in March of 2023. Registration may be found at: https://doi.org/10.17605/OSF.IO/6S9DY .
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Affiliation(s)
- Tyler J Varisco
- The Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, USA.
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, 77204, Houston, TX, USA.
| | - Hannah Fish
- The National Community Pharmacists Association, Alexandria, USA
| | - Joshua Bolin
- The National Association of Boards of Pharmacy, Mount Prospect, USA
| | - David Dadiomov
- Titus Family Department of Clinical Pharmacy, The University of Southern California College of Pharmacy, Los Angeles, USA
| | - Lucas G Hill
- Division of Pharmacy Practice, University of Texas at Austin College of Pharmacy, Austin, USA
| | - Ekere J Essien
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, 77204, Houston, TX, USA
| | - Matthew A Wanat
- The Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, USA
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, USA
| | - Diane Ginsburg
- Division of Pharmacy Practice, University of Texas at Austin College of Pharmacy, Austin, USA
| | - Jeanne Waggener
- The Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, USA
| | - Sahar Yazdanfard
- The Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, USA
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, 77204, Houston, TX, USA
| | - Juhyeon Song
- The Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, USA
| | - Whanhui Chi
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, 77204, Houston, TX, USA
| | - Douglas Thornton
- The Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, USA
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, 77204, Houston, TX, USA
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Wark PA, Marchant JM. Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia. Med J Aust 2024. [PMID: 38600861 DOI: 10.5694/mja2.52277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/23/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Peter Ab Wark
- Alfred Hospital, Melbourne, VIC
- Monash University, Melbourne, VIC
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
- Queensland Children's Hospital, Brisbane, QLD
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Freeman B, Peters MJ, Bittoun R, Brightwell R, English DR, Thomas DP, Otlowski MF, Zwar NA, Chamberlain C. National Health and Medical Research Council statement on electronic cigarettes: 2022 update. Med J Aust 2024; 220:100-106. [PMID: 37949610 DOI: 10.5694/mja2.52163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/19/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Electronic cigarette (e-cigarette) use in Australia has rapidly increased since the 2017 National Health and Medical Research Council (NHMRC) Chief Executive Officer (CEO) statement on e-cigarettes. The type of products available and the demographic characteristics of people using these products have changed. New evidence has been published and there is growing concern among public health professionals about the increased use, particularly among young people who do not currently smoke combustible cigarettes. The combination of these issues led NHMRC to review the current evidence and provide an updated statement on e-cigarettes. In this article, we describe the comprehensive process used to review the evidence and develop the 2022 NHMRC CEO statement on electronic cigarettes. MAIN RECOMMENDATIONS E-cigarettes can be harmful; all e-cigarette users are exposed to chemicals and toxins that have the potential to cause adverse health effects. There are no health benefits of using e-cigarettes if you do not currently smoke tobacco cigarettes. Adolescents are more likely to try e-cigarettes if they are exposed to e-cigarettes on social media. Short term e-cigarette use may help some smokers to quit who have been previously unsuccessful with other smoking cessation aids. There are other proven safe and effective options available to help smokers to quit. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT The evidence base for the harms of e-cigarette use has strengthened since the previous NHMRC statement. Significant gaps in the evidence base remain, especially about the longer term health harms of using e-cigarettes and the toxicity of many chemicals in e-cigarettes inhaled as an aerosol.
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Affiliation(s)
| | - Matthew J Peters
- Macquarie University, Sydney, NSW
- Concord Repatriation General Hospital, Sydney, NSW
| | - Renee Bittoun
- Avondale University, Cooranbong, NSW
- University of Notre Dame Australia, Sydney, NSW
| | | | - Dallas R English
- Centre for MEGA Epidemiology, University of Melbourne, Melbourne, VIC
| | - David P Thomas
- Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | | | | | - Catherine Chamberlain
- University of Melbourne, Melbourne, VIC
- Judith Lumley Centre, La Trobe University, Melbourne, VIC
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Marchant JM, Chang AB, Kennedy E, King D, Perret JL, Schultz A, Toombs MR, Versteegh L, Dharmage SC, Dingle R, Fitzerlakey N, George J, Holland A, Rigby D, Mann J, Mazzone S, O'Brien M, O'Grady KA, Petsky HL, Pham J, Smith SM, Wurzel DF, Vertigan AE, Wark P. Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia. Med J Aust 2024; 220:35-45. [PMID: 37982357 DOI: 10.5694/mja2.52157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/18/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation. MAIN RECOMMENDATIONS Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x-ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada-full-position-statement. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended. High quality evidence supports the use of child-specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults. Red flags that indicate serious underlying conditions requiring investigation or referral should be identified. Early and effective treatment of chronic wet/productive cough in children is critical. Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted. If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.
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Affiliation(s)
- Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
- Queensland Children's Hospital, Brisbane, QLD
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
- Queensland Children's Hospital, Brisbane, QLD
- Menzies School of Health Research, Darwin, NT
| | - Emma Kennedy
- Rural and Remote Health, Flinders University, Darwin, NT
| | | | - Jennifer L Perret
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
| | - Andre Schultz
- Wal-yan Respiratory Research Centre, Perth, WA
- Perth Children's Hospital, Perth, WA
| | | | | | - Shyamali C Dharmage
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
| | | | | | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
| | - Anne Holland
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
- Institute for Breathing and Sleep, University of Melbourne, Melbourne, VIC
| | - Debbie Rigby
- University of Queensland, Brisbane, QLD
- Queensland University of Technology, Brisbane, QLD
| | - Jennifer Mann
- Institute for Breathing and Sleep, University of Melbourne, Melbourne, VIC
- Austin Health, Melbourne, VIC
| | | | | | - Kerry-Ann O'Grady
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
| | | | | | | | | | - Anne E Vertigan
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
- John Hunter Hospital, Newcastle, NSW
| | - Peter Wark
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
- John Hunter Hospital, Newcastle, NSW
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Araújo NM, da Costa Silveira de Camargo J, Ochiai AM, Ferreira FM, Riesco MLG. Instructional and didactic support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings: Creation and validation. Nurse Educ Pract 2024; 74:103867. [PMID: 38101091 DOI: 10.1016/j.nepr.2023.103867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To describe the creation and validation process of an instructional, didactic and self-applied support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings. BACKGROUND Students frequently face difficulties performing the actions in the proper sequence in Post-Partum Haemorrhage simulated cases. Even in a controlled environment, anxiety, nervousness and fear of making mistakes are evident, which render the simulated experience highly stressful. Having a tool with a guideline can help students perform these actions more assertively. DESIGN A methodological study to develop a didactic tool. METHODS The creation process of the didactic tool, called Instructional Disk for the Management of Post-Partum Haemorrhage, was divided into five phases: Analysis, Design, Development, Implementation and Evaluation. Nine experts specialised in Obstetrics and Midwifery validated the tool by answering a questionnaire with nine items; in turn, 32 undergraduate Midwifery program students carried out the evaluation using a questionnaire on applicability, functionality, clarity, coherence and usability of the tool in Post-Partum Haemorrhage simulated stations. The data were analysed descriptively, considering absolute agreement when the answers to all questions in the five-point Likert scale corresponded to 5 (I totally agree). The Content Validity Index was calculated for the experts' questionnaires. RESULTS In the validation stage, the experts agreed or totally agreed with all nine items, reaching a Content Validity Index = 1. In the total scores assigned by the experts, there was a variation between 80.0% and 100% absolute agreement, with a mean of 95.6%. In the students' assessment, the variation was between 87.5% and 100% absolute agreement, with a mean of 97.7%, in the eight items evaluated. The agreement level above 90% among experts and students was considered high. CONCLUSIONS The Instructional Disk for the Management of Post-Partum Haemorrhage was validated by experts with extensive experience in Obstetrics and Midwifery care and teaching, ensuring that the content included in the guidelines for the management of Post-Partum Haemorrhage adopted in Brazil is covered. The students positively evaluated this support tool for learning the care to be provided in Post-Partum Haemorrhage cases in the simulated stations.
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Affiliation(s)
- Natalucia Matos Araújo
- Faculty of Midwifery Course School of Arts, Sciences and Humanities, Street Arlindo Bettio, 1000, ZIP 03828-000, Sao Paulo, SP, Brazil.
| | | | - Angela Megumi Ochiai
- Faculty of Midwifery Course School of Arts, Sciences and Humanities, Street Arlindo Bettio, 1000, ZIP 03828-000, Sao Paulo, SP, Brazil
| | - Fernanda Marçal Ferreira
- Faculty University of Sao Paulo School of Nurse, Avenue Dr. Enéas Carvalho de Aguiar, 419 - Cerqueira César, ZIP 05403-000, Sao Paulo, SP, Brazil
| | - Maria Luiza Gonzalez Riesco
- University of Sao Paulo School of Nurse, Avenue Dr. Enéas Carvalho de Aguiar, 419 - Cerqueira César, ZIP 05403-000, Sao Paulo, SP, Brazil
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Dijk SW, Kroencke T, Wollny C, Barkhausen J, Jansen O, Halfmann MC, Rizopoulos D, Hunink MGM. Medical Imaging Decision And Support (MIDAS): Study protocol for a multi-centre cluster randomized trial evaluating the ESR iGuide. Contemp Clin Trials 2023; 135:107384. [PMID: 37949165 DOI: 10.1016/j.cct.2023.107384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Medical imaging plays an essential role in healthcare. As a diagnostic test, imaging is prone to substantial overuse and potential overdiagnosis, with dire consequences to patient outcomes and health care costs. Clinical decision support systems (CDSSs) were developed to guide referring physicians in making appropriate imaging decisions. This study will evaluate the effect of implementing a CDSS (ESR iGuide) with versus without active decision support in a physician order entry on the appropriate use of imaging tests and ordering behaviour. METHODS A protocol for a multi-center cluster-randomized trial with departments acting as clusters, combined with a before-after-revert design. Four university hospitals with eight participating departments each for a total of thirty-two clusters will be included in the study. All departments start in control condition with structured data entry of the clinical indication and tracking of the imaging exams requested. Initially, the CDSS is implemented and all physicians remain blinded to appropriateness scores based on the ESR imaging referral guidelines. After randomization, half of the clusters switch to the active intervention of decision support. Physicians in the active condition are made aware of the categorization of their requests as appropriate, under certain conditions appropriate, or inappropriate, and appropriate exams are suggested. Physicians may change their requests in response to feedback. In the revert condition, active decision support is removed to study the educational effect. RESULTS/CONCLUSIONS The main outcome is the proportion of inappropriate diagnostic imaging exams requested per cluster. Secondary outcomes are the absolute number of imaging exams, radiation from diagnostic imaging, and medical costs. TRIAL REGISTRATION NUMBER Approval from the Medical Ethics Review Committee was obtained under protocol numbers 20-069 (Augsburg), B 238/21 (Kiel), 20-318 (Lübeck) and 2020-15,125 (Mainz). The trial is registered in the ClinicalTrials.gov register under registration number NCT05490290.
