Digital Commons Network^™

A Qualitative Study Exploring High School Students' Understanding Of, And Attitudes Towards, Health Information And Claims, Leila Cusack, Laura N Desha, Chris B Del Mar, Tammy C Hoffmann

Christopher Del Mar

BACKGROUND:

Exposure to health claims, particularly in the media and social media, is pervasive, and the information conveyed is often inaccurate, incomplete or misleading. Some young people of high school ages are already making decisions about using readily available health interventions (such as sports drinks and beauty products).Although previous research has assessed adults' understanding of health claims, no research has examined this issue in young adults who are attending high school.

OBJECTIVE:

To explore high school students' understanding of, and attitudes towards, concepts relevant to assessing health information and claims.

DESIGN:

A qualitative study involving semi-structured interviews with 27 Australian …

Determining The Gaps Between Cochrane Reviews And Trials Of Effectiveness Of Interventions For Acute Respiratory Infections: An Audit, Jasmin Alloo, Sanya Vallath, Chris Del Mar, Matt Carter, Sarah Thorning, Justin Clark

Christopher Del Mar

BACKGROUND:

Cochrane primarily aims to systematically review trials of effectiveness that are important to inform clinical decisions. Editorial groups support authors to achieve high-quality reviews and prioritise review proposals in their clinical domain that are submitted or elicited. Prioritising proposals requires two approaches, identifying (1) clinical practises for which the evidence of effectiveness is uncertain and (2) interventions in which there are trials of effectiveness (especially randomised controlled trials (RCTs)) not systematically reviewed. This study addresses this second approach for the Cochrane Acute Respiratory Infections Group (CARIG) in order to identify RCTs of acute respiratory infections that have not been …

The Match Between Common Antibiotics Packaging And Guidelines For Their Use In Australia, Treasure Mcguire, Jane Smith, Chris Del Mar

Christopher Del Mar

Objectives: To determine the potential for a source of surplus antibiotics in the community to come from the mismatch between the recommended duration of antibiotic treatment for common indications in primary care and that dictated by default pharmaceutical industry packaging. Methods: Analysis of existing published information of: 1) the most common antibiotics prescribed in primary care in Australia; 2) their most common indications; 3) the guideline recommendations for their duration; and 4) the duration dictated by antibiotic packaging. Results: Of 32 common antibiotic prescribing scenarios, 10 had doses left over in surplus and 18 had a shortfall, leaving only four …

Parents’ Beliefs And Knowledge About The Management Of Acute Otitis Media: A Qualitative Study, Malene Hansen, Janine Howlett, Chris Del Mar, Tammy Hoffmann

Christopher Del Mar

Acute otitis media is a common reason for antibiotic prescribing, despite strong evidence that antibiotics provide minimal benefit. Studies have demonstrated that patients’ (or parents’) expectations of antibiotics often influence general practitioners’ (GPs) decision to prescribe antibiotics, but few have explored parents’ expectations of the management of infections in children, or which factors influence the development of these expectations. This study aimed to explore parents’ knowledge and beliefs about the management of acute otitis media in children.

What Is The Effect Of A Formalised Trauma Tertiary Survey Procedure On A Missed Injury Rates In Multi-Trauma Patients? Study Protocol For A Randomised Controlled Trial, Gerben Keijzers, Chris Del Mar, Leo M.G. Geeraedts Jr., Josh Byrnes, Elaine Beller

Christopher Del Mar

Background Missed injury is commonly used as a quality indicator in trauma care. The trauma tertiary survey (TTS) has been proposed to reduce missed injuries. However a systematic review assessing the effect of the TTS on missed injury rates in trauma patients found only observational studies, only suggesting a possible increase in early detection and reduction in missed injuries, with significant potential biases. Therefore, more robust methods are necessary to test whether implementation of a formal TTS will increase early in-hospital injury detection, decrease delayed diagnosis and decrease missed injuries after hospital discharge. Methods/Design We propose a cluster-randomised, controlled trial …

