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Levesque JF, O'Dowd JJM, Ní Shé ÉM, Weenink JW, Gunn J. Moving regional health services planning and management to a population-based approach: implementation of the Regional Operating Model (ROM) in Victoria, Australia. Aust J Prim Health 2018; 24:PY17151. [PMID: 30086821 DOI: 10.1071/py17151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 05/03/2018] [Indexed: 11/23/2022]
Abstract
Various jurisdictions are moving towards population-based approaches to plan and manage healthcare services. The evidence on the implementation of these models remains limited. The aim of this study is to evaluate the effect of a regional operating model (ROM) on internal functioning and stakeholder engagement of a regional office. Semi-structured interviews and focus groups with staff members and stakeholders of the North West Metropolitan Regional office in Victoria, Australia, were conducted. Overall, the ROM was perceived as relevant to staff and stakeholders. However, creating shared objectives and priorities across a range of organisations remained a challenge. Area-based planning and management is seen as simplifying management of contracts; however, reservations were expressed about moving from specialist to more generalist approaches. A clearer articulation of the knowledge, skills and competencies required by staff would further support the implementation of the model. The ROM provides a platform for public services and stakeholders to discuss, negotiate and deliver on shared outcomes at the regional level. It provides an integrated managerial platform to improve service delivery and avoid narrow programmatic approaches.
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Sinisilta S, Hollmen M, Gunn J, Ruohonen I, Jalkanen J, Airaksinen J, Jalkanen S, Kiviniemi T. P1656Circulating cytokines predict atrial fibrillation in patients undergoing open-heart coronary bypass. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lehto J, Kiviniemi T, Gunn J, Airaksinen J, Kyto V. P5338The occurrence of postpericardiotomy syndrome: association with operation type and post-operative mortality after open-heart operations. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Viikinkoski E, Hollmen M, Jalkanen J, Gunn J, Airaksinen J, Jalkanen S, Kiviniemi T. P1655Preoperative predictors for systemic inflammatory response in open-heart surgery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Anand A, Cudmore S, Robertson S, Stephen J, Haga K, Weir CJ, Murray SA, Boyd K, Gunn J, Iqbal J, MacLullich A, Shenkin S, Fox KAA, Mills NL, Denvir MA. P4616Frailty assessment and risk prediction by GRACE score in older patients with acute myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Son S, Gosling R, Morris P, Gunn J. What will be the Impact of Virtual Coronary Physiology upon the Practice of Coronary Artery Bypass Grafting Surgery for Patients with Coronary Artery Disease? Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levesque JF, Harris MF, Scott C, Crabtree B, Miller W, Halma LM, Hogg WE, Weenink JW, Advocat JR, Gunn J, Russell G. Dimensions and intensity of inter-professional teamwork in primary care: evidence from five international jurisdictions. Fam Pract 2018; 35:285-294. [PMID: 29069391 PMCID: PMC5965094 DOI: 10.1093/fampra/cmx103] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inter-professional teamwork in primary care settings offers potential benefits for responding to the increasing complexity of patients' needs. While it is a central element in many reforms to primary care delivery, implementing inter-professional teamwork has proven to be more challenging than anticipated. OBJECTIVE The objective of this study was to better understand the dimensions and intensity of teamwork and the developmental process involved in creating fully integrated teams. METHODS Secondary analyses of qualitative and quantitative data from completed studies conducted in Australia, Canada and USA. Case studies and matrices were used, along with face-to-face group retreats, using a Collaborative Reflexive Deliberative Approach. RESULTS Four dimensions of teamwork were identified. The structural dimension relates to human resources and mechanisms implemented to create the foundations for teamwork. The operational dimension relates to the activities and programs conducted as part of the team's production of services. The relational dimension relates to the relationships and interactions occurring in the team. Finally, the functional dimension relates to definitions of roles and responsibilities aimed at coordinating the team's activities as well as to the shared vision, objectives and developmental activities aimed at ensuring the long-term cohesion of the team. There was a high degree of variation in the way the dimensions were addressed by reforms across the national contexts. CONCLUSION The framework enables a clearer understanding of the incremental and iterative aspects that relate to higher achievement of teamwork. Future reforms of primary care need to address higher-level dimensions of teamwork to achieve its expected outcomes.
