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Fisman D, Giglio N, Levin MJ, Nguyen VH, Pelton SI, Postma M, Ruiz-Aragón J, Urueña A, Mould-Quevedo JF. The economic rationale for cell-based influenza vaccines in children and adults: A review of cost-effectiveness analyses. Hum Vaccin Immunother 2024; 20:2351675. [PMID: 38835218 PMCID: PMC11155702 DOI: 10.1080/21645515.2024.2351675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/02/2024] [Indexed: 06/06/2024] Open
Abstract
Seasonal influenza significantly affects both health and economic costs in children and adults. This narrative review summarizes published cost-effectiveness analyses (CEAs) of cell-based influenza vaccines in children and adults <65 years of age, critically assesses the assumptions and approaches used in these analyses, and considers the role of cell-based influenza vaccines for children and adults. CEAs from multiple countries demonstrated the cost-effectiveness of cell-based quadrivalent influenza vaccines (QIVc) compared with egg-based trivalent/quadrivalent influenza vaccines (TIVe/QIVe). CEA findings were consistent across models relying on different relative vaccine effectiveness (rVE) estimate inputs, with the rVE of QIVc versus QIVe ranging from 8.1% to 36.2% in favor of QIVc. Across multiple scenarios and types of analyses, QIVc was consistently cost-effective compared with QIVe, including in children and adults across different regions of the world.
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Affiliation(s)
- David Fisman
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Norberto Giglio
- Servicio de Consultorios Externos de Pediatría. Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Myron J. Levin
- Departments of Pedatrics and Medicine, University of Colorado School of Medicine, Denver, Colorado, United States
| | | | - Stephen I. Pelton
- Department of Health Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Maarten Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
- Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Analia Urueña
- Centro de Estudios para la Prevención y Control de Enfermedades Transmisibles, Universidad Isalud, Buenos Aires, Argentina
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Ijaz N, Hunter J, Grant S, Templeman K. Protocol for a scoping review of traditional medicine research methods, methodologies, frameworks and strategies. Front Med (Lausanne) 2024; 11:1409392. [PMID: 39050530 PMCID: PMC11267516 DOI: 10.3389/fmed.2024.1409392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/11/2024] [Indexed: 07/27/2024] Open
Abstract
Background The World Health Organization (WHO) has called for the evidence-informed integration of traditional medicine (TM) into health systems. Research rigor requires a good "fit" between research designs and what is being studied. The expectation that TM research fully adheres to biomedical evidentiary norms potentially creates tensions, as TM paradigms have their own distinct features. A scoping review will be conducted to describe and characterize the research approaches used in TM and their paradigmatic alignment with the TM being studied. Methods This scoping review protocol was informed by Joanna Briggs Institute (JBI) methods. This protocol outlines an a priori conceptual framework, provisionally termed "paradigmatic alignment." The review will include all populations, TM types, research approaches (i.e., methods, methodologies, frameworks, strategies), cultural contexts, and health care settings. Up to 38 English and non-English language databases will be searched sequentially for both published and gray literature until reaching data saturation across relevant concepts and contexts. Analysis will begin deductively, using a pre-piloted data extraction template to describe the TM research approaches. A basic qualitative content analysis of a sample of evidence sources will explore how research approaches are applied or modified to align with the TM therapeutic paradigm, and the manner in which they co-exist, contrast, complement or align with established biomedical research approaches. The findings will be narrated and summarized in charting tables and figures. The review will be reported according to the PRISMA scoping review extension. Consultative engagement with knowledge users across all review stages is planned. Discussion Aligned with the principle of Two-Eyed Seeing (Etuaptmumk), wherein Indigenous/traditional and biomedical knowledges may equitably co-exist, this review promises to advance scholarly insights of critical value in an increasingly pluralistic, globalized world.Clinical trial registration: https://clinicaltrials.gov/, identifier INPLASY2023110071.
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Affiliation(s)
- Nadine Ijaz
- Department of Law and Legal Studies, Faculty of Public Affairs, Carleton University, Ottawa, ON, Canada
| | - Jennifer Hunter
- Health Research Group, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Suzanne Grant
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Kate Templeman
- Health Research Group, Sydney, NSW, Australia
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Greenhalgh T, MacIntyre CR, Baker MG, Bhattacharjee S, Chughtai AA, Fisman D, Kunasekaran M, Kvalsvig A, Lupton D, Oliver M, Tawfiq E, Ungrin M, Vipond J. Masks and respirators for prevention of respiratory infections: a state of the science review. Clin Microbiol Rev 2024; 37:e0012423. [PMID: 38775460 DOI: 10.1128/cmr.00124-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Shovon Bhattacharjee
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Abrar A Chughtai
- School of Population Health, University of New South Wales, Sydney, Australia
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amanda Kvalsvig
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah Lupton
- Centre for Social Research in Health and Social Policy Research Centre, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia
| | - Matt Oliver
- Professional Standards Advocate, Edmonton, Canada
| | - Essa Tawfiq
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Ungrin
- Faculty of Veterinary Medicine; Department of Biomedical Engineering, Schulich School of Engineering; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Joe Vipond
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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4
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Edmonds SW, Cullen L, DeBerg J. The Problem with the Pyramid for Grading Evidence: The Evidence Funnel Solution. J Perianesth Nurs 2024; 39:484-488. [PMID: 38823963 DOI: 10.1016/j.jopan.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/28/2023] [Indexed: 06/03/2024]
Affiliation(s)
- Stephanie W Edmonds
- Nurse Scientist, Nursing Administration, Abbott Northwestern Hospital, part of Allina Health, Minneapolis, MN
| | - Laura Cullen
- Evidence-Based Practice Scientist, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics.