Prevalence Of Incidental Prostate Cancer: A Systematic Review Of Autopsy Studies, Katy J. L. Bell, Chris Del Mar, Gordon Wright, James Dickinson, Paul Glasziou

Christopher Del Mar

Prostate cancer screening may detect non-progressive cancers, leading to over-diagnosis and over-treatment. The potential for over-diagnosis can be assessed from the reservoir of prostate cancer in autopsy studies that report incidental prostate cancer rates in men who died of other causes. We aimed to estimate the age-specific incidental cancer prevalence from all published autopsy studies. We identified eligible studies by: searches of Medline and Embase, forward and backward citation searches, and contacting authors. We screened the titles and abstracts of all articles; checked the full text articles for eligibility; and extracted clinical and pathology data using standardized forms. We extracted: …

Risk Of Bias In Industry-Funded Oseltamivir Trials: Comparison Of Core Reports Versus Full Clinical Study Reports, Tom Jefferson, Mark Jones, Peter Doshi, Chris B. Del Mar, Rokuro Hama, Matthew Thompson, Igho Onakpoya

Christopher Del Mar

Background: The Cochrane risk of bias tool is a prominent instrument used to evaluate potential biases in clinical trials. In three updates of our Cochrane review on neuraminidase inhibitors, we assessed risk of bias on the same trials using different levels of detail: the trials in journal publications, in core reports, and in full clinical study reports. Here we analyse whether progressively greater amounts of information and detail in full clinical study reports (including trial protocols, statistical analysis plans, certificates of analyses, individual participant data listings and randomisation lists) affected our risk of bias assessments. Methods and findings: We used …

Antibiotic Resistance: What Can Be Done In Primary Care To Alleviate The Crisis?, Malene Hansen, Tammy Hoffmann, Amanda Mccullough, Mieke Van Driel, Chris Del Mar

Christopher Del Mar

Numerous opportunities are available in primary care for alleviating the crisis of increasing antibiotic resistance. Preventing patients from developing an acute respiratory infection (ARI) will obviate any need for antibiotic use downstream. Hygiene measures such as physical barriers and hand hygiene, and possibly vaccination and exercise, may be effective. Also, a large range of complementary and alternative medicines (e.g. zinc, vitamin C and probiotics) are proposed for preventing and treating ARIs, but evidence for efficacy is scarce.

Clinical Decision-Making Tools: How Effective Are They In Improving The Quality Of Health Care?, Lyndal Trevana, Kirsten Mccaffery, Glenn Salkeld, Paul Glasziou, Chris Del Mar, Jenny A. Doust, Tammy Hoffmann

Christopher Del Mar

Exec Summary Clinical decision-making tools can be considered in two broad categories – those designed to be used by clinicians and those designed to promote shared decision making with the clinician and patient together. The potential effect of computerised clinical decision support systems (CDSS) on variations in practice is not well understood, and CDSS are currently not a recommended means of improving evidence-based practice, or patient outcomes, since the mechanisms of success and failure are not well defined and the potential impact on workflows and adverse events are poorly evaluated. Despite numerous randomised controlled trials, there is poor quality evidence …

Increasing Access To Consumer Health Organisations Among Patients With Chronic Disease - A Randomised Trial Of A Print-Based Intervention, Frances M. Boyle, Allyson J. Mutch, Julie H. Dean, Marie-Louise Dick, Chris Del Mar

Christopher Del Mar

To assess whether a print-based intervention led to increased contact with consumer health organisations (CHOs) by general practice patients with chronic disease. CHOs can enhance people's capacity to manage chronic illness by providing information, education and psychosocial support. However, these organisations appear to be grossly under-utilised by patients and clinicians. A total of 276 patients completed a computer-assisted telephone interview before randomisation to an intervention (n = 141) or control (n = 135) group. The intervention consisted of mailed printed materials designed to encourage contact with a CHO relevant to the patient's main diagnosed chronic condition. Follow-up interviews were conducted …

Letter To The Editor: Treatment Of Acute Otitis Media In Children, Chris Del Mar, Paul Glasziou, Maroeska Rovers

Christopher Del Mar

No abstract provided.

