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de Bruin M, Black N, Javornik N, Viechtbauer W, Eisma MC, Hartman-Boyce J, Williams AJ, West R, Michie S, Johnston M. Underreporting of the active content of behavioural interventions: a systematic review and meta-analysis of randomised trials of smoking cessation interventions. Health Psychol Rev 2021; 15:195-213. [PMID: 31906781 DOI: 10.1080/17437199.2019.1709098] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
Despite its importance, underreporting of the active content of experimental and comparator interventions in published literature has not been previously examined for behavioural trials. We assessed completeness and variability in reporting in 142 randomised controlled trials of behavioural interventions for smoking cessation published between 1/1996 and 11/2015. Two coders reliably identified the potential active components of experimental and comparator interventions (activities targeting behaviours key to smoking cessation and qualifying as behaviour change techniques, BCTs) in published, and in unpublished materials obtained from study authors directly. Unpublished materials were obtained for 129/204 (63%) experimental and 93/142 (65%) comparator groups. For those, only 35% (1200/3403) of experimental and 26% (491/1891) of comparator BCTs could be identified in published materials. Reporting quality (#published BCTs/#total BCTs) varied considerably between trials and between groups within trials. Experimental (vs. comparator) interventions were better reported (B(SE) = 0.34 (0.11), p < .001). Unpublished materials were more often obtained for recent studies (B(SE) = 0.093 (0.03), p = .003) published in behavioural (vs. medical) journals (B(SE) = 1.03 (0.41), p = .012). This high variability in underreporting of active content compromises reader's ability to interpret the effects of individual trials, compare and explain intervention effects in evidence syntheses, and estimate the additional benefit of an experimental intervention in other settings.
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Affiliation(s)
- Marijn de Bruin
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Aberdeen, UK
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Nicola Black
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Aberdeen, UK
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Neza Javornik
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Aberdeen, UK
| | - Wolfgang Viechtbauer
- Department of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Jamie Hartman-Boyce
- Nuffield Department of Primary Care Health Sciences and National Institute of Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - A Jess Williams
- Institute of Mental HealthSchool of Psychology, University of Birmingham, Birmingham, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Marie Johnston
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Aberdeen, UK
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Sanson-Fisher R, Hobden B, Carey M, Mackenzie L, Hyde L, Shepherd J. Interactional skills training in undergraduate medical education: ten principles for guiding future research. BMC MEDICAL EDUCATION 2019; 19:144. [PMID: 31092235 PMCID: PMC6521390 DOI: 10.1186/s12909-019-1566-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 04/22/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND High-quality healthcare requires practitioners who have technical competence and communication skills. Medical practitioners need interpersonal skills for gathering and transferring information to their patients, in addition to general consultation skills. Appropriate information gathering increases the likelihood of an accurate diagnosis. Transferring information should be performed in a way that promotes patient understanding and increases the probability of adherence to physician recommendations. This applies to: (i) primary prevention such as smoking cessation; (ii) secondary prevention including preparation for potentially threatening interventions; and (iii) tertiary care, including breaking bad news regarding treatment and prognosis. DISCUSSION This debate paper delineates factors associated with undergraduate medical communication skills training where robust research is needed. Ten key principles are presented and discussed, which are intended to guide future research in this field and ensure high quality studies with methodological rigour are conducted. The literature on communication skills training for medical school undergraduates continues to grow. A considerable portion of this output is represented by commentaries, descriptive studies or poorly designed interventions. As with any field of healthcare, quality research interventions are required to ensure practice is grounded in high-level evidence.