| | - Jennifer DeBerg
- User Services Librarian, Hardin Library for Health Sciences, University of Iowa, Iowa City, IA
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Littlecott H, Krishnaratne S, Burns J, Rehfuess E, Sell K, Klinger C, Strahwald B, Movsisyan A, Metzendorf MI, Schoenweger P, Voss S, Coenen M, Müller-Eberstein R, Pfadenhauer LM. Measures implemented in the school setting to contain the COVID-19 pandemic. Cochrane Database Syst Rev 2024; 5:CD015029. [PMID: 38695826 PMCID: PMC11064884 DOI: 10.1002/14651858.cd015029.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
BACKGROUND More than 767 million coronavirus 2019 (COVID-19) cases and 6.9 million deaths with COVID-19 have been recorded as of August 2023. Several public health and social measures were implemented in schools to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and prevent onward transmission. We built upon methods from a previous Cochrane review to capture current empirical evidence relating to the effectiveness of school measures to limit SARS-CoV-2 transmission. OBJECTIVES To provide an updated assessment of the evidence on the effectiveness of measures implemented in the school setting to keep schools open safely during the COVID-19 pandemic. SEARCH METHODS We searched the Cochrane COVID-19 Study Register, Educational Resources Information Center, World Health Organization (WHO) COVID-19 Global literature on coronavirus disease database, and the US Department of Veterans Affairs Evidence Synthesis Program COVID-19 Evidence Reviews on 18 February 2022. SELECTION CRITERIA Eligible studies focused on measures implemented in the school setting to contain the COVID-19 pandemic, among students (aged 4 to 18 years) or individuals relating to the school, or both. We categorized studies that reported quantitative measures of intervention effectiveness, and studies that assessed the performance of surveillance measures as either 'main' or 'supporting' studies based on design and approach to handling key confounders. We were interested in transmission-related outcomes and intended or unintended consequences. DATA COLLECTION AND ANALYSIS Two review authors screened titles, abstracts and full texts. We extracted minimal data for supporting studies. For main studies, one review author extracted comprehensive data and assessed risk of bias, which a second author checked. We narratively synthesized findings for each intervention-comparator-outcome category (body of evidence). Two review authors assessed certainty of evidence. MAIN RESULTS The 15 main studies consisted of measures to reduce contacts (4 studies), make contacts safer (7 studies), surveillance and response measures (6 studies; 1 assessed transmission outcomes, 5 assessed performance of surveillance measures), and multicomponent measures (1 study). These main studies assessed outcomes in the school population (12), general population (2), and adults living with a school-attending child (1). Settings included K-12 (kindergarten to grade 12; 9 studies), secondary (3 studies), and K-8 (kindergarten to grade 8; 1 study) schools. Two studies did not clearly report settings. Studies measured transmission-related outcomes (10), performance of surveillance measures (5), and intended and unintended consequences (4). The 15 main studies were based in the WHO Regions of the Americas (12), and the WHO European Region (3). Comparators were more versus less intense measures, single versus multicomponent measures, and measures versus no measures. We organized results into relevant bodies of evidence, or groups of studies relating to the same 'intervention-comparator-outcome' categories. Across all bodies of evidence, certainty of evidence ratings limit our confidence in findings. Where we describe an effect as 'beneficial', the direction of the point estimate of the effect favours the intervention; a 'harmful' effect does not favour the intervention and 'null' shows no effect either way. Measures to reduce contact (4 studies) We grouped studies into 21 bodies of evidence: moderate- (10 bodies), low- (3 bodies), or very low-certainty evidence (8 bodies). The evidence was very low to moderate certainty for beneficial effects of remote versus in-person or hybrid teaching on transmission in the general population. For students and staff, mostly harmful effects were observed when more students participated in remote teaching. Moderate-certainty evidence showed that in the general population there was probably no effect on deaths and a beneficial effect on hospitalizations for remote versus in-person teaching, but no effect for remote versus hybrid teaching. The effects of hybrid teaching, a combination of in-person and remote teaching, were mixed. Very low-certainty evidence showed that there may have been a harmful effect on risk of infection among adults living with a school student for closing playgrounds and cafeterias, a null effect for keeping the same teacher, and a beneficial effect for cancelling extracurricular activities, keeping the same students together and restricting entry for parents and caregivers. Measures to make contact safer (7 studies) We grouped studies into eight bodies of evidence: moderate- (5 bodies), and low-certainty evidence (3 bodies). Low-certainty evidence showed that there may have been a beneficial effect of mask mandates on transmission-related outcomes. Moderate-certainty evidence showed full mandates were probably more beneficial than partial or no mandates. Evidence of a beneficial effect of physical distancing on risk of infection among staff and students was mixed. Moderate-certainty evidence showed that ventilation measures probably reduce cases among staff and students. One study (very low-certainty evidence) found that there may be a beneficial effect of not sharing supplies and increasing desk space on risk of infection for adults living with a school student, but showed there may be a harmful effect of desk shields. Surveillance and response measures (6 studies) We grouped studies into seven bodies of evidence: moderate- (3 bodies), low- (1 body), and very low-certainty evidence (3 bodies). Daily testing strategies to replace or reduce quarantine probably helped to reduce missed school days and decrease the proportion of asymptomatic school contacts testing positive (moderate-certainty evidence). For studies that assessed the performance of surveillance measures, the proportion of cases detected by rapid antigen detection testing ranged from 28.6% to 95.8%, positive predictive value ranged from 24.0% to 100.0% (very low-certainty evidence). There was probably no onward transmission from contacts of a positive case (moderate-certainty evidence) and replacing or shortening quarantine with testing may have reduced missed school days (low-certainty evidence). Multicomponent measures (1 study) Combining multiple measures may have led to a reduction in risk of infection among adults living with a student (very low-certainty evidence). AUTHORS' CONCLUSIONS A range of measures can have a beneficial effect on transmission-related outcomes, healthcare utilization and school attendance. We rated the current findings at a higher level of certainty than the original review. Further high-quality research into school measures to control SARS-CoV-2 in a wider variety of contexts is needed to develop a more evidence-based understanding of how to keep schools open safely during COVID-19 or a similar public health emergency.
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Affiliation(s)
- Hannah Littlecott
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Shari Krishnaratne
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Kerstin Sell
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Carmen Klinger
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Brigitte Strahwald
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Petra Schoenweger
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Roxana Müller-Eberstein
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Khedmati Morasae E, Derbyshire DW, Amini P, Ebrahimi T. Social determinants of spatial inequalities in COVID-19 outcomes across England: A multiscale geographically weighted regression analysis. SSM Popul Health 2024; 25:101621. [PMID: 38420111 PMCID: PMC10899060 DOI: 10.1016/j.ssmph.2024.101621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
A variety of factors are associated with greater COVID-19 morbidity or mortality, due to how these factors influence exposure to (in the case of morbidity) or severity of (in the case of mortality) COVID-19 infections. We use multiscale geographically weighted regression to study spatial variation in the factors associated with COVID-19 morbidity and mortality rates at the local authority level across England (UK). We investigate the period between March 2020 and March 2021, prior to the rollout of the COVID-19 vaccination program. We consider a variety of factors including demographic (e.g. age, gender, and ethnicity), health (e.g. rates of smoking, obesity, and diabetes), social (e.g. Index of Multiple Deprivation), and economic (e.g. the Gini coefficient and economic complexity index) factors that have previously been found to impact COVID-19 morbidity and mortality. The Index of Multiple Deprivation has a significant impact on COVID-19 cases and deaths in all local authorities, although the effect is the strongest in the south of England. Higher proportions of ethnic minorities are associated with higher levels of COVID-19 mortality, with the strongest effect being found in the west of England. There is again a similar pattern in terms of cases, but strongest in the north of the country. Other factors including age and gender are also found to have significant effects on COVID-19 morbidity and mortality, with differential spatial effects across the country. The results provide insights into how national and local policymakers can take account of localized factors to address spatial health inequalities and address future infectious disease pandemics.
