Medicine and Health Sciences Commons^™

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

Jenny Doust

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 …

Systematic Review Of Clinical Practice Guidelines Recommendations About Primary Cardiovascular Disease Prevention For Older Adults, Jesse Jansen, Shannon Mckinn, Carissa Bonner, Les Irwig, Jenny Doust, Paul Glasziou, Brooke Nickel, Barbara Van Munster, Kirsten Mccaffery

Jenny Doust

Background: Clinical care for older adults is complex and represents a growing problem. They are a diverse patient group with varying needs, frequent presence of multiple comorbidities, and are more susceptible to treatment harms. Thus Clinical Practice Guidelines (CPGs) need to carefully consider older adults in order to guide clinicians. We reviewed CPG recommendations for primary cardiovascular disease (CVD) prevention and examined the extent to which CPGs address issues important for older people identified in the literature.

Antibiotics For Bronchiolitis In Children, Geoffrey Spurling, Jenny Doust, Chris Del Mar, Lars Ericksson

Jenny Doust

Background: Bronchiolitis is a serious, potentially life-threatening respiratory illness commonly affecting babies. It is often caused by respiratory syncytial virus (RSV). Antibiotics are not recommended for bronchiolitis unless there is concern about complications such as secondary bacterial pneumonia or respiratory failure. Nevertheless, they are used at rates of 34% to 99% in uncomplicated cases. Objectives: To evaluate the effectiveness of antibiotics for bronchiolitis. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2010, issue 4), which includes the Cochrane Acute Respiratory Infection Group’s Specialised Register, and the Database of Abstracts of Reviews of Effects, MEDLINE (January 1966 …

Qualification Versus Validation Of Biomarkers, Jenny Doust

Jenny Doust

The phases of research used to evaluate new drugs provide a useful reference point for determining the studies that need to be conducted to evaluate new biomarkers. However, biomarkers do not have a single pathway for changing health outcomes and may be used for a variety of purposes, such as improving diagnostic criteria, improving prognosis, improving the monitoring of disease or as a measurement of health outcomes. The impact on health outcomes is also less direct and is dependent on the sequence of actions taken as a consequence of the test results. The different purposes of biomarkers and the less …

Why Do Doctors Use Treatments That Do Not Work? For Many Reasons - Including Their Inability To Stand Idle And Do Nothing., Jenny Doust, Chris Del Mar

Jenny Doust

Why do we still use ineffective treatments? One reason is that our expectations for the benefits of treatment are too high. Also clinical experience can be a poor judge of what does and does not work - hence the need for randomised controlled trials. Even when empiricism is satisfied we can be misled by looking at the wrong outcome. Indeed some treatments have harms that outweigh their benefits and are not evident in trials. Much of the clinical examination and diagnostic testing is more of a ritual than diagnostically useful. Doctors must be willing to continually question their own managements …

Systematic Review And Individual Patient Data Meta-Analysis Of Diagnosis Of Heart Failure, With Modelling Of Implications Of Different Diagnostic Strategies In Primary Care, J. Mant, J. Doust, A. Roalfe, P. Barton, M. Cowie, P. Glasziou, D. Mant, R. Mcmanus, R. Holder, J. Deeks, K. Fletcher, M. Qume, S. Sohanpal, S. Sanders, F. Hobbs

Jenny Doust

Objectives: To assess the accuracy in diagnosing heart failure of clinical features and potential primary care investigations, and to perform a decision analysis to test the impact of plausible diagnostic strategies on costs and diagnostic yield in the UK health-care setting. Data sources: MEDLINE and CINAHL were searched from inception to 7 July 2006. ‘Grey literature’ databases and conference proceedings were searched and authors of relevant studies contacted for data that could not be extracted from the published papers. Review methods: A systematic review of the clinical evidence was carried out according to standard methods. Individual patient data (IPD) analysis …

Doctors As Patients: A Systematic Review Of Doctors' Health Access And The Barriers They Experience, Margaret Kay, Geoffrey Mitchell, Alexandra Clavarino, Jenny Doust

Jenny Doust

Background The need to improve doctors' access to health care by reducing the barriers they experience has been regularly described in the literature, yet the barriers experienced are not well defined, despite the volume of expert opinion in this area. Aim To define what is known about doctors' access to health care from the data within the current literature.Design of study A systematic review of studies of doctors' health access.Method A systematic search of MEDLINE® and CINAHL, supplemented by citation searches and searches of the grey literature, identified both quantitative and qualitative studies. Two reviewers used specific criteria for inclusion …