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Affiliation(s)
- Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Lisa Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Lisa Hyde
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Jan Shepherd
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
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Wilson SM, Newins AR, Medenblik AM, Kimbrel NA, Dedert EA, Hicks TA, Neal LC, Beckham JC, Calhoun PS. Contingency Management Versus Psychotherapy for Prenatal Smoking Cessation: A Meta-Analysis of Randomized Controlled Trials. Womens Health Issues 2018; 28:514-523. [PMID: 30061033 PMCID: PMC6215492 DOI: 10.1016/j.whi.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Prenatal smoking is the leading preventable cause of poor obstetric outcomes, yet treatment options are limited. Past reviews of prenatal smoking cessation have often grouped all counseling into a single category, which ignores the fact that psychotherapy is distinct from brief counseling. The objective of this study was to compare the effect sizes of two intensive interventions for prenatal smoking cessation: contingency management (i.e., financial incentives for abstinence) and psychotherapy. METHODS A systematic search for randomized controlled trials testing the efficacy of contingency management or psychotherapy was completed using PubMed, PsycINFO, Web of Science, the Cochrane Library, and EMBASE. Independent raters extracted data and assessed trials for risk of bias. Treatment effects were analyzed for three times points: late pregnancy, early postpartum, and late postpartum. RESULTS The search yielded 22 studies, and meta-analytic results indicated that interventions (compared with control groups) generally increased the odds of abstinence. Moderator analyses indicated that intervention type (contingency management vs. psychotherapy) accounted for variability in effect sizes. When comparing treatment type, effects of contingency management interventions were significantly greater than those of psychotherapeutic interventions. Although psychotherapy did not affect smoking abstinence, contingency management interventions had significant treatment effects at all three time points. CONCLUSIONS Contingency management seems to be a safe and efficacious prenatal smoking cessation treatment. Although psychotherapy alone did not show an effect on prenatal smoking abstinence, future research may seek to combine this approach with contingency management to promote prenatal smoking cessation.
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Affiliation(s)
- Sarah M Wilson
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; VA Center for Health Services Research in Primary Care, Durham, North Carolina.
| | | | | | - Nathan A Kimbrel
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Eric A Dedert
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | | | - Lydia C Neal
- Duke University School of Medicine, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Jean C Beckham
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Patrick S Calhoun
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; VA Center for Health Services Research in Primary Care, Durham, North Carolina
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Warner MM, Kelly JT, Reidlinger DP, Hoffmann TC, Campbell KL. Reporting of Telehealth-Delivered Dietary Intervention Trials in Chronic Disease: Systematic Review. J Med Internet Res 2017; 19:e410. [PMID: 29229588 PMCID: PMC5742660 DOI: 10.2196/jmir.8193] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/26/2017] [Accepted: 11/04/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Telehealth-delivered dietary interventions are effective for chronic disease management and are an emerging area of clinical practice. However, to apply interventions from the research setting in clinical practice, health professionals need details of each intervention component. OBJECTIVE The aim of this study was to evaluate the completeness of intervention reporting in published dietary chronic disease management trials that used telehealth delivery methods. METHODS Eligible randomized controlled trial publications were identified through a systematic review. The completeness of reporting of experimental and comparison interventions was assessed by two independent assessors using the Template for Intervention Description and Replication (TIDieR) checklist that consists of 12 items including intervention rationale, materials used, procedures, providers, delivery mode, location, when and how much intervention delivered, intervention tailoring, intervention modifications, and fidelity. Where reporting was incomplete, further information was sought from additional published material and through email correspondence with trial authors. RESULTS Within the 37 eligible trials, there were 49 experimental interventions and 37 comparison interventions. One trial reported every TIDieR item for their experimental intervention. No publications reported every item for the comparison intervention. For the experimental interventions, the most commonly reported items were location (96%), mode of delivery (98%), and rationale for the essential intervention elements (96%). Least reported items for experimental interventions were modifications (2%) and intervention material descriptions (39%) and where to access them (20%). Of the 37 authors, 14 responded with further information, and 8 could not be contacted. CONCLUSIONS Many details of the experimental and comparison interventions in telehealth-delivered dietary chronic disease management trials are incompletely reported. This prevents accurate interpretation of trial results and implementation of effective interventions in clinical practice.