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Affiliation(s)
- Esmaeil Khedmati Morasae
- Research Fellow in Operational Research, Exeter University Business School, University of Exeter, UK
| | - Daniel W. Derbyshire
- Department of Public Health and Sports Science, Faculty of Health and Life Science, University of Exeter, UK
| | - Payam Amini
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Tahera Ebrahimi
- Lecturer in Finance, Business School, Manchester Metropolitan University, UK
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Zyoud SH. Global landscape of COVID-19 research: a visualization analysis of randomized clinical trials. Clin Exp Med 2024; 24:14. [PMID: 38252392 PMCID: PMC10803477 DOI: 10.1007/s10238-023-01254-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024]
Abstract
The emergence of COVID-19 in 2019 has resulted in a significant global health crisis. Consequently, extensive research was published to understand and mitigate the disease. In particular, randomized controlled trials (RCTs) have been considered the benchmark for assessing the efficacy and safety of interventions. Hence, the present study strives to present a comprehensive overview of the global research landscape pertaining to RCTs and COVID-19. A bibliometric analysis was performed using the Scopus database. The search parameters included articles published from 2020 to 2022 using keywords specifically related to COVID-19 and RCTs. The data were analyzed using various bibliometric indicators. The volume of publications, contributions of countries and institutions, funding agencies, active journals, citation analysis, co-occurrence analysis, and future research direction analysis were specifically analyzed. A total of 223,480 research articles concerning COVID-19 were published, with 3,727 of them related to RCTs and COVID-19. The ten most productive countries collectively produced 75.8% of the documents, with the United States leading the way by contributing 31.77%, followed by the UK with 14.03% (n = 523), China with 12.96% (n = 483) and Canada with 7.16% (n = 267). Trials (n = 173, 4.64%), BMJ Open (n = 81, 2.17%), PLOS One (n = 73, 1.96%) and JAMA Network Open (n = 53, 1.42%) were the most active journals in publishing articles related to COVID-19 RCTs. The co-occurrence analysis identified four clusters of research areas: the safety and effectiveness of COVID-19 vaccines, mental health strategies to cope with the impact of the pandemic, the use of monoclonal antibodies to treat patients with COVID-19, and systematic reviews and meta-analyses of COVID-19 research. This paper offers a detailed examination of the global research environment pertaining to RCTs and their use in the context of the COVID-19 pandemic. The comprehensive body of research findings was found to have been generated by the collaborative efforts of multiple countries, institutions, and funding organizations. The predominant research areas encompassed COVID-19 vaccines, strategies for mental health, monoclonal antibodies, and systematic reviews. This information has the potential to aid researchers, policymakers, and funders in discerning areas of weakness and establishing areas of priority.
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Affiliation(s)
- Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Centre, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Yu X, Wu S, Sun Y, Wang P, Wang L, Su R, Zhao J, Fadlallah R, Boeira L, Oliver S, Abraha YG, Sewankambo NK, El-Jardali F, Norris SL, Chen Y. Exploring the diverse definitions of 'evidence': a scoping review. BMJ Evid Based Med 2024; 29:37-43. [PMID: 37940419 PMCID: PMC10850639 DOI: 10.1136/bmjebm-2023-112355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To systematically collect and analyse diverse definitions of 'evidence' in both health and social sciences, and help users to correctly use the term 'evidence' and rethink what is the definition of 'evidence' in scientific research. DESIGN Scoping review. METHODS Definitions of evidence in the health sciences and social sciences were included. We have excluded the definition of evidence applied in the legal field, abstracts without full text, documents not published in either Chinese or English and so on. We established a multidisciplinary working group and systematically searched five electronic databases including Medline, Web of Science, EBSCO, the Chinese Social Sciences Citation Index and the Chinese Science Citation Database from their inception to 26 February 2022. We also searched websites and reviewed the reference lists of the identified studies. Six reviewers working in pairs, independently, selected studies according to the inclusion and exclusion criteria, and extracted information. Any differences were discussed in pairs, and if there was disagreement, it was resolved via discussion or with the help of a third reviewer. Reviewers extracted document characteristics, the original content for the definitions of 'evidence', assessed definitions as either intensional or extensional, and any citations for the given definition. RESULTS Forty-nine documents were finally included after screening, and 68 definitions were obtained. After excluding duplicates, a total of 54 different definitions of 'evidence' were identified. There were 42 intensional definitions and 12 extensional definitions. The top three definiens were 'information', 'fact' and 'research/study'. The definition of 'evidence' differed between health and social sciences. The term 'research' appeared most frequently in the definitions. CONCLUSIONS The definition of 'evidence' has gradually attracted the attention of many scholars and decision-makers in health and social sciences. Nevertheless, there is no widely recognised and accepted definition in scientific research. Given the wide use of the term, we need to think about whether, or under what circumstances, a standardised, clear, meaningful and widely applicable definition of 'evidence' might be helpful.
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Affiliation(s)
- Xuan Yu
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Shouyuan Wu
- Department of Epidemiology and Biostatistics, Lanzhou University School of Public Health, Lanzhou, Gansu, China
| | - Yajia Sun
- Department of Epidemiology and Biostatistics, Lanzhou University School of Public Health, Lanzhou, Gansu, China
| | - Ping Wang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Ling Wang
- Department of Epidemiology and Biostatistics, Lanzhou University School of Public Health, Lanzhou, Gansu, China
| | - Renfeng Su
- Department of Epidemiology and Biostatistics, Lanzhou University School of Public Health, Lanzhou, Gansu, China
| | - Junxian Zhao
- Department of Social Medicine and Health Management, Lanzhou University School of Public Health, Lanzhou, Gansu, China
| | - Racha Fadlallah
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | | | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, UCL Social Research Institute, University College London, London, UK
- Africa Centre for Evidence, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Yoseph G Abraha
- Knowledge Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Susan L Norris
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), Lanzhou University School of Basic Medical Sciences, Lanzhou, Gansu, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, Gansu, China
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Conly JM, Loeb M. SARS-CoV-2 Exposures at a Large Gathering Event and Acquisition of COVID-19 in the Post-Vaccination Era: A Randomized Trial Is Possible During the Pandemic. Clin Infect Dis 2023; 77:1656-1658. [PMID: 37797309 DOI: 10.1093/cid/ciad609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
- John M Conly
- Departments of Medicine, Pathology and Laboratory Medicine, Microbiology, Immunology and Infectious Diseases, O'Brien Institute for Public Health, Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Mark Loeb
- Departments of Pathology and Molecular Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Durando P, Rahmani A, Montecucco A, Dini G. Learning from the Experience of the COVID-19 Pandemic: A New Paradigm for Occupational Biohazard Assessment and Management. LA MEDICINA DEL LAVORO 2023; 114:e2023056. [PMID: 38060205 PMCID: PMC10731573 DOI: 10.23749/mdl.v114i6.15452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
The COVID-19 pandemic has affected workplaces in many different aspects. In this scenario, Occupational Physicians played a crucial role in assessing and managing the risk of SARS-CoV-2 infection and associated diseases to guarantee workers' health and the safety of workplaces. However, the pandemic experience has drawn attention to several critical issues in overall biohazard prevention and management strategies, originating from important knowledge gaps in our scientific understanding. An extensive analysis of the relevant hurdles that have emerged in our medical field can bring valuable lessons for the post pandemic future, not only in preparation for possible new pathogens with pandemic potential but also with principles and concepts applicable to managing all biological agents. In particular, a paradigm shift is needed to properly approach occupational diseases caused by infective agents, accurately define the "case", assess exposure and possible causal relationship with work appropriately, and effectively manage the specific risk through implementing appropriate preventive and protective measures. In this framework, the Occupational Physician should expand his contribution based on his unique expertise and specific competencies, confirming his role as the go-to consultant in all occupational health matters, but also in a multidisciplinary approach, considering different scientific expertise and evidence.
