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Shikako K, Lai J, Yoo PY, Teachman G, Majnemer A. Evidence-informed stakeholder consultations to promote rights-based approaches for children with disabilities. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1322191. [PMID: 38742042 PMCID: PMC11089101 DOI: 10.3389/fresc.2024.1322191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024]
Abstract
Purpose To strengthen the translation of evidence to actionable policy, stakeholder engagement is necessary to synthesize, prioritize and contextualize the academic research content into accessible language. In this manuscript we describe a multi-level evidence-based stakeholder consultation process and related outcomes proposed to promote awareness of and foster cross-sectorial collaborations towards human rights-based approaches for children with disabilities. Methods Mixed-methods participatory action research done in three steps: (1) A literature review of peer-reviewed evidence on rights-based approaches in childhood disabilities; (2) Consultation with researchers in diverse fields, grassroot organizations, caregivers, and youth with disabilities; (3) A constructive dialogue with decision makers at federal and provincial levels in Canada to discuss consultations results. Results Stakeholders value human rights approaches that can have a direct impact on practical aspects of their daily living. Organizations give high importance to adopting rights-based approaches to measure policy outcomes, while parents value service provision and youth emphasize accessibility. Conclusion The implementation of rights-based approaches in childhood disabilities can support policy, services, and daily lives of children with disabilities and the ecosystems around them. It can also guide research priorities, and create a common language to foster collaborations across sectors and interested parties.
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Affiliation(s)
- Keiko Shikako
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Jonathan Lai
- Autism Alliance of Canada and Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul Y. Yoo
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Gail Teachman
- School of Occupational Therapy, Western University, London, ON, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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2
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Liang C, Yin G, Lin Z, Cui J, Wang Y, Liu S, Yin D, Liu P, Su X, Rong H, Wang C, Sun F, Fei Y. How well did the consensus methods apply in the guideline development of traditional Chinese medicine: a web-based survey in China. BMC Med Res Methodol 2023; 23:264. [PMID: 37950155 PMCID: PMC10636859 DOI: 10.1186/s12874-023-02087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Consensus methods are crucial in developing clinical guidelines. Different methods, such as the Delphi and nominal group techniques, are commonly used, but there is a lack of detailed instructions on how to implement them effectively. The survey aims to explore the opinions and attitudes of the chair, panel and working group on the critical elements of the consensus methods during guideline development. METHODS We used a cross-sectional design to conduct this study and sent a structured questionnaire to stakeholders, including the chair, panel members, and working group participants, through the popular mobile phone application WeChat.We selected participants using a combination of purposive and snowball sampling. The questionnaire gathered information on demographics, experiences, opinions, and concerns regarding consensus methods and guideline development. RESULTS The sample comprised 290 participants representing 31 provinces or municipalities. Among them, the most significant number of respondents (n = 107, 36.9%) were from Beijing. Most participants, specifically 211 (72.76%), held senior professional titles, while 186 (64.14%) adhered to ongoing guidelines. The Delphi method was the most commonly used consensus method (n = 132, 42.31%), but the respondents had only a preliminary understanding of it (n = 147, 47.12%). The consensus process also revealed the insufficiency of involving pharmacoeconomists, patients, and nurses. CONCLUSIONS Consensus methods have to be standardised and used consistently in the guideline development process. The findings of this study offer insights into diverse roles and more effective ways to apply the consensus process during guideline development.
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Affiliation(s)
- Changhao Liang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, North Third Ring Road, Chaoyang District, Beijing, 100029, China
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Guanxiang Yin
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ziyi Lin
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Jing Cui
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yaqi Wang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, North Third Ring Road, Chaoyang District, Beijing, 100029, China
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Siqi Liu
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Dingran Yin
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Pengwei Liu
- Chinese Society of Traditional Chinese Medicine, Beijing, 100029, China
| | - Xiangfei Su
- Chinese Society of Traditional Chinese Medicine, Beijing, 100029, China
| | - Hongguo Rong
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, North Third Ring Road, Chaoyang District, Beijing, 100029, China
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Cheng Wang
- Xinjiang Uygur Autonomous Region Academy of Traditional Chinese Medicine, Xinjiang, 830001, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Yutong Fei
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, North Third Ring Road, Chaoyang District, Beijing, 100029, China.
- Beijing University of Chinese Medicine, Beijing, 100029, China.