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Affiliation(s)
- Molly M Warner
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Jaimon T Kelly
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | | | - Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Katrina L Campbell
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
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Forman-Hoffman VL, Middleton JC, McKeeman JL, Stambaugh LF, Christian RB, Gaynes BN, Kane HL, Kahwati LC, Lohr KN, Viswanathan M. Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review. Implement Sci 2017; 12:93. [PMID: 28738821 PMCID: PMC5525230 DOI: 10.1186/s13012-017-0626-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some outcomes for children with mental health problems remain suboptimal because of poor access to care and the failure of systems and providers to adopt established quality improvement strategies and interventions with proven effectiveness. This review had three goals: (1) assess the effectiveness of quality improvement, implementation, and dissemination strategies intended to improve the mental health care of children and adolescents; (2) examine harms associated with these strategies; and (3) determine whether effectiveness or harms differ for subgroups based on system, organizational, practitioner, or patient characteristics. METHODS Sources included MEDLINE®, the Cochrane Library, PsycINFO, and CINAHL, from database inception through February 17, 2017. Additional sources included gray literature, additional studies from reference lists, and technical experts. Two reviewers selected relevant randomized controlled trials (RCTs) and observational studies, extracted data, and assessed risk of bias. Dual analysis, synthesis, and grading of the strength of evidence for each outcome followed for studies meeting inclusion criteria. We also used qualitative comparative analysis to examine relationships between combinations of strategy components and improvements in outcomes. RESULTS We identified 18 strategies described in 19 studies. Eleven strategies significantly improved at least one measure of intermediate outcomes, final health outcomes, or resource use. Moderate strength of evidence (from one RCT) supported using provider financial incentives such as pay for performance to improve the competence with which practitioners can implement evidence-based practices (EBPs). We found inconsistent evidence involving strategies with educational meetings, materials, and outreach; programs appeared to be successful in combination with reminders or providing practitioners with newly collected clinical information. We also found low strength of evidence for no benefit for initiatives that included only educational materials or meetings (or both), or only educational materials and outreach components. Evidence was insufficient to draw conclusions on harms and moderators of interventions. CONCLUSIONS Several strategies can improve both intermediate and final health outcomes and resource use. This complex and heterogeneous body of evidence does not permit us to have a high degree of confidence about the efficacy of any one strategy because we generally found only a single study testing each strategy. TRIAL REGISTRATION PROSPERO, CRD42015024759 .
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Affiliation(s)
- Valerie L. Forman-Hoffman
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Jennifer Cook Middleton
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, CB# 7590 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27599-7590 USA
| | - Joni L. McKeeman
- Department of Psychiatry, UNC School of Medicine, 235 Med Sch Wing C, 7160, Chapel Hill, NC 27599 USA
| | - Leyla F. Stambaugh
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Robert B. Christian
- The Carolina Institute for Developmental Disabilities, University of North Carolina Chapel Hill, Campus Box # 7255, Chapel Hill, NC 27599-7255 USA
| | - Bradley N. Gaynes
- Department of Psychiatry, UNC School of Medicine, 304 MacNider Hall, CB #7160 333 S. Columbia Street, Chapel Hill, NC 27599 USA
| | - Heather Lynne Kane
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Leila C. Kahwati
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Kathleen N. Lohr
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Meera Viswanathan
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
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Ludemann A, Power E, Hoffmann TC. Investigating the Adequacy of Intervention Descriptions in Recent Speech-Language Pathology Literature: Is Evidence From Randomized Trials Useable? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:443-455. [PMID: 28475801 DOI: 10.1044/2016_ajslp-16-0035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 12/01/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE To evaluate the completeness of intervention descriptions in recent randomized controlled trials of speech-language pathology treatments. METHOD A consecutive sample of entries on the speechBITE database yielded 129 articles and 162 interventions. Interventions were rated using the Template for Intervention Description and Replication (TIDieR) checklist. Rating occurred at 3 stages: interventions as published in the primary article, secondary locations referred to by the article (e.g., protocol papers, websites), and contact with corresponding authors. RESULTS No interventions were completely described in primary publications or after analyzing information from secondary locations. After information was added from correspondence with authors, a total of 28% of interventions was rated as complete. The intervention elements with the most information missing in the primary publications were tailoring and modification of interventions (in 25% and 13% of articles, respectively) and intervention materials and where they could be accessed (18%). Elements that were adequately described in most articles were intervention names (in 100% of articles); rationale (96%); and details of the frequency, session duration, and length of interventions (69%). CONCLUSIONS Clinicians and researchers are restricted in the usability of evidence from speech-language pathology randomized trials because of poor reporting of elements essential to the replication of interventions.