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Affiliation(s)
- Stijntje W Dijk
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Thomas Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Claudia Wollny
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Joerg Barkhausen
- Department of Radiology and Nuclear Medicine, University of Lübeck, Lübeck, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M G Myriam Hunink
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, United States of America.
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Kou K, Aitken JF, Pyke C, Chambers S, Dunn J, Baade PD. Treatment intervals and survival for women diagnosed with early breast cancer in Queensland: the Breast Cancer Outcomes Study, a population-based cohort study. Med J Aust 2023; 219:409-416. [PMID: 37667512 DOI: 10.5694/mja2.52091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To assess associations between breast cancer-specific survival and timeliness of treatment, based on 2020 Australian guidelines for the treatment of early breast cancer. DESIGN Population-based cohort study; analysis of linked Queensland Cancer Register, patient medical record, and National Death Index data, supplemented by telephone interviews. SETTING, PARTICIPANTS Women aged 20-79 years diagnosed with invasive breast cancer during 1 March 2010 - 30 June 2013, followed to 31 December 2020. MAIN OUTCOME MEASURES Breast cancer-specific survival for women who received or did not receive treatment within the recommended timeframe, overall and for six treatment intervals; optimal cut-points for each treatment interval; characteristics of women for whom treatment was not provided within the recommended timeframe. RESULTS Of 5426 eligible women, 4762 could be invited for interviews; complete data were available for 3044 women (56% of eligible women, 65% of invited women). Incomplete compliance with guideline interval recommendations was identified for 1375 women (45%); their risk of death from breast cancer during the follow-up period was greater than for those for whom guideline compliance was complete (adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 1.04-1.96). Risk of death was greater for women for whom the diagnosis to surgery interval exceeded 29 days (aHR, 1.76; 95% CI, 1.19-2.59), the surgery to chemotherapy interval exceeded 36 days (aHR, 1.63; 95% CI, 1.13-2.36), or the chemotherapy to radiotherapy interval exceeded 31 days (aHR, 1.83; 95% CI, 1.19-2.80). Treatment intervals longer than recommended were more frequent for women for whom breast cancer was detected by public facility screening (adjusted odds ratio [aOR], 1.58; 95% CI, 1.22-2.04) or by symptoms (aOR, 1.39; 95% CI, 1.09-1.79) than when cancer had been detected in private facilities, and for women without private health insurance (aOR, 1.96; 95% CI, 1.66-2.32) or living outside major cities (aOR, 1.38; 95% CI, 1.18-1.62). CONCLUSIONS Breast cancer-specific survival was poorer for women for whom the diagnosis to surgery, surgery to chemotherapy, or chemotherapy to radiotherapy intervals exceeded guideline-recommended limits. Our findings support 2020 Australian guideline recommendations regarding timely care.
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Affiliation(s)
- Kou Kou
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD
| | - Joanne F Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD
| | | | | | - Jeff Dunn
- Prostate Cancer Foundation of Australia, Sydney, NSW
| | - Peter D Baade
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD
- Queensland University of Technology, Brisbane, QLD
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Tunnicliffe DJ, Bateman S, Arnold‐Chamney M, Dwyer KM, Howell M, Gebadi A, Jesudason S, Kelly J, Lambert K, Majoni SW, Oliva D, Owen KJ, Pearson O, Rix E, Roberts I, Stirling‐Kelly R, Taylor K, Wittert GA, Widders K, Yip A, Craig J, Phoon RK. Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary. Med J Aust 2023; 219:374-385. [PMID: 37838977 PMCID: PMC10952490 DOI: 10.5694/mja2.52114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/23/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians. MAIN RECOMMENDATIONS These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age ≥ 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], ≤ 45 mL/min/1.73 m2 , and a sustained decrease in eGFR, > 10 mL/min/1.73 m2 per year) compared with the general population. CHANGES IN MANAGEMENT AS RESULT OF THE GUIDELINES Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services.
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Affiliation(s)
- David J Tunnicliffe
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Samantha Bateman
- University of AdelaideAdelaideSA
- Central and Northern Adelaide Renal and Transplantation Services, Central Adelaide Local Health NetworkAdelaideSA
| | | | | | - Martin Howell
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Azaria Gebadi
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | | | | | - Kelly Lambert
- University of WollongongWollongongNSW
- Illawarra Health and Medical Research InstituteUniversity of WollongongWollongongNSW
| | | | - Dora Oliva
- Drug and Alcohol Services, South Australia HealthAdelaideSA
| | - Kelli J Owen
- University of AdelaideAdelaideSA
- Central and Northern Adelaide Renal and TransplantationRoyal Adelaide HospitalAdelaideSA
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research InstituteAdelaideSA
- Cancer Research InstituteUniversity of South AustraliaAdelaideSA
| | - Elizabeth Rix
- University of AdelaideAdelaideSA
- Southern Cross UniversityLismoreNSW
| | - Ieyesha Roberts
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Ro‐Anne Stirling‐Kelly
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
- NSW Health Mid‐North Coast Local Health DistrictSydneyNSW
| | - Kimberly Taylor
- Aboriginal Communities and Families Health Research Alliance, South Australian Health and Medical Research InstituteAdelaideSA
| | - Gary A Wittert
- University of AdelaideAdelaideSA
- Royal Adelaide HospitalAdelaideSA
| | - Katherine Widders
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Adela Yip
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
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Barber BE, White H, Poole AP, Davis JS, McGloughlin SA, Turner T. Australian National Clinical Evidence Taskforce COVID-19 drug treatment guidelines: challenges of producing a living guideline. Med J Aust 2023; 219:197-199. [PMID: 37516997 DOI: 10.5694/mja2.52044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Bridget E Barber
- QIMR Berghofer Medical Research Institute, Brisbane, QLD
- Royal Brisbane and Women's Hospital, Brisbane, QLD
| | | | - Alexis P Poole
- Monash University, Melbourne, VIC
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA
| | - Joshua S Davis
- John Hunter Hospital, Newcastle, NSW
- University of Newcastle, Newcastle, NSW
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11
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Brown S, Banks E, Woodward M, Raffoul N, Jennings G, Paige E. Evidence supporting the choice of a new cardiovascular risk equation for Australia. Med J Aust 2023; 219:173-186. [PMID: 37496296 PMCID: PMC10952164 DOI: 10.5694/mja2.52052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/06/2023] [Accepted: 04/21/2023] [Indexed: 07/28/2023]
Abstract
This article reviews the risk equations recommended for use in international cardiovascular disease (CVD) primary prevention guidelines and assesses their suitability for use in Australia against a set of a priori defined selection criteria. The review and assessment were commissioned by the National Heart Foundation of Australia on behalf of the Australian Chronic Disease Prevention Alliance to inform recommendations on CVD risk estimation as part of the 2023 update of the Australian CVD risk assessment and management guidelines. Selected international risk equations were assessed against eight selection criteria: development using contemporary data; inclusion of established cardiovascular risk factors; inclusion of ethnicity and deprivation measures; prediction of a broad selection of fatal and non-fatal CVD outcomes; population representativeness; model performance; external validation in an Australian dataset; and the ability to be recalibrated or modified. Of the ten risk prediction equations reviewed, the New Zealand PREDICT equation met seven of the eight selection criteria, and met additional usability criteria aimed at assessing the ability to apply the risk equation in practice in Australia.
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Affiliation(s)
- Sinan Brown
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraACT
| | - Emily Banks
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraACT
| | - Mark Woodward
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW
- The George Institute for Global HealthImperial College LondonLondonUnited Kingdom
| | | | - Garry Jennings
- National Heart Foundation of AustraliaSydneyNSW
- University of New South WalesSydneyNSW
| | - Ellie Paige
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraACT
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
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12
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Huang J, Faisal W, Brand M, Smith S, Alexander M, Briggs L, Conron M, Duffy M, John T, Langton D, Lesage J, MacManus M, Mitchell P, Olesen I, Parente P, Philip J, Samuel E, Torres J, Underhill CR, Zalcberg JR, Harden S, Stirling R. Patterns of care for people with small cell lung cancer in Victoria, 2011-19: a retrospective, population-based registry data study. Med J Aust 2023; 219:120-126. [PMID: 37365486 DOI: 10.5694/mja2.52017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES To report stage-specific patterns of treatment and the influence of management and treatment type on survival rates for people newly diagnosed with small cell lung cancer (SCLC). DESIGN Cross-sectional patterns of care study; analysis of data prospectively collected for the Victorian Lung Cancer Registry (VLCR). SETTING, PARTICIPANTS All people diagnosed with SCLC in Victoria during 1 April 2011 - 18 December 2019. MAIN OUTCOME MEASURES Stage-specific management and treatment of people with SCLC; median survival time. RESULTS During 2011-19, 1006 people were diagnosed with SCLC (10.5% of all lung cancer diagnoses in Victoria); their median age was 69 years (interquartile range [IQR], 62-77 years), 429 were women (43%), and 921 were current or former smokers (92%). Clinical stage was defined for 896 people (89%; TNM stages I-III, 268 [30%]; TNM stage IV, 628 [70%]) and ECOG performance status at diagnosis for 663 (66%; 0 or 1, 489 [49%]; 2-4, 174 [17%]). The cases of 552 patients had been discussed at multidisciplinary meetings (55%), 377 people had received supportive care screening (37%), and 388 had been referred for palliative care (39%). Active treatment was received by 891 people (89%): chemotherapy, 843 (84%); radiotherapy, 460 (46%); chemotherapy and radiotherapy, 419 (42%); surgery, 23 (2%). Treatment had commenced within fourteen days of diagnosis for 632 of 875 patients (72%). Overall median survival time from diagnosis was 8.9 months (IQR, 4.2-16 months; stage I-III: 16.3 [IQR, 9.3-30] months; stage IV: 7.2 [IQR, 3.3-12] months). Multidisciplinary meeting presentation (hazard ratio [HR], 0.66; 95% CI, 0.58-0.77), multimodality treatment (HR, 0.42; 95% CI, 0.36-0.49), and chemotherapy within fourteen days of diagnosis (HR, 0.68; 95% CI, 0.48-0.94) were each associated with lower mortality during follow-up. CONCLUSION Rates of supportive care screening, multidisciplinary meeting evaluation, and palliative care referral for people with SCLC could be improved. A national registry of SCLC-specific management and outcomes data could improve the quality and safety of care.