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Gebrye T, Fatoye F, Mbada C, Hakimi Z. A scoping review on quality assessment tools used in systematic reviews and meta-analysis of real-world studies. Rheumatol Int 2023; 43:1573-1581. [PMID: 37326665 PMCID: PMC10348931 DOI: 10.1007/s00296-023-05354-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
Risk of bias tools is important in identifying inherent methodical flaws and for generating evidence in studies involving systematic reviews (SRs) and meta-analyses (MAs), hence the need for sensitive and study-specific tools. This study aimed to review quality assessment (QA) tools used in SRs and MAs involving real-world data. Electronic databases involving PubMed, Allied and Complementary Medicine Database, Cumulated Index to Nursing and Allied Health Literature, and MEDLINE were searched for SRs and MAs involving real-world data. Search was delimited to articles published in English, and between inception to 20 of November 2022 following the SRs and MAs extension for scoping checklist. Sixteen articles on real-world data published between 2016 and 2021 that reported their methodological quality met the inclusion criteria. Seven of these articles were observational studies, while the others were of interventional type. Overall, 16 QA tools were identified. Except one, all the QA tools employed in SRs and MAs involving real-world data are generic, and only three of these were validated. Generic QA tools are mostly used for real-world data SRs and MAs, while no validated and reliable specific tool currently exist. Thus, there is need for a standardized and specific QA tool of SRs and MAs for real-world data.
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Affiliation(s)
- Tadesse Gebrye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, Bonsall Street, 53 Bonsall Street, Manchester, M15 6GX UK
| | - Francis Fatoye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, Bonsall Street, 53 Bonsall Street, Manchester, M15 6GX UK
- Lifestyle Diseases, Faculty of Health Sciences, North-West University, Mahikeng, South Africa
| | - Chidozie Mbada
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, Birley Fields Campus, Bonsall Street, 53 Bonsall Street, Manchester, M15 6GX UK
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4
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Atkins B, Briffa T, Connell C, Buttery AK, Jennings GLR. Improving prioritization processes for clinical practice guidelines: new methods and an evaluation from the National Heart Foundation of Australia. Health Res Policy Syst 2023; 21:26. [PMID: 37020238 PMCID: PMC10075165 DOI: 10.1186/s12961-022-00953-9] [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: 08/23/2021] [Accepted: 12/21/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Releasing timely and relevant clinical guidelines is challenging for organizations globally. Priority-setting is crucial, as guideline development is resource-intensive. Our aim, as a national organization responsible for developing cardiovascular clinical guidelines, was to develop a method for generating and prioritizing topics for future clinical guideline development in areas where guidance was most needed. METHODS Several novel processes were developed, adopted and evaluated, including (1) initial public consultation for health professionals and the general public to generate topics; (2) thematic and qualitative analysis, according to the International Classification of Diseases (ICD-11), to aggregate topics; (3) adapting a criteria-based matrix tool to prioritize topics; (4) achieving consensus through a modified-nominal group technique and voting on priorities; and (5) process evaluation via survey of end-users. The latter comprised the organization's Expert Committee of 12 members with expertise across cardiology and public health, including two citizen representatives. RESULTS Topics (n = 405; reduced to n = 278 when duplicates removed) were identified from public consultation responses (n = 107 respondents). Thematic analysis synthesized 127 topics that were then categorized into 37 themes using ICD-11 codes. Exclusion criteria were applied (n = 32 themes omitted), resulting in five short-listed topics: (1) congenital heart disease, (2) valvular heart disease, (3) hypercholesterolaemia, (4) hypertension and (5) ischaemic heart diseases and diseases of the coronary artery. The Expert Committee applied the prioritization matrix to all five short-listed topics during a consensus meeting and voted to prioritize topics. Unanimous consensus was reached for the topic voted the highest priority: ischaemic heart disease and diseases of the coronary arteries, resulting in the decision to update the organization's 2016 clinical guidelines for acute coronary syndromes. Evaluation indicated that initial public consultation was highly valued by the Expert Committee, and the matrix tool was easy to use and improved transparency in priority-setting. CONCLUSION Developing a multistage, systematic process, incorporating public consultation and an international classification system led to improved transparency in our clinical guideline priority-setting processes and that topics chosen would have the greatest impact on health outcomes. These methods are potentially applicable to other national and international organizations responsible for developing clinical guidelines.
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Affiliation(s)
- Brooke Atkins
- National Heart Foundation of Australia, 2/850 Collins Street, Melbourne, VIC, 3008, Australia.