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Davidson S, Wadley G, Reavley N, Gunn J, Fletcher S. Psychological distress and unmet mental health needs among urban taxi drivers: A cross-sectional survey. Aust N Z J Psychiatry 2018; 52:473-482. [PMID: 29185352 DOI: 10.1177/0004867417741556] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The taxi industry relies on a male-dominated, predominately immigrant workforce who face multiple risk factors for poor mental health including shift work, low pay and threats of violence. Despite these risk factors, no previous study has documented the prevalence of psychological distress in the taxi industry. We investigated psychological distress among urban taxi drivers and explored the factors associated with high levels of distress. METHOD A total of 380 taxi drivers were surveyed at the Melbourne Airport holding yard between September 2016 and March 2017. Psychological distress was measured using the K10. Logistic regression models were used to estimate the association between high levels of psychological distress and migration, work patterns, potentially traumatic events, health care use and social connectedness. RESULTS A third (33%) of drivers had very high (K10 ⩾ 30) levels of distress and 28% had high (K10 = 22-29) levels of distress. Trauma was significantly associated with high levels of psychological distress, and rates of trauma were much higher among drivers than among the Australian population. Despite high levels of distress, drivers were no more likely than other Australian men to visit a health professional. CONCLUSION Urban taxi drivers are at very high risk for mental health problems, yet the mental health needs of this largely immigrant workforce has gone largely unnoticed. Interventions tailored to the unique characteristics of the job and the demographic composition of the workforce are urgently needed.
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Downs SH, More SJ, Goodchild AV, Whelan AO, Abernethy DA, Broughan JM, Cameron A, Cook AJ, Ricardo de la Rua-Domenech R, Greiner M, Gunn J, Nuñez-Garcia J, Rhodes S, Rolfe S, Sharp M, Upton P, Watson E, Welsh M, Woolliams JA, Clifton-Hadley RS, Parry JE. Evaluation of the methodological quality of studies of the performance of diagnostic tests for bovine tuberculosis using QUADAS. Prev Vet Med 2018; 153:108-116. [DOI: 10.1016/j.prevetmed.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 02/08/2017] [Accepted: 03/18/2017] [Indexed: 11/25/2022]
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Wachtler C, Coe A, Davidson S, Fletcher S, Mendoza A, Sterling L, Gunn J. Development of a Mobile Clinical Prediction Tool to Estimate Future Depression Severity and Guide Treatment in Primary Care: User-Centered Design. JMIR Mhealth Uhealth 2018; 6:e95. [PMID: 29685864 PMCID: PMC5938570 DOI: 10.2196/mhealth.9502] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background Around the world, depression is both under- and overtreated. The diamond clinical prediction tool was developed to assist with appropriate treatment allocation by estimating the 3-month prognosis among people with current depressive symptoms. Delivering clinical prediction tools in a way that will enhance their uptake in routine clinical practice remains challenging; however, mobile apps show promise in this respect. To increase the likelihood that an app-delivered clinical prediction tool can be successfully incorporated into clinical practice, it is important to involve end users in the app design process. Objective The aim of the study was to maximize patient engagement in an app designed to improve treatment allocation for depression. Methods An iterative, user-centered design process was employed. Qualitative data were collected via 2 focus groups with a community sample (n=17) and 7 semistructured interviews with people with depressive symptoms. The results of the focus groups and interviews were used by the computer engineering team to modify subsequent protoypes of the app. Results Iterative development resulted in 3 prototypes and a final app. The areas requiring the most substantial changes following end-user input were related to the iconography used and the way that feedback was provided. In particular, communicating risk of future depressive symptoms proved difficult; these messages were consistently misinterpreted and negatively viewed and were ultimately removed. All participants felt positively about seeing their results summarized after completion of the clinical prediction tool, but there was a need for a personalized treatment recommendation made in conjunction with a consultation with a health professional. Conclusions User-centered design led to valuable improvements in the content and design of an app designed to improve allocation of and engagement in depression treatment. Iterative design allowed us to develop a tool that allows users to feel hope, engage in self-reflection, and motivate them to treatment. The tool is currently being evaluated in a randomized controlled trial.
