Medicine and Health Sciences Commons^™

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 …

Faster Title And Abstract Screening? Evaluating Abstrackr, A Semi-Automated Online Screening Program For Systematic Reviewers, John Rathbone, Tammy Hoffmann, Paul Glasziou

Paul Glasziou

Background: Citation screening is time consuming and inefficient. We sought to evaluate the performance of Abstrackr, a semi-automated online tool for predictive title and abstract screening. Methods: Four systematic reviews (aHUS, dietary fibre, ECHO, rituximab) were used to evaluate Abstrackr. Citations from electronic searches of biomedical databases were imported into Abstrackr, and titles and abstracts were screened and included or excluded according to the entry criteria. This process was continued until Abstrackr predicted and classified the remaining unscreened citations as relevant or irrelevant. These classification predictions were checked for accuracy against the original review decisions. Sensitivity analyses were performed to …

A Randomised Controlled Trial Of A Blended Learning Education Intervention For Teaching Evidence-Based Medicine, Dragan Ilic, Rusli Bin Nordin, Paul Glasziou, Julie Tilson, Elmer Villanueva

Paul Glasziou

Background: Few studies have been performed to inform how best to teach evidence-based medicine (EBM) to medical trainees. Current evidence can only conclude that any form of teaching increases EBM competency, but cannot distinguish which form of teaching is most effective at increasing student competency in EBM. This study compared the effectiveness of a blended learning (BL) versus didactic learning (DL) approach of teaching EBM to medical students with respect to competency, self-efficacy, attitudes and behaviour toward EBM. Methods: A mixed methods study consisting of a randomised controlled trial (RCT) and qualitative case study was performed with medical students undertaking …

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.

Primary Care Streptococcal Management (Prism) Study: In Vitro Study, Diagnostic Cohorts And A Pragmatic Adaptive Randomised Controlled Trial With Nested Qualitative Study And Cost-Effectiveness Study, Paul Little, F. D. R. Hobbs, Michael Moore, David Mant, Ian Williamson, Cliodna Mcnulty, Gemma Lasseter, Edith Y. Cheng, Geraldine Leydon, Lisa Mcdermott, David Turner, Rafael Pinedo-Villanueva, James Raftery, Paul Glasziou, Mark Mullee

Paul Glasziou

The overuse of antibiotics in primary care not only increases the risk of antibiotic resistance but exposes patients to side effects, and medicalises what are mostly self-limiting illnesses. Antibiotics are still prescribed for most patients attending primary care with acute sore throat, despite evidence from systematic reviews that there is modest benefit overall from antibiotics. Approaches to targeting antibiotics could facilitate more appropriate use of antibiotics, either targeting antibiotics using clinical scoring methods or using rapid antigen detection tests (RADTs). RADTs are very commonly used in many countries and are designed to detect the major bacterial pathogen Lancefield group A …

Evidence-Based Medicine Teaching In Uk Medical Schools, Emma Meats, Carl Heneghan, Mike Crilly, Paul Glasziou

Paul Glasziou

No abstract provided.

Does The Current Version Of 'Tomorrow's Doctors' Adequately Support The Role Of Evidence-Based Medicine In The Undergraduate Curriculum?, Mike Crilly, Paul Glasziou, Carl Heneghan, Emma Meats, Amanda Burls

Paul Glasziou

No abstract provided.

A Delphi Survey To Determine How Educational Interventions For Evidence-Based Practice Should Be Reported: Stage 2 Of The Development Of A Reporting Guideline, Anna Phillips, Lucy Lewis, Maureen Mcevoy, James Galipeau, Paul Glasziou, Marilyn Hammick, David Moher, Julie Tilson, Marie Williams

Paul Glasziou

Background: Undertaking a Delphi exercise is recommended during the second stage in the development process for a reporting guideline. To continue the development for the Guideline for Reporting Evidence-based practice Educational interventions and Teaching (GREET) a Delphi survey was undertaken to determine the consensus opinion of researchers, journal editors and educators in evidence-based practice (EBP) regarding the information items that should be reported when describing an educational intervention for EBP. Methods. A four round online Delphi survey was conducted from October 2012 to March 2013. The Delphi panel comprised international researchers, educators and journal editors in EBP. Commencing with an …

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 …

A Systematic Review Of How Studies Describe Educational Interventions For Evidence-Based Practice: Stage 1 Of The Development Of A Reporting Guideline, Anna Phillips, Lucy Lewis, Maureen Mcevoy, James Galipeau, Paul Glasziou, Marilyn Hammick, David Moher, Julie Tilson, Marie Williams

Paul Glasziou

Background: The aim of this systematic review was to identify which information is included when reporting educational interventions used to facilitate foundational skills and knowledge of evidence-based practice (EBP) training for health professionals. This systematic review comprised the first stage in the three stage development process for a reporting guideline for educational interventions for EBP.