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Clifton Street Building, Clifton St, Nedlands, WA, 6009, Australia
| | - Cia Connell
- National Heart Foundation of Australia, 2/850 Collins Street, Melbourne, VIC, 3008, Australia
| | - Amanda K Buttery
- National Heart Foundation of Australia, 2/850 Collins Street, Melbourne, VIC, 3008, Australia
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5
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Saluja K, Reddy KS, Wang Q, Zhu Y, Li Y, Chu X, Li R, Hou L, Horsley T, Carden F, Bartolomeos K, Hatcher Roberts J. Improving WHO's understanding of WHO guideline uptake and use in Member States: a scoping review. Health Res Policy Syst 2022; 20:98. [PMID: 36071468 PMCID: PMC9449928 DOI: 10.1186/s12961-022-00899-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/16/2022] [Indexed: 11/20/2022] Open
Abstract
Background WHO publishes public health and clinical guidelines to guide Member States in achieving better health outcomes. Furthermore, WHO’s Thirteenth General Programme of Work for 2019–2023 prioritizes strengthening its normative functional role and uptake of normative and standard-setting products, including guidelines at the country level. Therefore, understanding WHO guideline uptake by the Member States, particularly the low- and middle-income countries (LMICs), is of utmost importance for the organization and scholarship. Methods We conducted a scoping review using a comprehensive search strategy to include published literature in English between 2007 and 2020. The review was conducted between May and June 2021. We searched five electronic databases including CINAHL, the Cochrane Library, PubMed, Embase and Scopus. We also searched Google Scholar as a supplementary source. The review adhered to the PRISMA-ScR (PRISMA extension for scoping reviews) guidelines for reporting the searches, screening and identification of evaluation studies from the literature. A narrative synthesis of the evidence around key barriers and challenges for WHO guideline uptake in LMICs is thematically presented.
Results The scoping review included 48 studies, and the findings were categorized into four themes: (1) lack of national legislation, regulations and policy coherence, (2) inadequate experience, expertise and training of healthcare providers for guideline uptake, (3) funding limitations for guideline uptake and use, and (4) inadequate healthcare infrastructure for guideline compliance. These challenges were situated in the Member States’ health systems. The findings suggest that governance was often weak within the existing health systems amongst most of the LMICs studied, as was the guidance provided by WHO’s guidelines on governance requirements. This challenge was further exacerbated by a lack of accountability and transparency mechanisms for uptake and implementation of guidelines. In addition, the WHO guidelines themselves were either unclear and were technically challenging for some health conditions; however, WHO guidelines were primarily used as a reference by Member States when they developed their national guidelines. Conclusions The challenges identified reflect the national health systems’ (in)ability to allocate, implement and monitor the guidelines. Historically this is beyond the remit of WHO, but Member States could benefit from WHO implementation guidance on requirements and needs for successful uptake and use of WHO guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00899-y.
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Affiliation(s)
- Kiran Saluja
- Bruyere Research Institute, Ottawa, Canada.,Science Division, World Health Organization, Geneva, Switzerland
| | - K Srikanth Reddy
- Bruyere Research Institute, Ottawa, Canada. .,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada. .,Using Evidence Inc., Ottawa, Canada. .,Science Division, World Health Organization, Geneva, Switzerland.
| | - Qi Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Ying Zhu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Yanfei Li
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xiajing Chu
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Rui Li
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liangying Hou
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | | | | | - Janet Hatcher Roberts
- WHO Collaborating Centre for Knowledge Translation and Health Impact Assessment in Health Equity, Bruyere Research Institute, University of Ottawa, Ottawa, Canada
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6
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Nguyen A, Nguyen HT. Income and cigarette price responsiveness: evidence from Vietnam. Tob Control 2022; 31:s152-s157. [PMID: 35977821 DOI: 10.1136/tc-2022-057584] [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: 06/13/2022] [Accepted: 08/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Vietnam has an ad valorem tobacco excise structure, with the tax base being factory gate price, making the excise susceptible to tax avoidance and less effective in reducing tobacco use. To address these issues, therefore, the government has considered switching to a mixed system in which a specific rate would be imposed on every cigarette pack in addition to the existing ad valorem rate. However, little is known about how smokers with different incomes respond to price increases in Vietnam, raising the concern of regressivity of the tax reform. OBJECTIVES This paper aims to provide timely and more updated evidence to support policy discussion on tobacco excise tax reform. METHODS The study relies on the smokers' stated preferences, which are elicited from the Tobacco Consumption Survey in Vietnam in 2017-2018. We use data on actual purchases and the stated maximum prices that smokers are willing to pay for their cigarette brands to calculate conditional price elasticity at the individual level. Regression analysis then is used to quantify the extent to which income and other socioeconomic characteristics shape the smokers' price sensitivity. RESULTS Both the individual incomes and household incomes have negative and significant effects on the price elasticity of conditional demand for cigarettes. This effect is particularly strong after taking the product heterogeneity into account by considering only the most popular brand, but becomes smaller when looking at a more heterogeneous market by excluding that brand from the original sample. The magnitude of the impact of income adjusted for cigarette price is much higher than unadjusted income. The implication is that with sufficiently large variation in price across cigarette brands, which are often the case for countries with ad valorem tobacco excise tax structures, the low-income smokers may not be more sensitive to cigarette price than the high-income smokers so that a uniform percentage increase does not necessarily result in larger consumption fall for the low-income smokers. Narrowing the price gaps between cigarette brands by adding a specific tax component can help address this issue. CONCLUSION Raising tobacco tax can make the tax policy more progressive and benefit the poor more than the rich in Vietnam. Thus, the Government of Vietnam should switch from the current, purely ad valorem excise tax structure to the mixed system to reduce price variation and make the tobacco tax more progressive.