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Chondros P, Davidson S, Wolfe R, Gilchrist G, Dowrick C, Griffiths F, Hegarty K, Herrman H, Gunn J. Development of a prognostic model for predicting depression severity in adult primary patients with depressive symptoms using the diamond longitudinal study. J Affect Disord 2018; 227:854-860. [PMID: 29689701 DOI: 10.1016/j.jad.2017.11.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/14/2017] [Accepted: 11/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depression trajectories among primary care patients are highly variable, making it difficult to identify patients that require intensive treatments or those that are likely to spontaneously remit. Currently, there are no easily implementable tools clinicians can use to stratify patients with depressive symptoms into different treatments according to their likely depression trajectory. We aimed to develop a prognostic tool to predict future depression severity among primary care patients with current depressive symptoms at three months. METHODS Patient-reported data from the diamond study, a prospective cohort of 593 primary care patients with depressive symptoms attending 30 Australian general practices. Participants responded affirmatively to at least one of the first two PHQ-9 items. Twenty predictors were pre-selected by expert consensus based on reliability, ease of administration, likely patient acceptability, and international applicability. Multivariable mixed effects linear regression was used to build the model. RESULTS The prognostic model included eight baseline predictors: sex, depressive symptoms, anxiety, history of depression, self-rated health, chronic physical illness, living alone, and perceived ability to manage on available income. Discrimination (c-statistic =0.74; 95% CI: 0.70-0.78) and calibration (agreement between predicted and observed symptom scores) were acceptable and comparable to other prognostic models in primary care. LIMITATIONS More complex model was not feasible because of modest sample size. Validation studies needed to confirm model performance in new primary care attendees. CONCLUSION A brief, easily administered algorithm predicting the severity of depressive symptoms has potential to assist clinicians to tailor treatment for adult primary care patients with current depressive symptoms.
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Brodaty H, Connors MH, Loy C, Teixeira-Pinto A, Stocks N, Gunn J, Mate KE, Pond CD. Screening for Dementia in Primary Care: A Comparison of the GPCOG and the MMSE. Dement Geriatr Cogn Disord 2018; 42:323-330. [PMID: 27811463 DOI: 10.1159/000450992] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The General Practitioner Assessment of Cognition (GPCOG) is a brief cognitive test. This study compared the GPCOG to the Mini-Mental State Examination (MMSE), the most widely used test, in terms of their ability to detect likely dementia in primary care. METHODS General practitioners across three states in Australia recruited 2,028 elderly patients from the community. A research nurse administered the GPCOG and the MMSE, as well as the Cambridge Examination for Mental Disorders of the Elderly Cognitive Scale-Revised that we used to define likely dementia. RESULTS Overall, the GPCOG and the MMSE were similarly effective at detecting likely dementia. The GPCOG, however, had a higher sensitivity than the MMSE when using published cutpoints. CONCLUSION The GPCOG is an effective screening tool for dementia in primary care. It appears to be a viable alternative to the MMSE, whilst also requiring less time to administer.
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Middleton A, Pirkis J, Chondros P, Bassilios B, Gunn J. The Health Service Use of Frequent Users of Telephone Helplines in a Cohort of General Practice Attendees with Depressive Symptoms. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:663-674. [PMID: 26370273 DOI: 10.1007/s10488-015-0680-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We examined the relationship between frequent use of telephone helplines and health service use over time in a cohort of 789 general practice attendees with depressive symptoms. Telephone helpline use (no use, non-frequent use, frequent use) was measured at 3, 6, 9 and 12 months and analysed using ordered logistic regression. Sixteen participants (2 %) reported frequent use of telephone helplines. Reporting frequent use was associated with visiting multiple general practitioners, using emergency services and visiting mental health specialists in the previous 3 months. Despite this pattern of service use, there was evidence that these services were not meeting the needs of frequent users of telephone helplines, as they were also more likely to report dissatisfaction with their access to health services compared to non-frequent and non-users of telephone helplines. Our findings suggest that a model of care which addresses the complex needs of frequent users of telephone helplines is needed.