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Affiliation(s)
| | - Emma Power
- Speech Pathology, University of Sydney, New South Wales
| | - Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia
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Giatras N, Wanninkhof E, Leontowitsch M, Lewis B, Taylor A, Cooper S, Ussher M. Lessons learned from the London Exercise and Pregnant (LEAP) Smokers randomised controlled trial process evaluation: implications for the design of physical activity for smoking cessation interventions during pregnancy. BMC Public Health 2017; 17:85. [PMID: 28095827 PMCID: PMC5240296 DOI: 10.1186/s12889-017-4013-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background The challenges of delivering interventions for pregnant smokers have been poorly documented. Also, the process of promoting a physical activity intervention for pregnant smokers has not been previously recorded. This study describes the experiences of researchers conducting a randomised controlled trial of physical activity as an aid to smoking cessation during pregnancy and explores how the effectiveness of future interventions could be improved. Methods Two focus groups, with independent facilitators, were conducted with six researchers who had enrolled pregnant smokers in the LEAP trial, provided the interventions, and administered the research measures. Topics included recruitment, retention and how the physical activity intervention for pregnant smokers was delivered and how it was adapted when necessary to suit the women. The focus groups were audio-recorded, transcribed verbatim and subjected to thematic analysis. Results Five themes emerged related to barriers or enablers to intervention delivery: (1) nature of the intervention; (2) personal characteristics of trial participants; (3) practical issues; (4) researchers’ engagement with participants; (5) training and support needs. Researchers perceived that participants may have been deterred by the intensive and generic nature of the intervention and the need to simultaneously quit smoking and increase physical activity. Women also appeared hampered by pregnancy ailments, social deprivation, and poor mental health. Researchers observed that their status as health professionals was valued by participants but it was challenging to maintain contact with participants. Training and support needs were identified for dealing with pregnant teenagers, participants’ friends and family, and post-natal return to smoking. Conclusions Future exercise interventions for smoking cessation in pregnancy may benefit by increased tailoring of the intervention to the characteristics of the women, including their psychological profile, socio-economic background, pregnancy ailments and exercise preferences. Delivering an effective physical activity intervention for smoking cessation in pregnancy may require more comprehensive training for those delivering the intervention, particularly with regard to dealing with teenage smokers and smokers’ friends and family, as well as for avoiding post-natal return to smoking. Trial registration ISRCTN48600346, date of registration: 21/07/2008. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4013-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nikoletta Giatras
- City University London, Cass Business School, 106 Bunhill Row, London, EC1Y 8TZ, UK
| | - Elisabeth Wanninkhof
- St George's University of London, Population Health Research Institute, Cranmer Terrace, London, SW17 0RE, UK
| | - Miranda Leontowitsch
- Interdisciplinary Ageing Research, Department of Education, Goethe University, Frankfurt am Main, 60323, Germany
| | - Beth Lewis
- School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Adrian Taylor
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, UK
| | - Sue Cooper
- Division of Primary Care, The University of Nottingham, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Michael Ussher
- St George's University of London, Population Health Research Institute, Cranmer Terrace, London, SW17 0RE, UK.