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Affiliation(s)
- Anh Nguyen
- Economics, Development and Policies Research Center, Hanoi, Viet Nam
| | - Hoang The Nguyen
- Economics, Development and Policies Research Center, Hanoi, Viet Nam
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7
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Odgers HL, Tong A, Lopez-Vargas P, Davidson A, Jaffe A, McKenzie A, Pinkerton R, Wake M, Richmond P, Crowe S, Caldwell PHY, Hill S, Couper J, Haddad S, Kassai B, Craig JC. Research priority setting in childhood chronic disease: a systematic review. Arch Dis Child 2018; 103:942-951. [PMID: 29643102 DOI: 10.1136/archdischild-2017-314631] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate research priority setting approaches in childhood chronic diseases and to describe the priorities of stakeholders including patients, caregivers/families and health professionals. DESIGN We conducted a systematic review of MEDLINE, Embase, PsycINFO and CINAHL from inception to 16 October 2016. Studies that elicited stakeholder priorities for paediatric chronic disease research were eligible for inclusion. Data on the prioritisation process were extracted using an appraisal checklist. Generated priorities were collated into common topic areas. RESULTS We identified 83 studies (n=15 722). Twenty (24%) studies involved parents/caregivers and four (5%) children. The top three health areas were cancer (11%), neurology (8%) and endocrine/metabolism (8%). Priority topic areas were treatment (78%), disease trajectory (48%), quality of life/psychosocial impact (48%), disease onset/prevention (43%), knowledge/self-management (33%), prevalence (30%), diagnostic methods (28%), access to healthcare (25%) and transition to adulthood (12%). The methods included workshops, Delphi techniques, surveys and focus groups/interviews. Specific methods for collecting and prioritising research topics were described in only 60% of studies. Most reviewed studies were conducted in high-income nations. CONCLUSIONS Research priority setting activities in paediatric chronic disease cover many discipline areas and have elicited a broad range of topics. However, child/caregiver involvement is uncommon, and the methods often lack clarity. A systematic and explicit process that involves patients and families in partnership may help to inform a more patient and family-relevant research agenda in paediatric chronic disease.
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Affiliation(s)
- Harrison Lindsay Odgers
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Pamela Lopez-Vargas
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Kid's Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Andrew Davidson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, France.,Department of Anaesthesiology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Adam Jaffe
- Department of Respiratory Medicine, The Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Discipline of Paediatrics, The University of New South Wales, Sydney, New South Wales, Australia
| | - Anne McKenzie
- Western Australian Health Translation Network, The University of Western Australia, Perth, Western Australia, Australia
| | - Ross Pinkerton
- Department of Oncology, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Melissa Wake
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, France.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Peter Richmond
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Departments of General Paediatrics and Immunology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | | | - Patrina Ha Yuen Caldwell
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Nephrology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Sophie Hill
- Center for Health Communication and Participation, La Trobe University, Melbourne, Victoria, Australia
| | - Jennifer Couper
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Suzy Haddad
- Patient and Carer Representative, Sydney, New South Wales, Australia
| | - Behrouz Kassai
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Centre d'Investigation Clinique de Lyon, Lyon, France
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Florez ID, Morgan RL, Falavigna M, Kowalski SC, Zhang Y, Etxeandia-Ikobaltzeta I, Santesso N, Wiercioch W, Schünemann HJ. Development of rapid guidelines: 2. A qualitative study with WHO guideline developers. Health Res Policy Syst 2018; 16:62. [PMID: 30005710 PMCID: PMC6044000 DOI: 10.1186/s12961-018-0329-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 05/22/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Situations such as public health emergencies and outbreaks necessitate the development and publication of high-quality recommendations within a condensed timeframe. For example, WHO has produced examples of and guidance for the development of rapid guidelines (RGs). However, more information is needed to understand the experiences and perceptions of guideline developers. This is the second of a series of three articles addressing methodological issues around RGs. This study describes the perceptions and experiences of guideline developers at WHO