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Affiliation(s)
| | | | | | | | - Marliese Alexander
- Peter MacCallum Cancer Institute, Melbourne, VIC
- The University of Melbourne, Melbourne, VIC
| | | | - Matthew Conron
- The University of Melbourne, Melbourne, VIC
- St Vincent's Hospital Melbourne, Melbourne, VIC
| | - Mary Duffy
- Peter MacCallum Cancer Institute, Melbourne, VIC
| | - Thomas John
- Peter MacCallum Cancer Institute, Melbourne, VIC
| | - David Langton
- Monash University, Melbourne, VIC
- Peninsula Health, Melbourne, VIC
| | | | | | - Paul Mitchell
- Olivia Newton-John Cancer Centre at Austin Health, Melbourne, VIC
| | - Inger Olesen
- Andrew Love Cancer Centre, Barwon Health, Geelong, VIC
| | - Phillip Parente
- Eastern Health Clinical School, Monash University, Melbourne, VIC
- Eastern Health, Melbourne, VIC
| | | | - Evangeline Samuel
- Alfred Health, Melbourne, VIC
- Latrobe Regional Hospital, Traralgon, VIC
| | | | - Craig R Underhill
- Albury Wodonga Health, Wodonga, NSW
- The University of New South Wales, Sydney, NSW
| | - John R Zalcberg
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
| | - Susan Harden
- Monash University, Melbourne, VIC
- Peter MacCallum Cancer Institute, Melbourne, VIC
| | - Rob Stirling
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
- Monash University Central Clinical School, Melbourne, VIC
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13
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Langford AV, Lin CC, Bero L, Blyth FM, Doctor J, Holliday S, Jeon YH, Moullin J, Murnion B, Nielsen S, Osman R, Penm J, Reeve E, Reid S, Wale J, Schneider CR, Gnjidic D. Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations. Med J Aust 2023; 219:80-89. [PMID: 37356051 DOI: 10.5694/mja2.52002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence-based clinical practice guideline for deprescribing opioid analgesics was developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain. MAIN RECOMMENDATIONS Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person's goals, values and preferences. The recommendations aim to achieve: implementation of a deprescribing plan at the point of opioid initiation; initiation of opioid deprescribing for persons with chronic non-cancer or chronic cancer-survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid-related adverse effects; gradual and individualised deprescribing, with regular monitoring and review; consideration of opioid deprescribing for individuals at high risk of opioid-related harms; avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated; avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence-based care, such as medication-assisted treatment of opioid use disorder; and use of evidence-based co-interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care. CHANGES IN MANAGEMENT AS A RESULT OF THESE GUIDELINES To our knowledge, these are the first evidence-based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.
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Affiliation(s)
- Aili V Langford
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
- University of Sydney, Sydney, NSW
| | - Christine Cw Lin
- Institute for Musculoskeletal Health, University of Sydney, Sydney, NSW
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado, Aurora (CO), USA
| | | | - Jason Doctor
- University of Southern California, Los Angeles (CA), USA
| | | | | | | | - Bridin Murnion
- University of Sydney, Sydney, NSW
- Western Sydney Local Health District, Sydney, NSW
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, VIC
| | | | - Jonathan Penm
- University of Sydney, Sydney, NSW
- Prince of Wales Hospital and Community Health Services, Sydney, NSW
| | - Emily Reeve
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
- University of South Australia, Adelaide, SA
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14
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Sheridan SL. From guidelines to decision aids and adherence supports: Insights from the process of evidence translation. Patient Educ Couns 2023; 113:107806. [PMID: 37229931 DOI: 10.1016/j.pec.2023.107806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To explore the evidence-translator's experience of the expert-recommended process of translating guidelines into tools for decision making, action, and adherence with the goal of improvement. METHODS A single reviewer dual reviewed the content, quality, certainty, and applicability of primary atherosclerotic cardiovascular prevention guidelines from the U.S. Preventive Services Task Force at the time of this work and used targeted searches of Medline to define the ideal structure and outcomes of tools; fill in gaps in guidelines; identify end-user needs; and choose and optimize existing tools in preparation for testing. RESULTS Guidelines addressed screening, treatments, and/or supports, but never the combination of all three. None provided all of the information needed for evidence translation. Searches in Medline filled in some evidence gaps and provided key insights into end-user needs and effective tools. However, evidence translators are left with complicated decisions about how to use and align evidence. CONCLUSION Guidelines provide some, but not all, of the evidence needed for evidence translation, requiring additional intensive work. Evidence gaps result in complicated decisions about how to use and align evidence and balance feasibility and rigor. PRACTICE IMPLICATIONS Guidelines, standards groups, and researchers should work to better support the process of evidence translation.
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15
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Maher CG, Archambeau A, Buchbinder R, French SD, Morphet J, Nicholas MK, O'Sullivan P, Pirotta M, Yelland MJ, Zeller L, Saad N, Marles E, Bhasale AL, Lane C. Introducing Australia's clinical care standard for low back pain. Med J Aust 2023; 218:354-356. [PMID: 37120763 DOI: 10.5694/mja2.51915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/27/2023] [Accepted: 02/16/2023] [Indexed: 05/01/2023]
Affiliation(s)
| | | | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW
| | - Julie Morphet
- School of Nursing and Midwifery, Monash University, Melbourne, VIC
- College of Emergency Nursing Australasia, Melbourne, VIC
| | - Michael K Nicholas
- Pain Management Research Institute, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW
| | | | - Marie Pirotta
- Department of General Practice, University of Melbourne, Melbourne, VIC
| | - Michael J Yelland
- School of Medicine, Griffith University, Gold Coast, QLD
- Arana Hills Medical Centre, Brisbane, QLD
| | - Leo Zeller
- Metro North Health, Royal Brisbane and Women's Hospital, Brisbane, QLD
| | - Nivene Saad
- Metro South Health, Princess Alexandra Hospital, Brisbane, QLD
| | - Elizabeth Marles
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW
| | - Alice L Bhasale
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW
| | - Christina Lane
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW
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16
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Shalit A, Vallely L, Nguyen R, Bohren M, Wilson A, Homer CSE, Vogel J. The representation of women on Australian clinical practice guideline panels, 2010-2020. Med J Aust 2023; 218:84-88. [PMID: 36599458 PMCID: PMC10953318 DOI: 10.5694/mja2.51831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To assess the composition by gender of Australian clinical practice guideline development panels; to explore guideline development-related factors that influence the composition of panels. DESIGN, SETTING, PARTICIPANTS Survey of clinical guidelines published in Australia during 2010-2020 that observed the 2016 NHMRC Standards for Guidelines, identified (June 2021) in the NHMRC Clinical Practice Guideline Portal or by searching the Guideline International Network guidelines library, the Trip medical database, and PubMed. The gender of contributors to guideline development was inferred from gendered titles (guideline documents) or pronouns (online biographies). MAIN OUTCOME MEASURES The overall proportion of guideline panel members - the guideline contributors who formally considered evidence and formulated recommendations (ie, guideline panel chairs and members) - who were women. RESULTS Of 406 eligible guidelines, 335 listed the names of people who contributed to their development (82%). Of 7472 named contributors (including 511 guideline panel chairs [6.8%] and 5039 guideline panel members [67.4%]), 3514 were men (47.0%), 3345 were women (44.8%), and gender could not be determined for 612 (8.2%). A total of 215 guideline panel chairs were women (42.1%), 280 were men (54.8%); 2566 guideline panel members were men (50.9%), 2071 were women (41.1%). The proportion of female guideline panel members was smaller than 40% for 179 guidelines (53%) and larger than 60% for 71 guidelines (21%). The median guideline proportion of female panel members was smaller than 50% for all but two years (2017, 2018). CONCLUSIONS The representation of women in health leadership roles in Australia does not reflect their level of participation in the health care workforce. In particular, clinical guideline development bodies should develop transparent policies for increasing the participation of women in guideline development panels.