Body Site Distribution Of Skin Cancer, Pre-Malignant And Common Benign Pigmented Lesions Excised In General Practice, Philippa H. Youl, Monika Janda, Joanne F. Aitken, Chris B. Del Mar, David C. Whiteman, Peter D. Baade

Christopher Del Mar

Background: Concern about skin cancer is a common reason for people from predominantly fair-skinned populations present to primary care doctors. Objectives: To examine the frequency and body site distribution of malignant, pre-malignant and benign pigmented skin lesions excised in primary care. Methods: This prospective study conducted in Queensland, Australia, included 154 primary care doctors. For all excised or biopsied lesions, doctors recorded the patient’s age and sex, body site, level of patient pressure to excise, and the clinical diagnosis. Histological confirmation was obtained through pathology laboratories. Results: Of 9,650 skin lesions, 57.7% were excised in men and 75.0% excised in …

Increasing Access To Consumer Health Organisations Among Patients With Chronic Disease – A Randomised Trial Of A Print-Based Intervention, Frances M. Boyle, Allyson J. Mutch, Julie H. Dean, Marie-Louise Dick, Chris B. Del Mar

Christopher Del Mar

Aim: To assess whether a print-based intervention led to increased contact with consumer health organisations (CHOs) by general practice patients with chronic disease. Background: CHOs can enhance people’s capacity to manage chronic illness by providing information, education and psychosocial support. However, these organisations appear to be grossly under-utilised by patients and clinicians. Methods: A total of 276 patients completed a computer-assisted telephone interview before randomisation to an intervention (n5141) or control (n5135) group. The intervention consisted of mailed printed materials designed to encourage contact with a CHO relevant to the patient’s main diagnosed chronic condition. Follow-up interviews were conducted 4 …

Stakeholders' Views On The Routine Use Of N-Of-1 Trials To Improve Clinical Care And To Make Resource Allocation Decisions For Drug Use, Jane Nikles, Geoffrey K. Mitchell, Alexandra Clavarino, Michael J. Yelland, Christopher B. Del Mar

Christopher Del Mar

N-of-1 trials are empirical formal tests using a within-patient randomised, double-blind, cross-over comparison of drug and placebo (or another drug), which we adapted to study individual patients’ responses as a clinical tool to guide clinical management. We administered semi-structured interviews to gauge stakeholder perspectives on the possibility of using routine n-of-1 trials for this purpose. Stakeholders included government and non-government health care sector, and patient, clinician and consumer, organisations. Stakeholders supported more widespread implementation of n-of-1 trials, in a targeted fashion, with some caveats. Barriers to their widespread implementation included constraints on doctors’ time, doctors’ acceptance, drug company acceptance, patient …

Urinary Tract Infections In Healthy Women: A Revolution In Management?, Chris Del Mar

Christopher Del Mar

Background. Urinary infection in otherwise healthy women has largely been a straightforward matter of diagnosis by identifying bacteria in the urine, and then cure by appropriate antibiotics. Recent research has shown this to be over-simplified. Evaluation of methods of self-management of symptoms has been neglected. Discussion. Firstly trial data show that women with what used to called 'urethral syndrome' (urinary symptoms but sterile urine) obtain relief from antibiotics. Other trial data have shown a surprisingly large placebo effect from the resolution of symptoms among women who feel their care has been 'positive'. In addition, data published this month in BMC …

But What Should Journals Actually Do To Keep Industry Sponsored Research Unbiased?, Chris Del Mar

Christopher Del Mar

No abstract provided.