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Affiliation(s)
- Paolo Durando
- Occupational Medicine, Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Alborz Rahmani
- Occupational Medicine, Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Alfredo Montecucco
- Occupational Medicine, Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Guglielmo Dini
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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11
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Powell JK, Costa N, Schram B, Hing W, Lewis J. "Restoring That Faith in My Shoulder": A Qualitative Investigation of How and Why Exercise Therapy Influenced the Clinical Outcomes of Individuals With Rotator Cuff-Related Shoulder Pain. Phys Ther 2023; 103:pzad088. [PMID: 37440455 PMCID: PMC10733131 DOI: 10.1093/ptj/pzad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Rotator cuff-related shoulder pain (RCRSP) is the most common form of shoulder pain. Exercise therapy is a first-line recommended treatment for RCRSP. However, the causal mechanisms underpinning the benefits of exercise for RCRSP are not well understood. Moreover, how individuals with lived experience of RCRSP believe exercise helped or did not help them is unknown. This study aimed to gain insights into how individuals with RCRSP believe exercise influenced their shoulder pain and identify the clinical conditions that promoted or inhibited their beliefs. METHODS This qualitative study was underpinned by a critical realist approach to thematic analysis. Participants were recruited using hybrid purposive and convenience sampling techniques. Each participant attended an online semi-structured interview. The data were coded by 2 members of the research team (J.K.P. and N.C.) and verified by a third (B.S.). Recruitment continued until theoretical sufficiency was achieved. Participants reviewed and validated preliminary causal explanations. RESULTS Three causal explanations were consistently expressed by 11 participants to explain the benefits of exercise therapy: (1) shoulder strength; (2) changes to psychoemotional status; and (3) exercise has widespread health effects. However, the activation of these causal mechanisms depended on (1) the presence of a strong therapeutic relationship; (2) the provision of a structured and tailored exercise program; and (3) experiencing timely clinical progress. CONCLUSION Participants believed exercise improved their shoulder pain through associated health benefits, improved shoulder strength, and psychoemotional variables. Whether an exercise program was able to cause a clinical improvement for an individual with RCRSP was contingent on clinical contextual features. Thus, the clinical context that an exercise program is delivered within may be just as important as the exercise program itself. IMPACT Exercise is a recommended first-line intervention to manage RCRSP. The results of this study suggest that a positive experience and outcome with exercise for RCRSP is contingent on several clinical contextual features, such as a strong therapeutic relationship. The clinical context that an exercise program is prescribed and delivered within should be considered by clinicians.
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Affiliation(s)
- Jared K Powell
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Australia
| | - Nathalia Costa
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Ben Schram
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Australia
| | - Wayne Hing
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Australia
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom
- Musculoskeletal Research, Clinical Therapies, University of Limerick, Limerick, Ireland
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12
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Pan D, Hui DSC, Tang JW. Defining infection transmission pathways for future pandemic preparedness - An urgent public health research priority. J Infect 2023; 87:595-597. [PMID: 37865295 DOI: 10.1016/j.jinf.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK; NIHR Leicester Biomedical Research Centre, UK; Development Centre for Population Health, University of Leicester, UK; Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, UK.
| | - David S C Hui
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Julian W Tang
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
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13
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Pfaff H, Schmitt J. Reducing uncertainty in evidence-based health policy by integrating empirical and theoretical evidence: An EbM+theory approach. J Eval Clin Pract 2023; 29:1279-1293. [PMID: 37427556 DOI: 10.1111/jep.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND To reduce their decisional uncertainty, health policy decision-makers rely more often on experts or their intuition than on evidence-based knowledge, especially in times of urgency. However, this practice is unacceptable from an evidence-based medicine (EbM) perspective. Therefore, in fast-changing and complex situations, we need an approach that delivers recommendations that serve decision-makers' needs for urgent, sound and uncertainty-reducing decisions based on the principles of EbM. AIMS The aim of this paper is to propose an approach that serves this need by enriching EbM with theory. MATERIALS AND METHODS We call this the EbM+theory approach, which integrates empirical and theoretical evidence in a context-sensitive way to reduce intervention and implementation uncertainty. RESULTS Within this framework, we propose two distinct roadmaps to decrease intervention and implementation uncertainty: one for simple and the other for complex interventions. As part of the roadmap, we present a three-step approach: applying theory (step 1), conducting mechanistic studies (EbM+; step 2) and conducting experiments (EbM; step 3). DISCUSSION This paper is a plea for integrating empirical and theoretical knowledge by combining EbM, EbM+ and theoretical knowledge in a common procedural framework that allows flexibility even in dynamic times. A further aim is to stimulate a discussion on using theories in health sciences, health policy, and implementation. CONCLUSION The main implications are that scientists and health politicians - the two main target groups of this paper-should receive more training in theoretical thinking; moreover, regulatory agencies like NICE may think about the usefulness of integrating elements of the EbM+theory approach into their considerations.
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Affiliation(s)
- Holger Pfaff
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Department of Rehabilitation and Special Education, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
- Centre for Health Services Research Cologne (CHSRC), Interfaculty Institution of the University of Cologne, Cologne, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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14
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Lamont T. Mindlines and beyond. BMJ 2023; 383:2511. [PMID: 37907204 DOI: 10.1136/bmj.p2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Tara Lamont
- NIHR Coordinating Centre, Southampton University
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15
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McCartney M. What has postmodernism done to evidence-based medicine? Br J Gen Pract 2023; 73:470-472. [PMID: 37770211 PMCID: PMC10544536 DOI: 10.3399/bjgp23x735201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Affiliation(s)
- Margaret McCartney
- Chief Scientist Office NHS Research Fellow and Honorary Senior Lecturer, University of St Andrews, St Andrews
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16
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Miao M, Morrow R, Salomon A, Mcculloch B, Evain JC, Wright MR, Murphy MT, Welsh M, Williams L, Power E, Rietdijk R, Debono D, Brunner M, Togher L. Digital Health Implementation Strategies Coproduced With Adults With Acquired Brain Injury, Their Close Others, and Clinicians: Mixed Methods Study With Collaborative Autoethnography and Network Analysis. J Med Internet Res 2023; 25:e46396. [PMID: 37725413 PMCID: PMC10548320 DOI: 10.2196/46396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/10/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Acquired brain injuries (ABIs), such as stroke and traumatic brain injury, commonly cause cognitive-communication disorders, in which underlying cognitive difficulties also impair communication. As communication is an exchange with others, close others such as family and friends also experience the impact of cognitive-communication impairment. It is therefore an internationally recommended best practice for speech-language pathologists to provide communication support to both people with ABI and the people who communicate with them. Current research also identifies a need for neurorehabilitation professionals to support digital communication, such as social media use, after ABI. However, with >135 million people worldwide affected by ABI, alternate and supplementary service delivery models are needed to meet these communication needs. The "Social Brain Toolkit" is a novel suite of 3 interventions to deliver communication rehabilitation via the internet. However, digital health implementation is complex, and minimal guidance exists for ABI. OBJECTIVE This study aimed to support the implementation of the Social Brain Toolkit by coproducing implementation knowledge with people with ABI, people who communicate with people with ABI, clinicians, and leaders in digital health implementation. METHODS A maximum variation sample (N=35) of individuals with living experience of ABI, close others, clinicians, and digital health implementation leaders participated in an explanatory sequential mixed methods design. Stakeholders quantitatively prioritized 4 of the 7 theoretical domains of the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework as being the most important for Social Brain Toolkit implementation. Qualitative interview and focus group data collection focused on these 4 domains. Data were deductively analyzed against the NASSS framework with stakeholder coauthors to determine implementation considerations and strategies. A collaborative autoethnography of the research was conducted. Interrelationships between considerations and strategies were identified through a post hoc network analysis. RESULTS Across the 4 prioritized domains of "condition," "technology," "value proposition," and "adopters," 48 digital health implementation considerations and 52 tailored developer and clinician implementation strategies were generated. Benefits and challenges of coproduction were identified. The post hoc network analysis revealed 172 unique relationships between the identified implementation considerations and strategies, with user and persona testing and responsive design identified as the potentially most impactful strategies. CONCLUSIONS People with ABI, close others, clinicians, and digital health leaders coproduced new knowledge of digital health implementation considerations for adults with ABI and the people who communicate with them, as well as tailored implementation strategies. Complexity-informed network analyses offered a data-driven method to identify the 2 most potentially impactful strategies. Although the study was limited by a focus on 4 NASSS domains and the underrepresentation of certain demographics, the wealth of actionable implementation knowledge produced supports future coproduction of implementation research with mutually beneficial outcomes for stakeholders and researchers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/35080.