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Affiliation(s)
| | | | | | - Meghan Bohren
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVIC
| | | | | | - Joshua Vogel
- The Burnet InstituteMelbourneVIC
- Cochrane AustraliaMonash UniversityMelbourneVIC
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17
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Carcel C, Woodward M. Gender diversity of clinical practice guideline panels in Australia: important opportunities for progress. Med J Aust 2023; 218:73-74. [PMID: 36625366 DOI: 10.5694/mja2.51832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, NSW
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, NSW
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18
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Kuhr K, Axelsson PB, Andersen BR, Ammitzbøll ILA, Clausen TD, Løkkegaard ECL. Postoperative infections after non-elective cesarean section - a retrospective cohort study of prevalence and risk factors at a single center in Denmark administering prophylactic antibiotics after cord clamping. BMC Pregnancy Childbirth 2022; 22:945. [PMID: 36528589 PMCID: PMC9758935 DOI: 10.1186/s12884-022-05300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mothers giving birth by non-elective cesarean section have considerably higher risk of developing postoperative infection, than mothers giving birth by elective cesarean section. Meta-analyses have shown that the risk of infection is reduced when administering antibiotics at least 30 min prior to skin incision rather than after cord clamping. If given prior to incision, antibiotics are present in the neonatal bloodstream for up to 24 h after delivery, with early exposure to antibiotics potentially disturbing development of the gut microbiome. We aimed to retrospectively assess the prevalence of postoperative infection after non-elective cesarean section at a single labor ward administering antibiotics after cord clamping, additionally investigating risk factors for developing postoperative infections. METHODS In this retrospective cohort study, we included a total of 2,725 women giving birth by non-elective cesarean section in 2010-2017 with a review of records for prenatal risk factors, labor management, and perinatal outcomes. The primary outcomes were a main composite infection of development of either endometritis, surgical-site infection, or sepsis in conjunction with a relevant antibiotic prescription. Secondary outcomes included infection of unknown focus, mastitis, urinary tract infection, and pneumonia. RESULTS A total of 88 patients developed a main composite infection (3.2%). These infections subdivide into endometritis (n = 37/2725, 1.4%), surgical-site infection (n = 35/2725, 1.3%) and sepsis (n = 15/2725, 0.6%). We found a high body mass index (aOR = 3.38, 95%CI 1.93-5.92) and intrapartum fever (aOR = 2.26, 95%CI 1.22-4.59) to be independent risk-factors for developing postoperative infection after non-elective cesarean section. Furthermore, we found delivery by a more expedient emergency grade 2 cesarean section (aOR = 0.61 95%CI 0.37-0.998) compared to grade 3 to be a protective factor for developing postoperative infection after non-elective cesarean section. CONCLUSION In a labor ward administering antibiotics after cord clamping at non-elective cesarean births, we find a low prevalence of main composite infections when compared to estimates from meta-analyses on the topic. We conclude that administration of prophylactic antibiotics after cord clamping appears to result in acceptable rates of postoperative infection and avoids transplacental-transmission of antibiotics to the infant.
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Affiliation(s)
- Katja Kuhr
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Paul Bryde Axelsson
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Betina Ristorp Andersen
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Ida Lise Arevad Ammitzbøll
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Tine Dalsgaard Clausen
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Ellen Christine Leth Løkkegaard
- grid.414092.a0000 0004 0626 2116Department of Obstetrics and Gynaecology, Nordsjaellands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
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19
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Chu K, Kelly A, Kinnear F, Keijzers G, Kamona S. Primary headache drug treatment in emergency departments in Australia and New Zealand. Med J Aust 2022; 217:366-367. [PMID: 35916121 PMCID: PMC9804343 DOI: 10.5694/mja2.51670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Kevin Chu
- The University of QueenslandBrisbaneQLD,Royal Brisbane and Women's HospitalBrisbaneQLD
| | - Anne‐Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western HealthMelbourneVIC
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20
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Mills JM, Luscombe GM, Hugh TJ. Same-day inguinal hernia repair in Australia, 2000-19. Med J Aust 2022; 216:303-304. [PMID: 35122258 DOI: 10.5694/mja2.51410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Joanna Mz Mills
- Northern Clinical School, the University of Sydney, Sydney, NSW
| | | | - Thomas J Hugh
- Northern Clinical School, the University of Sydney, Sydney, NSW.,Surgical Education Research and Training (SERT) Institute, Royal North Shore Hospital, Sydney, NSW
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21
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Cheyne S, Lindley RI, Smallwood N, Tendal B, Chapman M, Fraile Navarro D, Good PD, Jenkin P, McDonald S, Morgan D, Murano M, Millard T, Naganathan V, Srikanth V, Tuffin P, Vogel J, White H, Chakraborty SP, Whiting E, William L, Yates PM, Callary M, Elliott J, Agar MR. Care of older people and people requiring palliative care with COVID-19: guidance from the Australian National COVID-19 Clinical Evidence Taskforce. Med J Aust 2021; 216:203-208. [PMID: 34865227 PMCID: PMC9299653 DOI: 10.5694/mja2.51353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 12/26/2022]
Abstract
Introduction Older people living with frailty and/or cognitive impairment who have coronavirus disease 2019 (COVID‐19) experience higher rates of critical illness. There are also people who become critically ill with COVID‐19 for whom a decision is made to take a palliative approach to their care. The need for clinical guidance in these two populations resulted in the formation of the Care of Older People and Palliative Care Panel of the National COVID‐19 Clinical Evidence Taskforce in June 2020. This specialist panel consists of nursing, medical, pharmacy and allied health experts in geriatrics and palliative care from across Australia. Main recommendations The panel was tasked with developing two clinical flow charts for the management of people with COVID‐19 who are i) older and living with frailty and/or cognitive impairment, and ii) receiving palliative care for COVID‐19 or other underlying illnesses. The flow charts focus on goals of care, communication, medication management, escalation of care, active disease‐directed care, and managing symptoms such as delirium, anxiety, agitation, breathlessness or cough. The Taskforce also developed living guideline recommendations for the care of adults with COVID‐19, including a commentary to discuss special considerations when caring for older people and those requiring palliative care. Changes in management as result of the guideline The practice points in the flow charts emphasise quality clinical care, with a focus on addressing the most important challenges when caring for older individuals and people with COVID‐19 requiring palliative care. The adult recommendations contain additional considerations for the care of older people and those requiring palliative care.
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Affiliation(s)
- Saskia Cheyne
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW.,Cochrane Australia, Monash University, Melbourne, VIC
| | - Richard I Lindley
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW.,George Institute for Global Health, Sydney, NSW
| | | | - Britta Tendal
- Cochrane Australia, Monash University, Melbourne, VIC
| | | | | | | | | | | | - Deidre Morgan
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA.,Flinders University, Adelaide, SA
| | | | - Tanya Millard
- Cochrane Australia, Monash University, Melbourne, VIC
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CRGH), University of Sydney, Sydney, NSW
| | | | - Penelope Tuffin
- Royal Perth Hospital, Perth, WA.,Fiona Stanley Hospital, Perth, WA
| | - Joshua Vogel
- Cochrane Australia, Monash University, Melbourne, VIC.,Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC
| | - Heath White
- Cochrane Australia, Monash University, Melbourne, VIC
| | | | | | - Leeroy William
- Cochrane Australia, Monash University, Melbourne, VIC.,Eastern Health, Melbourne, VIC
| | - Patsy M Yates
- Centre for Cancer and Palliative Care Outcomes, Queensland University of Technology, Brisbane, QLD
| | | | | | - Meera R Agar
- IMPACCT Centre, University of Technology Sydney, Sydney, NSW
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22
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Fraile Navarro D, Tendal B, Tingay D, Vasilunas N, Anderson L, Best J, Burns P, Cheyne S, Craig SS, Erickson SJ, Fancourt NS, Goff Z, Kapuya V, Keyte C, Malyon L, McDonald S, White H, Wurzel D, Bowen AC, McMullan B. Clinical care of children and adolescents with COVID-19: recommendations from the National COVID-19 Clinical Evidence Taskforce. Med J Aust 2021; 216:255-263. [PMID: 34689329 PMCID: PMC8661691 DOI: 10.5694/mja2.51305] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID-19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS-TS). Recognising the distinct needs of this population, the National COVID-19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID-19 and COVID-19 complications. Living guidelines mean that these evidence-based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care. MAIN RECOMMENDATIONS To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID-19 and for the management of PIMS-TS. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES The Taskforce currently recommends corticosteroids as first line treatment for acute COVID-19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non-invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS-TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS-TS. The latest updates and full recommendations are available at www.covid19evidence.net.au.
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Affiliation(s)
- David Fraile Navarro
- Cochrane Australia, Monash University, Melbourne, VIC.,Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Britta Tendal
- Cochrane Australia, Monash University, Melbourne, VIC
| | - David Tingay
- Murdoch Children's Research Institute, Melbourne, VIC.,Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Nan Vasilunas
- Women's and Children's Health Network, Women's and Children's Hospital Adelaide, Adelaide, SA
| | - Lorraine Anderson
- Kimberley Aboriginal Medical Services Council, Broome, WA.,Junction Street Family Practice, Sydney, NSW
| | - James Best
- Junction Street Family Practice, Sydney, NSW
| | - Penelope Burns
- Australian National University, Canberra, ACT.,Northern Beaches Hospital, Sydney, NSW.,Western Sydney University, Sydney, NSW
| | - Saskia Cheyne
- Cochrane Australia, Monash University, Melbourne, VIC.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW
| | - Simon S Craig
- Monash University, Melbourne, VIC.,Monash Medical Centre, Monash Health, Melbourne, VIC
| | | | | | - Zoy Goff
- Perth Children's Hospital, Perth, WA
| | - Vimbai Kapuya
- Charles Darwin University, Darwin, NT.,Australian College of Rural and Remote Medicine, Brisbane, QLD
| | - Catherine Keyte
- Queensland Children's Hospital, Brisbane, QLD.,Australian College of Nursing, Canberra, ACT
| | - Lorelle Malyon
- College of Emergency Nursing Australasia, Melbourne, VIC
| | | | - Heath White
- Cochrane Australia, Monash University, Melbourne, VIC
| | - Danielle Wurzel
- Murdoch Children's Research Institute, Melbourne, VIC.,Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Asha C Bowen
- Perth Children's Hospital, Perth, WA.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Brendan McMullan
- Sydney Children's Hospital, Randwick, Sydney, NSW.,University of New South Wales, Sydney, NSW
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Haber PS, Riordan BC, Winter DT, Barrett L, Saunders J, Hides L, Gullo M, Manning V, Day CA, Bonomo Y, Burns L, Assan R, Curry K, Mooney-Somers J, Demirkol A, Monds L, McDonough M, Baillie AJ, Clark P, Ritter A, Quinn C, Cunningham J, Lintzeris N, Rombouts S, Savic M, Norman A, Reid S, Hutchinson D, Zheng C, Iese Y, Black N, Draper B, Ridley N, Gowing L, Stapinski L, Taye B, Lancaster K, Stjepanović D, Kay-Lambkin F, Jamshidi N, Lubman D, Pastor A, White N, Wilson S, Jaworski AL, Memedovic S, Logge W, Mills K, Seear K, Freeburn B, Lea T, Withall A, Marel C, Boffa J, Roxburgh A, Purcell-Khodr G, Doyle M, Conigrave K, Teesson M, Butler K, Connor J, Morley KC. New Australian guidelines for the treatment of alcohol problems: an overview of recommendations. Med J Aust 2021; 215 Suppl 7:S3-S32. [PMID: 34601742 DOI: 10.5694/mja2.51254] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
OF RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A). SUMMARY OF KEY RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).