about RGs. METHODS We conducted interviews consisting of open- and closed-ended questions with guideline developers at WHO. Our analysis described the definition and rationale of RGs, the differences from regular guidelines with regard to timelines from topic definition until publication, barriers to identifying the evidence and the lack of a standard methodology to develop RGs. RESULTS We interviewed 10 participants, the majority of whom were comfortable with the current WHO definition of RGs. Most stated that the rationale for developing RGs should be in response to new evidence about efficacy, cost-effectiveness or safety. Respondents differed with regards to the amount of time RGs should take. While the majority of participants agreed that guidelines should be based on a systematic review, this step in the process was considered the most time and resource intensive. Challenges for developing RGs included limited personnel and financial resources as well as the lack of evidence. Facilitators, in turn, that may improve RG development include additional financial and personnel resources as well as the use of virtual meetings. CONCLUSIONS While our study suggests a strong need and rationale for the development of RGs, standardisation of timelines and guidance on panel composition, peer-review process, conduct of meetings and sources of permissible evidence require further research.
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Affiliation(s)
- Ivan D. Florez
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
- Department of Pediatrics, University of Antioquia, Cra. 51D #62-29, Medellin, 050001 Colombia
| | - Rebecca L. Morgan
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
| | - Maicon Falavigna
- Hospital Moinhos de Vento, Porto Alegre, Brazil
- National Institute of Science and Technology for Health Technology Assessment, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sérgio C. Kowalski
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
- Department of Internal Medicine, Division of Rheumatology, Universidade Federal do Paraná, R. Gen. Carneiro, 181, Curitiba, PR Brazil
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
| | - Itziar Etxeandia-Ikobaltzeta
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
- Cochrane Canada Center, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
- Department of Medicine, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
- Cochrane Canada Center, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
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9
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Kowalski SC, Morgan RL, Falavigna M, Florez ID, Etxeandia-Ikobaltzeta I, Wiercioch W, Zhang Y, Sakhia F, Ivanova L, Santesso N, Schünemann HJ. Development of rapid guidelines: 1. Systematic survey of current practices and methods. Health Res Policy Syst 2018; 16:61. [PMID: 30005712 PMCID: PMC6044042 DOI: 10.1186/s12961-018-0327-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 05/22/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Guidelines in the healthcare field generally should contain evidence-based recommendations to inform healthcare decisions. Guidelines often require 2 years or more to develop, but certain circumstances necessitate the development of rapid guidelines (RGs) in a short period of time. Upholding methodological rigor while meeting the reduced development timeframe presents a challenge for developing RGs. Our objective was to review current practices and standards for the development of RGs. This is the first of a series of three articles addressing methodological issues around RGs. METHODS We conducted a systematic survey of methods manuals and published RGs to identify reasons for the development of RGs. Data sources included existing guideline manuals, published RGs, Trip Medical Database, MEDLINE, EMBASE and communication with guideline developers until February 2018. RESULTS We identified 46 guidelines that used a shortened timeframe for their development. Nomenclature describing RGs varied across organisations, wherein the United States Centers for Disease Control and Prevention produced 'Interim Guidelines', the National Institute for Health and Care Excellence in the United Kingdom developed 'Short Clinical Guidelines', and WHO provided 'Rapid Advice'. The rationale for RGs included response to emergencies, rapid increases in cases of a condition or disease severity, or new evidence regarding treatment. In general, the methods to assess the quality of evidence, the consensus process and the management of the conflict of interest were not always clear. While we identified another 11 RGs from other institutions, there was no reference to timeframe and reasons for conducting a RG. The three organisations mentioned above provide guidance for the development of RGs. CONCLUSIONS There is a lack of standardised nomenclature and definitions regarding RGs and there is inconsistency in the methods described in manuals and in RG. It is therefore important that all RGs provide a detailed and transparent description of their methods in order for readers and end-users to be able to assess their quality and validate their findings.