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Affiliation(s)
- Melissa Miao
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rosemary Morrow
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Alexander Salomon
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Ben Mcculloch
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Jean-Christophe Evain
- Acquired Brain Injury Rehabilitation Ward, Caulfield Hospital, Alfred Health Network, Melbourne, Australia
- Stakeholder with living experience of acquired brain injury, Melbourne, Australia
| | - Meg Rebecca Wright
- Stakeholder with living experience of acquired brain injury, Blenheim, Australia
| | - Marie Therese Murphy
- Stakeholder with living experience as a communication partner of a person with acquired brain injury, Sydney, Australia
- Faculty of Education, Western Sydney University, Sydney, Australia
- Faculty of Education and Social Work, The University of Sydney, Sydney, Australia
| | - Monica Welsh
- Brain Injury Rehabilitation Unit, South Australian Brain Injury Rehabilitation Service, Adelaide, Australia
| | - Liz Williams
- Brain Injury Rehabilitation Community and Home (BIRCH), South Australian Brain Injury Rehabilitation Service, Adelaide, Australia
| | - Emma Power
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Deborah Debono
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Melissa Brunner
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Ramani S, Whyle EB, Kagwanja N. What research evidence can support the decolonisation of global health? Making space for deeper scholarship in global health journals. Lancet Glob Health 2023; 11:e1464-e1468. [PMID: 37591593 DOI: 10.1016/s2214-109x(23)00299-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 08/19/2023]
Abstract
Much of the current global health publishing landscape is restricted in its epistemological diversity, relying heavily on a biomedical lens to examine and report on global health issues. In this Viewpoint, we argue that the space within global health journals needs to be expanded to include diverse forms of research scholarship, thereby shifting the kinds of stories that get told in these spaces. We particularly call for the inclusion of deeper research that values the tacit, experiential knowledge possessed by actors (eg, communities, health-care workers, policy makers, activisits, and researchers) in low-income and middle-income countries, and legitimises the perspectives of local doers and thinkers; research that pays careful attention to context, and does not treat local realities as mere background occurrences; and research that draws on alternative, counter-dominant epistemologies, that allow for the crucial examination of power imbalances, and that challenge hegemonic discourses in global health. To decolonise academic work in the global health field, we should look beyond diversity in research authorship. We need to tackle other unconscious biases such as presumptions about the superiority of particular forms of evidence over others, and thereby expand the plurality of perspectives in global health.
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Affiliation(s)
| | - Eleanor Beth Whyle
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Nancy Kagwanja
- Health Systems Research and Ethics, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
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18
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Chicoye A, Crépey P, Nguyen VH, Márquez-Peláez S, Postma M, Pugliese A, Ruiz-Aragón J, Mould-Quevedo J. Contributions of cost-effectiveness analyses (CEA) to influenza vaccination policy for older adults in Europe. Vaccine 2023; 41:5518-5524. [PMID: 37550142 DOI: 10.1016/j.vaccine.2023.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023]
Abstract
This review describes the importance of economic evaluations and real-world evidence (RWE) for the assessment of enhanced influenza vaccines for older adults in Europe. Individuals ≥65 years of age are at increased risk of severe influenza outcomes and many countries in Europe recommend enhanced vaccines for this population to mitigate immunosenescence. Some National Immunization Technical Advisory Groups (NITAGs) may preferentially recommend a specific enhanced vaccine, necessitating comparative economic evaluation and estimation of relative vaccine effectiveness between enhanced vaccine options in the absence of direct head-to-head efficacy data. Distinct approaches to economic modeling and cost-effectiveness analysis (CEA) guide national vaccination policies in Europe, including how underlying data, such as RWE, are used in these models. RWE is an important evidence source for input into CEA models based on disease factors (e.g., antigenic shift and seasonal variation) and practical factors (e.g., limitations of performing multiple randomized clinical trials to capture seasonal variation; the need to obtain relevant patient-oriented, real-world endpoints, such as hospitalizations). CEA is considered crucial to vaccine assessment among certain countries in Europe, but further harmonization of economic evaluations, including the use of RWE, across NITAGs in Europe may be of benefit, alongside standardized approaches for vaccine appraisal. In the future, more countries may use RWE as an input in CEA models to support NITAG recommendations for enhanced influenza vaccines in older populations, especially considering the value of RWE for the assessment of influenza epidemiology and vaccine effectiveness as stated by the World Health Organization, and the availability of a broad RWE base for certain enhanced vaccines.
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Affiliation(s)
- Annie Chicoye
- Sciences Po Paris, 27 Rue Saint-Guillaume, 75007 Paris, France
| | - Pascal Crépey
- EHESP School of Public Health, University of Rennes, CNRS, Arènes - UMR 6051, RSMS - Inserm U 1309, Rennes, France
| | | | - Sergio Márquez-Peláez
- Department of Economics, Economic Analysis, Faculty of Business Pablo de Olavide University, 41013 Seville, Spain
| | - Maarten Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, P.O. Box 72, 9700 AB Groningen, The Netherlands; Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, 9713 AV Groningen, The Netherlands; Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jl. Raya Bandung Sumedang KM 21, Jatinangor 45363, Bandung, Indonesia
| | - Andrea Pugliese
- Department of Mathematics, University of Trento, 38123 Trento, Italy
| | - Jesús Ruiz-Aragón
- Department of Clinical Microbiology, Lab. Clinical Analysis, Hospital de la Línea, Cádiz, Spain
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19
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D'Ambruoso L, Abruquah NA, Mabetha D, van der Merwe M, Goosen G, Sigudla J, Witter S. Expanding Community Health Worker decision space: learning from a Participatory Action Research training intervention in a rural South African district. HUMAN RESOURCES FOR HEALTH 2023; 21:66. [PMID: 37596628 PMCID: PMC10439531 DOI: 10.1186/s12960-023-00853-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND While integral to decentralising health reforms, Community Health Workers (CHWs) in South Africa experience many challenges. During COVID-19, CHW roles changed rapidly, shifting from communities to clinics. In the contexts of new roles and re-engineered primary healthcare (PHC), the objectives were to: (a) implement a training intervention to support local decision-making capability of CHWs; and (b) assess learning and impacts from the perspectives of CHWs. METHODS CHWs from three rural villages (n = 9) were trained in rapid Participatory Action Research (PAR) with peers and community stakeholders (n = 33). Training equipped CHWs with tools and techniques to convene community groups, raise and/or respond to local health concerns, understand concerns from different perspectives, and facilitate action in communities and public services. CHWs' perspectives before and after the intervention were gained through semi-structured interviews. Data were collected and analysed using the decision space framework to understand local actors' power to affect devolved decision-making. RESULTS CHWs demonstrated significant resilience and commitment in the face of COVID-19. They experienced multiple, intersecting challenges including: limited financial, logistical and health systems support, poor role clarity, precarious employment, low and no pay, unstable organisational capacity, fragile accountability mechanisms and belittling treatment in clinics. Together, these restricted decision space and were seen to reflect a low valuing of the cadre in the system. CHWs saw the training as a welcome opportunity to assert themselves as a recognised cadre. Regular, spaces for dialogue and mutual learning supported CHWs to gain tools and skills to rework their agency in more empowered ways. The training improved management capacity, capabilities for dialogue, which expanded role clarity, and strengthened community mobilisation, facilitation and analysis skills. Development of public speaking skills was especially valued. CHWs reported an overall 'tripe-benefit' from the training: community-acceptance; peer support; and dialogue with and recognition by the system. The training intervention was recommended for scale-up by the health authority as an implementation support strategy for PHC. CONCLUSIONS Lack of recognition of CHWs is coupled with limited opportunities for communication and trust-building. The training supported CHWs to find and amplify their voices in strategic partnerships, and helped build functionality for local decision-making.