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Haber PS, Riordan BC, Morley KC. Treatment of alcohol problems: current status and future directions. Med J Aust 2021; 215:315-316. [PMID: 34605031 DOI: 10.5694/mja2.51265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Paul S Haber
- Central Clinical School, University of Sydney, Sydney, NSW.,Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney, NSW.,Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW
| | - Benjamin C Riordan
- Central Clinical School, University of Sydney, Sydney, NSW.,Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney, NSW.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC
| | - Kirsten C Morley
- Central Clinical School, University of Sydney, Sydney, NSW.,Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney, NSW
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Sewell K, Tse T, Donnan GA, Carey LM. Screening for post-stroke depression: who, when and how? Med J Aust 2021; 215:305-307.e1. [PMID: 34519032 DOI: 10.5694/mja2.51256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Katherine Sewell
- La Trobe University, Melbourne, VIC.,Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
| | - Tamara Tse
- La Trobe University, Melbourne, VIC.,St Vincent's Hospital, Melbourne, VIC
| | - Geoffrey A Donnan
- Melbourne Brain Centre at The Royal Melbourne Hospital, Melbourne, VIC
| | - Leeanne M Carey
- La Trobe University, Melbourne, VIC.,Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
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Wiersma M, Kerridge IH, Stewart CL, Lipworth WL. Regulating complementary, unconventional and emerging treatments in Australia: a missed opportunity. Med J Aust 2021; 215:199-201.e1. [PMID: 34350605 DOI: 10.5694/mja2.51214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Ian H Kerridge
- University of Sydney, Sydney, NSW.,Royal North Shore Hospital, Sydney, NSW
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Franco GS, Hardie RA, Li L, Imai C, Sezgin G, Li J, McLeod A, Pearce C, Georgiou A. Prostate-specific antigen testing of asymptomatic men in Australia: an observational study based on electronic general practice data. Med J Aust 2021; 215:228-229. [PMID: 34164818 DOI: 10.5694/mja2.51147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Guilherme S Franco
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Rae-Anne Hardie
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Ling Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Chisato Imai
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Gorkem Sezgin
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Julie Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | | | - Christopher Pearce
- Outcome Health, Melbourne, VIC.,Health and Biomedical Informatics Centre, University of Melbourne, Melbourne, VIC
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
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Lynch EA, Lassig C, Turner T, Churilov L, Hill K, Shrubsole K. Prioritizing guideline recommendations for implementation: a systematic, consumer-inclusive process with a case study using the Australian Clinical Guidelines for Stroke Management. Health Res Policy Syst 2021; 19:85. [PMID: 34022906 PMCID: PMC8140744 DOI: 10.1186/s12961-021-00734-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Implementation of evidence-based care remains a key challenge in clinical practice. Determining "what" to implement can guide implementation efforts. This paper describes a process developed to identify priority recommendations from clinical guidelines for implementation, incorporating the perspectives of both consumers and health professionals. A case study is presented where the process was used to prioritize recommendations for implementation from the Australian Stroke Clinical Guidelines. METHODS The process was developed by a multidisciplinary group of researchers following consultation with experts in the field of implementation and stroke care in Australia. Use of the process incorporated surveys and facilitated workshops. Survey data were analysed descriptively; responses to ranking exercises were analysed via a graph theory-based voting system. RESULTS The four-step process to identify high-priority recommendations for implementation comprised the following: (1) identifying key implementation criteria, which included (a) reliability of the evidence underpinning the recommendation, (b) capacity to measure change in practice, (c) a recommendation-practice gap, (d) clinical importance and (e) feasibility of making the recommended changes; (2) shortlisting recommendations; (3) ranking shortlisted recommendations and (4) reaching consensus on top priorities. The process was applied to the Australian Stroke Clinical Guidelines between February 2019 and February 2020. Seventy-five health professionals and 16 consumers participated. Use of the process was feasible. Three recommendations were identified as priorities for implementation from over 400 recommendations. CONCLUSION It is possible to implement a robust process which involves consumers, clinicians and researchers to systematically prioritize guideline recommendations for implementation. The process is generalizable and could be applied in clinical areas other than stroke and in different geographical regions to identify implementation priorities. The identification of three clear priority recommendations for implementation from the Australian Stroke Clinical Guidelines will directly inform the development and delivery of national implementation strategies.
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Affiliation(s)
- Elizabeth A. Lynch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Campus, GPO Box 2100, Adelaide, SA 5001 Australia
- Adelaide Nursing School, University of Adelaide, Level 4 AHMS Building, Adelaide, 5005 Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, 245 Burgundy St, Heidelberg, VIC 3084 Australia
| | - Chris Lassig
- Stroke Foundation, Level 7/461 Bourke St, Melbourne, VIC 3000 Australia
| | - Tari Turner
- Cochrane Australia, Level 4/553 St Kilda Rd, Melbourne, VIC 3004 Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, VIC 3010 Australia
| | - Kelvin Hill
- Stroke Foundation, Level 7/461 Bourke St, Melbourne, VIC 3000 Australia
| | - Kirstine Shrubsole
- Southern Cross University, Bilinga, QLD 4225 Australia
- The Queensland Aphasia Research Centre, The University of Queensland, Brisbane, QLD Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
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Leach AJ, Morris PS, Coates HL, Nelson S, O'Leary SJ, Richmond PC, Gunasekera H, Harkus S, Kong K, Brennan-Jones CG, Brophy-Williams S, Currie K, Das SK, Isaacs D, Jarosz K, Lehmann D, Pak J, Patel H, Perry C, Reath JS, Sommer J, Torzillo PJ. Otitis media guidelines for Australian Aboriginal and Torres Strait Islander children: summary of recommendations. Med J Aust 2021; 214:228-233. [PMID: 33641192 PMCID: PMC7985866 DOI: 10.5694/mja2.50953] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/26/2020] [Indexed: 11/20/2022]
Abstract
Introduction The 2001 Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Islander populations were revised in 2010. This 2020 update by the Centre of Research Excellence in Ear and Hearing Health of Aboriginal and Torres Strait Islander Children used for the first time the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Main recommendations We performed systematic reviews of evidence across prevention, diagnosis, prognosis and management. We report ten algorithms to guide diagnosis and clinical management of all forms of otitis media. The guidelines include 14 prevention and 37 treatment strategies addressing 191 questions. Changes in management as a result of the guidelines A GRADE approach is used. Targeted recommendations for both high and low risk children. New tympanostomy tube otorrhoea section. New Priority 5 for health services: annual and catch‐up ear health checks for at‐risk children. Antibiotics are strongly recommended for persistent otitis media with effusion in high risk children. Azithromycin is strongly recommended for acute otitis media where adherence is difficult or there is no access to refrigeration. Concurrent audiology and surgical referrals are recommended where delays are likely. Surgical referral is recommended for chronic suppurative otitis media at the time of diagnosis. The use of autoinflation devices is recommended for some children with persistent otitis media with effusion. Definitions for mild (21–30 dB) and moderate (> 30 dB) hearing impairment have been updated. New “OMapp” enables free fast access to the guidelines, plus images, animations, and multiple Aboriginal and Torres Strait Islander language audio translations to aid communication with families.
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Affiliation(s)
| | - Peter S Morris
- Menzies School of Health Research, Darwin, NT.,Royal Darwin Hospital, Darwin, NT
| | - Harvey Lc Coates
- University of Western Australia, Perth, WA.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Sandra Nelson
- Department of Health, Northern Territory Government, Darwin, NT
| | - Stephen J O'Leary
- Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, VIC
| | - Peter C Richmond
- University of Western Australia, Perth, WA.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Hasantha Gunasekera
- University of Sydney, Sydney, NSW.,Children's Hospital at Westmead, Sydney, NSW
| | - Samantha Harkus
- Aboriginal and Torres Strait Islander Services, Hearing Australia, Sydney, NSW
| | | | - Christopher G Brennan-Jones
- University of Western Australia, Perth, WA.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | | | - Kathy Currie
- Department of Health, Northern Territory Government, Darwin, NT
| | - Sumon K Das
- Menzies School of Health Research, Darwin, NT
| | - David Isaacs
- University of Sydney, Sydney, NSW.,Children's Hospital at Westmead, Sydney, NSW
| | | | - Deborah Lehmann
- University of Western Australia, Perth, WA.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Jarod Pak
- Menzies School of Health Research, Darwin, NT
| | | | - Chris Perry
- Hospital and Health Services, Queensland Health, Brisbane, QLD
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Häuser W. [Endometriosis and chronic overlapping pain conditions]. Schmerz 2021; 35:179-82. [PMID: 33576864 DOI: 10.1007/s00482-021-00535-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/15/2020] [Accepted: 01/21/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND The concept of chronic overlapping pain conditions (COPC) is relatively unknown in German pain medicine. AIMS Definition, prevalence, shared etiological and pathophysiological mechanisms of COPC. Summary of recommendations of the interdisciplinary S2k guidelines on diagnostics and treatment of endometriosis relevant for pain physicians. METHODS Selective search of literature in PubMed and selection of recommendations of the S2k guidelines on diagnostics and treatment of endometriosis. RESULTS According to the US National Institutes of Health, COPCs comprise chronic fatigue syndrome, chronic (unspecific) low back pain, chronic tension headache, endometriosis, fibromyalgia syndrome, migraine, painful bladder syndrome, temporomandibular disorder and vulvodynia. Shared etiological factors are family aggregation, childhood adversities and major or traumatic life events. A major shared pathophysiological mechanism is altered processing of stimuli in the central nervous system. Patients with endometriosis should be screened for other chronic pain conditions and psychological distress. The physical examination should check for local (myofascial trigger points) and generalized signs of hyperalgesia and allodynia indicating central sensitization. In cases of endometriosis with COPCs repeated surgery for pain relief should be avoided. Amitriptyline and duloxetine can be considered as pharmacological treatment options. DISCUSSION Pain physicians can play a role in the management of patients with endometriosis and COPCs. A multimodal therapy should include physiotherapy and pain-related psychological treatment and possibly centrally acting pain modulation medication.