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Gunn J, Cameron J, Densley K, Davidson S, Fletcher S, Palmer V, Chondros P, Dowrick C, Pirkis J. Uptake of mental health websites in primary care: Insights from an Australian longitudinal cohort study of depression. PATIENT EDUCATION AND COUNSELING 2018; 101:105-112. [PMID: 28739180 DOI: 10.1016/j.pec.2017.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/25/2017] [Accepted: 07/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To describe the characteristics of primary care attendees with depressive symptoms who use mental health websites. METHODS 789 individuals with depressive symptoms recruited and followed up annually for nine years. Self-reported written surveys included mental health, professional and self-help use, e-mental health interventions or therapeutic websites. Marginal logistic regression examined association between mental health website (MHW) use and patient's mental health, health services use, anti-depressant use and self-help strategies. RESULTS 36% of participants used an MHW at least once. MHW users were more likely to be female, younger, highly educated and employed. MHW use increased with depressive symptom severity; reported in 16% of assessments when minimal symptoms were present and 28% when severe symptoms were present. MHW use was associated with: GP mental health visits, psychologist and psychiatrist visits and other self-help strategies including self-help books and telephone helplines. CONCLUSION(S) Mental health websites were more likely to be used by those with severe depressive symptoms rather than those with mild depression as recommended in current guidelines. PRACTICE IMPLICATION(S) Whilst mental health websites offer potential to support the high volume of people with mild depression new strategies may be required to ensure uptake.
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Downs SH, Parry JE, Upton PA, Broughan JM, Goodchild AV, Nuñez-Garcia J, Greiner M, Abernethy DA, Cameron AR, Cook AJ, de la Rua-Domenech R, Gunn J, Pritchard E, Rhodes S, Rolfe S, Sharp M, Vordermeier HM, Watson E, Welsh M, Whelan AO, Woolliams JA, More SJ, Clifton-Hadley RS. Methodology and preliminary results of a systematic literature review of ante-mortem and post-mortem diagnostic tests for bovine tuberculosis. Prev Vet Med 2017; 153:117-126. [PMID: 29395122 DOI: 10.1016/j.prevetmed.2017.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 02/04/2023]
Abstract
A systematic review was conducted to identify studies with data for statistical meta-analyses of sensitivity (Se) and specificity (Sp) of ante-mortem and post-mortem diagnostic tests for bovine tuberculosis (bTB) in cattle. Members of a working group (WG) developed and tested search criteria and developed a standardised two-stage review process, to identify primary studies with numerator and denominator data for test performance and an agreed range of covariate data. No limits were applied to year, language, region or type of test in initial searches of electronic databases. In stage 1, titles and available abstracts were reviewed. References that complied with stage 1 selection criteria were reviewed in entirety and agreed data were extracted from references that complied with stage 2 selection criteria. At stage 1, 9782 references were reviewed and 261 (2.6%) passed through to stage 2 where 215 English language references were each randomly allocated to two of 18 WG reviewers and 46 references in other languages were allocated to native speakers. Agreement regarding eligibility between reviewers of the same reference at stage 2 was moderate (Kappa statistic = 0.51) and a resolution procedure was conducted. Only 119 references (published 1934-2009) were identified with eligible performance estimates for one or more of 14 different diagnostic test types; despite a comprehensive search strategy and the global impact of bTB. Searches of electronic databases for diagnostic test performance data were found to be nonspecific with regard to identifying references with diagnostic test Se or Sp data. Guidelines for the content of abstracts to research papers reporting diagnostic test performance are presented. The results of meta-analyses of the sensitivity and specificity of the tests, and of an evaluation of the methodological quality of the source references, are presented in accompanying papers (Nuñez-Garcia et al., 2017; Downs et al., 2017).