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Affiliation(s)
- Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK.
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
- Public Health, National Health Service (NHS) Grampian, Aberdeen, Scotland, UK.
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
| | - Nana Akua Abruquah
- The University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Denny Mabetha
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Cochrane South Africa, South African Medical Research Council (MRC), Cape Town, South Africa
| | - Maria van der Merwe
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Maria Van Der Merwe Consulting, White River, South Africa
| | | | - Jerry Sigudla
- Mpumalanga Department of Health, Mbombela, South Africa
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Musselburgh, Scotland, UK
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20
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Archibald MM. Embedded Research: Possibilities for Learning Health Systems Comment on "'We're Not Providing the Best Care if We are Not on the Cutting Edge of Research': A Research Impact Evaluation at a Regional Australian Hospital and Health Service". Int J Health Policy Manag 2023; 12:7694. [PMID: 38618817 PMCID: PMC10590236 DOI: 10.34172/ijhpm.2023.7694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 07/19/2023] [Indexed: 04/16/2024] Open
Abstract
Brown et al show that research investments in an organization with a research and translation mandate can make important gains for research impact across domains, including quality of care and patient outcomes. Their multi-stage mixed methods evaluation provides insight into research capacity development in rural health systems in Australia and draws attention towards persistent geographic inequities. In extension of this important contribution, here, a focus on the "what and the why" of embedded research is offered. Specific attention is paid to the sustainability potentials of systematized data capture systems, funding-operational mandate alignments, researcher-scientist career pathways, and networked approaches to mentorship.
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Affiliation(s)
- Mandy M. Archibald
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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21
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Gualandi R, Ivziku D, Caruso R, Di Giacinto C, Lommi M, Tartaglini D, De Benedictis A. Nurse-Patient Communication and Relationship When Wearing Personal Protective Equipment: Nurses' Experience in a COVID-19 Ward. Healthcare (Basel) 2023; 11:1960. [PMID: 37444794 DOI: 10.3390/healthcare11131960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
Little is known about which communication strategies nurses carried out and whether the nurse-patient relationship has been altered due to the mandated use of personal protective equipment during the COVID-19 pandemic. This study describes how nurse-patient communication and relationships took place from the point of view of nurses engaged in caring for patients with COVID-19. A qualitative descriptive study design following COREQ guidelines was conducted. Semi-structured telephone interviews with nurses working in the COVID ward of an Italian university hospital were performed between September 2020 and June 2021. Ten nurses were recruited using convenience sampling. One overarching theme, three main themes, and nine sub-themes were identified. The overarching theme 'The in-out relationship: 'in here and out there' and 'inside me and out of me' included the main themes 'A closed system different from normal', 'Uncovering meaningful human gestures', and 'A deep experience to live''. The relational nature of nursing-where 'me and you' and the context are the main elements-leads nurses to find new ways of interacting and communicating with patients, even in a new situation that has never been experienced. Enhancing human gestures, thinking about new contexts of care, and educating new generations to maintain human-to-human interaction, regardless of the context of care, are the directives to be explored for creating the future of nursing care.
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Affiliation(s)
- Raffaella Gualandi
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Dhurata Ivziku
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Rosario Caruso
- Clinical Research Service, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milano, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milano, Italy
| | - Chiara Di Giacinto
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Marzia Lommi
- Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy
| | - Daniela Tartaglini
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Anna De Benedictis
- Clinical Directory, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
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22
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Postma M, Fisman D, Giglio N, Márquez-Peláez S, Nguyen VH, Pugliese A, Ruiz-Aragón J, Urueña A, Mould-Quevedo J. Real-World Evidence in Cost-Effectiveness Analysis of Enhanced Influenza Vaccines in Adults ≥ 65 Years of Age: Literature Review and Expert Opinion. Vaccines (Basel) 2023; 11:1089. [PMID: 37376478 DOI: 10.3390/vaccines11061089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Influenza vaccination can benefit most populations, including adults ≥ 65 years of age, who are at greater risk of influenza-related complications. In many countries, enhanced vaccines, such as adjuvanted, high-dose, and recombinant trivalent/quadrivalent influenza vaccines (aTIV/aQIV, HD-TIV/HD-QIV, and QIVr, respectively), are recommended in older populations to provide higher immunogenicity and increased relative vaccine efficacy/effectiveness (rVE) than standard-dose vaccines. This review explores how efficacy and effectiveness data from randomized controlled trials and real-world evidence (RWE) are used in economic evaluations. Findings from published cost-effectiveness analyses (CEA) on enhanced influenza vaccines for older adults are summarized, and the assumptions and approaches used in these CEA are assessed alongside discussion of the importance of RWE in CEA. Results from many CEA showed that adjuvanted and high-dose enhanced vaccines were cost-effective compared with standard vaccines, and that differences in rVE estimates and acquisition price may drive differences in cost-effectiveness estimates between enhanced vaccines. Overall, RWE and CEA provide clinical and economic rationale for enhanced vaccine use in people ≥ 65 years of age, an at-risk population with substantial burden of disease. Countries that consider RWE when making vaccine recommendations have preferentially recommended aTIV/aQIV, as well as HD-TIV/HD-QIV and QIVr, to protect older individuals.