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Riordan BC, Winter DT, Haber PS, Day CA, Morley KC. What are people saying on social networking sites about the Australian alcohol consumption guidelines? Med J Aust 2021; 214:105-107.e1. [PMID: 33429457 DOI: 10.5694/mja2.50902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chakrabarti R, George G, Wells K, Crock C, Fahy E. Characteristics, treatment and complications of herpes zoster ophthalmicus at a tertiary eye hospital. Med J Aust 2020; 213:226-227. [PMID: 32200560 DOI: 10.5694/mja2.50554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/25/2019] [Indexed: 02/08/2024]
Affiliation(s)
| | - Grace George
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Kristen Wells
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC
| | - Carmel Crock
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC
| | - Eamonn Fahy
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC
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Patel B, Peiris DP, Patel A, Jan S, Harris MF, Usherwood T, Panaretto K, Lung T. A computer-guided quality improvement tool for primary health care: cost-effectiveness analysis based on TORPEDO trial data. Med J Aust 2020; 213:73-78. [PMID: 32594567 DOI: 10.5694/mja2.50667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of a computer-guided quality improvement intervention for primary health care management of cardiovascular disease (CVD) in people at high risk. DESIGN Modelled cost-effectiveness analysis of the HealthTracker intervention and usual care for people with high CVD risk, based on TORPEDO trial data on prescribing patterns, changes in intermediate risk factors (low-density lipoprotein cholesterol, systolic blood pressure), and Framingham risk scores. PARTICIPANTS Hypothetical population of people with high CVD risk attending primary health care services in a New South Wales primary health network (PHN) of mean size. INTERVENTION HealthTracker, integrated into health care provider electronic health record systems, provides real time decision support, risk communication, a clinical audit tool, and a web portal for performance feedback. MAIN OUTCOME MEASURES Incremental cost-effectiveness ratios (ICERs): difference in costs of the intervention and usual care divided by number of CVD events averted with HealthTracker. RESULTS The estimated numbers of major CVD events over five years per 1000 patients at high CVD risk were lower in PHNs using HealthTracker, both for patients with prior CVD events (secondary prevention; 259 v 267 with usual care) and for those without prior events (primary prevention; 168 v 176). Medication costs were higher and hospitalisation costs lower with HealthTracker than with usual care for both primary and secondary prevention. The estimated ICER for one averted CVD event was $7406 for primary prevention and $17 988 for secondary prevention. CONCLUSION Modelled cost-effectiveness analyses provide information that can assist decisions about investing in health care quality improvement interventions. We estimate that HealthTracker could prevent major CVD events for less than $20 000 per event averted. TRIAL REGISTRATION (TORPEDO) Australian New Zealand Clinical Trials Registry, ACTRN 12611000478910.
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Affiliation(s)
- Bindu Patel
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - David P Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Anushka Patel
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Stephen Jan
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW.,Sydney Medical School, the University of Sydney, Sydney, NSW
| | - Tim Usherwood
- Sydney Medical School, the University of Sydney, Sydney, NSW
| | - Kathryn Panaretto
- Centre for Chronic Disease, University of Queensland, Brisbane, QLD.,Medical Centre Queensland, University of Technology, Brisbane, QLD
| | - Thomas Lung
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
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Vetterlein MW, Witjes JA, Loriot Y, Giannarini G, Albersen M, Ribal MJ, Rouprêt M. Cutting-edge Management of Muscle-invasive Bladder Cancer in 2020 and a Glimpse into the Future. Eur Urol Oncol 2020; 3:789-801. [PMID: 32553706 DOI: 10.1016/j.euo.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 01/15/2023]
Abstract
This case-based discussion describes the clinical course of a 63-yr-old patient who presented with gross hematuria and was diagnosed with a muscle-invasive bladder cancer at transurethral resection. Computed tomography revealed a locally advanced tumor, and the patient underwent neoadjuvant chemotherapy followed by open radical cystectomy with standard pelvic lymph node dissection. In a step-by-step fashion, we elaborate on diagnostic and therapeutic treatment options from two different vantage points: (1) guideline-adherent treatment with the state-of-the-art standard of care, and (2) a glimpse into the future discussing the evidence of potential additional or alternative approaches based on recent scientific advances. PATIENT SUMMARY: In this case-based discussion, we follow the clinical course of a patient with advanced bladder cancer and elaborate how the state-of-the-art treatment looks like in 2020, based on the best available evidence. This is compared with potential future treatment strategies, which may change and alternate our understanding of optimal bladder cancer care.
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Affiliation(s)
- Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yohann Loriot
- Department of Cancer Medicine, INSERM U981, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Center "Santa Maria della Misericordia", Udine, Italy
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maria J Ribal
- Department of Urology, University Hospital Clínic de Barcelona, Barcelona, Spain
| | - Morgan Rouprêt
- Sorbonne University, GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitié-Salpêtrière Hospital, Paris, France.
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36
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Subasinghe AK, Nankervis AJ, Boyle JA, Mazza D. Optimising the implementation of guidelines for the post partum testing and management of gestational diabetes in South Asian women in Australia. Med J Aust 2020; 213:189-189.e1. [PMID: 32524603 DOI: 10.5694/mja2.50660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
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Niño de Guzmán E, Song Y, Alonso-Coello P, Canelo-Aybar C, Neamtiu L, Parmelli E, Pérez-Bracchiglione J, Rabassa M, Rigau D, Parkinson ZS, Solà I, Vásquez-Mejía A, Ricci-Cabello I. Healthcare providers' adherence to breast cancer guidelines in Europe: a systematic literature review. Breast Cancer Res Treat 2020; 181:499-518. [PMID: 32378052 PMCID: PMC7220981 DOI: 10.1007/s10549-020-05657-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
Purpose Clinical guidelines’ (CGs) adherence supports high-quality care. However, healthcare providers do not always comply with CGs recommendations. This systematic literature review aims to assess the extent of healthcare providers’ adherence to breast cancer CGs in Europe and to identify the factors that impact on healthcare providers’ adherence. Methods We searched for systematic reviews and quantitative or qualitative primary studies in MEDLINE and Embase up to May 2019. The eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and cross-checked by a second author. We conducted a narrative synthesis attending to the modality of the healthcare process, methods to measure adherence, the scope of the CGs, and population characteristics. Results Out of 8137 references, we included 41 primary studies conducted in eight European countries. Most followed a retrospective cohort design (19/41; 46%) and were at low or moderate risk of bias. Adherence for overall breast cancer care process (from diagnosis to follow-up) ranged from 54 to 69%; for overall treatment process [including surgery, chemotherapy (CT), endocrine therapy (ET), and radiotherapy (RT)] the median adherence was 57.5% (interquartile range (IQR) 38.8–67.3%), while for systemic therapy (CT and ET) it was 76% (IQR 68–77%). The median adherence for the processes assessed individually was higher, ranging from 74% (IQR 10–80%), for the follow-up, to 90% (IQR 87–92.5%) for ET. Internal factors that potentially impact on healthcare providers’ adherence were their perceptions, preferences, lack of knowledge, or intentional decisions. Conclusions A substantial proportion of breast cancer patients are not receiving CGs-recommended care. Healthcare providers’ adherence to breast cancer CGs in Europe has room for improvement in almost all care processes. CGs development and implementation processes should address the main factors that influence healthcare providers' adherence, especially patient-related ones. Registration: PROSPERO (CRD42018092884). Electronic supplementary material The online version of this article (10.1007/s10549-020-05657-8) contains supplementary material, which is available to authorised users.
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Affiliation(s)
- Ena Niño de Guzmán
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.
| | - Yang Song
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luciana Neamtiu
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy.
| | - Elena Parmelli
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy
| | | | - Montserrat Rabassa
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - David Rigau
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Zuleika Saz Parkinson
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749, 21027, Ispra, VA, Italy
| | - Iván Solà
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Adrián Vásquez-Mejía
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Ignacio Ricci-Cabello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Balearic Islands Health Research Institute (IdISBa), Palma, Spain.,Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
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Farmer CI, Bourne AM, O'Connor D, Jarvik JG, Buchbinder R. Enhancing clinician and patient understanding of radiology reports: a scoping review of international guidelines. Insights Imaging 2020; 11:62. [PMID: 32372369 PMCID: PMC7200955 DOI: 10.1186/s13244-020-00864-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/31/2020] [Indexed: 11/10/2022] Open
Abstract
Imaging reports are the primary method of communicating diagnostic imaging findings between the radiologist and the referring clinician. Guidelines produced by professional bodies provide guidance on content and format of imaging reports, but the extent to which they consider comprehensibility for referring clinicians and their patients is unclear. The objective of this review was to determine the extent to which radiology reporting guidelines consider comprehensibility of imaging reports for referring clinicians and patients.We performed a scoping review of English-language diagnostic imaging reporting guidelines. We searched electronic databases (OVID MEDLINE, Embase) and websites of radiological professional organisations to identify guidelines. The extent to which the guidelines recommended essential report features such as technical information, content, format and language, as well as features to enhance comprehensibility, such as lay language summaries, was recorded.Six guidelines from professional bodies representing radiologists from the USA, Canada, Australia and New Zealand, Hong Kong, the UK and Europe were identified from the search. Inconsistencies exist between guidelines in their recommendations, and they rarely consider that patients may read the report. No guideline made recommendations about the reporting of results considering the clinical context, and none recommended features preferred by patients such as lay language summaries. This review identifies an opportunity for future radiology reporting guidelines to give greater consideration to referring clinician and patient preferences.
