Digital Commons Network^™

General Practitioners' Decision Making About Primary Prevention Of Cardiovascular Disease In Older Adults: A Qualitative Study, Jesse Jansen, Shannon Mckinn, Carissa Bonner, Les Irwig, Jenny Doust, Paul Glasziou, Katy Bell, Vasi Naganathan, Kirsten Mccaffery

Paul Glasziou

BACKGROUND: Primary cardiovascular disease (CVD) prevention in older people is challenging as they are a diverse group with varying needs, frequent presence of comorbidities, and are more susceptible to treatment harms. Moreover the potential benefits and harms of preventive medication for older people are uncertain. We explored GPs' decision making about primary CVD prevention in patients aged 75 years and older. METHOD: 25 GPs participated in semi-structured interviews in New South Wales, Australia. Transcribed audio-recordings were thematically coded and Framework Analysis was used. RESULTS: Analysis identified factors that are likely to contribute to variation in the management of CVD risk …

Communicating About Overdiagnosis: Learning From Community Focus Groups On Osteoporosis, Ray Moynihan, Rebecca Sims, Jolyn Hersch, Rae Thomas, Paul P. Glasziou, Kirsten Mccaffery

Paul Glasziou

BACKGROUND: Overdiagnosis is considered a risk associated with the diagnosis of osteoporosis-as many people diagnosed won't experience harm from the condition. As yet there's little evidence on community understanding of overdiagnosis outside cancer- where it is an established risk of some screening programs-or effective ways to communicate about it. We examined community understanding around overdiagnosis of osteoporosis, to optimise communication strategies about this problem. METHODS AND FINDINGS: Using a qualitative design we recruited a community sample of women, 50-80 years, from the Gold Coast community around Bond University, Australia, using random digit dialing, and conducted 5 focus groups with 41 …

The Contribution Of Individual Exercise Training Components To Clinical Outcomes In Randomised Controlled Trials Of Cardiac Rehabilitation: A Systematic Review And Meta-Regression, Bridget Abell, Paul Glasziou, Tammy Hoffmann

Paul Glasziou

Background While the clinical benefits of exercise-based cardiac rehabilitation are well established, there is extensive variation in the interventions used within these trials. It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes. This study aims to systematically examine the relationship between individual components of the exercise intervention in cardiac rehabilitation (such as intensity and frequency) and clinical outcomes for people with coronary heart disease. Methods In this systematic review, eligible trials were identified via searches of databases (PubMed, Allied and Complementary Medicine, EMBASE, PEDro, Science Citation Index Expanded, CINAHL, …

Patient Preferences For Cardiovascular Preventive Medication: A Systematic Review, Loai Albarqouni, Jenny Doust, Paul Glasziou

Paul Glasziou

OBJECTIVE: To systematically review current evidence regarding the minimum acceptable risk reduction of a cardiovascular event that patients feel would justify daily intake of a preventive medication. METHODS: We used the Web of Science to track the forward and backward citations of a set of five key articles until 15 November 2016. Studies were eligible if they quantitatively assessed the minimum acceptable benefit-in absolute values-of a cardiovascular disease preventive medication among a sample of the general population and required participants to choose if they would consider taking the medication. RESULTS: Of 341 studies screened, we included 22, involving a total …

Cjcheck Stage 1: Development And Testing Of A Checklist For Reporting Community Juries - Delphi Process And Analysis Of Studies Published In 1996-2015, Rae Thomas, Rebecca Sims, Chris Degeling, Jackie M Street, Stacy M Carter, Lucie Rychetnik, Jennifer A Whitty, Andrew Wilson, Paul Ward, Paul Glasziou

Paul Glasziou

BACKGROUND: Opportunities for community members to actively participate in policy development are increasing. Community/citizen's juries (CJs) are a deliberative democratic process aimed to illicit informed community perspectives on difficult topics. But how comprehensive these processes are reported in peer-reviewed literature is unknown. Adequate reporting of methodology enables others to judge process quality, compare outcomes, facilitate critical reflection and potentially repeat a process. We aimed to identify important elements for reporting CJs, to develop an initial checklist and to review published health and health policy CJs to examine reporting standards. DESIGN: Using the literature and expertise from CJ researchers and policy …