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Sanders SL, Rathbone J, Bell KJL, Glasziou PP, Doust JA. Systematic review of the effects of care provided with and without diagnostic clinical prediction rules. Diagn Progn Res 2017; 1:13. [PMID: 31093542 PMCID: PMC6460683 DOI: 10.1186/s41512-017-0013-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/06/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Diagnostic clinical prediction rules (CPRs) are worthwhile if they improve patient outcomes or provide benefits such as reduced resource use, without harming patients. We conducted a systematic review to assess the effects of diagnostic CPRs on patient and process of care outcomes. METHODS We searched electronic databases and a trial registry and performed citation and reference checks, for randomised trials comparing a diagnostic strategy with and without a CPR. Included studies were assessed for risk of bias and similar studies meta-analysed. RESULTS Twenty-seven studies evaluating diagnostic CPRs for 14 conditions were included. A clinical management decision was the primary outcome in the majority of studies. Most studies were judged to be at high or uncertain risk of bias on ≥3 of 6 domains. Details of study interventions and implementation were infrequently reported.For suspected Group A Streptococcus throat infection, diagnostic CPRs reduced symptoms (1 study) and antibiotic prescriptions (5 studies, RR 0.86, 95% CI 0.75 to 0.99). For suspected cardiac chest pain, diagnostic strategies incorporating a CPR improved early discharge rates (1 study), decreased objective cardiac testing (1 study) and decreased hospitalisations (1 study). For ankle injuries, Ottawa Ankle Rules reduced radiography when used with clinical examination (1 study) but had no effect on length of stay as a triage test (1 study). For suspected acute appendicitis, CPRs had no effect on rates of perforated appendix (1 study) or the number of non-therapeutic operations (5 studies, RR 0.68, 95% CI 0.43 to 1.08). For suspected pneumonia, CPRs reduced antibiotic prescribing without unfavourable outcomes (3 studies). For children with possible serious bacterial infection, diagnostic CPRs did not improve process of care outcomes (3 studies). CONCLUSION There are few randomised trials of diagnostic CPRs, and patient outcomes are infrequently reported. Diagnostic CPRs had a positive effect on process outcomes in some clinical conditions; however, many studies were at unclear or high risk of bias and the results may be context specific. Future studies should seek to detail how the CPR might alter the diagnostic pathway, report effects on both patient and process outcomes, and improve reporting of the study interventions and implementation. TRIAL REGISTRATION The protocol for this review was not registered with PROSPERO, the international prospective register of systematic review protocols. The review was conceived and protocol prepared prior to the launch of PROSPERO in February 2011.
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Affiliation(s)
- Sharon L Sanders
- 1Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland Australia
| | - John Rathbone
- 1Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland Australia
| | - Katy J L Bell
- 1Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland Australia
- 2Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Paul P Glasziou
- 1Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland Australia
| | - Jenny A Doust
- 1Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland Australia
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Sakzewski L, Reedman S, Hoffmann T. Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:417-427. [PMID: 27736712 DOI: 10.1016/j.ridd.2016.09.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Incomplete reporting of components of interventions limits uptake of evidence into clinical practice. AIMS To evaluate the completeness of reporting of research and control interventions in randomised trials of upper limb therapies for children with unilateral cerebral palsy. METHODS AND PROCEDURES Sixty randomized trials were included, encompassing 60 research and 68 control interventions. Using the 12-item Template for Intervention Description and Replication (TIDieR) checklist, two reviewers independently rated intervention and control descriptions. OUTCOMES AND RESULTS When using 50% of studies as the benchmark, five of the 12 TIDieR items for the research intervention, eight of the 12 items for the control intervention and 11 of 12 items for "usual care" interventions were inadequately reported. Procedures used to deliver the research intervention were adequately reported for 63% of studies. Materials were used in 94% of research interventions, yet only 27% provided details to access/replicate materials. Training materials for interventionists were used in 38% of trials, 10 (17%) had procedure manuals, yet only 3 reported details to access materials. The location where the research intervention was provided was detailed in 65% of studies. Reporting of all items was poorer for the control intervention. CONCLUSIONS No study adequately reported all elements on the TIDieR checklist. Details crucial for replication of interventions and interpretation of results were missing. Authors, reviewers, and editors all have a responsibility to improve the quality of intervention reporting in published trials. The TIDieR guide is a potential solution, helping to structure accounts of interventions.