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Affiliation(s)
- Caitlin I Farmer
- Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale St, Malvern, VIC, 3144, Australia. .,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Allison M Bourne
- Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale St, Malvern, VIC, 3144, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Denise O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale St, Malvern, VIC, 3144, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jeffrey G Jarvik
- Departments of Radiology, Neurological Surgery, School of Medicine and Health Services, School of Public Health, University of Washington, Seattle, WA, USA.,Departments of Pharmacy and Orthopaedic & Sports Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale St, Malvern, VIC, 3144, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Sharp MK, Glonti K, Hren D. Online survey about the STROBE statement highlighted diverging views about its content, purpose, and value. J Clin Epidemiol 2020; 123:100-106. [PMID: 32259582 DOI: 10.1016/j.jclinepi.2020.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The endorsement rates of The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Statement are low and little is known about authors' opinions about this reporting guideline. We conducted an online survey with observational study authors on attitude toward and experiences with the STROBE Statement with the aim of understanding how to effectively implement STROBE. METHODS A thematic analysis on the responses to an open-ended question was conducted using inductive coding. Two coders classified responses independently into themes using a codebook. The inter-rater agreement ranged from 87.7 to 99.9%. RESULTS 15% (n = 150) of survey participants (n = 1,015) shared perceptions and insights on STROBE. We established four themes: 1) perceptions of the checklist, 2) academic confidence, 3) use in education and training, and 4) journal endorsement and use in peer review. Views were diverse and revealed multiple misunderstandings about the checklist's purpose and content, and lack of incentives for its use. CONCLUSIONS Better communication efforts are needed when disseminating STROBE and other reporting guidelines. These should focus on content, education for early career researchers, and encouragement of critical self-reflection on one's own work. In addition, results emphasized the need for better incentive and enforcement mechanisms.
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Affiliation(s)
- Melissa K Sharp
- University of Split, Department of Psychology, Faculty of Humanities and Social Sciences, Split, Croatia; Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France.
| | - Ketevan Glonti
- University of Split, Department of Psychology, Faculty of Humanities and Social Sciences, Split, Croatia; Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France
| | - Darko Hren
- University of Split, Department of Psychology, Faculty of Humanities and Social Sciences, Split, Croatia
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Agostino JW, Wong D, Paige E, Wade V, Connell C, Davey ME, Peiris DP, Fitzsimmons D, Burgess CP, Mahoney R, Lonsdale E, Fernando P, Malamoo L, Eades S, Brown A, Jennings G, Lovett RW, Banks E. Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement. Med J Aust 2020; 212:422-427. [PMID: 32172533 DOI: 10.5694/mja2.50529] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of preventable morbidity and mortality in Aboriginal and Torres Strait Islander peoples. This statement from the Australian Chronic Disease Prevention Alliance, the Royal Australian College of General Practitioners, the National Aboriginal Community Controlled Health Organisation and the Editorial Committee for Remote Primary Health Care Manuals communicates the latest consensus advice of guideline developers, aligning recommendations on the age to commence Aboriginal and Torres Strait Islander CVD risk assessment across three guidelines. MAIN RECOMMENDATIONS: In Aboriginal and Torres Strait Islander peoples without existing CVD: CVD risk factor screening should commence from the age of 18 years at the latest, including for blood glucose level or glycated haemoglobin, estimated glomerular filtration rate, serum lipids, urine albumin to creatinine ratio, and other risk factors such as blood pressure, history of familial hypercholesterolaemia, and smoking status. Individuals aged 18-29 years with the following clinical conditions are automatically conferred high CVD risk: ▶type 2 diabetes and microalbuminuria; ▶moderate to severe chronic kidney disease; ▶systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg; ▶familial hypercholesterolaemia; or ▶serum total cholesterol > 7.5 mmol/L. Assessment using the National Vascular Disease Prevention Alliance absolute CVD risk algorithm should commence from the age of 30 years at the latest - consider upward adjustment of calculated CVD risk score, accounting for local guideline use, risk factor and CVD epidemiology, and clinical discretion. Assessment should occur as part of an annual health check or opportunistically. Subsequent review should be conducted according to level of risk. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: From age 18 years (at the latest), Aboriginal and Torres Strait Islander adults should undergo CVD risk factor screening, and from age 30 years (at the latest), they should undergo absolute CVD risk assessment using the NVDPA risk algorithm.
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Affiliation(s)
- Jason W Agostino
- Australian National University, Canberra, ACT.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Deborah Wong
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Ellie Paige
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Vicki Wade
- RHD Australia, Menzies School of Health Research, Darwin, NT
| | - Cia Connell
- National Heart Foundation of Australia, Melbourne, VIC
| | | | - David P Peiris
- George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Dana Fitzsimmons
- Top End Health Services, Northern Territory Government, Darwin, NT
| | - C Paul Burgess
- Northern Territory Medical Program, Flinders University, Darwin, NT
| | - Ray Mahoney
- Australian E-Health Research Centre, CSIRO, Brisbane, QLD
| | - Emma Lonsdale
- Australian Chronic Disease Prevention Alliance, Sydney, NSW
| | | | | | - Sandra Eades
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC
| | - Alex Brown
- University of Adelaide, Adelaide, SA.,University of South Australia, Adelaide, SA
| | | | - Raymond W Lovett
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
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Abstract
Public health physician is one of the four statutory types of physicians in China, but there is no consensus on their connotation. The main problems are that public health physician is confused with those who perform public health tasks, the relationship between public health physician and clinician and the connotation of prescription right is not clear, and there is limitation in public health education and relevant laws and regulations. Public health physician is positioned as professionals who monitor, investigate, evaluate, and intervene in population health-related issues. It is suggested to retain the practicing qualification of public health physicians and highlight the attribute of public health physicians' prescribing the prescriptions for community health. Encourage public health physicians to obtain qualification for clinicians to individual prescription, Encourage clinicians to access to public health physician qualification. Improve public health school education, take the pilot of public health physician standardization training, cultivate "prevention and treatment combined" physician.
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Affiliation(s)
- J Lei
- Specialty Administrative Department of Centre for Disease Control and Prevention of Shandong Province, Jinan 250014, China
| | - H M Luo
- Education and Training Department of Chinese Centre for Disease Control and Prevention, Beijing 102206, China
| | - Z Dai
- Education and Training Department of Chinese Centre for Disease Control and Prevention, Beijing 102206, China
| | - J Ma
- Education and Training Department of Chinese Centre for Disease Control and Prevention, Beijing 102206, China
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42
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Lazarus JV, Ekstedt M, Marchesini G, Mullen J, Novak K, Pericàs JM, Roel E, Romero-Gómez M, Ratziu V, Tacke F, Cortez-Pinto H, Anstee QM. A cross-sectional study of the public health response to non-alcoholic fatty liver disease in Europe. J Hepatol 2020; 72:14-24. [PMID: 31518646 DOI: 10.1016/j.jhep.2019.08.027] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/12/2019] [Accepted: 08/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) is a growing public health problem worldwide and has become an important field of biomedical inquiry. We aimed to determine whether European countries have mounted an adequate public health response to NAFLD and non-alcoholic steatohepatitis (NASH). METHODS In 2018 and 2019, NAFLD experts in 29 European countries completed an English-language survey on policies, guidelines, awareness, monitoring, diagnosis and clinical assessment in their country. The data were compiled, quality checked against existing official documents and reported descriptively. RESULTS None of the 29 participating countries had written strategies or action plans for NAFLD. Two countries (7%) had mentions of NAFLD or NASH in related existing strategies (obesity and alcohol). Ten (34%) reported having national clinical guidelines specifically addressing NAFLD and, upon diagnosis, all included recommendations for the assessment of diabetes and liver cirrhosis. Eleven countries (38%) recommended screening for NAFLD in all patients with either diabetes, obesity and/or metabolic syndrome. Five countries (17%) had referral algorithms for follow-up and specialist referral in primary care, and 7 (24%) reported structured lifestyle programmes aimed at NAFLD. Seven (24%) had funded awareness campaigns that specifically included prevention of liver disease. Four countries (14%) reported having civil society groups which address NAFLD and 3 countries (10%) had national registries that include NAFLD. CONCLUSIONS We found that a comprehensive public health response to NAFLD is lacking in the surveyed European countries. This includes policy in the form of a strategy, clinical guidelines, awareness campaigns, civil society involvement, and health systems organisation, including registries. LAY SUMMARY We conducted a survey on non-alcoholic fatty liver disease with experts in European countries, coupled with data extracted from official documents on policies, clinical guidelines, awareness, and monitoring. We found a general lack of national policies, awareness campaigns and civil society involvement, and few epidemiological registries.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Spain.
| | - Mattias Ekstedt
- Department of Gastroenterology and Hepatology. Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Giulio Marchesini
- Department of Medical & Surgical Sciences, "Alma Mater" University, Bologna, Italy
| | - Jillian Mullen
- EASL International Liver Foundation, Geneva, Switzerland
| | - Katja Novak
- University Medical Center Ljubljana, Dept. of Gastroenterology, Slovenia
| | - Juan M Pericàs
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Spain; Translational Research Group on Infectious Diseases of Lleida (TRIDLE), Infectious Diseases Clinical Direction, Biomedical Research Institute Dr Pifarré, University of Lleida, Lleida, Spain
| | - Elena Roel
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Spain; Preventive Medicine and Epidemiology, Hospital Clínic, Barcelona, Spain
| | - Manuel Romero-Gómez
- UCM Digestive Diseases, ciberehd and IBIS, Virgen del Rocío University Hospital, University of Seville, Seville, Spain
| | - Vlad Ratziu
- Pitie-Salpetriere Hospital, Department of Hepatology University Paris 6, France
| | - Frank Tacke
- Department of Hepatology/Gastroenterology, Charité University Medical Center, Berlin, Germany
| | - Helena Cortez-Pinto
- Departamento de Gastrenterologia, CHLN, Clínica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Quentin M Anstee
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; The Liver Unit & NIHR Biomedical Research Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Sipilä R, Mäkelä M, Komulainen J. Highlighting the need for de-implementation - Choosing Wisely recommendations based on clinical practice guidelines. BMC Health Serv Res 2019; 19:638. [PMID: 31488146 PMCID: PMC6729023 DOI: 10.1186/s12913-019-4460-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background The Choosing Wisely campaign has spread to many countries. Methods for developing recommendations are inconsistent. We describe our process of developing such recommendations from a comprehensive national set of clinical practice guidelines (Current Care, CC) and the results of a one-year Choosing Wisely Finland project. Methods Two of the authors drafted the quality and process criteria for all the Choosing Wisely Finland recommendations. The quality criteria were relevance, feasibility, evidence-based and strength. These were discussed in editors’ meetings and subsequently revised. Two different processes for developing recommendations within national clinical practice guidelines were designed and piloted (processes A and B). Process A was based on a published guideline. The recommendations are drafted by an editor and revised and approved by the guideline development group. In process B the development of the recommendations is integrated with guideline production or update. Choosing Wisely recommendations were then drafted for half of the published CC Guidelines. An additional process (process C) was designed for producing independent recommendations outside a guideline. Results At least one Choosing Wisely recommendation could be identified from 39 out of 52 reviewed guidelines. Of the 106 recommendations drafted, 62 (58%) were accepted for publication. The main reasons for rejection were inability to give a strong recommendation (n = 18, 41%) and insufficient relevance (n = 14, 32%). Two thirds (n = 41, 66%) of the published recommendations were based on high to moderate level of evidence, and 18% (n = 11) on low or very low level of evidence, whereas for the rest, the quality of evidence was not critically appraised. Conclusions Choosing Wisely recommendations can be produced systematically from existing clinical practice guidelines. The rigorous methods of evidence-based medicine ensure high-quality recommendations. We welcome the use of our processes and methods describes in this article by other guideline-producing organizations. Electronic supplementary material The online version of this article (10.1186/s12913-019-4460-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raija Sipilä
- Current Care Guidelines, The Finnish Medical Society Duodecim, Helsinki, Finland.