Seriously Working Together: Integrated Governance Models To Achieve Sustainable Partnerships Between Health Care Organisations, Claire Jackson, Caroline Nicholson, Jenny Doust, Lily Cheung, John O'Donnell

Jenny Doust

Objective: To identify sustainable governance arrangements for health care organisations undertaking integrated health service delivery based on best available evidence. Method: Systematic review of the literature (1990–2006), supported by key informant interviews as an integrative process. Results: 16 studies met our selection criteria. All described enablers of and barriers to delivering integrated health services. We identified three models for integrated health care governance with a demonstrated ability to be sustained in the medium term. Common themes that emerged as the logical starting point for more ambitious integrated governance arrangements regionally were: the need for a clear separation between governance and …

Scrub Typhus Serologic Testing With The Indirect Immunofluorescence Method As A Diagnostic Gold Standard: A Lack Of Consensus Leads To A Lot Of Confusion, Stuart Blacksell, Naomi Bryant, Daniel Paris, Jenny Doust, Yoshihiro Sakoda, Nicholas Day

Jenny Doust

A review was performed to determine the evidence base for scrub typhus indirect immunofluorescence assay (IFA) methodologies and the criteria for positive results. This review included a total of 109 publications, which comprised 123 eligible studies for analysis (14 publications included 2 substudies). There was considerable underreporting of the IFA methodology and seropositivity criteria used, with most studies using a defined cutoff titer rather than an increase in the titer in paired samples. The choice of positivity cutoff titer varied by country and purpose of the IFA test. This variation limits the comparability of seroprevalence rates between studies and, more …

Teaching Evidence Based Laboratory Medicine, Jenny Doust, Sharon Sanders

Jenny Doust

No abstract provided.

The Role Of Bnp Testing In Heart Failure, Jenny Doust, Richard Lehman, Paul Glasziou

Jenny Doust

Brain natriuretic peptide (BNP) levels are simple and objective measures of cardiac function. These measurements can be used to diagnose heart failure, including diastolic dysfunction, and using them has been shown to save money in the emergency department setting. The high negative predictive value of BNP tests is particularly helpful for ruling out heart failure. Treatment with angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, spironolactone, and diuretics reduces BNP levels, suggesting that BNP testing may have a role in monitoring patients with heart failure. However, patients with treated chronic stable heart failure may have levels in the normal range (i.e., BNP …

Is Pulse Palpation Helpful In Detecting Atrial Fibrillation? A Systematic Review, Georga Cooke, Jenny Doust, Sharon Sanders

Jenny Doust

Background: Atrial fibrillation in the elderly is common and potentially life threatening. The classical sign of atrial fibrillation is an irregularly irregular pulse. Objective: The objective of this research was to determine the accuracy of pulse palpation to detect atrial fibrillation. Methods: We searched Medline, EMBASE, and the reference lists of review articles for studies that compared pulse palpation with the electrocardiogram (ECG) diagnosis of atrial fibrillation. Two reviewers independently assessed the search results to determine the eligibility of studies, extracted data, and assessed the quality of the studies. Results: We identified 3 studies (2385 patients) that compared pulse palpation …

Evidence Based Answers - Is Salmeterol Safe In Asthma?, Geoffrey Spurling, Jenny Doust

Jenny Doust

Case history SW, 21 years of age, presented for a prescription for her salbutamol puffer. She had a long history of chronic persistent asthma usually exacerbated by upper respiratory tract infections (URTIs). These exacerbations had occasionally landed her in hospital but never in intensive care. After a friend died of an asthma attack, SW adhered rigorously to her asthma plan and always used a spacer for her preventer, fluticasone. It therefore surprised me when I noticed that she had had no URTIs yet had been prescribed salbutamol by another general practitioner in the practice only 2 weeks previously. In response …

How Well Does B-Type Natriuretic Peptide Predict Death And Cardiac Events In Patients With Heart Failure: Systematic Review, Jenny Doust, Eva Pietrzak, Annette Dobson, Paul Glasziou

Jenny Doust

Objective To assess how well B-type natriuretic peptide (BNP) predicts prognosis in patients with heart failure. Design Systematic review of studies assessing BNP for prognosis in patients with heart failure or asymptomatic patients. Data sources Electronic searches of Medline and Embase from January 1994 to March 2004 and reference lists of included studies. Study selection and data extraction We included all studies that estimated the relation between BNP measurement and the risk of death, cardiac death, sudden death, or cardiovascular event in patients with heart failure or asymptomatic patients, including initial values and changes in values in response to treatment. …