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Affiliation(s)
- Maarten Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, P.O. Box 72, 9700 AB Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, 9713 AB Groningen, The Netherlands
- Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, 40132 Bandung, Indonesia
| | - David Fisman
- Dalla Lana School of Public Health, Toronto, ON M5T 3M7, Canada
| | - Norberto Giglio
- Hospital de Niños Ricardo Gutièrrez, Buenos Aires 1425, Argentina
| | - Sergio Márquez-Peláez
- Department of Economics, Economic Analysis, Faculty of Business Pablo de Olavide University, 41013 Seville, Spain
| | | | - Andrea Pugliese
- Department of Mathematics, University of Trento, 38123 Trento, Italy
| | | | - Analia Urueña
- Centro de Estudios para la Prevención y Control de Enfermedades Transmisibles, Universidad Isalud, Buenos Aires C1095AAS, Argentina
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Matsuda S, Yoshimura H. Evidence-Based Policy Making during the Coronavirus Disease 2019 Pandemic: A Systematic Review. Prehosp Disaster Med 2023; 38:247-251. [PMID: 36872569 DOI: 10.1017/s1049023x23000262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
INTRODUCTION The aim of this systematic review was to collect evidence and recommendations for the applicability of the concept of evidence-based policy making (EBPM) during the coronavirus disease 2019 (COVID-19) pandemic and to discuss the implementation of this concept from a medical science perspective. METHODS This study was performed according to the guidelines, checklist, and flow diagram of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. An electronic literature search was conducted on September 20, 2022 using PubMed, Web of Science, Cochrane Library, and CINAHL databases with the following search terms: "evidence based policy making" and "infectious disease." Study eligibility assessment was performed based on the flow diagram of PRISMA 2020, and risk of bias assessment was performed using The Critical Appraisal Skills Program. RESULTS Eleven eligible articles were included in this review and divided into three groups as follows: early, middle, and late stages of the COVID-19 pandemic. Basics of COVID-19 control were suggested in the early stage. The articles published in the middle stage discussed the importance of the collection and analysis of evidence of COVID-19 from around the world for the establishment of EBPM in the COVID-19 pandemic. The articles published in the late stage discussed the collection of large amounts of high-quality data and the development of methods to analyze them, as well as emerging issues related to the COVID-19 pandemic. CONCLUSIONS This study revealed that the concept of EBPM applicable to emerging infectious disease pandemics changed between the early, middle, and late stages of the pandemic. The concept of EBPM will play an important role in medicine in the future.
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Affiliation(s)
- Shinpei Matsuda
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Heinsch M, Cootes H, Tickner C. Another implementation science is possible: engaging an 'intelligent public' in knowledge translation. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:1-14. [PMID: 36880797 DOI: 10.1080/14461242.2023.2174897] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
As the world contends with the COVID-19 pandemic, scientific expertise has permeated political discourse and the phrase 'following the science' is being used to build trust and justify government decision-making. This phrase reflects a problematic assumption that there is one objective science to follow and that the use of scientific knowledge in decision-making is inherently neutral. In this article, we examine more closely the dense and intricate relationships, values, politics, and interests that determine whose knowledge counts, who gets to speak, who is spoken for, and with what consequences, in the translation of scientific knowledge. Drawing key insights from Stengers' Manifesto for Slow Science, we argue that implementation science has a central role to play in problematising the historic dominance of certain voices and institutional structures that have come to symbolise trust, rigour, and knowledge. Yet to date, implementation science has tended to overlook these economic, social, historical, and political forces. Fraser's conception of social justice and Jasanoff's 'technologies of humility' are introduced as useful frameworks to extend the capacity of implementation science to engage the broader public as an 'intelligent public' in the translation of knowledge, during and beyond the pandemic.
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Affiliation(s)
- Milena Heinsch
- School of Social Sciences, University of Tasmania, Hobart, Australila
| | - Hannah Cootes
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australila
| | - Campbell Tickner
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australila
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25
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Treating COVID-19: Targeting the Host Response, Not the Virus. Life (Basel) 2023; 13:life13030712. [PMID: 36983871 PMCID: PMC10054780 DOI: 10.3390/life13030712] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 03/09/2023] Open
Abstract
In low- and middle-income countries (LMICs), inexpensive generic drugs like statins, ACE inhibitors, and ARBs, especially if used in combination, might be the only practical way to save the lives of patients with severe COVID-19. These drugs will already be available in all countries on the first pandemic day. Because they target the host response to infection instead of the virus, they could be used to save lives during any pandemic. Observational studies show that inpatient statin treatment reduces 28–30-day mortality but randomized controlled trials have failed to show this benefit. Combination treatment has been tested for antivirals and dexamethasone but, with the exception of one observational study in Belgium, not for inexpensive generic drugs. Future pandemic research must include testing combination generic drug treatments that could be used in LMICs.
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Abdin AY, De Pretis F, Landes J. Fast Methods for Drug Approval: Research Perspectives for Pandemic Preparedness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2404. [PMID: 36767769 PMCID: PMC9915940 DOI: 10.3390/ijerph20032404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
Public heath emergencies such as the outbreak of novel infectious diseases represent a major challenge for drug regulatory bodies, practitioners, and scientific communities. In such critical situations drug regulators and public health practitioners base their decisions on evidence generated and synthesised by scientists. The urgency and novelty of the situation create high levels of uncertainty concerning the safety and effectiveness of drugs. One key tool to mitigate such emergencies is pandemic preparedness. There seems to be, however, a lack of scholarly work on methodology for assessments of new or existing drugs during a pandemic. Issues related to risk attitudes, evidence production and evidence synthesis for drug approval require closer attention. This manuscript, therefore, engages in a conceptual analysis of relevant issues of drug assessment during a pandemic. To this end, we rely in our analysis on recent discussions in the philosophy of science and the philosophy of medicine. Important unanswered foundational questions are identified and possible ways to answer them are considered. Similar problems often have similar solutions, hence studying similar situations can provide important clues. We consider drug assessments of orphan drugs and drug assessments during endemics as similar to drug assessment during a pandemic. Furthermore, other scientific fields which cannot carry out controlled experiments may guide the methodology to draw defeasible causal inferences from imperfect data. Future contributions on methodologies for addressing the issues raised here will indeed have great potential to improve pandemic preparedness.
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Affiliation(s)
- Ahmad Yaman Abdin
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, D-66123 Saarbrucken, Germany
| | - Francesco De Pretis
- Department of Communication and Economics, University of Modena and Reggio Emilia, 42121 Reggio Emilia, Italy
- VTT Technical Research Centre of Finland Ltd., 70210 Kuopio, Finland
| | - Jürgen Landes
- Department of Philosophy “Piero Martinetti”, University of Milan, 20122 Milan, Italy
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27
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Yardley S. 'Theory and practice': Why does it matter? Palliat Med 2023; 37:4-6. [PMID: 36540038 DOI: 10.1177/02692163221144644] [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: 12/24/2022]
Affiliation(s)
- Sarah Yardley
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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MacLeod A, Luong V, Cameron P, Burm S, Field S, Kits O, Miller S, Stewart WA. Case-Informed Learning in Medical Education: A Call for Ontological Fidelity. PERSPECTIVES ON MEDICAL EDUCATION 2023; 2:120-128. [PMID: 37063601 PMCID: PMC10103732 DOI: 10.5334/pme.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023]
Abstract
Case-informed learning is an umbrella term we use to classify pedagogical approaches that use text-based cases for learning. Examples include Problem-Based, Case-Based, and Team-Based approaches, amongst others. We contend that the cases at the heart of case-informed learning are philosophical artefacts that reveal traditional positivist orientations of medical education and medicine, more broadly, through their centering scientific knowledge and objective fact. This positivist orientation, however, leads to an absence of the human experience of medicine in most cases. One of the rationales for using cases is that they allow for learning in context, representing aspects of real-life medical practice in controlled environments. Cases are, therefore, a form of simulation. Yet issues of fidelity, widely discussed in the broader simulation literature, have yet to enter discussions of case-informed learning. We propose the concept of ontological fidelity as a way to approach ontological questions (i.e., questions regarding what we assume to be real), so that they might centre narrative and experiential elements of medicine. Ontological fidelity can help medical educators grapple with what information should be included in a case by encouraging an exploration of the philosophical questions: What is real? Which (and whose) reality do we want to simulate through cases? What are the essential elements of a case that make it feel real? What is the clinical story we want to reproduce in case format? In this Eye-Opener, we explore what it would mean to create cases from a position of ontological fidelity and provide suggestions for how to do this in everyday medical education.