Optimal Strategies For Identifying Kidney Disease In Diabetes: Properties Of Screening Tests, Progression Of Renal Dysfunction And Impact Of Treatment- Systematic Review And Modelling Of Progression And Cost-Effectiveness, Andrew J. Farmer, Richard Stevens, Jennifer Hirst, Tom Lung, Jason Oke, Philip Clarke, Andrew Neil, Paul Glasziou, David Dunger, Helen Colhourn, Christopher Pugh, Germaine Wong, Rafael Perera, Brian Shine

Paul Glasziou

These results support current UK guidance, which recommends annual screening with ACR to identify early kidney disease in patients with diabetes, despite a high false-positive rate leading to, at worst, unnecessary or, at best, early therapeutic intervention. For type 1 diabetes, screening costs for annual compared with 2-yearly screening are well within the bounds of accepted cost-effectiveness. Annual screening is even more cost-effective in type 2 diabetes than in type 1 diabetes. Identification of alternative markers for developing diabetic nephropathy may improve targeting of treatment for those at high risk.

Ambulatory Blood Pressure Adds Little To Framingham Risk Score For The Primary Prevention Of Cardiovascular Disease In Older Men: Secondary Analysis Of Observational Study Data, Katy J. L. Bell, Elaine Beller, Johan Sundström, Kevin Mcgeechan, Andrew Hayen, Les Irwig, Bruce Neal, Paul Glasziou

Paul Glasziou

Objective To determine the incremental value of ambulatory blood pressure (BP) in predicting cardiovascular risk when the Framingham Risk Score (FRS) is known.

Methods We included 780 men without cardiovascular disease from the Uppsala Longitudinal Study of Adult Men, all aged approximately 70?years at baseline. We first screened ambulatory systolic BP (ASBP) parameters for their incremental value by adding them to a model with 10-year FRS. For the best ASBP parameter we estimated HRs and changes in discrimination, calibration and reclassification. We also estimated the difference in the number of men started on treatment and in the number of men …

Awareness, Agreement, Adoption And Adherence To Type 2 Diabetes Mellitus Guidelines: A Survey Of Indonesian Primary Care Physician, Indah Widyahening, Yolanda Van Der Graaf, Pradana Soewondo, Paul Glasziou, Geert Van Der Heijden

Paul Glasziou

Background: To assess the degree of awareness, agreement, adoption and adherence of physicians in Indonesia to type 2 diabetes mellitus guidelines, and their association with characteristics of the responders. Methods. Questionnaire survey among General Practitioners (GPs) attending the Indonesian Association of Family Practitioners annual conference in November 2012. The proportion of GPs who were aware of, agreed with, adopted and adhered to the seven recommendations in the guidelines (screening for diabetes, diagnosis, lifestyle modification, use of sulfonylurea, target blood glucose, target blood pressure and use of statin) were calculated in the total number of responders. Results: Of the 399 GPs …

Communicating Cardiovascular Disease Risk: An Interview Study Of General Practitioners' Use Of Absolute Risk Within Tailored Communication Strategies, Carissa Bonner, Jesse Jansen, Shannon Mckinn, Les Irwig, J. Doust, Paul Glasziou, Kirsten Mccaffery

Paul Glasziou

Background: Cardiovascular disease (CVD) prevention guidelines encourage assessment of absolute CVD risk - the probability of a CVD event within a fixed time period, based on the most predictive risk factors. However, few General Practitioners (GPs) use absolute CVD risk consistently, and communication difficulties have been identified as a barrier to changing practice. This study aimed to explore GPs' descriptions of their CVD risk communication strategies, including the role of absolute risk. Methods. Semi-structured interviews were conducted with a purposive sample of 25 GPs in New South Wales, Australia. Transcribed audio-recordings were thematically coded, using the Framework Analysis method to …