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Moreau P, Bucalossi J, Missirlian M, Samaille F, Courtois X, Gil C, Lotte P, Meyer O, Nardon E, Nouailletas R, Ravenel N, Travere J, Alarcon T, Antusch S, Aumeunier M, Barjat P, Belsare S, Bernard J, Bhandarkar M, Bottereau C, Bourdelle C, Brémond S, Camenen Y, Chaudhari V, Chavda C, Chernyshova M, Clairet F, Colnel J, Czarski T, Choi M, Colledani G, Corre Y, Daniel R, Davis D, Dejarnac R, Devynck P, Dhongde J, Douai D, Elbeze D, Escarguel A, Fenzi C, Figacz W, Guangwu Z, Giacalone J, Guirlet R, Gunn J, Hacquin S, Hao X, Harris J, Hoang G, Houry M, Imbeaux F, Jablonski S, Jardin A, Joshi H, Kasprowicz G, Klepper C, Kowalska-Strzeciwilk E, Kubkowska M, Kumar A, Kumar V, Kumari P, Laqua H, Le-Luyer A, Lee W, Lewerentz M, Lyu B, Malard P, Manenc L, Mansuri I, Marandet Y, Masand H, Mazon D, Molina D, Moureau G, Nam Y, Park H, Pascal J, Patel K, Patel M, Pozniak K, Radloff D, Ranjan S, Rapson C, Raupp G, Rieth M, Sabot R, Santraine B, Sestac D, Sharma M, Shen J, Signoret J, Soni J, Spring A, Spuig P, Sugandhi R, Treuterrer W, Tsitrone E, Varshney S, Vartanian S, Volpe D, Wang F, Werner A, Yun G, Zabolotny W, Zhao W. Measurements and controls implementation for WEST. FUSION ENGINEERING AND DESIGN 2017. [DOI: 10.1016/j.fusengdes.2017.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Proudfoot J, Clarke J, Gunn J, Fletcher S, Sanatkar S, Wilhelm K, Campbell L, Zwar N, Harris M, Lapsley H, Hadzi-Pavlovic D, Christensen H. A Web-Based Public Health Intervention to Reduce Functional Impairment and Depressive Symptoms in Adults With Type 2 Diabetes (The SpringboarD Trial): Randomized Controlled Trial Protocol. JMIR Res Protoc 2017; 6:e145. [PMID: 28778848 PMCID: PMC5561386 DOI: 10.2196/resprot.7348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 01/20/2023] Open
Abstract
Background Depressive symptoms are common in people with type 2 diabetes and contribute to adverse health consequences that substantially impact social and vocational function. Despite the existence of effective depression treatments, the majority of people with type 2 diabetes do not access these when needed. Web-based alternatives to more traditional psychotherapies offer a potential solution to reducing the personal and economic burdens of type 2 diabetes. Objective This paper outlines the protocol for a randomized controlled trial (RCT) of myCompass, a Web-based public health psychotherapy intervention, in people with type 2 diabetes. Fully automated, interactive, and delivered via the Internet without clinician support, myCompass teaches cognitive behavioral therapy-based skills and supports symptom monitoring to improve daily functioning and reduce mild-to-moderate mental health symptoms. Methods A two-arm RCT will be conducted. People with type 2 diabetes and mild-to-moderately severe depressive symptoms will be recruited from the community and general practice settings. Screening and enrollment is via an open-access website. Participants will be randomized to use either myCompass or an active placebo program for 8 weeks, followed by a 4-week tailing-off period. The placebo program is matched to myCompass on mode of delivery, interactivity, and duration. Outcomes will be assessed at baseline and at 3-month, 6-month, and 12-month follow-up. The primary study outcome is work and social functioning. Secondary study outcomes include depressive and anxious symptoms, diabetes-related distress, self-care behaviors, and glycemic control. Results Nationwide recruitment is currently underway with the aim of recruiting 600 people with type 2 diabetes. Recruitment will continue until October 2017. Conclusions This is the first known trial of a Web-based psychotherapy program that is not diabetes specific for improving social and vocational function in people with type 2 diabetes and mild-to-moderately severe depressive symptoms. With the increasing prevalence of type 2 diabetes and depression, a potentially scalable public health intervention could play a very large role in reducing unmet mental health need and ameliorating the personal and societal impact of illness comorbidity. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12615000931572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109 (Archived by WebCite at http://www.webcitation.org/ 6rh3imVMh)