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Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Sarah Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Pinnock H, Epiphaniou E, Sheikh A, Griffiths C, Eldridge S, Craig P, Taylor SJC. Developing standards for reporting implementation studies of complex interventions (StaRI): a systematic review and e-Delphi. Implement Sci 2015; 10:42. [PMID: 25888928 PMCID: PMC4393562 DOI: 10.1186/s13012-015-0235-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dissemination and implementation of health care interventions are currently hampered by the variable quality of reporting of implementation research. Reporting of other study types has been improved by the introduction of reporting standards (e.g. CONSORT). We are therefore developing guidelines for reporting implementation studies (StaRI). METHODS Using established methodology for developing health research reporting guidelines, we systematically reviewed the literature to generate items for a checklist of reporting standards. We then recruited an international, multidisciplinary panel for an e-Delphi consensus-building exercise which comprised an initial open round to revise/suggest a list of potential items for scoring in the subsequent two scoring rounds (scale 1 to 9). Consensus was defined a priori as 80% agreement with the priority scores of 7, 8, or 9. RESULTS We identified eight papers from the literature review from which we derived 36 potential items. We recruited 23 experts to the e-Delphi panel. Open round comments resulted in revisions, and 47 items went forward to the scoring rounds. Thirty-five items achieved consensus: 19 achieved 100% agreement. Prioritised items addressed the need to: provide an evidence-based justification for implementation; describe the setting, professional/service requirements, eligible population and intervention in detail; measure process and clinical outcomes at population level (using routine data); report impact on health care resources; describe local adaptations to the implementation strategy and describe barriers/facilitators. Over-arching themes from the free-text comments included balancing the need for detailed descriptions of interventions with publishing constraints, addressing the dual aims of reporting on the process of implementation and effectiveness of the intervention and monitoring fidelity to an intervention whilst encouraging adaptation to suit diverse local contexts. CONCLUSIONS We have identified priority items for reporting implementation studies and key issues for further discussion. An international, multidisciplinary workshop, where participants will debate the issues raised, clarify specific items and develop StaRI standards that fit within the suite of EQUATOR reporting guidelines, is planned. REGISTRATION The protocol is registered with Equator: http://www.equator-network.org/library/reporting-guidelines-under-development/#17 .
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Affiliation(s)
- Hilary Pinnock
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK.
| | - Eleni Epiphaniou
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK.
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.
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Passey ME, Sanson-Fisher RW. Provision of antenatal smoking cessation support: a survey with pregnant Aboriginal and Torres Strait Islander women. Nicotine Tob Res 2015; 17:746-9. [PMID: 25634937 PMCID: PMC4425935 DOI: 10.1093/ntr/ntv019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 01/15/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Guidelines recommend assessment of smoking status, with advice and support for smoking cessation, as a routine and integral part of antenatal care. Approximately 50% of pregnant Australian Aboriginal and Torres Strait Islander women smoke through pregnancy, 3 times the rate of other pregnant Australian women. This study describes smoking cessation assessment and support reported by pregnant Aboriginal and Torres Strait Islander women. METHODS Surveys of 261 pregnant Aboriginal and Torres Strait Islander women in New South Wales and the Northern Territory, Australia assessed women's reports of assessment, advice and support for smoking cessation from antenatal providers. RESULTS The majority of women (90%, 95% CI = 85, 93) reported being asked their smoking status; 81% (95% CI = 73, 87) of smokers reported being advised to stop smoking and 62% (95% CI = 53, 71) of smokers reported being offered support to quit. CONCLUSIONS Despite most pregnant women who smoke reporting advice and support to quit, the persisting high prevalence of smoking suggests that this support is insufficient to overcome the many factors pushing women to smoke. Improving the support provided to women will require empowering the antenatal providers with adequate skills, appropriate resources and effective interventions. Current guidelines are based on research from non-Indigenous populations, as there are no published effective interventions for Indigenous pregnant women. Trials of interventions designed specifically for pregnant Aboriginal and Torres Strait Islander women are urgently needed, as are approaches aimed at reducing uptake of smoking.
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Affiliation(s)
- Megan E Passey
- University Centre for Rural Health-North Coast, School of Public Health, University of Sydney, Lismore, Australia;
| | - Robert W Sanson-Fisher
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, Australia
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