Systematic Review Automation Technologies, Guy Tsafnat, Paul Glasziou, Miew Keen Choong, Adam Dunn, Filippo Galgani, Enrico Coiera

Paul Glasziou

Systematic reviews, a cornerstone of evidence-based medicine, are not produced quickly enough to support clinical practice. The cost of production, availability of the requisite expertise and timeliness are often quoted as major contributors for the delay. This detailed survey of the state of the art of information systems designed to support or automate individual tasks in the systematic review, and in particular systematic reviews of randomized controlled clinical trials, reveals trends that see the convergence of several parallel research projects. We surveyed literature describing informatics systems that support or automate the processes of systematic review or each of the tasks …

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

Paul Glasziou

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 …

Deliberative Democracy And Cancer Screening Consent: A Randomised Control Trial Of The Effect Of A Community Jury On Men's Knowledge About And Intentions To Participate In Psa Screening, Rae Thomas, Paul Glasziou, Lucie Rychetnik, Geraldine Mackenzie, Robert A. Gardiner, Jenny A. Doust

Paul Glasziou

Objective Prostate-specific antigen (PSA) screening is controversial. A community jury allows presentation of complex information and may clarify how participants view screening after being well-informed. We examined whether participating in a community jury had an effect on men's knowledge about and their intention to participate in PSA screening. Design Random allocation to either a 2-day community jury or a control group, with preassessment, postassessment and 3-month follow-up assessment. Setting Participants from the Gold Coast (Australia) recruited via radio, newspaper and community meetings. Participants Twenty-six men aged 50–70 years with no previous diagnosis of prostate cancer. Intervention The control group (n=14) …

Cross-Sectional Analysis Of The Reporting Of Continuous Outcome Measures And Clinical Significance Of Results In Randomized Trials Of Non-Pharmacological Interventions, Tammy Hoffmann, Sarah Thomas, Paul Ng Hung Shin, Paul Glasziou

Paul Glasziou

Background Reporting the scoring details of continuous outcome measures in randomized trials allows readers to interpret the size of any effect of the intervention. This study aimed to determine, in a sample of randomized trials: 1) the completeness of reporting of scoring details for continuous outcome measures, and 2) whether trial authors comment on the clinical significance of statistically significant trial results. Methods A descriptive analysis of randomized trials of non-pharmacological interventions published during 2009 in the six leading general medical journals (n = 138), and which used at least one continuous outcome measure (n = 85). From each trial …

Searching For Randomized Controlled Trials And Systematic Reviews On Exercise: A Descriptive Study, Antonio Jose Grande, Tammy Hoffmann, Paul Glasziou

Paul Glasziou

The current paradigm of science is to accumulate as much research data as possible, with less thought given to navigation or synthesis of the resulting mass, which hampers locating and using the research. The aim here was to describe the number of randomized controlled trials (RCTs) and systematic reviews (SRs) focusing on exercise, and their journal sources, that have been indexed in PubMed over time. DESIGN AND SETTING: Descriptive study conducted at Bond University, Australia. METHOD: To find RCTs, a search was conducted in PubMed Clinical Queries, using the category “Therapy” and the Medical Subject Headings (MeSH) term “Exercise”. To …

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

Paul Glasziou

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: …

New Treatments Compared To Established Treatments In Randomized Trials, Benjamin Djulbegovic, Ambuj Kumar, Paul Glasziou, Rafael Perera, Tea Reljic, Louise Dent, James Raftery, Marit Johansen, Gian Luca Di Tanna, Branko Miladinovic, Heloisa Soares, Gunn E. Vist, Iain Chalmers

Paul Glasziou

BACKGROUND: The proportion of proposed new treatments that are 'successful' is of ethical, scientific, and public importance. We investigated how often new, experimental treatments evaluated in randomized controlled trials (RCTs) are superior to established treatments. OBJECTIVES: Our main question was: "On average how often are new treatments more effective, equally effective or less effective than established treatments?" Additionally, we wanted to explain the observed results, i.e. whether the observed distribution of outcomes is consistent with the 'uncertainty requirement' for enrollment in RCTs. We also investigated the effect of choice of comparator (active versus no treatment/placebo) on the observed results.