Identifying Health Centers In Honduras Infested With Rhodnius Prolixus Using The Seroprevalence Of Chagas Disease In Children Younger Than 13 Years, Geoffrey Spurling, Romuald Lucas, Jenny Doust

Jenny Doust

The objective of this study is to determine if a Chagas disease protocol starting with a serological survey is as reliable at identifying insect-infested areas as one using the gold standard entomological survey. The study found that health center areas infested with Rhodnius prolixus were identified using a threshold seroprevalence of 0.1%. The serological survey took half the time and was 30% less expensive than the entomological survey. Developing countries with limited resources may find this strategy useful in combating Chagas disease. This strategy also identifies seropositive children, which facilitates their treatment.

A Systematic Review Of Brachytherapy. Is It An Effective And Safe Treatment For Localised Prostate Cancer?, Jenny Doust, Emma Miller, Gillian Duchesne, Michael Kitchener, David Weller

Jenny Doust

BACKGROUND Brachytherapy is a promising treatment for prostate cancer as it may have reduced rates of impotence and incontinence. OBJECTIVE General practitioners can influence the treatment patients receive by their referral patterns, so it is important they understand the effectiveness and safety of treatment. We reviewed the primary literature on brachytherapy as sole therapy for localised prostate cancer. DISCUSSION Although there have been many studies on the safety and effectiveness of brachytherapy, there have been no trials of brachytherapy versus other treatments that would control for factors such as tumour stage, grade, or initial prostate specific antigen levels. Brachytherapy for …

A Systematic Review Of The Diagnostic Accuracy Of Natriuretic Peptides For Heart Failure, Jenny Doust, Paul Glasziou, Eva Pietrzak, Annette Dobson

Jenny Doust

Background The diagnosis of heart failure is difficult, with both overdiagnosis and underdiagnosis occurring commonly in practice. Natriuretic peptides have been proposed as a possible test for assisting diagnosis. We assessed the diagnostic accuracy of brain natriuretic peptide (BNP), including a comparison with atrial natriuretic peptide (ANP). Methods Electronic searches were conducted of MEDLINE and EMBASE from January 1994 to December 2002 and handsearches of reference lists of included studies. We included studies that assessed the diagnostic accuracy of BNP against echocardiographic or clinical criteria or that compared the diagnostic accuracy of BNP with ANP. Two reviewers assessed studies for …

Diagnosing Patients With Tiredness In General Practice, Jenny Doust

Jenny Doust

Trying to sort out which patients have a relatively simple problem that will resolve spontaneously from those that require medical treatment and those that require urgent attention is one of the aspects of general practice that makes it interesting and challenging. Patients who present with tiredness in general practice can have any of a long list of diagnoses ranging from the trivial to the life threatening, and knowing how to determine who has which is an essential skill for competent practice.

Diagnostic And Management Strategies For Anaemia In Adults, Jenny Doust

Jenny Doust

BACKGROUND Anaemia is often an incidental finding or is discovered when patients present with nonspecific symptoms such as tiredness. OBJECTIVE This article presents strategies to identify the cause of anaemia and uses four case studies to illustrate these principles. DISCUSSION Few diagnostic tests can completely rule in or rule out causes of anaemia. This makes the investigation of anaemia complex. An understanding of the limitations of tests in aiding diagnosis is required.

Promoting Better Use Of The Psa Test In General Practice: Randomized Controlled Trial Of Educational Strategies Based On Outreach Visits And Mailout, D Weller, F May, D Rowett, A Esterman, C Pinnock, S Nicholson, Jenny Doust, C Silagy

Jenny Doust

Background. Prostate-specific antigen (PSA) testing for prostate cancer is controversial. Demand for PSA testing is likely to rise in the UK, Australia and other western countries. Primary care needs to develop appropriate strategies to respond to this demand. Objectives. Our aim was to compare the effectiveness of educational outreach visits (EOVs) and mailout strategies targeting PSA testing in Australian primary care. Methods. A randomized controlled trial was conducted in general practices in southern Adelaide. The main outcome measures at baseline, 6 months and 12 months post-intervention were PSA testing rates and GP knowledge in key areas relating to prostate cancer …

What Is Cochrane All About?, Chris Del Mar, Jenny Doust

Jenny Doust

Recently the Australian Minister for Health, the Hon Kay Patterson, announced that Australia is purchasing the Cochrane Library for all Australians. Australians will now have access to the library free of charge through the web.