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Affiliation(s)
- Sergio C. Kowalski
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
- Department of Internal Medicine, Division of Rheumatology- Universidade Federal do Paraná, R. Gen. Carneiro, 181, Curitiba, PR Brazil
| | - Rebecca L. Morgan
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
| | - Maicon Falavigna
- Hospital Moinhos de Vento, Porto Alegre, Brazil
- National Institute of Science and Technology for Health Technology Assessment, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Iván D. Florez
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
- Department of Pediatrics, University of Antioquia, Cra. 51D #62-29, Medellin, 050001 Colombia
| | - Itziar Etxeandia-Ikobaltzeta
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
| | - Faria Sakhia
- Public Health & Preventive Medicine Residency Program (including Family Medicine), McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Liudmila Ivanova
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
- Cochrane Canada Center, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence and Impact and Mac GRADE Center, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON L8N 4K1 Canada
- Cochrane Canada Center, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
- Department of Medicine, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
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10
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O’Brien S, Wilson S, Gill FJ, Cotterell E, Borland ML, Oakley E, Dalziel SR. The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline. BMC Med Res Methodol 2018; 18:22. [PMID: 29433429 PMCID: PMC5809867 DOI: 10.1186/s12874-018-0478-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 01/21/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Bronchiolitis is the commonest respiratory infection in children less than 12 months and cause of hospitalisation in infants under 6 months of age in Australasia. Unfortunately there is substantial variation in management, despite high levels of supporting evidence. This paper reports on the process, strengths and challenges of the hybrid approach used to develop the first Australasian management guideline relevant to the local population. METHOD An adaption of the nine steps recommended by the National Health and Medical Research Council (NHMRC) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology were utilised. Following establishment of the Guideline Development Committee (GDC), we identified the population, intervention, comparator, outcomes and time of interest (PICOt) questions, undertook a systematic literature search and graded the evidence and recommendations using the NHMRC and GRADE processes. Using Nominal Group Techniques (NGT), consensus was sought in formulating the clinical practice recommendations and practice points. Key health professional bodies were consulted to ensure relevance in the Australasian emergency and ward settings. RESULTS From 33 PICOT questions, clinical recommendations for practice that were deemed relevant to the Australasian population were identified. Specific considerations for the management of Australian and New Zealand indigenous infants in relation to the use of azithromycin and risk factors for more serious illness are included. Using NGT, consensus demonstrated by a median Likert score > 8 for all recommendations was achieved. The guideline presents clinical guidance, followed by the key recommendations and evidence review behind each recommendation. CONCLUSION Developing evidence-based clinical guidelines is a complex process with considerable challenges. Challenges included having committee members located over two countries and five time zones, large volume of literature and variation of member's knowledge of grading of evidence and recommendations. The GRADE and NHMRC processes provided a systematic and transparent approach ensuring a final structure including bedside interface, and a descriptive summary of the evidence base and tables for each key statement. Involvement of stakeholders who will ultimately be end-users as members of the GDC provided valuable knowledge. Lessons learnt during this guideline development process provide valuable insight for those planning development of evidence-based guidelines.
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Affiliation(s)
- Sharon O’Brien
- Child and Adolescent Health Service, Princess Margaret Hospital for Children, Roberts Road Subiaco, Perth, WA 6008 Australia
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA Australia
| | - Sally Wilson
- Child and Adolescent Health Service, Princess Margaret Hospital for Children, Roberts Road Subiaco, Perth, WA 6008 Australia
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA Australia
| | - Fenella J. Gill
- Child and Adolescent Health Service, Princess Margaret Hospital for Children, Roberts Road Subiaco, Perth, WA 6008 Australia
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA Australia
| | - Elizabeth Cotterell
- School of Rural Medicine, University of New England, Armidale, NSW 2351 Australia
| | - Meredith L Borland
- Child and Adolescent Health Service, Princess Margaret Hospital for Children, Roberts Road Subiaco, Perth, WA 6008 Australia
- School of Paediatric and Child Health, School of Primary, Aboriginal and Rural health Care, University of Western Australia, Perth, WA 6840 Australia