| | - Marjukka Mäkelä
- Current Care Guidelines, The Finnish Medical Society Duodecim, Helsinki, Finland.,Department of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Jorma Komulainen
- Current Care Guidelines, The Finnish Medical Society Duodecim, Helsinki, Finland
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Selva A, Sanabria AJ, Niño de Guzman E, Ballesteros M, Selva C, Valli C, Zhang Y, Yepes-Nuñez JJ, Solà I, Schünemann H, Alonso-Coello P. Colorectal cancer guidelines seldom include the patient perspective. J Clin Epidemiol 2019; 116:84-97. [PMID: 31470075 DOI: 10.1016/j.jclinepi.2019.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/09/2019] [Accepted: 08/20/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study aimed to describe how colorectal practice guidelines (PGs) incorporate the patient perspective. STUDY DESIGN AND SETTING We searched in the Guidelines International Network library, MEDLINE, National Guideline Clearinghouse, NHS Evidence database, and TRIP database. Two authors independently selected the PGs. We considered recommendations rated or worded as weak or conditional or suggesting multiple options, as potentially preference sensitive. Two authors independently evaluated if, in potentially sensitive recommendations, the patient perspective was incorporated. RESULTS We included 28 PGs that contained 588 recommendations, being 256 potentially preference sensitive. Ten PGs (36%) included patients in the development process, and 12 (43%) provided information about patients' perspectives. Nine PGs (32%) included recommendations in which the patient perspective was explicitly considered, and 13 (46.4%) that recommended a discussion with the patient. From a total of 588 recommendations, 9.7% (25/256) of potentially preference-sensitive recommendations considered the patient perspective. The inclusion of patients in the development process was associated with a more frequent incorporation of the patient perspective in potentially preference sensitive recommendations (70% vs. 0%; P < 0.001). CONCLUSIONS Guideline users should be aware that the incorporation of the patient perspective in colorectal cancer PGs is suboptimal. Guideline developers should make efforts to incorporate the patient perspective, especially in preference-sensitive recommendations.
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Affiliation(s)
- A Selva
- Department of Clinical Epidemiology and Cancer Screening, Corporació Sanitària Parc Taulí, Parc del Taulí,1, 08208 Sabadell, Spain; Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Spain.
| | - A J Sanabria
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - E Niño de Guzman
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - M Ballesteros
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - C Selva
- Department of Psychology and Educational Science, Open University of Catalonia (UOC), Rambla del Poblenou, 156, Barcelona 08018, Spain
| | - C Valli
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Y Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - J J Yepes-Nuñez
- Department of Health Research Methods, Evidence, and Impact, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - I Solà
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain; CIBER Epidemiología y Salud Pública, (CIBERESP), Spain
| | - H Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - P Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain; Department of Health Research Methods, Evidence, and Impact, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; CIBER Epidemiología y Salud Pública, (CIBERESP), Spain
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45
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Tooth L, Moss K, Hockey R, Mishra GD. Adherence to screen time recommendations for Australian children aged 0-12 years. Med J Aust 2019; 211:181-182. [PMID: 31334841 DOI: 10.5694/mja2.50286] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/26/2019] [Indexed: 11/17/2022]
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Mazza D, Chakraborty SP, Brijnath B, Nowak H, Howell C, Brott T, Atchison M, Gras D, Kenardy J, Buchanan R, Tawia S. Diagnosing and managing work-related mental health conditions in general practice: new Australian clinical practice guidelines. Med J Aust 2019; 211:76-81. [PMID: 31231820 PMCID: PMC6852433 DOI: 10.5694/mja2.50240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction In Australia, mental health conditions (MHCs) arising from workplace factors are a leading cause of long term work incapacity and absenteeism. While most patients are treated in general practice, general practitioners report several challenges associated with diagnosing and managing workplace MHCs. This guideline, approved by the National Health and Medical Research Council and endorsed by the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine, is the first internationally to address the clinical complexities associated with diagnosing and managing work‐related MHCs in general practice. Main recommendations Our 11 evidence‐based recommendations and 19 consensus‐based statements aim to assist GPs with: the assessment of symptoms and diagnosis of a work‐related MHC; the early identification of an MHC that develops as a comorbid or secondary condition after an initial workplace injury; determining if an MHC has arisen as a result of work factors; managing a work‐related MHC to improve personal recovery or return to work; determining if a patient can work in some capacity; communicating with the patient's workplace; and managing a work‐related MHC that is not improving as anticipated.
Changes in management as result of the guideline This guideline will enhance care and improve health outcomes by encouraging: the use of appropriate tools to assist the diagnosis and determine the severity of MHCs; consideration of factors that can lead to the development of an MHC after a workplace injury; more comprehensive clinical assessments; the use of existing high quality guidelines to inform the clinical management of MHCs; consideration of a patient's capacity to work; appropriate communication with the workplace; and collaboration with other health professionals.
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Affiliation(s)
| | | | - Bianca Brijnath
- Monash University, Melbourne, VIC.,National Ageing Research Institute, Melbourne, VIC
| | | | - Cate Howell
- Royal Australian College of General Practitioners, Melbourne, VIC
| | - Trevor Brott
- Western Industrial Screening and Accident Clinic, Melbourne, VIC
| | - Michelle Atchison
- Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC
| | - David Gras
- Royal Australasian College of Physicians, Melbourne, VIC
| | - Justin Kenardy
- University of Queensland, Brisbane, QLD.,Australian Psychological Society, Melbourne, VIC
| | - Richard Buchanan
- Office of Industrial Relations, Queensland Government, Brisbane, QLD
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Affiliation(s)
- Helena J Teede
- Monash Partners Academic Health Sciences Centre, Monash University, Melbourne, VIC
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide, Adelaide, SA.,Fertility SA, Adelaide, SA
| | - Rhonda M Garad
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
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Sharp MK, Tokalić R, Gómez G, Wager E, Altman DG, Hren D. A cross-sectional bibliometric study showed suboptimal journal endorsement rates of STROBE and its extensions. J Clin Epidemiol 2019; 107:42-50. [PMID: 30423373 DOI: 10.1016/j.jclinepi.2018.11.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/10/2018] [Accepted: 11/06/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The STrengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement provides guidance on reporting observational studies. Many extensions have been created for specialized methods or fields. We determined endorsement prevalence and typology by journals in extension-related fields. STUDY DESIGN AND SETTING A published protocol defined search strategies to identify journals publishing observational studies (2007-2017) across seven fields relating to STROBE extensions. We extracted text regarding STROBE, seven STROBE extensions, reporting guidelines Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and transparent reporting documents/groups: International Committee of Medical Journal Editors, Committee on Publication Ethics (COPE), and the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) networks. Relationships between endorsing STROBE, endorsing other guidelines, and journal impact factor were tested using chi square and Mann-Whitney tests. RESULTS Of 257 unique journals, 12 (5%) required STROBE on submission, 22 (9%) suggested use, 12 (5%) recommended a "relevant guideline," 72 (28%) mentioned it indirectly (via editorial policies or International Committee of Medical Journal Editors recommendations), and 139 (54%) did not mention STROBE. The relevant extension was required by 2 (<1%) journals; 4 (1%) suggested use. STROBE endorsement was not associated with journal impact indices but was with Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses endorsements. CONCLUSION Reporting guideline endorsement rates are low; information is vague and scattered. Unambiguous language is needed to improve adherence to reporting guidelines and increase the quality of reporting.
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Affiliation(s)
- Melissa K Sharp
- Department of Psychology, University of Split, Faculty of Humanities and Social Sciences, Split, Croatia; INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Methods of Therapeutic Evaluation of Chronic Diseases Team (METHODS), Paris, F-75014 France; Paris Descartes University, Sorbonne Paris Cité, France.
| | | | - Guadalupe Gómez
- Universitat Politècnica de Catalunya-BarcelonaTech, Departament d'Estadística i Investigació Operativa, Barcelona, Spain
| | - Elizabeth Wager
- Sideview, Buckinghamshire, UK; University of Split, School of Medicine, Split, Croatia
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Darko Hren
- Department of Psychology, University of Split, Faculty of Humanities and Social Sciences, Split, Croatia
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Tjokrowidjaja A, Hovey E, Lewis CR. Let's talk about cytotoxic chemotherapy dosing: unravelling adjustments and off-protocol prescribing. Med J Aust 2019; 210:65-66. [PMID: 30712300 DOI: 10.5694/mja2.12072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Elizabeth Hovey
- Prince of Wales Hospital and Community Health Services, Sydney, NSW.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW
| | - Craig R Lewis
- Prince of Wales Hospital and Community Health Services, Sydney, NSW.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW
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