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Rothman A, Arnold N, Abou Hanna J, Rowland H, Poff B, Macdonald K, Nagy M, Panian T, Sundaram B, Pham P, Forouzan O, Gunn J, Lawrie A, Chronos N. P612Feasibility and safety of a wireless pulmonary artery pressure monitoring system in chronic porcine models of pulmonary hypertension. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gunn J, Wachtler C, Fletcher S, Davidson S, Mihalopoulos C, Palmer V, Hegarty K, Coe A, Murray E, Dowrick C, Andrews G, Chondros P. Target-D: a stratified individually randomized controlled trial of the diamond clinical prediction tool to triage and target treatment for depressive symptoms in general practice: study protocol for a randomized controlled trial. Trials 2017; 18:342. [PMID: 28728604 PMCID: PMC5520374 DOI: 10.1186/s13063-017-2089-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/05/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Depression is a highly prevalent and costly disorder. Effective treatments are available but are not always delivered to the right person at the right time, with both under- and over-treatment a problem. Up to half the patients presenting to general practice report symptoms of depression, but general practitioners have no systematic way of efficiently identifying level of need and allocating treatment accordingly. Therefore, our team developed a new clinical prediction tool (CPT) to assist with this task. The CPT predicts depressive symptom severity in three months' time and based on these scores classifies individuals into three groups (minimal/mild, moderate, severe), then provides a matched treatment recommendation. This study aims to test whether using the CPT reduces depressive symptoms at three months compared with usual care. METHODS The Target-D study is an individually randomized controlled trial. Participants will be 1320 general practice patients with depressive symptoms who will be approached in the practice waiting room by a research assistant and invited to complete eligibility screening on an iPad. Eligible patients will provide informed consent and complete the CPT on a purpose-built website. A computer-generated allocation sequence stratified by practice and depressive symptom severity group, will randomly assign participants to intervention (treatment recommendation matched to predicted depressive symptom severity group) or comparison (usual care plus Target-D attention control) arms. Follow-up assessments will be completed online at three and 12 months. The primary outcome is depressive symptom severity at three months. Secondary outcomes include anxiety, mental health self-efficacy, quality of life, and cost-effectiveness. Intention-to-treat analyses will test for differences in outcome means between study arms overall and by depressive symptom severity group. DISCUSSION To our knowledge, this is the first depressive symptom stratification tool designed for primary care which takes a prognosis-based approach to provide a tailored treatment recommendation. If shown to be effective, this tool could be used to assist general practitioners to implement stepped mental-healthcare models and contribute to a more efficient and effective mental health system. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR 12616000537459 ). Retrospectively registered on 27 April 2016. See Additional file 1 for trial registration data.
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Middleton A, Woodward A, Gunn J, Bassilios B, Pirkis J. How do frequent users of crisis helplines differ from other users regarding their reasons for calling? Results from a survey with callers to Lifeline, Australia's national crisis helpline service. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1041-1049. [PMID: 27862572 DOI: 10.1111/hsc.12404] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2016] [Indexed: 06/06/2023]
Abstract
Crisis helplines are designed to provide short-term support to people in an immediate crisis. However, there is a group of users who call crisis helplines frequently over an extended period of time. The reasons for their ongoing use remain unclear. The aim of this study was to investigate the differences in the reasons for calling between frequent and other users of crisis helplines. This was achieved by examining the findings from a brief survey completed by callers to Lifeline Australia at the end of their call between February and July 2015. In the survey, callers reported on their socio-demographics, reasons for their current call and number of calls made in the past month. Survey respondents were categorised as frequent, episodic and one-off users, and analyses were conducted using ordered logistic regression. Three hundred and fifteen callers completed the survey, which represented 57% of eligible callers. Twenty-two per cent reported calling 20 times or more in the past month (frequent users), 51% reported calling between 2 and 19 times (episodic users) and 25% reported calling once (one-off users). Two per cent were unable to recall the number of calls they made in the past month. Frequent users reported similar reasons for calling as other users but they were more likely to call regularly to talk about their feelings [OR = 6.0; 95% CI: 3.7-9.8]. This pattern of service use is at odds with the current model of care offered by crisis helplines which is designed to provide one-off support. There is a need to investigate further the factors that drive frequent users to call crisis helplines regularly.