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Affiliation(s)
- Anna MacLeod
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Victoria Luong
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paula Cameron
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Burm
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Simon Field
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Kits
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephen Miller
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Wendy A. Stewart
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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29
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Leung T, Greenhalgh T, Hughes G, Finlay T, Wherton J. Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage. J Med Internet Res 2022; 24:e42358. [PMID: 36383632 PMCID: PMC9773024 DOI: 10.2196/42358] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Digital consultations between patients and clinicians increased markedly during the COVID-19 pandemic, raising questions about equity. OBJECTIVE This study aimed to review the literature on how multiple disadvantage-specifically, older age, lower socioeconomic status, and limited English proficiency-has been conceptualized, theorized, and studied empirically in relation to digital consultations. We focused mainly on video consultations as they have wider disparities than telephone consultations and relevant data on e-consultations are sparse. METHODS Using keyword and snowball searching, we identified relevant papers published between 2012 and 2022 using Ovid MEDLINE, Web of Science, Google Scholar, and PubMed. The first search was completed in July 2022. Papers meeting the inclusion criteria were analyzed thematically and summarized, and their key findings were tabulated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research criteria. Explanations for digital disparities were critically examined, and a search was undertaken in October 2022 to identify theoretical lenses on multiple disadvantage. RESULTS Of 663 articles from the initial search, 27 (4.1%) met our inclusion criteria. In total, 37% (10/27) were commentaries, and 63% (17/27) were peer-reviewed empirical studies (11/27, 41% quantitative; 5/27, 19% qualitative; 1/27, 4% mixed methods; 1/27, 4% systematic reviews; and 1/27, 4% narrative reviews). Empirical studies were mostly small, rapidly conducted, and briefly reported. Most studies (25/27, 93%) identified marked digital disparities but lacked a strong theoretical lens. Proposed solutions focused on identifying and removing barriers, but the authors generally overlooked the pervasive impact of multiple layers of disadvantage. The data set included no theoretically informed studies that examined how different dimensions of disadvantage combined to affect digital health disparities. In our subsequent search, we identified 3 theoretical approaches that might help account for these digital disparities. Fundamental cause theory by Link and Phelan addresses why the association between socioeconomic status and health is pervasive and persists over time. Digital capital theory by Ragnedda and Ruiu explains how people mobilize resources to participate in digitally mediated activities and services. Intersectionality theory by Crenshaw states that systems of oppression are inherently bound together, creating singular social experiences for people who bear the force of multiple adverse social structures. CONCLUSIONS A limitation of our initial sample was the sparse and undertheorized nature of the primary literature. The lack of attention to how digital health disparities emerge and play out both within and across categories of disadvantage means that solutions proposed to date may be oversimplistic and insufficient. Theories of multiple disadvantage have bearing on digital health, and there may be others of relevance besides those discussed in this paper. We call for greater interdisciplinary dialogue between theoretical research on multiple disadvantage and empirical studies on digital health disparities.
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Affiliation(s)
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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30
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Balancing promoting the public’s right to traditional, complementary and integrative health with evidence-based health care. ADVANCES IN INTEGRATIVE MEDICINE 2022. [DOI: 10.1016/j.aimed.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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31
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McKee M, Hanson K, Abbasi K. Guided by the science? Questions for the UK’s covid-19 public inquiry. BMJ : BRITISH MEDICAL JOURNAL 2022. [DOI: 10.1136/bmj.o2066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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32
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Fraiman J, Erviti J, Jones M, Greenland S, Whelan P, Kaplan RM, Doshi P. Serious adverse events of special interest following mRNA COVID-19 vaccination in randomized trials in adults. Vaccine 2022; 40:5798-5805. [PMID: 36055877 PMCID: PMC9428332 DOI: 10.1016/j.vaccine.2022.08.036] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION In 2020, prior to COVID-19 vaccine rollout, the Brighton Collaboration created a priority list, endorsed by the World Health Organization, of potential adverse events relevant to COVID-19 vaccines. We adapted the Brighton Collaboration list to evaluate serious adverse events of special interest observed in mRNA COVID-19 vaccine trials. METHODS Secondary analysis of serious adverse events reported in the placebo-controlled, phase III randomized clinical trials of Pfizer and Moderna mRNA COVID-19 vaccines in adults (NCT04368728 and NCT04470427), focusing analysis on Brighton Collaboration adverse events of special interest. RESULTS Pfizer and Moderna mRNA COVID-19 vaccines were associated with an excess risk of serious adverse events of special interest of 10.1 and 15.1 per 10,000 vaccinated over placebo baselines of 17.6 and 42.2 (95 % CI -0.4 to 20.6 and -3.6 to 33.8), respectively. Combined, the mRNA vaccines were associated with an excess risk of serious adverse events of special interest of 12.5 per 10,000 vaccinated (95 % CI 2.1 to 22.9); risk ratio 1.43 (95 % CI 1.07 to 1.92). The Pfizer trial exhibited a 36 % higher risk of serious adverse events in the vaccine group; risk difference 18.0 per 10,000 vaccinated (95 % CI 1.2 to 34.9); risk ratio 1.36 (95 % CI 1.02 to 1.83). The Moderna trial exhibited a 6 % higher risk of serious adverse events in the vaccine group: risk difference 7.1 per 10,000 (95 % CI -23.2 to 37.4); risk ratio 1.06 (95 % CI 0.84 to 1.33). Combined, there was a 16 % higher risk of serious adverse events in mRNA vaccine recipients: risk difference 13.2 (95 % CI -3.2 to 29.6); risk ratio 1.16 (95 % CI 0.97 to 1.39). DISCUSSION The excess risk of serious adverse events found in our study points to the need for formal harm-benefit analyses, particularly those that are stratified according to risk of serious COVID-19 outcomes. These analyses will require public release of participant level datasets.
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Affiliation(s)
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Spain.
| | - Mark Jones
- Institute of Evidence-Based Healthcare, Bond University, Gold Coast, QLD, Australia.
| | - Sander Greenland
- Fielding School of Public Health and College of Letters and Science, University of California, Los Angeles, CA, USA.
| | - Patrick Whelan
- Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Robert M Kaplan
- Clinical Excellence Research Center, School of Medicine, Stanford University, CA, USA.
| | - Peter Doshi
- School of Pharmacy, University of Maryland, Baltimore, MD, USA.
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Murad MH, Saadi S. Evidence-based medicine has already adapted and is very much alive. BMJ Evid Based Med 2022; 27:bmjebm-2022-112046. [PMID: 35853684 DOI: 10.1136/bmjebm-2022-112046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Mohammad Hassan Murad
- Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Evidence-Based Practice Center, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Samer Saadi
- Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Evidence-Based Practice Center, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA
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