| | - Edward Oakley
- Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville, VIC 3052 Australia
- University of Melbourne, Cnr Grattan Street & Royal Parade, Melbourne, VIC 3010 Australia
- Paediatric Emergency Medicine Centre of Research Excellence, Melbourne, Australia
| | - Stuart R Dalziel
- Children’s Emergency Department, Starship Children’s Hospital, Private Bag 92024, Auckland, 1142 New Zealand
| | - on behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, Australasia
- Child and Adolescent Health Service, Princess Margaret Hospital for Children, Roberts Road Subiaco, Perth, WA 6008 Australia
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- School of Rural Medicine, University of New England, Armidale, NSW 2351 Australia
- School of Paediatric and Child Health, School of Primary, Aboriginal and Rural health Care, University of Western Australia, Perth, WA 6840 Australia
- Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville, VIC 3052 Australia
- University of Melbourne, Cnr Grattan Street & Royal Parade, Melbourne, VIC 3010 Australia
- Paediatric Emergency Medicine Centre of Research Excellence, Melbourne, Australia
- Children’s Emergency Department, Starship Children’s Hospital, Private Bag 92024, Auckland, 1142 New Zealand
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11
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Serrano-Aguilar P, Trujillo-Martin MM, del Pino-Sedeño T, Pérez de la Rosa A, de Pascual y Medina AM, Perestelo-Pérez L, Toledo-Chávarri A, Posada de la Paz M, Sarría Santamera A. Patient participation in the development of a clinical guideline for inherited retinal dystrophies. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1182907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- P. Serrano-Aguilar
- Evaluation Service of the Canary Islands Health Service (SESCS), Santa Cruz de Tenerife, Spain
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain
- Centre for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, Canary Islands, Spain
| | - M. M. Trujillo-Martin
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain
- Centre for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, Canary Islands, Spain
- Canary Foundation for Health Care Research (FUNCANIS), Canary Islands, Spain
| | - T. del Pino-Sedeño
- Canarian Foundation for Advances in Biomedicine and Biotechnology (BIOAVANCE), Canary Islands, Spain
| | - A. Pérez de la Rosa
- Canary Foundation for Health Care Research (FUNCANIS), Canary Islands, Spain
| | | | - L. Perestelo-Pérez
- Evaluation Service of the Canary Islands Health Service (SESCS), Santa Cruz de Tenerife, Spain
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain
- Centre for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, Canary Islands, Spain
| | - A. Toledo-Chávarri
- Canary Foundation for Health Care Research (FUNCANIS), Canary Islands, Spain
| | - M. Posada de la Paz
- The Institute of Rare Diseases Research, The Institute of Health Carlos III. Ministry of Economy and Competitiveness, Madrid, Spain
| | - A. Sarría Santamera
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain
- Health Technology Assessment Agency, The Institute of Health Carlos III. Ministry of Economy and Competitiveness, Madrid, Spain
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12
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DiCarlo JM, Gopakumar S, Dhillon PK, Krishnan S. Adoption of Information and Communication Technologies for Early Detection of Breast and Cervical Cancers in Low- and Middle-Income Countries. J Glob Oncol 2016; 2:222-234. [PMID: 28717705 PMCID: PMC5497625 DOI: 10.1200/jgo.2015.002063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE In response to the growing burden of breast and cervical cancers, low- and middle-income countries (LMICs) are beginning to implement national cancer prevention programs. We reviewed the literature on information and communication technology (ICT) applications in the prevention of breast and cervical cancers in LMICs to examine their potential to enhance cancer prevention efforts. METHODS Ten databases of peer-reviewed and gray literature were searched using an automated strategy for English-language articles on the use of mobile health (mHealth) and telemedicine in breast and cervical cancer prevention (screening and early detection) published between 2005 and 2015. Articles that described the rationale for using these ICTs and/or implementation experiences (successes, challenges, and outcomes) were reviewed. Bibliographies of articles that matched the eligibility criteria were reviewed to identify additional relevant references. RESULTS Of the initial 285 citations identified, eight met the inclusion criteria. Of these, four used primary data, two were overviews of ICT applications, and two were commentaries. Articles described the potential for mHealth and telemedicine to address both demand- and supply-side challenges to cancer prevention, such as awareness, access, and cost, in LMICs. However, there was a dearth of evidence to support these hypotheses. CONCLUSION This review indicates that there are few publications that reflect specifically on the role of mHealth and telemedicine in cancer prevention and even fewer that describe or evaluate interventions. Although articles suggest that mHealth and telemedicine can enhance the implementation and use of cancer prevention interventions, more evidence is needed.