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Richard L, Piper D, Weavell W, Callander R, Iedema R, Furler J, Pierce D, Godbee K, Gunn J, Palmer VJ. Advancing engagement methods for trials: the CORE study relational model of engagement for a stepped wedge cluster randomised controlled trial of experience-based co-design for people living with severe mental illnesses. Trials 2017; 18:169. [PMID: 28388937 PMCID: PMC5385022 DOI: 10.1186/s13063-017-1878-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/06/2017] [Indexed: 11/17/2022] Open
Abstract
Background Engagement is essential in trials research but is rarely embedded across all stages of the research continuum. The development, use, effectiveness and value of engagement in trials research is poorly researched and understood, and models of engagement are rarely informed by theory. This article describes an innovative methodological approach for the development and application of a relational model of engagement in a stepped wedge designed cluster randomised controlled trial (RCT), the CORE study. The purpose of the model is to embed engagement across the continuum of the trial which will test if an experience-based co-design intervention improves psychosocial recovery for people affected by severe mental illness. Methods The model was developed in three stages and used a structured iterative approach. A context mapping assessment of trial sites was followed by a literature review on recruitment and retention of hard-to-reach groups in complex interventions and RCTs. Relevant theoretical and philosophical underpinnings were identified by an additional review of literature to inform model development and enactment of engagement activities. Results Policy, organisational and service user data combined with evidence from the literature on barriers to recruitment provided contextual information. Four perspectives support the theoretical framework of the relational model of engagement and this is organised around two facets: the relational and continuous. The relational facet is underpinned by relational ethical theories and participatory action research principles. The continuous facet is supported by systems thinking and translation theories. These combine to enact an ethics of engagement and evoke knowledge mobilisation to reach the higher order goals of the model. Conclusions Engagement models are invaluable for trials research, but there are opportunities to advance their theoretical development and application, particularly within stepped wedge designed studies where there may be a significant waiting period between enrolment in a study and receipt of an intervention.
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Nuñez-Garcia J, Downs SH, Parry JE, Abernethy DA, Broughan JM, Cameron AR, Cook AJ, de la Rua-Domenech R, Goodchild AV, Gunn J, More SJ, Rhodes S, Rolfe S, Sharp M, Upton PA, Vordermeier HM, Watson E, Welsh M, Whelan AO, Woolliams JA, Clifton-Hadley RS, Greiner M. Meta-analyses of the sensitivity and specificity of ante-mortem and post-mortem diagnostic tests for bovine tuberculosis in the UK and Ireland. Prev Vet Med 2017; 153:94-107. [PMID: 28347519 DOI: 10.1016/j.prevetmed.2017.02.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 01/07/2017] [Accepted: 02/26/2017] [Indexed: 10/20/2022]
Abstract
Bovine Tuberculosis (bTB) in cattle is a global health problem and eradication of the disease requires accurate estimates of diagnostic test performance to optimize their efficiency. The objective of this study was, through statistical meta-analyses, to obtain estimates of sensitivity (Se) and specificity (Sp), for 14 different ante-mortem and post-mortem diagnostic tests for bTB in cattle. Using data from a systematic review of the scientific literature (published 1934-2009) diagnostic Se and Sp were estimated using Bayesian logistic regression models adjusting for confounding factors. Random effect terms were used to account for unexplained heterogeneity. Parameters in the models were implemented using Markov Chain Monte Carlo (MCMC), and posterior distributions for the diagnostic parameters with adjustment for covariates (confounding factors) were obtained using the inverse logit function. Estimates for Se and/or Sp of the tuberculin skin tests and the IFN-γ blood test were compared with estimates published 2010-2015. Median Se for the single intradermal comparative cervical tuberculin skin (SICCT) test (standard interpretation) was 0.50 and Bayesian credible intervals (CrI) were wide (95% CrI 0.26, 0.78). Median Sp for the SICCT test was 1.00 (95% CrI 0.99, 1.00). Estimates for the IFN-γ blood test Bovine Purified Protein Derivative (PPD)-Avian PPD and Early Secreted Antigen target 6 and Culture Filtrate Protein 10 (ESAT-6/CFP10) ESAT6/CFP10 were 0.67 (95% CrI 0.49, 0.82) and 0.78 (95% CrI 0.60, 0.90) respectively for Se, and 0.98 (95% CrI 0.96, 0.99) and 0.99 (95% CrI 0.99, 1.00) for Sp. The study provides an overview of the accuracy of a range of contemporary diagnostic tests for bTB in cattle. Better understanding of diagnostic test performance is essential for the design of effective control strategies and their evaluation.