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

Christopher Del Mar

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

Christopher Del Mar

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 …

Excluding Serious Illness In Feverish Children In Primary Care: Restricted Rule-Out Method For Diagnosis, Matthew J. Thompson, Anthony Harnden, Chris Del Mar

Christopher Del Mar

Extract: The list of possible diagnoses for febrile children seen in primary care is long. Identifying children who may have a serious illness can be difficult and is at the heart of decisions to prescribe, investigate, and refer to hospital. Serious infections (including pneumonia, meningitis, septicaemia, appendicitis) account for less than 1% of children presenting to primary care, yet they are leading causes of morbidity and mortality in children. One of the key challenges for primary care practitioners is trying to balance the risk of missing a serious disease against unnecessary investigation or referral. The diagnostic process hinges on the …

Has The Investment In General Practice Research Been Worthwhile?, Christopher B. Del Mar, Mieke Van Driel

Christopher Del Mar

Extract: It may be time to invest more in primary care research, including research on clinical conditions Here is s a simple exercise: in the PubMed website (http://www.ncbi.nlm.nih.gov/pubmed), type “The New England Journal of Medicine[Jour] AND Australia[All Fields]”, and you will see that the journal has published about 90 Australian articles since 2000. Scanning through them, you will find that just one includes an Australian general practitioner as an author (Professor John Marley, in 10th author position), for an article describing the large blood pressure trial ANBP2. Repeating this exercise for JAMA (the journal of the American Medical Association) yields …

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

Christopher Del Mar

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 …

Neuraminidase Inhibitors For Preventing And Treating Influenza In Healthy Adults: Systematic Review And Meta-Analysis, Tom Jefferson, Mark Jones, Peter Doshi, Chris Del Mar

Christopher Del Mar

Objectives: To update a 2005 Cochrane review that assessed the effects of neuraminidase inhibitors in preventing or ameliorating the symptoms of influenza, the transmission of influenza, and complications from influenza in healthy adults, and to estimate the frequency of adverse effects. Search strategy: An updated search of the Cochrane central register of controlled trials (Cochrane Library 2009, issue 2), which contains the Acute Respiratory Infections Group’s specialised register, Medline (1950-Aug 2009), Embase (1980-Aug 2009), and post-marketing pharmacovigilance data and comparative safety cohorts. Selection criteria: Randomised placebo controlled studies of neuraminidase inhibitors in otherwise healthy adults exposed to naturally occurring influenza. …

Transparent Development Of The Who Rapid Advice Guidelines, Holger J. Schunemann, Suzanne R. Hill, Meetali Kakad, Gunn E. Vist, Richard Bellamy, Lauren Stockman, Torbjorn Fosen Wisloff, Chris Del Mar, Frederick Hayden, Timothy M. Uyeki, Jeremy Farrar, Yazdan Yazdanpanah, Howard Zucker, John Beigel, Tawee Chotpitayasunondh, Tran Tinh Hien, Bulent Ozbay, Norio Sugaya, Andrew D. Oxman

Christopher Del Mar

Emerging health problems require rapid advice. We describe the development and pilot testing of a systematic, transparent approach used by the World Health Organization (WHO) to develop rapid advice guidelines in response to requests from member states confronted with uncertainty about the pharmacological management of avian influenza A (H5N1) virus infection. We first searched for systematic reviews of randomized trials of treatment and prevention of seasonal influenza and for nontrial evidence on H5N1 infection, including case reports and animal and in vitro studies. A panel of clinical experts, clinicians with experience in treating patients with H5N1, influenza researchers, and methodologists …

Possible Harms Of Oseltamivir—A Call For Urgent Action, Tom Jefferson, Mark Jones, Peter Doshi, Chris Del Mar

Christopher Del Mar

Extract: Oseltamivir is a successful drug: between July, 2004, and June, 2009, more than 11·5 million new prescriptions were issued in the USA, and nearly all influenza pandemic plans recommend antiviral drugs as a mainstay of containment on a population basis and treatment on an individual basis, with oseltamivir preferred because of ease of administration and storage. Because 75% of the world production of oseltamivir has been used in Japan,¹ this is where to look for any serious harms the drug might cause. ¹ See note in article.

