Medicine and Health Sciences Commons^™

The Chronic Kidney Disease Controversy: How Expanding Definitions Care Unnecessarily Labelling Many People As Diseased, Ray Moynihan, Richard Glassock, Jenny A. Doust

Jenny Doust

Extract: In 2002 the United States Kidney Foundation launched a novel framework for defining and classifying chronic kidney disease. The framework was widely embraced because it imposed order in a chaotic landscape characterised by a variety of names, including renal insufficiency, renal impairment, and renal failure. It has had an appreciable effect on clinical care worldwide through guidelines, pay for performance measures, and sparked debate on the merits of screening programmes. However, it has also generated considerable controversy. We examine the rationale for the framework, the varying responses and controversies it has provoked, and provide advice for clinicians who are …

Expanding Disease Definitions In Guidelines And Expert Panel Ties To Industry: A Cross-Sectional Study Of Common Conditions In The United State, Ray Moynihan, Georga Cooke, Jenny Doust, Lisa Bero, Suzanne Hill, Paul Glasziou

Jenny Doust

Financial ties between health professionals and industry may unduly influence professional judgments and some researchers have suggested that widening disease definitions may be one driver of over-diagnosis, bringing potentially unnecessary labeling and harm. We aimed to identify guidelines in which disease definitions were changed, to assess whether any proposed changes would increase the numbers of individuals considered to have the disease, whether potential harms of expanding disease definitions were investigated, and the extent of members' industry ties.

Preventing Overdiagnosis: How To Stop Harming The Healthy, Ray Moynihan, Jenny Doust, David Henry

Jenny Doust

Medicine’s much hailed ability to help the sick is fast being challenged by its propensity to harm the healthy. A burgeoning scientific literature is fuelling public concerns that too many people are being overdosed, overtreated, and overdiagnosed. Screening programmes are detecting early cancers that will never cause symptoms or death, sensitive diagnostic technologies identify “abnormalities” so tiny they will remain benign, while widening disease definitions mean people at ever lower risks receive permanent medical labels and lifelong treatments that will fail to benefit many of them. With estimates that more than $200bn (£128bn; €160bn) may be wasted on unnecessary treatment …

Prioritising Cvd Prevention Therapy - Absolute Risk Versus Individual Risk Factors, Jenny Doust, Sharon Sanders, Jonathon Shaw, Paul Glasziou

Jenny Doust

Background: Previous studies suggest that a high proportion of persons at high risk of cardiovascular disease in Australia are not receiving adequate disease prevention with blood pressure and lipid lowering therapy. However, it is not clear how a move to an absolute risk factor approach will affect the proportion of the population that is treated with blood pressure and lipid lowering therapy versus treatment based on individual risk factors. Methods: We classified participants in the AusDiab follow up cohort study who had no previous history of cardiovascular disease and who were not taking blood pressure or lipid lowering medication currently …

Aloe Vera For Treating Acute And Chronic Wounds, Anthony D. Dat, Flora Poon, Kim Bt Pham, Jenny Doust

Jenny Doust

Background: Aloe vera is a cactus-like perennial succulent belonging to the Liliaceae Family that is commonly grown in tropical climates. Animal studies have suggested that Aloe vera may help accelerate the wound healing process.

Objectives: To determine the effects of Aloe vera-derived products (for example dressings and topical gels) on the healing of acute wounds (for example lacerations, surgical incisions and burns) and chronic wounds (for example infected wounds, arterial and venous ulcers).

Search methods: We searched the Cochrane Wounds Group Specialised Register (9 September 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3), …

Development And Initial Validation Of A Simple Clinical Decision Tool To Predict The Presence Of Heart Failure In Primary Care: The Mice (Male, Infarction, Crepitations, Edema) Rule, Andrea Roalfe, Jonathan Mant, Jenny Doust, Pelham Barton, Martin Cowie, Paul Glasziou, David Mant, Richard Mcmanus, Roger Holder, Jonathon Deeks, Robert Doughty, Arno Hoes, Kate Fletcher, F.D.Richard Hobbs

Jenny Doust

Aims: Diagnosis of heart failure in primary care is often inaccurate, and access to and use of echocardiography is suboptimal. This study aimed to develop and provisionally validate a clinical prediction rule to optimize referral for echocardiography of people identified in primary care with suspected heart failure. Methods and results: A systematic review identified studies of diagnosis of heart failure set in primary care. The individual patient data for five of these studies were obtained. Logistic regression models to predict heart failure were developed on one of the data sets and validated on the others using area under the receiver …

Systematic Review Did Not Consider Problem Of Treatment Effects, Su May Liew, Jenny Doust, Paul Glasziou

Jenny Doust

Extract: Siontis and colleagues’ systematic review comparing established risk prediction models for cardiovascular disease is a useful validation of previous studies, but they seem to have ignored the problem of treatment effects.

A Survey Of Resilience, Burnout, And Tolerance Of Uncertainty In Australian General Practice Registrars, Georga Cooke, Jenny Doust, Michael Steele

Jenny Doust

Burnout and intolerance of uncertainty have been linked to low job satisfaction and lower quality patient care. While resilience is related to these concepts, no study has examined these three concepts in a cohort of doctors. The objective of this study was to measure resilience, burnout, compassion satisfaction, personal meaning in patient care and intolerance of uncertainty in Australian general practice (GP) registrars. Methods: We conducted a paper-based cross-sectional survey of GP registrars in Australia from June to July 2010, recruited from a newsletter item or registrar education events. Survey measures included the Resilience Scale-14, a single-item scale for burnout, …