Development And Validation Of The Ace Tool: Assessing Medical Trainees' Competency In Evidence Based Medicine, Dragan Ilic, Rusli Bin Nordin, Paul Glasziou, Julie Tilson, Elmer Villanueva

Paul Glasziou

Background: While a variety of instruments have been developed to assess knowledge and skills in evidence based medicine (EBM), few assess all aspects of EBM - including knowledge, skills attitudes and behaviour - or have been psychometrically evaluated. The aim of this study was to develop and validate an instrument that evaluates medical trainees' competency in EBM across knowledge, skills and attitude. Methods. The 'Assessing Competency in EBM' (ACE) tool was developed by the authors, with content and face validity assessed by expert opinion. A cross-sectional sample of 342 medical trainees representing 'novice', 'intermediate' and 'advanced' EBM trainees were recruited …

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 …

Clinical Score And Rapid Antigen Detection Test To Guide Antiobiotic Use For Sore Throats: Randomised Controlled Trial Of Prism (Primary Care Streptoccal Management), Paul Little, F.D.Richard Hobbs, Michael Moore, David Mant, Ian Williamson, Cliodna Mcnulty, Edith Y. Cheng, Geraldine Leydon, Richard J. Mcmanus, Joanne Kelly, Jane Barnett, Paul Glasziou, Mark Mullee

Paul Glasziou

Objective To determine the effect of clinical scores that predict streptococcal infection or rapid streptococcal antigen detection tests compared with delayed antibiotic prescribing. Design: Open adaptive pragmatic parallel group randomised controlled trial. Setting: Primary care in United Kingdom. Patients: Patients aged .3 with acute sore throat. Intervention: An internet programme randomised patients to targeted antibiotic use according to: delayed antibiotics (the comparator group for analyses), clinical score, or antigen test used according to clinical score. During the trial a preliminary streptococcal score (score 1, n=1129) was replaced by a more consistent score (score 2, n=631; features: fever during previous 24 …

When To Remeasure Cardiovascular Risk In Untreated People At Low And Intermediate Risk: Observational Study, Katy J. L. Bell, Andrew Hayen, Les Irwig, Osamu Takahashi, Sachiko Ohde, Paul Glasziou

Paul Glasziou

Objective: To estimate the probability of becoming high risk for cardiovascular disease among people at low and intermediate risk and not being treated for high blood pressure or lipid levels. Design: Observational study. Setting: General communities in Japan and the United States. Participants: 13 757 participants of the Tokyo health check-up study and 3855 of the Framingham studies aged 30-74 years with complete data on risk equation covariates, not receiving blood pressure or cholesterol lowering treatment, and with an estimated risk of cardiovascular disease20% using the Framingham equation. Results: At baseline most participants had10% probability of crossing the treatment threshold …

A Community Jury On Psa Screening: What Do Well-Informed Men Want The Government To Do About Prostate Cancer Screening - A Qualitative Analysis, Lucie Rychetnik, Jenny Doust, Rae Thomas, Robert A. Gardiner, Geraldine Mackenzie, Paul Glasziou

Paul Glasziou

Objective: Cancer screening policies and programmes should take account of public values and concerns. This study sought to determine the priorities, values and concerns of men who were 'fully informed' about the benefits and harms of prostate-specific antigen (PSA) screening; and empirically examine the value of a community jury in eliciting public values on PSA screening. Setting: Community jury was convened on the Gold Coast, Queensland (Australia) to consider PSA screening benefits and harms, and whether government campaigns on PSA screening should be conducted. Participants: 27 men (volunteers) aged 50-70 with no personal history of prostate cancer and willing to …

Protocol For Development Of The Guideline For Reporting Evidence Based Practice Educational Interventions And Teaching (Greet) Statement., Anna Phillips, Lucy Lewis, Maureen Mcevoy, James Galipeau, Paul Glasziou, Marilyn Hammick, David Moher, Julie Tilson, Marie Wilson

Paul Glasziou

Background: There are an increasing number of studies reporting the efficacy of educational strategies to facilitate the development of knowledge and skills underpinning evidence based practice (EBP). To date there is no standardised guideline for describing the teaching, evaluation, context or content of EBP educational strategies. The heterogeneity in the reporting of EBP educational interventions makes comparisons between studies difficult. The aim of this program of research is to develop the Guideline for Reporting EBP Educational interventions and Teaching (GREET) statement and an accompanying explanation and elaboration (E&E) paper. Methods/design. Three stages are planned for the development process. Stage one …

Which Lipid Measurement Should We Monitor? An Analysis Of The Lipid Study, Paul Glasziou, Les Irwig, Adrienne Kirby, Andrew Tonkin, R J. Simes

Paul Glasziou

Objectives: To evaluate the optimal lipid to measure in monitoring patients, we assessed three factors that influence the choice of monitoring tests: (1) clinical validity; (2) responsiveness to therapy changes and (3) the size of the long-term ‘signal-to-noise’ ratio. Design: Longitudinal analyses of repeated lipid measurement over 5 years. Setting: Subsidiary analysis of a Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study—a clinical trial in Australia, New Zealand and Finland. Participants: 9014 patients aged 31–75 years with previous acute coronary syndromes. Interventions: Patients were randomly assigned to 40 mg daily pravastatin or placebo. Primary and secondary outcome measures: We …