Acute Respiratory Infections, Sharon Sanders, Jenny Doust, Chris Del Mar

Christopher Del Mar

Extract: Acute respiratory infections may be classified in several different ways: by their symptoms (fever, sore throat, cough, ear pain, runny nose); by their clinical manifestations (coryza, pharyngitis, tonsillitis, epiglottitis, otitis media, influenza, bronchitis, pneumonia); or by causative organism. Furthermore, their symptoms and sometimes the whole clinical picture may be shared by conditions that are not infections (asthma, allergic rhinitis). Some of this complexity is shown in Figure 46.1. Elucidating the exact location or responsible organism is usually clinically unhelpful. In this chapter, we focus on diagnostic questions that have the greatest impact on the patient with an acute respiratory …

Leaders, Leadership And Future Primary Care Clinical Research, John Furler, Jennifer Cleland, Chris Del Mar, Barbara Hanratty, Umesh Kadam, Daniel Lasserson, Colin Mccowan, Parker Magin, Caroline Mitchell, Nadeem Qureshi, Greta Rait, Nick Steel, Mieke Van Driel, Alison Ward

Christopher Del Mar

Background: A strong and self confident primary care workforce can deliver the highest quality care and outcomes equitably and cost effectively. To meet the increasing demands being made of it, primary care needs its own thriving research culture and knowledge base. Methods: Review of recent developments supporting primary care clinical research. Results: Primary care research has benefited from a small group of passionate leaders and significant investment in recent decades in some countries. Emerging from this has been innovation in research design and focus, although less is known of the effect on research output. Conclusion: Primary care research is now …

Matters Of Life And Death: Key Writings, Chris Del Mar

Christopher Del Mar

Extract These essays from the pricker of British medical establishment conscience are thought-provoking and controversial.

Letter: "Drink Plenty Of Fluids" Authors' Reply, Michelle P. B. Guppy, Sharon M. Mickan, Chris Del Mar

Christopher Del Mar

"Drink plenty of fluids" - Recommendations are not supported by data - [Authors' reply]. Let us look deeper at the indirect evidence. Two case reports describe children with only infections of the upper respiratory tract with hyponatraemia and seizures. In infections of the lower respiratory tract, observational studies show that increased secretion of antidiuretic hormone occurs in bronchiolitis, where it is the norm. It is becoming standard management to advise careful monitoring and restriction of fluid intake with bronchiolitis.

Topical Analgesia For Acute Otitis Media, Ruth Foxlee, Ann-Charlotte Johansson, Jessika Wejfalk, Liz Dooley, Chris Del Mar

Christopher Del Mar

Background Acute otitis media (AOM) is a spontaneously remitting disease for which pain is the most distressing symptom. Antibiotics are now known to have less benefit than previously assumed. Objectives To assess the effectiveness of topical analgesia for AOM. Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE (1966 to May Week 3 2006), EMBASE (1990 to December 2005) and LILACS (1982 to September 2005) without language restriction, and the reference lists of articles. We also contacted manufacturers and authors. Selection criteria Double-blind randomised or quasi-randomised controlled trials comparing an …

Models Of Disease, Chris Del Mar, Jenny Doust, Paul Glasziou

Christopher Del Mar

[Excerpt] What we will do here is set out some models of disease, and then apply them to some clinical problems to see how the models shape up. The models of disease we discuss are not all mutually exclusive, but different ways of viewing the clinical problems we encounter. The models include: *Cause and effect models, and their several variants; *‘edge of the distribution’ illnesses (also known as ‘spectrum disorders’); *Spontaneously remitting and self-perpetuating illnesses; and *‘alternative’ medicine models. These are all ‘transparent box’ approaches to disease: that is, a model of how the disease works, which in turn should …