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Affiliation(s)
- Jessica M DiCarlo
- , University of California Berkeley, Berkeley, CA; , Rice University, Houston, TX; , Public Health Foundation of India; and , Research Triangle Institute Global India Private Limited, New Delhi; St John's Research Institute, Bangalore, India
| | - Sricharan Gopakumar
- , University of California Berkeley, Berkeley, CA; , Rice University, Houston, TX; , Public Health Foundation of India; and , Research Triangle Institute Global India Private Limited, New Delhi; St John's Research Institute, Bangalore, India
| | - Preet K Dhillon
- , University of California Berkeley, Berkeley, CA; , Rice University, Houston, TX; , Public Health Foundation of India; and , Research Triangle Institute Global India Private Limited, New Delhi; St John's Research Institute, Bangalore, India
| | - Suneeta Krishnan
- , University of California Berkeley, Berkeley, CA; , Rice University, Houston, TX; , Public Health Foundation of India; and , Research Triangle Institute Global India Private Limited, New Delhi; St John's Research Institute, Bangalore, India
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13
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Azeredo TB, Luiza VL, Oliveira MA, Emmerick ICM, Bigdeli M. Stakeholders' perspectives on access-to-medicines policy and research priorities in Latin America and the Caribbean: face-to-face and web-based interviews. Health Res Policy Syst 2014; 12:31. [PMID: 24965383 PMCID: PMC4079916 DOI: 10.1186/1478-4505-12-31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 05/30/2014] [Indexed: 11/25/2022] Open
Abstract
Background This study aims to rank policy concerns and policy-related research issues in order to identify policy and research gaps on access to medicines (ATM) in low- and middle-income countries in Latin America and the Caribbean (LAC), as perceived by policy makers, researchers, NGO and international organization representatives, as part of a global prioritization exercise. Methods Data collection, conducted between January and May 2011, involved face-to-face interviews in El Salvador, Colombia, Dominican Republic, and Suriname, and an e-mail survey with key-stakeholders. Respondents were asked to choose the five most relevant criteria for research prioritization and to score policy/research items according to the degree to which they represented current policies, desired policies, current research topics, and/or desired research topics. Mean scores and summary rankings were obtained. Linear regressions were performed to contrast rankings concerning current and desired policies (policy gaps), and current and desired research (research gaps). Results Relevance, feasibility, and research utilization were the top ranked criteria for prioritizing research. Technical capacity, research and development for new drugs, and responsiveness, were the main policy gaps. Quality assurance, staff technical capacity, price regulation, out-of-pocket payments, and cost containment policies, were the main research gaps. There was high level of coherence between current and desired policies: coefficients of determination (R2) varied from 0.46 (Health system structure; r = 0.68, P <0.01) to 0.86 (Sustainable financing; r = 0.93, P <0.01). There was also high coherence between current and desired research on Rational selection and use of medicines (r = 0.71, P <0.05, R2 = 0.51), Pricing/affordability (r = 0.82, P <0.01, R2 = 0.67), and Sustainable financing (r = 0.76, P <0.01, R2 = 0.58). Coherence was less for Health system structure (r = 0.61, P <0.01, R2 = 0.38). Conclusions This study combines metrics approaches, contributing to priority setting methodology development, with country and regional level stakeholder participation. Stakeholders received feedback with the results, and we hope to have contributed to the discussion and implementation of ATM research and policy priorities in LAC.
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Affiliation(s)
| | - Vera Lucia Luiza
- Nucleus for Pharmaceutical Policies, National School of Public Health, Oswaldo Cruz Foundation, 1480, Rua Leopoldo Bulhões # 624, Manguinhos, 21021-000 Rio de Janeiro, RJ, Brazil.
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Marshall RC, Tlagadi A, Bronze M, Kana V, Naidoo S, Wiggill TM, Carmona SC. Lower frequency of NPM1 and FLT3-ITD mutations in a South African adult de novo AML cohort. Int J Lab Hematol 2014; 36:656-64. [PMID: 24666762 DOI: 10.1111/ijlh.12204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/31/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Acute myeloid leukemia (AML) is a heterogeneous clonal disorder of hemopoietic progenitor cells diagnosed in individuals of any age, but with a median age of 67 years at presentation in adults. Assessment of the mutation status of nucleophosmin protein-1 (NPM1) and FMS-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) is essential for the prognosis, and treatment of AML. METHODS A total of 160 de novo AML cases, both cytogenetically normal and abnormal, were analyzed for the presence of NPM1 and FLT3-ITD mutations, and the results assessed in conjunction with epidemiological, clinical, and laboratory findings. RESULTS Nucleophosmin protein-1 mutations were found in 7.5%, while FLT3-ITD was present in 12% of these cases. Both of these were lower than expected. The median age at diagnosis of AML was 41 years, and for the FLT3-ITD only cases, median age was 33 years; these ages were younger than expected. CONCLUSION The lower reported frequencies and younger median age at diagnosis of AML and these specific mutations may be contributed to by a number of factors including effects of race on age of presentation, inclusion of patients diagnosed with de novo AML only, and a generally younger median age of the South African population.
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Affiliation(s)
- R C Marshall
- National Health Laboratory Services, Johannesburg, South Africa; Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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