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Gunn J, Pirotta M. Research in general practice. AUSTRALIAN FAMILY PHYSICIAN 2017; 46:166-167. [PMID: 28260269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Mate KE, Magin PJ, Brodaty H, Stocks NP, Gunn J, Disler PB, Marley JE, Pond CD. An evaluation of the additional benefit of population screening for dementia beyond a passive case-finding approach. Int J Geriatr Psychiatry 2017; 32:316-323. [PMID: 26988976 DOI: 10.1002/gps.4466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE General practitioners (GPs) fail to identify more than 50% of dementia cases using the existing passive case-finding approach. Using data from the "Ageing in General Practice" study, we sought to establish the additional benefit of screening all patients over the age of 75 for dementia beyond those patients already identified by passive case-finding. METHOD Patients were classified as "case-finding" (n = 425) or "screening" (n = 1006) based on their answers to four subjective memory related questions or their GP's clinical judgement of their dementia status. Cognitive status of each patient was formally assessed by a research nurse using the Cambridge Cognition Examination (CAMCOG-R). Patients then attended their usual GP for administration of the GP assessment of Cognition (GPCOG) dementia screening instrument, and follow-up care and/or referral as necessary in light of the outcome. RESULTS The prevalence of dementia was significantly higher in the case-finding group (13.6%) compared to the screening group (4.6%; p < 0.01). The GPCOG had a positive predictive value (PPV) of 61% in the case-finding group and 39% in the screening group; negative predictive value was >95% in both groups. GPs and their patients both found the GPCOG to be an acceptable cognitive assessment tool. The dementia cases missed via case-finding were younger (p = 0.024) and less cognitively impaired (p = 0.020) than those detected. CONCLUSION There is a very limited benefit of screening for dementia, as most people with dementia could be detected using a case-finding approach, and considerable potential for social and economic harm because of the low PPV associated with screening.
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Killeen S, Gunn J, Hartley J. Surgical management of complicated and medically refractory inflammatory bowel disease during pregnancy. Colorectal Dis 2017; 19:123-138. [PMID: 27317641 DOI: 10.1111/codi.13413] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/28/2016] [Indexed: 02/08/2023]
Abstract
AIM The medical management of inflammatory bowel disease (IBD) in pregnancy and the puerperium is well defined. Data on surgical management of complicated IBD in this setting are lacking. This study aimed to determine the optimal surgical strategy for medically refractory IBD during pregnancy and the puerperium. METHOD Three databases were systematically reviewed to identify all published series or case reports of women undergoing surgery for Crohn's disease (CD) or ulcerative colitis (UC) while pregnant or during the puerperium. RESULTS Thirty-two papers were identified, including 86 patients. Nearly one-fifth (18%) of cases were de novo presentations and intervention was required at all stages of pregnancy. UC refractory to medical treatment and perforated small bowel CD were the commonest indications for surgery. Operations used included colectomy, colectomy with mucous fistula and Turnbull-blowhole colostomy for complicated UC and open or laparoscopic small bowel resection with stoma formation for CD. Surgical intervention during the third trimester universally resulted in the onset of labour. Endoscopic and radiological interventions were rarely employed. In studies after 1980 there was no maternal or foetal mortality but there was an almost 50% preterm delivery rate. CONCLUSION Surgical management of complicated IBD during pregnancy and the puerperium needs to be tailored to disease severity, the type of complications and foetal status. It should involve gastroenterologists, colorectal surgeons, obstetricians and neonatal specialists in a multidisciplinary manner within a single unit.
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