General Practitioners' Use Of Absolute Risk Versus Individual Risk Factors In Cardiovascular Disease Prevention: An Experimental Study, Jesse Jansen, Carissa Bonner, Shannon Mckinn, Les Irwig, Paul Glasziou, Jenny Doust, Armando Teixeira-Pinto, Andrew Hayen, Robin Turner, Kirsten Mccaffery

Paul Glasziou

Objective: To understand general practitioners' (GPs) use of individual risk factors (blood pressure and cholesterol levels) versus absolute risk in cardiovascular disease (CVD) risk management decision-making. Design: Randomised experiment. Absolute risk, systolic blood pressure (SBP), cholesterol ratio (total cholesterol/high-density lipoprotein (TC/HDL)) and age were systematically varied in hypothetical cases. High absolute risk was defined as 5-year risk of a cardiovascular event >15%, high blood pressure levels varied between SBP 147 and 179 mm Hg and high cholesterol (TC/HDL ratio) between 6.5 and 7.2 mmol/L. Setting: 4 GP conferences in Australia. Participants: 144 Australian GPs. Outcomes: GPs indicated whether they would …

Cardiovascular Risk Scores Do Not Account For The Effect Of Treatment: A Review, Su May Liew, Jenny Doust, Paul Glasziou

Paul Glasziou

Objective - To compare the strengths and limitations of cardiovascular risk scores available for clinicians in assessing the global (absolute) risk of cardiovascular disease.Design - Review of cardiovascular risk scores.Data sources - Medline (1966 to May 2009) using a mixture of MeSH terms and free text for the keywords ‘cardiovascular’, ‘risk prediction’ and ‘cohort studies’.Eligibility - criteria for selecting studies A study was eligible if it fulfilled the following criteria: (1) it was a cohort study of adults in the general population with no prior history of cardiovascular disease and not restricted by a disease condition; (2) the primary objective …

Corticosteroids For Pain Relief In Sore Throat: Systematic Review And Meta-Analysis, Gail Hayward, Matthew J. Thompson, Carl J. Heneghan, Rafael Perera, Paul P. Glasziou, Chris B. Del Mar

Paul Glasziou

Objective: To evaluate whether systemic corticosteroids improve symptoms of sore throat in adults and children. Design: Systematic review and meta-analysis. Data sources: Cochrane Central, Medline, Embase, Database of Reviews of Effectiveness (DARE), NHS Health Economics Database, and bibliographies. Outcome measures: Percentage of patients with complete resolution at 24 and 48 hours, mean time to onset of pain relief, mean time to complete resolution of symptoms, days missed from work or school, recurrence, and adverse events. Results: We included eight trials, consisting of 743 patients in total (369 children, 374 adults). 348 (47%) had exudative sore throat, and 330 (44%) were …

Antibiotics For Acute Otitis Media In Children (Review), Sharon Sanders, Paul P. Glasziou, Chris Del Mar, Maroeska Rovers

Paul Glasziou

Background: Acute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56% in the Netherlands to 95% in the USA and Australia. Objectives: To assess the effects of antibiotics for children with AOM. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, issue 2) which contains the Acute Respiratory Infections (ARI) Group's Specialized Register; MEDLINE (1966 to June week 4 2008); OLDMEDLINE (1958 to 1965); EMBASE (January 1990 to July 2008); and Current Contents (1966 to July 2008). Selection criteria: Randomised …

Antibiotics For Acute Otitis Media In Children [Review], Paul P. Glasziou, Chris Del Mar, Sharon L. Sanders, Mauricio Hayem

Paul Glasziou

Background: Acute otitis media is one of the most common diseases in early infancy and childhood. Antibiotic use for acute otitis media varies from 31% in the Netherlands to 98% in the USA and Australia. Objectives: The objective of this review was to assess the effects of antibiotics for children with acute otitis media. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE, Index Medicus (pre 1965), Current Contents and reference lists of articles from 1958 to January 2000. The search was updated in 2003. Selection criteria: Randomised trials comparing antimicrobial drugs with placebo in children …

Self Diagnosis, Clare Goyder, Ann Mcpherson, Paul Glasziou

Paul Glasziou

Extract:
Some conditions can be diagnosed correctly by the patient, but self diagnosis should always undergo challenge and refinement by the general practitioner.